The Frequency of Job Performance of the Korean Professional Medical Support Staff at Medical Institutions over 500 Beds / 중환자간호학회지

PURPOSE: This study was intended to investigate the frequency of job performance of the Korean professional medical support staffs (PMSS).METHOD: The data of 1,666 PMSS from 36 hospitals and over 500 beds were analyzed. The participants were divided into 5 groups: advanced practice nurses (APN), clinical nurse experts, physician assistants (PA), coordinators, and others.RESULTS: Among the 5 main domains of job performance, advanced clinical practice has the highest frequency (111.36 d/y), followed by consultation/collaboration (75.66 d/y), education/counseling (53.54 d/y), leadership (23.90 d/y), and research (19.14 d/y). There was a significant difference in the frequency of job performance between the 5 groups of participants. The invasive activities were more frequent in the PA group. In the education and counseling domain, APNs had a higher level of job frequency than others (p < .001). In the research and leadership domains, APNs and coordinators had more prominent performance frequency than other groups (p < .01). However, there are some ambiguities in the job performance of the 5 groups depending on institutional characteristics.CONCLUSION: To establish the scope of work of PMSS, organizational and individual efforts are needed to promote and expand the leadership and research domains. To resolve the ambiguities of PMSS' roles, it is necessary to reorganize their titles.

The Current Status of Professional Medical Support Staffs in General Hospitals less than 500 Beds / 임상간호연구

PURPOSE: This study aimed to investigate the current statistics of professional medical support staffs(PMSSs) working in general hospitals with less than 500 beds. METHODS: This study was conducted on 35 general hospitals with less than 500 beds from September 11th to October 27th, 2017. RESULTS: Four hundred fifty one PMSSs were currently providing medical support. The number of clinical nurse experts was the highest among the roles, followed by Physician Assistants(PA) and Advanced Practice Nurses. The mean job satisfaction score was 3.07 out of 5. In the case of PA group, most of the delegated prescriptions were performed, however the delegated roles were not much documented in written format. The paucity of documentation requires a development of a committee for PMSSs, including a development of selection criteria and a scope of practice in each institution. CONCLUSION: The results of this study suggested the composition of a committee for PMSSs in the medical institutions and renaming the specified titles of PMSSs.

Treatment and clinical outcomes of patients relapsing after allogeneic hematopoietic cell transplantation for myelodysplastic syndrome

BACKGROUND: Although allogeneic hematopoietic cell transplantation (HCT) is the only curative treatment option for myelodysplastic syndrome (MDS), a substantial number of patients experience relapse. We reviewed the clinical outcomes of patients with MDS who relapsed after allogeneic HCT. METHODS: Thirty patients who experienced relapse or progression after allogeneic HCT for MDS between July 2000 and May 2016 were included in this retrospective analysis. RESULTS: The median time from HCT to relapse was 6.6 (range, 0.9–136.3) months. Donor lymphocyte infusions (DLIs) were administered to four patients: one achieved complete remission (CR) and survived disease free, while three did not respond to DLI and died. Hypomethylating agents were administered to seven patients: one who had stable disease continuously received decitabine, while six died without response to treatment. Six patients received AML-like intensive chemotherapy, and three achieved CR: two underwent second HCT and one DLI. One patient receiving second HCT survived without disease, but the other two relapsed and died. Three, four, and eight patients who did not respond to intensive chemotherapy, low-dose cytarabine, and best supportive care, respectively, died. One patient who underwent second HCT following cytogenetic relapse survived disease free. Median overall survival after relapse was 4.4 months, and relapse within 6 months after HCT was associated with shorter survival. CONCLUSION: Outcomes of MDS patients relapsing after allogeneic HCT were disappointing. Some patients could be saved using DLI or second HCT.

The Current Status of Professional Medical Support Staffs in Medical Institutions with over 500 Beds / 임상간호연구

PURPOSE: This study was to investigate the nationwide operational status of the professional medical support staffs (PMSS) who practice the expanded roles in the hospital setting. METHODS: The data were obtained through survey from 36 hospitals with over 500 beds from 25th May to 12th July 2016. Data from 1,666 PMSS were analyzed. RESULTS: Since the job titles varied, we classified them into 5 groups according to their roles; advanced practice nurse, clinical nurse expert, PA (physician assistant), coordinator, and others. There were differences in the operation status of PMSSs depending on the region, nurse staffing grade and number of hospital beds. Qualification criteria varied from hospital to hospital, and almost half of the hospitals didn't have any qualification standards for them. There were differences in age, educational level, clinical careers, rewards, and job satisfaction in 5 groups. Especially PA group had low salary, poorer working conditions, more difficulties in performing their work, and lower job satisfaction than other groups. Most PMSS (99.5%) were using a delegated prescription authority, however only 68.3% had job description and 19.9% had documented delegated role. CONCLUSION: Adequate training curriculum, documented delegated roles, and the protocols for legal protection and efficient medical services are needed.

