The Influence of Health Status and Working Condition on the Absence of Adult Workers: Focusing on Gender Differences / 한국직업건강간호학회지

Purpose@#This descriptive correlation study was conducted to investigate factors affecting the absence of adult workers according to their gender. @*Methods@#Secondary data analysis was carried out using data from the fifth Korean Working Conditions Survey. Data on respondents’ demographic characteristics, working conditions, health status, and absence were analyzed; a descriptive analysis, x 2 -test, t-test, and logistic regression analysis were carried out. @*Results@#The factors that had the greatest impact on male workers' absence from work were service workers (2.74 times; B=.99), having more than 53 hours of work per week (1.17 times; B=.52), and when subjective health conditions were not satisfied (2.27 times; B=.82), whereas the factors that affected female workers' absence the most were a monthly income of 3 million won or more (2.74 times; B=1.34), a weekly work time of 53 hours (2.02 times; B=.71), and having a fewer number of sleep disorders (B=-.36). @*Conclusion@#This study suggests that not only the national interest should be considered in investigating the factors affecting absence but also the enterprise. Systematic support for the health care of workers is also needed.

Development of Reinforcement of Resilience and Relation Program for New Nurses / 임상간호연구

Purpose@#The purpose of this study was to develop a program for reinforcing the resilience of new nurses and relation-oriented organizational culture. @*Methods@#An Intervention Research (IR) model was used to develop a program. Literature review, focus group interviews with nurses and need surveys were conducted from August to December 2018. Based on the results of the investigation, the researcher developed the content of a program. The program was revised by nurse managers for the content validation. Results: According to the results of the need surveys, 58.8% of the participants thought relation-oriented culture was the most ideal, and 61.8% of the participants wanted to participate in a program for organizational culture improvement. In the focus group interview, not only new nurses but also wards and nursing organizations should be a target subject of the program. Reinforcement of resilience and relation (3R) program was developed as a one-year course, which includes a ‘mentor-mentee’ program and a ‘thanks’ program. Conclusion: It would contribute to improving the resilience of new nurses and creating a relation-oriented organizational culture by 3R program.The 3R program could play a role as expanded program from an existing pragmatic short-term training program for improving the competencies or communication skills of new nurses.

Deterioration of Sleep Quality According to Glycemic Status

Background@#Type 2 diabetes mellitus (T2DM) is a progressive disease with multiple complications. The present study aimed to determine the effects of glycemic status on sleep quality in individuals with T2DM, prediabetes, and normal glucose tolerance (NGT). @*Methods@#A total of 90 participants were categorized into three groups, T2DM (n=30), prediabetes (n=30), and NGT (n=30). @*Objective@#sleep quality was measured with the actigraph wrist-worn device over 3 nights and subjective sleep quality was evaluated with a questionnaire. @*Results@#The duration of diabetes in the T2DM group was 2.23 years and the glycosylated hemoglobin (HbA1c) levels in the T2DM, prediabetes, and NGT groups were 7.83%, 5.80%, and 5.31%, respectively. Sleep efficiency decreased across the T2DM, prediabetes, and NGT groups (86.25%, 87.99%, and 90.22%, respectively; P=0.047). Additionally, HbA1c levels revealed a significant negative correlation with sleep efficiency (r=–0.348, P=0.001). The sleep quality questionnaire results were similar among the three groups. @*Conclusion@#Although the participants in the present study were not necessarily conscious of their sleep disturbances, deterioration in sleep quality progressed according to glycemic status.

