Effects of SBAR Program on Communication Clarity, Clinical Competence and Self-efficacy for Nurses in Cancer Hospitals / 재활간호학회지

PURPOSE: The purpose of this study was to develop Situation, Background, Assessment, Recommendations(SBAR) program and to test the effects of the program on communication clarity, clinical competence, and self-efficacy for clinical nurses in cancer hospitals. METHODS: This study applied a nonequivalent control group non-synchronized design. There were 28 participants in the intervention group and 27 in the control group. SBAR program consisted of 4 parts and applied for 6 weeks in the intervention group. Data were analyzed with χ² test, Fisher's exact test, t-test and ANCOVA using the SPSS program. RESULTS: Communication clarity, clinical competence and self efficacy were significantly increased in the intervention group compared to those in the control group. CONCLUSION: These results suggest that SBAR program may improve communication clarity, clinical competence and self-efficacy for clinical nurses in cancer hospitals. Therefore, it is required to actively take advantage of this program to improve communication clarity among medical staffs, clinical competence, and self-efficacy in clinical nursing practices.

A Case of Esophageal Squamous Cell Carcinoma with Pancreatic Metastasis

Solitary pancreatic metastasis of esophageal cancer is extremely rare. We report the case of a 58-year-old male admitted with esophageal cancer. Additional asymptomatic solitary hepatic and pancreatic masses were observed in the staging work-up for esophageal cancer. The hepatic mass was confirmed as a primary hepatocellular carcinoma with an ultrasound-guided needle biopsy. An esophagectomy with a distal pancreatectomy and radiofrequency ablation for hepatocellular carcinoma were performed. Histologically, the pancreatic mass was confirmed to be a metastasis from the esophageal cancer. The patient has been followed up with chemotherapy.

A case of dermatomyositis associated with tonsil cancer / 대한내과학회지

Dermatomyositis is a rare and idiopathic inflammatory myopathy with characteristic cutaneous manifestations. A 61-year-old female presented with the chief complaints of proximal muscle weakness, facial edema and erythema on the face, chest and back. The patient was diagnosed with dermatomyositis by the clinical manifestation, laboratory findings and an electromyogram. After a year following appropriate treatment, a tonsil cancer was found. The patient was treated with three rounds of neoadjuvant chemotherapy and wide excision of the left tonsil. In Korea, a few cases of dermatomyositis have been reported associated with stomach cancer, breast cancer, acute lymphoblastic leukemia and lung cancer, but no associated cases with tonsil cancer have yet been reported. We report a case of tonsil cancer that developed in a patient with dermatomyosits during therapy.

Extrahepatic Biliary Schwannomas: A Case Report

Benign schwannomas arise in neural crest-derived Schwann cells. They can occur almost anywhere in the body, but their most common locations are the central nervous system, extremities, neck, mediastinum, and retroperitoneum. Schwannomas occurring in the biliary tract are extremely rare and mostly present with obstructive jaundice. We recently experienced a case of extrahepatic biliary schwannomas in a 64-yr-old female patient who presented with intra- and extrahepatic bile duct and gallbladder stones during a screening program. To the best of our knowledge, extrahepatic biliary schwannomas associated with bile duct stones have not been reported previously in the literature.

Unusual Presentation of Cystic Lymphangioma of the Gallbladder

Cystic lymphangioma of the gallbladder is quite a rare tumor with only a few cases having been reported in the literature. We describe here a rare case of cystic lymphangioma of the gallbladder, which was unusual in that the patient presented with biliary pain and an abnormal liver test. Ultrasonography and computed tomography of the abdomen showed a multi-septated cystic mass in the gallbladder fossa and an adjacent compressed gallbladder. Endoscopic retrograde cholangiography showed there was no communication between the bile tract and the lesion, and there were no other abnormal findings with the exception of a laterally compressed gallbladder. After performing endoscopic sphincterotomy, a small amount of sludge was released from the bile duct. The histological findings were consistent with a cystic lymphangioma originating from the subserosal layer of the gallbladder. This unusual clinical presentation of a gallbladder cystic lymphangioma was attributed to biliary sludge, and this was induced by gallbladder dysfunction that was possibly from compression of the gallbladder due to the mass.

