Validity and Reliability of the Korean Version of the Parkinson’s Disease Questionnaire–Carer

Background@#and Purpose The importance of the quality of life (QOL) of carers has been increasingly recognized as it has a wide range of effects on the psychological, emotional, and social outcomes of patients with Parkinson’s disease (PD). Understanding their QOL is important as it reflects their unique characteristics; however, there have been few studies on this in Korea. This study aimed to translate and validate the Korean version of the Parkinson’s Disease Questionnaire–Carer (PDQ-Carer). @*Methods@#This was a methodological study that included a translation process and a crosssectional investigation. The Korean version of the scale was developed using back translation, semantic adjustment, and pretests. The final version was self-administered by 125 Korean family carers. Cronbach’s alpha values were used to assess the internal consistency of the PDQ-Carer. Exploratory and confirmatory factor analyses were used to validate the translated scale. @*Results@#Exploratory factor analysis identified four factors that accounted for 64.51% of the variance. A modified model using modification indices was found to fit the data well in the confirmatory factor analysis. That factor analysis supported the structure of the original four factors with relocation of several items that reflected Korean culture. Cronbach’s alpha values were 0.96 for the total scale, 0.93 for personal and social activities, 0.89 for strain, 0.85 for anxiety and depression, and 0.85 for self-care. @*Conclusions@#This study verified that the Korean version of the PDQ-Carer can be used to acquire important information about the multidimensional aspects of the QOL of Korean carers for patients with PD.

Pro-inflammatory Cytokine Levels and Cancer-related Fatigue in Breast Cancer Survivors: Effects of an Exercise Adherence Program / 한국유방암학회지

Purpose@#This study aimed to determine the effect of an exercise intervention on subjective cancer-related fatigue (CRF) and pro-inflammatory cytokine levels in breast cancer survivors (BCS). @*Methods@#BCS with greater than moderate CRF (≥ 4) were recruited and randomly assigned to experimental or control groups. The experimental group participated in a 12-week exercise adherence program (Better Life after Cancer - Energy, Strength, and Support; BLESS). Interleukin (IL)-6 and tumor necrosis factor-α (TNF-α) levels were determined at 3 time points (M1: baseline, M2: post-intervention, and M4: 6 months after intervention). Subjective fatigue was measured using the Korean version of the revised Piper Fatigue Scale. @*Results@#In this analysis of participants with physiological fatigue measures available (19 experimental, 21 control), there were no statistically significant differences in IL-6 (F = 1.157, p = 0.341), TNF-α levels (F = 0.878, p = 0.436), and level of fatigue (F = 2.067, p = 0.118) between the 2 groups at baseline. Fatigue in the experimental group showed statistically significant improvement compared to the control only at M2 (p = 0.022). There was no significant relationship between subjective and physiological fatigue at the 3 measurement points. @*Conclusion@#The BLESS intervention improved CRF in BCS immediately at post-intervention, and this study presents clinical feasibility for the management of CRF in BCS in the early survivorship phase who are already experiencing fatigue.

Factors Affecting Clinical Practicum Stress of Nursing Students: Using the Lazarus and Folkman's Stress-Coping Model

