Support System, Stigma and Self-Care Behaviors in Patients with Pulmonary Tuberculosis

Purpose@#The purpose of this descriptive study was to identify factors influencing pulmonary tuberculosis patients’ self-care behaviors. @*Methods@#The patients were 125 adults over the age of 19 who were diagnosed with pulmonary tuberculosis, receiving care at the National tuberculosis hospital. The survey questions measured family support, multidimensional scale of perceived social support (MSPSS), stigma and self-care behaviors. @*Results@#The average score for self-care behaviors was 3.91, ranging from 2.22 to 5.00. There was a significant positive correlation between self-care behaviors and support system. There was a significant negative correlation between self-care behaviors and stigma. The significant variables influencing self-care behaviors were family support (β = .33, p< .001), smoking (β= -.23, p= .002), age (β= .22, p= .005) and experience of stopping treatment (β= -.17, p= .040). These factors explain 36% of pulmonary tuberculosis patients’ self-care behaviors. @*Conclusion@#Family support is very important to improve selfcare for tuberculosis patients. However, those in their fifties, men, and those who do not have a job and have underlying diseases have low family support, so they need active support at the national level. The study results suggest that a educational and nursing programs must be designed to reduce stigma and promote support system in order to enhance self-care behaviors.

The Effects of Self-leadership Reinforcement Program for Hospital Nurses

PURPOSE: This study has been carried out in order to develop and verify the effects of self-leadership reinforcement program for hospital nurses. METHODS: The research design was a non-equivalent control group pre-posttest design. Participants were 64 individuals (32 in each group), all of whom were nurses working at a university hospital, with less than five years of job experience. Experimental group was provided with two hours of self-leadership reinforcement program, once per week, for four weeks. The questionnaire for pre and post test included general characteristics, transfer motivation for learning, self-leadership, communication ability, clinical nursing competency, organizational commitment, and turnover intentions. RESULTS: There was a significant difference in self-leadership scores between experimental group and control group (F=15.10, p < .001). There was also a significant difference between the experimental group and the control group in terms of transfer motivation for learning (t=−5.44 p < .001), communication ability (F=15.29, p < .001), clinical nursing competency (F=15.23, p < .001), and organizational commitment scores (F=7.21, p=.009). CONCLUSION: The self-leadership reinforcement program developed in this study was effective in improving self-leadership, communication ability, clinical nursing competency, and organizational commitment. Thus, by implementing the program at clinical levels, it will be a basis for nursing personnel resource administration.

The Relation Among Moral Distress, Physical Symptoms and Burnout of Hospital Nurses / 한국간호교육학회지

PURPOSE: The purpose of this study was to explore the relationship between moral distress, physical symptoms, and burnout among clinical nurses. METHODS: Data were collected by self-report questionnaires targeting 140 nurses from a university hospital in Chungju. The data were analyzed by, Kruskal-Wallis, Pearson correlation coefficient, and stepwise multiple regression. RESULTS: Moral distress due to the general characteristics of the participants showed a statistically significant difference at the current working department (χ2=36.01, p<.001). Hospital nurses' moral distress had a statistically significant correlation with burnout (r=.358, p<.001) and physical symptoms (r=.440, p<.001). Factors influencing hospital nurses' burnout, pro were physical symptoms, moral distress, and marital status, accounting for 36% of the variance. CONCLUSION: The findings indicate that moral distress and physical symptoms influence burnout among hospital nurses. Therefore, interventions for burnout among hospital nurses should include an empowerment program to reduce physical symptoms and moral distress.

