Expert Consensus on COVID-19 Vaccination in Korean Adolescents:A Modified Delphi Survey

The effectiveness of coronavirus disease 2019 (COVID-19) vaccines had been shown in many studies in adult population, however, the real-world evidence in the childhood population was scarce. We aimed to organize the collective expert’s opinions on adolescent vaccination against COVID-19 in Korea, therefore to guide the vaccination policy in the setting of available evidence. The Delphi panels responded that adolescents were greatly impacted by the quarantine measures, and COVID-19 is an important health problem for adolescents.Panels responded that in general, the benefits of the COVID-19 vaccine overweigh the potential risks in Korean adolescents. Continuing monitoring of available data is needed to provide the best vaccination practices in adolescents guided by the updated evidence.

KCDC Risk Assessments on the Initial Phase of theCOVID-19 Outbreak in Korea

Objectives@#This study aims to evaluate the risk assessments of coronavirus 2019 (COVID-19) in the KoreaCenters for Disease Control and Prevention (KCDC), from the point of detection to the provision of basicinformation to the relevant public health authorities. @*Methods@#To estimate the overall risk of specific public health events, probability, and impact at thecountry-level were evaluated using available information. To determine the probability of particularpublic health events, the risk of importation and risk of transmission were taken into consideration.KCDC used 5 levels (“very low,” “low,” “moderate,” “high,” and “very high”) for each category and overallrisk was eventually decided. @*Results@#A total of 8 risk assessments were performed on 8 separate occasions between January 8th toFebruary 28th, 2020, depending on the detection and report of COVID-19 cases in other countries. Theoverall risk of the situation in each assessment increased in severity over this period: “low” (first),“moderate” (second), “high” (third), “high” (fourth), “high” (fifth), “high” (sixth), “high” (seventh), and“very high” (eighth). @*Conclusion@#The KCDC’s 8 risk assessments were utilized to activate national emergency responsemechanisms and eventually prepare for the pandemic to ensure the containment and mitigation ofCOVID-19 with non-pharmaceutical public health measures.

Cytotoxic and anticancer properties of the Malaysian mangrove pit viper (Trimeresurus purpureomaculatus) venom and its disintegrin (purpureomaculin)

The Asiatic pit vipers from the Trimeresurus complex are medically important venomous snakes. These pit vipers are often associated with snakebite that leads to fatal coagulopathy and tissue necrosis. The cytotoxic venoms of Trimeresurus spp.; however, hold great potential for the development of peptide-based anticancer drugs. Methods: This study investigated the cytotoxic effect of the venom from Trimeresurus purpureomaculatus, the mangrove pit viper (also known as shore pit viper) which is native in Malaysia, across a panel of human cancer cell lines from breast, lung, colon and prostate as well as the corresponding normal cell lines of each tissue. Results: The venom exhibited dose-dependent cytotoxic activities on all cell lines tested, with median inhibition concentrations (IC50) ranging from 0.42 to 6.98 µg/mL. The venom has a high selectivity index (SI = 14.54) on breast cancer cell line (MCF7), indicating that it is significantly more cytotoxic toward the cancer than to normal cell lines. Furthermore, the venom was fractionated using C18 reversed-phase high-performance liquid chromatography and the anticancer effect of each protein fraction was examined. Fraction 1 that contains a hydrophilic low molecular weight (approximately 7.5 kDa) protein was found to be the most cytotoxic and selective toward the breast cancer cell line (MCF7). The protein was identified using liquid chromatography-tandem mass spectrometry as a venom disintegrin, termed purpureomaculin in this study. Conclusion: Taken together, the findings revealed the potent and selective cytotoxicity of a disintegrin protein isolated from the Malaysian T. purpureomaculatus venom and suggested its anticancer potential in drug discovery.(AU)

Effects of Reminiscence Therapy on Depressive Symptoms in Older Adults with Dementia: A Systematic Review and Meta-Analysis / 간호학회지

