The Effect of Patient-Engaged Bedside Handoffs Protocol in Comprehensive Care Units / 임상간호연구

Purpose@#The purpose of this study was to apply patient-engaged bedside handoffs in comprehensive care units, and to evaluate the effects of bedsides to nurses and patients. @*Methods@#This study employed a cluster randomized cross-over design.Electrical Medical Record (EMR)-based handoffs and patient-engaged bedside handoffs were alternatively applied to 104 patients, who were assigned to a total of 30 clusters (nursing handoff teams) in 4 comprehensive care units at the S medical center in Seoul, and the patients evaluated each type of handoffs. A total of 139 nurses were also participated in the same units and evaluated each type of handoffs. Data were analyzed using t-test, Wilcoxon rank sum test, ANOVA, and Kruskal-Walls test. @*Results@#The patient's satisfaction of the patient-engaged bedside handoffs was higher than that of the EMR-based handoffs (Z=-5.16, p<.001). On the other hand, the nurse's satisfaction of the patient-engaged bedside handoffs was significantly lower than that of the EMR-based handoffs (t=13.21, p<.001). There were no differences in length of the reporting time between two types of handoffs (t=-0.48, p=.634). @*Conclusion@#Patient satisfaction with the patient-engaged bedside handoffs was higher than that of EMR-based handoffs, and nurses' satisfaction with the patient-engaged bedside handoffs was significantly lower than that of EMR-based handoffs. Future studies are needed regarding the impacts of patient-engaged bedside handoffs on the quality of healthcare by identifying the benefits of the handoffs.

Frequency, Intensity and Daily Life Distress of Urinary Dysfunction in Women with Cervical Cancer after Radical Hysterectomy

PURPOSE: This study was done to identify frequency, intensity of urinary dysfunction and daily life distress in women after a radical hysterectomy for cervical cancer. METHODS: One hundred and fifty seven women who had undergone a radical hysterectomy and one hundred and sixty five women as healthy controls completed questionnaires on intensity of urinary dysfunction and daily life distress caused by urinary dysfunction. RESULTS: Women with cervical cancer showed higher frequency of urinary dysfunction than healthy controls. Major urinary dysfunction for women with cervical cancer in order of frequency were night-time incontinence (odds ratio=10.39, p<.001), difficulty in starting urination, weak urine stream and sense of incomplete emptying of bladder. The highest score on intensity was difficulty in starting urination, followed by urgency, weak urine stream, daytime frequency and sense of incomplete emptying. Night-time incontinence was the urinary symptom causing the most daily life distress for cervical cancer women followed by difficulty in starting urination, urgency, sense of incomplete emptying, and night-time frequency. CONCLUSION: Results suggest that nurses should address the potential postoperative urinary complications and develop long term interventions to decrease urinary dysfunction and daily life distress for women who have had a radical hysterectomy for cervical cancer.

Differences in the Prognosis according to the Periods of Diagnosis in Ulcerative Colitis / 대한소화기학회지

BACKGROUND/AIMS: Infliximab was approved for the treatment of ulcerative colitis (UC) in 2006 and has recently been used as rescue therapy in steroid-refractory UC. The aim of this study was to investigate the differences of medication use and prognosis in UC patients according to the periods of diagnosis. METHODS: From 1987 to 2012, a total of 1,422 patients with UC were retrospectively reviewed in 12 hospitals. The study population was divided into two groups according to the periods of diagnosis as follows; group A: 1987-2005, group B: 2006-2012. Analyzed variables were compared by using chi-square test and logistic regression analysis. RESULTS: Mean age of the subjects was 42.2 years, and the mean follow-up period was 4.7 years. In univariate analysis, the use of infliximab in group B was significantly higher than group A (4.5% vs. 7.6%, p=0.016), and UC-related hospitalization (45.8% vs. 40.1%, p=0.031) and UC-related surgery (6.4% vs. 3.5%, p=0.010) in group B was significantly lower than that of group A. The use of oral steroid in surgery group was significantly higher than non-surgery group in multivariate analysis (OR 1.85, 95% CI 1.03-3.30, p=0.039). CONCLUSIONS: Infliximab might play an important role for the treatment of steroid-refractory UC. Well-designed prospective trials based on the efficacy and safety of infliximab are required in the future.

