The Leadership Experience of Advanced Practice Nurses in a Tertiary Hospital Setting : Focus Group Interview / 중환자간호학회지

Purpose@#: This study aimed to identify and describe the leadership experience of advanced practice nurses (APN). @*Methods@#: Data were collected through five focus group interviews in 2022 with a total of 24 APNs in groups of 4-6 participants. All interviews were recorded, transcribed, and data were analyzed using qualitative content analysis. @*Results@#: Nine categories emerged from three main themes. First, “Roles of APN leadership” comprised a trusted clinical expert, a moderator for the entire team, a resource person for nurturing the next generation, and a change agent for improving clinical practice. Second, “Facilitators and barriers to APN leadership” included ambiguity of APN role, support system, and institutional backing. Third, “Strategies for strengthening APN leadership competencies” comprised systematic leadership education and speaking up for APNs. @*Conclusion@#: APNs are passionate about their expertise and practice, but lack the legal and organizational authority and support to provide successive leadership. Systematic education including leadership and organizational advocacy will enable APN to provide leadership that benefits patients, institutions, and the wider healthcare system.

Prostate Cancer Presenting with Pruritus and Cholestasis / 대한소화기학회지

Jaundice is a rare symptom of the paraneoplastic syndrome associated with prostate cancer. We report a case of metastatic prostate cancer that presented as jaundice. There was an absence of biliary obstruction and hepatic metastasis; therefore, the paraneoplastic syndrome was suggested as the etiology of cholestasis. Jaundice improved with the treatment of prostate cancer. In the literature, interleukin-6 has been suggested to be associated with paraneoplastic syndrome.

Prostate Cancer Presenting with Pruritus and Cholestasis / 대한소화기학회지

Jaundice is a rare symptom of the paraneoplastic syndrome associated with prostate cancer. We report a case of metastatic prostate cancer that presented as jaundice. There was an absence of biliary obstruction and hepatic metastasis; therefore, the paraneoplastic syndrome was suggested as the etiology of cholestasis. Jaundice improved with the treatment of prostate cancer. In the literature, interleukin-6 has been suggested to be associated with paraneoplastic syndrome.

Prognostic significance of lymph node ratio after neoadjuvant chemoradiation therapy for esophageal squamous cell carcinoma

Purpose@#We retrospectively evaluated the prognostic significance of lymph node ratio (LNR) in patients with esophageal squamous cell carcinoma who underwent neoadjuvant concurrent chemoradiation therapy (NCRT) followed by surgery. @*Materials and Methods@#In total, 270 patients who underwent NCRT followed by surgery between August 2005 and December 2015 were included. They were divided into three groups: LNR 0 (n = 196), LNR low (0 0.1; n = 11). The primary endpoint was overall survival (OS), and the secondary endpoints were freedom from local recurrence (FFLR), distant metastasis-free survival (DMFS), and disease-free survival (DFS). @*Results@#The median number of retrieved lymph nodes per patient was 33. Pathologically, 74 patients had positive lymph nodes. The median follow-up duration was 36.1 months, and the median survival period was 68.4 months. There was a significant correlation between LNR and the number of positive lymph nodes (correlation coefficient = 0.763, p < 0.001). There was a substantial difference in the OS among the LNR groups, with 2-year survival rates of 79.0%, 54.0%, and 9.1% in the LNR 0, LNR low, and LNR high groups, respectively (p < 0.001). A marked decrease in FFLP, DMFS, and DFS was observed with the increasing LNR. In subgroup analysis, the survival results of patients with clinically positive lymph node were similar from those of entire cohort. @*Conclusion@#LNR is a significant prognostic factor in patients with esophageal squamous cell carcinoma who underwent NCRT followed by surgery. Additional treatment and closer follow-up would be necessary for patients with a high LNR.

