A Content Analysis of Disaster Nursing Education in Korean and Japanese Universities

PURPOSE: The purpose of this study is to analyze the contents of disaster nursing education at universities in Korea and Japan, with focus on textbooks. METHODS: Disaster nursing contents from 11 Korean community health nursing textbooks and 3 Japanese disaster nursing textbooks were analysed. RESULTS: Three themes and 8 categories of disaster nursing content in the selected textbooks were analyzed. The themes classified include ‘understanding of disaster’, ‘disaster management’ and ‘disaster management system’. The theme of ‘understanding of disaster’ consists of such categories as ‘disaster concept/outline’, ‘classification of disaster’, ‘disaster management step’ and ‘disaster impact’. The theme of ‘disaster management activities’ consists of categories such as ‘disaster management activities’ and ‘disaster nursing’. The theme of ‘national disaster management system’ consists of categories like ‘national disaster management system’ and ‘international disaster relief’. From the comparison of disaster nursing education in the two countries, we found that themes were similar but there were differences between the two countries in content configuration. Korea and Japan have adopted the framework of International Council of Nurses for disaster nursing education. Korea stressed legal and ethical capabilities, while Japan included psychological support for disaster management service providers. CONCLUSION: Disaster education is an important factor in a nurse's ability for a disaster management. Development of a comprehensive disaster education program is necessary to enhance disaster care capacities.

Cranioplasty Using Autologous Bone versus Porous Polyethylene versus Custom-Made Titanium Mesh : A Retrospective Review of 108 Patients

OBJECTIVE: The purpose of this study was to compare the cosmetic outcome and complications after cranioplasty (CP) due to three different implant materials, and analyze the mean implant survival and cumulative survival rate based on these results.METHODS: We reviewed 108 patients retrospectively who underwent CP between January 2014 and November 2016. Autologous bone (AB; 45 patients) and synthetic materials with porous polyethylene (PP; 32 patients) and custom-made 3-dimensional printed titanium mesh (CT; 31 patients) were used as implants.RESULTS: Regardless of implanted materials, more than 89.8% of the CP patients were satisfied with the cosmetic outcome. No statistically significant difference was observed among the three groups. The overall postoperative complication rates of each group were 31.1% in the AB group, 15.6% in the PP group and 3.2% in the CT group. The CT group showed lower complication rates compared with AB and PP groups (χ2-test : AB vs. PP, p=0.34; AB vs. CT, p=0.00; PP vs. CT, p=0.03). The AB and PP groups demonstrated a higher post-CP infection rate (11.1% and 6.3%) than the CT group (3.2%). However, no significant difference in the incidence of post-CP infection was observed among the three groups. The PP and CT groups demonstrated a higher mean implant survival time and cumulative survival rate than the AB group at the last follow-up (p < 0.05).CONCLUSION: In comparison with AB and PP, cranioplasty with CT shows benefits in terms of lower post-CP complication, less intraoperative bleeding loss, shorter operation time and in-hospital stay. The PP and CT groups showed higher implant survival time and cumulative survival rate compared with the AB group.

Cranioplasty Using Autologous Bone versus Porous Polyethylene versus Custom-Made Titanium Mesh : A Retrospective Review of 108 Patients

OBJECTIVE: The purpose of this study was to compare the cosmetic outcome and complications after cranioplasty (CP) due to three different implant materials, and analyze the mean implant survival and cumulative survival rate based on these results. METHODS: We reviewed 108 patients retrospectively who underwent CP between January 2014 and November 2016. Autologous bone (AB; 45 patients) and synthetic materials with porous polyethylene (PP; 32 patients) and custom-made 3-dimensional printed titanium mesh (CT; 31 patients) were used as implants. RESULTS: Regardless of implanted materials, more than 89.8% of the CP patients were satisfied with the cosmetic outcome. No statistically significant difference was observed among the three groups. The overall postoperative complication rates of each group were 31.1% in the AB group, 15.6% in the PP group and 3.2% in the CT group. The CT group showed lower complication rates compared with AB and PP groups (χ2-test : AB vs. PP, p=0.34; AB vs. CT, p=0.00; PP vs. CT, p=0.03). The AB and PP groups demonstrated a higher post-CP infection rate (11.1% and 6.3%) than the CT group (3.2%). However, no significant difference in the incidence of post-CP infection was observed among the three groups. The PP and CT groups demonstrated a higher mean implant survival time and cumulative survival rate than the AB group at the last follow-up (p < 0.05). CONCLUSION: In comparison with AB and PP, cranioplasty with CT shows benefits in terms of lower post-CP complication, less intraoperative bleeding loss, shorter operation time and in-hospital stay. The PP and CT groups showed higher implant survival time and cumulative survival rate compared with the AB group.

