Intravascular Large B-cell Lymphoma Presenting as Rapidly Progressive Encephalopathy

Intravascular large B-cell lymphoma (IVLBCL) is a rare form of non-Hodgkin’s lymphoma that selectively involves the lumina of vessels, and may present as ischemic stroke. A 62-year-old man presented with progressive aphasia, dementia, seizure and stroke-like symptom. Brain magnetic resonance imaging revealed dynamic progressive fluid attenuated inversion recovery lesions and multiple punctate microbleeds in the bilateral subcortical region. A kidney biopsy revealed IVLBCL. We report a patient with IVLBCL presenting as rapidly progressive encephalopathy.

A 4-Year Follow-Up of Subjects with Visually Equivocal Amyloid Positron Emission Tomography Findings from the Alzheimer’s Disease Neuroimaging Initiative Cohort / 대한핵의학회잡지

Background@#To date, the clinical significance of visually equivocal amyloid positron emission tomography (PET) has not been well established. @*Objective@#We studied the clinical significance of equivocal amyloid PET images from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). @*Methods@#Subjects with F-18 florbetapir PET scans at baseline who were followed up for 4 years were selected. Clinical characteristics, imaging biomarkers, cognitive function, and rate of conversion to AD were compared in subjects with visually equivocal findings. @*Results@#Of 249 subjects who completed the follow-up, 153 (61.4%), 20 (8.0%), and 129 (30.5%) were F-18 florbetapir-negative, -equivocal, and -positive, respectively. The mean standardized uptake value ratios (SUVR) of F-18 florbetapir PET were 0.75 ± 0.04, 0.85 ± 0.10, and 1.00 ± 0.09 for each group (p <0.001 between groups), and 15.0%, 70.0%, and 98.7% of patients were quantitatively above the positive threshold. The change in the SUVR of F-18 florbetapir PET was higher in the equivocal (6.09 ± 3.61%, p <0.001) and positive (3.13 ± 4.38%, p <0.001) groups than the negative group (0.88 ± 4.28%). Among the subjects with normal or subjective memory impairment and mild cognitive impairment, 5.3% with negative amyloid PET and 37.5% with positive amyloid PET converted to AD over the 4-year period. None of the equivocal amyloid PET subjects converted to AD during this period.

Experience of Healthcare Providers in the Advanced Practice Nurse System / 중환자간호학회지

Purpose@#: The purpose of this study was to understand and describe the experiences of the advanced nurse practitioner (APN) system used by healthcare providers including APNs, doctors who worked with APNs, and APN master’s course professors at a graduate school. @*Methods@#: Qualitative data were collected via snowball sampling. The participants were nine APNs, six doctors, and three professors. They were divided into three focus groups, each of which consisted of all three types of healthcare providers. Data were collected via interviews with the three focus groups conducted from September to October 2019. All interviews were audiotaped and transcribed verbatim. The transcribed data then underwent qualitative content analysis. @*Results@#: Based on the data, we extracted four themes and 14 categories. The themes were “Role and system of APNs started according to healthcare environment changes”, “Optimal healthcare provider to ensure quality of care”, “Confused role and system of APNs due to incomplete medical law”, and “Tasks for the stable operation of the APN system.” @*Conclusion@#: For quality treatment and safety of patients, a legal basis must be established for the APN system. For its stable operation, social consensus regarding legislation about APNs’ scope of practice is required. Finally, a discussion is necessary about the integration of APNs’ 13 fields.

Experience of Healthcare Providers in the Advanced Practice Nurse System / 중환자간호학회지

Purpose@#: The purpose of this study was to understand and describe the experiences of the advanced nurse practitioner (APN) system used by healthcare providers including APNs, doctors who worked with APNs, and APN master’s course professors at a graduate school. @*Methods@#: Qualitative data were collected via snowball sampling. The participants were nine APNs, six doctors, and three professors. They were divided into three focus groups, each of which consisted of all three types of healthcare providers. Data were collected via interviews with the three focus groups conducted from September to October 2019. All interviews were audiotaped and transcribed verbatim. The transcribed data then underwent qualitative content analysis. @*Results@#: Based on the data, we extracted four themes and 14 categories. The themes were “Role and system of APNs started according to healthcare environment changes”, “Optimal healthcare provider to ensure quality of care”, “Confused role and system of APNs due to incomplete medical law”, and “Tasks for the stable operation of the APN system.” @*Conclusion@#: For quality treatment and safety of patients, a legal basis must be established for the APN system. For its stable operation, social consensus regarding legislation about APNs’ scope of practice is required. Finally, a discussion is necessary about the integration of APNs’ 13 fields.

