Structural Equation Modeling on Clinical Decision Making Ability of Nurses

PURPOSE: The purpose of this study was to construct and test a hypothetical model of clinical decision-making ability of nurses based on the Decision Making Process model and the Cognitive Continuum theory. METHODS: The data were collected from nurses working at 11 hospitals in Busan, Daejeon, and South Gyeongsang Province from June 30 to August 1, 2017. Finally, the data from 323 nurses were analyzed. RESULTS: The goodness-of-fit of the final model was at a good level (χ²/df=2.46, GFI=.87, AGFI=.84, IFI=.90, CFI=.90, SRMR=.07, RMSEA=.07) and 6 out of 10 paths of the model were supported. The clinical decision-making ability was both directly and indirectly affected by task complexity and indirectly affected by experiences, autonomy, and work environment. Specifically, it was strongly directly affected by analytical competency but was insignificantly affected by intuitive competency. These variables accounted for 66.0% of clinical decision-making ability. CONCLUSION: The nurses' clinical decision-making ability can be improved by improving their analytical competency. Therefore, it is necessary to organize nursing work, create a supportive work environment, and develop and implement various education programs.

Structural Equation Modeling on Clinical Decision Making Ability of Nurses

PURPOSE@#The purpose of this study was to construct and test a hypothetical model of clinical decision-making ability of nurses based on the Decision Making Process model and the Cognitive Continuum theory.@*METHODS@#The data were collected from nurses working at 11 hospitals in Busan, Daejeon, and South Gyeongsang Province from June 30 to August 1, 2017. Finally, the data from 323 nurses were analyzed.@*RESULTS@#The goodness-of-fit of the final model was at a good level (χ²/df=2.46, GFI=.87, AGFI=.84, IFI=.90, CFI=.90, SRMR=.07, RMSEA=.07) and 6 out of 10 paths of the model were supported. The clinical decision-making ability was both directly and indirectly affected by task complexity and indirectly affected by experiences, autonomy, and work environment. Specifically, it was strongly directly affected by analytical competency but was insignificantly affected by intuitive competency. These variables accounted for 66.0% of clinical decision-making ability.@*CONCLUSION@#The nurses' clinical decision-making ability can be improved by improving their analytical competency. Therefore, it is necessary to organize nursing work, create a supportive work environment, and develop and implement various education programs.

Blockade of Trigeminal Glutamate Recycling Produces Anti-allodynic Effects in Rats with Inflammatory and Neuropathic Pain

The present study investigated the role of spinal glutamate recycling in the development of orofacial inflammatory pain or trigeminal neuropathic pain. Experiments were carried out on male Sprague-Dawley rats weighing between 230 and 280 g. Under anesthesia, a polyethylene tube was implanted in the atlanto-occipital membrane for intracisternal administration. IL-1β-induced inflammation was employed as an orofacial acute inflammatory pain model. IL-1β (10 ng) was injected subcutaneously into one vibrissal pad. We used the trigeminal neuropathic pain animal model produced by chronic constriction injury of the infraorbital nerve. DL-threo-β -benzyloxyaspartate (TBOA) or methionine sulfoximine (MSO) was administered intracisternally to block the spinal glutamate transporter and the glutamine synthetase activity in astroglia. Intracisternal administration of TBOA produced mechanical allodynia in naïve rats, but it significantly attenuated mechanical allodynia in rats with interleukin (IL)-1 β-induced inflammatory pain or trigeminal neuropathic pain. In contrast, intracisternal injection of MSO produced anti-allodynic effects in rats treated with IL-1β or with infraorbital nerve injury. Intracisternal administration of MSO did not produce mechanical allodynia in naive rats. These results suggest that blockade of glutamate recycling induced pro-nociception in naïve rats, but it paradoxically resulted in anti-nociception in rats experiencing inflammatory or neuropathic pain. Moreover, blockade of glutamate reuptake could represent a new therapeutic target for the treatment of chronic pain conditions.

