PURPOSE: In this study a system dynamics methodology was used to identify correlation and nonlinear feedback structure among factors affecting unplanned extubation (UE) of ICU patients and to construct and verify a simulation model. METHODS: Factors affecting UE were identified through a theoretical background established by reviewing literature and preceding studies and referencing various statistical data. Related variables were decided through verification of content validity by an expert group. A causal loop diagram (CLD) was made based on the variables. Stock & Flow modeling using Vensim PLE Plus Version 6.0b was performed to establish a model for UE. RESULTS: Based on the literature review and expert verification, 18 variables associated with UE were identified and CLD was prepared. From the prepared CLD, a model was developed by converting to the Stock & Flow Diagram. Results of the simulation showed that patient stress, patient in an agitated state, restraint application, patient movability, and individual intensive nursing were variables giving the greatest effect to UE probability. To verify agreement of the UE model with real situations, simulation with 5 cases was performed. Equation check and sensitivity analysis on TIME STEP were executed to validate model integrity. CONCLUSION: Results show that identification of a proper model enables prediction of UE probability. This prediction allows for adjustment of related factors, and provides basic data do develop nursing interventions to decrease UE.
Adult ; Airway Extubation/*psychology ; Female ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Male ; Middle Aged ; *Models, Theoretical ; Nonlinear Dynamics ; Risk Factors

OBJECTIVE: The purpose of this study was to analyze the impact of consumer's subjective health literacy on health information websites acceptance and empowerment. METHODS: Data were collected from people who had used health information website. Theoretical model was developed based on TAM(Technology Acceptance Model), and structural equation modeling(SEM) using Lisrel 8.5 was applied to test the relationship of hypotheses. RESULTS: The final trimmed model resulted in a proper solution that exhibited adequate fit. This study supported that consumer's subjective health literacy was found to have a significant effect on empowerment by using health information websites. CONCLUSION: This study showed the use of health information website is worthy of strengthening of consumer's empowerment, which can be expected to contribute to patient's active participation in health management.
Health Literacy* ; Models, Theoretical ; Power (Psychology)*

PURPOSE: This study aimed to construct a management model for patient transfer in a multilevel healthcare system and to predict the effect of counseling with nurses on the patient transfer process. METHODS: Data were collected from the electronic medical records of 20,400 patients using the referral system in a tertiary hospital in Seoul from May 2015 to April 2017. The data were analyzed using system dynamics methodology. RESULTS: The rates of patients who were referred to a tertiary hospital, continued treatment, and were terminated treatment at a tertiary hospital were affected by the management fee and nursing staffing in a referral center that provided patient transfer counseling. Nursing staffing in a referral center had direct influence on the range of increase or decrease in the rates, whereas the management fee had direct influence on time. They were nonlinear relations that converged the value within a certain period. CONCLUSION: The management fee and nursing staffing in a referral center affect patient transfer counseling, and can improve the patient transfer process. Our findings suggest that nurses play an important role in ensuring smooth transitions between clinics and hospitals.
Continuity of Patient Care ; Counseling* ; Delivery of Health Care ; Electronic Health Records ; Fees and Charges ; Humans ; Nursing ; Patient Transfer* ; Referral and Consultation ; Seoul ; Tertiary Care Centers

PURPOSE: The preceptorenewly graduated nurse (NGN) relationship is integral to the successful experience of clinical teaching and learning and new nurses' transition. However, interpersonal conflicts between them are common. Little is known whether their anger contributes to their level of job satisfaction and burnout. This study aimed to examine the effects of each nurse's anger on job satisfaction and burnout in preceptoreNGN dyads.METHODS: A cross-sectional, correlational survey design was used. This study involved 121 preceptor enewly graduate nurse dyads in two hospitals in South Korea. Nurses completed a questionnaire about demographics, the State-Trait Anger Expression Inventory-Korean version, a job satisfaction measure, and the Copenhagen Burnout Inventory. This study adopted the Actor-Partner Interdependence Model to handle dyadic data.RESULTS: Preceptor nurses reported higher frequencies of feeling anger than did new nurses and appear to have higher levels of trait anger, anger-out, and burnout. Both the preceptors' and NGNs' trait anger was positively associated with preceptors' burnout. Suppressing anger was closely related to the nurses' own job satisfaction and burnout. Preceptors with a higher level of anger-control had higher job satisfaction, and NGNs with a higher level of anger-control had less burnout.CONCLUSION: The results indicate that preceptors and new nurses appear to experience significant anger, which is closely associated with their job satisfaction and burnout during their preceptorship. Anger management training programs geared toward educating both preceptors and new nurses about appropriate anger expression in the workplace should be developed to retain valuable nurses.
Anger Management Therapy ; Anger ; Burnout, Professional ; Demography ; Interpersonal Relations ; Job Satisfaction ; Korea ; Learning ; Preceptorship

Purpose: To develop a self-reported communication competency scale for patients with schizophrenia. Methods: Twenty-nine preliminary items were selected from 42 candidate items derived from literature review and qualitative interviews using content validity analysis of expert opinions to evaluate 637 patients’ schizophrenia communication competence. Data from 383 individuals were analyzed. Confirmatory factor analysis was conducted using data of 280 individuals. The final dataset included data from 254 participants. Data were subjected to exploratory and confirmatory factor analyses using SPSS and AMOS 24.0. Results: After evaluating the model fit index for the last 24 items, the following results were obtained: x2=633.95 (p<.001), x2/df (degree of freedom)=2.26, SRMR=0.04, RMSEA=0.06, TLI=0.93, CFI=0.94, NFI=0.96. Therefore, this tool’s suitability was evaluated as acceptable. The final scale comprised 24 items and 3 subscales that could measure basic, interpersonal, and communicative expression of patients with schizophrenia. Conclusion A self-reported communication competency scale was developed for patients with schizophrenia. It is expected to help measure the effectiveness of intervention programs to improve communication among patients with schizophrenia.