PURPOSE: The purpose of this study was to evaluate the effects of reminiscence therapy on depressive symptoms in older adults with dementia using a systematic review and meta-analysis. METHODS: Randomized controlled trials (RCTs) published from January 2000 to January 2018 were searched through Research Information Sharing Service (RISS), Korean Studies Information Service System (KISS), Korean Medical Database (KMbase), KoreaMed, PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ovid MEDLINE. Two researchers independently performed the search, selection, and coding. Comprehensive Meta-Analysis 3.0 was used for meta-analysis, and Review Manager program 5.3 was used for quality assessment. RESULTS: Out of the 1,250 retrieved articles, 22 RCTs were selected for analysis. The overall effect size of reminiscence therapy for mitigating depressive symptoms in older adults with dementia was −0.62 (95% Cl: −0.92 to −0.31). The effect size was greater in older adults under 80, those with less disease severity, and those for whom the therapy session lasted less than 40 minutes. CONCLUSION: Reminiscence therapy is an effective non-pharmacological therapy to improve depressive symptoms in older adults with dementia. Because its effectiveness is also influenced by age, disease severity, and application method, it is necessary to consider treatment designs based on individual characteristics as well as methodological approaches.

Experiences of Mothers' Attachment in a Follow-Up Program Using Early Intervention for Low-Birth-Weight Infants

PURPOSE: Mothers who give birth prematurely experience parenting stress after their babies are discharged and find it difficult to emotionally bond with them. Forming an emotional bond with a baby promotes the baby's growth and development, helps the mother cope with parenting stress after discharge, and is important for maintaining family functioning. This study aimed to identify the attachment experiences of mothers with low-birth-weight infants (LBWIs) in a follow-up program using early intervention. METHODS: A phenomenological perspective was used for this qualitative research. Data were collected from in-depth interviews with twelve mothers who participated in a follow-up program using early intervention for mothers with LBWIs from September 2017 to December 2017. Colaizzi's method was used to analyze the data. RESULTS: The experience of mothers' attachment was investigated on the basis of three categories: ‘beginning of changes in parenting methods,’ ‘forming an intimate mother–child bond,’ and ‘concerns and expectation about the child's development.’ CONCLUSION: The results indicate that the follow-up program using an early intervention designed to increase mothers' confidence in their parenting skills can promote mother' attachment and the quality of life of families with LBWIs.

Effects of Reminiscence Therapy on Depressive Symptoms in Older Adults with Dementia: A Systematic Review and Meta-Analysis

PURPOSE@#The purpose of this study was to evaluate the effects of reminiscence therapy on depressive symptoms in older adults with dementia using a systematic review and meta-analysis.@*METHODS@#Randomized controlled trials (RCTs) published from January 2000 to January 2018 were searched through Research Information Sharing Service (RISS), Korean Studies Information Service System (KISS), Korean Medical Database (KMbase), KoreaMed, PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ovid MEDLINE. Two researchers independently performed the search, selection, and coding. Comprehensive Meta-Analysis 3.0 was used for meta-analysis, and Review Manager program 5.3 was used for quality assessment.@*RESULTS@#Out of the 1,250 retrieved articles, 22 RCTs were selected for analysis. The overall effect size of reminiscence therapy for mitigating depressive symptoms in older adults with dementia was −0.62 (95% Cl: −0.92 to −0.31). The effect size was greater in older adults under 80, those with less disease severity, and those for whom the therapy session lasted less than 40 minutes.@*CONCLUSION@#Reminiscence therapy is an effective non-pharmacological therapy to improve depressive symptoms in older adults with dementia. Because its effectiveness is also influenced by age, disease severity, and application method, it is necessary to consider treatment designs based on individual characteristics as well as methodological approaches.

