Stress due to End-of-Life Care, Coping Strategies, and Psychological Well-being among Nurses in Neonatal Intensive Care Units

PURPOSE: This study aimed to identify stress levels due to end-of-life care, coping strategies, and psychological well-being among nurses in neonatal intensive care unit, and to investigate the effect of stress levels and coping strategies on their well-being. METHODS: A total of 128 nurses in the neonatal intensive care units of general hospitals in B city participated. The data were collected using a self-report questionnaire. The collected data were analyzed using descriptive statistics, the t-test, ANOVA, the Pearson correlation coefficient, and hierarchical regression with SPSS version 22.0. RESULTS: The coping strategy that nurses most often used was seeking social support. The factors affecting the well-being of the participants were wishful thinking, problem-focused coping and seeking social support, in order. Those 3 variables explained 21 % of the total variance in psychological well-being. Problem-focused coping and seeking social support were positively associated with psychological well-being, while wishful thinking showed a negative association. CONCLUSION: In order to improve the psychological well-being of nurses in neonatal intensive care units, it is necessary to provide nurses with a program to build a social support system and to improve their problem-based coping skills.

Changes in the Physical Properties of Irradiated Red Blood Cells / 대한수혈학회지

BACKGROUND: Irradiation of cellular blood products is the current method used for the prevention of transfusion-associated graft-versus-host disease. However, irradiation has been shown to cause biochemical changes in stored red blood cells (RBCs) and to generate reactive oxygen species (ROS). Irradiation-induced biochemical changes and oxidation damage of the RBCs is closely related to the deformability of these cells. Furthermore, deformation of the RBCs may lead to alterations in the post-transfusion viability of stored RBCs. In this study, we evaluated the physical properties of irradiated RBCs. METHODS: Citrate phosphate dextrose adenine-1 preserved RBC concentrates were irradiated with a minimum dose of 25 Gy and stored at 4oC for 28 days. The deformation of the RBCs was measured by a microfluidic ektacytometer (RheoScan-D). To examine the effect of oxidative stress, the RBC concentrates were exposed to oxidative stress using FeSO4 and ascorbic acid. RESULTS: The deformability threshold of the irradiated RBCs was significantly lower than that of the control RBCs on day 21 of storage and later (P<0.05). The deformability threshold of the RBCs exposed to oxidative stress was lower than that of control RBCs, and the difference was significant on day 21 of storage and later (P<0.05). For up to 21 days of storage, the deformability of control and irradiated RBCs were maintained; however, they were significantly decreased at 28 days of storage compared with 1 day of storage (P<0.05). CONCLUSION: Irradiation reduced the threshold of RBC deformability during storage. In accordance with the effect of irradiation, oxidative stress affected the RBC deformability. Therefore, a ROS scavenger may play a protective role against deformation of irradiated RBC concentrates. Further evaluation will be required for confirmation and clarification of these findings.

Relation among the Tests and Comparison of Positivity of Tests for Multi-Drug Resistance in Newly Diagnosed Acute Leukemia / 대한진단검사의학회지

BACKGROUND: The expression of multi-drug resistance (MDR) in acute leukemia was known to decrease the outcome of chemotherapy and to increase the rate of relapse. Of the mechanism of MDR, the most well known is P-glycoprotein (P-gp) encoded by the mdr1 gene. There are MDR genes, P-gp tests and drug efflux function tests for the clinical measurement of MDR. To assess the clinical usefulness and MDR expression status in acute leukemia, MDR tests were performed. METHODS: MDR expression was assessed by MDR1 mRNA RT-PCR and flow cytometry measuring P-gp and daunorubicin (DNR) efflux in 77 patients with newly diagnosed acute leukemia (AL) including 48 acute myeloid leukemia (AML), 16 acute lymphoblastic leukemia (ALL) and 13 acute mixed-lineage leukemia (AMLL). The CD34 surface-marker study was also done by flow cytometry. The result of chemotherapy was evaluated by the percentage of remnant bone marrow (BM) blasts. RESULTS: The positivity of MDR1 mRNA was 57.1% (44/77) in AL, 61.5% (8/13) in AMLL, 60.4% (29/48) in AML, and 43.8% (7/16) in ALL. The positivity of P-gp expression was 36.5% (27/74) in AL and 100% in AML. The positivity of the DNR efflux test was 30.1% (22/73) in AL, 40.0% (18/45) in AML, 23.1% (3/13) in AMLL, and 6.7% (1/15) in ALL. There was a significant correlation between MDR1 mRNA and P-gp expression and between MDR1 mRNA and CD34 expression in AML. There was a significant correlation between the percentages of residual blast cells in BM and P-gp expression (P=0.039, r=0.312). CONCLUSIONS: It can be clinically useful to perform the mdr1 gene and P-gp test simultaneously both in newly diagnosed acute leukemia patients. The effectiveness of tests for MDR can be helpful to predict the outcome of chemotherapy.

