Assessment of Risk Factors for Postoperative Delirium in Older Adults Who Underwent Spinal Surgery and Identifying Associated Biomarkers Using Exosomal Protein

Purpose@#With an increase in the aging population, the number of patients with degenerative spinal diseases undergoing surgery has risen, as has the incidence of postoperative delirium. This study aimed to investigate the risk factors affecting postoperative delirium in older adults who had undergone spine surgery and to identify the associated biomarkers. @*Methods@#This study is a prospective study. Data of 100 patients aged ≥ 70 years who underwent spinal surgery were analyzed. Demographic data, medical history, clinical characteristics, cognitive function, depression symptoms, functional status, frailty, and nutritional status were investigated to identify the risk factors for delirium. The Confusion Assessment Method, Delirium Rating Scale-R-98, and Nursing Delirium Scale were also used for diagnosing deliri-um. To discover the biomarkers, urine extracellular vesicles (EVs) were analyzed for tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1),neurofilament light, and glial fibrillary acidic protein using digital immunoassay technology. @*Results@#Nine patients were excluded, and data obtained from the remaining 91 were analyzed. Among them, 18 (19.8%) developed delirium. Differences were observed between partici-pants with and without delirium in the contexts of a history of mental disorder and use of benzodiazepines (p = .005 and p = .026, respectively). Tau and UCH-L1—concentrations of urine EVs—were comparatively higher in participants with severe delirium than that in partici-pants without delirium (p = .002 and p = .001, respectively). @*Conclusion@#These findings can assist clinicians in accurately identifying the risk factors before surgery, classifying high-risk patients, and predicting and detecting delirium in older patients. Moreover, urine EV analysis revealed that postoperative delirium following spinal surgery is most likely associated with brain damage.

Validity and Reliability of the Korean Version of the Parkinson’s Disease Questionnaire–Carer

Background@#and Purpose The importance of the quality of life (QOL) of carers has been increasingly recognized as it has a wide range of effects on the psychological, emotional, and social outcomes of patients with Parkinson’s disease (PD). Understanding their QOL is important as it reflects their unique characteristics; however, there have been few studies on this in Korea. This study aimed to translate and validate the Korean version of the Parkinson’s Disease Questionnaire–Carer (PDQ-Carer). @*Methods@#This was a methodological study that included a translation process and a crosssectional investigation. The Korean version of the scale was developed using back translation, semantic adjustment, and pretests. The final version was self-administered by 125 Korean family carers. Cronbach’s alpha values were used to assess the internal consistency of the PDQ-Carer. Exploratory and confirmatory factor analyses were used to validate the translated scale. @*Results@#Exploratory factor analysis identified four factors that accounted for 64.51% of the variance. A modified model using modification indices was found to fit the data well in the confirmatory factor analysis. That factor analysis supported the structure of the original four factors with relocation of several items that reflected Korean culture. Cronbach’s alpha values were 0.96 for the total scale, 0.93 for personal and social activities, 0.89 for strain, 0.85 for anxiety and depression, and 0.85 for self-care. @*Conclusions@#This study verified that the Korean version of the PDQ-Carer can be used to acquire important information about the multidimensional aspects of the QOL of Korean carers for patients with PD.

Trapping of Methylglyoxal by Sieboldin from Malus baccata L. and Identification of Sieboldin-Methylglyoxal Adducts Forms

The methylglyoxal (MGO) trapping constituents from Malus baccata L. were investigated using incubation of MGO and crude extract under physiological conditions followed by HPLC analysis. The peak areas of MGO trapping compounds decreased, and their chemical structures were identified by HPLC-ESI/MS. Sieboldin was identified as a major active molecule representing MGO-trapping activity of the crude extract. After reaction of sieboldin and MGO, remaining MGO was calculated by microplate assay method using imine (Schiff base) formation of 2,4-dinitrophenylhydrazine (DNPH) and aldehyde group. After 4 h incubation, sieboldin trapped over 43.8% MGO at a concentration of 0.33 mM and showed MGO scavenging activity with an RC 50 value of 0.88 mM for the incubation of 30 min under physiological conditions. It was also confirmed that sieboldin inhibited the production of advanced glycation end products (AGE) produced by bovine serum albumins (BSA)/MGO. Additionally, MGO trapping mechanism of sieboldin was more specifically identified by 1 H-, 13 C-, 2D NMR and, confirm to be attached to the position of C-3' (or 5').

