Factors Related to Long-term Hospital Length of Stay and Opinions on Discharge-related Community-based Medical and Welfare Service on Elderly Patients with Chronic Diseases in Korean Veterans Hospitals

Purpose@#This study aims to investigate factors related to long-term length of stay (LOS) of patients with chronic diseases in Korean veterans hospitals. @*Methods@#The subjects were 196 elderly patients with chronic disease staying in the hospital for more than 10 days, Data were collected by the survey of patients with structured questionnaires and medical records review by nurses from July 15 to August 10, 2019. Collected data were analyzed using t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. @*Results@#The present and desired LOS were 37.78±32.66 days and 60.87±45.95 days, respectively. Factors affecting hospital LOS were found to be main disease (genitourinary) (p<.001), assistance in activities of daily living (p<.001), area of hospital (p<.001), payment of medical fees (p=.026), hospital satisfaction (p=.036) and the explanatory power of these variables was 26.4%. The most common health problems that need to be solved after discharge were symptom alleviation and health promotion.These problems can be solved using community-based facility services or visiting medical-welfare services (especially home care nursing). @*Conclusion@#In order to reduce hospital LOS, the following measures are required: personalized self-management education, provision of transportation services for dialysis therapy of inactive patients, linking patients with visiting medical-welfare services including home care nursing and mobile healthcare services, operation of the case management system including the notice of the discharge date at admission, interim check of patient status, and connecting the patient with community resources or transferring the patient to long-term care facilities at discharge.

Sequential Cases of Staphylococcal Scalded Skin Syndrome in Very Low Birth Weight Infants

Staphylococcal scalded skin syndrome (4S) is an exfoliative skin disease caused by Staphylococcus aureus toxins. 4S usually has a benign course in young infants and children; however, it could be fatal in preterm infants, especially very low birth weight infants. We experienced two sequential 4S cases that occurred in the neonatal intensive care unit. One of the patients had complications such as bacteremia and acute kidney injury.

Association of Immunoglobulin G at Birth with Late-Onset Sepsis and Related Mortality in Very Low Birth Weight Infants

PURPOSE: We aimed to evaluate the association between immunoglobulin G (IgG) at birth and late-onset sepsis (LoS) in preterm infants. METHODS: Medical records of very-low-birth-weight infants, born at gestational age <28 weeks, between 2013 and 2016, were retrospectively reviewed. Subjects were divided into two groups based on the occurrence of LoS (LoS vs. non-LoS), and IgG levels at 1 day, and at 2 weeks and 4 weeks after birth were investigated. IgG levels, other perinatal factors, and clinical factors were compared in the two groups. The relationship between IgG levels and mortality among infants in the LoS group was also analyzed. RESULTS: A total of 105 infants were analyzed after exclusion of cases with early onset sepsis or death at < 72 hours of life. Gestational age in the LoS group was lower than in the non-LoS group (25.0±1.8 vs. 26.3±1.4 weeks, P=0.004). IgG levels at birth were similar between the two groups (236.4±96.4 vs. 282.0±104.7 mg/dL, P=0.078). Multivariate analysis showed that IgG at birth was not an independent risk factor for LoS. In the LoS group, IgG levels at birth were comparable between survivors and cases involving mortality. CONCLUSION: IgG levels at birth were not associated with the occurrence of LoS in extremely preterm infants.

A Case of Congenital Lymphatic Dysplasia Complicated by Hydrops Fetalis

Congenital lymphatic dysplasia is a rare congenital maldevelopment of the lymphatic system, in which dysfunction of the lymphatic system may cause leakage of lymph fluid into the limbs and the pleural, pericardial, or peritoneal cavity. We experienced a case of hydrops fetalis with subcutaneous lymphedema, chylothorax, chylous ascites and pericardial effusion. Lymphangiography revealed a critical defect of lymphatic system. Here, we report the first case of premature infant with congenital lymphatic dysplasia confirmed by lymphangiography, which is the first reported in Korea.

