Relationships among Grit, Job Satisfaction, and the Intention to Stay of Clinical Nurses in Korea / 임상간호연구

PURPOSE@#This descriptive study aimed to identify the relationships among grit, job satisfaction, and the intention to stay of clinical nurses in Korea.@*METHODS@#Data collected from a total of 239 experienced nurses in four general hospitals of the Jeolla province. The t-test, ANOVA, and Pearson's Correlation Coefficient were performed using the IBM SPSS/WIN 21.@*RESULTS@#There were positive correlations between the grit and job satisfaction of the nurses (r=.31, p<.001), between their grit and intention to stay (r=.25, p<.001), and between their job satisfaction and intention to stay (r=.49, p<.001).@*CONCLUSION@#Developing and adapting educational programs to enhance the grit enthusiasm, and patience can contribute to increasing the intention to stay of nurses in hospitals.

Factors Influencing Self-Efficacy, Grit, Symptom Clusters on Self-Care Agency in Brain Neoplasms Patients

PURPOSE: The purpose of this study was to investigate the level of self-efficacy, grit (consistency of interest-CI, perseverance of effort-PE), symptom clusters and self-care agency in brain neoplasm patients and to identify factors influencing their self-care agency. METHODS: A descriptive correlational design was used, and the participants were a convenience sample of 152 brain neoplasm patients from C national university hospital in Hwasun. Data were collected using a structured questionnaire from October 1, 2017 to February 15, 2018. The collected data were analyzed using descriptive statistics, t-test, ANOVA, factor analysis, Pearson correlations and multiple regression analysis with the SPSS 22 program. RESULTS: The most frequently reported symptoms included sadness (57.9%), numbness (50.7%), lack of energy (49.3%), nervousness (45.4%), worry (40.8%). There were significant positive correlations between self-care agency and self-efficacy (r=.54, p < .001), CI (r=.58, p < .001), and PE (r=.50, p < .001). There were significant negative correlations between self-care agency and cluster I (r=−.56, p < .001), cluster II (r=−.31, p < .001), cluster III (r=−.49, p < .001) cluster IV (r=−.30, p < .001). The significant factors influencing self-care agency were self-efficacy, grit, cluster I and cluster IV. These variables explained 55.4% of the variance in self-care agency. CONCLUSION: The results suggest that intervention programs to increase the level of self-efficacy and grit, to reduce the level of symptoms among patients would improve the self-care agency of brain neoplasms patients.

The Impacts of Living Alone in in-Hospital and One-Year Clinical Outcomes after Acute Myocardial Infarction in Korean Patients

OBJECTIVE: The aim of this study is to evaluate the impact of living alone for in-hospital and one-year clinical outcome after acute myocardial infarction (AMI) in Korean patients. METHODS: A total of 1,700 patients who admitted at the Chonnam National University Hospital were analyzed. We divided the patients into two groups by the existence of a spouse or family member that lived together with the patient at the first time of hospital visit due to AMI. The primary endpoint was composed of in-hospital death and cardiac death during one-year clinical follow-up. Secondary end point was other major adverse cardio-cerebral events (MACCE) including non-fatal MI, repeat revascularization, ischemic or hemorrhagic stroke during one-year clinical follow-up. RESULTS: Living alone patient group had higher proportion of Killip class II-IV (34.3% vs. 26.6%, p=0.006) and higher value of high sensitivity C-reactive protein (2.2+/-4.0 vs. 1.5+/-3.4 ng/mL, p=0.019) than not living alone group. In-hospital death (8.9 % vs. 5.1%, p=0.010) and one-year cardiac death (7.7% vs. 4.6%, p=0.031) developed more in living alone groups. However, living alone was not an independent prognostic factor for in-hospital death (HR 1.51, 95% CI 0.91-2.52, p=0.113) and one-year cardiac death (HR 1.18, 95% CI 0.59-2.34, p=0.64) after multivariate analysis. CONCLUSION: Living alone was not an independent prognostic factor for in-hospital and one-year clinical outcome after AMI.

