Purpose: The purpose of this study was to develop nurses’ core competencies and sub-competencies and to verify the validity and importance-performance of core competencies. Methods: The core competencies of nurses were derived through an analysis of strengths, weaknesses, opportunities, and threats, as well as a literature analysis of domestic and foreign accreditation institutions. Validity and importance-performance analyses were conducted on the core competencies derived from nursing colleges nationwide. Results: Six core competencies of nurses were revealed: integration of knowledge and nursing skills, critical thinking, communication, leadership, safety management, and global competency. Further, eighteen sub-competencies were derived. The content validity ratio values for the core competencies were higher than 0.74. Communication skills among multidisciplinary teams and communication skills among nursing teams were shown to be the most important competencies to be improved. Conclusion The results of this study are meaningful in terms of how the core competencies of nurses were derived and evaluated for the fourth cycle of nursing education accreditation according to the changes of time and culture.

PURPOSE: The purpose of this study was to develop a resource-based relative value scale (RBRVS) and its conversion factor for advanced nursing practices carried out by critical care nurse practitioners (CCNP) in intensive care units. METHODS: The methodology was developed by calculating CCNP's RBRVS for 32 advanced nursing services based on CCNP's workload and time spent in the context of national health insurance. A cost analysis was performed to estimate the conversion factor of CCNP's RBRVS. The share of CCNP's contribution to fee-for-service in intensive care units was also analyzed. RESULTS: Calculation of the RBRVS of 32 advanced nursing practices showed a range of points from 100.0 to 1,181.4 and an average of 296.1 points. The relevant conversion factor for advanced nursing practices in CCNP were estimated at 37.3-48.4 won. The contribution rate of CCNP's advanced nursing practices in the relative value scale of the national health insurance was estimated at 0.1-31.3%. CONCLUSION: Measuring the economic value of advanced nursing services will be a basis for esta-blishing a reimbursement system for CCNP's practices and thus encourage a social demand for advanced nurse practitioners.
Adult ; Advanced Practice Nursing/*economics ; Costs and Cost Analysis ; Humans ; Intensive Care Units ; National Health Programs ; Nurse Practitioners/*economics ; *Relative Value Scales ; Workload

Nocardiosis is an acute, subacute, or chronic infection, most often beginning in the lung, and usually affects the immunocompromised host. Nocardial infections are not rare in the United States, 500 to 1000 cases are recognized each year, but rarely reported in Korea. Disorders associated with cellular immune dysfunction are the major risk factors for nocardiosis. We report one case of brain and retroperitoneal abscess caused by Nocardia asteroides in patient who has had a chronic lymphocytic leukemia and diabetes mellitus, with a review of the relevant literature.
Abscess ; Brain ; Diabetes Mellitus ; Humans ; Immunocompromised Host ; Korea ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Lung ; Nocardia asteroides ; Nocardia Infections* ; Risk Factors ; United States

A food exchange system for diabetes is a useful tool for meal planning and nutritional education. The first edition of the Korean food exchange lists was developed in 1988 and the second edition was revised in 1995. With recent changes in the food marketplace and eating patterns of Koreans, the third edition of food exchange lists was revised in 2010 by the Korean Diabetes Association, the Korean Nutrition Society, the Korean Society of Community Nutrition, the Korean Dietetic Association and the Korean Association of Diabetes Dietetic Educators through a joint research effort. The third edition is based on nutritional recommendations for people with diabetes and focuses in adding foods to implement personalized nutrition therapy considering individual preferences in diverse dietary environment. Foods were selected based on scientific evidence including the 2007 Korea National Health and Nutrition Examination Survey data analysis and survey responses from 53 diabetes dietetic educators. While a few foods were deleted, a number of foods were added, with 313 food items in food group lists and 339 food items in the appendix. Consistent with previous editions, the third edition of the food exchange lists included six food categories (grains, meat, vegetables, fats and oils, milk, and fruits). The milk group was subdivided into whole milk group and low fat milk. The standard nutrient content in one exchange from each food group was almost the same as the previous edition. Korea Food & Drug Administration's FANTASY(Food And Nutrient daTA SYstem) database was used to obtain nutrient values for each individual food and to determine the serving size most appropriate for matching reference nutrients values by each food group. The revised food exchange lists were subjected to a public hearing by experts. The third edition of the food exchange lists will be a helpful tool for educating people with diabetes to select the kinds and amounts of foods for glycemic control, which will eventually lead to preventing complications while maintaining the pleasure of eating.
Appendix ; Diabetes Mellitus ; Eating ; Fats ; Hearing ; Humans ; Joints ; Korea ; Meals ; Meat ; Milk ; Nutrition Surveys ; Nutrition Therapy ; Oils ; Pleasure ; Statistics as Topic ; Vegetables

