Usefulness of the Berlin, STOP, and STOP-Bang Questionnaires in the Diagnosis of Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a chronic sleep-related breathing disorder that requires long-term management. If OSA remains untreated, it can result in serious health consequences, including increased risk of both cardiovascular and cerebrovascular diseases. Polysomnography is considered to be the gold standard for diagnosing OSA; however, it is relatively expensive, time-consuming and technically complex. Thus, there is a growing interest in the use of simple and efficient screening tools for OSA. Although screening questionnaires such as the Berlin Questionnaire, the STOP Questionnaire, and the STOP-Bang Questionnaire are widely used to assess the presence of OSA, the findings regarding their diagnostic accuracy are not consistent. This review provides a descriptive summary of the scientific studies evaluating the accuracy of diagnostic tests for OSA.

Metronidazole Induced Encephalopathy with Irreversible Course

No abstract available.

Factors related to Self-leadership of Korean Clinical Nurses: A Systematic Review and Meta-analysis / 간호행정학회지

PURPOSE: In this study a systematic review and meta-analysis was used to examine the variables related to self-leadership in Korean clinical nurses. METHODS: A search and screening of the literature uncovered, 49 related studies done between 2003 and 2016 were then reviewed. A meta-analysis of 44 studies from doctoral dissertations, master's thesis and published articles was also carried out. The correlational effect size (ESr) for each related variable was calculated. RESULTS: Sixty-nine related variables were identified from the systematic review. Twenty-three (5 personal, 13 professional and 5 organizational) variables were eligible for meta-analysis. The overall effect size was .47. The personal factors (ESr=.48) and the professional factors (ESr=.44) had larger effect size than the organizational factors (ESr=.28). Factors with the largest effect size among personal, professional and organizational factors were self-efficacy (ESr=.58), nursing service (ESr=.68) and supervisor's leadership (ESr=.36) respectively. CONCLUSION: The results of this study show that for Korean clinical nurses individual factors including personal or professional factors have a stronger impact on self-leadership than organizational factors. It is necessary to develop interventions and training programs which focus on improving self-efficacy to promote self-leadership in clinical nurses.

Structural Model of Evidence-Based Practice Implementation among Clinical Nurses

PURPOSE: This study was conducted to develop and test a structural model of evidence-based practice (EBP) implementation among clinical nurses. The model was based on Melnyk and Fineout-Overholt's Advancing Research and Clinical Practice through Close Collaboration model and Rogers' Diffusion of Innovations theory. METHODS: Participants were 410 nurses recruited from ten different tertiary hospitals in Korea. A structured self-report questionnaire was used to assess EBP knowledge/skills, EBP beliefs, EBP attitudes, organizational culture & readiness for EBP, dimensions of a learning organization and organizational innovativeness. Collected data were analyzed using SPSS/WINdows 20.0 and AMOS 20.0 program. RESULTS: The modified research model provided a reasonable fit to the data. Clinical nurses' EBP knowledge/skills, EBP beliefs, and the organizational culture & readiness for EBP had statistically significant positive effects on the implementation of EBP. The impact of EBP attitudes was not significant. The dimensions of the learning organization and organizational innovativeness showed statistically significant negative effects on EBP implementation. These variables explained 32.8% of the variance of EBP implementation among clinical nurses. CONCLUSION: The findings suggest that not only individual nurses' knowledge/skills of and beliefs about EBP but organizational EBP culture should be strengthened to promote clinical nurses' EBP implementation.

The Effects of an Evidence-based Nursing Course Using Action Learning on Undergraduate Nursing Students / 한국간호교육학회지

PURPOSE: This study was conducted to evaluate the effectiveness of an evidence-based nursing (EBN) course using action learning-based team learning in undergraduate nursing students. METHODS: A quasi-experimental pretest-posttest control group design was employed. The participants who consented were 45 second-year nursing students (22 in the experimental, 23 in the control group) from a university in G-city, Korea. The intervention included lectures, practicals, team activities and reflection on overviewing EBN, formulating clinical questions, searching the evidence, and criticizing the research articles. At the beginning and the end of the 7-week EBN course, the participants completed self-reported questionnaires. Frequencies, chi2-test, t-test, and ANCOVA with the SPSS program 18.0, were used to analyze the data. RESULTS: The experimental group showed significantly higher scores on EBN competency (F=25.80, p<001), information literacy (F=13.75, p=.001), and proactivity in problem solving (F=5.32, p=.026) than the control group. CONCLUSION: This study provides evidence that an EBN course improves undergraduate nursing students' EBN competencies, information literacy, and proactivity in problem solving. Team learning in EBN education can be an effective teaching strategy.