Validity and Reliability of the Korean Version of the Partners In Health Scale (PIH-K) / 중환자간호학회지

PURPOSE: The purpose of this study was to validate the Korean version of Partners In Health scale (PIH-K) which is used to measure the self-management of patients with chronic illnesses in Korea.METHODS: Translation of the 12-item PIH-K was conducted according to the World Health Organization guidelines. Data from 306 participants who took medicines over 3 months by doctor's prescription were collected from October to November 2017. Validity such as content validity, construct validity, and concurrent validity were conducted using content validity index (CVI), exploratory and confirmatory factor analyses (CFA). To evaluate concurrent validity, the correlation coefficients between the PIH-K and concurrent scales (Self-As-Carer Inventory) were calculated. The reliability of the PIH-K was examined using the internal consistency and test-retest reliability tests.RESULTS: The CVI of the PIH-K was 0.91. According to the CFA, factor loadings for four factors ranged from .64 to .97, which explained 67.5% of the total variance. The PIH-K was significantly correlated with concurrent variables such as those on the Self-As-Carer Inventory. The Cronbach's α was .86 and the intraclass correlation coefficient for the two-week test-retest reliability was .88.CONCLUSION: Findings show that the PIH-K is reliable and valid in measuring self-management of patients with chronic illnesses.

Effect of Team-based Learning using Reflection Journal on Pregnancy Nursing Course for Nursing Students

PURPOSE: To examine the applicability of a team-based learning using reflection journal in Women's Health Nursing for nursing students. METHODS: This study had a nonequivalent control group non-synchronized design. Participants were 140 third-year undergraduate nursing students who agreed to participate in this study. The experimental group (n=70) received twice team-based learning using reflection journal about pregnancy nursing course while the control group (n=70) received only team-based learning. Data were analyzed with descriptive statistics, χ2 test, Fisher's exact test, and independent t-test using SPSS 23.0 program. RESULTS: Compared to the control group, the experimental group reported significant positive changes in critical thinking (t=2.03, p=.044). Problem-solving, self-leadership, or academic self-efficacy of nursing college students was not significantly different between the two groups. CONCLUSION: Team-based learning using reflection journal is an effective teaching strategy to enhance critical thinking of nursing students.

Aprepitant prophylaxis effectively reduces preventing postoperative nausea and vomiting in patients receiving opioid based intravenous patient-controlled analgesia

BACKGROUND: Aprepitant is effective in prevention of chemotherapy-induced nausea and vomiting, when administrated with other antiemetics. We compared the effectiveness of aprepitant to ondansetron for prevention of post-operative nausea and vomiting (PONV) in patients who received a patient-controlled analgesia (PCA) containing opioids. METHODS: 198 patients were randomized into two groups. The treatment group was received an aprepitant, 80 mg, and the control group received a placebo. General anesthesia with inhalational anesthetics–N2O was performed, and PCA was supplied, which contained opioids-NSAIDs-ondansetron. The primary end-point was the incidence of PONV for postoperative 48 hours, and the secondary end-point was the changes in the relationship between PONV incidence and risk factors. RESULTS: PONV incidence in the treatment group was lower than in the control group (18.6% [95% CI: 10.8–26.3], 33.3% [95% CI: 23.6–43.1], respectively, P = 0.021). Relative risk of PONV in the control group was 1.80 (95% CI: 1.08–3.00, P = 0.010). PONV scores peaked at around postoperative 6 hours, then gradually decreased in the control group but not in the treatment group, which showed lower values than the control group (P = 0.001), and no changing patterns were observed (P < 0.001). Risk factors analyzed were sex, surgery type, history of motion sickness or PONV, and smoking habits. Their effects of all risk factors except sex were abolished in the treatment group. CONCLUSIONS: Prophylactic aprepitant with ondansetron was more effective than ondansetron-only regimen in preventing PONV after volatile anesthesia with opioid-containing PCA. Aprepitant abolished the effects of most of risk factors, so it could be efficacious in a high-risk PONV group.

Pulmonary Extraintestinal Manifestation of Crohn's Disease Treated Successfully with Adalimumab / 대한소화기학회지

Pulmonary extraintestinal manifestation is rare in Crohn's disease and has been reported in only a few cases. Despite the presence of pulmonary abnormalities in a significant proportion of patients with inflammatory bowel disease, there are only few case reports, due to complicated diagnosis and low recognition by clinicians. Currently, treatment guidelines for pulmonary Crohn's disease have not been established. There are some case reports of pulmonary Crohn's disease that achieved remission after infliximab treatment. Clinical and radiological remission of pulmonary extraintestinal involvement in Crohn's disease after adalimumab therapy has not been reported yet. Here, we report one case of lung involvement of Crohn's disease, which shows radiological and clinical remission after adalimumab treatment.

