New Nurses' Experience of Turnover: A Qualitative Meta-Synthesis / 간호행정학회지

Purpose@#The aim of this research was to identify, appraise and synthesize available evidence exploring new nurses' experiences of turnover. @*Methods@#The qualitative meta-synthesis method suggested by Thomas and Harden was used. Qualitative research articles considered for inclusion in the review were identified through an extensive search of relevant literature in scientific databases. Data were extracted from the aforementioned articles, and qualitative research findings were pooled according to Thomas and Harden's review process. This process involved the categorization of findings according to similarity of meaning and aggregation of these sub-themes to produce a comprehensive set of synthesized themes. @*Results@#A total of 4 research articles met the inclusion criteria and were included in the review. The review process resulted in 30 sub-themes that were aggregated into 10 themes: ineffective education; overwhelming work; personal maltreatment by doctors, career nurses, patients and caregivers; lack of professional vision; suffering; fear; loss of confidence; isolation; cynical reaction to turnover; new beginning and growth. @*Conclusion@#These findings illuminated the necessity of educational, organizational, emotional and social support for new nurses to help them accomplish their developmental tasks during their transition, as well as the need for this support to continue even after the turnover.

The Association of Perceived Neighborhood Walkability and Environmental Pollution With Frailty Among Community-dwelling Older Adults in Korean Rural Areas: A Cross-sectional Study / 예방의학회지

OBJECTIVES@#The aim of this study was to evaluate the associations of frailty with perceived neighborhood walkability and environmental pollution among community-dwelling older adults in rural areas.@*METHODS@#The participants were 808 community-dwelling men and women aged 65 years and older in 2 rural towns. Comprehensive information, including demographics, socioeconomic status, grip strength, polypharmacy, perceived neighborhood environment (specifically, walkability and environmental pollution), and frailty, was collected from participants using face-to-face interviews conducted between June and August 2018. Perceived neighborhood walkability was measured using 20 items that were selected and revised from the Neighborhood Environment Walkability Scale, the Neighborhood Walkability Checklist from the National Heart Foundation of Australia, and the Physical Activity Neighborhood Environment Survey. The Kaigo-Yobo Checklist was used to assess participants’ frailty.@*RESULTS@#The overall prevalence of frailty in this community-dwelling population was 35.5%. Sex, age, cohabitation status, educational attainment, employment status, grip strength, and polypharmacy were significantly associated with frailty. In the logistic regression analysis, frailty was associated with low perceived neighborhood walkability (adjusted odds ratio [aOR], 0.881; 95% confidence interval [CI], 0.833 to 0.932; p<0.001) and severe perceived neighborhood environmental pollution (aOR, 1.052; 95% CI, 1.017 to 1.087; p=0.003) after adjusting for sex, age, cohabitation status, educational attainment, employment status, monthly income, grip strength, and polypharmacy.@*CONCLUSIONS@#More studies are warranted to establish causal relationships between walkability and environmental pollution and frailty.

Oral Health of Korean Patients With Head and Neck Cancer

BACKGROUND: Association between periodontitis and of head and neck carcinoma was suggested. In the present study, we evaluated the oral health status of patients with head and neck carcinoma and analyzed the relationship between cancer characteristics and oral health. METHODS: Oral health of 40 patients with head and neck carcinoma was examined. Decayed teeth, missing teeth, plaque index, gingival index, and probing depth were measured. Cancer type and site were recorded based on the patients’ medical records. RESULTS: The average age of participants was 60.10 ± 8.99 years, and 35 of participants were male. The decay or missing teeth index was 5.43 ± 5.57, and the plaque index, gingival index, and probing depth were 1.37 ± 1.03, 1.57 ± 0.84, and 4.13 ± 1.45, respectively. These indexes showed no significant difference according to the type or site of cancer (P > 0.05). CONCLUSIONS: This study showed that there was no correlation between oral health parameters and characteristics of head and neck carcinoma.