Comparison of the pharmacokinetics and pharmacodynamics of YH4808in healthy subjects for defining an appropriate dosing regimen

YH4808 is a novel potassium-competitive acid blocker developed for gastric acid-related disorders. Previous studies indicate its potential to improve symptoms of gastric acid-related disorders. The current study was aimed to find the optimal regimen of YH4808 for night time pH control. This study was performed in two parts. Each was a randomized, open-label, active-controlled, multiple-doses, two-treatment, two-period crossover study conducted in 20 healthy Korean volunteers. Subjects were randomly assigned to one of the four groups.The three groups received different dosage regimens of YH4808 (100 mg twice a day, 200 mg once a day, or 200 mg twice a day), and the fourth group received esomeprazole 40 mg twice a day. The pharmacokinetic parameters demonstrated that the systemic exposure of YH4808 increased in a dose-proportional manner. The difference in the proportion of time above pH 4 over 24 h from the baseline was the greatest in the group receiving YH4808 200 mg twice a day. The values of the area under the effect curve at night time (12 A.M.–7 A.M.) were higher in all YH4808 groups than in the esomeprazole group. However, the differences among the YH4808 groups were not statistically significant (p > 0.05). YH4808 exhibited potential for better pH control during the night in comparison to esomeprazole. The optimal regimen for night time pH control among all the YH4808 regimens was 200 mg twice a day.

Analysis of Korean Nursing Studies Applied in Interpersonal Caring Theory / 기본간호학회지

Purpose@#This study was conducted to analyze Korean research papers in which Interpersonal Caring Theory was applied and suggest future directions for effective application and development. @*Methods@#Data collection was done through electronic databases RISS, KISS, DBpia, NDSL and SCHOLAR. Twenty papers were analyzed according to general characteristics, interventions, variables and findings. @*Results@#The number of published papers per publication year was 5 in the 2000s and 15 in the 2010s. The type of research design was for case studies, 1, for survey studies, 8 and for quasi experimental studies, 11. Participants in the studies included students, nurses, patients, office workers, volunteers and widows. Interventions used included drama therapy, Enneagram based interpersonal caring, horticulture, hospice, multimedia, music and rehabilitation. Variables that were related to Interpersonal Caring work included anxiety, college life adjustment, emotional intelligence, grief, happiness heart rate variability, hope, interpersonal caring behaviors, interpersonal relations, job stress, knowledge on self illness, loneliness, mental health, quality of life, self-esteem, serum cortisol, social behavior and stress coping. Emotional intelligence, interpersonal relations, job stress, loneliness and self-esteem were among the variables that did not work. @*Conclusion@#The results show that Interpersonal Caring Theory can be a micro-range theory of nursing care that can be applied with clients in many fields by converging with various activities.

A Survey on Nurses' Perception, Satisfaction, and Needs related to Continuing Education / 간호행정학회지

PURPOSE: This study was conducted to investigate perception, satisfaction and needs for continuing education for nurses in Korea. METHODS: Participants were selected 1,106 using disproportional stratified sampling for the 110,601 members of the 10 affiliated organizations of the Korean Nurses Association and 873 nurses participated in the online survey. Data were collected from February 2 to 27, 2015, and analyzed using the SPSS/WIN 24.0 program. Descriptive statistics, independent t-test, One-way ANOVA, and Scheffé test were conducted. RESULTS: The perception of continuing education averaged 0.69 on a scale of 1, satisfaction with continuing education was 3.66 out of 5, and need for continuing education was 4.33 out of 6. Perception, satisfaction and needs for continuing education showed significant differences depending on age, marriage, education, work department, type of work and clinical career, while perception and satisfaction differed more among type of institution and the affiliated groups. CONCLUSION: For the development of continuing education for nurses, it is necessary to establish an integrated information system for nurse continuing education and to develop various education programs for career development.

