Re-evaluation characteristics of the Korean Triage and Acuity Scale (KTAS): the relationship between overcrowding and KTAS re-evaluation

Objective@#The purpose of the study was to analyze triage re-evaluation characteristics of the Korean Triage and Acuity Scale (KTAS). In particular, the relationship between overcrowding and KTAS re-evaluation at the emergency department (ED) was analyzed. @*Methods@#In this study, a retrospective chart review of 3,158 KTAS re-evaluation cases was performed. The sample included patients visiting a regional ED from January 1 to December 31 in 2018. Crowding was measured using the ED occupancy rate. Any cases assigned to a higher level on initial rather than the final evaluation were defined as overtriage, while any cases assigned to a lower level on initial rather than the final evaluation were defined as under-triage. @*Results@#The ED occupancy rate, which represents the level of ED overcrowding, scored 1.24±0.45 in case of undertriage, and 1.36±0.51 in case of over-triage. KTAS re-evaluation did not vary significantly based on the ED occupancy rate. The treatment results were analyzed according to the different KTAS grades of the KTAS re-evaluation group. The treatment results were different depending on the degree of under-triage. In the under-triage group, patients with a KTAS 2 or 3-grade difference had higher rates of ED hospitalization, mortality, and inter-hospital transfer than the patients with a KTAS 1 grade difference, and this variation was significant. @*Conclusion@#KTAS re-evaluation was not related to overcrowding in the ED. Among the KTAS re-evaluation cases, under-triage patients had higher rates of ED hospitalization, mortality, and hospital transfer. The triage provider, therefore, needs to be more careful at the time of initial classification.

Mental Health Status and Health-Promoting Lifestyle Behaviors among Call Center Employees

Background@#Call center employees experience high levels of occupational stress and other mental health issues. This study aimed to examine the relationship between mental health status and health-promoting lifestyles among call center employees. @*Methods@#A secondary data analysis from a descriptive cross-sectional study of 302 call center employees was conducted. Call center employees were asked to complete the Depression Anxiety Stress Scale (DASS) and the Health Promoting Lifestyle Profile-II (HPLP-II). @*Results@#Participants’ overall DASS score was 23.87±13.98 out of 63. Among the six subscales of the HPLP-II, participants’ highest scores were for interpersonal relations, spiritual growth, and stress management, whereas physical activity had the lowest score. Participants with a severe level of mental health issues (i.e., depression, anxiety, and stress) reported lower levels of health-promoting lifestyle behaviors, especially in the areas of physical activity, spiritual growth, interpersonal relationships, and stress management. @*Conclusions@#As call center service sectors increase in modern industries, so does the need to address the physical and mental health needs of its employees. Healthcare providers and organizations should closely and routinely monitor employee’s levels of depression, anxiety, and stress and develop organizational and health-related policies for the call center sector. Additionally, the development and implementation of health-related interventions to promote healthy lifestyle behaviors is critical for call center employees.

Venous Thromboembolism in a Single Korean Trauma Center: Incidence, Risk Factors, and Assessing the Validity of VTE Diagnostic Tools

Purpose@#Trauma increases the risk of venous thromboembolism (VTE) in hospitalized patients. However, the risk and incidence of VTE in Korean trauma patients are limited. Therefore, we aimed to evaluate the incidence and identify potential predictors of VTE occurrence in Korean trauma patients. Moreover, we assessed the validity of the Greenfield risk assessment profile (RAP) and the trauma embolic scoring system (TESS) in these patients. @*Materials and Methods@#This retrospective cohort study used the data of trauma patients who were admitted to a regional trauma center between 2010 and 2016 and were eligible for entry into the Korea Trauma Data Bank. Clinical data were collected from hospital medical records. The patient’s baseline characteristics and clinical data were compared between VTE and non-VTE groups. @*Results@#We included 9472 patients. The overall VTE rate was 0.87% (n=82), with 56 (0.59%) events of deep vein thrombosis and 39 (0.41%) of pulmonary embolism. Multiple regression analysis revealed that variables, including VTE history, pelvic-bone fracture, ventilator use, and hospitalization period, were significant, potential predictors of VTE occurrence. This study showed that increased RAP and TESS scores were correlated with increased VTE rate, with rates of 1% and 1.5% for the RAP and TESS scores of 6, respectively. The optimal cut-off value for RAP and TESS scores was 6. @*Conclusion@#RAP and TESS, which are well-known diagnostic tools, demonstrated potentials in predicting the VTE occurrence in Korean trauma patients. Additionally, patients with pelvic-bone fractures and long-term ventilator treatment should be carefully examined for possible VTE.

