The Occurrence Background of Incivility Perceived by Nursing Students / 의료커뮤니케이션

PURPOSE: The purpose of this qualitative research is to explore the background of occurrence of perceived incivility by nursing students in clinical practice.METHOD: Data were collected through focus interviews and individual interviews were analysed using qualitative content analysis.RESULT: The results showed that three categories that represented the background of occurrence of incivility were scheme which is not cleared, position which is not settled and unequal relationship.CONCLUSION: Since the background of occurrence of perceived incivility is complex, So it is required to macroscopic approach to reduce the perceived incivility of the students in the clinical practice.

Development of a Self-Care Performance Scale for Patients with Stomach Cancer after Gastrectomy

PURPOSE: This study was to develop a valid and reliable self-care performance scale for stomach cancer patients with gastrectomies. METHODS: The initial items for the self-care performance scale were derived by a literature review and in-depth interviews with stomach cancer patients with gastrectomies and a conceptual framework based on Orem's theory was used. The identified items were evaluated for content validity by experts. The main survey with refined items was performed with a sample of 232 patients. The data were analyzed using item analysis, Pearson correlation coefficients, Cronbach's alpha and factor analysis. RESULTS: A 22 item instrument with 7 factors was developed and the total variance explained was 66.9%. The factors were 'manage dietary restriction', 'avoid hazards', 'rest and elimination', 'manage social support and stress', 'regulation diet', 'meal portion control' and 'seek information and follow-up care'. The internal consistency, Cronbach's alpha was .86 and reliability of the subscale ranged from .65 to .82. CONCLUSION: This study suggested that the self-care performance scale is a reliable and valid instrument to measure self-care performance for patients with stomach cancer after gastrectomy.

Primary Biliary Mucosa-associated Lymphoid Tissue Lymphoma Mimicking Hilar Cholangiocarcinoma / 대한소화기학회지

Primary biliary mucosa-associated lymphoid tissue (MALT) lymphoma is extremely rare. We report a case of primary biliary MALT lymphoma with obstructive jaundice diagnosed by endoscopic biopsy, without surgical intervention. Obstructive jaundice was relieved by endoscopic drainage and endoscopic biopsy was done simultaneously during endoscopic retrograde cholangiopancreatography. Unnecessary surgical intervention can be avoided after pathological confirmation of lymphoma. The patient received radiotherapy, and is alive without any evidence of recurrence or biliary obstruction. Diagnosis of primary biliary lymphoma is very difficult because of its low prevalence. However, it should always be considered as a differential diagnosis, since when an accurate diagnosis is made, unnecessary surgical intervention can be avoided.

Hemophagocytic Lymphohistiocytosis Occurring after Induction Chemotherapy in Acute Myelocytic Leukemia / 대한내과학회지

Hemophagocytic lymphohistiocytosis (HLH), associated with acute myelocytic leukemia (AML), is a very rare disease. We here report a case of HLH occurring after induction chemotherapy for AML. AML-associated HLH can be triggered by AML itself, by chemotherapeutic agents, or by infectious complications. Our patient developed a high-grade fever of unknown cause, bilateral pulmonary infiltrates, and shock after successful treatment of AML with induction chemotherapy, and had high serum ferritin, hypertriglyceridemia, hypofibrinogenemia, hemophagocytic histiocytes in bone marrow, low natural killer cell activity, and elevated soluble interleukin-2 receptor levels. A diagnosis of HLH was made. Dexamethasone, cyclosporine, and etoposide were given and allogeneic hematopoietic stem cell transplantation was performed. Careful suspicion of HLH may be warranted if a patient experiences fever of unknown etiology, high ferritin levels, and liver dysfunction during AML treatment.

Lung Disease Caused by Mycobacterium malmoense in an Immunocompetent Patient / 결핵및호흡기질환

Mycobacterium malmoense is a very rare cause of lung disease in South Korea. We reported the first case of lung disease caused by M. malmoense in an immunocompetent patient. The patient was successfully treated with a 14-month course of antibiotics.

Potentially Inappropriate Medications in Elderly Outpatients by the 2012 Version of Beers Criteria: A Single Tertiary Medical Center Experience in South Korea

BACKGROUND: The American Geriatric Society released the 2012 updated version of the Beers criteria with intentions to improve care of older adults by reducing their exposure to potentially inappropriate medications (PIMs). However, there have been no reports on the prevalence of PIMs prescriptions according to the 2012 version of Beers criteria in South Korea. METHODS: This is a retrospective study using medical records and code analysis of each PIM to survey the prevalence of PIMs prescriptions and common PIMs used for elderly patients. Locating the PIMs was carried out in all outpatients who visited Asan Medical Center from May 2012 to April 2013. Selection of PIMs was based on the 2012 updated version of the Beers criteria. RESULTS: A total of 652,192 outpatients older than 65 years visited our medical center during the study period and were analyzed. Among them, 33,810 (5.19%) received at least one PIM and 125,498 cases of PIM prescriptions were written. The percentage of the patients who received at least two kinds of PIMs concurrently was 33.14%. Common PIMs were tramadol (24.15%), clonazepam(11.51%), ibuprofen (10.02%), megesterol (9.80%), and amitriptyline (9.51%). CONCLUSION: Our study investigated the prevalence of PIMs prescription for Korean elderly outpatients in a single tertiary medical center. Compared to previous reports using the older version of the Beers criteria, our study showed a change in the priority of common PIMs.