PURPOSE: Presenteeism is a relatively new concept in nursing describing the condition within which registered nurses (RNs) come to work while they are sick. The purpose of this study was to explore and describe presenteeism experiences among RNs in South Korea. METHODS: In this constructivist grounded theory study, a focus group interview (FGI) technique was utilized for data collection. A total of 20 RNs at one hospital in Chuncheon city joined in three different FGIs. Semistructured questions were asked in reference to their sickness experience in the workplace. Data analysis was conducted according to the constructivist grounded theory methodology. RESULTS: All participants had experiences of presenteeism. The overriding theme was "having no caring for nurses leads to losing one's nursing mind". The participants reported that due to either their personal preference or peer pressure they showed up to work, but they felt sad and their pride was hurt by the fact that there was no caring for them from other nurses. This emotional exhaustion often led to the loss of compassion and the resignation of nursing staff. CONCLUSIONS: Care for nurses in the workplace is necessary for RNs to make their presenteeism experience positive and even effective.
Adult ; *Attitude of Health Personnel ; Female ; Grounded Theory ; Humans ; Male ; Middle Aged ; Nursing Staff, Hospital/*psychology ; *Presenteeism ; Qualitative Research ; Republic of Korea ; Surveys and Questionnaires ; Workplace/*psychology

PURPOSE: To evaluate the effect of reconstruction algorithms on the CT measurement of mean lung mass density and normal thoracic structures. MATERIALS AND METHODS: Forty-six patients with a 2-9cm-sized lung mass underwent thoracic CT examinations with intravenous contrast enhancement and using a CT HiSpeed Advantage scanner (GE Medical Systems). In each examination, the axial image of the lung mass was reconstructed using soft, standard, detail, and bone algorithms. The mean value and standard deviation of mass density in Hounsfield Units (HU) were measured using ROIs of three different sizes (50 mm2, 200 mm2, and 350 mm2 or more), and the same method was used to measure the density of normal lung, muscle, bone, and vessels. In 21 patients, mass density was also measured on unenhanced and delayed enhanced images and the degree of enhancement was calculated. RESULTS: The average maximum difference in mean mass density in the images of the four different algorithms was less than 1 (range, 0.1 -1.9) HU (ROI size, 350 mm2 or more), 0 -4.2 HU (200 mm 2), and 0.1 -3.6 HU (50mm2). The average maximum difference in the degree of lung mass enhancement was 0.5 -1.2 (range, 0 -1.6 )HU (ROI size, 350 mm2 or more). The mean density of the four normal thoracic structures was highest in images reconstructed with the bone algorithm, though there was no significant difference between the four different algorithms (p = 1.000). CONCLUSION: The measured mean CT density of a lung mass larger than 2 cm does not significantly change according to the reconstruction algorithm used. When using a small ROI, however, the density difference may increase.
Densitometry* ; Humans ; Lung*

PURPOSE: Three-dimensional radiation dosimetry using magnetic resonance imaging of polymer gel was recently introduced. This dosimetry system is based on radiation induced chain polymerization of acrylic monomers in a muscle equivalent gel and provide accurate 3 dimensional dose distribution. We planned this study to evaluate the clinical value of this 3-dimensional dosimetry. MATERIALS AND METHODS: The polymer gel poured into a cylindrical glass flask and a spherical glass flask. The cylindrical test tubes were for dose response evaluation and the spherical flasks, which is comparable to the human head, were for isodose curves. T2 maps from MR images were calculated using software, IDL. Dose distributions have been displayed for dosimetry. The same spherical flask of gel and the same irradiation technique was used for film and TLD dosimetry and compared with each other. RESULTS: The R2 of the gel respond linearly with radiation doses in the range of 2 to 15 Gy. The repeated dosimetry of spherical gel showed the same isodose curves. These isodose curves were identical to dose distributions from treatment planning system especially high dose range. In addition, the gel dosimetry system showed comparable or superior results with the film and TLD dosimetry. CONCLUSION: The 3-dimensional dosimetry for conformal radiation therapy using MRI of polymer gel showed stable and accurate results. Although more studies are needed for convenient clinical application, it appears to be a useful tool for conformal radiation therapy.
Glass ; Head ; Humans ; Magnetic Resonance Imaging* ; Polymerization ; Polymers* ; Radiometry ; Radiotherapy, Conformal