Helicobacter pylori Eradication Downregulates Cellular Inhibitor of Apoptosis Protein 2 in Gastric Carcinogenesis

BACKGROUND/AIMS: To evaluate the expression of cellular inhibitor of apoptosis protein 2 (cIAP2) during gastric carcinogenesis after Helicobacter pylori (HP) infection and after HP eradication. METHODS: We divided non-cancer patients into four groups according to the status of HP infection and atrophic gastritis (AG)/intestinal metaplasia (IM). We compared cIAP2 mRNA expression among these four groups and patients with HP-positive early gastric cancer (EGC) by using real-time polymerase chain reaction (PCR). We evaluated the expression of cIAP2 messenger RNA (mRNA)/protein by using real-time PCR/immunohistochemistry and the degree of apoptosis with a terminal deoxynucleotidyl transferase-mediated nick end labeling assay before and 12 months after endoscopic submucosal dissection (ESD) in HP-positive EGC patients, regardless of whether they had undergone eradication therapy. RESULTS: The expression of cIAP2 mRNA was significantly higher in the groups with HP(+), AG/IM(+), and HP-positive EGC than in the control, HP(+), and AG/IM(−) groups (p<0.005). In the HP eradication group, the expression of cIAP2 mRNA/protein significantly decreased (p=0.006) and apoptosis increased at the 12-month follow-up after ESD. In the HP noneradication group, the aforementioned changes were not found during the same follow-up period. CONCLUSIONS: The expression of cIAP2 increased during gastric carcinogenesis after HP infection; HP eradication in the patients who had undergone ESD for EGC reversed overexpression of cIAP2 and suppressed cell apoptosis.

Risk Factors for Metachronous Gastric Neoplasms in Patients Who Underwent Endoscopic Resection of a Gastric Neoplasm

BACKGROUND/AIMS: To identify the risk factors for metachronous gastric neoplasms in patients who underwent an endoscopic resection of a gastric neoplasm. METHODS: We prospectively collected clinicopathologic data and measured the methylation levels of HAND1, THBD, APC, and MOS in the gastric mucosa by methylation-specific real-time polymerase chain reaction in patients who underwent endoscopic resection of gastric neoplasms. RESULTS: A total of 257 patients with gastric neoplasms (113 low-grade dysplasias, 25 high-grade dysplasias, and 119 early gastric cancers) were enrolled. Metachronous gastric neoplasm developed in 7.4% of patients during a mean follow-up of 52 months. The 5-year cumulative incidence of metachronous gastric neoplasm was 4.8%. Multivariate analysis showed that moderate/severe corpus intestinal metaplasia and family history of gastric cancer were independent risk factors for metachronous gastric neoplasm development; the hazard ratios were 4.12 (95% confidence interval [CI], 1.23 to 13.87; p=0.022) and 3.52 (95% CI, 1.09 to 11.40; p=0.036), respectively. The methylation level of MOS was significantly elevated in patients with metachronous gastric neoplasms compared age- and sex-matched patients without metachronous gastric neoplasms (p=0.020). CONCLUSIONS: In patients who underwent endoscopic resection of gastric neoplasms, moderate/severe corpus intestinal metaplasia and a family history of gastric cancer were independent risk factors for metachronous gastric neoplasm, and MOS was significantly hypermethylated in patients with metachronous gastric neoplasms.

Medication Adherence and its Predictors in Community Elderly Patients with Hypertension

