Characteristics of Early Onset Dementia and Caring Experiences and Service Needs of Family Caregivers: A Mixed Methods Study / 정신간호학회지

Purpose@#The purpose of this mixed methods study was to explore the caring experiences of the family caregivers of patients with early-onset dementia, and identify the characteristics of early-onset dementia. @*Methods@#A qualitative study was conducted using Colaizzi‘s phenomenological method to explore the caring experiences and service needs of ten family caregivers. A quantitative study was carried out by secondary data analysis to compare the differences in disease characteristics and comorbidities between early and late-onset dementia. @*Results@#The experiences of the family caregivers of patients with early-onset dementia were ‘Learning about dementia’, ‘Away from everyday life’, ‘Facing dementia’, and ‘Barely managing’. The study also revealed that one out of five dementia patients had early-onset dementia. However, most dementia services are concentrated on late-onset dementia. Thus, the family and caregivers of early-onset dementia patients experience relatively inadequate services. @*Conclusion@#This study’s findings identified the characteristics of early-onset dementia, as well as the caring experiences and service needs of family caregivers from a more holistic perspective, and will contribute to the development of adequate nursing intervention programs and policies in the future.

Clinical Manifestations and Genetic Analysis of 5 Korean Choroideremia Patients Initially Diagnosed With Retinitis Pigmentosa

Background@#To investigate the clinical findings of choroideremia patients and perform genetic analysis by whole-exome sequencing (WES). @*Methods@#A total of 94 patients initially diagnosed with retinitis pigmentosa (RP) at another hospital, and who visited our hospital for genetic analysis by WES, were included in the study, along with 64 family members. All subjects underwent comprehensive ophthalmic evaluation, including best-corrected visual acuity, slit lamp examination, fundus photography, fundus autofluorescence (FAF), fluorescein angiography (FAG), visual field (VF), electroretinogram (ERG), and optical coherence tomography (OCT). @*Results@#In six male patients with suspected choroideremia, extensive retinal pigment epithelium (RPE) and severe loss of choroid were observed in the fundus, but not in the macula. CHM gene mutation was confirmed in five patients. A novel single nucleotide variant at a splice site was observed in one patient. OCT showed marked thinning of the outernuclear layer and choroid, except in the macula. FAF showed a small area of hyperfluorescence in the posterior pole. In addition, characteristic interlaminar bridges were observed in four patients. On FAG, hypofluorescence was seen up to the far-peripheral retina in five patients. @*Conclusion@#Of the 94 patients initially diagnosed with RP, CHM mutation was identified in five (5.3%) by WES. Choroideremia should be considered as a differential diagnosis of RP.WES would be useful for identifying the causes of hereditary retinal disease.

Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

Objective@#This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Methods@#This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. @*Results@#The median maternal age was 33 years (range, 28–40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutes after delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Conclusion@#Two-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates of maternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy between the clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.

Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

Objective@#This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Methods@#This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. @*Results@#The median maternal age was 33 years (range, 28–40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutes after delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfying all 4 criteria and cases with at least 1 missing criterion. @*Conclusion@#Two-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates of maternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy between the clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.

Treatment of gestational diabetes diagnosed by the IADPSG criteria decreases excessive fetal growth

A Novel Method for Hyperacuity Measurement

PURPOSE: We developed a novel method for measurement of hyperacuity and verified the utility thereof.METHODS: We developed a three-dimensional (3D) hyperacuity test using a 3D liquid crystal flat screen, a left- and right-image polarized display, and liquid crystal shutter glasses. We tested the technique in three groups: normal (n = 48), with cataracts (n = 14), and with macular disease (n = 35). We used a chart consisting of five dots and a reference line. Of the five dots, one was variably shifted from the other dots. A chart was presented to one eye and the reference line or blank image to the other eye; a subject scored positive when the dot in the unusual position was recognized.RESULTS: Hyperacuity was measured in terms of the reference line seen by the reference eye (RR), a blank image seen by the reference eye (RB), the reference line seen by the contralateral eye (CR), and a blank image seen by the contralateral eye (CB). All test scores were significantly lower when the reference line was seen than not (RR vs. RB and CR vs. CB; p < 0.01, respectively). For the RR and CR tests, no significant difference was apparent between the normal and cataracts group (p = 0.553, p = 0.494) but such differences were evident between the normal and macular disease groups (p = 0.028, p = 0.002). Also, visualization of the reference line by the reference and contralateral eyes did not differ (p > 0.05).CONCLUSIONS: Measurement of hyperacuity using our new method was not affected by media opacity but was significantly affected by macular disease. Presentation of a reference line facilitated hyperacuity assessment.

