Performance, Perception, and Influencing Contexts of Intentional Rounding / 임상간호연구

Purpose@#This descriptive study aimed to explore the performance, nurses' perception, and influencing contexts of intentional rounding (IR), and to identify the factors influencing the performance of IR. @*Methods@#498 questionnaire responses were collected from clinical nurses with more than six months of work experiences in general wards performing IR in a general hospital. @*Results@#The mean scores of the performance, nurses' perception, and influencing contexts of IR were 3.81(±0.68), 3.46(±0.42), and 3.79(±0.51) out of 5.00, respectively. There were significant differences in performance (F=20.51, p<.001) and nurses' perception (F=4.96, p=.001) based on the work department. There were significant differences in the influencing contexts based on age (F=6.02, p=.003) and the length of clinical experience in the ward (F=3.36, p=.010). Performance and nurses’ perception(r=.42, p<.001), performance and influencing contexts (r=.46, p<.001), and nurses' perception and influencing contexts (r=.58, p<.001) showed a statistically positive correlation. Work unit (F=10.45, p<.001), nurses' perception of the benefits to patients (F=-2.46, p=.014) and to nurses (F=4.34, p<.001), and influencing contexts at the individual (F=7.77, p<.001) and department levels (F=2.99, p=.003) were found to be significant factors on the performance of IR. @*Conclusion@#It is necessary to support the education programs and active participation of nurses in their role as leaders to raise their awareness regarding the benefits of IR. Furthermore, there is a need to adapt the IR protocol according to the unique characteristics of each unit and evaluate the effectiveness.

Performance, Perception, and Influencing Contexts of Intentional Rounding / 임상간호연구

Purpose@#This descriptive study aimed to explore the performance, nurses' perception, and influencing contexts of intentional rounding (IR), and to identify the factors influencing the performance of IR. @*Methods@#498 questionnaire responses were collected from clinical nurses with more than six months of work experiences in general wards performing IR in a general hospital. @*Results@#The mean scores of the performance, nurses' perception, and influencing contexts of IR were 3.81(±0.68), 3.46(±0.42), and 3.79(±0.51) out of 5.00, respectively. There were significant differences in performance (F=20.51, p<.001) and nurses' perception (F=4.96, p=.001) based on the work department. There were significant differences in the influencing contexts based on age (F=6.02, p=.003) and the length of clinical experience in the ward (F=3.36, p=.010). Performance and nurses’ perception(r=.42, p<.001), performance and influencing contexts (r=.46, p<.001), and nurses' perception and influencing contexts (r=.58, p<.001) showed a statistically positive correlation. Work unit (F=10.45, p<.001), nurses' perception of the benefits to patients (F=-2.46, p=.014) and to nurses (F=4.34, p<.001), and influencing contexts at the individual (F=7.77, p<.001) and department levels (F=2.99, p=.003) were found to be significant factors on the performance of IR. @*Conclusion@#It is necessary to support the education programs and active participation of nurses in their role as leaders to raise their awareness regarding the benefits of IR. Furthermore, there is a need to adapt the IR protocol according to the unique characteristics of each unit and evaluate the effectiveness.

Correction: Development and Evaluation of an Obesity Ontology for Social Big Data Analysis / 대한의료정보학회지

The affiliation of the third author, Tae-Min Song, was changed during the submission and review process of the article. The third authors' affiliation should be corrected.

Prevalence and pathologic study of porcine salmonellosis in Jeju

Salmonella (S.) Typhimurium is highly contagious, and its infection may rapidly spread within pig populations of herd. According to the survey (1,191 pigs) from 2003 to 2012, 155 pigs (13.0%) were diagnosed as salmonellosis in Jeju. Major porcine salmonellosis cases (88.4%) were concentrated in 4- to 12-week-old weaned pigs, but 6 pigs (3.9%) under 4 weeks old were also diagnosed. Based on the histopathologic examinations, ulcerative enteritis (63.9%) in the large intestine and/or paratyphoid nodules formation (57.4%) in the liver were most prevalent lesions in porcine salmonellosis. Single infection of S. Typhimurium and mixed infection with more than 2 pathogens were detected in 38 (24.5%) and 117 (75.5%) in pigs, respectively. Co-infections of Porcine reproductive and respiratory syndrome virus and Porcine circovirus type 2 were very common in porcine salmonellosis in Jeju and detected in 84 (54.2%) and 59 (38.1%) pigs, respectively. Based on the serotyping tests using 41 bacterial isolates, S. Typhimurium and S. Rissen were confirmed in 39 (95.1%) and 2 (4.9%) cases, respectively.

