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Background: Health professionals had difficulty choosing the right time to discuss life-sustaining treatments (LSTs) since the Korean Act was passed in 2018. Objective: This study aimed to understand how patients decide to undergo LSTs in clinical practice and to compare the perceptions of these decisions among health professionals, patients, and families with suggestions to support the self-directed decisions of patients. Research design: A retrospective observational study with electronic medical records (EMRs) and a descriptive survey was used. Methods: The data obtained from the EMRs included all adult patients who died in end-of-life care at a university hospital in 2021. We also conducted a survey of 214 health professionals and 100 patients and their families (CNUH IRB approval no. 2022-07-006). Results: Based on the EMR data of 916 patients in end-of-life care, 78.4% signed do-not-attempt-resuscitation consents, 5.6% completed the documents for LSTs, and 10.2% completed both forms. LST decisions were mostly made by family members (81.5%). Most survey participants agreed that meaningless LSTs should be suspended, and the decision should be made by patients. Patients and family members (42–56%) and health professionals (56–58%) recommended discussing LST suspension when the patient is still conscious but with predicted deterioration of their condition. The suffering experienced by the patient was considered to be a priority by most patients (58%) and families (54%) during the decision-making process, while health professionals considered "the possibility of the patient's recovery" to be the highest priority (43–55%). Conclusions: There is still a significant discrepancy in the perceptions of LST decisions among health professionals, patients, and their families despite high awareness of the Act. This situation makes it challenging to implement the Act to ensure respect for the rights of patients to self-determination and dignified end-of-life. Further effort is needed to improve the awareness of LSTs and to clarify the ambiguity of document preparation timing. [ABSTRACT FROM AUTHOR]

Objectives: In general, fetal cfDNA is shorter than maternal cfDNA, and accuracy of noninvasive prenatal testing (NIPT) results can be improved by selecting shorter cfDNA fragments to enrich fetal‐derived cfDNA. This study investigated potential improvements in the accuracy of NIPT by performing classification and analysis based on differences in cfDNA size. Methods: We performed paired‐end sequencing to identify size ranges of fetal and maternal cfDNA from 62,374 pregnant women. We then developed a size‐selection method to isolate and analyze both fetal and maternal cfDNA, defining fetal‐derived cfDNA as less than 150 bp and maternal‐derived cfDNA as greater than 180 bp. Results: By implementing size‐selection method, the accuracy of NIPT was improved, resulting in an increase in the overall positive predictive value for all aneuploidies from 89.57% to 97.1%. This was achieved by enriching both fetal and maternal‐derived cfDNA, which increased fetal DNA fraction while the number of false positives for all aneuploidies was reduced by more than 70%. Conclusions: We identified the differences in read length between fetal and maternal‐derived cfDNA, and selectively enriched both shorter and longer cfDNA fragments for subsequent analysis. Our approach can increase the detection accuracy of NIPT for detecting fetal aneuploidies and reduce the number of false positives caused by maternal chromosomal abnormalities. Key points: What's already known about this topic?Typically, cell‐free DNA fragments are <200 bp in size, with fetal‐derived cfDNA being comparatively shorter in length than maternal‐derived cfDNA.Selective analysis of short‐sized cfDNA increases the fetal fraction. What does this study add?Based on the difference in cfDNA size, fetal‐derived cfDNA as well as maternal‐derived cfDNA were enriched.By separating fetal‐derived cfDNA and maternal‐derived cfDNA, it was possible to predict the origin of the chromosomal abnormality. [ABSTRACT FROM AUTHOR]

Aim: To investigate the incidence of post‐intensive care unit (ICU) depression and its risk factors among critical care survivors. Methods: The study data were extracted from the database of the National Health Insurance Service of Korea. We retrospectively analyzed data from 161,977 adult patients who were admitted to the ICU for more than 24 hr from January 1, 2012 to December 31, 2014 and survived for more than 1 year after discharge. Risk factors for newly diagnosed depression (Code F32) were analyzed using multiple logistic regression analysis. Results: The incidence of post‐ICU depression was 18.5%. The major risk factors were enteral nutrition (odds ratio [OR] = 2.28, 95% confidence interval [CI] = 2.19–2.36), cerebrovascular disease (OR = 1.59, 95% CI = 1.54–1.64), and hemi/paraplegia (OR = 1.48, 95% CI = 1.41–1.56). It was observed that cardiopulmonary resuscitation (OR = 0.55, 95% CI = 0.50–0.61) and myocardial infarction (OR = 0.75, 95% CI = 0.71–0.79) lowered depression. Conclusions: The incidence of post‐ICU depression was high and influenced by ICU treatment and physical impairments. Healthcare providers must pay attention to the psychological changes in survivors with major risk factors in the recovery process. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify factors influencing workplace bullying among Korean hospital nurses. Methods: Subjects in this study included 178 hospital nurses who attended two nationwide nursing educational conferences in 2013. The data was collected using self-report questionnaires which were used to identify the subjects’ characteristics, self-esteem, perception of nursing organizational culture, and workplace bullying experience. Results: The results showed that 19.1% of study subjects reported being victims of workplace bullying and mostly experienced person-related and work-related bullying. Multiple regression analysis was done to identify factors affecting workplace bullying. The perception of relation-oriented culture, task-oriented culture and self-esteem turned out to be variables that explained nurses’ workplace bullying, and these factors accounted for 32.0% of the variance. Conclusion: The findings suggest that nurses experience more workplace bullying in task-oriented cultures. However, they experience less bullying and report higher self-esteem and awareness in relation-oriented cultures. Interventions focused on the characteristics of the organization need to be developed to prevent workplace bullying in hospital nurses. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to analyze the nursing activities related to continuous renal replacement therapy (CRRT) in the intensive care units (ICU). Methods: We developed a list of 31 CRRT related nursing activities based on literature review and reviewed by expert group. A total of 109 direct time measurement records by 43 ICU nurses were collected and analyzed in terms of total time per shift, frequency, standard time, difficulty and performance levels of each CRRT nursing activity. Results: The mean time for CRRT nursing activity was 85.60 minutes per 8 hour shift. Nurses have spent average 9.46±6.98 minutes in a shift for "waste fluid bag change" activity. In addition, "check catheter location" was the most time consuming single activity. The most difficult activity was "counseling-answer" and the most competent one was "dialysis solutions change". Conclusion: The CRRT nursing activities accounted for a significant portion of total nursing workload. Practical allocation of nursing staff for CRRT patient along with development of a new nursing cost system need to be considered. Continuous nursing educational and training programs on CRRT should be developed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the experience of horizontal violence in intensive care unit (ICU) nurses. Methods: This is a methodological triangulation study consists of quantitative and qualitative research methods. A total of 134 ICU nurses from 5 hospitals participated in a survey on nurse to nurse horizontal violence, and the qualitative data were collected through 3 focus group interviews. Results: 94.0% of the participants have experienced horizontal violence within the past 6 months. The question with the highest mean score was "dominating senior nurses mood", and the question with the lowest mean score was "physical assaults". The qualitative data analysis revealed 17 themes on the backgrounds, types, and influence of horizontal violence. Conclusion: The survey result shows that the problem of horizontal violence in ICU nurses is serious, and the focus group interview extracts additional types of horizontal violence such as "scolding in a wrong way", "pressing to resign", "leaving out in the cold", and "burning". Further research needs to be done to build a multidimensional model of horizontal violence in the nursing workplace. [ABSTRACT FROM AUTHOR]