Comparison between Korean and Japanese Nursing Students in Their Disaster Preparedness

PURPOSE: The purpose of this study is to identify differences in disaster awareness, disaster preparedness, and nursing knowledge and practices between Korean and Japanese nursing students. METHODS: The study subjects were 4th grade nursing students who completed their nursing education in Korea or in Japan. 359 students from Korea and 135 students from Japan participated in this study. Data were analyzed using IBM SPSS 21.0. The χ2 test and the t-test were used to analyze the homogeneity of subjects' general characteristics and disaster-related characteristics. The comparison between the Korean and Japanese nursing students in disaster awareness, disaster preparedness, and nursing knowledge and practices were conducted using ANCOVA. RESULTS: The Korean nursing students' disaster awareness, disaster preparedness, and nursing knowledge and practice were different from their Japanese counterparts'. The Korean nursing students recognized that the system of disaster management in Korea was insufficient and the negligence of management was one of the causes of the disaster. They wanted to participate in activities for disaster preparedness education and management. CONCLUSION: A disaster nursing curriculum dealing with disaster awareness, disaster preparedness, and nursing knowledge and practices, should be developed, implemented, and evaluated particularly for Korean nursing students.

Development of Korean Menstrual Symptom Scale for University Students

PURPOSE: To develop Korean Menstrual Symptom Scale (KMSS) for university students and test its reliability and validity. METHODS: The scale was developed by intensive literature review, development of preliminary items, verification of content validity, development of secondary items, verification of construct validity, and extraction of final items. Thirty-nine items were constructed. Data for validity and reliability testing were collected with a questionnaire survey from 391 university students. Data were analyzed with descriptive statistics, factor analysis, and reliability coefficients (Cronbach's α) with the SPSS program. RESULTS: There were 37 final items which were sorted into six factors: ‘negative affection (8 items)’, ‘change of activity level (7 items)’, ‘physical symptom (9 items)’, ‘mood change (9 items)’, ‘change in concentration level (4 items)’, and ‘body water retention (5 items)’. The cumulative percent of variance was 63.3%. Regarding the reliability of the scale, its Cronbach's α was 0.96. Cronbach's α values for these factors ranged from 0.75 to 0.91. CONCLUSION: The KMSS demonstrated acceptable validity and reliability. Repeated research is needed to measure menstrual symptom experienced by women of variable ages.

Correlations between Xerostomia, Oral Health Quality of Life and Knowledge about Water Intake among Community-dwelling Older Adults / 재활간호학회지

PURPOSE: This study is to verify the correlations between xerostomia, oral health quality of life, and knowledge about water intake among community-dwelling older adults and to suggest basic data for the development of oral health enhancement programs to improve the quality of life in the elderly. METHODS: A convenience sample of 112 elders was recruited in W city, Gangwon-do from July to August 2017. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, and Pearson's correlation coefficients with SPSS/WIN 23.0 Program. RESULTS: The mean age of the subjects was 73 years old. As the score of knowledge about water intake was average 3 point (out of ten), the knowledge about physical symptoms in case of water deficiency was very insufficient. Xerostomia showed negative correlations with the oral health quality of life (r=−.379, p < .001) and knowledge about water intake (r=−.228, p < .016). CONCLUSION: For the relief of xerostomia having effects on the oral health quality of life in the elderly, it would be necessary to develop and apply oral health enhancement programs including the recommendation of water intake, and then to verify the effects.

A Comparison of Anterior Cervical Discectomy and Fusion versus Fusion Combined with Artificial Disc Replacement for Treating 3-Level Cervical Spondylotic Disease

OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of 3-level hybrid surgery (HS), which combines fusion and cervical disc replacement (CDR), compared to 3-level fusionin patient with cervical spondylosis involving 3 levels. METHODS: Patients in the anterior cervical discectomy and fusion (ACDF) group (n=30) underwent 3-level fusion and the HS group (n=19) underwent combined surgery with fusion and CDR. Clinical outcomes were evaluated using the visual analogue scale for the arm, the neck disability index (NDI), Odom criteria and postoperative complications. The cervical range of motion (ROM), fusion rate and adjacent segments degeneration were assessed with radiographs. RESULTS: Significant improvements in arm pain relief and functional outcome were observed in ACDF and HS group. The NDI in the HS group showed better improvement 6 months after surgery than that of the ACDF group. The ACDF group had a lower fusion rate, higher incidence of device related complications and radiological changes in adjacent segments compared with the HS group. The better recovery of cervical ROM was observed in HS group. However, that of the ACDF group was significantly decreased and did not recover. CONCLUSION: The HS group was better than the ACDF group in terms of NDI, cervical ROM, fusion rate, incidence of postoperative complications and adjacent segment degeneration.

