Treatment of advanced urogenital cancers with immune checkpoint inhibitors

The development of immune checkpoint inhibitors has improved the long-term survival of patients with several types of cancers, including bladder and renal cell carcinomas. Atezolizumab, an anti-programmed death-ligand 1 monoclonal antibody, became the first immune checkpoint inhibitor to receive the US Food and Drug Administration approval for the treatment of advanced bladder cancer in 2016. Four additional immune checkpoint inhibitors have shown a durable efficacy and have been approved for the treatment of metastatic bladder cancers with progressive disease after treatment with platinum-containing chemotherapy. Currently, trials are exploring the effectiveness of these immune checkpoint inhibitors for first-line or perioperative cancer treatments. The treatment paradigm for advanced and metastatic renal cell carcinomas has also evolved rapidly since the introduction of immune checkpoint inhibitors. Various combinations with immune checkpoint inhibitors, such as nivolumab plus ipilimumab and pembrolizumab plus axitinib, have shown better efficacy than the treatment with sunitinib as first-line treatment for metastatic renal cell carcinoma. The challenges include the development of biomarkers to guide the selection of optimal patients to receive the therapies, the optimization of the sequences of immune checkpoint inhibitors, and the determination of more effective combinations with immune checkpoint inhibitors.

Analysis of the Status of Nursing Shifts and Nurses’ Perceptions of Work Schedules in General Wards Based on the Government Guidelines for Night Shift Work / 임상간호연구

Purpose@#To analyze nurses’ shift work according to the government guidelines for night work and their perceptions of their work schedules. @*Methods@#The study sample included 487 nurses who provided information on their schedules, including the normal working hours of each shift, and overtime per shift during September 2020. Nurses’ perceptions were measured in terms of satisfaction, appropriateness for work-life balance, and fairness to their work schedule. @*Results@#One-third of the respondents worked more than 40 hours per week. The average overtime hour was 1.14 hours per shift. Unsocial hours (8 pm to 6 am on weekdays, midnight to midnight on weekends and public holidays) accounted for 56.4% of all working hours. During their last night shift, on average, nurses worked 9.62 hours and had a break of 39 minutes, although 20.5% reported no break. Sixty-eight percent of nurses had at least one between-shift break shorter than 48 hours after a consecutive night shifts. Fifty-seven percent were satisfied with their schedule. One-third perceived their schedule as appropriate for work-life balance, and two-thirds perceived that days off on weekends and nights were fairly distributed within the unit. Working and overtime hours had an inverse relationship with all three aspects of nurses’ perceptions. A higher proportion of unsocial hours and having no breaks during the night shift were associated with lower perceptions of fairness. @*Conclusion@#Reducing working hours, ensuring breaks during night shifts, and increasing rewards for unsocial hours are required to improve nurses’ perceptions and reduce turnover due to shift work.

Treatment of advanced urogenital cancers with immune checkpoint inhibitors

The development of immune checkpoint inhibitors has improved the long-term survival of patients with several types of cancers, including bladder and renal cell carcinomas. Atezolizumab, an anti-programmed death-ligand 1 monoclonal antibody, became the first immune checkpoint inhibitor to receive the US Food and Drug Administration approval for the treatment of advanced bladder cancer in 2016. Four additional immune checkpoint inhibitors have shown a durable efficacy and have been approved for the treatment of metastatic bladder cancers with progressive disease after treatment with platinum-containing chemotherapy. Currently, trials are exploring the effectiveness of these immune checkpoint inhibitors for first-line or perioperative cancer treatments. The treatment paradigm for advanced and metastatic renal cell carcinomas has also evolved rapidly since the introduction of immune checkpoint inhibitors. Various combinations with immune checkpoint inhibitors, such as nivolumab plus ipilimumab and pembrolizumab plus axitinib, have shown better efficacy than the treatment with sunitinib as first-line treatment for metastatic renal cell carcinoma. The challenges include the development of biomarkers to guide the selection of optimal patients to receive the therapies, the optimization of the sequences of immune checkpoint inhibitors, and the determination of more effective combinations with immune checkpoint inhibitors.

