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Background@#Proper nasal tip projection and rotation are essential for an aesthetically pleasing nose. However, East Asians usually have thicker skin and underdeveloped nasal cartilage compared to Caucasians. Thus, techniques such as the septal extension graft, columellar strut graft, and L-shaped alloplastic implants have been introduced for additional nasal tip support and projection. However, no consensus exists regarding the optimal method. @*Methods@#A hybrid columellar strut made of an osteochondral graft recombined with the nasal crest of the maxilla and conchal cartilage was devised. In a cadaveric study, changes due to an external bending force of the hybrid strut and costal cartilage in the same dimension were measured. In a comparative study, we divided 20 subjects into two groups according to the material used for the columellar strut graft: a hybrid columellar strut (experimental group) and a double-layered conchal columellar strut (control group). Preoperative, 1-month postoperative, and 1-year postoperative anthropometric measurements were compared between groups. @*Results@#In the cadaveric study, the hybrid columellar strut showed superior mechanical strength. In the comparative study, the average 1-year postoperative change of the columellar labial angle was significantly smaller in the experimental group (–0.7°±1.16° vs. 2.2°±1.32°, P=0.015). The hybrid columellar strut showed superior postoperative nasal tip stability. @*Conclusions@#We devised a new hybrid columellar strut and confirmed its superior mechanical firmness and stability. Considering the suggested indications and contraindications, the hybrid columellar strut graft can be a new modality for tip plasty in East Asian rhinoplasty that can provide sufficient long-term nasal tip stability.
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Skin avulsions are severe traumatic injuries, in which sections of skin and subcutaneous tissue are torn off from the body, and the surgical management and salvage of these injuries are quite challenging due to their high morbidity and mortality. The entire or partial loss of an avulsed flap is prone to occur. If this happens, scars can be particularly conspicuous, and additional surgery, such as skin grafts or local flaps or even composite grafts, might be required. A 24-year-old male patient presented to the emergency room with a severe traumatic avulsion injury on his nose. We used a combination of three therapies to minimize the loss of the distal portion of the avulsed flap: polydeoxyribonucleotide injection, continuous non-rebreather mask oxygen therapy, and chemical leeching. We achieved complete flap salvage of the avulsed wound, and the patient showed full satisfaction in both aesthetic and functional aspects. Although this report is confined to a single case of severe avulsed injury, we suggest this triple-combination therapy as a good combined modality for maximizing the salvage of an avulsed flap on the basis of this case and a literature review.
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The coronavirus disease 2019 (COVID-19) has been a major public health emergency worldwide. Vaccines were rapidly developed and approved to prevent the spread of viral infection. However, various side effects of the COVID-19 messenger RNA (mRNA) vaccines have been reported after their commercialization. A 24-year-old man visited our emergency department with polyuria and polydipsia that occurred after he received a COVID-19 mRNA vaccine 10 days beforehand. The initial laboratory findings showed very low urine osmolality with hyperosmolar hypernatremia. Based on these findings, diabetes insipidus was suspected, and sella magnetic resonance imaging showed an enlarged pituitary gland and the absence of posterior pituitary higher intensity. After 12 hours of using oral desmopressin acetate, urine volume decreased, and after 5 days of administration, serum electrolyte and serum osmolality improved. This case report of diabetes insipidus occurring after vaccination with the BNT162b2 mRNA COVID-19 vaccine is presented as a reminder that close monitoring is necessary for patients with polyuria and polydipsia after vaccination.
