Relationship between Use of Rehabilitation Resources and ICU Readmission and ER Visits in ICU Survivors: the Korean ICU National Data Study 2008-2015

Background@#Despite the increasing importance of rehabilitation for critically ill patients, there is little information regarding how rehabilitation therapy is utilized in clinical practice. Our objectives were to evaluate the implementation rate of rehabilitation therapy in the intensive care unit (ICU) survivors and to investigate the effects of rehabilitation therapy on outcomes. @*Methods@#A retrospective nationwide cohort study with including > 18 years of ages admitted to ICU between January 2008 and May 2015 (n = 1,465,776). The analyzed outcomes were readmission to ICU readmission and emergency room (ER) visit. @*Results@#During the study period, 249,918 (17.1%) patients received rehabilitation therapy. The percentage of patients receiving any rehabilitation therapy increased annually from 14% in 2008 to 20% in 2014, and the percentages for each type of therapy also increased over time. The most common type of rehabilitation was physical therapy (91.9%), followed by neuromuscular electrical stimulation (29.6%), occupational (28.6%), respiratory, (11.6%) and swallowing (10.3%) therapies. After adjusting for confounding variables, the risk of 30-day ICU readmission was lower in patients who received rehabilitation therapy than in those who did not (P < 0.001; hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.65–0.75). And, the risk of 30-day ER visit was also lower in patients who received rehabilitation therapy (P < 0.001; HR, 0.83; 95% CI, 0.77–0.88). @*Conclusion@#In this nationwide cohort study in Korea, only 17% of all ICU patients received rehabilitation therapy. However, rehabilitation is associated with a significant reduction in the risk of 30-day ICU readmission and ER visit.

The Validity of Two Neuromotor Assessments for Predicting Motor Performance at 12 Months in Preterm Infants

OBJECTIVE: To evaluate the validity of the Test of Infant Motor Performance (TIMP) and general movements (GMs) assessment for predicting Alberta Infant Motor Scale (AIMS) score at 12 months in preterm infants. METHODS: A total of 44 preterm infants who underwent the GMs and TIMP at 1 month and 3 months of corrected age (CA) and whose motor performance was evaluated using AIMS at 12 months CA were included. GMs were judged as abnormal on basis of poor repertoire or cramped-synchronized movements at 1 month CA and abnormal or absent fidgety movement at 3 months CA. TIMP and AIMS scores were categorized as normal (average and low average and >5th percentile, respectively) or abnormal (below average and far below average or < 5th percentile, respectively). Correlations between GMs and TIMP scores at 1 month and 3 months CA and the AIMS classification at 12 months CA were examined. RESULTS: The TIMP score at 3 months CA and GMs at 1 month and 3 months CA were significantly correlated with the motor performance at 12 months CA. However, the TIMP score at 1 month CA did not correlate with the AIMS classification at 12 months CA. For infants with normal GMs at 3 months CA, the TIMP score at 3 months CA correlated significantly with the AIMS classification at 12 months CA. CONCLUSION: Our findings suggest that neuromotor assessment using GMs and TIMP could be useful to identify preterm infants who are likely to benefit from intervention.

Measurements of Multifidus Signal Intensity in Magnetic Resonance Imaging of the Patients with Unilateral Lumbar Radiculopathy

OBJECTIVE: To quantitatively evaluate the side- and level-specific change of the multifidus muscle in unilateral radicular pain caused by lumbar disc herniation using magnetic resonance imaging (MRI).METHOD: Sixty-nine patients with L4-5 disc herniation who underwent electrodiagnostic study and spine MRI were enrolled and divided into the radiculopathy group (n=30) and the control group (n=39) according to the presence of L5 radiculopathy. The radiculopathy group was subdivided into the paraspinalis group (n=12) and the limb group (n=18) according to whether or not paraspinalis muscle was denervated. The cross-sectional area (CSA) and signal intensity (SI) of the multifidus muscle were measured bilaterally at L4-5 and L5-S1 middle intervertebral levels on axial T2-weighted MRI.RESULTS: There was no significant difference in the CSA of the multifidus muscle between the radiculopathy group and the control group. In the radiculopathy group, multifidus SI was greater than the control group on the affected side and below the level of herniation (p=0.015). In the subgroup comparison, affected side L5-S1 multifidus SI was significantly different between the paraspinalis group and the control group (p=0.001), but not between the limb group and the control group (p>0.05).CONCLUSION: Our findings suggest that quantitative measurement of multifidus SI may be indicative of the location of nerve root compromise through side- and level- specific changes.

