False-Positive T-Cell Cytotoxicity Crossmatch Results Due to Autoantibodies in Korean Network for Organ Sharing Crossmatch Tests / 대한이식학회지

BACKGROUND: Basic National Institute of Health (NIH) and sensitive antihuman globulin (AHG) methods are widely used for T-cell complement-dependent cytotoxicity crossmatch (XM) tests. Whereas NIH-negative, AHG-positive (NIH⁻/AHG⁺) results are caused by weak antibodies, NIH⁺/AHG⁻ results are usually due to autoantibodies. We found that solid organ transplantation candidates with NIH⁺/AHG⁻ XM results are repeatedly excluded from allocation of deceased donor organs by the Korean Network for Organ Sharing (KONOS) allocation system. Here, we attempted to demonstrate that these patients do not have donor-specific HLA antibodies (DSAs). METHODS: Sera showing NIH⁺/AHG⁻ results in the analysis of 1,668 KONOS T-cell XM tests were screened for panel reactive antibody (PRA) using a Luminex test. For screen-positive samples, antibody identification was conducted using a Luminex single antigen assay and the presence or absence of class I DSAs was determined. For positive controls, 42 KONOS XM tests showing probable true-positive (NIH⁻/AHG⁺ or NIH⁺/AHG⁺) results were reviewed for PRA results based on electronic medical records and the presence or absence of DSAs was determined. RESULTS: NIH⁺/AHG⁻ results were observed in 1.3% (21/1,668) of KONOS XM tests analyzed. Most of these (18/21, 85.7%) were negative for PRA or DSAs. All probable true-positive cases were either positive for DSAs (24/42, 57.1%) or had high PRA (mean, 92% [range; 42%~100%]), complicating accurate identification of antibody specificities. CONCLUSIONS: NIH⁺/AHG⁻ results are not rare (1.3%) in KONOS XM tests. Most of these results are not due to DSAs, and these patients should not be excluded from organ allocation.

Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis

OBJECTIVE: Adenomyosis and endometriosis are relatively common gynecological diseases that exhibit many common features. This study identified gynecological and non-gynecological diseases that exhibited comorbidity with adenomyosis and endometriosis in Korean women. METHODS: We used Health Insurance Review and Assessment data from 2009 to 2011 and searched for adenomyosis and endometriosis (coded as N80.1 and D25 in International Classification of Disease, 10th revision [ICD-10], respectively). We selected records from patients who had independent disease occurrences in each year, and comorbidities were estimated using Fisher's exact test. We computed each year's similarities and combined 3 years' results using Fisher's P-value summation method. RESULTS: A total of 61,516 patients' data were collected during the study period. The prevalence of adenomyosis and endometriosis were similar each year: 12.4% and 9.3% in 2009, 12.5% and 9.4% in 2010 and 13.3% and 9.1% in 2011, respectively. Meta-analysis revealed that 31 ICD-10 codes were significantly related with adenomyosis, and 44 ICD-10 codes were related with endometriosis. Gynecological diseases, such as leiomyoma and benign ovarian tumor, were significantly related to adenomyosis and endometriosis. Non-gynecological diseases, such as anemia and hypercholesterolemia, were also related to adenomyosis and endometriosis. CONCLUSION: We must monitor for the presence of gynecological and non-gynecological diseases with co-morbidities during evaluations and follow-up of patients with adenomyosis or endometriosis.

Reliability and Validity of the Decision-Making-Competency Inventory (DMCI) in Korean Adolescents

PURPOSE: This study was done to verify the reliability and validity of the Korean version of DMCI in Korean adolescents. METHODS: A methodological study design was used with Cronbach's alpha for reliability, and an exploratory factor analysis and contrasted groups approach for construct validity. DMCI was translated into Korean and tested with a sample of 406 adolescents in Korea. The data were analyzed using Cronbach's alpha, item correlation with total, principal component factor analysis, and t-test. RESULTS: The translated content of the DMCI was validated by nursing faculty members and translation equivalency was obtained. The Cronbach's alpha of the DMCI simplified with 18 items was .78. The factor analysis revealed three factors explaining 41.5% of total variance and the corresponding factors were self-observation (21.6%), self-judgement (11.4%), and self-confidence (8.6%). The mean score for the DMCI in the aggression group was significantly lower than the non-aggression group. CONCLUSION: Results of this study suggest that the Korean version of DMCI can used as a reliable and valid measure to assess decision making competency in Korean adolescents.

