Objective: The Korean Triage and Acuity Scale (KTAS) is a triage tool for patients in the emergency department (ED). This study aimed to evaluate the ability of the KTAS to predict poor outcomes in South Korean ED patients with a suspected infection. We also compared the effectiveness of KTAS with that of the National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) in predicting poor outcomes. Methods: We conducted a single-center retrospective study that included adult patients with a suspected infection who were admitted to the ED between January 2019 and December 2019. Patients who received a prescription for antibiotics and associated culture tests in the ED were considered to have an infection. Poor outcomes were evaluated by in-hospital mortality, general ward admission, and intensive care unit (ICU) admission. A receiver operating characteristics (ROC) curve analysis was performed to evaluate and compare KTAS, NEWS, and MEWS. Results: Of the 4,127 patients in the study, in-hospital mortality was reported in 154 (3.7%) patients. The median KTAS was lower in the non-survivors than in the survivors (2.51 vs. 3.35). Multivariate logistic regression analysis showed that the KTAS was associated with in-hospital mortality, ward admission, and ICU admission. The area under the ROC curve (AUROC) values for predicting in-hospital mortality associated with the KTAS, NEWS, and MEWS were 0.776 (95% confidence interval, 0.747-0.803), 0.829 (0.759-0.811) and 0.739 (0.694-0.786), respectively. Conclusion Our results showed that the KTAS was associated with in-hospital mortality, ward admissions, and ICU admissions among ED patients with a suspected infection. Thus, KTAS may be reliable in predicting a poor outcome in ED patients with a suspected infection.

Purpose: The purpose of this study is to understand the actual status of fundamentals of nursing practice (FNP) education at nursing colleges, and the difficulties of FNP operation in the early stages of the COVID-19. Methods: This study used a descriptive design. Data collection was conducted from December 9, 2020 to January 31, 2021 using the self-report questionnaire method for a total of 95 nursing colleges. The questionnaire consisted of characteristics related to FNP, changes in FNP education, difficulties in operating FNP, and countermeasures in the COVID-19 situation. Results: Changes in FNP due to COVID-19 were distribution of practice places, reduction of the number of students, short-term intensive classes, and reduction of face-to-face practice. Most colleges conducted FNP face-to-face, but some schools showed that FNP was conducted non-face-to-face. The difficulties of operating FNP that instructors experienced induced concerns about a decrease in student competency due to lack of face-to-face practice and an unofficial increase in the number of teaching hours and physical demands on instructors due to the expansion of the division. Conclusion In order to develop the capabilities of nursing students in other pandemic situations in the future, it is necessary to find systematic coping strategy to reduce the burden of FNP instructors, and to develop non-face-to-face online practice contents and consumables for online practice.

Purpose: This study was done to investigate the experience of physical and emotional safety in nursing students during fundamentals of nursing practicum. Methods: A descriptive cross-sectional study was conducted from March to September 2019. A total of 553 nursing students, who had completed fundamental nursing laboratories, participated in this study. Data were collected using self-report questionnaires which included questions about general characteristics, physical and emotional safety during fundamental nursing laboratories along with an informed consent given prior to the practicum. Results: Of the students, 26 experienced physical safety accidents, and 18 reported emotional safety accidents. Students' mean stress score for physical safety was 1.95, and the mean score for emotional safety was 1.92. Of the students, more than 59.1% agreed to volunteer as practice models in certain nursing procedures’ training. Of the students, 55.8% were satisfied with using their bodies to train fundamental nursing skills. 61.8% of students reported that informed consent was obtained during the nursing laboratory, and 88.6% of students thought that informed consent needs to be obtained. Conclusion To prevent safety accidents during the fundamentals of nursing practicum and systematically manage accidents, standardized safety guidelines for nursing practicum should be developed. Establishing various training strategies using advanced models or simulators to increase education efficiency and satisfaction is necessary.

