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Aims: The study aimed to develop and evaluate the effects of a self‐determination theory‐based, nurse‐led, physical activity programme for postmenopausal women with rheumatoid arthritis. Methods: Between December 2019 and April 2020, this randomized controlled trial recruited 62 postmenopausal women with rheumatoid arthritis from a university‐affiliated hospital in South Korea. The intervention group participated in a self‐determination theory‐based, nurse‐led, physical activity programme that consisted of Tai Chi‐based physical activity, a supportive psychosocial strategy, and interactive counselling for 16 weeks, and the control group continued to undergo their usual care. Results: There were statistically significant group‐by‐time interactions in physical activity and perceived sarcopenia, which favoured the intervention group. Additionally, the intervention group showed significant improvements in the perceived therapeutic efficacy of physical activity, grip strength, walking speed, disease activity score, and health‐related quality of life. Conclusions: The programme developed in this study can be an effective and feasible approach for postmenopausal women with rheumatoid arthritis in improving physical activity, selected osteosarcopenic outcomes, and health‐related quality of life. Further research is required to investigate the long‐term effects of this theory‐based programme for postmenopausal women in diverse settings. Summary statement: What is already known about this topic? Tai Chi‐based physical activity has been known to be a component of self‐management for rheumatoid arthritis. What this paper adds? It highlights the efficacy of a theory‐based, nurse‐led, physical activity programme to improve the quality of life of postmenopausal women with rheumatoid arthritis.The evidenced‐based programme could be transferred to postmenopausal women with rheumatoid arthritis in clinical settings. The implications of this paper: The self‐determination theory‐based, nurse‐led, physical activity programme can improve physical and psychosocial outcomes in postmenopausal women with rheumatoid arthritis.Importantly, this nurse‐led and theory‐based programme is expected to be applicable to postmenopausal women with rheumatoid arthritis in clinical settings, including both hospitals and communities. [ABSTRACT FROM AUTHOR]

Background/Aims: This study aimed to investigate the patterns of preferred endoscopic procedure types and techniques for managing difficult common bile duct (CBD) stones in South Korea. Methods: The Committee of Policy and Quality Management of Korean Pancreatobiliary Association (KPBA) conducted a survey containing 19 questions. Both paper and online surveys were carried out; with the paper survey being conducted during the 2019 Annual Congress of KPBA and the online survey being conducted through Google Forms from April 2020 to February 2021. Results: The response rate was approximately 41.3% (86/208). Sixty-two (73.0%) worked at tertiary hospitals or academic medical centers, and 60 (69.7%) had more than 5 years of endoscopic retrograde cholangiopancreatography experience. The preferred size criteria for large CBD stones were 15 mm (40.6%), 20 mm (31.3%), and 30 mm (4.6%). For managing of large CBD stones, endoscopic papillary large balloon dilation after endoscopic sphincterotomy was the most preferred technique (74.4%). When performing procedures in those with bleeding diathesis, 64 (74.4%) respondents favored endoscopic papillary balloon dilation (EPBD) alone or EPBD with small endoscopic sphincterotomy. Fifty-five respondents (63.9%) preferred the doubleguidewire technique when faced with difficult bile duct cannulation in patients with periampullary diverticulum. In surgically altered anatomies, cap-fitted forward viewing endoscopy (76.7%) and percutaneous transhepatic cholangioscopy (48.8%) were the preferred techniques for Billroth-II anastomosis and total gastrectomy with Roux-en-Y anastomosis, respectively. Conclusions: Most respondents showed unifying trends for the management of difficult CBD stones. The current practice patterns could be used as basic data for clinical quality improvements in the management of difficult CBD stones. [ABSTRACT FROM AUTHOR]

Background: An association between health literacy and health outcomes has been widely reported in the literature. However, models exploring the links between health literacy and the outcomes of health literacy need further testing. The purpose of this study was to examine the pathways of health literacy on diabetes self‐care activities amongst patients with Type 2 diabetes. Methods: A cross‐sectional survey using secondary data analysis was conducted on 155 patients with Type 2 diabetes recruited from the diabetes clinics of two university hospitals in a metropolitan city in South Korea. Structural equation modelling analysis using bootstrapping was carried out using the AMOS software. Results: Health literacy had no significant direct effect on diabetes self‐care activities. Rather, health literacy had a significant indirect effect on diabetes self‐care activities mediated through diabetes knowledge and patient activation. Conclusion: These findings indicate that interventions intended to improve self‐care activity amongst older adults with low health literacy should include strategies to enhance patients' knowledge, as well as their activation for diabetes self‐care. SUMMARY STATEMENT: What is already known about this topic? Health literacy is known to be a factor influencing self‐management of patients with diabetes.Low level of health literacy is associated with adverse health outcomes of patients with chronic illness.It is important to understand the processes through which health literacy affects health outcomes. What is already known about this topic? Health literacy had a significant direct effect on knowledge and patient activation but not on diabetes self‐care activities.Health literacy had a significant indirect effect on diabetes self‐care activities mediated through diabetes knowledge and patient activation. The implications of this paper: Interventions intended to improve self‐care activities amongst older adults with low health literacy should include strategies to enhance patients' knowledge, as well as their activation for diabetes self‐care.For patients with low health literacy, information processing should be used to facilitate the advancement of their knowledge and the subsequent influence of this knowledge on diabetes self‐care activities.Patient activation should be encouraged by nurses during interactions with patients with diabetes. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the influencing factors of breast cancer recurrence by comparing the risk factors and lifestyle patterns related to breast cancer in Korean women with and without recurrence. Methods: This cross-sectional survey comprised 241 Korean women diagnosed with breast cancer who had received follow-up treatment. Participants were recruited from a university hospital in Seoul and an online social media platform for breast cancer patients. Data were collected either via online or a paper survey, using a structured questionnaire that included general and disease-related characteristics and lifestyle behaviors. Data were analyzed using descriptive statistics, univariate analysis, and logistic regression. Results: Recurrence of breast cancer was influenced by four factors; childbirth experience, consumption of green/yellow vegetables, drinking behavior, and recovery from fatigue after sleep. Prevalence of recurrent breast cancer was associated with no childbirth experience (OR=2.29, p=.010), fewer green/yellow vegetables (OR=0.71, p=.008), drinking behavior (OR=0.24, p=.001), and a lower level of recovery from fatigue after sleep (OR=0.51, p<.001). Conclusion: Aside from having experienced childbirth, this study identified several modifiable factors that influence breast cancer recurrence. Increasing green/ yellow vegetable intake, alleviating fatigue, and reducing alcohol intake are important. Intervention strategies in clinical research and practice can be applied to address risk factors and reduce the prevalence of recurrent breast cancer. [ABSTRACT FROM AUTHOR]