Detection of Chlamydophila pneumoniae in Acute Myocardial Infarction / 대한임상미생물학회지

BACKGROUND: There is growing evidence linking infection with Chlamydophila pneumoniae with vascular diseases, such as atherosclerosis and myocardial infarction. However, the data remain inconclusive and the clinical importance of C. pneumoniae as vasculopathic is unclear. So, we intend to detect C. pneumoniae in acute myocardial infarction patients by microimmunofluorescence (mIF) and polymerase chain reaction (PCR). METHODS: Blood and peripheral mononuclear cells (PMNCs) of 24 myocardial infarction patients and 100 normal controls were collected. Serum were used in mIF and PMNCs in PCR. PMNC sample were tested for C. pneumoniae by 'touchdown 'nested PCR. The first round PCR amplified DNA from both C. pneumoniae and Chlamydophila psittaci, while the second round specially targeted C. pneumoniae allowing the two species to be differentiated. RESULTS: Seropositivity of IgG and IgM anti-Chlamydophila pneumoniae antibody titers were 95.8% and 25% in myocardial infarction patients and 61% and 16% in control group, respectively. Positive rates of PCR of PMNCs were 8.3% in the patients and 15% in control group. CONCLUSION: The results of mIF show that mIF positive rate in myocardial infarction was much higher than control group. So an association between C. pneumoniae and myocardial infarction can be concluded. But the opposite results of PCR of PMNCs needed further studies.

The Efficacy and Safety of Large Volume Leukapheresis in Allogeneic Peripheral Blood Stem Cells Collection / 대한수혈학회지

BACKGROUND: Transplantation of allogeneic peripheral blood stem cells (PBSCs) may have advantage over bone marrow transplantation with regards to the speed of hematopoietic and immunologic recovery. Recently to overcome the need for multiple leukaphereses to collect enough PBSCs for autologous transplantation, large volume leukaphereses (LVL) are used to process multiple blood volumes per session. Experience with this technique in healthy individuals after mobilization with colony stimulating factor (CSF) is limited. We have investigated the efficacy and safety of LVL for the collection of G-CSF and GM-CSF mobilized PBSCs from healthy donors. METHODS: This study was done on 40 healthy donors who were mobilized with G-CSF and GM-CSF for allogeneic peripheral blood stem cells transplantation (allo-PBSCT). After 5 days of mobilization treatment, PBSCs were collected by LVL with Fenwal CS-3000 Plus (Baxter Co, USA). In LVL, heparin was administered in addition to ACD-A. Patients underwent of LVL procedures daily to obtain a target cell dose of >or= 4x10(8)/kg MNCs and >or= 6x10(6)/kg CD34+ cells. RESULTS: 66 LVL procedures were done on 40 donors. Of these donors, 31 (77.5%) reached the collection target with one leukapheresis. The product per LVL contained a mean 5.79+/-2.47 10(8)MNCs/kg and 11.6+/-10.62x10(6) CD34+ cells/kg respectively. Mean percentages of MNC were 79.88+/-22.15% and collection efficiencies of MNCs were inversely related to the starting MNC count (r=-0.536, P<0.001). After LVL, although none of the donors exhibited bleeding complications, platelets decreased from 187.4+/-52.68x10(3)/microL to 74.88+/-13.7x10(3)/microL and activated partial thromboplastin time (APTT) prolonged from 29.13+/-3.77 seconds to 67.51+/-54.26 seconds. CONCLUSION: We conclude that LVL after mobilization treatment with G-CSF and GM-CSF in normal healthy donors was tolerable and efficient methods for PBSCs collection, but long-term risk of adverse effects in normal donors needs to be carefully addressed by individual institutions as well as national and international registries.

Phenotypes and Interpretive Reading of Antimicrobial Susceptibility Tests for Clinical Isolates of Several Species / 대한임상미생물학회지

BACKGROUND: In recent years, knowledge of bacterial resistance to antimicobials has expanded in important ways. Availability of an increasing number of antibiotics allows more precise individualization of resistance phenotypes and recording susceptibility results as patterns or phenotypes is valuable for both surveillance and patient care. If the patterns of resistance to panels of related antimicrobials are considered the underlying mechanisms can often be inferred. And the inferred mechanisms make the clinician to be advised to use alternative treatment. Interpretation of resistance phenotypes is based on the comparison of clinical isolates with prototype susceptible bacteria belonging to the same species. But interpretative reading of antimicrobial susceptibility tests requires an immense knowledge of antibiotics. Such interpretative reading is best achieved by computerized expert systems. METHODS: The authors attempt to determine phenotypes for the clinically isolated strains for each class of drugs tested by the Vitek 2 systemTM(bioMerieux, Marcy I'Etoile, France) using the Advanced Expert SystemTM(AES, bioMerieux, Marcy I'Etoile, France). A total of 91, 107, 89, 65, 251, 113, 47, 33, 23, 122 and 110 isolates of Staphylococcus aureus, coagulase negative staphylococci, Enterococcus faecalis, Enterococcus facium, Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, Enterobacter cloacae, Enterobacter aerogenes, Pseudomonas aeruginosae and Acinetobacter baumannii, were examined respectively. RESULTS: Biological correction based on the phenotype was recommended from 2.2% of E. faecalis to 46.8% of S. marcescens and therapeutic correction, from 7.3% of A. baumannii to 60.9% of E. aerogenes. A total of 25, 26, 18, 19, 22, 22, 15, 15, 17, 19, 19 phenotypes of S. aureus, coagulase negative staphylococci, E. faecalis, E. facium, E. coli, K. pneumoniae, S. marcescens, E. cloacae, E. aerogenes, P. aeruginosa and A. baumannii, were detected respectively. Association of resistance mechanism from S. aureus, coagulase negative staphylococci, E. coli, K. pneumoniae, S. marcescens, show 10, 11, 6, 4 and 3 pairs from resistant phenotypes, respectively. CONCLUSION: Vitek AES potentially provides a tool to assist the development of antimicrobial susceptibility interpretation in the clinical microbiology laboratory. The inferred mechanisms make the clinician to be advised to use alternative treatment.

