Machine Learning to Compare Frequent Medical Problems of African American and Caucasian Diabetic Kidney Patients / 대한의료정보학회지

OBJECTIVES: End-stage renal disease (ESRD), which is primarily a consequence of diabetes mellitus, shows an exemplary health disparity between African American and Caucasian patients in the United States. Because diabetic chronic kidney disease (CKD) patients of these two groups show differences in their medical problems, the markers leading to ESRD are also expected to differ. The purpose of this study was, therefore, to compare their medical complications at various levels of kidney function and to identify markers that can be used to predict ESRD. METHODS: The data of type 2 diabetic patients was obtained from the 2012 Cerner database, which totaled 1,038,499 records. The data was then filtered to include only African American and Caucasian outpatients with estimated glomerular filtration rates (eGFR), leaving 4,623 records. A priori machine learning was used to discover frequently appearing medical problems within the filtered data. CKD is defined as abnormalities of kidney structure, present for >3 months. RESULTS: This study found that African Americans have much higher rates of CKD-related medical problems than Caucasians for all five stages, and prominent markers leading to ESRD were discovered only for the African American group. These markers are high glucose, high systolic blood pressure (BP), obesity, alcohol/drug use, and low hematocrit. Additionally, the roles of systolic BP and diastolic BP vary depending on the CKD stage. CONCLUSIONS: This research discovered frequently appearing medical problems across five stages of CKD and further showed that many of the markers reported in previous studies are more applicable to African American patients than Caucasian patients.

Intensive Care Nurses' Experiences of Death of Patients with DNR Orders / 한국호스피스완화의료학회지

PURPOSE: The purpose of this study is to describe and understand the meaning and the structure of subjective experiences of intensive care nurses with death of patients with do-not-resuscitate (DNR) orders. METHODS: Data were collected from eight intensive care nurses at general hospitals using individual in-depth interviews and analyzed by phenomenological research method. RESULTS: The nurses' experiences were grouped into four theme clusters: 1) ambiguity of death without correct answer, 2) a dilemma experienced at the border between death and work, 3) the weight of death that is difficult to carry and 4) death-triggered reflection of life. CONCLUSION: It is necessary to develop accurate judgment criteria for DNR, detailed regulations on the DNR decision process, guidelines and education on DNR patient care for nurses. It is also needed to develop an intervention program for DNR patients' families.

Periodontitis is associated with rheumatoid arthritis: a study with longstanding rheumatoid arthritis patients in Korea

BACKGROUND/AIMS: A cross-sectional study was undertaken to investigate the association between severity of periodontitis and clinical manifestation of rheumatoid arthritis (RA). METHODS: Two hundred sixty-four RA patients and 88 age- and sex-matched controls underwent dental exam. Additionally, clinical manifestations including disease activity and anti-citrullinated protein antibodies were evaluated in RA patients. RESULTS: The prevalence of moderate or severe periodontitis was higher in RA patients compared to controls (63.6% vs 34.1%, p < 0.001). In markers of periodontal inflammation, bleeding on probing was correlated with disease activity score 28 (r = 0.128, p = 0.041), RA disease duration (r = 0.211, p = 0.001), erythrocyte sedimentation rate (ESR; r = 0.141, p = 0.023), anti-cyclic citrullinated peptide antibody (r = 0.183, p = 0.009), and anti-citrullinated α-enolase peptide-1 antibody (r = 0.143, p = 0.025). Gingival index was correlated with RA duration (r = 0.262, p < 0.001), ESR (r = 0.162, p = 0.009), anti-cyclic citrullinated peptide antibody (r = 0.203, p = 0.004) and anti-citrullinated α-enolase peptide-1 antibody (r = 0.225, p < 0.001). Periodontal structural damage represented by probing pocket depth and clinical attachment level were less in RA patients with human leukocyte antigen (HLA)-DRB1 shared epitope compared than those without shared epitope (p = 0.005 and p =0.006, respectively). CONCLUSIONS: The prevalence of moderate or severe periodontitis was increased in RA patients compared to controls. Periodontal inflammation was correlated with RA disease duration, ESR, and anti-citrullinated protein antibodies. Periodontal structural damage was less in RA patients with HLA-DRB1 shared epitope.

