Effects of Non-pharmacological Interventions on Cancer Patients with Sleep Disorder:A Meta-analysis

Purpose@#The objective of this study was to analyze the effects of non-pharmacological interventions on cancer patients with sleep disorder. @*Methods@#A total of 4,246 studies published between 2000 and 2018 were identified by searching NDSL, RISS, Koreamed, PubMed, EMBASE, Cochrane Library, and CINAHL. Seventeen of these studies were selected for inclusion in the meta-analysis.Data were analyzed using the Comprehensive Meta-Analysis (CMA) Ver. 3.4.1 program, and the effect sizes were shown using Hedges’ g score. @*Results@#Intervention studies included 8 studies on exercise, 4 studies on cognitive-behavioral therapy, 2 studies on music, and 1 study each on aromatherapy, massage, and mindfulness-based stress reduction. The overall controlled effect size was .78 (95% Confidence Interval=.40, 1.16, Z=4.02, p<.001), using a random effects model. @*Conclusion@#Through this study, it was found that the effects of exercise (walking), aromatherapy, massage, and music intervention were all statistically significant. As such, the findings of this study provide evidence supporting the incorporation of various non-pharmacological interventions into nursing practice to improve sleep quality in patients with sleep disorder.

Effects of Non-pharmacological Interventions on Cancer Patients with Sleep Disorder:A Meta-analysis

Purpose@#The objective of this study was to analyze the effects of non-pharmacological interventions on cancer patients with sleep disorder. @*Methods@#A total of 4,246 studies published between 2000 and 2018 were identified by searching NDSL, RISS, Koreamed, PubMed, EMBASE, Cochrane Library, and CINAHL. Seventeen of these studies were selected for inclusion in the meta-analysis.Data were analyzed using the Comprehensive Meta-Analysis (CMA) Ver. 3.4.1 program, and the effect sizes were shown using Hedges’ g score. @*Results@#Intervention studies included 8 studies on exercise, 4 studies on cognitive-behavioral therapy, 2 studies on music, and 1 study each on aromatherapy, massage, and mindfulness-based stress reduction. The overall controlled effect size was .78 (95% Confidence Interval=.40, 1.16, Z=4.02, p<.001), using a random effects model. @*Conclusion@#Through this study, it was found that the effects of exercise (walking), aromatherapy, massage, and music intervention were all statistically significant. As such, the findings of this study provide evidence supporting the incorporation of various non-pharmacological interventions into nursing practice to improve sleep quality in patients with sleep disorder.

High antistreptolysin O titer is associated with coronary artery lesions in patients with Kawasaki disease / 소아과

PURPOSE: In Kawasaki disease (KD) patients, coronary artery complications, incomplete and refractory types occur more frequently in patients with streptococcal or other bacterial/viral infections. Recently, we observed a higher incidence of coronary lesions in KD patients with high anti-streptolysin O (ASO) titer. Therefore, we hypothesized that KD patients diagnosed with concurrent streptococcal infection have poor prognoses, with respect to treatment response and development of coronary artery lesions. METHODS: A retrospective review was performed in 723 patients with KD who were admitted to 2 major hospitals between June 2010 and September 2017. RESULTS: Among 723 patients with KD, 11 initially showed an elevated ASO titer (>320 IU/mL) or elevated follow-up ASO titer after treatment. Of these patients, 5 showed no response to the first intravenous immunoglobulin treatment, 3 had abnormalities of the coronary arteries. This is a significantly higher proportion of patients with a high ASO titer (n=3, 27.3%) than those with a normal ASO titer (n=53 [7.4%], P=0.047). A severe clinical course was seen in 81.8% of patients in the high ASO group versus 14.5% of patients in the normal ASO group. CONCLUSION: It is not certain whether acute streptococcal infection may cause KD, but this study revealed that KD with high ASO titers showed higher rates of severe clinical course. It may be helpful to analyze concurrent streptococcal infection in patients with a severe clinical course.

