Effects of a Fall Prevention Program Based on Goal Attainment Theory for Homebound Older Adults With Osteoarthritis of the Lower Extremities.

This study implemented and evaluated a community-based fall prevention program based on goal attainment theory that targeted older adults with osteoarthritis. The program included education, exercise, and one-on-one counseling during which the participant and the provider set individual fall prevention goals. This study used a nonequivalent control group pre-/posttest design. Participants were older adults in senior centers with lower extremity osteoarthritis. A fall prevention program in the experimental group included group (70 minutes, once/week; education and exercise) and individual counseling (10 minutes, twice/week; emotional support and goal setting). Data analysis was conducted using SPSS/WIN 22.0 with the χ2 test, Fisher's exact test, independent t test, and Mann-Whitney U test. The experimental group experienced significantly fewer falls, less stiffness, less difficulty performing activity; more muscular strength, walking ability, and balance; as well as less fear of falling and higher falls efficacy in comparison with the control group. However, pain did not improve in either of the two groups. Fall prevention programs need to include the active involvement of carers in ensuring environmental changes to reduce fall risks. In addition, health professionals who care for community patients with osteoarthritis could strengthen interactions and exchanges to prevent falls and actively modify home hazards.

Risk factors for postoperative delirium in patients with colorectal cancer.

AIM: The purpose of this study was to identify the incidence of postoperative delirium in PCC (patients with colorectal cancer) and the related factors of postoperative delirium by analysing the differences in the general, disease-related and operation-related characteristics. BACKGROUND: Previous studies had some limitations in generalising the risk factors for postoperative delirium in PCC due to the lack of relevant factors, such as disease- and operation-related characteristics. There is a need to investigate the factors of postoperative delirium by including cancer and surgical characteristics. DESIGN: The current study is a cross-sectional study to investigate the correlated factors of postoperative delirium in PCC. METHODS: A total of 196 patients who underwent colorectal cancer surgery at the Keimyung University Dongsan Hospital in Korea participated in the study. Data collection was performed from 15 August 2018 to 10 July 2019. Patients' general, disease-related and operation-related characteristics were collected from questionnaires and electronic medical records. Data analysis was performed using descriptive statistics, t test, Chi-square test and logistic regression using SPSS/WIN 22.0. The STROBE checklist has been used to report this study. RESULTS: The results of this study showed that 26 (13.2%) PCC exhibited postoperative delirium and the risk factors for postoperative delirium were physical activity (OR = 2.94, p = .001), infection (OR = 2.17, p = .001) and nutritional status (OR = 1.10, p = .028). CONCLUSION: To reduce and prevent the occurrence of postoperative delirium in PCC, encouraging participation in physical activity before and after surgery are required, and regular monitoring of the infection symptoms and nutritional status. RELEVANCE TO CLINICAL PRACTICE: Based on the results of this study, postoperative delirium in PCC could be decreased by encouraging physical activity immediately following operation, monitoring the signs and symptoms of infection using diverse objective laboratory findings and maintaining the nutritional status within the normal range.

The effect of a comprehensive mobile application program (CMAP) for family caregivers of home-dwelling patients with dementia: A preliminary research.

AIM: The purpose of this study was to evaluate the effect of a comprehensive mobile application program in managing behavior and psychological symptoms of home-dwelling patients with dementia in South Korea. METHODS: A nonequivalent control group pretest-posttest design was conducted. A total of 26 family caregivers participated in this study. The application program consists of understanding of dementia, interventions, communication skills, coping methods, and bulletin boards. Data collection was performed from July 9, 2018, to October 4, 2018. Family caregivers' fatigue, sleep, and burden and patients with behavioral and psychological symptoms of dementia were measured. For data analysis, descriptive statistics, independent t tests, Mann-Whitney U test, repeated measures analysis of variance, and Friedman test were used. RESULTS: The application program offered environmental management in an intervention using communication skills and coping methods, depending on the behavioral and psychological symptom type. The results showed significant differences between the two groups in family caregivers' fatigue (F = 11.24, p = .003) and burden (χ2 = 10.55, p = .005). CONCLUSION: The findings showed the application program improved family caregivers' fatigue and burden. It also suggested there is a need to develop a wandering persons location program to improve family caregivers' stress and patients' behavioral problems in future studies.

Predictors of Emergency Room Admission in Patients With Liver Cirrhosis: A Prospective, Descriptive Study.

