Improvement in nurse staffing ratios according to policy changes: a prospective cohort study.

BACKGROUND: Since 1999, reimbursements for nursing services for inpatients have been paid differentially according to the nurse staffing ratios in Korea. However, differentiated nursing fees are insufficient for nurse staffing; thus, steps have been taken to improve the policy. This study aimed to identify the impact of a policy that changed the method of calculating nurse staffing ratios from the nurse-to-bed ratio to the nurse-to-patient ratio on improving the nurse staffing ratio in medical institutions. METHODS: Data were collected from 1,339 medical institutions that continuously provided medical services from 2017 to of 2021, and a prospective cohort was used for analysis. A generalized estimating equation for longitudinal ordered logistic regression was used to identify the impact of this policy change on the nurse staffing ratios in medical institutions. RESULTS: During the cohort study, 59.8% of the first-applied group of medical institutions and 65.6% of the second-applied group of medical institutions improved their nurse staffing ratios. However, only 22.6% of the medical institutions to which the revised calculation method was not applied improved their nurse staffing ratios. A statistically significant difference was found in the improved nurse staffing ratio depending on whether and when the revised calculation method was applied (χ2 = 89.830, p < .001). The analysis of nurse staffing ratios of medical institutions from 2017 to 2021 showed that the likelihood of improving the nurse staffing ratio increased gradually after the revised calculation method was adopted. Also,the likelihood of the nurse staffing ratio improving in the first-applied group was 1.41 times higher (odds ratio = 1.41, 95% confidence interval = 1.04-1.92) than in the non-applied group. The odds ratio for the improvement of nurse staffing ratio in the second-applied group was 2.35 (95% confidence interval = 1.76-3.14). CONCLUSIONS: Financial incentives inherent in the new policy can be regarded as the driving force behind improvements in nurse staffing ratios. The revised calculation method should be extended to all medical institutions nationwide, and the law should be revised to secure the minimum number of nurses.

Effects of a disincentive policy on behavioral changes by South Korean medical institutions that do not submit official nursing grade data.

AIM: This study aimed to determine whether the policy of imposing deductions on medical institutions in South Korea led to increased submission of nursing grade data. BACKGROUND: In Korea, medical institutions are required to report data on their nursing workforce; however, many institutions did not comply with this regulation, making it difficult to gauge their level of nurse staffing. Therefore, in 2020, a nursing fee deduction policy was introduced that penalizes medical institutions financially for failing to submit nursing workforce data. METHODS: We prospectively collected data on the characteristics, nursing grade, and data submission status of 1,200 hospitals in South Korea from 2015 to 2021. We analyzed the submission rate of data related to nursing grades according to the characteristics of the medical institutions and evaluated the effect of policy change on data submission status using multiple logistic regression. FINDINGS: The submission rate of data increased from 50.2% in 2015 to 93.3% in 2021, and 39.3% of medical institutions that had not previously submitted data did so after the policy was introduced. The submission rate of medical institutions unaffected by the policy also increased after its introduction. Compared with 2015, the likelihood of medical institutions submitting data increased by 23.69 times in 2020 and 20.47 times in 2021. CONCLUSION: The appropriate use of disincentive policies, such as financial deductions for medical institutions showing inappropriate behavior, was found to be effective in inducing desirable changes in the behavior of medical institutions. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Properly planned and implemented policies can contribute to improved quality of medical services and patient safety through effective administrative control.

Assessment of User Needs for Telemedicine Robots in a Developing Nation Hospital Setting.

Background: This study aimed to investigate the needs of medical users of telemedicine robots to encourage international cooperation and development. Introduction: As the use of telemedicine expands, it is necessary to develop new systems, including robots, which consider the perceived needs of end users to ensure quality of care and positive user experience. Materials and Methods: A survey of medical staff was conducted at a hospital in Vietnam to investigate users' needs for a telemedicine robot system. Results: A total of 117 medical staff participated in the survey, comprising 74 nurses and 43 doctors. The most preferred type of robot was the humanoid type, female version, and the preferred mobility type was walking. The most requested functions were "heart rate measurement," "recognition and avoidance of obstacles," "oxygen saturation measurement," "Transmitting Medical Information," and "wireless system." In addition, the most important considerations in developing a robot system were "cleaning the robot to prevent infection," followed by "convenience of operation." Discussion: The results of this study largely supported those of similar previous studies. However, some differences may reflect the cultural variation or differences in the level of medical development across contexts. Conclusion: To apply robotic systems to help develop telemedicine internationally, it is essential to develop a robot that reflects actual users' needs. If relevant matters such as legal issues are considered and addressed, an appropriate robotic telemedicine system can be successfully developed. Consequently, telemedicine can improve the quality of local medical care, strengthen practitioner capacity, and improve outcomes.