The Occurrence Background of Incivility Perceived by Nursing Students / 의료커뮤니케이션

PURPOSE: The purpose of this qualitative research is to explore the background of occurrence of perceived incivility by nursing students in clinical practice.METHOD: Data were collected through focus interviews and individual interviews were analysed using qualitative content analysis.RESULT: The results showed that three categories that represented the background of occurrence of incivility were scheme which is not cleared, position which is not settled and unequal relationship.CONCLUSION: Since the background of occurrence of perceived incivility is complex, So it is required to macroscopic approach to reduce the perceived incivility of the students in the clinical practice.

Experience in Microbiology Course of Nursing Students: Qualitative Content Analysis

PURPOSE: The purpose of this study was to explore nursing students' experience in microbiology courses. METHODS: Data were gathered through 4 focus group interviews and 1 in-depth personal interview, by 19 nursing students who attended microbiology courses. Data were collected June 15-July 20, 2018. Conventional content analysis was used for data analysis. RESULTS: The result of this study revealed 4 categories: “facing the challenge”, “types of learning”, “lack of learning motivation”, “acquiring knowledge of infection”. CONCLUSION: Findings suggest that it is important to identify nursing students' perspectives, to improve microbiology curriculum in the educational process. Also, it is necessary to connect continuously, between educational and practical environments, for effective management of microbiology courses.

Effect of Hospital Nurses' Perceptions of Organizational Health and Patient Safety Culture on Patient Safety Nursing Activities / 간호행정학회지

PURPOSE: This study was conducted to identify the effects of organizational health and patient safety culture on nursing activities for patient safety as perceived by hospital nurses. METHODS: A self-report survey was administered to staff nurses of one advanced general hospital and two general hospitals in South Korea. Of the questionnaires, 188 were analyzed. RESULTS: Organizational health had a significantly positive correlation with patient safety culture (r=.52, p<.001) and patient safety nursing activities (r=.31, p<.001). CONCLUSION: The findings in this study indicate that among the factors influencing patient safety nursing activities, organizational factors were more important than individual factors, and organizational health had a big effect on patient safety nursing activities.

Multicenter, Single-Arm, Phase IV Study of Combined Aspirin and High-Dose “IVIG-SN” Therapy for Pediatric Patients with Kawasaki Disease

BACKGROUND AND OBJECTIVES: Intravenous immunoglobulin-SN (IVIG-SN) is a new human immunoglobulin product. Its safety is ensured by pathogen-elimination steps comprising solvent/detergent treatment and a nanofiltration process. This multicenter clinical study was designed to evaluate the efficacy and safety of combined aspirin and high-dose IVIG-SN therapy in pediatric patients with Kawasaki disease (KD). SUBJECTS AND METHODS: We evaluated coronary artery lesions (CALs) at 2 and 7 weeks after administering IVIG-SN; total fever duration; and variations in erythrocyte sedimentation rate, N-terminal pro B-type natriuretic peptide or B-type natriuretic peptide, and creatine kinase-myocardial band level before and after treatment with IVIG-SN (2 g/kg). Adverse events were monitored. RESULTS: Forty-five patients were enrolled, three of whom were excluded according to the exclusion criteria; the other 42 completed the study. The male:female ratio was 0.91:1, and the mean age was 29.11±17.23 months. The mean fever duration before IVIG-SN treatment was 6.45±1.30 days. Although most patients had complete KD (40 patients, 90.91%), four had atypical KD (9.09%). After IVIG-SN treatment, one patient (2.38%) had CALs, which was significantly lower than the incidence reported previously (15%) (p=0.022), but not significantly different from recent data (5%). There were no serious adverse events, though 28 patients (63.64%) had mild adverse events. Three adverse drug reactions occurred in 2 patients (eczema, anemia, and increased eosinophil count), all of which were transient. CONCLUSION: IVIG-SN treatment in patients with KD was safe and effective.

