Purpose: This study was conducted to develop a simulation-based postpartum care education program for women with postpartum hemorrhage and to verify the effects of the program on postpartum care. Methods: This program was developed according to the ADDIE model of instructional system design, which consists of analysis, design, development, implementation, and evaluation phases. This quasi-experimental study used a non-equivalent control group pre- and post-test design, and data were collected from April 23 to May 4, 2015. To verify the effects of the program, 33 nursing students in the experimental group participated in a simulation program, whereas 31 students in the control group were given a case study. Results: The experimental group had statistically significantly higher scores for clinical performance (t=–4.80, p<.001), clinical judgment (t=–4.14, p<.001), and learning satisfaction (t=–10.45, p<.001) than the control group. Conclusion The results of this study indicate that the simulation-based postpartum care education program for women with postpartum hemorrhage was effective for developing students’ competency, implying that this program should be integrated into the clinical training component of the maternal nursing curriculum.

Purpose: The purpose of this study was to compare sociodemographic characteristics of a normal cognitive group and mild cognitive impairment group, and establish prediction models of Mild Cognitive Impairment (MCI). Methods: This study was a secondary data analysis research using data from “the 4th Korea Longitudinal Study of Ageing” of the Korea Employment Information Service. A total of 6,405 individuals, including 1,329 individuals with MCI and 5,076 individuals with normal cognitive abilities, were part of the study. Based on the panel survey items, the research used 28 variables. The methods of analysis included a c2-test, logistic regression analysis, decision tree analysis, predicted error rate, and an ROC curve calculated using SPSS 23.0 and SAS 13.2. Results: In the MCI group, the mean age was 71.4 and 65.8% of the participants was women. There were statistically significant differences in gender, age, and education in both groups. Predictors of MCI determined by using a logistic regression analysis were gender, age, education, instrumental activity of daily living (IADL), perceived health status, participation group, cultural activities, and life satisfaction. Decision tree analysis of predictors of MCI identified education, age, life satisfaction, and IADL as predictors. Conclusion The accuracy of logistic regression model for MCI is slightly higher than that of decision tree model. The implementation of the prediction model for MCI established in this study may be utilized to identify middle-aged and elderly people with risks of MCI. Therefore, this study may contribute to the prevention and reduction of dementia.

PURPOSE: The adult tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine has been introduced in order to provide individual protection and reduce the risk of transmitting pertussis to infants. We assessed the knowledge and acceptability of the Tdap vaccine around pregnancy. MATERIALS AND METHODS: This study was a cross-sectional survey of women of childbearing age (20-45 years) who visited obstetrics and gynecologic units of primary, secondary, or tertiary hospitals. They were asked to fill in a questionnaire assessing their knowledge, attitudes, and acceptability of Tdap. RESULTS: The questionnaire was completed by 308 women; 293 (95.1%) had not received information from doctors about Tdap, and 250 (81.2%) did not know about the need for vaccination. A significantly important factor related to subjects' intention to be vaccinated, identified by stepwise multiple logistic regression, was the knowledge (OR 13.5, CI 3.92-46.33) that adult Tdap is effective in preventing pertussis for infants aged 0-6 months. Additionally, 276 (89.6%) considered the recommendation of obstetric doctors as the most influencing factor about Tdap vaccination. CONCLUSION: In Korea, most women of childbearing age seem to be neither recommended nor adequately informed about the vaccination, although our population was not a nationwide representative sample. Information given by healthcare workers may be critical for improving awareness and preventing pertussis.
Adult ; Cross-Sectional Studies ; Diphtheria ; Diphtheria-Tetanus-acellular Pertussis Vaccines/*administration & dosage ; Female ; Health Knowledge, Attitudes, Practice/*ethnology ; Humans ; Immunization/*statistics & numerical data ; Infant ; Logistic Models ; Multivariate Analysis ; Patient Acceptance of Health Care/*ethnology/statistics & numerical data ; Pregnancy ; Republic of Korea/epidemiology ; Risk ; Surveys and Questionnaires ; Tetanus ; Vaccination ; Whooping Cough/diagnosis/ethnology