Toxoplasmic Encephalitis in Patient with Acquired Immunodeficiency Syndrome

Toxoplasmic encephalitis (TE) is an opportunistic infection found in immunocompromised patients and TE related cerebral mass lesion is often reported in acquired immunodeficiency acquired immunodeficiency syndrome (AIDS) patients. However, incidence of TE related AIDS in Korea is still rare and is unfamiliar to neurosurgeons. Differential diagnosis is needed to rule out other brain lesions. A 39-year-old man visited the emergency room with rapid progressive left hemiparesis. Magnetic resonance imaging showed a ring-enhanced mass lesion in his right frontal lobe. Human immunodeficiency virus and Toxoplasma gondii immunoglobulin G were tested positive by a serologic test. We report here a rare case of patient with TE related AIDS.

Delayed Esophagus Perforation after Anterior Cervical Spine Surgery / 대한신경손상학회지

Esophageal perforation is a serious possible complication after anterior cervical discectomy and fusion (ACDF). It usually occurs during the first postoperative day. Esophageal perforation is a potentially life-threatening complication. A 63-year-old man who underwent ACDF 8 years prior visited our emergency room with recurrent aspiration pneumonia, fever, dysphagia and neck pain. Endoscopic study showed esophageal perforation by cervical plate. Successful treatment of the perforation resulted after surgical repair using a sternocleidomastoid muscle flap. We presented a rare case of delayed esophageal perforation after ACDF and successful treatment of the perforation by surgical repair using a sternocleidomastoid muscle flap.

Rapid Spontaneous Resolution of Acute Subdural Hematoma in a Patient with Liver Cirrhosis / 대한신경손상학회지

Acute subdural hematoma (ASDH) constitutes one of the most critical emergencies in neurosurgery and rapid spontaneous resolution of ASDH is an infrequent phenomenon. Several mechanisms have been attributed to explain this phenomenon including redistribution of subdural blood, dilution by cerebral spinal fluid and brain atrophy. Rapid resolution of ASDH related to coagulopathy is a rare phenomenon; to our knowledge, only one case has been reported. We report on a patient who showed rapid resolution of ASDH with coagulopathy and also discuss such a rare case with speculation of the coagulopathy as a factor to promote this phenomenon.

Endovascular Treatment of the Distal Internal Carotid Artery Large Aneurysm

OBJECTIVE: According to the development of endovascular technique and devices, larger aneurysms on the distal internal carotid artery (ICA) can be treated using a less invasive method. The authors report on clinical and angiographic outcomes of these aneurysms treated using an endovascular technique. MATERIALS AND METHODS: Data on 21 patients with large aneurysms at distal ICA treated by endovascular method between January 2005 and December 2012 were included in this retrospective analysis. RESULTS: Clinical outcome of patients showed strong correlation with the initial neurologic status (p < 0.05). Aneurysm morphology showed saccular, fusiform, and wide-neck in 12, six and three patients. Six patients underwent stent assisted coiling and the other 15 patients underwent simple coiling. Aneurysm occlusion was performed immediately after embolization with near-complete (Raymond class 1-2) in 20 patients (95.2%) and incomplete (Raymond class 3) in one patient (4.8%). Delayed thrombotic occlusion occurred in two patients and their clinical result was fatal. Another five patients died in the hospital, from massive brain edema and/or increased intracranial pressure due to initial subarachnoid hemorrhage. Overall mortality was 30% (seven out of 21). Fatal complication related to the endovascular procedure occurred in two patients with thrombosis at middle cerebral artery (one with stent, the other without it). CONCLUSION: Recent developed endovascular device and technique is safe enough and a less invasive method for distal large or giant aneurysms. Based on our analysis of the study, we suspect that coil embolization of large distal ICA aneurysms (with or without stenting) is effective and safe.

Single Stage Posterior Lumbar-Sacral Reconstruction with Expendable Cage and Iliac Screw for Fifth Lumbar Fracture-Dislocation / 대한신경손상학회지

Fracture-dislocations of the fifth lumbar vertebra are rare. Treatment of L5 vertebra fractures depends on fracture type and neurological findings. The authors describe a single-staged surgical technique of only posterior circumferential decompression, spinal reconstruction with expandable cage insertion and instrument fixation.

