A systematic review and meta-analysis of studies on extended reality-based pediatric nursing simulation program development

Purpose@#This systematic literature review and meta-analysis explored extended reality (XR)-based pediatric nursing simulation programs and analyzed their effectiveness. @*Methods@#A literature search was conducted between May 1 and 30, 2022 in the following electronic databases: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. The search period was from 2000 to 2022. In total, 6,095 articles were reviewed according to the inclusion and exclusion criteria, and 14 articles were selected for the final content analysis and 10 for the meta-analysis. Data analysis was performed using descriptive statistics and the Comprehensive Meta- Analysis program. @*Results@#XR-based pediatric nursing simulation programs have increased since 2019. Studies using virtual reality with manikins or high-fidelity simulators were the most common, with six studies. The total effect size was statistically significant at 0.84 (95% confidence interval=0.50-1.19, z=4.82, p<.001). @*Conclusion@#Based on the findings, we suggest developing standardized guidelines for the operation of virtual pediatric nursing simulation education and practice. Simultaneously, the application of more sophisticated research designs for effect measurement and the combined applications of various virtual simulation methods are needed to validate the most effective simulation methodology.

The effect of curcumin on blood pressure and cognitive impairment in spontaneously hypertensive rats

BACKGROUND/OBJECTIVES@#It is known that the renin-angiotensin system (RAS) in the brain could regulate cognitive functions as well as blood pressure. Inhibition of RAS for the improvement of cognitive function may be a new strategy, but studies so far have mostly reported on the effects of RAS inhibition by drugs, and there is no research on cognitive improvement through RAS inhibition of food ingredients. Therefore, this study investigated the effect of curcumin on blood pressure and cognitive function and its related mechanism in spontaneously hypertensive rat/Izm (SHR/Izm).MATERIALS/METHODS: Six-week-old SHR/Izm rats were divided into 5 groups: control group (CON), scopolamine group (SCO, drug for inducing cognitive deficits), positive control (SCO and tacrine [TAC]), curcumin 100 group (CUR100, SCO + Cur 100 mg/kg), and curcumin 200 group (CUR200, SCO + Cur 200 mg/kg). Changes in blood pressure, RAS, cholinergic system, and cognitive function were compared before and after cognitive impairment. @*RESULTS@#The SCO group showed increased blood pressure and significantly reduced cognitive function based on the y-maze and passive avoidance test. Curcumin treatments significantly improved blood pressure and cognitive function compared with the SCO group.In both the CUR100 and CUR200 groups, the mRNA expressions of angiotensin-converting enzyme (ACE) and angiotensin II receptor type1 (AT1), as well as the concentrations of angiotensin II (Ang II) in brain tissue were significantly decreased. The mRNA expression of the muscarinic acetylcholine receptors (mAChRs) and acetylcholine (ACh) content was significantly increased, compared with the SCO group. @*CONCLUSIONS@#The administration of curcumin improved blood pressure and cognitive function in SCO-induced hypertensive mice, indicating that the cholinergic system was improved by suppressing RAS and AT1 receptor expression and increasing the mAChR expression.

Impact of Adjuvant Hormone Therapy on Sleep, Physical Activity, and Quality of Life in Premenopausal Breast Cancer: 12-Month Observational Study / 한국유방암학회지