PURPOSE: This study was conducted to test a path model for the factors related to undergraduate nursing students' clinical practicum stress, based on Lazarus and Folkman's stress-coping model. METHODS: This study utilized a path analysis design. A total of 235 undergraduate nursing students participated in this study. The variables in the hypothetical path model consisted of clinical practicum, emotional intelligence, self-efficacy, Nun-chi, and nursing professionalism. We tested the fit of the hypothetical path model using SPSS/WIN 23.0 and AMOS 22.0. RESULTS: The final model fit demonstrated a satisfactory statistical acceptance level: goodness-of-fit-index=.98, adjusted goodness-of-fit-index=.91, comparative fit index=.98, normed fit index=.95, Tucker-Lewis index=.92, and root mean square error of approximation=.06. Self-efficacy (β=−.22, p=.003) and Nun-chi behavior (β=−.17, p=.024) were reported as significant factors affecting clinical practicum stress, explaining 10.2% of the variance. Nursing professionalism (β=.20, p=.006) and self-efficacy (β=.45, p<.001) had direct effects on emotional intelligence, explaining 45.9% of the variance. Self-efficacy had indirect effects on Nun-chi understanding (β=.20, p<.001) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. Nursing professionalism had indirect effects on Nun-chi understanding (β=.09, p=.005) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. The variables for self-efficacy and nursing professionalism explained 29.1% of the Nun-chi understanding and 18.2% of the Nun-chi behavior, respectively. CONCLUSION: In undergraduate nursing education, it is important to identify and manage factors that affect clinical practicum stress. The findings of this study emphasize the importance of Nun-chi, self-efficacy, emotional intelligence, and nursing professionalism in the development of an educational strategy for undergraduate nursing students.

Factors Affecting Clinical Practicum Stress of Nursing Students: Using the Lazarus and Folkman's Stress-Coping Model

PURPOSE@#This study was conducted to test a path model for the factors related to undergraduate nursing students' clinical practicum stress, based on Lazarus and Folkman's stress-coping model.@*METHODS@#This study utilized a path analysis design. A total of 235 undergraduate nursing students participated in this study. The variables in the hypothetical path model consisted of clinical practicum, emotional intelligence, self-efficacy, Nun-chi, and nursing professionalism. We tested the fit of the hypothetical path model using SPSS/WIN 23.0 and AMOS 22.0.@*RESULTS@#The final model fit demonstrated a satisfactory statistical acceptance level: goodness-of-fit-index=.98, adjusted goodness-of-fit-index=.91, comparative fit index=.98, normed fit index=.95, Tucker-Lewis index=.92, and root mean square error of approximation=.06. Self-efficacy (β=−.22, p=.003) and Nun-chi behavior (β=−.17, p=.024) were reported as significant factors affecting clinical practicum stress, explaining 10.2% of the variance. Nursing professionalism (β=.20, p=.006) and self-efficacy (β=.45, p<.001) had direct effects on emotional intelligence, explaining 45.9% of the variance. Self-efficacy had indirect effects on Nun-chi understanding (β=.20, p<.001) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. Nursing professionalism had indirect effects on Nun-chi understanding (β=.09, p=.005) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. The variables for self-efficacy and nursing professionalism explained 29.1% of the Nun-chi understanding and 18.2% of the Nun-chi behavior, respectively.@*CONCLUSION@#In undergraduate nursing education, it is important to identify and manage factors that affect clinical practicum stress. The findings of this study emphasize the importance of Nun-chi, self-efficacy, emotional intelligence, and nursing professionalism in the development of an educational strategy for undergraduate nursing students.

Job Analysis of Standardized Patient Trainer / 한국의학교육

PURPOSE: Although standardized patients (SPs) have been used widely in medical education, there has been little research on SP trainers. The purpose of this study was to examine the roles SP trainers by establishing their job description and assessing the importance, frequency, and difficulty of each task element. METHODS: SP trainers' responsibilities were defined and their job descriptions were developed based on a focus group interview (FGI) of 6 panels. The validity of the duties, tasks, and task elements that were elicited from the FGI was examined by the 6 panels and a medical school professor. The data were collected using a questionnaire survey from 24 SP trainers in April 2011. The questionnaire pertained to the importance, frequency, and difficulty of the duties, tasks, and task elements that were identified in SP trainers' job descriptions. RESULTS: The job description of SP trainers consisted of 10 duties, 25 tasks, and 76 task elements. The average level of importance of the 10 duties was 4.29; "SP training" was identified as the most important duty (4.79+/-0.41). Of the 76 task elements, "providing training regarding the scoring criteria and standardizing the scoring system" had the highest levels of importance and frequency (4.83+/-0.48, 4.08+/-1.06). "Standardizing the acting abilities of SPs" was the most difficult task element (4.50+/-0.66). CONCLUSION: By analyzing the job description of SP trainers, this study is expected to help define the roles of SP trainers and facilitate their deployment.