Single Stage Posterior Lumbar-Sacral Reconstruction with Expendable Cage and Iliac Screw for Fifth Lumbar Fracture-Dislocation / 대한신경손상학회지

Fracture-dislocations of the fifth lumbar vertebra are rare. Treatment of L5 vertebra fractures depends on fracture type and neurological findings. The authors describe a single-staged surgical technique of only posterior circumferential decompression, spinal reconstruction with expandable cage insertion and instrument fixation.

Thirteen-year Experience of 44 Patients with Adult Hemorrhagic Moyamoya Disease from a Single Institution: Clinical Analysis by Management Modality

Our objective was a retrospective assessment of the management modalities that provided the most beneficial treatment in hemorrhagic moyamoya disease during the last 13 years at our institution. The clinical results of 44 patients with hemorrhagic moyamoya disease were investigated, comparing revascularization surgery (direct, indirect, and combined bypass) or conservative treatment. Angiographic features, rebleeding, and clinical outcome were investigated. Six of the 35 patients (17.1%) with revascularization surgery experienced rebleeding, as did 4 of 9 patients (44.4%) with conservative treatment. However, patients who underwent bypass surgery had a lower chance of rebleeding. No significant difference in chance of rebleeding was observed between bypass surgery and non surgery groups (p > 0.05). Cerebral angiography performed after bypass surgery showed that for achieving good postoperative revascularization, direct and combined bypass methods were much more effective (p < 0.05). While the risk of rebleeding in the revascularization group was generally lower than in the conservative treatment group, there was no statistically significant difference between treatment modalities and conservative treatment. Although statistical significance was not attained, direct and combined bypass may reduce the risk of hemorrhage more effectively than indirect bypass.

Thirteen-year Experience of 44 Patients with Adult Hemorrhagic Moyamoya Disease from a Single Institution: Clinical Analysis by Management Modality

Our objective was a retrospective assessment of the management modalities that provided the most beneficial treatment in hemorrhagic moyamoya disease during the last 13 years at our institution. The clinical results of 44 patients with hemorrhagic moyamoya disease were investigated, comparing revascularization surgery (direct, indirect, and combined bypass) or conservative treatment. Angiographic features, rebleeding, and clinical outcome were investigated. Six of the 35 patients (17.1%) with revascularization surgery experienced rebleeding, as did 4 of 9 patients (44.4%) with conservative treatment. However, patients who underwent bypass surgery had a lower chance of rebleeding. No significant difference in chance of rebleeding was observed between bypass surgery and non surgery groups (p > 0.05). Cerebral angiography performed after bypass surgery showed that for achieving good postoperative revascularization, direct and combined bypass methods were much more effective (p < 0.05). While the risk of rebleeding in the revascularization group was generally lower than in the conservative treatment group, there was no statistically significant difference between treatment modalities and conservative treatment. Although statistical significance was not attained, direct and combined bypass may reduce the risk of hemorrhage more effectively than indirect bypass.

Hybrid Surgery of Multilevel Cervical Degenerative Disc Disease : Review of Literature and Clinical Results

OBJECTIVE: In the present study, we evaluated the effect, safety and radiological outcomes of cervical hybrid surgery (cervical disc prosthesis replacement at one level, and interbody fusion at the other level) on the multilevel cervical degenerative disc disease (DDD). METHODS: Fifty-one patients (mean age 46.7 years) with symptomatic multilevel cervical spondylosis were treated using hybrid surgery (HS). Clinical [neck disability index (NDI) and Visual Analogue Scale (VAS) score] and radiologic outcomes [range of motion (ROM) for cervical spine, adjacent segment and arthroplasty level] were evaluated at routine postoperative intervals of 1, 6, 12, 24 months. Review of other similar studies that examined the HS in multilevel cervical DDD was performed. RESULTS: Out of 51 patients, 41 patients received 2 level hybrid surgery and 10 patients received 3 level hybrid surgery. The NDI and VAS score were significantly decreased during the follow up periods (p<0.05). The cervical ROM was recovered at 6 and 12 month postoperatively and the mean ROM of inferior adjacent segment was significantly larger than that of superior adjacent segments after surgery. The ROM of the arthoplasty level was preserved well during the follow up periods. No surgical and device related complications were observed. CONCLUSION: Hybrid surgery is a safe and effective alternative to fusion for the management of multilevel cervical spondylosis.