Purpose@#This study aimed to investigate the differences in sleep disturbance changes between patients receiving two hormone therapies (“tamoxifen plus ovarian function suppression group [T+OFS group]” versus “tamoxifen group [T group]”) and the chronological changes in sleep disturbances in each group. @*Methods@#Premenopausal women with unilateral breast cancer who underwent surgery and were scheduled to receive hormone therapy (HT) with tamoxifen alone or with tamoxifen plus gonadotropin-releasing hormone (GnRH) agonist for ovarian function suppression were included. The enrolled patients wore an actigraphy watch for two weeks and completed questionnaires (insomnia, sleep quality, physical activity [PA], and quality of life [QOL]) at five time points: immediately before HT and 2, 5, 8, and 11 months after HT. @*Results@#Among the 39 enrolled patients (21 and 18 patients in the T+OFS group and T group, respectively), 25 (17 and 8 patients in the T+OFS group and T group, respectively) were finally analyzed. There were no differences between the two groups in time-dependent changes in insomnia, sleep quality, total sleep time, rapid eye movement sleep rate, QOL, and PA;however, the severity of hot flashes was significantly higher in the T+OFS group than in the T group. Although the interaction between group and time was not significant, insomnia and sleep quality significantly worsened at 2–5 months of HT when changes over time were analyzed within the T+OFS group. In both the groups, PA and QOL were maintained without significant changes. @*Conclusion@#Unlike tamoxifen alone, tamoxifen plus GnRH agonist initially worsened insomnia and sleep quality, but gradually improved with long-term follow-up. Patients who initially experience insomnia during tamoxifen plus GnRH agonist administration can be reassured based on the results of this study, and active supportive care may be used during this period.

Research Trends Review of Financial Performance in Hospitals / 간호행정학회지

Purpose@#This study aims to analyze the financial performance research trends in medical institutions and to suggest the necessity and future research direction for financial management from the perspective of nursing organizations. @*Methods@#Financial performance research in medical institutions was extracted by combining the keywords ‘finance’, ‘nursing’, ‘medical’, and ‘hospital’ in three domestic and foreign online databases. 55 studies were finally extracted. @*Results@#Of the 55 studies selected, 41.8% have been published after 2010, and 79.6% have been published in Korea. 83.6% of the studies used financial statements, and 74.5% used the financial ratio. Among the studies on the use of financial statements, 40 balance sheets and 41 profit and loss statements were used. @*Conclusion@#There were some limitations in deriving implications for financial performance management at the level of nursing organization. When establishing strategies for future financial performance improvement, it is recommended to prioritize nursing cost optimization and profitability enhancement at the nursing organization level.

Choice Stepping Reaction Time under Unstable Conditions in Healthy Young and Older Adults: A Reliability and Comparison Study

Purpose@#We aimed to analyze the reliability of the test for choice stepping reaction time (CSRT) under an unstable surface and determine whether there were differences in CSRT between support surface conditions (stable vs. unstable conditions) and between age groups (young adults vs. community-dwelling older adults). @*Methods@#Twenty healthy community-dwelling older adults and twenty young adults performed the stepping task under an unstable condition over two visits. The mean of the two trials measured for each visit was used for the analysis. The test-retest reliability was analyzed using intra-class correlation coefficient (ICC) with a 95% confidence interval, standard error of measurement (SEM), and minimal detectable change (MDC). Differences in CSRT between support surface conditions and age groups were analyzed using the independent t-test with Bonferroni correction. @*Results@#Excellent consistency was observed for ICC > 0.90 in both groups. Moreover, the SEM and MDC values of the CSRT in older and young adults were 0.03 and 0.09 and 0.01 and 0.04, respectively. There was a significant difference in the CSRT between the age groups under stable (p < 0.001) and unstable conditions (p < 0.001). @*Conclusion@#The findings demonstrated that the test for CSRT under an unstable condition had reliable results in both groups. Although older adults demonstrated longer reaction times than younger adults in all surface conditions, increasing the balance control demand by implementing a choice stepping task concomitant with a balance task had no influence on the reaction time in both age groups.

An electronic medical record-based fall risk assessment tool for pediatric inpatients in South Korea: Improved sensitivity and specificity

