Usefulness of the Berlin Questionnaire for Screening Patients With Obstructive Sleep Apnea

Objectives@#This study aimed to evaluate the usefulness of the Berlin questionnaire (BQ) as a screening tool for obstructive sleep apnea (OSA) in a sleep clinic. @*Methods@#We used a retrospective review of 77 subjects with suspected OSA to conduct a secondary analysis of a previously published sleep study. A total of 77 subjects attended and completed overnight, in-laboratory polysomnography. Subjects completed the standard BQ in the evening just before the sleep study. @*Results@#The mean age of 77 subjects was 49.94±15.78 years, of which 37 (48.1%) were male and 42 (63.7%) were white. Forty-six subjects (59.7%) were diagnosed with OSA through polysomnography. In the analysis of each item of the standard BQ, the sensitivity ranged from 4.6% to 92.5%, and the specificity ranged from 13.3% to 85.7%. For item 8, the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 4.6%, 84.9%, 0.3, and 1.1, respectively. The area under the curve values of the standard BQ and after deleting item 8 were 0.634 and 0.751, respectively. When item 8 was deleted and each item on the standard BQ was calculated as one point, the cutoff values representing the highest Yuden index were 3.5 and 4.5. @*Conclusions@#A modified BQ that selects four different questions for each subject, regardless of the number of positive categories in the standard BQ, will provide improved accuracy in screening subjects with a high likelihood of having OSA.

Relationships among Lifestyle, Depression, Anxiety, and Reproductive Health in Female University Students

PURPOSE: To identify relationships among lifestyle, psychological distress, and reproductive health in female university students. METHODS: We used a descriptive cross-sectional design. A total of 275 subjects were enrolled. Subjects agreed to undergo a face-to-face interview, including administration of structured questionnaires to determine health promotion lifestyle profile II (HPLP-II), depression anxiety stress scale for depression and anxiety (DASS-D, DASS-A), and reproductive health (knowledge, attitude, behavior, menstruation irregularity, dysmenorrhea, and gynecologic symptoms). RESULTS: The mean age of subjects was 21.2 years. Those with low HPLP-II score showed significantly high menstruation irregularity. Those with high depression and anxiety had significantly high reproductive symptoms. In addition, high HPLP-II score was correlated with low depression, anxiety, and high reproductive health. CONCLUSION: The life style of female university students is associated with depression, anxiety, and reproductive health. To improve female university students' reproductive health, life style interventions including healthy nutritional habit, physical activity, and stress management are important.

Changes in suprarenal and infrarenal aortic angles after endovascular aneurysm repair

PURPOSE: We investigated whether suprarenal and infrarenal aortic angles change after the endovascular aneurysm repair (EVAR) procedure and during follow-up, and investigated the correlation between infrarenal aortic angle after EVAR and type Ia endoleaks. METHODS: Data collected on 70 EVAR procedures for a fusiform infrarenal aortic aneurysm performed between May 2006 and December 2012 were supplemented with a retrospective review of charts and radiographs. RESULTS: The greater the preoperative infrarenal aortic angle, the greater the suprarenal aortic angle (r = 0.72, P < 0.001). The infrarenal aortic angle decreased after the EVAR procedure and continued to decrease slowly thereafter (all P < 0.001). Suprarenal aortic angle decreased immediately after the EVAR procedure and continued to decrease during the first month (P < 0.001). No differences in angulation were observed based on stent graft type. Type Ia endoleaks occurred with significantly greater incidence in patients with a larger post EVAR infrarenal angle (P = 0.037). CONCLUSION: The infrarenal aortic angle decreased significantly immediately after the EVAR procedure and continued to decrease slowly thereafter. Suprarenal aortic angle decreased immediately after the EVAR procedure and continued to decrease during the first month. We found a correlation between infrarenal and suprarenal aortic angle. Type Ia endoleaks occurred with greater incidence in patients with a larger infrarenal angle immediately after EVAR.