Mycoplasma Infection as a cause of Persistent Fever after Intravenous Immunoglobulin Treatment of Patients with Kawasaki Disease: Frequency and Clinical Impact

BACKGROUND: Mycoplasma is a common cause of respiratory infections and may require differential diagnosis from Kawasaki disease (KD). In this study, we investigated the frequency and clinical manifestations of mycoplasma infection in patients with KD. MATERIALS AND METHODS: Medical records of 375 in-patients admitted for treatment during the acute stage of KD, were collected, and reviewed retrospectively. Of these patients, 152 (40.5%) were also tested for recent mycoplasma infection. Patients with positive results (anti-mycoplasma IgM Ab >1:640 or cold agglutinin >1:64) were designated as the case group (n = 37, 24.3%) whereas those with negative results were designated as the control group (n = 115, 75.7%). Clinical findings of the two groups were compared. RESULTS: Patients in the case group were older than those in the control group (mean age, 48.2 ± 32.1 months, vs. 31.7 ± 21.7 months; P = 0.001). There were significant differences between the case and control groups in the changes in the extremities (78.3% vs. 57.4%, respectively; P = 0.031), and in fever duration (6.5 ± 2.5 days vs. 5.4 ± 1.5 days; P = 0.047). Of the 37 patients with positive mycoplasma testing, 7 (18.9%) had persistent fever even after the symptoms and signs of systemic inflammation (acute phase of KD) had been resolved. These patients were positive for mycoplasma infection during further evaluation of persistent fever, and all of them responded to macrolide antibiotics. CONCLUSIONS: We found that mycoplasma infection is somewhat related to KD. When fever persists after resolution of the acute stage of KD, mycoplasma infection may be considered as a possible cause of fever in preschool-aged children.

Severe Skin Lesions or Arthritis May be Associated with Coronary Artery Lesions in Kawasaki Disease

PURPOSE: Kawasaki disease (KD) shows a variety of clinical signs of multi-system involvement, including clinical diagnostic criteria. It is unknown that the severity of the clinical signs is associated with the risk of coronary artery lesions (CALs). We wanted to evaluate clinical characteristics and the risk of CALs in the patient groups who had severe skin lesions or those with arthritis. METHODS: We retrospectively reviewed the medical records of 220 KD patients who were treated with intravenous immunoglobulin (IVIG). We compared clinical and laboratory data between the group with severe skin lesions (n=52) and those with mild or no skin lesions (n=168), and between the group with arthritis (n=6) and those without arthritis (n=214). RESULTS: The mean age of total patients was 2.23±1.87 years of age, and the male-to-female ratio was 1.5:1 (138/82). Among 220 patients, 52 patients had CALs (23.6%), and 29 patients (13.2%) showed incomplete KD. The patients with CALs had a higher mean age, longer total fever duration, and higher rate of IVIG non-responsiveness. The patient group with severe skin lesions showed a higher mean age (P<0.001), more prolonged fever duration (P=0.041), higher frequency of CALs (P=0.033), higher WBC, neutrophil, and neutrophil-to-lymphocyte ratio levels, compared to the patient group without severe skin lesions. The patients with arthritis had a tendency of further treatment with methylprednisolone or infliximab. CONCLUSIONS: The frequency of CALs was higher in patient group with severe skin lesions. Our results suggest that the intensity of clinical signs of KD such as skin rash, cervical lymphadenopathy and possibly arthritis may be associated the risk of CALs.

Effects of Nursing Practice Environment, Compassion Fatigue and Compassion Satisfaction on Burnout in Clinical Nurses / 간호행정학회지

PURPOSE: The purposes of this study was to identify the effects of nursing practice environment, compassion fatigue and compassion satisfaction on burnout in clinical nurses. METHODS: Participants selected for the final analysis were 208 nurses working in 2 general hospitals in Busan and Masan. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation and Hierarchial Multiple Regression with SPSS/WIN 18.0. RESULTS: Compassion fatigue had a significant positive effect on burnout, while Compassion satisfaction had a negative effect on burnout, but Nursing practice environment had no effect on burnout. The explained variance for burnout was 61% and compassion satisfaction was the most significant factor in burnout of nurses. CONCLUSION: The results of this study indicate that to reduce burnout in clinical nurses it is necessary to develop programs to increase nurses' compassion satisfaction and decrease compassion fatigue.

