Tracheal neurofibroma treated by repeated flexible bronchoscopic cryotherapy: A case report.

RATIONALE: Isolated endotracheal neurofibroma is very rare. The majority of neurofibromas are benign, but rarely, they can become cancerous. Furthermore, symptomatic neurofibroma is usually treated by surgical resection. Recently, several alternative options for surgical resection of this airway pathology have been suggested and developed, including bronchoscopic cryotherapy. Nevertheless, there has been no report on the application of repeated flexible bronchoscopic cryotherapy to remove an endotracheal neurofibroma. PATIENT CONCERNS: A 65-year-old woman presented with progressive dyspnea and productive cough. Chest computed tomography scans revealed a 1.5-cm polypoid-shaped mass with fat attenuation and mild enhancement in the distal trachea. Flexible bronchoscopic cryotherapy was performed to remove the mass and confirm the diagnosis. DIAGNOSIS: Pathologically, the mass was diagnosed as an endotracheal neurofibroma occupying the distal tracheal lumen. INTERVENTIONS: The endotracheal neurofibroma was completely removed with repeated flexible bronchoscopic cryotherapy instead of surgical resection. OUTCOMES: Follow-up flexible bronchoscopy also revealed that there was no regrowth of the neurofibroma. Up to 18 months after the completion of serial cryotherapy, the patient had no recurrent symptoms or complaints. LESSONS: Flexible bronchoscopic cryotherapy can be performed repeatedly for therapeutic purposes for airway tumors. It is recommended to consider flexible bronchoscopic cryotherapy as an alternative therapeutic option for patients with central airway obstruction due to tumorous lesions such as neurofibromas.

Effect of a mind-body therapeutic program for infertile women repeating in vitro fertilization treatment on uncertainty, anxiety, and implantation rate.

PURPOSE: The study aimed to develop a mind-body therapeutic program and evaluate its effects on mitigating uncertainty, anxiety, and implantation rate of second-trial in vitro fertilization (IVF) women. METHODS: This study employed a nonequivalent control group nonsynchronized design. The conceptual framework and program content were developed from a preliminary survey of eight infertile women and the extensive review of the literature. Program focuses on three uncertainty-induced anxieties in infertile women: cognitive, emotional, and biological responses. To evaluate the effect of the intervention, the infertile women with unknown cause preparing for a second IVF treatment were sampled at convenience (26 experimental and 24 control). RESULTS: The experimental group in the study showed greater decrease in uncertainty and anxiety in premeasurements and postmeasurements than the control group did. However, no statistically significant differences in the implantation rate between groups were observed. CONCLUSION: This study is meaningful as the first intervention program for alleviating uncertainty and anxiety provided during the IVF treatment process. The positive effects of the mind-body therapeutic program in alleviating both uncertainty and anxiety have direct meaning for clinical applications.

Factors affecting quality of life in Korean patients with chronic heart failure.

AIM: Poor health-related quality of life (HRQOL) in patients with chronic heart failure (CHF) may be one of the most common predictors of mortality and rehospitalization. This study was conducted to identify factors affecting HRQOL in Korean patients with CHF using two HRQOL measurements. METHODS: The study included a sample of 114 patients. HRQOL was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the World Health Organization's Quality of Life Instrument - Short Version (WHOQOL-BREF). Multiple regression analyses were performed to analyze the relationship between the factors and HRQOL. RESULTS: Significant correlations were found between MLHFQ and WHOQOL-BREF in total and component scores, with the two exceptions of WHOQOL-BREF psychological and MLHFQ physical or total. The perceived economic status, functional status, and sex were factors identified as having an effect on HRQOL. CONCLUSION: The MLHFQ was better able to differentiate sex, comorbidity, and functional status. Further studies are needed to implement cost-effective nursing interventions for patients with CHF to improve their HRQOL.

Health-promoting lifestyle and depression in metabolic syndrome patients in Korea.

