Comparison of Neck Pain, Shoulder Pain, and Comfort between Buckwheat and Latex Pillows

BACKGROUND: This study aimed to investigate differences in neck pain, shoulder pain, and comfort between buckwheat and latex pillows in elderly sanatorium residents. METHODS: The crossover experimental study was performed with 30 elderly patients in a convalescent hospital for seniors. The buckwheat and latex pillows were used for 2 weeks, the 7 day was assigned as the washout between each one week intervention, respectively. Pre- and posttest visual analog scale (VAS) scores for neck and shoulder pains and the neck disability index (NDI) were investigated. Data were analyzed using paired-samples t test, and their correlations were analyzed using SPSS/WIN 21.0 (IBM Corp., New York, NY, USA). RESULTS: After the 2-week intervention, results showed that the use of buckwheat pillows decreased the VAS scores for neck and shoulder pains and NDI. Further, the use of latex pillows decreased the VAS score for neck pain and NDI, but the VAS score for shoulder pain showed no statistically significant differences (t=1.887, P=0.069). CONCLUSION: In conclusion, using latex and buckwheat pillows is the best option for reducing neck pain. Between the buckwheat and latex pillows, the buckwheat pillow is a better option for decreasing neck and shoulder pains.

A Panel Study on the Determinants of the Regional Variation in the Rate of Certification in Long-Term Care Insurance / 보건행정학회지

BACKGROUND: There have been deviations in the regional rate of certification in Korean long-term care insurance (LTCI). This study aimed to explore the determinants of the rate of certification in LTCI. METHODS: The panel data of the year 2010–2014 of the 227 National Health Insurance Service (NHIS) regional office were used. Making use of 26 explanatory variables (socio-demographic factors, access to the long-term care services, etc.), we estimated the random effects model using STATA SE ver. 13.0 program (Stata Corp., College Station, TX, USA) and tried to find out the determinants of the regional rate of certification. RESULTS: Estimation results showed that the most important determinants of the regional rate of certification in LTCI are the long-term care infrastructure such as capacity or number of the homecare service institution, sanatorium, or convalescent hospital. The number of the elderly who lives alone and the dimentia patients were positively related to the regional rate of certification in LTCI. CONCLUSION: The estimation results implied that the regional variation in the rate of certification in LTCI has nothing to do with the NHIS regional offices or their employees. To alleviate the deviation in the regional rate of certification in LTCI, we suggested the analysis of the deviation in the survey checklist. We also proposed to found the regional comprehensive support center to prevent the geriatric illness and to improve the residents' health, etc.

Importance-Performance Analysis of Clinical Nutrition Management in Convalescent Hospitals in the Gyeongnam Area

The purpose of this study was to analyze the importance-performance of clinical nutrition management in convalescent hospitals. The research was carried out based on questionnaires administered from March to April, 2015 to 73 dietitians at 40 convalescent hospitals in the Gyeongnam area. There was a statistically significant difference between the mean scores for importance (4.01/5.00) and performance (2.95/5.00) of clinical nutrition management. The importance and performance grid analysis showed that participation in a nutritional management committee, administration of patients using a cooperation program among hospital departments, cooperation with a medical team on patient's nutrition status, nutrition initial assessment, nutrition care process for patients showing malnutrition, nutrition care process for tube feeding patients, management of a therapeutic diet, meal management using dietary slip instructions including a therapeutic diet, and explication of a therapeutic diet for patients scored high regarding importance and performance (doing great area). Medical records on patient's nutrition management, and nutrition counseling for requested patient scored low regarding the importance and high regarding performance (overdone area). Participation in medical rounds, personal nutrition education for patients, group nutrition education for patients, nutrition education for medical teams, development of a menu for therapeutic diet and standardized recipes, and provision of information on diet therapy for patients after discharge scored low regarding importance and performance (low priority area). Accreditation of convalescent hospitals and interest of medical professionals in clinical nutrition management were effective variables for the importance-performance gap of clinical nutrition management. In conclusion, the accreditation process and positive awareness of medical professionals with regard to clinical nutrition management had positive effects on reduction of the importance-performance gap in clinical nutrition management at convalescent hospitals. The strength of clinical nutrition management in the accreditation and development of an education program for increasing medical team or administrator interest in clinical nutrition management could lead to improvement of clinical nutrition management for elderly patients in convalescent hospitals.

