An Exploratory Study on Human Factor Analysis of Medical Accidents Using the SHELL (Software, Hardware, Environment, Liveware) Model / 항공우주의학회지

The SHELL (Software, Hardware, Environment, Liveware) model is one of the models for determining the cause of aviation accidents. The human factors of medical accidents are analyzed through the SHELL model. This study is a case study that analyzed a total of three cases, including two medical accident court precedents and one large fire at a medical institution. In the human factor analysis of cases 1 and 2, the main factors were that liveware (human) violated the duty of care and did not follow the guidelines of the institution. The large fire incident in the hospital in Case 3 was caused by a lack of awareness of the safety of managers, the installation of illegal facilities and environments, lack of medical staff’s response and training, and the condition of patients who were mostly elderly. The liveware at the center of the SHELL model is the most important human factor, and the environment, facilities, and equipment surrounding liveware must be supplemented to prevent future medical accidents.

Personal Factors and Clinical Learning Environment as Predictors of Nursing Students' Readiness for Practice: A Structural Equation Modeling Analysis

Purpose@#It is essential to ensure the readiness for practice among undergraduate nursing students since the purpose of such education is to cultivate competent nurses who deliver high-quality and safe nursing. Astin's theory of student involvement suggests that this is affected by their personal factors and learning environment. @*Methods@#We conducted a cross-sectional study between November 16, 2020 and December 21, 2020 which examined personal factors and aspects of the clinical learning environment among senior nursing students (n = 838) enrolled across 54 nursing schools in Korea. The participants were asked to fill out a self-administered online survey, which assessed demographic characteristics, self-esteem, depression, work-life balance, clinical learning environment, anxiety during clinical practicum, and readiness for practice. Readiness for practice was measured using the Casey-Fink Readiness for practice survey. We used structural equational modeling to test our hypothetical model. @*Results@#The nursing students' readiness for practice was significantly affected by their self-esteem, work-life balance satisfaction, and clinical learning environment. Anxiety during clinical practicum directly influenced their readiness for practice. @*Conclusion@#Increasing self-esteem and work-life balance satisfaction, and improving their clinical learning environment by providing sufficient educational and clinical support, could help facilitate the transition from nursing schools to real-world practice for nursing students.

Clinical Outcomes between Amniotic Membrane Transplantation and Conjunctival Autograft Using Fibrin Glue for Pterygium Surgery

Purpose@#We compared clinical outcomes including recurrence rate between amniotic membrane transplantation (AMT) and conjunctival autograft using fibrin glue and minimal conjunctival sutures for pterygium surgery. @*Methods@#We retrospectively analyzed 217 eyes of 198 patients with pterygia who underwent surgery from May 2016 to December 2019. Pterygium excision was performed with conjunctival autograft or AMT, using fibrin glue with both. Recurrence rates and complications were evaluated between the two groups. @*Results@#Postoperative recurrences were noted in one of 185 eyes (0.5%) in the conjunctival autograft group, and in six of 32 eyes (18.8%) in the AMT group. The recurrence rate was significantly lower in the conjunctival autograft group (p < 0.001). Logistic regression analysis revealed that conjunctival autograft was associated with a significantly lower risk of pterygium recurrence compared to AMT (odds ratio, 0.023; 95% confidence interval, 0.003-0.206; p = 0.001). No ocular complication was noted in both groups during follow-up. @*Conclusions@#Pterygium excision with conjunctival autograft using fibrin glue was more effective in preventing recurrence compared to AMT.

