Reattachment of Graft Using Atropine after Descemet Stripping Automated Endothelial Keratoplasty in Iris Deformity

Purpose@#To report successful graft reattachment using atropine after Descemet’s membrane stripping automated endothelial keratoplasty (DSAEK) in iris deformity.Case summary: A 76-year-old male was referred for decreased visual acuity due to bullous keratopathy in his right eye. He had previously undergone several eye surgeries, including vitrectomy and intraocular lens fixation, because of retinal detachment, which caused the iris deformity. DSAEK was performed, but the graft detached because of an air bubble in the posterior chamber. Atropine was used to move the air into the anterior chamber. The graft was attached the next day, and maintained during 3 months of follow-up. @*Conclusions@#Atropine is an effective treatment option for cases with air bubble migration to the posterior chamber, leading to graft detachment after DSAEK in iris deformity.

Probable Posterior Ischemic Optic Neuropathy Associated with Acute Fungal Sinusitis

Purpose@#We report a case of probable posterior ischemic optic neuropathy in a patient with acute fungal sinusitis.Case Summary: An 81-year-old male patient presented with sudden-onset visual loss in his left eye 3 weeks prior to presentation. His best corrected visual acuity was 0.6 in his right eye and light perception in his left eye. Pupillary size was 3 mm in both eyes, and a relative afferent pupillary defect was detected in his left eye. In fundus examination, diabetic retinopathy was found, and cup/disc ratios were increased in both eyes, but disc swelling and hemorrhage were not observed. Fluorescein angiography did not indicate filling delay, defects, or leakage of discs in either eye. Magnetic resonance imaging of the brain revealed multi-sinusitis in the sphenoid, ethmoid, and frontal sinuses. No bony defects or erosion were found around the optic canal or orbital apex during endoscopic surgery; however, histological examination revealed aspergillosis. The patient was diagnosed with posterior ischemic optic neuropathy caused by acute fungal sinusitis. @*Conclusions@#When elderly patients with uncontrolled diabetes experience sudden visual disturbances without ocular pain, posterior ischemic optic neuropathy with fungal sinusitis should be considered as a differential diagnosis. Immediate imaging studies and appropriate treatment should be performed.

Evaluation of the Interaction Model of Client Health Behavior-based multifaceted intervention on patient activation and osteoarthritis symptoms.

PURPOSE: This study evaluated a multifaceted intervention for osteoarthritis symptoms. METHODS: A cluster randomized controlled trial was conducted with a convenience sample of 90 patients aged between 45 and 82 years, who were recruited from three Community Health Posts (CHPs). The CHPs were randomized into two experimental groups (E1 and E2) and one control group (C). The intervention included health education and counseling combined with exercise classes based on the Interaction Model of Client Health Behavior. Trained community health nurse practitioners led the intervention. Stretching exercise (E1) and walking (E2) combined with muscle strengthening exercise were provided. The instruments included the Patient Activation Measure (PAM), Korean version of the Western Ontario and McMaster Universities Osteoarthritis Index (K-WOMAC), Stanford Health Assessment Questionnaire Disability Scale (HAQDS), and Center for Epidemiologic Studies Depression Scale (CES-D). The HAQDS was measured using an ordinal scale, and Likert scales were used for the other instruments. Chi-square test and analysis of covariance were used; P values <.05 were considered significant. The study was conducted in 2014. RESULTS: The groups were similar at the baseline (P > .05) except for joint pain and patient activation (P < .05). At post-test, the changes in the mean scores were significant for joint pain and stiffness, and physical functioning. E2 with walking exercise showed better improvements in joint pain and physical functioning than the other groups (P < .01). CONCLUSIONS: Eight sessions of multifaceted intervention improved the osteoarthritis symptoms. Follow-up studies will be needed to determine the intermediate and long-term effects of the multifaceted intervention.

Incivility experiences in clinical practicum education among nursing students.