Analysis of the Status of Nursing Shifts and Nurses’ Perceptions of Work Schedules in General Wards Based on the Government Guidelines for Night Shift Work / 임상간호연구

Purpose@#To analyze nurses’ shift work according to the government guidelines for night work and their perceptions of their work schedules. @*Methods@#The study sample included 487 nurses who provided information on their schedules, including the normal working hours of each shift, and overtime per shift during September 2020. Nurses’ perceptions were measured in terms of satisfaction, appropriateness for work-life balance, and fairness to their work schedule. @*Results@#One-third of the respondents worked more than 40 hours per week. The average overtime hour was 1.14 hours per shift. Unsocial hours (8 pm to 6 am on weekdays, midnight to midnight on weekends and public holidays) accounted for 56.4% of all working hours. During their last night shift, on average, nurses worked 9.62 hours and had a break of 39 minutes, although 20.5% reported no break. Sixty-eight percent of nurses had at least one between-shift break shorter than 48 hours after a consecutive night shifts. Fifty-seven percent were satisfied with their schedule. One-third perceived their schedule as appropriate for work-life balance, and two-thirds perceived that days off on weekends and nights were fairly distributed within the unit. Working and overtime hours had an inverse relationship with all three aspects of nurses’ perceptions. A higher proportion of unsocial hours and having no breaks during the night shift were associated with lower perceptions of fairness. @*Conclusion@#Reducing working hours, ensuring breaks during night shifts, and increasing rewards for unsocial hours are required to improve nurses’ perceptions and reduce turnover due to shift work.

Nursing Hours and Nurse Staffing according to Korean Triage Acuity Scale and Patient Dependency / 임상간호연구

Purpose@#The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. @*Methods@#The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. @*Results@#Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. @*Conclusion@#Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.

Nurses' Job Analysis in a Regional Emergency Center Using the DACUM / 임상간호연구

Purpose@#This study aimed to establish the role of and to analyze the job of nurses in a regional emergency center using the Developing a Curriculum(DACUM) process, a job analysis technique. @*Methods@#The DACUM committee was organized, and three workshops were held from June 1st to July 4th, 2016. One hundred two nurses in a regional emergency center participated in a survey from October 3rd to 10th, 2016. The frequency, importance and difficulty of each tasks and task elements in the DACUM were investigated on a Likert scale. @*Results@#The roles of nurses in a regional emergency center were identified and the DACUM chart was developed with 6 duties, 29 tasks and 153 task elements. According to the survey, some tasks such as ‘CPR,’ ‘acute respiratory distress care,’ and ‘drug administration’ showed high frequency and importance or difficulty in all nursing units in common, and different results reflected the characteristics of each nursing unit were also found. @*Conclusion@#The results showed the feature of the regional emergency center. Based on these results, it is necessary to develop educational programs for practice.

Nursing Hours and Nurse Staffing according to Korean Triage Acuity Scale and Patient Dependency / 임상간호연구

Purpose@#The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. @*Methods@#The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. @*Results@#Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. @*Conclusion@#Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.

A Comparative Study of Suicide Rates among 10–19-Year-Olds in 29 OECD Countries

OBJECTIVE: This study had two main objectives: to compare current suicide rates in OECD countries among 10–19-year-olds and to identify patterns of suicide rates based on age, gender and time. Furthermore we investigated the main dimensions that contributed to the variation in child and adolescent suicide rates across countries. METHODS: We combined the WHO mortality data and the population data released by OECD to calculate the suicide rates in 29 OECD countries. A self-organizing map (SOM), k-means clustering analysis, and multi-dimensional scaling were used to classify countries based on similarities in suicide rate structure and to identify the important dimensions accounting for differences among groups. RESULTS: We identified significant differences in suicide rates depending on age, sex, country, and time period. Late adolescence and male gender were universal risk factors for suicide, and we observed a general trend of declining suicide rates in OECD countries. The SOM analysis yielded eight types of countries. Most countries showed gender gaps in suicide rates of similar magnitudes; however, there were outliers in which the gender gap was particularly large or small. CONCLUSION: Significant variation exists with respect to suicide rates and their associated gender gaps in OECD countries.

Actor and Partner Effects of Health Status, Marital Satisfaction and Self Efficacy on Retirement Preparation of Middle Aged Couples: Actor-Partner Interdependence Model Analysis

PURPOSE: This study aimed to identify the actor and partner effects of health status, marital satisfaction, and self efficacy on retirement preparation in middle aged couples using the Actor-Partner Interdependence Model. METHODS: Participants were 121 middle aged couples living in Seoul, Gyeonggi-do and Daegu City, Korea. All measures were self-administered. The collected data were analyzed using SPSS 20.0 and AMOS 20.0. RESULTS: 1) Wife's self efficacy and marital satisfaction showed direct actor and partner effects on retirement preparation in middle aged couples. Wife's health status showed an indirect actor effect through wife's self efficacy and marital satisfaction on wife's retirement preparation, and showed an indirect partner effect through husband's self efficacy on husband's retirement preparation. 2) Husband's self efficacy and marital satisfaction showed only direct actor effect on retirement preparation. Health status among the husbands showed an indirect actor effect on husband's retirement preparation through their self efficacy and marital satisfaction, and an indirect partner effect through wife's marital satisfaction on wife's retirement preparation. 3) The actor effect size of health status on self efficacy and marital satisfaction was larger among husband's than wife's. Additionally, the partner effect size of health status on self efficacy and marital satisfaction was different between the two groups; however, the actor and partner effect size of self efficacy and marital satisfaction on retirement preparation was the same for husband and wife. CONCLUSION: The results of this study indicate that nursing intervention strategies for improving self efficacy and marital satisfaction are strongly needed to enhance retirement preparation of middle aged couples in Korean community.