Factors Influencing Happiness Index of Nursing Students / 간호행정학회지

PURPOSE: The purposes of this study were to identify the effects of social support, resilience, stress and satisfaction in major on the happiness index of nursing students. METHODS: Data were collected from March 16 to April 10, 2015 through a self-report questionnaire survey. Participants were 205 students in three different nursing colleges located in Busan and Yangsan. Measured variables were social support, resilience, stress, satisfaction in major and Happiness index. RESULTS: Social support, resilience, satisfaction in major, and personal relationships had significant positive effects on the happiness index, while stress had a negative effect on the happiness index. Explained variance for the happiness index was 46% and social support was the most significant factor in the happiness index of nursing students. CONCLUSION: The results from this study suggest that resilience, social support, stress, satisfaction in major, and personal relationships should be considered as the main influential factors when developing intervention strategies to increase of the happiness index of nursing students.

A Korean Case of De Novo 18q Deletion Syndrome With a Large Atrial Septal Defect and Cyanosis

No abstract available.

Analysis of clinical characteristics and causes of chest pain in children and adolescents / 소아과

PURPOSE: Chest pain is common in children and adolescents and is a reason for referral to pediatric cardiologists. Although most cases of chest pain in these age groups are benign and do not require treatment, timely diagnosis is important not to miss life-threatening diseases requiring prompt treatment. We investigated certain clinical characteristics that may be useful in the diagnosis of such critical diseases. METHODS: Patient medical records between July 2006 and September 2013 were retrospectively examined. We included 517 patients who presented with chest pain to the Department of Pediatrics at Kyung Hee University Hospital in Gangdong. RESULTS: Most cases of chest pain were idiopathic in origin (73.6%), followed by cases with respiratory (9.3%), musculoskeletal (8.8%), cardiac (3.8%), gastrointestinal (2.9%), and psychiatric (1.4%) causes. In 6 patients (1.2%) with air-leak syndrome including pneumothorax or pneumomediastinum, the pain was abrupt, continuous, and lasted for a short period of 1-2 days after onset in the older adolescents. Of the patients with cardiac pain, 13 had cardiac arrhythmias (65.0%), 6 had congenital heart diseases (30%), and 1 had coronary aneurysms caused by Kawasaki disease (5.0%). One patient with atrial flutter had only symptoms of syncope and chest pain. CONCLUSION: The abrupt, continuous chest pain of a short duration in the older children was characteristic of air-leak syndrome. In patients with pneumomediastinum, radiological diagnosis was difficult without careful examination. Combined syncope should not be neglected and further cardiac workup is essential in such patients.

Transforming growth factor beta receptor II polymorphisms are associated with Kawasaki disease / 소아과

PURPOSE: Transforming growth factor beta receptor 2 (TGFBR2) is a tumor suppressor gene that plays a role in the differentiation of striated cells and remodeling of coronary arteries. Single nucleotide polymorphisms (SNPs) of this gene are associated with Marfan syndrome and sudden death in patients with coronary artery disease. Cardiovascular remodeling and T cell activation of TGFBR2 gene suggest that the TGFBR2 gene SNPs are related to the pathogenesis of Kawasaki disease (KD) and coronary artery lesion (CAL). METHODS: The subjects were 105 patients with KD and 500 healthy adults as controls. Mean age of KD group was 32 months age and 26.6% of those had CAL. We selected TGFBR2 gene SNPs from serum and performed direct sequencing. RESULTS: The sequences of the eleven SNPs in the TGFBR2 gene were compared between the KD group and controls. Three SNPs (rs1495592, rs6550004, rs795430) were associated with development of KD (P=0.019, P=0.026, P=0.016, respectively). One SNP (rs1495592) was associated with CAL in KD group (P=0.022). CONCLUSION: Eleven SNPs in TGFBR2 gene were identified at that time the genome wide association. But, with the change of the data base, only six SNPs remained associated with the TGFBR2 gene. One of the six SNPs (rs6550004) was associated with development of KD. One SNP associated with CAL (rs1495592) was disassociated from the TGFBR2 gene. The other five SNPs were not functionally identified, but these SNPs are notable because the data base is changing. Further studies involving larger group of patients with KD are needed.