Effects of Hand Massage on Depression, Self-esteem and Vitality of the Elderly Patients in Convalescent Hospital / 한국간호교육학회지

PURPOSE: The purpose of this study was to examine the effects of hand massage on depression, self-esteem and vitality in elderly patients in convalescent hospitals. METHODS: This study employed a nonequivalent control group pretest-posttest design. The subjects were 24 elderly patients in the experimental group and 25 in a control group in a convalescent hospital located in G city. Data were collected using a questionnaire that relied on the geriatric depression scale (short form) by Sheikh and Yesavage; the self-esteem scale by Rosenberg; and the vitality scale used by Johnson and revised by Oh. The experimental group were treated with a general hand massage using only carrier oil on both hands for 10 minutes a day for seven days. The control group was given no treatment. The collected data were analyzed using t-test, χ2-test, and Fisher's exact test with SPSS Win Version 18.0. RESULTS: The results are as follows: The experimental group showed a significant improvement in depression, self-esteem and vitality than the control group. CONCLUSION: The results showed that hand massage was an effective intervention program for depression, self-esteem and vitality of elderly patients in convalescent hospitals.

A Case of Septic Shock Following Catheter-related Infection Caused by Lactococcus lactis subsp. lactis in an Adult

Lactococcus lactis is a gram-positive cocci used extensively in the dairy industry, but considered an unusual pathogen in humans. Among its five subspecies, L. lactis subsp. lactis in particular has rarely been reported as a pathogen. We report a case of septic shock caused by L. lactis subsp. lactis in an adult patient. A 64-yr-old male patient was admitted to outpatient clinics, with chief complaints of fever and chills for one week after convalescent hospital admission. He had severe ileus requiring surgery. He had a peripherally inserted central catheter from convalescent hospital, which was immediately removed. From two sets of blood and catheter tip cultures, we identified L. lactis subsp. lactis using the Vitek 2 system (bioMerieux Inc., USA), and confirmed this result by 16S rRNA sequencing. The patient was empirically treated with ciprofloxacin, and he recovered and was discharged.

Leading a Patient of Ankylosing Spondylitis to Death by Iatrogenic Spinal Fracture

Fractures in ankylosing spondylitis (AS) are often difficult to identify and treat. If combined with osteoporosis, the spine becomes weaker and vulnerable to minor trauma. An 83-year-old woman with a history of chronic AS and severe osteoporosis developed paraparesis and voiding difficulty for 4 days prior. She had been placed in the lateral decubitus position in a bedridden state in a convalescent hospital due to the progressive paraparesis. The laboratory findings showed CO₂ retention in the arterial blood gas analysis. After the patient was transferred to the computed tomography (CT) room, a CT was taken in the supine position. Approximately half an hour later, the resident in our neurosurgical department checked on her, and the neurological examination showed a complete paraplegic state. She was treated conservatively and finally expired 20 days later.

The Effects of Attitude to Death in the Hospice and Palliative Professionals on Their Terminal Care Stress / 한국호스피스완화의료학회지

PURPOSE: This study was conducted to explore the effects of attitude to death in hospice and palliative professionals on their terminal care stress, and to analyze relationships among variables related to the two aforementioned parameters, such as depression and coping strategies. METHODS: Participants were 131 hospice and palliative professionals from the cancer units of two tertiary hospitals and two general hospitals, two hospice facilities, two geriatric hospitals, and two convalescent hospitals in J province. Data were collected from April through June 2015 and analyzed using t-test, factor analysis, ANOVA (Scheffe test), ANCOVA, and Pearson's correlation and a path analysis using the SPSS/WIN 21.0 and AMOS 18.0 programs. RESULTS: The score for attitude to death was low (2.63), and that for depression was 0.45. Among all, 16.0% of the participants showed need for depression management. They scored 3.82 on terminal care stress. The subcategory with the highest mark was inner conflicts on limitation given availability of medical services (4.04). The score on coping strategy was low (3.13). They used passive coping strategies such as interpersonal avoidance (4.03), fulfilling basic needs (3.65) such as sleeping or eating. Attitudes to death had a direct negative effect on the terminal care stress level and indirectly affected through depression and fulfilling basic needs (CS2). CONCLUSION: It is necessary to provide hospice and palliative professionals with education on death and dying, as well as access to programs that provide emotional support and promote positive cognition of death and dying.

The role of primary care of voiding dysfunction in rehabilitation and convalescent hospitals

As the average life expectancy is longer and the prevalence of chronic disease increases in the elderly, the number of people who needs the care and treatment in the sanatorium is also growing. Voiding dysfunction is common disease in elderly people admitted in the sanatorium and it causes various problems such as fall and fracture. Urinary incontinence is the most frequent condition that decreases physical and mental ability and therefore, it is an important risk factor to reduce the quality of life in the elderly. Thus, investigation of the prevalence and actual practise about the care of urinary incontinence is necessary to reduce not only urinary incontinence but also combined problems in the sanatorium. About 48.1 - 65.3% of the elderly experienced urinary incontinence and the most common management for urinary incontinence was pad usage. However, pad usage without considering the each patient's condition induces poor hygiene, skin problem, and pressure ulcer. Therefore, care according to the each patient's type of urinary incontinence and condition is needed.