Primary lymphoma presenting in the thyroid gland is uncommon. A review of the Yonsei University Medical Center experience between 1982 and 1994 was performed retrospectively to assess the treatment outcome and prognostic factors. There were four females and one male, and the median age was 65 years. All 5 cases presented with a neck mass. Two of them had co-existing biopsy-proved Hashimoto's thyroiditis and three cases were each in a hypothyroid state. All cases with non-Hodgkin's disease were of intermediate grade. One case was in stage IE and four were in stage IIE. Three cases were treated with surgery alone and two cases with bulky inoperable stage IIB were treated with chemo-radiotherapy. Chemotherapy induced a complete response in one and a partial response in the other with minimal transient toxicity. As the questions regarding justification for extensive surgical intervention increase, combined chemo-radiotherapy can be suggested as an initial treatment even in stage I, and stage II thyroid lymphoma based on prognostic factor evaluation.
Aged ; Biopsy, Needle ; Combined Modality Therapy ; Female ; Human ; Lymphoma/*diagnosis/pathology/*therapy ; Male ; Middle Age ; Neoplasm Staging ; Thyroid Neoplasms/*diagnosis/pathology/*therapy ; Treatment Outcome

We report an unusual case of acute myelogenous leukemia in a patient who showed an extramedullary relapse in her uterus, without bone marrow recurrence, two years after an allogeneic bone marrow transplant. She complained of irregular vaginal spotting, and magnetic resonance imaging demonstrated a uterine mass. A biopsy revealed a massive infiltration of immature myeloid cells. A variable number of tandem repeats (VNTR) based on an examination of peripheral blood cells showed full donor chimerism. After receiving chemotherapy, her uterine mass had completely resolved. She has remained in complete remission for more than 6 months. This case suggests that physicians should be aware of the possibility of a uterine relapse in female bone marrow transplant recipients with acute myelogenous leukemia.
Adult ; Female ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Human ; Leukemia, Myelocytic, Acute/*pathology/*therapy ; Neoplasm Recurrence, Local ; Sarcoma, Granulocytic/etiology/*pathology ; Uterine Neoplasms/etiology/*pathology

Alport syndrome is the most common type of hereditary nephritis, and acute poststreptococcal glomerulonephritis(APSGN) is a common disease in children. We experienced the clinical and pathologic findings of Alport syndrome and APSGN in brothers of one family. Both patients presented with heavy gross hematuria and proteinuria. ASO titer was elevated in both cases, and the C3 level was reduced in one of the cases. In renal pathology, both showed characteristics of Alport syndrome as well as the glomerular changes of APSGN with hump-like subepithelial deposits by electron microscopy. These clinical observation indicated that the patients had APSGN superimposed on Alport syndrome, and that the episode of APSGN might exacerbate the clinical course of Alport syndrome.
Child ; Glomerulonephritis* ; Hematuria ; Humans ; Microscopy, Electron ; Nephritis, Hereditary* ; Pathology ; Proteinuria ; Siblings*

