PURPOSE: This study aimed to investigate the effects of a secondary stroke prevention education program on the health risk indicators and self-care compliance of stroke patients. METHODS: A non-equivalent control group pretest-posttest design was used to select the participants. Subjects were 54 stroke patients (27 in the experimental group and 27 in the control group) hospitalized in a K university hospital in D city, Korea. Health risk indicators and self-care compliance were measured both for a baseline, as well as after intervention. The data was analyzed using a chi-square test, paired t-test and ANCOVA. RESULTS: There were significant differences in systolic blood pressure, diastolic blood pressure, fasting blood sugar, weight and self-care compliance. CONCLUSION: The results of the study indicate that an educational secondary stroke prevention program is effective for health risk indicators and self-care compliance of patients. Therefore it can be used as an effective nursing intervention in clinical practice.
Blood Glucose ; Blood Pressure ; Compliance* ; Education ; Fasting ; Humans ; Korea ; Nursing ; Secondary Prevention ; Self Care* ; Stroke*

BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

PURPOSE: The purpose of this study was to investigate the effects of case-based learning (CBL) on learning motivation and learning satisfaction of nursing students in a human physiology course. METHODS: The development and application of CBL scenarios was conducted from February to June, 2013. Nursing students (n=142) who registered for a human physiology course were assigned into either a control or CLB group. The control group received traditional lectures for 14 weeks. The CBL group received the same 14-week lectures and an additional 5 CBL sessions. The learning motivation and satisfaction were measured by questionnaires at the beginning and the end of the semester. Seven students in the CBL group were randomly selected for a focus-group interview. Quantitative data were analyzed by chi2-test and t-test, and qualitative data were analyzed by content analysis. RESULTS: The learning motivation and learning satisfaction were not significantly different between the two groups. However, 59% of the CBL group answered with a positive impression on the CBL approach as it helped them to feel a sense of achievement, excitement, to form their identity as nursing students, and so on. CONCLUSION: These findings suggest that the CBL could be a challenging but useful learning method in a physiology course for nursing students. Further studies with guidance, such as instructors' questions and feedback design are needed to utilize CBL more effectively.
Humans ; Humans* ; Learning* ; Lectures ; Motivation* ; Nursing* ; Physiology* ; Students, Nursing*

No abstract available.
Apoptosis* ; Cell Line* ; Colon* ; Colonic Neoplasms* ; Etoposide*

PURPOSE: To evaluate the tear meniscus in aqueous tear-deficient dry eye patients using Fourier-domain optical coherence tomography (FD-OCT) and to investigate the clinical usefulness of tear meniscus values. METHODS: The present study included 79 aqueous tear-deficient dry eyes and 50 normal eyes. Tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) were imaged using FD-OCT and measured with computer calipers. Schirmer's test, tear break-up time, and corneal fluorescein staining were also performed and the correlations between the tests were analyzed. Additionally, the diagnostic power of tear meniscus values was compared using area under the receiver operating characteristic curve (AUROC). RESULTS: Tear meniscus values were significantly decreased in the aqueous tear-deficient dry eye group (p < 0.05). TMH, TMD, and TMA were positively correlated with Schirmer's test and tear break-up time (p < 0.05), and TMH and TMD were negatively correlated with corneal fluorescein staining in the aqueous tear-deficient dry eye group (p < 0.05). The AUROCs of TMH, TMD, and TMA were 0.978, 0.788, and 0.957, respectively. CONCLUSIONS: Tear meniscus values measured using FD-OCT were significantly lower in aqueous tear-deficient dry eyes and were correlated with Schirmer's test, tear break-up time, and corneal fluorescein staining. Tear meniscus measurements obtained using FD-OCT can be useful clinical parameters for the diagnosis and treatment of aqueous tear-deficient dry eye.
Diagnosis ; Fluorescein ; Humans ; ROC Curve ; Tears* ; Tomography, Optical Coherence*

