BACKGROUND: Herpes zoster meningitis and meningoencephalitis, rare complications of herpes zoster, may follow the onset of rash, precede it, or even occur without rash. There have been few studies describing the order of occurrence of neurological symptoms and zoster. OBJECTIVE: We compared the clinical and laboratory features, treatments, and progress of the conditions among patients with herpes zoster meningitis and meningoencephalitis according to the timing of zoster onset in relation to neurological symptoms and also according to the immune status. METHODS: We performed a retrospective review of 21 patients with meningitis and 3 patients with meningoencephalitis who showed the characteristic rash of herpes zoster at National Health Insurance Service Ilsan Hospital between March 2000 and June 2015. RESULTS: The 11 patients in whom zoster preceded neurological symptoms had a shorter duration of neurological symptoms (median 3 days; range 1~10) than did the 13 patients who experienced neurological symptoms first (median 10 days; range 4~27) (p<0.05). The intervals between the onset of neurological symptoms and a) presentation to the hospital, b) cerebrospinal fluid tests, and c) intravenous acyclovir treatment were all shorter in the patients with zoster preceding neurological symptoms (p<0.05). No significant differences in age or immune status were observed between the two groups. In the 9 immunocompromised patients, higher incidence of meningoencephalitis and neurologic complications was noted in comparison to the 15 immunocompetent patients (p<0.05). CONCLUSION: Antecedent zoster rash in varicella zoster virus-induced meningitis and meningoencephalitis appears to lead to more rapid initiation of diagnostic tests and antiviral treatment. The possibility of central nervous system complications should not be overlooked even in patients with herpes zoster.
Acyclovir ; Central Nervous System ; Cerebrospinal Fluid ; Chickenpox* ; Diagnostic Tests, Routine ; Exanthema ; Herpes Zoster ; Herpesvirus 3, Human* ; Humans ; Immunocompetence ; Immunocompromised Host ; Incidence ; Meningitis* ; Meningoencephalitis* ; National Health Programs ; Retrospective Studies

PURPOSE: Clinical nursing practice is important because it helps nursing students experience realities of clinical nursing that cannot be learned through theoretical education. This study aimed to evaluate the effect of an interactive nursing skills mobile application for nursing students. METHODS: Sixty-six senior nursing students were randomly assigned to experimental or control groups. The experimental group used an interactive nursing skills mobile application for 1 week. The control group was provided with a mobile application containing noninteractive nursing video contents for 1 week. Before (pre-test) and 1 week after (post-test) using the mobile application, participants' knowledge of clinical nursing skills, self-efficacy of nursing practice, and nursing skills performance were assessed. RESULTS: The experimental group showed a significantly higher value for knowledge after 1 week of treatment via their mobile application than the control group (t = 3.34, p = .001). In addition, they showed significantly improved self-efficacy before and after intervention (t = 2.46, p = .017) than the control group. The experimental group's nursing skills performance was also significantly enhanced after intervention (t = 7.05, p < .001), with a significant difference in the degree of improvement (t = 4.47, p < .001). CONCLUSION: The interactive learner-centered nursing education mobile application with systematic contents was an effective method for students to experience practical nursing skills. Developing and applying a mobile application with other nursing contents that can be effectively used across all range of nursing students is recommended.
Education ; Education, Nursing ; Humans ; Methods ; Mobile Applications* ; Nursing* ; Nursing, Practical ; Simulation Training ; Students, Nursing

Recent studies have shown that coronavirus disease-2019 (COVID-19) infection increased risk of stroke. Significant differences have been identified between the general population and COVID-19 stroke patients. There are unusual patterns of stroke occurred in COVID-19 patient are reported. Pathophysiologic theories about the relationship of COVID-19 infection and stroke are being published. Herein we report a rare case of stroke in a young COVID-19 patient, considered to be the result of vasculitis, and vessel changes that might have been caused by vasospasm based on serial brain imaging follow-up data. And we interpret this case based on pathophysiological characteristics of the severe acute respiratory syndrome coronavirus 2.

