PURPOSE: In this study a system dynamics methodology was used to identify correlation and nonlinear feedback structure among factors affecting unplanned extubation (UE) of ICU patients and to construct and verify a simulation model. METHODS: Factors affecting UE were identified through a theoretical background established by reviewing literature and preceding studies and referencing various statistical data. Related variables were decided through verification of content validity by an expert group. A causal loop diagram (CLD) was made based on the variables. Stock & Flow modeling using Vensim PLE Plus Version 6.0b was performed to establish a model for UE. RESULTS: Based on the literature review and expert verification, 18 variables associated with UE were identified and CLD was prepared. From the prepared CLD, a model was developed by converting to the Stock & Flow Diagram. Results of the simulation showed that patient stress, patient in an agitated state, restraint application, patient movability, and individual intensive nursing were variables giving the greatest effect to UE probability. To verify agreement of the UE model with real situations, simulation with 5 cases was performed. Equation check and sensitivity analysis on TIME STEP were executed to validate model integrity. CONCLUSION: Results show that identification of a proper model enables prediction of UE probability. This prediction allows for adjustment of related factors, and provides basic data do develop nursing interventions to decrease UE.
Adult ; Airway Extubation/*psychology ; Female ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Male ; Middle Aged ; *Models, Theoretical ; Nonlinear Dynamics ; Risk Factors

Purpose: To develop a self-reported communication competency scale for patients with schizophrenia. Methods: Twenty-nine preliminary items were selected from 42 candidate items derived from literature review and qualitative interviews using content validity analysis of expert opinions to evaluate 637 patients’ schizophrenia communication competence. Data from 383 individuals were analyzed. Confirmatory factor analysis was conducted using data of 280 individuals. The final dataset included data from 254 participants. Data were subjected to exploratory and confirmatory factor analyses using SPSS and AMOS 24.0. Results: After evaluating the model fit index for the last 24 items, the following results were obtained: x2=633.95 (p<.001), x2/df (degree of freedom)=2.26, SRMR=0.04, RMSEA=0.06, TLI=0.93, CFI=0.94, NFI=0.96. Therefore, this tool’s suitability was evaluated as acceptable. The final scale comprised 24 items and 3 subscales that could measure basic, interpersonal, and communicative expression of patients with schizophrenia. Conclusion A self-reported communication competency scale was developed for patients with schizophrenia. It is expected to help measure the effectiveness of intervention programs to improve communication among patients with schizophrenia.

BACKGROUND: There have been no studies of airway management strategies for difficult intubation and cannot intubate, cannot ventilate (CICV) situations in Korea. This study was intended to survey devices or methods that Korean anesthesiologists and intensivists prefer in difficult intubation and CICV situations. METHODS: A face-to-face questionnaire that consisted of a doctor's preference, experience and comfort level for alternative airway management devices was presented to anesthesiologists and intensivists at study meetings and conferences from October 2014 to December 2014. RESULTS: We received 218 completed questionnaires. In regards to difficult intubation, the order of preferred alternative airway devices was a videolaryngoscope (51.8%), an optical stylet (22.9%), an intubating laryngeal mask airway (11.5%), and a fiber-optic bronchoscope (10.6%). One hundred forty-two (65.1%) respondents had encountered CICV situations, and most of the cases were identified during elective surgery. In CICV situations, the order of preferred methods of infraglottic airway management was cricothyroidotomy (CT) by intravenous (IV) catheter (57.3%), tracheostomy by a surgeon (18.8%), wire-guided CT (18.8%), CT using a bougie (2.8%), and open surgery CT using a scalpel (2.3%). Ninety-eight (45%) of the 218 respondents were familiar with the American Society of Anesthesiologists' difficult airway algorithm or Difficult Airway Society algorithm, and only 43 (19.7%) had participated in airway workshops within the past five years. CONCLUSION: The videolaryngoscope was the most preferred device for difficult airways. In CICV situations, the method of CT via an IV catheter was the most frequently used, followed by wire-guided CT method and tracheostomy by the attending surgeon.
Airway Management ; Bronchoscopes ; Catheters ; Congresses as Topic ; Education ; Intubation* ; Intubation, Intratracheal ; Korea* ; Laryngeal Masks ; Methods ; Surveys and Questionnaires ; Tracheostomy

Sarcomatoid carcinoma is a rare and occurs mainly in the upper aerodigestive tract such as the oral cavity, esophagus and vocal cords. It is a unique variant of squamous cell carcinoma. We report the case of a patient with spindle cell squamous cell carcinoma involving the mandible. At initial examination, overlying mucosa of that lesion was normal appearance. One week later, that lesion showed ulcerative and bloody change and rapid growth in size. This case showed unpredictable rapid growth although rapid growth in size was suspected of undergoing malignancy.
Carcinoma, Squamous Cell ; Esophagus ; Humans ; Mandible ; Mandibular Neoplasms ; Mouth ; Mucous Membrane ; Ulcer ; Vocal Cords

