PURPOSE: This study aimed to develop a smartphone overdependence prevention program for college students based on the self-determination theory (SDT) and evaluate its effectiveness.METHODS: A non-equivalent control group repeated measures design was used for the study. Participants were 64 university freshmen (experimental group: 29, control group: 35). The developed program consists of eight sessions conducted twice a week. The program was designed to promote autonomy, competence, and relatedness the three elements of the basic psychological needs of self-determination theory. The participants were assessed before the program, immediately after, and 1 and 3 months after the program. Data were collected from April 23 to September 14, 2018 and analyzed by performing a Chi-square test, Fisher's exact test, independent t-test, and repeated measures ANOVA using SPSS/WIN 23.0.RESULTS: This study showed improvement in the basic psychological needs (F=3.90, p =.010) in the experimental group compared to the control group. Specifically, competence (F=2.93, p =.035), relatedness (F=2.89, p =.045), and self-regulatory ability (F=3.11, p =.028) improved significantly.CONCLUSION: Study findings indicate thatthe smartphone overdependence prevention program based on the Self-determination theory could be an effective intervention for improving basic psychological needs and self-regulation ability. Therefore, this program could be an efficient strategy for smartphone overdependence prevention in university students.
Humans ; Mental Competency ; Personal Autonomy ; Self-Control ; Smartphone

Percutaneous pulmonary valve implantation (PPVI) is recognized as a feasible and low risk alternative to surgery to treat dysfunctional right ventricular outflow tract (RVOT) in usually pluri-operated patients. Evolving technology allowed to develop different kind of prosthesis and to go from an initial treatment exclusively of stenotic conduit to an actual approach extended also to wide native RVOT. The Melody transcatheter pulmonary valve (TPV) and the Edwards Sapien valve are nowadays the most commonly implanted prostheses. However, other devices have been developed to treat large RVOT (i.e., the Venus p-valve, the Medtronic Harmony TPV, the Alterra Adaptive Prestent, and the Pulsta valve). Indications for PPVI are the same as for surgical interventions on pulmonary valve, with limits related to the maximum diameter of the available percutaneous prosthesis. Therefore, an accurate preoperative evaluation is of paramount importance to select patients who could benefit from this procedure. The overall periprocedural mortality incidence is around 1.4%, while freedom from RVOT reintervention ranges from 100% at 4 months to 70% at 70 months, according to the different published studies.
Freedom ; Heart Defects, Congenital ; Humans ; Incidence ; Mortality ; Prostheses and Implants ; Pulmonary Valve ; Venus

Freedom from adverse aortic events (aortic dissection or rupture, reoperation, or sudden death) at 10 years was 97.9%. No significant dilation at the level of the sinuses of Valsalva (0.069 mm/year, p=0.524) or ascending aorta (0.152 mm/year, p=0.124) was observed. Significant dilation occurred at the proximal aortic arch (0.343 mm/year, p=0.006). Subgroup analysis with a multivariable linear mixed model identified initial ascending aortic diameter to be a significant predictor of proximal arch dilation (p=0.032). Receiver operating characteristic curve analysis revealed that the cut-off for the prediction of proximal arch redilation was an initial mid-ascending aortic diameter of 47.0 mm (area under the curve 0.747, 90% confidence interval 0.613–0.881, p=0.023).CONCLUSION: Aortic wrapping could be considered as a safe and long-term therapeutic option. Redilation of the proximal arch should be carefully observed during long-term follow-up.]]>
Aorta ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Valve ; Follow-Up Studies ; Freedom ; Humans ; Reoperation ; Retrospective Studies ; ROC Curve ; Rupture