The Effects of a Self-esteem Improvement Program on Self-esteem, Depression, and Interpersonal Relationships in Community Dwelling Patients with Chronic Schizophrenia / 정신간호학회지

PURPOSE: The purpose of this study was to determine the effects of self-esteem improvement program on self-esteem, depression, and interpersonal relationship in chronic schizophrenia patients living in the community. METHODS: The research design was a non-equivalent pre and post control group design. One of two community mental health centers was randomly assigned to receive the intervention and the other served as a control. Eight patients in the intervention group and ten in the control group participated. For the intervention group, the self-esteem improvement program was provided in 60-minute session once a week for 12-weeks. Measurements were Korean version of self-esteem scale (SES-K), Korean version of beck depression inventory (BDI-K), and Korean version of interpersonal relationships (IR-K). RESULTS: The only statistically significant difference between the experimental and control group was for interpersonal relationships. For the experimental group, there were statistically significant differences in self-esteem and interpersonal relationships. CONCLUSION: The results indicate that this type of program has a positive effect on self-esteem and interpersonal relationships and can be a feasible type of intervention program for community dwelling patients with chronic schizophrenia.

Discrepancies between Human Leukocyte Antigen Registry Typing and Confirmatory Typing Results of Unrelated Hematopoietic Stem Cell Donors / 대한진단검사의학회지

BACKGROUND: In unrelated hematopoietic stem cell transplantation, the accuracy of HLA registry typing (RT) of donors is important for timely search and coordination of HLA-matched donors. We analyzed discrepancies between HLA RT and confirmatory typing (CT) results of stem cell donors in Korean and foreign registries. METHODS: We analyzed the HLA typing results of 834 donors for whom CT was performed at Seoul National University Hospital between April 1997 and March 2010. For CT, DNA typing was used in majority of the cases and HLA-A and HLA-B serological typing was used in some early cases. The discrepancies between the typing results were analyzed at the serological/generic level. RESULTS: The overall discrepancy rate (RT error rate) was 3.2%, and the rate was similar in the Korean and foreign registries. The discrepancy rates in the Korean and foreign registries were more than 10% in the 1997-2001 searches, but decreased to less than 3% in the 2002-2010 searches. Analysis of 19 cases of RT errors in the Korean registry revealed 3 cases of sample switchover errors and 16 cases of typing errors in one of the HLA-A, HLA-B, or HLA-DR loci. The RT error rate in Japan Marrow Donor Program was lower than those in other foreign registries. CONCLUSIONS: The error rate of HLA RT results of unrelated stem cell donors in the Korean registry was similar to those in the foreign registries, and has decreased in the recent searches following the change in the typing method from serological to DNA typing.

An Evaluation of Platelet Transfusion Response Using HLA Crossmatch-compatible Donors in Patients with Platelet Refractoriness / 대한진단검사의학회지

BACKGROUND: Majority of immune-mediated platelet refractoriness is caused by HLA alloimmunization and can be effectively managed by HLA-matched platelet transfusions. However, HLA class I-typed large-sized donor registry has not been well established in Korea. We evaluated the effectiveness of platelet transfusion using HLA crossmatch-compatible donors without HLA typing. METHODS: Sixteen patients showing platelet refractoriness to random donor platelets (1 hr corrected count increment [CCI] 60%) were crossmatched with 78 platelet apheresis-eligible donors using National Institute of Health (NIH) and anti-human globulin (AHG) lymphocytotoxicity methods. NIH negative/AHG negative and NIH negative/AHG positive donors were selected as best and second choice donors, respectively. RESULTS: Eleven patients (11/16, 69%) could find NIH-crossmatch negative donors and 27 donors (27/78, 35%) belonged to the best donors. To 8 patients, 32 apheresis platelet products from 19 donors were transfused. The mean 1 hr and 24 hr CCI values from the best donors were significantly higher than those from random donors (17,893 vs 2,358, P=0.003; 8,292 vs -614, P<0.001), whereas such differences were not observed for those from the second choice donors. Platelet storage time was inversely correlated with CCI values and platelets stored < or =10 hr after collection gave significantly higher CCI values. Neither ABO match nor donor status (related vs unrelated) affected the transfusion effectiveness. CONCLUSIONS: Effective post-transfusion platelet increment using HLA crossmatch-compatible donors was attained in patients with platelet refractoriness due to HLA antibodies, and this method can be used effectively where HLA-typed platelet donor registry is not available.

