Career Exploration Process of Nursing Student in Clinical Practice: A Voyage to Find the Authentic Nurse of Pre-registration Nurses / 한국간호교육학회지

PURPOSE: The purpose of the study is to understand the experiences of career exploration among nursing students during their clinical practice and to develop a theoretical framework for the career exploration process. METHODS: From February 2 to 28, 2015, data were collected through focus group interviews from 24 participating fourth-year nursing students. The data were analyzed using grounded theory. RESULTS: The central phenomenon of 'confusion between the ideal and the reality of nursing' occurred in contexts for various reasons of choosing one's major, nurses in the ideal, a vague fear of the field, arduous nursing assignments in the field, and severe adversity in the nursing field. Nursing students tried to deal with their confusion by using interaction strategies such as pursuing the intrinsic value of nursing, finding role models, trying to project oneself, and preparing for adapting to reality. The career exploration process in clinical practice was a voyage to discover the authentic nurse of the pre-registration nurse. CONCLUSION: This result shows that nursing students were to gain confidence in their career choices by finding the value of nursing and interacting with patients. Therefore, opportunities for learning experiences about interaction with patients and various positive experiences in clinical practice should be provided for nursing students.

The Prevalence and Associated Factors of Kidney Disease in Korean Rheumatoid Arthritis Patients

OBJECTIVE: To determine the prevalence and associated factors of kidney disease in Korean rheumatoid arthritis (RA) patient, and describe the profile of RA drugs prescribed in RA patients. METHODS: A total of 284 patients at the division of rheumatology with confirmed RA were prospectively included in this study from May 1 to August 31, 2008. Renal function was assessed using Cockcroft-Gault (CG) and abbreviated Modification of Diet in Renal Disease (aMDRD) study formulae, and classified by the National Kidney Foundation (NKF) classification. Comparisons was were performed by the two sample t-test, chi-square-test and binary logistic regression analysis. RESULTS: Of 281 patients with RA, only 7 (2.5%) patients had abnormal serum creatinine (sCr) levels. According to the NFK classification, the prevalence of kidney disease using aMDRD and CG formula was 23.8% and 31.7%, respectively. Among the patients with eGRF <60 mL/min/m2 according to aMDRD or CG formulae, 91.8~100% received at least one drug that was potentially nephrotoxic. RA patients with renal dysfunction was associated with advanced age, body mass index (BMI), antinuclear antibody (ANA). CONCLUSION: Estimation of renal function with CG or aMDRD formulae is important in RA patients, particularly in those with low BMI or old age. Also, appropriate dosage adjustment is needed in patients with renal dysfunction.

Thrombotic Thrombocytopenic Purpura Induced by Trimethoprim-Sulfamethoxazole in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

Thromobotic thrombocytopenic purpura (TTP) is a multisystem disorder that's characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia,and neurologic symptoms. TTP is associated with many diseases and several therapeutic drugs. We report here on the first Korean case of a patient with rheumatoid arthritis (RA) and who developed TTP that was associated with trimethoprim-sulfamethoxazole (TMP-SMX) in Korea. She recovered from the TTP following daily sessions of therapeutic plasma exchange (TPE) with fresh plasma replacement and glucocorticoid therapy. Awareness of the possible development of TTP in patient with RA and who is being treated with TMP-SMX is important for making the early diagnosis and administering proper treatment.

Paroxysmal Autonomic Dysregulation with Fever that was Controlled by Propranolol in a Brain Neoplasm Patient

Intractable fever in cancer patients is problematic and the causes of this fever can be diverse. Paroxysmal persistent hyperthermia after sudden mental change or neurologic deficit can develop via autonomic dysregulation without infection or any other causes of fever. Paroxysmal hyperthermic autonomic dysregulation is a rare disease entity. It manifests as a form of paroxysmal hypertension, fever, tachycardia, tachypnea, pupillary dilation, agitation and extensor posturing after traumatic brain injury, hydrocephalus, brain hemorrhage or brain neoplasm. We recently experienced a case of paroxysmal hyperthermia following intracerebral hemorrhage along with brain neoplasm. Extensive fever workups failed to show an infectious or inflammatory source and/or hormonal abnormality. Empirical treatments with antibiotics, antipyretics, morphine, steroid and antiepileptic agents were also ineffective. However, Propranolol, a lipophilic beta-blocker, successfully controlled the fever and stabilized the patient. Fever in cancer patients is a common phenomenon, but a central origin should be considered when the fever is intractable. Propranolol is one of the most effective drugs for treating paroxysmal hyperthermia that is due to autonomic dysregulation.

Clinical Significance of Methacholine Bronchial Challenge Test in Differentiating Asthma From COPD / 결핵및호흡기질환

BACKGROUND: Although airway hyper-responsiveness is one of the characteristics of asthma. bronchial hyper-responsiveness has also been observed to some degree in patients with chronic obstructive pulmonary disease (COPD). Moreover, several reports have demonstrated that a number of patients have both COPD and asthma. The methacholine bronchial challenge test (MCT) is a widely used method for the detecting and quantifying the airway hyper-responsiveness, and is one of the diagnostic tools in asthma. However, the significance of MCT in differentiating asthma or COPD combined with asthma from pure COPD has not been defined. The aim of this study was to determine the role of MCT in differentiating asthma from pure COPD. METHOD: This study was performed prospectively and was composed of one hundred eleven patients who had undergone MCT at Chonbuk National University Hospital. Sixty-five asthma patients and 23 COPD patients were enrolled and their MCT data were analyzed and compared with the results of a control group. RESULT: The positive rates of MCT were 65%, 30%, and 9% in the asthma, COPD, and control groups, respectively. The mean PC20 values of the asthma, COPD, and control groups were 8.1+/-1.16 mg/mL, 16.9+/-2.21 mg/mL, and 22.0+/-1.47 mg/mL, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MCT for diagnosing asthma were 65%, 84%, 81%, and 69%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MCT (ed note: please check this as I believe that these values correspond to the one PC20 value. Please check my changes.) at the new cut-off points of PC20 < or = 16 mg/ml, were 80%, 75%, 78%, and 78%, respectively. CONCLUSION: MCT using the new cut-off point can be used as a more precise and useful diagnostic tool for distinguishing asthma from pure COPD.