Purpose: Patients in the Intensive Care Unit (ICU) experience a variety of symptoms. This descriptive correlational study aimed to determine the prevalence of symptoms and the physiological and situational factors associated with these symptoms in ICU patients. Methods: We analyzed the Electronic Medical Records (EMRs) of 1,214 cases admitted to and discharged from the ICUs of a university hospital in Seoul over a 1-year period from June to September 2022. This analysis utilized standardized instruments embedded in EMRs and a natural language analysis framework developed by the researchers. Descriptive statistics, the x2 test, the Fisher exact test, and multivariate logistic regression were employed to identify common symptoms and their related factors. Results: In total, 85.7% of the cases had at least one symptom during their ICU stay, and 36.6% experienced 2 symptoms. Pain was the most frequently experienced symptom, affecting 69.5% of cases, followed by agitation (29.7%), dyspnea (29.7%), and delirium (4.8%). Multivariate logistic regression analysis indicated that the length of ICU stay influenced pain (odds ratio [OR]=1.04; 95% confidence interval [CI], 1.02~1.06; p<.001), delirium (OR=1.08; 95% CI, 1.06~1.11; p<.001), agitation (OR=1.07; 95% CI, 1.05~1.10; p<.001), and dyspnea (OR=1.19; 95% CI, 1.13~1.26; p<.001). Conclusion: Pain, agitation, and dyspnea are common in ICU patients and are associated with the length of their ICU stay. Our study identifies factors related to these symptoms that could be targeted to manage and reduce their occurrence, providing a foundation for future research on various symptom assessment tools and natural language transcripts. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine Korean registered nurses' level of perceived knowledge and practice of venous thromboembolism risk assessment as well as prevention, self-efficacy in venous thromboembolism care and actual knowledge of venous thromboembolism. Background For hospitalised patients, venous thromboembolism is a preventable clinical disorder. Caring for venous thromboembolism patients requires coordination across multiple providers and settings. Clinical nurses can play a major role in improving venous thromboembolism prevention care, assessing venous thromboembolism risks and providing appropriate prophylactic measures to those who are at risk for venous thromboembolism. Design A cross-sectional descriptive study. Methods Anonymous paper-based surveys were conducted for a convenience sample of registered nurses' ( n = 452) from two university-affiliated hospitals in South Korea. Results The majority of participants indicated that their overall self-rated venous thromboembolism knowledge was 'fair', while only 2·4% rated it as 'very good' or 'excellent'. The overall mean score of the venous thromboembolism knowledge questions was 50·9 (±13·0) of a possible score of 100. The mean score of self-efficacy in practising venous thromboembolism prevention/prophylaxis was 3·0 (based on a one to five Likert scale). The self-reported venous thromboembolism assessment performance on patients varied among clinical units. Only 9·3% of participants reported having received in-service venous thromboembolism education from their hospital. Conclusions The findings showed that overall venous thromboembolism knowledge and self-efficacy in venous thromboembolism prevention practices of Korean registered nurses' were not highly rated. Korean nurses demonstrated a lack of knowledge about venous thromboembolism, particularly in the areas of venous thromboembolism prophylaxis measures and venous thromboembolism diagnosis methods. Relevance to clinical practice Focused education on venous thromboembolism prevention and risk assessment should be considered a component of continuing education for Korean nurses. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify factors affecting the noise management performance of adult intensive care unit (ICU) nurses in Korea. The ICU environment is exposed to various types of noises due to the use of medical devices for the treatment of critically ill patients. The noise has an adverse effect on nurses' health and their nursing performance, which might potentially threaten patient safety. A cross-sectional study was conducted with a total of 148 nurses working in adult ICUs from two university hospitals in Korea. Data were collected using self-administered questionnaires, which included various aspects such as noise knowledge, response to noise, patient safety culture, and noise management performance. Multiple regression analysis revealed that teamwork (β = 0.33, p = 0.004), patient safety policy, and procedure (β = 0.25, p = 0.037), which were subscales of patient safety culture, as well as frequency of noise experience (β = 0.16, p = 0.030) were significant factors affecting adult ICU nurses' performance of noise management. This study provides a significant basis for promoting adult ICU nurses' performance in noise management. A structured policy and procedure for noise management should be established for reducing noise in adult ICUs. In terms of nursing education, it is necessary to consider and develop team-based training programs to promote noise management performance in the ICU. Nurse managers and nursing organizations should consider how to create conditions in which nurses can recognize the importance of noise reduction and perform well in noise management. [ABSTRACT FROM AUTHOR]

Aims: This descriptive, exploratory, correlational analysis investigated patients with type 2 diabetes and their diabetes knowledge, depression, diabetes‐management self‐efficacy, and social support and sought to determine the effects of these factors on psychological insulin resistance among type 2 diabetes patients in South Korea. Methods: This descriptive cross‐sectional study included 136 patients with type 2 diabetes who visited an endocrinology clinic. A structured questionnaire and electronic medical records were used to collect data regarding demographic and disease‐related characteristics as well as scores on the Diabetes Knowledge Tests, Center for Epidemiologic Studies Depression Scale, Diabetes Management Self‐efficacy Scale, Social Support Scale, and Psychological Insulin Resistance Scale, between September and December 2017. Data were analysed using descriptive statistics, independent t‐tests, a one‐way ANOVA, Pearson's correlation coefficient, and stepwise multiple regression. Results: The total score for psychological insulin resistance was 60.92 ± 14.75 of a maximum of 90. Stepwise multiple regression showed that diabetes knowledge, diabetes‐management self‐efficacy, social support, absence of diabetes complications, and depression explained 38.6% of the variance in psychological insulin resistance. Conclusion: Diabetes knowledge was found to have the largest influence on psychological insulin resistance, followed by social support, absence of complications, depression, and diabetes‐management self‐efficacy. Development of interventions that consider all these factors is required, and the effects of such interventions should be tested through further research. SUMMARY STATEMENT: What is already known about this topic? Patients with diabetes in Korea have been reported to have relatively high levels of psychological resistance to insulin therapy compared with their counterparts in the West.Previous studies on factors associated with psychological insulin resistance have considered only a limited number of factors and have simply analysed the association between these factors. The full range of disease‐related factors that can affect psychological insulin resistance has not been considered.Research on the psychological insulin resistance of patients with type 2 diabetes, and the factors that affect it, is currently lacking in Korea. What this paper adds? The level of psychological insulin resistance of Korean patients with type 2 diabetes was found to be higher than that of patients from other countries.Diabetes knowledge was found to have the most significant influence on the psychological insulin resistance in Korean patients with type 2 diabetes, followed by social support, absence of diabetes complications, depression, and diabetes‐management self‐efficacy. The implications of this paper: Levels of psychological insulin resistance among patients with type 2 diabetes should be monitored, and nursing education programs should be developed that are tailored to patients' level of psychological insulin resistance.Diabetes knowledge, social support, diabetes complications, depression, and diabetes‐management self‐efficacy should be systematically monitored to reduce the level of psychological insulin resistance in patients with type 2 diabetes. Development of detailed interventions that consider these factors may be helpful, and their effectiveness should be tested through further research. [ABSTRACT FROM AUTHOR]

Purpose: Artificial intelligence (AI) has had a profound impact on humanity; in particular, chatbots have been designed for interactivity and applied to many aspects of daily life. Chatbots are also regarded as an innovative modality in nursing education. This study aimed to identify nursing students' awareness of using chatbots and factors influencing their usage intention. Methods: This study, which employed a descriptive design using a self-reported questionnaire, was conducted at three university nursing schools located in Seoul, South Korea. The participants were 289 junior and senior nursing students. Data were collected using self-reported questionnaires, both online via a Naver Form and offline. Results: The total mean score of awareness of using chatbots was 3.49±0.61 points out of 5. The mean scores of the four dimensions of awareness of using chatbots were 3.37±0.60 for perceived value, 3.66±0.73 for perceived usefulness, 3.83±0.73 for perceived ease of use, and 3.36±0.87 for intention to use. Significant differences were observed in awareness of using chatbots according to satisfaction with nursing (p<.001), effectiveness of using various methods for nursing education (p<.001), and interest in chatbots (p<.001). The correlations among the four dimensions ranged from .52 to .80. In a hierarchical regression analysis, perceived value (β=.45) accounted for 60.2% of variance in intention to use. Conclusion: The results suggest that chatbots have the potential to be used in nursing education. Further research is needed to clarify the effectiveness of using chatbots in nursing education. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is considered as a major health problem for women, and the prevalence is increasing over the world. Research to improve their quality of life is necessary. Purpose: This study was to examine the body image and self‐esteem of breast cancer patients who underwent breast reconstruction in order to determine whether these affect their quality of life. Methods: A cross‐sectional descriptive design was employed. This study was conducted on 140 patients who underwent breast reconstruction following breast cancer surgery at S University Hospital in Gyeonggi‐do, South Korea. Measures were the general characteristics list, body image scale, self‐esteem scale, and the Korean version of the Functional Assessment of Cancer Therapy‐Breast Cancer Version 4 for quality of life. Data were analysed using descriptive statistics, Pearson correlation coefficient, linear regression, and process macro bootstrapping for mediation effect. Data were collected from October 2020 to March 2021. Results: The path regression coefficient was 1.59 (p <.001), and the direct effect of body image on the quality of life was 1.34 (p <.001) considering the effect of self‐esteem, which is a parameter. This confirmed that self‐esteem mediates body image and quality of life. The explanatory power of self‐esteem for quality of life was 54%. Conclusion: This study suggests that body image and self‐esteem are important factors in the quality of life of breast cancer patients who underwent breast reconstruction. Also, the self‐esteem has a mediating effect in the relationship between body image and quality of life. Relevance to clinical practice: In clinical practice, nurses should focus on the body image and self‐esteem of breast cancer patients who have undergone breast reconstruction in order to improve their quality of life. Patient or public contribution: This cross‐sectional descriptive design study was conducted on patients who underwent breast reconstruction following breast cancer surgery at hospital in South Korea. [ABSTRACT FROM AUTHOR]