Relationship between Expectations of Clinical Ladder System, Career Commitment and Turnover Intention of Nurses in Small and MediumSized Hospitals / 임상간호연구

PURPOSE: This study was done to explore the relationship between expectations of the clinical ladder system (CLS), career commitment and turnover intention in nurses employed in small-medium sized hospitals. METHODS: Participants were 154 nurses from 3 small-medium sized hospitals in Gyeonggi Province and Gwangju City. From February, 8 to April, 14, 2017, self-report questionnaires were collected and analyzed using frequency, t-test, ANOVA, Scheffé test, and Person correlation coefficients. RESULTS: Of the participant nurses, 61% perceived the CLS as needed. The mean score for expectation of CLS, career commitment, and turnover intention on 5-point scale were 3.38, 3.17, 3.21, respectively. There were no significant differences in expectation of CLS according to general characteristics, but career commitment and turnover intention did show significant differences depending on age, position, type of work shift. Expectation of CLS correlated positively with career commitment (r=.23, p=.005), and career commitment correlated negatively with turnover intention (r=−.49, p < .001). CONCLUSION: The results of this study show that there is a need to adopt the clinical ladder system to improve career commitment.

Erratum: Socio-demographic factors and diet-related characteristics of community-dwelling elderly individuals with dysphagia risk in South Korea

We made a mistake in presenting ORCID of Chorong Kim.

Socio-demographic factors and diet-related characteristics of community-dwelling elderly individuals with dysphagia risk in South Korea

BACKGROUND/OBJECTIVES: The objective of this study was to determine dysphagia risk among community-dwelling elderly people living at home. We also examined the impact of socio-demographic variables on dysphagia risk as well as the relationship between dysphagia risk and dietary characteristics. SUBJECTS/METHODS: The study sample included 568 community-dwelling individuals, aged 65 years and above, who were living independently in their own home in Seoul, Gyeonggi, or Gwangju in South Korea. We used a dysphagia risk assessment scale to screen for dysphagia risk and the Mini nutritional assessment to evaluate the nutritional status. Associations between dysphagia risk and other variables were assessed using logistic regression analysis. RESULTS: Of the 568 subjects, 350 (61.6%) were classified into the dysphagia risk group (DR) and 218 (38.4%) were classified into the normal group (non-DR). Being female (odds ratio (OR) = 1.82, 95% confidence interval (CI) = 1.28–2.59), being 75 years and older (OR = 2.40, 95% CI = 1.69–3.42), having a lower education level (OR = 2.29, 95% CI = 1.33–3.97), and having a lower perceived economic status (OR = 2.18, 95% CI = 1.32–3.60) were more frequently observed with dysphagia risk compared to those who did not have such characteristics. Lowered mastication ability (OR = 14.40, 95% CI = 4.43–46.95), being at risk of malnutrition or malnourished (OR = 2.72, 95% CI = 1.75–4.23), lowered appetite (OR = 3.27, 95% CI = 2.16–4.93), and decreased food intake (OR = 2.95, 95% CI = 1.83–4.78) were observed more frequently in the DR group than in the non-DR group when adjusting for potential confounding factors. CONCLUSIONS: It is necessary to develop and apply integrated programs to improve the dietary habits and nutritional status of elderly individuals at risk for dysphagia, especially for women aged 75 years or older with lower educational and economic levels.

