A Concept Analysis of Compliance in Kidney Transplant Recipient Including Compliance with Immunosuppressive Medication

Purpose@#Compliance in kidney transplant recipients is critical for a positive prognosis. Especially compliance with medications after kidney transplantation is a major health care issue with implications for graft rejection and graft loss. But the definition of compliance in transplantation varies among centers. The purpose of this study was to clarify the concept of compliance in kidney transplant recipients. @*Methods@#A literature search was conducted using RISS, MEDLINE, CINAHL. The concept analysis was guided by the methodology posited by Walker and Avant. @*Results@#In this study, we found the attributes of the concept: ‘compliance with immunosuppressive medication’, ‘compliance with follow-up’, ‘compliance with early detection of graft rejection and complication’, and ‘compliance with prevention of complication’. The antecedents of ‘compliance in kidney transplant recipients’ included ‘having a kidney transplant surgery’ and ‘normal function of transplanted kidney’. The consequences of ‘compliance in kidney transplant recipients’ included ‘affecting the function of the transplanted kidney’ and ‘affecting the health of kidney transplant recipients. @*Conclusion@#This study may contribute to the development of tools for measuring compliance in kidney transplant recipients, as well as benefit nursing interventions research to increase compliance in kidney transplant recipients.

The effects of empathy and self concept on problem solving: Focusing on the mediating effect of communication of nursing students / 한국간호교육학회지

Purpose@#This study aimed to identify the effect of nursing students' empathy and self-esteem on problem-solving ability through the mediated effect of communication skills. @*Methods@#Data were collected from 179 nursing students between 1 October and 30 October, 2018 from three universities in Gyeonggi-Do. Data on subjects’ general characteristics, empathy, self-esteem, communication skills, and problem solving ability were collected using a structured self-reporting questionnaire. @*Results@#Of the total subjects, 89.9% were female. The subjects' empathy was 3.40±0.36, self-esteem was 3.16±0.56, communication skills was 3.65±0.48, and problem-solving ability was 3.52±0.42. Communication skills showed a partial mediating effect on the relationship between empathy and problem solving ability. Communication skills also showed a partial mediating effect on the relationship between self-esteem and problem solving ability. @*Conclusion@#These findings indicate that it will be more effective to develop strategies that can improve empathy, self-esteem, and communication skills together when developing programs that improve problem-solving ability.

The effects of empathy and self concept on problem solving: Focusing on the mediating effect of communication of nursing students / 한국간호교육학회지

Purpose@#This study aimed to identify the effect of nursing students' empathy and self-esteem on problem-solving ability through the mediated effect of communication skills. @*Methods@#Data were collected from 179 nursing students between 1 October and 30 October, 2018 from three universities in Gyeonggi-Do. Data on subjects’ general characteristics, empathy, self-esteem, communication skills, and problem solving ability were collected using a structured self-reporting questionnaire. @*Results@#Of the total subjects, 89.9% were female. The subjects' empathy was 3.40±0.36, self-esteem was 3.16±0.56, communication skills was 3.65±0.48, and problem-solving ability was 3.52±0.42. Communication skills showed a partial mediating effect on the relationship between empathy and problem solving ability. Communication skills also showed a partial mediating effect on the relationship between self-esteem and problem solving ability. @*Conclusion@#These findings indicate that it will be more effective to develop strategies that can improve empathy, self-esteem, and communication skills together when developing programs that improve problem-solving ability.

