PURPOSE: The purpose of this study was to explore the relationships of critical thinking disposition (CT), nursing work environment (NWE), and clinical decision making ability among nurses. METHODS: A cross-sectional, descriptive study design was conducted on 192 nurses who had worked for more than six months in five general hospitals. A self-reported questionnaire was used to collect data, which included demographics, CT, NWE, and clinical decision making ability. RESULTS: The mean score of CT was 3.5. The highest score was on the objectivity of CT and the lowest on systematicity. The mean score of NWE was 2.3. The highest score was on the collegial nurse-physician relations of NWE and the lowest on the staffing and resource adequacy. The mean score of clinical decision making ability was 3.3. In hierarchical multiple regression, affecting factors on clinical decision making ability were CT and NWE. CONCLUSION: The findings showed that clinical decision making ability is associated with CT and NWE. To improve clinical decision making ability, it is important to improve CT. In addition, it should be considered to improve NWE where the nurses can make a decision with their job through critical thinking.
Clinical Decision-Making* ; Demography ; Hospitals, General ; Nursing* ; Physician-Nurse Relations ; Thinking*

BACKGROUND: This study aimed to identify the level of frailty and major health problems among participants of a tailored home visiting service. METHODS: This secondary data analysis study used the 2009 data of 588 participants of a tailored home visiting service in 2 public health centers in Busan. Data on demographics and health-related characteristics were collected from household sheet, disease sheet, and health interview sheet for the elderly. The level of frailty was measured by an instrument developed by the Japanese Ministry of Health. RESULTS: 15.3% of the elderly subjects were considered frail elderly (FE). The major health problems of the FE were poorer activities of daily living skills and higher prevalences of stroke and cognitive impairment than their non-frail counterpart. The mean number of disease was 3 for the FE and 2 for the non-FE. The prevalence of stroke was 12.2% for the FE and 5.8% for the non-FE (p=0.014). The mean dementia screening score was 2.2 (of maximum 10 points) for the FE and 1.4 for the non-FE (p=0.040). CONCLUSIONS: Our results showed that one of seven vulnerable elderly individuals was frail; and stroke and dementia were more prevalent in the frail elderly. We recommend the further developing of service programs for the participants of tailored home visiting services to better manage and prevent the deterioration of stroke and cognitive impairment.
Activities of Daily Living ; Aged ; Asian Continental Ancestry Group ; Dementia ; Demography ; Family Characteristics ; Frail Elderly ; Home Care Services ; House Calls ; Humans ; Mass Screening ; Prevalence ; Public Health ; Statistics as Topic ; Stroke

PURPOSE: This study aimed to validate instruments to classify the frailty of Korean elderly people in community. METHODS: For this study, 632 elders were selected from community-based elderly houses and home visiting registries, and data on frailty were collected using three instruments during November, 2008. The Korean Frail Scale (KFS) was composed of 10 domains with the maximum score of 20. The Edmonton Frail Scale (EFS) had 10 domains with the maximum score of 17. The 25_Japan Frail Scale (25_JFS) was composed of 6 domains with the maximum score of 25. Internal consistency was measured with Cronbach's alpha. Sensitivity, specificity and area under the curve (AUC) of ROC were measured to see validity with long-term care insurance grade as a gold standard. RESULTS: The Cronbach's alpha was .72 for KFS, .55 for EFS, and .80 for 25_JFS. Sensitivity, specificity, and AUC were 70.0%, 83.2%, and .83, respectively, at cutting point 10.5 for the KFS, 50.0%, 80.9%, and .66, respectively, at 8.5 for EFS, and 80.0%, 85.9%, and .86, respectively, at 12.5 for 25_JFS. CONCLUSION: KFS and three JFS showed favorable internal consistency and predictive validity. Further longitudinal studies are recommended to confirm predictive validity.
Aged* ; Area Under Curve ; Frail Elderly ; House Calls ; Humans ; Insurance, Long-Term Care ; Longitudinal Studies ; Registries ; Sensitivity and Specificity