Validity and Reliability of the Self-Reflection and Insight Scale for Korean Nursing Students / 기본간호학회지

PURPOSE: The purpose of this study was to translate the Self-Reflection and Insight Scale (SRIS) into Korean and test its validity and reliability. METHODS: Participants were 340 nursing students who were recruited from 5 nursing colleges in Korea. Data were collected from November 21 to December 20, 2016 and analyzed using the IBM Statistics SPSS 22.0 and AMOS 23.0 programs. Exploratory factor analysis, Confirmatory factor analysis, and concurrent validity analysis were performed. RESULTS: For the Korean-SRIS (K-SRIS) 4 items were deleted from the original SRIS. The final scale consisted of 16 items which were sorted into- the 2 factors: self-reflection (11 items), insight (5 items). The cumulative percent of variance was 50.91%. The statistically significant correlation between K-SRIS scores and the Reflection in Learning Scale (RLS) support the concurrent validity of the K-SRIS. The reliability of the scale, Cronbach's α was .83. CONCLUSION: The finding indicate that the K-SRIS has validity and reliability. Therefore it can be used for measuring and developing reflection ability in nursing students.

Establishing a Clinical Ladder System for Nurses in a Small and Medium-sized Hospital / 간호행정학회지

PURPOSE: This study was done to establish a clinical ladder system for nurses in a small and medium-sized hospital in Korea. METHODS: The study was carried from July, 2016 to May, 2018. Data collection was done in a general hospital with 250 beds located in Gyeonggi Province. The clinical ladder system was developed and operated according to the value system of small and medium-sized hospital. Focus group interviews and a satisfaction survey were conducted for evaluation. Collected quantitative data were analyzed using the SPSS/WIN 22.0 program and qualitative data underwent content analysis. RESULTS: The clinical ladder system is a 5-step ladder that includes 3 domains, 5 nursing competencies and 25 nursing behavioral indicators related to core values of the hospital. The operating system were promotion review system, education system and support/reward system. After conducting a pilot clinical ladder system, satisfaction of nurses was 2.86, out of a possible 4. Nurses who participated in the clinical ladder system experienced improvement in motivation, job performance, self-esteem, professionalism, recognition and were able to develop a goal in their minds. CONCLUSION: The results indicate that the clinical ladder system can be used as a strategy for professional development for nurses in small and medium-sized hospitals.

Relationship between Career Plateau, Career Planning, Social Support, and Turnover Intention in Nurses / 간호행정학회지

PURPOSE: This study was a correlational research to examine the relationship between career plateau, career planning, social support and turnover intention experienced by nurses in the clinical nursing field. METHODS: Participants were 237 nurses working in general hospitals with 100~300 beds located in G Metropolitan City. Data were collected from September 26 to October 6, 2016, and analyzed using the SPSS/WIN 22.0 program. Descriptive statistics, independent t-test, univariate ANOVA, Scheffé test, correlation analysis, and hierarchical multiple regression analysis were conducted. RESULTS: Participants' turnover intention was positively correlated with career plateau (r=.38, p < .001), structural career plateau (r=.31, p < .001) and content plateau (r=.35, p < .001), but negatively correlated with social support (r=−.38, p < .001), supervisor support (r=−.36, p < .001), peer support (r=−.32, p < .001), and career planning (r=−.15, p=.043). Factors associated with participants' turnover intention were supervisor support (β=−.22, p=.006), structural career plateau (β=.19, p=.012), and content career plateau (β=.14, p=.047). CONCLUSION: Results suggest that structural career plateau, content career plateau, and supervisor support are related to nurses' turnover intention. To lower nurses' turnover intention, alternative ways must be developed to improve the structure of nursing organizations to address career plateau and establish an organizational culture that can be supported by supervisors.

An Action Research on Flipped Learning for Fundamental Nursing Practice Courses / 기본간호학회지

PURPOSE: This study was conducted to design and implement a fundamental nursing practice based on flipped learning and to examine the effects. METHODS: Participants were 57 students who were taking the fundamental nursing practice course at D university in N city. The study included processes of instructional design, action/effects and reflection. Data were analyzed using paired t-test with the SPSS/WIN 23.0. RESULTS: In the instructional design stage, the class consisted of 3 parts: outside class (pre-learning), inside class (assessment, collaborative practice, peer review, reflection), after-class (self-directed practice, feedback). In the action/effects stage, the flipped learning was applied for 15 weeks according to the instructional design and then the effects of flipped learning were evaluated. Students showed a significant improvement in self-directed learning ability (t=−3.56, p=.001) and critical thinking disposition after the class (t=−3.72, p<.001). Finally, in the reflection stage, the researchers examined whether the four pillars of flipped learning occurred. CONCLUSION: Findings indicate that flipped learning applied in fundamental nursing practice is effective in improving self-directed learning ability and critical thinking disposition. The action research method was a useful way to foster professor's educational competency as well as to verify effects of a new nursing education method.