Combined effects of soy isoflavone and lecithin on bone loss in ovariectomized mice

BACKGROUND/OBJECTIVES@#Isoflavones (ISFs) are effective in preventing bone loss, but not effective enough to prevent osteoporosis. Mixtures of soy ISF and lecithin (LCT) were prepared and characterized in an attempt to improve the bone loss.MATERIALS/METHODS: The daidzein (DZ) and genistein (GN) solubility in soy ISF were measured using liquid chromatography-mass spectrometry. The change in the crystalline characteristics of soy ISF in LCT was evaluated using X-ray diffraction analysis.Pharmacokinetic studies were conducted to evaluate and compare ISF bioavailability. Animal studies with ovariectomized (OVX) mice were carried out to estimate the effects on bone loss. The Student's t-test was used to evaluate statistical significance. @*RESULTS@#The solubility of DZ and GN in LCT was 125.6 and 9.7 mg/L, respectively, which were approximately 25 and 7 times higher, respectively, than those in water. The bioavailability determined by the area under the curve of DZ for the oral administration (400 mg/kg) of soy ISF alone and the soy ISF-LCT mixture was 13.19 and 16.09 µg·h/mL, respectively. The bone mineral density of OVX mice given soy ISF-LCT mixtures at ISF doses of 60 and 100 mg/kg daily was 0.189 ± 0.020 and 0.194 ± 0.010 g/mm3 , respectively, whereas that of mice given 100 mg/kg soy ISF was 0.172 ± 0.028 g/mm3 . The number of osteoclasts per bone perimeter was reduced by the simultaneous administration of soy ISF and LCT. @*CONCLUSIONS@#The effect of preventing bone loss and osteoclast formation by ingesting soy ISF and LCT at the same time was superior to soy ISF alone as the bioavailability of ISF may have been improved by the emulsification and solvation of LCT. These results suggest the possibility of using the combination of soy ISF and LCT to prevent osteoporosis.

The Influence of Workplace Violence Experience on Depression among Female Caregivers / 한국직업건강간호학회지

Purpose@#This study aimed to investigate the influence of workplace violence experience on depression among female caregivers in Korea. @*Methods@#This study was a secondary data analysis of data from the 5th Korean Working Conditions Survey (KWCS). The study sample consisted of 484 female caregivers. IBM SPSS 25.0 was used for complex sample analysis, which considered sampling the weights of variables. Based on the survey questions, we used complex sample cross-tabulation and the complex sample general linear model (CSGLM). @*Results@#About 10.1% of female caregivers experienced workplace violence. The factors influencing workplace violence experience on depression were organizational justice (p=.048) and illness (p=.004). However, in cases with no violence, the influencing factors were psychological work environment (p=.001), work environment satisfaction (p=.024), and work engagement (p=.004). @*Conclusion@#Caregivers are vulnerable to workplace violence. Therefore, it is necessary to formulate a policies such as organizational justice, work environment satisfaction, and work engagement to improve the working environment.

Clinical Outcomes between Amniotic Membrane Transplantation and Conjunctival Autograft Using Fibrin Glue for Pterygium Surgery

Purpose@#We compared clinical outcomes including recurrence rate between amniotic membrane transplantation (AMT) and conjunctival autograft using fibrin glue and minimal conjunctival sutures for pterygium surgery. @*Methods@#We retrospectively analyzed 217 eyes of 198 patients with pterygia who underwent surgery from May 2016 to December 2019. Pterygium excision was performed with conjunctival autograft or AMT, using fibrin glue with both. Recurrence rates and complications were evaluated between the two groups. @*Results@#Postoperative recurrences were noted in one of 185 eyes (0.5%) in the conjunctival autograft group, and in six of 32 eyes (18.8%) in the AMT group. The recurrence rate was significantly lower in the conjunctival autograft group (p < 0.001). Logistic regression analysis revealed that conjunctival autograft was associated with a significantly lower risk of pterygium recurrence compared to AMT (odds ratio, 0.023; 95% confidence interval, 0.003-0.206; p = 0.001). No ocular complication was noted in both groups during follow-up. @*Conclusions@#Pterygium excision with conjunctival autograft using fibrin glue was more effective in preventing recurrence compared to AMT.