Validity Test of K-SKAGOAO for Korean Nursing Groups and the Relationship of Nursing Group Power and Job Satisfaction, Organizational Commitment, Organizational Performance / 임상간호연구

PURPOSE: The purpose of this study was to test validity and reliability of the Korean-Sieloff King Assessment of Group Outcome Attainment within organization in Korea (K-SKAGOAO), and also to explore the relationship of Korean nursing group power and job satisfaction, organizational commitment, organizational performance. METHODS: Participants were 481 nurse managers, nurse unit managers or staff nurses with over 7 years experience. Data were collected by post mail and analyzed using descriptive statistics, ANOVA, Kruskal-Wallis test, Tukey test, and Spearman's correlation. RESULTS: Content Validity Index was over .82 and Cronbach's α coefficient for the K-SKAGOAO was .97. The mean score for Korean nursing group power was 136.77 among the total participants, 139.89 among nurse managers, 136.74 among nurse unit managers and 132.47 among staff nurses. These results showed high nursing group power in Korea nursing organization in hospitals. There was also a significant difference according to nurse position (p=.003). Korean nursing group power was positively related to job satisfaction, organizational commitment, and organizational performance. CONCLUSION: Findings show that the K-SKAGOAO has validity and reliability. Nursing groups can use the K-SKAGOAO to evaluate the nursing group power of each nursing organization and to develop strategies to improve nursing power and nursing outcomes.

Effects of the Flipped Classroom Approach on the Psychiatric Nursing Practicum Course / 정신간호학회지

PURPOSE: In this study effects of a flipped learning-based psychiatric nursing practicum were evaluated for appropriateness with undergraduate nursing students who are digital natives and tech-savvy millennial students. METHODS: For this retrospective comparative study data from 146 undergraduate students (flipped learning group n=70, traditional learning group n=76) were evaluated for academic performance and life core competencies. RESULTS: There was no significant difference between the flipped and traditional learning groups in prior homogeneity tests. The academic performance of the flipped learning group was higher than the control group in all aspects, except for practical quiz scores. The flipped leaning group had significantly higher self-assessment scores for academic performance (t=2.77, p=.006) and therapeutic communication simulation scores (t=3.18, p=.002). In addition, they showed a significant increase in core life competencies after participating in the flipped-learning practicum (t=-8.56, p<.001). They showed significant increases in all subdomains except Identity-value [Socialization (t=-5.13, p<.001), Responsibility-practice (t=-3.52, p=.001), Problem-solving (t=-2.67, p=.010), Knowledge-construction (t=-2.48, p=.016), and Information-management (t=-5.54, p<.001)]. Nursing students in the flipped learning-based clinical practicum showed significant improvement in performance and life core competencies. CONCLUSION: These results suggest that as a student-centered pedagogy, flipped learning is an effective strategy for improving academic performance and core competencies.

Ultrasound-guided Continuous Axillary Brachial Plexus Block Using a Nerve Stimulating Catheter: EpiStim(R) Catheter

Brachial plexus block (BPB) under ultrasound guidance has come to be widely used. However, nerve injury has been reported following ultrasound-guided BPB. We hypothesized that BPB under ultrasound guidance in conjunction with real-time electrical nerve stimulation would help us prevent nerve injury and do more successful procedure. Here, we report the successful induction and maintenance of ultrasound-guided BPB and the achievement of good peri- and postoperative pain control using a conductive catheter, the EpiStim(R).