Background: Certain routine medication could result in post-induction hypotension (PIH), such as angiotensin axis blockades, which are frequently administered as a first-line therapy against hypertension. Remimazolam is reportedly associated with lesser intraoperative hypotension than propofol. This study compared the overall incidence of PIH following remimazolam or propofol administration in patients managed by angiotensin axis blockades. Methods: This single-blind, parallel-group, randomized control trial was conducted in a tertiary university hospital in South Korea. Patients undergoing surgery with general anesthesia were considered for enrollment if the inclusion criteria were met: administration of an angiotensin converting enzyme inhibitor or angiotensin receptor blocker, 19 to 65 years old, American Society of Anesthesiologists physical status classification ≤ III, and no involvement in other clinical trials. The primary outcome was the overall incidence of PIH, defined as a mean blood pressure (MBP) < 65 mmHg or decrease by ≥ 30% of the baseline MBP. The time points of measurement were baseline, just before the initial intubation attempt, and 1, 5, 10, and 15 min following intubation. The heart rate, systolic and diastolic blood pressures, and bispectral index were also recorded. Groups P and R included patients administered propofol and remimazolam, respectively, as an induction agent. Results: A total of 81 patients were analyzed, of the 82 randomized patients. PIH was less frequent in group R than group P (62.5% versus 82.9%; t value 4.27, P = 0.04, adjusted odds ratio = 0.32 [95% confidence interval 0.10–0.99]). The decrease in the MBP from baseline was 9.6 mmHg lesser in group R than in group P before the initial intubation attempt (95% confidence interval 3.3–15.9). A similar trend was observed for systolic and diastolic blood pressures. No severe adverse events were observed in either group. Conclusion: Remimazolam results in less frequent PIH than propofol in patients undergoing routine administration of angiotensin axis blockades. Trial registration: This trial was retrospectively registered on Clinical Research Information Service (CRIS), Republic of Korea (KCT0007488). Registration date: 30/06/2022. [ABSTRACT FROM AUTHOR]

This study aimed to examine the energy drink consumption pattern of Korean nurses and related factors. A descriptive cross‐sectional design was utilized, and data were collected through a self‐reporting questionnaire. Participants were Korean nurses working in hospitals. Data were analyzed by descriptive statistics, chi‐square test, and binomial logistic regression test. A total of 388 nurses participated in the study. Approximately two‐thirds of the nurses consumed energy drinks in addition to caffeinated coffee and/or tea. They usually consumed energy drinks during working hours and at the workplace. In comparison with nonconsumers, nurses who consumed energy drinks perceived that they had a stimulating effect and could replace regular drinks. Having colleagues who consume energy drinks and perceiving that energy drinks had an arousal effect were shown to be associated factors for energy drink consumption; thus, it is necessary to develop educational strategies targeting these groups of nurses. The reasons for the dependence of hospital nurses on energy drinks should be further investigated. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the validity and reliability of the revised Korean version of the Nurses' Ethical Behaviors for Protecting Patient's Rights Scale (NEBPPRS-K25). Methods: The participants in this study consisted of 311 nurses employed at university hospitals located in D, S, or U cities. Data were collected from July 1 to August 31, 2022. The collected data were analyzed utilizing SPSS and AMOS version 28.0. Results: The statistical analysis led to the exclusion of three items from the original version, resulting in five subscales encompassing a total of 25 items. Confirmatory factor analysis demonstrated satisfactory model fit indices (normed χ²=2.56, p<.001, RMR=.05, RMSEA=.07, GFI=.84, CFI=.86, TLI=.85, IFI=.87). The items' convergent and discriminant validity were verified using confirmed through the extracted mean variance (.54~.65) and composite reliability (.78~.90). The Cronbach's α value for the overall NEBPPRS-K instrument was .89, while the Cronbach's α value for each individual subscale ranged from .66 to .85. Conclusion: The NEBPPRS-K25 is a valid and reliable scale, making it suitable for widespread use in measuring nurses' ethical behaviors to safeguard patient rights. [ABSTRACT FROM AUTHOR]

Aim: We examined Korean nurses professional quality of life, emotional labour and workplace violence to guide development of interventions to improve nurses professional quality of life. Background: Nurses face heavy exposure to emotional labour and workplace violence. Stress experienced by nurses reduces compassion satisfaction and increases compassion fatigue. Methods: Participants comprised 399 clinical nurses chosen by convenience sampling. Questionnaires measured demographic characteristics, emotional labour, workplace violence and professional quality of life. Results: Nurses professional quality of life was affected by emotional labour and workplace violence. Graduate educational level, emotional exposure and emotional supervision were associated with compassion satisfaction. Burnout was commonly associated with emotional exposure, experience and supervision of workplace violence. Secondary traumatic stress was associated with emotional exposure and experience of workplace violence. Conclusions: We elucidated the relationship between professional quality of life, emotional labour and workplace violence. Raising professional quality of life among nurses requires regular analysis of emotional labour and provision of organizational‐level interventions. Counselling programmes that address violence prevention education and comprehensive response strategies among nurses and policies that foster an organizational culture of respect and cooperation in hospitals are needed. SUMMARY STATEMENT: What is already known about this topic? Promoting nurses professional quality of life is important in managing the quality of nursing care.Nurses with exposure to emotional labour show negative health effects, reduced willingness and ability to work, frequent absences, dissatisfaction and turnoverWorkplace violence negatively affects professional quality of life among clinical nurses. What is already known about this topic? Compassion satisfaction was highly related to organizational management systems for emotional labour and workplace violence.Burnout was associated with the magnitude of exposure to emotional labour and experience of workplace violence and negative organizational management systems for workplace violence.Secondary traumatic stress was associated with the magnitude of exposure to emotional labour and experience of workplace violence. The implications of this paper: To increase nurses professional quality of life, organizational management systems that address and reduce emotional labour and workplace violence are critical.It is necessary to develop programmes that address violence prevention education and comprehensive response strategies regarding emotional labour.Counselling programmes that address violence prevention education and comprehensive response strategies among nurses and policies that foster an organizational culture of respect and cooperation in hospitals are needed. [ABSTRACT FROM AUTHOR]

Background: Muted or controlled alarms resulting from alarm fatigue have become a threat to patient safety and several institutions are aware of this risk. Aims: This study aimed to investigate critical care nurses' perceptions of medical device alarms, alarm fatigue, and alarm management practices. Methods: This descriptive study investigated 48 nurses working at two intensive care units (ICUs) within a single university hospital, in South Korea. They were asked to complete a self‐administered questionnaire about their perception of the ICU medical device alarm, alarm fatigue, and related management practices. The response rate was 100%. Results: Critical care nurses experienced a moderate or higher level of alarm fatigue, scoring 29.1 out of 40. Participants identified the items "Frequent false alarms, which lead to reduced attention or response to alarm when they occur," and "Inadequate staff" as the most important issues for alarm management. The most frequently involved item in alarm management practice was "I only use infusion pumps for drugs that require precise dose." Alarm management practices among the nurses differed significantly according to ICU clinical career and experience of patient safety accidents. Conclusions: This study highlights the need to develop a standardized medical device alarm management protocol that can help identify different alarms correctly and respond to them rapidly and appropriately. Relevance to Clinical Practice: It is necessary to reduce alarm fatigue and promote safe and effective alarm management practices among critical care nurses through sufficient education and steady training. Alarm fatigue should also be mitigated by employment of sufficient nursing personnel in ICUs. [ABSTRACT FROM AUTHOR]

Introduction: Central compartment atopic disease (CCAD) has recently been suggested as a phenotype of chronic rhinosinusitis (CRS). This study aims to investigate the prevalence of the radiologic CCAD phenotype in CRS within a pediatric population and identify its ability to predict comorbid allergy and asthma. Methods: Computed tomography and endoscopic examination were conducted on pediatric patients with CRS either with or without nasal polyps. Allergen sensitization was determined with the multiple-allergen simultaneous test and skin prick test. Serum total immunoglobulin E (IgE), peripheral blood eosinophil percentage, and presence of asthma were also evaluated. Results: A total of 82 pediatric patients were enrolled. Overall, 55 (67.1%) of the participants demonstrated aeroallergen sensitization, and 31 (18.9%) of the 164 sides of sinuses were radiologically defined to fit the CCAD phenotype. Patients having CRS with the CCAD phenotype had a higher prevalence of aeroallergen sensitization (87.1% vs 62.4%, P =.008), particularly house dust mite (74.2% vs 53.4%, P =.035), and a higher incidence of asthma (16.1% vs 3.8%, P =.010). Additionally, patients having CRS with the CCAD phenotype demonstrated a high serum total IgE levels (51.6% vs 30.1%, P =.023) in comparison to patients having CRS without CCAD. Conclusion: In pediatric CRS, the radiological CCAD phenotype was associated with allergen sensitization and asthma. Furthermore, the CCAD phenotype was associated with high serum total IgE levels, suggesting allergy etiology should be considered with this type of pediatric patients with CRS. [ABSTRACT FROM AUTHOR]

Accurate diagnosis of acute appendicitis is a difficult problem in practice especially when the patient is too young or women in pregnancy. In this paper, we propose a fully automatic appendix extractor from ultrasonography by applying a series of image processing algorithms and an unsupervised neural learning algorithm, self-organizing map. From the suggestions of clinical practitioners, we define four shape patterns of appendix and self-organizing map learns those patterns in pixel clustering phase. In the experiment designed to test the performance for those four frequently found shape patterns, our method is successful in 3 types (1 failure out of 45 cases) but leaves a question for one shape pattern (80% correct). [ABSTRACT FROM AUTHOR]