Development and Evaluation of an Obesity Ontology for Social Big Data Analysis / 대한의료정보학회지

OBJECTIVES: The aim of this study was to develop and evaluate an obesity ontology as a framework for collecting and analyzing unstructured obesity-related social media posts. METHODS: The obesity ontology was developed according to the ‘Ontology Development 101’. The coverage rate of the developed ontology was examined by mapping concepts and terms of the ontology with concepts and terms extracted from obesity-related Twitter postings. The structure and representative ability of the ontology was evaluated by nurse experts. We applied the ontology to the density analysis of keywords related to obesity types and management strategies and to the sentiment analysis of obesity and diet using social big data. RESULTS: The developed obesity ontology was represented by 8 superclasses and 124 subordinate classes. The superclasses comprised ‘risk factors,’‘types,’‘symptoms,’‘complications,’‘assessment,’‘diagnosis,’‘management strategies,’ and ‘settings.’ The coverage rate of the ontology was 100% for the concepts and 87.8% for the terms. The evaluation scores for representative ability were higher than 4.0 out of 5.0 for all of the evaluation items. The density analysis of keywords revealed that the top-two posted types of obesity were abdomen and thigh, and the top-three posted management strategies were diet, exercise, and dietary supplements or drug therapy. Positive expressions of obesity-related postings has increased annually in the sentiment analysis. CONCLUSIONS: It was found that the developed obesity ontology was useful to identify the most frequently used terms on obesity and opinions and emotions toward obesity posted by the geneal population on social media.

Bronchiolitis Obliterans Organizing Pneumonia in the Patient with Non-Small Cell Lung Cancer Treated with Docetaxel/Cisplatin Chemotherapy: A Case Report / 결핵및호흡기질환

A 60-year-old man was diagnosed with stage IV squamous cell carcinoma of lung and treated with weekly doses of docetaxel and cisplatin. Tumor mass and mediastinal lymphadenopathy disappeared after 4.5 cycles of chemotherapy. At one week post final chemotherapy, the patients developed sudden shortness of breath. New, multifocal infiltrations developed on both lungs without definitive evidence of infection. Despite administration of broad spectrum antibiotics, the lung lesion did not improve, so bronchoalveolar lavage and computed tomography-guided lung biopsy were performed. The proportion of lymphocytes was increased markedly and histopathology revealed squamous cell carcinoma combined with bronchiolitis obliterans organizing pneumonia. After high dose corticosteroid therapy, dyspnea and the newly developed consolidation had decreased slightly. However, dyspnea and hypoxemia increased again because of aggravated lung cancer since chemotherapy had stopped. Chemotherapy couldn't be restarted due to the poor performance status of the patient. Later, patient died of respiratory failure from poor general condition and progression of lung cancer.

Informational Needs of Postoperative Gastric Cancer Patients

PURPOSE: Adequate health-related information provided by health professionals may help cancer patients overcome their uncertain situation and manage their healthcare. To provide information effectively, there is a need to understand the content of the patients' essential information. The purpose of this study was to identify recent informational needs of postoperative gastric cancer patients. MATERIALS AND METHODS: Data were collected from 190 postoperative gastric cancer patients who attended the Stomach Cancer Patients' Day ceremony (18 November 2008) held by the Stomach Cancer Center of Samsung Medical Center with the use of a questionnaire which measured informational needs. A questionnaire with 37 items was comprised of domains of diagnostic tests, cancer therapy, prognosis, follow-up, sexual activity, stomach cancer-related information, and 7 single items. RESULTS: The priorities of informational needs were the domains of prognosis, ways of healthcare during treatment (a single item), follow-up, stomach cancer-related information, cancer therapy, and diagnostic tests (in descending order). Items related to prognosis, diet, and management of their healthcare ranked in the top 10 informational need scores. As age decreased, the degree of informational needs about diagnostic tests, cancer therapy, sexual activity, and stomach cancer-related information increased. CONCLUSION: We suggest that prognosis-related information based on the accumulated institutional therapeutic outcomes and objective prognosis data should be incorporated in the current education program. Health professionals should provide comprehensible information content to cancer patients and caregivers and encourage patients to participate in their therapy with a more positive attitude.

