Neutrophil-to-Lymphocyte Ratio at Emergency Room Predicts Mechanical Complications of ST-segment Elevation Myocardial Infarction

Background@#The neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI). @*Methods@#A total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization. @*Results@#Patients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI (P = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136–3.339, P= 0.015) along with symptom-to balloon time (P = 0.002) and left ventricular dysfunction (P < 0.001). @*Conclusion@#NLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.

Neutrophil-to-Lymphocyte Ratio at Emergency Room Predicts Mechanical Complications of ST-segment Elevation Myocardial Infarction

Background@#The neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI). @*Methods@#A total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization. @*Results@#Patients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI (P = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136–3.339, P= 0.015) along with symptom-to balloon time (P = 0.002) and left ventricular dysfunction (P < 0.001). @*Conclusion@#NLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.

Influences of Critical Thinking Disposition, Nurse Managers’ Transformation and Transactional Leadership Style on Nurses’ Competency with Evidence Based Practice / 간호행정학회지

Purpose@#This study was conducted to identify the influences of critical thinking disposition and perceived nurse managers' leadership style on nurses' competency with evidence based practice in hospitals. @*Methods@#The participants were 147 nurses working in two university hospitals in Seoul, Korea. Data were collected during February and March in 2017 and were analyzed with Multiple Regression Analysis using SPSS/WIN 18.0. @*Results@#The most influential factor on nurses' competency of evidence based practice was critical thinking disposition (β=.55, p<.001), followed by transformation (β=.20, p=.011) which together explained their competency of evidence based practice up to 53.0%. @*Conclusion@#It is necessary to develop intervention programs and curriculum to enhance competence for nurses. It is also necessary to draw plans to develop nursing managers’ transformational leadership. Therefore not only clinical nurses but also throughout the organization, strategies and curriculums should be developed to help nurses perform evidence based practice.

A Study the Relationships among Verbal Violence Experience, Job Stress, and Resilience and the Communication Ability of Operating Room Nurses / 간호행정학회지

Purpose@#This study was done to provide basic data for nursing intervention to increase communication ability of operating room nurses by identifying the relation among their verbal violence experience, job stress, resilience, and communication ability. @*Methods@#The participants were 136 nurses, working in the operating rooms of six academic and general hospitals located in Seoul and Gyeonggi-Do. Data were collected from May 1st through October 31st, 2016. Collected data were analyzed for frequency and percentage, mean and standard deviation, association among related factors, and stepwise multi-regression using the SPSS 21.0 program. @*Results@#It was found that the strongest factor influencing the communication ability of operating room nurses was persistence (β=.41, p <.001; sub-item of Resilience), followed by support (β=.26, p =.001; sub-item of Resilience). These two sub-items have positive influences on communication ability of operating room nurses. The lack of professional knowledge and skill (β=-.19, p <.001; sub-item of job stress) and verbal violence experience from nurse (β=-.16, p <.001; sub-item of verbal violence experience) have negative influences on communication ability of operating room nurses. These sub-items explained 47.0% of communication ability of operating room nurses. @*Conclusion@#The study results can be used as basic data to develop effective communication. Also, the results show the necessity of developing and applying concrete nursing interventions to improve job satisfaction of operating room nurses.

Comparison of Standard and Specialized Readings in Routine Practice for the Assessment of Extraprostatic Extension of Prostate Cancer on MRI after Biopsy

Purpose@#To retrospectively determine whether specialized magnetic resonance imaging (MRI) reading performed by an experienced radiologist affected the successful assessment of extraprostatic extension (EPE) in the presence of biopsyrelated hemorrhage after prostate biopsy. @*Materials and Methods@#Two hundred consecutive patients with biopsy-proven prostate cancer underwent MRI. General radiologist and subspecialized radiologist readings were unpaired and reviewed in random order by a radiologist who was blinded to patients’ clinical details and histopathologic data. The extent of hemorrhage was assessed on T1-weighted (T1W) MRI using a 1-4 scale, and the likelihood of EPE was assessed for each of the four categories. Histopathologic specimens served as the reference standard. The area under the curve (AUC) of the standard reading was compared to that of the specialized reading. @*Results@#Post-biopsy hemorrhage was subjectively graded as ≥ 3 in 101 patients (50.5%) by standard reading, and in 100 patients (50.0%) by specialized reading.The standard and specialized readings disagreed for 40 (20.7%) of the patients (kappa [κ] = 0.35; 95% CI, 0.14-0.48). Of these, specialized reading was the correct interpretation for 21 patients (52.5%). The sensitivity (75% vs. 44%; P = 0.002) and area under the receiver operating characteristics (AUROC) (0.83 vs. 0.67; P = 0.008) of the specialized readings were significantly higher than those of the standard readings, while there was no significant difference in specificity (84% vs. 87%; P = 0.434). @*Conclusion@#The reinterpretation of MRI by experienced radiologists significantly improves the diagnosis of EPE in prostate cancer in the presence of post-biopsy hemorrhage.