Prognostic significance of lymph node ratio after neoadjuvant chemoradiation therapy for esophageal squamous cell carcinoma

Purpose@#We retrospectively evaluated the prognostic significance of lymph node ratio (LNR) in patients with esophageal squamous cell carcinoma who underwent neoadjuvant concurrent chemoradiation therapy (NCRT) followed by surgery. @*Materials and Methods@#In total, 270 patients who underwent NCRT followed by surgery between August 2005 and December 2015 were included. They were divided into three groups: LNR 0 (n = 196), LNR low (0 0.1; n = 11). The primary endpoint was overall survival (OS), and the secondary endpoints were freedom from local recurrence (FFLR), distant metastasis-free survival (DMFS), and disease-free survival (DFS). @*Results@#The median number of retrieved lymph nodes per patient was 33. Pathologically, 74 patients had positive lymph nodes. The median follow-up duration was 36.1 months, and the median survival period was 68.4 months. There was a significant correlation between LNR and the number of positive lymph nodes (correlation coefficient = 0.763, p < 0.001). There was a substantial difference in the OS among the LNR groups, with 2-year survival rates of 79.0%, 54.0%, and 9.1% in the LNR 0, LNR low, and LNR high groups, respectively (p < 0.001). A marked decrease in FFLP, DMFS, and DFS was observed with the increasing LNR. In subgroup analysis, the survival results of patients with clinically positive lymph node were similar from those of entire cohort. @*Conclusion@#LNR is a significant prognostic factor in patients with esophageal squamous cell carcinoma who underwent NCRT followed by surgery. Additional treatment and closer follow-up would be necessary for patients with a high LNR.

Development of the Cultural Competence Scale for Registered Nurses (CCS-RN)

PURPOSE: This study is to develop the Cultural Competence Scale for Registered Nurses (CCS-RN) and to examine its validity and reliability. METHODS: The item pool was generated based on related scales, a wide review of the literature, and in-depth interviews with nurses according to Purnell's cultural competence model. Content validity was verified by nursing experts. Construct validity using exploratory factor analysis, convergent validity using correlation coefficients, discriminant validity, internal consistency reliability, and test-retest reliability were examined. RESULTS: The CCS-RN consists of a 35-item/7-factor solution with 54.1% of the total variance explained. The convergent validity of CCS-RN was supported. Cronbach's α was .94 for the total scale and ranged from .77 to .90 for the seven factors. Test-retest reliability was moderate. CONCLUSION: The evaluation of the psychometric properties of the CCS-RN shows that this scale is expected to be a valid and reliable measure of cultural competence among nurses. This scale may be useful for assessing nurses' own cultural competence and thus contribute to strengthening cultural competence.

Development of an Instrument to Assess the Quality of Childbirth Care from the Mother's Perspective / 간호학회지

PURPOSE: This study aimed to develop an instrument to assess the quality of childbirth care from the perspective of a mother after delivery. METHODS: The instrument was developed from a literature review, interviews, and item validation. Thirty-eight items were compiled for the instrument. The data for validity and reliability testing were collected using a questionnaire survey conducted on 270 women who had undergone normal vaginal delivery in Korea and analyzed with descriptive statistics, exploratory factor analysis, and reliability coefficients. RESULTS: The exploratory factor analysis reduced the number of items in the instrument to 28 items that were factored into four subscales: family-centered care, personal care, emotional empowerment, and information provision. With respect to convergence validation, there was positive correlation between this instrument and birth satisfaction scale (r=.34, p < .001). The internal consistency reliability was acceptable (Cronbach's alpha =.96). CONCLUSION: This instrument could be used as a measure of the quality of nursing care for women who have a normal vaginal delivery.