PURPOSE: With continuous positive airway pressure (CPAP) being the treatment of choice for Obstructive Sleep Apnea (OSA), adherence rates to CPAP are still low without a clear consensus of causes. The Self-Determination Theory (SDT) is a general theory of human motivation that emphasizes the extent to which behaviors are relatively autonomous based on the psychological needs that are critical to supporting the process of internalization and the development of optimal motivation. This study sought to determine whether the implementation of an SDT-based intervention is effective in improving: (1) perceived competence, (2) treatment self-regulation, (3) CPAP treatment adherence, and (4) Apnea–hypopnea index (AHI) of OSA patients. METHODS. Using a true experimental pretest-posttest design, 30 purposively selected participants were randomly allocated to experimental and control groups. The SDT-based intervention included group sessions, individual sessions, and follow up phone calls in three weeks. Written permission to conduct the study was obtained from the Institutional Review Board of the University of the East - Ramon Magsaysay Memorial Medical Center, Inc. (UERMMMCI) and the Lung Center of the Philippines. Participation was voluntary and all participants had the right to refuse or discontinue their participation at any time during the study. Data were analyzed using two way repeated-measures ANOVA, student's T-test, and chi-square. RESULTS AND CONCLUSION: The participants in the experimental group have increased adherence rates from Time 1 (60%) to Time 2 (92.9%) and Time 3 (85.7%). Although, when compared to the control group, no significant difference was noted across the different periods of measurement (p=0.70810, p=0870, p=0.2403). There were higher proportions of patients who eventually became adherent in the experimental group compared to the control group immediately after and 5 weeks after the intervention (p=0.0001). The experimental group had significantly better improvement in AHI compared to the control group immediately after (p=0.0152) and 5 weeks after the intervention (p=0.0022). Considering the importance of CPAP adherence in effectively treating OSA, measures to improve adherence such as SDT-based intervention could be usefully incorporated into OSA patients' treatment plans.
Continuous Positive Airway Pressure ; Personal Autonomy ; Sleep Apnea, Obstructive

BACKGROUND AND PURPOSE: This study investigated the seizure recurrence rate and potential predictors of seizure recurrence following antiepileptic drug (AED) withdrawal after resective epilepsy surgery in children with focal cortical dysplasia (FCD). METHODS: We retrospectively analyzed the records of 70 children and adolescents with FCD types I, II, and IIIa who underwent resective epilepsy surgery between 2004 and 2015 and were followed for at least 2 years after surgery. RESULTS: We attempted AED withdrawal in 40 patients. The median time of starting the AED reduction was 10.8 months after surgery. Of these 40 patients, 14 patients (35%) experienced seizure recurrence during AED reduction or after AED withdrawal. Half of the 14 patients who experienced recurrence regained seizure freedom after AED reintroduction and optimization. Compared with their preoperative status, the AED dose or number was decreased in 57.1% of patients, and remained unchanged in 14.3% after surgery. A multivariate analysis found that incomplete resection (p=0.004) and epileptic discharges on the postoperative EEG (p=0.025) were important predictors of seizure recurrence after AED withdrawal. Over the mean follow-up duration of 4.5 years after surgery, 34 patients (48.6% of the entire cohort) were seizure-free with and without AEDs. CONCLUSIONS: Children with incomplete resection and epileptic discharges on postoperative EEG are at a high risk of seizure recurrence after drug withdrawal. Complete resection of FCD may lead to a favorable surgical outcome and successful AED withdrawal after surgery.
Adolescent ; Anticonvulsants ; Child* ; Electroencephalography ; Epilepsy ; Follow-Up Studies ; Freedom ; Humans ; Malformations of Cortical Development* ; Multivariate Analysis ; Recurrence* ; Retrospective Studies ; Seizures*