BACKGROUND: Nursing students' incivility experiences not only cause stress and burnout but also have other negative effects on general clinical training, hindering their learning or even affecting their career decisions. OBJECTIVES: This study aimed to comprehensively and thoroughly examine the specific phenomena and implications of incivility experienced by nursing students during clinical practicum. DESIGN: Based on the hermeneutical philosophy, this study utilizes an exploratory and qualitative design to describe the incivility experiences among nursing students undertaking clinical practicum. SETTING: This study was conducted at Y nursing college located in W city of South Korea. PARTICIPANTS: The participants were nursing students attending nursing colleges who were able to describe, in detail, their incivility experiences in clinical practice. These 32 senior-year students completed an entire course of clinical practice. METHODS: Data were collected through focus group interviews from September to November 2017. The focus group comprised 6 subgroups, with four to seven individuals each. For data analysis, the research manager compared the transcriptions with the recordings to confirm their accuracy. Qualitative content analysis methods were used to analyze the transcription contents. RESULTS: Based on the data analysis, 5 themes and 12 subheadings were derived from 131 significant statements. The derived themes included lack of respect, lack of role models, excessive demands, hostile behavior, and mean behavior. CONCLUSIONS: Nursing students felt neglected and disrespected during clinical practicum, and clinical practice guides made unreasonable demands rather than presenting examples as role models during the learning process. The students also experienced mean behaviors such as refusal and hostile acts. The findings of this study imply the necessity to promote clinical practicum environments that can reduce incivility experiences and empower nursing students undertaking clinical practicum education.

Effects of acupuncture on chronic idiopathic pruritus: an uncontrolled pilot study evaluating inflammatory changes with treatment.

Background Conduct a pilot study addressing the efficacy of acupuncture in the treatment of chronic idiopathic pruritus to aid in the design of a larger clinical trial. Routine laboratory tests to assess systemic inflammation in addition to subjective patient surveys were performed provide documentation of efficacy of treatment. Methods Patients with chronic pruritus who did not respond to standard treatment were recruited to participate. After exclusion of systemic or known reversible causes, each patient received up to 10 treatments which were performed approximately one week apart. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured before and after a series of acupuncture treatments to evaluate levels of inflammation and pre- and post-treatment surveys were conducted to evaluate levels of perceived itch. Results Only one of the ten patients in this study possessed an elevation of ESR before treatment. This patient's ESR value returned to normal range after treatment and this participant reported subjective relief of her pruritus. Conclusions Future studies on the efficacy of acupuncture in the treatment of chronic idiopathic pruritus should focus on those patients with measurable levels of inflammation at the initiation of the study or utilize alternative and more comprehensive values to monitor disease response.

Factors Associated With Medication Adherence Among Medical-Aid Beneficiaries With Hypertension.

The purpose was to examine factors associated with medication adherence among medical-aid beneficiaries with hypertension using the Expanded Behavioral Model of Health Services Utilization. A cross-sectional study was conducted with a convenient sample of 289 patients. The instruments included scales to measure medication adherence, health literacy, general self-efficacy, and pros and cons of chronic disease management. Data collection was performed between February and March 2011. A hierarchical regression analysis was performed. The study found that 25.6% to 34.6% had low motivation and low knowledge regarding medication adherence. Those with higher health literacy and higher self-efficacy scores were more likely to have higher medication adherence, whereas widowed and those who perceived more cons of chronic disease management were more likely to have lower medication adherence than their counterparts (p < .05). Interventions incorporating significant factors associated with medication adherence are required to enhance medication adherence and to prevent complications associated with medication non-adherence.

Multidimensional Caregiving Burden of Female Family Caregivers in Korea.