Evaluation of the effect of zirconia all-ceramic fixed dental prostheses designed and manufactured by CAD/CAM in restoration of posterior teeth / 实用口腔医学杂志

To observe the 36 months follow-up outcome of zirconia all-ceramic posterior fixed dental prostheses(FDPs)designed and manu-factured by computer aided design and computer aided manufacture (CAD /CAM)from clinical aspect,and to evaluate the success rate of zirconia framework and veneering porcelain.78 patients with less than three teeth lost which had natural opposing teeth were included.A to-tal of ninty-two zirconia all-ceramic FDPs (59 three-unit FDPs,20 four-unit FDPs and 13 five-unit FDPs)were made by CAD /CAM.Three years after cementation of the restorations,the reasons for complication and failure of FDPs in different lengths were analysed.Six FDPs were removed (frame fracture:1;porcelain fracture:1;secondary caries:2;vertical root fractures and post-core fracture after root canal therapy of premolars:2).The success rate of these FDPs was 93.5%.The success rate of zirconia all-ceramic crowns and bridges was higher.Their clinical effect was satisfactory.The main complications of these FDPs were porcelain fracture and de-bonding.

Experience of College Students on Suicide Attempts

PURPOSE: The purpose of the study was to explore and describe the experience of Korean college students on suicide attempts. METHODS: Eight students participated and data were collected through in-depth individual interviews between September, 2011 and April, 2012. Data were analyzed using Strauss and Corbin's grounded theory method. RESULTS: Analysis showed that the central phenomenon of suicide attempt experience of college students was 'inextricable despair'. Causal conditions were 'sense of shame by failure to achieve perfect independence' and 'a big gap between reality and ideals'. Contextual conditions were 'extreme situation of being cornered' and 'excessive changes in emotions'. Intervening conditions were 'important others' and 'perspectives on the world'. Action/interaction strategies were 'temporary efforts' and 'gathering up one's mind'. Consequences were 'trauma as one's own hurt', 'conflict between life and death' and 'becoming mature'. CONCLUSION: The results of this study provide an in-depth understanding of the experience of college students with attempted suicide. It is necessary to develop programs to prevent suicide attempts by college students and these results can be used as a basis for program development.

Effects of a Recreation Therapy Program on Mental Health and Heart Rate Variability in Burn Rehabilitation Patients

PURPOSE: This study was done to evaluate the effects of a recreation therapy program on burn rehabilitation patients to determine if the program is an effective nursing intervention which can affect mental health problems and heart rate variability. METHODS: Subjects were 54 hospitalized burn rehabilitation patients (25 in the control group, 29 in the experimental group). The experimental group participated 6 times in a recreation therapy program led by a qualified instructor. Brief symptoms inventory-18 (somatization, anxiety, depression) questionnaire, and heart rate variability were checked before and after the recreation therapy program. RESULTS: The mental health scale showed significant differences in somatization (p<.001), anxiety (p<.001) and depression (p<.001). There was no significant difference in heart rate variability (autonomic activity, autonomic balance, stress resistance, stress parameter and fatigue, mean heart rate, electro-cardiac stability). CONCLUSION: The findings from this study suggest that a recreation therapy program is an effective nursing intervention to decrease the level of mental health problems of burn rehabilitation patients. However, a subsequent study is needed to develop an intervention program that will induce the effect of physiological parameters like heart rate variability (HRV).