OBJECTIVES: This study was designed to investigate the effect of delivery nursing care using essential oils on labor stress response, labor anxiety and postpartum status anxiety for primipara. METHODS: This study used nonequivalent control group pretest-posttest design. The subjects of this experiment consisted of forty eight primipara with single gestation, full term, & uncomplicated pregnancies. Twenty four primipra were in the experimental and control group each. Their mean age was 27.9 years old, their mean gestation period 279.9 days. As a treatment, delivery nursing care using essential oils was applied by nurses. Data collected epinephrine, norepinephrine, anxiety during labor. In the 24 hours after birth, the data for the postpartum mother's status anxiety was collected. Data was analyzed by t-test, repeated measures ANOVA, Mann-Whitney U test, & Wilcoxon signed ranks test with SPSS Program. RESULTS: Plasma epinephrine, norepinephrine were significantly low in the experimental group (P=0.001, P=0.033, respectively). There was no significant difference between the two groups in anxiety during labor and postpartum mother's status anxiety. CONCLUSION: These findings indicate that delivery nursing care using essential oils could be effective in decreasing plasma epinephrine, norepinephrine. But, that could not be verified in decreasing mother's anxiety.
Stress/*prevention & control ; Pregnancy ; Postpartum Period/*psychology ; Oils, Volatile/*therapeutic use ; Norepinephrine/blood ; Labor, Obstetric/*psychology ; Humans ; Female ; Epinephrine/blood ; Delivery, Obstetric/*nursing ; *Aromatherapy ; Anxiety/*prevention & control ; Adult

Objective: This study aimed to analyze the important medical adverse events (IMEs) of cyclosporine and tacrolimus using the reports in US FDA adverse event reporting system (FAERS) and to detect related signals. Methods: The FAERS database was used to analyze the IMEs reported for cyclosporine or tacrolimus during 2017-2021. Reporting odds ratio (ROR) and information component were used to analyze signals for adverse events of both drugs. It was investigated whether the detected signals were present on drug labels in Korea and the United States. Results: Among the total 24,688 reports, the reports on tacrolimus accounted 75.8%. Mean age of the patients was 47.9 years old and median number of adverse events was 2.0 per report. The number of patients hospitalized for adverse events was 7,979 (25.3%). Among the adverse reactions reported on the cyclosporine and tacrolimus, 576 and 1,363 events were detected as signals for cyclosporine and tacrolimus, respectively, and of these, IMEs accounted for 44.8 and 59.2%, respectively. The IMEs related with infections/infestations, renal/urinary disorders, and blood and lymphatic system disorders were reported frequently for both drugs. The most frequently detected IMEs were renal impairment for cyclosporine and acute kidney injury for tacrolimus. Among the top 3 IMEs for each reported SOC for cyclosporine and tacrolimus, 9 and 2 unexpected adverse events were identified, respectively. Conclusion This study identified the IMEs and signals of cyclosporine and tacrolimus, and detected unidentified adverse events in a drug information database.

PURPOSE: To reconstruct the midface, local flaps such as nasolabial flaps have been frequently used. These local flaps, however, have the shortcomings of requiring a secondary operation or limitations in the movement of the flap. Thus, new methods have been developed. This paper reports a case wherein the basal cell carcinoma on the cheek was resected and the skin and soft tissue defect was successfully treated using a facial artery perforator flap. METHODS: A 68-year-old female consulted the authors on the basal cell carcinoma that developed on her cheek. The mass was fully resected and revealed a 2.3 x 2.3 cm defective region. Using a Doppler ultrasonography, the facial artery path was traced, and using a loupe magnification, the facial artery perforator flap was elevated and the defective region was covered with the flap. RESULTS: The flap developed early venous congestion, but it disappeared without any treatment. Six months after the surgery, the patient was satisfied with the postoperative result. CONCLUSION: The facial artery perforator flap has a thin pedicle. It offers a big arc of the rotation that allows free movement and one-stage operation. These strengths make the method useful for the reconstruction of the midface among other procedures.
Aged ; Arteries ; Carcinoma, Basal Cell ; Cheek ; Female ; Humans ; Hyperemia ; Perforator Flap ; Skin ; Ultrasonography, Doppler