Development of an Instrument to Assess the Quality of Childbirth Care from the Mother's Perspective

PURPOSE@#This study aimed to develop an instrument to assess the quality of childbirth care from the perspective of a mother after delivery.@*METHODS@#The instrument was developed from a literature review, interviews, and item validation. Thirty-eight items were compiled for the instrument. The data for validity and reliability testing were collected using a questionnaire survey conducted on 270 women who had undergone normal vaginal delivery in Korea and analyzed with descriptive statistics, exploratory factor analysis, and reliability coefficients.@*RESULTS@#The exploratory factor analysis reduced the number of items in the instrument to 28 items that were factored into four subscales: family-centered care, personal care, emotional empowerment, and information provision. With respect to convergence validation, there was positive correlation between this instrument and birth satisfaction scale (r=.34, p < .001). The internal consistency reliability was acceptable (Cronbach's alpha =.96).@*CONCLUSION@#This instrument could be used as a measure of the quality of nursing care for women who have a normal vaginal delivery.

Clinical reliability of zirconium abutment in implant restorations in the English and Korean literature / 대한악안면성형재건외과학회지

BACKGROUND: This study aimed to evaluate the mechanical, biological, and esthetic stability of a zirconium abutment according to evidence-based dentistry. MAIN TEXT: An electronic search was performed. Domestic studies were found using the keywords “zirconia abutments” and “zirconium abutment” in KMbase, KoreaMed, and the National Assembly Library, and international studies were found using the same keywords in PubMed. All identified studies were divided by evidence level from the viewpoint of the research type utilizing the evidence-based review manual. A total of 102 domestic studies (with Korean language) were found, and 9 of these studies were selected. In these nine studies, 3 had evidence level 3 and 6 had evidence level 4. A total of 97 international studies (with English language) were found, and 19 were selected. Among these 19 studies, 5 had evidence level 2 and 7 had evidence level 3, whereas the remainder had evidence level 4. According to the studies, zirconium abutments are mechanically, biologically, and esthetically stable, but the evidence level of these studies is low, and the follow-up duration is no longer than 5 years. CONCLUSIONS: All examined studies verified the mechanical stability of zirconium abutments for a period no longer than 5 years. Therefore, a long-term clinical observation is needed. Zirconium abutments are thought to be biologically stable, but they are not superior to titanium abutments. As the esthetic stability of such abutments had a low evidence level in the studies that examined here, a much higher evidence level is needed.

Impact of a school-based culinary nutrition education program on vegetable consumption behavior, intention, and personal factors among Korean second-graders

BACKGROUND/OBJECTIVES: Veggiecation was developed to improve children's vegetable consumption through classroom lecture and cooking activities. In this study, we explored potential determinants of vegetable consumption behavior and intention, and examined the impact of Veggiecation on vegetable consumption behavior, intention and personal factors among Korean children. MATERIALS/METHODS: The 4-week Veggiecation program was implemented for second-graders in South Korea (35 children in the intervention group, 36 in the control group). We identified personal and environmental factors influencing vegetable consumption behavior and intention using multiple regression analyses. Consumption behavior, intention and, personal factors such as preference, attitude, and self-efficacy were compared between the groups before and after the intervention. RESULTS: Children's vegetable consumption behavior was significantly correlated with personal, social-, and physical-environmental factors as well as intention. Among the variables, preference was the most influential factor on intention, and attitude and intention had great influence on the behavior. After the program, children in the intervention group demonstrated significant improvements in vegetable consumption, intention, attitude, preference, and self-efficacy compared with children in the control group. CONCLUSION: Veggiecation, a school-based culinary nutrition education program, improved vegetable consumption and intention, as well as preference, attitude, and self-efficacy, in second-graders. Veggiecation has great potential, as a global program, to increase children's vegetable consumption. This program can be expanded through various channels, such as after-school programs or camps, to provide a positive impact for children.

Factors Affecting Depression in Women Patients with Osteoarthritis / 기본간호학회지

PURPOSE: This study was conducted to determine factors affecting depression in women patients with osteoarthritis. METHODS: Raw data from the 6th Korea National Health and Nutrition Examination Survey in 2014 was used. Data for 480 women were included. Variables related to general, physical and psychological characteristics were selected. After a sampling plan compound file was created using IBM SPSS 23.0 program, data were analyzed by giving weights. RESULTS: The results of the study are as follows. 1) Depression was significantly different according to economic status, marital status, knee pain, stress and subjective health status (p<.05). 2) Factors affecting the women included marital status, knee pain, stress, and subjective health status. The explanatory power was 41.0%. CONCLUSION: Results indicate that there is a need to give comprehensive consideration to the factors identified in this study when designing preventive interventions and management plans to alleviate depression in women with osteoarthritis.

