Purpose: This study aimed to identify the factors that influence nursing performance for patients after attempted suicide among clinical nurses. Methods: The participants in this study were 200 clinical nurses working at hospitals in Korea. Data was collected from February 22, 2022 to March 18, 2022 through a structured online survey that included general characteristics, suicide literacy, attitudes towards suicide, social stigma toward suicidal people, and nursing performance for patients after attempted suicide. SPSS/WIN 25.0 program was used for data analysis, including a descriptive analysis, t-test, one way analysis of variance, the Scheffé test, Pearson correlation coefficients, and multiple linear regression. Results: A higher level of suicide literacy (r=.36, p<.001) and attitudes towards suicide (r=.23, p<.001) were associated with higher nursing performance for patients after attempted suicide. The factors affecting nursing performance for patients after attempted suicide were suicide literacy (β=.38, p<.001) and attitudes towards suicide (β=.26, p<.001). This model showed a 18.0% explanation of nursing performance for patients after attempted suicide. Conclusion It is necessary to develop an effective educational program and to establish an organizational system to improve the quality of nursing performance for patients after attempted suicide.

Phenytoin is a commonly used antiepileptic drug, and its narrow therapeutic index causes various toxicities. Although acute toxicity commonly causes ataxia, few cases have been reported of permanent cerebellar atrophy. A 49-year-old female with epilepsy was prescribed oral phenytoin. After three years of medication, seizure was controlled, but she developed unsteady gait and dysarthria. On admission, the patient showed severe bilateral ataxia, gingival hypertrophy, nystagmus, and dysarthria. Phenytoin toxicity was the impression, and phenytoin was omitted. Serum phenytoin level was 46.9 mg/L (therapeutic range being 10~20 mg/L). Brain magnetic resonance imaging (MRI) was performed to rule out other brain lesions, and diffuse cerebellar atrophy was revealed. After rehabilitation, mild bilateral ataxia remained, standing balance was poor, and the patient was able to walk 70 meters with minimal assist using roller walker. We review a case of chronic phenytoin toxicity that manifested as cerebellar ataxia and later showed atrophy of cerebellum.
Ataxia ; Atrophy ; Brain ; Cerebellar Ataxia ; Cerebellum ; Dysarthria ; Epilepsy ; Female ; Gait Disorders, Neurologic ; Gingival Hypertrophy ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Phenytoin ; Seizures ; Walkers

OBJECTIVES: Despite increasing use of antipsychotic polypharmacy (APP), few studies have investigated APP for Korean patients with schizophrenia. The aim of this study was to identify the sociodemographic and clinical correlates and recent prescription profiles of APP in schizophrenia patients. METHODS: A total of 297 schizophrenia patients were recruited and interviewed using standardized assessment instruments in Seoul National Hospital. Differences in demographic and clinical characteristics between APP and antipsychotic monopharmacy (APM) groups were analyzed. The prescriptions of psychotropic drugs were collected by a review of medical records. RESULTS: In comparison with the APM group, the APP group showed association with earlier onset, lower employment rate, and higher scores for Clinical Global Impression-Severity and Brief Psychiatric Rating Scale (BPRS) (p<0.001). In particular, the BPRS positive (p<0.001) and affective symptom scores (p<0.001) of the APP group were higher those of the APM group. The most frequent combination pattern of APP was second generation antipsychotics (SGA)+SGA, followed by SGA+first generation antipsychotics (FGA), and SGA+SGA+FGA. For antipsychotics, it was risperidone+quetiapine, followed by clozapine+risperidone, risperidone+sulpiride, and risperidone+haloperidol. CONCLUSION: The current study suggests that the usage of APP for schizophrenia could be related to symptom severity affected by positive and affective symptoms. The prescription profile reflects that the proportion of atypical antipsychotics on APP has increased.
Affective Symptoms ; Antipsychotic Agents ; Brief Psychiatric Rating Scale ; Employment ; Humans ; Medical Records ; Polypharmacy* ; Prescriptions ; Psychotropic Drugs ; Schizophrenia* ; Seoul

OBJECTIVE: To determine the useful tool for evaluating salivary aspiration in brain-injured patients with tracheostomy. METHODS: Radionuclide salivagram and laryngoscopy was done in 27 brain-injured patients with tracheostomy. During salivagram, 99mTc sulfur colloid was placed sublingually in the supine position, and 50-minute dynamic images and 2-hour delayed images were obtained. Salivary aspiration was detected when the tracer was entered into the major airways or lung parenchyma. Laryngoscopy was done by otolaryngologists, and saliva aspiration, saliva pooling, and vocal cord palsy were evaluated. Videofluoroscopic swallowing study was done in patients who were able to undergo the test. RESULTS: The detection rate of salivary aspiration was 44.4% with salivagram, and 29.6% with laryngoscopy. The correlation of the two tests was 70.4%. Of the laryngoscopy findings, salivary pooling had significant correlation with positive salivagram results (p=0.04). Frequent need of suction correlated with salivary aspiration in both salivagram (p=0.01) and laryngoscopy (p=0.01). Patients with negative results in salivagram or laryngoscopy had higher rates of progressing to oral feeding or tapering tracheostomy. Two patients developed aspiration pneumonia, and both patients only showed aspiration in salivagram. CONCLUSION: Brain-injured patients with tracheostomy have a high risk of salivary aspiration. Evaluation of salivary aspiration is important, as it may predict aspiration pneumonia and aids in clinical decisions of oral feeding or tracheostomy removal. Salivagram is more sensitive than laryngoscopy, but laryngoscopy may be useful for evaluating structural abnormalities or for follow-up examinations to assess the changes.
Colloids ; Deglutition ; Follow-Up Studies ; Humans ; Laryngoscopy ; Lung ; Pneumonia, Aspiration ; Respiratory Aspiration ; Saliva ; Suction ; Sulfur ; Supine Position ; Tracheostomy ; Vocal Cord Paralysis

Few reliable studies have used standardized outcome measures to examine the effectiveness of sensory interventions to treat somatosensory impairment. The aim of this study is to examine the effectiveness of Frenkel’s exercise for improving lower limb sensation, balance, motor function, functional ambulation, and activities of daily living in subacute ischemic stroke patients with impaired proprioception. Methods: This retrospective cohort study enrolled 14 patients suffering subacute ischemic stroke between 7 to 30 days of onset who showed reduced proprioception in the lower limbs. They were divided into two groups: intervention group (performed Frenkel’s exercise, 15 minutes per day, 15 days over a period of 3 weeks, n=7) and control group (received conventional physical therapy instead, n=7). Outcome measurements included the kinesthetic and light touch sensation subscales of the Nottingham Sensory Assessment (NSA) for the lower limb, the Korean version of the Berg balance scale (K-BBS), the Functional Ambulation Classification (FAC), the Motricity Index (MI), and the Korean version of the Modified Barthel Index (K-MBI). Results: Patients in both groups showed significant improvements on the kinesthetic and tactile sensation subscale of the NSA for the lower limb, the K-BBS, the FAC, and the K-MBI, but not the MI, from baseline to post-intervention at 3 weeks. When compared between the two groups, significant improvements were only seen in the kinesthetic sensation subscale of the NSA for the lower limb and the K-BBS (p<0.05). Conclusions: Frenkel’s exercise improves sensory and balance recovery among subacute ischemic stroke patients with impaired proprioception and minimal lower limb motor weakness.