PURPOSE: The purpose of this methodological study was to examine the reliability and validity of a translated Korean version of the Critical Care Pain Observation Tool (CPOT) developed for assessment of pain in critically ill nonverbal patients. METHODS: A cross-sectional study design was used. Data were collected from a convenience sample of 202 critically ill patients admitted to a university hospital. Upon establishment of content and translation equivalence between the English and Korean version of CPOT, psychometric properties were evaluated. RESULTS: The interrater reliability was found to be acceptable with the weighted kappa coefficients of .81-.88. Significant high correlations between the CPOT and the Checklist of Nonverbal Pain Indicators were found indicating good concurrent validity (r=.72-.83, p<.001). Data showed the area under the ROC curve of 0.86 with a cut-off point of 1, which resulted in 76.9% sensitivity and 88.6% specificity. The mean score of CPOT during suctioning was significantly different from that of before (t=-14.16, p<.001) or 20 minutes after suctioning (t=16.31, p<.001). CONCLUSION: Results of this study suggest that the CPOT can be used as a reliable and valid measure to assess pain in critically ill nonverbal patients.
Adult ; *Critical Care ; Critical Illness ; Female ; Humans ; Intensive Care Units ; Intubation ; Male ; Middle Aged ; Pain Measurement/*statistics & numerical data ; Psychometrics ; ROC Curve ; Republic of Korea ; Respiration, Artificial ; Suction ; *Translating

BACKGROUND: Antibiotics are used prophylactically in surgery to prevent postoperative infection. However, antibiotics administered in large doses can cause a bleeding diathesis as a result of platelet dysfunction. We wondered whether these antibiotics might impair platelet function by interfering with the initial step of platelet activation: the binding of agonists to their specific receptors on the platelet surface. METHODS: In 30 patients (male 18, women 12) undergoing primary elective knee arthroscopic surgery, the whole blood coagulation system was prospectively evaluated before, and 10 and 40 minutes after administration of 1 g of augmentin. All patients who had abnormal preoperative coagulation profiles or who received anticoagulant or antiplatelet, antibiotics therapy within 7 days prior to surgery were precluded. RESULTS: At 10 minutes after augmentin administration 25 of 30 patients had a significant impairment in all phases of whole blood coagulation as monitored by thromboelastography. In contrast, three of 30 patients had a significantly decreased coagulation time. Two of 30 patients had no significant changes of TEG variables. TEG variables were restored toward baseline in fourty minutes after augmentin administration. CONCLUSIONS: Augmentin can cause a significant but transient change in the viscoelastic properties of blood. Coagulation parameters of the TEG should be measured prior to augmentin administration to prevent and prospect a bleeding diathesis as a result of platelet dysfunction.
Amoxicillin-Potassium Clavulanate Combination ; Anti-Bacterial Agents ; Arthroscopy ; Blood Coagulation ; Blood Platelets ; Disease Susceptibility ; Female ; Hemorrhage ; Humans ; Knee ; Platelet Activation ; Prospective Studies ; Thrombelastography*

BACKGROUND: Epidural anesthesia is becoming an increasingly important aspect of anaesthetic practice because it has many advantages. To achieve the appropriate sedation, various methods have been described. The authors applied the ketamine for this purpose in subanesthetic dose and compared with the midazolam that has been most commonly used for intravenous sedation. METHODS: Fifty-seven adult patients undergoing lower abdominal and extremity surgery who were receiving epidural anesthesia were randomely enrolled into this clinical study. They were allocated to three groups to receive only normal saline (group C), midazolam 0.05 mg/kg (group M) and ketamine 0.5 mg/kg midazolam 0.05 mg/kg (group K) in normal saline 10ml, respectively. Hemodynamic and respiratory measurements were recorded at baseline, 1 minute, 3 minute, 5 minute, 10 minute, 20 minute and 30 minute after sedation. The degree of sedation was assessed by a blinded observer using sedation score. RESULTS: There were no significant differences for hemodynamic and respiratory parameters, but decrements of arterial pressure at 1 minute after sedation were most remarkable in the group M. Sedation was satisfactorily achieved by combination of ketamine and midazolam without significant emergence reaction. CONCLUSIONS: The combination of ketamine and midazolam was judged to be suitable alternative for sedation during epidural anesthesia.
Adult ; Anesthesia, Epidural* ; Arterial Pressure ; Extremities ; Hemodynamics ; Humans ; Ketamine* ; Midazolam*