Artificial Intelligence-Driven Oncology Clinical Decision Support System for Multidisciplinary Teams.

Watson for Oncology (WfO) is a clinical decision support system driven by artificial intelligence. In Korea, WfO is used by multidisciplinary teams (MDTs) caring for cancer patients. This study aimed to investigate the effect of WfO use on hospital satisfaction and perception among patients cared for by MDTs. This was a descriptive study that used a written survey to gather information from cancer patients at a hospital in Korea. The rate of positive change in patient perception after treatment was 86.8% in the MDT-WfO group and 71.2% in the MDT group. In terms of easily understandable explanations, the MDT-WfO (9.53 points) group reported higher satisfaction than the MDT group (9.24 points). Younger patients in the MDT-WfO group showed high levels of satisfaction and reliability of treatment. When WfO was used, the probability of positive change in patient perception of the hospital was 2.53 times higher than when WfO was not used. With a one-point increase in overall satisfaction, the probability of positive change in patient perception of the hospital increased 1.97 times. Therefore, if WfO is used appropriately in the medical field, it may enhance patient satisfaction and change patient perception positively.

Economic Evaluation of Robot-Based Telemedicine Consultation Services.

Background: Through information and communication technology, telemedicine can deliver medical care without time and place restrictions, increasing health care accessibility in medically underdeveloped regions. Although there is growing interest in using robots in telemedicine, there are few economic evaluation studies of robot-based telemedicine. Introduction: Robots developed for use in telemedicine consultation services may help address the challenges that result from Korean physicians' efforts to support patients in Vietnam. We perform a cost-benefit analysis to assess the economic feasibility of a robot-based telemedicine consultation system compared with traditional face-to-face outpatient services. Methods: A cost-benefit analysis is performed of a robot-based telemedicine consultation system between S Hospital in Korea and H Hospital in Vietnam. The threshold was calculated as the point at which the cost of providing telemedicine consultation equals the cost of providing the same service using traditional methods. Results: The annual cost of a robot-based telemedicine consultation system was estimated as 6,056.40 USD, whereas the annual benefit from replacing traditional outpatient services was estimated as 1,508.51 USD, resulting in a threshold point of 4.01 visits per year. Consequently, if the telemedicine consultation robot system replaces >4.01 physician visits per year, it is more economical than conventional face-to-face services. If the physician needs to stay longer, the threshold will be lower. Conclusions: As our results show, robot-based systems for telemedicine have economic value and can potentially offer a solution to the unmet health care needs among patients living in medically underdeveloped regions by providing proper and timely medical care.

Association between registered nurse staffing levels and in-hospital mortality in craniotomy patients using Korean National Health Insurance data.

BACKGROUND: The level of registered nurse (RN) staffing is a fundamental factor influencing patient safety. Craniotomy patients need intensive care after surgery, the majority of which is provided by RNs. METHODS: This study was conducted to investigate the relationship of the RN staffing level of general wards and intensive care units (ICUs) with in-hospital mortality after craniotomy using Korean National Health Insurance claim data. The RN staffing level was categorized based on the bed-to-RN ratio. RESULTS: The in-hospital mortality rate of craniotomy patients was elevated at hospitals with a high bed-to-RN ratio in general wards, ICUs, and hospitals overall. It was determined that in-hospital mortality of craniotomy patients could be decreased by more than 50% by reducing the bed-to-RN ratio from 4.5 or more to less than 3.5 in general wards, from 1.25 or more to less than 0.88 in ICUs, and from 2.5 or more to less than 1.67 in hospitals overall. CONCLUSIONS: Since the RN staffing level is related to the in-hospital mortality rate of craniotomy patients, a sufficient staffing level of RNs should be ensured to reduce the mortality of craniotomy patients.