The purpose of this study was to examine a staged theoretical model to explain cultural knowledge-based multidimensional burden of women family caregivers caring for community-dwelling older adults using a modified Poulshock and Deimling model. In the model, the antecedents included elders' impairment in activities of daily living (ADL), elders' cognitive impairment, caregivers' self-efficacy, and caregivers' familism. The perception contained the disruptive behavior burden and social functioning burden of caregivers. The consequence variable included social activity restriction and negative changes in family relationships. The total sample was 157 primary women caregivers caring for community-dwelling older adults aged 65 and older. Instruments were General Self-Efficacy Scale, Family Scale, and Burden Scale. Path analysis was done to analyze the model using multiple linear regression methods. This study showed that impairments of older adults (impairment in ADL, cognitive impairment) and caregiver beliefs (strong familism, low self-efficacy) had an indirect influence on negative changes in family relationship and social activity restriction through the perceived emotional distress.

Factors affecting Korean nursing student empowerment in clinical practice.

BACKGROUND: Understanding the phenomenon of nursing student empowerment in clinical practice is important. Investigating the cognition of empowerment and identifying predictors are necessary to enhance nursing student empowerment in clinical practice. OBJECTIVES: To identify empowerment predictors for Korean nursing students in clinical practice based on studies by Bradbury-Jones et al. and Spreitzer. DESIGN: A cross-sectional design was used for this study. SETTING: This study was performed in three nursing colleges in Korea, all of which had similar baccalaureate nursing curricula. PARTICIPANTS: Three hundred seven junior or senior nursing students completed a survey designed to measure factors that were hypothesized to influence nursing student empowerment in clinical practice. METHODS: Data were collected from November to December 2011. Study variables included self-esteem, clinical decision making, being valued as a learner, satisfaction regarding practice with a team member, perception on professor/instructor/clinical preceptor attitude, and total number of clinical practice fields. Data were analyzed using stepwise multiple regression analyses. RESULTS: All of the hypothesized study variables were significantly correlated to nursing student empowerment. Stepwise multiple regression analysis revealed that clinical decision making in nursing (t=7.59, p<0.001), being valued as a learner (t=6.24, p<0.001), self-esteem (t=3.62, p<0.001), and total number of clinical practice fields (t=2.06, p=0.040). The explanatory power of these predictors was 35% (F=40.71, p<0.001). CONCLUSION: Enhancing nursing student empowerment in clinical practice will be possible by using educational strategies to improve nursing student clinical decision making. Simultaneously, attitudes of nurse educators are also important to ensure that nursing students are treated as valued learners and to increase student self-esteem in clinical practice. Finally, diverse clinical practice field environments should be considered to enhance experience.

Psychometric Properties of the Korean Version of the "Patient Activation Measure 13" (PAM13-K) in Patients With Osteoarthritis.

This study investigated the psychometric properties of the Korean version of the Patient Activation Measure 13 (PAM13) using Rasch analysis. The sample consisted of 270 Korean patients with osteoarthritis. The PAM13 was translated into Korean using a standardized forward-backward translation approach. In this study, the Cronbach's α coefficient was .88, the average interitem correlation was .34, and the average item-rest correlation was .55. The difficulty ranking of the item in this study differed from that in the original version. We did not need to collapse response categories. A total of 57.5% of the variance was explained by the residuals, indicating unidimensionality. The results suggest that the PAM13-K is a reliable and valid measure of activation. Further research is needed to validate item responsiveness and intervention effects.

Compensation of elemental image using multiple view vectors for off-axis integral floating system.

A novel method is proposed to compensate the distortion caused by the off-axis structure in integral floating with a concave mirror. The proposed method of this paper can generate the elemental image that is integrated into the multiple predistortion images for the corresponding multiview directions, which cannot be performed by the predistortion method using a single-view vector. The fundamental concept of the proposed method is that the predistortion images can be generated for more than two view vectors, which are defined by each set of corresponding elemental lens and subimage, and captured onto the subimage. In addition, the subimage can be divided into the several segments to increase the number of view vectors, so that the predistortion images generated by more view vectors can enhance the degree of compensation. The proper number of the view vectors per subimage is discussed and analyzed based on the small-angle approximation. Experiments to verify the feasibility of the proposed method are performed.

[Validation of a needs assessment tool for case management in Korean medical aid beneficiaries].