Effect of Sedatives on In-hospital and Long-term Mortality of Critically Ill Patients Requiring Extended Mechanical Ventilation for ≥ 48 Hours

Background@#The purpose of this study was to assess the correlation between sedatives and mortality in critically ill patients who required mechanical ventilation (MV) for ≥ 48 hours from 2008 to 2016. @*Methods@#We conducted a nationwide retrospective cohort study using population-based healthcare reimbursement claims database. Data from adult patients (aged ≥ 18) who underwent MV for ≥ 48 hours between 2008 and 2016 were identified and extracted from the National Health Insurance Service database. The benzodiazepine group consisted of patients who were administered benzodiazepines for sedation during MV. All other patients were assigned to the non-benzodiazepine group. @*Results@#A total of 158,712 patients requiring MV for ≥ 48 hours were admitted in 55 centers in Korea from 2008 to 2016. The benzodiazepine group had significantly higher in-hospital and one-year mortality compared to the non-benzodiazepine group (37.0% vs. 34.3%, 55.0% vs. 54.4%, respectively). Benzodiazepine use decreased from 2008 to 2016, after adjusting for age, sex, and mean Elixhauser comorbidity index in the Poisson regression analysis (incidence rate ratio, 0.968; 95% confident interval, 0.954–0.983; P < 0.001). Benzodiazepine use, older age, lower case volume (≤ 500 cases/year), chronic kidney disease, and higher Elixhauser comorbidity index were common significant risk factors for in-hospital and oneyear mortality. @*Conclusion@#In critically ill patients undergoing MV for ≥ 48 hour, the use of benzodiazepines for sedation, older age, and chronic kidney disease were associated with higher in-hospital mortality and one-year mortality. Further studies are needed to evaluate the impact of benzodiazepines on the mortality in elderly patients with chronic kidney disease requiring MV for ≥ 48 hours.

Effect of Sedatives on In-hospital and Long-term Mortality of Critically Ill Patients Requiring Extended Mechanical Ventilation for ≥ 48 Hours

Background@#The purpose of this study was to assess the correlation between sedatives and mortality in critically ill patients who required mechanical ventilation (MV) for ≥ 48 hours from 2008 to 2016. @*Methods@#We conducted a nationwide retrospective cohort study using population-based healthcare reimbursement claims database. Data from adult patients (aged ≥ 18) who underwent MV for ≥ 48 hours between 2008 and 2016 were identified and extracted from the National Health Insurance Service database. The benzodiazepine group consisted of patients who were administered benzodiazepines for sedation during MV. All other patients were assigned to the non-benzodiazepine group. @*Results@#A total of 158,712 patients requiring MV for ≥ 48 hours were admitted in 55 centers in Korea from 2008 to 2016. The benzodiazepine group had significantly higher in-hospital and one-year mortality compared to the non-benzodiazepine group (37.0% vs. 34.3%, 55.0% vs. 54.4%, respectively). Benzodiazepine use decreased from 2008 to 2016, after adjusting for age, sex, and mean Elixhauser comorbidity index in the Poisson regression analysis (incidence rate ratio, 0.968; 95% confident interval, 0.954–0.983; P < 0.001). Benzodiazepine use, older age, lower case volume (≤ 500 cases/year), chronic kidney disease, and higher Elixhauser comorbidity index were common significant risk factors for in-hospital and oneyear mortality. @*Conclusion@#In critically ill patients undergoing MV for ≥ 48 hour, the use of benzodiazepines for sedation, older age, and chronic kidney disease were associated with higher in-hospital mortality and one-year mortality. Further studies are needed to evaluate the impact of benzodiazepines on the mortality in elderly patients with chronic kidney disease requiring MV for ≥ 48 hours.

