Compliance with Recommendations on Work Schedule for Shift Nurses in South Korea

Background@#A well-designed shift schedule has been reported to have a positive effect on improving health problems associated with shift work. This study aimed to identify compliance with the 17 recommendations on work schedule (WSRs) for shift nurses and related factors. @*Methods@#The descriptive study was conducted with 182 nurses who worked in three shifts for more than 1 year at superior general and general hospitals in three regions. Data were collected with self-administered questionnaire and 13-week work schedule tables, and analyzed with both person- and cycle-based compliance. @*Results@#Person-based compliance was 11.77 among 17 items in total. However, no one completely complied with WSRs of “no work on weekends” and which showed the lowest cycle-based compliance (22.3%). Compliance with some WSRs was related to hospital type, proportion of nurses in school and having standards on work schedule at institutional level. @*Conclusion@#Compliance with WSRs of shift nurses in Korea is still unsatisfactory, and one day off after night shift and work on weekend are quite common. Hospitals should keep the standards on work schedule, monitor compliance with standards, and try to introduce modified shift systems to improve the current problems.

Cryptococcosis with Mediastinal Lymph Node and Lung Involvement in an Immunocompetent Adolescent: A Case Report

Cryptococcus neoformans is a fungus that primarily causes opportunistic infections in immunocompromised hosts. It can also cause various infections in immunocompetent patients. Pulmonary cryptococcosis involving the lymph node is relatively rare in immunocompetent patients. In this report, a previously healthy 17-year-old girl presented with high-grade fever and persistent cough. Chest X-ray and computed tomography (CT) scan revealed an anterior mediastinal conglomerate mass that expanded to the right supraclavicular area. Ultrasound-guided gun biopsy revealed histological evidence of cryptococcosis. Immunological screening tests did not identify immunodeficiency. She recovered completely with a combination therapy of amphotericin B and flucytosine for 2 weeks, followed by fluconazole for 8 months. The characteristics of cryptococcosis involving the mediastinal lymph node and the lung should be understood, and the possibility of cryptococcosis even in immunocompetent hosts should be considered.

A Patient with Neutropenia and Splenomegaly: A Case Report from Department of Family Medicine in Tertiary Hospital Center / 가정의학회지

Pancytopenia represents a unique challenge for primary care doctors and its etiological causes encompass various specialties, including hematology and rheumatology. Despite the existence of effective tests such as bone marrow biopsy and immunoassays to rule out the potential causes of pancytopenia, it is often difficult to pinpoint the exact diagnosis. In this case report, we have described such a ‘gray zone’ patient, who presented with pancytopenia, neutropenia, and splenomegaly, and was being treated for fungal pneumonia before being transferred to Severance Hospital (department of family medicine). As the patient had a 10-year history of multiple, long-term hospital admissions that were having a severely debilitating impact on the quality of life, we performed a partial splenic embolization as a potential cure for the symptoms. Although this induced acute blood count recovery, it failed to prevent eventual mortality from septic shock.

Metastatic leiomyosarcoma of the thyroid gland: cytologic findings and differential diagnosis

Metastatic leiomyosarcoma to the thyroid is an extremely rare occurrence, and only 18 cases have been reported. Here, we report a case of a 37-year-old woman who presented with multiple masses on the scalp. Excisional biopsy was done and the mass revealed fascicles of smooth muscle fibers which showed positive staining for smooth muscle actin, thus confirming the diagnosis of leiomyosarcoma. The patient was also found to have a 0.9 cm mass within the left thyroid. Fine-needle aspiration was done and the cytological smear showed hypercellular spindle cell clusters with hyperchromatic and large nuclei. Normal thyroid follicular cells were found within or around tumor cells. In this report, we present the cytologic findings of metastatic leiomyosarcoma to the thyroid and offer differential diagnoses of the aspirated spindle cells.

