Purpose: This study was done clarify the concept of illness acceptance in patients with chronic disease. Methods: This study was conducted using a hybrid model of concept analysis that consists of three phases. In the theoretical phase, a working definition was formulated through a systematic review. In the fieldwork phase, five participants who had diabetes or hypertension for at least one year were interviewed. In the third phase, the results were combined in the final analysis. Results: There are three phases of accepting an illness: experiencing the limits, disease management, and designing new life. At the experience of the limits and disease management stages, the attributes of physical, psychological and social domains were derived, but at the stage of designing their new life, integrated attributes of these three domains were derived. Conclusion Illness acceptance of chronic disease was defined as a continuous and dynamic process in three phases. First, patients experience limitations due to the disease, such as physical illness, psychological instability, and difficulty performing social roles. Second, patients manage the disease by engaging in self-management, psychological coping strategies, and establishing social support. Third, patients design their new life by seeking better health-related quality of life and integrating the illness into their everyday life. However, patients experienced negative changes when disease management was not performed properly. The fact that illness acceptance could be cyclic means the difference between illness and loss/death acceptance. Nurse should develop and provide an integrated nursing intervention that is appropriate for phases of illness acceptance.

PURPOSE: Severe atopic dermatitis is a condition that can seriously affect the quality of life. This study was performed to evaluate the efficacy and side effect of cyclosporin A treatment in children. METHODS: Nine children(male 7, female 2) with severe atopic dermatitis resistant to conventional therapy and/or significant suffering and disability. The initial dose of cyclosporin A was 2.1-5.2 mg/kg/day and the duration of treatment was 4-6 weeks. The severity and extent of atopic dermatitis were evaluated with modified criteria of Hanifin and Rajka, at 0, 2, 4 and 6th week and after cessation of cyclosporin, at 10th week. Total clinical score was calculated as the average of both extent and severity score. RESULTS: There are significant improvement in both of the symptom severity and the extent of atopic dermatitis. The mean severity and extent scores were 92% and 88% before treatment and 28% and 34% after 6 weeks' treatment. The overall change of the total clinical score was 59% of decrease. Two patients had to stop the drug after 4 weeks of treatment because of severe abdominal pain, especially at night. After stopping the drug, at the 10th weeks' evaluation, 3 patients showed symptomatic exacervations but 6 patients maintain their improved state only with conventional treatment. CONCLUSION : Despite the side effect, cyclosporin A gave a rapid clinical response to severe refractory atopic dermatitis in children.
Abdominal Pain ; Child* ; Cyclosporine* ; Dermatitis, Atopic* ; Female ; Humans ; Quality of Life

PURPOSE: The smoking rates among teenagers in Korea grow gradually since 1980s despite of the numerous programs for youth smoking prevention and cessation have been developed and implemented. The purpose of this study was to explore and describe the processes of habituating to smoking among teenagers using the grounded theory methodology. METHOD: Qualitative data was collected via six focus group interviews. A total of 38 people, twelve teachers and 24 middle school students participated in this study. All focus group interviews were tape-recorded, transcribed, and analyzed according to the grounded theory methodology. RESULTS: The overriding theme of the elicited grounded theory was "stepping into a quagmire by a merest chance". The student participants began smoking by a simple chance. The contingent factors to starting smoking were "discord within the family", "family member's smoking", "schoolwork stresses", or "a rebellious spirit". The conditions of smoking included accessibility, going around in group, and the lack of discipline. "Stigmatizing", "involved in mob violence", and "making a poor academic record" coexisted as the covariance of the smoking habituation. CONCLUSION: The findings of this study illustrated the comprehensive and insightful picture of the phenomena under investigation. Nursing implications and further directions for research were discussed.
Adolescent* ; Focus Groups ; Humans ; Korea ; Nursing ; Smoke* ; Smoking* ; Tobacco Products

PURPOSE: A better predictive model for occult invasive disease in ductal carcinoma in situ (DCIS) patients is essential to guide the tailored use of sentinel node biopsies. We hypothesized that recent improvement of contrast-enhanced breast magnetic resonance imaging (MRI) could provide more accurate information on the presence of occult invasion in DCIS patients. METHODS: From a prospectively maintained database, we identified 143 DCIS patients diagnosed with needle biopsies in whom MRI images were available. RESULTS: Sixty-five patients (45.5%) were upstaged to invasive carcinoma after curative surgery. Ultrasonographic lesion size, mass-appearance on mammography, type of needle used, and the presence of suspicious microinvasive foci were associated with increased likelihood of upstaging. Among the features of MRI, only mass-appearance was significantly associated with the presence of invasive disease (p=0.002). However, up to 50% of masses in MRI cases had massappearance on mammography as well. Other morphologic and pharmacokinetic features of MRI, such as shape, margin, and patterns of enhancement and washout, did not have a significant association. CONCLUSION: Among various morphologic and pharmacokinetic parameters of contrast-enhanced MRI, only mass-appearance was associated with occult invasive disease. Our results show the limitations of current contrast-enhanced MRI in predicting invasive disease in patients with preoperative diagnoses of DCIS.
Biopsy ; Biopsy, Needle ; Breast ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Magnetic Resonance Imaging ; Mammography ; Needles ; Nitriles ; Prospective Studies ; Pyrethrins ; Sentinel Lymph Node Biopsy