Purpose@#To develop a fall risk assessment tool to predict fall risk in pediatric inpatients. @*Methods@#Three tools widely used in clinical practice (Humpty Dumpty Fall Scale, General Risk Assessment for Pediatric Inpatient Falls, and Seoul National University Hospital Pediatric Fall Risk Scale) were examined, and assessment items were extracted. Employing a case-control design, 29 children who experienced falls during hospital stays were selected as the "fall" group, and a control group (93 children) was selected based on age and sex matching. The sensitivity, specificity, and positive and negative predictive values of the newly developed tool ("Newfs-PI") were analyzed. @*Results@#The Newfs-PI consisted of seven items: age, activity, history of falls, length of hospital stay, and medication. The total score ranged from 0 to 15. Its sensitivity and specificity were 62.07% and 74.19%, respectively. @*Conclusion@#The Newfs-PI has high specificity and sensitivity, which are essential for a fall risk assessment tool that complements existing tools. These values are high relative to those of existing assessment tools and satisfy both sensitivity and specificity criteria. As the EMR enables monitoring of the components of the Newfs-PI, the tool can be used as a fall risk assessment and prevention scale for pediatric inpatients.

Is Transarterial Chemoembolization Only Treatment Option in Patients with Intermediate Stage of Hepatocellular Carcinoma?: in Perspectives of Surgery

In the Barcelona Clinic Liver Cancer staging system, intermediate stage hepatocellular carcinoma (HCC) is defined as large multinodular tumors without vascular invasion or extrahepatic spread in an asymptomatic patient with good performance status. Intermediate stage HCC includes various subgroups and it is characterized by extensive heterogeneity. Current guidelines recommend transarterial chemoembolization (TACE) as the standard treatment modality for patients with intermediate stage HCC. Although TACE provides improved survival benefits compared with supportive care for patients with intermediate stage HCC, all of them are not good candidates for TACE. TACE refractoriness is another obstacle to effective treatment of patients with intermediate stage HCC. Given that many studies recently reported improved survival in patients treated with hepatic resection over TACE, we reviewed the survival outcomes of TACE and hepatic resection as a treatment strategy of intermediate stage HCC.

Analysis of Variables related to Entrepreneurial Intention of University Students in Korea: Derivation of Research Variables to Promote Entrepreneurial Intention of Nursing Students / 간호행정학회지

Purpose@#This study was done to explore research trends on start-up intention of college students in Korea. @*Methods@#Articles published from 2014 to 2018 were searched. Search term was “start-up intention.” At the first search, 2,137 articles were extracted from academic databases (DB). One hundred forty six articles were used in the systematic review and 88 articles were used in the meta analysis. @*Results@#There were 384 variables explored in relation to start-up intention. In the correlation and regression analysis, self efficacy and risk taking showed statistical significance in most research. In the meta analysis, career orientation, start-up preparation behavior, and start-up attitude showed statistical significant effect size. @*Conclusion@#We propose that structural equation model analysis be conducted to find causal relation among variables affecting start-up intention of college students. This will contribute to development of theoretical models for the activation of nursing entrepreneurship.

Development of the Nursing Start-up Attitude Scale for Student Nurses / 간호행정학회지

Purpose@#The purpose of this study was to develop and psychometrically test the nursing start-up attitude scale for student nurses. @*Methods@#The initial items were based on the second analysis of systematic review of previous studies and in-depth interview data with 9 nurse entrepreneurs. In total, 25 items were derived based on the pilot survey.Psychometric testing was conducted with 324 student nurses. Data were analyzed using validity and reliability test methods. @*Results@#Six factors, including 12 items explaining 74.4% of the total variance, were verified. The factors were opportunity of self actualization, network building, enhacing start-up competencies, outcomes of start-up, preparation for start-ups, and risk taking. Cronbach's ⍺ was .75. @*Conclusion@#As validity and reliability have been verified through various methods, the developed scale in this study can contribute to assessing student nurses’ attitudes to nursing start-ups.