The relationship between J wave and ventricular tachycardia during Takotsubo cardiomyopathy

Background and objectives@#Takotsubo cardiomyopathy (TTC) occasionally causes life-threatening ventricular arrhythmia. J wave on surface electrocardiography (sECG) has also been associated with idiopathic ventricular fibrillation and cardiac events; therefore, we investigated whether the presence of J wave on sECG is a potential risk factor for ventricular arrhythmia in patients with TTC. @*Subjects and methods@#We performed a retrospective study in 79 patients who were diagnosed with TTC from 2010 to 2014. Among them, 20 (25.3%) were diagnosed with ventricular tachycardia (VT). The J wave on the sECG was defined as J point elevation manifested through QRS notching or slurring at least 1 mm above the baseline in at least two leads. @*Results@#A higher prevalence of ventricular tachycardia was observed in patients with J wave. The corrected QT interval (QTc) was significantly longer in the VT group than in the non-VT group. In a multivariate analysis, the presence of J wave appeared to be the only independent predictors of VT [Hazard Ratio (HR) 3.5, p = 0.019]. @*Conclusion@#Our results suggest that the presence of J wave on the sECG is significantly associated with VT, and appear to indicate that the presence of J wave is a strong and independent predictor of VT in patients with TTC.

What does left atrial structural remodeling mean in cardiac resynchronization therapy?

See Article on Page 1125-1135

Validity and Reliability of a Korean Version of Yale Food Addiction Scale for Children (YFAS-C) / 간호학회지

PURPOSE: This study evaluated the psychometric properties of the Korean version of Yale Food Addiction Scale for Children (YFAS-C). METHODS: Participants were 419 young adolescent students (11~15 years old). The content validity of the expert group was calculated as the content validity index (CVI) after the translation and reverse translation process of the 25 items of the YFAS-C. The multitrait-multimethod matrix (MTMM) method was used to verify the construct validity; the generalized linear model (GLM) was used to evaluate the concurrent and incremental validity. Reliability was calculated as Kuder-Richardson-20 (KR-20) and Spearman-Brown coefficients. RESULTS: The CVI of the 25 items was greater than the item-level CVI .80 and the scale-level CVI .90. The Korean version of YFAS-C had verified convergent validity in emotional eating and external eating and discriminant validity in restrained eating. In addition, it had verified concurrent validity in emotional eating and external eating. Finally the incremental validity of the Korean version of YFAS-C was statistically significant on BMI. Reliability was KR-20 α=.69 and the Spearman-Brown coefficient was .64. CONCLUSION: The Korean version of YFAS-C is a valid and reliable scale for measuring the severity of food addiction; it can be a useful scale for preventing obesity by predicting food addiction early.

Relation of blood pressure variability to left ventricular function and arterial stiffness in hypertensive patients

INTRODUCTION@#Variability of blood pressure (BP) has been reported to be related to worse cardiovascular outcomes. We examined the impact of daytime systolic BP variability on left ventricular (LV) function and arterial stiffness in hypertensive patients.@*METHODS@#Ambulatory BP monitoring (ABPM) and echocardiography were performed in 116 hypertensive patients. We assessed BP variability as standard deviations of daytime systolic BP on 24-hour ABPM. Conventional echocardiographic parameters, area strain and three-dimensional diastolic index (3D-DI) using 3D speckle tracking were measured. Arterial stiffness was evaluated by acquiring pulse wave velocity (PWV) and augmentation index.@*RESULTS@#Patients with higher BP variability showed significantly increased left ventricular mass index (LVMI) and late mitral inflow velocity, as well as decreased E/A (early mitral inflow velocity/late mitral inflow velocity) ratio, area strain and 3D-DI than those with lower BP variability (LVMI: p = 0.02; A velocity: p < 0.001; E/A ratio: p < 0.001; area strain: p = 0.02; 3D-DI: p = 0.04). In addition, increased BP variability was associated with higher PWV and augmentation index (p < 0.001). Even among patients whose BP was well controlled, BP variability was related to LV mass, diastolic dysfunction and arterial stiffness.@*CONCLUSION@#Increased BP variability was associated with LV mass and dysfunction, as well as arterial stiffness, suggesting that BP variability may be an important determinant of target organ damage in hypertensive patients.