State Anger, Depression, Resilience and Self-esteem According to School Violence Type of Elementary School Students / 한국간호교육학회지

PURPOSE: The purpose of this study was to investigate differences in the states of anger, depression, resilience and self-esteem according to type of school violence involving elementary school students. METHODS: The participants were 257 elementary school students in the 4th, 5th and 6th grades. Data was collected by structured questionnaires, and analyzed using descriptive statistics, chi2-test, t-test, ANOVA, and Pearson correlation coefficients with the SPSS/WIN 20.0 program. RESULTS: There were significant differences among the states of anger (Fs=16.66, p<.001), depression (Fs=18.04, p<.001), resilience (F=12.77, p<.001) and self-esteem (F=10.39, p<.001) according to the type of school violence. Of all the groups, bully-victim exhibited the highest score for anger and depression, and the lowest score for resilience and self-esteem. CONCLUSION: Based on the findings, developing intervention programs that consider the psychological characteristics of elementary school students is necessary. Also, the results of this study suggest that integrative programs for students that can enhance resilience and self-esteem, such as self-discovery programs, and reduce anger, such as anger control programs, need to be developed.

Factors Affecting Job-Seeking Stress in Nursing Students / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to investigate what factors are affecting job-seeking stress in nursing students. METHODS: Subjects were 463 students from two 3-year and two 4-year colleges of nursing in K-Province in Korea. Data was collected from self-administered questionnaires. t-test, ANOVA, Pearson's and Spearman's correlation coefficients, and hierarchical multiple regression with dummy variables were used for statistical analysis of data. RESULTS: Job-seeking stress was significantly different by school system (t=2.76, p=.006), family economic status (F=3.40, p=.005), characteristics (t=1.99, p=.047), academic achievement (F=6.54, p=.002), current weight control status (t=2.23, p=.026), times of cosmetic surgery (r=.11, p=.022), self-esteem (r=-.47, p<.001) and appearance stress (r=.40, p<.001). However, after controlling for general characteristics, self-esteem, and perceived appearance stress, job-seeking stress was significantly different by grade (1st vs 3rd, beta=0.163, p<.001), academic achievement (low vs. high, beta=-0.121, p=.0321), self-esteem (beta=-0.224, p<.001), and appearance stress (beta=0.099, p<.001). The explanation power of self-esteem on job-seeking stress was greater compared with that of appearance stress. CONCLUSION: Results of this study suggest that it is necessary for nursing students to develop intervention program aimed at reducing job-seeking stress, and it would be effective to focus on improving self-esteem for them.

Effects of a Social Skills Training Program on Problem Behaviors, Social Skill, and Peer Relationship in Children using a Community Child Center at Vulnerable Area / 정신간호학회지

PURPOSE: The purpose of this study was to investigate the effects of using a social skills training program to address problem behaviors, social skill, and peer relationship in children using a community child center in a vulnerable area. METHODS: The research design was a non-equivalent control group pretest-posttest quasi-experimental study. Participants in the experimental group were 25 children, recruited from a community child center in G-city. Participants in the control group were 25 children, recruited from a community child center in S-city. Data were collected from September, 2014 to January, 2015. Outcomes were measured using the Child Problem-Behavior Screening Questionnaire (CPSQ), Social Skill Rating System (SSRS), and Peer Relational Skills Scale (PRSS). The experimental group participated in the social skills training weekly for 10 weeks. Statistical analysis was performed using the SPSS 18.0 program. RESULTS: Significant differences were found in problem behaviors, social skills, and peer relationship scores between the two groups. CONCLUSION: This social skills training program was found to be effective in reducing problem behaviors and improving the social skill and peer relationship of these children, and is recommended for use in community health services as an effective nursing intervention for children in vulnerable areas.

Study on the shearing bond strength between Vita Mark II and two kinds of veneering ceramics / 实用口腔医学杂志

Objective:To compare the shear bonding strength between two kinds of veneering ceramics respectively bonded to Vita Mark II.Methods:Vita Mark II samples were prepaired in the size of 8 mm ×6 mm ×2 mm.Veneering ceramic VM9 and Titankeram-ik were sintered on the Vita Mark II blocks respectively(n =1 0).The shear bond strength of each specimen was measured,the failure mode of the fracture surface was observed by SEM.The element in the bonding interface was analysed by field emission scanning elec-tron microscope(FE-SEM).Results:The values of shear bond strength (MPa)of VM9 and Titankeramik groups were 36.1 7 ±8.91 and 42.07 ±8.31 respectively(P >0.05).SEM observation showed tight bond between the two materials,FE-SEM results showed penetration of Al element from MarkⅡblock into veneering porcelain VM9 or Titankeramik.Conclusion:Veneered porcelain of VM9 and Titankeramik can be used as the individual veneering ceramics for Vita Mark II blocs.

