PURPOSE: This study aimed to construct a management model for patient transfer in a multilevel healthcare system and to predict the effect of counseling with nurses on the patient transfer process. METHODS: Data were collected from the electronic medical records of 20,400 patients using the referral system in a tertiary hospital in Seoul from May 2015 to April 2017. The data were analyzed using system dynamics methodology. RESULTS: The rates of patients who were referred to a tertiary hospital, continued treatment, and were terminated treatment at a tertiary hospital were affected by the management fee and nursing staffing in a referral center that provided patient transfer counseling. Nursing staffing in a referral center had direct influence on the range of increase or decrease in the rates, whereas the management fee had direct influence on time. They were nonlinear relations that converged the value within a certain period. CONCLUSION: The management fee and nursing staffing in a referral center affect patient transfer counseling, and can improve the patient transfer process. Our findings suggest that nurses play an important role in ensuring smooth transitions between clinics and hospitals.
Continuity of Patient Care ; Counseling* ; Delivery of Health Care ; Electronic Health Records ; Fees and Charges ; Humans ; Nursing ; Patient Transfer* ; Referral and Consultation ; Seoul ; Tertiary Care Centers

BACKGROUND: Mivacurium is a nondepolarizing muscle relaxant and metabolized by pseudo-cholinesterase(pChe). Many reports show fall in pChe activity during pregnancy, so the metabolism of mivacurium may be delayed and muscle relaxation would be prolonged. METHODS: Muscle relaxation of full-term pregnant women(C group, n=10) and nopregnant women(Non-C group, n=10) was maintained by continuous infusion of mivacurium to keep 1st response of TOF at 5+/-1%. After discontinuance of infusion, recovery profiles were measured with accelerography. RESULTS: The Infusion rate of mivacurium to maintain 1st twich response of TOF at 5+/-1% was significantly low in C group comparing with Non-C group(P<0.05). There was no significant difference in pChe activity between two groups. There was no significant difference in recovery index, recovery time(T1 25%-T4 ratio, 0.75). There was a little correlation between the total infusion time and recovery profiles(recovery index: r2=0.37, recovery time: r2=0.28). Strong correlation existed between bolus-TS(time interval from the injection of mivacurium to recovery of 5% twitch hight) and infusion rate(r2=0.76). CONCLUSION: The mivacurium infusion rate of C group to maintain muscle relaxation was significantly lower than Non-C group. There would be many possible reasons including over-estimation of paturient body weight compared with lean body mass, decrease of blood volume due to hemorrhage.
Blood Volume ; Body Weight ; Cesarean Section* ; Female ; Hemorrhage ; Metabolism ; Muscle Relaxation ; Obstetrics ; Pregnancy ; Pseudocholinesterase

BACKGROUND: Mivacurium is a nondepolarizing muscle relaxant and metabolized by pseudo-cholinesterase(pChe). Many reports show fall in pChe activity during pregnancy, so the metabolism of mivacurium may be delayed and muscle relaxation would be prolonged. METHODS: Muscle relaxation of full-term pregnant women(C group, n=10) and nopregnant women(Non-C group, n=10) was maintained by continuous infusion of mivacurium to keep 1st response of TOF at 5+/-1%. After discontinuance of infusion, recovery profiles were measured with accelerography. RESULTS: The Infusion rate of mivacurium to maintain 1st twich response of TOF at 5+/-1% was significantly low in C group comparing with Non-C group(P<0.05). There was no significant difference in pChe activity between two groups. There was no significant difference in recovery index, recovery time(T1 25%-T4 ratio, 0.75). There was a little correlation between the total infusion time and recovery profiles(recovery index: r2=0.37, recovery time: r2=0.28). Strong correlation existed between bolus-TS(time interval from the injection of mivacurium to recovery of 5% twitch hight) and infusion rate(r2=0.76). CONCLUSION: The mivacurium infusion rate of C group to maintain muscle relaxation was significantly lower than Non-C group. There would be many possible reasons including over-estimation of paturient body weight compared with lean body mass, decrease of blood volume due to hemorrhage.
Blood Volume ; Body Weight ; Cesarean Section* ; Female ; Hemorrhage ; Metabolism ; Muscle Relaxation ; Obstetrics ; Pregnancy ; Pseudocholinesterase

