Eun Nam Lee

Tai Chi for Disease Activity and Flexibility in Patients with Ankylosing Spondylitis—A Controlled Clinical Trial

We investigated the effects of tai chi on disease activity, flexibility and depression in patients with ankylosing spondylitis (AS). We allocated 40 patients to either a tai chi treatment group or a no-treatment control group. The tai chi group performed 60 min of tai chi twice weekly for eight consecutive weeks and 8 weeks of home-based tai chi, after which the group showed significant improvement in disease activity and flexibility compared to the control group. All outcome measures were significantly lower in the tai chi group than they were during pre-treatment, while they did not change in the control group. These findings suggest that tai chi can improve disease activity and flexibility for patients with AS. Tai chi is an easily accessible therapy for patients and, as such, may be an effective intervention for AS. However, we cannot completely discount the possibility that the placebo effect was responsible for the improvement.

The relationship between the BRAF V600E mutation in papillary thyroid microcarcinoma and clinicopathologic factors

BackgroundThe BRAFV600E mutation, which accounts for about 60–80% papillary thyroid carcinoma(PTC), has been identifiedas a prognostic marker for risk stratification of PTC patients. However, the BRAFV600E mutation as a prognostic marker in papillary thyroid microcarcinoma (PTMC) is unclear.MethodsWe performed a retrospective review of 101 patients who underwent surgery for PTMC. We studied the prevalence of the BRAFV600E mutation. The associations between the BRAFV600E mutation and clinicopathologic characteristics were analyzed.ResultsThe BRAFV600E mutation was observed in 72 patients (71.3%). There was no statistically significant correlation in age, gender, multifocality, extrathyroidal extension, presence of Hashimoto thyroiditis, and lymph node metastasis between the BRAFV600E mutant group and wild group.ConclusionsThe BRAFV600E mutation is not significantly associated with prognostic factors in PTMC.

The Effects of Low-Dose Ketamine on Acute Pain in an Emergency Setting: A Systematic Review and Meta-Analysis

Objectives Currently ketamine is not used often as an analgesic in the emergency department (ED). Nonetheless, it can increase the efficiency of opioids and decrease their side effects. The purpose of this systematic review and meta-analysis was to evaluate whether low-dose ketamine in the ED provides better analgesia with fewer adverse effects. Methods The PubMed, EMBASE, and Cochrane Library databases were searched by two reviewers independently (last search performed on January 2016). Data were also extracted independently. Results A total of 6 trials involving 438 patients were included in the current analysis. Our subgroup analysis of pain reduction indicates that the favorable effects of ketamine were similar or superior to those of placebo or opioids, although these effects were heterogeneous. However, low-dose ketamine was associated with a higher risk of neurological (relative risk [RR] = 2.17, 95% confidence interval [CI] = 1.37–3.42, P < 0.001) and psychological events (RR = 13.86, 95% CI = 4.85–39.58, P < 0.001). In contrast, the opioid group had a higher risk of major cardiopulmonary events (RR = 0.22, 95% CI = 0.05–1.01, P = 0.05). Conclusions The efficiency of ketamine varies depending on the pain site, but low-dose ketamine may be a key agent for pain control in the ED, as it has no side effects. It may also help to reduce the side effects of opioids.

[The reactions of emergency department nurses to violence: Q-methodological approach].

PURPOSE The purpose of this study was to identify the reactions of emergency department nurses to violence. METHODS Q-methodology which provides a method of analyzing the subjectivity of each item was used. Thirty emergency department nurses classified 33 selected Q-statements into a normal distribution using a 9 point scale. The collected data was analyzed using the Quanl PC Program. RESULTS Three types of reactions to violence were identified. The first type(emotional and physical reactions) showed a sense of regret on the selection of an occupation and emotional and physical reactions such as anxiety, fear, depression, hopelessness, heart palpitations and trembling hands due to the violence. The second type(problem solving) actively coped to prevent the occurrence of violence, grasped the causes of violence and sought out a problem solving plan. The third type(anger reactions) felt a lot of anger against violence, and resented their reality of working under conditions of inadequately secured facilities and systems. CONCLUSION The emotional and physical reactions type and the anger reactions type should be required to attend educational programs to improve attitudes and abilities to solve the problems in a more active and positive manner.

Validity and Reliability of ARQ-K (Korean Version of the Assault Response Questionnaire) for Emergency Department Nurses in Korea

Purpose: To investigate the validity and reliability of the Korean Version of the Assault Response Questionnaire (ARQ-K) measuring the intensity of reaction to victimization of emergency nurses in Korea. Methods: An internal consistency reliability and construct validity using exploratory and confirmatory factor analysis were conducted using SPSS WIN (20.0) and AMOS (20.0). Survey data were collected from 321 nurses who worked in 3 levels - wide regional emergency centers, regional emergency centers, appointed emergency centers - of emergency care facilities in Busan, Korea. Results: The Cronbach’s alpha values regarding internal consistency were .77~.93 for the subscales of ARQ-K. Factor loadings of the 26 items on the four subscales ranged from .59 to .84. The four-subscale model was validated by confirmatory factor analysis ( χ 2/df=3.85, p <.001, RMR=.06, GFI=.80, NFI=.81, TLI=.83, CFI=.85, RMSEA=.09). Conclusion: This study shows that the Korean Version of the Assault Response Questionnaire is a valid and reliable instrument to assess nurses’ reaction to victimization of emergency nurses in Korea.

