Updates of Evidence-Based Nursing Practice Guidelines for Pressure Injury / 임상간호연구

Purpose@#This study was conducted to update the previous evidence-based nursing clinical practice guidelines for pressure injury. @*Methods@#The guideline was revised in 22 steps based on the international standards. @*Results@#The updated nursing practice guideline for pressure injury consisted of four domains and 494 recommendations. The numbers of recommendations in each domain was: 31 hospital policy, 64 assessment, 386 prevention and management, and 13 education. The recommended grade was 10.3% for A, 13.8% for B, and 75.9% for C. Of these, the major revision was done in 40 recommendations (8.1%). A total of 55 recommendations (11.0%) were newly added. 25 recommendations had minor revisions such as changes or additions for some words, and only one recommendation was deleted. @*Conclusion@#The revised nursing practice guidelines for pressure injury are expected to serve as an evidence-based practice guideline for pressure injury in Korea. This guideline will provide healthcare providers, patients, and caregivers with information to help prevent and manage pressure injuries, leading to improving patient outcomes.

Job Performance of Advanced Practice Nurses, Perceived Difficulty and Importance, and Willingness to Legally Delegate Clinical Practices to Advanced Practice Nurses by Health Care Professionals / 임상간호연구

Purpose@#To identify the clinical role of Advanced Practice Nurses (APN), and evaluate how other medical personnel perceive their work(difficulty, importance). @*Methods@#A questionnaire survey was performed with 277 health care providers (APN 52, nurses 88, and medical doctors 137 [professors 51, fellows 44, & residents 42]) in a single, tertiary hospital. The questionnaire was categorized into 6 domains (total 40 tasks): 6 tasks on identifying health issues (A); 3 tasks on prescribing and conducting diagnostic tests (D); 18 tasks on disease treatment (T); 4 tasks regarding prescribing medicine (M); 3 tasks regarding medical collaboration (C); 6 tasks regarding patient education (E). The survey measured the frequency, difficulty, and importance of APN’s clinical tasks, and evaluated the willingness of authorizing clinical tasks to APN. Results: The most frequent tasks for APN were A domain, lowest were T domain. The scores for perceived job difficulty were lower than those for job importance in all groups. The proportion of willingness to legally delegate clinical practices to APN was higher in A and E domains, but lower in D and T domains. However, professors, who spent the most time with APN, showed a higher willingness to legally delegate clinical practice. The participants favored medical doctors as substitutes for tasks which were not legislated for delegated job performance. @*Conclusion@#In this study identified clinical roles that medical doctors considered possible for legal delegation to APN were identified.The results can be used as evidence for the legalization of the practice of APN.

Study on the Shelf Life of Sterilized Products according to Packaging Materials / 임상간호연구

PURPOSE@#The purpose of this study was to determine the most appropriate shelf life for sterilized products according to their packaging material.@*METHODS@#Samples were prepared to target six nursing units in one general hospital in Seoul. After steam and E.O gas sterilization, sterilized product, samples were supplied to wards. Data collection was conducted for 3 months, after the expiration date of 3 months had passed for samples packaged with crepe paper and nonwoven wraps. For samples packaged with paper-plastic pouches, data collection conducted for 3 months when the expiration date of 9 months had passed. The sterilized products were collected and tested for microbial contamination. Identification of the storage environment was done as samples were collected.@*RESULTS@#This study confirmed that the storage environment met international standards such as CDC, except for temperature. For steam sterilized crepe paper packaging samples and steam and E.O gas sterilized for nonwoven packaging samples no contamination in all products was found for 3 months past the expiration date. However, in the E.O gas sterilized paper-plastic pouch packaging sterile samples, Gram-positive bacilli were detected in one sample from a surgical intensive care unit at 45 weeks and another sample from an operating room at 47 weeks. Furthermore, the results did not show any microorganisms for up to 52 weeks in all products.@*CONCLUSION@#According to the results of this study, sterilized product packaging made with crepe paper and nonwoven wraps is better able an extended shelf life from 3 months to 6 months, reducing unnecessary costs.