Objective. This study is aimed at investigating the pattern of change occurring in respiratory pathogens before and after the outbreak of COVID-19, a type of viral pneumonia for which a pandemic was declared (March 2020). The results were analyzed by gender and age to identify the association between personal hygiene and prevention of infection by respiratory pathogens. Methods. A retrospective analysis was performed on 39,814 sputum, bronchial aspirate, and transtracheal aspirate samples obtained from 15,398 patients visiting a university hospital, located in Chungcheongnam-do, South Korea, between January 2018 and December 2021. From 4,454 patients whose samples were culture positive for bacteria, 6,389 strains were isolated and further cultured. Results. The mean age of the outpatients with respiratory pathogens was 66.2 years, and the comparison of the culture test results by gender showed that 64.9% (2,892/4,454) were male and 35.1% (1,562/4,454) were female. Compared to the pre-COVID-19 pandemic period, the number of outpatients with a request for respiratory microbial cultures after the onset of the pandemic was reduced by 20.7% and the number of outpatients with a positive culture result was reduced by 23.0%. The number of respiratory samples received was reduced by 6.7% after the pandemic, while the sample positive rate was reduced by 18.3%. Among the isolated microbial strains, there was a significant decrease of 43.1% for the Acinetobacter baumannii complex, 60.5% for Streptococcus pneumoniae, 67.2% for Haemophilus influenzae, and 78.1% for Moraxella catarrhalis when compared with pre-COVID-19 levels. The distribution of respiratory microbial strains by age group showed that the highest percentage of isolated strains was in patients in their 70s. Conclusions. The improvements in personal hygiene due to the COVID-19 pandemic exerted a substantial influence on the pattern of change in other common respiratory microorganisms, which highlights the importance of personal hygiene management in the prevention of respiratory infections. [ABSTRACT FROM AUTHOR]

Antioxidants decrease the risk of breast cancer by reducing oxidative stress, but the association between dietary total antioxidant capacity (DTAC) and cancer recurrence has not yet been investigated. The present study aimed to test the hypothesis that DTAC is inversely associated with cancer recurrence and mortality in breast cancer patients. Breast cancer patients (n = 603) who underwent breast cancer surgery and a dietary survey within 5 years after surgery were recruited. This study observed disease-free survival (DFS) and mortality in breast cancer patients according to DTAC calculated based on 24-hr dietary recall. Total DTAC was significantly lower in patients with cancer recurrence than in those without. DFS was positively associated with the total DTAC (p = 0.005) and DTAC of vegetables and legumes (p = 0.001 and p = 0.010), respectively. However, total DTAC was not associated with mortality. Cox proportional hazards regression analysis showed that total DTAC (HR: 0.44, 95% CI 0.26-0.94) and DTAC of vegetables (HR: 0.30, 95% CI 0.14-0.65) and legumes (HR: 0.38, 95% CI 0.18-0.73) were inversely associated with cancer recurrence after adjusting for confounding factors. This study was the first to indicate that total DTAC and DTAC of vegetables and legumes could be beneficial in decreasing breast cancer recurrence. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate the differences in practices, policies, and perceptions of nurses regarding work‐related utilization of smartphones in acute‐care settings. Background: Mobile devices utilizing emerging technology are widely used in acute‐care settings; however, concerns such as potential distraction, improper use, and negative impact on the nursing image in clinical practice remain valid. Methods: Nurse managers (n = 8) and nurses (n = 181) were enrolled from eight academic tertiary hospitals that have comprehensive electronic medical record systems and mobile versions. Between October 2018 and February 2019, participants completed a questionnaire designed to explore their use of smartphones. The reporting guide for self‐administered surveys of clinicians was applied. Results: Approximately 80% of nurses carried personal smartphones while working, with 70% using their devices for work. The prevalence of work‐related smartphone use ranged from 3% to 43% by functionality, which was lower than that estimated by managers. Frequent uses included taking pictures/videos and internet browsing. Nurses were more positive than managers about the benefits of smartphone use and less burdened by related concerns. Novice and junior nurses were more optimistic than senior nurses. Only one hospital had a policy on nurses' use of personal devices at work. Conclusion: Two unmet needs in the current clinical information system were identified: information supporting task‐related knowledge at the bedside and security of data capture and communication. Implication for nursing policy: The unintended perception gaps between nurses and managers regarding work‐related smartphone use can be closed by nursing leadership. Unmet nursing informatics, particularly for information‐seeking purposes, can be addressed in the context of quality assurance. Nurse leaders can advocate secure and proper use of smartphones in clinical practice. [ABSTRACT FROM AUTHOR]

The artice presents research that examines the practical difficulties interfering the appropriate use of intermittent pneumatic compression and graduated compression stocking for critical patients. Topics discussed include the significant use of mechanical prophylaxis by nurses, systematic education based on information needs for improvement, and necessary Velcro loosening problems. The importance of additional knowledge on the problems encountered by nurses is also noted.

Aim: There is no validated tool to predict persistent ovulatory dysfunction after medication with oral contraceptives in women with polycystic ovary syndrome (PCOS), which is the most severe subtype of PCOS. We aimed to build a model to predict persistent ovulatory dysfunction after medication of oral contraceptives in women with PCOS. Methods: A total of 286 patients with PCOS were treated with and without oral contraceptives at a tertiary academic medical center. Data were obtained from the electronic medical record system between January 2016 and March 2019. A risk prediction model was developed using multivariable logistic regression. Model 1 was based on age and chief complaints and Model 2 further included predictors evaluated during a clinic visit. Model 3 additionally included laboratory findings. Results: Of the study population, ovulatory dysfunction was persistent in 117 patients (40.9%). Compared with the simple model (Models 1 and 2), the full prediction model (Model 3) had better Akaike's information criterion (286, 244 vs. 225) and the area under the curve (AUC) increased from 0.74 and 0.79 to 0.84. The full model included 7 covariates measured during the evaluation of PCOS, and two covariates were significant predictors of persistent ovulatory dysfunction in PCOS: age (OR 0.91; 95% CI 0.84–0.97), and anti‐Müllerian hormone (OR 1.17; 95% CI 1.09–1.26). This model demonstrated good discrimination (AUC, 0.84) and calibration (Hosmer–Lemeshow goodness of fit test, p = 0.74). Conclusions: This prediction model was shown to be a useful method for predicting persistent ovulatory dysfunction after oral contraceptive medication in patients with PCOS. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate how pediatric intensive care unit (PICU) nurses and the mothers of hospitalized children perceived their partnership and identify the detailed differences in the common domains of partnership between them. Methods: A qualitative descriptive design with semi-structured and open-ended interviews was used. Interviews with mothers of hospitalized children and nurses in the PICU were conducted at a national university hospital in South Korea. Results: Five integrated categories were identified concerning nurses' and mothers' perceptions of partnership. Five common domains were derived by merging the partnership categories perceived by each PICU mother and nurse: expectation of trust, sharing and communication, participation in care, equality in the relationship, and coordination of opinion However, there were significant differences in the composition of the categories of these common domains. Conclusion: These results may facilitate more effective partnerships between parents and PICU nurses. Efforts should be taken to promote the formation of trust between nurses and parents and create an environment that is conductive to regular open communication in particular, steps should be taken to reduce gaps in awareness concerning this partnership and information sharing, nursing methods, and decision-making. [ABSTRACT FROM AUTHOR]

Aims: To identify the unique profiles of emotional labour management strategies among Korean nurses in regards to the preferences of surface acting (affecting emotions required at the workplace) and deep acting (trying to genuinely experience emotions required at the workplace), a latent profile analysis (LPA) was conducted. In addition, differences in psychological and occupational well‐being between the discovered profiles are examined. Design: An exploratory, cross‐sectional LPA design was employed. Methods: Nurses (N = 204) working in university hospitals in South Korea responded to the survey during November 2019. Participants completed the Emotional Labour Questionnaire, a portion of the Maslach Burnout Inventory, the Minnesota Satisfaction Questionnaire short form and the Turnover Intentions Scale. Results: As a result of LPA on nurses' surface acting and deep acting, five profiles were discovered: non‐actors, surface actors, moderators, regulators and high regulators. In addition, differences in emotional exhaustion, job satisfaction and turnover intentions between profiles were examined. Profiles that used high levels of surface acting had high levels of emotional exhaustion and turnover intentions. Conclusion: Nurses with characteristics of surface actors, high regulators profiles in emotional labour context are more prone to emotional exhaustion and turnover possibilities, compared with other profiles (non‐actors, moderators and regulators). Impact: Insights from the current study are beneficial to hospitals in preventing potential emotional exhaustion and nurse turnover by responding to high‐risk profiles and customizing emotional labour management policies with regards to the different profiles of nurses' emotional labour. [ABSTRACT FROM AUTHOR]