Effect of Smoking Duration, Smoked Cigarettes per Day and Cessation Period on Pulmonary Function in Ex-smokers: Based on the 6th Korea National Health and Nutrition Examination Survey Data (KNHANES, 2016)

PURPOSE: This study aimed to investigate the effect of smoking duration, smoked cigarettes per day and smoking cessation period on pulmonary function among ex-smokers: based on the 6th Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: This study was analyzed using the 6th KNHANES data. Pulmonary function tests were performed on a total of 4,214 adults (>40 years old). A total of 770 adults ex-smokers were eligible for inclusion in the final analysis. Forced vital capacity (FVC), forced expiratory volume in one second (FEV₁) and FEV₁/FEV were measured to evaluate pulmonary function. RESULTS: This study showed that there were significant differences in both FEV₁ and FVC values based on gender, age and height, among ex-smokers. FEV₁/FVC significantly differed by age, height and the smoking duration prior to smoking cessation. Multiple regression analysis revealed that, FEV₁/FVC accounted for 26.0% of the variance by age, height and smoking duration. There was a difference in the mean value of FEV₁/FVC with or without smoking for more than 10 years. CONCLUSION: This study's findings show that smoking for over 10 years in an ex-smoker can lead to problems with the respiratory system. The long-term cigarette has progressive ill effects on the respiratory system.

The Effects of Empathy on Interpersonal Relationship through the Mediating Effect of Ego-resilience in Nursing Students

PURPOSE: The study was performed to investigate the effects of empathy on interpersonal relationships through the mediating effect of ego-resilience in nursing students. METHODS: Data were collected from June 5 to 30, 2018 using a self-report questionnaire measuring empathy, interpersonal relationships and ego-resilience. The sample was 204 nursing college students. SPSS WIN 23.0 programs were used to analyze the data. RESULTS: Ego-resilience was positively related to empathy (r=.37, p < .001) and interpersonal relationships (r=.36, p < .001) and empathy was positively related to interpersonal relationships (r=.37, p < .001). Regression analysis showed that ego-resilience was affected by empathy (β=0.37, p < .001), interpersonal relationships were affected by empathy (β=0.37, p < .001). Interpersonal relationships were affected by empathy (β=0.28, p < .001) and ego-resilience (β=0.26, p < .001). Therefore ego-resilience mediates between empathy and interpersonal relationships. CONCLUSION: It is necessary to develop an effective intervention program to improve nursing students' empathy and ego-resilience.

Effects of Daily Chlorhexidine Bathing on the Acquisition of Multidrug-resistant Organisms and Healthcare-associated Infection in an Intensive Care Unit

PURPOSE: The aim of this study was to verify the effects of daily 2% chlorhexidine gluconate (CHG) bathing on the acquisition of multidrug-resistant organisms (MDRO) and healthcare-associated infection (HAI) in a medical intensive care unit (MICU). METHODS: The study was a randomized controlled group posttest only design, involving 91 patients in MICU at a tertiary hospital (47 patients in the experimental group and 44 patients in the control group). The 2% CHG bathing was performed daily according to bathing protocol to the patients in the experimental group, and traditional bath was performed every three days to those in the control group. Fisher's exact test and χ² test were used to analyze the data. RESULTS: MDRO were found in 6 patients of the experimental group and in 15 patients of the control group. The difference was statistically significant (p=.016). HAI occurred in 2 patients of the experimental group and in 7 patients of the control group. The difference was not statistically significant (p=.084). CONCLUSION: The results confirmed that daily bathing with CHG was effective in reducing the incidence of MDRO acquisition. Therefore, it is expected that daily bathing with CHG will be used as an effective nursing intervention to reduce the incidence of MDRO acquisition.

Current Status of Biological Nursing Science Education for Clinical Nurses in General Hospital

PURPOSE: The purpose of this study was to investigate the extent and the nature of biological nursing science education for clinical nurses in general hospital. METHODS: Five advanced general hospitals located in Seoul and Gyeonggi province were conveniently sampled. Contents of education for nurses conducted by the hospital nursing department from January 1 to December 31 of 2015 were collected. Contents of education included biological nursing science and the scope of inclusion and time of assignment were analyzed. RESULTS: A total of 271 cases of nursing education data were collected and 223 cases were analyzed after excluding 48 cases whose contents were not confirmed. Biological nursing science was included in the contents of education for 117 cases (52.5%), but not for 106 cases (47.5%). Regarding the frequency of the biological nursing science education contents, ‘pathophysiology’was the most frequently included (n=286), followed by ‘structure and function of the human body’ (n=191), ‘mechanisms and effects of drugs’ (n=114) and ‘clinical microbiology’ (n=43). CONCLUSION: Results of this study confirmed that the education for clinical nurses included a lot of biological nursing science related contents. These results can be used as basis for the development of curriculum and training course for nurses.