Effects of Emotional Labor, Emotional Intelligence and Social Support on Job Stress in Clinical Nurses / 기본간호학회지

PURPOSE: The purpose of this study was to investigate the effects of emotional labor, emotional intelligence and social support on job stress in clinical nurses. METHODS: Participants were 123 clinical nurses and data were collected from October to December, 2011 and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and multiple regression with SPSS 18.0. RESULTS: A positive correlation was found between job stress and emotional labor. Emotional labor showed a significant negative correlation with emotional intelligence and social support, whereas a positive correlation was found between emotional intelligence and social support. The strongest predictor of job stress was emotional labor. In addition, institution satisfaction (dissatisfaction) and the reason for selecting the job (opportunities for service) accounted for 21% of variance in job stress. CONCLUSION: The results of this study suggest that it is important to manage emotional labor as well as to improve job satisfaction in order to reduce job stress in clinical nurses.

Patterns of Anger Expression among Middle-aged Korean Women: Q methodology

PURPOSE: The purpose of this study was to identify the characteristics of anger expression in middle-aged Korean women by categorizing their patterns of expression while considering the complexity and multidimensionality of anger, and by investigating the characteristics relative to the patterns. METHODS: The research design was a descriptive design using Q methodology, which is a method of measuring subjectivity. A convenience sample of 42 participants aged 40-60 years and living in the community in Korea was recruited. The PC-QUANL software program (a factor analysis program for the Q technique) was used to analyze the Q-sort data. RESULTS: Four factors were extracted that described different expressions of anger among middle-aged Korean women; these factors explained 50.1% of the total variance. The frames of reference of the four factors were a) direct diversion, b) silent masking with remaining anger, c) self digestion, and d) controlling anger with objectification. CONCLUSION: In this study has identified patterns and characteristics of anger expression among middle-aged Korean women were identified, which will aid the development of effective anger-management programs for controlling anger in this population. In future studies, it would be helpful to investigate how the patterns of anger expression established herein are associated with specific health problems such as cardiovascular disorder and cancer.

Effects of Cognitive Behavioral Therapy Program on Mental Health Problems in Children Dealing with Trauma: Focused on Community District Victimized by Oil Spill

PURPOSE: This study was done to evaluate the effects of cognitive behavioral therapy in a victimized community district and to determine if the program is an effective nursing intervention to reduce posttraumatic stress disorder symptom, depression and state anxiety. METHODS: A nonequivalent control group design was used for the study. The participants, 32 elementary school students, were selected from grades 4, 5, 6 and each student was assigned to either the experimental (16) or control (16) group. Cognitive behavioral therapy was used as the experimental treatment from April 9 to May 28, 2009. The experimental group received cognitive behavior therapy intervention 8 times. Data analysis was done using ANCOVA with SPSS 17.0. RESULTS: After the intervention, the experimental group showed significantly lower levels of posttraumatic stress disorder symptoms than the control group. CONCLUSION: The findings from this study suggest that cognitive behavioral therapy is an effective nursing intervention to decrease the level of mental health problems of children in victimized district. Further research is required in order to identify the continuous effects of cognitive behavioral therapy.

