Bladder injury with vesicocutaneous fistula following acupuncture: a case report

Acupuncture is globally practiced extensively, especially in Northeast Asian countries. We present a case of bladder injury with vesicocutaneous fistula (VCF) subsequent to acupuncture treatment on the lower abdomen. We believe that no similar case has been reported in previous literature. A 54-year-old woman was admitted to our emergency department, complaining of lower abdominal pain with erythema, after undergoing acupuncture. Physical examination revealed swelling with erythema and slight pus-like discharges in the lower abdomen, with accompanying tenderness over the area of the swelling. An abdominal computed tomography showed evidence of bladder injury with VCF and abscess. Considering the underlying disease and the risk of surgical treatment, the patient was successfully treated with percutaneous abscess drainage and an indwelling urinary catheter. Considering the outcome of this case, we recommend that practitioners need to perform acupuncture treatment with sufficient anatomical knowledge and proper technique, to reduce the possibility of subsequent complications.

Two case reports of pneumatosis intestinalis in patients with cancer:is surgical management mandatory?

Pneumatosis intestinalis (PI) can be classified into two groups. Primary PI is idiopathic, and patients can recover spontaneously. In contrast, secondary PI is considered fatal due to the high mortality rate associated with mesenteric ischemia. Herein, we describe two patients with PI and concurrent pneumoperitoneum. Both patients were receiving targeted anticancer therapy, yet neither developed abdominal pain nor fatal symptoms. One of the patients underwent surgery, while the other was managed conservatively. Even though there were no complications, the patient who underwent surgery was hospitalized for 34 days, whereas the one who was managed conservatively was hospitalized for only five days. Usually, patients with cancer receiving chemotherapy are immunosuppressed and susceptible to infections. Therefore, based on the patients’ clinical features, surgical management of patients with cancer who develop PI after receiving anticancer chemotherapy should be done prudently.

Public awareness and willingness to use automated external defibrillators in a metropolitan city

Objective@#Early defibrillation is crucial for the survival of patients with out-of-hospital cardiac arrest. This study aimed to examine the trends and associated factors regarding public awareness and willingness to use automated external defibrillators (AEDs) through citywide surveys. @*Methods@#Three-round surveys were conducted in February 2012 (n=1,000), December 2016 (n=1,141), and December 2018 (n=1,001) among citizens in Daegu, South Korea, who were aged ≥19 years. The subjects were selected through a three-stage quota sampling. Awareness and willingness to use an AED were assessed in the three groups. The primary outcome was willingness to use AEDs. @*Results@#Of 3,142 respondents, 3,069 were eligible for analysis. The proportion of respondents who knew how to use AEDs increased from 4.7% in 2012 to 20.8% in 2018. Of the respondents in 2012, 2016, and 2018, 39.7%, 50.0%, and 43.2%, respectively, were willing to use an AED. Factors associated with willingness to use AEDs were male sex (adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.10–1.75), cardiopulmonary resuscitation training experience in the previous 2 years (AOR, 1.80; 95% CI, 1.43–2.28), recognition of the Good Samaritan law (AOR, 1.45; 95% CI, 1.13–1.86), and awareness of how to use an AED (AOR, 4.40; 95% CI, 3.26–5.93). @*Conclusion@#To increase willingness to use AEDs, education in AED use and the Good Samaritan law, along with re-education to maintain knowledge of AED use, should be considered.

Factors affecting successful esophageal foreign body removal using a Foley catheter in pediatric patients

Objective@#This study aimed to determine the factors that affect successful esophageal foreign body (FB) removal using a Foley catheter and to identify methods to increase the success rate. @*Methods@#In this retrospective, cross-sectional study, we included pediatric patients who presented with esophageal FB impaction that was removed using a Foley catheter in the emergency departments of tertiary care and academic hospitals. We analyzed the effect of the patients’ age, sex, and symptoms; FB type, size, and location; Foley catheter size; complications during FB removal; duration between FB ingestion and removal; operator’s years of training; sedation; success rate of FB removal; endoscopy; and patient’s posture during FB removal on the success of Foley catheter-based FB removal. @*Results@#Of the 43 patients we enrolled, Foley catheter-based FB removal was successful in 81.4% (35/43) but failed in 18.6% (8/43) of patients; no FB-removal-related complications were reported. There was no significant association between the success rate of Foley catheter-based FB removal and any study variable. A higher number of years in training tended to increase the success rate of Foley catheter-based FB removal, although statistical significance was not achieved. @*Conclusion@#Children’s esophageal FB removal is a practical challenge in the emergency rooms, and using a Foley catheter is associated with a high success rate of the removal and low occurrence of complications. In this study, no single variable was found correlated with the success rate of Foley catheter-based esophageal FB removal in pediatric patients, which may indicate multiple variables interacting with one another to affect the success rate.