BACKGROUND: Dexmedetomidine is a highly selective alpha2 adrenergic agonist that has been shown to decrease the intensity of opioid-induced hyperalgesia (OIH). We aimed to investigate the antihyperalgesic effects of dexmedetomidine on high-dose remifentanil-induced hyperalgesia. METHODS: Ninety American Society of Anesthesiologists physical status I-II patients undergoing laparoscopically assisted vaginal hysterectomy (LAVH) were randomly assigned to one of the following three groups, each of which received either dexmedetomidine (an initial dose of 1.0 microg/kg for 10 min, followed by a continuous infusion of 0.7 microg/kg/hr) or placebo saline 15 min before the induction of anesthesia and intraoperative remifentanil infusion: group C received a placebo and 0.05 microg/kg/min remifentanil; group RH received a placebo and 0.3 microg/kg/min remifentanil; and group DRH received dexmedetomidine and 0.3 microg/kg/min remifentanil. RESULTS: The mechanical hyperalgesia threshold 24 hr after surgery was significantly lower in group RH than in the other two groups. Postoperative pain intensity using visual analog scale (VAS) and cumulative volume of a patient-controlled analgesia (PCA) containing morphine over 24 hr were significantly greater in group RH than in group DRH. The time to the first postoperative analgesic requirement was significantly shorter in group RH than in the other two groups. The desflurane requirement was significantly greater in group C than in the other groups. The frequency of hypotension and bradycardia was significantly higher, but shivering and postoperative nausea and vomiting were significantly lower in group DRH than in the other two groups. CONCLUSIONS: High-doses of remifentanil induced hyperalgesia, which presented a decreased mechanical hyperalgesia threshold, enhanced pain intensity, a shorter time to first postoperative analgesic requirement, and greater morphine consumption, but dexmedetomidine efficiently alleviated those symptoms. Dexmedetomidine may be a novel and effective treatment option for preventing or attenuating OIH.
Adrenergic Agonists ; Analgesia, Patient-Controlled ; Anesthesia ; Bradycardia ; Dexmedetomidine ; Female ; Humans ; Hyperalgesia ; Hypotension ; Hysterectomy, Vaginal ; Isoflurane ; Morphine ; Pain, Postoperative ; Piperidines ; Postoperative Nausea and Vomiting ; Shivering

Objectives: This study aimed to establish a linkage model involving regional responsible medical institutions after analyzing the existing conditions and deriving problems through qualitative analysis within the community care system. Methods: A total of 14 participants of this study were selected through the snowball sampling method, including 7 community care service providers and 7 service users. As for the research data, primary data were collected through interviews, and as a result of analyzing according to Aday&Anderson’ model, a total of 5 catergories, 8 topics, and 22 sub theme were derived. Results: The problem derived from the interview is that division services are provided for each institution due to the absence of a key central institution of community care system, and users’ commercial institutions is unclear. The second is the inconsistency between the needs and supply for community care, resulting in a possibility of delay in returning to the community after discharge. Based on these problems, it is necessary to unify it as an community care window of the Dong-community center. In addition, there is a need for public health centers to play an active role, and to establish a public-private joint system with the Health and Living Support Center to establish a model that can play a certain role. Conclusions Therefore, based on the results of this study, it can be used as basic data when constructing community care model and applying it as an expanded model in the future.