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Purpose@#This study aimed to investigate the nationwide intention to delegate clinical practice of medical specialists in accordance with the enactment of the scope of practice for advanced practice nurses (APNs). @*Methods@#Data were collected from October to December 2021 using Google Surveys. In total, 147 medical specialists from 12 provinces responded to the survey. The survey questionnaire was categorized into four legislative draft duties, according to the scope of practice (a total of 41 tasks): Twenty-nine tasks on treatments, injects, etc., performed under the guidance of a physician and other activities necessary for medical treatment (treatment domain); two tasks on collaboration and coordination; six tasks on education, counseling, and quality improvement; four regarding other necessary tasks. Participants were asked whether they were willing to delegate the tasks to APN. @*Results@#The intention to delegate tasks to APN was higher for non-invasive tasks such as blood sampling (97.3%) or simple dressing (96.6%). Invasive tasks such as endotracheal tube insertion (10.2%), sampling: bone marrow biopsy & aspiration (23.8%) showed low intention to delegate in the treatment domain. Participants who were older, male, and had more work careers with APN, showed a higher intention to delegate tasks. @*Conclusion@#To prevent confusion in the clinical setting, a clear agreement on the scope of APN practice as APN delegated by physicians should be established. Based on this study, legal practices that APN can perform legally should be established.
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Purpose@#: The purpose of this study was to identify the mediating effect of role clarity in the relationship between clinical decision-making abilities and job stress among advanced practice nurses at tertiary hospitals. @*Methods@#: The participants were 137 advanced practice nurses. The assessment tools were clinical decisionmaking in nursing scale, role ambiguity scale, and Korean occupational stress scale (KOSS-26). Data were analyzed with the SPSS/24.0 program and mediation analysis was performed according to the Baron and Kenny methods. @*Results@#: There were significant relationships between clinical decision-making abilities and job stress (r=-.33, p<.001), and role clarity and job stress (r=-.29, p=.001). Role clarity showed partial mediating effects in the relationship between clinical decision-making abilities and job stress (Z=2.02, p=.043). @*Conclusion@#: Therefore, to reduce advanced practice nurses’ job stress, it is necessary to develop a program and strategies to increase their clinical decision-making abilities.
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Purpose@#This study aimed to identify the relationships among disease severity, anxiety, depression, social support, unpleasant symptoms and self-care among patients with atrial fibrillation based on the unpleasant symptom theory, and to examine the mediating effects of unpleasant symptoms. @*Methods@#A cross-sectional study was conducted. The participants were 216 patients with atrial fibrillation who were being followed up on an outpatient basis at a university hospital in Seoul. Data were collected from November 1, 2020 to June 30, 2021, using self-report questionnaires. Data were analyzed using IBM SPSS/WIN 27.0 and PROCESS macro with 95% bias-corrected bootstrap confidence interval(CI). @*Results@#The average age of participants in this study was 66.0years. Disease severity (β=10.19,p<.001) and depression (β=1.53, p<.001) had significant positive relationships with unpleasant symptoms. Also, unpleasant symptoms (β=-0.03, p=.006) had a negative relationship with physical activity, which is a subscale of self- care. Social support (β=0.06, p<.001) was positively related with physical activity. Unpleasant symptoms showed a mediation effect in the relationship between disease severity and physical activity (Bias corrected bootstrap CI -0.65, -0.04). Depression had an indirect effect on physical activity that was mediated by unpleasant symptoms (Bias corrected bootstrap CI -0.11, -0.00). @*Conclusion@#The findings of this study suggest that integrated strategies including physical, psychological, and social factors should be considered to promote self-care in patients with atrial fibrillation.
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Background@#Subclinical left ventricular diastolic dysfunction (LVDD) is an emerging consequence of increased insulin resistance, and dyslipidemia is one of the few correctable risk factors of LVDD. This study evaluated the role of mean and visit-to-visit variability of lipid measurements in risk of LVDD in a healthy population. @*Methods@#This was a 3.7-year (interquartile range, 2.1 to 4.9) longitudinal cohort study including 2,817 adults (median age 55 years) with left ventricular ejection fraction >50% who underwent an annual or biannual health screening between January 2008 and July 2016. The mean, standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average real variability of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein B (apoB), non-HDL-C, and triglycerides were obtained from three to six measurements during the 5 years preceding the first echocardiogram. @*Results@#Among the 2,817 patients, 560 (19.9%) developed LVDD. The mean of no component of lipid measurements was associated with risk of LVDD. CV (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.10 to 1.67), SD (HR, 1.27; 95% CI, 1.03 to 1.57), and VIM (HR, 1.26; 95% CI, 1.03 to 1.55) of LDL-C and all the variability parameters of apoB were significantly associated with development of LVDD. The association between CV-LDL and risk of LVDD did not have significant interaction with sex, increasing/decreasing trend at baseline, or use of stain and/or lipid-modifying agents. @*Conclusion@#The variability of LDL-C and apoB, rather than their mean, was associated with risk for LVDD.