Effect of ECQ on Iodoacetamide-Induced Chronic Gastritis in Rats

This study investigated effect of extract containing quercetin-3-O-beta-D-glucuronopyranoside from Rumex Aquaticus Herba (ECQ) against chronic gastritis in rats. To produce chronic gastritis, the animals received a daily intra-gastric administration of 0.1 ml of 0.15% iodoacetamide (IA) solution for 7 days. Daily exposure of the gastric mucosa to IA induced both gastric lesions and significant reductions of body weight and food and water intake. These reductions recovered with treatment with ECQ for 7 days. ECQ significantly inhibited the elevation of the malondialdehyde levels and myeloperoxidase activity, which were used as indices of lipid peroxidation and neutrophil infiltration. ECQ recovered the level of glutathione, activity of superoxide dismutase (SOD), and expression of SOD-2. The increased levels of total NO concentration and iNOS expression in the IA-induced chronic gastritis were significantly reduced by treatment with ECQ. These results suggest that the ECQ has a therapeutic effect on chronic gastritis in rats by inhibitory actions on neutrophil infiltration, lipid peroxidation and various steps of reactive oxygen species (ROS) generation.

Anti-Oxidative and Anti-Inflammatory Effects of QGC in Cultured Feline Esophageal Epithelial Cells

Quercetin-3-O-beta-D-glucuronopyranoside (QGC) is a flavonoid glucoside extracted from Rumex Aquaticus Herba. In the present study, anti-oxidative and anti-inflammatory effects of QGC were tested in vitro. Epithelial cells obtained from cat esophagus were cultured. When the cells were exposed to acid for 2 h, cell viability was decreased to 36%. Pretreatment with 50 microM QGC for 2 h prevented the reduction in cell viability. QGC also inhibited the productions of intracellular ROS by inflammatory inducers such as acid, lipopolysaccharide, indomethacin and ethanol. QGC significantly increased the activities of superoxide dismutase (SOD) and catalase, and also induced the expression of SOD2, while it restored the decrease of catalase expression in cells exposed to acid. QGC inhibited NF-kappaB translocation, cyclooxygenase-2 expression and PGE2 secretion in cells exposed to acid, which plays an important role in the pathogenesis of esophagitis. The data suggest that QGC may well be one of the promising substances to attenuate oxidative epithelial cell injury and inflammatory signaling in esophagus inflammation.

Signaling Pathway of Lysophosphatidic Acid-Induced Contraction in Feline Esophageal Smooth Muscle Cells

Lysolipids such as LPA, S1P and SPC have diverse biological activities including cell proliferation, differentiation, and migration. We investigated signaling pathways of LPA-induced contraction in feline esophageal smooth muscle cells. We used freshly isolated smooth muscle cells and permeabilized cells from cat esophagus to measure the length of cells. Maximal contraction occurred at 10(-6) M and the response peaked at 30s. To identify LPA receptor subtypes in cells, western blot analysis was performed with antibodies to LPA receptor subtypes. LPA1 and LPA3 receptor were detected at 50 kDa and 44 kDa. LPA-induced contraction was almost completely blocked by LPA receptor (1/3) antagonist KI16425. Pertussis toxin (PTX) inhibited the contraction induced by LPA, suggesting that the contraction is mediated by a PTX-sensitive G protein. Phospholipase C (PLC) inhibitors U73122 and neomycin, and protein kinase C (PKC) inhibitor GF109203X also reduced the contraction. The PKC-mediated contraction may be isozyme-specific since only PKCepsilon antibody inhibited the contraction. MEK inhibitor PD98059 and JNK inhibitor SP600125 blocked the contraction. However, there is no synergistic effect of PKC and MAPK on the LPA-induced contraction. In addition, RhoA inhibitor C3 exoenzyme and ROCK inhibitor Y27632 significantly, but not completely, reduced the contraction. The present study demonstrated that LPA-induced contraction seems to be mediated by LPA receptors (1/3), coupled to PTX-sensitive G protein, resulting in activation of PLC, PKC-epsilon pathway, which subsequently mediates activation of ERK and JNK. The data also suggest that RhoA/ROCK are involved in the LPA-induced contraction.