Combined effects of soy isoflavone and lecithin on bone loss in ovariectomized mice

BACKGROUND/OBJECTIVES@#Isoflavones (ISFs) are effective in preventing bone loss, but not effective enough to prevent osteoporosis. Mixtures of soy ISF and lecithin (LCT) were prepared and characterized in an attempt to improve the bone loss.MATERIALS/METHODS: The daidzein (DZ) and genistein (GN) solubility in soy ISF were measured using liquid chromatography-mass spectrometry. The change in the crystalline characteristics of soy ISF in LCT was evaluated using X-ray diffraction analysis.Pharmacokinetic studies were conducted to evaluate and compare ISF bioavailability. Animal studies with ovariectomized (OVX) mice were carried out to estimate the effects on bone loss. The Student's t-test was used to evaluate statistical significance. @*RESULTS@#The solubility of DZ and GN in LCT was 125.6 and 9.7 mg/L, respectively, which were approximately 25 and 7 times higher, respectively, than those in water. The bioavailability determined by the area under the curve of DZ for the oral administration (400 mg/kg) of soy ISF alone and the soy ISF-LCT mixture was 13.19 and 16.09 µg·h/mL, respectively. The bone mineral density of OVX mice given soy ISF-LCT mixtures at ISF doses of 60 and 100 mg/kg daily was 0.189 ± 0.020 and 0.194 ± 0.010 g/mm3 , respectively, whereas that of mice given 100 mg/kg soy ISF was 0.172 ± 0.028 g/mm3 . The number of osteoclasts per bone perimeter was reduced by the simultaneous administration of soy ISF and LCT. @*CONCLUSIONS@#The effect of preventing bone loss and osteoclast formation by ingesting soy ISF and LCT at the same time was superior to soy ISF alone as the bioavailability of ISF may have been improved by the emulsification and solvation of LCT. These results suggest the possibility of using the combination of soy ISF and LCT to prevent osteoporosis.

The Influence of Workplace Violence Experience on Depression among Female Caregivers / 한국직업건강간호학회지

Purpose@#This study aimed to investigate the influence of workplace violence experience on depression among female caregivers in Korea. @*Methods@#This study was a secondary data analysis of data from the 5th Korean Working Conditions Survey (KWCS). The study sample consisted of 484 female caregivers. IBM SPSS 25.0 was used for complex sample analysis, which considered sampling the weights of variables. Based on the survey questions, we used complex sample cross-tabulation and the complex sample general linear model (CSGLM). @*Results@#About 10.1% of female caregivers experienced workplace violence. The factors influencing workplace violence experience on depression were organizational justice (p=.048) and illness (p=.004). However, in cases with no violence, the influencing factors were psychological work environment (p=.001), work environment satisfaction (p=.024), and work engagement (p=.004). @*Conclusion@#Caregivers are vulnerable to workplace violence. Therefore, it is necessary to formulate a policies such as organizational justice, work environment satisfaction, and work engagement to improve the working environment.

An Alport syndrome boy with Van Wyk-Grumbach syndrome induced by prolonged untreated congenital hypothyroidism

Alport syndrome (AS) is a rare genetic disorder that causes progressive nephritis and is more common among males. Studies have reported an association between thyroid antibodies and hypothyroidism in patients with AS, but the relevance of this relationship is under debate. Prolonged untreated hypothyroidism induces short stature, abnormal pubertal development, and various other symptoms. However, children with long-standing hypothyroidism rarely present with signs of precocious puberty, or Van Wyk-Grumbach syndrome (VWGS). We report the case of a boy, 8 years and 4 months old, who had VWGS caused by prolonged untreated congenital hypothyroidism and AS. The boy had repeated gross hematuria and proteinuria and was diagnosed with AS by renal biopsy and genetic testing. He had normal renal function but severe growth retardation and hypothyroidism. Obesity, bone age delay, hyperlipidemia, and abnormal increased testicle size were also present due to prolonged untreated hypothyroidism. His thyroid antibody titer elevation was unclear, although ultrasonography and thyroid scanning showed a decrease in thyroid volume. We diagnosed the patient with congenital hypothyroidism caused by thyroid dysgenesis. VWGS was diagnosed due to hypothyroidism, delayed bone age, and pseudoprecocious puberty. To the best of our knowledge, this is the first report of a prepubertal Korean boy with prolonged untreated congenital hypothyroidism complicated by VWGS in AS.

A POLG2 Homozygous Mutation in an Autosomal Recessive Epilepsy Family Without Ophthalmoplegia

No abstract available.