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Background@#The purpose of this study is to investigate the effect of liquefied digestive medicines on the composite resin surface. @*Methods@#Three types of liquefied digestive medicines (Gashwalmyeongsu, Wicheongsu, and Saengrokcheon) were selected as experimental groups, Samdasoo and Chamisul as negative controls, and Trevi as positive controls were selected to measure pH and titratable acidity. The samples filled with resin at acrylic were made total 300, 50 per group. To evaluate the erosion risk of the composite resin, the specimens were immersed in a liquefied medicine for 1, 3, 5, 15, and 30 minutes, and then the surface microhardness was measured using the Vickers Hardness Number, and the surface change was observed with scanning electron microscope (SEM). @*Results@#The average pH of the three liquefied medicine was 3.75±0.30, the Saengrokcheon was the lowest at 3.45±0.01, and the Trevi was 4.66 and Samdasoo and Chamisul were 7.40 and 8.58, respectively. The amount of NaOH reaching pH 5.5 and 7.0 was the lowest in the order of Trevi, Gashwalmyeongsu, Wicheongsu, and Saengrokcheon. The largest surface hardness reduction value was shown in Gashwalmyeongsu (−11.85±3.73), followed by Saengrokcheon (−9.79±3.11) and Wicheongsu (−8.28±2.83), and Samdasoo (−0.84±1.56) and Chamisul (−6.24±0.42) had relatively low surface hardness reduction values. However, Trevi (−16.67±5.41), a positive control group containing carbonic acid, showed a higher decrease in surface hardness than the experimental group. As a result of observation with SEM, experimental group and positive control group, showed rough surfaces and irregular cracks, and negative control groups showed smooth patterns similar to before immersion. @*Conclusion@#The liquefied digestive medicine with low pH could weaken the composite resin surface, and the carbonic acid component could more effect on the physical properties of the composite resin than pH.
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Purpose@#The aim of this study was to investigate the intensity of physical activity predicting afterward childbirth for infertile women in order to improve the development of an infertility support. @*Methods@#The complete enumeration data of the National Health Insurance Service of Korea for women who had been diagnosed with infertility in 2016 were analyzed to investigate the predictors of childbirth in 2016–2017. The data were analyzed using descriptive statistics and linear regression with SPSS. @*Results@#When age and body mass index were controlled for, intermediate intense physical activity increased the rate of childbirth, but low or heavy intensity did not. @*Conclusion@#Women who have been diagnosed with infertility should be given advice to engage in intermediate levels of physical activity in order to increase their chances of having a child.
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Purpose@#: The purpose of this study was to understand and describe the experiences of the advanced nurse practitioner (APN) system used by healthcare providers including APNs, doctors who worked with APNs, and APN master’s course professors at a graduate school. @*Methods@#: Qualitative data were collected via snowball sampling. The participants were nine APNs, six doctors, and three professors. They were divided into three focus groups, each of which consisted of all three types of healthcare providers. Data were collected via interviews with the three focus groups conducted from September to October 2019. All interviews were audiotaped and transcribed verbatim. The transcribed data then underwent qualitative content analysis. @*Results@#: Based on the data, we extracted four themes and 14 categories. The themes were “Role and system of APNs started according to healthcare environment changes”, “Optimal healthcare provider to ensure quality of care”, “Confused role and system of APNs due to incomplete medical law”, and “Tasks for the stable operation of the APN system.” @*Conclusion@#: For quality treatment and safety of patients, a legal basis must be established for the APN system. For its stable operation, social consensus regarding legislation about APNs’ scope of practice is required. Finally, a discussion is necessary about the integration of APNs’ 13 fields.