Aims and objectives: To validate a hypothetical path model estimating the health status of patients with insulin‐treated type 2 diabetes and to verify the mediating effects of diabetes management self‐efficacy, diabetes self‐management behaviour and haemoglobin A1c using a multi‐mediation model. Background: Diabetes knowledge, personal and social motivations, diabetes management self‐efficacy and health behaviours may be interrelated and may directly or indirectly affect the objective and subjective health outcomes of patients with type 2 diabetes mellitus receiving insulin treatments. Design: Model testing correlational design. Methods: The participants were 193 outpatients with insulin‐treated type 2 diabetes. Data were collected between July and November 2019. The collected data were analysed using SPSS version 25.0® and AMOS 23.0. This study is based on STROBE guidelines. Results: The model's fit indices were adequate. Diabetes‐related knowledge, psychological insulin resistance, family support for diabetes management, diabetes self‐care activities and haemoglobin A1c had significant direct effects on subjective health status. Diabetes management self‐efficacy had significant indirect effects on subjective health status via diabetes self‐care activities and haemoglobin A1c, and mediated the path through which diabetes knowledge, psychological insulin resistance and family support for diabetes management indirectly affect subjective health status. These variables explained 55.0% of the total variance of subjective health status. Conclusion: Diabetes knowledge, psychological insulin resistance, diabetes management family support, diabetes management self‐efficacy and diabetes self‐care activities were found to be related to the subjective and objective health status. Relevance to clinical practice: The findings can help health professionals improve diabetes self‐care activities and haemoglobin A1c, which will influence subjective health status in patients with type 2 diabetes mellitus, receiving insulin treatments. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to identify the effects of the subfactors of self‐compassion on hospital nurse burnout and provide basic knowledge for an intervention programme to prevent nurse burnout. Background: Burnout in nurses has been reported to influence their own and patients' mental health and safety. Enhancing self‐compassion can help to prevent burnout. Methods: This study involved descriptive research using a cross‐sectional design. Data were collected at H University Hospital in Korea, from January to March 2020. Of the 213 questionnaires collected, 208 were included in data analysis. Results: Burnout was higher when nurses were younger, unmarried, in poor health, general nurses, dissatisfied with their jobs, planning to leave their jobs or receiving low social support from peers. There was a negative correlation between burnout and the self‐compassion subscales. Multiple regression analysis showed that isolation and mindfulness among self‐compassion, were significantly related to burnout. Conclusions: Since individual variables and self‐compassion are major elements impacting nurse burnout, it is important for nursing organizations to investigate nurses' individual variables, including subfactors of self‐compassion, to help them prevent burnout. Implications for Nursing Management: Nurse burnout might be prevented by increasing self‐compassion. Hospital and nurse managers may employ individualized strategies to enhance nurses' self‐compassion. [ABSTRACT FROM AUTHOR]

Background: Interstitial lung abnormality (ILA) is closely related to lung cancer. This study aimed to assess whether the presence of ILA is associated with the clinicoradiological features of elderly patients (≥70 years) with early‐stage non‐small cell lung cancer (NSCLC). Methods: Elderly patients who underwent surgical resection for stage I or II NSCLC with preserved lung function between 2012 and 2019 were retrospectively identified. ILA was evaluated using a three‐point scale. Univariate analyses were performed for clinicoradiological features based on the presence of ILA. Logistic and linear regression analyses were performed for cancer staging and tumor size, respectively. Results: A total of 254 patients were evaluated. The presence of ILA (score = 2) was significantly associated with male sex, current or former smoker status, higher pack‐years of smoking, low forced expiratory volume in one second/forced vital capacity ratios and diffusing capacity of the lung for carbon monoxide, and presence of emphysema (≥5%). Tumor characteristics, such as lower lobe and outer one‐third location, squamous cell carcinoma, and higher cancer stage (stage II) were significantly associated with ILA. The presence of ILA independently predicted a higher cancer stage (adjusted odds ratio, 1.81; 95% confidence interval, 1.10–2.96; p = 0.02) and a larger tumor size in linear regression analysis (p = 0.04). Conclusions: Patients with ILA showed clinicoradiological features similar to those of idiopathic pulmonary fibrosis in elderly patients with early‐stage NSCLC. Identifying the clinical implications of ILA in early‐stage lung cancer will guide clinicians in providing appropriate management for these patients. [ABSTRACT FROM AUTHOR]

Background and Aim: Several barriers prevent the proper screening, diagnosis, and treatment of hepatitis C virus (HCV) infection. We aimed to evaluate the status of HCV screening, confirmation, and treatment rates in a tertiary academic medical center in Korea. Methods: Patients who visited Severance Hospital between 2015 and 2019 were eligible in this retrospective study. The testing and positivity rates for anti‐HCV antibodies and HCV RNA were sequentially analyzed. Results: Between 2015 and 2019, 252 057 patients (117 131 men, 46.5%) who underwent anti‐HCV antibody testing were retrospectively reviewed. The median age of the study population was 51.0 years. Patients with positive anti‐HCV antibody test results (n = 2623, 1.0%) showed a higher proportion of liver cirrhosis (17.6% vs 2.0%) and unfavorable laboratory test results (all P < 0.05). The positivity rates were 1.3% and 0.8% in the medical and surgical departments, respectively. HCV RNA was tested in 1628 (62.1%) patients, with a 57.4% (n = 928) positivity rate. The medical department had a higher HCV RNA testing rate than the surgical department (75.4% vs 40.8%). Among the 928 patients who showed positivity for HCV RNA, 847 (90.7%) underwent genotype testing (mostly 1 and 2 [95.4%]). The treatment rate was 66.9% (n = 567); it was higher in the gastroenterology department (70.8%) than in the non‐gastroenterology departments (62.3%). Conclusions: A considerable proportion of patients testing positive for anti‐HCV antibodies were not referred for proper management. Systematic and automated screening and referral systems, which may help identify patients requiring treatment for HCV infection, are necessary even in tertiary academic medical centers. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate the clinical outcomes after bilateral mix-and-match cataract surgery using extended depth of focus (EDOF) and diffractive multifocal (DMF) intraocular lenses (IOLs). Setting. Asan Medical Center, Seoul, South Korea. Design. Prospective clinical study. Methods. Thirty-seven patients underwent TECNIS Symfony EDOF IOL (ZXR00) implantation in the dominant eye, and TECNIS +3.25 DMF IOL (ZLB00) implantation in the nondominant eye. Patients were followed up for 3 months; uncorrected and corrected distance visual acuity (UDVA and CDVA), uncorrected intermediate and near visual acuity (UIVA and UNVA), contrast sensitivity, defocus curves, stereopsis, and patient satisfaction were assessed. Results. At 3 months, the mean logarithm of the minimum angle of resolution (logMAR) of UDVA was 0.07 ± 0.09 in EDOF IOL eyes, 0.12 ± 0.11 in DMF IOL eyes, and 0.02 ± 0.05 in both eyes. UIVA was 0.11 ± 0.11 in EDOF IOL eyes, 0.16 ± 0.12 in DMF IOL eyes, and 0.04 ± 0.07 in both eyes. UNVA was 0.25 ± 0.15 in EDOF IOL eyes, 0.22 ± 0.16 in DMF IOL eyes, and 0.13 ± 0.13 in both eyes. Thirty patients (81.1%) were more than satisfied with near vision, and 8 patients (21.6%) complained of severe glare and halo. Spectacle independence for near vision was achieved in 34 patients (91.9%), and 31 patients (83.8%) had better than a 50-second arc of stereopsis. Conclusion. Mix-and-match cataract surgery with EDOF and DMF IOL implantation provided good visual outcomes for all distances. Additionally, excellent patient satisfaction was achieved with a high level of spectacle independence and acceptable photic phenomena. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate clinical and demographic factors associated with oral health‐related quality of life (OHRQoL) in patients with xerostomia. Methods: Forty‐one patients (55.2 ± 13.8 years) with xerostomia as a chief complaint participated in the study. Comprehensive information about clinical and demographic characteristics of the patients with xerostomia, xerostomia‐related symptoms and behaviours, and xerostomia‐associated complaints was investigated using a xerostomia questionnaire. Flow rates of unstimulated and stimulated whole saliva were measured. The Oral Health Impact Profile‐14 (OHIP‐14) score was used to assess the OHRQoL of patients. The relationships between various factors and the OHIP‐14 score were assessed by simple and multiple linear regression analyses. Results: The OHIP‐14 score of patients with xerostomia was high (44.3 ± 13.2). Characteristics of the patients with xerostomia associated with high OHIP‐14 score were the intensity of xerostomia‐related symptoms, frequency of xerostomia‐related behaviours and the presence of speaking difficulty. Results from multiple linear regressions found that self‐reported amount of saliva in usual, everyday life (β = 0.622, p = 0.012) and the presence of a speaking difficulty (β = 0.348, p = 0.014) had significant adversely affected the OHRQoL in patients with xerostomia. Conclusions: Subjective perceptions of the amount of saliva in the mouth and the experience of speaking difficulty affected the OHRQoL in patients with xerostomia. [ABSTRACT FROM AUTHOR]