Development and Validation of a Tool for Evaluating Core Competencies in Nursing Cancer Patients on Chemotherapy

PURPOSE: This study was done to develop tool to evaluate the core competencies regarding nursing cancer patients on chemotherapy, and to verify the reliability and efficacy of the developed tool. METHODS: A tool to evaluate the core competencies was developed from a preliminary tool consisting of 112 items verified by expert groups. The adequacy of the preliminary tool was analyzed and refined to the final evaluation tool containing 76 items in 8 core competencies and 18 specific competencies. The evaluation tool is in the form of a self-report, and each item is evaluated according to a 3-point scale. From September 22 to October 14, 2011, 349 survey responses were analyzed using SPSS 20.0 and the WINSTEPS program that employs the Rasch model. RESULTS: Results indicated that there were no inappropriate items and the items had low levels of difficulty in comparison with the knowledge levels of the study participants. The results of factor analysis yielded 18 factors, and the reliability of the tools was very high with Cronbach's alpha=.97. CONCLUSION: The results of this study can be used for training and evaluation of core competencies for nursing cancer patients, and for standardizing nursing practices associated with chemotherapy.

Effect of Emotional Intelligence on Patient-Physician Interaction Scores of Clinical Performance Examination / 한국의학교육

PURPOSE: The patient-physician interaction (PPI) is a critical part of the clinical encounter. Recent studies have emphasized the importance of the emotional intelligence (EI) of physician in the PPI. Despite emphasizing the EI, previous studies offer limited evidence regarding the effect of a student's EI on the PPI. The purpose of this study is to explore the differences in EI depending on the demographics of medical students and the correlation between EI and PPI scores. METHODS: The sample was 85 fourth-grade medical students. Prior to taking a 12-station clinical performance examination, the students completed questionnaires on their own perception of the EI, which included 5 domains and 50 items. The tool that was used to assess the level of EI was Moon's modified version of the EI test for adults. We investigated differences in EI depending on the demographics of medical students by ANOVA and noted a correlation between EI and PPI scores by stepwise multiple regression analysis. RESULTS: This study found that females or graduate entry students have higher EI scores and that 25 to 30-year-old students have higher EI scores than aged under 25 years. The PPI scores correlated positively with total EI scores (r=0.32) and 2 subdomains (perception and expression of emotion, r=0.26; empathy, r=0.33). Two subdomains were the best predictors of PPI score (R2=0.171). CONCLUSION: EI correlates significantly with PPI score and affects it. We conclude that EI is a key influence of the PPI. Further research is required to explore whether this is a consistent effect.

Genetic Analysis of Three Korean Patients with Clinical Features of Ehlers-Danlos Syndrome Type IV

Ehlers-Danlos syndrome (EDS) is a hereditary disorder of the connective tissue. EDS type IV (EDS IV), the vascular type of the disease, is characterized by easy bruising, thin skin with visible veins, and spontaneous rupture of the large arteries, uterus, or bowel. EDS IV is caused by mutations in the gene for type III procollagen (COL3A1). However, recent studies suggest that the causative mutation of EDS IV is not homogeneous. We report our experience with three patients presenting with clinical features of type IV EDS. A 48-yr-old woman presented with acute aortic dissection (patient 1) and 36-yr-old and 21-yr-old women presented with carotidcavernous fistula (patients 2 and 3, respectively). All three patients bruised easily. Two patients (patients 1 and 3) had thin transparent skin with visible veins. Genetic analysis of COL3A1 revealed a Gly732Val (c.2195G>T) mutation in patient 1 and a duplication of 15 base pairs (c.3221_3235dup) which resulted in an interposition of five amino acids (p.Gly1074_Pro1078dup) in patient 2. However, no mutations were observed in COL3A1 or transforming growth factor beta receptors 1 and 2 in patients 3, which might be either due to a deletion of single or multiple exons in the COL3A1 gene or due to a genetic heterogeneity. This is the first report of genetically confirmed cases of EDS IV in Korea.

