Adaptation of Isolation Guidelines for Health Care Settings / 임상간호연구

PURPOSE: This purpose of this study was to develop evidence-based practice guideline for isolation in health care settings to prevent transmission of infectious diseases utilizing guideline adaption process. METHODS: The process of guideline adaptation was performed according to the Korean hospital nurses association's guideline adaptation manual which consisted of three main phases, 9 modules, and 24 steps. RESULTS: The adapted isolation guideline consisted of introduction, overview of isolation guideline, summary of recommendations, recommendations, references, and appendices. The guideline includes 224 recommendations in 4 sections which are organizational administration, standard precautions, transmission-based precautions, and education/counselling. CONCLUSION: The adapted isolation guideline is recommended to be disseminated and utilized by nurses and clinicians nationwide to improve the isolation practices for infected or colonized patients with communicable diseases and to decrease the transmission of infections in the healthcare settings.

Core nursing practice and educational requirements according to nursing unit and clinical career in tertiary hospital / 기본간호학회지

PURPOSE: The purpose of this study was to provide fundamental data to develop an educational program for the development of nurses' core competences, and to improve the curriculum in nursing education institutions. METHODS: This study, based on a descriptive survey, was conducted with 1,019 nurses working in a tertiary hospital in Seoul. Among 47 core nursing practice items, core nursing practices as perceived by the participants and relevant educational requirements were measured on a four-point scale. The collected data were analyzed using descriptive statistics for the mean and standard deviation, one way ANOVA, and Duncan test as post-hoc test. RESULTS: Regarding the core nursing practice perceived as by the nurses, there were statistically significant differences in 43 out of 47 items according to nursing unit, and in 15 items according to clinical career. Regarding the educational requirements for core nursing practice, there were also statistically significant difference for the same items as perception differences according to nursing unit and clinical career. CONCLUSION: The results of this study suggest further study on the development of educational programs to advance the clinical expertise of nurses and for the development of curriculum reflecting the actual conditions and requirements in clinical nursing practice fields.

Development and Evaluation of Learning Program for Oncology Unit-based Core Nursing Practice: Outcomes based Cancer Patients Pain Management Learning Program

PURPOSE: This study was conducted to develop a nurse-learning program for the pain management of cancer patients. METHODS: In this methodological study, a learning program was developed between January and June 2011, following the methodological procedure based on the ADDIE Instructional System Design. RESULTS: The learning program consists of 4 parts: learning goal, learning outcomes, learning method, and evaluation method. Learner-centered learning goal and learning outcomes were established, and lecture-based group learning and self-directed study were combined as the learning method. For the evaluation, we developed a written test, a nursing skill checklist, and a case report evaluation tool. After a pilot test, the learning program was assessed by an expert group for its construct validity and content-related conformance. Moreover, the effectiveness of the program was validated by the results of the learning outcomes evaluation and the achievement levels of 40 trainees who participated in the program. CONCLUSION: On the basis of the results of this study, we suggest that this unit-based core nursing practice learning program, comprising 202 nursing units developed by a research institute nursing department since 2010, be shared by all nurses in clinical nursing care settings to improve their practical performance and ensure necessary specialization.

A case of prosthetic valve endocarditis due to Neisseria elongata subsp. nitroreducens / 대한내과학회지

Infective endocarditis due to Neisseria elongata subsp. nitroreducens occurs infrequently. In this report, we describe a case of infective endocarditis caused by N. elongata subsp. nitroreducens in a patient with a prosthetic heart valve. A 55-year-old woman presented with complaints of fever and headache that she had been experiencing over the course of 4 weeks. Transesophageal echocardiography showed vegetation on the prosthetic mitral valve. A blood culture isolate was confirmed as N. elongata subsp. nitroreducens using biochemical characterization and DNA sequencing of 16S rRNA. The clinical manifestations improved with medical treatment.