This study aimed to identify the predictors of emergency room (ER) admission in patients with liver cirrhosis. The data of 215 patients with liver cirrhosis who visited the ER were collected from January 1 to March 15, 2017, at Yeungnam hospital in Daegu city, South Korea. Measurement scales were designed on the basis of the liver function test and evaluation of anxiety and depression, self-care, and family support. Diseases that cause liver cirrhosis, their associated characteristics, and respective hematologic examination results were reviewed from the hospital's electronic medical records. Among the 215 patients with liver cirrhosis who visited the ER, 47 (21.9%) had previous ER admissions, whereas 168 (78.1%) had none. Fifteen predictive factors that were significantly different between the ER admission and non-ER admission groups were included as variables in logistic regression analysis. This analysis revealed that the 3 significant predictors of ER admission in patients with liver cirrhosis were number of prior complications, serum bilirubin level, and self-care compliance. An increased number of prior complications, increased bilirubin level, and low self-care compliance increased the ER admission rates in patients with liver cirrhosis. Thus, further studies are necessary to measure the effects of nursing intervention strategies based on these findings.

Factors influencing caregiver burden in families of hospitalised patients with lung cancer.

AIMS AND OBJECTIVES: To investigate the factors influencing caregiver burden in families of hospitalised lung cancer patients. BACKGROUND: Even though cancer symptoms among hospitalised lung cancer patients are serious and negatively affect caregivers, few research regarding to the factors of caregiver burden in hospitalised lung cancer patient has been carried out. DESIGN: Cross-sectional, descriptive and correlational study. METHODS: A convenience sample of hospitalised lung cancer patients (n = 107) was recruited from K University hospital in South Korea. Family depression, social support and caregiver burden as well as patients' lung cancer symptoms were measured using peer-reviewed and standard measurement tools. Descriptive statistics and parametric tests including stepwise regression were used to analyse the data. The STROBE guideline has been used to report this study. RESULTS: Caregiver burden among the families of hospitalised lung cancer patients was high; the regression model for caregiver burden among participants' families was significant. Depression among families was found to be the most influential factor for caregiver burden, followed by patients' lung cancer symptoms. CONCLUSIONS: This study revealed that family caregivers' depression and patients' lung cancer symptoms were the most significant factors for families' caregiver burden. Future research should be conducted to identify the causes of depression among families of hospitalised lung cancer patients and develop management programmes to address such causes. It is also necessary to investigate the causes of increased caregiver burden that differentiate families of lung cancer patients from other cancer patients and provide education to help such families understand such causes. RELEVANCE TO CLINICAL PRACTICE: Findings from this study show that family's depression and lung cancer symptoms were significant factors for caregivers' burden. Hence, it is suggested for the healthcare providers to find for the best solution/strategies to reduce the caregiver's burden.

Outcomes of Patients With Delirium in Long-Term Care Facilities: A Prospective Cohort Study.

A 6-month prospective cohort study was performed in patients with or without dementia admitted to two Korean long-term care (LTC) facilities. Participants were categorized into four groups: (a) no delirium or dementia, (b) dementia only, (c) delirium only, and (d) delirium superimposed on dementia (DSD). Delirium incidence, mortality, readmission, discharge placement, length of stay, and other associated factors were evaluated. The incidence of delirium was 48%. The largest number of patients belonged to the DSD group; outcomes associated with delirium were analyzed as covariates. The delirium-only group had a significantly higher mortality rate than other groups. Length of stay was the longest for the dementia-only group. On the Kaplan-Meier survival curve, the delirium-only group had the lowest probability of survival compared to other groups. The mortality rate of patients with delirium only was significantly higher than the mortality rates of all other groups. LTC facilities should provide preventive interventions for patients with delirium. [Journal of Gerontological Nursing, 44(9), 41-50.].

Effects of the Patient-Centered Environment Program on Behavioral and Emotional Problems in Home-Dwelling Patients With Dementia.

The current pilot study examined the effects of the Patient-Centered Environment Program (PCEP) on agitation, cognition, stress, pain, sleep, and activities of daily living for home-dwelling patients with dementia. Nine individuals participated in the study. The PCEP included visual, auditory, olfactory, and tactile areas based on participants' preferences. PCEP sessions were held for 30 minutes twice per week and a total of 16 sessions were performed at participants' homes. Findings showed that agitation and pain improved with the PCEP (t = 2.91, p < 0.02; t = 4.51, p < 0.002, respectively). Findings suggested that a better study design, repeated with a reasonable sample size, must be considered for participants' health statuses to meet the PCEP contents.