Congenital Cystic Adenomatoid Malformation of Lung in Adults: Clinical, Pathologic and Radiologic Evaluation of Six Patients / 결핵및호흡기질환

BACKGROUND: Congenital cystic adenomatoid malformation of the lung (CCAM) is a rare congenital developmental anomaly of the lower respiratory tract. Most cases are diagnosed within the first 2 years of life, so adult presentation of CCAM is rare. We describe here six adult cases of CCAM and the patients underwent surgical resection, and all these patients were seen during a five and a half year period. The purpose of this study was to analyze the clinical, radiological and histological characteristics of adult patients with CCAM. METHODS: Through medical records analysis, we retrospectively reviewed the clinical characteristics, the chest pictures (X-ray and CT) and the histological characteristics. RESULTS: Four patients were women and the mean age at diagnosis was 23.5 years (range: 18~39 years). The major clinical presentations were lower respiratory tract infection, hemoptysis and pneumothorax. According to the chest CT scan, 5 patients had multiseptated cystic lesions with air fluid levels and one patient had multiple cavitary lesions with air fluid levels, and these lesions were surrounded by poorly defined opacities at the right upper lobe. All the patients were treated with surgical resection. 5 patients underwent open lobectomy and one patient underwent VATS lobectomy. On the pathological examination, 3 were found to be CCAM type I and 3 patients were CCAM type II, according to Stocker's classification. There was no associated malignancy on the histological studies of the surgical specimens. CONCLUSION: As CCAM can cause various respiratory complications and malignant changes, and the risks associated with surgery are extremely low, those patients who are suspected of having or who are diagnosed with CCAM should go through surgical treatment for making the correct diagnosis and administering appropriate treatment.

A Case of Acute Respiratory Distress Syndrome Caused By Zinc Fume Inhalation / 결핵및호흡기질환

The Inhalation of certain freshly formed metal oxides can cause metal fume fever, which is an acute, self-limiting, flu-like illness. The most common cause of this syndrome is the inhalation of zinc oxide. The inhalation of zinc oxide can lead to tracheobronchiolitis, chemical pulmonary edema or to respiratory failure and acute respiratory distress syndrome(ARDS). We encountered a 43-years-old man who developed severe dyspnea after inhaling of zinc oxide while working for 5 hours in a closed space. He was diagnosed with ARDS and was treated successfully with glucocorticoid. We report a case of ARDS caused by the inhalation of zinc fumes.

A Case of Tuberculous Pleural Effusion Developed after Percutaneous Needle Biopsy of a Solitary Pulmonary Nodule / 결핵및호흡기질환

A tuberculous pleural effusion may be a sequel to a primary infection or represent the reactivation of pulmonary tuberculosis. It is believed to result from a rupture of a subpleural caseous focus in the lung into the pleural space. It appears that delayed hypersensitivity plays a large role in the pathogenesis of a tuberculous pleural effusion. We encountered a 52 years old man with pleural effusion that developed several days after a CT guided percutaneous needle biopsy of a solitary pulmonary nodule. He was diagnosed with TB pleurisy. It is believed that his pleural effusion probably developed due to exposure of the parenchymal tuberculous focus into the pleural space during the percutaneous needle biopsy. This case might suggest one of the possible pathogeneses of tuberculous pleural effusion.

Alteration in gyrA and parC Gene Associated with Fluoroquinolone Resistance of Enterococcus spp. Isolated from Feces of Chicken

The purpose of this study was to investigate the fluoroquinolone resistance frequency of Enterococcus spp. from normal chicken feces and to analyse mutations of the gyrA and parC gene associated with fluoroquinolone resistance. Among 52 Enterococcus faecalis and 25 E. faecium isolates, 23 (44.2%) E. faecalis and 7 (28.0%) E. faecium were resistant to ciprofloxacin (CIP) by disc diffusion method. Genetic exchange in gyrA and parC gene among 2 CIP intermediate isolates and 15 CIP resistant isolates were found in the amino acid codon of Ser-83 and Asp-87, and Ser-80 and Glu-84, respectively. These mutants contained a change from Ser to Phe, Val, Tyr, Ile, Thr or Pro at codon 83 and from Glu to Gly or Leu at codon 87 in gyrA gene, and a change from Ser to Ile or Thr at codon 80 and from Glu to Asp or Lys at codon 84 in parC gene. The isolates with mutation in gyrA regardless of a mutation in parC showed high resistance (MIC > or =32 microgram/ml) to CIP, enrofloxacin, norfloxacin and ofloxacin. These results suggested that gyrA gene is the primary target for 4 fluoroquinolones resistance in Enterococcus spp.