PURPOSE: The purpose of this study was to validate the Needs Assessment Tool for Case Management (NATCM) for use with Korean medical aid beneficiaries. METHODS: Psychometric testing was performed with a sample of 645 Korean medical aid beneficiaries, which included 41 beneficiaries who were selected using proportional sampling method, to examine intraclass correlation coefficients (ICC). Data were evaluated using item analyses, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Cronbach's alpha, and ICC. RESULTS: Through psychometric testing the final version of NATCM was found to consist of two subscales: 1) Appropriateness of Health Care Utilization (5 items) and 2) Self Care Ability (6 items). The two subscale model was validated by CFA (RMSEA=.08, GFI=.97, and CFI=.93). Internal consistency measured by Cronbach's alpha was .82, and subscale reliability ranged from .79 to .84. The ICC of the NATCM between case managers was .73 and between case managers and health care professionals. .82. CONCLUSION: This study suggests that the final version of NATCM is a brief, reliable, and valid instrument to measure needs of Korean medical aid beneficiaries. Therefore, the NATCM can be effectively utilized as an important needs assessment as well as outcome evaluation tool for case management programs in Korea.

Quality of nursing doctoral education in Korea: towards policy development.

AIMS: This article is a report on an international study of the quality of nursing doctoral education; herein, we report findings for Korea. Specific aims were to: examine the validity and reliability of the quality of nursing doctoral education questionnaire; and identify contributing factors and domain(s) for improvement. BACKGROUND: The quality of nursing doctoral education has been a worldwide concern with the recent rapid increase in number of nursing doctoral programmes around the world, and comprehensive evaluation is needed for policy recommendations. METHODS: A cross-sectional descriptive study, conducted from October 2006 to January 2007, used an online questionnaire evaluating four domains: programme, faculty, resources and evaluation. Seven deans, 48 faculty, 52 graduates and 87 students from 14 nursing schools participated. RESULTS: Content and construct validity, and construct reliability of the questionnaire were established. Overall, participants reported that the perceived quality of private universities/schools was significantly higher than that of public/national universities. A higher ratio of doctoral to non-doctoral students was significantly associated with higher quality. The domains of programme, faculty and resources were highly correlated. The programme was the most important domain; availability of sufficient materials and information for students most needed improvement. Overall, faculty perceived the quality of the programme, faculty and resources as more positively than did the graduates and students. CONCLUSION: This study provides useful policy guidance for nurse educators worldwide for improving doctoral programmes and faculty's role in educating students. Further study is recommended that examines contributing factors to quality doctoral education.

Multilevel analysis of health care service utilization among medical aid beneficiaries in Korea.

PURPOSE: The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. METHODS: Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. RESULTS: Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. CONCLUSION: The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.

Factors associated with the overuse or underuse of health care services among medical aid beneficiaries in Korea.

PURPOSE: To compare and contrast demographic characteristics and health care service utilization between overusers and underusers of health care services and to identify factors associated with the overuse or underuse of health care services among the medical aid beneficiaries in Korea. METHODS: Secondary data analysis was performed using health care costs and medical aid case management progress data. Data on demographic characteristics, health-related quality of life (HRQoL), and inappropriate health care service user category (overuse or underuse) were provided by the Medical-Aid Case Management Center of Korea, and heath care service reimbursement data were provided by the Korea National Health Insurance Corporation (NHIC). Data on 22,697 beneficiaries were used for analysis, and logistic regression analysis was conducted to examine factors that are associated with overuse and underuse of health care services. RESULTS: The study results revealed that older individuals, women, unemployed individuals, type 1 medical aid beneficiaries, and those with higher education and disabilities were more likely to belong to the overuse group, but urban residents, compared to metropolitan residents, and those with higher HRQoL were more likely to belong to the underuse group (p < .05). CONCLUSIONS: Understanding factors associated with the overuse or underuse of health care services may help to provide tailored case management services to improve the HRQoL of the beneficiaries and optimize their use of health care services. CLINICAL RELEVANCE: Promoting appropriate use of health care services may enhance clients' quality of life and preserve resources for other essential services for medical aid beneficiaries.