A Case of Nocardia asteroides Isolated from Subcutaneous Abscess in a Pneumonic Patient with a Rejected Transplant Kidney / 대한임상병리학회지

Opportunistic infections are common after a renal transplant as a result of immunosuppression. Nocardiosis is a rare but important cause of morbidity and mortality among renal transplant recipi-ents. Nocardiosis is a localized or disseminated infection, which is usually introduced through the respiratory tract resulting in pneumonia, and may develop a disseminated infection, in particular a subcutaneous abscess and/or central nervous system infection. Because effective therapy for these nocardiosis is available, an accurate and timely diagnosis is crucial. However, nocardiosis is an infrequent disease and many physicians are unfamiliar to it. In addition, in the laboratory, cul-tures may be discarded too early, which often delays an early diagnosis and treatment. The authors isolated Nocardia asteroides from an abscess of the skin in a rejected renal allograft patient suffering pneumonia. The patient was successfully treated with trimethoprim/sulfamethoxa-zole.

The Discrimination Power and Effectiveness of 3 Kinds of LTR Primers in the VNTR-PCR for Evaluation of the Engraftment of Allogeneic Peripheral Blood Stem Cells Transplantation / 대한임상병리학회지

BACKGROUND: There are highly-polymorphic DNA markers in the human genomic DNA, known as the variable number of tandem repeats (VNTR). The VNTR markers can be used to evaluate the engraftment of stem cells. We evaluated the discrimination power of 3 types of long-tandem repeat (LTR) and tried to predict underlying disease relapses by DNA chimerism. METHODS: Twenty-nine patients were transplanted with allogeneic peripheral blood stem cells (PBSCs) and their related donors were tested. We used the three long-tandem repeats (LTR) D1S80, D1S111, and YNZ22 for VNTR-PCR. The informative test was performed before transplantation. The chimerism analysis was performed on days +30, +60, +90, and +180 after transplantation. RESULTS: The most informative marker was D1S80 with 55.2% discrimination potential. The power of discrimination was 79.3% in the combination of 3 LTRs. Twenty-two cases were tested for DNA chimerism analysis. When the complete chimerism was represented, the engraftment was more successful and when the mixed chimerism was represented, the underlying disease relapse rate increased. CONCLUSTIONS: DNA chimerism analysis was useful to evaluate the marrow status of patients. It also served as an indication for donor lymphocyte infusion. However, compared to unrelated allogenic PBSCT, the discrimination potential for the combination of 3 LTR loci was lower in the related allogenic PBSCT. Therefore, it is thought that additional short-tandem repeats and DNA sequencing are required for more discrimination power especially in related transplantation cases.

Unexpected Antibody Positivity with the Use of the LISS/Coombs Gel Test / 대한임상병리학회지

BACKGROUND: There is a recent trend of increased use of the gel test for the detection of unexpected antibodies (Abs) because of its simplicity and ease with which definitive interpretation can be made. However, because of the low insurance payments in Korea, only the LISS/Coombs card is used and thus the detection rate of the cold Abs has decreased. We have studied the detection rates of the Abs in patients by using the LISS/Coombs gel test and thus evaluated the clinical usefulness of the LISS/Coombs gel test. METHODS: Abs screening tests have been carried out using the DiaMed(TM) LISS/Coombs gel card test (Murten, Switzerland) on 14,942 patients for whom blood transfusions were ordered between July 1, 1997 and March 31, 2001. When the test for Abs was positive, Ab identification tests were further carried out with the DiaMed(TM) LISS/Coombs gel card and the ID-DiaPanel 1-11. RESULTS: Eighty-one out of 14,942 patients (0.54%) revealed positive results. Of these, 15 showed anti-E, 5 showed anti-E+c, 4 showed anti-C, 3 showed anti-D, 2 showed anti-Jk(a), 1 each showed anti-c, anti-M, anti-Lu(a), and anti-K Abs. CONCLUSIONS: Although the detection rate for the cold Abs of the LISS/Coombs gel test was low, it is considered to be highly useful because of the high detection rate for the clinically important warm Abs, the simplicity in carrying out the test, and the easy readability of test results.