The purpose of this study was to develop predictive models for pressure ulcer incidence using electronic health record (EHR) data and to compare their predictive validity performance indicators with that of the Braden Scale used in the study hospital.
A retrospective case-control study was conducted in a tertiary teaching hospital in Korea. Data of 202 pressure ulcer patients and 14,705 non-pressure ulcer patients admitted between January 2015 and May 2016 were extracted from the EHRs. Three predictive models for pressure ulcer incidence were developed using logistic regression, Cox proportional hazards regression, and decision tree modeling. The predictive validity performance indicators of the three models were compared with those of the Braden Scale.
The logistic regression model was most efficient with a high area under the receiver operating characteristics curve (AUC) estimate of 0.97, followed by the decision tree model (AUC 0.95), Cox proportional hazards regression model (AUC 0.95), and the Braden Scale (AUC 0.82). Decreased mobility was the most significant factor in the logistic regression and Cox proportional hazards models, and the endotracheal tube was the most important factor in the decision tree model.
Predictive validity performance indicators of the Braden Scale were lower than those of the logistic regression, Cox proportional hazards regression, and decision tree models. The models developed in this study can be used to develop a clinical decision support system that automatically assesses risk for pressure ulcers to aid nurses.
The aim of this study was to explore characteristics of and risk factors for accidental inpatient falls.
Participants were classified as fallers or non-fallers based on the fall history of inpatients in a tertiary hospital in Seoul between June 2014 and May 2015. Data on falls were obtained from the fall report forms and data on risk factors were obtained from the electronic nursing records. Characteristics of fallers and non-fallers were analyzed using descriptive statistics. Risk factors for falls were identified using univariate analyses and logistic regression analysis.
Average length of stay prior to the fall was 21.52 days and average age of fallers was 61.37 years. Most falls occurred during the night shifts and in the bedroom and were due to sudden leg weakness during ambulation. It was found that gender, BMI, physical problems such elimination, gait, vision and hearing and medications such as sleeping pills, antiarrhythmics, vasodilators, and muscle relaxant were statistically significant factors affecting falls.
The findings show that there are significant risk factors such as BMI and history of surgery which are not part of fall assessment tools. There are also items on fall assessment tools which are not found to be significant such as mental status, emotional unstability, dizziness, and impairment of urination. Therefore, these various risk factors should be examined in the fall risk assessments and these risk factors should be considered in the development of fall assessment tools.
The purpose of this study was to determine whether walking exercise improved physical function in elderly people using meta-analysis.
Medical and nursing literature databases were searched to identify the studies on the effectiveness of walking exercise on physical function. In the databases, there were 16 articles reporting 21 interventions. Overall effect sizes for three outcome variables, elders' physical function in lower limb muscle endurance, whole body endurance and upper body flexibility, were calculated. Effects of study characteristics on outcome variables were analyzed.
The meta-analysis showed that walking exercise generally had positive effects on CST (chair stand test), 6MW (6 min walking), and SRT (standing or sitting reach test) with overall weighted effect sizes of 1.06, 0.41 and 0.29 respectively. This study also showed that the chronic disease status of the elders, intervention methods, and type of residence had different effects on CST, 6MW and SRT.
The results indicate that walking exercise improves physical function in elders. Walking exercise which can be done at any time and any location is indeed a very effective exercise for elderly people.
The purpose of this article is twofold: 1) introducing logistic regression (LR), a multivariable method for modeling the relationship between multiple independent variables and a categorical dependent variable, and 2) examining use and reporting of LR in the nursing literature.
Text books on LR and research articles employing LR as main statistical analysis were reviewed. Twenty-three articles published between 2010 and 2011 in the Journal of Korean Academy of Nursing were analyzed for proper use and reporting of LR models.
Logistic regression from basic concepts such as odds, odds ratio, logit transformation and logistic curve, assumption, fitting, reporting and interpreting to cautions were presented. Substantial shortcomings were found in both use of LR and reporting of results. For many studies, sample size was not sufficiently large to call into question the accuracy of the regression model. Additionally, only one study reported validation analysis.
Nursing researchers need to pay greater attention to guidelines concerning the use and reporting of LR models.
This study was conducted to develop and evaluate a web-based education program for secondary stroke prevention.
A web-based secondary stroke prevention education program was developed using the system's life cycle methods and evaluated by comparing the effects of education among three groups, a web group, a booklet group and a control group.
Knowledge level of both patients and family, as well as some health behavior compliance in the web-based and booklet education groups were significantly higher than those of the control group. Family support in the web-based and booklet education groups was significantly higher than that of the control group after 12 weeks. The urine cotinine level in the web-based education group was significantly lower than that of the control group after 12 weeks. Medication adherence, blood pressure and perceived health status were not statistically different among the three groups at any time.
Web-based and booklet education programs were equally effective regarding the level of knowledge of patients and their families, family support, health behavior compliance, and urine cotinine level. These results demonstrate the potential use of a web-based education program for secondary stroke prevention.