Customer Experience Management for Cancer Patients in a Tertiary Hospital / 임상간호연구

PURPOSE: The purpose of this study was to investigate the effect of customer experience management on nursing service satisfaction of cancer patients and their intent to revisit the hospital and also to identify empathy ability of oncology nurses. METHODS: Participants were 376 cancer patients and 190 oncology nurses from a tertiary hospital in Korea. Cancer patients' satisfaction with nursing care and intent to continue using the hospital were measured and empathy of oncology nurses was measured using Empathy Construct Rating Scale. Data were analyzed using descriptive statistics, χ² test, t-test, one-way ANOVA and stepwise multiple regression analysis. RESULTS: Patient satisfaction with nursing care and intent to continue using the hospital were higher in patients who received the customer experience management program than those who did not. Oncology nurses' ability to empathize was high. Clinical career, participate in customer experience management and education level together explained 20% of variance in empathy ability of oncology nurses. CONCLUSION: Findings from this study confirm that customer experience management affects patient satisfaction with nursing service and intent to continue using the hospital. Further research is necessary to reaffirm the empathy ability of the oncology nurses and to identify the related various factors.

Frequency of Silent Myocardial Ischemia Detected by Thallium-201 SPECT in Patients with Type 2 Diabetes / 당뇨병

BACKGROUND: Silent myocardial ischemia (SMI) is more common in diabetic patients than among the general population. It is not yet established whether a routine screening test for SMI is necessary, and which screening test would be most useful. The purpose of this study was to estimate the prevalence of SMI detected by Thallium-201 perfusion single photon emission computed tomography (SPECT) in type 2 diabetic patients. METHODS: A total of 173 asymptomatic type 2 diabetic patients were included in the study. Thallium-201 perfusion SPECT was performed to screen for SMI. RESULTS: Among the 173 patients, abnormal perfusion patterns were found in 11 patients. Coronary angiography was carried out for these patients, and significant coronary artery stenosis was found in ten of them (positive predictive value; 90.9%). There was a significant association between SMI and overt albuminuria (OR = 7.33, 95% CI, 1.825-29.437). CONCLUSION: Thallium-201 perfusion SPECT is not sensitive enough to identify SMI, but is accurate in detecting decreased myocardial perfusion. This may be a useful screening tool for detecting SMI in type 2 diabetic patients with impaired renal function.

Chronic Complications of Inhalation Injury: Chest HRCT Findings and a Correlation with the Pulmonary Function Test in Reactive Airway Dysfunction Syndrome

PURPOSE: To evaluate the HRCT findings and to correlate the findings with the results of a pulmonary function test (PFT) in patients with reactive airway dysfunction syndrome (RADS). MATERIALS AND METHODS: On March 2003, a fire at a boarding house of primary school soccer players caused a multiple casualty disaster. After 8 months, nine boys that presented with chronic cough and dyspnea were treated, and were subjected to follow-up evaluations. Eight patients underwent a chest radiograph, HRCT, and a PFT. Two patients with severe symptoms received extended follow-up after 1 year. Two radiologists retrospectively reviewed the chest radiographs and the follow-up HRCT scans. We correlated the HRCT findings with the results of the PFT. RESULTS: Six patients with an inhalation injury were diagnosed with RADS. On the chest radiographs, eight patients showed no abnormal findings. On an HRCT scan, four patients showed abnormal findings. The abnormal findings were mosaic air trapping (n = 4), bronchial wall thickening (n = 1), and parenchymal consolidation (n = 1). In all four patients that showed abnormal findings in the HRCT scan, abnormal results of the PFT were also seen. The two patients that received extended follow-up showed an improvement of the clinical symptoms, as seen by the PFT, and had a decreased extent and degree of mosaic air trapping, as seen on HRCT. CONCLUSION: An HRCT scan is an essential modality for the diagnosis and follow-up of patients with RADS. Both a full expiratory and inspiratory HRCT scan must be performed for an accurate diagnosis.

