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.

A submental artery perforator flap was applied to the defect site after surgical excision of basal cell carcinoma on the right lower face. Three points were beneficial: it was perfect for assuring the safe margin of the mandibular branch of the facial nerve as well as intact platysma muscle, functionally; harvesting the flap was much easier than that of submental artery flap, surgically; and the color and contour were well matched aesthetically.
Arteries* ; Carcinoma, Basal Cell ; Facial Nerve ; Perforator Flap*

BACKGROUND: In Korea, clinical performance examination (CPX) has been included in license examination for medical doctors since 2009 in order to improve clinical performance of medical students. This study aimed to evaluate the contribution of CPX to medical education. METHODS: Clinical competency in the differential diagnosis of secondary headache was compared between the incoming interns in 2009 unexposed to CPX and the incoming interns in 2010 exposed to CPX, using the data of patients who visited the emergency department due to headache (181 patients seen by 60 CPX non-exposed interns and 150 patients seen by 50 CPX-exposed interns). We obtained the data by reviewing electronic medical records and nominal lists of doctors. Clinical competency was assessed by sensitivity and specificity between the diagnostic impression by interns and the final diagnosis. The association between CPX exposure and clinical competency in secondary headache diagnosis was evaluated using multiple logistic regression analysis. RESULTS: When we assessed clinical competency on the basis of all listed diagnostic impressions, sensitivity and specificity were 67.9% and 80.0%, respectively, for headaches seen by CPX-exposed interns, and 51.7%, and 71.7%, respectively, for headaches seen by CPX non-exposed interns. Multivariable adjusted logistic regression analysis showed exposure to CPX was not associated with increased competency for identifying secondary headache. CONCLUSION: Exposure to CPX as a part of the medical license examination was not effective for the improvement of clinical competency of interns in identifying secondary headache.
Competency-Based Education ; Diagnosis ; Diagnosis, Differential* ; Education, Medical ; Electronic Health Records ; Emergency Service, Hospital ; Headache* ; Humans ; Internship and Residency ; Korea ; Licensure ; Logistic Models ; Sensitivity and Specificity ; Students, Medical

BACKGROUND: Recently the tocopherol, which has been proven as an antioxidant, has also been found to possess non-antioxidant roles such as anti-inflammatory and chemopreventive effects, which has heightened the importance of rapid, accurate and reliable testing methods. We evaluated the performance of normal phase high-pressure liquid chromatography (NP-HPLC) for analysis of tocopherol in serum. METHODS: The chromatographic separation parameters, linearity, precision, accuracy and detection limit were evaluated. The analytical column was hypersil silica (4.6 mm*200 mm*5 micrometer, Thermo Electron Corporation, Keystone, PA, USA) and mobile phase comprised 2% (v/v) of isopropanol in n-hexane. Analyses were run at a flow rate of 0.7 mL/min at 295 nm. RESULTS: The run time of separation of tocopherol was completed in less than 15 minutes and its retention factor (0.61-2.13) and resolution including positional isomers ( beta- and gamma-tocopherol) were excellent. Their linearity was good (r>0.999). The coefficient of variation (CV) at medium and high concentrations did not exceed 15% and those at low concentrations did not exceed 20%. The range of its recovery was 91.4-107.8% and bias was within 15%. The detection limits of alpha-, beta-, gamma- and delta-tocopherol were 0.038, 0.064, 0.078 and 0.049, respectively. CONCLUSIONS: NP-HPLC provided a rapid, accurate and reliable performance for the separation of tocopherol and would be helpful as a routine method in the clinical laboratory.
2-Propanol ; Bias (Epidemiology) ; Chromatography, Liquid* ; Limit of Detection ; Silicon Dioxide ; Tocopherols*

BACKGROUND: Diabetes mellitus (DM) is one of the most important chronic diseases in public health, thus optimal management of this condition is crucial. For this purpose, oral hypoglycemic agents (OHA) are commonly prescribed with their consistent use being mandatory to maintain adequate blood glucose levels. We aimed to evaluate the compliance with OHA in patients with DM, and to determine the factors associated with compliance. METHODS: From March 2006 to December 2007, we enrolled patients with type 2 DM who were newly diagnosed or had discontinued OHAs for more than four weeks. For OHA, diamicron was prescribed to the participants and response to medication was evaluated by physicians after 12 weeks. Compliance was defined as patients taking diamicron continuously or stopping the medication due to well-controlled blood sugar levels. Demographic characteristics, anthropometric measurements, fasting glucose, and lipid profiles were collected and analyzed. RESULTS: The mean age of our 326 subjects was 56.0+/-9.9 years and 74.5% was defined to be compliant. Logistic regression analysis adjusting for age and sex revealed that combined medication use (odd ratio [OR], 2.03; 95% confidence interval [CI], 1.04-3.97) and diabetes-related nutritional education (OR, 2.08; 95% CI, 1.08-4.03) (P<0.05) were factors associated with compliance with OHA. CONCLUSIONS: About three quarters of the DM patients in our study, using diamicron for the first time, showed compliance after 12 weeks of treatment. Concomitant medications and diabetes-related nutrition education were associated with compliance.
Blood Glucose ; Chronic Disease ; Compliance* ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Education ; Fasting ; Gliclazide* ; Glucose ; Humans ; Hypoglycemic Agents ; Logistic Models ; Patient Education as Topic ; Public Health