Two case reports of pneumatosis intestinalis in patients with cancer:is surgical management mandatory?

Pneumatosis intestinalis (PI) can be classified into two groups. Primary PI is idiopathic, and patients can recover spontaneously. In contrast, secondary PI is considered fatal due to the high mortality rate associated with mesenteric ischemia. Herein, we describe two patients with PI and concurrent pneumoperitoneum. Both patients were receiving targeted anticancer therapy, yet neither developed abdominal pain nor fatal symptoms. One of the patients underwent surgery, while the other was managed conservatively. Even though there were no complications, the patient who underwent surgery was hospitalized for 34 days, whereas the one who was managed conservatively was hospitalized for only five days. Usually, patients with cancer receiving chemotherapy are immunosuppressed and susceptible to infections. Therefore, based on the patients’ clinical features, surgical management of patients with cancer who develop PI after receiving anticancer chemotherapy should be done prudently.

Public awareness and willingness to use automated external defibrillators in a metropolitan city

Objective@#Early defibrillation is crucial for the survival of patients with out-of-hospital cardiac arrest. This study aimed to examine the trends and associated factors regarding public awareness and willingness to use automated external defibrillators (AEDs) through citywide surveys. @*Methods@#Three-round surveys were conducted in February 2012 (n=1,000), December 2016 (n=1,141), and December 2018 (n=1,001) among citizens in Daegu, South Korea, who were aged ≥19 years. The subjects were selected through a three-stage quota sampling. Awareness and willingness to use an AED were assessed in the three groups. The primary outcome was willingness to use AEDs. @*Results@#Of 3,142 respondents, 3,069 were eligible for analysis. The proportion of respondents who knew how to use AEDs increased from 4.7% in 2012 to 20.8% in 2018. Of the respondents in 2012, 2016, and 2018, 39.7%, 50.0%, and 43.2%, respectively, were willing to use an AED. Factors associated with willingness to use AEDs were male sex (adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.10–1.75), cardiopulmonary resuscitation training experience in the previous 2 years (AOR, 1.80; 95% CI, 1.43–2.28), recognition of the Good Samaritan law (AOR, 1.45; 95% CI, 1.13–1.86), and awareness of how to use an AED (AOR, 4.40; 95% CI, 3.26–5.93). @*Conclusion@#To increase willingness to use AEDs, education in AED use and the Good Samaritan law, along with re-education to maintain knowledge of AED use, should be considered.

Factors affecting successful esophageal foreign body removal using a Foley catheter in pediatric patients

Objective@#This study aimed to determine the factors that affect successful esophageal foreign body (FB) removal using a Foley catheter and to identify methods to increase the success rate. @*Methods@#In this retrospective, cross-sectional study, we included pediatric patients who presented with esophageal FB impaction that was removed using a Foley catheter in the emergency departments of tertiary care and academic hospitals. We analyzed the effect of the patients’ age, sex, and symptoms; FB type, size, and location; Foley catheter size; complications during FB removal; duration between FB ingestion and removal; operator’s years of training; sedation; success rate of FB removal; endoscopy; and patient’s posture during FB removal on the success of Foley catheter-based FB removal. @*Results@#Of the 43 patients we enrolled, Foley catheter-based FB removal was successful in 81.4% (35/43) but failed in 18.6% (8/43) of patients; no FB-removal-related complications were reported. There was no significant association between the success rate of Foley catheter-based FB removal and any study variable. A higher number of years in training tended to increase the success rate of Foley catheter-based FB removal, although statistical significance was not achieved. @*Conclusion@#Children’s esophageal FB removal is a practical challenge in the emergency rooms, and using a Foley catheter is associated with a high success rate of the removal and low occurrence of complications. In this study, no single variable was found correlated with the success rate of Foley catheter-based esophageal FB removal in pediatric patients, which may indicate multiple variables interacting with one another to affect the success rate.