Association between dietary sodium intake and disease burden and mortality in Koreans between 1998 and 2016: The Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVES@#Sodium intake is positively associated with blood pressure, which may increase the risk for cardiovascular disease (CVD). Therefore, we assessed the disease burden of CVD attributable to sodium intakes above 2,000 mg/day and prospectively investigated the association between dietary/urinary sodium levels and the risk of all-cause and CVD-mortality using the Korea National Health and Nutrition Examination Survey (KNHNES). @*SUBJECTS/METHODS@#A total of 68,578 and 33,113 participants were included for comparative risk assessment (CRA) analysis and mortality analysis, respectively, and mean follow-up time for mortality was 5.4 years. CRA analysis was used to quantify attributable incidences of stroke, ischemic heart disease (IHD), and deaths attributable to sodium intake between 1998 and 2016. Cox proportional hazard regression model was used to determine the association between sodium intake and all-cause and CVD-mortality. @*RESULTS@#Mean dietary sodium intake decreased over time, reaching 3,647 mg/day in 2016.Similarly, the population attributable fractions of stroke and IHD, and the number of CVDassociated deaths attributable to high sodium intake/excretion also decreased. In terms of association with mortality, when participants were grouped into quartiles (Q) by energyadjusted sodium intake, those in Q2 had a lower risk of all-cause mortality than those in Q1 with lower intakes. The risk of CVD-associated mortality was higher only in females with high sodium intake in Q4 than those in Q1. @*CONCLUSIONS@#This nationwide data indicates that, in line with previous studies of multiple cohorts, both low and high sodium intakes may be associated with an increased risk of mortality; therefore, the optimal sodium intake for Koreans needs to be revised.

Status Quo and Innovative Directions for Inpatient Fall Interventions / 기본간호학회지

Purpose@#The purpose of this study was to explore nurses’ experience of falls, and their perception of the status quo of inpatient fall interventions. @*Methods@#The participants were 28 ward nurses in a university hospital, Seoul, Korea. Five focus group interviews and three individual interviews were conducted. The interviews were analyzed using thematic analysis. @*Results@#The findings from this study suggest that nurses face limitations in providing conventional fall interventions due to patient disease related characteristics, situations in hospital, and medical devices used in the hospital settings. Although nurses adopted their own strategies to prevent falls effectively, they expressed the need for innovative approaches to overcome these limitations. @*Conclusion@#Systematic, technology-based approaches are needed to create a safer physical environment and to improve current nursing interventions to prevent falls.

Factors Affecting Clinical Practicum Stress of Nursing Students: Using the Lazarus and Folkman's Stress-Coping Model / 간호학회지

PURPOSE: This study was conducted to test a path model for the factors related to undergraduate nursing students' clinical practicum stress, based on Lazarus and Folkman's stress-coping model. METHODS: This study utilized a path analysis design. A total of 235 undergraduate nursing students participated in this study. The variables in the hypothetical path model consisted of clinical practicum, emotional intelligence, self-efficacy, Nun-chi, and nursing professionalism. We tested the fit of the hypothetical path model using SPSS/WIN 23.0 and AMOS 22.0. RESULTS: The final model fit demonstrated a satisfactory statistical acceptance level: goodness-of-fit-index=.98, adjusted goodness-of-fit-index=.91, comparative fit index=.98, normed fit index=.95, Tucker-Lewis index=.92, and root mean square error of approximation=.06. Self-efficacy (β=−.22, p=.003) and Nun-chi behavior (β=−.17, p=.024) were reported as significant factors affecting clinical practicum stress, explaining 10.2% of the variance. Nursing professionalism (β=.20, p=.006) and self-efficacy (β=.45, p<.001) had direct effects on emotional intelligence, explaining 45.9% of the variance. Self-efficacy had indirect effects on Nun-chi understanding (β=.20, p<.001) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. Nursing professionalism had indirect effects on Nun-chi understanding (β=.09, p=.005) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. The variables for self-efficacy and nursing professionalism explained 29.1% of the Nun-chi understanding and 18.2% of the Nun-chi behavior, respectively. CONCLUSION: In undergraduate nursing education, it is important to identify and manage factors that affect clinical practicum stress. The findings of this study emphasize the importance of Nun-chi, self-efficacy, emotional intelligence, and nursing professionalism in the development of an educational strategy for undergraduate nursing students.