This cross-sectional study assessed the association between health-promoting lifestyle and depression in metabolic syndrome patients by using a questionnaire survey in Korea. Data were collected from 195 adults (> 20 years old) with hypertension, dyslipidemia and diabetes. The correlation coefficient (r) between health-promoting lifestyle and depression was -0.309 (P < 0.001), and correlation between individual lifestyle dimensions and depression varied from -0.135 to -0.391. The non-depressed group had higher health-promoting lifestyle scores than the depressed group (P = 0.003). Scores for three dimensions of the health-promoting lifestyle profile--self-actualization (P < 0.001), interpersonal support (P = 0.001) and stress management (P = 0.025)--were significantly higher in the non-depressed groups. Logistic regression analysis provided an odds ratio of 2.766 (P = 0.003) for health-promoting lifestyle between the two groups. For patients with metabolic syndrome, depression was negatively associated with health-promoting lifestyle and is an important factor affecting health-promoting behaviour.

Psychometric properties of a Korean version of the summary of diabetes self-care activities measure.

BACKGROUND: The summary of diabetes self-care activities (SDSCA) questionnaire is one of the most widely used self-report instruments for measuring diabetes self-management in adults. OBJECTIVES: This study aimed to examine the psychometric properties of a Korean version of the SDSCA questionnaire. METHODS: The 11-item English version of the SDSCA was translated into Korean following the standard translation methodology. The questionnaire was administered to 208 patients with type 2 diabetes. Exploratory and confirmatory factor analyses (EFA and CFA) were carried out for construct validity. Content validity index (CVI), internal consistency and a diabetes management self-efficacy scale (DMSES) were assessed. RESULTS: The CVI of a Korean version of the SDSCA was .83. The EFA yielded a 9-item measure with a four factor solution with the same labels for original scales. The results of CFA showed the goodness of fit in the 9-item Korean SDSCA version (SDSCA-K). The internal consistency of SDSCA-K was moderate (Cronbach's α=.69) and the positive correlation between the SDSCA-K and the DMSES was identified. CONCLUSION: The current study provides the initial psychometric properties of SDSCA-K modified to 9 items and supports SDSCA-K as a reliable and valid measure of diabetes self-management in Korean patients.

[Comparison for risk estimate of aspiration between the revised dysphagia assessment tool and videofluoroscopy in post-stroke patients].

PURPOSE: The purpose of this study was to determine the significant factors for risk estimate of aspiration and to evaluate the efficiency of the dysphagia assessment tool. METHODS: A consecutive series of 210 stroke patients with aspiration symptoms such as cough and dysphagia who had soft or regular diet without tube feeding were examined. The dysphagia assessment tool for aspiration was compared with videofluoroscopy using Classification and Regression Tree (CART) analysis. RESULTS: In CART analysis, of 34 factors, the significant factors for estimating risk of aspiration were cough during swallowing, oral stasis, facial symmetry, salivary drooling, and cough after swallowing. The risk estimate error of the revised dysphagia assessment tool was 25.2%, equal to that of videofluoroscopy. CONCLUSION: The results indicate that the dysphagia assessment tool developed and examined in this study was potentially useful in the clinical field and the primary risk estimating factor was cough during swallowing. Oral stasis, facial symmetry, salivary drooling, cough after swallowing were other significant factors, and based on these results, the dysphagia assessment tool for aspiration was revised and complemented.

Integrating evidence-based practice into RN-to-BSN clinical nursing education.

This study examines the effects of integrating evidence-based practice (EBP) into clinical practicum on EBP efficacy and barriers to research utilization among Korean RN-to-BSN students. A one-group pretest-posttest design was used. Eighty-one students were recruited from a school of nursing in Korea. Evidence-based practice clinical practicum was composed of two consecutive programs during one semester. Lectures, individual mentoring on EBP practicum, small group, and wrap-up conferences were provided. Outcomes of EBP efficacy and barriers to research utilization were analyzed using paired t tests for 74 final participants. Evidence-based practice efficacy scores increased significantly (p < 0.05), and the barriers to research utilization scores decreased significantly after the EBP clinical practicum. The results highlight the effectiveness of EBP education among RN-to-BSN students. These results may help health educators develop effective educational strategies to integrate EBP concepts into a clinical practicum.

Development and validation of a scale for the end of life caregiving appraisal.