Extracorporeal Shock Wave Therapy and Quantitative Ultrasonographic Evaluation of the Rheologic Effect in the Patients with Post-stroke Upper Limb Spasticity: A Case Report

Post-stroke spasticity is a common complication that causes limitations of function, pain and decrement of the quality of life. Although botulinum toxin injection and anti-spastic medications are effective and widely used for the management of post-stroke spasticity, clinical applications are often limited in stroke patients because of their invasiveness and systemic side effects. Alternatively, we performed upper limb muscle-belly extracorporeal shock wave therapy (ESWT) to resolve problematic spasticity in two subacute stroke patients. Serial quantitative ultrasonographic measurements of spastic muscle were conducted to investigate the rheological changes in chronological order by echogenicity comparison. After 4 sessions of weekly ESWT, gradual decrements of clinical spasticity parameters and muscle echogenicity were observed and lasted for 1 week after the cessation of the therapy. ESWT may be a useful alternative management for treating post-stroke spasticity.

Comparison of Gait Speed and Peripheral Nerve Function Between Chronic Kidney Disease Patients With and Without Diabetes

OBJECTIVE: To compare overall physical function, including gait speed and peripheral nerve function, between diabetic chronic kidney disease (CKD) patients and nondiabetic CKD patients and to investigate the association between gait speed and peripheral nerve function in CKD patients. METHODS: Sixty adult CKD patients (35 with and 25 without diabetes), who received maintenance hemodialysis (HD), were included in this study. Demographic data, past medical history, current medical condition and functional data—usual gait speed, vibration perception threshold for the index finger (VPT-F) and the great toe (VPT-T), activity of daily living (ADL) difficulty, and peripheral neuropathy (PN) along with the degree of its severity—were collected and compared between the two groups. Correlations between the severity of PN and the impairment of other functions were identified. RESULTS: Diabetic CKD patients showed significantly slower gait speed (p=0.029), impaired sensory function (VPT-F, p=0.011; VPT-T, p=0.023), and more frequent and severe PN (number of PN, p<0.001; severity of PN, p<0.001) as compared to those without diabetes. Usual gait speed had a significant negative correlation with the severity of PN (rho=−0.249, p=0.013). By contrast, VPT-F (rho=0.286, p=0.014) and VPT-T (rho=0.332, p=0.035) were positively correlated with the severity of PN. ADL difficulty was comparatively more frequent in the patients with more severe PN (p=0.031). CONCLUSION: In CKD patients with maintenance HD, their gait speed, sensory functions, and peripheral nerve functions were all significantly impaired when they have diabetes, and the severity of PN was negatively correlated with their gait speed, sensory function, and ADL function. Adverse effects of diabetes impacted physical performance of CKD patients. The physical disability of those patients might be attributable to PN and its severity.

Weight Changes according to the Period of Chemotherapy Treatments for Breast Cancer

PURPOSE: This study aimed to evaluate weight changes in women during the period of TAC (docetaxel-doxorubicin-cyclophosphamide) chemotherapy after breast surgery and the differences in weight changes by disease characteristics among Korean women with breast cancer. METHODS: The design of this study was retrospective survey research. The subjects of this study were 130 patients with fully completed TAC chemotherapy between January 2012 and April 2015. Body weight before their operation, and at 3 weeks, 6 weeks, 9 weeks, 12 weeks, 15 weeks, and 18 weeks after surgery, as well as general and disease characteristics, were reviewed via their medical charts. RESULTS: The mean age of the patients was 51.2 years. The preoperative (baseline) mean weight was 59.4±8.44. Significant weight losses were observed in the initial (1st 3 week) period of TAC chemotherapy compared to the baseline and significant weight losses were observed with the exception of the period 6 weeks after breast surgery. There were significant differences in mean weight changes according to the stage of breast cancer, radiotherapy, and hormone therapy among disease characteristics. CONCLUSION: It is necessary to study weight changes after breast surgery for the long periods of TAC chemotherapy. Through the accumulated results of studies, nursing programs for breast cancer patients must be developed for the prevention of weight gain in the periods of TAC chemotherapy.