Secretory Breast Carcinoma: A Case Report with MRI Findings

Secretory carcinoma of the breast is an extremely rare, clinically and histologically distinct variant of invasive ductal carcinoma, with an indolent growth pattern and a more favorable prognosis than that of typical ductal carcinoma. Few studies have described its imaging features. Herein, we report on a secretory breast carcinoma with findings from various imaging modalities, especially including the MRI findings, which appears a well-defined complex cystic mass. Awareness of its imaging features using various modalities will be helpful for the differential diagnosis.

Validity and Reliability of a Korean Version of Yale Food Addiction Scale for Children (YFAS-C)

PURPOSE@#This study evaluated the psychometric properties of the Korean version of Yale Food Addiction Scale for Children (YFAS-C).@*METHODS@#Participants were 419 young adolescent students (11~15 years old). The content validity of the expert group was calculated as the content validity index (CVI) after the translation and reverse translation process of the 25 items of the YFAS-C. The multitrait-multimethod matrix (MTMM) method was used to verify the construct validity; the generalized linear model (GLM) was used to evaluate the concurrent and incremental validity. Reliability was calculated as Kuder-Richardson-20 (KR-20) and Spearman-Brown coefficients.@*RESULTS@#TheCVI of the 25 items was greater than the item-level CVI .80 and the scale-level CVI .90. The Korean version of YFAS-C had verified convergent validity in emotional eating and external eating and discriminant validity in restrained eating. In addition, it had verified concurrent validity in emotional eating and external eating. Finally the incremental validity of the Korean version of YFAS-C was statistically significant on BMI. Reliability was KR-20 α=.69 and the Spearman-Brown coefficient was .64.@*CONCLUSION@#The Korean version of YFAS-C is a valid and reliable scale for measuring the severity of food addiction; it can be a useful scale for preventing obesity by predicting food addiction early.

Actor and Partner Effects of Health Status, Marital Satisfaction and Self Efficacy on Retirement Preparation of Middle Aged Couples: Actor-Partner Interdependence Model Analysis

PURPOSE: This study aimed to identify the actor and partner effects of health status, marital satisfaction, and self efficacy on retirement preparation in middle aged couples using the Actor-Partner Interdependence Model. METHODS: Participants were 121 middle aged couples living in Seoul, Gyeonggi-do and Daegu City, Korea. All measures were self-administered. The collected data were analyzed using SPSS 20.0 and AMOS 20.0. RESULTS: 1) Wife's self efficacy and marital satisfaction showed direct actor and partner effects on retirement preparation in middle aged couples. Wife's health status showed an indirect actor effect through wife's self efficacy and marital satisfaction on wife's retirement preparation, and showed an indirect partner effect through husband's self efficacy on husband's retirement preparation. 2) Husband's self efficacy and marital satisfaction showed only direct actor effect on retirement preparation. Health status among the husbands showed an indirect actor effect on husband's retirement preparation through their self efficacy and marital satisfaction, and an indirect partner effect through wife's marital satisfaction on wife's retirement preparation. 3) The actor effect size of health status on self efficacy and marital satisfaction was larger among husband's than wife's. Additionally, the partner effect size of health status on self efficacy and marital satisfaction was different between the two groups; however, the actor and partner effect size of self efficacy and marital satisfaction on retirement preparation was the same for husband and wife. CONCLUSION: The results of this study indicate that nursing intervention strategies for improving self efficacy and marital satisfaction are strongly needed to enhance retirement preparation of middle aged couples in Korean community.

Care Burden for Mental Illness Patients, Attitude toward Mental Illness and Psychiatric Nursing Competency in Non-psychiatric Nurses / 정신간호학회지

PURPOSE: The purposes of this study were to identify the level of care burden for patients with mental illness, attitudes toward mental illness and psychiatric nursing competency in non-psychiatric nurses and to identify correlations among these variables. METHODS: Data were collected from 153 non-psychiatric nurses who worked at a hospital located in Seoul, Korea. Care burden for mental illness patients, attitudes toward mental illness, and psychiatric nursing competency were measured using structured questionnaires. The collected data were analyzed using frequency, percentage, independent t-test, one-way ANOVA, Scheffé test and Pearson's correlation coefficients with the SPSS/WIN 21.0 program. RESULTS: Non-psychiatric nurses' care burden for mental illness patients showed negative correlations with attitude toward mental illness (r=-.50, p<.001) and intervention competency (r=-.31, p<.001). CONCLUSION: The findings of this study suggest that effective nursing care for patients with mental illness in non-psychiatric departments requires enhancing nurses' competency in psychiatric nursing and developing positive attitudes toward mental illness.