Effect of angiotensin receptor blockade on central aortic systolic blood pressure in hypertensive Asians measured using radial tonometry: an open prospective cohort study

<p><b>INTRODUCTION</b>Central aortic systolic pressure (CASP) has been shown to be a stronger predictor of cardiovascular events than brachial blood pressure (BP). Different classes of drugs have differential effects on CASP and brachial BP. This open prospective cohort study aimed to observe changes in CASP (measured using radial tonometry) among hypertensive Asians after 12 weeks of treatment with valsartan, an angiotensin receptor blocker (ARB).</p><p><b>METHODS</b>Patients with treatment-naïve hypertension or uncontrolled hypertension who were on non-ARB therapy were eligible for inclusion. Patients with uncontrolled BP (i.e. ≥ 140/90 mmHg) received valsartan for 12 weeks. The patients' brachial systolic and diastolic BP (SBP and DBP), and CASP changes were monitored using the BPro® watch.</p><p><b>RESULTS</b>The mean age of the 44 enrolled patients was 35 years. At baseline, the mean BP and CASP were 150.2/91.4 ± 10.6/9.4 mmHg and 136.3 ± 12.2 mmHg, respectively. Valsartan reduced SBP, DBP and CASP by 14.9 ± 10.7 mmHg, 10.9 ± 8.4 mmHg and 15.3 ± 10.9 mmHg, respectively (all p < 0.001). Every 1.0-mmHg reduction in brachial SBP resulted in a 0.8-mmHg reduction in CASP (p < 0.001). A CASP cut-off of 122.5 mmHg discriminated between controlled and uncontrolled BP (sensitivity 74%, specificity 88%).</p><p><b>CONCLUSION</b>Using radial tonometry, we demonstrated good correlation between CASP and brachial SBP reductions after 12 weeks of treatment with valsartan in our study cohort. Correlation analysis between CASP and SBP reductions may be useful for demonstrating whether a drug is able to lower CASP beyond lowering SBP.</p>

Evaluation of an Individualized Education before Discharge and Follow-up Telephone Consultation on Self-efficacy for Kidney Transplant Patients

PURPOSE: This study was to develop and evaluate an individualized education program based on self-efficacy for patients with kidney transplantation in Korea. METHODS: A nonequivalent control group pretest-posttest design was used. The participants consisted of 43 patients who underwent kidney transplants at one hospital in Seoul, from July 2012 to April 2013. The experimental group received an individualized education based on self-efficacy in the hospital and follow-up telephone consultation in the 2nd and 3rd week after discharge. The control group received a routine discharge education. Knowledge, self-efficacy, and compliance related to kidney transplant were measured and analyzed by frequency, average, Mann-Whitney U test, Fisher's exact test, independent t-test, and chi2-test using SPSS Win 20.0. RESULTS: Significant differences were found in self-efficacy between the experimental group and the control group. But no significant differences were found in knowledge and compliance between two groups. The scores of several items on monitoring health status in compliance were higher in the experimental group than those of the control group. CONCLUSION: The results of this study demonstrate the fact that an education program based in self-efficacy for patients with kidney transplant would be effective in improving self-efficacy and the ability to monitor their health status.