Assertive Behavior in Asking Smokers Not to Smoke among Patients with Vascular Diseases

PURPOSE: The purpose of this study was to identify the assertive behavior of asking smokers not to smoke and investigate the factors related to assertive behavior in patients with vascular diseases. METHODS: Participants were 203 adult Korean patients with vascular diseases such as cerebral infarction and myocardial infarction. Data were collected using questionnaires that included the characteristics of secondhand smoke (SHS), secondhand smoke-related variables (Health belief model factors, health promotion model factors) and level of assertive behavior. Descriptive statistics, t-test, ANOVA and multiple regression using SPSS/WIN 18.0 were performed. RESULTS: Participants who never ask smokers not to smoke was 39.9%, whereas participants who always ask was 7.4%. There was a weak positive relationship between assertive behavior and susceptibility to disease (r=.18), severity of disease (r=.19), benefit of assertive behavior to SHS exposure (r=.10), barrier of assertive behavior to SHS exposure (r=.24), and self-rated health (r=.21) respectively. There was a moderate positive relationship between assertive behavior and self-efficacy of assertive behavior to SHS exposure (r=.49). Health belief model factors explained 15.7% variance and health promotion model factors explained 27.0% of assertive behavior. CONCLUSION: The findings of this study suggest that self-efficacy of assertive behavior to SHS exposure is a very important factor. Therefore the development of a program to foster self-efficacy of assertive behavior regarding SHS exposure in patients with vascular diseases is needed.

Seroprevalence of Helicobacter pylori Infection in Korean Health Personnel

BACKGROUND/AIMS: The aims of this study were to evaluate whether doctors and nurses in a single hospital were at an increased risk of acquiring Helicobacter pylori infection in 2011 and to identify risk factors for H. pylori seroprevalence. METHODS: Nurses (n=362), doctors (n=110), health personnel without patient contact (medical control, n=179), and nonhospital controls (n=359) responded to a questionnaire during a health check-up, which included questions on socioeconomic status, education level, working years, and occupation in 2011. The prevalence of H. pylori was measured by serology. RESULTS: The seroprevalence rate was 29.8% (nurses), 34.5% (doctors), 30.7% (medical control), and 52.9% (nonhospital control). Among younger subjects ( or =40 years of age. The risk factors for H. pylori seroprevalence were not different for health and nonhealth personnel. A multivariate analysis indicated that seropositivity significantly increased with age, the province of residence, and a gastroscopic finding of a peptic ulcer. CONCLUSIONS: The medical occupation was not associated with H. pylori infection. The seroprevalence of H. pylori in one hospital in 2011 was found to be 38.7%, most likely due to the improvement in socioeconomic status and hospital hygiene policy in Korea.

Causes, Clinical Features and Functional Outcome of Pediatric Stroke

OBJECTIVE: To investigate the changes of causes, clinical features, and functional outcomes in childhood strokes. METHOD: This study included 152 patients, aged from 1 to 18 years, who were diagnosed with stroke and admitted to a tertiary hospital between January 2000 and April 2004. All medical records and neurologic images of the patients were reviewed. A parental questionnaire was used to investigate patients' functional outcomes. These results were compared with those of the previous study performed in the same hospital in 2001. RESULTS: The number of hemorrhagic stroke was 78 (51.3%) and that of ischemic stroke was 74 (48.7%). When compared to the previous study, the incidence of hemorrhagic stroke especially above the age of 10 years decreased and that of ischemic stroke below the age of 10 years increased. The causes of stroke were arteriovenous malformation (AVM, 42.8%), Moyamoya disease (37.5%), vasculitis (5.3%), cardiac disease (3.9%), hematologic disease (2.0%), and undetermined (8.5%). Common clinical features were headache (53.8%), vomiting (43.6%) and loss of consciousness (28.2%) in the hemorrhagic stroke, and hemiparesis (94.6%), headache (35.1%) and speech disorder (31.1%) in the ischemic stroke. 86.0% of the hemorrhagic and 64.8% of the ischemic stroke patients were categorized in the 'good' outcome group. CONCLUSION: The incidence of ischemic stroke increased to the similar level of hemorrhagic stroke. The most common causes were AVM in the hemorrhagic and Moyamoya disease in the ischemic stroke. Most of these patients showed good functional outcome, regardless of the causes of stroke.