The Effects of Flash Animation Facilitated Oral Self Care Education on the Incidence of Oral Mucositis and Performance of Self-Care in Pediatric Cancer Patients Undergoing Chemotherapy

PURPOSE: In this study, we aimed to investigate the effects of oral self-care education on the oral mucositis and oral self-care performance in pediatric cancer patients undergoing chemotherapy. METHODS: We conducted the study using the nonequivalent control group and non-synchronized design, and invited pediatric cancer patients, admitted to a university hospital for chemotherapy, to participate in the study. Data collection was completed for the control group first and proceeded to the experimental group. The data were collected from September 24 to November 5, 2015. Twenty children were enrolled in the study and divided into two groups: experimental (n=10) and control (n=10) groups. The children in the experimental group, along with their parents, were provided with a 10-minute flash animation and a brochure, both explaining oral self-care practices. Children in the groups were evaluated for the status of oral mucositis and their ability to perform oral self-care before chemotherapy, as well as at 3, 7, 14, and 21 days after the administration of chemotherapy. Descriptive statistics, t-test, chi-square, Fisher's exact test, and repeated measures ANOVA were utilized to test the homogeneity of variance between the two groups and examine the effectiveness of the oral self-care education. RESULTS: Children in the experimental group showed significant improvement in oral self-care performance compared to the control group post oral self-care education. CONCLUSION: Promoting oral self-care practices is an important nursing intervention in the prevention of oral mucositis in pediatric cancer patients. Inclusion of advanced smart technology, such as the use of flash animation, to facilitate nursing intervention could enhance the effectiveness of the intervention in young cancer patients. Broader application of smart technology in patient education is warranted.

A Concept Analysis of Cultural Nursing Competence

PURPOSE: The aim of this study was to conduct a concept analysis of cultural nursing competence. METHODS: Cultural nursing competence was analyzed using Rodgers' evolutionary concept development method. A literature search using the keywords "cultural nursing competence", "intercultural nursing competence", "cultural nursing", "cultural health nursing", and "cultural competence" was conducted in PubMed, CINAHL, ERIC, and RISS on material published before 2015. Database and bibliographic searches yielded 35 records. RESULTS: Cultural nursing competence comprised cognitive, affective, and behavioral domains. The critical attributes of the concept were sensitivity, equality, and activity. The analysis identified the following dimensions: awareness, openness, and coherence. The consequences of cultural nursing competence were personal satisfaction and social justice. The definition contained competence on both an individual and social level. CONCLUSION: Cultural competency enhances quality of care by narrowing health disparities and increasing client satisfaction. The concept analysis of cultural nursing competence may offer an acceptable framework which can be used to develop psychometric tools of this concept and provide guidelines in nursing practice.

Dental care utilization by diabetics according to the Korea Health Panel Survey / 대한구강보건학회지

OBJECTIVES: The objective of this study was to examine the difference in dental care utilization between diabetics (diabetes group) and nondiabetics (normal group). METHODS: We examined the data of 5108 subjects enrolled in the Korea Health Panel Survey, every year for three years between 2010 and 2012. Of these, 458 subjects were included in the diabetes group and 458 in the normal group using the propensity score matching method to control confounding variables. To compare dental care utilization by the diabetes and normal groups, we examined the odds ratio (OR) and 95% confidence interval (CI) using a generalized estimating equation. RESULTS: We found that the odds of dental care utilization by the diabetes group compared with the normal group was significantly high (OR=1.82, 95% CI: 1.60-2.09). The result was consistent according to sensitivity analysis (OR=1.96, 95% CI: 1.63-2.35). CONCLUSIONS: Dental care utilization by the diabetes group was 82% higher than that by the normal group. Therefore, patients with diabetes need to be more concerned about oral health care.