Purpose: This study aimed to analyze the mass and social media contents and structures related to particulate matter before and after the policy enforcement of the comprehensive countermeasures for particulate matter, derive nursing implications, and provide a basis for designing health policies. Methods: After crawling online news articles and posts on social networking sites before and after policy enforcement with particulate matter as keywords, we conducted topic and semantic network analysis using TEXTOM, R, and UCINET 6. Results: In topic analysis, behavior tips was the common main topic in both media before and after the policy enforcement. After the policy enforcement, influence on health disappeared from the main topics due to increased reports about reduction measures and government in mass media, whereas influence on health appeared as the main topic in social media. However semantic network analysis confirmed that social media had much number of nodes and links and lower centrality than mass media, leaving substantial information that was not organically connected and unstructured. Conclusion Understanding of particulate matter policy and implications influence health, as well as gaps in the needs and use of health information, should be integrated with leadership and supports in the nurses’ care of vulnerable patients and public health promotion.

Purpose: This study aimed to examine the differences in COVID-19 work-related characteristics, workload, anxiety, stress, and burnout between nurses working in the COVID-19 designated units and those in the general units caring for both COVID-19 and non-COVID-19 patients and to identify factors related to burnout in these two nurse groups. Methods: The study was conducted using data from 192 nurses in the COVID-19 designated units and 340 nurses in the general units from two general hospitals. The data were collected using self-report, structured questionnaires.Independent t-test, chi-squared test, and logistic regression analysis were performed. Results: There were no significant differences observed in workload and burnout between the two groups. For nurses in the general units, workload, stress, adequacy of the number of patients assigned, and the experience of temporary, floating staff were significant factors associated with burnout, while only clinical experience in the current unit was a significant factor among those in the COVID-19 units. Conclusion Findings indicate significant differences in factors related to burnout between the two nurse groups. Thus, substantial support and strategies tailored to the working environments of each nursing unit are required to prevent burnout among nurses caring for COVID-19 patients.

Purpose: This study was conducted to assess public awareness and policy challenges faced by practicing nurses. Methods: After collecting nurse-related news articles published before and after ‘the Thanks to You Challenge’ campaign (between December 31, 2019, and July 15, 2020), keywords were extracted via preprocessing. A three-step method keyword analysis, latent Dirichlet allocation topic modeling, and keyword network analysis was used to examine the text and the structure of the selected news articles. Results: Top 30 keywords with similar occurrences were collected before and after the campaign. The five dominant topics before the campaign were: pandemic, infection of medical staff, local transmission, medical resources, and return of overseas Koreans. After the campaign, the topics ‘infection of medical staff’ and ‘return of overseas Koreans’ disappeared, but ‘the Thanks to You Challenge’ emerged as a dominant topic. A keyword network analysis revealed that the word of nurse was linked with keywords like thanks and campaign, through the word of sacrifice. These words formed interrelated domains of ‘the Thanks to You Challenge’ topic. Conclusion The findings of this study can provide useful information for understanding various issues and social perspectives on COVID-19 nursing. The major themes of news reports lagged behind the real problems faced by nurses in COVID-19 crisis. While the press tends to focus on heroism and whole society, issues and policies mutually beneficial to public and nursing need to be further explored and enhanced by nurses.

Purpose: This study was conducted to assess public awareness and policy challenges faced by practicing nurses. Methods: After collecting nurse-related news articles published before and after ‘the Thanks to You Challenge’ campaign (between December 31, 2019, and July 15, 2020), keywords were extracted via preprocessing. A three-step method keyword analysis, latent Dirichlet allocation topic modeling, and keyword network analysis was used to examine the text and the structure of the selected news articles. Results: Top 30 keywords with similar occurrences were collected before and after the campaign. The five dominant topics before the campaign were: pandemic, infection of medical staff, local transmission, medical resources, and return of overseas Koreans. After the campaign, the topics ‘infection of medical staff’ and ‘return of overseas Koreans’ disappeared, but ‘the Thanks to You Challenge’ emerged as a dominant topic. A keyword network analysis revealed that the word of nurse was linked with keywords like thanks and campaign, through the word of sacrifice. These words formed interrelated domains of ‘the Thanks to You Challenge’ topic. Conclusion The findings of this study can provide useful information for understanding various issues and social perspectives on COVID-19 nursing. The major themes of news reports lagged behind the real problems faced by nurses in COVID-19 crisis. While the press tends to focus on heroism and whole society, issues and policies mutually beneficial to public and nursing need to be further explored and enhanced by nurses.