Emergence of CTX-M-9 Extended-Spectrum beta-Lactamase-Producing Enterobacter cloacae Isolates / 대한임상미생물학회지

BACKGROUND: The aim of this study is to assess the prevalence and to investigate the molecular epidemiology of Ambler class A extended-spectrum beta-lactamase (ESBL)-producing Enterobacter cloacae isolates in a university hospital in Busan, Korea. METHODS: Non-duplicated clinical isolates of E.cloacae from patients admitted in Kosin University Gospel Hospital were collected during the period from January through September, 2003. ESBL-production was examined by the double-disk synergy test (DDST) and the transferability of cefotaxime-resistance by conjugation. MICs of beta-lactam antibiotics were determined by the agar dilution method and Ambler class A ESBL genes were searched by PCR amplification. Enterobacterial repetitive intergenic consensus (ERIC) PCR was performed to investigate epidemiological relationships among bla CTX-M-9 gene-carrying E.cloacae isolates. RESULTS: Antimicrobial resistance rates of E.cloacae isolates (n=148) to ceftazidime, cefotaxime, and aztreonam were 50.0%, 29.6%, and 48.0%, respectively. Among 50 E.cloacae isolates intermediate or resistant to more than one expanded-spectrum beta-lactam agent, 41 (27.7%) showed positive results in DDST; of these 41 isolates, 1 was found to carry bla TEM-52 gene, 16 carried bla SHV-12 gene, 4 bla CTX-M-9 gene, and 19 both bla SHV-12 and bla CTX-M-9 genes. The 23 E.cloacae isolates carrying bla CTX-M-9 gene showed 9 different profiles by ERIC PCR. CONCLUSION: ESBL-producing E.cloacae was not uncommon in a university hospital in Busan, Korea. The commonest types of ESBLs produced by E.cloacae isolates were SHV-12 and CTX-M-9. CTX-M-9 ESBL-producing E.cloacae isolates showed diverse ERIC-PCR profiles, indicating that they were not originated from a common source.

A case of primary biliary cirrhosis manifestated with idiopathic thrombocytopenic purpura and Sjogren's syndrome / 대한내과학회지

Primary biliary cirrhosis (PBC) is rare in Korea. Although its pathogenesis is not fully understood, immunologic dysregulation is suspected because it is frequently associated with other immunologic disorders. A few cases of primary biliary cirrhosis associated with idiopathic thrombocytopenic purpura (ITP) has previously been reported. However, PBC associated with ITP and Sjogren's syndrome simultaenously has not been reported yet. We experienced a 72-year-old woman had been finally diagnosed as PBC, ITP and Sjogren's syndrome. To the best of our knowledge, this is the first case in the world. We report this case with review of related literature.

Diffuse Esophageal Leiomyomatosis: A Case Report

Leiomyomas are the most common benign tumors found in the esophagus. They are mostly solitary and multiple diffuse lesions are rare, occurring in only 2.4% of cases (1). We describe the case of a 13-year-old boy with a history of Alport syndrome who complained of progressive dysphagia and postprandial vomiting, and in whom diffuse leiomyomatosis of the esophagus was diagnosed. Chest PA showed mediastinal widening, and a barium study revealed diffuse esophageal wall thickening with dilatation, and obstruction at the level of the distal esophagus. Manometry showed increased pressure in the lower esophagus, and CT demonstrated diffuse thickening of the entire esophageal wall and an intraluminal mass in the distal esophagus. Follow-up CT three years later showed further esophageal wall thickening, as well as luminal narrowing. By means of distal esophagectomy, diffuse leiomyomatosis involving the entire esophageal wall and intraluminal mass was diagnosed.