The anterior maxillary sinus walls are the most frequently injured sites in midfacial fractures. The maxillary sinus is a difficult surgical site for reduction and fixation due to its narrow surgical field, and has a chance of developing sinusitis when sufficient treatment is not given. In this study, the methods developed by the authors for managing such are introduced. Two small openings were made on both sides of the fracture line, then a suture knot was tied instead of wiring for reduction and fixation. Then an absorbable mesh was applied on top of the fracture site, with a suture knot for additional fixation. This method was applied on an actual patient, and it was a convenient method despite the narrow surgical field that was provided. The authors believe that using suture knots to fixate fractured segments and absorbable mesh is relatively convenient and economically efficient when it comes to the reduction and fixation of the maxillary sinus wall fracture with several fragments.
Humans ; Maxillary Sinus* ; Sinusitis ; Sutures*

Generally, osteoporosis is caused by the age-related physiologic bone loss. In cases of severe osteoporosis, the reduced bone mass and increaed skeletal fragility make the risk of fracture high. Recently, the relationship between the mandible and the condition of the skeletal bone, the molphometric data about the quality and quantity of the mandible are very important in the diagnosis and treatment of osteoporosis. This study was undertaken to clarify the correlations of the mineral density between mandible and other bones, to predict the bone mineral density (BMD) of the mandible. Cervical (2nd~5th) and lumbar (1st~4th) vertebrae, the bones of forearm and proximal femurs, mandibles from 42-embalmed cadavers (22/M, 20/F, mean age: 66.95 years) were examined. The BMD was measured by dual energy X-ray absorptiometry. The data were analysed with SPSS 12.0 program according to age, gender, to verify the statistical significance. 1. The BMD in the mandibular areas were variable. The BMD in the angle of the mandible (mean 0.40 g/cm2) was similar with that of ultra-distal part of the forearm (mean 0.34 g/cm2). 2. The BMD in the mandible was highly correlated with that of around the forearm. The correlation coefficient between density in the angle, the part between 1st and 2nd molar, the part between 1st molar and 2nd premolar and incisor portion of the mandible and density in the 1/3-distal part of the forearm was high (r=0.742, 0.697, 0.618, 0.652). The correlation coefficient between density in the part between 1st and 2nd premolar and density in the total femur was high (r=0.542). 3. The BMD in the mandible was correlated with that of around the femur neck (r=0.607). 4. The correlation coefficient between the BMD in the 1st and 2nd molar of the mandible and the BMD in the 5th cervical vertebra was high (r=0.543). And also, the correlation coefficient between the BMD in the incisor area of the mandible and the BMD in the 3rd lumbar vertebra was high (r=0.561). 5. Bony status of the mandible was classified into normal, osteopenia, osteoporosis by BMD of WHO criteria. The data represented that BMD of the mandible was decreased as BMD of the skeletal bones decreased. It is concluded that it could be possible to predict BMD of the mandible by the measurement of BMD in the forearm.
Absorptiometry, Photon ; Bicuspid ; Bone Density ; Bone Diseases, Metabolic ; Cadaver ; Femur ; Femur Neck ; Forearm ; Incisor ; Mandible ; Molar ; Osteoporosis ; Spine

BACKGROUND: Jeju Island is geographically and socioeconomically distinct from the mainland of South Korea. Thus, the presentation and management of non-melanocytic skin cancers (NMSC) of the head and neck may differ from those in other regions of the country. We compared the clinical characteristics and treatment modalities of NMSC on Jeju Island with the findings of similar regional studies. METHODS: Patient data, including age, sex, diagnosis, tumor site, treatment, and recurrence, were obtained from the medical and pathology records of patients diagnosed with NMSC between January 2010 and June 2015. RESULTS: In total, 190 patients (57 men) with a mean age of 75 years (range, 42–97) were assessed. Overall, 203 NMSCs were diagnosed, including 123 basal cell carcinomas and 80 squamous cell carcinomas. The tumor sites included the nose, cheeks, periorbital area, and lips (n=55, 54, 25, and 20, respectively). We identified 92 T1-stage and 60 T2-stage tumors, and 120 cases were treated with wide surgical resection and 17 cases were treated with radiation therapy at the medical center. Of the 120 cases treated surgically, 69 required reconstructive surgery using a local skin flap, 22 required full-thickness skin grafting, and 12 underwent primary closure. Basal and squamous cell carcinomas recurred in 2 and 1 cases, respectively. CONCLUSIONS: Compared to the reports from other regions, the average patient age was 10 years higher, with a marked female preponderance. While the proportion of squamous cell carcinoma was higher than in other regions, the tumor distribution and surgical management profiles were similar.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cheek ; Clinical Study* ; Diagnosis ; Female ; Head* ; Humans ; Korea ; Lip ; Neck* ; Nose ; Pathology ; Recurrence ; Skin Neoplasms* ; Skin Transplantation ; Skin*