Erk and retinoic acid signaling participate in the segregation and patterning of first arch derived maxilla and mandible

Effects of Resting Hand Splint in Early Stroke Patients

OBJECTIVE: To assess effectiveness of resting hand splints to prevent contracture, maintain functional position and minimize spasticity in early stroke patients. METHOD: Subjects were hemiplegic patients with stroke less than one month. Both splint and control groups participated in individual motor training and upper limb stretching exercise. The subjects of the splint group wore resting hand splints for maximum of 12 hours each night for 4 weeks. Measurements of edema by measuring circumference of the third phalanx, pain at hemiplegic upper extremity using visual analog scale, spasticity at the wrist graded by the modified Ashworth scale, passive range of motion at the wrist with goniometer, and functional hand use with the manual function test (MFT) were made. All measurements were taken during standard rehabilitation at the beginning and end of a 4-week treatment period. RESULTS: Before treatment, the circumferences of the splint and control groups were 6.7+/-0.5 cm and 6.7+/-0.8 cm, respectively. After 4 weeks, both were 6.8+/-0.6 cm and 6.8+/-0.8 cm, which showed no significant differences between the groups. The effects of splinting were statistically nonsignificant between control and splint groups for all measurements. CONCLUSION: An overnight splint-wearing regimen for early stroke patients may not produce clinically beneficial effects.

The Functional Prognosis of Ambulation in Each Type of Cerebral Palsy

OBJECTIVE: This study is to investigate the prognosis of functional ambulation in each type of cerebral palsy (CP). METHOD: Medical records of 385 patients were retrospectively reviewed that visited outpatients department and were diagnosed as CP. Various information was surveyed including CP type, gestational age at birth, birth weight and associated problems such as mental retardation and seizure and gross motor functional status such as ambulational status and Gross Motor Functional Classification System (GMFCS). All of them were compared between each type. The influences of seizure and mental retardation on gross motor function were also investigated. RESULTS: Functional ambulation was achieved in 58.2% in overall. Inspecting in each type, 93.7% of spastic hemiplegia, 67.6% of spastic diplegia, 12.2% of spastic quadriplegia, 78.7% of dyskinetic type can ambulate functionally. Birth weight or gestational age had no independent influences on ambulation within each type. Seizure influenced negatively on ambulation of diplegic CPs with significance and mental retardation in diplegic CPs and quadriplegic CPs than any other type. CONCLUSION: Over the half of CP patients achieved functional ambulation. Hemiplegia and diplegia had good prognosis among all types. Seizure and mental retardation negatively affected ambulation function of CP patients, especially in diplegic CPs and quadriplegic CPs.

Patients' Gender Preference for Colonoscopist / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonoscopy is anticipated as embarrassing and uncomfortable procedure. However, the patients' gender preference for doctor has not been well evaluated in those undergoing colonoscopy. This study was to assess patients' preference for gender and age of colonoscopist. METHODS: A total of one hundread and ninety eight patients (118 males and 80 females) scheduled for colonoscopy were prospectively asked to answer the questionnaires consisting of patient characteristics, preference for gender of colonoscopist, and the period they can wait until their preferred colonoscopist would be acceptable. RESULTS: Among male patients, 51% expressed a gender preference (47% for male and 4% for female colonoscopist) and 52% of female expressed two gender preference (26% for male and 26% for female colonoscopist), and colonoscopists in their forties were preferred the most. Aged female patients and male patients with family history of colorectal cancer preferred a male colonoscopist. The strength of gender preference shown by the period they could wait was weak. CONCLUSIONS: Half of the female and male patients showed gender preference in choosing a colonoscopist. Among the patients expressing a gender preference, most male patients preferred the same gender whereas half of female preferred the opposite gender.

A Case of Poststreptococcal Reactive Arthritis / 감염과화학요법

Poststreptococcal reactive arthritis (PSRA) is associated with recent streptococcal infections. However, PSRA is distinct from acute rheumatic fever by its clinical manifestations: non-migrating arthritis, erythema nodosum or erythema multiforme, and transient elevation of serum transaminases. We experienced a 33-year-old man who presented with fever, arthritis of both knees and ankles, and erythema nodosums on extensor surfaces of lower legs which developed 6 days after the onset of pharyngitis symptoms. Blood and urine cultures were negative. Throat culture was negative for group A beta-hemolytic streptococcus. The ASO titers increased up to 2080 IU/mL in sequential monitoring. The result of bone scan was compatible to arthritis of both knees and ankles. There were no signs or symptom of carditis. He showed clinical improvement with anti-inflammatory drugs (naproxen 1,000 mg/day and prednisolone 7.5 mg/d). PSRA should be included in the differential diagnosis of patients presenting with arthritis combined with fever.