PURPOSE: Studies on the efficacy of infliximab (IFX) in a large population of pediatric patients with Crohn's disease (CD) are limited, and prognostic factors are not well-known. The aim of this study was to evaluate outcomes of IFX in pediatric patients with CD and to identify factors associated with poor prognosis. METHODS: We retrospectively analyzed medical data of 594 pediatric patients with CD between 1987 and 2013 in a tertiary center. Of these, 156 children treated with IFX were enrolled and were followed up for at least a year with intact data. Outcomes of induction and maintenance, classified as failure or clinical response, were evaluated on the tenth and 54th week of IFX therapy. RESULTS: We treated 156 pediatric patients with CD with IFX, and the median duration of IFX therapy was 47 months. For IFX induction therapy, 134 (85.9%) patients experienced clinical response on the 10th week. Among the 134 patients who showed response to induction, 111 (82.8%) patients maintained the clinical response on the 54th week. In multivariate analysis, low hematocrit (p=0.046) at the time of IFX initiation was associated with the failure of IFX induction. For IFX maintenance therapy, longer duration from the initial diagnosis to IFX therapy (p=0.017) was associated with maintenance failure on the 54th week. CONCLUSION: We have shown the acceptable outcomes of IFX in a large cohort of pediatric CD patients in Korea. Hematocrit and early introduction of IFX may be prognostic factors for the outcomes of IFX.
Child ; Cohort Studies ; Crohn Disease* ; Diagnosis ; Hematocrit ; Humans ; Infliximab* ; Korea ; Multivariate Analysis ; Prognosis ; Retrospective Studies

PURPOSE: Studies on the efficacy of infliximab (IFX) in a large population of pediatric patients with Crohn's disease (CD) are limited, and prognostic factors are not well-known. The aim of this study was to evaluate outcomes of IFX in pediatric patients with CD and to identify factors associated with poor prognosis. METHODS: We retrospectively analyzed medical data of 594 pediatric patients with CD between 1987 and 2013 in a tertiary center. Of these, 156 children treated with IFX were enrolled and were followed up for at least a year with intact data. Outcomes of induction and maintenance, classified as failure or clinical response, were evaluated on the tenth and 54th week of IFX therapy. RESULTS: We treated 156 pediatric patients with CD with IFX, and the median duration of IFX therapy was 47 months. For IFX induction therapy, 134 (85.9%) patients experienced clinical response on the 10th week. Among the 134 patients who showed response to induction, 111 (82.8%) patients maintained the clinical response on the 54th week. In multivariate analysis, low hematocrit (p=0.046) at the time of IFX initiation was associated with the failure of IFX induction. For IFX maintenance therapy, longer duration from the initial diagnosis to IFX therapy (p=0.017) was associated with maintenance failure on the 54th week. CONCLUSION: We have shown the acceptable outcomes of IFX in a large cohort of pediatric CD patients in Korea. Hematocrit and early introduction of IFX may be prognostic factors for the outcomes of IFX.
Child ; Cohort Studies ; Crohn Disease* ; Diagnosis ; Hematocrit ; Humans ; Infliximab* ; Korea ; Multivariate Analysis ; Prognosis ; Retrospective Studies

PURPOSE: To evaluate the outcomes of a hybrid prophylactic strategy to prevent cytomegalovirus (CMV) disease in pediatric liver transplantation (LT) patients. METHODS: CMV DNAemia was regularly monitored by quantitative nucleic acid amplification test (QNAT) and was quantified in all children. CMV infection and disease were defined according to the International Consensus Guidelines. The hybrid strategy against CMV infection consisted of universal 3-week prophylaxis and preemptive treatment of intravenous ganciclovir regardless of the recipient's serostatus. RESULTS: A total of 143 children who underwent living donor LT were managed using the hybrid strategy. The overall incidence of CMV infection by QNAT was 48.3% (n=69/143). The highest CMV DNAemia positivity was observed in 49.2% (n=60/122) of children in the D+/R+ group, followed by 46.7% (n=7/15) in the D+/R− group. CMV disease was noted in 26.1% (n=18/69) patients. Forty-three (62.3%) children had undergone preemptive therapy consisting of intravenous ganciclovir. No symptomatic patients developed tissue-invasive disease, resulting in no CMV-associated mortality. CONCLUSION: The incidence of CMV infection was high in pediatric LT patients despite the hybrid strategy. However, tissue-invasive disease in pediatric LT did not occur.
Child ; Consensus ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Ganciclovir ; Humans ; Incidence ; Liver Transplantation* ; Liver* ; Living Donors ; Mortality ; Nucleic Acid Amplification Techniques