Efficacy of CT Colonography in the Detection of Colorectal Polypoid Lesions

PURPOSE: We wished to compare CT colonography with conventional colonoscopy for the detection of colorectal polypoid lesions, and we wanted to evaluate the role of IV contrast-enhanced CT colonography for the differentiation between benign polypoid lesions and malignant polypoid lesions. MATERIALS AND METHODS: Thirty-four consecutive patients underwent CT colonography prior to conventional colonoscopy. Precontrast prone-position CT images and postcontrast supine position CT images were obtained and the virtual colonoscopic images were reconstructed. Axial, sagittal and coronal images with virtual colonoscopic images were prospectively interpreted for the presence, size and morphologic features of colorectal polypoid lesions, and then these findings were compared with the colonoscopic findings. The degree of enhancement of colorectal polypoid lesions was measured by subtracting the attenuation values obtained with precontrast and postcontrast CT images for the differentiation of benignity and malignancy of the colorectal polypoid lesions. RESULTS: Among 75 colorectal polypoid lesions identified on conventional colonoscopy, 49 neoplasms were found on CT colonography, and the overall detection rate was 65.3%. Detection rate of lesions smaller than 10 mm was 52.1% (24/46), and the detection rate for lesions equal to or larger than 10 mm was 86.2% (25/29). Morphologic features of the sessile type lesions on CT colonography were well correlated with those noted on colonoscopy, but the stalks were not identified in 6 of 13 polyps on CT colonography. There was no statistical correlation between benignity and malignancy and the degree of contrast enhancement on CT colonography. CONCLUSION: CT colonography is a useful modality for the detection of colorectal polypoid lesions equal to or larger than 10mm, and it well demonstrates the morphologic features, except for the stalk of pedunculated polyps. However, CT colonography cannot differentiate benignity from malignancy.

MAPK Activation and Cell Viability after H2O2 Stimulation in Cultured Feline Ileal Smooth Muscle Cells

Recent data have shown the importance of oxidative stresses in the pathogenesis of inflammatory bowel disease, crohn's disease and ulcerative colitis. H2O2, reactive oxygen species (ROS) donor, has been reported to act as a signaling molecule involved in a variety of cellular functions such as apoptosis and proliferation. In the present study, we investigated viability of cultured ileal smooth muscle cells (ISMC) after stimulation with H2O2. Trypan blue method revealed that the cell viability of ISMC treated with 1 mM H2O2 was not different from that of controls at up to 2 h time point, while treatment of ISMC with 1 mM H2O2 for 48 h finally induced significant decrease in the cell viability. Therefore, we evaluated whether H2O2 was capable of ERKs activation in ISMC for the short-term exposure and examined whether tyrosine kinase was involved in the process of ERK activation by H2O2 in ISMC. We also investigated the effects of H2O2 on activation of SAPK/JNK and p38 MAP kinase in ISMC. Thus, ISMC were cultured and exposed to H2O2, and western blot analysis was performed with phospho- specific MAP kinase antibodies. Robust activation of ERK occurred within 30 min of 1 mM H2O2 treatment. H2O2-induced ERK activation was attenuated by a tyrosine kinase inhibitor, genistein, indicating that tyrosine kinase was probably involved in the ERK activation by H2O2. H2O2 was a moderate activator of SAPK/JNK, while p38 MAP kinase was not activated by H2O2. We suggest that ERK activation induced by short-term H2O2 treatment plays a critical role in cellular protection in the early stage of response to oxidative stress. The present study suggests the necessity of identification of MAPK signaling pathways affected by ROS, since it could ultimately elucidate cellular consequences involved in initiation and perpetuation of intestinal tissue damage in the diseases such as crohn's disease and ulcerative colitis, resulted from excessive ROS.

