PURPOSE: The aim of this study was to compare job satisfaction, quality of life (QOL), incident report rate and overtime hours for 12-hour shifts and for 8-hour shifts in a pediatric intensive care unit (PICU). METHODS: A descriptive survey was conducted with a convenience sample of 36 staff nurses from a PICU in a regional hospital in Korea. Data were collected using self-administrated questionnaires regarding job satisfaction and QOL at 6 months before and after the beginning of 12-hour shifts. Incident report rate and overtime hours for both 12-hour and 8-hour shifts were compared. Comparisons were made using chi2-test, paired t-test and Mann-Whitney U test. RESULTS: After 12-hour shifts were initiated, job satisfaction significantly increased (t=3.93, p<.001) and QOL was higher for nurses on 12-hour shifts compared to 8-hour (t=7.83, p<.001). There was no statistically significant change in incident report rate (chi2=0.15, p=.720). The overtimes decreased from 36.3+/-34.7 to 17.3+/-34.9 minutes (Z=-8.91, p<.001). CONCLUSION: These results provide evidence that 12-hour shifts can be an effective ways of scheduling for staff nurses to increase job satisfaction and quality of life without increasing patient safety incidents or prolonged overtime work hours.
Intensive Care Units* ; Job Satisfaction* ; Korea ; Patient Safety ; Quality of Life* ; Surveys and Questionnaires ; Risk Management*

Primary hepatocellular carcinoma with metastasis to the ovary is a rare malady. To the best of our knowledge, approximately eight cases in the English literature and two cases in the Korean literature have been reported. We report here a case of hepatocellular carcinoma with metastasis to the ovary in a 40-year-old woman who presented with a month long history of lower abdominal discomfort and a palpable mass. She had been diagnosed with hepatocellular carcinoma (HCC) four years prior and subsequently underwent a several courses of transarterial chemoembolization and radio-frequency ablation. The patient had then been seen regularly and was generally well until 4 month ago, when the alpha fetoprotein (AFP) level began to rise to 425 ng/mL. After that time she had been seen and examined every month, however, the AFP level rose to 2,150 ng/mL without evidence of recurrence on the computed tomography (CT) scan of liver, the heapatic artery angiography, PET and so on. On admission, a pelvis MRI revealed mainly solid masses of both ovaries and multiple peritoneal and omental nodules. Transvaginal core biopsy was performed and the histologic examination of the specimen revealed metastatic hepatocellular carcinoma. We report here on one case of ovarian metastasis from hepatocellular carcinoma together with a brief review of the literature.
Adult ; alpha-Fetoproteins ; Angiography ; Arteries ; Biopsy ; Carcinoma, Hepatocellular* ; Female ; Humans ; Liver ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Ovary ; Pelvis ; Recurrence

Malignant melanoma arising in the uterine endometrium is extremely rare. Only 12 cases of malignant melanoma of the uterine endometrium have been previously reported to date. All of them were metastatic cases. The most common presenting symptom was abnormal uterine bleeding. We report a case of primary malignant melanoma arising from the uterine endometrium. A 63-year-old multigravid woman presented with uterine bleeding. The pathologic review of an endometrial curettage specimen suggested an undifferentiated malignant tumor. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection were performed. Final pathologic examination revealed malignant melanoma. Immunohistochemical studies demonstrated reactivity of tumor cells for HMB-45 and S-100 protein. She had no previous history of malignancy. Whole body PET scan was performed in an effort to find the primary site of malignant melanoma and showed no demonstrable abnormal FDG uptake suggesting malignancy elsewhere. This case is the first report of primary malignant melanoma involving uterine endometrium in Korea.
Curettage ; Endometrial Neoplasms ; Endometrium* ; Female ; Humans ; Hysterectomy ; Korea ; Lymph Node Excision ; Melanoma* ; Middle Aged ; Positron-Emission Tomography ; S100 Proteins ; Uterine Hemorrhage