Peripheral Cellular Mechanisms of Artemin-induced Thermal Hyperalgesia in Rats

In the present study, we investigated the role of peripheral ionotropic receptors in artemin-induced thermal hyperalgesia in the orofacial area. Male Sprague-Dawley rats weighting 230 to 280 g were used in the study. Under anesthesia, a polyethylene tube was implanted in the subcutaneous area of the vibrissa pad, which enabled drug-injection. After subcutaneous injection of artemin, changes in air-puff thresholds and head withdrawal latency time were evaluated. Subcutaneous injection of artemin (0.5 or 1 µg) produced significant thermal hyperalgesia in a dose-dependent manner. However, subcutaneous injection of artemin showed no effect on air-puff thresholds. IRTX (4 µg), a TRPV1 receptor antagonist, D-AP5 (40 or 80 µg), an NMDA receptor antagonist, or NBQX (20 or 40 µg), an AMPA receptor antagonist, was injected subcutaneously 10 min prior to the artemin injection. Pretreatment with IRTX and D-AP5 significantly inhibited the artemin-induced thermal hyperalgesia. In contrast, pretreatment with both doses of NBQX showed no effect on artemin-induced thermal hyperalgesia. Moreover, pretreatment with H-89, a PKA inhibitor, and chelerythrine, a PKC inhibitor, decreased the artemin-induced thermal hyperalgesia. These results suggested that artemin-induced thermal hyperalgesia is mediated by the sensitized peripheral TRPV1 and NMDA receptor via activation of protein kinases.

Botulinum Toxin Type A Attenuates Activation of Glial Cells in Rat Medullary Dorsal Horn with CFA-induced Inflammatory Pain

The activation of glial cells in the spinal cord has been contribute to the initiation and maintenance of pain facilitation induced by peripheral inflammation and nerve injury. The present study investigated effects of botulinum toxin type A (BoNT-A), injected subcutaneously or intracisternally, on the expression of microglia and astrocytes in rats. Complete Freund's Adjuvant (CFA)-induced inflammation was employed as an orofacial chronic inflammatory pain model. A subcutaneous injection of 40 microL CFA into the vibrissa pad was performed under 3% isoflurane anesthesia in SD rats. Immunohistochemical analysis for changes in Iba1 (a microglia marker) and GFAP (an astrocyte marker), were performed 5 days after CFA injection. Subcutaneous injection of CFA produced increases in Iba1 and GFAP expression, in the ipsilateral superficial lamia I and II in the medullary dorsal horn of rats. Subcutaneous treatment with BoNT-A attenuated the up-regulation of Iba1 and GFAP expressions induced by CFA injection. Moreover intracisternal injection of BoNT-A also attenuated the up-regulated Iba1 and GFAP expressions. These results suggest that the anti-nociceptive action of BoNT-A is mediated by modulation activation of glial cells, including microglia and astrocyte.

Differential Role of Central GABA Receptors in Nociception of Orofacial Area in Rats

The present study investigated the role of central GABA(A) and GABA(B) receptors in orofacial pain in rats. Experiments were conducted on Sprague-Dawley rats weighing between 230 and 280 g. Intracisternal catheterization was performed for intracisternal injection, under ketamine anesthesia. Complete Freund's Adjuvant (CFA)-induced thermal hyperalgesia and inferior alveolar nerve injury-induced mechanical allodynia were employed as orofacial pain models. Intracisternal administration of bicuculline, a GABA(A) receptor antagonist, produced mechanical allodynia in naive rats, but not thermal hyperalgesia. However, CGP35348, a GABA(B) receptor antagonist, did not show any pain behavior in naive rats. Intracisternal administration of muscimol, a GABA(A) receptor agonist, attenuated the thermal hyperalgesia and mechanical allodynia in rats with CFA treatment and inferior alveolar nerve injury, respectively. On the contrary, intracisternal administration of bicuculline also attenuated the mechanical allodynia in rats with inferior alveolar nerve injury. Intracisternal administration of baclofen, a GABA(B) receptor agonist, attenuated the thermal hyperalgesia and mechanical allodynia in rats with CFA treatment and inferior alveolar nerve injury, respectively. In contrast to GABA(A) receptor antagonist, intracisternal administration of CGP35348 did not affect either the thermal hyperalgesia or mechanical allodynia. Our current findings suggest that the GABA(A) receptor, but not the GABA(B) receptor, participates in pain processing under normal conditions. Intracisternal administration of GABA(A) receptor antagonist, but not GABA(B) receptor antagonist, produces paradoxical antinociception under pain conditions. These results suggest that central GABA has differential roles in the processing of orofacial pain, and the blockade of GABA(A) receptor provides new therapeutic targets for the treatment of chronic pain.