Prirnary sclerosing cholangitis, a chronic progressive cholestatic hepatobiliary disorder of unknown etiology, is characterized by inflammation, scarring and obliteration of bile duct leading to biliary cirrhosis and liver failure. Because histologic finding has only a limited role in the diagnosis, the gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricutre or beading. The natural history is extremely variable. We report two cases of primary sclerosing cholangitis diagnosed by repeated endoscopic retrograde cholangiographies. They were followed up for 7 and 2 years, respectively.
Bile Ducts ; Cholangiography ; Cholangitis, Sclerosing* ; Cicatrix ; Diagnosis ; Inflammation ; Liver Cirrhosis, Biliary ; Liver Failure ; Natural History

Congenital central hypoventilation syndrome (CCHS) is a life-threatening disorder with apnea and cyanosis during sleep requiring immediate endotracheal intubation during the first day of life. The PHOX2B gene has been identified as the major gene involved in CCHS. This is the first report of a Korean neonate with CCHS confirmed to have a PHOX2B mutation with expanded alleles containing 20 polyalanine repeats that is a relatively small number compared to previous cases. The patient required intermittent ventilator support during sleep only and did not suffer from any other disorders of the autonomic nerve system. He consistently needs ventilator support during sleep and remains alive. Analysis of PHOX2B gene is useful for diagnosis and appropriate therapeutic intervention of CCHS patients.
Alleles ; Asian Continental Ancestry Group/*genetics ; Genotype ; Homeodomain Proteins/*genetics ; Humans ; Hypoventilation/congenital/*genetics ; Infant, Newborn ; Male ; Mutation ; Peptides/genetics ; Republic of Korea ; Sequence Analysis, DNA ; Transcription Factors/*genetics ; Ventilators, Mechanical

Intracytoplasmic sperm injection (ICSI) recently has been utilized widely as the most successful technique to overcome the unfertilization problem in cases of severe male infertility in couples who could not be treated by conventional IVF. Recently, indications of ICSI have been extended further and more fertilized oocytes become available. Thus, it is necessary to examine the efficiency of freezing the surplus embryos obtained from ICSI. We compared the survival rate and the future outcome of cryopreserved embryos obtained either after conventional IVF or ICSI during the same period. After ICSI or IVF, five best-quality embryos from each patient were transferred in the stimulation cycle and the surplus pronuclear (PN) stage oocytes or multicellular embryos were cryopreserved by slow freezing protocol with 1,2-propanediol (PROH) as a cryoprotectant.4 total of 792 embryos from ICSI trial were thawed and 65.2% (516/792) survived. The survival rates of PN stage oocyte, multicellular embryo and PN + multicellular embryo were 63.5%, 68.2%, 64.0%, respectively. After 111 transfers, 34 pregnancies were achieved, corresponding to a clinical pregnancy rate of 30.6% per transfers. We thawed 1033 embryos from IVF trials and 57.5% (594/1033) survived. In IVF cycle, the survival rates of PN stage oocyte, multicellular embryo and PN + multicellular embryo were 58.2%, 65.2%, 40.2%, respectively. Thirty eight clinical pregnancies were established after 134 transfers, corresponding to a pregnancy rate of 28.4% per transfer The cleavage rate of thawed PN stage oocytes from ICSI trial (61.3%) was significantly higher than those from conventional IVF (53.4%). The developmental rates of good embryo (> or = grade II) in thawed PN stage oocytes obtained from conventional IVF and ICSI were 63% and 65%, respectively. We concluded that PN stage oocytes, multicellular embryos resulting from ICSI procedure can be successfully frozen/thawed with reasonable clinical pregnancy rates comparable to those of IVF.
Embryonic Structures* ; Family Characteristics ; Fertilization in Vitro* ; Freezing ; Humans ; Infertility, Male ; Male ; Oocytes ; Pregnancy ; Pregnancy Rate ; Propylene Glycol ; Sperm Injections, Intracytoplasmic* ; Survival Rate