Psychosocial Adjustment in Korean Colorectal Cancer Survivors

PURPOSE: The increasing survival rate of colorectal cancer demands various nursing interventions and continuous care for patients to adapt to their psychosocial daily lives. The purpose of this study was to identify factors associated with psychosocial adjustment in colorectal cancer survivors. METHODS: A cross-sectional descriptive study with face-to-face interviews was conducted of 156 colorectal cancer survivors after surgery visiting an outpatient cancer clinic at a tertiary hospital in S city, Korea. Posttraumatic growth, health-promoting behavior, length of treatment, difficulty in activities of daily living, and having a stoma were entered into the linear regression model. RESULTS: The strongest factor influencing the level of psychosocial adjustment was health-promoting behavior (β=.33, p < .001), followed by difficulty in activities of daily living (β=-.24, p=.001), posttraumatic growth (β=.20, p=.004), and having a stoma (β=-.19, p=.004). CONCLUSION: Nursing interventions for psychosocial adjustment in colorectal cancer survivors need to include the contents for posttraumatic growth, as well as health-promoting behavior, and activities of daily living.

Relationships between Personal Traits, Emotional Intelligence, Internal Marketing, Service Management, and Customer Orientation in Korean Outpatient Department Nurses

PURPOSE: Current increase and complexity of medical tests and surgical procedures at outpatient department (OPD) require OPD nurses to have customer orientation focusing on various customers' interests and needs. The purpose of this study was to identify the factors associated with customer orientation in nurses working at OPD of hospitals. METHODS: The study used a descriptive correlational design with cross-sectional survey. The study settings were four general hospitals in Seoul and its metropolitan area. Data were collected from 138 OPD nurses from general hospitals. Study variables were personal traits, emotional intelligence, internal marketing, service management and customer orientation. RESULTS: Factors associated with customer orientation were identified as conscientiousness from personal traits (β .37, p < .001), emotional intelligence from individual characteristics (β .21, p = .032), and internal marketing from environmental characteristics (β .21, p = .001). CONCLUSIONS: Hospital administrators should support OPD nurses to cultivate sincere and sociable personal traits and emotional intelligence, and to consider employees as internal customers to improve patient-oriented services and satisfaction.

Symptom Clusters in Korean Patients with Acute Myocardial Infarction

PURPOSE: Acute myocardial infarction (AMI) leads to death if the patient does not receive emergency treatment. Thus it is very important to recognize the symptoms in the early stage. The purpose of this study was to identify clusters of symptoms that represent AMI in Koreans. METHODS: The study used a retrospective, descriptive design with secondary data analysis. Data were abstracted from 725 medical records of AMI patients admitted from June 1, 2006 to August 15, 2014 at a university hospital. RESULTS: Analysis of the AMI symptoms revealed five symptom clusters; Cluster 1 (n=140): middle chest pain (100%), shortness of breath, and cold sweating, Cluster 2 (n=256): substernal pain (100%), cold sweating, and shortness of breath, Cluster 3 (n=47): substernal pain (95.7%), left arm pain, shortness of breath, cold sweating, left shoulder pain, right arm pain, and the lower neck pain, Cluster 4 (n=212): shortness of breath (28.3%), left chest pain, and upper abdominal pain, and Cluster 5 (n=70): cold sweating (100%), left chest pain, shortness of breath, left shoulder pain, and upper abdominal pain. Length of hospital stay and mortality rate were significantly different according to symptom clusters (F=2.52, p=.040; F=3.62, p=.006, respectively). CONCLUSION: Symptom clusters of AMI from this study can be used for AMI patients in order to recognize their symptoms at an early stage. The study findings should be considered when developing educational prevention programs for Koreans with AMI.

Gender Specific Role of Anger Expression in Association with Depression and Health Behavior in Community-Dwelling Elders / 정신간호학회지

PURPOSE: The purpose of this study was to identify the total, direct, and indirect influence of depression on health behavior (HB); to determine relative magnitudes of specific mediating effects of anger expression in gender specific subgroup among elders. METHODS: A cross-sectional correlational survey was conducted in S and G cities with 333 community-dwe1ling elders (male=170, female=163). Data were collected from September 7 to November 7, 2013. Kee's GDSSF-K for depression, Spielberger's STAXI for anger expression and Choi & Kim's health behavior assessment tool were used. Multiple-mediation analyses using Indirect SPSS macros were performed. RESULTS: Depression had a significant total, direct and indirect effect on HB in both male and female. In women, direct and indirect effect of depression on HB were higher than in men. Specific indirect effects of depression on HB were evidenced via anger-control and anger-out for men and via anger-control and anger-in for women. Among anger expression, anger-control was a more salient mediator for both male and female. CONCLUSION: Findings suggest that depression and anger-control should be addressed in tandem for promotion of HB for elders. Tailored interventions for the promotion of HB should be developed considering gender of target population.