Polymorphisms of methylenetetrahydrofolate reductase are not a risk factor for Kawasaki disease in the Korean population / 소아과

PURPOSE: Hyperhomocysteinemia is known as a risk factor for atherosclerosis. Preclinical arteriosclerosis is noted and premature atherosclerosis is known to be accelerated in Kawasaki disease (KD) patients. Genetic polymorphisms in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene result in elevated plasma homocysteine concentrations and are known to be associated with the development of coronary artery disease. Our hypothesis is that single nucleotide polymorphisms (SNPs) of the MTHFR gene are related to the development of KD and coronary artery lesions (CALs). METHODS: For this study, we selected 3 candidate single nucleotide polymorphisms (SNPs) (rs2274976, rs1801131, and rs1801133) of MTHFR. These SNPs are located on chromosome 1p36.3. We included 101 KD patients and 306 healthy adults as controls in this study. CALs were seen in 38 patients. Genotypes of the selected SNPs were determined by direct sequencing and analyzed with SNPAlyze. RESULTS: The genetic distribution and allelic frequency of the 3 MTHFR SNPs (rs2274976, rs1801131, and rs1801133) were not significantly different in patients with KD compared to the control group (P=0.71, 0.17, and 0.96, respectively). There was no difference in the genetic distribution of the MTHFR SNPs between the normal control group and the CAL group (P=0.43, 0.39, 0.52 respectively). CONCLUSION: The genetic distribution of the MTHFR SNPs (rs2274976, rs1801131, and rs1801133) was not different in the KD group compared to the control group. In addition, the genetic distribution of these SNPs was not different in the CAL group compared to the control group in the Korean population.

The relationship between catechol-O-methyltransferase gene polymorphism and coronary artery abnormality in Kawasaki disease / 소아과

PURPOSE: Many gene polymorphisms are associated with coronary artery abnormalities in Kawasaki disease. Catechol-O-methyltransfe rase (COMT) plays an important role in the metabolism of catecholamines, catechol estrogen, and catechol drugs. Polymorphisms of the COMT gene are reported to be associated with myocardial infarction and coronary artery abnormalities. The aim of this study was to evaluate the relationship between COMT gene polymorphisms and coronary artery abnormalities in Kawasaki disease patients. METHODS: One hundred and one Korean children with Kawasaki disease and 306 healthy Korean control subjects were enrolled in this study. The polymorphisms of the COMT gene were analyzed by direct sequencing. RESULTS: There were no differences in the genotype and allelic frequency of the rs4680 and rs769224 polymorphic sites between Kawasaki disease and control subjects. Further, no significant difference was found in the rs4680 polymorphism between patients with coronary artery abnormalities and patients without coronary artery abnormalities (codominant P=0.32, dominant P=0.74, recessive P=0.13). However, the distribution of the rs769224 polymorphism was significantly different between patie nts with coronary artery abnormalities and patients without coronary artery abnormalities (codominant P=0.0077, dominant P=0.0021, recessive P=0.16). CONCLUSION: Our results indicate that the polymorphisms of the rs769224 gene might be related to the development of coronary artery abnormalities in Kawasaki disease.

The factors associated with the efficacy of indomethacin treatment in premature infants with patent ductus arteriosus / 소아과

PURPOSE: Indomethacin treatment is successful in about 90% of patent ductus arteriosus (PDA) in premature infants, but in some, repeated administration or surgical closure is required. The object of the present study is to determine the factors affecting the efficacy of indomethacin treatment and to predict the treatment result. METHOD: The 29 preterm neonates, admitted to neonatal intensive care unit of Kyunghee university medical center and Eulji university hospital between September 2002 and April 2006 were diagnosed of PDA and treated with indomethacin. The risk factors that might affect the efficacy of treatment were studied retrospectively. RESULTS: The single-administered group was 19 patients out of 29 (65.5%) and among the repeated- administered group, 5 patients (17.2%) had repeated indomethacin administration and the other 5 patients (17.2%) underwent surgery due to reopening of the duct after repeated medical treatment. In repeated-administered group, the diameter of PDA was significantly larger (3.66+/-0.8 mm vs 2.55+/-0.8 mm, P3.5 mm) and older postnatal age (>7 days), the effect of indomethacin was decreased. Therefore in such cases, repeated dose of indomethacin or surgical ligation should be considered earlier.