This randomized prospective study investigated the effect of fibrin glue use on drainage duration and overall drain output after lumpectomy and axillary dissection in breast cancer patients. A total of 100 patients undergoing breast lumpectomy and axillary dissection were randomized to a fibrin glue group (N=50; glue sprayed onto the axillary dissection site) or a control group (N=50). Outcome measures were drainage duration, overall drain output, and incidence of seroma. Overall, the fibrin glue and control groups were similar in terms of drainage duration, overall drain output, and incidence of seroma. However, subgroup analysis showed that fibrin glue use resulted in a shorter drainage duration (3.5 vs. 4.7 days; p=0.0006) and overall drain output (196 vs. 278 mL; p=0.0255) in patients undergoing level II or III axillary dissection. Fibrin glue use reduced drainage duration and overall drain output in breast cancer patients undergoing a lumpectomy and level II or III axillary dissection.
Adult ; Axilla ; Breast Neoplasms/pathology/*surgery ; Drainage ; Female ; Fibrin Tissue Adhesive/*therapeutic use ; Humans ; *Lymph Node Excision ; *Mastectomy, Segmental ; Middle Aged ; Prospective Studies ; Seroma/epidemiology/etiology ; Severity of Illness Index ; Time Factors ; Tissue Adhesives/*therapeutic use

The Korean Breast Cancer Society has constructed a nationwide breast cancer database through utilization of an online registration program. We have reported the basic facts about breast cancer in Korea in 2012, and analyzed the changing patterns in the clinical characteristics and management of breast cancer in Korea over the last 10 years. Data on patients newly diagnosed with breast cancer were collected for the year 2012 from 97 hospitals and clinics nationwide using a questionnaire survey, and from the online registry database. A total of 17,792 patients were newly diagnosed with breast cancer in 2012. The crude incidence rate of female breast cancer, including invasive cancer and in situ cancer, was 70.7 cases per 100,000 women. The median age at diagnosis was 51 years, and the proportion of postmenopausal women was higher than that of premenopausal women among those diagnosed with breast cancer. The proportion of cases of early breast cancer increased continuously, and breast-conserving surgery was performed in more cases than total mastectomy in that same year. The total number of breast reconstruction surgeries increased approximately 3-fold over last 10 years. The 5-year overall survival rate for all stages of breast cancer patients was extremely high. The clinical characteristics of breast cancer have changed in ways that resulted in high overall survival over the past 10 years in Korea, and the surgical management of the disease has changed accordingly. Analysis of nationwide registry data will contribute to a better understanding of the characteristics of breast cancer in Korea.
Breast Neoplasms* ; Diagnosis ; Female ; Humans ; Incidence ; Korea ; Mammaplasty ; Mastectomy, Segmental ; Mastectomy, Simple ; Online Systems ; Registries ; Survival Rate ; Surveys and Questionnaires

OBJECTIVE: To report the feasibility of magnetic resonance imaging (MRI)-guided intervention for diagnosing suspicious breast lesions detectable by MRI only, using the freehand technique with a 3.0-T closed-bore MRI scanner. MATERIALS AND METHODS: Five women with 5 consecutive MRI-only breast lesions underwent MRI-guided intervention: 3 underwent MRI-guided needle localization and 2, MRI-guided vacuum-assisted biopsy. The interventions were performed in a 3.0-T closed-bore MRI system using a dedicated phased-array breast coil with the patients in the prone position; the freehand technique was used. Technical success and histopathologic outcome were analyzed. RESULTS: MRI showed that four lesions were masses (mean size, 11.5 mm; range, 7-18 mm); and 1, a nonmass-like enhancement (maximum diameter, 21 mm). The locations of the lesions with respect to the breast with index cancer were as follows: different quadrant, same breast - 3 cases; same quadrant, same breast - 1 case; and contralateral breast - 1 case. Histopathologic evaluation of the lesions treated with needle localization disclosed perilobular hemangioma, fibrocystic change, and fibroadenomatous change. The lesions treated with vacuum-assisted biopsy demonstrated a radial scar and atypical apocrine hyperplasia. Follow-up MRI after 2-7 months (mean, 4.6 months) confirmed complete lesion removal in all cases. CONCLUSION: MRI-guided intervention for breast lesions using the freehand technique with a 3.0-T closed-bore MRI scanner is feasible and accurate for diagnosing MRI-only lesions.
Adult ; Biopsy, Needle ; Breast Neoplasms/*pathology ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Feasibility Studies ; Female ; Gadolinium DTPA/diagnostic use ; Humans ; Magnetic Resonance Imaging/*instrumentation ; Magnetic Resonance Imaging, Interventional/*methods ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Vacuum