PURPOSE: To determine the baseline clinical characteristics associated with dose escalation of solifenacin in patients with overactive bladder (OAB). METHODS: We analyzed the data of patients with OAB (micturition frequency > or =8/day and urgency > or =1/day) who were treated with solifenacin and followed up for 24 weeks. According to our department protocol, all the patients kept voiding diaries, and OAB symptom scores (OABSS) were monitored at baseline and after 4, 12, and 24 weeks of solifenacin treatment. RESULTS: In total, 68 patients (mean age, 60.8+/-10.0 years) were recruited. The dose escalation rate by the end of the study was 41.2%, from 23.5% at 4 weeks and 17.6% at 12 weeks. At baseline, the dose escalator group had significantly more OAB wet patients (53.6% vs. 20.0%) and higher total OABSS (10.2+/-2.4 vs. 7.9+/-3.5, P=0.032) than the nonescalator group. OAB wet (odds ratio [OR], 4.615; 95% confidence interval [CI], 1.578-13.499; P<0.05) and total OABSS (OR, 1.398; 95% CI, 1.046-1.869; P<0.05) were found to be independently associated with dose escalation. CONCLUSIONS: Patients who have urgency urinary incontinence and high total OABSS have a tendency for dose escalation of solifenacin.
Elevators and Escalators ; Humans ; Muscarinic Antagonists ; Solifenacin Succinate ; Urinary Bladder, Overactive* ; Urinary Incontinence

PURPOSE: The aim of this study was to compare job satisfaction, quality of life (QOL), incident report rate and overtime hours for 12-hour shifts and for 8-hour shifts in a pediatric intensive care unit (PICU). METHODS: A descriptive survey was conducted with a convenience sample of 36 staff nurses from a PICU in a regional hospital in Korea. Data were collected using self-administrated questionnaires regarding job satisfaction and QOL at 6 months before and after the beginning of 12-hour shifts. Incident report rate and overtime hours for both 12-hour and 8-hour shifts were compared. Comparisons were made using chi2-test, paired t-test and Mann-Whitney U test. RESULTS: After 12-hour shifts were initiated, job satisfaction significantly increased (t=3.93, p<.001) and QOL was higher for nurses on 12-hour shifts compared to 8-hour (t=7.83, p<.001). There was no statistically significant change in incident report rate (chi2=0.15, p=.720). The overtimes decreased from 36.3+/-34.7 to 17.3+/-34.9 minutes (Z=-8.91, p<.001). CONCLUSION: These results provide evidence that 12-hour shifts can be an effective ways of scheduling for staff nurses to increase job satisfaction and quality of life without increasing patient safety incidents or prolonged overtime work hours.
Intensive Care Units* ; Job Satisfaction* ; Korea ; Patient Safety ; Quality of Life* ; Surveys and Questionnaires ; Risk Management*

PURPOSE: Our aim was to investigate the predictive factors for detecting grade III-V vesicoureteral reflux(VUR) in young infants less than 3 months with urinary tract infections (UTI). METHODS: Data of infants who underwent ultrasonography and VCUG between January 2004 and September 2007 were reviewed. Age, gender, incidence of bacteremia, C-reactive protein(CRP) and imaging studies were compared between group I(grade III-V VUR) and group II (normal or grade I and II VUR) retrospectively. Sensitivity, specificity, positive and negative predictive values, odds ratio, and likelihood ratio of ultrasonography for high grade VUR were evaluated. RESULTS: Among 54 enrolled infants(41 males, 13 females), 14 infants were group I and 40 infants were group II. In the group I, CRP level was significantly higher(6.11+/-5.18 vs. 3.27+/-3.45, P=0.025), and there were more ultrasonographic abnormal findings(71.4%, vs. 22.5%, P=0.002) compared with group II. However, ultrasonography was the only significant factor after adjusting with logistic regression(P=0.002). Incidence of bacteremia and abnormal DMSA findings were not significantly different in two groups. Sensitivity, specificity, and odds ratio of ultrasonography was 71.4%, 77.5%, 6.9 respectively. Negative predictive value was 88.6% and negative likelihood ratio was 0.37. Ultrasonography had significant negative likelihood ratio for grade III-V VUR, but missed 4 infants with grade III VUR. CONCLUSION: We could not find any alternative predictive factors to reduce VCUG in detecting high grade VUR. Therefore, VCUG must be considered in young infants less than 3 months with UTI.
Bacteremia ; Humans ; Incidence ; Infant ; Male ; Odds Ratio ; Prednisolone ; Retrospective Studies ; Sensitivity and Specificity ; Succimer ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux