Purpose: This study aimed to determine the mediating effect of leader-member exchange (LMX) on the relationship between nursing unit managers’ethical leadership and nurses’turnover intentions. Methods: A cross-sectional nationwide survey was performed using structured questionnaires. A total of 225 clinical nurses working in general tertiary hospitals were recruited through proportional quota sampling; the quota used represented the location of working hospitals in South Korea. Data were collected through an online survey and snowball sampling from June to September 2022 and analyzed using the SPSS 25.0 program. A mediation analysis was performed using a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval. Results: In bootstrapping, the indirect effect (X→M→Y) was statistically significant (B=-0.77, 95% CI:-1.02 to -0.50). LMX showed a mediating effect on the relationship between nursing unit managers’ethical leadership and clinical nurses’ turnover intention. In this model, the total effect was B=-0.93 (p<.001). Conclusion These findings suggest that LMX must be considered when making a strategy for nursing retention in the hospital setting. Nursing unit managers with ethical leadership could decrease nurses’ turnover intention by improving the LMX.

Purpose: This study aimed to determine the mediating effect of leader-member exchange (LMX) on the relationship between nursing unit managers’ethical leadership and nurses’turnover intentions. Methods: A cross-sectional nationwide survey was performed using structured questionnaires. A total of 225 clinical nurses working in general tertiary hospitals were recruited through proportional quota sampling; the quota used represented the location of working hospitals in South Korea. Data were collected through an online survey and snowball sampling from June to September 2022 and analyzed using the SPSS 25.0 program. A mediation analysis was performed using a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval. Results: In bootstrapping, the indirect effect (X→M→Y) was statistically significant (B=-0.77, 95% CI:-1.02 to -0.50). LMX showed a mediating effect on the relationship between nursing unit managers’ethical leadership and clinical nurses’ turnover intention. In this model, the total effect was B=-0.93 (p<.001). Conclusion These findings suggest that LMX must be considered when making a strategy for nursing retention in the hospital setting. Nursing unit managers with ethical leadership could decrease nurses’ turnover intention by improving the LMX.

Purpose: This study aimed to determine the mediating effect of leader-member exchange (LMX) on the relationship between nursing unit managers’ethical leadership and nurses’turnover intentions. Methods: A cross-sectional nationwide survey was performed using structured questionnaires. A total of 225 clinical nurses working in general tertiary hospitals were recruited through proportional quota sampling; the quota used represented the location of working hospitals in South Korea. Data were collected through an online survey and snowball sampling from June to September 2022 and analyzed using the SPSS 25.0 program. A mediation analysis was performed using a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval. Results: In bootstrapping, the indirect effect (X→M→Y) was statistically significant (B=-0.77, 95% CI:-1.02 to -0.50). LMX showed a mediating effect on the relationship between nursing unit managers’ethical leadership and clinical nurses’ turnover intention. In this model, the total effect was B=-0.93 (p<.001). Conclusion These findings suggest that LMX must be considered when making a strategy for nursing retention in the hospital setting. Nursing unit managers with ethical leadership could decrease nurses’ turnover intention by improving the LMX.

Purpose: This study aimed to determine the mediating effect of leader-member exchange (LMX) on the relationship between nursing unit managers’ethical leadership and nurses’turnover intentions. Methods: A cross-sectional nationwide survey was performed using structured questionnaires. A total of 225 clinical nurses working in general tertiary hospitals were recruited through proportional quota sampling; the quota used represented the location of working hospitals in South Korea. Data were collected through an online survey and snowball sampling from June to September 2022 and analyzed using the SPSS 25.0 program. A mediation analysis was performed using a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval. Results: In bootstrapping, the indirect effect (X→M→Y) was statistically significant (B=-0.77, 95% CI:-1.02 to -0.50). LMX showed a mediating effect on the relationship between nursing unit managers’ethical leadership and clinical nurses’ turnover intention. In this model, the total effect was B=-0.93 (p<.001). Conclusion These findings suggest that LMX must be considered when making a strategy for nursing retention in the hospital setting. Nursing unit managers with ethical leadership could decrease nurses’ turnover intention by improving the LMX.

BACKGROUND AND OBJECTIVES: Not all impaired listeners may have the same speech perception ability although they will have similar pure-tone threshold and configuration. For this reason, the present study analyzes error patterns in the hearing-impaired compared to normal hearing (NH) listeners as a function of signal-to-noise ratio (SNR). SUBJECTS AND METHODS: Forty-four adults participated: 10 listeners with NH, 20 hearing aids (HA) users and 14 cochlear implants (CI) users. The Korean standardized monosyllables were presented as the stimuli in quiet and three different SNRs. Total error patterns were classified into types of substitution, omission, addition, fail, and no response, using stacked bar plots. RESULTS: Total error percent for the three groups significantly increased as the SNRs decreased. For error pattern analysis, the NH group showed substitution errors dominantly regardless of the SNRs compared to the other groups. Both the HA and CI groups had substitution errors that declined, while no response errors appeared as the SNRs increased. The CI group was characterized by lower substitution and higher fail errors than did the HA group. Substitutions of initial and final phonemes in the HA and CI groups were limited by place of articulation errors. However, the HA group had missed consonant place cues, such as formant transitions and stop consonant bursts, whereas the CI group usually had limited confusions of nasal consonants with low frequency characteristics. Interestingly, all three groups showed /k/ addition in the final phoneme, a trend that magnified as noise increased. CONCLUSIONS: The HA and CI groups had their unique error patterns even though the aided thresholds of the two groups were similar. We expect that the results of this study will focus on high error patterns in auditory training of hearing-impaired listeners, resulting in reducing those errors and improving their speech perception ability.
Adult ; Cochlear Implants* ; Cues ; Hearing Aids* ; Hearing* ; Humans ; Noise* ; Signal-To-Noise Ratio ; Speech Perception

BACKGROUND: The purpose of this study was to estimate socioeconomic costs caused by alcohol drinking in Korea as of 2004 in an effort to raise the awareness of the gravity of problems associated with alcohol drinking and the necessity of active intervention by family physicians. METHODS: The costs were classified as direct costs, indirect costs and other costs. The direct costs consisted of direct medical costs and direct non-medical costs. The indirect costs were computed by the reduction and loss of productivity and the loss of workforce. Other costs consisted of property loss, administration costs and costs of alcohol beverage. RESULTS: The annual costs, which seemed to be attributable to alcohol drinking, were estimated to be 200,990 hundred million won (2.9% of GDP). In the case of the former, the amount included 38.83% for reduction of productivity, 26.92% for loss of the workforce, 22.24% for alcoholic beverage, 5.34% for direct medical costs, 2.29% for loss of productivity, 1.87% for direct non- medical costs, 1.54% for administration costs and 0.97% for loss of property. CONCLUSION: Our study confirms that compared with the cases of Japan (1.9% of GNP), Canada (1.09% of GDP), France (1.42% of GDP) and Scotland (1.19% of GDP), alcohol drinking incurs substantial socioeconomic costs to Koreans. An active intervention by family physicians is suggested.
Alcohol Drinking ; Alcoholic Beverages ; Canada ; Efficiency ; France ; Gravitation ; Humans ; Japan ; Korea ; Physicians, Family ; Scotland

PURPOSE: This study aimed to evaluate the effects of radiotherapy (RT) on progression-free survival (PFS) for patients with recurrent colorectal cancer. METHODS: We reviewed the records of 22 patients with recurrent colorectal cancer treated with RT between 2008 and 2014. The median radiation dose for recurrent disease was 57.6 Gy (range, 45-75.6 Gy). Patients were divided into 2 groups according to the type of RT: patients underwent RT without previous history of irradiation (n = 14) and those treated with secondary RT (reirradiation: n = 8) at the time of recurrence. RESULTS: The median follow-up period was 24.9 months (range, 4.5-66.6 months). Progression was observed in 14 patients (including 8 with loco-regional failure and 9 with distant metastases). Distant metastases were related to the RT dose (<70 Gy, P = 0.031). The 2-year loco-regional control (LRC), PFS, and overall survival (OS) rates were 74.6%, 45.1%, and 82.0%, respectively. The LRC rate was not different between the patients treated with RT for the first time and those treated with reirradiation (P = 0.101, 2-year LRC 79.5% vs. 41.7%). However, reirradiation was related to poor PFS (P = 0.022) and OS (P = 0.002). An escalated RT dose (≥70 Gy) was associated with a higher PFS (P = 0.014, 2-year PFS 63.5% vs. 20.8%). CONCLUSION: Salvage RT for locally recurrent colorectal cancer can be offered when surgery is impossible. Dose-escalated RT shows a possible benefit in reducing the risk of progression.
Colorectal Neoplasms* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Radiotherapy* ; Rectal Neoplasms ; Recurrence

BACKGROUND: The number of elderly patients admitted to intensive care units (ICUs) is growing with the increasing proportion of elderly persons in the Korean general population. It is often difficult to make decisions about ICU care for elderly patients, especially when they are in their 90s. Data regarding the proportion of elderly patients in their 90s along with their clinical characteristics in ICU are scarce. METHODS: The records of Korean patients > or = 90 years old who were admitted to the medical ICU in a tertiary referral hospital between January 2005 and December 2014 were retrospectively reviewed. We compared the trend in ICU use and characteristics of these elderly patients between 2005-2009 and 2010-2014. RESULTS: Among 6,186 referred patients, 55 aged > or = 90 years were admitted to the medical ICU from 2005 to 2014. About 58.2% of these patients were male, and their mean age was 92.7 years. Their median Charlson comorbidity index score was 2 (IQR 1-3) and their mean APACHE II score was 25.0 (IQR 19.0-34.0). The most common reason for ICU care was acute respiratory failure. There were no differences in the survival rates between the earlier and more recent cohorts. However, after excluding patients who had specified "do not resuscitate" (DNR), the more recent group showed a significantly higher survival rate (53.8% mortality for the earlier group and 0% mortality for the recent group). Among the survivors, over half were discharged to their homes. More patients in the recent cohort (n=26 [78.8%]) specified DNR than in the earlier cohort (n=7 [35.0%], p=0.004). The number and proportion of patients > or = 90 years old among patients using ICU during the 2005-2014 study period did not differ. CONCLUSIONS: The use of ICU care by elderly patients > or = 90 years old was consistent from 2005-2014. The overall mortality rate tended to decrease, but this was not statistically significant. However, the proportion of patients specifying DNR was higher among more recent patients, and the recent group showed an even better survivorship after sensitivity analysis excluded patients specifying DNR.
Aged* ; APACHE ; Cohort Studies ; Comorbidity ; Humans ; Intensive Care Units ; Critical Care* ; Korea* ; Male ; Mortality ; Respiratory Insufficiency ; Retrospective Studies ; Survival Rate ; Survivors ; Tertiary Care Centers*

BACKGROUND: Flow cytometric analysis is the standard method for enumerating CD34+ stem cells in hematopoietic stem cell transplantation. However, it has some limitations such as expensive instrumentation, high reagent costs, and discrepancies between technicians and laboratories. We compared counts of total nucleated cells (TNCs) and CD34+ cells counts obtained from a flow cytometer with a newly-developed image-based microscopic cell counter (ADAM II) to evaluate the possibility of clinical application of the ADAM II.METHODS: We used 18 samples of circulating peripheral blood (PB) and waste tube fractions of peripheral blood stem cells (PBSCs) harvested by apheresis after G-CSF mobilization from adult volunteer donors. We assessed the reproducibility and linearity of the new procedure and compared the numbers of TNCs and viable CD34+ cells determined with the ADAM II and two different flow cytometers (FACSCalibur, FACSCanto II).RESULTS: Numbers of viable CD34+ cells determined with the ADAM II were accurate over the expected range; the intra-assay coefficient of variation was ≤19.8%. Linearity was also satisfactory (R²=0.99). TNC counts obtained with the ADAM II were highly correlated with those obtained with the FACSCalibur (R²>0.9841, P<0.0001) and FACSCanto II (R²>0.9620, P<0.0001), as were the numbers of viable CD34+ cells obtained with the ADAM II and the FACSCalibur and FACSCanto II (R²>0.9911, P<0.0001 and R²>0.9791, P<0.0001), respectively.CONCLUSION: The newly developed image-based microscopic cell counter (ADAM II) appears to be suitable for enumerating TNCs and viable CD34+ cells.
Adult ; Blood Component Removal ; Cell Count ; Granulocyte Colony-Stimulating Factor ; Hematopoietic Stem Cell Transplantation ; Humans ; Methods ; Stem Cells ; Tissue Donors ; Volunteers

BACKGROUND: It is very important to accurately enumerate CD34-positive (CD34+) cells for successful hematopoietic stem cell transplantation (HSCT). We evaluated the ability of the newly developed image based-immunofluorescence cell counter ADAMII (NanoEntek, Seoul, Korea) to enumerate CD34+ cells, which was improved through simultaneous CD45 analysis. METHODS: We enumerated CD34+ cells with ADAMII using 19 peripheral blood (PB) and 91 leukapheresis samples from HSCT donors. Analytical performance, including precision and linearity, was analyzed, and sample stability during storage was evaluated. Viable CD34+ cell count (vCD34) and viable CD45+ cell count (vCD45) and the percentage of viable CD34+ cells among viable CD45+ cells (CD34/CD45) as measured by ADAMII were compared with the corresponding values from two flow cytometry assays, using regression analysis. RESULTS: ADAMII demonstrated acceptable precision, as CV values of vCD34 from six samples with different counts were all < 10% (range: 3.49–9.51%). CV values of the vCD45 and CD34/45 ranged from 4.03% to 9.67% and from 2.48% to 10.07%, respectively. The linearity of vCD34 showed an excellent R 2 value (0.99) when analyzed using the intended count and flow cytometry data. The ADAMII and two flow cytometry-based assays generated very similar data for the PB and leukapheresis samples. CONCLUSIONS: ADAMII demonstrated excellent performance for use as a routine clinical assay in terms of CD34+ cell enumeration from PB and leukapheresis samples. Moreover, it could be used as a point-of-care-test for determining mobilization time and predicting an adequate apheresis stem cell product.
Blood Component Removal ; Cell Count ; Flow Cytometry ; Fluorescence ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukapheresis ; Seoul ; Stem Cells ; Tissue Donors