The Knowledge, Attitudes, Performance, and Barriers of Nurses to Pain in Oncology Settings:A Multi-Center Study

Purpose@#The purpose of this study was to examine knowledge, attitudes, performance, and barriers to pain management of nurses working in oncology settings. @*Methods@#This cross-sectional study was conducted on 222 nurses in five tertiary hospitals in Korea.The period of data collection was 1 September to 30 November 2018. Participants were surveyed using the Nurse Knowledge and Attitudes Survey Regarding Pain (NKASRP), a pain management performance, and barriers questionnaire. The data were analyzed through independent t-test and One-way ANOVA, and the post-hoc test was conducted with the Scheffé test using the SPSS 23 program. @*Results@#According to the study, oncology nurses’ knowledge and attitudes to pain received a score of 26.4±3.77 (out of 41 points) and the performance received a score of 3.24±0.35 (out of 4 points). Among the barriers to pain management, time constraints were the most frequent medical staff-related factor, and reluctance to take opioids was the most frequent patient-related factor. In terms of factors related to the health care system, strict regulation of opioids was the most significant. There was a significant positive correlation between knowledge and attitude of pain management and performance of pain management. @*Conclusion@#Based on the findings of this study, it is recommended that structured education programs to be developed and implemented to enhance knowledge, attitudes, and performance on pain.

Compliance with Recommendations on Work Schedule for Shift Nurses in South Korea

Background@#A well-designed shift schedule has been reported to have a positive effect on improving health problems associated with shift work. This study aimed to identify compliance with the 17 recommendations on work schedule (WSRs) for shift nurses and related factors. @*Methods@#The descriptive study was conducted with 182 nurses who worked in three shifts for more than 1 year at superior general and general hospitals in three regions. Data were collected with self-administered questionnaire and 13-week work schedule tables, and analyzed with both person- and cycle-based compliance. @*Results@#Person-based compliance was 11.77 among 17 items in total. However, no one completely complied with WSRs of “no work on weekends” and which showed the lowest cycle-based compliance (22.3%). Compliance with some WSRs was related to hospital type, proportion of nurses in school and having standards on work schedule at institutional level. @*Conclusion@#Compliance with WSRs of shift nurses in Korea is still unsatisfactory, and one day off after night shift and work on weekend are quite common. Hospitals should keep the standards on work schedule, monitor compliance with standards, and try to introduce modified shift systems to improve the current problems.

Cryptococcosis with Mediastinal Lymph Node and Lung Involvement in an Immunocompetent Adolescent: A Case Report

Cryptococcus neoformans is a fungus that primarily causes opportunistic infections in immunocompromised hosts. It can also cause various infections in immunocompetent patients. Pulmonary cryptococcosis involving the lymph node is relatively rare in immunocompetent patients. In this report, a previously healthy 17-year-old girl presented with high-grade fever and persistent cough. Chest X-ray and computed tomography (CT) scan revealed an anterior mediastinal conglomerate mass that expanded to the right supraclavicular area. Ultrasound-guided gun biopsy revealed histological evidence of cryptococcosis. Immunological screening tests did not identify immunodeficiency. She recovered completely with a combination therapy of amphotericin B and flucytosine for 2 weeks, followed by fluconazole for 8 months. The characteristics of cryptococcosis involving the mediastinal lymph node and the lung should be understood, and the possibility of cryptococcosis even in immunocompetent hosts should be considered.

A Patient with Neutropenia and Splenomegaly: A Case Report from Department of Family Medicine in Tertiary Hospital Center / 가정의학회지

Pancytopenia represents a unique challenge for primary care doctors and its etiological causes encompass various specialties, including hematology and rheumatology. Despite the existence of effective tests such as bone marrow biopsy and immunoassays to rule out the potential causes of pancytopenia, it is often difficult to pinpoint the exact diagnosis. In this case report, we have described such a ‘gray zone’ patient, who presented with pancytopenia, neutropenia, and splenomegaly, and was being treated for fungal pneumonia before being transferred to Severance Hospital (department of family medicine). As the patient had a 10-year history of multiple, long-term hospital admissions that were having a severely debilitating impact on the quality of life, we performed a partial splenic embolization as a potential cure for the symptoms. Although this induced acute blood count recovery, it failed to prevent eventual mortality from septic shock.

