Tracheostomy Following Anterior Cervical Discectomy and Fusion With Plating in Trauma Patients: Is It Safe?

Objective

This study aimed to evaluate the safety and necessity of tracheostomy after anterior cervical discectomy and fusion (ACDF) with plating, despite the close proximity of the two surgical skin incisions.

Methods

Sixty-three patients with traumatic cervical fractures or spinal cord injury (SCI) who underwent single-level ACDF and plating between January 2014 and June 2019 were included in this study. The patients included 45 men and 18 women, with a mean age of 48.5 years. A retrospective analysis of the patients’ demographic data, level of injury, radiological findings, and neurological status was performed based on the American Spinal Injury Association (ASIA), open tracheostomy, and decannulation rate. Additionally, risk factors necessitating tracheostomy were statistically analyzed.

Results

Eighteen patients (28.5%) required subsequent open tracheostomy. Among them, 11 patients were successfully decannulated, four patients could not be decannulated during the follow-up period, and three patients died of unrelated complications. The median interval from ACDF with plating to open tracheostomy was 9.6 days (range, 5–23 days). On the basis of neurological status, ASIA A and B patients (p<0.001), high signal intensity on T2-weighted-magnetic resonance (MR) images (p=0.001), and major cervical fracture and dislocation were significant risk factors for tracheostomy (p=0.02). No patient showed evidence of significant soft tissue, bony infection, or nonunion during the follow-up period.

Conclusion

Independent tracheostomy did not increase the risk of infection or nonunion despite the close proximity of the two surgical skin incisions.

Anterior Approaches for Two-Level Cervical Degenerative Disease: A Comparative Study of at least 6-Year Follow-Up

Objective

To compare the clinical and radiogrincaphic results of a hybrid surgery (HS) and cervical artificial disc replacement (ADR) for contiguous two-level cervical spondylosis.

Methods

A total of 56 patients with contiguous two-level degenerative cervical spondylosis who underwent cervical HS and ADR via an anterior approach and completed at least 6 years of follow-up were included in this study. Patients were divided into two groups: group I, comprising 22 patients who underwent ADR, and group II, comprising 34 patients who underwent HS combined ADR and anterior cervical discectomy and fusion using a cage. Clinical outcomes were evaluated based on the visual analog scale (VAS) scores for arm pain, neck disability index (NDI), and modified MacNab criteria. Radiological parameters were assessed by measuring the bone fusion status, cervical range of motion (ROM C2-C7), heterotopic ossification (HO), adjacent segment disease (ASD) incidence, and fused segment height (FSH).

Results

The VAS scores and NDI significantly improved in both groups, without significant differences between the groups. The incidences of HO, ROM C2-C7, and FSH were similar between groups, without significant differences. New osteophyte formation and osteophyte enlargement at adjacent segments were more frequently found in the HS group; however, the difference was not significant.

Conclusion

Clinical results of this study showed that the clinical efficacy and radiological changes in HS were similar to those of ADR. HS can be an alternative procedure for the treatment of two-level cervical spondylosis.

Formation and Growth of Intermetallic Compounds during Reactions between Liquid Gallium and Solid Nickel

Liquid metals, such as Ga and eutectic Ga-In, have been extensively studied for various applications, including flexible and wearable devices. For applying liquid metal to electronic devices, interconnection with the various metal electrodes currently in use, and verifying their mechanical reliability are essential. Here, detailed investigations of the formation and growth of intermetallic compounds (IMCs) during the reactions between liquid Ga and solid nickel were conducted. Ga and Ni were reacted at 250, 300, and 350 °C for 10-240 min. The IMC double layer observed after the reactions contained a Ga7Ni3 bottom layer formed during the reactions, and a GaxNi top layer (with 89-95 at.% of Ga) precipitated during cooling. Numerous empty channels exist between the rod-type Ga7Ni3 IMCs. Ga7Ni3 growth occurred only in the vertical direction, without lateral coarsening and merging between the rods. The time exponents were measured at 1.1-1.5, implying that the reaction kinetics were near-interface reaction-controlled. The activation energy for Ga7Ni3 growth was determined as 49.1 kJ/mol. The experimental results of the Ga-Ni reaction study are expected to provide important information for incorporating liquid metals into electronic devices in the future.