Does Maintained Medical Aid Coverage Affect Healthy Lifestyle Factors, Metabolic Syndrome-Related Health Status, and Individuals' Use of Healthcare Services?

Concerns about the moral hazards and usage of universal health insurance require examination. This study aimed to analyze changes in lifestyle, metabolic syndrome-related health status, and individuals' tendency to use healthcare services according to changes in the eligibility status of medical aid recipients. This paper reports a retrospective cohort study that involved analyzing data from 2366 medical aid recipients aged 40 years or older who underwent national health screenings in 2012 and 2014. Of the recipients, 1606 participants continued to be eligible for medical aid (the "maintained" group) and 760 changed from being medical aid recipients to National Health Insurance (NHI) enrollees (the "changed" group). Compared to the "changed" group, the "maintained" group was less likely to quit smoking, more likely to begin smoking, less likely to reduce binge drinking to moderate drinking, and had a significant increase in blood glucose and waist circumference. Annual total medical expenses also increased significantly in the "maintained" group. Since the mere strengthening of healthcare coverage may lead to moral hazards and the failure to link individuals' tendency to use healthcare services and outcomes, establishing mechanisms is necessary to educate people about the health-related outcomes of maintaining a healthy lifestyle and ensure the appropriate use of healthcare services.

Association of nursing hours with cognitive function, balance, and dependency level of stroke patients.

AIMS: To examine the association of nursing hours given to patients with stroke with clinical characteristics to predict the nursing care needs. DESIGN: Twenty-four-hour observational study METHODS: Nursing hours per patient day (NHPPD) of 171 stroke patients were measured by 146 nursing personnel who worked on the day of the observation. Cognitive function, balance ability and dependency level were assessed using the Korean version of the Mini-Mental State Examination (K-MMSE), the Korean version of the Berg Balance Scale (K-BBS) and the Korean version of the Modified Barthel Index (K-MBI), respectively. RESULTS: The NHPPD were moderately correlated with K-MMSE (r = -.450), K-BBS (r = -.529) and K-MBI (r = -.549). The worse the cognitive function, balance ability and dependency level, the more were the nursing hours given to the patients. Therefore, these factors can be considered to be factors that predict nursing care needs for patients with stroke.

Social Frailty and Health-Related Quality of Life in Community-Dwelling Older Adults.

This study aimed to identify the association between social frailty and health-related quality of life (HRQoL) and to identify the factors influencing HRQoL in community-dwelling older adults in South Korea. This was a secondary analysis of a cross-sectional survey study of 735 older adults. HRQoL was measured using the EuroQoL-5 Dimension, and social frailty was measured using five items. The differences in HRQoL according to sociodemographic characteristics, health-related characteristics, and social frailty of subjects were tested using the Mann−Whitney test, Kruskal−Wallis test, and χ2 test. A Tobit regression model was used to identify the influencing factor of HRQoL. About 31.0% of the older adults were in a social pre-frailty state, and 48.4% were in a social frailty state. Of the five components of social frailty, going out less compared to the previous year and being alone were frequently observed. Older adults who had social frailty had lower HRQoL scores than those who were robust after controlling for sociodemographic and health-related characteristics (BT = −0.04, p < 0.001). Researchers need to consider older adults' social frailty as well as health status and sociodemographic status in future interventions to improve the HRQoL of older adults.

Influence of the Workload and Years of Experience of Nurses on Hemodialysis Quality Using Korean National Hemodialysis Adequacy Evaluation Data.

The aim of this study is to examine the influence of nurses' workload and years of experience on the rate of patients with normal calcium-phosphorus products levels and the adequacy evaluation grade of hemodialysis (HD) facilities using 2015 and 2018 national HD adequacy evaluation data. The data of 616 hospital-level outpatient HD facilities were analyzed using multiple linear regression and ordinal logistic regression. A higher rate of nurses with ≥2 years of HD experience was correlated with a higher rate of patients with normal calcium-phosphorus levels. As the average daily number of HD cases per nurse increased, the probability of HD facilities' receiving the higher adequacy evaluation grade decreased by 83% (odds ratio (OR)=.17, 95% confidence interval (CI)=.14-.22), whereas it increased by 4% as the rate of nurses with ≥2 years of HD experience increased by 1%p (OR=1.04, 95% CI=1.03-1.05). Reducing the nursing workload by maintaining sufficient nurses and increasing the rate of nurses with ≥2 years of HD experience would improve the quality of HD and patient outcomes.