Development and Evaluation of a Web-based Ostomy Self-care Education Program / 대한의료정보학회지

OBJECTIVE: The purpose of this study was to develop a Web-based ostomy self-care education program and to evaluate its effects on ostomates' self-care knowledge and self-care behavior. METHODS: Based on the needs assessment and literature review, a Web-based ostomy self-care education program was developed and modified incorporating feedbacks from nurse experts panel. The experimental group received the ostomy self-care using the Web-based program and the control group received the traditional education. The level of self-care knowledge and self-care behavior were measured and were compared between the experimental and the control groups. RESULTS: The levels of self-care knowledge and self-care behavior in the experimental group were significantly higher than those of the control group. CONCLUSION: This study implies that a Web-based education program for the ostomates can be used to improve ostomy self-care.

A Case of Multiple Metastatic Renal Cell Carcinoma in an Adult Patient Presenting with Ventricular Tachycardia

Cardiac metastases of renal cell carcinomas are rare, and usually clinically silent. A case of a 53-year-old man without a significant medical history, who presented with ventricular tachycardia, which resulted in a cardiac mass of the right ventricle is reported. On chest X-ray, echocardiography, CT scanning, esophagogastroduode-noscopy and MRI, multiple metastatic masses were observed in both lungs, and the kidneys, adrenal, stomach and right ventricle. The kidney mass and the gastric polyp were revealed on biopsy to be a renal cell carcinoma mixed with sarcomatoid and conventional types.

The Analysis of Appendiceal Mucocele with Emphasis on the Colonoscopic Findings / 대한소화기내시경학회지

BACKGROUND/AIMS: Appendiceal mucocele is relatively rare disease, however early diagnosis and adequate treatment is important because the rupture of mucocele during operation may results in pseudomyxoma peritonei which is fatal. Colonoscopy is very important tool to diagnose the mucocele of appendix earlier period. METHODS: We retrospectively analysed the medical records of ten cases of appendiceal mucoceles which were suspected by colonoscopy and surgically confirmed from January 1997 to March 2004. RESULTS: There was no gender difference and mean age was 55 years old. The colonoscopic findings of appendiceal mucocele were a type of submucosal tumor and the orifice of appendix was not seen in all the cases. The size was variable from 2.5 cm to 5.0 cm and the shape was spherical in majority, but one case of appendiceal mucocele lately diagnosed as mucinous cystadenocarcinoma had elongated, oval shape. The histologic diagnosis after resection were as follows: mucosal hyperplasia 4 cases (40%), mucinous cystadenoma 5 cases (50%) and mucinous cystadenocarcinoma 1 case (10%). CONCLUSIONS: Colonoscopy is an important diagnostic tool for suspecting appendiceal mucocele. It is important to confirm by surgical resection of appendiceal mucocele which is found even incidentally by colonoscopy.

A Case of Low Grade MALT Lymphoma in the Mediastinum with Clinical Appearance of Waldenstr m's Macroglobulinemia / 대한혈액학회지

Low-grade B cell mucosa-associated lymphoid tissue (MALT) lymphoma makes up 8% of non-Hodgkin's lymphomas. It has been characterized by a prolonged clinical course and persistent disease at the site of origin. Most patients with low-grade B cell MALT lymphoma occur in the stomach, orbit, intestine, lung, thyroid, salivary gland, skin, soft tissues, bladder, kidney, and central nervous system. The diagnosis of MALT lymphoma can be established by a characteristic finding of infiltration of small lymphocytes that are monoclonal B cell and CD5 negative. Bone marrow involvement seems uncommom but has been developed. Waldenstr m's macroglobulinemia (WM) is usually defined as bone marrow infiltration of lymphoplasmacytoid lymphocytes with a high level of circulating macroglobulin IgM. Lymphadenopathy and splenomegaly occurs in 20~40% of WM. It is very hard work to do differential diagnosis between disseminated low-grade B cell MALT lymphoma and WM with organ involvement by a bone marrow examination. We reprot one case of low grade mediastinal MALT lymphoma with bone marrow involvement and a high level of serum monoclonal IgM with clinical appearance of WM.