PURPOSE: End-of-life caregiving experiences can be complex. Family members experience physical and mental suffering as they anticipate their impending loss. Healthcare providers should be able to provide good quality of end-of-life (EOL) care and support for primary EOL caregivers. Studies have highlighted the role of healthcare providers providing information in the EOL situation to caregivers of chronic disease patients. This has resulted in the development of the End-of-life Caregiving Experience Appraisal Scale (EOLCAS) presented in this paper. The purposes of this study were to develop a scale that can evaluate the experiences of EOL caregivers, and to test the reliability and validity of this scale. METHODS: The scale domains were derived from systematic review of 35 relevant studies. We then examined its content validity with nurse scholars and clinicians using content validity index. To examine construct validity, a total of 175 caregivers from tertiary hospital setting in Korea participated in this study from December 2007 to May 2008. For the construct validity, factor analysis was utilized. RESULTS: The scale was composed of 32 items with four subscales: two negative appraisals (physical suffering and burden), one positive appraisal (maturation), and one neutral appraisal (social support pursuit). In this sample, the Cronbach's alpha for the entire scale was .84 indicating adequate reliability. However, Cronbach's alpha of subscales was varied. CONCLUSION: Nurses and other healthcare professionals could use the EOLCAS to assess the experiences of EOL caregivers to understand their experience in the EOL and enhance their quality of life although psychometrics of EOLCAS shows limited findings.

Middle-aged women's awareness of cholesterol as a risk factor: results from a national survey of Korean Middle-aged Women's Health Awareness (KomWHA) study.

BACKGROUND: Dyslipidemia, a risk factor for cardiovascular disease (CVD), is more prevalent in middle-aged women than in men of the same age in Korea. This study, the first national survey that focused on cholesterol in Korean women, aimed to: (1) assess their awareness and knowledge of cholesterol, (2) evaluate their risk reduction behavior, and (3) examine differences in these variables among geographical regions in Korea. METHODS: A questionnaire survey study was conducted in a randomly selected national sample of 1304 Korean women, aged 40-64 years in 3 geographic regions. RESULTS: High cholesterol was identified as a cause of CVD by 54.4% of respondents, however, 95.4% did not know their own values. Only 4.1% of respondents were aware of desirable level of total cholesterol. Eight percent of respondents perceived correctly the meaning of high-density lipoprotein cholesterol (HDL-C) as good cholesterol. And 32.9% had cholesterol check at least once a year. No significant regional differences were found in women's awareness and knowledge on cholesterol. No smoking (93.6%), low salt diet (52.5%) and weight management (50.6%) were the most prevalent risk reduction behaviors. Women in the rural area performed less risk reduction behaviors than those in urban area. CONCLUSIONS: Given the low level of awareness and knowledge about cholesterol in these women, nurses need to increase their education about cholesterol and risk reduction behaviors of CVD for middle-aged Korean women, particularly those in rural area. To resolve identified disparities in women's risk reduction behaviors between the rural and urban area, a national-level health policy can result in a successful effort to promote women's awareness of cholesterol and risk reduction behaviors for the cardiovascular health of the public.

[Impact of life style characteristics on prevalence risk of metabolic syndrome].

PURPOSE: The goal of this study was to evaluate the impact of life style characteristics on the prevalence risk of metabolic syndrome (MS). METHODS: A total of 581 adults were recruited from a cardiovascular outpatient clinic. A newly developed comprehensive life style evaluation tool for MS patients was used, and patient data related to the MS diagnosis were reviewed from the hospital records. RESULTS: The overall prevalence of MS was 53.2%, and the mean of MS score was 2.6 for patients at a cardiovascular outpatient clinic (78% of the patients had hypertension). Dietary habits among the life style characteristics had significant influence on the prevalence risk of MS and MS scores. And also interestingly, the classification and regression tree (CART) model suggested that the high prevalence risk groups for MS were older adults (61.5< or =age<79.4), and adults between 48.5 and 61.5 yr of age with bad dietary habits. CONCLUSION: This study indicates that nurses should focus on dietary habits of patients (especially patients classified as high prevalence risk for MS) for improvement and prevention of MS prevalence risk.