Differences in Function and Healthcare Cost of Older Adults with Dementia by Long-Term Care Service Type: A National Dataset Analysis.

This study aims to analyze the function and cost changes among long-term care insurance (LTCI) beneficiaries with low-severity dementia according to their LTCI service type. Data were collected from the Korean LTCI and national health insurance (NHI) datasets. Participants were 4414 beneficiaries with dementia aged 65 or older who received LTC services continuously for 4 years (2008-2011). LTCI service types were classified into home care (HC), institutional care (IC), and combined care (CC). Activities of daily living (ADL), cognitive function, medical cost, and benefit-cost were assessed. Linear mixed models and multiple regression models were used to analyze the changes in function and costs of the beneficiaries. ADL, cognitive function, medical cost, and benefit-cost differed significantly depending on the service type and time (p < 0.001). LTCI service types affected the degree of changes in ADL, cognitive function, medical cost, and benefit-cost over four years and showed negative changes in IC and CC beneficiaries than HC beneficiaries. HC is a cost-effective way to maintain the function of beneficiaries with low-severity dementia. Thus, efforts are needed to actively promote HC services.

The Humanoid Robot Sil-Bot in a Cognitive Training Program for Community-Dwelling Elderly People with Mild Cognitive Impairment during the COVID-19 Pandemic: A Randomized Controlled Trial.

BACKGROUND: Mild cognitive impairment (MCI) is a stage preceding dementia, and early intervention is critical. This study investigated whether multi-domain cognitive training programs, especially robot-assisted training, conducted 12 times, twice a week for 6 weeks can improve cognitive function and depression decline in community-dwelling older adults with mild cognitive impairment (MCI). METHODS: A randomized controlled trial was conducted with 135 volunteers without cognitive impairment aged 60 years old or older. Participants were first randomized into two groups. One group consisted of 90 participants who would receive cognitive training and 45 who would not receive any training (NI). The cognitive training group was randomly divided into two groups, 45 who received traditional cognitive training (TCT) and 45 who received robot-assisted cognitive training (RACT). The training for both groups consisted of a daily 60 min session, twice a week for six weeks. RESULTS: RACT participants had significantly greater post-intervention improvement in cognitive function (t = 4.707, p < 0.001), memory (t = -2.282, p = 0.007), executive function (t = 4.610, p < 0.001), and depression (t = -3.307, p = 0.004). TCT participants had greater post-intervention improvement in memory (t = -6.671, p < 0.001) and executive function (t = 5.393, p < 0.001). CONCLUSIONS: A 6-week robot-assisted, multi-domain cognitive training program can improve the efficiency of global cognitive function and depression during cognitive tasks in older adults with MCI, which is associated with improvements in memory and executive function.

The Prevalence of Metabolic Syndrome and Health-Related Behavior Changes: The Korea National Health Examination Survey.

This study was conducted to investigate the effect of health-related behavior changes on the prevalence of metabolic syndrome (MetS). This study utilized data from the Korea National Health Examination Survey of adults aged 40 or older who underwent health screening in 2011, 2013, and 2015. The prevalence of MetS was analyzed according to sex, age, income, residence location, and health-related behaviors by conducting multiple logistic regression analysis. For health-related behaviors, smoking, drinking, and physical activity were examined, and changes in health-related behaviors over five years from 2011 to 2015 were included in the analysis. The prevalence of MetS in Korea in 2015 was 31.7%. The prevalence showed statistically significant differences according to sex, age, income, location, and health-related behaviors. The prevalence was higher in men than in women and increased with aging. Regarding income, MetS prevalence was slightly higher in the middle-income groups compared with the lowest or the highest. Regarding location, MetS prevalence was lower in metropolitan areas compared to small- to medium-sized cities and farming/fishery rural areas. Regarding health-related behavior, MetS prevalence increased in the smoking, heavy drinking, and passive activity groups compared with the nonsmoking, moderate drinking, and active activity groups. Regarding health-related behavior change, MetS prevalence was higher by 22% in the short-term nonsmoking group (subjects who smoked in the past but not currently) compared to the continuous nonsmoking group. The risk for MetS also increased by 84.9% in the continuous heavy drinking group compared to the continuous moderate drinking group. Finally, the risk for MetS increased by 30.3% in the continuous passive physical activity group compared to the continuous active physical activity group. This study's findings indicate the importance of maintaining healthy lifestyle habits to prevent MetS. In particular, the focus for change should be concentrated on short-term nonsmoking, continuous heavy drinking, and continuous passive physical activities to improve health-related behaviors.

