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Purpose@#Providing continuous self-care support to the growing diabetes population is challenging. Strategies are needed to enhance engagement in self-care, utilizing innovative technologies for personalized feedback. This study aimed to assess the feasibility of the Automated Personalized Self-Care program among type 2 diabetes patients and evaluate its preliminary effectiveness. @*Methods@#A parallel randomized pilot trial with qualitative interviews occurred from May 3, 2022, to September 27, 2022. Participants aged 40e69 years with type 2 diabetes and HbA1c ! 7.0% were recruited. The three-month program involved automated personalized goal setting, education, monitoring, and feedback. Feasibility was measured by participants' engagement and intervention usability. Preliminary effectiveness was examined through self-care self-efficacy, self-care behaviors, and health outcomes. Qualitative interviews were conducted with the intervention group. @*Results@#A total of 404 patients were screened. Out of the 61 eligible patients, 32 were enrolled, resulting in a recruitment rate of 52.5%. Retention rates at three months were 84.2% and 84.6% in the intervention and control groups, respectively. Among the intervention group, 81.3% satisfied adherence criteria.Mobile application's usability scored 66.25, and participants' satisfaction was 8.06. Intention-to-treat analysis showed improvements in self-measured blood glucose testing, grain intake, and HbA1c in the intervention group. Qualitative content analysis identified nine themes. @*Conclusion@#Feasibility of the program was verified. A larger randomized controlled trial is needed to determine its effectiveness in self-care self-efficacy, self-care behaviors, and health outcomes among type 2 diabetes patients. This study offers insights for optimizing future trials assessing clinical effectiveness.

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Purpose@#This study aimed to investigate the influence of uncertainty-related factors on the health behavior of individuals with coronary artery disease (CAD) based on Mishel’s uncertainty in illness theory (UIT). @*Methods@#We conducted a cross-sectional study and path analysis to investigate uncertainty and factors related to health behavior. The study participants were 228 CAD patients who visited the outpatient cardiology department between September 2020 and June 2021. We used SPSS 25.0 and AMOS 25.0 software to analyze the data. @*Results@#The final model demonstrated a good fit with the data. Eleven of the twelve paths were significant. Uncertainty positively affected danger and negatively affected self-efficacy and opportunity. Danger had a positive effect on perceived risk. Opportunity positively affected social support, self-efficacy, perceived benefit and intention, whereas it negatively affected perceived risk. Social support, self-efficacy, perceived benefit and intention had a positive effect on health behavior. We found that perceived benefit and intention had the most significant direct effects, whereas self-efficacy indirectly affected the relationship between uncertainty and health behavior. @*Conclusion@#The path model is suitable for predicting the health behavior of CAD patients who experience uncertainty. When patients experience uncertainty, interventions to increase their self-efficacy are required first. Additionally, we need to develop programs that quickly shift to appraisal uncertainty as an opportunity, increase perceived benefits of health behavior, and improve intentions.

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Purpose@#This study aimed to identify the factors influencing job satisfaction among nurses working in integrated nursing care wards. @*Methods@#The study participants were 196 nurses working in integrated nursing care wards at four general hospitals and one tertiary hospital. Data were collected using structured questionnaires from April 11 to 25, 2022, through an online survey. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson correlation, and stepwise multiple regression with SPSS/WIN 26.0. @*Results@#The factors influencing job satisfaction of participants were team structure (β=.32, p<.001), role conflict regarding nursing practice (β=-.24, p<.001), mutual support (β=.23, p<.001), master's degree or higher(β=.16, p=.004), and spousal presence (β=.15, p=.005). @*Conclusion@#The findings of this study suggest that the tasks and roles of team members should be clarified, and a supportive team culture of mutual cooperation should be fostered to improve the job satisfaction of nurses working in the integrated nursing ward. In addition, it is necessary to reduce role conflict by providing support focused on allocating tasks that can strengthen the role of professional nurses.

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Purpose@#The purpose of this study was to develop and compare the prediction model for suicide attempts by Korean adolescents using logistic regression and decision tree analysis. Methods: This study utilized secondary data drawn from the 2019 Youth Health Risk Behavior web-based survey. A total of 20 items were selected as the explanatory variables (5 of sociodemographic characteristics, 10 of health-related behaviors, and 5 of psychosocial characteristics). For data analysis, descriptive statistics and logistic regression with complex samples and decision tree analysis were performed using IBM SPSS ver. 25.0 and Stata ver. 16.0. @*Results@#A total of 1,731 participants (3.0%) out of 57,303 responded that they had attempted suicide. The most significant predictors of suicide attempts as determined using the logistic regression model were experience of sadness and hopelessness, substance abuse, and violent victimization. Girls who have experience of sadness and hopelessness, and experience of substance abuse have been identified as the most vulnerable group in suicide attempts in the decision tree model. @*Conclusion@#Experiences of sadness and hopelessness, experiences of substance abuse, and experiences of violent victimization are the common major predictors of suicide attempts in both logistic regression and decision tree models, and the predict rates of both models were similar. We suggest to provide programs considering combination of high-risk predictors for adolescents to prevent suicide attempt.