Narrow-diameter implants with conical connection for restoring the posterior edentulous region / 대한악안면성형재건외과학회지

BACKGROUND: The objective of this retrospective study was to show results from platform-switched narrow-diameter implants in the posterior edentulous region, which we followed up for more than 1 year after functional loading. METHODS: Ninety-eight narrow implants were inserted into 66 patients. After healing, fixed implant-supported prostheses were delivered to the patients, and Periotest and radiographic examinations were performed. After the first year of loading, the implant outcome was again evaluated clinically and radiographically using the Periotest analysis. Crestal bone loss and Periotest values (PTVs) were used to evaluate the effect of surgery, prosthesis, implant, and a host-related factor. A general linear model was used to statistically detect variables statistically associated with crestal bone loss and Periotest value. RESULTS: We followed up on the implants over 1 to 4 years after loading; their survival rate was 100%, and pronounced differences from PTVs were noted among jaw location, bone quality, and loading period. No difference was detected in bone loss among the variables studied. Bone loss after functional loading was 0.14 ± 0.39 mm. The stability value from the Periotest was −3.29 ± 0.50. CONCLUSIONS: Within the limitations of this study, judicious use of platform-switched narrow implants with a conical connection must be considered an alternative for wide-diameter implants to restore a posterior edentulous region.

The Clinical Characteristics of Subependymal Giant Cell Astrocytoma: Five Cases

In this study, we reviewed the clinical characteristics of five cases of subependymal giant cell astrocytoma (SEGA) at our hospital between May 1997 and July 2012. The median age was 18 years old (range, 8 to 26). The clinical symptoms were presented as seizure in two patients and headache in three patients. All the tumors were located near the foramen of Monro. The median size of the tumors was 2.5 cm (range, 1.9-4.0). Two patients showed the solitary lesion, and three had subependymal nodules and cortical tubers. The median follow-up duration was 7.4 years (range, 2.0-14.3). Three patients were associated with the tuberous sclerosis complex (TSC). Four patients showed the SEGA at the first presentation and one patient experienced the 1.9 cm-sized growing mass during 7.7 years follow-up after the diagnosis of the TSC. The mass was totally removed in four patients and subtotally in one. Postoperatively, one patient took the medication for the seizure, which was controllable. The subtotally removed mass showed the recurrence postoperative 4.1 years later, and the recurred mass was stable for 4.5 years after the recurrence. The clinical follow-up study of the SEGA showed an indolent behavior before and after the surgery.

Effect of smoking on utilization of and expenses in ambulatory dental care / 대한구강보건학회지

OBJECTIVES: The objectives of this study were to evaluate the effect of smoking on utilization of and expenses in ambulatory dental care. METHODS: The subjects of this study were 5,751 men aged over 20 years selected from the Korea Health Panel data collected during 2010-2012. Pack-years of smoking were calculated based on the survey data. Dental utilization was defined as dental outpatient clinic use least once in three years. The expenses in ambulatory dental care were summed to determine total dental health care spending for three years. To detect the effect of smoking, we used multiple logistic regression analysis for dental utilization and multiple linear regression for expenses in ambulatory dental care after changing log. RESULTS: The pack-years had a significant effect on dental utilization and expenses in participants aged 40-59 years. After controlling for income level, bedtime brushing, and the presence of chronic disease, dental care utilization rates in the over 10 to less than 25 pack-year and the over 25 pack-year groups were about 1.4 (OR=1.37, (P =0.007)) and 1.6 times (OR=1.59, (P =0.001)) those in the 0 pack-year group. In comparison with the 0 pack-year group, the over 10 to less than 25 pack-year group spent 50,000 won more over dental expenses, while the corresponding number for the over 25 pack-year group was about 100,000 won. Thus, the ambulatory dental care expenses increased with the packyears of smoking. CONCLUSIONS: Smoking significantly influenced the utilization and expense in ambulatory dental care in men aged 40-59 years.