Comparison of Formulas for Calculating Low-density Lipoprotein Cholesterol in General Population and High-risk Patients with Cardiovascular Disease

BACKGROUND AND OBJECTIVES: Low-density lipoprotein cholesterol (LDL-C), an established cardiovascular risk factor, can be generally determined by calculation from total cholesterol, high-density lipoprotein cholesterol, and triglyceride concentrations. The aim of this study was to compare LDL-C estimations using various formulas with directly measured LDL-C in a community-based group and hospital-based group among the Korean population. SUBJECTS AND METHODS: A total of 1498 participants were classified into four groups according to triglyceride concentrations as follows: <100, 100–199, 200–299, and ≥300 mg/dL. LDL-C was calculated using the Friedewald, Chen, Vujovic, Hattori, de Cordova, and Anandaraja formulas and directly measured using a homogenous enzymatic method. Pearson's correlation coefficients, intraclass correlation coefficients (ICC), Passing & Bablok regression, and Bland-Altman plots were used to evaluate the performance of six formulas. RESULTS: The Friedewald formula had the highest accuracy (ICC=0.977; 95% confidence interval 0.974-0.979) of all the triglyceride ranges, while the Vujovic formula had the highest accuracy (ICC=0.876; 98.75% confidence interval 0.668–0.951) in people with triglycerides ≥300 mg/dL. The mean difference was the lowest for the Friedewald formula (0.5 mg/dL) and the percentage error was the lowest for the Vujovic formula (30.2%). However, underestimation of the LDL-C formulas increased with triglyceride concentrations. CONCLUSION: The accuracy of the LDL-C formulas varied considerably with differences in triglyceride concentrations. The Friedewald formula outperformed other formulas for estimating LDL-C against a direct measurement and the Vujovic formula was suitable for hypertriglyceridemic samples; it could be used as an alternative cost-effective tool to measure LDL-C when the direct measurement cannot be afforded.

Association between carotid intima-media thickness and Ankle-Brachial Index in patients with ischemic stroke / 동물의과학연구지

BACKGROUND AND PURPOSE: The Ankle-Brachial Index (ABI) is the ratio of blood pressure in the lower legs to that in the arms. The intima-media thickness (IMT) of extracranial carotid arteries determined by B-mode ultrasound is a measurable index of the presence of atherosclerosis. A low ABI and a high carotid IMT are independently related to increased risk of cardiovascular events. This study examined the association between carotid IMT and ABI in patients with ischemic stroke. MATERIALS AND METHODS: Retrospectively, 116 hospitalized patients with ischemic stroke were recruited. Using a pulse wave velocity ABI device along with carotid duplex sonography, we measured carotid IMT and ABI and investigated the correlation between average values. RESULTS: There was a significant difference in carotid IMT between the normal and abnormal ABI groups (P=0.0262). The group with an abnormal ABI was more than five times as likely to have increased carotid IMT as the group with a normal ABI (age, sex-adjusted OR 5.67 (95% CI 1.85~17.38)). The ABI and carotid IMT showed a weak inverse linear correlation in patients with ischemic stroke (correlation coefficient -0.378 after adjusting for age and sex). CONCLUSION: Our study suggests that an abnormal ABI is associated with a high carotid IMT in patients with ischemic stroke.

Meta-analysis of the Effects of Obesity Management Program for Children

PURPOSE: The aims of this study is to analysis the effects of obesity management programs for children and to measure the differences in the effects by type and dependent variables in order to analyze the structures of the programs. METHODS: Sixty-one peer-reviewed journals including child obesity and intervention studies published between 2000 and 2010 were included for meta-analysis. Effect size and statistics of homogeneity were by STAT 10.0. RESULTS: A total of 61 studies were used in the analysis, and the effect size of the independent studies was determined to be -0.23 (95% CI, -0.32 ~ -0.15). Serum Leptin and Insulin were the big effect size among the studies that used dependent variables. The theses used in the research did not display publishing bias. CONCLUSION: Obesity management programs that have been confirmed to be effective need to be developed into regional protocols. A continuous control of obese children and research for effective intervention program are in need.

Factors Influencing Meaning of Life in Adolescents

PURPOSE: The purpose of this study was to analyze factors affecting meaning of life in adolescents. METHODS: Data were collected from April 5 to June 20, 2010. The participants for this study were 343 Korean middle and high school students, recruited from four middle and high schools located in Seoul. Data collection was conducted through the use of 7 questionnaires. The data were analyzed with the SPSS WIN 12.0 program using descriptive statistics, ANOVA, Pearson correlation coefficients and stepwise multiple regression. RESULTS: 1) The mean total item score for the meaning of life scales was 2.99, which was slightly high. 2) There was a significant relationship between meaning of life and self-esteem, self control, parenting attitude, family satisfaction, school adjustment, and career maturity. 3) Stepwise multiple regression analysis showed that self-esteem, family satisfaction, school adjustment, parenting attitude and career maturity were predictors of meaning of life and accounted for 57.1% of the variance in meaning of life. CONCLUSION: Self-esteem, family satisfaction, school adjustment, parenting attitude and career maturity were variables influencing meaning of life in adolescents. These results indicate a need to develop nursing interventions to increase self-esteem, family satisfaction, school adjustment, parenting attitude and career maturity in order to improve meaning of life for adolescents.