BACKGROUND: Medication adherence is important for hypertension management but still stay low level. It is reasonable method to classify medication nonadherence into intentional nonadherence and unintentional nonadherence and manage it according to this categories. This study aimed to explore medication adherence and its predictors in community patients with hypertension, especially dividing into intentional nonadherence and unintentional nonadherence. METHODS: Study subjects included 1,988 patients who were prescribed hypertension drugs among 2012 community health survey subjects of 10 cities in Gyeongsangnamdo and we analyzed medication adherence with hypertension and its predictors. We conducted chi-square test for nominal variable and ANOVA test for continuous variable and use multinominal regression to analyze independent predictors of intentional nonadherence and unintentional nonadherence in contrast to medication adherence. RESULTS: Of the 1,988 patients, 49.7% were adherent, 26.1% were unintentionally nonadherent and 24.2% intentionally nonadherent. Independent predictors of unintentional nonadherence were depressive symptoms (odds ratio [OR]=1.696, P=0.047) and arthritis (OR=1.319, P=0.030) and independent predictors of intentional nonadherence were cardiocerebrovascular disease (OR=1.464, P=0.044), self-efficacy (OR=0.984, P=0.007), beliefs about medications questionnaire (necessity [OR=0.834, P<0.001] and concern [OR=1.236, P<0.001]). CONCLUSIONS: In order to manage hypertension in community, improvement in medication adherence is needed. Depressive symptom and self-efficacy need to be managed, but especially patients'beliefs about their medication need to be considered to improve intentional nonadherence.

A Case of Spontaneous Bacterial Peritonitis with Bacteremia Caused by Shewanella algae

Human infection caused by Shewanella algae is rare, which usually occurred after direct contact with seawater or ingestion of raw seafood in the immunocompromised host. There have been anecdotal reports about Shewanella infections in human, but their pathogenic role and microbiologic data are limited. Here, we report a fatal case of spontaneous bacterial peritonitis with bacteremia due to S. algae in a 57-year-old male with liver cirrhosis who had no history of exposure to seawater or raw seafood. Polymicrobial infection with Streptococcus mitis and Escherichia coli was combined and the patient died in spite of early appropriate antimicrobial therapy and early goal-directed therapy for sepsis.

The Relationships Between Determination of Treatment Success and Emotional Factors in Patients With Chronic Musculoskeletal Pain

OBJECTIVE: To investigate the relationship of the patient's criteria of successful treatment to emotional factors in patients with chronic musculoskeletal pain. METHODS: Patients who visited our outpatient hospital due to chronic musculoskeletal pain were evaluated using a questionnaire survey. Patients were evaluated with the Patient-Centered Outcomes Questionnaire (PCOQ) to investigate their expectation and criteria for success regarding treatment of chronic musculoskeletal pain. Beck Depression Inventory and State-Trait Anxiety Inventory were used to check for psychological variables. Correlations among each of the variables were evaluated statistically. RESULTS: Patients with higher levels of depression and anxiety needed larger improvements to consider the treatment as a success in the pain domain (depression, r=0.398, p=0.04; anxiety, r=0.447, p=0.02) and emotional distress domain (depression, r=0.617, p=0.001; anxiety, r=0.415, p=0.03), but had lower level of expectation of the treatment in the pain domain (depression, r=-0.427, p=0.01; anxiety, r=-0.441, p=0.004), emotional distress domain (depression, r=-0.454, p=0.01; anxiety, r=-0.395, p=0.04), and interference of daily activities domain (depression, r=-0.474, p=0.01; anxiety, r=-0.396, p=0.04). Patients were classified into 3 clusters based on the importance rating of each domain via a hierarchical analysis. The cluster of the patients with the higher rating of importance across all domains (importance of pain domain, 9.54; fatigue domain, 9.08; emotional distress domain, 9.23; interference of daily activities domain, 9.23) had the highest level of depression and anxiety. CONCLUSION: Consideration of psychological factors, especially in patients who require larger improvements in all treatment domains, may be helpful for the successful treatment of chronic musculoskeletal pain.