OBJECTIVE: To obtain reliability and applicability of the Korean version Bayley Scale of Infant Development-II (BSID-II) in evaluating the developmental status of children with cerebral palsy (CP). METHODS: The inter-rater reliability of BSID-II scores from 68 children with CP (46 boys and 22 girls; mean age, 32.54+/-16.76 months; age range, 4 to 78 months) was evaluated by 10 pediatric occupational therapists. Patients were classified in several ways according to age group, typology, and the severity of motor impairment by the level of the Gross Motor Function Classification System (GMFCS). The measures were performed by video analysis, and the results of intraclass correlation (ICC) were obtained for each of the above classifications. To evaluate the clinical applicability of BSID-II for CP, its correlation with the Gross Motor Function Measure (GMFM), which has been known as the standard motor assessment for CP, was investigated. RESULTS: ICC was 0.99 for the Mental scale and 0.98 for the Motor scale in all subjects. The values of ICC ranged from 0.92 to 0.99 for each age group, 0.93 to 0.99 for each typology, and 0.99 to 1.00 for each GMFCS level. A strong positive correlation was found between the BSID-II Motor raw score and the GMFM total score (r=0.84, p<0.001), and a moderate correlation was observed between the BSID-II Mental raw score and the GMFM total score (r=0.65, p<0.001). CONCLUSION: The Korean version of BSID-II is a reliable tool to measure the functional status of children with CP. The raw scores of BSID-II showed a great correlation with GMFM, indicating validity of this measure for children with CP on clinical basis.
Cerebral Palsy ; Child ; Child Development ; Humans ; Infant

BACKGROUND: Transfusion in neonates and infants can be performed using an electromechanical infusion system that has appropriate accuracy in terms of flow rate, volume, and bolus. However, there are no infusion systems approved for transfusion in Korea. In this study, we evaluate the performance of two electromechanical infusion systems for transfusion in pediatric patients. METHODS: We tested two systems, Baxter and Terumo, using 9 units of leukocyte-filtered red blood cells. The blood samples were delivered through the systems at constant speeds of 10, 30, and 100 mL/hr, and the accuracy in terms of the delivered volume was estimated. Before and after infusion, hemoglobin, hematocrit, plasma hemoglobin, potassium, and lactate dehydrogenase levels were measured in each sample. The percentage of hemolysis (%Hemolysis) was calculated to evaluate the safety of the infusion systems. RESULTS: For Terumo, the mean error rate of the infused volume was less than 5%. We expect that Terumo can transfuse blood at a volume close to the set volume. Further, both infusion systems showed acceptable %Hemolysis levels (mean±standard deviation: Terumo, 0.14±0.04; Baxter, 0.17±0.06). CONCLUSIONS: Both infusion systems can be used safely for transfusion in pediatric patients.
Erythrocyte Transfusion ; Erythrocytes ; Hematocrit ; Hemolysis ; Humans ; Infant ; Infant, Newborn ; Korea ; L-Lactate Dehydrogenase ; Plasma ; Potassium

PURPOSE: Breast cancer in male is uncommon, accounting for approximately 1% of all breast cancer and less than 1.5% of all the malignant neoplasms in males. The information concerned with the treatment of male breast cancer is limited. The objective of this study is to evaluate the histopathologic characteristics and clinical outcome of male breast cancer patients. METHODS: We retrospectively analyzed the medical record of 17 male breast cancer patients who had been operated on Seoul National University Hospital between 1996 and 2006. RESULTS: The peak age of incidence was the 6th decade and the mean age of the patients was 56.2 yr. The most common symptom was a palpable mass and the mean duration of symptoms was 13 months. Fifty-three percent of the patients were stage 0 or I. Mastectomy was performed in 15 cases and lumpectomy was performed in 2 cases. Twelve patients received adjuvant hormonal therapy. The median duration of follow up was 28 months. Of the two patients with distant relapse, one patient died due to multiple metastasis and the other patient is still alive. The other patients are still alive without any evidence of metastasis or recurrence. CONCLUSION: Active diagnosis, appropriate treatments (surgery and adjuvant therapy) and close follow up are necessary for male patients who have a palpable mass in their breast.
Breast ; Breast Neoplasms ; Breast Neoplasms, Male* ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Male ; Male* ; Mastectomy ; Mastectomy, Segmental ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Seoul