Aim: To develop and initially validate the Diabetes Self‐Stigma Scale for assessing self‐stigma in people with diabetes. Design: Scale development and evaluation. Methods: Participants were 399 patients with diabetes. In phase 1, initial items were generated based on the concept analysis of diabetes self‐stigma. Moreover, content validity was established by diabetes experts. Phase 2 evaluated structural validity through item analysis, exploratory factor analysis and confirmatory factor analysis. Reliability was evaluated by examining stability and internal consistency. Results: The findings revealed that the self‐stigma scale for patients with diabetes is a valid and reliable instrument. The Diabetes Self‐Stigma Scale was confirmed with 16 items. It consists of four domains: comparative inability, social withdrawal, self‐devaluation and apprehensive feeling. The scale developed in this study can measure self‐stigma in diabetes patients and can be used as an intervention to reduce self‐stigma. [ABSTRACT FROM AUTHOR]

Objective: To test the effectiveness of electroacupuncture (EA) for managing intractable neuropathic pain (NeP) and assess the protocol for a larger confirmatory trial. Design: A prospective, multicenter, single-armed, add-on, pilot study. Settings/location: At two tertiary university-based hospitals in Seoul, Republic of Korea. Subjects: Patients with chronic peripheral NeP, who have received conventional oral medications but complained of moderate to severe pain. Interventions: Two Korean medicine doctors conducted 12 sessions of EA (2 sessions per week for 4 weeks, followed by 1 session per week for the second month) in addition to conventional treatment. Outcome measures: During the 8-week treatment period, pain intensity, pain natures such as burning, electric shock-like, temperature or mechanical hyperalgesia, and numbness, Short Form of the McGill Pain Questionnaire (SF-MPQ) and the Brief Pain Inventory (BPI-SF), the EuroQol five dimensions questionnaire, patients' satisfaction, and adverse events were evaluated. The primary endpoint was a change in pain intensity (%) at 4 weeks from the baseline. Results: Among 22 patients, 19 finished the protocol. The eight EA sessions over a month reduced pain intensity from 6.0 ± 1.6 at baseline to 3.2 ± 0.9 at 4 weeks, which was a 46.7% reduction (p < 0.001). The incidences of severe burning, electric shock-like pain, and mechanical hyperalgesia reduced at 8 weeks [36%–16% (p = 0.04), 53%–21% (p = 0.009), and 53%–26% (p = 0.03), respectively]. The affective dimensions in the SF-MPQ (p = 0.007) and the pain interference parameters, including mood (p = 0.02), relations with other people (p = 0.03), and enjoyment of life (p = 0.002) in the BPI-SF, were improved at 4 and 8 weeks. The majority of patients (68%) responded that their pain was "much or somewhat improved." Overall, 84.2% expressed "satisfaction" with their multidisciplinary management. Conclusions: EA might decrease the intensity of NeP, in particular, such as burning, electric shock-like pain, and mechanical hyperalgesia, which was accompanied by psychosocial and functional improvement. A larger study is warranted to prove the effectiveness of EA for managing refractory NeP. Trial registration: ClinicalTrials.gov: NCT03315598. Retrospectively registered on October 20, 2017. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To evaluate the psychometric quality of two single‐item pain‐intensity measures: the Numeric Rating Scale (NRS) and the Verbal Rating Scale (VRS). Background: Measuring pain intensity is a vital step in initiating symptom management and evaluating the effectiveness of interventions with cancer patients. Single‐item pain‐intensity measures of the NRS and VRS format have been evaluated to be acceptable for use in clinical practice and research; however, evidence to choose one over the other, as a standardised pain‐assessment format, is insufficient. Design: Descriptive correlational study. The study was guided and reported following the STROBE guideline. Methods: Data accrued at two time points during cancer treatment with a total of 249 patients treated in a Korean University Hospital. Two single‐item measures were constructed to assess pain intensity over 1 week. The Brief Pain Inventory (BPI; pain intensity subscale and interference subscale) and the functional assessment of chronic illness therapy‐fatigue were the criterion. Convergent and concurrent validity were tested with Pearson's correlations. Results: In the convergent‐validity evaluation of the cross‐sectional association with the BPI, the NRS showed a much higher level of association than the VRS (0.81 versus 0.61). In convergent validity with a longitudinal association with the BPI, the NRS score change had a much higher level of association (0.61 versus 0.37). In concurrent‐validity evaluation, the NRS and VRS showed similar levels of associations with fatigue (−0.48 versus −0.49). Yet, the NRS showed statistically higher levels of correlation with functional limitations than the VRS (0.55 versus 0.42), comparable to the concurrent validity of the BPI. Conclusion: The NRS showed higher validity than VRS when assessing overall pain intensity over the past week. Relevance to Clinical Nursing: Pain assessment is a vital role of nurses in caring for patients with cancer. Current study findings support the use of the single‐item NRS pain measure to assess global pain intensity over the past week. [ABSTRACT FROM AUTHOR]

Background: Using biological evidence to define subtypes within the heterogeneous population with obsessive--compulsive disorder (OCD) is important for improving treatment response. Based on age at onset, OCD can be clustered into 2 groups, each of which is more homogeneous with respect to clinical and cognitive phenotype. However, the neural bases for these phenotypic differences need to be established to construct evidence-based homogeneous groups. Methods: We compared brain volumes, clinical symptoms, and neurocognitive function for 49 people with early-onset OCD and 52 with late-onset OCD (participants in both groups were unmedicated or drug-naïve), and 103 healthy controls. We performed regression analyses to examine group x volume interaction effects on clinical outcomes or neurocognitive function in people with OCD. Results: We observed larger volumes in the precentral, orbitofrontal, middle frontal, and middle temporal gyri in people with early-onset OCD compared to those with late-onset OCD. Poorer visuospatial construction in early-onset OCD was correlated with a larger left middle frontal gyrus volume. Impaired visuospatial memory in people with early-onset OCD and cognitive inflexibility in people with late-onset OCD were correlated with increased and decreased volume in the left middle frontal gyrus, respectively. We found group x volume interactions for obsessive--compulsive symptom scores in the left middle temporal gyrus of people with OCD. Limitations: Although we divided the subtypes using the commonly adopted criterion of age at onset, this criterion is still somewhat controversial. Conclusion: We provided the neural bases for clinical and neurocognitive differences to demonstrate that biological evidence underlies the distinctions between early- and late-onset OCD. This study suggests that different treatment options should be considered for the OCD subtypes, because their neurobiology differs and is related to distinct phenotypic profiles. [ABSTRACT FROM AUTHOR]