Impact of Clinical Performance Examination on Incoming Interns' Clinical Competency in Differential Diagnosis of Headache / 가정의학회지

BACKGROUND: In Korea, clinical performance examination (CPX) has been included in license examination for medical doctors since 2009 in order to improve clinical performance of medical students. This study aimed to evaluate the contribution of CPX to medical education. METHODS: Clinical competency in the differential diagnosis of secondary headache was compared between the incoming interns in 2009 unexposed to CPX and the incoming interns in 2010 exposed to CPX, using the data of patients who visited the emergency department due to headache (181 patients seen by 60 CPX non-exposed interns and 150 patients seen by 50 CPX-exposed interns). We obtained the data by reviewing electronic medical records and nominal lists of doctors. Clinical competency was assessed by sensitivity and specificity between the diagnostic impression by interns and the final diagnosis. The association between CPX exposure and clinical competency in secondary headache diagnosis was evaluated using multiple logistic regression analysis. RESULTS: When we assessed clinical competency on the basis of all listed diagnostic impressions, sensitivity and specificity were 67.9% and 80.0%, respectively, for headaches seen by CPX-exposed interns, and 51.7%, and 71.7%, respectively, for headaches seen by CPX non-exposed interns. Multivariable adjusted logistic regression analysis showed exposure to CPX was not associated with increased competency for identifying secondary headache. CONCLUSION: Exposure to CPX as a part of the medical license examination was not effective for the improvement of clinical competency of interns in identifying secondary headache.

A Fatal Spontaneous Gas Gangrene due to Clostridium perfringens during Neutropenia of Allogeneic Stem Cell Transplantation: Case Report and Literature Review

Most cases of gas gangrene caused by Clostridium species begin with trauma-related injuries but in rare cases, spontaneous gas gangrene (SGG) can occur when patients have conditions such as advanced malignancy, diabetes, or immunosuppression. Clostridium perfringens, a rare cause of SGG, exists as normal flora of skin and intestines of human. Adequate antibiotics with surgical debridement of infected tissue is the only curative therapeutic management. Mortality rate among adults is reported range of 67-100% and majority of deaths are occurred within 24 hours of onset. We experienced a case of SGG on the trunk, buttock and thigh in a neutropenic patient with acute lymphoblastic leukemia. His clinical course was rapid and fatal during pre-engraftment neutropenic period of allogeneic stem cell transplantation.

Neuropsychological and Psychiatric Impairment after West Nile Virus Encephalitis in Korean: A Case Report

West Nile virus (WNV) is the most widespread arbovirus in the world. It can cause serious or fatal central nervous system (CNS) infection. We present a case of 58-year-old man who developed neuropsychologic and psychiatric impairment such as cognitive impairment, depressive symptoms, health concerns and thought disorder after West Nile virus encephalitis. This is the first imported case of West Nile virus infection in Korean.

Trends in Cervical Cancer Mortality by Socioeconomic Status in Korean Women between 1998 and 2009 / 가정의학회지

BACKGROUND: Death from uterine cervical cancer could be preventable by an active participation of women at risk in a screening program such as the Papanicolaou test. In order to examine the presence of socioeconomic disparity in preventable deaths, we evaluated the time trends of cervical cancer mortality by socioeconomic status in Korean women. METHODS: We selected level of educational attainment and marital status as surrogate indices of socioeconomic status. Using death certificate data and Korean Population and Housing Census data from Korea National Statistical office, we calculated age-standardized yearly mortality rates from cervical cancer between 1998 and 2009 according to the level of education as well as marital status. RESULTS: Cervical cancer mortality peaked in 2003 and then decreased gradually over time. Cervical cancer mortality was the highest in the group with the lowest level of educational attainment in all age groups and the gap between the lowest and the highest educational level has increased over time. Cervical cancer mortality was lower in married women than unmarried women in all age groups, and the degree of difference did not change over time. CONCLUSION: In the Korean population, socioeconomic differential in cervical cancer mortality has persisted over time.