PURPOSE: The purpose of this study was to develop a system dynamics model for adolescent obesity in Korea that could be used for obesity policy analysis. METHODS: On the basis of the casual loop diagram, a model was developed by converting to stock and flow diagram. The Vensim DSS 5.0 program was used in the model development. We simulated method of moments to the calibration of this model with data from The Korea Youth Risk Behavior Web-based Survey 2005 to 2013. We ran the scenario simulation. RESULTS: This model can be used to understand the current adolescent obesity rate, predict the future obesity rate, and be utilized as a tool for controlling the risk factors. The results of the model simulation match well with the data. It was identified that a proper model, able to predict obesity probability, was established. CONCLUSION: These results of stock and flow diagram modeling in adolescent obesity can be helpful in development of obesity by policy planners and other stakeholders to better anticipate the multiple effects of interventions in both the short and the long term. In the future we suggest the development of an expanded model based on this adolescent obesity model.
Adolescent ; Humans ; Internet ; *Nonlinear Dynamics ; Obesity/*pathology ; Republic of Korea ; Risk Factors ; *Risk-Taking ; Surveys and Questionnaires

OBJECTIVES: This study evaluated the relationship between oral hygiene and health status and radiationinduced mucositis among patients with head and neck cancer over an 8-week period. METHODS: We recruited 40 patients with head and neck cancer scheduled to receive radiation therapy (RT), and 25 patients were included in the study. Before commencing RT, a dentist examined the patients for plaque, and determined the gingival index and pocket depth. A dental hygienist assessed the patients for radiation-induced mucositis once weekly, for 8 weeks, during RT. RESULTS: The mean patient age was 60.96 (±8.47) years, and 21 (87.5%) patients were male. Twenty patients (83.3%) had been diagnosed with squamous cell carcinoma. Patients with cancer located in the head region had more severe mucositis than those with cancer in the neck region, but this was not significant statistically (P=0.053). However, toothbrushing frequency, plaque, gingival index, and pocket depth were not related to radiation-induced mucositis. During RT, the severity of mucositis significantly worsened compared to that at baseline. CONCLUSIONS: Mucositis severity worsened during RT, but this was not related to oral hygiene and health status among patients with head and neck cancer.
Carcinoma, Squamous Cell ; Dental Hygienists ; Dentists ; Head and Neck Neoplasms ; Head ; Humans ; Male ; Mucositis ; Neck ; Oral Health ; Oral Hygiene ; Periodontal Index ; Radiotherapy ; Toothbrushing

Uterine papillary serous carcinoma (UPSC) behave more aggressively than other endometrial carcinomas and have a propensity for intraabdominal spread, simulating the behavior of ovarian carcinoma. Because of high relapsing rate, and high mortality rate of UPSC, many gynecologist studied about its treatment regimen and recommended many treatment method. Many investigators recommended that patients with UPSC should undergo a staging laparotomy and they suggested the surgery should include at least total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic lymphadenectomy, paraaortic lymphadenectomy, peritoneal washing and peritoneal cytology, By and large, adjuvant systemic Platinum based chemotherapy or, paclitaxel based chemotherapy and adjuvant whole abdominal irradiation or pelvic irradiation was prescribed. We experienced two cases of the UPSC stage IIIc and stage IV diagnosed after explolaparotomy. We present these cases and review the literatures about the optimal treatment regimen of UPSC.
Drug Therapy ; Endometrial Neoplasms ; Female ; Humans ; Hysterectomy ; Laparotomy ; Lymph Node Excision ; Mortality ; Paclitaxel ; Platinum ; Research Personnel

Behcet's disease is a systemic vasculitis that is characterized mainly by recurrent oral and genital aphthous ulcers, uveitis, and skin findings. Its neurological manifestations are well recognized. Recurrent meningitis in Behcet's disease is exceptional. We describe herein the case of a 31-year-old man who presented with recurrent aseptic meningitis without any specific cause. A few years later he developed oral and genital ulcers, and uveitis. Behcet's disease should always be considered in a differential diagnosis of recurrent aseptic meningitis without viral infection, particularly in the context of multisystem manifestations.
Adult ; Diagnosis, Differential ; Humans ; Meningitis ; Meningitis, Aseptic ; Neurologic Manifestations ; Skin ; Stomatitis, Aphthous ; Systemic Vasculitis ; Ulcer ; Uveitis

Castleman's disease is a rare lymphoproliferative disorder of uncertain etiology which most commonly occurs in the mediastinum. We describe a case of a benign Castleman 's disease of the hyaline vascular type affecting the upper extremity, an extremely rare site of the disease.
Giant Lymph Node Hyperplasia* ; Hamartoma ; Hyalin ; Lymphoproliferative Disorders ; Mediastinum ; Upper Extremity*