A Case of Baclofen-Associated Encephalopathy in a Maintenance Hemodialysis Patient / 대한신장학회잡지

Baclofen, a derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), is used for the treatment of muscle spasm, intractable hiccups and multiple sclerosis. It is mostly excreted by glomerular filtration with a clearance that is proportional to creatinine clearance. Early hemodialysis is a treatment of the choice for baclofen-induced neurologic complication in renal failure patients. We experienced a 57-year-old hemodialysis patient with right arm muscle spasm who developed baclofen-associated encephalopathy by a single dose of oral baclofen (10 mg). He admitted to the hospital with the symptom of stuporous mental status with no specific focal neurologic signs. Brain CT imaging and blood biochemistry showed no specific abnormality. EEG revealed the typical metabolic encephalopathy findings, such as triphasic wave and frontal lobe syndrome with delta wave. After daily hemodialysis for 3 days, there was a complete recovery of an altered mentality. After one month later, the follow-up EEG showed normal finding with the resolution of abnormal waves. We report this case with a review of relevant literature. Baclofen should be used carefully, and rather recommended not to be administered in patients with renal failure.

A Case of Baclofen-Associated Encephalopathy in a Maintenance Hemodialysis Patient / 대한신장학회잡지

Baclofen, a derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), is used for the treatment of muscle spasm, intractable hiccups and multiple sclerosis. It is mostly excreted by glomerular filtration with a clearance that is proportional to creatinine clearance. Early hemodialysis is a treatment of the choice for baclofen-induced neurologic complication in renal failure patients. We experienced a 57-year-old hemodialysis patient with right arm muscle spasm who developed baclofen-associated encephalopathy by a single dose of oral baclofen (10 mg). He admitted to the hospital with the symptom of stuporous mental status with no specific focal neurologic signs. Brain CT imaging and blood biochemistry showed no specific abnormality. EEG revealed the typical metabolic encephalopathy findings, such as triphasic wave and frontal lobe syndrome with delta wave. After daily hemodialysis for 3 days, there was a complete recovery of an altered mentality. After one month later, the follow-up EEG showed normal finding with the resolution of abnormal waves. We report this case with a review of relevant literature. Baclofen should be used carefully, and rather recommended not to be administered in patients with renal failure.

Coil Embolization of Septal Branches in Hypertrophic Obstructive Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) has been associated with sudden death in young athletes. On long-term follow up, syncope, chest pain and dyspnea are well known frequent symptoms due to the dynamic left ventricular outflow tract (LVOT) obstruction, mitral regurgitation and diastolic dysfunction. To reduce the LVOT pressure gradient, septal myectomy and alcohol injection have recently been utilized. However, some complications have been reported with alcohol ablation of the septal branches, such as complete atrioventricular block and alcohol spill over to ablate the entire left anterior descending coronary artery. Herein, a case of coil embolization of the septal branches, with successful reduction of the LVOT pressure gradient, is reported in a patient with HOCM.

A Case of Native Valve Salvage for 8 Years Longstanding Ruptured Tricuspid Valve after Blunt Chest Trauma

Although very rare, the incidence of tricuspid valve regurgitation after blunt chest trauma has risen in line with the increasing rate of car accidents and steering wheel trauma. It is easy to miss the diagnosis of tricuspid valve regurgitation following blunt chest trauma because most patients feel no symptoms at trauma, and the condition is sometimes overlooked for a long period of time due to its mild symptoms. A 49-year-old man suffered dyspnea on exertion for 1 month due to right heart failure 8 years after accidentally falling from a third floor. Preoperative echocardiography revealed severe tricuspid valve regurgitation resulting from prolapse of the anterior leaflet with annular dilatation. The patient underwent tricuspid valvuloplasty with a 36-mm Carpentier tricuspid ring. Intraoperative transesophageal echocardiography showed mild tricuspid valve regurgitation. We report a case of successful native valve salvage of ruptured tricuspid valve after blunt chest trauma, and present a review of the relevant literature.