A Case of Poststreptococcal Reactive Arthritis / 감염과화학요법

Poststreptococcal reactive arthritis (PSRA) is associated with recent streptococcal infections. However, PSRA is distinct from acute rheumatic fever by its clinical manifestations: non-migrating arthritis, erythema nodosum or erythema multiforme, and transient elevation of serum transaminases. We experienced a 33-year-old man who presented with fever, arthritis of both knees and ankles, and erythema nodosums on extensor surfaces of lower legs which developed 6 days after the onset of pharyngitis symptoms. Blood and urine cultures were negative. Throat culture was negative for group A beta-hemolytic streptococcus. The ASO titers increased up to 2080 IU/mL in sequential monitoring. The result of bone scan was compatible to arthritis of both knees and ankles. There were no signs or symptom of carditis. He showed clinical improvement with anti-inflammatory drugs (naproxen 1,000 mg/day and prednisolone 7.5 mg/d). PSRA should be included in the differential diagnosis of patients presenting with arthritis combined with fever.

Successful conservative management of perforation in stomach caused by endoscopic mucosal resection (EMR) / 대한내과학회지

The serious complication after endoscopic mucosal resection (EMR) was bleeding and perforation. Most of bleedings could be controlled by endoscopic procedure. However, the strategy of treatment for perforation was not established. A 60-year-old man was admitted to our center for EMR of gastric adenomatous lesion. After EMR, perforation in stomach was detected by peumoperitoneum on plain upright chest X-ray. We treated with conservative management such as withholding of oral intake, administration of broad-spectrum antibiotics, parenteral nutrition and close monitoring. There were no worsening clinical sings of peritoneal inflammation except mild leukocytosis during the in-hospital course. On the third hospital day after EMR, the patient resumed oral intake. The seventh hospital day, he was discharged. Our experience showed that selected small microperforation in stomach after EMR could be treated by not endoscopic procedures or surgical interventions but conservative management.

A Case of Hypersensitivity Pneumonitis Caused by Methotrexate / 결핵

BACKGROUND: Methotrexate (MTX) has been used to treat a wide range of malignant and benign diseases including osteosarcoma, advanced stage non-Hodgkin's lymphoma, psoriasis, severe rheumatoid arthritis, sarcoidosis, and Wegener's granulomatosis. MTX-induced lung injury occurs in up to 10% of treated patients. Although both acute and chronic presentations have been described, typical manifestation of MTX-induced lung injury is subacute with symptoms usually developing within several months after starting therapy. Nonspecific interstitial pneumonia (NSIP) is the most common histopathologic manifestation of MTX-induced lung disease, while bronchiolitis obliterans organizing pneumonia (BOOP) and diffuse alveolar damage (DAD) are less common. Granuloma formation is reported in 34.7%. In Korea, Two reports of MTX pneumonitis have been published. The one presented with NSIP and the other with DAD. We recently experienced a case of MTX pneumonitis with presentation of hypersensitivity pneumonitis.

A case of Sweet syndrome involving small bowel / 대한내과학회지

Sweet syndrome is characterized by fever and abrupt appearance of painful, erythematous plaques: a dermal infiltrate of mature neutrophils. Extracutaneous manifestations often occur in Sweet syndrome, but intestinal involvement is extremely rare. We report a case of Sweet syndrome involving small bowel in a 56-year old male with fever and abdominal pain. An abdominal CT showed diffuse wall thickening in the ileal loop. He underwent explorative laparotomy and segmental resection of involved small bowel. Skin, bone marrow, and muscle biopsies were done because he had persistent fever, cutaneous plaques, pancytopenia, and swelling of lower extremities after operation. Finally, he was diagnosed as myelodysplastic syndrome combined with Sweet syndrome, which involved small bowel, skin, and muscle simultaneously. Fever, cutaneous plaques and leg swelling resolved after systemic administration of corticosteroids.