Total mesorectal excision (TME) has gained worldwide acceptance as a standard surgical technique in the treatment of rectal cancer. Ever since laparoscopic surgery was first applied to TME for rectal cancer, with increasing penetration rates, especially in Asia, an unstable camera platform, the limited mobility of straight laparoscopic instruments, the two-dimensional imaging, and a poor ergonomic position for surgeons have been regarded as limitations. Robotic technology was developed in an attempt to reduce the limitations of laparoscopic surgery. The robotic system has many advantages, including a more ergonomic position, stable camera platform and stereoscopic view, as well as elimination of tremor and subsequent improved dexterity. Current comparison data between robotic and laparoscopic rectal cancer surgery show similar intraoperative results and morbidity, postoperative recovery, and short-term oncologic outcomes. Potential benefits of a robotic system include reduction of surgeon's fatigue during surgery, improved performance and safety for intracorporeal suture, reduction of postoperative complications, sharper and more meticulous dissection, and completion of autonomic nerve preservation techniques. However, the higher cost for a robotic system still remains an obstacle to wide application, and many socioeconomic issues remain to be solved in the future. In addition, we need more concrete evidence regarding the merits for both patients and surgeons, as well as the merits compared to conventional laparoscopic techniques. Therefore, we need large-scale prospective randomized clinical trials to prove the potential benefits of robot TME for the treatment of rectal cancer.
Asia ; Autonomic Pathways ; Fatigue ; Humans ; Laparoscopy ; Postoperative Complications ; Rectal Neoplasms ; Robotics ; Sutures ; Tremor

Purpose: The purpose of this study was to develop a scale to measure professionalism of clinical nurses and evaluate the reliability and validity of the scale. Methods: DeVellis’s scale-development eight steps were applied.The initial items were developed through a literature review and discussion with investigators, and the content validity was verified by seven experts. The data were collected from 250 hospital nurses for exploratory factor analysis and 217 hospital nurses for confirmatory factor analysis. Exploratory and confirmatory factor analyses were utilized to assess the construct validity. Cronbach’s ⍺ was used to test the internal consistency reliability. Results: The results of the exploratory and confirmatory factor analyses showed that the scale comprised four factors: professional skill(eight items), sense of ethics (five items), knowledge-seeking activities (four items), and autonomy(three items). The four-factor structure was validated (x2 =600.85 p<.001, GFI=.88, CFI=.84, RMSEA=.07), and Cronbach’s ⍺ for the total scale was .84. Conclusion The study results showed satisfactory reliability and validity of the professionalism measurement scale for clinical nurses. This scale has potential as an appropriate instrument for measuring clinical nurse professionalism.

PURPOSE: The purpose of this study was to evaluate the effectiveness of a ventilator-associated pneumonia (VAP) bundle.METHODS: This was a retrospective study that was carried out between June 2010 and October 2015. In this study, 3,224 intubated patients were included. The VAP bundle which was applied to Group 1 patients (n=470) included head-of-bed elevation to 30 degrees, cuff pressure monitorization, prophylaxis of peptic ulcer, and prophylaxis of deep vein thrombosis. The VAP bundle for Group 2 patients (n=1,914) included all the elements of the VAP bundle for Group 1 patients and one additional element which was oral care with 0.12% chlorhexidine. The VAP bundle for Group 3 patients (n=870) added sedative interruption and assessment of readiness to extubate to the VAP bundle for Group 2.RESULTS: The numbers and incidences of VAP were significantly different among the three groups. Moreover, there were significant differences among groups in ICU length of stay and mortality.CONCLUSION: Three different VAP prevention bundles made different effects in patient outcomes.
Chlorhexidine ; Humans ; Incidence ; Infection Control ; Intensive Care Units ; Length of Stay ; Mortality ; Patient Care Bundles ; Peptic Ulcer ; Pneumonia, Ventilator-Associated ; Retrospective Studies ; Venous Thrombosis

It is inconvenient to perform serum lipid analysis in fasting state in diabetic patients with drug treatment. In patients with statin treatment and Asian diet, it has not been clearly known whether non-fasting values could be used for the clinical decision making in diabetic patients. In this study, fasting and post-prandial plasma lipid profiles of hospitalized type 2 diabetic patients taking statin, were measured in whom standard diabetic breakfast in traditional Korean style were provided. In repeated-measures ANOVA, there were no significant differences among fasting, post-prandial 2 and 4 hr low-density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol values. When compared to fasting levels, both post-prandial 2 hr and 4 hr LDL cholesterol levels were misclassified as not achieved target goal only in 4% of patients. Post-prandial HDL cholesterol matched with fasting values in women, without exception. In conclusion, the fasting and post-prandial LDL and HDL cholesterol levels are not significantly different each other and can be used in the assessment of achieving target goal in type 2 diabetes taking statin after Korean diet.
Aged ; Cholesterol, HDL/*blood ; Cholesterol, LDL/*blood ; Diabetes Mellitus, Type 2/*blood/drug therapy ; Diet ; Fasting ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use ; Korea ; Male ; Middle Aged ; *Postprandial Period ; Pregnancy