Annual Report on the External Quality Assessment Scheme for Blood Blank Tests in Korea (2014)

We report here the results of surveys on external quality assessment (EQA) of blood bank tests in Korea carried out in 2014. The proficiency testing specimens were prepared at Ajou University Hospital and the response rates for the 1st and 2nd trials were 94.3% (537/549) and 96.0% (545/554), respectively. No answers were considered incorrect, and the average accuracy rates of six different test items on the regular survey were as follows: ABO grouping, 98.5% to 100.0%; RhD typing, 98.1% to 99.4%; crossmatching, 91.2% to 99.6%; direct antiglobulin test (DAT) using a polyspecific reagent, 96.7% to 98.4%; DAT using an immunoglobulin-G monospecific reagent, 93.8% to 98.7%; DAT using a C3d monospecific reagent, 89.5% to 98.7%; unexpected antibody screening test, 96.2% to 100.0%; and antibody identification test, 69.8% to 100.0%. Test items for the pilot survey were reactivities to anti-A1 and anti-H, Rh subgrouping, and ABO antibody titration. Except for the result of the antibody identification test for specimens with multiple antibodies, we obtained excellent survey results for the EQA of blood bank tests carried out in 2014. In addition, the number of participating institutes was higher in 2014 than in 2013. The EQA of blood bank tests in 2014 should be helpful for improving the quality of the participating laboratories.

The relationship between perioperative nausea and vomiting and serum serotonin concentrations in patients undergoing cesarean section under epidural anesthesia / 대한마취과학회지

BACKGROUND: Serotonin-also known as 5-hydroxytryptamine or 5-HT-can induce nausea and vomiting (NV) by peripheral mechanisms via the activation of 5-HT3 receptors. In this study, we observed perioperative NV, including intraoperative NV, and changes in serum 5-HT concentrations. We evaluated the relationship between perioperative NV and serum 5-HT levels in patients undergoing cesarean section under epidural anesthesia, and carried out a pilot study to determine if further studies on a larger scale were justified. METHODS: Twenty-eight patients who were scheduled for cesarean section under epidural anesthesia were included in the study. Patients were assigned to 2 groups according to the occurrence of NV after induction, i.e., an NV-positive or an NV-negative group. Serum 5-HT concentrations were measured before induction, at the time that NV occurred (in the case of the NV-positive group) or 5 min after the umbilical cord clamping (in the case of the NV-negative group) during surgery, and at 2 h postoperatively. RESULTS: NV occurred in 10 of the 28 patients. No significant differences in serum 5-HT concentrations were found within or between the two groups. CONCLUSIONS: This study suggests that there is no correlation between serum 5-HT concentration and the occurrence of perioperative NV in patients undergoing cesarean section under epidural anesthesia, and the findings do not seem to support further investigations regarding a possible relationship between serum 5-HT concentration and perioperative NV.

Unexpected tracheal narrowing during general anesthesia in the prone position of Duchenne muscular dystrophy patient: A report of two cases / 대한마취과학회지

Unexpected tracheal narrowing was observed in a patient with Duchenne muscular dystrophy during a corrective operation for thoracolumbar scoliosis. As the operating time progressed, peak airway pressure and end-tidal CO2 increased gradually in the prone position. We found a floppy portion of the trachea using fiberoptic bronchoscopy (FB) in the prone position. We advanced a wire-reinforced tube toward the carina beyond the lesion. This allowed correction of the ventilatory abnormalities. We encountered another patient scheduled for the same operation. We performed FB in advance before the position change and observed a narrowed portion of trachea. We advanced the tracheal tube under FB beyond the pathologic portion and then moved the patient into the prone position. The operation was done successfully without any problems.

Metastatic thyroid C-cell carcinoma in a beagle dog / 대한수의학회지

An adult beagle dog was presented with a cervical mass detected by palpation and computed tomography. Fine needle aspirates revealed numerous epithelial cells with plasmacytoid appearance and frequent naked nuclei. Histologically, the mass consists of multiple packets of neoplastic cells and extensive areas of necrosis and fibrosis. Neoplastic cells were also found in submandibular lymph nodes. Immunohistochemistry showed that neoplastic cells were positive for calcitonin and negative for thyroglobulin. Based on these findings, the cervical mass was diagnosed as thyroid C-cell carcinoma. Almost one year after the surgical excision, the dog remains healthy without any symptom of recurrence or metastasis.