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PURPOSE: This study was done to examine good death awareness, attitudes toward advance directives (ADs), and preference for care near the end-of-life (PCEOL) of hospitalized elders in long-term care hospitals. Relevant characteristics were investigated as well as correlation of the variables. METHODS: This descriptive research study involved 161 hospitalized elderly patients in long-term care hospitals. A self-report questionnaire was used to measure Good Death Scale, ADs Survey, PCEOL Scale, and general characteristics. Collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation with SPSS/WIN 23.0. RESULTS: In terms of good death awareness, a significant difference was observed; in according to age (F=3.35, p=.037), payer of treatment costs (F=3.98, p=.021), mobility (F=3.97, p=.021), heard discussion about ADs (t=−3.89, p<.001), and willing to complete ADs (t=2.12, p=.036). As far as attitudes toward ADs, the participants presented significant difference depending on religion (t=2.38, p=.018), average monthly income (F=3.91, p=.022), duration of hospital admission (F=5.33, p=.006), person to discuss ADs (t=−2.76, p=.006). On PCEOL, there was a significant difference, depending on religion (t=−3.59, p<.001) and perceived health status (F=3.93, p=.022). Finally, as for how the variables were related to each other, good death awareness and attitudes toward ADs had a weak positive correlation with PCEOL. CONCLUSION: To help seniors staying in nursing homes face a good death and enjoy autonomy, there should be educational and support systems that reflect each individual's sociodemographic characteristics so that the seniors can choose what kind of care they want to receive near the end-of-life.

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Familial hyperekplexia, also called startle disease, is a rare neurological disorder characterized by excessive startle responses to noise or touch. It can be associated with serious injury from frequent falls, apnea spells, and aspiration pneumonia. Familial hyperekplexia has a heterogeneous genetic background with several identified causative genes; it demonstrates both dominant and recessive inheritance in the α1 subunit of the glycine receptor (GLRA1), the β subunit of the glycine receptor and the presynaptic sodium and chloride-dependent glycine transporter 2 genes. Clonazepam is an effective medical treatment for hyperekplexia. Here, we report genetically confirmed familial hyperekplexia patients presenting early adult cautious gait. Additionally, we review clinical features, mode of inheritance, ethnicity and the types and locations of mutations of previously reported hyperekplexia cases with a GLRA1 gene mutation.

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Dystonia has a wide range of causes, but treatment of dystonia is limited to minimizing the symptoms as there is yet no successful treatment for its cause. One of the optimal treatment methods for dystonia is chemodenervation using botulinum toxin type A (BTX-A), alcohol injection, etc., but its success depends on how precisely the dystonic muscle is selected. Here, we reported a successful experience in a 49-year-old post-stroke female patient who showed paroxysmal repetitive contractions involving the right leg, which may be of dystonic nature. BTX-A and alcohol were injected into the muscles which were identified by dynamic polyelectromyography. After injection, the dystonic muscle spasm, cramping pain, and the range of motion of the affected lower limb improved markedly, and she was able to walk independently indoors. In such a case, dynamic polyelectromyography may be a useful method for selecting the dominant dystonic muscles.

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Dystonia has a wide range of causes, but treatment of dystonia is limited to minimizing the symptoms as there is yet no successful treatment for its cause. One of the optimal treatment methods for dystonia is chemodenervation using botulinum toxin type A (BTX-A), alcohol injection, etc., but its success depends on how precisely the dystonic muscle is selected. Here, we reported a successful experience in a 49-year-old post-stroke female patient who showed paroxysmal repetitive contractions involving the right leg, which may be of dystonic nature. BTX-A and alcohol were injected into the muscles which were identified by dynamic polyelectromyography. After injection, the dystonic muscle spasm, cramping pain, and the range of motion of the affected lower limb improved markedly, and she was able to walk independently indoors. In such a case, dynamic polyelectromyography may be a useful method for selecting the dominant dystonic muscles.