Nursing Students' Hearing Levels and Blood Pressure Measurement Accuracy / 기본간호학회지

PURPOSE: This study was done to examine the relationship between nursing students' hearing levels and accuracy of blood pressure (BP) measurements. METHODS: Participants were 107 students who had finished their fundamental nursing practice and clinical practicum and who used earphones. Data were collected from October 13 to November 30, 2014 and from April 30 to May 19, 2015. Students' hearing thresholds were examined using an audiometer. Students were assigned to take two BP measurements on BP measurement training simulators, but only the second measurement was used for analysis. RESULTS: All nursing students' hearing levels were within normal range, and there was no significant difference found among the settings for diastolic blood pressure. However, there were significant differences between low systolic blood pressure (SBP) (below 120mmHg) and high SBP (over 140mmHg) (z=9.02, p=.011). Measurement error in SBP showed a positive correlation with hearing threshold in the right ear at frequencies of 1000Hz and 500Hz. CONCLUSION: Findings indicate that BP measurement error is correlated with hearing threshold at some frequencies. To reduce measurement error, nursing students should be provided with health education about hearing and to improve training for students, further studies need to examine other factors influencing BP measurement error.

An Action Research to Improve Fundamental Nursing Practice Course: Designing College Courses Model / 기본간호학회지

PURPOSE: The purpose of this study was to improve the quality of fundamental nursing practice course. METHODS: Participants were 132 students who took the fundamental nursing practice course at D university in N city. The study included processes of planning, action, observation, and reflection. Quantitative data were analyzed using SPSS 20.0 program and qualitative data were evaluated through content analysis. RESULTS: The 12-step designing college courses model by Fink was applied in the planning. In the acting stage, the course was conducted according to the instruction in designing the course, students wrote reflective journals and the professor gave feedback to the reflective journal and the class observation journal was used for lessons. In the observation stage, the course evaluation was surveyed and analyzed, evaluations were positive with 47.1% of students positively evaluating the teaching strategy. In the reflecting stage, outcomes in course improvement were reflected on and, the number of students at the lower level-of-achievement decreased. CONCLUSION: Action research was a useful research method that could capture the quality improvement process in college courses. Expression of effort and passion to improve quality of education through action research in various ways and to share quality improvement strategies for nursing education are important.

The Assessment and Consideration about Feasibility of eFAST Exam in Medical School Students in Korea

PURPOSE: Emergency physicians usually perform ultrasound exams for patients with multiple injuries. Extended focused assessment with sonography for trauma (eFAST) can reveal injuries from chest to the abdomen immediately. However, in Korea, the curriculums of medical schools do not currently include eFAST. We have devised a study to assess the feasibility of the eFAST exam in medical school students. METHODS: This study was conducted in students in their fifth year out of six years of medical school, over 11 weeks. Four Emergency Medicine specialists trained the students over 4 hours, tested the students, and conducted a questionnaire. RESULTS: Average age of students was 25.9+/-2.6 years, and 24 were male and 20 were female. Mean success rate of 17 components on the eFAST exam was 95.9% (94.6%-97.4%). The success rate of transverse view of aorta, transverse view of bladder, lung sliding sign, and sea-shore sign of both anterior chest walls was 100%, scanning the spleen and attaching the probe to a body surface were 75%, 86.3%. Total time consumption was 449.0+/-22.2 seconds. The questionnaires showed that the eFAST exam for the splenorenal recess, spleen, and left upper quadrant lung was difficult. CONCLUSION: We found that medical students in Korea could perform the eFAST exam by themselves after 4 hours education. In the future, these findings can be helpful in development of an eFAST education program for medical students.