Prevalence and Social Correlates of Frailty Among Rural Community-Dwelling Older Adults

BACKGROUND: Frailty, a multidimensional geriatric syndrome, confers a high risk of falls, disability, hospitalization, and mortality. The prevalence and correlates of frailty in older people dwelling in rural communities are unknown. METHODS: We examined frailty, as defined by the Korean Geriatric Society, and social correlates among rural community-dwelling older adults (n=419) aged 65 or older. RESULTS: The prevalence of frailty and prefrailty was 11.5% and 38.7%, respectively. Among eight frailty criteria, the prevalence of multiple medications was highest (57.3%), while self-rated health as "unhealthy" was the second highest (45.1%). In contrast, the prevalence of exhaustion was the lowest (10%) among the eight frailty criteria. The prevalence of frailty was 12.6% among women and 6.3% among men (p=0.02). Uneducated older adults showed a significantly higher prevalence of frailty (13.1%) than any other educational groups (6.3-9.2%). In addition, older adults with high social support showed lower frailty than the other groups. After adjustment for other factors; however, a lack of social support (odds ratio for frailty, 1.98; 95% confidence interval, 1.14-3.44) was associated with increased odds of frailty. CONCLUSION: Frailty is not uncommon among rural community-dwelling old men and women in Korea. In the rural community, females with a lack of social support might be at a higher risk of frailty, as those were two of the strongest risk factors discovered in this study. This study calls for more interest and concern for the frail older adults with a lack of social support in rural communities.

Effects of Low Dose versus High Dose Statin Therapy on the Changes of Endothelial Function and Carotid Intima-Media Thickness in Patients with Variant Angina

BACKGROUND: To compare the effects of low dose and high dose of statin treatment on endothelial function and carotid intima-media thickness (IMT) in patients with variant angina (VAP). METHODS: A total of 70 patients with VAP were divided into two groups; atorvastatin 10 mg treatment group (group I: n = 35, 54.2 +/- 12.5 years) versus atorvastatin 40 mg treatment group (group II: n = 35, 52.6 +/- 9.8 years). Flow mediated vasodilation (FMD) of the brachial artery and IMT of the carotid artery were compared between the groups after 6 months of statin treatment. RESULTS: The baseline FMD and carotid IMT were not different between the groups. After 6 months of statin therapy, FMD was significantly improved in both groups (7.7 +/- 2.5% to 8.9 +/- 2.2% in group I, p = 0.001, 7.9 +/- 2.7% to 9.5 +/- 2.8% in group II, p < 0.001), but the degree of FMD change and FMD at 6 month were not different between the groups. Carotid IMT were not changed in both groups after 6 months of statin therapy. CONCLUSION: The use of statin for 6 months significantly improved endothelial function in patients with VAP, but carotid IMT was not changed. The use of high dose statin did not show significant additional benefit as compared with the use of low dose statin. The present study suggested that statin therapy would be beneficial in the treatment of VAP.

Association of Waist Circumference with Risk Factors for Coronary Artery Diseases in Women Patients with Chest Pain / 기본간호학회지

PURPOSE: The purpose of this study was to compare the associations of body mass index (BMI) and waist circumference (WC) with coronary artery diseases (CAD) in women patients with chest pain. METHOD: BMI, WC, and flow-mediated vasodilation (FMD) were measured for 162 women patients with chest pain whose mean age was 54.9+/-9.2 years. CAD was diagnosed by coronary angiography. RESULTS: In comparing BMI and WC, WC was found to be more strongly associated with cardiovascular risk factors. For example, correlations with the high density lipoprotein cholesterol were r=-.266, p=.001 (WC) vs. r=-.131, p=.104 (BMI), and for homocystein, r=.378, p<.001 (WC) vs. r=.150, p=.068 (BMI). Obstructive CAD develops more frequently in women patients with abdominal obesity than in patients without abdominal obesity. CONCLUSION: The results of the study indicate that WC is a better index of adiposity than BMI.