A Case of Mycoplasma pneumoniae Pneumonia Complicated with Guillain-Barre Syndrome and Encephalitis / 소아과

The most common pathogen of respiratory tract infection among school-age children and adolescents is Mycoplasma pneumoniae, which causes clinical manifestations of pneumonia, acute asthmatic attack, pharygitis, and tonsilitis. It can also cause extrapulmonary infections that involves skin, the nervous system, the digestive system, the cardiovascular system, and the hematopoietic system. It is reported that the central nervous system symptoms may occur in 0.1% to 7% of patients hospitalized with Mycoplasma pneumoniae infection. Direct invasion, toxin, immune-mediated, and vascular phenomenon have been proposed for the etiology of the neurological manifestations. We have experienced a six-year-old male patient with Mycoplasma pneumoniae pneumonia who had complained of both leg pains and immobility two weeks after the onset of pneumonia, which was confirmed as peripheral neuropathy of Guillain-Barr syndrome. Three weeks after the disease-onset, altered consciousness and seizure attacks developed and intravenous immunoglobulins infused under the impression of encephalitis induced by Mycoplasma pneumoniae infection. He showed complete recovery of running and mentality five months after the disease-onset. We herein report a case of Mycoplasma pneumoniae pneumonia complicated with Guillain-Barr Syndrome and encephalitis about 2 or 3 weeks after the disease onset with a review of literatures.

Juvenile Drinking and Dietary Habit in High School Students / 대한지역사회영양학회지

This study was conducted to investigate the drinking status, drinking habit and dietary habit of high school students using anonymous questionnaires. DVS and skipped meal status were obtained by 24 hour recall method. Two hundreds ninety seven of 380 students (78.2%) have experienced the drinking even though 73.7% of them was not addictive. One hundred sixty one students (54.2%) initiated drinking in the middle school, mostly because of 'peer pressure' and 'curiosity'. The most plausible reasons for drinking were 'for mingling' and 'for stress reduction', and they used to have desire for drinking mostly when felt 'anger or frustration' and 'feel good'. Drinking behavior was significantly different in age of first smoking, drinking history, amount, reason for drinking and desire for drinking between male and female student. There was no significant difference in dietary habits between drinking students and non-drinking students. DVS, skipped meal status, snack preferences and food intake frequency also did not show the significant differences. However, considering that the drinking experience of high school students increased, and drinking experience of female students approached to that of male student, more attention needs to be given to juvenile drinking and its' prevention.

Development of Dietary Supplement for the Growth and Exercise Performance Improvement / 대한지역사회영양학회지

We developed a dietary supplement using natural herbs and nutrients for the growth and exercise performance improvement. It called 50-22 supplement containing distilled extracts of natural herbs to remove bitterness and the addition of Vitamin B1, B6, Ca and xylitol. We investigated on the effect of 10-22 supplementation on the maximal exercise performance, IGF-1 (insulin like growth factor-1) concentration and antioxidant activity in SD rat model. In result, JR-22 supplement group was better than control group about 10% in exercise performance test and increased about 63% of IGF-1 concentration in blood. In addition, the oxidative damage induced by exercise was reduced by JR-22 supplementation. Therefore, we suggested that 50-22 supplementation enhanced effectively exercise performance and IGF-1 concentration and reduced to oxidative stress in muscles. Also, we analysed biochemical factors in blood for the safety of JR-22 supplement. We known that there is no change of blood lactic acid, ammonia, inorganic phosphorous ion and creatine kinase activity.

Smoking Status and Dietary Habits of Middle School Students / 대한지역사회영양학회지

Adolescent smoking has been a great concern with respect to it's causing more serious health problems than adult smoking. The smoking status and habits of middle school students were studied using anonymous questionnaires, and their dietary habits were compared. Ninety-two of 4l4 students (22.2%) had experienced smoking, and 62.0% of them began in primary school, mostly out of curiosity. The most plausible reasons for smoking were 'boredom' and/or 'stress reduction'. Dietary habits were generally inadequate in the smoking group. Compared with the non-smoking group, the smoking group paid less attention to a balanced diet, more skipped breakfasts, more had irregular meal times and fewer snacked. There was no significant difference between the smoking and non-smoking groups in food intake frequency, except of sweet foods and caffeinated foods, which were more frequent consumed by the smoking group. These results suggest that more attention needs to be paid to nutrition and health education programs in elementary schools and also that proper support programs for smoking by themselves.