Factors related to incidence of eye disorders in Korean patients at intensive care units.

AIMS: The purpose of this study was to identify the incidence rate of eye disorders and further to identify factors related to incidence of eye disorders in intensive care unit patients. BACKGROUND: Although the incidence of eye disorders in intensive care unit patients is very high, it is difficult to come to an accurate estimate of number of eye disorders in intensive care unit patients because eye disorders are often perceived to be minor problems. DESIGN: A retrospective, descriptive survey design was used. METHOD: The medical records of a total 235 patients with eye disorders were identified through a review of the medical records of 2,500 patients hospitalised in the intensive care units of Yonsei University Hospital, Seoul, Korea from January to December, 2004. To examine factors related to eye disorders, 522 patients without eye disorders from the cohort of 2,265 patients were randomly selected. Factors related to incidence of eye disorder were included in a multiple logistic regression model, after screening by the chi-squared test. RESULTS: The incidence rate for eye disorders in the intensive care unit patients was 8.6%. From the multiple regression model, the following odds ratios (95% confidence intervals) of eye disorder were estimated; length of stay in intensive care unit of at least seven days: 2.8 (1.70-4.70); death: 2.5 (1.47-4.29); drowsy mental state: 2.2 (1.10-4.37); stupor mental state: 7.0 (3.20-15.45); coma mental state: 10.8 (3.47-33.74); no self-respiration: 1.9 (1.00-3.52); positive end expiratory pressure: 2.9 (1.66-4.92); sedatives: 4.2 (2.26-7.74); muscle relaxants: 2.3 (1.11-4.95). CONCLUSIONS: Factors related to incidence of eye disorders in intensive care unit patients identified in this study support the need to pay attention to eye problems and eye care in intensive care unit patients. RELEVANCE TO CLINICAL PRACTICE: An evidence-based eye care protocol should be provided as routine care to prevent eye complication, especially in critically ill patients with mechanical ventilators, positive end expiratory pressure, sedatives or muscle relaxants and for patients whose mental status is decreased.

Evaluation of a complementary cyber education program for a pathophysiology class.

PURPOSE: The goal of this study was to develop and evaluate a complementary cyber education program for a required pathophysiology class for nursing students. METHODS: The cyber education program comprised electronic bulletin boards, correspondence material storage, an announcement section, a report submission section, reference sites, and statistics on learning rates. Twelve online lectures complemented five lectures in the classroom. To evaluate the course's educational effectiveness, we performed an online objective questionnaire and an open questionnaire survey anonymously, and compared the complementary cyber education program with traditional classroom education. RESULTS: The complementary cyber education program effected significant improvements in scores for importance with regard to major, clarity of goals and education plans for courses, professor readiness, preciseness and description of lectures, amount and efficiency of assignments, and fairness in appraisal standards compared with the traditional classroom education group. CONCLUSION: This study indicates that a complementary cyber education program provides nursing students with the flexibility of time and space, the newest information through updated lectures, efficient motivational aids through intimacy between the lecturer and students, and concrete and meaningful tasks. The complementary cyber education course also increased student effort toward studying and student satisfaction with the class.

[Development of a stress scale for Korean nursing students].

PURPOSE: The purpose of this study was to develop a stress measurement scale for Korean nursing students. METHODS: Sixty preliminary items were selected by classifying 229 basic items extracted via literature review and Q-sorting method. In order to verify the reliability and validity of the preliminary instrument, data were collected from 617 nursing students in 2 colleges of nursing in Korea. RESULTS: As a result of the item analysis, 58 items were selected. They consisted of 2 types of stress which were college-based stress (38 items) and clinical-based stress (20 items). Ten factors in college-based stress and four factors in clinical-based stress were extracted by factor analysis, and each had a total variance of 63.01%, and 64.93%. Cronbach's Alpha of those 58 items were .937 in college-based stress and .922 in clinical-based stress, which was high. CONCLUSION: This paper is meaningful in a way that it has developed a tool capable of measuring stress for nursing students, which reflects the characteristics of our country. It is recommended for further study to re-verify the relevance and stability of this measurement.