Comparison of Reflection Hierarchy, Team Learning Climate, and Learning Organization Building on Nursing Competency in Clinical Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to identify clusters of nursing competency, and investigate the influence of reflective thinking, team learning climate, and learning organization building according to nursing competency clusters. METHODS: Participants were 244 clinical nurses who worked in 4 general hospitals in Gwangju Metropolitan City. Data were collected by self-report questionnaires during June and July, 2011. Nursing competency, levels of reflection hierarchy, team learning climate, and learning organization building were measured. Data were analyzed using frequencies, means, t-test, one-way ANOVA, Pearson correlation coefficients, and K-means cluster analysis with SPSS/WIN 20.0 version. RESULTS: Nursing competency correlated positively with intensive reflection, reflection, team learning climate, and learning organization building (p<.001). There were three clusters of nursing competency in a clinical ladder, which were derived from cluster analysis, grouped as high, middle, and low competency. Intensive reflection, reflection, team learning climate, and learning organization building showed significant differences according to grouping of nursing competency. CONCLUSION: The results indicate that developing intensive reflection, reflection, team learning climate, and learning organization building would be useful strategies for enhancement of nursing competency.

A Journey to Action Research in a Clinical Nursing Context / 간호행정학회지

PURPOSE: The purpose of this study was to examine the effectiveness of Action Research (AR) approach in nursing. METHODS: Participants were 64 perioperative nurses recruited from C hospital in Gwangju, Korea. The nurses were engaged in the project through 2 cycles of planning, acting, observing, and reflecting. A mixed-methods design was used to examine changes in participants and their knowledge management practice. Quantitative data were analyzed using SPSS 20.0 program and qualitative reflection data underwent content analysis. RESULTS: During the project, participants developed standardized pre-operative checklists and opened an Internet Cafe to better manage their perioperative nursing information. At the end of the project, there was a significant increase in nurses' knowledge management (p=.015) and the rate of surgical material prescription errors decreased from 8.0% to 2.9%. Core AR project team members' teamwork skills and organizational commitment increased significantly (p=.040, p=.301, respectively). The main themes that emerged from the qualitative data were learning how to solve problems in practice, facilitating team activities through motivation, barriers of large participation, and rewarded efforts and inflated expectations. CONCLUSION: The AR project contributed to empowering participants to solve local problems. AR is a useful methodology to promote changes in practices and research participants.

The Correlation of the White Matter Lesions and Lacunar Infarcts in Patients with Vascular Cognitive Impairment

BACKGROUND: Cerebral white matter lesions (WMLs) and lacunar infarcts (LIs) are mostly caused by small vessel disease (SVD). Whereas the main pathomechanism behind LIs is SVD, a variety of mechanisms could be responsible for WMLs. We tried to investigate the relationship between WMLs and LIs and the impact of subtypes of WMLs on its relationship. METHODS: We assessed 128 subjects with vascular cognitive impairment with subcortical vascular lesion (VCI-S). LI number and WML volume were determined on T1-, T2-weighted images and fluid-attenuated inversion recovery images using a semiquantitative visual scale. Cognitive function and daily functional impairment were assessed with Mini-Mental State Examination (MMSE) and the Seoul-Instrumental Activities of Daily Living (S-IADL). RESULTS: Of the 128 patients, 106 (82.8%) had Alzheimer's disease with WML and 22 (17.2%) had subcortical vascular dementia. Seventy patients (54.7%) had at least one lacune. A univariate Poisson model showed that history of hypertension, history of stroke and WML volume (periventricular and deep subcortical) were associated with LIs. A multivariate Poisson model showed that increased WML volume of both types and history of hypertension were associated with LIs. Neither S-IADL score nor MMSE was significantly associated with WML volume of both types. CONCLUSIONS: We found that LIs were associated with WMLs regardless of their types in patients with VCI-S. These findings may suggest that periventricular and deep subcortical WMLs share the same vascular pathomechanism of SVD as LIs.