Delay of the Blink Reflex in Patients Receiving Platinum-Analogue Chemotherapy

OBJECTIVE: To investigate the presence of cranial neuropathy in patients with platinum-analogue chemotherapy using electrodiagnostic evaluations. METHODS: Thirty-nine patients whose chemotherapy was completed within a month and 40 control subjects were enrolled in the study. Electrodiagnostic evaluation was performed using sensory and motor nerve conduction studies and blink reflex studies, in addition to the two-point discrimination test. RESULTS: The chemotherapy group had significantly longer latencies of bilateral R1 responses (left p<0.001; right p<0.001) and greater distance in two-point discrimination (p<0.001) compared to the control group. In the subgroup with peripheral polyneuropathy, the left R1 (p=0.01), both R2i (left p=0.02; right p=0.03) and the left R2c (p=0.02) were prolonged relative to those without the polyneuropathy, and both R1 (left p<0.001; right p<0.001), R2i (left p=0.01; right p=0.03), and the left R2c (p=0.01) were prolonged relative to the controls. On the other hand, the subgroup without the polyneuropathy showed only prolongation of both R1 (left p=0.006; right p<0.001) relative to the controls. CONCLUSION: In the present study, comparison of blink reflex and two-point discrimination showed the likelihood of subclinical cranial neuropathy following platinum-analogue chemotherapy. Cranial neuropathy caused by platinum agents was more profound in patients with peripheral polyneuropathy and may be dependent on the cumulative dose of the drug. The blink reflex may be of value in detecting subclinical cranial neuropathy in patients undergoing platinum-analogue chemotherapy.

Associations Between Prolonged Intubation and Developing Post-extubation Dysphagia and Aspiration Pneumonia in Non-neurologic Critically Ill Patients

OBJECTIVE: To identify the associations between the duration of endotracheal intubation and developing post-extubational supraglottic and infraglottic aspiration (PEA) and subsequent aspiration pneumonia. METHODS: This was a retrospective observational study from January 2009 to November 2014 of all adult patients who had non-neurologic critical illness, required endotracheal intubation and were referred for videofluoroscopic swallowing study. Demographic information, intensive care unit (ICU) admission diagnosis, severity of critical illness, duration of endotracheal intubation, length of stay in ICU, presence of PEA and severity of dysphagia were reviewed. RESULTS: Seventy-four patients were enrolled and their PEA frequency was 59%. Patients with PEA had significantly longer endotracheal intubation durations than did those without (median [interquartile range]: 15 [9-21] vs. 10 [6-15] days; p=0.02). In multivariate logistic regression analysis, the endotracheal intubation duration was significantly associated with PEA (odds ratio, 1.09; 95% confidence interval [CI], 1.01-1.18; p=0.04). Spearman correlation analysis of intubation duration and dysphagia severity showed a positive linear association (r=0.282, p=0.02). The areas under the receiver operating characteristic curves (AUCs) of endotracheal intubation duration for developing PEA and aspiration pneumonia were 0.665 (95% CI, 0.542-0.788; p=0.02) and 0.727 (95% CI, 0.614-0.840; p=0.001), respectively. CONCLUSION: In non-neurologic critically ill patients, the duration of endotracheal intubation was independently associated with PEA development. Additionally, the duration was positively correlated with dysphagia severity and may be helpful for identifying patients who require a swallowing evaluation after extubation.

Reliability, Validity, and Responsiveness of the Korean Version of the Shoulder Disability Questionnaire and Shoulder Rating Questionnaire