Factors Influencing Fatigue in Elderly People with Chronic Pain / 정신간호학회지

PURPOSE: This study was done to examine fatigue in elderly people with chronic pain and identify factors influencing fatigue. METHODS: Participants in the study were 296 elders suffering from pain for more than 6 months. The data were collected by personal interviews using questionnaires and were analyzed using Pearson correlation coefficients, t-test, ANOVA, and stepwise multiple regression with SPSS/WIN 15.0 version. RESULTS: The mean score for fatigue was 30.5, and fatigue showed a significant positive correlation with depression (r=.57, p<.001), perceived stress (r=.12, p=.035) and pain disability (r=.52, p<.001), but a negative correlation with social support (r=-.21, p<.001) and ADL (r=-.22, p<.001). Depression was found to be a significant predictor of fatigue. CONCLUSION: The results of this study show that psychological factors like depression have more influence on fatigue in elders than physical activities or daily capability. Therefore, it is important to consider psychological factors which influence fatigue as well as the fatigue itself in order to efficiently control fatigue.

The Effect of Virtual Reality Training on Unilateral Spatial Neglect in Stroke Patients

OBJECTIVE: To investigate the effect of virtual reality training on unilateral spatial neglect in stroke patients. METHOD: Twenty-four stroke patients (14 males and 10 females, mean age=64.7) who had unilateral spatial neglect as a result of right hemisphere stroke were recruited. All patients were randomly assigned to either the virtual reality (VR) group (n=12) or the control group (n=12). The VR group received VR training, which stimulated the left side of their bodies. The control group received conventional neglect therapy such as visual scanning training. Both groups received therapy for 30 minutes a day, five days per week for three weeks. Outcome measurements included star cancellation test, line bisection test, Catherine Bergego scale (CBS), and the Korean version of modified Barthel index (K-MBI). These measurements were taken before and after treatment. RESULTS: There were no significant differences in the baseline characteristics and initial values between the two groups. The changes in star cancellation test results and CBS in the VR group were significantly higher than those of the control group after treatment. The changes in line bisection test score and the K-MBI in the VR group were not statistically significant. CONCLUSION: This study suggests that virtual reality training may be a beneficial therapeutic technique on unilateral spatial neglect in stroke patients.

Cancer Rehabilitation: Experience, Symptoms, and Needs

The aim of this study was to examine the experience of cancer patients undergoing rehabilitation, to identify symptoms associated with rehabilitation from cancer, and to assess the need for rehabilitation services for cancer patients. Cancer patients (n = 402) at the Asan Medical Center (Seoul, Korea) were enrolled from June to September 2008. A chart review was used to collect demographic and clinical data, including type of cancer, current treatment, time from initial diagnosis to screening, and cancer stage. Each participant provided informed consent and was then given a questionnaire that asked about experience with rehabilitation, symptoms associated with rehabilitation, and the need for different types of rehabilitation services. Clinicians recommended rehabilitation for 8.5% of patients, and 6.7% underwent rehabilitation. Among study patients, 83.8% had one or more symptoms associated with rehabilitation, and 71.6% of patients with symptoms wanted rehabilitation management. The need for rehabilitation was associated with the presence of metastasis, advanced cancer stage, time to diagnosis, and type of current treatment. Our results provide specific information about particular functional symptoms and the rehabilitative needs of subgroups of cancer patients. It is suggested to develope and implement rehabilitation programs for cancer patients.

Sequential Tongue Pressure and Laryngeal Movement during Swallowing

OBJECTIVE: To test the repeatability and the reproducibility of a newly developed device which measures tongue pressure and laryngeal movement, to identify the range of tongue pressure and to reveal the relationships between tongue pressure and age, gender and diet formula. METHOD: One hundred five healthy subjects (50 males, 55 females, range 20 to 74 years) were recruited for the study. They had examinations of tongue pressure and laryngeal movement. The pressure was measured with two air-filled bulbs connected to a transducer. Laryngeal movement was measured with a strain gauge. The test was repeated three times with a two minute rest interval and monitored twice by the same investigator and once by another investigator. All subjects performed 10 times of swallowing: 5 times each of 3 ml liquid and dry swallowing. RESULTS: Intraclass correlation coefficient (ICC) for both the repeatability and the reproducibility revealed good to moderate reliability for tongue pressure measurement and the time of maximum tongue pressure (ICC, 0.60~0.84). However, it was poor for measurement of laryngeal movement. There were no significant differences between gender and age groups in tongue pressure, the time to maximum tongue pressure and laryngeal movement. The tongue pressure was higher in dry swallowing than in wet swallowing. Also, the time to maximum tongue pressure and overall laryngeal movement were prolonged in dry swallowing. CONCLUSION: The newly developed tongue pressure measurement system is a reliable apparatus and there are no significant age and gender differences in tongue and laryngeal movement in healthy subjects.