Surgical Treatment of Craniovertebral Junction Instability : Clinical Outcomes and Effectiveness in Personal Experience

OBJECTIVE: Craniovertebral junction (CVJ) consists of the occipital bone that surrounds the foramen magnum, the atlas and the axis vertebrae. The mortality and morbidity is high for irreducible CVJ lesion with cervico-medullary compression. In a clinical retrospective study, the authors reviewed clinical and radiographic results of occipitocervical fusion using a various methods in 32 patients with CVJ instability. METHODS: Thirty-two CVJ lesions (18 male and 14 female) were treated in our department for 12 years. Instability resulted from trauma (14 cases), rheumatoid arthritis (8 cases), assimilation of atlas (4 cases), tumor (2 cases), basilar invagination (2 cases) and miscellaneous (2 cases). Thirty-two patients were internally fixed with 7 anterior and posterior decompression with occipitocervical fusion, 15 posterior decompression and occipitocervical fusion with wire-rod, 5 C1-2 transarticular screw fixation, and 5 C1 lateral mass-C2 transpedicular screw. Outcome (mean follow-up period, 38 months) was based on clinical and radiographic review. The clinical outcome was assessed by Japanese Orthopedic Association (JOA) score. RESULTS: Nine neurologically intact patients remained same after surgery. Among 23 patients with cervical myelopathy, clinical improvement was noted in 18 cases (78.3%). One patient died 2 months after the surgery because of pneumonia and sepsis. Fusion was achieved in 27 patients (93%) at last follow-up. No patient developed evidence of new, recurrent, or progressive instability. CONCLUSION: The authors conclude that early occipitocervical fusion to be recommended in case of reducible CVJ lesion and the appropriate decompression and occipitocervical fusion are recommended in case of irreducible craniovertebral junction lesion.

Bilateral Multiple Intracerebral Hemorrhagic Infarction after Cranioplasty in a Patient with Cerebral Infarction: Case Report / 대한뇌혈관외과학회지

Bilateral multiple intracranial hemorrhagic infarction after cranioplasty is an extremely rare complication. We present a case of a bilateral multiple intracranial hemorrhagic infarction following cranioplasty with an autologous bone graft. A 63-year-old woman had a previous decompressive craniectomy after a right middle cerebral artery infarction. The possible pathogenesis of the complication is discussed.

Intramedullary Kirschner Wire Fixation for Forearm Fractures in Children

PURPOSE: To evaluate the clinical and radiological results of intramedullary fixation using Kirschner wires (K-wires) for the treatment of unstable forearm fractures in children. MATERIALS AND METHODS: Forty-three children who underwent intramedullary fixation using K-wires for the treatment of a forearm bone fracture were evaluated. The rodiological results were based on the time to union and angular deformity at last follow-up. The clinical results were analyzed according to Price criteria. RESULTS: Average union time was 6.9 weeks. Preoperatively, average angular deformity of radius is 11.4 degrees in anteroposterior (AP) view and 15.3 degrees in lateral view. In case of the ulna, arerage angular deformity was 8.3 degrees in AP view and 12.7 degrees in lateral view. At last follow up, average angular deformity of radius was 1.5 degrees in AP view and 1.6 degrees in lateral view. In case of the ulna, arerage angular deformity was 1.3 degrees in AP view and 2.5 degrees in lateral view. According to the criteria of Price et al., 42 patients (97%) were excellent and one patient (3%) was good. No specific complication was observed. CONCLUSION: An intramedullary fixation using K-wires is an attractive treatment option for unstable forearm fractures in children in terms of safety, excellent cosmesis, short hospitalization, easy hardware removal, and providing excellent radiological and clinical results.

Intramedullary Entire Spinal Cord Abscess Secondary to a Congenital Dermal Sinus: A Case Report

Intramedullary spinal abscesses are rare and potentially devastating lesions. The first case of spinal abscess was described in 1830 and fewer than 100 cases have been reported subsequently. Only sixteen previous reports have described an intramedullary abscess of the central nervous system secondary to a dermal sinus. Involvement of the entire cord is thus exceedingly rare. We present a case of a 7-month-old girl who had rapidly progressing quadriplegia with urinary and bowel retention and was found to have an intramedullary abscess as a result of a dermal sinus. Spine MRI shows thick irregular ring enhancement appeared within the broadest area of the spinal cord on the thoracic and lumbar area on mid thoracic level to L3 and high cervical area which extended to medulla. Immediate decompressive surgery and antibiotic treatment were performed. Excellent clinical outcome was obtained with a combination of medical and surgical management. Complete neurological assessment and diagnostic study of all patients with a congenital dermal sinus are very important. Prophylatic surgery is indicated in many cases to prevent dangerous and recurrent infections of the central nervous system.