BACKGROUND: Pincer nail is a deformity of the nail that is characterized by the transverse overcurvature of the nail plate. Both conservative and surgical treatments can be used to treat pincer nail. However, there are no reports regarding non-surgical, laser treatment of pincer nail. OBJECTIVE: To evaluate the treatment outcomes and adverse events of CO₂ fractional laser and topical agent combination therapy on pincer nail. METHODS: Eleven pincer nails (all great toenails) were treated with a CO₂ fractional laser. An antifungal agent (in case of co-existing onychomycosis) or 20% urea cream was applied to the toenails. The effect of the treatment was measured by evaluating the difference in the width index, height index, and nail angle before and after treatment. Changes in pain levels were also evaluated. All adverse events and recurrences were observed until the last follow-up visit. RESULTS: The mean number of laser treatments was 2.27 and the mean follow-up period was 18.36 weeks after the last treatment. All 3 measured indices changed significantly after the treatment. The width index increased by 0.16 (p=0.0016), the height index decreased by 1.89 (p=0.008), and the nail angle increased by 29.60° (p=0.005). The pain was reduced in all cases. There were no serious adverse events. CONCLUSION The combination of CO₂ fractional laser therapy and topical application is an effective and tolerable treatment for pincer nail. Larger studies with long-term observations are needed to confirm this result.

PURPOSE: To establish and validate a formula to predict spectral domain (SD)-optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness from time domain (TD)-OCT RNFL measurements and other factors. METHODS: SD-OCT and TD-OCT scans were obtained on the same day from healthy participants and patients with glaucoma. Univariate and multivariate linear regression relationships were analyzed to convert average Stratus TD-OCT measurements to average Cirrus SD-OCT measurements. Additional baseline characteristics included age, sex, intraocular pressure, central corneal thickness, spherical equivalent, anterior chamber depth, optic disc area, visual field (VF) mean deviation, and pattern standard deviation. The formula was generated using a training set of 220 patients and then evaluated on a validation dataset of 105 patients. RESULTS: The training set included 71 healthy participants and 149 patients with glaucoma. The validation set included 27 healthy participants and 78 patients with glaucoma. Univariate analysis determined that TD-OCT RNFL thickness, age, optic disc area, VF mean deviation, and pattern standard deviation were significantly associated with SD-OCT RNFL thickness. Multivariate regression analysis using available variables yielded the following equation: SD-OCT RNFL = 0.746 x TD-OCT RNFL + 17.104 (determination coefficient [R2] = 0.879). In the validation sample, the multiple regression model explained 85.6% of the variance in the SD-OCT RNFL thickness. CONCLUSIONS: The proposed formula based on TD-OCT RNFL thickness may be useful in predicting SD-OCT RNFL thickness. Other factors associated with SD-OCT RNFL thickness, such as age, disc area, and mean deviation, did not contribute to the accuracy of the final equation.
*Algorithms ; Female ; Glaucoma/*pathology ; Humans ; Linear Models ; Male ; Middle Aged ; Predictive Value of Tests ; Retinal Ganglion Cells/*pathology ; Tomography, Optical Coherence/*methods

PURPOSE: The purpose of this study was to explore and describe the meanings of hands among clinical nurses.METHODS: A descriptive qualitative study design was used. Participants were 1,048 nurses working in a tertiary hospital in G city. From April to May 2018, an open-ended survey on how nurses felt about their hands and what their hands meant to them was conducted. The collected data were analyzed using MAXQDA 2018 version as well as content analysis.RESULTS: A total of 1,048 pieces of data were analyzed, and 2,094 units of analysis were categorized based on their attributes, resulting in physical, emotional, and social domains. The data in the social domain were reported in a narrative format; thus, they were analyzed using content analysis. Three themes and eight sub-themes were elicited. The three themes included “meaning as an instrument,” “meaning of infection control,” and “meaning of caring.”CONCLUSION: Nurses imbue essential meanings of caring on their hands even though they face negative skin symptoms. Furthermore, nurses understand the importance of hand hygiene on infection control. The findings of this study provide an in-depth look into nurses' perceptions of their hands.
Empathy ; Hand Disinfection ; Hand Hygiene ; Hand ; Infection Control ; Skin ; Tertiary Care Centers