Comparison of Healthy Life Style and Chronic Disease Management between Urban and Rural Older Adults / 재활간호학회지

PURPOSE: The purpose of this study was to compare healthy life style and chronic disease management between urban and rural older adults. METHODS: The study employed a comparative and descriptive survey design. Data were collected from 154 older adults living independently in communities (79 from urban and 75 from rural areas) using structured questionaries from 24 July, 2010 to 14 August, 2011. RESULTS: Perceived health status was significantly lower in urban older adults than those in rural areas (chi2=13.27, p = .001). Frequency of regular health examination was better in the urban group than the rural group (chi2=4.71, p = .030). Among older adults with hypertension, medication noncompliance was higher, and participation rate in disease management education was lower in the rural group than the urban group (chi2=6.43, p = .040; chi2=23.51, p<.001, respectively) and the same as arthritis. CONCLUSION: Rural older adults had more problems with health and disease management in this study, might be, due to difficulties in access to health care services than urban residents. More tailored programs of disease management as well as health service programs and staffing should be developed in rural areas. For urban older adults, meal preparation program and more opportunities producing income may be needed.

Effects of a Face-to-face Self-management Program on Knowledge, Self-care Practice and Kidney Function in Patients with Chronic Kidney Disease before the Renal Replacement Therapy

PURPOSE: The purpose of this study was to examine the effects of a face-to-face self-management educational program on knowledge, self-care practice and kidney function in patients with chronic kidney disease (CKD) before kidney replacement therapy. METHODS: This study employed a nonequivalent control group, non-synchronized design. Data were collected from 61 patients with CKD visiting an outpatient department of nephrology in a university hospital in Seoul, South Korea. The experimental group (n=31) took the pre-test, then after 3 weeks, face-to-face education and individualized consultation (1st intervention), after a week of self-practice, the 1st post-test, followed by re-enforcement education and consultation (2nd intervention), and 4 weeks later, the 2nd post-test. The control group (n=30) took the pre-test and post-tests at 4 and 8 weeks. RESULTS: Scores for knowledge of CKD and self-care practice over time improved significantly in the experimental group compared to the control group. Kidney function did not improve significantly in the experimental group. CONCLUSION: Health care providers can identify various and individualized needs, and provide effective education and consultation through face to face self-management for patients with chronic irreversible illnesses. Nurses can coordinate for these program by designing and providing systematic and effective education.

Breeding of New Strains of Mushroom by Basidiospore Chemical Mutagenesis

Chemical mutagenesis of basidiospores of Hypsizygus marmoreus generated new mushroom strains. The basidospores were treated with methanesulfonate methylester, an alkylating agent, to yield 400 mutant monokaryotic mycelia. Twenty fast-growing mycelia were selected and mated each other by hyphal fusion. Fifty out of the 190 matings were successful (mating rate of 26.3%), judged by the formation of clamp connections. The mutant dikaryons were cultivated to investigate their morphological and cultivation characteristics. Mutant strains No. 3 and No. 5 showed 10% and 6% increase in fruiting body production, respectively. Eight mutant strains showed delayed and reduced primordia formation, resulting in the reduced production yield with prolonged cultivation period. The number of the fruiting bodies of mutant No. 31, which displayed reduced primordial formation, was only 15, compared to the parental number of 65. Another interesting phenotype was a fruiting body with a flattened stipe and pileus. Dikaryons generated by mating with the mutant spore No. 14 produced flat fruiting bodies. Further molecular biological studies will provide details of the mechanism. This work shows that the chemical mutagenesis approach is highly utilizable in the development of mushroom strains as well as in the generation of resources for molecular genetic studies.