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Purpose@#The purpose of this study was to develop a video education program (VEP) for the caregivers and to verify its effectiveness on the maintenance of a peripheral intravenous catheter (PIVC) among hospitalized children. @*Methods@#The VEP was developed through a literature review, educational need assessment of caregivers, and interviews with pediatric nurses, and validation of an expert group. The effectiveness of the VEP was tested on 102 caregivers and their children in a children’s hospital at D city. A nonequivalent control group pretest-posttest design was used in which different types of intervention were given to caregivers in intervention group (n=51) and control group (n=51). All caregivers received brief verbal information about the PIVC maintenance. The intervention group was additionally provided with VEP using a smartphone. Data were analyzed using SPSS/Win 21.0 program. @*Results@#The caregivers’ knowledge score on PIVC maintenance in the intervention group was significantly higher than that of the control group. The numbers of flushing in case of blockage of PIVC and gauze dressing change of the intervention group was significantly lower than those of the control group. @*Conclusion@#These results suggest that the VEP developed in this study can be useful for the maintenance of PIVC among hospitalized children.
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Purpose@#The aim of this study was to investigate the intensity of physical activity predicting afterward childbirth for infertile women in order to improve the development of an infertility support. @*Methods@#The complete enumeration data of the National Health Insurance Service of Korea for women who had been diagnosed with infertility in 2016 were analyzed to investigate the predictors of childbirth in 2016–2017. The data were analyzed using descriptive statistics and linear regression with SPSS. @*Results@#When age and body mass index were controlled for, intermediate intense physical activity increased the rate of childbirth, but low or heavy intensity did not. @*Conclusion@#Women who have been diagnosed with infertility should be given advice to engage in intermediate levels of physical activity in order to increase their chances of having a child.
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Purpose@#: The purpose of this study was to understand and describe the experiences of the advanced nurse practitioner (APN) system used by healthcare providers including APNs, doctors who worked with APNs, and APN master’s course professors at a graduate school. @*Methods@#: Qualitative data were collected via snowball sampling. The participants were nine APNs, six doctors, and three professors. They were divided into three focus groups, each of which consisted of all three types of healthcare providers. Data were collected via interviews with the three focus groups conducted from September to October 2019. All interviews were audiotaped and transcribed verbatim. The transcribed data then underwent qualitative content analysis. @*Results@#: Based on the data, we extracted four themes and 14 categories. The themes were “Role and system of APNs started according to healthcare environment changes”, “Optimal healthcare provider to ensure quality of care”, “Confused role and system of APNs due to incomplete medical law”, and “Tasks for the stable operation of the APN system.” @*Conclusion@#: For quality treatment and safety of patients, a legal basis must be established for the APN system. For its stable operation, social consensus regarding legislation about APNs’ scope of practice is required. Finally, a discussion is necessary about the integration of APNs’ 13 fields.
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Purpose@#The purpose of this study was to develop a video education program (VEP) for the caregivers and to verify its effectiveness on the maintenance of a peripheral intravenous catheter (PIVC) among hospitalized children. @*Methods@#The VEP was developed through a literature review, educational need assessment of caregivers, and interviews with pediatric nurses, and validation of an expert group. The effectiveness of the VEP was tested on 102 caregivers and their children in a children’s hospital at D city. A nonequivalent control group pretest-posttest design was used in which different types of intervention were given to caregivers in intervention group (n=51) and control group (n=51). All caregivers received brief verbal information about the PIVC maintenance. The intervention group was additionally provided with VEP using a smartphone. Data were analyzed using SPSS/Win 21.0 program. @*Results@#The caregivers’ knowledge score on PIVC maintenance in the intervention group was significantly higher than that of the control group. The numbers of flushing in case of blockage of PIVC and gauze dressing change of the intervention group was significantly lower than those of the control group. @*Conclusion@#These results suggest that the VEP developed in this study can be useful for the maintenance of PIVC among hospitalized children.