Effects of Combined Upper Limb Robotic Therapy in Patients With Tetraplegic Spinal Cord Injury

OBJECTIVE: To confirm the effects of combined upper limb robotic therapy (RT) as compared to conventional occupational therapy (OT) in tetraplegic spinal cord injury (SCI) patients and to suggest the optimized treatment guidelines of combined upper limb RT. METHODS: After subject recruitment and screening for eligibility, the baseline evaluation for outcome measures were performed. We evaluated the Graded and Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), the American Spinal Injury Association upper extremity motor score, grip and pinch strength, and the Spinal Cord Independence Measurement III (SCIM-III). In this study, the pre-tested participants were divided randomly into the RT and OT group. The utilized interventions included combined upper limb RT using ArmeoPower and Amadeo (RT group), or conventional OT (OT group) in addition to daily inpatient rehabilitation program. The participants underwent 40 minutes×3 sessions×5 weeks of interventions. RESULTS: A total of 30 tetraplegic SCI patients completed entire study program. After 5 weeks of intervention, both groups demonstrated increases in GRASSP-strength and SCIM-III. The manual muscle test scores of elbow flexion, elbow extension, 2-5th metacarpophalangeal extension, and SCIM-III subscores of bathing-upper, dressing-upper, and grooming as well as the GRASSP-qualitative prehension score were noted to have been significantly increased in the RT group as evaluated. The OT group showed improvements in the GRASSP-quantitative prehension score and some items in grip and pinch strength. There was no significant difference between the two groups in almost all measurements except for the SCIM-III bathing-upper subscore. CONCLUSION: Combined upper limb RT demonstrated beneficial effects on the upper limb motor function in patients with tetraplegic SCI, which were comparable with conventional OT.

De novo a novel variant of CaSR gene in a neonate with congenital hypoparathyroidism

Autosomal-dominant hypocalcemia with hypercalciuria (ADHH) is a genetic disease characterized by hypoparathyroidism with hypercalciuria. Most patients with ADHH have calcium-sensing receptor (CaSR) gene mutations. The CaSR gene controls parathyroid secretions, and mutations in this gene can be detected via changes in serum calcium level. The activating mutation of the CaSR gene results in familial or sporadic ADHH. Most activating mutations of the CaSR gene are reportedly de novo missense mutations. This is the first case report of a novel activating variant of the CaSR gene in a neonate with congenital hypoparathyroidism with hypomagnesemia and hypercalciuria. We also report the 3-month follow-up management of the patient.

Early Diagnosis of ABCB11 Spectrum Liver Disorders by Next Generation Sequencing / 대한소아소화기영양학회지

PURPOSE: The goal of this study was the early diagnosis of ABCB11 spectrum liver disorders, especially those focused on benign recurrent intrahepatic cholestasis and progressive familial intrahepatic cholestasis. METHODS: Fifty patients presenting neonatal cholestasis were evaluated to identify underlying etiologies. Genetic analysis was performed on patients suspected to have syndromic diseases or ABCB11 spectrum liver disorders. Two families with proven ABCB11 spectrum liver disorders were subjected to genetic analyses to confirm the diagnosis and were provided genetic counseling. Whole exome sequencing and Sanger sequencing were performed on the patients and the family members. RESULTS: Idiopathic or viral hepatitis was diagnosed in 34%, metabolic disease in 20%, total parenteral nutrition induced cholestasis in 16%, extrahepatic biliary atresia in 14%, genetic disease in 10%, neonatal lupus in 2%, congenital syphilis in 2%, and choledochal cyst in 2% of the patients. The patient with progressive familial intrahepatic cholestasis had novel heterozygous mutations of ABCB11 c.11C>G (p.Ser4*) and c.1543A>G (p.Asn515Asp). The patient with benign recurrent intrahepatic cholestasis had homozygous mutations of ABCB11 c.1331T>C (p.Val444Ala) and heterozygous, c.3084A>G (p.Ala1028Ala). Genetic confirmation of ABCB11 spectrum liver disorder led to early liver transplantation in the progressive familial intrahepatic cholestasis patient. In addition, the atypically severe benign recurrent intrahepatic cholestasis patient was able to avoid unnecessary liver transplantation after genetic analysis. CONCLUSION: ABCB11 spectrum liver disorders can be clinically indistinguishable as they share similar characteristics related to acute episodes. A comprehensive genetic analysis will facilitate optimal diagnosis and treatment.