Usefulness of acoustic radiation force impulse elastography in the differential diagnosis of benign and malignant solid pancreatic lesions

PURPOSE: The aim of this study was to evaluate the tissue stiffness of solid pancreatic lesions by using acoustic radiation force impulse (ARFI) elastography to differentiate benign from malignant pancreatic lesions. METHODS: ARFI elastography was performed in 26 patients who had 27 focal solid pancreatic lesions, including 8 benign lesions (mass-forming pancreatitis, 5; autoimmune pancreatitis, 3) and 19 malignant lesions (pancreatic adenocarcinoma, 16; metastasis from colorectal cancer, 2; malignant neuroendocrine tumor, 1). On the elastographic images of virtual touch tissue imaging (VTI), the echogenicity of the mass was categorized on a 5-grade scale. On the elastographic image of virtual touch tissue quantification (VTQ), the shear wave velocities (SWVs) of the lesion and surrounding parenchyma were measured. RESULTS: On the VTI images, the mean echogenicity score of the malignant lesions (3.7+/-1.0) was higher than that of the benign lesions (3.1+/-0.4; P=0.023). On the VTQ images, there were no statistical differences in the mean SWV between the benign (2.4+/-1.1 m/sec) and malignant (3.3+/-1.0 m/sec) lesions (P=0.101). However, the mean SWV difference values between the lesion and background parenchyma of the malignant lesions (1.5+/-0.8 m/sec) were higher than those of the benign lesions (0.4+/-0.3 m/sec; P=0.011). CONCLUSION: ARFI elastography can determine the relative stiffness between a lesion and the background pancreatic parenchyma using VTI and VTQ, which is helpful in the differentiation between benign and malignant solid pancreatic lesions.

Effects of Health Belief on Fall Prevention Activities of Emergency Room Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to analyze factors affecting fall prevention activities of emergency room (ER) nurses based on their health belief factors (perceived susceptibility, perceived benefits, perceived severity, perceived barriers, and cues to action). METHODS: The study design was a descriptive survey using questionnaires which were given to 127 emergency room nurses from two regional emergency medical centers, four local emergency medical centers, and two local emergency medical facilities. Data were analyzed using descriptive analysis, t-test, one-way ANOVA with LSD test, Pearson correlation, and multiple regressions. RESULTS: ER nurses' fall prevention activities had a mean of 3.78+/-0.50. Eight individual characteristics and health belief factors accounted for 30.8% of the fall prevention activities. Fall prevention activities were found to be positively affected by emergency medical facilities, perceived benefits, and cues to action and negatively affected by factors, such as ER career and perceived severity. CONCLUSION: The results indicate that it is necessary to formulate a plan for enhancing perceived benefits and cues to action to improve fall prevention activities. In addition, fall prevention activities should be encouraged for ER nurses who have worked in local medical institutions for less than 1 year or more than 5 years.

Participation of Peripheral P2X Receptors in Orofacial Inflammatory Nociception in Rats

The present study investigated the role of peripheral P2X receptors in inflammatory pain transmission in the orofacial area in rats. Experiments were carried out on male Sprague-Dawley rats weighing 220 to 280 g. Formalin (5%, 50 microL) and complete Freund's adjuvant (CFA, 25 microL) was applied subcutaneously to the vibrissa pad to produce inflammatory pain. TNP-ATP, a P2X(2,2/3,4) receptor antagonist, or OX-ATP, a P2X(7) receptor antagonist, was then injected subcutaneously at 20 minutes prior to formalin injection. One of the antagonists was administered subcutaneously at three days after CFA injection. The subcutaneous injection of formalin produced a biphasic nociceptive behavioral response. Subcutaneous pretreatment with TNP-ATP (80, 160 or 240 microg) significantly suppressed the number of scratches in the second phase produced by formalin injection. The subcutaneous injection of 50 microg of OX-ATP also produced significant antinociceptive effects in the second phase. Subcutaneous injections of CFA produced increases in mechanical and thermal hypersensitivity. Both TNP-ATP (480 microg) and OX-ATP (100 microg) produced an attenuation of mechanical hypersensitivity. However, no change was observed in thermal hypersensitivity after the injection of either chemical. These results suggest that the blockade of peripheral P2X receptors is a potential therapeutic approach to the onset of inflammatory pain in the orofacial area.