Repeat Vertebroplasty for the Subsequent Refracture of Procedured Vertebra

Vertebroplasty (VP) can effectively treat pain and immobility caused by vertebral compression fracture. Because of complications such as extravasation of bone cement (polymethylmethacrylate, PMMA) and adjacent vertebral fractures, some practitioners prefer to inject a small volume of PMMA. In that case, however, insufficient augmentation or a subsequent refracture of the treated vertebrae can occur. A 65-year-old woman visited our clinic complaining of unrelieved severe low back and bilateral flank pain even after she had undergone VP on the 1st and 4th (L1 and L4) lumbar vertebrae a month earlier. Radiologic findings showed the refracture of L1. We successfully performed the repeat VP by filling the vertebra with a sufficient volume of PMMA, and no complications occurred. The patient's pain and immobility resolved completely three days after the procedure and she remained symptom-free a month later. In conclusion, VP with small volume cement impaction may fail to relieve fracture-induced symptoms, and the refracture of an augmented vertebral body may occur. In this case, repeat VP can effectively resolve both the persistent symptoms and problems of new onset resulting from refracture of the augmented vertebral body due to insufficient volume of bone cement.

Comparison of Indomethacin, Diclofenac and Aspirin-Induced Gastric Damage according to Age in Rats

BACKGROUND/AIMS: Aging gastric mucosa is known to have decreased mucosal defenses and increased susceptibility to injury by nonsteroidal anti-inflammatory drugs. Depending on the type of nonsteroidal anti-inflammatory drug (NSAID), the underlying mechanisms and the extent of damage to the stomach or intestine may differ. This study was performed to evaluate the acute gastric damage caused by different doses of indomethacin, diclofenac and aspirin in rats of various ages. METHODS: For the acute models, indomethacin (10, 20 or 40 mg/kg), diclofenac (40 or 80 mg/kg) or aspirin (100 mg/kg) was given to 7- and 25-week-old and 1-year-old Sprague-Dawley rats by intragastric gavage. The gross ulcer index, damage area as assessed by imaging, histological index, myeloperoxidase (MPO) activity, and cytosolic phospholipase A2 (cPLA2) levels were measured after 24 hours. RESULTS: The gross ulcer index and damage area increased with age in the presence of three NSAIDs (p<0.05). The increases in MPO levels induced by diclofenac and aspirin were significantly higher in 1-year-old than 7-week-old rats (p<0.05). cPLA2 expression induced by indomethacin (10 and 40 mg/kg) was greater in the 1-year-old rats, compared with 7-week-old rats (p<0.05). CONCLUSIONS: NSAID-induced acute gastric damage increased in a dose- and age-dependent manner.

Fiberoptic intubation through a laryngeal mask airway as a management of difficult airwary due to the fusion of the entire cervical spine: A report of two cases / 대한마취과학회지

Patients with cervical spine instability and limited range of motion are challenge to anesthesiologists. It is important to consider alternatetive methods for securing the airway while maintaining neutral position and minimizing neck motion, because these patients are at increased risk for tracheal intubation failure and neurologic injury during airway management or position change. We experienced two cases that patients had cervical spine instability and severe limited range of motion due to the fusion of the entire cervical spine. One patient was a 6-year-old girl weighing 12.7 kg and had Klippel-Feil syndrome with Arnold-Chiari malformation, the other was a 24-year-old female weighing 31 kg and had juvenile rheumatoid arthritis. We successfully performed the intubation by using the fiberoptic intubation though a laryngeal mask airway in these two cases.