OBJECTIVE: To translate, adapt, and test the reliability, validity, and responsiveness of the Korean version of the Shoulder Disability Questionnaire (SDQ) and the Shoulder Rating Questionnaire (SRQ). METHODS: The international guideline for the adaptation of questionnaires was referenced for the translation and adaptation of the original SDQ and SRQ. Correlations of the SDQ-K and SRQ-K with the Shoulder Pain and Disability Index (SPADI) and the Numeric Rating Scale (NRS) were assessed to determine the reliability and validity of the questionnaires. To evaluate reliability, surveys were performed at baseline and a mean of 6 days later in 29 subjects who did not undergo any treatment for shoulder problems. To evaluate responsiveness, assessments were performed at baseline with 4-week intervals in 23 subjects with adhesive capsulitis who were administered triamcinolone injection into the glenohumeral joint. RESULTS: Fifty-two subjects with shoulder-related problems were surveyed. Cronbach alpha for internal consistency was 0.82 for the summary SDQ-K and 0.75 for the summary SRQ-K. The test-retest reliability of the SDQ-K, SRQ-K, and domains of the SRQ-K ranged from 0.84 to 0.95. The SDQ-K and SRQ-K summary scores correlated well with the SPADI and NRS summary scores. Generally, the effect sizes and standardized response means of the summary scores of the SDQ-K, SRQ-K, and domains of the SRQ-K were large, reflecting their responsiveness to clinical changes after treatment. CONCLUSION: The reliability, validity, and responsiveness of the SDQ-K and SRQ-K were excellent. The SDQ-K and SRQ-K are feasible for Korean patients with shoulder pain or disability.

Adhesive Capsulitis in the Elderly: Comparison of Magnetic Resonance Imaging Findings with Effectiveness of Hydrodilatation Treatment

BACKGROUND: Shoulder pain and disability are common problems in the elderly, and adhesive capsulitis is one of the main causes. To identify the characteristics of adhesive capsulitis in elderly patients, we compared magnetic resonance imaging (MRI) findings of treatment effect between two age groups. METHODS: We enrolled 54 adult patients with adhesive capsulitis who underwent shoulder MRI and hydrodilatation treatment, and divided them into the elderly and the control groups. Capsular thickness in the axillary pouch, presence of subcoracoid fat obliteration in the rotator interval and accompanying lesions in the rotator cuff were evaluated on the shoulder MRI. The constant score and range of motion of the shoulder joints were measured three times-baseline, week 2, and week 12. RESULTS: The elderly group showed significantly higher frequencies of subcoracoid fat obliteration (p=0.04) and rotator cuff lesion (p=0.003). Constant scores (p=0.006) and range of motion (forward flexion, p=0.012; external rotation, p=0.001; internal rotation, p=0.007) at week 12 were better in the control group. The control group showed significant increases in the scores at all 3 assessments (p<0.001), whereas the elderly group did not show significant improvement between weeks 2 and 12. Neither the elderly nor the control patients with rotator cuff tears showed a significant increase in the constant score at all 3 assessments. CONCLUSION: Elderly patients showed more frequent rates of secondary adhesive capsulitis caused by rotator cuff injuries. Also, these rotator cuff injuries, especially tendon tears, might be related to a lack in long-term effect of hydrodilatation treatment.

Estimation of Effects of Factors Related to Preschooler Body Mass Index Using Quantile Regression Model

PURPOSE: The purpose of this study was to investigate Korean preschoolers' obesity-related factors through an ecological approach and to identify Korean preschoolers' obesity-related factors and the different effects of ecological variables on body mass index and its quantiles through an ecological approach. METHODS: The study design was cross-sectional. Through convenience sampling, 241 cases were collected from three kindergartens and seven nurseries in the Seoul metropolitan area and Kyunggi Province in April 2013 using self-administered questionnaires from preschoolers' mothers and homeroom teachers. RESULTS: Results of ordinary least square regression analysis show that mother's sedentary behavior (p < .001), sedentary behavior parenting (p = .039), healthy eating parenting (p = .027), physical activity erelated social capital (p = .029) were significant factors of preschoolers' body mass index. While in the 5% body mass index distribution group, gender (p = .031), preference for physical activity (p = .015), mother's sedentary behavior parenting (p = .032), healthy eating parenting (p = .005), and teacher's sedentary behavior (p = .037) showed significant influences. In the 25% group, the effects of gender and preference for physical activity were no longer significant. In the 75% and 95% group, only mother's sedentary behavior showed a statistically significant influence (p < .001, p = .012 respectively). CONCLUSION: Efforts to lower the obesity rate of preschoolers should focus on their environment, especially on the sedentary behavior of mothers, as mothers are the main nurturers of this age group.