The efficacy of Kinesio taping in patients with a low back pain

BACKGROUND: Kinesio taping is a treatment for pain and dysfunction of musculoskeletal system, using tapes which have a similar elasticity to skin. This study was done to find out about the efficacy of kinesio taping on patients with a low back pain. METHODS: This study was performed in patients with a non-specific low back pain who had visited the Inchon International Airport Construction Authority Clinic from January 2000 to April 2000. We performed taping to a randomized case group and a placebo to control group during the first 3 days. After the first 3 days, we assessed the changes of improvement in low back pain with visual-analogue pain scale (VAS) . From the second visit on, we also started carrying out kinesio taping in the control group. RESULTS: The total number of patients participating in this study was 43, but 4 patients did not complete the study stopped. After the first 3 days, control group showed just 0.93 of the VAS score improvement, while randomized case group showed 2.55(p=0.003). The VAS score of case and control group were 3.18 and 3.03 respectively, which showed improvement at the end point of treatment compared with the first score. CONCLUSIONS: Kinesio taping was more efficacious than placebo in patients with a nonspecific low back pain.

Total Parenteral Nutrition-associated Cholestasis in Very Low Birth Weight Infants

PURPOSE: Very low birth weigh infants (VLBWI), who often require a long-term parenteral nutrition, are at high risk for the development of parenteral nutrition-associated cholestasis. This study was conducted to determine the incidence of total parenteral nutrition (TPN)-associated cholestasis and its risk factors in the VLBI. We evaluated the clinical courses and outcomes. METHODS: The hospital records of 165 VLBWI who were admitted to the neonatal intensive care unit at Asan medical center from Jan. 1997 to Dec. 1999 and received TPN for more than 2 weeks were reviewed. Cholestasis was defined as a direct serum bilirubin level greater than 2.0 mg/dl during the period of TPN, and other causes of cholestasis were ruled out. RESULTS: Twenty-seven out of 165 VLBWI developed TPN-associated cholestasis with the incidence of 16.4%. Significant risk factors for the development of cholestasis included birth weight, small for gestational age, duration of enteral starvation, duration of parenteral nutrition, septic episodes, necrotizing enterocolitis, and the number of surgery in 30 days of age. Cholestasis occurred at the mean age of 48.8+/-20.7 days and resolved in 53.7+/-8.8 days after onset of cholestasis. The mortality rate of infants with cholestasis was significantly higher than that of infants without cholestasis. Two infants appeared to die of a progressive hepatic dysfunction associated with TPN. CONCLUSION: TPN-associated cholestasis is relatively common in VLBWI, and may progress to the hepatic failure and death. The strategies such as early enteral feeding or the reduction of septic episodes would need to be seriously adopted in order to prevent the morbidity and mortality from TPN-associated cholestasis.

Total Parenteral Nutrition-associated Cholestasis in Very Low Birth Weight Infants

PURPOSE: Very low birth weigh infants (VLBWI), who often require a long-term parenteral nutrition, are at high risk for the development of parenteral nutrition-associated cholestasis. This study was conducted to determine the incidence of total parenteral nutrition (TPN)-associated cholestasis and its risk factors in the VLBI. We evaluated the clinical courses and outcomes. METHODS: The hospital records of 165 VLBWI who were admitted to the neonatal intensive care unit at Asan medical center from Jan. 1997 to Dec. 1999 and received TPN for more than 2 weeks were reviewed. Cholestasis was defined as a direct serum bilirubin level greater than 2.0 mg/dl during the period of TPN, and other causes of cholestasis were ruled out. RESULTS: Twenty-seven out of 165 VLBWI developed TPN-associated cholestasis with the incidence of 16.4%. Significant risk factors for the development of cholestasis included birth weight, small for gestational age, duration of enteral starvation, duration of parenteral nutrition, septic episodes, necrotizing enterocolitis, and the number of surgery in 30 days of age. Cholestasis occurred at the mean age of 48.8+/-20.7 days and resolved in 53.7+/-8.8 days after onset of cholestasis. The mortality rate of infants with cholestasis was significantly higher than that of infants without cholestasis. Two infants appeared to die of a progressive hepatic dysfunction associated with TPN. CONCLUSION: TPN-associated cholestasis is relatively common in VLBWI, and may progress to the hepatic failure and death. The strategies such as early enteral feeding or the reduction of septic episodes would need to be seriously adopted in order to prevent the morbidity and mortality from TPN-associated cholestasis.