Endothelial Dysfunction and Increased Carotid Intima-Media Thickness in the Patients with Slow Coronary Flow

Flow mediated brachial dilatation (FMD) and carotid intima-media thickness (IMT) have been a surrogate for early atherosclerosis. Slow coronary flow in a normal coronary angiogram is not a rare condition, but its pathogenesis remains unclear. A total of 85 patients with angina were evaluated of their brachial artery FMD, carotid IMT and conventional coronary angiography. Coronary flow was quantified using the corrected thrombosis in myocardial infarction (TIMI) frame count method. Group I was a control with normal coronary angiography (n = 41, 56.1 +/- 8.0 yr) and group II was no significant coronary stenosis with slow flow (n = 44, 56.3 +/- 10.0 yr). Diabetes was rare but dyslipidemia and family history were frequent in group II. Heart rate was higher in group II than in group I. White blood cells, especially monocytes and homocysteine were higher in group II. The FMD was significantly lower in group II than in group I. Elevated heart rate, dyslipidemia and low FMD were independently related with slow coronary flow in regression analysis. Therefore, endothelial dysfunction may be an earlier vascular phenomenon than increased carotid IMT in the patients with slow coronary flow.

Effects of a Smoking Cessation Education on Smoking Cessation, Endothelial Function, and Serum Carboxyhemoglobin in Male Patients with Variant Angina

PURPOSE: The aim of this study was to evaluate the effects of a smoking cessation education on endothelial function and carboxyhemoglobin levels in smokers with variant angina. METHODS: A nonequivalent control group pretest-posttest design was used. Participants were 60 male smokers with variant angina admitted to one hospital: the control group (30) between September and December, 2009, and the experimental group (30) between February and May, 2010. Endothelial function, as defined by flow-mediated vasodilation (FMD) of the brachial artery, and serum carboxyhemoglobin (COHb) were determined at baseline and at 3 months after the initiation of education in both groups. RESULTS: Three months after the program, smoking cessation was successful in 22 of the 30 smokers in the experimental group, but only in 4 of 30 smokers in the control group (p<.001). After the education, the experimental group showed a significant increase in FMD, and a significant decreased in serum COHb compared with the control group. CONCLUSION: The findings indicate that this smoking cessation education program is effective for hospitalized smokers with variant angina.

Diagnostic Value of Nitroglycerin-Induced Headache as a Negative Predictor of Coronary Atherosclerosis / 전남의대학술지

The purpose of the present study was to clarify the possible relationship between nitroglycerin (NTG)-induced headache and both vascular functional and organic atherosclerosis. The study included 96 patients with NTG-induced headache (group I: 54.7+/-9.5 years, 52 males) and 204 patients without headache (group II: 58.1+/-9.1 years, 127 males) who suffered from new-onset chest pain. Flow-mediated dilation and nitroglycerin-mediated dilation were significantly greater in group I than in group II (8.8+/-4.1% vs. 7.1+/-3.5%, p=0.001, and 23.1+/-7.3% vs. 17.1+/-11.8%, p<0.001, respectively). The carotid intima-media thickness was significantly smaller in group I than in group II (0.55+/-0.15 mm vs. 0.67+/-0.22 mm, p=0.001). Heart-carotid pulse wave velocity was significantly lower in group I than in group II (784.5+/-160.1 m/s vs. 979.1+/-215.6 m/s, p=0.003). In the multiple regression analysis, the absence of NTG-induced headache was a predictor of coronary artery disease (CAD) (odds ratio: 17.89, 95% confidence interval: 7.89-40.02, p<0.001). NTG-induced headache developed more frequently in patients with normal coronary arteries or minimal CAD than in patients with obstructive CAD. The presence of NTG-induced headache might be helpful and provide additional information in evaluating patients with chest pain syndrome.

Diagnostic Value of Nitroglycerin-Induced Headache as a Negative Predictor of Coronary Atherosclerosis / 전남의대학술지

The purpose of the present study was to clarify the possible relationship between nitroglycerin (NTG)-induced headache and both vascular functional and organic atherosclerosis. The study included 96 patients with NTG-induced headache (group I: 54.7+/-9.5 years, 52 males) and 204 patients without headache (group II: 58.1+/-9.1 years, 127 males) who suffered from new-onset chest pain. Flow-mediated dilation and nitroglycerin-mediated dilation were significantly greater in group I than in group II (8.8+/-4.1% vs. 7.1+/-3.5%, p=0.001, and 23.1+/-7.3% vs. 17.1+/-11.8%, p<0.001, respectively). The carotid intima-media thickness was significantly smaller in group I than in group II (0.55+/-0.15 mm vs. 0.67+/-0.22 mm, p=0.001). Heart-carotid pulse wave velocity was significantly lower in group I than in group II (784.5+/-160.1 m/s vs. 979.1+/-215.6 m/s, p=0.003). In the multiple regression analysis, the absence of NTG-induced headache was a predictor of coronary artery disease (CAD) (odds ratio: 17.89, 95% confidence interval: 7.89-40.02, p<0.001). NTG-induced headache developed more frequently in patients with normal coronary arteries or minimal CAD than in patients with obstructive CAD. The presence of NTG-induced headache might be helpful and provide additional information in evaluating patients with chest pain syndrome.