Factors Affecting Clinical Practicum Stress of Nursing Students: Using the Lazarus and Folkman's Stress-Coping Model

PURPOSE@#This study was conducted to test a path model for the factors related to undergraduate nursing students' clinical practicum stress, based on Lazarus and Folkman's stress-coping model.@*METHODS@#This study utilized a path analysis design. A total of 235 undergraduate nursing students participated in this study. The variables in the hypothetical path model consisted of clinical practicum, emotional intelligence, self-efficacy, Nun-chi, and nursing professionalism. We tested the fit of the hypothetical path model using SPSS/WIN 23.0 and AMOS 22.0.@*RESULTS@#The final model fit demonstrated a satisfactory statistical acceptance level: goodness-of-fit-index=.98, adjusted goodness-of-fit-index=.91, comparative fit index=.98, normed fit index=.95, Tucker-Lewis index=.92, and root mean square error of approximation=.06. Self-efficacy (β=−.22, p=.003) and Nun-chi behavior (β=−.17, p=.024) were reported as significant factors affecting clinical practicum stress, explaining 10.2% of the variance. Nursing professionalism (β=.20, p=.006) and self-efficacy (β=.45, p<.001) had direct effects on emotional intelligence, explaining 45.9% of the variance. Self-efficacy had indirect effects on Nun-chi understanding (β=.20, p<.001) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. Nursing professionalism had indirect effects on Nun-chi understanding (β=.09, p=.005) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. The variables for self-efficacy and nursing professionalism explained 29.1% of the Nun-chi understanding and 18.2% of the Nun-chi behavior, respectively.@*CONCLUSION@#In undergraduate nursing education, it is important to identify and manage factors that affect clinical practicum stress. The findings of this study emphasize the importance of Nun-chi, self-efficacy, emotional intelligence, and nursing professionalism in the development of an educational strategy for undergraduate nursing students.

Effect of Institutional Case Volume on In-Hospital and Long-Term Mortality in Critically Ill Patients Requiring Mechanical Ventilation for 48 Hours or More

BACKGROUND: The purpose of this study was to evaluate whether institutional case volume affects clinical outcomes in patients receiving mechanical ventilation for 48 hours or more. METHODS: We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 158,712 adult patients were included at 55 centers in Korea. Centers were categorized according to the average annual number of patients: > 500, 500 to 300, and 500 patients/year) showed lower in-hospital mortality and long-term mortality, compared to centers with lower case volume (< 300 patients/year) in patients who required mechanical ventilation for 48 hours or more.

Factors Affecting the Successful Aging of Late Middle-Aged Adults

BACKGROUND: As aging is a process that everyone must experience, life expectancy is getting longer and living standards are getting better. But aging can be successful or unsuccessful. Middle-aged adults experience an existential crisis of physical burdens and middle-aged crises, thereby changing the quality of life in old age. The purpose of this study was to identify the factors affecting successful aging in middle-aged adults. METHODS: This is a cross sectional descriptive study design was used to examine the association among middle-age crisis, perceived health status, self-esteem, social support and successful aging in late middle-aged adults. RESULTS: Perceived health status and social support had a statistically significant effect on successful aging, and middle-aged crisis and self-esteem were not significant. The factors' determination value was 63.6%. CONCLUSIONS: The perceived health status and social support of middle-aged adults may help the successful aging of middle-aged adults. Therefore, it is necessary to develop education for health promoting activities and social support programs with various materials.

Factors Related to Extravasation of Non-chemotherapy Vesicant Drugs in Peripheral Vein Catheters / 중환자간호학회지

PURPOSE: This study aimed to investigate the incidence of intravenous extravasation and the risk factors associated with the use of peripheral intravenous catheters in adults.METHOD: This prospective observational study included 203 adult patients admitted to the general ward who received non-chemotherapy vesicant drug infusion treatments. Data were analyzed using frequencies, percentage, means, standard deviations, and odds ratios (ORs) from multiple logistic regressions.RESULTS: The incidence of extravasation was 43.3%. Risk factors for intravenous extravasation included continuous injections (OR=5.35, 95% CI [1.38, 20.83]), and parenteral nutrition (OR=3.53, 95% CI [1.43, 8.73]).CONCLUSION: The present findings revealed that gastrointernal medicine problems, continuous injection, and parenteral nutrition were related to intravenous extravasation. Further research is necessary to reduce the incidence of extravasation related to peripheral intravenous catheterization in adults, and to prevent secondary complications. Finally, patients should be provided appropriate and continuous care based on the type of intravenous infusion.