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PURPOSE: The purpose of this study was to examine factors influencing resilience in breast cancer patients. METHODS: The data were collected using structured questionnaires from 106 breast cancer patients who are members of a self-help group. The data were analyzed using descriptive statistics, a t-test, ANOVA, Pearson correlation coefficients and stepwise multiple regression in SPSS WIN version 21.0. RESULTS: Resilience was significantly negatively correlated to depression and positively correlated to hope and family support. However, resilience was not significantly correlated to anxiety. In the regression analysis, factors influencing resilience were reported as hope, religion, lymph node metastasis, surgery side, and time since surgery, which explained 34.1% of the variation. CONCLUSION: The resilience scores of women with breast cancer were higher when depression was lower, hope was higher, and greater family support. This means that reducing depression and increasing hope and family support are necessary when developing and implementing nursing interventions. The results of this study also show the importance of hope in explaining resilience in patients with breast cancer. Therefore, nurses should focus on encouraging hope when they develop programs in order to implement more effective interventions to improve breast cancer patients' resilience.

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BACKGROUND: The safety of repeated mechanical thrombectomy within the acute stroke period has not yet been clearly demonstrated. We describe herein a patient who was successfully treated with repeated mechanical thrombectomy within the acute index stroke period. CASE REPORT: A 50-year-old woman with atrial fibrillation presented with left-sided weakness caused by occlusion of the right middle cerebral artery (MCA). Emergent mechanical thrombectomy with the Solitaire device achieved complete recanalization. The left MCA occlusion redeveloped at 6 days after the first treatment, at which time her international normalized ratio (INR) was 2.3. Endovascular thrombectomy was reattempted rapidly and complete recanalization was achieved again. Her neurologic symptoms resolved after the thrombectomy. CONCLUSIONS: This case demonstrates that repeated mechanical thrombectomy can be safely and successfully performed even in a patient with a high INR and a recurrent stroke during the acute period after the index stroke.

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Five patients with favorable outcomes after a shunt operation in normal pressure hydrocephalus were analyzed with the aim of identifying consistent findings in a lumbar puncture (LP) test. The cases commonly showed improvement in at least one cognition and two gait LP parameters. We suggest that when judging the effects of LP on a shunt operation, the gait parameters need to be tailored to the gait status and the analyzed LP parameters should be evaluated at least twice at different times.

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Takotsubo cardiomyopathy is a reversible cardiac syndrome that occurs subsequently to other medical illnesses such as cerebral hemorrhage, shock, or seizure disorders that are presumed to disturb autonomic regulation. This syndrome is characterized by chest pain, dyspnea, and electrocardiographic changes mimicking an acute coronary syndrome. Mild elevation of cardiac enzymes and transient wall-motion abnormalities of apical akinesia can appear. However, takotsubo cardiomyopathy following epilepsy is not well recognized. We report two cases of takotsubo-cardiomyopathy-related idiopathic status epilepticus presenting with cardiogenic shock.

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BACKGROUND: Nocturnal muscle cramps are sudden, involuntary, painful muscle contractions that occur in the night and are accompanied by hardening of the muscles. Many symptomatic treatments have been introduced for nocturnal muscle cramps, such as quinine, magnesium, and phenytoin. However, the efficacy and safety of these drugs have not been adequately evaluated. To demonstrate the efficacy and safety of phenytoin treatment for nocturnal muscle cramps, we conducted a retrospective study of 16 patients with nocturnal muscle cramps. METHODS: We reviewed 16 patients (6 men, 10 women) who suffered frequent nocturnal muscle cramps and were treated with phenytoin. The patients' clinical information (age, sex, disease duration, and locations of cramps), treatment dosage, and frequency of cramps were obtained by reviewing their medical records. RESULTS: The patients were aged 63.1+/-14.7 years (mean+/-SD; age range, 30-80 years; median age, 68 years). Twelve and four patients received phenytoin doses of 100 and 200 mg/day, respectively. The median duration of medication was 51 days (range, 14-378 days). Phenytoin treatment was effective in all patients; 13 patients (81.3%) experienced a total remission of their symptoms, and a significant reduction (66.7-85.7%) in the frequency of cramps was found in the remaining 3 patients. No adverse effects were reported by any of the patients. CONCLUSIONS: While this retrospective study was conducted with only a small number of patients, the clinical results suggest that phenytoin is a safe and helpful therapy for the treatment of nocturnal muscle cramps.

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Data analysis processes in scientific applications can be expressed as coarse-grain workflows of complex data processing operations with data flow dependencies between them. Performance optimization of these workflows can be viewed as a search for a set of optimal values in a multidimensional parameter space consisting of input performance parameters to the applications that are known to affect their execution times. While some performance parameters such as grouping of workflow components and their mapping to machines do not affect the accuracy of the analysis, others may dictate trading the output quality of individual components (and of the whole workflow) for performance. This paper describes an integrated framework which is capable of supporting performance optimizations along multiple such parameters. Using two real-world applications in the spatial, multidimensional data analysis domain, we present an experimental evaluation of the proposed framework.