Personal and Environmental Predictors of Internet Addiction in Higher Grade Elementary School Students / 아동간호학회지

PURPOSE: The purpose of this study was to identify the degree of internet addiction and factors affecting internet addiction in elementary school students. METHOD: The participants in this study were 1,328 students in 4, 5 or 6 grades of elementary school. They were recruited from two elementary schools. Data collection was conducted using of 6 questionnaires that were modified by the investigator. The data were analyzed with the SPSS win 10.0 program using descriptive statistics, Pearson correlation coefficients and stepwise multiple regression. RESULTS: 1) The mean of total item score for internet addiction was 2.1, which was slightly low. Of respondents in this research 48.4% normally use the internet, while 48.5% addictively use the internet and as high as 3.1% were serious internet-addicted. 2) There was a significant correlation between internet addiction, self-esteem, aggression, impulsivity, parent's support and friend's support(gamma= -.15 ~ .44). 3) Stepwise multiple regression analysis showed that amount of time spent on the internet per day, impulsivity, aggression, gender, self-esteem, duration to use of internet, father's age, and the major place where the internet was used were the predictors of internet addiction and accounted for 47% of the variance in internet addiction. CONCLUSION: Time spend on the internet per day, impulsivity, aggression, gender, self-esteem, duration to use of internet, father's age, the major place where the internet was used accounted for internet addiction in elementary school students. Therefore it is necessary to develop nursing interventions and to further identify the depth of the relationship of the related factors in order to decrease internet addiction.

Influencing Predictors of Quality of Life in Burn Patients / 성인간호학회지

PURPOSE: The purpose of this study was to identify predictors of quality of life in burn patients. The predictors of quality of life were the subject's characteristics(marriage, income, burn size, burn site, pain and functional limitation) and personal resources(self esteem and social support). METHOD: 96 burn subjects who were hospitalized participated in the study. The data analysed was with descriptive analysis, ANOVA, Pearson correlation coefficient and multiple regression. RESULT: Burn patients who had a spouse and had higher levels of income, with smaller size of burn, no arm burn, with lower levels of pain and functional limitation, plus higher levels of self esteem and social support reported higher levels of quality of life(R2=0.5229). CONCLUSION: Based on the finding of this study, development of nursing intervention programs including reduction of pain and functional limitation, enhancing self esteem and social support can be suggested.

The Parenting Image of Modern Korean Society Described in Modern Novels / 아동간호학회지

PURPOSE: The purpose of this study was to explore the parenting image of modern Korean society through modern novels published during in the stage of modern change in Korea. METHOD: The data were analyzed through latent content analysis. Modern Korean novels (N=138) written during the Korean modernization stage were chosen for analysis. Five categories and seventeen meaningful sub-categories were drawn out from 636 significant sentences. RESULTS: The parenting images expressed in modern Korean society were as follows: From the category of [Devotional love], 5 sub-categories were drawn: Hedgehog's love, Lavish love, Sacrificial care, Exertion of the mind, and Prayer for the future of their children. From the category of [Stern father and affectionate mother], 3 sub-categories were drawn: Stern and Strict father, Tender and loving mother, and Strong maternal love. From the category of [Enthusiasm for their children's education], 3 sub-categories were drawn: Sense of duty to provide good education for their children, Zeal for their children's education, and Satisfaction with their hard-working children. From the category of [The head of family], 3 sub-categories were drawn: Person who has the right to make decisions, Reliable protector, and Object of filial devotion. From the category of [sexual discrimination], 3 sub-categories were drawn: Preference and favoritism to sons, Attaching importance to education of sons, Regarding daughters as those who help support the family. CONCLUSIONS: The results of this study will help to improve the basic understanding the parenting image and parent-child relationship in present day Korea.

Factors Affecting the Self Care Behavior of Korean High School Students / 아동간호학회지

PURPOSE: The purpose of this study was to analyze the factors affecting Self Care Behavior in Korean high school students. METHOD: Data were collected from November 9 to December 28, 2003. The participants in this study were 293 students(134 boys, 159 girls), recruited from two High School located in Seoul. Data collection was conducted through the use of Questionnaire that was modified by the investigator. The data were analyzed with descriptive statistics, Pearson Correlation coefficients and stepwise multiple regression. The SPSS win 10.0 program was used. RESULTS: The mean of total item score the Self Care Behaviors scales was 3.37, which was slightly low. There was a significant correlation between Self Care Behavior, Hope, Social Support, and Self Care Agency(gamma= .30 ~ .65, p<.001). Stepwise multiple regression analysis showed that Self Care Agency was a predictor of Self Care Behavior and accounted for 28% of the variance. Self Care Agency account for 31% of the variance in Self Care Behavior in the high school girls. Self Care Agency and Hope accounted for 27% of the variance in Self Care Behavior in High school boys. CONCLUSION: Self Care Agency accounted for variance in Self Care Behavior in these high school students. Therefore it is necessary to develop nursing interventions to increase Self Care Agency in high school students in order to increase the Self Care Behavior.