Korean Work Environment Scales for Clinical Nurses.

AIM: The aim of this study was to develop an assessment tool for the hospital nursing work environment in Korea. METHODS: The participants were 564 clinical nurses who worked in 13 hospitals in seven provinces in regions throughout South Korea; they worked in medical-surgical nursing, pediatric and maternal nursing, intensive care unit, and other areas. The data analysis relied on descriptive analysis and exploratory factor analysis, including varimax rotation, and reliability was determined using SPSS software. RESULTS: The final assessment tool, the Korean Work Environment Scales for Clinical Nurses (KWES-CN) was composed of 39 items divided into nine factors: (i) manager leadership; (ii) supporting environment for nursing work; (iii) patient care environment and professional activities; (iv) violence within ward; (v) sufficient inventory and supply; (vi) hospital's support for working environment; (vii) recognition and respect; (viii) satisfaction with work schedule; and (ix) computer problems. The total variance for validity described by the nine factors was 58.7% and the reliability of the tool was a Cronbach's alpha of 0.87. CONCLUSION: This final assessment tool will be used to improve nursing work. Further research must be conducted to verify the reliability and validity of this tool, and evaluations of nursing quality and patient results related to the nursing environment.

Aggressive angiomyxoma of the vulva: A case report.

Aggressive angiomyxoma (AA) is an unusual mesenchymal tumor. AA occurs most commonly in women of reproductive age and is located in the perineal or pelvic region. This is a distinct soft tissue tumor that has a prominent myxoid matrix and numerous thin-walled blood vessels and may have an aggressive local recurrence. The tumors have the characteristics of large size (usually greater than 10 cm) and slow growth, and are not painful. The standard treatment for AA is total excision and close follow-up. We announce a case of a 35 year-old female presenting with a pedunculated AA on the right labium majora that has not relapsed for seven years.

Vaginal cancer with multiple liver and pulmonary metastases that achieved long-term survival.

Primary vaginal cancer represents only 1% to 2% of malignant neoplasm of the female genital tract. Here, we report a 68-year-old woman who showed a vaginal tumor extending to urethra and clitoris, a 10 cm-sized mass in left adnexa and multiple metastases in lung and liver. Vaginal biopsy showed squamous cell carcinoma of vagina and she was diagnosed as International Federation of Gynecology and Obstetrics stage IVB vaginal cancer. Palliative surgery including left salpingectomy, tumorectomy, and clitoris mass excision was performed. Concurrent chemoradiation therapy (CCRT) with six cycles of 5-fluorouracil and cisplatin was administered. The patient had a complete remission of 20 months after treatment. At a 40-month follow-up, there was no evidence of local recurrence or distant metastasis. We can suggest that CCRT is very effective in treating primary squamous cell carcinoma of the vagina, not only in locally advanced but also systemically involved vaginal cancer in selected cases.

Angiomyofibroblastoma of the vulva.

Angiomyofibroblastoma (AMFB) is an uncommon benign mesenchymal tumor. AMFB occurs almost in the vulvo-vaginal area of women. The gross features of AMFB are well-circumscribed so it clinically is often thought as Bartholin gland cyst or aggressive angiomyxoma. Usually, most tumors grow slowly, and patients do not feel pain. It also has low tendency for local recurrence. The histologic findings of the tumors are abundant thin-walled blood vessels with hypocellular and hypercellular areas. Almost all tumor cells have immunoreactivity for both desmin and vimentin. It also has estrogen and/or progesterone receptors, but staining for cytokeratin is negative. Here is a case of AMFB of the vulva occurring in a 40-year-old woman, involving the right labia majora. The patient described that her vulva mass grew in about few months. The maximum dimension of the tumor was measured as 2 cm, and we resected the tumor one month after as her second visit.