Factors Associated with Persistent Smoking after the Diagnosis of Cardiovascular Disease / 가정의학회지

BACKGROUND: Although cigarette smoking is a major modifiable risk factor for the occurrence of primary and secondary cardiovascular disease (CVD), not all survivors from CVD attacks can successfully stop smoking. However, little is known about the factors associated with the change in smoking behavior after CVD attack. METHODS: Study subjects included 16,807 participants (> or =19 years) in the fourth Korean National Health and Nutrition Examination Surveys. From them, we selected 180 persons who had previous CVD diagnosis (angina pectoris, myocardial infarction, or stroke) and were smoking at the time of CVD diagnosis. Then, we categorized the 180 persons into two groups according to change in smoking status after the CVD: quitter and non-quitter. Logistic regression analysis was done to evaluate multivariable-adjusted association. RESULTS: Even after CVD diagnosis, 63.60% continued to smoke. Fully-adjusted analysis revealed that regular drinking (odds ratio [OR], 4.44) and presence of smokers among family members (OR, 5.86) were significantly (P < 0.05) associated with greater risk of persistent smoking, whereas lower education level (OR, 0.20), larger amount of smoking (OR, 0.95), longer time since diagnosis (OR, 0.88), and diabetes (OR, 0.36) were significantly (P < 0.05) associated with decreased risk of persistent smoking after CVD. CONCLUSION: A great proportion of CVD patients tended to continue smoking in the Korean population. In order to reduce smoking rates among CVD patients further, more aggressive efforts towards smoking cessation should be continuously made with consideration of individual socioeconomic, behavioral, and clinical characteristics of CVD patients.

Motor Axonal Neuropathy Associated With Idiopathic CD4+ T-Lymphocytopenia

Idiopathic CD4+ T-lymphocytopenia is a rare immune disorder characterized by an unexplained deficit of CD4+ T cells and results in various opportunistic infections. Herein, we report a case of new onset weakness in a 10-year-old boy secondary to motor axonal neuropathy associated with idiopathic CD4+ T-lymphocytopenia. The patient was referred to rehabilitation for an evaluation of progressive weakness involving all four limbs. A subsequent nerve conduction study and needle electromyography identified motor axonal neuropathy. At that time, laboratory studies specific to the differential diagnosis of motor axonal neuropathy were performed; however, the abnormality noted was a decreased CD4+ T-lymphocyte count. Motor axonal neuropathy represents an uncommon manifestation of idiopathic CD4+ T-lymphocytopenia and is probably associated with an underlying immune process.

A Case of Pancreatic Pseudocyst Presenting as Duodenal Bleeding / 대한내과학회지

Pancreatic pseudocysts occur following acute pancreatitis, chronic pancreatitis or secondary to pancreatic trauma. Most pancreatic pseudocysts are located in or around the pancreas, but they can be found in all the potential spaces around viscera in and outside of the abdominal cavity. The complications of pancreatic pseudocyst are infection, rupture, obstruction, fistula, or hemorrhage. Hemorrhage is a rare but frequently fatal complication of pancreatic pseudocysts. We report a case of pancreatic pseudocyst presented as bleeding of duodenum, which was misidentified for duodenal submucosal tumor bleeding.

Metastatic Hepatocellular Carcinoma to the Distal Phalanx: a Case Report and Review of Literature / 한국호스피스완화의료학회지

Metastatic tumors to the hand are rare and often overlooked by clinicians. Here, we report a rare case of phalangeal metastasis of right 4th finger in a patient with hepatocellular carcinoma. Treatment was given with right 4th finger disarticulation. This report suggests that physicians must take consideration into the possibility of metastatic tumors in patients with bone lesions on hands and a history of malignancy.