Primary Pure Squamous Cell Carcinoma Originating from the Stomach

Primary gastric squamous cell carcinoma represents a rare entity. Up to date, only seven cases have been reported in Korea. This paper reports a case of a 51-year-old male patient whose stomach cancer was diagnosed during general routine check-up. Upper gastrointestinal endoscopy showed a large ulcero-fungating mass on the body of the stomach. Histological examination of biopsy confirmed squamous cell carcinoma. An extended total gastrectomy including splenectomy and segmental resection of the large bowel was conducted. Postoperative adjuvant chemotherapy with capecitabine and oxaliplatin was followed. The patient has been following up the out patient's clinic after discharge.

Primary Pure Squamous Cell Carcinoma Originating from the Stomach

Primary gastric squamous cell carcinoma represents a rare entity. Up to date, only seven cases have been reported in Korea. This paper reports a case of a 51-year-old male patient whose stomach cancer was diagnosed during general routine check-up. Upper gastrointestinal endoscopy showed a large ulcero-fungating mass on the body of the stomach. Histological examination of biopsy confirmed squamous cell carcinoma. An extended total gastrectomy including splenectomy and segmental resection of the large bowel was conducted. Postoperative adjuvant chemotherapy with capecitabine and oxaliplatin was followed. The patient has been following up the out patient's clinic after discharge.

A case of Becker muscular dystrophy with early manifestation of cardiomyopathy / 소아과

An 18-year-old boy was admitted with chest discomfort, nausea, and dyspnea at rest. At the age of 3 years, he underwent muscle biopsy and dystrophin gene analysis owing to an enlarged calf muscle and elevated serum kinase level (6,378 U/L) without overt weakness; based on the results, Becker muscular dystrophy (BMD) was diagnosed. The dystrophin gene showed deletion of exons 45 to 49. He remained ambulant and could step upstairs without significant difficulties. A chest roentgenogram showed cardiomegaly (cardiothoracic ratio, 54%), and his electrocardiogram (ECG) showed abnormal ST-T wave, biatrial enlargement, and left ventricular hypertrophy. The 2-dimensional and M-mode ECGs showed a severely dilated left ventricular cavity with diffuse hypokinesis. The systolic indices were reduced, including fractional shortening (9%) and ejection fraction (19%). Despite receiving intensive medical treatment, he died from congestive heart failure 5 months after the initial cardiac symptoms. We report a case of BMD with early-onset dilated cardiomyopathy associated with deletion of exons 45 to 49. Early cardiomyopathy can occur in BMD patients with certain genotypes; therefore, careful follow-up is required even in patients with mild phenotypes of BMD.

Neurologic Complications of Bacterial Meningitis in Children

PURPOSE: This study was performed to investigate clinical findings of acute neurologic complications and risk factors for chronic neurologic complications of bacterial meningitis in children. METHODS: Pediatric patients with community acquired bacterial meningitis diagnosed at Seoul National University Children's Hospital and Bundang Seoul National University Hospital were included. We investigated the relative frequency of neurologic complications and distribution of causative organisms. Chronic neurologic complication was defined as persistent neurologic deficit including recurrent seizures 6 months from the diagnosis. Multiple logistic regression analysis was used to identify risk factors for epilepsy and motor deficits, which were the most frequently reported chronic neurologic complications. RESULTS: A total of 90 cases were included in the study. Thirteen cases with less than 6 months follow-up duration were excluded from the analysis of risk factors for chronic neurologic complications. The mean age at diagnosis was 15.6 months. Streptococcus agalactiae was the most common pathogen accounting for 27 cases, followed by Streptococcus pneumoniae (19 cases), Hemophilus influenzae type b (13 cases), and Neisseria meningitidis (12 cases). Acute neurologic complications were found in 28 cases (31%): cerebral infarction in 16 cases, subdural effusion in 15 cases, and hydrocephalus in 9 cases. Chronic neurologic complications were found in 41 (53%) cases: epilepsy in 28 cases, motor deficit in 16 cases, hearing loss in 6 cases, and cognitive impairment in 4 cases. Cerebral infarction and S. pneumoniae infection were identified as risk factors for epilepsy. Cerebral infarction was a unique risk factor for motor deficit. CONCLUSION: Cerebral infarction is the important risk factor for the development of chronic neurologic complications including epilepsy and motor deficit in pediatric patients with bacterial meningitis.