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Background@#Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted primarily through droplets, and dental practitioners are at risk of occupational exposure to SARS-CoV-2 infection owing to direct contact with the patient’s mouth, aerosols from dental procedures, and saliva. Wearing a mask is believed to be the best method of protection against infection, and a systematic literature review was conducted on whether the dental masks used in dentistry are effective in preventing Coronavirus Infectious Disease-19 (COVID-19). @*Methods@#We used PubMed, Google Scholar, DBpia, NDSL, and KISS databases for this study. Of the 917 documents narrowed down by the search terms “Coronavirus, COVID-19, and dental,” 83 documents were collected and studied. Ultimately, 42 of these papers were selected for analysis after considering duplication from the flow chart of the literature selection process. @*Results@#While dental masks are often used when treating patients with unknown COVID-19 status, the Ministry of Food and Drug Safety stated that the use of dental masks is insufficient in preventing cross-transmission of COVID-19; instead, it was recommended that N95 masks, which correspond to KF94 masks, should be worn daily. On the other hand, wearing a dental mask and following precautions such as hand hygiene may not pose a significantly higher risk of infection than wearing an N95 mask when treating COVID-19 patients. @*Conclusion@#There is an ongoing discussion regarding the use of dental masks when treating dental patients, and many argue that different types of masks should be selected according to the degree of infection and the individual's respiratory condition. By considering the safety and efficacy of dental masks in preventing infection, improvements can be made in the management of COVID-19 and dental-related infections.
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Background@#s: This study was performed to analyze the main key words of newspaper articles related to COVID-19 in 2020 for each category of quarantine measures according to the epidemic period of COVID-19. @*Methods@#We analyzed articles related to COVID-19 in three major newspapers of Korea between February 17 and December 31, 2020. We targeted the front page articles on mondays and thursdays. The analysis of the relationship between the two variables was confirmed through the chi-square test. @*Results@#As a result of analyzing the main key words for each category of quarantine measures, non-pharmaceutical intervention were the most common at 54.3%, followed by 3Ts(test, tracing, treatment and vaccine) at 31.9%. In the category of non-pharmaceutical intervention, social distancing was the most common at 33.9%. In the categories such as 3Ts(test, tracing, treatment) and vaccine, diagnostic tests were the most common at 41.8%. @*Conclusions@#It was identified that non-pharmaceutical intervention were the most common, and there was a difference in the reporting of main key words by category of quarantine measures for each epidemic period related to COVID-19 in 2020.
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The present study attempts to study alcohol metabolizing and antioxidant properties of Gynostemma pentaphyllum(Thunb.) Makino distillate (GPD) and combination effects with Hovenia dulcis Thunb. extract (HDE) on these activities.The alcohol-metabolizing activity of GPD with/without HDE was determined by assessing alcohol dehydrogenase(ADH) and acetaldehyde dehydrogenase (ALDH) activities. To define the effect of GPD with/without HDE on alcoholmetabolism, antioxidant activities and total phenolic content of GPD with/without HD extract were evaluated using2-diphenyl-1-picrylhydrazyl free radical scavenging, ferrous chelating assays, and the Folin–Ciocalteu method.Cytotoxicity against human normal liver CHANG cells was also evaluated using the 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. GPD treatment alone or in combination with HDE significantly increased ADHand ALDH activities; combined treatment was most effective. Total phenolic and flavonoid contents were greater incombination than the level found in GPD alone. GPD revealed a synergistic antioxidant effect when combined withHDE. GPD and/or HDE had no antiproliferative activity against the normal liver cell line. These results suggest thatGPD-HDE combination is the possible natural resource for the management of alcohol-induced liver injury.