A Validation of Dietary Self-Efficacy Questionnaire in Hemodialysis Patients

BACKGROUND: This study was performed to develop a dietary self-efficacy questionnaire and to determine how dietary self-efficacy is related to selected biochemical markers and health-related quality of life in hemodialysis patients. METHODS: Participants included 172 patients who had been participating in a dialysis program for at least 6 months at two teaching hospitals. A questionnaire was used to assess socio-demographic factors, dialysis-related factors, dietary self-efficacy, and kidney disease quality of life (KDQOL). Serum levels of potassium and phosphorus and interdialytic weight gain were also measured. RESULTS: The internal reliability of dietary self-efficacy was 0.944 (Cronbach's alpha). Principal component analysis resulted in two factors, situational self-efficacy of compliance with dietary guidelines and self-efficacy of food choice. The correlation analysis showed a significant association between situational self-efficacy of compliance with dietary guidelines and serum potassium and KIDQOL. The average scores of situational self-efficacy of compliance with dietary guidelines and self-efficacy of food choice in the participants were 3.52+/-0.72 and 3.61+/-0.71 respectively. Multiple linear regression analysis showed that the situational self-efficacy of compliance with dietary guidelines was significantly associated with serum potassium level and KDQOL and self-efficacy of food choice was significantly associated with KDQOL. CONCLUSIONS: Based on our results, the developed dietary self-efficacy questionnaire may be a suitable survey tool for hemodialysis patients, which can play a role in predicting clinical indicators of patient and health-related quality of life. We recommend further research into clarifying whether the positive effects of increased dietary self-efficacy is maintained in long-term dialysis patients.

Associations between Self-Efficacy, Social Capital and Self-Rated Health Status in Healthy Individuals

BACKGROUND: Discrepancies exist in the existing researches regarding the association between social capital and self-efficacy, and most of these researches have been done in developed countries. The aims of this study were to assess the independent association between individual social capital and self-efficacy and to assess the associations between individual social capital, self-efficacy and self-rated health. METHODS: Data were obtained from the Gyeongnam health survey (6,500 persons) conducted in 2008. A self-administered questionnaire was additionally administered to gather information on demographic variables, health behaviors, chronic diseases, self-efficacy, social capital, and self-rated health status. Total study population was 3,843 as those with chronic diseases were excluded. RESULTS: In males, trust was positively associated with confidence and preference to task difficulty, and participation was negatively associated with confidence and positively associated with regulation and preference to task difficulty. In females, trust was positively associated with confidence and preference to task difficulty and negatively associated with regulation. Participation was positively associated with preference to task difficulty. In males, the odds for self-rated health status was better for persons with confidence (95% confidence interval, CI 1.088-1.705), trust (95% CI 1.172-1.821) and participation (95% CI 1.268-2.117). In females, the odds for self-rated health status was better for those with confidence (95% CI 1.250-1.803), preference of task difficulty (95% CI 1.019-1.683) and participation (95% CI 1.024-1.555). CONCLUSIONS: High social capital measured at an individual level may promote self-efficacy and health status.

A Case of Huge Pedunculated Hepatocellular Carcinoma Mimicking a Gastrointestinal Stromal Tumor / 대한내과학회지

Pedunculated hepatocellular carcinoma (P-HCC) can be defined as a carcinoma protruding from the liver with or without a pedicle. Cases of P-HCC showing extrahepatic growth are very rare. P-HCC constitutes 0.2-4.2% of all HCC cases in Japan and Taiwan, but few cases in Korea have been reported. A 67-year-old female patient was admitted to our hospital with a 6-month history of epigastric discomfort. Examination identified an abdominal mass in the left upper quadrant, and abdominal computed tomography revealed a huge mass adjacent to the fundus of the stomach. We diagnosed this mass as a gastrointestinal stromal tumor because of its size and site. However, postoperative histopathological findings showed that the mass was HCC. Here, we report this case and review the relevant medical literature.

A Case of Huge Pedunculated Hepatocellular Carcinoma Mimicking a Gastrointestinal Stromal Tumor / 대한내과학회지

Pedunculated hepatocellular carcinoma (P-HCC) can be defined as a carcinoma protruding from the liver with or without a pedicle. Cases of P-HCC showing extrahepatic growth are very rare. P-HCC constitutes 0.2-4.2% of all HCC cases in Japan and Taiwan, but few cases in Korea have been reported. A 67-year-old female patient was admitted to our hospital with a 6-month history of epigastric discomfort. Examination identified an abdominal mass in the left upper quadrant, and abdominal computed tomography revealed a huge mass adjacent to the fundus of the stomach. We diagnosed this mass as a gastrointestinal stromal tumor because of its size and site. However, postoperative histopathological findings showed that the mass was HCC. Here, we report this case and review the relevant medical literature.