A Case of Native Valve Salvage for 8 Years Longstanding Ruptured Tricuspid Valve after Blunt Chest Trauma

Although very rare, the incidence of tricuspid valve regurgitation after blunt chest trauma has risen in line with the increasing rate of car accidents and steering wheel trauma. It is easy to miss the diagnosis of tricuspid valve regurgitation following blunt chest trauma because most patients feel no symptoms at trauma, and the condition is sometimes overlooked for a long period of time due to its mild symptoms. A 49-year-old man suffered dyspnea on exertion for 1 month due to right heart failure 8 years after accidentally falling from a third floor. Preoperative echocardiography revealed severe tricuspid valve regurgitation resulting from prolapse of the anterior leaflet with annular dilatation. The patient underwent tricuspid valvuloplasty with a 36-mm Carpentier tricuspid ring. Intraoperative transesophageal echocardiography showed mild tricuspid valve regurgitation. We report a case of successful native valve salvage of ruptured tricuspid valve after blunt chest trauma, and present a review of the relevant literature.

Clinical Significance of Erosive and/or Small Ulcerative Lesions in the Colon and Terminal Ileum: Short-term Follow-up Study / 대한소화기학회지

BACKGROUND/AIMS: Various etiologies and diseases may be related to erosions and/or small ulcers without gross inflammatory changes in the surrounding mucosa found in the colon and terminal ileum during colonoscopy. However, studies on follow-up of these lesions are rare. Thus, we investigated the clinical significance of these lesions and their characteristics helpful for differential diagnosis. METHODS: We reviewed the data of 183 patients with colonoscopically observed erosive or small ulcerative lesions (<2 cm), and analyzed them according to the location, number, and size of lesions, histopathologic findings, chief complaints, laboratory findings, changes of symptoms, and changes in lesions during 4-12 week follow-up period. RESULTS: Histopathologic findings of these lesions included acute nonspecific inflammation, chronic nonspecific inflammation, Crohn's disease, tuberculous colitis, ischemic colitis, Behcet's disease, cytomegalovirus infection, eosinophilic colitis, ulcerative colitis or pseudomembranous colitis, but most of them were nonspecific (84%). In patients with nonspecific inflammation, histopathologic findings, symptoms, location and multiplicity of the lesions were not prognostic factors for the persistency of symptoms and lesions during follow-up period. Two patients with acute inflammation, who showed no improvement in symptoms and lesions, were later diagnosed as Crohn's disease. CONCLUSIONS: Erosive or small ulcerative lesions without macroscopic inflammatory changes in the surrounding mucosa during colonoscopy, are mainly nonspecific. However, careful follow-up is required when the symptoms and/or lesions are not improved.

Clinical significance of serum ECP and sero-prevalence of human toxocariasis in patients with eosinophilia / 천식및알레르기

BACKGROUND: Several studies have reported that the serum concentration of eosinophil cationic protein (ECP) reflects the intensity of eosinophilic airway inflammation in asthmatic patients, and the ratio of serum ECP concentration to peripheral blood eosinophil counts (ECP/Eo ratio) may be useful in assessing asthma severity. Human toxocariasis, of which diagnosis relies upon specific serology, is a common. worldwide helminthozoonosis and one of the causes of blood eosinophilia. OBJECTIVES: The aim of this study is to evaluate the clinical significance of serum ECP concentration, peripheral-blood eosinophil count and ECP/Eo ratio in relation to clinical severity, and the sero-prevalence of human toxocariasis in patients with eosinophilia. MATERIALS AND METHODS: Fifteen patients with eosinophilia were enrolled. Serum ECP concentrations by CAP system, peripheral-blood eosinophil counts, and ECP/Eo ratio were determined. Clinical severity of the disease was represented as the number of organs with eosinophilic infiltration, and we divided the study subjects in to two groups according to therapeutic response. The diagnosis of toxocariasis was confirmed by detecting serum specific IgE antibody to Toxocara excretory-secretory antigens (TES-Ag) by ELISA and IgG immunoblot analysis. RESULTS: A significant positive correlation was found between the number of organs with eosinophilic infiltration, serum ECP concentration, and peak peripheral-blood eosinophil count (p < 0.05, respectively). The number of organs with eosinophilic infiltration was significantly higher in the poor therapeutic response group compared to the good therapeutic response group (p < 0.01). Fourteen of 15 patients (93.3%) showed positive reactions in Toxocara serologic test. CONCLUSION: Toxocara infection should be considered as a major cause of eosinophilia in this country. Serum ECP, peak peripheral-blood eosinophil count and the number of organs with eosinophilic infiltration may be used as useful markers for assessment of therapeutic response in patients with eosinophilia.

