Oncology Nurses' Knowledge of Safety Guidelines and Compliance with Safe Handling of Antineoplastic Agents in a Tertiary Hospitall

PURPOSE: The purpose of this study was to identify the knowledge and compliance of guidelines for safe handling of antineoplastic agents among the oncology nurses. METHODS: The participants were 186 nurses from oncology-hematology unit, and outpatient's infusion room in a tertiary hospital. The levels of knowledge of safety guidelines and compliance with safe handling of antineoplastic agents of oncology nurses were measured using structured questionnaires from October 1 to November 30, 2014. RESULTS: Oncology nurses' knowledge of guideline for safe handling of antineoplastic agents presented an average 79.7 out of 100 points. Compliance with safe handling of antineoplastic agents presented an average 4.28 (range: 2.9~5) out of 5 points. The knowledge of guidelines for safe handling of antineoplastic agents was related with oncology experience (F=3.78, p=.012). There were positive relationships of knowledge and compliance with safe handling of antineoplastic agents (r=0.23, p=.002). CONCLUSION: The findings showed that there was a need to establish efficient guidelines for the safe handling of antineoplastic agents and develop our structured, continuous educational program for the improvement of safe practices related to the handling of antineoplastic agents. The developed and enhanced that guideline and educational program would contribute to improvement of staff and patient safety related to the handling of antineoplastic agents.

Pyogenic Sacroiliitis Caused by Salmonella enterica Serotype Livingstone / 대한내과학회지

Pyogenic sacroiliitis is a rare joint infection, with a challenging diagnosis due to its nonspecific indicators and symptoms. Staphylococcus aureus is the most common causative bacteria of pyogenic sacroiliitis, with Pseudomonas aeruginosa being the most common causative gram-negative bacteria. Interestingly, whereas Salmonella species. is reportedly the second most common cause of this disorder there have been no reported cases of acute sacroiliitis due to Salmonella spp. in Korea, to the best of our knowledge. In this study, we report on the first case in a young Korean adult caused by Salmonella enterica serotype Livingstone, with no underlying disease or predisposing factors.

Use of Splenectomy to Treat Evans Syndrome Following an ABO-Matched Liver Transplant / 대한내과학회지

Evans syndrome is a rare complication that develops in adults after liver transplantation. The possible etiologies include ABO mismatch, viral infection, post-transplantation lymphoproliferative disease, graft-versus-host disease, and the use of certain immunosuppressive drugs (e.g., calcineurin inhibitors). Here, we present a case of Evans syndrome that developed after an ABO-matched liver transplant. Glucocorticosteroid, intravenous immunoglobulin, and alternative immunosuppressant therapies all failed. Weekly rituximab (375 mg/m2) was then administered for 4 weeks. The cytopenia improved transiently after the second dose of rituximab, but soon worsened again. However, the cytopenia normalized after a splenectomy.

Knowledge and Educational Need of Central Supply Room Nurses for the Sterilization Process / 병원감염관리

BACKGROUND: This study aimed to assess central supply room nurses' knowledge on and educational needs for the sterilization process. METHODS: The participants were 88 nurses working at central supply rooms of hospitals in Busan, Ulsan, and Gyeong-nam. From August to September 2014, knowledge and educational needs of the sterilization process were measured by using self-reported questionnaires. Data were analyzed by descriptive statistics, t test or analysis of variance (ANOVA), Scheffe test, and repeated-measures ANOVA with the SPSS 21.0 program. RESULTS: The mean score for knowledge on the sterilization process was 39.58 out of 50 points and was highest in keeping sterilization (8.94 out of 10 points) and lowest in packing sterilization (6.82 out of 10 points). The mean score for knowledge was significantly higher in the nurses with postgraduate studies (F=3.35, P=0.040), in those with internal training (t=2.03, P=0.045), with three or more internal trainings (F=9.72, P<0.001), with external training (t=3.48, P=.001), with two or more external trainings (F=8.40, P=0.001), and in those working in hospitals with 700 beds or more (F=15.88, P<0.001). The mean score for educational need was 4.06 out of 5 points, ranging from 3.99 to 4.12 points. It was significantly higher in nurses aged 40 years and older (F=4.28, P=0.017) and in those working in hospitals with 700 beds or more (F=4.82, P=0.010). CONCLUSION: Nurses working in central supply rooms need education on the sterilization process. We recommend the development of a standardized textbook and an educational program based on the results of this study.