A study on Korean nursing students' educational outcomes.

The purpose of this study was to describe outcome indicators of nursing education including critical thinking, professionalism, leadership, and communication and to evaluate differences among nursing programs and academic years. A descriptive research design was employed. A total of 454 students from four year baccalaureate (BS) nursing programs and two three-year associate degree (AD) programs consented to complete self-administered questionnaires. The variables were critical thinking, professionalism, leadership and communication. Descriptive statistics, χ(2)-test, t-tests, ANOVA, and the Tukey test were utilized for the data analysis. All the mean scores of the variables were above average for the test instruments utilized. Among the BS students, those in the upper classes tended to attain higher scores, but this tendency was not identified in AD students. There were significant differences between BS students and AD students for the mean scores of leadership and communication. These findings suggested the need for further research to define properties of nursing educational outcomes, and to develop standardized instruments for research replication and verification.

Lifestyle advice for Korean Americans and native Koreans with hypertension.

AIM: This paper is a report of a comparison of advice on lifestyle given by healthcare providers and subsequent action by recipients between Korean Americans and native Koreans with hypertension. BACKGROUND: High blood pressure is controllable by having a healthy lifestyle, such as weight control, dietary change, exercise, low-sodium diet, alcohol restriction and smoking cessation, and by taking medication. Healthcare providers play an important role in teaching individuals with hypertension on healthy lifestyles. METHOD: This descriptive comparative study was conducted with a convenience sample of 100 Korean Americans and 100 native Koreans with hypertension. They were interviewed between May 2003 and June 2004 on the advice they received from healthcare providers on lifestyle and their subsequent action in terms of taking medication, weight control, dietary change, exercise, low-sodium diet, smoking cessation, alcohol restriction and tension reduction. Nutrient profiles were examined using the 24-hour dietary recall method. FINDINGS: Korean Americans received advice on lifestyle less than did native Koreans, but more Korean Americans followed healthy lifestyle advice on dietary change and exercise than did native Koreans (P<0.001). Weight control was the least adhered to behaviour among the Korean Americans, although almost two-thirds of them were overweight or obese. Both groups exceeded the Dietary Reference Intakes of sodium, but perceived their sodium consumption as low. CONCLUSION: Native Korean participants need to pay closer attention to carrying out the advice, whereas healthcare providers to Korean Americans need to give more advice on culturally acceptable healthy lifestyles, particularly on dietary changes and weight control. Both groups need to monitor their sodium intake more realistically. It is not only advice from healthcare providers that is integral to control of hypertension, but also that patients should follow that advice.

Translation and validation of the Korean version of Family Scale.

BACKGROUND: Familism is an important and complex clinical issue because of its significant impact on family caregiving of elders. PURPOSE: The purpose of this study was to examine the psychometric properties of a Korean-translated version of the Family Scale (FS-K) among Korean adults. A descriptive, cross-sectional survey design was used. METHODS: A panel of experts completed the initial translation into Korean and back-translated the FS. Upon establishment of the content and translation equivalence between English and Korean versions of the FS, psychometric properties were evaluated for reliability and construct validity with a sample of 577 adults. RESULTS: The internal consistency of FS-K was found to be acceptable, and Cronbach's alpha coefficient was .75. For construct validity, the mean scores of the FS-K were significantly different for gender and marital status (p < .05). For the FS-K, six components were extracted, accounting for 53.9% of the variance. CONCLUSIONS: Results of this study suggest that the FS-K can be used as a reliable and valid measure of familism among Korean adults. The FS-K will contribute to the understanding of familism for family caregivers caring for elders in both research and clinical practices.

Effects on Nursing Students of Cognition-Behavior Integrated Breast Cancer Prevention Education Using an Interchangeable Nodule Model.

