PURPOSE: This study aimed to compare the quality of nursing care as perceived by registered nurses and mothers of hospitalized children in South Korea. METHODS: This was a descriptive study that recruited 70 mothers of hospitalized children and 70 nurses in pediatric units in university hospitals as participants. The quality of pediatric nursing care was measured using importance and performance scores for 19 items describing various elements of nursing care. The collected data were analyzed using descriptive statistics and the independent t-test. RESULTS: The hospitalized children mothers' mean importance scores were significantly higher than those of the nurses (t=2.94, p=.004). However, there were no significant differences in the mean performance scores of nurses and mothers (t=0.91, p=.363) or between nurses' and mothers' perceptions of quality of nursing care, with the exception of a significant difference for the quality of explanations (t=2.78, p=.006). The quality of explanations was assessed more positively by nurses than by mothers. CONCLUSION: This study suggests that when developing strategies to improve the quality of nursing care in pediatric wards, ensuring that pediatric nurses provide detailed explanations should be considered as a way to improve the quality of nursing care in pediatric units.
Child ; Child, Hospitalized* ; Hospitals, University ; Humans ; Korea ; Mothers* ; Nurses ; Nursing Care* ; Nursing* ; Pediatric Nursing ; Quality of Health Care

PURPOSE: This study investigated the mediating effects of loneliness and depression on the relationship between adult attachment and smartphone addiction in university students. METHODS: A total of 200 university students participated in this study. The data was analysed using descriptive statistics, correlation analysis, and structural equation modeling. RESULTS: There were significant positive relationships between attachment anxiety, loneliness, depression, and smartphone addiction. However, attachment anxiety was not significantly correlated with smartphone addiction. The results also showed that loneliness did not directly mediate between attachment anxiety and smartphone addiction. In addition, loneliness and depression serially mediated between attachment anxiety and smartphone addiction. CONCLUSION: The results suggest there are mediating effects of loneliness and depression in the relationship between attachment anxiety and smartphone addiction. The hypothesized model was found to be a suitable model for predicting smartphone addiction among university students. Future study is required to find a causal path to prevent smartphone addiction among university students.
Adult* ; Anxiety ; Depression* ; Family Relations ; Humans ; Loneliness* ; Negotiating* ; Smartphone*

A traumatic sternal segment dislocation in children is very rare. Of the few cases reported, some recommended surgical treatment, while others reported good results by conservative treatment. Therefore, the treatment remains unclear. This paper reports a case of completely remodeled traumatic sternal segment dislocation in a 13-year-old boy treated by the restriction of activity and periodic observations.

Purpose: This study investigated the relationship of the partnership between nurses and parents of hospitalized children with the quality of pediatric nursing care as perceived by pediatric nurses. Methods: A cross-sectional descriptive study was conducted among 90 nurses. The data collected were analyzed using the independent t-test and the Pearson correlation coefficient. Results: The level of partnership between nurses and parents showed significant differences by nurses’ age (t=2.22, p=.029) and marital status (t=2.54, p=.013). The quality of pediatric nursing care was found to significantly differ by the nurses’ age (t=2.62, p=.013), marital status (t=4.17, p<.001), whether nurses had children (t=2.53, p=.020), pediatric ward work experience (t=2.43, p=.020), and total work experience (t=2.51, p=.016). The level of partnership between nurses and parents was positively correlated with the quality of pediatric nursing care (r=.48, p<.001). Conclusion To improve the quality of nursing care for hospitalized children and their parents, it is important to consider the specific characteristics of pediatric nurses, whose clinical skills should be improved.

Candida is a relatively rare cause of spinal infections that commonly affects immunocompromised patients. A 70-year-old woman, who underwent a lumbar discectomy on L5-S1 two months earlier, was admitted to our department complaining of persistent back and leg pain. Magnetic resonance imaging showed irregular enhancing mass lesion in L5-S1 intervertebral space, suggest of pyogenic discitis with epidural abscess. The surgery was performed via retroperitoneal approach and the infected material at L5-S1 intervertebral space was removed. The histological examination of the specimen revealed chronic inflammation involving the bone and soft tissue, and a culture of the excised material was positive for Candida parapsilosis. The patient received intravenous fluconazole for 4 weeks after surgery and oral fluconazole 400 mg/day for 3 months after surgery. The patient made a full recovery with no symptoms 6 months after surgery. We present a rare case of spondylodiscitis after a lumbar discectomy due to Candida parapsilosis and discuss treatment option with a review of the literatures.
Aged ; Candida ; Discitis ; Diskectomy ; Epidural Abscess ; Female ; Fluconazole ; Humans ; Immunocompromised Host ; Inflammation ; Leg ; Magnetic Resonance Imaging ; Osteomyelitis ; Spine