Discriminant Factors of Attitude Pattern toward Sexual Violence of College Women / 여성건강간호학회지

PURPOSE: The purpose of this study was to determine the discriminant factors of attitude pattern toward sexual violence of college women. METHODS: A cross-sectional research design with non-probability samples was conducted. A total of 292 college women participated. The instruments were Attitude Pattern toward Sexual Violence, Self-Esteem Scale, Gender Role Scale, and Attitude toward Sexuality. Dependent variable is Attitude Pattern toward Sexual Violence, which is composed of two groups; cases either harmer blame or sufferer blame. Independent variables were self-esteem, attitude toward gender role, and attitude toward sexuality. Data were analyzed by SPSS WIN program and descriptive analysis, chi-square -test, and discriminant analysis. RESULTS: To assess the adequacy of classification, the overall hit ratio was 68.5%, and the significant predictor variable was attitude toward sexuality. CONCLUSION: Replication of the study needs to be considered to further enrich the specific knowledge base regarding attitude toward sexual violence among college women.

Translation and Validation of the Korean Version of MUDI and MUSIQ with Urinary Incontinent Older Men

PURPOSE: The purpose of this study was to evaluate the psychometric properties of the Korean version of the Male Urinary Distress Inventory (MUDI) and Male Urinary Symptom Impact Questionnaire (MUSIQ). PATIENTS AND METHODS: A convenient sample of community-dwelling older men with urinary incontinence participated. A cross-sectional survey design was used for this study. A panel of experts completed the initial translation into Korean and back-translated the MUDI and MUSIQ. Upon establishment of the content and translation equivalence between English and Korean versions of the MUDI and MUSIQ, psychometric properties were evaluated for reliability, concurrent, and construct validity with a sample of 143 older men. RESULTS: The internal consistencies of both instruments were found to be acceptable, and Cronbach's coefficients were 0.88 for the MUDI-K and 0.92 for the MUSIQ-K. A significant moderate correlation between MUDI-K and MUSIQ-K was found in this study, indicating modest concurrent validity between these 2 instruments (r = 0.56, p < 0.001). For construct validity, the mean scores of the MUDI-K were significantly different for age, marital status, prostate surgery, erectile dysfunction, and depression (p < 0.05). The means scores of MUSIQ-K were significantly different for depression (p < 0.05) only. For both the MUDI-K and MUSIQ-K, 7 factors were extracted, accounting for 68.1% and 72.1% of the variance. CONCLUSION: Results of this study suggest that the MUDI-K and MUSIQ-K can be used as a reliable and valid measure of health-related quality of life in community- dwelling Korean older men with urinary incontinence.

Wandering Behavior in Korean Elders with Dementia Residing in Nursing Homes / 간호학회지

PURPOSE: This study investigated various factors relatied to wandering behavior of Korean elders with dementia (KED). METHODS: A sample of 160 ambulatory residents with dementia from 14 long term care facilities was used to examine demographic, individual, cognitive, physical health, and environmental characteristics by comparing wanderers (N=108) to nonwanders (N=52). Subjects were evaluated by Korean versions of the Mini-mental State Exam (K-MMSE), the Physical and Instrumental Activities of Daily Living (K-PIADL), and the Revised Algase Wandering Scale Nursing Home version (KRAWS-NH) along its six dimensions. Demographic and environmental data were also obtained. Independent sample ttests, Chi-square test, Fisher's Exact tests, and ANCOVAs were used to examine differences between wanderers and nonwanders. RESULTS: Wanderers were significantly (p<.05) older and had more limitations in K-PADL and K-IADL. The degree of overall wandering and certain features of wandering were significantly different (p<.05) by total number of residents in the facility, type of bedroom (i.e., "Ondol"), and color of bedroom and living-room walls (i.e., sky blue). CONCLUSIONS: Findings of this study may be useful in understanding wandering behavior of KEDs and thus developing more culturally specific management strategies.