Repeatability and Reproducibility of Tear Meniscus Evaluations Using Two Different Spectral Domain-optical Coherence Tomography

PURPOSE: To evaluate the repeatability and reproducibility of inferior tear meniscus measurements using two different spectral domain-optical coherence tomography (OCT), and to compare the inter-device agreements between these devices. METHODS: Two examiners evaluated the tear meniscus depth (TMD) and tear meniscus height (TMH) of 20 eyes in 20 normal subjects using Cirrus OCT and Spectralis OCT with the examiners calculating the TMD and TMH. We analyzed intra-examiner repeatability, inter-examiner reproducibility, and inter-device agreement. RESULTS: The average TMD measurements using the Cirrus OCT and Spectralis OCT devices were 151.25 ± 41.53 µm and 139.10 ± 40.56 µm by examiner 1, respectively, and 152.03 ± 42.77 µm and 138.35 ± 39.70 µm by examiner 2, respectively. The TMHs were 291.90 ± 100.19 µm and 245.43 ± 66.44 µm by examiner 1, respectively, and 288.25 ± 98.72 µm and 244.23 ± 60.69 µm by examiner 2, respectively. The TMDs and TMHs measured using these OCT devices were not statistically significant for intra-examiner and inter-examiner measurements (all, p > 0.05). These devices showed high repeatability (intraclass correlation coefficient ≥ 0.991) for intra-examiner TMD and TMH measurements and the inter-examiner coefficient of variation ranged from 2.04% to 4.32%. The 95% limits of agreement between the two devices were −66.13 to 91.95 µm for TMD and −127.18 to 217.68 µm for TMH. CONCLUSIONS: Both OCT devices are useful for conducting inferior tear meniscus measurements. The inter-device agreement was poor, and the devices were not interchangeable.

Construction of a Structural Model Incorporating Nurse Image, Image Determinants, and Self-esteem for Evaluation of Cambodian Nursing Students / 한국간호교육학회지

PURPOSE: This study, on the basis of a structural model that includes nurse image, image determinants, and self-esteem of Cambodian nursing students influenced by the Korean nursing education system, demonstrates distinctions between senior and junior according to experience in clinical practice. METHODS: Data were collected via a questionnaire from 194 nursing students in Cambodia and subsequently analyzed using the STATA IC 12 program. RESULTS: First, image determinants and their sub-factors-subjective, institutional, and media-effect both the nurse image and self-esteem of nursing students. Second, the study confirms that nurse image has no significant effect on self-esteem. Also, the individual factor, a sub-factor of nurse image, possesses a weak relationship with nurse image. Third, the structural model mediating between senior and junior reveals differences resulting from experiences derived from clinical practice. CONCLUSION: The study has significance in that Cambodian nursing students, who are rarely studied in terms of nurse image, have been systemically analyzed via a structural model incorporating image determinants and self-esteem.

Analysis of patient-dropouts from the critical pathways for gastric cancer

PURPOSE: This study was designed to determine the factors affecting completion of critical pathway for elective gastrectomy. METHODS: Since 2008, a critical pathway has been applied for elective gastrectomy at Chosun University Hospital. We retrospectively analyzed 252 patients who underwent elective gastrectomies from January 2009 to April 2013. The completion rate was determined, and risk factors for patient dropout were examined. RESULTS: The completion rate of the critical pathway was 45.6% (115/252). Mean length of stay was 11.7 +/- 8.6 days (8-59 days). Readmission rates were 4.4% (11/252). Causes of failure for clinical pathway were systemic complications (21/137, 15.3%), intra-abdominal complications (44/137, 32.8%), patient factors (41/137, 29.9%), and wound complications (30/137, 21.9%). There were no significant differences between the two groups in age, sex, American Society of Anesthesiologists (ASA) score, operation time, readmission, and underlying disease (P > 0.05). Body mass index (P = 0.008) and pathologic stage (P = 0.001) were significantly different between the two groups. In multivariate analysis, the conventional approach (odds ratio, 2.0), and total gastrectomy (odds ratio, 5.3) were determined to be independent risk factors to drop the critical pathway. But there were no significant differences between total and distal gastrectomy groups in age, gender, underlying diseases, ASA score, readmission, operation time, and cause of dropout (P > 0.05). CONCLUSION: We concluded that total gastrectomy may not be suitable for the critical pathway. We suggest that the critical pathway for elective distal gastrectomy is divided 2 subgroups, according to the surgical approach.