BACKGROUND AND OBJECTIVES: Previous studies have evaluated atrial electromechanical delays (AEMDs) with a number of different definitions to discriminate patients with paroxysmal atrial fibrillation (PAF) from controls without PAF. However, their discriminative values for PAF have not previously been directly compared. SUBJECTS AND METHODS: A total of 65 PAF patients and 130 control subjects matched for age, sex, history of hypertension, and diabetes mellitus were selected. The AEMDi and AEMDp were defined as the time intervals from the initiation of the P wave on the surface electrocardiogram to the initiation and peak of the late diastolic transmitral inflow on pulsed wave Doppler images, respectively. The AEMDim and AEMDpm were defined as the time intervals from the initiation of the P wave on the surface electrocardiogram to the initiation and peak of the late diastolic lateral mitral annular motion on tissue Doppler images, respectively. RESULTS: There were no significant differences in the clinical characteristics between the two groups. All 4 AEMDs were consistently longer in the PAF group, and proven effective to differentiate the PAF patients from the controls. The AEMDi measurement had a larger area under the curve (AUC) than the other AEMDs, left atrial volume index, and P wave amplitude. However, the AEMDp, AEMDim, and AEMDpm measurements had AUCs similar to those of the left atrial volume index and P wave amplitude. CONCLUSION: The findings suggest that the AEMDi is better than the other AEMDs for the discrimination of PAF patients from the controls.
Area Under Curve ; Atrial Fibrillation* ; Diabetes Mellitus ; Discrimination (Psychology)* ; Echocardiography ; Electrocardiography ; Humans ; Hypertension

BACKGROUND AND OBJECTIVES: Cardiac troponins are associated with increased mortality, even among patients with no coronary artery disease. Elevated cardiac troponin levels are frequently observed in patients without significant coronary lesions, although the mechanism underlying this finding is unclear. The aim of our study was to evaluate the association between the levels of cardiac troponin and coronary flow reserve (CFR). SUBJECTS AND METHODS: We evaluated serum cardiac troponin-I in 19 patients (9 female; age 61.9+/-10.9 year-old). All patients had an ejection fraction >40% and angiographically normal coronary arteries. Simultaneous measurements of fractional flow reserve (FFR), the index of microcirculatory resistance (IMR), and CFR measurements using an intracoronary temperature- and pressure-sensing guidewire under basal conditions and during maximal hyperemia were performed in three vessels: the left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA). RESULTS: All patients were followed for a median of 13 months. FFR, IMR, and CFR measurements were performed successfully in all subjects. Mean CFRs of LAD, LCX, and RCA were 1.98+/-1.20, 2.75+/-2.11, and 4.44+/-2.51, respectively. Mean IMRs of LAD, LCX and RCA were 33.28+/-18.78, 29.11+/-26.70, and 30.55+/-23.65, respectively. There was a poor correlation between CFR and troponin-I values in each vessel. In selecting the lowest value of CFR in each patient as the corresponding value, the lowest CFR was not associated with troponin-I levels (r=-0.219, p=0.367). CONCLUSION: In patients without significant coronary lesions, the correlation between CFR and troponin-I level was not significant using a thermodilution technique. Further study of a larger population with longer-term follow-up may be needed to more fully understand microvascular dysfunction.
Arteries ; Coronary Artery Disease* ; Coronary Vessels ; Female ; Follow-Up Studies ; Humans ; Hyperemia ; Microvessels ; Mortality ; Thermodilution* ; Troponin I ; Troponin* ; Vascular Resistance