Family Experiences in End-of-Life Care: A Literature Review.

PURPOSE: The purpose of this study was to summarize and analyze families' experiences of end-of-life care by conducting a systematic review of peer reviewed journals both in Korea and abroad. BACKGROUND: Families play an increasingly important role in care and medical treatment, acting as caregivers or decision makers rather than just being passive observers. It is necessary to understand the experiences of family members in order to provide appropriate care for them. METHODS: A systematic search of the literature was performed using the Cumulative Index for Nursing and Allied Health Literature (CINAHL) and the Korea Education & Research Information Service (KERIS) for the period of January 1990 through to December 2006. A total of 35 studies met the inclusion criteria. RESULTS: Seventeen studies used a quantitative design, while 18 studies used qualitative methods. Quantitative studies reported that the family's quality of life was relatively low when the patient was in need of high medical/nursing services. The perceived burden levels were moderately high, and depression levels were high among family caregivers. Various concepts emerged from the 18 qualitative studies, including psychological issues, physical problems, burdens, needs and interpersonal relationships. CONCLUSION: This study found that most previous research findings were focused on negative and neutral experiences. A few studies identified positive experiences. Based on the study results, we suggest that nurses need to be more aware of the experiences of patients' families and their potential needs.

[The use of propensity score matching for evaluation of the effects of nursing interventions].

BACKGROUND: Nursing intervention studies often suffer from a selection bias introduced by failure of random assignment. Evaluation with selection bias could under or over-estimate any intervention's effects. PS matching (PSM) can reduce a selection bias through matching similar Propensity Scores (PS). PS is defined as the conditional probability of being treated given the individual's covariates and it can be reused to balance the covariates of two groups. PURPOSE: This study was done to assess the significance of PSM as an alternative evaluation method of nursing interventions. METHOD: An intervention study for patients with some baseline individual characteristic differences between two groups was used for this demonstration. The result of a t-test with PSM was compared with a t-test without matching. RESULTS: The level of HbA1c at 12 months after baseline was different between the two groups in terms of matching or not. CONCLUSION: This study demonstrated the effects of a quasi-random assignment. Evaluation using PSM can reduce a selection bias impact that affects the result of the nursing intervention. Analyzing nursing research more objectively to reduce selection bias using PSM is needed.

The effect of a comprehensive lifestyle modification program on glycemic control and body composition in patients with type 2 diabetes.

PURPOSE: This paper describes the effects of a comprehensive lifestyle modification program (CLMP) on glycemic control and body composition in patients with type 2 diabetes. METHODS: This study was performed from October 2003 to April 2005, and used an experimental design with random assignment. The experimental group (n = 25) received CLMP for 4 months and follow-up sessions for 9 months. CLMP included nurse-led education on exercise and diet, and counseling on stress management and self-monitoring of their diabetic health. The control group (n = 23) received a 1-hour educational session on diabetic diet at the beginning of the study. Glucose level and body composition were measured in both groups a total of five times: at baseline (pre-intervention) and at 0, 3, 6 and 9 months post intervention. RESULTS: Repeated-measures ANOVA showed that there were statistically significant differences in fasting blood sugar and HbA1c levels between the two groups (both p < .05). Both groups demonstrated statistically significant changes in body composition over time, but there was no significant difference in the pattern of change between the two groups. CONCLUSION: CLMP is a useful program, and its multiple approaches by nurses as the leaders and coordinators appear to have positive and synergistic roles in improving and maintaining stable glucose level and body composition in patients with type 2 diabetes.

Parenting stress in mothers of children with congenital heart disease.