Comparison of Blended Practicum Combined E-learning between Cooperative and Individual Learning on Learning Outcomes / 한국간호교육학회지

PURPOSE: This study was conducted to compare blended practicum with clinical and lab combined e-learning between cooperative and individual group on learning outcomes. METHOD: A total of 63 junior Nursing students were recruited from C University in G city from May, 2012 to June, 2012. Ten hours lab practicum for two weeks was provided for both two groups during the period of adult nursing practicum. Prior to blended practicum, e-learning was conducted. For cooperative group, two hours off line team learning with a tutor for eight weeks was provided, in other hands, for individual group, any off line team learning was not provided and self study on line was not evaluated by the tutor. RESULTS: The result of ANCOVA showed that critical thinking and self directed learning were significantly improved in the individual group compared to the cooperative group (F=-18.15, p<.001; F=28.12, p<.001). In other hands, clinical competence was significantly higher in the cooperative group than in the individual group (F=16.61, p<.001). CONCLUSION: Through development of self-leaning facilitating online contents, the blended practicum combined e-learning could be effective in critical thinking, self-directed learning and clinical competence. Further studies about e-learning strategies of off-line learning are still needed.

Development and Evaluation of an Enteral Nutrition Protocol for Dysphagia in Patients with Acute Stroke

PURPOSE: The study was done to develop an evidence-based enteral nutrition (EN) protocol for effective nutritional support for dysphagia in patients with acute stroke, and to evaluate effects of this protocol on clinical outcomes. METHODS: A methodological study was used to develop the EN protocol and a quasi-experimental study to verify the effectiveness of the protocol. The preliminary EN protocol was drawn by selecting recommendations from previous well-designed EN guidelines, and then developing additional recommendations based on high-quality evidence. Content validation was assessed by an expert group, and clinical applicability by care providers and patients. The scale-level content validity index of the final EN protocol was 0.99. Assessment was done of differences in percentage of caloric goals achieved and presence of undernutrition, aspiration pneumonia, and gastrointestinal (GI) complications after application of the EN protocol. RESULTS: In the EN protocol group, the percentage of caloric goals achieved (R2=.24, p=.001) and the reduction of GI complications (p=.045) were significantly improved, but the presence of undernutrition (p=.296) and aspiration pneumonia (p=.601) did not differ from the usual care group. CONCLUSION: Results indicate that the new EN protocol for dysphagia in patients with acute stroke significantly increased their nutritional intake and reduced GI complications.

The Reliability and Validity of Patient-Generated Subjective Global Assessment (PG-SGA) in Stroke Patients / 성인간호학회지

PURPOSE: This study was to examine the reliability and validity of Patient-Generated Subjective Global Assessment (PG-SGA) as a nutritional measurement for stroke patients. METHODS: This was a methodological study performed from May 6 to June 10, 2009 at a tertiary university hospital in Seoul. For reliability of PG-SGA, inter-rater reliability was used for statistics. For concurrent validity, BMI and biomarkers were compared between PG-SGA 0 ~ 8 and > or = 9. In addition, sensitivity, specificity, and predictive value of PG-SGA compared with SGA were calculated using a contingency table. For predictive validity, hospital day, complications, and readmission within 1-month after discharge were compared between PG-SGA 0 ~ 8 and > or = 9. RESULTS: Correlation of PG-SGA score between two observers was 0.83, and kappa value for the agreement of severe malnutrition was 0.78(all p(s) or = 9) had significantly low TLC, protein, albumin, and prealbumin (all p(s) < .01) compared with non-undernourished patients (PG-SGA 0 ~ 8). Also, in severe undernourished patients, complications and readmission (all p(s) = 0.01) were more often represented, and hospital days (p = .013) were significantly delayed. CONCLUSION: PG-SGA is a reliable and valid measurement to assess nutritional status for stroke patients.