Comparison of the new and conventional injury severity scoring systems for predicting mortality in severe geriatric trauma

Objective@#This study compared the prognostic performance of the following five injury severity scores: the Geriatric Trauma Outcome Score (GTOS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS), the Revised Trauma Score (RTS), and the Trauma and Injury Severity Score (TRISS) for in-hospital mortality in severe geriatric trauma patients. @*Methods@#A retrospective, cross-sectional, observational study was conducted using a database of severe geriatric trauma patients (age ≥65 years and ISS ≥16) who presented to a single regional trauma center between November 2016 and October 2018. We compared the baseline characteristics between the survivor and mortality groups and the predictive ability of the five scoring systems. @*Results@#A total of 402 patients were included in the analysis; the in-hospital mortality rate was 25.6% (n=103). The TRISS had the highest area under the curve of 0.953 (95% confidence interval [CI], 0.927-0.971); followed by RTS, 0.777 (95% CI, 0.733-0.817); NISS, 0.733 (95% CI, 0.687-0.776); ISS, 0.660 (95% CI, 0.612-0.707); and GTOS, 0.660 (95% CI, 0.611-0.706) in severe geriatric trauma. The TRISS also had the highest area under the curve of 0.961 (0.919-0.985) among the injury severity scoring systems in polytrauma. The predictive ability of TRISS was significantly higher than the other four scores with respect to overall trauma and polytrauma (P<0.001). @*Conclusion@#The TRISS showed the highest prognostic performance for predicting in-hospital mortality among all the injury severity scoring systems in severe geriatric trauma.

Comparison of the new and conventional injury severity scoring systems for predicting mortality in severe geriatric trauma

Objective@#This study compared the prognostic performance of the following five injury severity scores: the Geriatric Trauma Outcome Score (GTOS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS), the Revised Trauma Score (RTS), and the Trauma and Injury Severity Score (TRISS) for in-hospital mortality in severe geriatric trauma patients. @*Methods@#A retrospective, cross-sectional, observational study was conducted using a database of severe geriatric trauma patients (age ≥65 years and ISS ≥16) who presented to a single regional trauma center between November 2016 and October 2018. We compared the baseline characteristics between the survivor and mortality groups and the predictive ability of the five scoring systems. @*Results@#A total of 402 patients were included in the analysis; the in-hospital mortality rate was 25.6% (n=103). The TRISS had the highest area under the curve of 0.953 (95% confidence interval [CI], 0.927-0.971); followed by RTS, 0.777 (95% CI, 0.733-0.817); NISS, 0.733 (95% CI, 0.687-0.776); ISS, 0.660 (95% CI, 0.612-0.707); and GTOS, 0.660 (95% CI, 0.611-0.706) in severe geriatric trauma. The TRISS also had the highest area under the curve of 0.961 (0.919-0.985) among the injury severity scoring systems in polytrauma. The predictive ability of TRISS was significantly higher than the other four scores with respect to overall trauma and polytrauma (P<0.001). @*Conclusion@#The TRISS showed the highest prognostic performance for predicting in-hospital mortality among all the injury severity scoring systems in severe geriatric trauma.

Does the placement of automated external defibrillators affect first responders' willingness to perform cardiopulmonary resuscitation in high-rise residential buildings?

OBJECTIVE: The increasing number of people living in high-rise apartments may result in a delayed response from emergency medical technicians called out for an out-of-hospital cardiac arrest, making the role of apartment managers as the first responders extremely important. This study investigated whether automated external defibrillator (AED) placement influences the willingness of apartment managers to perform cardiopulmonary resuscitation (CPR) and use an AED. METHODS: A cross-sectional target population-based survey was conducted in Daegu, July 2016. Questionnaires were sent to apartment managers working in apartments with more than 500 households. The general characteristics of the respondents, status of CPR education, and knowledge about and willingness to perform CPR and use an AED were investigated. RESULTS: Of the 1,445 respondents, 758 (52.5%) worked in apartments with AEDs, of which 77.8% and 70.8% were willing to perform CPR and use an AED, respectively, compared with 68.1% and 60.0% of respondents who worked in apartments without AEDs. After adjusting for potential confounders, AED placement was associated with the willingness to perform CPR (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.04–1.71) and use an AED (OR, 1.39; 95% CI, 1.10–1.75). Prior CPR training and accurate knowledge of CPR skills were also associated with the willingness to perform CPR and use an AED. CONCLUSION: Placing AEDs in high-rise apartment buildings and providing refresher CPR education for maintaining CPR skills will be necessary to support apartment managers in their role as first responders.