Influences of Workplace Violence Experience on Job Satisfaction and Turnover Intention of New Nurses / 간호행정학회지

Purpose@#The purpose of this study was to identify workplace violence experience of new nurses and to investigate effects on organizational variables. Workplace violence experience can lead to new nurses developing negative attitudes towards nursing jobs. A safe organizational culture in which new nurses can work while being protected from workplace violence must be established. @*Methods@#An online survey was conducted with 180 nurses. Collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and regression analysis. @*Results@#The total score for workplace violence experience of new nurses was 1.75±0.55. There was a statistically significant negative correlation between verbal (r=-.32, p <.001), threatening (r=-.26, p <.001), and total (r=-.28, p <.001) workplace violence experience and job satisfaction, and a positive correlation between verbal (r=.18, p =.016), threatening (r=.17, p =.024), total (r=.17, p =.021) and turnover intention, respectively. Verbal violence experience was found to be a significant factor influencing job satisfaction, and the explanatory power of the model was 9.5%. @*Conclusion@#Based on the results of this study, it is necessary to develop a workplace violence prevention program for new nurses and a procedure and reporting system to cope with workplace violence. Furthermore, there is a need to expand a culture of mutual cooperation and a nonviolent atmosphere.

Meta-analysis of the Diagnostic Test Accuracy of Pediatric Inpatient Fall Risk Assessment Scales

PURPOSE: This study was conducted to obtain data for the development of an effective fall risk assessment tool for pediatric inpatients through a systematic review and meta-analysis of the diagnostic test accuracy of existing scales. METHODS: A literature search using Medline, Science Direct, CINAHL, EMBASE, and the Cochrane Library was performed between March 1 and 31, 2018. Of 890 identified papers, 10 were selected for review. Nine were used in the meta-analysis. Stata version 14.0 was used to create forest plots of sensitivity and specificity. A summary receiver operating characteristic curve was used to compare all diagnostic test accuracies. RESULTS: Four studies used the Humpty Dumpty Falls Scale. The most common items included the patient's diagnoses, use of sedative medications, and mobility. The pooled sensitivity and specificity of the nine studies were .79 and .36, respectively. CONCLUSION: Considering the low specificity of the pediatric fall risk assessment scales currently available, there is a need to subdivide scoring categories and to minimize items that are evaluated using nurses' subjective judgment alone. Fall risk assessment scales should be incorporated into the electronic medical record system and an automated scoring system should be developed.

Nursing Productivity of Tertiary General Hospitals using Financial Statements / 간호행정학회지

PURPOSE: This study was performed to analyze financial ratios and nursing productivity and to interpret comparisons of financial standard ratios. METHODS: The financial statements of 21 tertiary general hospitals were collected from the webpage of the National Tax Service in Korea. General characteristics of the hospitals were acquired from their webpages. RESULTS: The results obtained were compared with the financial standard ratios of Korean hospitals. The majority of hospitals showed poor liquidity, performance, turnover, and growth. Nursing productivity was measured by calculating annual value added per nurse (￦ 39,746,938) and annual gross revenues per nurses (￦ 65,803,550). CONCLUSION: Interestingly, although the financial ratios were generally poor, nursing productivities were very good. Nurse managers can suggest increasing nursing staff levels based on high nursing productivity despite poor financial conditions.

Developing and Evaluating a Camp-style Leadership Enhancement Program for Nursing Students / 간호행정학회지

PURPOSE: The aim of this study was to develop a camp-style leadership enhancement program (CLEP) and evaluate its effects to provide basic data for developing such programs for nursing students. METHODS: The study design was a randomized control pre/post-test. There were 35 participants each in the experimental and control groups for a total of 70 participants. The content and structure of the CLEP reflected 13 core concepts extracted using a systematic literature review. The program included a two-day camp-style program with eight modules consisting of lectures, individual and team activities, group discussions, team presentations, and feedback from the lecturer. The impacts of CLEP were measured using self, transformational, and servant leadership. RESULTS: Pre-homogeneity between the group participants' general and leadership characteristics was confirmed. After the CLEP, the experimental group showed a significant increase in self, transformational, and servant leadership. CONCLUSION: These findings suggest that universities utilize the performance-based self-learning CLEP to increase leadership among nursing students.