Affecting Factors of Deviant Behaviors of Korean High School Students / 아동간호학회지

PURPOSE: The purpose of this study is to analyze the factors affecting Deviant Behaviors of Korean High school Students. METHOD: Data was collected from October 8 to 31, 2002. The subjects for this study were 697 Korean High school Students(boys 347, girls 350), recruited from two High School located in Seoul. Data collection was conducted through the use of 6 Questionnaire that modified by the investigator. The data was analyzed by the SPSS win 10.0 program using Descriptive statistics, Pearson Correlation coefficient and stepwise multiple regression. RESULT: 1) The mean of total item score the Deviant Behaviors scales was 1.59, which was slightly low. 2) There was a significant correlation between Deviant Behaviors, Type A Personality, Aggression, Impulsivity, Stress and Social Support(gamma= .11 ~ .65, p < .001), but It was no significant correlation Type A Personality and Stress(gamma= -.01). 3) Stepwise multiple regression analysis showed that (1) Impulsivity, Social Support and Type A Personality were the predictors of Deviant Behaviors and account for 18.6% of the variance in Deviant Behaviors. (2) Impulsivity account for 3.6% of the variance in Deviant Behaviors in Subjects with a lower degree of score the Deviant Behaviors. Impulsivity and Social Support account for 23.2% of the variance in Deviant Behaviors in subjects with higher degree of score the Deviant Behaviors. (3) Impulsivity account for 18.3% of the variance in Deviant Behaviors in High school girls (n=350). Impulsivity and Social Support account for 20.1% of the variance in Deviant Behaviors in High school boys (n=347). CONCLUSION: Impulsivity and Social Support account for Deviant Behaviors of High school Students. Therefore it is necessary to develop nursing intervention to reduce the level of Impulsivity, to increase the Social Support in order to decrease the Deviant Behaviors.

Endoscopic Treatment of Spontaneous Intramural Dissection of the Esophagus: A Case Report / 대한소화기내시경학회지

Intramural dissection of the esophagus is a rare esophageal disorder which reveals characteristic endoscopic and radiologic features. Some authors have recognized that this injury is an intermediate stage between a transmural esophageal rupture (Boerhaave's syndrome) and an esophageal mucosal tear (Mallory-Weiss syndrome). Presenting symptoms are sudden severe retrosternal pain, hematemesis, odynophagia, and dysphagia. The diagnosis is made by contrast esophagography, esophageal endoscopy, or both. Conservative management is usually successful. Surgery should be reserved for the cases of protracted disease or perforation with mediastinitis. We report a case of spontaneous intramural esophageal dissection, in which the symptom of dysphagia did not improve with a conservative management. Then we treated with an endoscopic incision of the septum between the true and false lumens using a needle type papillotome.

A Predictive Model Comparison by Sex for Alcohol Consumption Behavior among Korea University Students / 간호학회지

The purpose of this study was designed to develope and test the structural model that explains alcohol consumption behaviors among university students in Republic of Korea. The hypothetical model was constructed on the basis of the literature review and Pender's Health promotion model. Data was collected from questionnaires from 512 university students in Republic of Korea, from August to September, 2000. The reliability of instruments was adequate (Cronbach's alpha= .69-.90). Data analysis was done with SAS 6.12 for descriptive statistics and LISREL 8.13 program for covariance structural analysis. The results are as follows;1. The overall fit of the hypothetical model to the data was moderate. Thus it was modified by male and female models.2. The revised model has become parsimonious and had a better fit to the empirical data (male: x2=87.21 p=.00, GFI=.97, AGFI= .94, NFI=.99, NNFI=1.0, CN=619.17, female: x2=49.29 p=.31, GFI=.45, AGFI= .95, NFI=.99, NNFI=1.0, CN=370.02).3. Self-efficacy was most significant factor and personality of novelty seeking, reward compensation, alcohol expectancy and drinking attitude have significant effects on male alcohol consumption behavior. 4. Personality of novelty seeking was most significant factor and personality of harm avoidance, friend influence, self-efficacies, alcohol expectancy and drinking attitude have significant effects on female alcohol consumption behavior.