Spontaneous native aortic valvular thrombosis is an uncommon event that usually results from cardiac catheterization, bacterial endocarditis or a hypercoagulable state. We report here on a case of native valvular thrombus that was incidentally detected as masses that caused aortic stenoinsufficiency during routine follow-up, and the patient was without any of the previously described precipitating factors. The patient underwent aortic valvular surgery for removal of the aortic valvular mass. The pathological findings of the aortic valve showed organized valvular thrombus without evidence of any tumor.
Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Aortic Valve* ; Bicuspid* ; Cardiac Catheterization ; Cardiac Catheters ; Endocarditis, Bacterial ; Follow-Up Studies ; Humans ; Precipitating Factors ; Thrombosis*

Granulocytic sarcoma is an extramedullary tumor composed of immature cells of the granulocytic series known to occur in patients with myelodysplastic syndrome, chronic myeloid leukemia, or acute myeloid leukemia. and occasionally it has been presented without overt leukemia. Involvement of pancreas and kidney is relatively rare in granulocytic sarcoma. We present an extremely rare case of granulocytic sarcoma of pancreas and kidney in a 56-year-old male patient of acute myeloid leukemia presenting with obstructive jaundice due to a pancreatic mass and peri-lymphadenopathy consisting of myeloblast and review the literatures. It should be kept in mind that granulocytic sarcoma is a possible cause of obstructive jaundice in patient with acute myeloid leukemia.
Granulocyte Precursor Cells ; Humans ; Jaundice* ; Jaundice, Obstructive ; Kidney* ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid, Acute ; Male ; Middle Aged ; Myelodysplastic Syndromes ; Pancreas* ; Sarcoma, Myeloid*

PURPOSE: Recently established in 1997, Sungkyunkwan University School of Medicine was the first medical school in Korea to adopt problem-based learning (PBL) as a core curriculum from the very beginning. The purpose of this study was to evaluate the PBL curriculum from the viewpoint of the medical students. METHODS: This study used a qualitative approach to understand students' perceptions of the positive aspects of PBL. A total of 22 second-year medical students at Sungkynkwan medical school were surveyed. Student perceptions were obtained from questionnaires and face-to-face interviews. The interview was designed to evoke more personal and in-depth responses. RESULTS: Students' perceptions of the effects of PBL were found to be very favorable. Most students showed positive responses on the issues of more active learning attitude, self-directed learning, motivation to study, improved problem solving, and integrated learning. CONCLUSION: The results of this study demonstrated that the students had a good understanding of PBL and experienced its positive aspects of PBL approach. It might be concluded that PBL was successfully implemented into the curriculum and specific and expected effects of PBL accomplished.
Curriculum* ; Evaluation Studies as Topic* ; Humans ; Korea ; Learning ; Motivation ; Problem Solving ; Problem-Based Learning* ; Schools, Medical ; Students, Medical ; Surveys and Questionnaires

We investigated the effect by the chemical fixative on human fibroblast cells (HFCs) in order to make nano-scale images using by the atomic force microscopy (AFM). The cell fixation needed to be optimized as prerequisite step for the preparation before analysis. AFM imaging after optimal wet fixation can provide practical, simple and fast technique for scanning living cells. In this study, AFM images - topography and amplitude - and the optic images of HFCs which were fixed with phosphate buffered saline (PBS), 2:1 ethanol:acetic acid, 4% glutaraldehyde and 37% formaldehyde were compared respectively. The final effect by washing with PBS or distilled water (D.W.) was examined after 4% glutaraldehyde fixation. To determine the optimal fixation method for HFCs, we performed quantitative and qualitative analysis by the height profile, the presence of artifacts and the morphology of well-conserved fibroblastic topography image by AFM. From AFM image which showed fibroblastic cellular morphology and differential height value of cytoplasm (670+/-47 nm, n=10) and nucleus (847+/-32 nm, n=10) in HFCs, we proposed that wet fixation by 4% glutaraldehyde, followed by final washing with PBS, could be the most suitable preparation for AFM imaging of HFCs, which enable us to approach easily on living cells with the least shrinkage.
Artifacts ; Cytoplasm ; Fibroblasts ; Formaldehyde ; Glutaral ; Humans ; Microscopy, Atomic Force ; Water