Polymorphism in the promoter region of the plasminogen activator inhibitor-1 (PAI-1) gene in Kawasaki disease / 소아과

PURPOSE: To demonstrate genetic background of pathogenesis of Kawasaki disease (KD), I examined the genetic polymorphism of plasminogen activator inhibitor-1 (PAI-1) in KD patients. METHODS: PCR-RFLP of PAI- 1 promotor gene was analyzed in 56 KD patients admitted to Kyunghee University Hospital, Gachon Medical School Gil Hospital, and Eulji Hospital from March to August 2000 and 206 normal control populations. RESULTS: There were no differences in the genotype and allelic frequency of the PAI-1-675 (4G/5G) and PAI-1-844 (G/A) polymorphic site (which are located in the promoter region) between KD and control subjects. Also I could not detect any significant differences in specific genotypes between patients with the coronary artery lesion (CAL) and patients without CAL. CONCLUSION: No association was observed in -844 G/A and -675 4G/5G of PAI-1 gene polymorphism with KD.

Surgical removal of a left ventricular thrombus caused by acute myocarditis / 소아과

Left ventricular thrombus is mainly caused by anterior myocardial infarction or severe cardiac wall dysfunction of the apex, and is rarely caused by a complication of acute myocarditis. A 12-year-old female who developed symptoms of motor dysphasia and incomplete hemiparesis of the right side was admitted to the hospital. The brain MRI taken on the day of her admission showed acute cerebral infarction in the left basal ganglia and the frontoparietal lobe. The echocardiogram showed a movable thrombus, which was 19x28 mm sized and located in the apex of the left ventricle. So in order to prevent further thromboembolic event we performed open cardiac surgery via the atrium and removed the thrombus of the left ventricle. After the removal of the thrombus her symptoms improved and she was discharged from the hospital. Thrombus formation in acute viral myocarditis are considered to be related with endocardial injury and blood flow stasis. Treatment with anticoagulants in left ventricular thrombosis may not be effective and may even cause a major thromboembolism. When the thrombus is laminar and fixed, one should consider anticoagulant therapy. But if the thrombus is pedunculated and movable, which means that there are higher possibilities of major embolism or there may be already one, one should consider surgical removal. We report a 12-year-old girl who required surgical removal of a left ventricular thrombus caused by acute viral myocarditis.

Association Study of Glutathione-S-Transferase M1/T1 Gene Polymorphism in Korean Children with Kawasaki Disease

PURPOSE: Glutathione-S-transferase (GST) is a phase II metabolism enzyme and plays an important role in the detoxification of various chemicals. Recently, the genetic background of Kawasaki disease has been investigated by some researchers and significant results were documented. To demonstrate genetic background of pathogenesis of Kawasaki disease (KD), we examined the genetic polymorphism of Glutathione-S-transferase in KD patients. METHODS: Sixty-seven Korean children with Kawasaki disease and 252 Korean healthy controls were enrolled in this study. The polymorphisms of GSTM1 and GSTT1 gene were analyzed. RESULTS: The distribution of GSTM1 polymorphism between Kawasaki disease patients and controls was not significantly different [2=0.6479, P=0.4209; odds ratios (95% confidence intervals)=0.8004 (0.4651-1.3772)]. However, the distribution of GSTT1 polymorphism was significantly different between two groups [2=18.7898, P<0.0001; odds ratios (95% confidence intervals)=4.1009 (2.0950- 8.0274)]. In the combined analysis of GSTM1 and GSTT1 genes, the frequency of both null type of GSTM1/T1 genes was significantly different from both positive type of GSTM1/T1 genes [2= 8.2528, P=0.0041; odds ratios (95% confidence intervals)=4.1486 (1.4846-11.5927)]. The group of the GSTM1 positive and GSTT null type also showed significantly different from both positive type of GSTM1/T1 genes [2=17.3479, P<0.0001; odds ratios (95% confidence intervals)=6.9143 (2.5387- 18.8314)]. CONCLUSION: These results indicates that the polymorphisms of GSTT1 gene might be a susceptible factor in development of Kawasaki disease in Koreans.