Morphologic analysis of C-shaped root using 3-D reconstruction / 대한치과보존학회지

C-shaped canal configuration is very difficult to treat because that clues about preoperative canal anatomy cannot be ascertained from clinical crown morphology and limited information can be derived from radiographic examination. This study was done to get more informations about the root and canal configuration of C-shape root by 3-dimensionally reconstructing for the purpose of enhancing success rate of endodontic treatment. 30 mandibular molars with C-shaped root were selected. Six photo images from occlusal, apical, mesial, distal, buccal, lingual directions and radiographic view were taken as preoperative ones to compare them with 3-D image. After crown reduction to the level of 1-2mm over pulpal floor was performed, teeth were stored in 5.25% sodium hypochlorite solution for the removal of pulp tissue and debris. They were cleaned under running water, allowed to bench dry and embedded in a self-curing resin. This resin block was serially ground with a microtome (Accutom-50, Struers, Denmark) and the image of each level was recorded by digital camera (FinePix S1-pro, Fuji Co., Japan). The thickness of each section was 0.25mm. Photographs of serial sections through all root canal were digitized using Adobe Photoshop 5.0 and then minimum thickness of open and closed sites were measured (open site is the surface containing occluso-apical groove : closed site is oppsite). After dizitization using 3-D Doctor (Able software Corp, USA), 3D reconstruction of the outer surface of tooth and the inner surface of pulp space was made. Canal classsification of C-shaped roots was performed from this 3-D reconstructed image. The results were as follows: 1. Most C-shape rooted teeth showed lingual groove (28/30). 2. According to Vertuccis'calssification, type I, II, III, IV, VII were observed, but also new canal types such as 2-3-2, 1-2-3-2, 2-3-2-1, 2-3-2-3 were shown. 3. There was little difference in minimum thickness on coronal and apical portions, but open site were thinner than closed site on mid portion. Conclusively, 3D reconstruction method could make the exact configurations of C-shape root possible to be visualized and analyzed from multi-directions. Data from minimum thickness recommend cleaning and shaping be more carefully done on dangerous mid portion.

Measles, Mumps, and Rubella Immunization in Children with Egg Allergies

PURPOSE: The safety of MMR(Measles, Mumps, and Rubella) immunization to children with egg allergies has been debated for decades because the live attenuated virus used in the vaccine is grown in cultured chick-embryo fibroblasts. Many studies that investigated adverse reactions to MMR vaccine have been reported abroad, but there has been no report in Korean children. So, this study is aimed at determining the prevalence of positive reactions to skin test with the diluted MMR vaccine and the safety of MMR immunization in Korean children with egg allergies. METHODS: Twenty children who have atopic dermatitis or urticaria associated with egg allergies in Samsung Medical Center underwent prick and intradermal tests with diluted MMR vaccine. Then, we administered the vaccine to the children subcutaneously. RESULTS: One patient(5.0%) had a positive result on the prick test and five(25.0%) on the intradermal test. Urticaria was elicited after MMR immunization in two children(10%) who had past illness of urticaria. One of them had a positive result on the prick and intradermal tests, but the other had negative results on both tests. CONCLUSION: Although anaphylaxis did not appear in our study, adverse reactions to MMR vaccination can occur in children with egg allergies, regardless of skin test result to MMR vaccine, prick or intradermal. Thus, in children with a history of severe systemic allergic reaction to egg, it is safe to perform MMR vaccination in a tertiary medical center where emergency care can be taken appropriately.

The Effectiveness and Preferences of Nutritional Supplementary Drinks for the Elderly / 대한지역사회영양학회지

This study was conducted to evaluate the effectiveness and preferences of supplementary drinks for very old subjects who are likely to be malnourished. Twenty-five elderly subjects were divided into two groups. The supplemented group(N=15) received 500mls of nutrient supplement(New Care) two times daily for 4 weeks. This resulted in a significant increase in the total calories, protein, minerals and vitamins. Nutritional status was assessed both anthropometrically and biochemically, before and after the study period. A significant improvement in mid arm circumference, triceps skinfold thickness and serum albumin were observed in the supplemented group but not in the control group. There is a possibility that most of the elderly were in an anemic state at the beginning of the study since their mean hematologic parameters were within the lower normal range while their mean serum osmolarities was slightly higher than normal,. Although mean serum hemoglobin and hematocrit were not increased significantly, th percentage of the recovery rate from anemia in the supplemented group was higher than in the control group. Total lymphocyte count also showed similar tendency. Sensory evaluation of nutritional supplementary drinks were relatively good and the elderly showed great interest in nutrient supplements. This study suggests that a nutritional status of poorly nourished elderly subjects can be improved by providing them with nutritional supplementations.