Systematic Search for Guidelines to Prevent Catheter-associated Urinary Tract Infections-Part II: Using the Ovid MEDLINE / 간호행정학회지

PURPOSE: To implement evidence-based nursing, it is important to know where and how to find the best available evidence. This study was conducted to identify the results of a search from Ovid MEDLINE and to compare the results from Ovid MEDLINE with those from PubMed MEDLINE. METHODS: Four different approaches via Ovid MEDLINE were used to search for guidelines on preventing catheter-associated urinary tract infections. Outcomes of this study were the number of records and relevant literature, and the sensitivity and precision of the search methods via Ovid MEDLINE. RESULTS: The number of retrieved items ranged 23 to 6,005 and that of relevant studies, 5 to 8 of 8. Simple searches resulted in the highest sensitivity of 100.0%. When using MeSH terms and limits feature, the precision was highest (21.7%) among four approaches for literature searches. Simple searches in Ovid had higher sensitivity and lower precision than those in PubMed. CONCLUSION: Simple searches in Ovid may be inefficient for busy clinicians compared to PubMed. However, to ensure a comprehensive and systematic literature search, using Ovid MEDLINE in addition to PubMed is recommended.

Prevalence and risk factors of cerebral white matter changes and silent infarcts on brain computed tomography scans among community-dwelling healthy adults: The PRESENT project

Cerebral white matter changes (WMCs) and silent brain infarcts (SBIs) are common radiologic findings in neurologically asymptomatic elderly people, but are associated with an increased risk of subsequent stroke. We investigated the prevalence and risk factors for these cerebral changes on brain computed tomography (CT) in 480 community-dwelling healthy Korean adults without stroke or dementia, who were recruited for an early health program. Cerebral WMCs were defined as the presence of approximately 5 mm wide ill-defined and moderately hypodense lesions, and SBIs were defined as the presence of >2 mm wide well-defined hypodense lesions. Of the 480 patients, 49 (10.2%) had cerebral WMCs and SBIs findings on brain CT. The prevalence of WMCs and SBIs increased with age: the prevalence was 2.4%, 9%, and 32% for subjects in their 50, 60s, and 70s, respectively. In addition, hypertension, abdominal obesity, increased levels of homocysteine and high sensitivity C-reactive protein were significantly associated with cerebral WMCs and SBIs. Our study suggests that regular monitoring of risk factors is required to prevent cerebral WMCs and SBIs and decrease the incidence of stroke and dementia in healthy individuals.

Effects of an Action Learning based Creative Problem-Solving Course for Nursing Students / 간호행정학회지

PURPOSE: This study was conducted to identify the effects of an action learning based creative problem-solving (CPS) course on problem solving, creativity and team-member exchange in nursing students. METHODS: A quasi-experimental study applying a non-equivalent control group pre-post design was employed. Sophomore nursing students (32 in the experimental group and 33 in the control group) were recruited from a university in G-city, Korea. Problem solving, creativity and team-member exchange were measured for the pretest and posttest using self-report questionnaires. Kolmogorov-Smirnov test, Chi-square, Fisher's exact test, t-test, and ANCOVA with SPSS/Win 20.0 program were used to analyze the data. RESULTS: The scores for problem solving, creativity and team-member exchange in the experimental group were significantly higher than those of the control group. CONCLUSION: Results of this study indicate that an action learning based CPS course is an effective teaching method to improve nursing students' competencies. In the future longitudinal studies are needed to assess the long term effects of the course.

Recurrent Herpes Simplex Virus Type-2 Meningitis in an Adolescent Girl / 대한임상신경생리학회지

Herpes simplex virus type 2 (HSV2) meningitis primarily develops during or following a primary genital HSV2 infection that was acquired from sexual contact or through the birth canal during delivery from mother. We describe a 15 year old virgin without history of previous herpes simplex infection who developed 2 episodes of HSV2 meningitis. Although recurrent meningitis due to HSV is primarily seen in young or sexually active adults. HSV2 meningitis should be in the differential diagnosis of recurrent meningitis in adolescent patients.

Bacterial Meningitis due to Cervical Epidural Abscess / 대한임상신경생리학회지

No abstract available.

An Example of Systematic Searching for Guidelines to Prevent Catheter-associated Urinary Tract Infections - Part I: Using the PubMed Database / 간호행정학회지

PURPOSE: Effective literature searching is essential to support evidence-based nursing. The aim of this study was to present our recent systematic search experience to identify guidelines in PubMed for prevention of catheter-associated urinary tract infections. METHODS: Five approaches to the literature search via PubMed were employed. The searches were restricted to items published from 1980 to 2010, for patients admitted to hospital, and in the English language. The search results were compared using the number of records and relevant items, and the sensitivity and precision of each search strategy. RESULTS: The individual approaches retrieved 19-141 of records and 3-6 of relevant items. Sensitivity ranged from 37.5% to 75.0% with the highest values for simple searches and a search combining MeSH terms and free textwords with a methodological search filter. Precision varied from 4.3% to 21.7% and the highest precision was found for MeSH terms with limits feature. CONCLUSION: The simple search in PubMed is an appropriate way for nurses in a busy clinical practice to search the literature for evidence. However, several approaches using MeSH terms, free textwords, limits feature or methodological search filters are also required to have more efficient and better informed search results.

