A Qualitative Content Analysis of the Person-Centered Care Experienced by Critical Care Patients / 중환자간호학회지

PURPOSE: To explore the person-centered care (PCC) experienced by critical patients.METHOD: This qualitative study deductively examined the attributes of the PCC model proposed by Jakimowicz and Perry. The participants were 16 patients who were recently discharged from intensive care units at a university hospital. Data were collected through in-depth interviews and were analyzed using the deductive method of content analysis.RESULTS: A total of 4 categories, 16 subcategories, and 33 codes were generated from 171 meaningful statements. The final 4 categories were “compassionate presence,” “professional interaction,” “outstanding competency,” and “patient identity.” These were consistent with the main attributes of Jakimowicz and Perry's model. However, most of the codes belonged to the “compassionate presence” and “patient identity” categories. Among the attributes of the model, “continuity of nursing,” “therapeutic relationship,” “expert knowledge,” “clinical knowledge,” “evidence-based intervention,” and “patient's rights” were not derived as codes.CONCLUSION: These findings deepen the understanding of the PCC model from the patient's point of view. The main attributes of PCC identified in the current study can be applied to the development of practical guidelines for intensive care nursing. In addition, we recommend the development of a PCC measurement tool for critical care patients.

Post-Intensive Care Syndrome Experience among Critical Care Survivors: A Meta-synthesis of Qualitative Research / 중환자간호학회지

PURPOSE: The purpose of this study was to integrate the results of qualitative studies to understand critical care survivors' experience of the post-intensive care syndrome (PICS).METHODS: This was a meta-synthesis of primary studies that used qualitative methods. We reviewed 26 qualitative studies on PICS selected from 8 international and Korean databases and from a manual search. Thomas and Harden's 3 stages (free coding, development of descriptive themes, generation of analytical themes) for thematic synthesis were utilized to analyze the collected qualitative data.RESULTS: Four descriptive themes emerged from the thematic synthesis: weak physical conditions, psycho-emotional changes, the painful-memory of intensive care units, and social vulnerability. The analytical theme for the current study was “unfamiliarity with the vulnerable self.” Critical care survivors had to confront entirely different “selves” after discharge from intensive care units. They had become physically weak, psychologically unstable, and the critical memories continued to create distress. These changes increased their social vulnerability by making them dependent on others, causing family conflicts, and changing interpersonal relationships.CONCLUSIONS: Finding from this qualitative synthesis and other related literature highlight the severity of PICS and the importance of rehabilitative intervention for critical care survivors.

Common Bile Duct Obstruction Due to a Large Stone at the Duodenal Stump / 대한소화기학회지

Enterolith is a rare complication of Billroth II gastrectomy. Most enterolith cases have been reported in association with diverticula, tuberculosis, and Crohn's disease. We report the case of a huge enterolith that developed in the duodenal stump following common bile duct obstruction and cholangitis, necessitating surgery. The enterolith was clearly visible on the abdominal computed tomography. It was removed through a duodenotomy. The surgery was successful without any significant complications.

Metastatic Thyroid Gland Tumor Presenting as an Initial Manifestation of Recurrent Uterine Cervical Cancer / 대한내과학회지

Most patients with recurrent uterine cervical cancer have intra-pelvis metastasis with adjacent lymph node involvement, while a lone, distant metastasis is extremely rare. We report a 79-year-old woman with recurrent uterine cervical cancer that presented as thyroid mass with no intra-pelvic recurrence. Four years earlier, the patient had been diagnosed with uterine cervical cancer. She had undergone a course of concurrent chemoradiotherapy to the pelvis and had no subsequent evidence of recurrence. Several weeks before presenting, she had noticed a foreign body sensation in her throat and a palpable mass in the left side of her neck. Clinically, this was metastatic squamous cell carcinoma from the uterine cervix. Patients who present with swelling or palpable nodules in the neck with a previously diagnosed malignancy must be evaluated for metastatic disease, although metastasis from uterine cervical carcinoma to the thyroid gland is rare.