Discriminating Factors of Stages of Change for Exercise among Patients with Metabolic Syndrome

Purpose: This study was designed to explore the stage distribution of subjects according to stages of change for exercise and to identify factors that could discriminate subjects in various stages. Methods: The sample consisted of 182 subjects who had metabolic syndrome. The instruments used in this study were the stage placement instrument for exercise, the metabolic syndrome knowledge and metabolic syndrome health belief scale, and the metabolic syndrome exercise self efficacy scale. Data were analyzed using chi-square, ANOVA, and discriminant analysis by using the SPSS 19.0 program. Results: For exercise stages, exercise efficacy, occupation, and exercise benefit showed high standardized canonical discriminant function coefficients. Subjects in precontemplation/contemplation stage for exercise were more likely to have occupations, had less exercise efficacy and exercise benefit than those in other stage. Conclusion: This study implies that the level of exercise efficacy and exercise benefit of subjects in precontemplation/contemplation stage need to be enhanced in developing exercise program incorporating the stage of change for metabolic syndrome patients.

Hardiness Mediates Stress and Impact Level in ED Nurses Who Experienced a Violent Event

Introduction: This secondary analysis examined the mediating effect of hardiness between stress and impact level in ED nurses who experienced a violent event. Method: This correlational study was conducted from June to August 2014. We used the visual analog scale to measure stress level, the Impact of Event Scale–Revised to measure impact level after the violent event, and the Dispositional Resilience Scale to measure hardiness. We then analyzed mediating effects with the Sobel test. Data were collected in 31 emergency medical centers located in B city in Korea. Data from 321 ED nurses who experienced a violent event were analyzed. Most nurses (91.9%) were women, with a mean age of 28.73 years. The main outcome measure was the mediating effect of hardiness between stress and impact level after ED nurses experienced violence. Results: We found that both violence‐related stress (B = 0.22, P < .001) and hardiness (B = –0.33, P = .037) were significant predictors of impact level from a violent event. Based on results of a Sobel test, hardiness partially mediated the relationship between violence‐related stress and impact level from a violent event (Z = 2.03, P = .044). Discussion: Hardiness had an effect on reducing the impact level of ED nurses who had experienced a violent event and had a mediating role in mitigating their stress. Therefore, we recommend the development of an intervention program that emphasizes the improvement of hardiness in ED nurses.

Usefulness of Korean Version of Behavioral Cue Checklist for Predicting of Patient Violence in Emergency Departments

PURPOSE This study aimed to evaluate the usefulness of a behavioral cue checklist (BCC) containing 17 items developed by Wilkes et al. (2010) for identifying potentially violent patients in emergency departments. METHODS This was a prospective observational study to evaluate the usefulness of the Korean version of a BCC (K-BCC) as an assessment tool for predicting patient violence in emergency departments, and was conducted over 4 weeks in a regional emergency medical center located in B City. A total of 1,324 patients were finally analyzed. RESULTS Logistic regression analysis was performed to investigate whether each item of the K-BCC predicts violence, and a parsimonious set of 8 statistically significant items was selected for the tool. Receiver operating characteristic analysis of the BCC showed that the area under the curve was .97 (95% confidence interval: .94~1.0). The sensitivity, specificity, positive predictive value, and negative predictive value at the cut-off score of 2 were 75.6%, 98.9%, 68.2%, and 99.2%, respectively. CONCLUSION The K-BCC was found to be useful in predicting patient violence toward emergency department staff. This tool is simple, and fast to use and can play a significantly role identifying potentially violent patients. Owing to this advance identification, this tool can be helpful in preventing the potential for violence from manifesting as violent behaviors.

Factors Influencing Overactive Bladder Symptom Severity in Community Residents

Purpose: This study was conducted to determine factors that influence overactive bladder (OAB) symptom severity in community residents. Methods: The participants of the study were 115 adults who participated in the health lectures for patients with OAB between March 1 and June 30, 2013. The overactive bladder-questionnaire (OAB-q) was used to assess the OAB symptom severity. Results: The mean score of OAB symptom severity was 35.48 out of 100. Participants showed the highest score of urgency among OAB symptoms. The significant predictors were the monthly income, operation history of urogynecology, and body mass index accounting for 23% of the variance of OAB symptom severity. The OAB symptom severity was higher in subjects who had lower monthly income, urogynecology operation history and higher BMI (>25 kg/m 2 ). Conclusion: The findings of this study demonstrate that it should be considered to recommend weight

A Pilot Study Examining the Effects of 12-week Tai chi Exercise on the Activity of Autonomic Nervous System and Risk Factors of Metabolic Syndrome in Patients with Metabolic Syndrome

A single group pre-posttest was used. Subjects were 16 participants aged 51~71 years with metabolic syndrome. All of the subjects were met the criteria of the National Cholesterol E ducation Program -Adult Treatm ent Panel III (NCEP-AT P III). The Tai Chi ex ercise consisted of 19 movements from Yang and Sun styles provided twice a week for 3 months. Metabolic syndrome risk factors including waist circumference, blood pressure, glucose, triglyceride, high density lipoprotein cholesterol (HDL-cholesterol) were measured. A heart rate variability device was used to measure the activity of autonomic nervous system.