A Case of Nonparaneoplastic Autoimmune Retinopathy

PURPOSE: To report a case of nonparaneoplastic autoimmune retinopathy diagnosed using serum anti-retinal autoantibodies. CASE SUMMARY: A 60-year-old female complained of progressive visual loss in both eyes over 3 months. Her best corrected visual acuity was hand motion in the right eye, 0.9 (decimal) in the left eye, and no definite abnormal findings were identified on fundus examinations. Automated visual field test revealed severely depressed visual fields in both eyes. Standard full-field electroretinogram (ERG) revealed nearly extinguished scotopic b-waves and spectral-domain optical coherence tomography (SD-OCT) showed subtle obscuration and interruption of the inner segment/outer segment (IS/OS) junction of the photoreceptors. Using Western blotting with human retinal proteins and the patient's serum, we diagnosed nonparaneoplastic autoimmune retinopathy and performed posterior subtenon steroid injection in the right eye, systemic corticosteroids, and oral mycophenolate mofetil. Full-field ERG after treatment showed slightly increased amplitude but there was no subjective visual improvement. OCT after treatment did not reveal significant changes in the photoreceptor layer. CONCLUSIONS: This is the first reported case of nonparaneoplastic autoimmune retinopathy in Korea diagnosed using Western blotting with anti-retinal autoantibodies. Autoimmune retinopathy should be considered in patients with visual field and ERG impairment without definite fundus abnormalities.

Infections after lung transplantation: time of occurrence, sites, and microbiologic etiologies

BACKGROUND/AIMS: Infections are major causes of both early and late death after lung transplantation (LT). The development of prophylaxis strategies has altered the epidemiology of post-LT infections; however, recent epidemiological data are limited. We evaluated infections after LT at our institution by time of occurrence, site of infections, and microbiologic etiologies. METHODS: All consecutive patients undergoing lung or heart-lung transplantation between October 2008 and August 2014 at our institution were enrolled. Cases of infections after LT were initially identified from the prospective registry database, which was followed by a detailed review of the patients' medical records. RESULTS: A total of 108 episodes of post-LT infections (56 bacterial, 43 viral, and nine fungal infections) were observed in 34 LT recipients. Within 1 month after LT, the most common bacterial infections were catheter-related bloodstream infections (42%). Pneumonia was the most common site of bacterial infection in the 2- to 6-month period (28%) and after 6 months (47%). Cytomegalovirus was the most common viral infection within 1 month (75%) and in the 2- to 6-month period (80%). Respiratory viruses were the most common viruses after 6 months (48%). Catheter-related candidemia was the most common fungal infection. Invasive pulmonary aspergillosis developed after 6 months. Survival rates at the first and third years were 79% and 73%, respectively. CONCLUSIONS: Although this study was performed in a single center, we provide valuable and recent detailed epidemiology data for post-LT infections. A further multicenter study is required to properly evaluate the epidemiology of post-LT infections in Korea.

Polypoid Arteriovenous Malformation Presenting with Jejunojejunal Intussusceptions in an Adult

Jejunal polypoid arteriovenous malformations (AVMs) and jejunojejunal intussusceptions are both rare. Here, we present the case of a 61-year-old woman who suffered intermittent episodes of abdominal pain over the course of 13 years. A computed tomography scan of her abdomen and pelvis revealed a distal jejunojejunal intussusception. A suspected low density mass was observed at the tip of the intussusception. Treatment comprised laparoscopic small bowel resection with end-to-end jejunostomy. The final diagnosis was a polypoid AVM measuring 5x3.5x3 cm. We suggest that polypoid AVM should be considered as a differential diagnosis in patients presenting with small intestinal neoplasms.