OBJECTIVE: Juvenile rheumatoid arthritis (JRA) is classified as polyarticular, oligoarticular, and systemic onset type by clinical symptoms presented during first six months. This study was performed to investigate the clinical features and course of systemic onset JRA. METHODS: We performed a retrospective study for patients who were diagnosed as JRA between March 2000 and March 2006 according to the JRA criteria of the International League of Association for Rheumatology (ILAR). RESULTS: Of the 216 JRA patients, 33 patients (11 male/ 22 female) were systemic onset type. Because of insufficient data, 6 patients were excluded. Chief complaints at the time of diagnosis were fever (81.5%) and arthralgia (77.7%). During the disease course, all patients manifested fever and arthritis, rash (59.2%) and splenomegaly (22.2%) also occurred. Most patients had symmetric (81.5%) arthritis, and involved more than five joints (59.3%) including knee and wrist. Anemia, leukocytosis, and thrombocytosis were common laboratory abnormalities. Almost all patients had elevated level of C-reactive protein and erythrocyte sediment rate. Some patients had positive results about immunologic marker such as rheumatoid factor (3.8%), antinuclear antibody (57.7%), and antiperinuclear factor (9.5%). Therapeutic regimens included glucocorticoids (88.9%), nonsteroidal anti-inflammatory drugs (81.5%), methotrexate (81.5%), and hydroxychloroquine (55.6%). Biologic agents were applied in 5 patients, and 3 showed improvement of disease activity. Combination therapy was introduced in 18.5% of patients, and 63% of patients still required medications. CONCLUSION: In Korea, systemic onset JRA patients had variable clinical manifestations and chronic course of disease, which often extended into adulthood.
Anemia ; Antibodies, Antinuclear ; Arthralgia ; Arthritis ; Arthritis, Juvenile* ; Biological Factors ; Biomarkers ; C-Reactive Protein ; Diagnosis ; Erythrocytes ; Exanthema ; Fever ; Glucocorticoids ; Humans ; Hydroxychloroquine ; Joints ; Knee ; Korea ; Leukocytosis ; Methotrexate ; Retrospective Studies ; Rheumatoid Factor ; Rheumatology ; Splenomegaly ; Thrombocytosis ; Wrist

INTRODUCTIONWith the increase in the patient survival rates of many types of cancers, a greater proportion of cancer patients live with disease-related problems that diminish their quality of life. This study aimed to investigate the clinical characteristics and rehabilitation of hospitalised cancer patients who were referred to the Department of Physical and Rehabilitation Medicine (PRM) at Samsung Medical Center, a tertiary university hospital in Seoul, Korea.

METHODSHospitalised cancer patients aged > 18 years who were referred to the Department of PRM from January to December 2012 were enrolled in this retrospective study. We reviewed the clinical characteristics of the patients, the principal reasons for their referral and relevant details of their rehabilitative management.

RESULTSA total of 1,340 cases were included. The most common primary cancer was lung cancer (19.0%) and 28.6% of the cases had solid organ metastasis. The most common reason for referral was deconditioning (31.7%), followed by weakness (23.1%) and respiratory problems (14.5%). Bedside exercise was prescribed to 28.4% of the patients, exercise in the rehabilitation therapy unit to 28.0% and pulmonary rehabilitation to 14.3%. Among the 1,340 cases, 107 (8.0%) were transferred to the Department of PRM for comprehensive rehabilitation. The 32 patients with an identifiable Modified Barthel Index score showed significant functional improvement.

CONCLUSIONThe findings of the present study contribute to a better understanding of rehabilitation for hospitalised cancer patients. The information obtained will also be helpful in the development of appropriate cancer rehabilitation strategies.