Updates of Nursing Practice Guideline for Pressure Injury / 임상간호연구

PURPOSE: This study was conducted to update the existing evidence-based nursing clinical practice guideline in management of pressure injury in South Korea. METHODS: The update process underwent the 22 steps according to the update method based on the international standards. RESULTS: The updated nursing practice guideline for pressure injury consists of 4 domains and 436 recommendations. The numbers of recommendations in each domain were 25 for hospital policies, 51 for assessment, 350 for prevention and management, and 10 for education. There were 2.5% of A, 13.3% of B, 84.2% of C in terms of grading of recommendations. Among these, the major revision was done in 32 recommendations (7.4%). A total of 299 recommendations (68.6%) were added newly. Minor revisions, such as change or addition of some words, were also made in 25 recommendations(5.7%). No change was made in 80 recommendations (18.3%) compared to the previous ones. CONCLUSION: The nursing practice guideline for pressure injury has been updated. This updated guideline can be used as educational materials for both healthcare workers and patients with pressure injury.

ERRATUM: Caveolin-1 Modulates Docetaxel-Induced Cell Death in Breast Cancer Cell Subtypes through Different Mechanisms / Journal of the Korean Cancer Association, 대한암학회지

For the data represented in Fig. 4B, we have generated a new figure from one of these repeat experiments.

Adaptation of the Evidence-Based Nursing Practice Guideline: Prevention and Management of Moisture Associated Skin Damage / 임상간호연구

PURPOSE: This study was done to develop an evidence-based nursing clinical practice guideline for Moisture associated skin damage (MASD) prevention and management for patients in Korea. METHODS: The guideline adaptation process was used and conducted according to the guideline adaptation manual developed by the Korean Hospital Nurses Association. It consists of three main phases and 9 modules including a total of 24 steps. RESULTS: The adapted MASD clinical practice guideline consisted of 4 sections, 8 domains and 28 recommendations. The number of recommendations in each section was: 7 on MASD assessment, 14 on MASD prevention and management, 4 on education, and 3 on organizational policy. Of the recommendations, 3.6% were marked as A grade, 28.6% as B grade, and 67.8% as C grade. CONCLUSION: This MASD clinical practice guideline is the first to be developed in Korea. The developed guideline will contribute to standardized and consistent MASD prevention and management. The guideline can be recommended for dissemination and utilization by nurses nationwide to improve the quality of MASD prevention and management. Regular revision is recommended.

Caveolin-1 Modulates Docetaxel-Induced Cell Death in Breast Cancer Cell Subtypes through Different Mechanisms / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Caveolin-1 (CAV-1) expression is more associated with basal-like cancers than estrogen receptor- or ErbB-2-expressing breast cancers. However, the biological relevance of different levels of CAV-1 expression according to subtype in the epithelial compartment of breast cancer remains unclear. MATERIALS AND METHODS: We investigated whether CAV-1 functions as a tumor suppressor and/or modulator of the cytotoxic activity of docetaxel (DTX) in subtypes of breast cancer using in vitro and xenograft models. RESULTS: The levels of CAV-1 expression were closely associated with DTX sensitivity in triple-negative breast cancer cells. In addition, CAV-1 significantly inhibited cell proliferation and modulated DTX-induced apoptosis through cell cycle arrest in the G2/M phase. The mechanisms underlying DTX-induced apoptosis differed in breast cancers according to the levels of CAV-1 expression. DTX robustly enhanced Bcl-2 inactivation by CAV-1 in MDA-MB-231 cells, while p53-mediated cell cycle arrest by DTX was more pronounced in CAV-1-low but p53-functional MCF-7 cells. In parallel with the data from breast cancer cell lines, CAV-1-transfected MCF-7 cells showed higher efficacy of DTX treatment in a xenograft model. CONCLUSION: We clearly demonstrated cooperative effects between CAV-1 and DTX in mediating apoptosis, suggesting that the levels of CAV-1 expression might be an important indicator for DTX use in breast cancer.

A Case of Wegener's Granulomatosis with Central Nervous System Involvement Mimicking Lung Cancer with Brain Metastasis

Wegener's granulomatosis (WG) classically consists of necrotizing granulomatous inflammation of the upper and/or lower respiratory tract, necrotizing glomerulonephritis, and an autoimmune necrotizing systemic vasculitis affecting predominantly small vessels. We report a case of WG with central nervous system (CNS) involvement. WG is being diagnosed through pulmonary nodule biopsy. A small nodular lesion in the left posterior basal ganglia of brain being highly suspicious for granulomatosis was detected by MRI. After IV pulse cyclophosphamide and oral corticosteroid treatment for over 4 months, clinical manifestations and CNS lesions in brain MRI is improved. WG might have multiple granulomatous lesions which could be misdiagnosed due to malignancy. CNS involvement in WG is rare but careful evaluation is necessary when there are suspicious symptoms or lesions in CNS.