Purpose: The aims of this systematic review were to identify the study protocol of Virtual Reality Therapy (VRT) and review the effect of VRT among patients with Post-Traumatic Stress Disorder (PTSD). Methods: This review followed the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search was conducted using 12 electronic databases including gray literature with no limit of publication year. Search terms included relevant terms regarding “PTSD”, “trauma”, and “VRT”. Among 265 studies extracted through PRISMA, 20 studies were selected and evaluated for quality assessment using the Risk of Bias tool of Cochrane’s collaboration. Results: The majority of the literature focused on combat veterans and war situations (95%).Usually, each session usually took 60~120 minutes of VRT in 10~20 sessions for 5~10 weeks. The VRT equipment and contents were individually designed considering patients’ traumatic experiences. Most of the studies reported the positive effects associated to reduced levels of PTSD (80%) and related symptoms, such as, depression (45%) and anxiety (25%). Conclusion Based on our findings, further studies are required to evaluate VRT in people with PTSD, after improving study design and standardizing protocols.

Purpose: The aims of this systematic review were to identify the study protocol of Virtual Reality Therapy (VRT) and review the effect of VRT among patients with Post-Traumatic Stress Disorder (PTSD). Methods: This review followed the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search was conducted using 12 electronic databases including gray literature with no limit of publication year. Search terms included relevant terms regarding “PTSD”, “trauma”, and “VRT”. Among 265 studies extracted through PRISMA, 20 studies were selected and evaluated for quality assessment using the Risk of Bias tool of Cochrane’s collaboration. Results: The majority of the literature focused on combat veterans and war situations (95%).Usually, each session usually took 60~120 minutes of VRT in 10~20 sessions for 5~10 weeks. The VRT equipment and contents were individually designed considering patients’ traumatic experiences. Most of the studies reported the positive effects associated to reduced levels of PTSD (80%) and related symptoms, such as, depression (45%) and anxiety (25%). Conclusion Based on our findings, further studies are required to evaluate VRT in people with PTSD, after improving study design and standardizing protocols.

Purpose: The purposes of this study were to analyze and compare the textbooks of fundamentals of nursing and practice in order to standardize them for medication administration, infection control, and pressure injury. Methods: The current study is a literature review of the ten textbooks published after 2013. Ten textbooks were the ones selected by the Korea Health Personnel Licensing Examination Institute as major textbooks. Three items were reviewed: medication administration, infection control, and pressure injury, with a focus on differences in numbers, range, direction, and others. Results: For medication administration, there were some discrepancies in the size of needle and syringe, maximum dosage depending on injection methods, replacement period of catheter and infusion set, depth of insertion for vaginal medication administration. For infection control, items with discrepancies included length of time for hand washing, concentration of chemical sterilant, frequency of ventilation to prevent airborne disease, distance to prevent droplet-borne infection, the latent period of infectious disease, and methods to treat medical wastes. For pressure injury, the discrepancies were exhibited in the degree and duration of pressure for pressure injuries, range of scores for risks in pressure injury assessment tools, and temperature of the solution to irrigate pressure injuries. Conclusion Standardized textbooks for these three parts will be useful teaching aide for students and nurses to carry out consistent and professional nursing for patients’ safety.

PURPOSE: This study aimed to validate the psychometric properties of the CRAFFT (Car, Relax, Alone, Forget, Family/Friends, Trouble) by using item response theory (IRT) and further examine gender differences in item-level responses.METHODS: This study used the 13(th) (2017) Korea Youth Risk Behavior Survey data conducted by the Korean Centers for Disease and Prevention and analyzed data of 8,568 students who reported drinking alcohol in the previous 30 days. IRT assumptions including unidimensionality, local independence, and monotonicity were tested. A one-factor two-parameter IRT model was fitted for item parameterization (M₂ = 76.92, 20 df, p < .001, root mean square error of approximation = 0.02). Graphics for item characteristic curves and item and test information curves were provided. Differential item functioning (DIF) analysis was evaluated to measure item equivalence between boys and girls.RESULTS: Unidimensionality and local independence were satisfied, and the dominant factor eigenvalue and variance were 2.48 and 41.3% in boys and 2.08 and 34.7% in girls, respectively, and residual correlations in paired items were less than .2. The discrimination parameters were estimated as 1.32–3.59 for boys and 1.30–3.64 for girls. The severity parameters estimated verity as −0.23 to 1.67 for boys and −0.32 to 2.17 for girls. DIF was detected for four of six items, “Car,” “Relax,” “Forget,” and “Family/friends.” However, its impact on the total score was negligible.CONCLUSION: The CRAFFT is a valid and reliable screening tool to identify alcohol use problems for both boys and girls, exhibiting good discrimination, good coverage of severity, and negligible DIF.
Adolescent ; Alcohols ; Discrimination (Psychology) ; Drinking ; Female ; Humans ; Korea ; Mass Screening ; Psychometrics ; Risk-Taking