Animal Models for Orofacial Neuropathic Pain / 한양의대학술지

Orofacial neuropathic pain is initiated by extraction of teeth or nerve injury from trauma in the trigeminal nerve that innervates the facial area. In the experiment, orofacial neuropathic pain usually occurred following injury of peripheral trigeminal nerve including infra-orbital nerve, inferior alveolar nerve, or mental nerve. In addition, pathology from trigeminal nerve root or ganglion is involved in orofacial neuropathic pain. This study introduced various animal models that help us study the underlying mechanisms of development or maintenance of orofacial neuropathic pain. One of the most typical symptoms of orofacial neuropathic pain is hypersensitivity to the innocuous mechanical stimuli. Our study presents a novel method to evaluate mechanical allodynia in rats with orofacial neuropathic pain. Recently, accumulate evidence support participation of central glial cells in the development or maintenance of orofacial neuropathic pain. Signaling molecules in glial cells also play an important role in neuropathic pain in the orofacial area.

A Case of Pseudomalignant Erosion in an Inflammatory Polyp at the Esophagogastric Junction / 대한소화기내시경학회지

Some cases of polypoid lesions arisen from the gastric mucosa just below a lower esophageal erosion. This lesion can have various sizes and shapes. It is known as a hyperplastic lesion associated with esophagitis or an inflammatory lesion. Sometimes only a polyp is found without an erosion. This polypoid lesion is often called as sentinel polyp and is usually considered to be a benign lesion. Here we report a case of a pseudomalignant erosion in which an inflammatory polyp at the esophagogastric junction was successfully removed by endoscopic submucosal dissection even though the polyp was initially mistaken for a squamous cell carcinoma.

A Case of Primary Extragastrointestinal Stromal Tumor Presenting as Peritoneal Dissemination / 대한소화기학회지

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract, but also occurs at a lower frequency in extra-gastrointestinal regions such as omentum, mesentery, retroperitoneum and undefined abdominal sites. This tumor is called extragastrointestinal stromal tumor (EGIST). EGIST is mostly diagnosed as a cystic mass, but rarely occurs as a disseminated abdominal tumor. We experienced a 70-year-old man with primary EGIST presenting as peritoneal dissemination. Abdominal CT showed diffuse peritoneal thickening with a large amount of ascites, but no definite mass lesion. Laparoscopic biopsy was performed and histologic findings showed tumor composed of epithelioid cells. In the results of immunohistochemical stains, the tumor showed positive reactivity with CD117 (c-kit), CD34, vimentin and actin, but negative reactivity with desmin and S-100 protein. On account of unresectability and histologic parameters of malignant behavior, he was started on imatinib.

Xanthogranulomatous Inflammation Presenting as a Submucosal Mass of the Stomach / 대한소화기내시경학회지

Xanthogranulomatous inflammation is a rare chronic inflammatory condition that is characterized by aggregation of lipid-laden foamy macrophages (xanthoma cells). Although the precise pathogenesis of xanthogranulomatous inflammation is not well understood, various mechanisms have been proposed, including chronic recurrent infection, the presence of gallstones, immunologic disorders and defective lipid transport. This disease entity is well recognized in the kidney and gallbladder, yet involvement of the gastrointestinal tract is extremely rare and the involvement of both the stomach and colon has never been reported on. A coexisting malignancy rarely has been reported in a patient with xanthogranulomatous inflammation. This might present as an inflammatory mass-like lesion with infiltration to the surrounding tissues, and so this often mimics advanced cancer. Therefore, a surgical operation together with careful pathological evaluation is required for making the precise diagnosis. We herein report on a case of xanthogranulomatous inflammation that presented as a submucosal mass in the stomach which was a huge irregular mass involving transverse colon.