Immunophenotypic markers in adult acute lymphoblastic leukemia: the prognostic significance of CD20 and TdT expression

BACKGROUND: Efforts to overcome poor outcomes in patients with adult acute lymphoblastic leukemia (ALL) have focused on combining new therapeutic agents targeting immunophenotypic markers (IPMs) with classical cytotoxic agents; therefore, it is important to evaluate the clinical significance of IPMs. METHODS: Baseline characteristics and clinical outcomes of patients with adult ALL were retrospectively analyzed. The percentage of blasts expressing IPMs at diagnosis was measured by multicolor flow cytometry analysis. Samples in which > or =20% of blasts expressed an IPM were considered positive. RESULTS: Among the total patient population (N=230), almost all (92%) were in first or second hematological complete remission (HCR) and 54% received allogeneic hematopoietic cell transplant (allo-HCT). Five-year hematologic relapse-free survival (HRFS) and overall survival (OS) rates were 36% and 39%, respectively, and 45.6% and 80.5% of patients were positive for the IPMs CD20 and terminal deoxynucleotidyl transferase (TdT), respectively. Expression of CD20, CD13, CD34, and TdT was associated with HRFS rate, and expression of CD20 and CD13 was associated with OS rate, as was the performance of allo-HCT. In multivariate analysis, positivity for CD20 (HRFS: hazard ratio [HR], 2.21, P<0.001; OS: HR, 1.63, P=0.015) and negativity for TdT (HRFS: HR, 2.30, P=0.001) were both significantly associated with outcomes. When patients were categorized into three subgroups according to positivity for CD20 and TdT, there were significant differences in HRFS and OS among the subgroups. CONCLUSION: Positivity for CD20 and TdT expression and clinical risk group were prognostic factors in adult ALL.

An Improved Outlook for Patients with Acute Leukemia over the Last 14 Years: A Perspective from a University Hospital / 대한혈액학회지

BACKGROUND: To see whether there has been improvement in the survival of patients with acute leukemia over the last 14 years, a retrospective analysis was performed. METHODS: Clinical and laboratory data were obtained form the medical records. Patient survival data was obtained from the hospital records, national cancer registry or by direct phone contacts. RESULTS: Between June, 1989 and August 2002, 714 adult patients were diagnosed with acute leukemia at Asan Medical Center in Seoul. Fourteen patients were lost to follow-up within 100 days of the diagnosis and excluded. There were 535 patients with acute myelogenous leukemia (AML) and 165 with acute lymphoblastic leukemia (ALL). There were 65 patients with acute promyelocytic leukemia (APL) among 535 patients with AML. Patients with non-APL AML and ALL were divided into 3 cohorts according to the year of the diagnosis: cohort I, 1989~1994; cohort II, 1995~1998; cohort III, 1999~2002. Patients with APL were also divided into 3 cohorts: cohort I, pre-all-transretinoic acid (ATRA) period (1989~1994. 2); cohort II, ATRA with or without chemotherapy (1994. 3~2000. 8); and cohort III, ATRA plus idarubicin (2000. 9~2002). Univariate analysis showed significant improvement in patient survival in non-APL AML (4-year projected survival rates of 10%, 19%, and 33% for cohorts I, II, and III, respectively, P=0.0000), in ALL (27%, 28%, and 52%, P=0.03), and in APL (36%, 56%, and 80%, P=0.04). Multivariate analysis showed that the year of diagnosis was a significant independent variable for patient survival in non-APL AML and ALL. CONCLUSION: Our study showed significant survival improvement in acute leukemia over the last 14 years. This improvement is not likely due to change in patient demographics. Rather, it is likely that introduction of newer methods of treatment of acute leukemia, such as multi-cycle combination chemotherapy for ALL, high dose cytarabine consolidation for AML, ATRA for APL, and wider application of allogeneic hematopoietic cell transplantation, has resulted in a better patient survival.

Hemorrhagic Cystitis Following Allogeneic Hematopoietic Cell Transplantation

We conducted a retrospective study to investigate the incidence, risk factors, and clinical features of hemorrhagic cystitis (HC) following allogeneic hematopoietic cell transplantation (allo-HCT). Adult patients who developed HC after allo-HCT were identified from the HCT database of the Asan Medical Center and their medical records were reviewed. From December 1993 to August 2001, a total of 210 adult patients underwent allo-HCT. Fifty-one patients developed HC with a cumulative incidence of 25.7%. The median onset of HC was post-transplant day 24 (range, -2 to 474), and the median duration was 31 days (range, 8 to 369). Significant risk factors for HC by univariate analysis included diagnosis of chronic myelogenous leukemia (p=0.028), unrelated HCT (p=0.029), grade III-IV acute graft-versus-host disease (GVHD) (p<0.001), extensive chronic GVHD (p=0.001), and positive cytomegalovirus antigenemia between post transplant days 31 and 60 (p=0.031). Multivariate analysis showed that grade III-IV acute GVHD was the most important risk factor for the occurrence of HC after allo-HCT (odds ratio, 3.38; 95% CI, 1.36-8.39). Late-onset HC, which occurred beyond 3 weeks after allo-HCT, was more frequently associated with GVHD than earlyonset HC (p=0.007). Our data suggest that a portion of late-onset HC might be a manifestation of GVHD.