Mediating Effects of Cognitive Emotion Regulation on Influences of Self-differentiation and Family Function in High School Students' Problem Behavior / 정신간호학회지

PURPOSE: This study was done to investigate the mediation effects of cognitive emotion regulation on influences of self-differentiation and family function in high school students' problem behavior. METHODS: Study design was a cross-sectional descriptive analysis of causal research. A survey was conducted with 194 students in a C city high school. Data were analyzed using SPSS 21.0 and AMOS 21.0. RESULTS: There were direct effects of self-differentiation (β= -.39, p<.001), adaptive cognitive emotion regulation strategies (β=-.16, p=.004) and maladaptive cognitive emotion regulation strategies (β=.34, p<.001) on problem behavior in these students. A mediator effect was found for self-differentiation, as it had a direct impact on the maladaptive cognitive emotion regulation strategy (β=-.15, p=.014), which then had a direct impact on problem behavior. However, family function had no direct impact on both the maladaptive cognitive emotion regulation strategy and the adaptive cognitive emotion regulation strategy and on problem behavior, no mediator effect was observed. Explanatory power of these variables for problem behavior was 48.0%. CONCLUSION: Study findings suggest that to intervene for problem behavior in high school students, there is a need to develop and utilize programs that not only intervene for self-differentiation but also decrease high school students' use of non-adaptive cognitive emotion regulation.

Difficulties in Caring for Psychiatric Patient as Experienced by Non-Psychiatric Nurses

PURPOSE: The purpose of this study was to identify non-psychiatric nurses' difficulties in caring for patients with mental illness. METHODS: Data were collected from eighteen general medical-surgical nurses working at a university hospital in Seoul, Korea. This study involved two focus group discussions and three in-depth individual interviews. All interviews were recorded and transcribed as they were spoken, and data were analyzed using qualitative content analysis. RESULTS: General medical-surgical nurses experienced difficulties in 3 categories, 9 subcategories, 27 codes. The three categories were ‘nurse’ related factors, ‘patient’ related factors, ‘resource’ related factors. The nine categories were ‘unpreparedness’, ‘nursing barriers due to stigma’, ‘undervaluing and avoidance of psychiatric nursing’, ‘eroding into the trap of a vicious cycle’, ‘facing unapproachable patients’, ‘dealing with unhelpful family members’, ‘burdening already overburdened staff’, ‘obstructive environment’, and ‘isolation of staff with heavy responsibilities’. CONCLUSION: The results of this study indicate the need to develop psychiatric mental health education programs for non-psychiatric nurses. Education about psychiatric mental health and support from institutions for non-psychiatric nurses can reduce their negative attitude toward psychiatric patients and difficulties in caring for psychiatric patients.

Effects of Psychiatric Nurses' Perception of the Healthcare Accreditation System and Safety Climate on Patient Safety Management Activities / 정신간호학회지

PURPOSE: This study was done to provide a basis for effective patient safety management activities and quality improvement by identifying the relationship among psychiatric nurses' perception of the healthcare accreditation system, safety climate and patient safety management activities. METHODS: The study participants included 163 psychiatric nurses from 8 mental hospitals and data was collected using self-report questionnaires. Collected data were analyzed with the SPSS/WIN 21.0 using mean, t-test, ANOVA, Pearson correlation coefficient and multiple regression analysis. RESULTS: Main factors which affect patient safety management activities are education and organizational structure for accreditation, and the total career record. The explanatory power for patient safety management activities of these variables was 41%. CONCLUSION: Findings indicate that psychiatric institutions have to develop their own effective measures, work out plans to support administrative and financial nursing services, and continuously provide useful information and educational opportunities.

A Case of Endovascular Treatment of Severe Graft Limb Kinking after Endovascular Abdominal Aortic Aneurysm Repair

Endovascular aneurysm repair (EVAR) has been recommended as an alternative to open aneurysm repair. The risk of severe perioperative complications is lower than that in open surgical repair; however, late complications are more likely. After EVAR, regular yearly surveillance by duplex ultrasonography or computed tomography is recommended. We report the case of a 67-year-old man with a severely kinked left iliac branch of the stent graft 10 years after EVAR. He had not undergone regular follow-up during the last 4 years. We realigned the endograft kink by percutaneous transluminal angioplasty.