PURPOSE: The study was done to examine the effects of cognition-behavior integrated breast cancer prevention education, in which a breast model with interchangeable nodules was utilized, on the self-competency of nursing students in performing breast cancer education. METHODS: A nonequivalent control group non-synchronized design was used. A traditional lecture intervention was provided for 49 3rd year college of nursing students (control group) while the integrated breast cancer prevention education was given to 47 3rd year students in the same college one year later (experimental group). The integrated breast cancer prevention education was developed by the research team to strengthen the competency of cognitive and behavioral components in education on breast cancer. RESULTS: Effects of the intervention were found to be significant through all study variables: knowledge about breast cancer (t=7.79, p <.001), breast cancer risk awareness (t=2.05, p <.05), self-competency of breast self-exam (t=8.27, p <.001), and intention to teach breast self-exam (t=3.87, p <.001). CONCLUSION: The integrated breast cancer prevention education was useful to improve not only knowledge about breast cancer but competency in performing breast examination for nursing students who acquired technical skills from various simulation nodules. As the program helped the students to be prepared as confident educators, future application of the module is recommended for academic curricula.

Quality of faculty, students, curriculum and resources for nursing doctoral education in Korea: a focus group study.

BACKGROUND: The rapidly increasing number of nursing doctoral programs has caused concern about the quality of nursing doctoral education, including in Korea. OBJECTIVES: To describe the perceived quality of Korean nursing doctoral education in faculty, student, curriculum and resources. DESIGN: Focus group. SETTINGS: Fourteen Korean nursing doctoral programs that are research focused and include coursework. PARTICIPANTS: Four groups of deans, faculty, students and graduates; students completed three semesters of doctoral program; and graduates completed doctoral programs within the most recent 3 years. METHODS: Focus groups examined the strengths and weaknesses of faculty, students, curriculum, and resources. RESULTS: Faculty strengths were universities' recognition of faculty research/scholarship and the ability of faculty to attract extramural funding. Faculty weaknesses were aging faculty; high faculty workload; insufficient number of faculty; and teaching without expertise in nursing theories. Student strengths were diverse student backgrounds; multidisciplinary dissertation committee members, and opportunities to socialize with peers and graduates/faculty. Students' weaknesses were overproduction of PhDs with low academic quality; a lower number and quality of doctoral applicants; and lack of full-time students. Curriculum strengths were focusing on specific research areas; emphasis on research ethics; and multidisciplinary courses. Curriculum weaknesses were insufficient time for curriculum development; inadequate courses for core research competencies; and a lack of linkage between theory and practice. Resources strengths were inter-institutional courses with credit transfer. Weaknesses were diminished university financial support for graduate students and limited access to school facilities. Variations in participant groups (providers [deans and faculty] vs. receivers [students and graduates]) and geographical location (capital city vs. regional) were noted on all the four components. CONCLUSIONS: The quality characteristics of faculty, students, curriculum, and resources identified in this first systematic evaluation of the quality of nursing doctoral education can inform nursing schools, universities, and policy-makers about areas for improvement in Korea and possibly in the world. Geographical variations found in these four components of doctoral education warrant attention by policy-makers in Korea.

Development of a community health promotion center based on the World Health Organization's Ottawa Charter health promotion strategies.

AIM: To describe the development process of nursing school-led community health promotion centers (CHPC) to improve the health of the surrounding communities. METHODS: This study design was a research and development study. (i) Assessment of health needs by interviewing 359 people in the community to select health programs for the community health promotion center. (ii) Five health promotion strategies from the Ottawa Charter were applied to develop the community health promotion center for a city community. RESULTS: (i) The people in the community had higher socioeconomic status levels and better health behaviors compared to the general Korean population, and they also listed chronic health problem management as their first priority health service. (ii) Development of the community health promotion center was done based on the five World Health Organization's Ottawa Charter Health Promotion Strategies: build healthy public policy, create supportive environments, strengthen community actions, develop personal skills, and reorient health services. CONCLUSIONS: The present study showed that the WHO's five Ottawa Charter Health Promotion Strategies were useful for developing health promotion centers in the community.