Acute pyelonephritis with anaplastic thyroid carcinoma producing granulocyte colony-stimulating factor

Paraneoplastic leukocytosis was defined as elevated white blood cell (WBC) levels caused by cytokines, likely produced by the tumor itself, without evidence of infection or myeloproliferative disease. We report a case of anaplastic thyroid carcinoma with leukocytosis caused by elevated production of granulocyte colony-stimulating factor (G-CSF) by the carcinoma. Initially, acute pyelonephritis (APN) was diagnosed and treatment for APN was ongoing, but the WBC count steadily increased to 68.8x10(9)/L. She was diagnosed with anaplastic thyroid carcinoma on her neck mass, and the serum concentration of G-CSF was found to be markedly increased at 1,010 pg/mL. In spite of supportive care, the patient's condition rapidly deteriorated and the patient died on day 23 of hospital stay. Leukocytosis without definite evidence of infection could be a paraneoplastic manifestation in patients with malignant tumors, and paraneoplastic leukocytosis may be related to poor prognosis.

Acute pyelonephritis with anaplastic thyroid carcinoma producing granulocyte colony-stimulating factor

Paraneoplastic leukocytosis was defined as elevated white blood cell (WBC) levels caused by cytokines, likely produced by the tumor itself, without evidence of infection or myeloproliferative disease. We report a case of anaplastic thyroid carcinoma with leukocytosis caused by elevated production of granulocyte colony-stimulating factor (G-CSF) by the carcinoma. Initially, acute pyelonephritis (APN) was diagnosed and treatment for APN was ongoing, but the WBC count steadily increased to 68.8x10(9)/L. She was diagnosed with anaplastic thyroid carcinoma on her neck mass, and the serum concentration of G-CSF was found to be markedly increased at 1,010 pg/mL. In spite of supportive care, the patient's condition rapidly deteriorated and the patient died on day 23 of hospital stay. Leukocytosis without definite evidence of infection could be a paraneoplastic manifestation in patients with malignant tumors, and paraneoplastic leukocytosis may be related to poor prognosis.

Hepatic and Small Bowel Mucormycosis after Chemotherapy in a Patient with Acute Myeloid Leukemia: A Case Report and Literature Review / 감염과화학요법

We present a case of a 64-year-old woman with acute myeloid leukemia who developed a hepatic abscess during the neutropenic period after induction chemotherapy. To treat the abscess, meropenem and ciprofloxacin were administered to target Klebsiella pneumoniae and percutaneous drainage performed. As a result, the patient's fever and c-reactive protein (CRP) subsequently improved. After six weeks of antibiotic therapy, an abdominal computed tomography scan revealed remains of the liver abscess as well as an ileus in the small bowel. Molds from the Mucor genus were cultured from repeated liver abscess drainage and an abscess wall biopsy confirmed hepatic mucormycosis. Along with administration of amphotericin-B deoxycholate for four weeks, we performed lobectomy for hepatic mucormycosis and small bowel resection for a suspected small bowel mucormycosis. After these operations, the patient received liposomal amphotericin B for three weeks and was then maintained with oral posaconazole for more than four weeks. Our case report suggests that hepatic mucormycosis should be considered when a hepatic abscess exhibits a retarded response to antibacterial agents, especially for patients with risk factors. In addition, because an isolated hepatic mucormycosis is infrequent, a thorough search for the extent of the disease is necessary before surgical resection.