BACKGROUND: Scarce data have been reported on the efficacy of concomitant atrial fibrillation (AF) ablation in patients undergoing bioprosthetic valve replacement. METHODS: From 2001 and 2014, 146 consecutive patients (69.3±9.4 years, 84 females) who underwent bioprosthetic heart valve replacement concomitant with AF ablation were assessed. We evaluated long-term rhythm and valve-related outcomes. RESULTS: During 49.1 months of follow-up (interquartile range, 22.5–96.8 months), 7 in-hospital and 49 (6.7% per person-year) post-discharge deaths occurred. The thromboembolic event-free survival rate at 5 years was 79.2%±3.5%. The freedom from AF recurrence rate at 5 years was 59.8%±4.9%. Multivariate analysis showed that old age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02–1.11; p=0.002), previous cardiac operation (HR, 3.01; 95% CI, 1.22–7.43; p=0.02), and a large left atrial (LA) dimension (HR, 1.02; 95% CI, 1.00–1.05; p=0.045) were significantly associated with AF recurrence. CONCLUSION: The overall long-term clinical outcomes in these predominantly elderly patients undergoing AF ablation concomitantly with bioprosthetic valve replacement were satisfactory; however, AF recurrence was frequent. Older age, a history of prior cardiac surgery, and large LA size were associated with an increased risk of AF recurrence.
Aged ; Anticoagulants ; Atrial Fibrillation ; Bioprosthesis ; Disease-Free Survival ; Follow-Up Studies ; Freedom ; Heart Valves ; Humans ; Multivariate Analysis ; Recurrence ; Thoracic Surgery

BACKGROUND: The endovascular approach to aortic disease treatment has been increasingly utilized in the past 2 decades. This study aimed to determine the long-term results of using the Seal thoracic stent graft. METHODS: We retrospectively reviewed the outcomes of patients who underwent thoracic endovascular aortic repair or a hybrid procedure using the Seal thoracic stent graft (S&G Biotech, Seongnam, Korea) from January 2008 to July 2018 at a single institution. We investigated in-hospital mortality and the incidence of postoperative complications. We also investigated the mid-term survival rate and incidence of aorta-related complications. RESULTS: Among 72 patients with stent grafts, 15 patients underwent the hybrid procedure and 21 underwent emergency surgery. The mean follow-up period was 37.86±30.73 months (range, 0–124 months). Five patients (6.9%) died within 30 days. Two patients developed cerebrovascular accidents. Spinal cord injury occurred in 2 patients. Postoperative renal failure, postoperative extracorporeal membrane oxygenation support, and pneumonia were reported in 3, 1, and 6 patients, respectively. Stent-related aortic complications were observed in 5 patients (6.8%). The 1- and 5-year survival and freedom from stent-induced aortic event rates were 81.5% and 58.7%, and 97.0% and 89.1%, respectively. CONCLUSION: The use of the Seal thoracic stent graft yielded good mid-term results. Further studies are needed to examine the long-term outcomes of this device.
Aorta, Thoracic ; Aortic Diseases ; Aortic Rupture ; Blood Vessel Prosthesis ; Emergencies ; Endoleak ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Freedom ; Gyeonggi-do ; Hospital Mortality ; Humans ; Incidence ; Pneumonia ; Postoperative Complications ; Renal Insufficiency ; Retrospective Studies ; Spinal Cord Injuries ; Stents ; Stroke ; Survival Rate

PURPOSE: The field of physical therapy education is seeking an evidence-based approach for admitting qualified applicants, as previous research has assessed various outcomes, impeding practical application. This study was conducted to identify preadmission criteria predictive of graduation success. METHODS: Data from the 2013–2016 graduating cohorts (n=149) were collected. Predictors included verbal Graduate Record Examination rank percentile (VGRE%), quantitative GRE rank percentile, analytical GRE rank percentile, the admissions interview, precumulative science grade point average (SGPA), precumulative grade point average (UGPA), and a reflective essay. The National Physical Therapy Examination (NPTE) and grade point average at the time of graduation (GGPA) were used as measures of graduation success. Two separate mixed-effects models determined the associations of preadmission predictors with NPTE performance and GGPA. RESULTS: The NPTE model fit comparison showed significant results (degrees of freedom [df]=10, P=0.001), decreasing within-cohort variance by 59.5%. NPTE performance was associated with GGPA (β=125.21, P=0.001), and VGRE%, the interview, the essay, and GGPA (P≤0.001) impacted the model fit. The GGPA model fit comparison did not show significant results (df=8, P=0.56), decreasing within-cohort variance by 16.4%. The GGPA was associated with the interview (β=0.02, P=0.04) and UGPA (β=0.25, P=0.04), and VGRE%, the interview, UGPA, and the essay (P≤0.02) impacted model fit. CONCLUSION: In our findings, GGPA predicted NPTE performance, and the interview and UGPA predicted GGPA. Unlike past evidence, SGPA showed no predictive power. The essay and VGRE% warrant attention because of their influence on model fit. We recommend that admissions ranking matrices place a greater weight on the interview, UGPA, VGRE%, and the essay.
Cohort Studies ; Education ; Freedom ; School Admission Criteria ; United States