Metastatic leiomyosarcoma of the thyroid gland: cytologic findings and differential diagnosis

Metastatic leiomyosarcoma to the thyroid is an extremely rare occurrence, and only 18 cases have been reported. Here, we report a case of a 37-year-old woman who presented with multiple masses on the scalp. Excisional biopsy was done and the mass revealed fascicles of smooth muscle fibers which showed positive staining for smooth muscle actin, thus confirming the diagnosis of leiomyosarcoma. The patient was also found to have a 0.9 cm mass within the left thyroid. Fine-needle aspiration was done and the cytological smear showed hypercellular spindle cell clusters with hyperchromatic and large nuclei. Normal thyroid follicular cells were found within or around tumor cells. In this report, we present the cytologic findings of metastatic leiomyosarcoma to the thyroid and offer differential diagnoses of the aspirated spindle cells.

The Knowledge, Attitudes, Performance, and Barriers of Nurses to Pain in Oncology Settings:A Multi-Center Study

Purpose@#The purpose of this study was to examine knowledge, attitudes, performance, and barriers to pain management of nurses working in oncology settings. @*Methods@#This cross-sectional study was conducted on 222 nurses in five tertiary hospitals in Korea.The period of data collection was 1 September to 30 November 2018. Participants were surveyed using the Nurse Knowledge and Attitudes Survey Regarding Pain (NKASRP), a pain management performance, and barriers questionnaire. The data were analyzed through independent t-test and One-way ANOVA, and the post-hoc test was conducted with the Scheffé test using the SPSS 23 program. @*Results@#According to the study, oncology nurses’ knowledge and attitudes to pain received a score of 26.4±3.77 (out of 41 points) and the performance received a score of 3.24±0.35 (out of 4 points). Among the barriers to pain management, time constraints were the most frequent medical staff-related factor, and reluctance to take opioids was the most frequent patient-related factor. In terms of factors related to the health care system, strict regulation of opioids was the most significant. There was a significant positive correlation between knowledge and attitude of pain management and performance of pain management. @*Conclusion@#Based on the findings of this study, it is recommended that structured education programs to be developed and implemented to enhance knowledge, attitudes, and performance on pain.

Current Status and Future Forecast of the Number of Otolaryngologists in Korea / 대한이비인후과학회지

Background and Objectives@#The number of otolaryngologists in Korea has increased rapidly in recent years. However, as the population is expected to decrease gradually, it is necessary to study the appropriate number of otolaryngologists. @*Subjects and Methods@#We counted the number of otolaryngologists certified annually and the number of currently active otolaryngologists, and estimated the retirement time from this data. In addition, the statistics from the National Statistical Office were used to survey the total population and the youth population under the age of 14 up to 2060. Finally, changes in the number of active otolaryngologists and the population per otolaryngologist were predicted by 2060. @*Results@#The total number of otolaryngologists certified by 2020 was 4699, and the number of active otolaryngologists in 2019 was 3950. The average duration of retirement is about 36.5 years, and it is expected to be 40 years soon. Currently, 77.4% of otolaryngologists are practitioners, and 51.3% are working in Seoul and Gyeonggi-do. In 2009, the number of people per otolaryngologist was about 17000, whereas in 2019 it was sharply reduced to about 13000. If 120 otolaryngologists are produced each year, it decreases to about 10000 by 2060. However, if the number of new otolaryngologists is reduced to 100 per year, it can be maintained at around 12000 in 2060. In any case, however, the number of patients under 14 years of age cannot be prevented from falling sharply. @*Conclusion@#It is necessary to adjust the number of otolaryngologists to account for population decline.

Does Improved Attention Induced by Caffeine Intake Affect Olfactory Function?

