Nurse Staffing and Health Outcomes of Psychiatric Inpatients: A Secondary Analysis of National Health Insurance Claims Data

Purpose@#The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Koreaby assessing National Health Insurance claims data. @*Methods@#The dataset included 70,136 patients aged 19 years who were inpatientsin psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia,schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registerednurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomesincluded length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint,and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and systemcharacteristics using multilevel modeling. @*Results@#Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatientsper registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission.More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnoticsuse but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injectedpsycholeptics for chemical restraint. @*Conclusion@#Lower nurse staffing levels are associated with negative health outcomes of psychiatricinpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatricinpatients in Korea.

Effectiveness of Telephone-Delivered Cognitive Behavioral Therapy for Depression in Patients with Chronic Physical Health Conditions: A Meta-Analysis / 정신간호학회지

PURPOSE: This study was a systematic review and meta-analysis of randomized controlled trials of telephonedelivered cognitive behavioral therapy (T-CBT) among patients with chronic physical health conditions and has been conducted to evaluate its effectiveness on depression. METHODS: A literature search was conducted of electronic databases published from the journal inception to December 2017. Thirteen of 1,609 studies met the inclusion criteria. Selected studies were rated for quality assessment by two independent reviewers using Cochrane's collaboration tool. RESULTS: Meta-analysis showed that T-CBT significantly reduces depression. The effect size of T-CBT was small (d=−0.20, 95% CI: −0.29~−0.10, Z=4.09, p < .001) and showed low heterogeneity (I2=0.0%). The effect of T-CBT at the 12-month follow-up was not sustained (d=−0.19, 95% CI:−0.42~0.03, Z=1.66, p=.10). CONCLUSION: The current findings indicate that T-CBT for patients with chronic physical health conditions has a significant post-treatment effect on depression. T-CBT can be a useful intervention reducing barriers to treatment and improving depression in patients with chronic physical health conditions.

Influence of Sexual Behavior and Emotional State on Suicidal Ideation among Female Adolescents with Sexual Intercourse Experience / 정신간호학회지

PURPOSE: This study investigated the sexual behaviors, emotional state, and suicide-related characteristics of female adolescents with sexual experience. METHODS: This is a secondary data analysis study using the data of the 11th (2015) Youth Health Behavior Online Survey. The subjects were 889 female students who had sexual intercourse experience in middle and high schools in the Republic of Korea. For data analysis, descriptive statistics, χ² test, and hierarchical logistic regression were used. RESULTS: Among the subjects, 22.2% reported having experienced homosexual or bisexual relations. The sexual debut time of 31.9% of the subjects was in elementary school or earlier, while 8.1% and 10.7% experienced pregnancy and sexually transmitted diseases, respectively. They reported negative emotional states (high stress 51.7%, unhappiness 17.8%, depressive mood 9.8%) and substantial suicide experiences (suicidal ideation 33.6%, suicidal plan 16.6%, suicidal attempt 13.2%). Through hierarchical logistic regression (Cox & Snell R²=.31), the influencing factors for suicide ideation identified included being subjected to sexual relations, experience of pregnancy, perceived stress and happiness, and depressive mood. CONCLUSION: It is important to prevent negative mental health consequences among female students with early sexual experience. Sexual education should strengthen their physical and mental safety through psychological care strategies.

Reporting and methodologic evaluation of meta-analyses published in the anesthesia literature according to AMSTAR and PRISMA checklists: a preliminary study / 대한마취과학회지