A case of angioedema associated with losartan / 천식및알레르기

Angioedema is a non-pitting edema that occurs in the skin and mucus membranes. It is known that major etiologies include hereditary deficiency of C1 esterase inhibitor, temperature extreme, trauma, food sensitivity, and medications such as penicillin, aspirin, NSAIDS and ACE inhibitors. ACE inhibitors are blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, and increasing local levels of bradykinin, a potent vasodilator. This increased bradykinin has been theorized to cause angioedema and cough in patients on ACE inhibitors. However, there has been very few causes of angioedema induced by angiotensin II receptor blocker. This is the first report of a patient presenting angioedema induced by losartan -angiotensin II receptor blocker- in this century.

A Case of Spontaneous Rupture of the Kidney with Acute Pyelonephritis / 대한신장학회잡지

Spontaneous rupture of the kidney, Wonderlich syndrome, is a rare event but potentially life-threatening condition. The most comman causes are clear cell carcinoma, benign angiomyolipoma and vascular disease. Among this event, acute pyelonephritis is a very unusual cause. A 67-year-old diabetic woman was admitted with high fever and left flank pain due to acute pyelonephritis. She had uterine prolapse for 10 years with both renal hydronephrosis before this event. Abdominal ultrasonography and CT scan showed fluid collection around left kidney with a rupture of renal parenchyme at lower pole. The renal angiography showed displaced capsular artery due to subcapsular hematoma and decreased blood flow at lower pole. The percutaneous needle aspiration revealed blood collection around left kidney, which confirmed spontaneous rupture of the kidney. We report this case with a review of the relevant literature.

A Case of Adult-onset Still's Disease Associated with Leukopenia / 대한류마티스학회지

Adult-onset Still's disease (AOSD) is a multi-systemic inflammatory disorder characterized by high spiking fever, evanescent salmon-colored rash, arthralgia or arthritis, leukocytosis and the involvement of various organs. However, leukopenia is rarely associated with AOSD. It may be due to hemophagocytic syndrome, which usually present with acute febrile illness, pancytopenia, hepatosplenomegaly, and hyperferritinemia. We report a case of 28-year-old man with AOSD and leukopenia. There is no evidence of other causes of cytopenia and hemophagocytosis in bone marrow examination. Leukopenia can be the initial presentation of AOSD.

A Case of Seronegative Rheumatoid Arthritis with Idiopathic Hypereosinophilic Syndrome / 대한류마티스학회지

The idiopathic hypereosinophilic syndrome (HES) is a disorder marked by the sustained overproduction of eosinophils. The disease is characterized by damage of multiple organ including heart, nerve system, skin and lung due to eosinophilic infiltration and the diagnosis is one of exclusion. Rheumatologic manifestations of HES are infrequent. In about 10~40% of rheumatoid arthritis (RA) patients, persistent eosinophilia is observed. That can be due to the RA itself and is often associated with active disease and extra-articular features. Sometimes, it is attributed to the drug therapy, especially gold and penicillamine. We would like to report a 37-year-old female patient with HES who developed seronegative RA 2 years later.

A Case of Adult Dermatomyositis with Diffuse Soft Tissue Calcification / 대한류마티스학회지

Dermatomyositis is a disease of non-pyogenic inflammation of skin and muscles in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. Diffuse subcutaneous and interstitial muscular calcinosis is well recognised and common in childhood dermatomyositis. However, soft tissue calcification in a patient with adult onset dermatomyositis has been rarely reported. We have experienced a patient with adult onset dermatomyositis who had diffuse subcutaneous tissue calcification on hands, arms, chest, abdomen and buttocks.