A case of tricuspid valve endocarditis with septic pneumonia caused by methicillin-resistant Staphylococcus aureus in a healthy woman / 대한내과학회지

Tricuspid valve endocarditis accounts for 5~10% of all cases of infective endocarditis. It commonly occurs in intravenous drug abusers, immunocompromised hosts, and patients with intravenous catheters, burns, or genital sepsis. Right-sided infective endocarditis without a predisposing factor is very rare. We experienced a case of tricuspid valve endocarditis with septic pneumonia caused by methicillin-resistant Staphylococcus aureus in an otherwise healthy 26-year-old female with no underlying cardiac disease. The diagnosis was delayed because pulmonary manifestations were predominant. The staphylococcal cassette chromosome mec typing and multilocus sequence typing revealed ST72-MRSA IVA without the Panton-Valentine leukocidin gene clone, which is the most common form of community-associated methicillin-resistant S. aureus in Korea.

Hemorrhagic fever with renal syndrome complicated by iliopsoas hemorrhage during the diuretic phase / 대한내과학회지

Hemorrhagic fever with renal syndrome (HFRS) presents clinically with the triad of fever, hemorrhage, and renal failure. The hemorrhage varies from transient petechial lesions to fulminant, massive bleeding. Most of the hemorrhagic manifestations occur from the febrile stage to the oliguric stage, and rarely in the convalescent stage. We report a case of bilateral psoas and left iliacus muscle hemorrhage occurring during the diuretic stage in a patient with HFRS. Without surgical decompression, he recovered from the iliopsoas hemorrhage with hemodialysis and supportive care.

A case of Klebsiella pneumoniae pituitary abscess cured by medical treatment / 대한내과학회지

Pituitary abscesses are rare, but potentially life-threatening. Drainage of the abscess through a transsphenoidal approach is the standard treatment for a pituitary abscess. Recently, we experienced a patient with a Klebsiella pneumoniae pituitary abscess who was cured using antibiotics, without surgery. A 52-year-old man had a chronic, persistent headache for 1 month. Magnetic resonance imaging showed a fluid collection in his pituitary fossa. Pituitary hormone tests showed mild hypopituitarism. He was put on antibiotics and discharged after 6 weeks without sequelae. An early diagnosis and adequate antibiotics treatment for this life-threatening infection can result in an excellent prognosis.

Activation of Lysozyme and Lactoferrin in Endolymphatic Duct of Rats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Secretory activity, particularly of antibacterial agents such as lysozyme and lactoferrin, is an important aspect of the mucosal defense mechanism. The development of these agents may have a direct bearing on the susceptibility of the mucosa to infection. The antibacterial secretory enzymes such as lysozymes and lactoferrins are found in various mucosal tissues, and it has been suggested that these enzymes contribut to the defense against local mucosal infection. Specifically, lysozyme and lactoferrin are important components of innate immunity against pathogens at mucosal surfaces. The purpose of this study is to identify the distribution and expression of lysozyme, lactoferrin in endolymphatic duct of rat. MATERIALS AND METHOD: Normal rats (129P3/J, 10 cases) were used for this study. The expression level and distribution of lysozyme mRNA were analyzed by RT-PCR and quantitative image analysis. RESULTS: The expression of lysozyme and lactoferrin mRNA in endolymphatic ducts of rats was compared by quantitative image analysis. The results indicate that the relative expression of lysozyme mRNA resulted as 2.5 times greater than that of lactoferrin mRNA. CONCLUSION: The distribution and expression of lysozyme and lactoferrin in the endolymphatic duct of rat were identified. The study suggests that innate immunity such as lysozyme and lactoferrin are important components of defense mechanisms along with mucociliary clearance. Additionally, the authors think that the activity of lysozymes is more effective than that of lactoferrin in the endolymphatic duct of rat.

Primary Shewanella algae Bacteremia Mimicking Vibrio Septicemia

Shewanella algae infections are rare in humans. Previously reported cases of S. algae have mainly been associated with direct contact with seawater. We report a case of primary S. algae bacteremia occurring after the ingestion of raw seafood in a patient with liver cirrhosis that presented a fulminent course of necrotizing fasciitis.