Nurses' Adaptations in Caring for COVID-19 Patients: A Grounded Theory Study

As the novel coronavirus (COVID-19) pandemic continues, frontline nurses caring for COVID-19 patients are experiencing severe fatigue and mental stress. This study explored nurses' adaptation process in caring for COVID-19 patients and examined how nurses interact with the phenomenon using a grounded theory approach. The study aimed to develop a substantive theory and provide basic data with which to develop intervention programs that can support nurses caring for COVID-19 patients. Data were collected between 7 August and 31 October 2020, via face-to-face in-depth interviews with 23 nurses who had been caring for COVID-19 patients for six months or more at a nationally designated COVID-19 hospital. Sampling was started purposively and continued theoretically. Data analysis, performed using the method proposed by Strauss and Corbin, resulted in 13 main categories, the core one being "growing as a proficient nurse alongside comrades on the COVID-19 frontline". The study's results identify the nurses' adaptation process in caring for COVID-19 patients and their reactions to the circumstances around it. Ensuring that nurses can systematically cope with emerging infectious diseases requires regularly providing them with basic education on caring for patients with such diseases and strengthening professional education in order to develop nurses specializing in them. This study also recommends that a support system for work and childrearing be developed.

Epitaxial Growth of Nanostructured Li2 Se on Lithium Metal for All Solid-State Batteries

Lithium is considered to be the ultimate anode material for high energy-density rechargeable batteries. Recent emerging technologies of all solid-state batteries based on sulfide-based electrolytes raise hope for the practical use of lithium, as it is likely to suppress lithium dendrite growth. However, such devices suffer from undesirable side reactions and a degradation of electrochemical performance. In this work, nanostructured Li2 Se epitaxially grown on Li metal by chemical vapor deposition are investigated as a protective layer. By adjusting reaction time and cooling rate, a morphology of as-prepared Li2 Se is controlled, resulting in nanoparticles, nanorods, or nanowalls with a dominant (220) plane parallel to the (110) plane of the Li metal substrate. Uniaxial pressing the layers under a pressure of 50 MPa for a cell preparation transforms more compact and denser. Dual compatibility of the Li2 Se layers with strong chemical bonds to Li metal and uniform physical contact to a Li6 PS5 Csulfide electrolyte prevents undesirable side reactions and enables a homogeneous charge transfer at the interface upon cycling. As a result, a full cell coupled with a LiCoO2 -based cathode shows significantly enhanced electrochemical performance and demonstrates the practical use of Li anodes with Li2 Se layers for all solid-state battery applications.

The influence of patient-centeredness on patient safety perception among inpatients

PURPOSE

This study investigated the influence of patient-centeredness on patient safety perception among inpatients, with particular focus on the relationships between subfactors of patient-centeredness and patient safety perception.

METHODS

Data were collected from 122 inpatients in a university hospital from September 24 to October 8, 2019. Patient-centeredness was evaluated using the Patient-Centeredness Assessment Scale; patient safety perception was evaluated using the Korean version of the Patient Safety Perception Scale. Multiple linear regression analysis was conducted using SPSS for Windows 24.0.

RESULTS

Average patient-centeredness score among inpatients was 77.14 ± 12.64 (range 0-100), and average patient safety perception score was 99.24 ± 15.90 (range 24-120). Patient-centeredness influenced patient safety perception (R2 = 70%, F = 27.75, p < .001). With respect to subfactors of patient safety perception, the medical team's activities to ensure safety was affected by the general treatment process and overall evaluation of patient-centeredness (R2 = 54%, F = 13.14, p < .001); patient safety practice was influenced only by the general treatment process (R2 = 39%, F = 7.02, p < .001); and trust in the medical system was affected by nurses' service, the general treatment process, and the hospital environment (R2 = 44%, F = 8.49, p < .001).

CONCLUSIONS

To enhance patient safety perception, strategies should seek to strengthen patient-centeredness and its related subfactors, particularly the general treatment process, the hospital environment, and nurses' service.

Impact of blended learning on learning outcomes in the public healthcare education course: a review of flipped classroom with team-based learning

BACKGROUND

A flipped classroom with team-based learning is a blended educational strategy that guides active learning inside and outside the classroom. This study aimed to verify the effects of this innovative blended educational strategy on knowledge, problem-solving ability, and learning satisfaction of undergraduate nursing students undergoing public healthcare education.

METHODS

The subjects were undergraduate nursing students enrolled in H University in South Korea. The experiment was conducted over a period of 8 weeks in the public healthcare course. Two groups, blended learning (A flipped classroom with team-based learning) which was the experimental group and traditional lecture-based classroom group, the control group, were assessed. In the blended learning group, the students had pre-class, in-class (including team-based learning elements), and post-class learning elements. The two groups were compared on the following learning outcomes: knowledge, problem-solving ability, and learning satisfaction.

RESULTS

Results showed that the blended learning instructional methods, in comparison with traditional lectures, enhanced the students' knowledge, problem-solving ability, and learning satisfaction in the public healthcare course.