PURPOSE: The main purposes of this study were to examine the relationships among uncertainty, social support and parenting stress in mothers of children with congenital heart disease (CHD) and to identify the factors related to parenting stress. METHODS: This was a survey study using a questionnaire. Fifty-one mothers of children with CHD were recruited at the pediatric cardiac outpatient clinic at one university-affiliated hospital in Seoul between July 14th and September 25th, 2006. Abidin's Parenting Stress Index-Short Form, Mishel's Parents' Perception Uncertainty in Illness Scale, and Brandt and Weinert's Personal Resource Questionnaire were used to collect data. RESULTS: The results of bivariate analysis showed that parenting stress was significantly related to social support, ambiguity, lack of clarity, and lack of information, but was not related to unpredictability, one of the subconcepts of uncertainty. Multiple regression analysis showed that parenting stress was significantly related to social support and Internet information. CONCLUSION: Mothers who reported they had more social support and less uncertainty showed lower parenting stress. Also, the Internet could be an effective method to obtain information and to share child-rearing experiences with other mothers of children with CHD.

Development of a-health information website evaluation categories with items for diabetes mellitus.

As one of four major causes of death in Korea, diabetes mellitus has dramatically increased since the 1980s because of westernized lifestyles. Diabetes patients try to learn the knowledge and skills necessary for disease care since diabetes management is highly dependent on self- management. To do this, patients pursue more health information and proper sources for themselves. This study developed an evaluation tool including categories with items necessary for evaluation of Websites for health information on diabetes mellitus, as a method to offer consumers certified high quality health information on diabetes.

[The effects of a comprehensive life style modification program on glycemic control and stress response in type 2 diabetes].

PURPOSE: This study was to evaluate the effects of a comprehensive life style modification program on glycemic control and stress response in type 2 diabetes. METHOD: The participants(n=34) with type 2 diabetes were divided into either a usual care(control) or treatment(experimental) group. The experimental group(n=21) received a program that was based on a comprehensive life style modification protocol at a weekly meeting for 16 weeks. They also participated in individually prescribed exercise and diet along with stress management and self monitoring. The participants were followed for 6 months, during which postprandial glucose, HbA1C, and stress response inventory were measured. RESULT: The experimental group showed a significant lower postprandial glucose and stress response compared to those of the control group. However, there was no significant change in the HbA1C value in either group. CONCLUSIONS: These results suggest that a type 2 diabetes comprehensive lifestyle modification program may lead to clinical improvement in glycemic control and reduce the stress response.

Effects of lifestyle modification on metabolic parameters and carotid intima-media thickness in patients with type 2 diabetes mellitus.

The aim of this study was to examine the effects of a 6-month intensive lifestyle modification intervention on metabolic parameters and carotid intima-media thickness (IMT) in patients with type 2 diabetes mellitus. Fifty-eight subjects with type 2 diabetes mellitus were randomly assigned to the intervention group or the control group. The subjects in the intervention group participated in a 16-week intensive lifestyle modification program and subsequent monthly meetings during the 6-month study period. Control subjects received basic dietary education and usual care. Anthropometric data, metabolic parameters, and carotid IMT were examined before the intervention and after 6 months. Lifestyle modification intervention group patients showed a significant reduction in HbA1c (-1.0% +/- 1.3% vs +0.1% +/- 1.2%, P = .002), fasting blood glucose (-1.6 +/- 1.5 vs +0.3 +/- 2.5 mmol/L, P = .001), and 2-hour postprandial plasma glucose (-2.1 +/- 2.5 vs +0.8 +/- 4.4 mmol/L, P = .003) compared with control patients after 6 months. Body weight (-2.0 +/- 2.6 vs +0.2 +/- 1.7 kg, P = .001), body mass index (-0.8 +/- 1.0 vs 0.0 +/- 0.8 kg/m2, P = .003), and systolic blood pressure (-8.2 +/- 15.9 vs +0.4 +/- 14.1 mm Hg, P = .041) were significantly decreased in the intervention group. A significantly reduced carotid mean IMT progression was seen in the intervention group after 6 months (-0.040 +/- 0.136 vs +0.083 +/- 0.167 mm, P = .007). Changes in HbA1c (r = 0.34, P = .028), fasting plasma glucose (r = 0.31, P = .045), and 2-hour postprandial plasma glucose (r = 0.37, P = .015) correlated with the mean carotid IMT change after adjustment for age and sex. In conclusion, a 6-month intensive lifestyle modification intervention in patients with type 2 diabetes mellitus resulted in improved glycemic control and decreased progression of carotid IMT.