Successful treatment of vesicoureteral reflux by ureteroureterostomy in renal transplant recipients / 대한내과학회지

Recurrent urinary tract infection due to vesicoureteral reflux is one of the important medical complications in renal transplant recipients. Injection of macroplastique is recommended to reduce the vesicoureteral reflux, but it can result in poor responses. Ureteroureterostomy is an invasive method, but it is advisable in patients with higher grades of vesicoureteral reflux that do not respond to medical or macroplastique injection. We here report on two cases of successful treatment of vesicoureteral reflux by ureteroureterostomy. These patients experienced repeated episodes of acute pyelonephritis in spite of long-term antibiotic treatment and repeated macroplastique injection. No more urinary tract infection was observed after ureteroureterostomy. We recommend ureteroureterostomy in renal transplant recipients who suffer with repeated acute pyelonephritis due to vesicoureteral refulx.

The Change of Cyclooxygenase-2 and Inducible Nitric Oxide Synthase in the Gastric Mucosa One Year after Eradication of Helicobacter pylori / 대한소화기학회지

BACKGROUND/AIMS: The cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS), the proteins that have the role in the gastric carcinogenesis, are stimulated by H. pylori infection in the gastric mucosa. The aim of this study was to evaluate the expression of COX-2 and iNOS proteins one year after the eradication of H. pylori. METHODS: Gastric antral mucosa from fifty eight patients with chronic gastritis who were all infected with H. pylori was examined for the expression of COX-2 and iNOS proteins before and one year after the eradication of H. pylori by immunohistochemical stain. RESULTS: COX-2 and iNOS proteins were expressed in the epithelial cells and interstitial inflammatory cells of gastric mucosa. Percent expressions of COX-2 and iNOS were significantly decreased one year after the eradication in the patients with cured infection, but not in those having persistent H. pylori. COX-2 and iNOS expressions were well correlated with H. pylori density, acute and chronic inflammation of gastric mucosa. CONCLUSIONS: The eradication of H. pylori can decrease the expression of COX-2 and iNOS in the gastric mucosa in long-term period. This seems to be due to the removal of H. pylori itself and related regression of gastric inflammation.

Factors Associated with Changes in Bone Mineral Content among Girls in Early Pubertal Age

The study was conducted to investigate the factors associated with bone mineral content ( BMC) changes among early pubertal aged girls. Two hundred and thirty girls between 9 to 11 years of age participated in four surveys over 2 year period. During each survey, dietary intakes were collected with 3-day food records, BMC of left leg's calcaneus were measured by PIXI ( Lunar Ltd.) and body composition was measured by bioimpedance method ( Inbody 3.0 Biospace Co. Ltd, Seoul, Korea) . Mean values of BMC increased in consecutive measurements - 1.48 g, 1.54 g, 1.61 g and 1.66 g. The change of BMC between the first and last measurements was significantly positively correlated with % body fat, negatively correlated with BMC at the baseline ( p < 0.05) . Change of BMC was also significantly positively correlated with % change of lean mass and mineral mass between the first and last measurements. Nutrient intakes during the study period were calculated as mean daily intakes from all surveys. Mean daily intakes of Vit. C and Vit. B6 were positively and isoflavone intake was negatively correlated with changes of BMC ( p < 0.05) . In stepwise regression of BMC change with body composition and nutrient intakes, baseline values of BMC, weight, BMI and age, % change of mineral mass during the study period, mean intakes of isoflavone, Vit. B6, protein, carotene and zinc were significant explanatory variables ( R 2 = 0.38, p < .001, F = 32.39) . The results imply that the change of BMC among early pubertal aged girls are associated with some body composition and intakes of certain nutrients.