Effects of a First Aid Coaching Program on First Aid Knowledge, Confidence, and Performance of Child Care Teachers

PURPOSE: The purpose of this study was to develop a first aid coaching program (FACP) and to investigate its effects on the first aid knowledge, confidence, and performance of childcare teachers. METHODS: A Delphi survey that included 16 experts was used to develop the FACP. A total of 60 participants were included to test the effectiveness of the program. The FACP developed using the survey results focused on improving first aid knowledge, confidence, and performance using a coaching-based method. First aid and cardiopulmonary resuscitation (CPR) performance was assessed using 39 items from the program content. RESULTS: Using a 3-round Delphi survey, 6 areas and 42 detailed topics for group and individual coaching programs were developed. The knowledge scores were significantly higher in the experimental group than in the control group (t=4.24, p=.001). The confidence scores were significantly higher in the experimental group than in the control group (F=3.89, p < .001). The performance scores were significantly higher in the experimental group than in the control group (t=12.40, p < .001). CONCLUSION: Continuous application of the FACP among child care teachers is expected to minimize the harm caused by minor accidents at child care facilities. This program should be formally implemented on a consistent basis.

Factors Affecting the Successful Aging of Late Middle-Aged Adults

BACKGROUND@#As aging is a process that everyone must experience, life expectancy is getting longer and living standards are getting better. But aging can be successful or unsuccessful. Middle-aged adults experience an existential crisis of physical burdens and middle-aged crises, thereby changing the quality of life in old age. The purpose of this study was to identify the factors affecting successful aging in middle-aged adults.@*METHODS@#This is a cross sectional descriptive study design was used to examine the association among middle-age crisis, perceived health status, self-esteem, social support and successful aging in late middle-aged adults.@*RESULTS@#Perceived health status and social support had a statistically significant effect on successful aging, and middle-aged crisis and self-esteem were not significant. The factors' determination value was 63.6%.@*CONCLUSIONS@#The perceived health status and social support of middle-aged adults may help the successful aging of middle-aged adults. Therefore, it is necessary to develop education for health promoting activities and social support programs with various materials.

Relationships between Sedation Knowledge and Nurse Practice Competences in Intensive Care Unit / 임상간호연구

PURPOSE: For this study an examination was done of relationships between intensive care unit (ICU) nurses' knowledge related to sedation and their clinical competencies in sedation practice. METHODS: Ninety one ICU nurses were recruited from two tertiary hospitals in South Korea. A self-report questionnaire was used to examine the levels of knowledge related to sedation and nursing practice competence based on Ajzen's theory of planned behavior. Descriptive statistics, independent t-tests, one-way ANOVA, and Pearson correlations were performed using the IBM SPSS 21.0 RESULTS: ICU nurses are more knowledgeable about general information on sedation rather than up-to-date information. Continuing education on sedation was related to difference in knowledge levels. However, the levels of knowledge were not related to competence in sedation practice. Instead, a positive attitude toward sedation practice was significantly related to the subjective norms; orders and goals, perceived behavioral control, practice of sedation, and intention to use. CONCLUSION: The results of this study provide fundamental information on levels of knowledge related to sedation practices of Korean ICU nurses. Continuing education should emphasize up-to-date information on sedation practice and need for positive attitudes which influence all other competencies towards sedation practices to achieve optical care of sedation in the ICU.

Therapy-related acute promyelocytic leukemia in plasma cell myeloma treated with melphalan: a case report and literature review

No abstract available.