A Study on Factors Affecting Cultural Competency of General Hospital Nurses / 간호행정학회지

PURPOSE: As Korea has been rapidly transformed to be a multicultural society, it becomes essential for nurses to develop cultural competency. The purpose of this descriptive study was to assess the cultural competency level of general hospital nurses and to examine its contributing factors adopting ecological model. METHOD: A convenience sample of 327 nurses from six general hospitals in Seoul metropolitan area was recruited between November 14 to 28, 2011. Cultural competency was measured using the Korean version of the Caffrey Cultural Competence in Healthcare Scale (CCCHS) and Cultural Competence Assessment(CCA). Hierarchical multiple regression analysis was performed to assess the influence of intrapersonal, cultural-experience, and organizational factors on cultural competency. RESULTS: Mean cultural competency in this study was 2.57(+/-0.43). Cultural competency was associated with job position (p=.044) at the intrapersonal level. At the cultural experience level, foreign language classes experience (p=.005), fluency in a foreign language (p=.000), experience of working with foreign health care professionals (p=.000) were associated cultural competency. At the organizational level, training program (p=.000), job description (p=.002), health education materials (p=.016), insufficient job control (p=.000), and interpersonal conflicts (p=.011) showed significant difference. Foreign language class experience, foreign language fluency, experience of working with foreign health care professionals, and job control were the most consistent predictors of cultural competence and explained 20.4% of the total variance in the proposed ecological model. CONCLUSIONS: The findings suggest that to enhance cultural competency in general hospital nurses, cultural experience and organizational factors need to be more fully considered than intrapersonal factors.

Correlation of Alcohol intake with Suicide in Cases confirmed by Legal autopsy / 대한법의학회지

The purpose of this study is to provide a fundamental basis for defining measures to prevent suicide by specifically examining the relationship between suicide and alcohol consumption, which is thought to be a key factor in suicide. This study reviewed 426 suicide autopsies diagnosed by the department of forensic medicine, National Forensic Service (2007-2009) and analyzed the preliminary data on variables such as gender, age, and cause of death, with particular focus on the relationship between these variables and blood alcohol concentration. The relationship between each variable and alcohol consumption was as follows. First, alcohol was present in 48.4% of suicides. Second, blood alcohol concentration wrere twice as high in women as in men. Third, the relationship between suicide and alcohol consumption was greater in people in their 30s and 40s. The correlation between suicide and alcohol intake was evident this age group. These results are more specific and practical than the results of previous studies on the correlation between suicide and alcohol intake. The results of this study will help define measures to facilitate suicide prevention as an important reference and may eventually help lower the suicide rate in Korea.

Deletion of GBG1/AYR1 Alters Cell Wall Biogenesis in Saccharomyces cerevisiae

We identified a gene for beta-1,3-glucan synthesis (GBG1), a nonessential gene whose disruption alters cell wall synthesis enzyme activities and cell wall composition. This gene was cloned by functional complementation of defects in beta-1,3-glucan synthase activity of the the previously isolated Saccharomyces cerevisiae mutant LP0353, which displays a number of cell wall defects at restrictive temperature. Disruption of the GBG1 gene did not affect cell viability or growth rate, but did cause alterations in cell wall synthesis enzyme activities: reduction of beta-1,3-glucan synthase and chitin synthase III activities as well as increased chitin synthase I and II activities. GBG1 disruption also showed altered cell wall composition as well as susceptibility toward cell wall inhibitors such as Zymolyase, Calcofluor white, and Nikkomycin Z. These results indicate that GBG1 plays a role in cell wall biogenesis in S. cerevisiae

Prevalence and Association Factors of Posterior Longitudinal Ligament in Patients with Spondyloarthropathies