Development and Application of Cost Management Program for Visiting Nursing Centers Using Time-Driven Activity-Based Costing

PURPOSE@#This study aimed to develop a web-based cost management program for visiting nursing centers (CMP-VNC), using time-driven activity-based costing (TD-ABC), and to analyze effects of the program.@*METHODS@#The CMP-VNC was developed using the combined prototyping approach and system developing life cycle method following four stages: need analysis with comprehensive literature reviews and focus group interviews, design and development of program algorithm, evaluation of the developed program validity using experts and users group, and application and effects analysis. The non-equivalent control group pretest-posttest design was used to analyze the effects of the program. The program demonstration was conducted for four weeks with 60 visiting nurses in 35 visiting centers.@*RESULTS@#The web-based program was developed. It has five interfaces with basic and special functions using TD-ABC, namely, input, visiting nursing activity, visiting nursing activity cost, cost efficiency, and cost calculation report. The experimental group showed significantly higher cost perception and cost confidence than control group.@*CONCLUSION@#We found that the CMP-VNC can be an effective tool to increase visiting nurses' competency of costing and enhance efficiencies of visiting nursing centers.

Comparison of the Diagnostic Ability of Endoscopic Ultrasonography and Abdominopelvic Computed Tomography in the Diagnosis of Gastric Subepithelial Tumors

BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) is the most efficient imaging modality for gastric subepithelial tumors (SETs). However, abdominopelvic computed tomography (APCT) has other advantages in evaluating the characteristics, local extension, or invasion of SETs to adjacent organs. This study aimed to compare the diagnostic ability of EUS and APCT based on surgical histopathology results.METHODS: We retrospectively reviewed data from 53 patients who underwent both EUS and APCT before laparoscopic wedge resection for gastric SETs from January 2010 to December 2017 at a single institution. On the basis of histopathology results, we assessed the diagnostic ability of the 2 tests.RESULTS: The overall accuracy of EUS and APCT was 64.2% and 50.9%, respectively. In particular, the accuracy of EUS vs. APCT for the diagnosis of gastrointestinal stromal tumors (GISTs), leiomyomas, and ectopic pancreas was 83.9% vs. 74.2%, 37.5% vs. 0.0%, and 57.1% vs. 14.3%, respectively. Most of the incorrect diagnoses with EUS involved hypoechoic lesions originating in the fourth echolayer, with the most common misdiagnosed lesions being GISTs mistaken for leiomyomas and vice versa.CONCLUSIONS: APCT showed a lower overall accuracy than EUS; however, APCT remains a useful modality for malignant/potentially malignant gastric SETs.

Gastric Ulcers with Cytomegalovirus Infection in an Immunocompetent Patient

Cases of cytomegalovirus (CMV) infection are rare, and this infection is commonly asymptomatic in immunocompetent patients. Here, we report a pathologically proven case of CMV infection in gastric ulcers in an immunocompetent patient. A 35-year-old man visited our hospital for a surveillance esophagogastroduodenoscopy. Except fatigue, he had no other symptoms. Laboratory data showed that his white cell count was 9.28×10³/µL with 60.1% lymphocytes. However, aspartate transaminase and alanine aminotransferase levels were elevated. Esophagogastroduodenoscopy revealed multiple gastric ulcers that were healing. Two endoscopic biopsies were performed to obtain specimens at the ulcer base. Histological examination and immunohistochemistry confirmed CMV infection; subsequently, we decided that the best option was observation without medication. He revisited a month later, and the ulcers had disappeared.

Development and Application of Cost Management Program for Visiting Nursing Centers Using Time-Driven Activity-Based Costing / 간호학회지

PURPOSE: This study aimed to develop a web-based cost management program for visiting nursing centers (CMP-VNC), using time-driven activity-based costing (TD-ABC), and to analyze effects of the program. METHODS: The CMP-VNC was developed using the combined prototyping approach and system developing life cycle method following four stages: need analysis with comprehensive literature reviews and focus group interviews, design and development of program algorithm, evaluation of the developed program validity using experts and users group, and application and effects analysis. The non-equivalent control group pretest-posttest design was used to analyze the effects of the program. The program demonstration was conducted for four weeks with 60 visiting nurses in 35 visiting centers. RESULTS: The web-based program was developed. It has five interfaces with basic and special functions using TD-ABC, namely, input, visiting nursing activity, visiting nursing activity cost, cost efficiency, and cost calculation report. The experimental group showed significantly higher cost perception and cost confidence than control group. CONCLUSION: We found that the CMP-VNC can be an effective tool to increase visiting nurses' competency of costing and enhance efficiencies of visiting nursing centers.