Comparison of Clinical Manifestations of Rotaviral Gastroenteritis between Neonates and Infants / 대한소아소화기영양학회지

PURPOSE: This study was designed to investigate rotavirus infection by comparing the clinical characteristics in neonates and infants. METHODS: We enrolled 104 neonates and 250 infants wiht gastroenteritis and a rotazyme test positive reaction at the Soonchunhyang University Bucheon Hospital from February 2001 to January 2003. RESULTS: The seasonal peaks of infection in infants occurred from February to June. However, in neonates, it occurred from October to December due to nursery outbreaks. Diarrhea, vomiting, fever and convulsions were significant symptoms in infants; however, metabolic acidosis with dehydration, jaundice, irritability, apnea, bloody stool, gastric residual, grunting, poor oral intake, lethargy as well as fever and diarrhea were more common in the neonates. Upper respiratory infection, pneumonia and bronchitis were present in the infants; however, necrotizing enterocolitis was more commonly observed in the in neonates. Among the patients with rotaviral infection, formula feeding was more popular than breast milk feeding in both the neonates and infants; however, this finding was not statistically significant. CONCLUSION: Rotavirus can be a significant pathogen in neonates as well as infants. Neonates suffering from fever, poor oral intake, lethargy and apnea should be investigated for rotaviral infection. A new vaccine, rotaviral specific immunoglobulin and treatment guidelines are needed for eradicating rotavirus infection. Further studies on isolation, infection pathway, immune response and treatment of rotavirus are needed.

Two Cases of Influenza-associated Encephalopathy / 대한소아신경학회지

Influenza-associated encephalopathy is typically associated with a sudden onset of high fever, severe convulsions, rapidly progressive coma and death within 2 or 3 days. It has been actively researched in Japan as it caused a tremendous increase in the number of deaths from 1997 to 2002. But there has been reported only one case in Korea, who was diagnosed on the basis of serologic testing by hemagglutinin inhibition. We report here a 14-month-old boy who was taken supportive care and a 3-year-old girl who was taken amantadine and methyprednisolone pulse therapy. Both of them were admitted under the diagnosis of influenza-associated encephalopathy on the basis of reverse transcription-polymerase chain reaction of nasopharyngeal fluid and cerebrospinal fluidm, brain magnetic resonance imagings. The first case was confirmed by the identification of influenza A/H3N2 in the cerebrospinal fluid culture by RT-PCR for the first time in Korea.

The roles of arachidonic acid and calcium in the angiotensin II-induced inhibition of Na+ uptake in renal proximal tubule cells

Angiotensin II (ANG II) has a biphasic effect on Na+ transport in proximal tubule: low doses of ANG II increase the Na+ transport, whereas high doses of ANG II inhibit it. However, the mechanisms of high dose ANG II-induced inhibition on Na+ uptake are poorly understood. Thus the aim of the present study was to investigate signal transduction pathways involved in the ANG II-induced inhibition of Na+ uptake in the primary cultured rabbit renal proximal tubule cells (PTCs) in hormonally defined serum-free medium. ANG II (10-9 M)-induced inhibition of Na+ uptake was blocked by losartan (10-8 M, AT1 antagonist), but not by PD123319 (10-8 M, AT2 antagonist) (P < 0.05). ANG II-induced inhibition of Na+ uptake was also completely abolished by neomycin (10-4 M, PLC inhibitor), W-7 (10-4 M, calmodulin antagonist), and AACOCF3 (10-6 M, PLA2 inhibitor) (P < 0.05). ANG II significantly increased (3H)arachidonic acid (AA) release compared to control. The ANG II-induced (3H)AA release was blocked by losartan, AACOCF3, neomycin, and W-7, but not by PD123319. ANG II-induced (3H)AA release in the presence of extracellular Ca2+ was greater than in Ca2+-free medium, and it was partially blocked by TMB-8 (10-4 M, intracelluar Ca2+ mobilization blocker). However, in the absence of extracellular Ca2+, it was completely blocked by TMB-8. In addition, econazole (10-6 M, cytochrome P-450 monooxygenase inhibitor) and indomethacin (10-6 M, cyclooxygenase inhibitor) blocked ANG II-induced inhibition of Na+ uptake, but NGDA (10-6 M, lipoxygenase inhibitor) did not affect it. In conclusion, PLA2-mediated AA release is involved in ANG II-induced inhibition of Na+ uptake and is modulated by (Ca2+)i in the PTCs.