BACKGROUND: There have been few recent reports on the methodological quality of meta-analysis, despite the enormous number of studies using meta-analytic techniques in the field of anesthesia. The purpose of this study was to evaluate the quality of meta-analyses and systematic reviews according to the Assessment of Multiple Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the anesthesia literature. METHODS: A search was conducted to identify all meta-analyses ever been published in the British Journal of Anaesthesia (BJA), Anaesthesia, and Korean Journal of Anesthesiology (KJA) between Jan. 01, 2004 and Nov. 31, 2016. We aimed to apply the AMSTAR and PRISMA checklists to all published meta-analyses. RESULTS: We identified 121 meta-analyses in the anesthesia literature from January 2004 through the end of November 2016 (BJA; 75, Anaesthesia; 43, KJA; 3). The number of studies published and percentage of ‘Yes’ responses for meta-analysis articles published after the year 2010 was significantly increased compared to that of studies published before the year 2009 (P = 0.014 for Anaesthesia). In the anesthesia literature as a whole, participation of statisticians as authors statistically improved average scores of PRISMA items (P = 0.004) especially in the BJA (P = 0.003). CONCLUSIONS: Even though there is little variability in the reporting and methodology of meta-analysis in the anesthesia literature, significant quality improvement in the reporting was observed in the Anaesthesia by applying the PRISMA checklist. Participation of a statistician as an author improved the reporting quality of the meta-analysis.

Does preoperative anxiety felt by patients requested to participate in clinical trials related to general anesthesia before elective surgery depend on temperament? / 대한마취과학회지

BACKGROUND: Preoperative anxiety may differ according to patient temperament. It will be increased when patients are requested to participate in a study involving anesthesia. The purpose of this study was to show that the anxiety felt when patients are requested to participate may differ according to temperament in both patients who agree and disagree to participate. METHODS: Three hundred and twenty-one patients over age 18 with American Society of Anesthesiologists 1 and 2 completed a survey questionnaire. The degree of anxiety was measured according to patient temperament. It was compared on the basis of the State-Trait Anxiety Inventory (STAI) and visual analogue scale (VAS). RESULTS: In the agreed group, the degree of anxiety measured by “usual, present STAI” and VAS in the monitors (those who want to know as much as possible about anesthesia and surgery) was significantly higher than that in the blunters (those who want to know as little as possible) (P = 0.041 for the “usual STAI”, 0.017 for “present STAI”, and 0.001 for VAS, respectively). Among patients with a lower educational level, the numbers of blunters and monitors were 57 (79%) and 32 (59%), respectively, indicating that the ratio of blunters was significantly higher (P = 0.026). CONCLUSIONS: Both traits of patients in each group were influenced by psychological burdens. The anxiety of the monitors who agreed to participate was significantly higher than that of blunters. In addition to temperament, education level affects participation. Obtaining consent for participation by understanding temperament and considering factors that may reduce the participation rate will be required.

Communication abilities, Interpersonal Relationship, Anxiety, and Depression in Korean Soldiers / 정신간호학회지

PURPOSE: The purpose of this study was to explore status and level of communication ability, interpersonal relationships, anxiety, and depression in Korean soldiers and identify factors that influence depression. METHODS: A cross sectional study design was employed. The instruments were PCI (Primary Communication Inventory), RCS (Relationship Change Scale), STAI (State-Trait Anxiety Inventory), and CES-D (The Center for Epidemiologic Studies-Depression Scale). Data were collected from 961 soldiers from Gyeong-gi Province and analyzed using SPSS/WIN 17.0 program. RESULTS: The mean score for PCS, RCS were 87.0+/-11.43; and 98.8+/-14.17 respectfully and for STAI-I (state-anxiety), and STAI-II (trait-anxiety), 34.7+/-10.36; and 36.6+/-9.64 respectfully, and for CES-D, 11.2+/-7.0. Of the participants 22.2% were in the clinical group for depression. Major variables showing significant correlations were family intimacy, intimacy with friends or colleague, and inconvenience in not being able to use computer or internet. STAI-II, intimacy with friends or colleague, STAI-I accounted for 44.2double dagger of the variance in depression. CONCLUSION: The study results suggest that a systemic approach needed to relieve soldiers' anxiety and depression. Development of program for communication training, activities for leisure and interpersonal relationship during military life could contribute to lessening depression and anxiety in solder.