The purpose of this study was to identify the current status of the new graduate nurses' education system, to establish guidelines for the education of new graduate nurses, and to provide dates for the improvement of the education system. Eighty-nine hospitals participated in the survey from July to August 2018. The questionnaires consisted of 24 items including general characteristics, new graduate nurses' education system, operation of nursing education teams, and preceptorship programs. The average duration of education/training for new graduate nurses was 57.3 days, and 26.6%–58.5% of general hospitals, hospitals, and long-term care hospitals had less than 30 days of new graduate nurses education/training, which is shorter than the education/training period of tertiary hospitals. There were new nursing education guidelines in 88.8% of all medical institutions and 58.6% of them had nursing education teams. Most of the personnel in charge of nursing education were not dedicated to education. A total of 87.6% of the all participating medical institutions had preceptorship programs, while 23.1%–33.3% of hospitals and long-term care hospitals did not. The breakdown of preceptorship programs showed 68.4% as “preceptor and preceptee are in charge of one team, and preceptor is teaching preceptee,” and 19.7% were “preceptor and preceptee are in charge of each team, and preceptor is teaching preceptee at the same time.” These results show that standardization and management of new graduate nurses' education programs is necessary. For the standardization and management of new graduate nurses' education programs, joint efforts of nurses' associations and support from the government should be encouraged.
Education ; Education, Nursing ; Hospitals, General ; Joints ; Long-Term Care ; Nursing ; Preceptorship ; Tertiary Care Centers

Fukuyama congenital muscular dystrophy is a genetic disease and common in Japan. The typical clinical features are hypotonia with an early infantile onset and severe developmental delay. The diagnosis is based on pathologic evidence of muscular dystrophy revealed by biopsy or an increased serum creatine kinase levels. Involvement of the brain is characterized by abnormal cerebral cortical dysplasia, cerebellar dysplasia, and white matter changes. We encountered a case of Fukuyama congenital muscular dystrophy in which brain MRI findings were typical, and present this case together with a review of the literature.
Biopsy ; Brain ; Creatine Kinase ; Diagnosis ; Japan ; Magnetic Resonance Imaging* ; Malformations of Cortical Development ; Muscle Hypotonia ; Muscular Dystrophies ; Walker-Warburg Syndrome*

PURPOSE: The purpose of this study was to examine the sleep quality of nurses in the comprehensive nursing care units of small-medium sized hospitals, and general and work-related characteristics associated with sleep quality of nurses. METHODS: Participants were 312 nurses in comprehensive nursing care units of eight small and medium hospitals. The data were collected between June and August, 2018. A survey questionnaire including, sleep quality, general, and work-related characteristics of nurses was used. The data were analyzed using SPSS/WIN 23.0 program with descriptive statistics, independent t-test, and χ² test. Logistic regression analyses were used to identify factors associated with sleep quality. RESULTS: The average score for sleep quality was 8.58±3.18 (0~21). Using a cut-off point of 8.5, 51.9% were poor sleepers. Sleep quality was associated with age (Odds Ratio [OR]=0.93, 95% Confidence Interval [CI]=0.88~0.99). CONCLUSION Age was identified as a factor associated with sleep quality among nurses in the comprehensive nursing care units at small and medium sized hospitals. Researchers and nurse administrators need to develop and provide strategies to improve young nurses' sleep quality.

Purpose: This study was done to develop and validate a scale for assessing nursing needs on comprehensive nursing care units and to derive a patient classification system based on nursing needs. Methods: In this methodological study, the initial items were identified through a review of the literature and surveys from nursing staff regarding the nursing needs on comprehensive nursing care units. Content validity was evaluated by nine nursing staff members from comprehensive nursing care units. To evaluate the concurrent validity and derive a patient classification system, nursing needs scores, perceived nursing needs and perceived patient severity for 216 patient cases were evaluated by five nurses. These data were analyzed using Pearson‘s correlation coefficients, one-way ANOVA with Scheffépost hoc tests and K-means clustering. Results: After evaluating content validity, the developed scale contained 64 activities in two domains: nursing intervention and assistance of daily living. Concurrent validity was verified by analyzing the differences in the nursing needs scores according to each group of perceived nursing needs and severity (p<.001) and by analyzing the correlation between the score of the developed scale and the National Health Insurance Service nursing need assessment scale (r=.68, p<.001). Based on the score of the developed scale, a patient classification system that classified nursing needs into four stages was derived. Conclusion The developed scale represented nursing activities in comprehensive nursing care units. It also provided specific data regarding the time spent on nursing activities. Therefore, it is expected to contribute toward establishing appropriate nurse staffing strategies to provide quality patient care.

Purpureocillium(P) lilacinum is a ubiquitous, saprophytic filamentous fungus that is infrequently reported in keratitis and cutaneous infections. However, the microbiological characterization of the culture isolates is limited in Korea. A 56-year-old male who suffered a pine needlestick to his right eye 10 days previously presented with ocular opacity and pain. A microscopic examination of a corneal scraping by Gram staining and calcofluor white staining was negative for bacteria and fungi. Fungal culture yielded pure white cottony molds on Sabouraud's dextrose agar after a 3-day incubation. Microscopic examination further revealed a mixture of a verticillate arrangement of phialides resembling the Penicillium structure and sparsely branched conidiophores bearing single to small clusters of conidia. This was initially presumed to be a species of Penicillium but the colonies never turned green with further incubation. It was subsequently identified as P. lilacinum by 28S rDNA sequencing and MALDI-TOF mass spectrometry. Antifungal susceptibility test revealed that this organism was resistant to flucytosine, amphotericin B, fluconazole, itraconazole, voriconazole, and caspofungin. After treatment with topical 5% voriconazole and oral itrazonazole combined with multiple debridements for 2 weeks, the patient was discharged with improved visual acuity. We thus report the first case of P. lilacinum infection that required molecular identification due to mixed conidiogenesis features and that showed laboratory-confirmed antifungal resistance in Korea.
Agar ; Amphotericin B ; Bacteria ; Debridement ; DNA, Ribosomal ; Drug Resistance ; Fluconazole ; Flucytosine ; Fungi ; Glucose ; Humans ; Itraconazole ; Keratitis* ; Korea ; Male ; Mass Spectrometry ; Middle Aged ; Needlestick Injuries ; Penicillium ; Sequence Analysis, DNA ; Spores, Fungal ; Visual Acuity ; Voriconazole