Effect of an Integral Care System: a Combination of Oriental and Western Care for Older Adults with Degenerative Arthritis

PURPOSE: This study was done to examine the effect of an integrated care service which included a combination of oriental and western care on health outcomes in elderly patients with degenerative arthritis. METHODS: A prospective comparative design was used. Data were collected from May 1, 2008 to June 30, 2009 from 85 elderly patients with degenerative arthritis in the lower extremities who were followed in a hospital out-patient department for 8 weeks. The integrated care service group (n=36) received a combination of physical therapy, acupuncture, western medicines or herbal medicines, and the western care group (n=49) received physical therapy or western medicines. Functional independence, walking speed, rotation balance, pain intensity, service satisfaction and total medical costs for the two groups were compared at 8 weeks. RESULTS: Functional independence (t=2.14, p=.036) and walking speed (t=2.51, p=.014) improved significantly in the integrated care group while pain intensity improved significantly in the western care group (t=3.35, p=.002). The integrated care group reported higher scores for service satisfaction (t=2.09, p=.041) and higher medical costs than the western care group (t=2.15, p=.035). CONCLUSION: The results suggest that integrated care services are effective modalities to improve mobility and quality of life for elders with degenerative arthritis.

Development of an Evaluation Instrument for Service Quality in Nursing Homes

PURPOSE: The purposes of this study were to identify the factors influencing service quality in nursing homes, and to develop an evaluation instrument for service quality. METHODS: A three-phase process was employed for the study. 1) The important factors to evaluate the service quality in nursing homes were identified through a literature review, panel discussion and focus group interview, 2) the evaluation instrument was developed, and 3) validity and reliability of the study instrument were tested by factor analysis, Pearson correlation coefficient, Cronbach's alpha and Cohen's Kappa. RESULTS: Factor analysis showed that the factors influencing service quality in nursing homes were healthcare, diet/assistance, therapy, environment and staff. To improve objectivity of the instrument, quantitative as well as qualitative evaluation approaches were adopted. The study instrument was developed with 30 items and showed acceptable construct validity. The criterion-related validity was a Pearson correlation coefficient of .85 in 151 care facilities. The internal consistency was Cronbach's alpha=.95. CONCLUSION: The instrument has acceptable validity and a high degree of reliability. Staff in nursing homes can continuously improve and manage their services using the results of the evaluation instrument.

Performance and Importance of Nursing Jobs in General Hospitals according to Levels of Work Experience of Nursing Staff / 기본간호학회지

PURPOSE: In this study differences in levels of performance and importance of nursing jobs were explored in relation to levels of work experience. METHOD: The sample was chosen by convenient sampling (N=363) and a cross-sectional study design was used. Frequencies and percentages were used for descriptive statistics. ANOVA was utilized to examine differences in performance and importance of nursing jobs among three groups of nurses, divided based on levels of work experience (less than 1 year, 1 to 4 years, and 5 or more years). RESULTS: Regarding performance of nursing jobs, novice nurses provided more support for patients, but provided less assessment of patients (i.e., investigation of levels of nutrition and exercise, and observation of verbal, and non-verbal behavior, and levels of cognition). Regarding the importance of nursing jobs, nursing linked to exercise and activities, and post-operative and excretion care were considered to be less important among novice nurses than among experienced nurses. CONCLUSION: Different training programs should be developed and provided to nurses according to levels of work experience. By doing so, it will be feasible to minimize differences in quality of nursing care triggered by different levels of work experience.