Trunk Impairment Scale for Evaluation of Functional Improvement in Acute Stroke Patients

OBJECTIVE: To evaluate the change of balance of the trunk using the Trunk Impairment Scale (TIS) in acute stroke patients and to compare it with the improvement in activities in their daily living (ADL) and gait. METHOD: The mean days from the onset of stroke were 11.3 (6~17) days, and functional improvement of 24 hemiplegic patients was evaluated using the trunk impairment scale, Berg balance scale, timed up and go test, 6 minutes walk test, and the modified Barthel index every week for 4 weeks' conventional rehabilitation programs. Correlations between the trunk impairment scale and the other parameters were evaluated. RESULTS: The trunk impairment scale and the modified Barthel index, both which showed significant improvement after 4 weeks, had statistically significant correlation (p<0.05). The Berg balance scale had not improved significantly in 4 weeks. The timed up and go test and the 6 minutes' walk test could not be evaluated in most of these patients within 4 weeks. CONCLUSION: The trunk impairment scale could be a useful parameter for evaluating activities in their daily living (ADL) improvement in acute stroke patients who are unable to ambulate independently. And good trunk balance in acute stroke period is positive correlation with ambulation potential.

The Effects of Laughter Therapy on Anger, Anger Expressions and Mental Status After Oil Spill in Victimized Community Residence / 정신간호학회지

PURPOSE: This study was done to evaluate the effects of laughter therapy in victimized community residence and to suggest that the practice is an effective nursing intervention to reduce anger, anger expression and to improve mental health. METHODS: The research design was a non-synchronized design with a nonequivalent control group. Laughter therapy was used as the experimental treatment from March 21 to April 16 2009. The 31research participants were assigned to an experimental (15) or control (16) group. Laughter therapy was administered four times to the experimental group. Data analysis was done with SPSS/win 17.0 for Mann-Whitney U test and ANCOVA. RESULTS: There were significant changes in the level of trait anger and somatization. There were no significant changes in the level of anger expression, depression, anxiety, phobic anxiety, psychosis, obsessive-compulsive, paranoid and interpersonal sensitivity. CONCLUSION: These results show that laughter therapy is an effective nursing intervention to decrease the level of trait anger and somatization.

An Analysis of the Meaning of Respite for Family Caregivers of Elderly with Dementia

PURPOSE: This study was a qualitative research study in which focus group interviews were used to collect data on the meaning of respite for family caregivers who are taking care of elders with dementia. METHODS: The focus group interviews and participants consisted of 2 family caregiver groups, for a total of 8 people taking care of their elders and 5 professional caregivers working in a geriatrics hospital or social welfare institutions. Content analysis was used and debriefing notes were referred in order to analyze the data. RESULTS: The meaning of respite in this research was measured using 4 main categories: 'Temporary break from routine', 'direct help', 'psychological comfort', 'valuables which cannot be taken easily' and 9 subcategories: 'Temporary diversion of attention', 'temporarily free from my duty', 'taking care of oneself', 'receiving economic help', 'empathize with others', 'comfort based on trust', 'resting together with the elder', 'no time to rest', 'cannot get out of one's obligatory duty'. CONCLUSION: The findings of the study show that rest means not only a temporary relief from caretaking, but also a real respite based on the patients' stable state and comfort. These results indicate a new meaning for respite, that the first step of respite program has to begin even when the caregivers do not recognize the need for respite.