A Case of Coronary Arteriovenous Fistula Associated with Giant Coronary Artery Aneurysm

Coronary arteriovenous fistula is a more prevalent, hemodynamically significant congenital malformation. Both coronary arteries arise normally from their aortic sinuses, but the branches of fistula communicate directly with cardiac chamber, pulmonary trunk, coronary sinus, superior vena cava, or pulmonary vein. Fistula associated with coronary aneurysm is an uncommon finding. We report a rare case of 76-year-old female patient who had a coronary arteriovenous fistula with giant coronary artery aneurysm. This case is clearly diagnosed by echocardiography, three-dimensional computed tomography (3D-CT), and coronary angiography (CAG).

Cardiovascular Risk Factors Predicting Endothelial Dysfunction in Patients with Variant Angina / 성인간호학회지

PURPOSE: This study was conducted to identify the clinical characteristics and risk factors on the occurrence of variant angina, and to examine the predicting factors on the vascular endothelial dysfunction of the patients with variant angina. METHODS: A total of 134 patients diagnosed with variant angina were recruited from 2006 to 2008. The degrees of endothelial dysfunction were measured and recorded by the researcher using the values of flow-mediated vasodilation of their brachial arteries and Nitroglycerine-mediated dilation. Subjects' demographic data and risk factors were gathered after obtaining informed consent, and their electronic medical records were reviewed to collect laboratory data. RESULTS: The mean age was 54.2 +/- 9.6 years and 52% was male patients. More than 50% of the male patients were cigarette smokers and had hypercholesterolemia. 84% of the male patients and 70% of the female patients had more than one risk factor of cardiovascular disease. A stepwise multiple regression analysis showed that smoking and hypercholesterolemia predicted the decrease of flow-mediated vasodilation (Adjusted R(2) = .204, p < .001). CONCLUSION: Tailored educational interventions for smoking cessation and cholesterol management are needed to prevent recurrence of angina attack for patients with variant angina and to prevent cardiovascular disease for middle-aged workers.

Clinical Effects of Calcium Channel Blocker and Angiotensin Converting Enzyme Inhibitor on Endothelial Function and Arterial Stiffness in Patients with Angina Pectoris

To evaluate the effects of calcium channel blocker (CCB) and angiotensin converting enzyme inhibitor (ACEI) on endothelial function and arterial stiffness in stable angina pectoris (SAP), 87 patients with SAP (57.6+/-10.0 yr, 52 males) were divided into two groups; CCB group (group I: n=44, 57.9+/-9.7 yr, 23 males) vs. CCB plus ACEI group (group II: n=43, 57.2+/-10.5 yr, 29 males). Flow mediated vasodilation (FMD) of the brachial artery, pulse wave velocity (PWV), urinary albumin excretion (UAE), and high sensitivity C-reactive protein (hsCRP) were compared. FMD, PWV, UAE, and hsCRP were not different between the groups at baseline. After 6 months of treatment, FMD were significantly improved in group II (7.5+/-3.7 to 8.8+/-2.7%, p<0.001), but not in group I (7.9+/-2.7 to 8.2+/-2.8%, p=0.535). Brachial-ankle PWV were significantly improved in both groups (1,621.3+/-279.4 to 1,512.1+/-225.0 cm/sec in group I, p<0.001, 1,586.8+/-278.5 to 1,434.5+/-200.5 cm/sec in group II, p<0.001). However, heart-femoral PWV were significantly improved (1,025.7+/-145.1 to 946.2+/-112.2 cm/sec, p<0.001) and UAE were significantly decreased (20.19+/-29.92 to 13.03+/-16.42 mg/g Cr, p=0.019) in group II only. In conclusion, combination therapy with CCB and ACEI improves endothelial function, arterial stiffness, and UAE than CCB mono-therapy more effectively in patients with SAP.