Fluoroscopy-induced Subacute Radiation Dermatitis in Patient with Hepatocellular Carcinoma / 대한소화기학회지

Radiation dermatitis can develop after fluoroscopy-guided interventional procedures. Cases of fluoroscopy-induced radiation dermatitis have been reported since 1996, mostly documented in the fields of radiology, cardiology and dermatology. Since diagnosis and treatment of fluoroscopy-induced radiation dermatitis can be difficult, high grade of suspicion is required. The extent of this reaction is determined by radiation dose, duration of exposure, type of procedure, and host factors and can be aggravated by concomitant use of photosensitizers. Follow-up is important after long and complicated procedures and efforts to minimize radiation exposure time will be necessary to prevent radiation dermatitis. Herein, we report a case of a 58-year-old man with hepatocellular carcinoma presenting with subacute radiation dermatitis after prolonged fluoroscopic exposure during transarterial chemoembolization and chemoport insertion. Physicians should be aware that fluoroscopy is a potential cause of radiation dermatitis.

Double-Scope Peroral Endoscopic Myotomy (POEM) for Esophageal Achalasia: The First Trial of a New Double-Scope POEM

With the accumulation of clinical trials demonstrating its efficacy and safety, peroral endoscopic myotomy (POEM) has emerged as a less invasive treatment option for esophageal achalasia compared with laparoscopic Heller myotomy. However, the difficulty in determining the exact extent of myotomy, a critical factor associated with the success and safety of the procedure, remains a limitation. Although the various endoscopic landmarks and ancillary techniques have been applied, none of these has been proven sufficient. As a solution for this limitation, the double-scope POEM technique with a second endoscope to assure the exact length of the submucosal tunnel has been applied since 2014. Before double-scope POEM was introduced, the second endoscope was applied only to confirm the accuracy of the procedure. In the present study, we performed double-scope POEM in the treatment of esophageal achalasia through a novel procedure of simultaneous application of the second endoscope to assist in the conventional POEM procedure.

Living Donor Liver Transplantation in a Hepatitis B Patient with Acute on Chronic Liver Failure Accompanying Hepatocellular Carcinoma / 이화의대지

Acute clinical deterioration in patients with chronic liver disease is called acute on chronic liver failure (ACLF). Principles of management of ACLF consist of early identifying etiology of liver disease, rapid intervention of precipitating event and discreet intensive cares. Despite medical intensive cares, if liver failure progresses, liver transplantation could be the other option. Also, liver transplantation is the only treatment that offers a chance of cure for hepatocellular carcinoma (HCC) and the underlying liver cirrhosis simultaneously. Emergent living donor liver transplantation (LDLT) can be performed for patients with acute liver failure and improves survival rate, especially in circumstances which liver graft is often not available because of deceased donors are not affordable. Here, we describe a chronic hepatitis B patient who developed ACLF accompanying early HCC. Because he did not improved with medical care, he received emergent LDLT. After LDLT, he showed great improvement without critical complications.

A Case of Sjogren's Syndrome Associated with Common Variable Immunodeficiency / 대한내과학회지

Common variable immunodeficiency (CVID) is a heterogeneous group of primary immune deficiencies in adults characterized by hypogammaglobulinemia, recurrent bacterial infections, and a higher incidence of autoimmune diseases. More than 25% of CVID patients also have autoimmune diseases such as autoimmune hemolytic anemia, immune thrombocytopenic purpura, rheumatoid arthritis, and systemic lupus erythematosus. However, the pathogenesis of autoimmunity in CVID remains obscure. We report a 56-year-old woman with CVID and Sjogren's syndrome. In addition to a long history of recurrent upper respiratory infections, acute gastroenteritis, and cellulitis, she has also suffered from persistent xerostomia and xerophthalmia for the past 10 years. Serologic studies revealed hypogammaglobulinemia (low levels of IgG, IgA, and IgM in serum) and the presence of anti-Ro antibodies, and salivary scintigraphy indicated salivary gland involvement. These findings led to a diagnosis of CVID and Sjogren's syndrome, which was treated by monthly intravenous immunoglobulin therapy.