A case of omental pregnancy / 대한산부인과학회지

Abdominal pregnancy is a rare variation of ectopic pregnancy, which has been classified as primary or secondary. The clinical characteristics of abdominal pregnancy are extremely variable, so early diagnosis is very difficult. Because of high maternal morbidity and mortality, the prompt surgical intervention is required. Omental pregnancy is a very rare form of abdominal pregnancy, which is hard to detect early. The diagnosis of omental pregnancy is hardly ever made prior to laparotomy. We have experienced a case of omental pregnancy in a 36-year-old woman and report this case with brief review of literature.

A case of ipsilateral cornual pregnancy after previous salpingectomy for tubal pregnancy / 대한산부인과학회지

Cornual pregnancy is a rare form of ectopic pregnancy and its diagnosis is difficult. Its incidence is 2-4% of all tubal pregnancies. Because greater vascularity and distensibility of implantation site lead to rupture at a later gestational age and cause the rapid intraperitoneal hemorrhage, cornual pregnancy causes serious maternal mortality and morbidity. Cornual pregnancy is relatively rare in the woman who has the history of ipsilateral salpingectomy. We have experienced a case of ipsilateral cornual pregnancy after previous salpingectomy in a 31-year-old woman and report this case with brief review of literature.

Content Analysis of the Experience of Preceptors in Clinical Education for Senior Student Nurses / 간호학회지

PURPOSE: The purpose of this study was to identify experiences of nurses who served as preceptors in clinical education for senior student nurses in a college of medicine in Wonju city. METHOD: Data was collected from 20 preceptors instructing senior student nurses in 2001 using a self-completion questionnaire. To analyze data, content analysis was done using an analysis scheme developed by the investigators. RESULT: The analysis scheme consisted of 7 categories and 25 subcategories. 135 significant statements were analyzed and categorized. Preceptors indicated that they were role models, socialization facilitators and educators while instructing students in the clinical practicum. In performing the preceptors' role, preceptors reported that their most important change was self-enhancement,and positive experience was a constructive work atmosphere. The most important factor facilitating the preceptors' role performance was support from head nurses, and the most discouraging factor was work loads. CONCLUSION: This study suggests that interventions for encouragement and socialization of preceptors should be developed to promote clinical education for senior student nurses.

Content Analysis of the Experience of Preceptors in Clinical Education for Senior Student Nurses / 간호학회지

PURPOSE: The purpose of this study was to identify experiences of nurses who served as preceptors in clinical education for senior student nurses in a college of medicine in Wonju city. METHOD: Data was collected from 20 preceptors instructing senior student nurses in 2001 using a self-completion questionnaire. To analyze data, content analysis was done using an analysis scheme developed by the investigators. RESULT: The analysis scheme consisted of 7 categories and 25 subcategories. 135 significant statements were analyzed and categorized. Preceptors indicated that they were role models, socialization facilitators and educators while instructing students in the clinical practicum. In performing the preceptors' role, preceptors reported that their most important change was self-enhancement,and positive experience was a constructive work atmosphere. The most important factor facilitating the preceptors' role performance was support from head nurses, and the most discouraging factor was work loads. CONCLUSION: This study suggests that interventions for encouragement and socialization of preceptors should be developed to promote clinical education for senior student nurses.

The Study on Health Promoting Lifestyle of the Elderly Women / 간호학회지

PURPOSE: This study was undertaken in order to determine factors affecting health promoting lifestyle of elderly women. METHOD: The subjects were 299 elderly community residing women over the age 65 living in 2 large cities. The instruments used for this study were a survey of general characteristics, health promoting lifestyle(47items), perceived health status(6 items), self-efficacy(17 items), and social support(18 items). The data was analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and Stepwise Multiple Regression. RESULT: The result of the study are as follows : The average item score for the health promoting lifestyle was 2.46, the highest score on the subscale was interpersonal support(M=2.83). A significant difference between age, education level, income, experience of smoking, alcohol, exercise, and health promoting lifestyle were found. Stepwise multiple regression analysis revealed that the most powerful predictor of health promoting lifestyle was social support(55%). CONCLUSION: Social support accounted for 54% of the variance in health promoting lifestyle in the elderly women. Therefore, health promoting programs that increase social support should be developed to promote a healthy lifestyle of the elderly women.