A Survey of Caregivers' Knowledge About Caring for Stroke Patients

OBJECTIVE: To investigate how much formal caregivers know about caring for stroke patients, and whether they adequately provide it. METHODS: Formal caregivers, who worked for stroke patients at 8 hospitals (including 4 university hospitals, 2 rehabilitation hospitals, and 2 convalescent hospitals) participated in this study. The survey was based on a self-report questionnaire, with 6 categories containing a total of 48 questions about the specific care of stroke patients: the demographic characteristics of the caregivers, bed positioning, the provision of meals, position changes and transfers, the range of motion exercises, and caregiver training. RESULTS: A total of 217 caregivers were surveyed, and they were distributed as follows: 41% came from the university hospitals, 35% came from the rehabilitation hospitals, and 24% came from the convalescent hospitals. The percentages of correct answers were distributed as follows: 64.3% for bed positioning, 74.3% for providing meals, and 62.4% for position change and transfer. The total and subscale scores of the caregivers working at convalescent hospitals were significantly lower than those of the caregivers working at the other types of hospitals (p<0.05). Only 7.8% of the total participants received training on a regular basis. The caregivers obtained most of the information from caregiver associations (58.1%), and the majority of the caregivers (65.4%) were willing to receive training. CONCLUSION: About one third (33.8%) of caregivers did not have adequate knowledge of how to properly care for stroke patients; in fact, a significant number of caregivers demonstrated inappropriate and insufficient knowledge in several areas. It is assumed that the provision of regular training, by rehabilitation experts, will improve the professionalism and knowledge of the caregivers, and positively affect patient outcomes.

Clinical Nutrition Management Status in Convalescent Hospitals Before and After Healthcare Accreditation Process

The increasing elderly population has created an urgent need for well-managed convalescent hospitals, which should provide appropriate clinical nutrition services. The new accreditation policy requiring participation of all convalescent hospitals since 2013 may promote improvement of clinical nutrition services. This study examined whether or not the accreditation policy has increased practice level and dietitians' perception of the importance of clinical nutrition management. Of the 177 convalescent hospitals accredited by January 30, 2014, dietitians from 73 hospitals (41.2%) completed the survey questionnaire. The pre-tested questionnaire surveyed general characteristics of the hospital and dietitians, current status of clinical nutrition management, and changes in the perception and practice levels of various aspects of food and clinical nutrition management. In average, dietitians with more than 5 years of work experience (68.1%) provided food and clinical nutrition services (71.2%). After accreditation, dietitians' perception of the importance and practice level of clinical nutrition service increased (P<0.001). Level of perception, however, was significantly (P<0.001) higher than practice level before and after accreditation. During perception and practice level of initial nutrition assessment, a compulsory accreditation item, notably and significantly (P<0.001) improved after accreditation. The significant difference between perception and practice level disappeared after accreditation. In conclusion, the accreditation process had positive effects on clinical nutrition management in terms of dietitians' perception and practice levels. Making more accreditation items compulsory and providing motivation and professional education to dietitians in convalescent hospitals could lead to additional improvements.

Job Satisfaction Level and Related Factors among Korean Hospital Dietitians

The objective of this study was to examine job satisfaction status and its related factors among dietitians working in hospitals. A survey questionnaire was sent to dietitians working in tertiary, general, and convalescent hospitals in Korea. The study sample hospitals included all tertiary hospitals (n=43), and the sample of general hospitals (n=114) and convalescent hospitals (n=240) was randomly selected using a stratified sampling method. A total of 665 dietitians completed the survey questionnaire. The questionnaire included 27 job satisfaction questions on task, stability.vision, working conditions, and relationship areas, and the questions on task improvement need. The job satisfaction scores in all four areas ranged from 2.53/5.00 to 3.89/5.00, implying generally low job satisfaction level in hospital dietitians. The job satisfaction levels in the convalescent hospital group were significantly lower compared to those in the tertiary and general hospital groups. Whereas job satisfaction levels of tertiary and convalescent hospital groups did not differ by number of beds, those of the general hospital group increased significantly with the number of beds for all four areas. Multivariate regression analysis results showed that hospital type was a significant predictor of job satisfaction level for all four areas. Job satisfaction of relationship area was also significantly affected by the number of beds, whereas that of working conditions was influenced by annual income and working experience. The study findings provide useful information in planning clinical dietitians' optimal supply outlook for the improvement of clinical nutrition services.