Nociceptin/orphanin FQ (N/OFQ) and its receptor, nociceptin opioid peptide (NOP) receptor, are localized in brain areas implicated in depression including the amygdala, bed nucleus of the stria terminalis, habenula, and monoaminergic nuclei in the brain stem. N/OFQ inhibits neuronal excitability of monoaminergic neurons and monoamine release from their terminals by activation of G protein-coupled inwardly rectifying K⁺ channels and inhibition of voltage sensitive calcium channels, respectively. Therefore, NOP receptor antagonists have been proposed as a potential antidepressant. Indeed, mounting evidence shows that NOP receptor antagonists have antidepressant-like effects in various preclinical animal models of depression, and recent clinical studies again confirmed the idea that blockade of NOP receptor signaling could provide a novel strategy for the treatment of depression. In this review, we describe the pharmacological effects of N/OFQ in relation to depression and explore the possible mechanism of NOP receptor antagonists as potential antidepressants.
Amygdala ; Antidepressive Agents ; Brain ; Brain Stem ; Calcium Channels ; Depression ; Habenula ; Models, Animal ; Neurons ; Neuropeptides ; Opioid Peptides ; Receptors, Drug ; Septal Nuclei

PURPOSE: This study aimed to examine the perception of food allergy among parents and school health instructors in Korea. METHODS: A nationwide epidemiological survey in Korea was conducted in September 2015. From 17 cities and provinces, a total of 1,000 elementary, middle and high schools were selected by stratified random sampling. Parents and school health instructors were surveyed using a questionnaire on the perception of food allergy. RESULTS: The prevalence of food-induced anaphylaxis was 22.3%. Of 252 children with anaphylaxis, 47.6% were prescribed epinephrine auto-injector (EAI). Forty-three parents (37.7%) were educated about the use of EAI. Parents carrying their own EAI at all times or keeping them at schools were 5.6% and 3.8%, respectively. For the food allergen-labeling system, 42.1% of parents read food labels, and 32.1% were satisfied with the system. Only 35.2% of school health instructors received education on food allergy and anaphylaxis, and 42.5% of them knew how to use EAI. There were 70 children (9.4%) with anaphylaxis in school, and 75.9% of schools had the emergency management system. CONCLUSION: The awareness of Korean parents and school health instructors on food allergy is still low, and many parents are dissatisfied with the food allergen labeling system. Many school health instructors have difficulty in using EAI in case of anaphylaxis and are insufficiently educated about food allergy. Therefore, it is necessary to establish more systematic food allergy management plans by providing high-quality education to parents and school health instructors and by utilizing legal systems.
Anaphylaxis ; Child ; Education ; Emergencies ; Epinephrine ; Food Hypersensitivity* ; Humans ; Korea ; Parents* ; Prevalence ; School Health Services*

BACKGROUND/AIMS: The appropriateness assessment of hemodialysis therapy by Korean Health Insurance Review & Assessment service was conducted five times. The purpose of this study was to analyze the effect of the appropriateness assessment on the clinical hemodialysis treatment through the analysis of the medical expenses. METHODS: The medical insurance claims during the three months before and after the second, third, and fourth appropriateness assessment and the patient survival rate were analyzed according to the appropriateness rating level. RESULTS: The medical costs per patient during the three months before and after the assessment period were 6 to 8% lower than that of the assessment period. The medication cost (drug fee) was the best part of the evaluation because the cost differences according to the appropriateness rating grade were obvious. In addition, the cost of erythropoietin gradually decreased over each evaluation period, but there was no cost decrease in other drugs and the diabetic drug was even slightly increased. Patient survival rate according to the appropriateness rating grade was not large, but grade 2 was the best which was followed by grade 1 and grade 3, 4, and 5 were almost the same. Patient survival rate according to the appropriateness rating grade was not significant. CONCLUSIONS: The variation of medical costs associated with the assessment implicates the necessity of all year-round assessment. In addition, drug costs among the medical expenses seem to be the best reflected part of the evaluation grade because of the difference.
Costs and Cost Analysis ; Drug Costs ; Erythropoietin ; Health Impact Assessment ; Humans ; Insurance ; Insurance, Health ; Korea* ; Renal Dialysis* ; Survival Rate