Tooth Loss May Predict Poor Cognitive Function in Community-Dwelling Adults without Dementia or Stroke: The PRESENT Project

Periodontal disease is a potential predictor of stroke and cognitive impairment. However, this association is unclear in adults aged 50 yr and above without a history of stroke or dementia. We evaluated the association between the number of teeth lost, indicating periodontal disease, and cognitive impairment in community-dwelling adults without any history of dementia or stroke. Dental examinations were performed on 438 adults older than 50 yr (315 females, mean age 63+/-7.8 yr; 123 males, mean age 61.5+/-8.5 yr) between January 2009 and December 2010. In the unadjusted analysis, odds ratios (OR) of cognitive impairment based on MMSE score were 2.46 (95% CI, 1.38-4.39) and 2.7 (95% CI, 1.57-4.64) for subjects who had lost 6-10 teeth and those who had lost more than 10 teeth, respectively, when compared with subjects who had lost 0-5 teeth. After adjusting for age, education level, hypertension, diabetes, hyperlipidemia, and smoking, the relationship remained significant (OR, 2.0; 95% CI, 1.08-3.69, P=0.027 for those with 6-10 teeth lost; OR, 2.26; 95% CI, 1.27-4.02, P=0.006 for those with more than 10 teeth lost). The number of teeth lost is correlated with cognitive impairment among community-dwelling adults aged 50 and above without any medical history of stroke or dementia.

A Journey to Action Research in a Clinical Nursing Context / 간호행정학회지

PURPOSE: The purpose of this study was to examine the effectiveness of Action Research (AR) approach in nursing. METHODS: Participants were 64 perioperative nurses recruited from C hospital in Gwangju, Korea. The nurses were engaged in the project through 2 cycles of planning, acting, observing, and reflecting. A mixed-methods design was used to examine changes in participants and their knowledge management practice. Quantitative data were analyzed using SPSS 20.0 program and qualitative reflection data underwent content analysis. RESULTS: During the project, participants developed standardized pre-operative checklists and opened an Internet Cafe to better manage their perioperative nursing information. At the end of the project, there was a significant increase in nurses' knowledge management (p=.015) and the rate of surgical material prescription errors decreased from 8.0% to 2.9%. Core AR project team members' teamwork skills and organizational commitment increased significantly (p=.040, p=.301, respectively). The main themes that emerged from the qualitative data were learning how to solve problems in practice, facilitating team activities through motivation, barriers of large participation, and rewarded efforts and inflated expectations. CONCLUSION: The AR project contributed to empowering participants to solve local problems. AR is a useful methodology to promote changes in practices and research participants.

Tooth Loss Is Associated with Brain White Matter Change and Silent Infarction among Adults without Dementia and Stroke

Periodontal disease is a predictor of stroke and cognitive impairment. The association between the number of lost teeth (an indicator of periodontal disease) and silent infarcts and cerebral white matter changes on brain CT was investigated in community-dwelling adults without dementia or stroke. Dental examination and CT were performed in 438 stroke- and dementia-free subjects older than 50 yr (mean age, 63 +/- 7.9 yr), who were recruited for an early health check-up program as part of the Prevention of Stroke and Dementia (PRESENT) project between 2009 and 2010. In unadjusted analyses, the odds ratio (OR) for silent cerebral infarcts and cerebral white matter changes for subjects with 6-10 and > 10 lost teeth was 2.3 (95% CI, 1.38-4.39; P = 0.006) and 4.2 (95% CI, 1.57-5.64; P < 0.001), respectively, as compared to subjects with 0-5 lost teeth. After adjustment for age, education, hypertension, diabetes mellitus, hyperlipidemia, and smoking, the ORs were 1.7 (95% CI, 1.08-3.69; P = 0.12) and 3.9 (95% CI, 1.27-5.02; P < 0.001), respectively. These findings suggest that severe tooth loss may be a predictor of silent cerebral infarcts and cerebral white matter changes in community-dwelling, stroke- and dementia-free adults.

Clinical Characteristics and Classifications of Retinal Vein Occlusion

Clinical evaluation was performed in 181 eyes of 173 patients with retinal vein occlusion in aspects of disease onset, visual acuity, age and sex distribution, associated systemic disorders, laser treatment and ocular complications. The age of onset ranged from 20 to 82 years old. Seventy five patients were male and 98 were female. Central retinal vein occlusion included 38 eyes(ischemic type; 16 eyes, non-ischemic type; 22 eyes), hemi-central retinal vein occlusion 15 eyes(ischemic type; 5 eyes, non-ischemic type; 10 eyes), and branch retinal vein occlusion 128 eyes(major branch type; 91 eyes, macular branch type: 37 eyes). Hypertension was the most common associated systemic disease for each retinal vein occlusion type. The causes of severe visual loss in retinal vein occlusive diseases were macular edema, anterior and posterior segment neovascularization, and vitreous hemorrhage.