To what extent the risks of neonatal morbidities are directly related to premature birth or to biological mechanisms of preterm birth remains uncertain. We aimed to examine the effect of exposure to amniotic fluid (AF) infection and elevated cytokine levels on the mortality and pulmonary, intestinal, and neurologic outcomes of preterm infants, and whether these associations persist after adjustment for gestational age at birth. This retrospective cohort study included 152 premature singleton infants who were born at ≤ 32 weeks. AF obtained by amniocentesis was cultured; and interleukin-6 (IL-6) and IL-8 levels in AF were determined. The primary outcome was adverse perinatal outcome defined as the presence of one or more of the followings: stillbirth, neonatal death, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage, and periventricular leukomalacia. Logistic regression analysis was adjusted for gestational age at birth and other potential confounders. In bivariate analyses, elevated AF IL-6 and IL-8 levels were significantly associated with adverse perinatal outcome. These results were not changed after adjusting for potential confounders, such as low Apgar scores, mechanical ventilation, and surfactant application. However, the independent effect of elevated cytokine levels in AF disappeared when additionally adjusted for low gestational age at birth; consequently, low gestational age remained strongly associated with the risk of adverse perinatal outcome. In conclusion, elevated levels of pro-inflammatory cytokines in AF are associated with increased risk of adverse perinatal outcomes, but this risk is not independent of low gestational age at birth. Culture-proven AF infection is not associated with this risk.
Amniocentesis ; Amniotic Fluid* ; Bronchopulmonary Dysplasia ; Cohort Studies ; Cytokines ; Enterocolitis, Necrotizing ; Female ; Gestational Age ; Hemorrhage ; Humans ; Infant* ; Infant, Newborn ; Infant, Premature ; Interleukin-6 ; Interleukin-8 ; Leukomalacia, Periventricular ; Logistic Models ; Mortality* ; Parturition ; Perinatal Death ; Pregnancy* ; Premature Birth ; Respiration, Artificial ; Retrospective Studies ; Stillbirth

BACKGROUND AND OBJECTIVES: Eosinophilic otitis media (EOM) is characterized by the presence of a highly viscous effusion containing eosinophils. It mainly occurs in patients with bronchial asthma, nasal polyps and is resistant to conventional treatments for otitis media. In these patients, steroid is very effective in controlling the disease. However, the major complication is sensorineural hearing loss, especially at high frequencies, which may occur despite steroid therapy. SUBJECTS AND METHOD: Here we report 10 cases of EOM at Seoul National University Hospital. Clinical courses and characteristics of the patients were analyzed. We compared the hearing deterioration and other clinical variables between EOM patients and age-matched non-EOM chronic otitis media patients. RESULTS: All cases had viscous effusion and 9 cases were associated with asthma and nasal polyps. All patients had a decreased hearing in high frequency range compared to the age matched controls. The average bone conduction threshold difference at 2 kHz, 4 kHz was 22.4 dB HL and 42.5 dB HL, respectively. Among the patients, one showed profound sensorineural hearing loss bilaterally after the onset of EOM and received cochlear implantation. The open set sentence score was 82% 6 months after cochlear implantation. Most of the cases were resistant to conventional treatments for otitis media, such as administration of antibiotic agents, ventilation tube insertion or mastoidectomy. However, cases that were given steroid treatment had improvement in ear symptoms. CONCLUSION: Since EOM patients show deterioration of hearing, it is important to properly diagnose EOM, start adequate treatment and explain to patients that the disease may last for a long period and progressive hearing loss may occur.
Asthma ; Bone Conduction ; Cochlear Implantation ; Cochlear Implants ; Ear ; Eosinophils* ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Korea* ; Nasal Polyps ; Otitis Media* ; Otitis* ; Steroids ; Ventilation

BACKGROUND: The ideal alternative airway device should be intuitive to use, yielding proficiency after only a few trials. The Clarus Video System (CVS) is a novel optical stylet with a semi-rigid tip; however, the learning curve and associated orodental trauma are poorly understood. METHODS: Two novice practitioners with no CVS experience performed 30 intubations each. Each trial was divided into learning (first 10 intubations) and standard phases (remaining 20 intubations). Total time to achieve successful intubation, number of intubation attempts, ease of use, and orodental trauma were recorded. RESULTS: Intubation was successful in all patients. In 51 patients (85%), intubation was accomplished in the first attempt. Nine patients required two or three intubation attempts; six were with the first 10 patients. Learning and standard phases differed significantly in terms of success at first attempt, number of attempts, and intubation time (70% vs. 93%, 1.4 ± 0.7 vs. 1.1 ± 0.3, and 71.4 ± 92.3 s vs. 24.6 ± 21.9 s, respectively). The first five patients required longer intubation times than the subsequent five patients (106.8 ± 120.3 s vs. 36.0 ± 26.8 s); however, the number of attempts was similar. Sequential subgroups of five patients in the standard phase did not differ in the number of attempts or intubation time. Dental trauma, lip laceration, or mucosal bleeding were absent. CONCLUSIONS: Ten intubations are sufficient to learn CVS utilization properly without causing any orodental trauma. A relatively small number of experiences are required in the learning curve compared with other devices.
Education ; Hemorrhage ; Humans ; Intubation ; Intubation, Intratracheal* ; Lacerations ; Learning Curve* ; Learning* ; Lip