Effect of continuous psoas compartment block and intravenous patient controlled analgesia on postoperative pain control after total knee arthroplasty / 대한마취과학회지

BACKGROUND: Total knee arthroplasty (TKA) generates severe postoperative pain in 60% of patients and moderate pain in 30% of patients. Because inadequate postoperative pain control can hinder early physiotherapy and rehabilitation, it is the most influential factor dictating a good outcome. The purpose of this study was to evaluate the effectiveness of continuous psoas compartment block (PCB) in comparison to intravenous patient-controlled analgesia (IVPCA) in TKA patients. METHODS: 40 TKA patients were randomly divided into 2 groups. Group IVPCA (n = 20) received intravenous patient controlled analgesia (IVPCA) for 48 hours. Group PCB (n = 20) received continuous PCB for 48 hours at the fourth intertransverse process of the lumbar using the C-arm. Pain scores, side effects, satisfaction, the length of hospital stay, rescue antiemetics, and analgesics were recorded. RESULTS: Pain scores (VNRS 0-100) were higher in Group IVPCA than in Group PCB. Nausea and sedation occurred more frequently in Group IVPCA than in Group PCB. There were no differences between the groups in the length of the hospital stay, satisfaction scores, and the use of rescue antiemetics and analgesics. CONCLUSIONS: Continuous PCB seemed to be an appropriate and reliable technique for TKA patients, because it provided better analgesia and fewer side effects such as nausea and sedation when compared to IVPCA.

Medication Status and Adherence of the Elderly under Home Care Nursing

PURPOSE: This study is a descriptive research intended to clarify the medication status of community-dwelling elders and to identify factors affecting their medication adherence. METHODS: Data were collected using questionnaires and interviews from 101 subjects who had taken prescribed drugs for at least 7 days sampled among elderly people using home care nursing at a general hospital in Seoul. RESULTS: According to the results of this study, medication adherence measured by pill counting was 88.3% and that measured by self-reporting was 94.6%. There were statistically significant differences in medication adherence according to major disease (p=.006), the number of admissions (p=.032), the number of drugs (p=.051), the frequency of medication (p=.026), and depression (r=-.205). In addition, depression was found to be a significant variable explaining the medication adherence with explanatory power 3.8% (p=.035). CONCLUSION: The presence of depression affected the elderly subjects' the medication adherence. Therefore, more concern and educational approaches are required to encourage elderly people to comply correctly with medication regimens particularly for elderly patients who have a malignant or long-lasting disease or who have to take multiple drugs or maintain a daily dosing frequency.

The effect and optimal dose of sufentanil in reducing injection pain of microemulsion propofol / 대한마취과학회지

BACKGROUND: Propofol is used as an induction and maintenance agent for general anesthesia but it can cause adverse reactions like hyperlipidemia, growth of microorganisms, and pulmonary embolisms. Microemulsion propofol was developed to avoid these side effects but incidence and severity of pain on injection is higher than with lipid emulsion propofol. We aimed to compare the effects of sufentanil in analgesic doses for reducing the injection pain of microemulsion propofol. METHODS: The candidates included eighty patients, 19-60 years old and ASA I-II. They were randomly classified into four groups and pretreated with normal saline, sufentanil 0.1 microg/kg, 0.2 microg/kg or 0.3 microg/kg before injection of microemulsion propofol. Five minutes after receiving pretreatment drug, 2 mg/kg of microemulsion propofol was injected and VAS was recorded. RESULTS: There were no significant differences in the incidence of injection pain among the groups. Severity of injection pain was significantly lower in the sufentanil 0.3 microg/kg group than normal saline and sufentanil 0.1 microg/kg group. Significant differences in blood pressure and heart rate were observed in sufentanil groups only after endotracheal intubation. One patient each in sufentanil 0.1 microg/kg and 0.3 microg/kg group experienced mild cough, one from sufentanil 0.3 microg/kg group experienced dizziness and another showed signs of hypoxia. One patient each in normal saline and sufentanil 0.1 microg/kg group showed clinical symptoms of phlebitis in the injection area. CONCLUSIONS: Pretreatment with sufentanil 0.3 microg/kg reduced the severity of microemulsion propofol injection pain without increasing arterial blood pressure and heart rate after endotracheal intubation.