Background: Few studies have reported the healing process of anterolateral ligament (ALL) injuries. Purpose/Hypothesis: This study investigated the healing status of ALL injuries after primary anterior cruciate ligament (ACL) reconstruction (ACLR). Additionally, we investigated the association between the healing status of ALL injuries and associated lesions such as osseous lesions and meniscal tears occurring at the time of an ACL rupture. We hypothesized that acute ALL injuries show a high rate (more than two-thirds) of healing at the 1-year follow-up after ACLR and that concomitant lesions observed at the time of an ACL rupture affect the healing status of the ALL. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively investigated patients with ALL injuries who underwent primary ACLR between March 2015 and February 2017. Using magnetic resonance imaging (MRI), we evaluated the features of ALL injuries and concomitant lesions, and MRI was performed at the 1-year follow-up to assess the healing status of the ALL. We investigated the association between the healing status of the ALL and concomitant lesions observed at the time of an ACL rupture. A subjective assessment was performed using the Lysholm score, International Knee Documentation Committee subjective score, and Tegner activity scale. Objective tests included an isokinetic strength assessment and functional performance testing. Results: With respect to the severity of ALL injuries, of 54 patients, a complete rupture occurred in 16 (29.6%) of the 54 patients and a partial rupture in 38 (70%). A significant association was observed between the severity of ALL injuries and bone contusions (lateral tibial plateau and medial tibial plateau [MTP]) and meniscus ramp lesions (Fisher exact test: P =.023,.012, and.023, respectively). Good and partial healing of the ALL occurred in 16 (29.6%) and 23 (42.6%) of 54 patients, respectively. Scar formation occurred in 12 (22.2%), and nonvisualization of the ALL was observed in 3 (5.6%) of 54 patients. Poor healing of the ALL was associated with preoperative MTP bone contusions and a high-grade pivot shift. Multivariate analysis showed that an MTP bone contusion was an independent risk factor associated with poor healing of the ALL. Among the functional tests performed, significant differences were observed between the good and poor healing groups with respect to the carioca test (P =.039). The good healing group (n = 16) showed a negative pivot shift at the last follow-up, whereas 5 (13.2%) of the patients from the poor healing group (n = 38) showed a positive pivot shift, including 2 (5.3%) with a high-grade pivot shift. Conclusion: Approximately 70% of acute ALL injuries showed poor healing at the 1-year follow-up. Poor healing of ALL injuries was significantly associated with preoperative MTP bone contusions and a high-grade pivot shift. Therefore, a careful assessment of posteromedial bone contusions at the time of an ACL rupture is warranted, particularly in patients with a high-grade pivot shift. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate celiac plexus neurolysis (CPN) for the treatment of cancerous upper abdominal pain in a tertiary university hospital in Korea. Methods: At the tertiary university hospital in Korea, electronic medical records of cancer patients who underwent CPN and died in the hospital from November 2009 to June 2018 were retrospectively analyzed. Results: The total number of subjects was 51. The 17 patients were from the Department of Gastroenterology (33.0%), followed by 11 patients from the Department of Hemato-oncology (21.6%), 11 patients from the Department of Anesthesia and Pain Medicine (21.6%), 9 patients from the Department of General Surgery (17.6%). The diagnosis was pancreatic cancer in 15 patients (29.4%), stomach cancer in 8 patients (15.7%), hepatobiliary cancer in 20 patients (39.2%), colon cancer in 1 patient (2.0%), esophageal cancer in 2 patient (3.9%) and intra-abdominal metastasis in 5 patients (9.8%). The mean survival time after the surgery was 66.4±55.0 days. The pain intensity before and 1 week after the procedure significantly decreased, but the amounts of opioids consumed before and 1 week after the procedure were not statistically significant. Side effects occurred after the procedure including temporary localized pain in 24 patients (47.0%), hypotension in 12 (23.5%), and diarrhea in 6 (11.8%). Conclusion: CPN is an effective and safe procedure for reducing upper abdominal pain caused by cancer, and it is necessary to perform CPN within the appropriate time by establishing a system of interdepartmental cooperation. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed at examining the construct validity and reliability of the Full Outline of UnResponsiveness score in patients with spontaneous subarachnoid haemorrhage caused by aneurysm rupture. Background: The Full Outline of UnResponsiveness score is known to be a valid and reliable consciousness assessment tool and provides comprehensive information not given by the Glasgow Coma Scale. However, the validity and reliability of this tool have not been tested in patients with spontaneous subarachnoid haemorrhage. Design: A nonexperimental, descriptive, correlational study design was adopted. Methods: The STROBE statement was used for reporting this study. The study participants were 72 patients with spontaneous subarachnoid haemorrhage caused by aneurysm rupture, admitted to an intensive care unit in a university hospital between August 2016–July 2017. Data on demographic characteristics, Hunt–Hess clinical stage scores, Fisher CT stage scores, disease‐related characteristics, Full Outline of UnResponsiveness scores and 1‐month Glasgow Outcome Scale scores were subjected to analysis. Results: Full Outline of UnResponsiveness scores were found to have significant correlations with scores on Hunt–Hess clinical or Fisher CT stage tool and adequately predict 1‐month recovery. This tool also exhibited excellent inter‐rater agreement and internal consistency. Conclusions: The Full Outline of UnResponsiveness score is valid and reliable for consciousness evaluation in spontaneous subarachnoid haemorrhage. It has been believed that use of this tool may help prevent negative consequences arising from impaired consciousness and improve the outcomes of patients with spontaneous aneurysmatic subarachnoid haemorrhage. Relevance to clinical practice: The Full Outline of UnResponsiveness score is a consciousness assessment tool that provides more neurological detail because it includes consideration of brainstem reflexes, visual tracking, breathing patterns and respiratory drive, and can be applied in cases of spontaneous subarachnoid haemorrhage and other types of brain injury, especially in patients with severe consciousness impairment. [ABSTRACT FROM AUTHOR]

This study was conducted to document temporal patterns of blood glucose level changes during the first 10-day critical period and to identify factors that influence stress-induced hyperglycemia development in brain injury patients. The medical records of 190 brain injury patients were retrospectively reviewed. Blood glucose levels in the poor recovery group were significantly higher than in the good recovery group, particularly during the first 72 hr (158-172 mg/dl). The poor recovery group showed persistent, fluctuating hyperglycemia, whereas the good recovery group exhibited hyperglycemic peaks during the first 3 days that subsequently reduced linearly to normal. Gender, preexisting hypertension, disease severity at admission, total calorie intake, and steroid use were found to influence stress-induced hyperglycemia development significantly. In conclusion, close monitoring and adjustment are required to maintain safe blood glucose levels and the development of protocols for safe glycemic management is essential to improve critical care in brain injury patients. [ABSTRACT FROM AUTHOR]

Aims To compare the cost-effectiveness of coronary computed tomography angiography (CCTA) vs. myocardial single photon emission computed tomography (SPECT) in patients with stable intermediate risk chest pain. Methods and results Non-acute patients with 10–90% pre-test probability of coronary artery disease from three high-volume centres in Korea (n  = 965) were randomized 1:1 to CCTA or myocardial SPECT as the initial non-invasive imaging test. Medical costs after randomization, the downstream outcome, including all-cause death, acute coronary syndrome, cerebrovascular accident, repeat revascularization, stent thrombosis, and significant bleeding following the initial test and the quality-adjusted life-years (QALYs) gained by the EuroQoL-5D questionnaire was compared between the two groups. In all, 903 patients underwent the initially randomized study (n  = 460 for CCTA, 443 for SPECT). In all, 65 patients underwent invasive coronary angiography (ICA) in the CCTA and 85 in the SPECT group, of which 4 in the CCTA and 30 in the SPECT group demonstrated no stenosis on ICA [6.2% (4/65) vs. 35.3% (30/85), P -value < 0.001]. There was no difference in the downstream clinical events. QALYs gained was higher in the SPECT group (0.938 vs. 0.955, P -value = 0.039) but below the threshold of minimal clinically important difference of 0.08. Overall cost per patient was lower in the CCTA group (USD 4514 vs. 5208, P -value = 0.043), the tendency of which was non-significantly opposite in patients with 60–90% pre-test probability (USD 5807 vs. 5659, P -value = 0.845). Conclusion CCTA is associated with fewer subsequent ICA with no difference in downstream outcome. CCTA may be more cost-effective than SPECT in Korean patients with stable, intermediate risk chest pain. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to examine the relationship among metacognition, emotional intelligence, and self-leadership in nursing students, and to investigate factors influencing self-leadership. Methods: A descriptive survey design was used for this study. Participants were 216 nursing students in one university located in J-city, in South Korea. Data were collected from May 30 to June 8, 2018, and analyzed using independent t-test, one way ANOVA, Scheffeé test, Pearson correlation coefficients, and stepwise multiple regression analysis with SPSS/WIN 20.0. Results: Self-leadership had significantly positive correlations with metacognition (r=.61, p<.001) and emotional intelligence (r=.61, p<.001). Significant predictors of self-leadership were metacognitive control (β=.28, p<.001), regulator of emotions (β=.25, p<.001), self-emotional appraisal (β=.17, p=.006), metacognitive knowledge (β=.15, p=.021), and perceived leadership level (low) (β=-.10, p=.043). These factors explained 49.0% of the variance. Conclusion: The findings show that self-leadership should be strengthened by increasing the metacognition and emotional intelligence of nursing students. [ABSTRACT FROM AUTHOR]