Effects of a Combined Exercise Program Using an iPad for Older Adults / 대한의료정보학회지

OBJECTIVES: The purpose of this study was to examine the function, health status, and efficacy effects of a combined exercise program using an iPad among older women in Korea, a tech-savvy country. METHODS: The study employed a pretest and posttest experimental design with a control group. The experimental group of subjects comprised 16 female older adults and the control group comprised 10 who were aged 65 years or older. The experimental group participated in a supervised group-based exercise program and an individualized home-based exercise program that involved the use of an iPad. The combined group and home-based exercise program consisted of group exercise, which took place in a senior center for 30 minutes weekly, and a home-based iPad exercise program, which the subjects followed at least 3 times a week. The collected data were analyzed using the Statistical Analysis System (SAS ver. 9.3 TS Level 1M0) program, which utilized a chi-square test, a Fisher exact test, a t-test, and a repeated-measures ANOVA. RESULTS: The results showed that cognitive status changed significantly over time, and there was an interaction between group and time. Further, self-efficacy for exercise and outcome expectations for exercise changed significantly over time. CONCLUSIONS: Exercise programs using iPad interventions may be useful for the management of cognitive functioning and the integration of functional physical abilities in older adults.

Factors Related to Emergency Department Healthcare Providers' Attitudes towards End-of-Life Care / 한국호스피스완화의료학회지

PURPOSE: The purpose of this study was to determine the factors that influence healthcare providers' attitude towards end-of-life care (EOLC) in the emergency department (ED) in hospital settings. METHODS: From June 1 through June 30, 2014, a descriptive correlational study was performed with 41 doctors and 105 nurses stationed in the ED. RESULTS: According to a regression model on the factors affecting healthcare providers' professional attitude towards EOLC, 28.1% of variance (F=15.185, P=0.000) was explained by awareness of death, gender and personal attitude towards EOLC. And 34.1% of the healthcare providers' personal attitude was related with awareness of death, experience of hospice education, occupations and professional attitude towards EOLC. CONCLUSION: This study demonstrated that attitude towards EOLC was influenced by awareness of death and personal characteristics. Healthcare providers in the ED should be provided with tailored training to improve their understanding of death. Also an educational program should be developed and provided to ED healthcare providers to improve their awareness of death.

The Development of the Integrated Nursing Practicum Education Matrix based on Learning Outcomes / 한국간호교육학회지

PURPOSE: The purpose of this study was to develop an integrated nursing practicum education matrix based on the learning outcomes of each stage. METHODS: In this Delphi technique study, 10 experts, consisting of six professors and four nurses, participated in the development of the matrix. The first step was an in-depth review for the composition of the questionnaire and the second step was the Delphi technique. The Delphi survey was conducted two times in order to complete the components of the matrix. The survey data was analyzed for statistical averages and standard deviations to decide the order of priority. RESULTS: According to each stage (i.e. fundamental stage, competent stage, and proficient stage), the matrix was composed of education contents, methods, evaluation methods, and curriculum outcomes. CONCLUSION: The integrated nursing practicum education matrix of Y University was completed. The developed matrix will result in a reduction in the gap between nursing education and clinical practice and an improvement in nursing competency.

Relationship between Expectations Regarding Aging and Physical Activity among Middle Aged Adults in Urban Areas: Based on the Pender's Health Promotion Model

PURPOSE: The purpose of this study was to measure the level of expectations regarding aging (ERA) and identify relationship between ERA and physical activity of middle aged adults. METHODS: Participants were middle aged adults who resided in the community in three cities in Korea. Data were collected using questionnaires that contained items on individual characteristic, International Physical Activity Questionnaires (IPAQ), and behavior-specific cognitive factors including ERA-12. Hierarchical multiple regression was conducted to examine whether ERA would predict physical activity by controlling other factors. RESULTS: The mean age of the participants was 51.1+/-6.9 years. The mean score for ERA (possible range=0 to 100) was 40.04+/-14.31. More than half of the participants (62.6%) were not engaged in health promoting physical activity. Gender, employment status and exercise confidence were associated with level of physical activity (F=7.14, p<.001, R2=.36). After controlling for individual factors and behavior-specific cognitive factors, ERA was independently related to physical activity (F=7.19, p<.001, R2=.38). CONCLUSION: The results demonstrate that individuals' belief about aging has effects on physical activity in Korean middle aged adults. Thus, nursing interventions which focused on ERA could help enhance physical activity in middle aged adults.