Perspectives of Korean Patients, Families, Physicians and Nurses on Advance Directives

PURPOSE: The purpose of this study was to explore the perspectives of lung cancer patients, their families, physicians and nurses on advance directives. METHODS: The study employed a comparative descriptive design. A total of 124 participants from six general hospitals in Seoul and metropolitan area participated in this study from January 1, 2009 to November 15, 2009. Face-to-face interviews were conducted using a structured questionnaire. RESULTS: The majority of participants were not aware of advance directives. Most participants desired the establishment of a reliable legal system and a specific legal protocol for the design and application of advance directives. The perspectives of patients, their families, physicians and nurses differed regarding end-of-life care decisions. The least preferred treatment by patients with lung cancer was intensive care, followed by cardiopulmonary resuscitation, tracheotomy and artificial ventilation, and radiotherapy. CONCLUSIONS: There were many differences in the perspectives of patients, families, physicians and nurses on advance directives. End-of-life care decisions should take the wishes of patients into account, and that such decisions should therefore be made before the patients lose the capacity to make them. To make well-informed decisions regarding future care, patients and families must be fully educated about advance directives and expected outcomes.

Predictors of Facility Adaptation in Nursing Home Residents

PURPOSE: The purposes of this study were to examine the relationships among activities of daily living, self-efficiency, nursing home care quality and nursing home adaptation, and to identify the influencing factors of nursing home adaptation in nursing home residents. METHODS: The study employed a descriptive correlational design. The data were collected from 148 older adults without dementia by interview from six nursing homes in three cities from February 1, 2008 to February 28, 2008. RESULTS: Levels of nursing home adaptation in older adult residents were different by type of decision maker of nursing home admission, reason of nursing home admission, type of payment and length of nursing home stay. The nursing home adaptation was significantly correlated with self-efficiency and nursing home care quality. The strongest predictor of nursing home adaptation was type of decision maker of nursing home admission followed by the self-efficiency. CONCLUSION: The study suggested that during the decision making period of nursing home admission, older adults should have enough time and careful considerations of their families to decide by themselves in positive ways. Nursing home staff should be able to identify reasons of nursing home admission and demands or expectations of older adults and their families.

Development of a Multimedia Learning DM Diet Education Program using Standardized Patients and Analysis of Its Effects on Clinical Competency and Learning Satisfaction for Nursing Students

PURPOSE: The purpose of this study was to develop a multimedia learning program for patients with diabetes mellitus (DM) diet education using standardized patients and to examine the effects of the program on educational skills, communication skills, DM diet knowledge and learning satisfaction. METHODS: The study employed a randomized control posttest non-synchronized design. The participants were 108 third year nursing students (52 experimental group, 56 control group) at K university in Seoul, Korea. The experimental group had regular lectures and the multimedia learning program for DM diet education using standardized patients while the control group had regular lectures only. The DM educational skills were measured by trained research assistants. RESULTS: The students who received the multimedia learning program scored higher for DM diet educational skills, communication skills and DM diet knowledge compared to the control group. Learning satisfaction of the experimental group was higher than the control group, but statistically insignificant. CONCLUSION: Clinical competency was improved for students receiving the multimedia learning program for DM diet education using standardized patients, but there was no statistically significant effect on learning satisfaction. In the nursing education system there is a need to develop and apply more multimedia materials for education and to use standardized patients effectively.

The Effects of Danjeon Breathing Exercise on Vital Capacity, Physical Fitness, Anxiety and Depression among Older Adults

PURPOSE: The purpose of this study was to examine the effects of Danjeon Breathing Exercise (DBE) on vital capacity, physical fitness, anxiety and depression among older adults. METHODS: This study employed the nonequivalent control group pretest-posttest design. The experimental group participated in a 12-week DBE program. Vital capacity and physical fitness were measured with a health measurement system (HELMAS). Anxiety and depression were measured with SCL-90-R-K. Data were collected from 37 community-dwelling older adults (experimental group=21, control group=16) in the Seoul metropolitan area. The data were analyzed by chi2-test, Mann-Whitney test and ANCOVA. RESULTS: The experimental group taking DBE reported significant increases in flexibility than the control group, but differences in vital capacity and balance were not significant. Older adults taking DBE showed significant decreases in the anxiety and depression levels. CONCLUSION: A DBE program may be a useful nursing intervention for older adults to improve their flexibility and to reduce anxiety and depression.