Relationship between emergency department crowding and initial management, mortality of severe trauma patients

OBJECTIVE: This study examined whether emergency department (ED) crowding influences the timing of the initial assessment and treatment in severe trauma patients, as well as their mortality rates. METHODS: This retrospective, observational study was conducted between January 2015 and October 2016, and included adult severe trauma patients who presented to the ED. The emergency department occupancy rate (EDOR) was used to measure ED crowding. The patients were divided into four groups using the EDOR quartile. The timeliness of the initial assessment and treatment in the four groups as well as the mortality rates were compared. RESULTS: This study investigated 307 patients. The timing of the first computed tomography (CT) and laboratory test order, CT and laboratory test result acquisition, first transfusion, and patient transfer from the ED to the operating room were similar in the four groups. Multivariable logistic regression analysis did not show a significant difference in mortality between the groups. CONCLUSION: ED crowding was not associated with delays in the initial assessment and treatment of severe trauma patients, or in their mortality rates.

Validation of critical administration threshold and massive transfusion for mortality prediction in patients with adult severe trauma

OBJECTIVE: A massive transfusion (MT) of 10 or more units of packed red blood cells (PRCs) focuses on the summation volumes over 24 hours. This traditional concept promotes survivor bias and fails to identify the “massively” transfused patient. The critical administration threshold (≥3 units of PRCs per hour, CAT+) has been proposed as a new definition of MT that includes the volume and rate of blood transfusion. This study examined the CAT in predicting mortality in adult patients with severe trauma, compared to MT. METHODS: Retrospective data of adult major trauma patients (age≥15 years, Injury Severity Score [ISS]≥16) from a regional trauma center collected between May 2016 and June 2017 were used to identify the factors associated with trauma-related death. Univariate associations were calculated, and multiple logistic regression analysis was performed to determine the parameters associated with in-hospital mortality. RESULTS: A total of 540 patients were analyzed. The median ISS was 22, and the hospital mortality rate was 30.9% (n=92). Forty-two (7.8%) and 23 (4.3%) patients were CAT+ and traditional MT+, respectively. Severe brain injury, CAT+, acidosis, and elderly age were significant variables in multivariate analysis. CAT+ was associated with a fourfold increased risk of death (odds ratio, 4.427; 95% confidence interval, 1.040–18.849), but MT+ was not associated (odds, 1.837; 95% confidence interval, 0.376–8.979). CONCLUSION: The new concept of CAT for transfusion was a more useful validation concept of mortality in adult severe trauma patients on admission than traditional MT. Encompassing both the rate and volume of transfusion, CAT is a more sensitive tool than common MT definitions.

Probability of Early Retirement Among Emergency Physicians / 예방의학회지

OBJECTIVES: Early retirement occurs when one's job satisfaction suffers due to employment mismatch resulting from factors such as inadequate compensation. Medical doctors report high levels of job stress and burnout relative to other professionals. These levels are highest among emergency physicians (EPs), and despite general improvements in their working conditions, early retirement continues to become more common in this population. The purpose of this study was to identify the factors influencing EPs intention to retire early and to develop a probability equation for its prediction. METHODS: A secondary analysis of data from the 2015 Korean Society of Emergency Physicians Survey was performed. The variables potentially influencing early retirement were organized into personal characteristics, extrinsic factors, and intrinsic factors. Logistic regression analysis was performed to identify risk factors and to develop a probability equation; these findings were then arranged in a nomogram. RESULTS: Of the 377 survey respondents included in the analysis, 48.0% intended to retire early. Risk factors for early retirement included level of satisfaction with the specialty and its outlook, slanderous reviews, emergency room safety, health status, workload intensity, age, and hospital type. Intrinsic factors (i.e., slanderous reviews and satisfaction with the specialty and its outlook) had a stronger influence on early retirement than did extrinsic factors. CONCLUSIONS: To promote career longevity among EPs, it is vital to improve emergency room safety and workload intensity, to enhance medical professionalism through a stronger vision of emergency medicine, and to strengthen the patient-doctor relationship.