Micro-computed tomography evaluation and pathological analyses of female rats with collagen-induced arthritis

Imaging techniques have been introduced to assess the efficacy and toxicity of developing pharmaceuticals. The purpose of this study was to perform a comprehensive characterization of collagen-induced arthritis (CIA) in rats using micro-computed tomography (micro-CT) and to compare the results with data from conventional pathological examination. Arthritis was induced by collagen in 24 female Wistar rats. Micro-CT and pathological analyses were performed to assess arthritis progression. Micro-CT analysis showed marked joint destruction occurring in a time-dependent manner following collagen administration. Bone volume was significantly decreased in the tibia at weeks 3 and 4 compared to week 0 (p < 0.05 and p < 0.01, respectively). Additionally, percent bone volume was significantly reduced in the tibia at week 4 compared to week 0 (p < 0.05). In contrast, bone surface/bone volume and trabecular separation were significantly increased in the tibia of the animals at week 4 compared to week 0 (p < 0.05). Severe joint destruction with extensive inflammation, erosion of cartilage and bone, and infiltration of inflammatory cells were observed in the knee joints of the collagen-treated rats. Taken together, micro-CT made it possible to quantify CIA lesions and should be performed with pathological examination in rats.

Effect of Methotrexate on Collagen-Induced Arthritis Assessed by Micro-Computed Tomography and Histopathological Examination in Female Rats

We tested the hypothesis that micro-computed tomography (micro-CT) analysis provides a better quantitative readout of the therapeutic potential of methotrexate (MTX) for treating collagen-induced arthritis (CIA) in rats and compared to conventional histopathological examination. Rats were divided into three groups: Group 1 (G1) was treated with 0.9% saline, whereas groups 2 (G2) and 3 (G3) were boosted with type II collagen at days 0 and 7. Following the first collagen immunization, rats in G1 and G2 were treated with 0.9% saline and those in G3 were treated with 1.5 mg/kg MTX from day 14 to 28. All rats were sacrificed on day 28, at which point and all hind knee joints were analyzed by micro-CT and histopathological examination. Micro-CT analyses showed that bone volume and trabecular number were significantly decreased in G2 and G3 compared to G1 (p<0.01), as was percent bone volume (p<0.05 and p<0.01, respectively). However, bone surface/bone volume was significantly increased in G2 and G3 compared to G1 (p<0.05 and p<0.01, respectively). Trabecular separation was significantly increased in G3 compared to G1 (p<0.05). Histopathological examination showed that knee joints of rats in G2 and G3 showed severe joint destruction with inflammatory cell infiltration. However, cartilage destruction was slightly reduced in G3 compared to G2. Taken together, these results suggest that MTX treatment reduced cartilage destruction in rats with CIA, and micro-CT analyses made it possible to quantify arthritic bony lesion.

Efficacy of orally administered ginseng stem and leaf in chickens / 대한수의학회지

Ginseng has been widely used in Korea as a natural medicine due to its saponin contents. Although the total amount of ginseng stem and leaf saponins (GSLS) is 4~5 times higher than that of saponin in the root, the root is mainly used. This is due to two reasons: nervous system-stimulant activity of GSLS and pesticide residues in GSLS. In this study, residual agricultural pesticides were removed from GSLS using two types of bacterial treatments. Two GSLS treatment groups of chickens (GSLS-1 and GSLS-2) were established. The chickens were fed 0.4% GSLS-1 or GSLS-2 mixed with crop. We then evaluated the effects of GSLS on bodyweight and several immune parameters. At the end of the experiments, chickens fed GSLS-1 and red ginseng saponin had significantly higher growth rates (16.6% and 8.0%, respectively) compared to the vaccine control group treated with Noblis Salenvac-T. The group fed GSLS-1 also had the highest IgG titer that was significantly different at the end of experiments compared to the other groups. These findings imply that GSLS-1 is a good candidate feed additive for the chicken industry.