Objectives@#. Past several studies have proven that caffeine facilitates attentional enhancement by acting as an adenosine antagonist once it is absorbed by the body, resulting in improved psycho-behavioral function. Modern clinical olfactory function tests are usually assessed by psychophysical tests but due to a paucity of data, the influence of enhanced attention by caffeine on olfactory function still remains unclear. The objective of this study was to compare results of cognitive function (attention) and olfactory function before and after caffeine administration in order to analyze effects of caffeine on olfactory function in normosmic subjects. @*Methods@#. This study enrolled 49 participants of Konkuk University Hospital with a mean age of 27.7 years who had patent olfactory clefts and no olfactory dysfunction from May 2015 to February 2016. Subjects were restrained from caffeine 10 hours before the test. On day 1, participant’s subjective olfactory function was evaluated before and after uptake of either caffeinated or decaffeinated coffee using visual analog scale (VAS) score, minimum cross-sectional area (MCA) measured by acoustic rhinometry, and the Korean version of Sniffin’ Stick II (KVSS II). Evaluation of participant’s attentional degree was measured by d2 test. On day 2, the same procedure was carried out with counterpart substance. The type of coffee initially administrated was randomly selected. @*Results@#. After administration, caffeinated coffee resulted in significant attentional enhancement than decaffeinated coffee. Results of d2 test showed statistically significant differences in the parameters of total number of errors and omission errors. In both the caffeinated and decaffeinated groups, the patients showed slight increase in VAS score and nasal cavity area; however, the difference was not statistically significant. Also, caffeinated coffee intake compared to decaffeinated coffee intake showed no significant relevance to olfactory function. @*Conclusion@#. Caffeine may significantly improve attentional congnitive function, while not have acute effects on olfactory function.

Analysis of Obstruction Site in Obstructive Sleep Apnea Patients Based on Videofluoroscopy

BACKGROUND AND OBJECTIVES: Upper airway obstruction can occur at the soft palate, tongue base, or epiglottis among obstructive sleep apnea (OSA) patients. Detection of these obstruction sites is very important for choosing a treatment modality for OSA. The purpose of this study was to evaluate the obstruction site of OSA patients and its association with mouth opening and head position. SUBJECTS AND METHOD: Forty-eight consecutive patients with suspicion of OSA were enrolled and underwent videofluoroscopy to evaluate the obstruction site, as well as polysomnography. Obstruction site, mouth opening, and head position were evaluated on videofluoroscopy, and their association was analyzed. RESULTS: According to the videofluoroscopy, 47 (97.9%) of 48 patients showed an obstruction in the soft palate, while 24 (50.0%) were located in the tongue base and 14 (29.2%) in the epiglottis. Multiple obstructions were observed in many patients. Mean apnea-hypopnea index was higher among patients with tongue base obstruction (42.3±26.7) compared to those without obstruction (26.4±21.2, p=0.058). However, epiglottis obstruction did not influence apnea-hypopnea index. Mouth opening did not show any association with tongue base obstruction (p=0.564), while head flexion was highly associated (p<0.001). CONCLUSION: Half of patients with OSA have tongue base obstruction, which worsens the apnea-hypopnea index. Head flexion is associated with tongue base obstruction, while mouth opening is not.

Spinal anesthesia and postoperative epidural analgesia in a patient with congenital central hypoventilation syndrome: a case report / 대한마취과학회지

BACKGROUND: Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by alveolar hypoventilation and autonomic dysregulation. Patients with CCHS have adequate ventilation while awake but exhibit hypoventilation while asleep. More severely affected patients exhibit hypoventilation both when awake and when asleep. CASE: Here, we report a case of successful spinal anesthesia and postoperative epidural analgesia in a patient with CCHS who underwent orthostatic surgery. CONCLUSIONS: In patients with CCHS, anesthesia is used with the goal of minimizing respiratory depression to avoid prolonged mechanical ventilation. Regional anesthesia should be considered where appropriate. Continuous oxygen saturation and end-tidal carbon dioxide monitoring must be available.