Postoperative Changes in Body Weight, Anxiety, Depression, and Quality of Life after Radical Gastrectomy among Patients with Gastric Cancer

PURPOSE: The purpose of this study was to identify the changes in body weight, anxiety, depression, and quality of life in patients during a one month period following a radical gastrectomy. METHODS: Data were collected from 30 patients with gastric cancer from July 2, 2012 through December 31, 2012, at C University Hospital, Gwangju, South Korea. The body weight, anxiety, depression, and quality of life (QoL) of the patients were measured using structured questionnaires the day before surgery, day 7 postoperative, and 1 month postoperative. RESULTS: There were significant changes in the average body weight and the general health status/QoL, the functionality, and the symptoms of general QoL, and the functionality and the symptoms of specific QoL during the postoperative 1 month period (chi2=52.47-7.68, p<.001-.022). CONCLUSION: Oncology nurses should assess the nutritive conditions of gastrectomy patients carefully to avoid malnutrition during the postoperative 1 month period. Also, as the general and specific quality of life changes during the postoperative 1 month period, adequate support and sufficient attention should be provided to these patients to minimize the negative influence on quality of life, and to assist them in recovery to the preoperative state.

Right side fixation of sigmoid colon with a hepato-sigmoidocolic fistula in patient with hepatocellular carcinoma and midgut malrotation / 대한외과학회지

The location of the sigmoid colon varies within the abdominal cavity, but its mesocolon is fixed to the left side. Right side fixation of the sigmoid colon is a very rare congenital positional anomaly. In addition, it has been reported that hepatocolic fistula is also a very rare disease that may present lower gastrointestinal bleeding. Here, the authors describe a case of a 71-year-old man who underwent surgery for hepato-sigmoidocolic fistula complicated by hepatocellular carcinoma and the right side fixation of the sigmoid colon.

Giant Ascending Colonic Diverticulum Presenting With Intussusception

Diverticular disease of the colon is a common disease, and its incidence is increasing gradually. A giant colonic diverticulum (GCD) is a rare entity and is defined as a diverticulum greater than 4 cm in size. It mainly arises from the sigmoid colon, and possible etiology is a ball-valve mechanism permitting progressive enlargement. A plain abdominal X-ray can be helpful to make a diagnosis initially, and a barium enema and abdominal computed tomography may confirm the diagnosis. Surgical intervention is a definite treatment for a GCD. We report a case of an ascending GCD presenting with intussusception in a young adult.

Giant Ascending Colonic Diverticulum Presenting With Intussusception

Diverticular disease of the colon is a common disease, and its incidence is increasing gradually. A giant colonic diverticulum (GCD) is a rare entity and is defined as a diverticulum greater than 4 cm in size. It mainly arises from the sigmoid colon, and possible etiology is a ball-valve mechanism permitting progressive enlargement. A plain abdominal X-ray can be helpful to make a diagnosis initially, and a barium enema and abdominal computed tomography may confirm the diagnosis. Surgical intervention is a definite treatment for a GCD. We report a case of an ascending GCD presenting with intussusception in a young adult.

Removal of a broken needle using three-dimensional computed tomography: a case report

Inferior alveolar nerve block obtained maximum anesthetic effect using a small dose of local anesthetic agent, which also has low a complication incidence. Complications of an inferior alveolar nerve block include direct nerve damage, bleeding, trismus, temporary facial nerve palsy, and etc. Among them, the major iatrogenic complication is dental needle fracture. A fragment that disappears into the soft tissue would be hard to remove, giving rise to a legal problem. A 31-year-old woman was referred for the removal of a broken needle, following an inferior alveolar nerve block. Management involved the removal of the needle under local anesthesia with pre- and peri-operative computed tomography scans.