PURPOSE: The purposes of this study were to develop a self-determination improvement program for enhancing nursing students' professional competence and to evaluate effects of the intervention on nursing professionalism, communication skills, and career decision-making autonomy among nursing students. METHODS: The study was in a pre-test, post-test 1, and post-test 2 for a nonequivalent control group design. The participants were 56 students enrolled a nursing school or college (experimental group: 28; control group: 28). The self-determination improvement program was provided in 12 sessions over 4 weeks. Data was collected from August to September 2018. Data were analyzed using SPSS/WIN 25.0 program with χ² test, Fisher's exact test, the independent t-test, and repeated measurement ANOVA. RESULTS: Participants receiving the self-determination improvement program reported increased nursing professionalism, communication skills, and career decision-making autonomy that was significantly different from those in the control group. CONCLUSION: Our study findings suggest that the self-determination improvement program could be effective for enhancing career decision-making autonomy by strengthening nursing students' professionalism and communication skills. Nursing educational program based on self-determination may be helpful for nursing students who need to prepare themselves as competent nurses in future profession.
Humans ; Nursing ; Personal Autonomy ; Professional Competence ; Professionalism ; Schools, Nursing ; Students, Nursing

BACKGROUND: This study was conducted to evaluate the prognostic value of the frailty index based on routine laboratory data (FI-L) in elderly patients who underwent surgical aortic valve replacement (SAVR). METHODS: A total of 154 elderly patients (≥ 75 years) (78.7 ± 3.6 years; men:women = 78:76) who underwent aortic valve replacement with stented bioprosthesis between 2001 and 2018 were enrolled. The FI-L was calculated as the proportion of abnormal results out of 32 items based on laboratory tests, pulse rate and blood pressure. The primary outcome was all-cause mortality. Secondary outcomes included operative mortality and aortic valve-related events (AVREs) during follow-up. The predictive values of FI-L for the early and late outcomes were evaluated using logistic regression and Cox proportional hazards models, respectively. The median follow-up duration was 40 months (interquartile, 15–74). RESULTS: The operative mortality rate was 3.9% (n = 6). Late death occurred in 29 patients. The overall survival (OS) rates at 5, 10, and 15 years were 83.3%, 59.0%, and 41.6%, respectively. The AVREs occurred in 28 patients and the freedom rates from AVREs at 5, 10, and 15 years were 79.4%, 72.7%, and 52.9%, respectively. Multivariable analyses demonstrated that FI-L was a significant factor for OS (hazard ratio, 1.075; 95% confidence interval, 1.040–1.111). A minimal P value approach showed that a FI-L of 25% was the best cutoff value to predict OS after SAVR. CONCLUSION: The FI-L is significantly associated with early and long-term outcomes after SAVR in elderly patients. Frailty rather than a patient's age should be considered in the decision-making process for SAVR in elderly patients.
Aged ; Aortic Valve Stenosis ; Aortic Valve ; Bioprosthesis ; Blood Pressure ; Follow-Up Studies ; Freedom ; Heart Rate ; Humans ; Logistic Models ; Mortality ; Proportional Hazards Models ; Stents