Association between public cardiopulmonary resuscitation education and the willingness to perform bystander cardiopulmonary resuscitation: a metropolitan citywide survey

OBJECTIVE: Bystander cardiopulmonary resuscitation (CPR) is an important factor associated with improved survival rates and neurologic prognoses in cases of out-of-hospital cardiac arrest. We assessed how factors related to CPR education including timing of education, period from the most recent education session, and content, affected CPR willingness. METHODS: In February 2012, trained interviewers conducted an interview survey of 1,000 Daegu citizens through an organized questionnaire. The subjects were aged ≥19 years and were selected by quota sampling. Their social and demographic characteristics, as well as CPR and factors related to CPR education, were investigated. Chi-square tests and multivariate logistic regression analyses were used to evaluate how education-related factors affected the willingness to perform CPR. RESULTS: Of total 1,000 cases, 48.0% were male. The multivariate analyses revealed several factors significantly associated with CPR willingness: didactic plus practice group (adjusted odds ratio [AOR], 3.38; 95% confidence interval [CI], 2.3 to 5.0), group with more than four CPR education session (AOR, 7.68; 95% CI, 3.21 to 18.35), interval of less than 6 months from the last CPR education (AOR, 4.47; 95% CI 1.29 to 15.52), and education with automated external defibrillator (AOR, 5.98; 95% CI 2.30 to 15.53). CONCLUSION: The following were associated with increased willingness to perform CPR: practice sessions and automated electrical defibrillator training in public CPR education, more frequent CPR training, and shorter time period from the most recent CPR education sessions.

Efficacy of embryo transfer on day 2 versus day 3 according to maternal age in patients with normal ovarian response / 대한생식의학회지

OBJECTIVE: Delaying embryo transfer (ET) enables us to select among the embryos available for transfer and is associated with positive effects on implantation and pregnancy outcomes. However, the optimal day for ET of human cleavage-stage embryos remains controversial. METHODS: A retrospective study of 3,124 in vitro fertilization/intracytoplasmic sperm injection cycles (2,440 patients) was conducted. We compared the effects of day 2 and 3 ET on rates of implantation and pregnancy outcomes between young maternal age (YMA; <38 years old, n=2,295) and old maternal age (OMA; ≥38 years old, n=829) patient groups. RESULTS: The YMA and OMA groups did not differ in terms of patient characteristics except for the proportion of unexplained factor infertility, which was significantly greater in the OMA group, and the proportion of arrested embryos, which was significantly greater in the YMA group. However, the biochemical pregnancy, clinical pregnancy, ongoing pregnancy, abortion, and implantation rates per cycle were not significantly different between day 2 and 3 ET in the YMA group or the OMA group. CONCLUSION: We suggest that offering patients the opportunity to decide which day would be suitable for ET could be part of a patient-friendly protocol that takes into consideration an infertile woman's circumstances and work schedule by allowing ET to be performed on day 2 instead of the traditional transfer on day 3.

Association of Public CPR Education with Willingness to Perform Bystander CPR: A Metropolitan City Wide Survey

PURPOSE: Bystander cardiopulmonary resuscitation (CPR) is an important factor in improving the survival rate and neurologic prognosis for out-of-hospital cardiac arrest patients. Here, we aimed to establish factors related to CPR education, such as timing of education, interval from the most recent education session, and contents, that may influence CPR willingness. METHODS: In February 2012, an interview survey of 1,000 Daegu citizens was conducted via organized questionnaire, administered by trained interviewers. Subjects were aged 19 years or older and selected by a quota sampling technique. Social and population characteristics, factors related to CPR, and factors related to CPR education, were investigated. The chi-square test and multivariate logistic regression analysis were used to evaluate education-related factors that may affect the willingness to perform CPR. RESULTS: The adjusted odds ratio (OR) for CPR willingness was 3.38 (95% confidence interval [CI], 2.3–5.0) among the respondents in the didactic plus practice group. The adjusted OR for CPR willingness was 7.68 (95% CI, 3.21–18.35) among the respondents receiving over 4 CPR education sessions. The adjusted OR for CPR willingness, in accordance with the time interval from the last CPR education session, was 4.47 (95% CI, 1.29–15.52) for intervals under 6 months and 3.80 (95% CI, 1.91–7.56) for intervals between 6 months and 1 year. If automated external defibrillator (AED) training was included in CPR education, the adjusted OR for CPR willingness was 5.98 (95% CI, 2.30–15.53). CONCLUSION: Including practice sessions and AED training in public CPR education, more frequent CPR revision and short time intervals in between CPR education sessions are associated with greater willingness to perform CPR.