BACKGROUND: The opioid sparing effect of low dose ketamine is influenced by bolus dose, infusion rate, duration of infusion, and differences in the intensity of postoperative pain. In this study, we investigated the opioid sparing effect of low dose ketamine in patients with intravenous patient-controlled analgesia (PCA) using fentanyl after lumbar spinal fusion surgery, which can cause severe postoperative pain. METHODS: Sixty patients scheduled for elective lumbar spinal fusion surgery were randomly assigned to receive one of three study medications (K1 group: ketamine infusion of 1 microg/kg/min following bolus 0.5 mg/kg, K2 group: ketamine infusion of 2 microg/kg/min following bolus 0.5 mg/kg, Control group: saline infusion following bolus of saline). Continuous infusion of ketamine began before skin incision intraoperatively, and continued until 48 h postoperatively. For postoperative pain control, patients were administered fentanyl using IV-PCA (bolus dose 15 microg of fentanyl, lockout interval of 5 min, no basal infusion). For 48 h postoperatively, the total amount of fentanyl consumption, postoperative pain score, adverse effects and patients' satisfaction were evaluated. RESULTS: The total amount of fentanyl consumption was significantly lower in the K2 group (474 microg) compared to the control group (826 microg) and the K1 group (756 microg) during the 48 h after surgery. Pain scores at rest or with movement, the incidence of adverse events and patient satisfaction were not significantly different among the groups. CONCLUSIONS: Low-dose ketamine at 2 microg/kg/min following bolus 0.5 mg/kg significantly reduced the total amount of fentanyl consumption during the 48 h after lumbar spinal fusion surgery without increasing adverse effects.
Analgesia, Patient-Controlled ; Fentanyl ; Humans ; Incidence ; Ketamine ; Pain, Postoperative ; Patient Satisfaction ; Skin ; Spinal Fusion

Intermittent pneumatic compression device is a standard component for prevention of deep venous thrombosis in immobile patients. This method has been known to be safe with very low rate of complications compared to medical thromboprophylaxis. Therefore, this modality has been used widely in patients who underwent a general surgery. We report a patient who developed common peroneal nerve palsy during the use of intermittent pneumatic compression device after Hartmann's operation.
Humans ; Intermittent Pneumatic Compression Devices ; Paralysis ; Peroneal Nerve ; Peroneal Neuropathies ; Postoperative Complications ; Venous Thrombosis

Complex regional pain syndrome (CRPS) is a chronic neuropathic pain disorder. Pain catastrophizing, characterized by magnification, rumination, and helplessness, increases perceived pain intensity and mental distress in CRPS patients. As functional connectivity patterns in CRPS remain largely unknown, we aimed to investigate functional connectivity alterations in CRPS patients and their association with pain catastrophizing using a whole-brain analysis approach. Twenty-one patients with CRPS and 49 healthy controls were included in the study for clinical assessment and resting-state functional magnetic resonance imaging. Between-group differences in whole-brain functional connectivity were examined through a Network-based Statistics analysis. Associations between altered functional connectivity and the extent of pain catastrophizing were also assessed in CRPS patients. Relative to healthy controls, CRPS patients showed higher levels of functional connectivity in the bilateral somatosensory subnetworks (components 1~2), but lower functional connectivity within the prefronto-posterior cingulate (component 3), prefrontal (component 4), prefronto-parietal (component 5), and thalamo-anterior cingulate (component 6) subnetworks (p<0.05, family-wise error corrected). Higher levels of functional connectivity in components 1~2 (β=0.45, p=0.04) and lower levels of functional connectivity in components 3~6 (β=-0.49, p=0.047) were significantly correlated with higher levels of pain catastrophizing in CRPS patients. Higher functional connectivity in the somatosensory subnetworks implicating exaggerated pain perception and lower functional connectivity in the prefronto-parieto-cingulo-thalamic subnetworks indicating impaired cognitive-affective pain processing may underlie pain catastrophizing in CRPS.