Factors Influencing Entrepreneurial Intention of Nursing Students Based on Theory of Planned Behavior / 간호행정학회지

PURPOSE: Based on the theory of planned behavior, the purpose of this study was to investigate factors influencing entrepreneurial intention in nursing students. METHODS: Convenience sampling was used to recruit 434 participants from five nursing departments. The investigators used self-report questionnaires. The data were collected from October 25 to November 25, 2018. Data were analyzed using descriptive statistics and three-step hierarchical regression analysis. RESULTS: Attitude, subjective norm, and perceived behavior control of the theory of planned behavior, and role model showed a significant effect on entrepreneurial intention. The explanatory power of the whole model was 63%. CONCLUSION: Based on the results of this study, we propose developing a nursing entrepreneurial education model focusing on attitude, subjective norm, and perceived behavior control in the theory of planned behavior.

Predictive Role of Circulating Immune Cell Subtypes Early after Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Acute Leukemia

BACKGROUND AND OBJECTIVES: Cells of innate immunity normally recover in the first weeks to months after allogenenic hematopoietic stem cell transplantation (allo-HSCT). Their relevance in terms of graft-versus-host disease (GVHD) and graft-versus-leukemia (GVL) effect is largely unknown. The predictive role of early recovery in the immune cells on acute GVHD and GVL effect after allo-HSCT was investigated in patients with acute leukemia who achieved the first complete remission. METHODS: Peripheral blood samples were taken at the median of 14 days (range, 12~29 days) after allo-HSCT. A cohort including 119 samples and characteristics of patients were analyzed. Immune cell populations were identified by flow cytometry. RESULTS: The median age was 49.0 years (range, 21~69) at transplantation. Univariate analysis showed that age less than 40 years old, lower frequencies of CD8+ T cells, invariant natural killer T (iNKT) cells, monocytic myeloid derived suppressor cells (M-MDSCs) and higher frequency of immature MDSCs were associated with occurrence of grade III–IV acute GVHD. Multivariate analyses showed that iNKT cells (hazard ratio (HR), 0.453, 95% CI, 0.091~0.844, p=0.024) and M-MDSCs (HR, 0.271, 95% CI, 0.078~0.937, p=0.039) were independent factors. Combination of higher frequencies of both cell subsets was associated with lower incidence of grade III–IV acute GVHD, whereas patients with lower frequency of iNKT cells and higher frequency of M-MDSCs showed significant higher probability of relapse. CONCLUSIONS: iNKT cells and M-MDSCs could be relevant cell biomarkers for predicting acute GVHD and/or relapse in acute leukemia patients treated with allo-HSCT.

Patient Safety Perception of Nurses as related to Patient Safety Management Performance in Tertiary Hospitals / 간호행정학회지

PURPOSE: This study was done to identify the relationship between perception of the importance and job performance of patient safety management. METHODS: This descriptive study was performed using self-report questionnaires. Participants were 200 nurses who worked at 4 tertiary university hospitals where data were collected for 4 weeks in June 2016. RESULTS: The scores for perception and performance were 4.28 and 4.37 points. A positive correlation was found between perception of the importance of patient safety management and job performance (r=.74, p < .001). In regression analysis, the perception of the importance of patient safety management (β=.74, p < .001) was a significant factor in the performance of patient safety management. The regression model was statistically significant (F=134.43, p < .001) and the explanatory power of the model was 58%. CONCLUSION: The findings from this study indicate a need to develop strategies to improve perception of the importance of patient safety management. Also, this data should be used as a basis to develop education programs to improve awareness of the importance of patient safety management.