Outcome after Fontan Operation in Korea

PURPOSE: Despite extracardiac conduit Fontan had many advantages, long-term results related to longevity of conduit, and anticoagulation were not proven. This study was to evaluate the long-term outcome of hospital survivors with extracardiac Fontan circulation. METHODS: Between 1996 and 2006, 200 patients underwent extracardiac conduit Fontan operation. Median age at the Fontan operation was 3.4 years (range:16 months-35.7 years). All patients (89.5 %) except 21 patients of one stage Fontan operation underwent bi-directional cavopulmonary shunt. Fenestration was required in 85 patients (42.5%). RESULTS: There has been 6 hospital mortalities (3.0%), and 7 late mortalities (3.6%) at a mean follow-up of 52.4+/-32.2 months (range; 18days-120 months). Overall 10-years survival was 92.4 2.1%. Multivariate analysis identified severe infection at early postoperative periods (hazard ratio =12.439, P=0.001), and high pulmonary arterial pressure at preoperative period (hazard ratio=3.445, P=0.038) as risk factors for mortality. Reoperation was performed in 24 patients (12.0%), and freedom from reoperation was 82.4+/-4.1% at 10 years. Arrhythmia occurred in 32 patients (16.0%) after Fontan operation, and freedom from arrhythmia was 85.14.4% at 10 years. Risk factors for arrhythmia were heterotaxy syndrome (P=0.001), Follow up duration (P=0.027) and the age at Fontan operation (P=0.001). Freedom from thromboembolism was 92.91.9% at 10 years. The conduit cross- sectional area decreased by 14%, and the extent of decrease of the conduit cross-sectional remained stable irrespective of the follow-up duration. 95.2% of patients had New York Heart Association class I. CONCLUSIONS: After 10 years of follow-up, the overall survival, and the functional status of survivors of the extracardiac Fontan procedure are satisfactory. Fenestration has a beneficial effect on the results of high-risk Fontan patients. The incidence of late deaths, reoperations, obstructions of the cavopulmonary pathway, arrhythmias and thromboembolisms is low.

Impact of Pulmonary Hypertension on the Regional Right Ventricular Strain

BACKGROUND AND OBJECTIVES: Evaluation of right ventricular dysfunction in patients with pulmonary hypertension is useful for clinical management and it has prognostic implications. The purpose of this study was to evaluate the impact of pulmonary hypertension on the regional strain of the right ventricle and to assess the correlation between pulmonary arterial (PA) pressure and right ventricular (RV) strain. SUBJECTS AND METHODS: A total of fiftyone patients with chronic obstructive lung disease were classified into two groups on the basis of the presence of normal PA pressure (group I, PA pressure<35 mmHg, n=22) or high PA pressure (group II, PA pressure(35 mmHg, n=29), as estimated by the peak tricuspid regurgitation velocity on Doppler echocardiography. The left ventricular (LV) ejection fraction and RV fractional area change were assessed by conventional echocardiography, and the strain values were obtained from the RV, the LV free wall and the septum. RESULTS: The baseline characteristics were similar in both groups except for the peak PA pressure (group I: 30.2+/-3.9 mmHg, group II: 44.4+/-7.5 mmHg, p<0.00001). Group II had statistically reduced basal RV strain (-%) (20.3+/-7.1) compared to group I (24.1+/-6.7, p=0.033). The basal RV strain correlated with the PA pressure (r2=0.269, p=0.004). CONCLUSION: RV strain could determine regional RV dysfunction in patients with pulmonary hypertension.