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

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

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

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.

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*

PURPOSE: To investigate whether the result of RigiScan after intracorporeal injection could predict the result of duplex ultrasonography, and determine the necessity of duplex ultrasonography. MATERIALS AND METHODS: We performed both RigiScan and duplex ultrasonography after intracorporeal injection in 18 men with erectile dysfunction. All of the patients were evaluated by history taking, physical examination, laboratory test, hormonal tests, and neurologic examination before RigiScan and duplex ultrasonography. We measured maximal arterial diameter, peak systolic velocity, end-diastolic velocity using a 7 MHz. color Doppler unit and these results of duplex ultrasonography were compared with penile rigidity and tumescence measured by RigiScan. RESULTS: The positive and negative predictive value of RigiScan were 81.8% and 85.7%, respectively. The result of RigiScan was comparable with that of duplex ultrasonography and the accuracy of RigiScan was resonable. CONCLUSIONS: According to this results, duplex ultrasonography was needed if the response of RigiScan is abnormal after intracorporeal injection. However, duplex ultrasonography can be ommitted if the response of RigiScan is normal after intracorporeal injection.
Erectile Dysfunction ; Humans ; Male ; Mass Screening* ; Neurologic Examination ; Physical Examination ; Ultrasonography*

BACKGROUND: The association between obesity development and poor family function was controversial in previous studies and has been seldom evaluated in Korean adolescents. METHODS: A questionnaire asking family function (family APGAR, Korean family function assessment tool for adolescents), socioeconomic environment, and behavioral characteristics was self-administered to 1,056 adolescents enrolled in a Korean middle school. A total of 774 adolescents who answered the questionnaire thoroughly and had no diseases influencing family function were included. After calculating body mass index (BMI) using the data of physical measurement at school, we classified participants into overweight-obesity (upper 15%) and normal weight group (lower 85%) based on the reference data of Korean childrens' BMI distribution (Korean pediatric society, 1998). RESULTS: The prevalence of overweight-obesity was 13.0% (14.8% among boys and 10.9% among girls). Multivariable-adjusted logistic regression analysis showed overweight-obesity was associated with better family function, higher school grade, fattier body shape of mother, and lower educational level of mother. Gender- specifically, overweight-obesity was associated with better family functioning and higher school grade with odds ratios (95% confidence interval) of 2.36 (1.13, 5.55) and 2.59 (1.36, 4.93), respectively, in boys, whereas only those who were not living with both parents were 2.67 (1.09~6.54) times more likely to be overweight or obese among girls. CONCLUSION: The factors associated with overweight- obesity differed by gender and the family function of overweight-obesity group was better than normal weight group, especially in boys. These findings suggest poor family function is neither the cause nor the result of obesity development in adolescents.
Adolescent ; Body Mass Index ; Family Relations ; Humans ; Korea ; Logistic Models ; Mothers ; Obesity ; Odds Ratio ; Overweight ; Parents ; Prevalence ; Surveys and Questionnaires

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