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PURPOSE: This study was done to investigate the relationships between nursing work environment, leader-member exchange(LMX), peer support, and organizational commitment in one city with a severe nurse shortage. METHODS: Participants were 198 nurses who had worked for more than 6 months with the same head nurse. They worked in five general hospitals located in one city. In April 2016 participants completed a survey questionnaire about their nursing work environment, LMX, peer support, and organizational commitment. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and multiple regression. RESULTS: There was a significant difference in nursing work environment by experience of turnover (t=−2.58, p=.010). LMX showed significant difference by department (F=3.81, p=.011). Factors influencing nurses' organizational commitment were nurse participation in hospital affairs (β=.23, p=.028) and nurse manager ability, leadership and support (β=.18, p=.022). Explanatory power was 18.2% in the regression model. CONCLUSION: The results suggest that it is necessary to improve the nursing work environment in order to increase organizational commitment. Improvement of the nursing system should be considered along with supplementation of nurses particularly during a severe nurse shortage.
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Humans , Hospitals, General , Leadership , Nurse Administrators , Nursing , Nursing, Supervisory , Peer InfluenceABSTRACT
PURPOSE: The purpose of this study was to determine whether poor preoperative nutritional status in elderly patients exhibited a negative influence on postoperative clinical outcomes.METHODS: The medical records of 645 elderly patients were examined retrospectively. The patients had undergone major surgery between January 2017 and January 2018. Their nutritional status was measured using the Nutritional Risk Screening 2002. The data were analyzed using the chi-squared test, the Mann-Whitney U test, logistic regression, linear regression, Cox proportional hazards regression, and the Kaplan-Meier analysis.RESULTS: Preoperative malnutrition was found in 73 patients (11.3%). Poor preoperative nutritional status was significantly associated with pressure ulcers, length of hospitalization, discharge to patient care facilities rather than home, and mortality rate at three months.CONCLUSION: Preoperative malnutrition in elderly patients was associated with negative postoperative clinical outcomes. These results indicate that an effective nutritional program before surgery can lead to a more rapid postoperative recovery.
Subject(s)
Aged , Humans , Hospitalization , Kaplan-Meier Estimate , Linear Models , Logistic Models , Malnutrition , Mass Screening , Medical Records , Mortality , Nutritional Status , Patient Care , Postoperative Complications , Pressure Ulcer , Retrospective StudiesABSTRACT
Hyper-O-GlcNAcylation is a general feature of cancer which contributes to various cancer phenotypes, including cell proliferation and cell growth. Quercetin, a naturally occurring dietary flavonoid, has been reported to reduce the proliferation and growth of cancer. Several reports of the anticancer effect of quercetin have been published, but there is no study regarding its effect on O-GlcNAcylation. The aim of this study was to investigate the anticancer effect of quercetin on HeLa cells and compare this with its effect on HaCaT cells. Cell viability and cell death were determined by MTT and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labelling assays. O-GlcNAcylation of AMP-activated protein kinase (AMPK) was examined by succinylated wheat germ agglutinin pulldown and immunoprecipitation. Immunofluorescence staining was used to detect the immunoreactivitiy of O-linked N-acetylglucosamine transferase (OGT) and sterol regulatory element binding protein 1 (SREBP-1). Quercetin decreased cell proliferation and induced cell death, but its effect on HaCaT cells was lower than that on HeLa cells. O-GlcNAcylation level was higher in HeLa cells than in HaCaT cells. Quercetin decreased the expression of global O-GlcNAcylation and increased AMPK activation by reducing the O-GlcNAcylation of AMPK. AMPK activation due to reduced O-GlcNAcylation of AMPK was confirmed by treatment with 6-diazo-5-oxo-L-norleucine. Our results also demonstrated that quercetin regulated SREBP-1 and its transcriptional targets. Furthermore, immunofluorescence staining showed that quercetin treatment decreased the immunoreactivities of OGT and SREBP-1 in HeLa cells. Our findings demonstrate that quercetin exhibited its anticancer effect by decreasing the O-GlcNAcylation of AMPK. Further studies are needed to explore how quercetin regulates O-GlcNAcylation in cancer.