Study on the Changes in Limb Circumferences and Muscle Areas of Critically Ill Patients using Ventilators

PURPOSE: The purpose of this study was to identify muscle atrophy in critically ill patients on ventilators. A comparison was made between limb circumferences and muscle areas on the day of admission to an intensive care unit (ICU) and on the 8th day after admission. METHODS: The data were collected from 30 critically ill patients using ventilators at S hospital ICU in Seoul during the period from October 2005 to April 2006. Limb circumferences and skinfold thickness were measured on the day of admission and on the 8th day after admission to the ICU. Limb circumferences and skinfold thickness were measured on the right mid-arm, right mid-thigh, and right mid-calf using a measuring tape and a skinfold calipers. Limb muscle areas were calculated by an equation after measuring limb circumferences and skinfold thickness. The data were analyzed by paired t-test and independent t-test. RESULTS: 1) Mid-arm circumference, mid-thigh circumference and mid-calf circumference on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 2) Mid-arm muscle area, mid-thigh muscle area and mid-calf muscle area on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 3) Steroid and vecuronium medication didn't affect changes in limb circumferences (mid-arm, mid-thigh, mid-calf) and muscle areas (mid-arm, mid-thigh, mid-calf) on the 8th day after admission to the ICU compared to the day of admission. CONCLUSION: Limb muscle atrophy may occur on the 8th day after admission to the ICU in critically ill patients using ventilator.

A Study on the Effects of Retinoic Acid on the Epithelium of Palatine Process in Albino Rat Fetus

The elevation and fusion of palatine are essential processes in the completion of the palatal development. It is believed that the mesenchyme plays a major role in the ascent of the palatal process, and that the palatal epithelium is involved in its fusion. The mechanism of fusion requires several different morphologic and molecular changes prior to the completion of the mesenchymal continuity between different palatine processes. The mechanism of removing the epithelial cells from the fusion zone could include either programmed cell death, epithelial-mesenchymal transformation or migration to adjacent epithelia. Retinoic acid has been known to induce cleft palate by disturbing mesenchymal growth and/or epithelial fusion. The effect of retinoic acid on the epithelium of the palatine process was studied in the fetus of the Sprague- Dawley rat with feeding 100 mg/kg of retinoic acid mixed in olive oil on the 10th day of fetal age and controlled with feeding pure olive oil. The epithelium of the palatine process was examined by PAS reaction and electron- microscopy on the 14th, 15th, 16th and 18th day of fetal age. The obtained results were as follows: 1. In the control group, glycogen was plentiful at the entire epithelium of the palatine process during the pre-fusion period(14th and 15th day), but it diminished in contact epithelium at the fusion stage(16th day). On the contrary, in the experimental group treated with retinoic acid, glycogen was plentiful and did not change from the 14th to 18th day of gestation. 2. In the control group at fusion stage(16th and 18th day), PAS-positive cells increased in the nasal and oral epithelium adjacent to the fusion site, and in the mesenchyme around the fusion site. 3. As a result of electronmicroscopic findings, the epithelium in the experimental group with retinoic acid seemed to be injured by retinoic acid; RER was composed of flattened cisternas and ribosomes were detached, mitochondrial crista and membrane were destructed and sacculated, and Golgi complex was extremely atrophied. According to the results, it seems that apoptosis as well as cell migration and transformation happen in the mechanism of cleaning the epithelium at the contact site, and that retinoic acid injures directly intracytoplasmic organelles and disturbs apoptosis, a sort of normal developmental process. More studies should be done to verify relations between apoptosis and large-sized glycogen granule in superficial epithelium.