CONCLUSIONS

This study supports the feasibility of the flipped classroom with team-based learning as a blended learning strategy, able to produce improvements in nursing students' learning outcomes. Blended learning approaches may be an effective alternative to conventional approaches in nursing education.

Usefulness of Nested Polymerase Chain Reaction with Clinical Specimens for Diagnosis of Leptospirosis: a Case Series and a Review of Literature

A culture of the Leptospira species and the microscopic agglutination test (MAT) are considered as the reference standard for the diagnosis of leptospirosis, but both tests are imperfect for early diagnosis. We describe 4 patients diagnosed with leptospirosis using nested polymerase chain reaction (N-PCR) that targeted the 16S rRNA gene and the passive hemagglutination assay (PHA). In our 4 cases, Leptospira DNA in the urine, plasma, or cerebrospinal fluid (CSF), was detected by N-PCR in the early phase of leptospirosis, except in the sample from the buffy coat. Especially, case 3 showed that N-PCR with the urine and CSF was positive 8 days after symptom onset, but not for the plasma or buffy coat. We report 4 cases of leptospirosis that were diagnosed by N-PCR that targeted the 16S rRNA gene with urine, plasma, or CSF, but not the buffy coat. Three were cured by doxycycline but the case 4 was fatal. Detection of Leptospira DNA by PCR from the urine and CSF, in addition to plasma, may be helpful to confirm the diagnosis.

A moderated mediation analysis of occupational stress, presenteeism, and turnover intention among occupational therapists in Korea

OBJECTIVES

Presenteeism is undoubtedly a widespread phenomenon in organizations. Research on presenteeism has been conducted for decades in the broader workforce (eg, nurses, doctors, teachers, police officers). Occupational stress and turnover intention in occupational therapy have been extensively studied. However, the effect of presenteeism on the relationship between occupational stress and resultant turnover intention among occupational therapists is unclear. This study aims to explore the mediating effect of presenteeism and moderating effect of perceived organizational support in the relationship between occupational stress and turnover intention among occupational therapists in Korea.

METHODS

We conducted an individual and cross-sectional analysis of 257 occupational therapists from various health care institutions in Korea. Data were collected and hypotheses were tested via Process macro. Quantitative analyses were conducted with SPSS 26 and LISREL 8.54.

RESULTS

Occupational stress was strongly related to presenteeism, which in turn predicted turnover intention. Presenteeism played a mediating role between occupational stress and turnover intention. Moreover, occupational therapists' perception of organizational support acted as an important mechanism through which presenteeism mediated the relationship between occupational stress and turnover intention.

CONCLUSIONS

This study highlights the need to maximize employee productivity and retain talent by providing managers with insight into the mechanism of presenteeism in relation to occupational stress and turnover intention among occupational therapists in Korea.

Clinical nurses' beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture

BACKGROUND

This study aimed to identify clinical nurses' evidence-based practice (EBP) knowledge, beliefs, organizational readiness, and EBP implementation levels, and to determine the factors that affect EBP implementation in order to successfully establish EBP. This study was conducted at a university-affiliated tertiary hospital located in a provincial area in Korea. The research design was based on Melnyk and Fineout-Overholt's Advancing Research & Clinical Practice through Close Collaboration model as the first step.

METHODS

A descriptive and cross-sectional design was conducted and a convenience sample of 521 full-time registered nurses from an 849-bed tertiary hospital were included. Structured questionnaires were used to assess EBP knowledge, EBP beliefs, organizational culture & readiness and EBP implementation. Data were analyzed using SPSS V 25.0 by using descriptive and inferential statistics and hierarchical multiple regression was performed to determine the factors affecting the implementation of EBP.

RESULTS

Our findings showed that the clinical nurses had a positive level of EBP beliefs, but the level of EBP knowledge, organizational readiness and EBP implementation were insufficient. EBP knowledge, beliefs, and organizational readiness were significantly positively correlated with EBP implementation. In the final model, EBP knowledge and organizational readiness were significant predictors of EBP implementation; the model predicted 22.2% of the variance in implementation.

CONCLUSIONS

Based on these results, the main focus of the study was the importance of individual nurses' efforts in carrying out EBP, but above all efforts to create an organizational culture to prepare and support EBP at the nursing organization level. In the initial process of introducing and establishing EBP, nurse administrators will need to minimize expected barriers, enhance facilitators, and strive to build an infrastructure based on vision, policy-making, budgeting, excellent personnel and facilities within the organization.