Analysis of Ambiguities of HLA-B Typing using the Dynal RELI(TM) SSO HLA-B Test and Development of an`Interpretation Program for Koreans' / 대한진단검사의학회지

BACKGROUND: In recent years, DNA typing has been increasingly used in HLA-A and B typing, and commercial kits based on the PCR-SSO method are most commonly used in Korea. However, SSO typing kits show ambiguities to some extent in the generic level typing of HLA-B alleles. We analyzed the ambiguities in the Dynal RELI(TM) SSO HLA-B test (Dynal B test) with confirmatory typing results, and developed and evaluated the accuracy and efficacy of an `Interpretation Program for Koreans'. METHODS: A total of 2, 169 Korean marrow donor registry samples were typed for HLA-B alleles using the Dynal B test (56 probes) and all of the 222 cases showing ambiguities were subjected to confirmatory typing. We have developed an `Interpretation Program for Koreans' for the Dynal B test on the basis of the allele frequencies of Korean, Japanese and Asian populations. The samples showing ambiguities in the Dynal B test were interpreted using the `Interpretation Program for Koreans' and the results were compared with confirmatory typing results. RESULTS: The Dynal B test showed 10.2% (222/2, 169) of ambiguities and these ambiguities were classified into 47 different band patterns. These ambiguity patterns were interpreted using the `Interpretation Program for Koreans', which showed ambiguities in 14 band patterns and 3.4% (73/2, 169) of the total samples. Among these ambiguities, 4 band patterns (55 samples) arose from those alleles which are not found in Koreans and rarely found in Japanese or Asians (B*1522, *3521, *7802). Thus, excluding these rarities, only less than 1% (18/2, 169) of samples resulted in ambiguities, and most (16/18) of these were B55 vs. B56 ambiguities. The results from the `Interpretation Program for Koreans' were fully concordant with the confirmatory typing results. CONCLUSIONS: The Dynal B test showed around 10% ambiguities and the `Interpretation Program for Koreans' showed 3.4% of ambiguities. Excluding the ambiguities with extremely low probabilities arising from rare alleles in Japanese or Asians, actually >S99% of the samples could be typed accurately using the program without additional confirmatory tests.

HLA-A, -B, -DR Allele Frequencies and Haplotypic Associations in Koreans Defined by Generic-Level DNA Typing / 대한진단검사의학회지

BACKGROUND: HLA allele and haplotype distribution varies widely among different ethnic groups. For organ transplantation, anthropology and disease association studies, reliable data on the HLA distribution in each ethnic group is needed. In recent years, more accurate DNA typing methods are increasingly used in place of the serologic typing method. METHODS: We examined HLA-A, -B, and -DR alleles at the generic (serologic) level in 1, 600 Koreans registered for the Korea Marrow Donor Program (KMDP) using the PCR-sequence specific oligonucleotide (SSO) method (Dynal RELI(TM) kit). Allele and haplotype frequencies were estimated by the maximum likelihood method using the computer program developed for the 11th International Histocompatibility Workshop. RESULTS: HLA alleles found in Koreans were 13 in A, 31 in B, and 13 in DR locus. Most frequent alleles with frequencies > or =10% were: A2, A24, A33, A11; B62, B44, B51; DR4, DR15, DR13, and DR8 in each locus in decreasing order of frequency. Subtype frequencies of B61 and B75 serologic specificities were identified: B*4002 (51.1%), *4003 (7.6%) and *4006 (41.3%) for B61, and B*1502 (9.5%) and *1511 (90.5%) for B75. Two-locus haplotypes with frequencies> or =0.1% were presented (99 A-B, 115 B-DR), among which those with frequencies> or =1.0% showing significant positive linkage disequilibrium (P or =0.1% were identified in Koreans, among which 38 haplotypes showed frequencies> or =0.5%. We compared the results of this study with those of our previous study of serologically typed HLA-A, -B and DNA typed HLA-DR in 2, 000 Koreans. Results from the two studies were similar, but blank frequencies were decreased to 0% for HLA-A, -B, and -DR locus compared with the frequencies of 0.3-0.8% in the previous study (A, 0.3%; B, 0.8%; DR, 0.3%) and all of the serologic splits could be assigned in this study. CONCLUSIONS: In this study, we provided the allele and haplotype frequencies of HLA-A, -B, and -DR in Koreans defined by a DNA typing method, which can be used as basic data on Koreans for organ transplantation and disease association studies.