Clinical manifestations and prognostic factors in Vibrio vulnificus septicemia / 대한내과학회지

BACKGROUND/AIMS: Vibrio vulnificus infection is a common fatal infectious disease in Korea. This study was performed to investigate the clinical manifestations and prognostic factors associated with V. vulnificus infection. METHODS: Patients with microbiologically confirmed V. vulnificus infections who were admitted to Chonnam National University Hospital from 2000 to 2005 were enrolled. The epidemiologic characteristics, clinical features, laboratory findings, and prognostic factors were evaluated. RESULTS: Eighty-one patients were enrolled. More than 90% of these patients had various underlying medical conditions such as chronic liver disease or diabetes mellitus. Seventy-one patients (88%) confirmed eating raw fish or exposure to sea water. Characteristic cutaneous lesions were observed in 70 patients (86%). The initial manifestations of the patients without cutaneous lesions were gastrointestinal bleeding (2), peritonitis (2), septicemia (2), acute cholangitis (1), enteritis (1), liver abscess (1), endophthalmitis (1), and hepatic failure (1). The overall case-fatality rate was 65%. Multivariate analysis showed that leukopenia (<4000/mm3) (OR=8.6, 95% CI 1.3~55.2, p=0.023) and medical treatment without surgery (OR=14.7, 95% CI 1.2~172.7, p=0.033) were independent risk factors for mortality among the patients with cutaneous lesions. CONCLUSIONS: Although V. vulnificus infection is a still a life-threatening disease in patients with underlying medical conditions, aggressive treatment including surgical intervention is important for the prognosis in patients with vibrio septicemia.

A case of brucella endocarditis with spondylitis in a patient with multiple myeloma / 대한내과학회지

Brucella endocarditis is a rare complication, but it is responsible for the majority of deaths related to this illness. A 67 year-old man presented with complaints of fever and lower back pain that he had experienced during the previous four weeks. The laboratory finding showed pancytopenia and an inverted total protein/globulin ratio. Multiple myeloma was diagnosed by bone marrow biopsy and serum electrophorosis. The spine MRI scan demonstrated spondylitis with epidural abscess (L5-S1). On the echocardiographic examination, there was vegetation on the right coronary cusp of the aortic valve and perivalvular abscess. The blood isolate was confirmed as Brucella abortus by using DNA sequencing of the 16S rRNA and the omp2a and omp2b genes. The clinical manifestations improved after appropriate antibiotics and aortic valve replacement. We describe here the first Korean case of human brucella endocarditis that was treated by valve replacement.

Effect on body weight control through behavior, diet, exercise therapy in obese patients

No abstract available.

The Echocardiographic Estimation of Left Ventricle Function in the Congestive Heart Failure after Vasodilator(Prazosin) Therapy

We studied the left ventricular function with the use of M-mode and 2-D Echocardiography to 32 patients with congestive heart failure before and 2 weeks after medication of prazosin 2 mg tid during July 1979 and Dec. 1980 in Heart Center, Paik Hospital, In-Je Medical College, Busan, Korea. The results were following; 1) LVDeD before and after vasodilaor therapy was each 5.64+/-0.76 and 5.04+/-0.57.cm, LVSeD before and after therapy each 4.52+/-0.51 and 3.70+/-0.57cm, and F.S. before and after therapy 19.87+/-3.66 and 26.59+/-6.75%. The difference of LVSeD, LVDeD and F.S. was each statistically significant. 2) LVDeV before and after therapy was each 182.2+/-58.07 and 132.80+/-47.01 ml LVSeV before and after therapy each 92.35+/-23.60 and 50.65+/-27.21ml, and E.F. before and after therapy each 49.31+/-7.07 and 61.86+/-11.74%. The difference of LVDeV, LVSeV and E.F. was each statisitically significant. 3) LVPWTh before and after therapy was each 0.89+/-0.11 and 0.77+/-0.08cm, and Vcf before and after therapy 0.83+/-0.11 and 1.03+/-0.27 cir./sec. The difference of LVPWTh and vcf before and after therapy was each statistically significant. 4) The difference of VSTh, RVD, LAD, and Aorta Dimension before and after therapy was each statisitically significant.