Effects of self-esteem improvement program on self-esteem and peer attachment in elementary school children with observed problematic behaviors.

PURPOSE: The purpose of this study was to investigate the effects of a self-esteem improvement program on self-esteem and peer attachment in elementary school children with observed problematic behaviors. METHODS: This study is a quasi-experimental study with a nonequivalent control group pretest-post-test design. A total of 47 fourth grade elementary school students participated in this study. The program was provided for 45 minutes once a week; a total of 12 sessions were completed with a group in the classroom for the experimental group. Child Problem-Behavior Screening Questionnaire was used to measure problematic behavior. Self-esteem was measured using the Rosenberg's Self-esteem Questionnaire, and peer attachment was measured using the Inventory of Parent and Attachment. Measuring was performed right after the program was done (post 1) and 1 month after the program was finished (post 2). To compare the differences in self-esteem and peer attachment between groups, repeated measures analysis of variance was used. RESULTS: Most participants in the experimental group were 10 years old (62.5%, range 10-11), male (52.0%) and with middle grade point average (64.0%). The self-esteem scores in the experimental group were significantly higher than those of the control group (F = 26.64, p < .001). The peer attachment scores in the experimental group were significantly higher than those of the control group (F = 6.48, p = .014). CONCLUSIONS: The self-esteem improvement program in this study improved the self-esteem and peer attachment in elementary school children. The self-esteem program helped acknowledge the peer's name and increased their connections. The program needs to be considered as a formal and consistent program.

Effect of sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit.

AIM AND OBJECTIVE: The study compared the effect of earplug-delivered sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit. BACKGROUND: Diverse types of music have been claimed to improve sleeping elsewhere, but relatively little is known in South Korea. Most studies investigating the effect of sleep-inducing music on sleep have involved persons with insomnia, even though many persons with cardiovascular disease in the intensive care unit suffer from sleeping problems. There is a need to investigate the effect of sleep-inducing music on sleep disorders in persons with percutaneous transluminal coronary angiography in the cardiac care unit. DESIGN: An experimental research design was used. METHODS: Data collection was conducted in the cardiac care unit of K University Hospital in D city, from 3 September-4 October 2010. Fifty-eight subjects participated and were randomly assigned to the experimental group (earplug-delivered sleep-inducing music for 52 min beginning at 10:00 pm, while wearing an eyeshield, n = 29) and the control group (no music, but earplugs and eyeshield worn, n = 29). The quantity and quality of sleep were measured using questionnaires at 7 am the next morning for each group. RESULTS: Participants in the experimental group reported that the sleeping quantity and quality were significantly higher than control group (t = 3·181, p = 0·002, t = 5·269, p < 0·001, respectively). CONCLUSION: Sleep-inducing music significantly improved sleep in patients with percutaneous transluminal coronary angiography at a cardiac care unit. Offering earplugs and playing sleep-inducing music may be a meaningful and easily enacted nursing intervention to improve sleep for intensive care unit patients. RELEVANCE TO CLINICAL PRACTICE: Nurses working at cardiac care unit can use music to improve sleeping in clients with percutaneous transluminal coronary angiography.

Effect of music on pain for home-dwelling persons with dementia.

The purpose of this study was to investigate the effect of music on pain for home-dwelling persons with dementia. A quasiexperimental design was used. Fifteen subjects listened to their preferred music for 30 minutes before peak agitation time, for 2 days per week, followed by no music for 2 weeks. The process was repeated once. The finding of this study showed that mean pain levels after listening to music were significantly lower than before listening to the music (t=2.21, df=28; p < .05). The findings of this pilot study suggest the importance of music intervention to control pain for home-dwelling persons with dementia.

Effect of individualized music on agitation in individuals with dementia who live at home.

This pilot study investigated the effect of individualized music on agitation in individuals with dementia who live at home. Fifteen individuals listened to their preferred music for 30 minutes prior to peak agitation time, two times per week for 2 weeks, followed by no music intervention for 2 weeks. The process was repeated once. The findings showed that mean agitation levels were significantly lower while listening to music than before listening to the music. The findings of this pilot study suggest the importance of music intervention for individuals with dementia who live at home.

The inter-rater reliability of the Clinical Signs and Symptoms Checklist in diabetic foot ulcers.