Analysis for the Patterns of Medical Care Utilization during 19 Years (1990-2008) and Its Related Factors in Hypertensive Patients Using National Patient Survey in Korea

BACKGROUND: To analyze the patterns of medical care utilization and its related factors in hypertensive patients during 19 years (1990-2008), utilizing national patient survey in Korea. METHODS: Using seven surveyed data, age-standardized medical care utilization increasing ratios for the inpatients and outpatients compared to the year of 1990 were calculated, respectively. Changes of medical facilities (%) of patients used in 1990, 1999, and 2008 were compared. For the outpatients, median length of stay and discharge mortality rate per 1,000 persons were calculated. Multivariate logistic regression methods were used to identify related factors of the resident patients and the comparison characteristics between hypertensives and the others of all subjects. Sample weights were used. RESULTS: The medical care utilization of hypertensives were increased for both inpatients and outpatients. However, the ratios were dramatically diminished after the standardization. Age-standardized ratios were 3.6 in outpatients and 5.9 in inpatients compared to 1990. For the outpatients, mainly used medical facilities were changed from general hospital to convalescent hospital. Also, median length of stay and discharge mortality rate were increased up to 5 times and 4 times compared to 1990. The odds of being resident patients were related with discharge as death and using oriental medical center convalescent hospital in 2008. Hypertensive patients were older than the others. Confined to hypertensive patients, member of National Health Insurance was more tend to be outpatients but less inpatients. CONCLUSIONS: Aging population and long-term care Act were presumed as the main reason for the increasing of medical care utilization in 1990 to 2008.

The Time Series Analysis of Standards and Results of Nutritional Domain in Hospital Evaluation Program

The purpose of this study was to evaluate the current state of foodservice and clinical nutrition management in a hospital-based nutrition department. Nutritional guidelines and survey reports of hospital evaluation programs from 2004 to 2009 were analyzed. In total, 275 hospitals in the first period and 288 hospitals in the second period were evaluated. The division of knife and chopping board use decreased from 97.2% in 2005 to 89.7% in 2008, the maintenance of a proper freezer temperature (below -18degrees C) increased from 82.1% in 2004 to 97.7% in 2007 (88.9% to 97.4% from large hospitals and 69.8% to 86.5% from small/medium hospitals in 2005 and 2008, respectively). In tube-feeding management, the performance rate of material cold storage and the offer rate of tube-feeding were 65.9% and 94.2% in 2007, respectively. The cold storage of material, proper use within 24 hours after opening or production, and the use of an appropriate label were 47.3%, 71.2% and 67.2% in 2009, respectively. The rate of a management system for undernourished patients was 86.0% in 2007 (56.4% for large hospitals, 18.9% for small/medium hospitals) and 14.3% in 2009. In standards of nutrition support management, the performance rates of constructing a nutrition support team, the nutrition support team activity, and organizing multidisciplinary team were 66.7%, 43.6%, and 64.1% respectively, in 2004. For large hospitals, those rates were 61.1%, 36.1%, and 58.3%, in 2005, 93.0%, 62.8%, and 91.9% in 2007, and 69.2%, 43.6%, and 69.2% in 2008, respectively. The results of this study suggest standards on sanitary foodservice preparation, production, and tube-feeding production need to correspond with HACCP regulations for small/meidium hospitals in standards of a healthcare accreditation system. It will be necessary to understand the operating conditions of nutrition departments in convalescent hospitals, psychiatric hospitals, and geriatrics hospitals. As the application of accreditation is required from 2013, standards will need to be improved and continuously updated for healthcare accreditation.

Characteristics of Scabies Patients in Goyang City and Transmission Route / 대한피부과학회지

BACKGROUND: Scabies is an ectoparasite caused by the mite Sarcoptes scabiei var. hominis, an obligate human parasite. Although its incidence has been decreasing, it is not a rare dermatologic disease and is difficult to diagnosis. OBJECTIVE: To evaluate the clinical characteristics of scabies patients and find out etiologic factors in transmission. METHODS: Two hundred and ninety-five patients who were diagnosed with scabies at the Dermatologic Department, Myongji Hospital, Goyang city, Korea were enrolled. Medical records were evaluated in a retrospective manner. RESULTS: We studied 295 scabies patients who were diagnosed by the mineral oil test or skin biopsy. The mean age of the patients was 58.2 (male: 56.7/female: 61.2), and 74% of patients were over 60 years. There was seasonal variation in occurrence, and scabies was found to be most common in winter. The majority of suspected routes of infection were transmission through convalescent hospitals (38.1%) and caregivers (15.2%). Nosocomial infection and communal living were the major causes. 73.8% of scabies patients had underlying medical disease, such as hypertension (32.2%) and dementia (11.9%). CONCLUSION: Currently, scabies prevalence is still increasing in Goyang city, because of the increased number of convalescent hospitals.