Analysis of Ambiguities of HLA-DR Typing using the Dynal RELI(TM) SSO HLA-DRB Kit and Development of an 'Interpretation Program for Koreans' / 대한진단검사의학회지

BACKGROUND: HLA-DR typing kits using reverse-SSO (sequence specific oligonucleotide) method show considerable ambiguities in HLA-DRB1 generic typing. We analyzed the ambiguities of the Dynal RELI(TM) SSO HLA-DRB test (Dynal DRB test) and developed an 'Interpretation Program for Koreans'. METHODS: A total of 3,000 Koreans were typed for HLA-DRB1/B3/B4/B5 using the 36 probe Dynal DRB test and all of the cases showing ambiguities in HLA-DRB1 generic typing were subjected to confirmatory typing using the PCR-single strand conformation polymorphism (SSCP) method. On the basis of these results, an 'Interpretation Program for Koreans'was developed for the 45 probe Dynal DRB test. RESULTS: Among 3,000 Koreans tested by the 36 probe Dynal DRB test, 456 cases (15.2%) showed ambiguities. In 95% of the ambiguity cases (433/456) and 99.2% of the total cases tested (433/3,000), the'most probable type'could be expected from the DRB1 gene frequencies and DRB1-B3/B4/B5 associations in Koreans and these results were in accordance with the confirmatory typing results as well as the results given by the 'Interpretation Program for Koreans'. Similarly, the 'Most Probable'could be assigned by the program in 99.4% (348/350) of the cases tested with the 45 probe Dynal DRB test. CONCLUSIONS: Ambiguity in the Dynal DRB test was observed in >15% of the Korean samples tested. The majority (95%) of the ambiguities could be resolved on the basis of HLA-DRB1 gene frequencies and DRB1-B3/B4/B5 associations in Koreans. Furthermore, using the program developed in this study, the correct assignment of DRB1 generic types was possible without additional typing in the majority (>99%) of the cases tested.

Nursing Diagnosis for Aged Persons in Gerontological Clinical Practice of Nursing Students / 성인간호학회지

The purpose of the study was to identify the nursing diagnoses for aged persons in gerontological clinical practice of nursing students. In this study, a total of 101 cases including 36 cases of hospitalized elder, 33 cases of institutionalized elders, and 32 cases of community dwelling elders were used in case studies reported by nursing students. Descriptive statistics was employed to determine 370 nursing diagnoses in 101 cases. There were four findings. First, 47.5% of total 370 nursing diagnoses was 'risk for injury'. The next highest percentage of nursing diagnoses was 38.9%( powerless/hopelessness/self-esteem disturbance). Second, the most nursing diagnosis for hospitalized elders was 'knowledge deficit'(41.7%), and the next was 'risk for injury'(38.9%), and 'risk for impaired skin integrity'(27.8%). Third, for both institutionalized elders and community dwelling elders, the most nursing diagnosis was 'risk for injury', and the next was 'powerlessness/hopelessness/self-esteem disturbance', and 'activity intolerance/impaired physical immobility'. Fourth, the related factors of 'risk for injury' were low bone density, low balance, low visual and auditory ability, muscle atrophy, low cognitive function, danger environment, and knowledge deficit. the related factors of 'powerlessness/hopelessness/self-esteem disturbance' were low activity ability, social isolation, low motivation depression, change of daily pattern, decrease of memory, and disorientation. These findings have implications that risk for injury related to physical changes of aging is the most significant health problem of frail elders in diverse setting. In addition, emotional problems of powerless, hopelessness, and self-esteem disturbance are significant need to develop nursing intervention for frail elders in diverse setting.

A Case of Endometriosis in the Abdominal Scar Following Cesarean Section / 대한산부인과학회잡지

Although benign, endometriosis possesses the unique ability to invade tissue and to disseminate or metastasize by hematogeneous, lymphatic route, or direct implantation. Scar from operations are occasionally the site of endometriosis implatation. A case of endometriosis in the abdominal scar following cesarean section was experienced and treatd with complete surgical excision. We reported this case with brief review of the literature.