Cognitive dysfunction, a significant complication of type 2 diabetes mellitus (T2DM), can potentially manifest even from the early stages of the disease. Despite evidence of global brain atrophy and related cognitive dysfunction in early-stage T2DM patients, specific regions vulnerable to these changes have not yet been identified. The study enrolled patients with T2DM of less than five years’ duration and without chronic complications (T2DM group, n=100) and demographically similar healthy controls (control group, n=50). High-resolution T1-weighted magnetic resonance imaging data were subjected to independent component analysis to identify structurally significant components indicative of morphometric networks. Within these networks, the groups’ gray matter volumes were compared, and distinctions in memory performance were assessed. In the T2DM group, the relationship between changes in gray matter volume within these networks and declines in memory performance was examined. Among the identified morphometric networks, the T2DM group exhibited reduced gray matter volumes in both the precuneus (Bonferronicorrected p=0.003) and insular-opercular (Bonferroni-corrected p=0.024) networks relative to the control group. Patients with T2DM demonstrated significantly lower memory performance than the control group (p=0.001). In the T2DM group, reductions in gray matter volume in both the precuneus (r=0.316, p=0.001) and insular-opercular (r=0.199, p=0.047) networks were correlated with diminished memory performance. Our findings indicate that structural alterations in the precuneus and insular-opercular networks, along with memory dysfunction, can manifest within the first 5 years following a diagnosis of T2DM.

Purpose: Patients who have undergone gastrectomy have unique symptoms that are not appropriately assessed using currently available tools. This study developed and validated a symptom-focused quality of life (QoL) questionnaire for patients who have received gastrectomy for gastric cancer. Materials and Methods Based on a literature review, patient interviews, and expert consultation by the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS), the initial item pool was developed. Two large-scale developmental studies were then sequentially conducted for exploratory factor analyses for content validity and item reduction. The final item pool was validated in a separate cohort of patients and assessed for internal consistency, test-retest reliability, construct validity, and clinical validity. Results The initial questionnaire consisted of 46-items in 12 domains. Data from 465 patients at 11 institutions, followed by 499 patients at 13 institutions, were used to conduct item reduction and exploratory factor analyses. The final questionnaire (KOQUSS-40) comprised 40 items within 11 domains. Validation of KOQUSS-40 was conducted on 413 patients from 12 hospitals. KOQUSS-40 was found to have good model fit. The mean summary score of the KOQUSS-40 was correlated with the EORTC QLQ-C30 and STO22 (correlation coefficients, 0.821 and 0.778, respectively). The KOQUSS-40 score was also correlated with clinical factors, and had acceptable internal consistency (> 0.7). Test-retest reliability was greater than 0.8. Conclusion The KOQUSS-40 can be used to assess QoL of gastric cancer patients after gastrectomy and allows for a robust comparison of surgical techniques in clinical trials.

Purpose: Patients who have undergone gastrectomy have unique symptoms that are not appropriately assessed using currently available tools. This study developed and validated a symptom-focused quality of life (QoL) questionnaire for patients who have received gastrectomy for gastric cancer. Materials and Methods Based on a literature review, patient interviews, and expert consultation by the KOrean QUality of life in Stomach cancer patients Study group (KOQUSS), the initial item pool was developed. Two large-scale developmental studies were then sequentially conducted for exploratory factor analyses for content validity and item reduction. The final item pool was validated in a separate cohort of patients and assessed for internal consistency, test-retest reliability, construct validity, and clinical validity. Results The initial questionnaire consisted of 46-items in 12 domains. Data from 465 patients at 11 institutions, followed by 499 patients at 13 institutions, were used to conduct item reduction and exploratory factor analyses. The final questionnaire (KOQUSS-40) comprised 40 items within 11 domains. Validation of KOQUSS-40 was conducted on 413 patients from 12 hospitals. KOQUSS-40 was found to have good model fit. The mean summary score of the KOQUSS-40 was correlated with the EORTC QLQ-C30 and STO22 (correlation coefficients, 0.821 and 0.778, respectively). The KOQUSS-40 score was also correlated with clinical factors, and had acceptable internal consistency (> 0.7). Test-retest reliability was greater than 0.8. Conclusion The KOQUSS-40 can be used to assess QoL of gastric cancer patients after gastrectomy and allows for a robust comparison of surgical techniques in clinical trials.