Predictors of Hypertension among Middle-aged and Elderly Self-employed Workers: Results from a Baseline Survey of the Korean Longitudinal Study of Aging / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to investigate the individual and working environment-related factors affecting hypertension among middle-aged and elderly self-employed workers in South Korea. METHODS: This was a secondary data analysis of data from the Korean Longitudinal Study of Aging (KLoSA). The study sample included 1,319 middle-aged and elderly self-employed workers who were diagnosed without hypertension and older than 45 years at Wave 1 of the KLoSA. Data were analyzed using descriptive statistics and Cox proportional hazards regression analysis using SPSS 20.0. RESULTS: About 20% of the middle-aged and elderly self-employed workers were diagnosed with hypertension within about 8 years from the baseline. the significant predictors of hypertension among the participants were age, diabetes mellitus, body mass index, frequency of health examinations, working hours per week, the presence of regular day off, and the type of job. CONCLUSION: Middle-aged and elderly self-employed workers are vulnerable to work-related health problems. In order to prevent hypertension among self-employed workers, it is necessary to improve the work environment-related factors as well as individual life styles.

Experience of Life-sustaining Treatment in Patient Care among Intensive Care Unit Nurses: Phenomenological Approach / 기본간호학회지

PURPOSE: The purpose of this study was to explore the subjective experience of life-sustaining treatment care among nurses in intensive care units. METHODS: A phenomenology was used for the study. Data were collected from October to December, 2015 using open-ended questions during in-depth interviews. Participants were nurses working in intensive care units and were contacted through purposive techniques. Eight nurses participated in this study. RESULTS: Four categories emerged from the analysis using Colaizzi's method: (a) difficulties due to life-sustaining treatment care, (b) dilemma of extension or cessation of life-sustaining treatment, (c) repressed feelings and emotional exhaustion, and (d) forming values for life-sustaining treatment from nursing experience CONCLUSION: Provision of clearer guidelines on life-sustaining treatment which reflect a family-oriented culture is important for nurses in ICU and will promote nurses involvement in the decision-making process of life-sustaining treatment of patients.

Pathogenetic Overlapping of Renovascular Hypertension Developed in a Child with Takayasu Arteritis: 'One-clip, One and Half-kidney Model'

There are two pathogenic models of renovascular hypertension (RVH) originating from renal artery stenosis. We noted a case of a boy who had severe hypertension with atrophic left kidney, hypertrophic right kidney, a segmental stricture of the abdominal aorta, and total occlusion of the right renal artery. Due to the atrophic change of the contralateral, unclipped left kidney, this patient presented with various clinical manifestations related to both models of pathogenesis of RVH occurring at the same time. We conclude that this patient presented with the middle stage of the two RVH pathogenetic models, so called the 'one-clip, one and half-kidney model.'

Sleep Problems and Daytime Sleepiness in Children with Nocturnal Enuresis

PURPOSE: Nocturnal enuresis (NE) is one of the most common problems in childhood. NE has a multifactorial etiology and is influenced by sleep and arousal mechanisms. The aim of the present study was to prospectively evaluate sleep problems and patterns in children with NE compared with normal healthy controls. METHODS: Twenty-eight children with NE and 16 healthy controls were included in the study. To evaluate sleep habits and disturbances, parents and children filled out a questionnaire that included items about sleep patterns and sleep-related behaviors prior to treatment for NE. Demographic factors and other data were compared for the two groups based on the responses to the sleep questionnaire. RESULTS: Night awakening, sleepwalking, and periodic limb movements were more prevalent in children with NE, but symptoms of sleep-disordered breathing were not increased in this group. There were statistically significant differences in periodic limb movements and daytime sleepiness between the two groups. CONCLUSION: Children with NE seemed to have more sleep problems such as night awakening, sleepwalking, and periodic limb movements. In addition, a higher level of daytime sleepiness and hyperactivity in patients with NE suggested a relationship between NE and sleep disorders.