Nitroglycerin-Induced Headache is Associated With Mild Coronary Artery Disease in Patients With Chest Pain

BACKGROUND AND OBJECTIVES: We hypothesized that patients with nitroglycerin-induced headache had preserved systemic vasomotion and there might be an increased nitroglycerin-mediated dilation (NMD) response in the brachial artery. The aim of this study is to evaluate whether nitroglycerin (NTG)-induced headache is associated with the level of the NMD and flow-mediated dilation (FMD) or the severity of coronary artery disease (CAD). SUBJECTS AND METHODS: The study included 87 patients (Group I: mean age: 54.8+/-9.5 years, 46 males) with headache and new onset chest pain, and 109 patients (Group II: mean age: 57.4+/-8.9 years, 67 males) without headache and with new onset of chest pain. Patients were excluded from this study if they had a history of chronic headache, long term nitrates use and coronary artery procedures. Coronary angiography was performed within one month after administering nitroglycerin for the usual clinical indications. RESULTS: The clinical characteristics did not differ between the two groups. The NMD was significantly higher in Group I than in Group II (23.0+/-7.5% vs. 18.5+/-8.6%, respectively, p<0.001). The FMD was significantly higher in Group I than in Group II (9.0+/-4.1% vs. 7.5+/-4.3%, respectively, p=0.007). On multiple regression analysis, NTG-induced headache was a predictor of CAD {oddsratio (OR), 0.04, 95% confidence interval (CI), 0.02-0.11: p<0.001, respectively}. CONCLUSION: We have shown that the vasodilator response to NTG and FMD are increased in the patients with NTG-induced headache. More NTGinduced headache developed in the patients with normal coronary arteries or minimal CAD than in the patients with obstructive CAD. This finding might be helpful as additional information for evaluating the patients with chest pain syndrome.

Papillary Fibroelastoma of Pulmonary Valve Mimicking Infective Endocarditis

In this report, we describe a case of previous undiagnosed masses of the pulmonary valve mimicking infective endocarditis that were incidentally found during the work-up of a 62-year-old woman, who was presented with abdominal discomfort and dyspepsia. The pathologic findings were characteristics of a papillary fibroelastoma. Although benign, papillary fibroelastomas have the potential to cause lethal embolic events such as stroke, myocardial infarction, and pulmonary embolism are reported in some cases. Tumor identification and surgical excision are important to prevent such complications.

Increased Inflammatory Markers and Endothelial Dysfunction are Associated with Variant Angina

BACKGROUND AND OBJECTIVES: Endothelial dysfunction and increased vascular inflammation may be associated with variant angina (VA). However, their exact roles remain to be clarified. The aim of the presents study is to investigate whether the level of inflammation markers and the flow-mediated dilation (FMD) are related to VA. SUBJECTS AND METHODS: The study included 46 patients (VA group: 53.9+/-12.0 years, 20 males) with positive spasm provocation tests and they were without significant coronary stenosis, and 14 patients (control group: 46.6+/-13.5 years, 7 males) with negative spasm provocation tests and they were without significant coronary stenosis. The clinical characteristics and inflammatory markers, including the high sensitive C-reactive protein (hsCRP) level, the monocyte count and the von Willebrand factor (vWF) level, and the FMD were compared between the two groups. The FMD and inflammatory markers were measured in the morning before performing the ergonovine provocation coronary angiogram. RESULTS: The level of vWF was significantly higher in the VA group than in the control group (166.5+/-41.9% vs. 118.0+/-65.3%, respectively, p=0.029). The FMD was significantly decreased in the VA group compared with the control group (9.2+/-4.3% vs. 12.4+/-4.2%, respectively, p=0.021). Nitrate-mediated dilation did not differ between the two groups. The levels of the monocyte count, hs-CRP and homocysteine were higher in the VA group than in the control group (554.7+/-261.0/mm3 vs. 440.7+/-136.0/mm3, respectively, p=0.039; 0.3+/-0.4 mg/dL vs. 0.1+/-0.1 mg/dL, respectively, p=0.029; 7.54+/-4.0micronmol/L vs. 5.92+/-1.6micronmol/L, respectively, p=0.033). CONCLUSION: The results of this study suggested that increased inflammatory markers and endothelial dysfunction may be associated with variant angina.