Effects of a Facial Muscle Exercise Program including Facial Massage for Patients with Facial Palsy

PURPOSE: The purpose of this study was to examine the effects of a facial muscle exercise program including facial massage on the facial muscle function, subjective symptoms related to paralysis and depression in patients with facial palsy. METHODS: This study was a quasi-experimental research with a non-equivalent control group non-synchronized design. Participants were 70 patients with facial palsy (experimental group 35, control group 35). For the experimental group, the facial muscular exercise program including facial massage was performed 20 minutes a day, 3 times a week for two weeks. Data were analyzed using descriptive statistics, χ²-test, Fisher's exact test and independent sample t-test with the SPSS 18.0 program. RESULTS: Facial muscular function of the experimental group improved significantly compared to the control group. There was no significant difference in symptoms related to paralysis between the experimental group and control group. The level of depression in the experimental group was significantly lower than the control group. CONCLUSION: Results suggest that a facial muscle exercise program including facial massage is an effective nursing intervention to improve facial muscle function and decrease depression in patients with facial palsy.

Normal Echocardiographic Measurements in a Korean Population Study: Part II. Doppler and Tissue Doppler Imaging

BACKGROUND: Hemodynamic and functional evaluation with Doppler and tissue Doppler study as a part of comprehensive echocardiography is essential but normal reference values have never been reported from Korean normal population especially according to age and sex. METHODS: Using Normal echOcaRdiographic Measurements in a KoreAn popuLation study subjects, we obtained normal reference values for Doppler and tissue Doppler echocardiography including tricuspid annular velocities according to current guidelines and compared values according to gender and age groups. RESULTS: Mitral early diastolic (E) and late diastolic (A) velocity as well as E/A ratio were significantly higher in women compared to those in men. Conversely, mitral peak systolic and late diastolic annular velocity in both septal and lateral mitral annulus were significantly lower in women compared to those in men. However, there were no significant differences in both septal and lateral mitral early diastolic annular (e') velocity between men and women. In both men and women, mitral E velocity and its deceleration time as well as both E/A and E/e' ratio considerably increased with age. There were no significant differences in tricuspid inflow velocities and tricuspid lateral annular velocities between men and women except e' velocity, which was significantly higher in women compared to that in men. However, changes in both tricuspid inflow and lateral annular velocities according to age were similar to those in mitral velocities. CONCLUSION: Since there were significant differences in Doppler and tissue Doppler echocardiographic variables between men and women and changes according to age were even more considerable in both gender groups, normal Doppler echocardiographic values should be differentially applied based on age and sex.

Normal 2-Dimensional Strain Values of the Left Ventricle: A Substudy of the Normal Echocardiographic Measurements in Korean Population Study

BACKGROUND: It is important to understand the distribution of 2-dimensional strain values in normal population. We performed a multicenter trial to measure normal echocardiographic values in the Korean population. METHODS: This was a substudy of the Normal echOcardiogRaphic Measurements in KoreAn popuLation (NORMAL) study. Echocardiographic specialists measured frequently used echocardiographic indices in healthy people according to a standardized method at 23 different university hospitals. The strain values were analyzed from digitally stored images. RESULTS: Of a total of 1003 healthy participants in NORMAL study, 2-dimensional strain values were measured in 501 subjects (265 females, mean age 47 ± 15 years old) with echocardiographic images only by GE echocardiographic machines. Interventricular septal thickness, left ventricular (LV) posterior wall thickness, systolic and diastolic LV dimensions, and LV ejection fraction were 7.5 ± 1.0 mm, 7.4 ± 1.0 mm, 29.9 ± 2.8 mm, 48.9 ± 3.6 mm, and 62 ± 4%, respectively. LV longitudinal systolic strain (LS) values of apical 4-chamber (A4C) view, apical 3-chamber (A3C) view, apical 2-chamber (A2C) view, and LV global LS (LVGLS) were −20.1 ± 2.3, −19.9 ± 2.7, −21.2 ± 2.6, and −20.4 ± 2.2%, respectively. LV longitudinal systolic strain rate (LVLSR) values of the A4C view, A3C view, A2C view, and LV global LSR (LVGLSR) were −1.18 ± 0.18, −1.20 ± 0.21, −1.25 ± 0.21, and −1.21 ± 0.21(−s), respectively. Females had lower LVGLS (−21.2 ± 2.2% vs. −19.5 ± 1.9%, p < 0.001) and LVGLSR (−1.25 ± 0.18(−s) vs. −1.17 ± 0.15(−s), p < 0.001) values than males. CONCLUSION: We measured LV longitudinal strain and strain rate values in the normal Korean population. Since considerable gender differences were observed, normal echocardiographic cutoff values should be differentially applied based on sex.