Re-evaluation characteristics of the Korean Triage and Acuity Scale (KTAS): the relationship between overcrowding and KTAS re-evaluation

Objective@#The purpose of the study was to analyze triage re-evaluation characteristics of the Korean Triage and Acuity Scale (KTAS). In particular, the relationship between overcrowding and KTAS re-evaluation at the emergency department (ED) was analyzed. @*Methods@#In this study, a retrospective chart review of 3,158 KTAS re-evaluation cases was performed. The sample included patients visiting a regional ED from January 1 to December 31 in 2018. Crowding was measured using the ED occupancy rate. Any cases assigned to a higher level on initial rather than the final evaluation were defined as overtriage, while any cases assigned to a lower level on initial rather than the final evaluation were defined as under-triage. @*Results@#The ED occupancy rate, which represents the level of ED overcrowding, scored 1.24±0.45 in case of undertriage, and 1.36±0.51 in case of over-triage. KTAS re-evaluation did not vary significantly based on the ED occupancy rate. The treatment results were analyzed according to the different KTAS grades of the KTAS re-evaluation group. The treatment results were different depending on the degree of under-triage. In the under-triage group, patients with a KTAS 2 or 3-grade difference had higher rates of ED hospitalization, mortality, and inter-hospital transfer than the patients with a KTAS 1 grade difference, and this variation was significant. @*Conclusion@#KTAS re-evaluation was not related to overcrowding in the ED. Among the KTAS re-evaluation cases, under-triage patients had higher rates of ED hospitalization, mortality, and hospital transfer. The triage provider, therefore, needs to be more careful at the time of initial classification.

Venous Thromboembolism in a Single Korean Trauma Center: Incidence, Risk Factors, and Assessing the Validity of VTE Diagnostic Tools

Purpose@#Trauma increases the risk of venous thromboembolism (VTE) in hospitalized patients. However, the risk and incidence of VTE in Korean trauma patients are limited. Therefore, we aimed to evaluate the incidence and identify potential predictors of VTE occurrence in Korean trauma patients. Moreover, we assessed the validity of the Greenfield risk assessment profile (RAP) and the trauma embolic scoring system (TESS) in these patients. @*Materials and Methods@#This retrospective cohort study used the data of trauma patients who were admitted to a regional trauma center between 2010 and 2016 and were eligible for entry into the Korea Trauma Data Bank. Clinical data were collected from hospital medical records. The patient’s baseline characteristics and clinical data were compared between VTE and non-VTE groups. @*Results@#We included 9472 patients. The overall VTE rate was 0.87% (n=82), with 56 (0.59%) events of deep vein thrombosis and 39 (0.41%) of pulmonary embolism. Multiple regression analysis revealed that variables, including VTE history, pelvic-bone fracture, ventilator use, and hospitalization period, were significant, potential predictors of VTE occurrence. This study showed that increased RAP and TESS scores were correlated with increased VTE rate, with rates of 1% and 1.5% for the RAP and TESS scores of 6, respectively. The optimal cut-off value for RAP and TESS scores was 6. @*Conclusion@#RAP and TESS, which are well-known diagnostic tools, demonstrated potentials in predicting the VTE occurrence in Korean trauma patients. Additionally, patients with pelvic-bone fractures and long-term ventilator treatment should be carefully examined for possible VTE.

Disaster Preparation of Visiting Nurses in Public Health Centers / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify the factors influencing personal disaster preparation and disaster nursing core competency among visiting nurses in public health centers. METHODS: A descriptive survey study was adopted. A convenience sample was taken from 277 subjects in three regions. Data were analyzed by descriptive statistics, t-test, ANOVA, correlation, Pearson correlation coefficient and multiple regression. RESULTS: The mean personal disaster preparation and disaster nursing core competency scores were 11.13 and 76.87, respectively. Personal disaster preparation was statistically significant by experience of disaster victims and disaster management guideline. Disaster nursing core competency was statistically significant by participation in future disaster recovery. As a result of multiple regression analysis, personal disaster preparation accounted for 14.9 of the variance by experience of disaster victims and disaster management guidelines; disaster nursing core competency accounted for 8.9 of the variance by perception of disaster nursing. CONCLUSION: Although visiting nurses are ill-prepared for disaster, global natural and man-made disasters can occur regardless of time and place. Disaster education and training should therefore be included in nurses' fundamental education.