Design and Implementation of an Effective Hospital System Based on an RFID and Web Service Technology / 대한의료정보학회지

OBJECTIVE: Currently hospitals are working hard to make their hospital stand out from the rest in the medical market. The government is trying to hard to resolve the problem in regards to false claims for treatment expenses through issued medical prescriptions. There is a known limit to 1:1 service which needs much improvement. This proposed system will help prevent fake medical prescriptions from being issued. METHODS: In order to provide distinguished medical services for the next generation, we have designed and implemented a system that applies the Radio Frequency Identification standard, web services and mobile technology. RESULTS: In the proposed system, the Radio Frequency Identification card is issued to the patient and the hospital system can automatically recognize the patient and a simple SMS message will be sent. Through this method of communication 1:1 customer service can be accomplished. By applying the web services technology, any pharmacy can use the saved medical prescription code contained in the Radio Frequency Identification tag. This in turn resolves the systematic problems with illegal usage. CONCLUSION: Through this proposed system, we offer the functionality of easily applying the Radio Frequency Identification technology to various medical fields. By using a mobile device, it is possible to collect bio data remotely about a patient.

Comparison of Renal Function Indices Between Occupationally lead Exposed Females and Healthy Non-exposed Females / 대한산업의학회지

This study was to investigate the effect of lead on the selected clinical renal function in female lead workers. The 123 female lead workers from 9 lead industry and 177 females who were not occupationally exposed were examined. Females who had history of renal disease or oral medication were excluded. Blood lead, zinc protoporhphyrin in blood, delta-aminolevulinic acid and haemoglobin were examined as of lead exposure indices and blood urea nitrogen, serum creatinine, serum uric acid and urine protein were examined as of renal function indices. Mean concentration of lead were 40.7(+/-13.02)ug/dl for lead workers and 10.7(+/-3.56)ug/dl for non-lead workers. Differences between lead workers and non-lead workers in blood lead, zinc protoporhphyrin in blood and delta-aminoleuvulinic acid were statistically significant. There were significant differences between lead workers and non-lead workers in blood urea nitrogen, serum creatinine, serum uric acid except urine protein but their mean concentrations were all within normal limits. Serum creatinine and urine protein were not increasing according to the increasing blood lead. When cut off points of 20mg/dl in blood urea nitrogen, 1.2mg/dl in serum creatine, 7.0mg/dl in serum uric acid, 8.0mg/dl in urine protein and 40ug/dl in blood lead, 100ug/dl in zinc-protoporhphyrin in blood, 7.0mg/l in delta-aminoleuvulinic acid were accepted, comparison between frequencies of blood urea nitrogen, serum creatine, serum uric acid, urin protein by the level of blood lead, zinc-protoporhphyrin in blood and delta-aminoleuvulinic acid respectively was not statistically different. There were no dose-repsonse relationships in risk ratios by the level of blood lead and zinc-protoporphyrin in blood respectively. In summary, there were no significant effect of lead on the selected clinical renal function among the female lead workers at level of blood lead 40ug/dl that is the permissible level of lead poisoning in Korea.

A Study on the Incidence of Diabetes and Its Risk Factors in the Impaired Glucose Tolerence / 예방의학회지

This is to study the incidence of Diabetes and its risk factors in the impaired glucose tolerance group. 1084 subjects who had been examined 3 times for regular check-up in one human dock center under the university hospital were studied between 1986~1993. The results are as follows; Prevalence rate of diabetes was 3.56%, and that of impaired glucose tolerance was 30.90% as of initial examination. The rate of diabetes was increasing with the age where 1.2% at age group 30~39, 3.21% at age group 40~49, 5.84% at age group 50~59, 14.28% at age group 60 and over. And also the rate of impaired glucose tolerance was increasing with the age where 21.29% at age group 30~39, 31.42% at age group 40~49, 38.91% at age group 50~59, 33.33% at age group 60 and over. Of the examinees who were initially examined, total incidence rate of diabetes who developed to obvious diabetes at the 3rd follow-up examination from the initially impaired glucose tolerance group was 4.63% and it was 11.3 times higher than from the normal group (0.41%). After controlling for the effects of both age and obesity, the risk of subsequent diabetes for subjects with impaired glucose tolerance remained significantly higher than for normal subjects (Relative Risk, 10.48). Test for trends for developing to diabetes by the increasing level of fasting blood sugar and 1 hr blood sugar at the initial examination were statistically significant in either normal and impaired glucose tolerance group. To determine the risk factor for developing to diabetes, logistic regression test was applied. Only fasting blood sugar and 1 hr blood sugar were predictors for developing diabetes from the impaired glucose tolerance group at initial examination.