PURPOSE: The purpose of this study was to describe the level of satisfaction with the role of Korean oncology advanced practice nurses (KOAPNs) among cancer patients, physicians, and nurses. METHODS: This study was conducted with 176 patients who had experienced KOPANs' care more than three times, as well as 82 physicians and 190 nurses who have worked with KOAPNs at four hospitals in Korea. RESULTS: The results indicate that 1) Overall satisfaction in the patient group was high (3.61) and they were most satisfied with the 'attentiveness' domain; 2) Overall satisfaction in the physician group was also high (3.61), however, that in the nurse group was relatively low (3.28); 'coordination & cooperation' showed the highest score for satisfaction in both groups, while 'research' domain showed the lowest score; 3) Cancer type in patients, working department in physicians or nurses, and duration working with KOAPNs in nurses showed significant association with satisfaction; and 4) The ratio of KOAPNs-to-patient, time since introduction of the KOAPNs policy, and incentive system were institutional factors showing significant association with it. CONCLUSION: These findings suggest the necessity for identification and standardization of the roles of KOAPNs, as well as promotion of awareness of KOAPNs' care.
Advanced Practice Nursing ; Humans ; Korea ; Motivation ; Oncology Nursing

PURPOSE: Noonan syndrome (NS) is characterized by short stature, heart anomalies, developmental delays, dysmorphic features, cryptorchidism, and coagulation defects. Several studies reported the short-term effects of recombinant human growth hormone (rhGH) treatment on the improvement of height. This study was performed to evaluate the long-term efficacy of rhGH in children with NS in Korea. METHODS: This study included 15 prepubertal NS children who received rhGH subcutaneously at a dose of 50-75 µg/kg/day for 6 days a week for at least >3 years. Preand posttreatment data, such as height, weight, bone age, insulin-like growth factor 1 (IGF-1), and IGF binding protein 3 (IGFBP-3) levels, were collected every 6 months. RESULTS: Chronologic age and bone age at the start of treatment were 7.97±1.81 and 5.09±2.12 years, respectively. Height standard deviation score (SDS) was increased from -2.64±0.64 to -1.54±1.24 years after 3 years (P<0.001). Serum IGF-1 SDS levels were elevated from -1.28±1.03 to -0.10±0.94 (P<0.001). Height SDS was more increased in subjects without PTPN11 mutations compared to those with mutations after 3 years (P=0.012). However, the other parameters, including bone age, IGF-1 SDS, and IGFBP-3 SDS, were not significantly different between patients with and without PTPN11 mutations. CONCLUSION: Although this study included a relatively small number of patients, long-term rhGH therapy in NS patients was safe and effective at improving height, growth velocity, and serum IGF-1 levels, in accordance with previous studies. However, the meticulous monitoring of potential adverse events is still needed because of high dose of rhGH and preexisting hyperactivity of RAS-MAPK pathway. Patients with PTPN11 mutations demonstrated a decreased response to rhGH therapy compared to those without mutations.
Child ; Cryptorchidism ; Growth Hormone ; Heart ; Human Growth Hormone* ; Humans* ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Korea ; Male ; Noonan Syndrome*

Cushing disease is caused by excessive adrenocorticotropic hormone (ACTH) production by the pituitary adenoma. Transsphenoidal surgery is its first-line treatment. The incidence of Cushing disease in children and adolescents is so rare that long-term prognoses have yet to be made in most cases. We followed-up on a 16-year-old male Cushing disease patient who presented with rapid weight gain and growth retardation. The laboratory findings showed increased 24-hour urine free cortisol and lack of overnight cortisol suppression by low-dose dexamethasone test. The serum cortisol and 24-hour urine free cortisol, by high-dose dexamethasone test, also showed a lack of suppression, and a bilateral inferior petrosal sinus sampling suggested lateralization of ACTH secretion from the right-side pituitary gland. However, after a right hemihypophysectomy by the transsphenoidal approach, the 24-hour urine free cortisol levels were persistently high. Thus the patient underwent a total hypophysectomy, since which time he has been treated with hydrocortisone, levothyroxine, recombinant human growth hormone, and testosterone enanthate. Intravenous bisphosphonate for osteoporosis had been administered for three years. At his current age of 26 years, his final height had attained the target level range; his bone mineral density was normal, and his pubic hair was Tanner stage 4. This report describes the long-term treatment course of a Cushing disease patient according to growth profile, pubertal status, and responses to hormone replacement therapy. The clinical results serve to emphasize the importance of growth optimization, puberty, and bone health in the treatment management of Cushing disease patients who have undergone transsphenoidal surgery.
Adolescent ; Adrenocorticotropic Hormone ; Bone Density ; Child ; Dexamethasone ; Follow-Up Studies* ; Hair ; Hormone Replacement Therapy ; Human Growth Hormone ; Humans ; Hydrocortisone ; Hypophysectomy ; Hypopituitarism ; Incidence ; Male ; Osteoporosis ; Petrosal Sinus Sampling ; Pituitary ACTH Hypersecretion* ; Pituitary Gland ; Pituitary Neoplasms ; Prognosis ; Puberty ; Testosterone ; Thyroxine ; Weight Gain