Intradialytic exercise improves physical function and reduces intradialytic hypotension and depression in hemodialysis patients

BACKGROUND/AIMS@#As numbers of maintenance hemodialysis patients are growing, debilitating conditions of muscle wasting and atrophy are becoming some of the greatest concerns in end-stage renal disease patients. Exercise training has various potential benefits in terms of prevention of a sustained decline in functional status. This study aimed to evaluate the physical, psychological, laboratory, and dialysis-related effects of intradialytic exercise.@*METHODS@#We enrolled 22 patients from a hemodialysis center for a 6-month non-randomized prospective trial. Combination of aerobic exercise with bicycle ergometer and anaerobic exercise with elastic bands was conducted during hemodialysis. Data including physical fitness test results, dialysis-related measurements, and biochemical laboratory results were collected at baseline, 3, and 6 months. Depression and quality of life were assessed using Beck Depression Inventory and Short Form-36 health survey.@*RESULTS@#After exercise completion, there were significant improvements in back muscle power, forward and backward trunk flexibility, vertical jump, elbow flexion, sit to stand test, and 6-minute walk test (p < 0.05). No significant changes were observed in dry weight, blood pressure, Kt/V, and biochemical variables, except for intradialytic hypotension (p < 0.05). For depression, Beck Depression Inventory showed statistically significant enhancement (p < 0.05). Scores of Short Form-36 health survey did not show significant increase in each domain, except for bodily pain (p < 0.05).@*CONCLUSIONS@#Combined aerobic and anaerobic exercise training during dialysis was found to be effective on physical health status, intradialytic hypotension, and depression in terms of mental health. Therefore, the findings of the current study may provide an appropriate guidance for encouraging exercise by nephrologists.

Spinal anesthesia and postoperative epidural analgesia in a patient with congenital central hypoventilation syndrome: a case report / 대한마취과학회지

BACKGROUND@#Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by alveolar hypoventilation and autonomic dysregulation. Patients with CCHS have adequate ventilation while awake but exhibit hypoventilation while asleep. More severely affected patients exhibit hypoventilation both when awake and when asleep.CASE: Here, we report a case of successful spinal anesthesia and postoperative epidural analgesia in a patient with CCHS who underwent orthostatic surgery.@*CONCLUSIONS@#In patients with CCHS, anesthesia is used with the goal of minimizing respiratory depression to avoid prolonged mechanical ventilation. Regional anesthesia should be considered where appropriate. Continuous oxygen saturation and end-tidal carbon dioxide monitoring must be available.

Anti-Bacterial Effect of Lactobacillus rhamnosus Cell-Free Supernatant Possessing Lysozyme Activity Against Pathogenic Bacteria

Recently, there has been a growing demand for natural preservatives because of increased consumer interest in health. In this study, we produced Lactobacillus rhamnosus cell-free supernatant (LCFS) and evaluated and compared its antimicrobial activity with existing natural preservatives against pathogenic microorganisms and in chicken breast meat contaminated with Escherichia coli and Staphylococcus aureus. Lactobacillus rhamnosus cell-free supernatant possessed 30 units of lysozyme activity and contained 18,835 mg/L of lactic acid, 2,051 mg/L of citric acid and 5,060 mg/L of acetic acid. Additionally, LCFS inhibited the growth of fourteen pathogenic bacteria, S. aureus, Bacillus cereus, Listeria monocytogenes, Vibrio parahaemolyticus, Listeria innocua, S. epidermidis, L. ivanovii, E. coli, Pseudomonas aeruginosa, Shigella sonnei, Shi. flexneri, Proteus vulgaris, Pseudomonas fluorescens, and Klebsiella pneumoniae. The antibacterial activity of LCFS was stronger than that of egg white lysozyme (EWL), Durafresh (DF) and grapefruit seed extract (GSE). Additionally, LCFS maintained its antimicrobial activity after heat treatment at 50℃~95℃ and at pH values of 3~9. Moreover, LCFS inhibited the growth of E. coli and S. aureus in chicken breast meat. In conclusion, it is expected that LCFS, which contains both lysozyme and three organic acids, will be useful as a good natural preservative in the food industry.