Anesthetic experience using extracorporeal membrane oxygenation for cesarean section in the patient with peripartum cardiomyopathy: a case report / 대한마취과학회지

Peripartum cardiomyopathy is a rare form of cardiomyopathy that is associated with significant mortality. It can cause a cardiac arrest during cesarean section even though the patient does not have any previous symptom and sign. The most important thing of anesthesia in this patient is an optimization of hemodynamic and respiratory status. We report the successful general anesthesia using of extracorporeal membrane oxygenation for cesarean section in a 34-year-old woman with fulminant peripartum cardiomyopathy.

A Case of Vertebral Osteomyelitis with Bacteremia and Psoas Abscess Caused by Non-typeable Haemophilus influenzae / 대한내과학회지

Vertebral osteomyelitis is primarily seen in middle-aged individuals, with a mean age of presentation of ~60 years. Recent trends suggest an increase in the incidence of vertebral osteomyelitis due to longer life expectancy of patients with chronic debilitating diseases. Haemophilus influenzae is a small, fastidious, gram-negative bacillus, which is known to cause infections in young children. While invasive H. influenzae infections have become increasingly common in adult populations, bone infections caused by this organism remain extremely rare. The existing medical literature includes only 11 reports of vertebral osteomyelitis caused by H. influenzae since 1978, with no reports of H. influenzae-associated vertebral osteomyelitis observed in Korea. Here, we present the case of a 72-year old patient with hematogenous vertebral osteomyelitis and psoas abscess caused by non-typeable H. influenzae.

A Case of Vertebral Osteomyelitis with Bacteremia and Psoas Abscess Caused by Non-typeable Haemophilus influenzae / 대한내과학회지

Vertebral osteomyelitis is primarily seen in middle-aged individuals, with a mean age of presentation of ~60 years. Recent trends suggest an increase in the incidence of vertebral osteomyelitis due to longer life expectancy of patients with chronic debilitating diseases. Haemophilus influenzae is a small, fastidious, gram-negative bacillus, which is known to cause infections in young children. While invasive H. influenzae infections have become increasingly common in adult populations, bone infections caused by this organism remain extremely rare. The existing medical literature includes only 11 reports of vertebral osteomyelitis caused by H. influenzae since 1978, with no reports of H. influenzae-associated vertebral osteomyelitis observed in Korea. Here, we present the case of a 72-year old patient with hematogenous vertebral osteomyelitis and psoas abscess caused by non-typeable H. influenzae.

Development of Clinical Contents Model Markup Language for Electronic Health Records / 대한의료정보학회지

OBJECTIVES: To develop dedicated markup language for clinical contents models (CCM) to facilitate the active use of CCM in electronic health record systems. METHODS: Based on analysis of the structure and characteristics of CCM in the clinical domain, we designed extensible markup language (XML) based CCM markup language (CCML) schema manually. RESULTS: CCML faithfully reflects CCM in both the syntactic and semantic aspects. As this language is based on XML, it can be expressed and processed in computer systems and can be used in a technology-neutral way. CONCLUSIONS: CCML has the following strengths: it is machine-readable and highly human-readable, it does not require a dedicated parser, and it can be applied for existing electronic health record systems.

The Development of Clinical Terminology Dictionary for Integration and Management of Clinical Terminologies in EMR Systems / 대한의료정보학회지

OBJECTIVE: The development of a dictionary of clinical terminology based on medical concepts is essential for understanding the precise meanings of the clinical terminologies used in EMR systems. For an unambiguous presentation and retrieval of the terminologies in practical data entry, this study propose a clinical terminology dictionary, which integrates and manages the wide range of data in EMR Systems. METHODS: The structure of the system and attributes were defined. The structures should satisfy the following: all terminologies should be consistent with the medical concepts, all concepts have multiple relationships, all concepts have many synonyms, all concepts can be mapped to concepts in an external medical terminology system, and all concepts can be grouped as value sets by setting the "domain". RESULTS: With the derived entity objects and attributes, the physical clinical terminology database was constructed and an editor was developed using MySQL 5.0.45 and JAVA Swing. To verify the structure and contents of the developed clinical terminology dictionary, the terminology experts used the editor to search and register the medical concepts. CONCLUSION: Although the contents refinement and complements are an unsolved problem, it is anticipated that the proposed research will provide unambiguous meanings of the clinical terminology and be applicable to many services in EMR systems.