Hepatitis B virus (HBV) reactivation is the frequent complication after cytotoxic chemotherapy in HBsAg-positive non-Hodgkin's lymphoma (NHL) patients. Pre-chemotherapy viral load may be a risk factor and HBeAg-positive status is associated with increased viral load. The aim of this study was to investigate the long-term treatment outcome of lamivudine in preventing HBV reactivation and its associated morbidity according to HBeAg status. Twenty-four adult HBsAg-positive NHL patients were taken 100mg of lamivudine daily before the initiation of chemotherapy. The median duration of lamivudine therapy was 11.5 months (range: 1-54 months) and the median number of chemotherapy cycles was 6 (range: 1-16 cycles). The steroid containing chemotherapy regimens were used in 18 patients (75%), and the anti-CD20 monoclonal antibody containing chemotherapy regimen was used in 6 patients (25%). Four patients received autologous peripheral blood stem cell transplantation without resultant HBV reactivation. Hepatitis related to HBV reactivation was developed in 1 patient among 14 HBeAg-positive patients and no one among 10 HBeAg-negative. One patient developed HBV reactivation after lamivudine withdrawal, and 4 patients developed the YMDD (tyrosine-methionine-aspartate-aspartate) mutation during lamivudine therapy. There were no statistical differences in HBV reactivation rate during chemotherapy according to the HBeAg status. Our results demonstrate that lamivudine should be considered preemptively before the chemotherapy for all HBsAg-positive NHL patients to prevent HBV reactivation, regardless of pre-chemotherapy HBeAg status. Finally, compared with the chronic hepatitis B patients, similar rate of HBV reactivation after lamivudine withdrawal and development of YMDD mutation was observed in NHL patients.

BACKGROUND: Disturbances in apoptosis through phosphoinositide 3-kinase(PI3K)/Akt pathway is thought to be crucial in cancer cell immortality. Enhanced expression and activation of Akt was investigated in several malignancies but not in acute leukemia. We investigated the expression of Akt and phospho-Akt in acute leukemia cells and clinical characteristics of expression and non-expression group. METHODS: Bone marrow cells from patients who were newly diagnosed as acute leukemia and healthy volunteer were obtained and analyzed by Western blot analysis using monoclonal antibody against Akt, phospho-Akt (Ser473), and phospho-Akt (Thr308). Clinical data were obtained retrospectively. RESULTS: The expression of Akt was demonstrated in 27 of 43 cases (63%) and phospho- Akt(Ser473) was noted in 24 of 27 (54%) Akt-positive cases, respectively. Phospho-Akt (Ser473)-expression group showed significantly higher initial WBC counts compared to negative group (P=0.003). By chromosomal analysis, patients with Akt expression did not show any good prognostic karyotype (P=0.001). CONCLUSION: This result suggests that Akt overexpression and activation is detected in acute leukemia cells and might have a role in molecular pathogenesis of acute leukemia.
Apoptosis ; Blotting, Western ; Bone Marrow Cells ; Healthy Volunteers ; Humans ; Karyotype ; Leukemia* ; Retrospective Studies

Acquired Hemophilia A is a rare and considerably life-threatening coagulopathy, which is caused by the development of autoantibodies against factor VIII (FVIII) in non-hemophilic adults. Acquired FVIII inhibitors can be associated with diverse conditions, such as malignant disorders, medications, autoimmune diseases, postpartum states and others. These autoantibodies inhibit normal coagulation, had results in bleeding complications, which can contribute to mortality in a high percentages of cases. Effective control of the disorder can be achieved by prompt diagnosis and appropriate managements. Generally, the managements of acquired hemophilia A are aimed at treating the acute bleeding and eliminating inhibitors by immunosuppression. Although a range of treatment options exists for patients with acquired hemophilia A, there is no consensus with regard to the optimal therapies for this disorder. Herein, two cases, an 82-year-old man and a 78-year-old man who were successfully treated by steroid or danazol, which is a relatively mild immunosuppressive agent, are reported.
Adult ; Aged ; Aged, 80 and over ; Autoantibodies ; Autoimmune Diseases ; Consensus ; Danazol* ; Diagnosis ; Factor VIII ; Hemophilia A* ; Hemorrhage ; Humans ; Immunosuppression ; Mortality ; Postpartum Period