Effects of Written Information for Coronary Artery Disease Depending on Patients' Health Literacy on Health Behavior Compliance Related Self-efficacy, Knowledge of Disease, Anxiety, and Educational Satisfaction / 의료커뮤니케이션

PURPOSE: The purpose of this study was to investigate effects of providing written information for coronary artery disease on health behavior compliance related self-efficacy, knowledge of disease, anxiety, and educational satisfaction depending on patients' health literacy.METHODS: The participants in this study were 40 patients who underwent coronary angiography or coronary intervention, and depending on the level of health literacy 30 patients were high group and 10 patients were low group. Each group was evaluated on health behavior compliance related self-efficacy, knowledge of disease, anxiety, and educational satisfaction with providing written information.RESULTS: By providing written information in the group with high health literacy, there was a significant difference in health behavior compliance related self-efficacy, knowledge of disease, but there was no significant difference in anxiety variable. On the other hand, there was no significant difference in health behavior compliance related self-efficacy, knowledge of disease, and anxiety by providing written information in the group with low health literacy. Also, there was no significant difference in the educational satisfaction between high and low group of health literacy after providing written information.CONCLUSION: It is necessary to develop educational materials that can be applied to clinical nursing field with considering health literacy of patients with coronary artery disease. In addition to providing written information, it is also necessary to develop other educational intervention programs such as video and personalized counseling that may be helpful for coronary patients with low health literacy and investigate their effectiveness.

Stimulation of osteoclast migration and bone resorption by C–C chemokine ligands 19 and 21

Osteoclasts are responsible for the bone erosion associated with rheumatoid arthritis (RA). The upregulation of the chemokines CCL19 and CCL21 and their receptor CCR7 has been linked to RA pathogenesis. The purpose of this study was to evaluate the effects of CCL19 and CCL21 on osteoclasts and to reveal their underlying mechanisms. The expression of CCL19, CCL21 and CCR7 was higher in RA patients than in osteoarthritis patients. In differentiating osteoclasts, tumor necrosis factor-α, interleukin-1β and lipopolysaccharide stimulated CCR7 expression. CCL19 and CCL21 promoted osteoclast migration and resorption activity. These effects were dependent on the presence of CCR7 and abolished by the inhibition of the Rho signaling pathway. CCL19 and CCL21 promoted bone resorption by osteoclasts in an in vivo mice calvarial model. These findings demonstrate for the first time that CCL19, CCL21 and CCR7 play important roles in bone destruction by increasing osteoclast migration and resorption activity. This study also suggests that the interaction of CCL19 and CCL21 with CCR7 is an effective strategic focus in developing therapeutics for alleviating inflammatory bone destruction.

Vestibulo-Ocular Reflex Recordings of Small Rodents using a Novel Marker Array / 대한평형의학회지

OBJECTIVE: Recording the nystagmus of small experimental rodents is an integral technique in vestibular research. Theoretically, the size and the shape of markers strongly affect the analysis of 3 dimensional nystagmus. METHODS: The nystagmus of 6 healthy ICR mice were recorded and their gain values were compared using 200 µm, 300 µm, 400 µm, and 600 µm isosceles triangle markers at the peak velocity of 60°/sec and 100°/sec with the rotational stimulations of 0.1 Hz, 0.2 Hz, and 0.5 Hz. RESULTS: The gain values of 3 different sizes of the markers showed no significant differences in horizontal- vertical-torsional component. However, it was unable to record the nystagmus with 200 µm markers since the markers were too small to be placed and stayed on the center of the pupils. CONCLUSION: Technicians can decide the size of the markers from 200 to 600 µm to record the nystagmus of mice, depending on the technicians' skills.