Purpose: Gambling disorder is highly prevalent, and harms individuals, families, interpersonal relationships, and society. However, the efforts to treat and recover from a gambling disorder are insufficient. The purpose of this study was to construct an integrated body of knowledge related to the recovery of gambling disorder, by synthesizing qualitative studies showing the recovery process in gambling. Methods: The qualitative meta-synthesis method was used to search for qualitative studies on recovery from gambling, and the experiences of 213 people of 22 articles were analyzed. Results: The overall theme representing the recovery of a gambling disorder was derived as ‘the journey of becoming the master of my life and growing together’. The process of recovery from a gambling disorder was subdivided into the decision-making phase, life-reconstruction phase, and life-fulfillment phase. The factors that enable as well as hinder recovery are presented in detail. Conclusion It is expected that the results of this study can be used as an empirical basis, for planning gambling-related policies and programs in practice through the experiences of recovering gamblers.

PURPOSE: The purpose of this retrospective study was to investigate the relationships of types of dental insurance coverage in Korea with sociodemographic characteristics and the prevalence of systemic and oral diseases, as well as to evaluate the socioeconomic impact of Korean dental insurance policies. METHODS: Sample cohort data from 2006 to 2015 were obtained from the National Health Insurance Service. Patients were divided into 2 groups. The exposed group comprised patients who received insurance benefits for complete dentures, removable partial dentures, and implant care, while the control group comprised patients who did not receive these benefits. The type of insurance coverage and the prevalence of systemic and oral diseases were compared between the 2 groups. RESULTS: Patients who received benefits in the form of complete dentures, removable partial dentures, and implants had similar sociodemographic characteristics in terms of sex, age, income quintile, and type of insurance coverage to the control group. The prevalence of hypertension, anemia, renal disease, rheumatoid arthritis, osteoporosis, asthma, and cerebral infarction was higher in the exposed group than in the control group (P<0.05). The prevalence of periodontal diseases and dental caries was also higher in the exposed group. CONCLUSIONS: Korean dental health insurance policy has been beneficial for the medical expenses of low-income and elderly people suffering from a cost burden due to systemic diseases. However, since there is a tendency to avoid invasive interventions in older patients due to the high risk of systemic diseases, insurance coverage of dentures may be more helpful from a socioeconomic perspective than coverage of dental implant treatments.
Aged ; Anemia ; Arthritis, Rheumatoid ; Asthma ; Cerebral Infarction ; Cohort Studies ; Dental Caries ; Dental Implants ; Denture, Complete ; Denture, Partial, Removable ; Dentures ; Health Services for the Aged ; Humans ; Hypertension ; Insurance Benefits ; Insurance Coverage ; Insurance, Dental ; Insurance, Health ; Korea ; National Health Programs ; Osteoporosis ; Periodontal Diseases ; Prevalence ; Retrospective Studies

Background: This study aimed to examine the association of serum uric acid levels with incident cardiovascular disease and mortality in Korean adults without gout. Methods: This large longitudinal cohort study included adults aged > 19 years who had serum uric acid levels measured at least once at the National Health Insurance Service Ilsan Hospital from January 1, 2006 to December 31, 2015. Longitudinal data on person-level cardiovascular disease and cardiovascular mortality were linked to the National Health Insurance Service claims database and National Death Index. Results: Among a total of 92,454 study participants with a median follow-up of 4.7 years, 7,670 (8.3%) composite events of cardiovascular disease or cardiovascular mortality were observed. Multivariable Cox proportional-hazards models revealed that each 1 mg/dL increment in uric acid level was associated with a 6% higher risk of composite outcomes.Compared with that for the uric acid level category of 4.0 to < 5.0 mg/dL, adjusted hazard ratios (95% confidence interval) for uric acid level categories of 5.0 to < 6.0, 6.0 to < 7.0, and ≥ 7.0 mg/dL were 1.10 (1.04–1.18), 1.20 (1.11–1.30), and 1.36 (1.25–1.47), respectively. In the secondary analyses for cardiovascular disease or cardiovascular mortality examined separately, a higher uric acid level was similarly associated with a higher risk of each adverse outcome. These associations were generally consistent across clinically relevant subgroups. Conclusion A graded association was noted between serum uric acid levels and cardiovascular risk, suggesting that higher uric acid levels may adversely affect cardiovascular health and survival in individuals without gout.