Clinical Experiences as Related to Standard Precautions Compliance among Nursing Students: A Focus Group Interview Based on the Theory of Planned Behavior

PURPOSE: During clinical placements, nursing students who come into close contact with patients and provide nursing interventions may be exposed to harmful pathogens. However, little is known about nursing students' experiences with standard precautions (SP) in clinical settings. METHODS: We conducted interviews with six focus groups of nursing students (n = 38) from two universities in South Korea. The focus group interviews each took 90e120 minutes and included 6e7 participants from two different universities. The meetings used semi-structured interview protocols. Qualitative content analysis was employed. RESULTS: Four themes and 9 subthemes were identified: (a) attitudes (knowledge deficit, sensitivity), (b) subjective norms (negative role models, classroom and in-field gaps, blind spots), (c) perceived behavioral control (psychological barriers, physical barriers, lack of information), and (d) intention (changes in compliance awareness). CONCLUSIONS: These focus groups revealed that many nursing students worked in vulnerable environments and risked pathogen exposure. Nursing students expressed the importance of SP but reported witnessing many instances of failure to comply with established measures. Several barriers were explored as reasons of SP noncompliance. By removing the barriers presented in this study, nursing students would be able to perform their duties in a safe clinical environment.

Psychosocial Responses and Quality of Life among Amyotrophic Lateral Sclerosis Patients and Their Caregivers / 재활간호학회지

PURPOSE: The purpose of this study was to explore the psychosocial responses and quality of life (QOL) among Amyotrophic Lateral Sclerosis (ALS) patients and their caregivers in South Korea. METHODS: A cross-sectional design was used. Purposive sample of 15 ALS patients and their 14 caregivers were recruited via Korean Amyotrophic Lateral Sclerosis Association (KALSA) website. Demographic characteristics, hopelessness, quality of life, physical function, and caregiver burden were measured. RESULTS: The mean period after being diagnosed with ALS was 57.73 months. The mean score of amyotrophic lateral sclerosis functional rating scale and quality of life was 21.33 (SD=11.97) and 5.70 (SD=1.23) respectively. The mean score of hopelessness was 11.87 (SD=4.72). The caregivers' mean score of McGill quality of life was 4.29 (SD=1.46), and the mean score of McGill quality of life-single item scale was 4.29 (SD=2.02). CONCLUSION: Since the cause of ALS has not been identified and cure is yet to be discovered, supportive care should be provided for not only quality of life but hope of patients. The findings may be used to develop knowledge based nursing intervention for patients diagnosed with ALS and their caregivers.

Knowledge about HPV, and the Attitudes Toward HPV Vaccination among Adult Women in Asian Countries: A Literature Review / 종양간호학회지

PURPOSE: This literature review was conducted to provide a summary of the findings from research on knowledge and attitudes about human papilloma virus (HPV) and HPV vaccination, and studies of its actual uptake among women in Asian countries. METHODS: The author searched the Pubmed, CINAHL, and KISS electronic databases to identify peer-reviewed articles published between 2006 and 2011. RESULTS: Seventeen peer-reviewed studies met the inclusion criteria (13 quantitative, 4 qualitative). Findings from seven Asian countries that measured female adult's knowledge of HPV related issues and attitudes toward HPV vaccination were reviewed. Low level of knowledge about HPV and its related conditions, willingness to be vaccinated, and low uptake of vaccines were identified across the studies. Cultural barriers and social stigmatization about HPV vaccination were also discussed. CONCLUSION: Findings from this review indicate that adult women in Asian countries are in urgent need of improving HPV related knowledge and its actual vaccination. Policy makers, health care providers, and public health educators should take into account the cultural barriers and attitudes toward HPV vaccination in the process of developing and implementing educational programs and interventions for adult women in Asian countries.

The Change of Bispectral Index in Endotracheal Intubation with Propofol and Remifentanil without Muscle Relaxant

BACKGROUND: There have been conflicting reports about the effect of muscle relaxant to bispectral index during propofol anesthesia. The purpose of this study was to investigate the change of bispectral index (BIS) in endotracheal intubation with propofol and remifentanil without muscle relaxant and to compare with those in endotracheal intubation with muscle relaxant. METHODS: Forty-eight ASA physical status I or II patients were randomly allocated to 2 groups. Each patient were anesthetized with propofol at target effect site concentration of 4.0microg/ml with remifentanil 3.0microg/kg. Saline was injected in Group S and rocuronium 0.6 mg/kg was injected in Group R. Intubation was attempted, and the BIS, intubating condition, mean arterial pressure and heart rate were observed up to 5 minutes after intubation. RESULTS: BIS was elevated after intubation in Group S. BIS after intubation in group S were significantly higher than group R. BIS after injection of rocuronium in group R was significantly decreased. There were no significant differences in hemodynamic datas in two groups. Intubation condition was acceptable in all patients. CONCLUSIONS: The BIS in endotracheal intubation with propofol and remifentanil without muscle relaxantI can be higher than in endotracheal intubation with muscle relaxant.