The limitation so direct or indirect laryngoscopy and laryngogram in detemining the exact site and anatomiclocation of laryngeal carcinoma were well documented by many authors. As compared with laryngoscopy and laryngogram, CT study for laryngeal cancer is more exact and accurate method demonstrating anatomic sites of involvement, invasion into deep soft tissue spaces of endolarynx, destruction of laryngeal cartilages and cervical metastasis. Fourteen laryngeal cancer patients proven by laryngoscopic biopsy were further examined by computed tomography for staging. The authors compared laryngoscopic findings with those of computed tomography, and their clinical, surgical and computed tomographic findings were analysed. The results were as follows; 1. All patients were proved as squamous cell carcinoma. They were 12 males and 2 females aged over 50 yrs. 2. Common clinical symptoms were hoarseness, dysphagia and swallowing difficulty. The pirmary anatomic sites determined by CT were 8 transglottic, 2 glottic, 2 supraglottic and 1 pyriform sinus respectively. They were 2 T1. 7 T2, 1 T3, 3 T4 by TNM systems, respectivly. (One case was difficult to evaluate exactly). 3. Invasion into deep soft tissue spaces of endolarynx, cartilage destruction, and neck metastasis were relatively predominant in transglottic caracinomas. 4.CT was superior in evaluating tumor invasion, especially into deep soft tissue spaces of endolarynx, laryngeal cartilages and metastasis ot soft tissue and lymph nodes of neck. However CT had some limitation in determining primary site of laryngeal cancer.
Biopsy ; Carcinoma, Squamous Cell ; Cartilage ; Deglutition ; Deglutition Disorders ; Female ; Hoarseness ; Humans ; Laryngeal Cartilages ; Laryngeal Neoplasms ; Laryngoscopy ; Lymph Nodes ; Male ; Methods ; Neck ; Neoplasm Metastasis ; Pyriform Sinus

OBJECTIVES: Midlife women's knowledge, positive attitudes and management toward menopause may improve the quality of peri and post-menopause life. This study was to identify correlations of the knowledge, attitude, symptoms and management toward menopause in middle-aged women. METHODS: We used a cross-sectional questionnaire study applying to 231 perimenopausal and menopausal women aged from 40 to 59 years old. The completed data of 189 perimenopausal and menopausal women were analyzed through t-test, ANOVA and pearson's correlation coefficient using the SPSS statistical programme. RESULTS: The menopausal women showed significantly higher physical symptoms than perimenopausal women. The menopausal women showed significantly higher psychosomatic symptom than perimenopausal women. There was a significant correlation between the menopausal attitude and management. CONCLUSION: This study suggests that the fundamental data of developing midlife women's symptom index (MSI) and providing menopause management could be a strategy to encourage successful menopausal transition in middle-aged women.
Female ; Humans ; Menopause* ; Postmenopause ; Surveys and Questionnaires

PURPOSE: This study was done to verify the self-directed learning instrument (SDLI) developed to measure self-directed learning ability in nursing students. METHODS: The participants for the study were 425 nursing college students. Their self-directed learning was verified using self-reports and results through questionnaires. SDLI was translated into Korean through translation/reverse translation process and its content validity verified by five experts. The validity of the instrument was verified through item analysis, exploratory factor analysis, and confirmatory factor analysis. Reliability verification was analyzed using internal consistency reliability. RESULTS: Four factors were identified through exploratory factor analysis and 20 items of the original instrument were found to be valid. In the confirmatory factor analysis, the validity of the instrument was verified as the model was valid. The internal consistency reliability was also acceptable and SDLI was found to be an applicable instrument. CONCLUSION: SDLI has been developed and verified by selecting nursing students as participants for the study. Use if SDLI is expected to improve the quality of self-directed learning in nursing education and to be used in future nursing research.
Education, Nursing ; Humans ; Learning ; Nursing ; Nursing Research ; Reproducibility of Results ; Students, Nursing

BACKGROUND: Although several studies have shown the role of interleukin-31 (IL-31) and its receptors in inducing pruritus in certain skin disorders, knowledge of its role in post-burn hypertrophic scars is insufficient. Therefore, the histopathological expression levels of IL-31, IL-31 receptor alpha (IL-31RA), and oncostatin M receptor (OSMR) in post-burn hypertrophic scar tissues were investigated and compared with normal tissue expression levels. METHODS: Samples of hypertrophic scar tissue were obtained from 20 burn patients through punch biopsy. Normal samples were obtained from areas adjacent to the burn injury site of the same patients. Samples were placed in 10% neutral buffered formalin, embedded in paraplast, and processed into serial 5-μm sections. Immunohistochemistry results were semi-quantitatively evaluated for IL-31, IL-31RA, and OSMR. By hematoxylin and eosin staining, epidermal and dermal thickness were assessed with a microscope and digital camera. Intensities were rated on a scale of 1 to 4. RESULTS: Percentages for IL-31, IL-31RA, and OSMR in the epidermal basal layer cell cytoplasm were significantly greater in the burn scar tissue compared to normal skin, as well as the dermal and epidermal thickness (p < .05). There was a significant difference in IL-31 epidermal basal layer intensity in burn scar tissue compared to normal skin (p < .05). Besides the OSMR basal layer intensity, IL-31 and IL-31RA intensities between the burn scar and normal tissues were not significant. However, correlations were significant, indicating that the greater the infiltration percentage, the higher the intensity (p < .05). CONCLUSIONS: IL-31, IL-31RA, and OSMR expression levels are increased in hypertrophic scars compared with normal tissue.
Biopsy ; Burns ; Cicatrix ; Cicatrix, Hypertrophic ; Cytoplasm ; Eosine Yellowish-(YS) ; Formaldehyde ; Hematoxylin ; Humans ; Immunohistochemistry ; Pruritus ; Receptors, Oncostatin M ; Skin