Expression of Vascular Endothelial Growth Factor and Platelet-Derived Endothelial Cell Growth Factor in Head and Neck Squamous Cell Carcinoma and It's Relation to Angiogensis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tumor angiogenesis is an essential process required for growth and metastasis in cancer. Vascular endothelial growth Factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) are known to be angiogenetic factors. The objectives of this study were to measure the expression of VEGF, PD-ECGF and microvessel density (MVD) in head and neck squamous cell carcinoma (HNSCC) and compare them to normal larynx. We also evaluated relationships of VEGF, PD-ECGF and MVD to clinicopathologic findings in HNSCC. MATERIAL AND METHODS: The expression of VEGF, PD-ECGF and MVD were evaluated by immunohistochemical staining of 26 cases of HNSCC and 6 cases of normal larynx. RESULTS: The expressions of VEGF, PD-ECGF and MVD in HNSCC were significantly higher than in the normal control (p<0.05). MVD were significantly correlated with VEGF and PD-ECGF expressions in HNSCC (p<0.05). The VEGF, PD-ECGF expression and MVD correlated with many clinicopathologic findings in HNSCC. CONCLUSION: These results suggest that VEGF and PD-ECGF are involved in angiogenesis and are related to clinicopathologic findings of HNSCC. Furthermore, we propose that expressions of VEGF, PD-ECGF and MVD to be investigated more in the future as prognostic indicators of HNSCC.

A Case of Gastric Carcinosarcoma with Pancreatic / 대한소화기내시경학회지

Carcinosarcoma of the stomach is regarded as a rare malignant neoplasm composed of both carcinomatous and sarcomatous components in a given tumor. Few cases have been reported since 1904. This is a case of carcinosarcoma of the stomach in a 61-year-old man. He suffered from indigestion, vomiting, and epigastric pain. Endoscopic finding showed a huge protruding mass with intact mucosa on the posterior wall of the antrum up to the pylorus. Surgery was performed and carcinosarcoma with pancreatic invasion was confirmed by pathology.

A Study on the Nurse's Recognition and Performance in Intravenous Therapy Management / 기본간호학회지

The purpose of this study were to identify nurse's recognition and performance and to represent the factors of hindrance in the IV therapy management. The subjects were 420 nurses who worked at five general hospitals in Pusan. The data were collected using a questionnaire and the period of data collection was from January 1 to January 31, 1998. The instrument for this study was made by author oneself on the basis of guidelines Simmons et al., CDC' Stanley' and Kurdi' guideline, Clinical Nurses's Association' that consist of 68 items for 5 fields ; pre-injection, just before-injection, needle-injection, during injection, post-injection field. Cronbach Alpha coefficient of recognition and performance in the IV therapy management was .93 and .87. The data were analyzed by a SPSS program using frequency, percent, paired t-test, t-test and oneway ANOVA. The results obtained were as follows : 1. The mean score of recognition in IV therapy management was significantly higher than that of performance(t=5.86, P<.001). 2. The items of lower than mean score of each fields in performance were the identification of drugs, hands washing, patient methods of the injection site and the rubber stopper in bottle, the use of disposable gloves, mask and eye goggles at the chemotherapy preparation, use of tape and armboard, changing the IV tubing, labeling the dressing over the injection site, observation and recordings of patient's condition after medication and confirmation of the needle length at the needle removal. 3. The factors of hindrance on IV therapy were "having no time", "insufficiency of goods", "unknowing of methods", "no disadvantage", and "factors of doctor's doing". the most important factor was "have no time", especially item of hands showed high frequency in the following items ; "insufficiency of goods" in the use of disposable gloves, mask and eye goggles at the chemotherapy preparation, "unknowing of methods" in the certification of drugs compatibility, "no disadvantage" in the labeling the dressing over the injection site, and "factors of doctor's doing" in the changing the subclavian catheter dressing and checking the glucose level during the TPN infusion. In conclusion, there is necessity of educational program which can improve the nurse's knowledge of drugs, disinfection methods, comfort of patient and recordings in IV therapy management and financial aids such as setting up the sink, giving of paper for reducing the factors of hindrance for IV therapy management.