The Clinical Signs and Symptoms Checklist is a tool designed to measure 12 clinical signs and symptoms of localized chronic wound infection. Since its initial development, this Checklist has been revised to include sanguineous drainage. To examine the inter-rater reliability of the revised Clinical Signs and Symptoms Checklist in diabetic foot ulcers, an observational, cross-sectional study was conducted in conjunction with a larger study examining the validity of each sign and symptom for identifying infection in diabetic foot ulcers. Two independent nurse observers assessed 64 diabetic foot ulcers in 64 patients using the Checklist. The reliability of each item was calculated using percent agreement and the Kappa coefficient. Total percent agreement ranged from 76% to 100%, and Kappa statistics ranged from .34 to 1.00. Study findings confirm that the Clinical Signs and Symptoms Checklist is a reliable tool for identifying the clinical signs and symptoms of localized infection in diabetic foot ulcers.

Diagnostic Validity of Semiquantitative Swab Cultures.

Swab cultures of wounds are noninvasive and most laboratories are capable of semiquantitatively processing these specimens. This study examined the diagnostic validity of semiquantitative swab cultures obtained using Levine's technique and compared semiquantitative and quantitative swab cultures. Two swab specimens were obtained from a sample of 44 chronic wounds using Levine's technique. One was processed using quantitative laboratory procedures and the other using semiquantitative laboratory procedures. The diagnostic validity of the findings from each swab culture process was determined by associating the culture findings of each with quantitative tissue cultures (reference standard) using receiver operating characteristic (ROC) curves and by evaluating concordance. The area under the curve (AUC) of the semiquantitative swab culture was 0.639, which was not significantly higher than the .50 diagonal chance (P = 0.0501), suggesting a non-informative test. The AUC for quantitative swab cultures was 0.821. The AUC of the quantitative swab culture was significantly higher than the diagonal chance line of 0.5 and was significantly higher than the AUC of the semiquantitative swab culture (P = 0.0128). The mean concordance of semiquantitative cultures in recovering all organisms was 57%. The mean concordance of quantitative swab cultures in recovering all organisms was 72%. The findings of this study suggest that swab specimens processed using semiquantitative processes do not provide culture findings that correlate well with culture findings from tissue specimens. More meaningful information can be obtained from swab specimens if they are quantitatively processed in the laboratory.

Diagnostic validity of three swab techniques for identifying chronic wound infection.

This study examined the diagnostic validity of three different swab techniques in identifying chronic wound infection. Concurrent swab specimens of chronic wounds were obtained using wound exudate, the Z-technique, and the Levine technique, along with a specimen of viable wound tissue. Swab and tissue specimens were cultured using quantitative and qualitative laboratory procedures. Infected wounds were defined as those containing 1 x 10(6) or more organisms per gram of tissue. Accuracy was determined by associating the quantitative cultures of swab specimens with the cultures from tissue specimens using receiver operating characteristic curves. Of the 83 study wounds, 30 (36%) were infected. Accuracy was the highest for swab specimens obtained using Levine's technique at 0.80. Based on Levine's technique, a critical threshold of 37,000 organisms per swab provided a sensitivity of 90% and a specificity of 57%. The mean concordance between swab specimens obtained using Levine's technique and tissue specimens was 78%. The findings suggest that swab specimens collected using Levine's technique provide a reasonably accurate measure of wound bioburden, given that they are more widely applicable than tissue cultures. The diagnostic validity of Levine's technique needs further study using an alternative reference standard, such as the development of infection-related complications.

[Effects of a short-term home-based pulmonary rehabilitation program in patients with chronic lung disease].

PURPOSE: The purpose of this study is to exam the effects of a short-term pulmonary program on lung function, exercise tolerance, and quality of life in chronic lung patients. METHOD: Randomized controlled pre-post test design was used. The outcome measures were forced expiratory volume in one second (FEV1, % predicted), 6 min walking distance (6MWD), Borg score after 6MWD, and Chronic Respiratory Disease Questionnaire (CRDQ). Experimental group performed the 4-week home-based pulmonary rehabilitation program composed of inspiratory muscle training, upper and lower extremity exercise, relaxation, and telephone visit. Patients in control group were only given education about self-management strategies. Thirty four patients with moderate-to-severe respiratory impairment were recruited, and 28 patients (19 in experiments, 15 in control) completed the study. RESULT: Significant improvements in lung function, exercise tolerance, and health related quality of life were found only in the experiment group. CONCLUSION: This study yielded evidence for the potential and beneficial effects of home-based pulmonary rehabilitation program in patients with moderate to severe chronic lung disease. The program could be adequately utilized for improvement of health related quality of life in chronic lung patients.