Objectives: The Regional CardioCerebroVascular Center (RCCVC) project was initiated to improve clinical outcomes for patients with acute myocardial infarction or stroke in non-capital areas of Korea. The purpose of this study was to evaluate the outcomes and issues identified by the Busan RCCVC project in the treatment of ST-segment elevation myocardial infarction (STEMI). Methods: Among the patients who were registered in the Korean Registry of Acute Myocardial Infarction for the RCCVC project between 2007 and 2019, those who underwent percutaneous coronary intervention (PCI) for STEMI at the Busan RCCVC were selected, and their medical data were compared with a historical cohort. Results: In total, 1161 patients were selected for the analysis. Ten years after the implementation of the Busan RCCVC project, the median door-to-balloon time was reduced from 86 (interquartile range [IQR], 64-116) to 54 (IQR, 44-61) minutes, and the median symptom-to-balloon time was reduced from 256 (IQR, 180-407) to 189 (IQR, 118-305) minutes (p<0.001). Inversely, the false-positive PCI team activation rate increased from 0.6% to 21.4% (p<0.001). However, the 1-year cardiovascular death and major adverse cardiac event rates did not change. Even after 10 years, approximately 75% of the patients had a symptom-to-balloon time over 120 minutes, and approximately 50% of the patients underwent inter-hospital transfer for primary PCI. Conclusions A decade after the implementation of the Busan RCCVC project, although time parameters for early reperfusion therapy for STEMI improved, at the cost of an increased false-positive PCI team activation rate, survival outcomes were unchanged.

BACKGROUND/AIMS: The purpose of this study was to compare changes in primary percutaneous coronary artery intervention (PCI) outcomes after starting the government-directed Busan-Ulsan Regional Cardiocerebrovascular Center Project. METHODS: Patients with ST segment elevation myocardial infarction (STEMI) who visited the Busan-Ulsan Regional Cardiocerebrovascular Center from 1 June 2009 to 30 May 2011 were selected. Their medical records were retrospectively reviewed. Clinical and survival outcomes before and after starting the project were compared. RESULTS: A total of 122 patients (mean age, 63 +/- 13 years; male, 74%) with STEMI were selected for analysis. There were no significant differences in patients' baseline characteristics. After starting the Busan-Ulsan Regional Cardiocerebrovascular Center Project, the door-to-balloon time decreased from 72 +/- 30 to 59 +/- 22 minutes (p = 0.011). The door-to-balloon time when the PCI team did not stay in the hospital also decreased from 80 +/- 30 to 62 +/- 12 minutes (p = 0.005). However, there was no significant change in the total ischemic time (339 +/- 293 vs. 304 +/- 287 minutes, p = 0.514), survival discharge rate (94% vs. 93%, p = 1.000), or 1-year survival rate (89% vs. 91%, p = 0.996). CONCLUSIONS: After starting the government-directed Busan-Ulsan Regional Cardiocerebrovascular Center Project, the door-to-balloon time was significantly reduced. However, the total ischemic time and short-term survival remained unchanged.
Coronary Vessels ; Humans ; Male ; Medical Records ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Retrospective Studies ; Survival Rate

Background and Objectives: In acute ST-segment elevation myocardial infarction (STEMI),on-site transmission of electrocardiogram (ECG) has been shown to reduce systemic timedelay to reperfusion and improve outcomes. However, it has not been adopted in communitybasedemergency transport system in Korea. Methods: Busan Regional Cardio-cerebrovascular Center and Busan Metropolitan City Fireand Safety Headquarters (BMFSH) jointly developed and conducted a pre-hospital ECGtransmission program. Seven tertiary hospitals and 22 safety stations of BMFSH participated.Systemic time delay to reperfusion of STEMI patients in the program was compared with thatof 95 patients transported by 119 emergency medical system (EMS) before the program wasimplemented. Results: During the study period, 289 ECG transmissions were made by 119 EMS personnel,executed within 5 minutes in 88.1% of cases. Of these, 42 ECGs were interpreted as STsegmentelevation. Final diagnosis of STEMI was made in 20 patients who underwent primarypercutaneous coronary intervention. With the program, systemic time delay to reperfusion wassignificantly reduced (median [interquartile range; IQR], 76.0 [62.2–98.7] vs. 90.0 [75.0–112.0],p<0.01). Significant reduction of door-to-balloon time was also observed (median [IQR], 45.0[34.0–69.5] vs. 58.0 [51.0–68.0], p=0.03). The proportion of patients with systemic time delayshorter than 90 minutes rose (51.6% vs. 75.0%, p=0.08) with pre-hospital ECG transmission. Conclusions We developed and implemented a community-based pre-hospital ECG transmission program for expeditious triage of STEMI patients. Significant reductions ofsystemic time delay and door-to-balloon time were observed. The expanded use of prehospitalECG transmission should be encouraged to realize the full potential of this program.