Preventable Trauma Death Rate in Daegu, South Korea

PURPOSE: This study was performed to investigate the preventable death rate (PDR) in Daegu, South Korea, and to assess both its affecting- and preventable-factors to improve the treatment of regional trauma patients. METHODS: All cases of traumatic death that occurred between January 2012 and December 2012 in five hospitals in Daegu were analyzed retrospectively by a panel review. Cases were classified into preventable (P) and non-preventable deaths (NP). We determined the affecting factors of trauma deaths and preventable factors during trauma care. RESULTS: The PDR was 25.2%. Significant differences by mode of arrival, day of injury, cause of death, and time of emergency department (ED) arrival were observed between P and NP groups. According to the logistic regression analysis, preventability was associated with patients transferred from other hospitals, ED arrival at night and dawn, and non-head injuries. A total of 145 preventable factors were discovered in 59 preventable trauma deaths. When we categorized by location, the ED was the most common, with 71 cases, followed by 57 prehospital preventable factors. When we classified the preventable factors by process, 76.8% were process-related and 23.4% were structure-related. CONCLUSION: Our study is valuable to build an adequate trauma system in Daegu as it provides the baseline quality control data. Efforts to mediate the preventable factors were revealed in this study, and continuous reviews to calculate and track the PDR are needed to evaluate the local trauma system and establish a system specific to Daegu.

New method of assessing the relationship between buccal bone thickness and gingival thickness

PURPOSE: The aim of this study was to determine the relationship between buccal bone thickness and gingival thickness by means of a noninvasive and relatively accurate digital registration method. METHODS: In 20 periodontally healthy subjects, cone-beam computed tomographic images and intraoral scanned files were obtained. Measurements of buccal bone thickness and gingival thickness at the central incisors, lateral incisors, and canines were performed at points 0–5 mm from the alveolar crest on the superimposed images. The Friedman test was used to compare buccal bone and gingival thickness for each depth between the 3 tooth types. Spearman's correlation coefficient was calculated to assess the correlation between buccal bone thickness and gingival thickness. RESULTS: Of the central incisors, 77% of all sites had a buccal thickness of 0.5–1.0 mm, and 23% had a thickness of 1.0–1.5 mm. Of the lateral incisors, 71% of sites demonstrated a buccal bone thickness <1.0 mm, as did 63% of the canine sites. For gingival thickness, the proportion of sites <1.0 mm was 88%, 82%, and 91% for the central incisors, lateral incisors, and canines, respectively. Significant differences were observed in gingival thickness at the alveolar crest level (G0) between the central incisors and canines (P=0.032) and between the central incisors and lateral incisors (P=0.013). At 1 mm inferior to the alveolar crest, a difference was found between the central incisors and canines (P=0.025). The lateral incisors and canines showed a significant difference for buccal bone thickness 5 mm under the alveolar crest (P=0.025). CONCLUSIONS: The gingiva and buccal bone of the anterior maxillary teeth were found to be relatively thin (<1 mm) overall. A tendency was found for gingival thickness to increase and bone thickness to decrease toward the root apex. Differences were found between teeth at some positions, although the correlation between buccal bone thickness and soft tissue thickness was generally not significant.

Effects of Early Exercise Education using Video on Exercise Knowledge and Compliance of Elderly Patients Who Undergo Total Knee Replacement Surgery / 한국간호교육학회지

PURPOSE: This study was conducted to identify the effects of early exercise education using videos on exercise knowledge and compliance of elderly patients who undergo total knee replacement surgery. METHODS: This is a quasi-experimental study with a nonequivalent control group non-synchronized design. The participants were 70 elderly patients who had total knee arthroplasty in the C university hospital located in G city, Korea. Thirty-five patients were assigned to an experimental group and the other patients were assigned to a control group. After the total knee arthroplasty, the early exercise education accompanied by watching video instruction was conducted on the experimental group at post-operation second and third day for 15 minutes. General exercise education was administered to the control group. The exercise knowledge and compliance of the elderly patients were measured through structured questionnaires. CONCLUSION: The results of this study indicate that early exercise education using videos has positive effects to improve the exercise knowledge and compliance of elderly patients after total knee arthroplasty. This early exercise education can be used going forward as nursing intervention for elderly patients who undergo total knee replacement surgery.

Recurrent onycholysis in a patient with Behcet's disease / 영남의대학술지

Onycholysis is defined as a distal or distal lateral separation of the nail plate from the underlying or lateral supporting structures including nail bed, hyponychium, and lateral nail fold. Trauma, infection, psoriasis, thyrotoxicosis, and numerous drugs are common causes of onycholysis. However, there are few specific data on nail findings in Behcet's disease (BD). In this paper, we report on a 60-year-old man with BD, with no past history except BD, who developed recurrent onycholysis. The symptoms of onycholysis are considered to be recurrent depending on the activity of BD. The nail lesion showed improvement after classic treatment of BD and topical steroid ointment.