Production of the polyclonal subunit C protein antibody against Aggregatibacter actinomycetemcomitans cytolethal distending toxin / 대한치주과학회지

PURPOSE: Cytolethal distending toxin (CDT) considered as a key factor of localized aggressive periodontitis, endocarditis, meningitis, and osteomyelitis is composed of five open reading frames (ORFs). Among of them, the individual role of CdtA and CdtC is not clear; several reports presents that CDT is an AB2 toxin and they enters the host cell via clathrin-coated pits or through the interaction with GM3 ganglioside. So, CdtA, CdtC, or both seem to be required for the delivery of the CdtB protein into the host cell. Moreover, recombinant CDT was suggested as good vaccine material and antibody against CDT can be used for neutralization or for a detection kit. MATERIALS AND METHODS: We constructed the pET28a-cdtC plasmid from Aggregatibacter actinomycetemcomitans Y4 by genomic DNA PCR and expressed in BL21 (DE3) Escherichia coli system. We obtained the antibody against the recombinant CdtC in mice system. Using the anti-CdtC antibody, we test the native CdtC detection by ELISA and Western Blotting and confirm the expression time of native CdtC protein during the growth phase of A. actinomycetemcomitans. RESULTS: In this study we reconstructed CdtC subunit of A. actinomycetemcomitans Y4 and generated the anti CdtC antibody against recombinant CdtC subunit expressed in E. coli system. Our anti CdtC antibody can be interacting with recombinant CdtC and native CDT in ELISA and Western system. Also, CDT holotoxin existed at 24h but not at 48h meaning that CDT holotoxin was assembled at specific time during the bacterial growth. CONCLUSION: In conclusion, we thought that our anti CdtC antibody could be used mucosal adjuvant or detection kit development, because it could interact with native CDT holotoxin.

Comparison of Influential Variables for Smoking Temptation between Adolescent and Adult Smokers / 간호학회지

PURPOSE: This study attempted to identify influential variables on smoking temptation between groups: adolescent smokers and adult smokers. METHOD: A survey was conducted with 376 adolescent smokers in 4 high schools and 451 adult smokers in community settings in South Korea. Univariate statistics and regression were used for data analysis. RESULT: The most powerful predictor of smoking temptation for adolescent smokers was nicotine dependency. On the other hand, the most powerful predictor of smoking temptation for adult smokers was self-efficacy for smoking abstinence. In the high smoking temptation group, depression and nicotine dependency were the predictors for smoking temptation for adolescent smokers and nicotine dependency and pros for smoking were the predictors for smoking temptation for adult smokers. In the low smoking temptation group, cons for smoking and process of change for smoking abstinence were the predictors on smoking temptation for adolescent smokers and self-efficacy for smoking abstention and pros for smoking were the predictors on smoking temptation for adult smokers. CONCLUSION: There were different influential variables on smoking temptation according to age groups and level of smoking temptation. Smoking-cessation interventions should be tailored to the level of smoking temptation of the individual smokers.

Predictors of Pre and Post Preparation in Stages of Change of Smoking for Adolescent Smokers and Adult Smokers / 기본간호학회지

PURPOSE: This study was done to identify predictors differentiating the preparation stage, which is the stage that the smoker is ready to quit smoking, between adolescent smokers and adult smokers. METHOD: A survey was conducted with 376 adolescent smokers in 4 high schools and 451 adult smokers in community settings in South Korea from August 2003 to April 2005. To identify the predictors before and after preparation in stages of change of smoking, logistic regression was done. RESULTS: The predictors for before preparation in stages of change of smoking were process of change for smoking abstinence for adolescent smokers and depression for adult smokers. The predictors for after preparation in stages of change of smoking were self-efficacy for smoking abstinence for adolescent smoker and self-efficacy for smoking abstinence and smoking temptation for adult smokers. CONCLUSION: For each group, adolescent smokers and adult smokers, specific smoking intervention methods need to be developed based on the different ways individuals make the decision to quit smoking within their contexts.