Effects of Guided Imagery on Stress of Adolescents / 아동간호학회지

The purpose of this study was to identify the effects of the guided imagery program on stress of adolescents. The study design was nonequivalent control group pretest-posttest study. The Data were collected from the 1st to 30th of September in 2000. Two schools were selected as an experimental group and a control group. Each group included two classes. The experimental group was consisted of 40 male students and 42 female students and the control group was consisted of 41 males and 42 females. The guided imagery was provided with audiotapes to the subjects in the classroom for 8 minutes per each therapy, 5 times a week for 4 weeks. The pretest was given before the therapy to measure variables for both groups and the posttests were performed twice after 2 weeks and 4 weeks from the start of intervention. The Instruments used in this study were perception of stress scale developed by Park(1996), Vividness of Imagery Scale; short form of bett's test scale developed by Sheenhan(1967). The data were analyzed by the SAS program using Chi-square test, t-test, repeated measure ANOVA and Bonferroni correction. The results of this study are as follows: "The level of stress of adolescents who received the guided imagery will be significantly lower than that of control group" was supported(F=10.14, p=.00). In conclusion, the guided imagery was suggested as an effective nursing intervention did reduce the stress of adolescents which school nurses could utilize for adolescents at school.

A Survey of the Nursing Interventions Performed by Neonatal Nursing Unit Nurses Using the NIC / 아동간호학회지

The purpose of this study was to identify nursing interventions performed by neonatal nursing unit nurses. For data collection this study used the taxonomy of Nursing Intervention Classification(NIC : 486 nursing intervention) which was modified by McCloskey & Bulecheck(2000). The new 58 nursing interventions was translated into Korean, and then modified by pannel group, which consist of clinical experts and nursing scholars and finally the 419 nursing interventions was selected. The data were collected from 112 nurses. 168 nursing interventions were performed at least monthly by 50% or more of the nurses. The high frequency of performed nursing interventions were Family domain. 37 nursing interventions were performed at least once a day. The nursing interventions receiving the highest item mean score were neonatal care, neonatal monitoring, phototherapy; neonate, bottle feeding and temperature regulation. 56 nursing interventions were rarely performed by 90% or more of the nurses. Most of them were in the behavioral domain. The rarely used interventions were urinary bladder training, art therapy, religious addiction prevention, religious ritual enhancement and bladder irrigation. Therefore, neonatal nursing units nurses used interventions in the Physiological: basic domain most often on a daily basis and the interventions in the behavioral domain least often. These findings will help in building of a standardized language for the neonatal nursing units and enhance the quality of nursing care. Further study will be needed to classify each intervention class and nursing activity and validate NIC in pediatric care unit.

A status of Assessment and Management about Children in Pain / 아동간호학회지

This study was performed to understand pediatric pain management status and nurses' knowledge and attitudes toward it. In addition, it aimed to provide basic data in order to establish effective nursing intervention strategies by confirming the barriers of effective pain management in practice. The subjects were 195 nurses working in pediatric units(general pediatric unit, oncology unit, neonatal unit, neonatal ICU, pediatric ICU) of 8 university hospitals and one general hospital. Data was collected by the questionnaire from the 3rd of August to the 20th of September in 1999. The instrument developed by Sanna(1999) to measure nurses' knowledge and their attitudes and the other tool by Cleeland(1984) to evaluate barriers in effective pain management was used. Results of this study are summarized as follows : 1. Most nurses learn about the pain management knowledges from through regular curriculum of nursing school(62.0%). And almost nurses(90.8%) don't used to utilize pain assessment tool, but the "Faces Rating Scale" is the most frequently used by nurses. 2. The use of pain medication(65.6%) is most frequently taken by nurses as pain management and is followed by massage (55.9%), distraction(27.7%). 3. Nurses' knowledge level is moderate (Mn=3.07). Nurses don't seem to understand pediatric physical development (Mn= 2.86), psychological development(Mn=2.94) well, meanwhile they seem relatively quite knowledgeable about the way pain emerges. 4. Nurses' attitudes toward pain is based on behavioral and physiological responses to pain. They believe 'changes in behavior are a way of assessing pain in child' and 'acute pain increases the number of respiration'. Nurses are ready to accept pediatric pain, but are not positive in adopting pain intervention in practice. 5. The barriers of effective pain management are inadequate assessment of pain and pain relief(81.5%), ineffective incorporation among health professionals(80%), and lack of equipment or skills(80.0%).