Effect of Black Cohosh on Genital Atrophy and Its Adverse Effect in Postmenopausal Women / 대한폐경학회지

OBJECTIVES: It is to evaluate the effect of black cohosh on genital atrophy and its adverse effect in postmenopausal women. METHODS: A total of 100 postmenopausal women having moderate to severe degree of climacteric symptoms were randomly allocated to receive black cohosh combined proparation (n = 50) or placebo (n = 50) daily for 12 weeks. A total of seventy eight subjects completed the study. The effect of black cohosh on vaginal atrophy was evaluated by measuring Maturation value (MV). MV was determined from vaginal smear at 0 and 12 weeks of treatment. Safety assessment included vital signs, physical examinations, adverse events, and routine laboratory parameters. Assessments were carried out at the beginning, and after 4, 8, and 12 weeks of treatment. RESULTS: The mean (+/- standard deviation) MV decreased 0.18 (0.48 +/- 0.33 to 0.30 +/- 0.24) in the black cohosh group and 0.13 (0.44 +/- 0.31 to 0.31 +/- 0.22) in the placebo group. There was no statistical difference between the groups. But adverse events were observed in 7 (14%) patients in the black cohosh group and 6 (12%) patients in the placebo group, without statistical significance. No significant effects were observed on blood pressure, heart rate, body temperature, physical findings, and laboratory values. Black cohosh was well tolerated. CONCLUSION: Black cohosh did not exert estrogenic effects with regards to vaginal atrophy. Further studies on the long-term safety and the appropriate doses of cohosh are needed.

Prognostic Implication of 15-Hydroxyprostaglandin Dehydrogenase Down-Regulation in Patients with Colorectal Cancer

PURPOSE: Prostaglandin (PG) E2 is known to be closely related to cancer progression and is inactivated by 15-hydroxyprostaglandin dehydrogenase (PGDH). 15-PGDH is shown to have tumor suppressor activity and to be down-regulated in various cancers, including colorectal cancer (CRC). Therefore, we evaluated the expression of 15-PGDH and its prognostic effect in patients with CRC. METHODS: 15-PGDH expression was examined by using immunohistochemistry in 77 patients with CRC. Its prognostic significance was statistically evaluated. RESULTS: Negative 15-PGDH expression was noted in 55.8% of the 77 cases of CRC. 15-PGDH expression showed no correlation with any of the various clinicopathologic parameters. The status of lymph node metastasis, tumor-node-metastasis stages, and pre-operative carcinoembryonic antigen levels showed significant prognostic effect. However, univariate analysis revealed down-regulation of 15-PGDH not to be a predictor of poor survival. The 5-year overall survival rate was 71.7% in the group with positive expression of 15-PGDH and 67.1% in the group with negative expression of 15-PGDH, but this difference was not statistically significant (P = 0.751). CONCLUSION: 15-PGDH was down-regulated in 55.8% of the colorectal cancer patients. However, down-regulation of 15-PGDH showed no prognostic value in patients with CRC. Further larger scale or prospective studies are needed to clarify the prognostic effect of 15-PGDH down-regulation in patients with colorectal cancer.

Comparative Evaluation of Infection Rate according to Extraction of Teeth in the Line of Mandibular Angle Fractures Treated with Stable Internal Fixation

Compliance with the Protocol Considered Emetogenic Potential for Prophylaxis of Chemotherapy Induced Nausea and Vomiting / 종양간호학회지

PURPOSE: The purpose of this study was to identify the compliance with the protocol, which was developed considering the emetogenic potential for prophylaxis of chemotherapy. METHODS: Data was collected from 144 patients who received chemotherapy from June 15 to August 31, 2010 in C University Hospital in Jeollanamdo, Korea. The level of chemotherapy-induced nausea and vomiting (CINV) and the compliance with the protocol for prophylaxis of CINV were measured. RESULTS: There was statistically significant difference of CINV in morning sickness and anticipatory nausea of general and clinical characteristics. Also, the compliance with the protocol developed according to emetogenic potential of chemotherapy was statistically significant. There was no difference in CINV in regard to the compliance with the protocol. CONCLUSION: There was a good compliance with the protocol for prophylaxis according to emetogenic potential. But it should be recommended to use antiemetics for prophylaxis aggressively to relieve CINV for the patients who already experienced morning sickness and anticipatory nausea. In addition, the oncology nurses should respond sensitively to the complaints of nausea and vomiting no matter what the emetogenic potentials of chemotherapy regimen are.

The Clinico-Statisitical Analysis of Ameloblastoma of Mandible

Complications Related to Orthognathic Surgery