PURPOSE: This study investigated the morphological characteristics of hypertrophic scars of various ages. METHODS: This was a retrospective study. Tissue samples from 170 normal skin (control) and 126 scar tissue after undergoing conservative treatment (CT) (n=62) or split thickness skin graft (STSG) (n=64) were obtained. Time from injury (CT) or surgery (STSG) was grouped into periods as follows: first 6 months (period 1), 7~12 months (period 2), 13~24 months (period 3), 25~120 months (period 4), >120 months (period 5). Epidermal thickness (ET), dermal thickness (DT), and dermal collagen fiber thickness and length (CFT, CFL) were measured using an image analyzer. RESULTS: Scar tissue ET was significantly thicker compared to normal skin (P<0.05) and was greatest at period 1. Scar tissue DT was significantly thicker compared to normal skin (P<0.05), which increased until period 3 but then decreased afterwards. Scar tissue CFT was significantly thinner compared to normal skin (P<0.05) except for period 5. Scar tissue CFL was significantly longer compared to normal skin (P<0.05). Significant differences were observed especially in younger scar ET, DT, CFT, and CFL. CONCLUSION: These findings may assist to increase the understanding of the pathohistological changes in burn scar tissues over time and provide guidance in receiving burn treatment.
Burns ; Cicatrix* ; Cicatrix, Hypertrophic* ; Collagen ; Pathology ; Retrospective Studies ; Skin ; Transplants

BACKGROUND: As of 2011, among 250 administrative districts in Korea, 54 districts did not have obstetrics and gynecology clinics or hospitals providing prenatal care and delivery services. The Korean government designated 38 regions among 54 districts as “Obstetric Care Underserved Areas (OCUA).” However, little is known there are any differences in pregnancy, prenatal care, and outcomes of women dwelling in OCUA compared to women in other areas. The purposes of this study were to compare the pregnancy related indicators (PRIs) and adequacy of prenatal care between OCUA region and non-OCUA region. METHODS: Using National Health Insurance database in Korea from January 1, 2012 to December 31, 2014, we constructed the whole dataset of women who terminated pregnancy including delivery and abortion. We assessed incidence rate of 17 PRIs and adequacy of prenatal care. All indicators were compared between OCUA group and non-OCUA group. RESULTS: The women dwelling in OCUA regions were more likely to get abortion (4.6% in OCUA vs. 3.6% in non-OCUA) and receive inadequate prenatal care (7.2% vs. 4.4%). Regarding abortion rate, there were significant regional differences in abortion rate. The highest abortion rate was 10.3% and the lowest region was 1.2%. Among 38 OCUA regions, 29 regions' abortion rates were higher than the national average of abortion rate (3.56%) and there were 10 regions in which abortion rates were higher than 7.0%. In addition, some PRIs such as acute pyelonephritis and transfusion in obstetric hemorrhage were more worse in OCUA regions compared to non-OCUA regions. CONCLUSION: PRIs are different according to the regions where women are living. The Korean government should make an effort reducing these gaps of obstetric cares between OCUA and non-OCUA.
Abortion, Induced ; Dataset ; Female ; Gynecology ; Hemorrhage ; Humans ; Incidence ; Korea ; Medically Underserved Area ; National Health Programs ; Obstetrics ; Pregnancy ; Pregnant Women* ; Prenatal Care* ; Pyelonephritis

Black-pigmented bacteria have been implicated in the endodontic infections. This group of microorganisms includes Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia, and Prevotella nigrescens. The organisms display a wide variety of virulence factors that may be pertinent to acute endodontic infections. The aim of this study was to identify P. endodontalis, P. gingivalis, P. intermedia, and P. nigrescens by using special potency disk test, filter paper spot test, 16S rRNA gene-directed PCR, and API 32A. Microbial samples were collected from root canals of 33 intact teeth with necrotic pulp and/or apical periodontitis. Conventional laboratory methods were used for identification of the strains of black pigmented bacteria. Eighteen of 33 samples were positive for the growth of black-pigmented bacrteria. Five colonies were cultured from each pure cultured colonies from Brucella agar plate. Seventy seven colonies were positive for the growth of black-pigmented bacteria. Thirty three of 77(42.6%) were identifed as P. nigrescens, 10 of 77(12.9%) were P. gingivalis, 6 of 77(7.8%) were P. endodontalis, 10 of 77(12.9%) were P. intermedia. On the contrary the reference strains of P. nigrescens, experimental strains of P. nigrescens was sensitive to kanamycin in special potency disk test. 16S rRNA gene PCR and API test after rapid presumptative identification methods, such as special potency disk test and filter paper spot test, would be accurate detection methods for black-pigemented bacteria.
Agar ; Bacteria ; Brucella ; Dental Pulp Cavity ; Genes, rRNA ; Kanamycin ; Periapical Periodontitis ; Polymerase Chain Reaction ; Porphyromonas endodontalis ; Porphyromonas gingivalis ; Prevotella intermedia ; Prevotella nigrescens ; Tooth ; Virulence Factors