OBJECTIVE: To investigate prevalence of ossification of posterior longitudinal ligament (OPLL) in Korean patients with Spondyloarthropathies (SpA), and the associations between OPLL and clinical, radiologic findings of SpA. METHOD: A cross-sectional radiological review was performed in patients diagnosed with SpA from 2000 to 2007. Each of two physiatrists and musculoskeletal radiologists screened the cervical (lateral) and pelvis (anterior-posterior) radiographs of these patients separately, then confirmed presence of OPLL. Bath ankylosing spondylitis radiology index (BASRI) of the cervical spine and grade of sacroiliitis were also measured. A review of the medical records and laboratory findings was conducted to investigate the association between the clinical, laboratory findings and the OPLL. RESULTS: Among 172 patients with SpA, OPLL was found in 16 patients (9.3%; 95% CI 5.0, 13.6). There were significant associations between OPLL and old age (p=0.043), symptoms and signs of myeloradiculopathy (p=0.030), and diabetes mellitus (DM) (p=0.022). CONCLUSION: The prevalence of OPLL in Korean patients with SpA is 9.3%. OPLL in patients with SpA is associated with old age, symptoms and signs of myeloradiculopathy, and diabetes. However, no factors specific characteristics of SpA were associated with OPLL.

The Prevalence and Clinical Features of Diffuse Idiopathic Skeletal Hyperostosis in the Patients with Dorsal Back Pain

OBJECTIVE: To investigate the prevalence and clinical features of diffuse idiopathic skeletal hyperostosis (DISH) in patients with dorsal back pain. METHOD: A total of 229 patients (119 men and 110 women) with dorsal back pain were included. Medical records including age, sex, chief complaints, medical history, physical findings, laboratory data, and musculoskeletal radiographs were reviewed retrospectively. RESULTS: Twenty-seven (11.8%, by Resnick's criteria) and thirty-eight (16.6%, by Julkunen's criteria) of the 229 patients were diagnosed with DISH by thoracic spine radiographs. A significant increase of risk with age was observed (Resnick's criteria: odds ratio 1.10, 95% CI 1.05~1.16, p< 0.001, Julkunen's criteria: odds ratio 1.08, 95% CI 1.04~1.12, p<0.001). Male sex (Resnick's criteria: odds ratio 2.65, 95% CI 1.01~6.95, p=0.048, Julkunen's criteria: odds ratio 2.87, 95% CI 1.27~6.59, p=0.011) and inflammatory pain (Resnick's criteria: odds ratio 7.76, 95% CI 2.69~22.33, p<0.001, Julkunen's criteria: odds ratio 3.84, 95% CI 1.55~9.47, p=0.004) showed higher risk for development of DISH. Mean body mass index of patients with DISH were higher in all age groups, and they showed higher prevalence of DM and hyperlipidemia than general population. CONCLUSION: Patients with dorsal back pain showed higher prevalence of DISH than previous results with random samples. Aging, male sex and inflammatory pain might be a risk factor for development of DISH. Also, obesity, DM and hyperlipidemia might be strongly related with DISH.

Association between BMI and Mortality: Kangwha cohort study / 예방의학회지

OBJECTIVES: To investigate the association between BMI and Mortality. METHODS: This study was based on the analysis and assembly of the 'Kangwha Cohort Study', previously conducted by the Department of Preventive Medicine, Yonsei University. A total of 2,696 males and 3,595 females were followed for almost ten years and ten months from March 1985 to January 1996, a total of whom 2,420 died during this period. The Cox's proportional hazards regression model was used to analyze this data. RESULTS: We found a U-shaped relationship between BMI and mortality among the aged men in the Kangwha cohort. The hazard ratio of dying was adjusted for age, marital status, occupation, self cognitive health level, chronic disease, smoking, and alcohol frequency, then sorted by body mass index into the following groups; less than 18.5, 18.5 to less than 21.0, 21.0 to less than 23.5, 23.5 to less than 26.0 and greater than or equal to 26. The corresponding ratios for men were 1.81(1.50-2.19, 95%CI), 1.31(1.14-1.51, 95%CI), 1.0(referent), 1.05(0.87-1.26, 95%CI) and 1.39(1.09-1.76, 95%CI), respectively. And for women, 1.46(1.19-1.78), 1.12(0.95-1.31, 95%CI), 1.0(referent), 1.00(0.84-1.20, 95%CI) and 1.09(0.89-1.34, 95%CI), respectively. CONCLUSIONS: The risk of death among aged men in Kangwha increased in the under and overweight groups. The relationship between BMI and mortality has been well studied in Western populations, but little is known about the association between BMI and mortality in our country. So, on the basis of this study, it is apparent that more studies of the relationship between BMI and mortality will be needed for future work.