Sasang typology is a traditional Korean medical classification scheme that combines medical management with general medicine and can be applied to chronic diseases. We aimed to analyze differences in Sasang Personality Questionnaire (SPQ) and Sasang Digestive Function Inventory (SDFI) results in patients with diabetes mellitus (DM), hypertension, functional dyspepsia, major depressive disorder (MDD), and adenomyosis. In this cross-sectional study, data were collected at a medical college hospital in South Korea. A total of 248 patients were included: 52 with DM, 47 with hypertension, 36 with functional dyspepsia, 26 with MDD, and 87 with adenomyosis. The subjects took both the SPQ and the SDFI. The outcome measures in this study were body mass index (BMI), SPQ score, and SDFI score. The DM and hypertension groups, which were expected to demonstrate many Taeeum-type traits, exhibited high BMI, high SPQ-Behavior and SDFI-Appetite scores, and low SPQ-Emotionality and SDFI-Digestion scores. The functional dyspepsia group showed low BMI and high scores for SPQ-Behavior, SPQ-Emotionality, SDFI-Digestion, and SDFI-Appetite. The MDD group demonstrated high SPQ-Emotionality and SDFI-Digestion scores, low BMI, and low SPQ-Behavior and SDFI-Appetite scores. The adenomyosis group demonstrated high scores for SPQ-Behavior, SDFI-Digestion, and SDFI-Appetite, low BMI, and low SPQ-Emotionality scores. Different characteristics distinguishing Sasang traits according to chronic diseases were ascertained, especially for Taeeum and Soeum types. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify the factors associated with the discontinuation of patient controlled analgesia (PCA) after surgery. Methods: The data of 1,092 adult patients that were over 20 years of age and underwent PCA after surgery in the Gachon University Hospital from May 1 to June 30, 2017, were collected through the patients’ Electronic Medical Record (EMR). The collected data was analyzed via the use of the Chi-test, t-test and multivariate logistic regression analysis using SPSS 18.0 program. Results: The postoperative PCA discontinuation rate was 26.1%. It was associated with various symptoms, such as those of nausea, dizziness, and headache. The PCA discontinuation was also related with female (odds ratio, OR=1.75; confidence interval, CI=1.09- 2.82), nausea (OR=105.27; CI=61.03-181.58), total intravenous anesthesia (TIVA) of the thyroidectomy (OR=10.43; CI=5.01-21.70). Conclusion: It is necessary to provide additional medication and nursing interventions to reduce nausea, which is the symptom associated with PCA discontinuation, especially in the operation of female subjects and thyroidectomy under TIVA. That is, those who are at a high risk for PCA discontinuation should be able to administer additional antiemetics or reduce non medication nursing interventions. [ABSTRACT FROM AUTHOR]

Anticoagulant therapy is used to reduce the risk of thromboembolic events in patients with atrial fibrillation. Warfarin has been the traditional anticoagulant but is difficult to use because of its narrow therapeutic window. Recently, newer oral anticoagulants (NOACs) have been developed. However, bleeding continues to be a significant complication. The objective of this study was to assess the safety of acupuncture in patients taking NOACs. The medical records in the Stroke Center at Kyung Hee University Korean Medicine Hospital were retrospectively reviewed to identify patients who had received acupuncture between January 2017 and September 2017. The patients were divided into groups according to whether they were taking an NOAC, an antiplatelet agent, or no anticoagulant therapy. Bleeding-related side effects that occurred immediately after removal of acupuncture needles were recorded. Three hundred and sixteen patients underwent 10,177 acupuncture sessions during the study period. Microbleeding (bleeding that ceased within 30 s) occurred at a rate of 3.9% in the NOAC group, 5.6% in the antiplatelet group, and 5.1% in the control group. There were no between-group differences in the microbleeding rate. No serious adverse events, including major bleeding, were detected. These findings indicate that acupuncture is safe in patients taking NOACs. [ABSTRACT FROM AUTHOR]

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Purpose: This study was intended to investigate the frequency of job performance of the Korean professional medical support staffs (PMSS). Method : The data of 1,666 PMSS from 36 hospitals and over 500 beds were analyzed. The participants were divided into 5 groups: advanced practice nurses (APN), clinical nurse experts, physician assistants (PA), coordinators, and others. Results : Among the 5 main domains of job performance, advanced clinical practice has the highest frequency (111.36 d/y), followed by consultation/collaboration (75.66 d/y), education/counseling (53.54 d/y), leadership (23.90 d/y), and research (19.14 d/y). There was a significant difference in the frequency of job performance between the 5 groups of participants. The invasive activities were more frequent in the PA group. In the education and counseling domain, APNs had a higher level of job frequency than others (p<.001). In the research and leadership domains, APNs and coordinators had more prominent performance frequency than other groups (p<.01). However, there are some ambiguities in the job performance of the 5 groups depending on institutional characteristics. Conclusion : To establish the scope of work of PMSS, organizational and individual efforts are needed to promote and expand the leadership and research domains. To resolve the ambiguities of PMSS' roles, it is necessary to reorganize their titles. [ABSTRACT FROM AUTHOR]

Background: Health care workers (HCWs) are at high risk for occupational blood exposures (OBEs) and transmission of bloodborne pathogens. This study elucidated the incidence rate and epidemiological characteristics of OBEs among HCWs and investigated the pathogen transmission rate for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).Methods: Self-reported OBEs from January 1, 2011 to December 31, 2015 were obtained from the electronic recording system. OBE incidence densities per 100 person-years and per 100 bed-years were calculated with a 5-year trend analysis. OBE characteristics and pathogen transmission rates were evaluated.Results: Among 10,452 HCWs and 1072 average yearly beds, 1076 OBEs were reported. OBE incidence rate was 5.6 cases per 100 person (full-time equivalent)-years and 20.3 per 100 bed-years. Incidence rate decreased and was significantly associated with a decrease of beds served per HCW. Housekeeping showed the highest OBE rate (14.8%) followed by doctors (8.5%) and nurses (6.2%). OBEs occurred in wards, emergency rooms, and operating rooms (38.1%, 13.3% and 12.2%, respectively) via percutaneous (86.7%) and mucocutaneous exposures (13.2%). Of OBEs associated with HBV (n = 133), HCV (n = 126), and HIV (n = 25), only one led to an infection (HCV; transmission rate of 0.8%). Neither HBV nor HIV infection occurred.Conclusions: OBE incidence rate in a Korean university hospital was 5.6 cases per 100 person-years and 20.3 per 100 bed-years and was related to HCW workload and work proficiency. Though the actual bloodborne pathogen transmission rate was low, efforts to prevent OBE should be made for hospital safety. [ABSTRACT FROM AUTHOR]

Background Ineffective communication of critical care nurses can lead to higher levels of burnout and negatively affect quality of patient care and patient outcomes such as higher mortality. Aim The purpose of this study is to describe the relationship between professional communication competences and nursing performance of critical care nurses in South Korea. Method This cross-sectional study collected data on 197 intensive care unit staff nurses in 3 tertiary academic medical centres in South Korea from July to November 2014. Results In the hierarchical regression analysis, the professional communication competences were the only significant predictors of nursing performance after adjusting for sociodemographic characteristics. In addition, the greater professional communication competences of nurses were associated with being older and having a higher education level, more years of overall clinical and intensive care unit experience, and a higher monthly salary. Conclusion Our findings indicate that communication skills-related training should be included in the practical education to improve nursing performance for the quality of intensive care. Further research is needed to identify the comprehensive factors on professional communication competences of nurses in intensive care units. [ABSTRACT FROM AUTHOR]

Purpose: There have been global initiatives and efforts over the last decade to manage patient safety. Thus aims of this study were to examine university hospital nurses' perceptions of patient safety culture and levels of safety control, and to identify factors that affect patient safety management activities. Methods: Participants were 222 nurses who had worked as nurses for more than one year and who conducted patient safety management activities at a university hospital. Data were collected using structured questionnaires and were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson correlation coefficient, and multiple regression analysis with SPSS/WIN 20.0 computer program. Results: General factors which positively impacted nurses' patient safety management were total length of work in nursing, total length of work in present hospital, and experience of a patient safety accident along with safety factors of perception of communication about accident related events and frequency of reporting accident events. These variables explained 45% of the variance in patient safety management activities. Conclusion: The findings from this study suggest solutions to promote patient safety management activities in hospitals and provide basic background for nursing education intervention strategies to promote safety control and patient safety management activities intended for nurses. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop and validate an eye care educational programme for intensive care unit nurses. Background Eye care guidelines and protocols have been developed for increasing eye care implementation in intensive care units. However, the guidelines lack consistency in assessment or intervention methodology. Design This was a one-sample pre/postprogramme evaluation study design for testing the effects of the eye care educational programme, developed for and applied to intensive care unit nurses, on their levels of knowledge and awareness. Methods The eye care educational programme was developed based on literature review and survey of educational needs. Thirty intensive care unit nurses served as subjects for the study. Results The levels of eye care-related knowledge, awareness and practice were enhanced following the implementation of the educational programme. Moreover, satisfaction with the educational programme was high. Conclusion It is necessary to intensify eye care education aimed at new nurses who are inexperienced in intensive care unit nursing and provide continuing education on the latest eye care methods and information to experienced nurses. Relevance to clinical practice The eye care educational programme developed in this study can be used as a strategy to periodically assess the eye status of patients and facilitate the appropriate eye care. [ABSTRACT FROM AUTHOR]