SPME-GC/MS Analysis of Methanol in Biospecimen by Derivatization with Pyran Compound

Methanol is metabolized in the body to highly toxic formaldehyde and formate when consumed accidentally. Methanol has been typically analyzed with gas chromatography-flame ionization detector (GC-FID). However, its retention time may overlap with other volatile compounds and lead to confusion. Alternative analysis of methanol using gas chromatography/mass spectrometry (GC/MS) also has limitations due to its similar molecular weight with oxygen and low boiling point. In this study, methanol and internal standard of deuterium-substituted ethanol were derivatized with 3,4-dihydro-2H-pyran under acid catalysis using concentrated hydrochloric acid. The reaction products including 2-methoxytetrahydropyran were extracted with solid-phase microextraction followed by GC/MS analysis. This method was successfully applied to measure the lethal concentration of methanol in the blood of a victim with a standard addition method to overcome the complex matrix effect of the biospecimen. Identification of the metabolite formate by ion chromatography confirmed the death cause to be methanol poisoning. This new method was a much more convenient and reliable process to measure methanol in complex matrix samples by reducing sample pretreatment effort and cost.

Heat Shock Factor 1 Predicts Poor Prognosis of Gastric Cancer

PURPOSE

Heat shock factor 1 (HSF1) is a key regulator of the heat shock response and plays an important role in various cancers. However, the role of HSF1 in gastric cancer is still unknown. The present study evaluated the function of HSF1 and related mechanisms in gastric cancer.

MATERIALS AND METHODS

The expression levels of HSF1 in normal and gastric cancer tissues were compared using cDNA microarray data from the NCBI Gene Expression Omnibus (GEO) dataset. The proliferation of gastric cancer cells was analyzed using the WST assay. Transwell migration and invasion assays were used to evaluate the migration and invasion abilities of gastric cancer cells. Protein levels of HSF1 were analyzed using immunohistochemical staining of tissue microarrays from patients with gastric cancer.

RESULTS

HSF1 expression was significantly higher in gastric cancer tissue than in normal tissue. Knockdown of HSF1 reduced the proliferation, migration, and invasion of gastric cancer cells, while HSF1 overexpression promoted proliferation, migration, and invasion of gastric cancer cells. Furthermore, HSF1 promoted the proliferation of gastric cancer cells in vivo. In Kaplan-Meier analysis, high levels of HSF1 were associated with poor prognosis for patients with gastric cancer (p=0.028).

CONCLUSION

HSF1 may be closely associated with the proliferation and motility of gastric cancer cells and poor prognosis of patients with gastric cancer. Accordingly, HSF1 could serve as a prognostic marker for gastric cancer.

Cancer screening in Koreans: a focus group approach

BACKGROUND

Cancer is the greatest disease burden in Korea. Cancer screening can reduce the burden of cancer but cancer screening rates among Koreans remain low. The purposes of this study were to a) understand Koreans' beliefs and knowledge about cancer screening, and b) explore preferred strategies for increasing cancer screening utilization.

METHODS

We conducted a descriptive, qualitative study using eight face-to-face focus groups with a total of 64 Koreans aged 40 and over. Participants answered semi-structured, open-ended questions assessing their experiences with, and beliefs, knowledge, and opinions about, cancer screening. All interview data were recorded and analyzed in the context of the health belief model (HBM).

RESULTS

The most important themes that emerged from the focus group data were (a) perceived susceptibility (most of the participants believed they were not susceptible to cancer; those who perceived themselves susceptible to cancer were reluctant to express it); (b) perceived benefits (early detection and feelings of relief after cancer screening were benefits; participants had screening because they wanted to take advantage of the Korean government's Medical Payment Support program for cancer patients who have participated in the National Cancer Screening program); (c) perceived barriers (no symptoms; self-care when having symptoms; widespread distrust of tests, doctors, and hospitals; unkind health care providers; the financial burdens of advanced cancer screening tests; and the discomfort during cancer screening); and (d) knowledge of the causes of cancer (incorrect knowledge including beliefs that stress, personality, and body overuse cause cancer). Almost all of the participants were very knowledgeable about the seriousness of cancer and were confident that they were able to have cancer screening. Participants preferred strategies of cancer screening using group interventions with family or friends; various information delivery methods; information emphasizing the importance of cancer prevention; convenient, free, or inexpensive services; and kind health care providers.

CONCLUSIONS

This HBM-based research suggests that beliefs in low susceptibility to cancer, many barriers to cancer screening, and incorrect knowledge should be the foci for increasing cancer screening rates in Koreans. Interventions could change individual cultural beliefs and increase knowledge as well as the quality of health care for Koreans.