PURPOSE: The present study was designed to understand the conceptual definition and attributes of the clinical critical thinking ability(CCTA) in nursing and to grasp the characteristics of clinical critical thinking abilities. METHODS: The data were analyzed using the Hybrid model of Schwartz-Barcott and Kim(2000). RESULTS: Having the skills and dispositions to think critically, CCTA refers to something that implies the cognizant ability to interpret contextual meanings, analyze the relationships between materials or circumstances, draw out the best conclusions, predict things using relevant information and evaluate the reliability of information and the strength of inference on the one hand and the emphatic disposition to be curious, open-minded, intellectually integral, systematic and creative and to reflect on things in contextual terms on the other. CONCLUSION: CCTA is characterized by clinical circumstances, such as guessing the reasons for facts, predicting things, connecting theory to practice and approaching individual situation in total terms as well as by the Korean circumstances, such as taking another person's perspective. Hence, this study proposes developing the tools to measure the clinical critical thinking ability and the strategies to improve the clinical critical thinking ability and seeking to verify their validity, on the basis of the findings.
Chimera ; Clinical Competence ; Concept Formation ; Hand ; Hand Strength ; Problem Solving ; Thinking

PURPOSE: This study investigated the relationship between height and psychopathology in community children with relatively short stature according to the parents' reports. Also, the matter of parental concern about child's height was explored. METHODS: The child behavior checklist (CBCL), the Brief Encounter Psychosocial Instrument (BEPSI), and the child-health questionnaire-parent form 50 (CHQ-PF50) were administered to 423 parents (from elementary and middle school children's) in Gangnam, South Korea. Subjects were divided into three groups; (1) relatively short (n=30), (2) average stature (n=131), (3) relatively tall (n=153). CBCL, BEPSI, and CHQ-PF50 scores were compared among three groups. RESULTS: There were no significant differences in psychosocial burden associated with relatively short stature measured by Korean version of the BEPSI and Korean version of the CBCL scores among three groups. But general health perception score of relatively short was significantly lower than that of nonshort on the CHQ-PF50. Also, they were more used complementary medicines, milk and growth hormone compared to the nonshort. The parents' expected height of their children was 180.6+/-3.5 cm for boys and 166.7+/-3.5 cm for girls. This is respectively 90 percentile and 75-90 percentile for the Korean standard adult height. CONCLUSION: Our study shows that in Korea, Parents tended to regard relatively short children as having health problems. Also, the parental expectation for their child's attainable height is unrealistically tall, mostly due to lack of correct medical information.
Adult ; Checklist ; Child Behavior ; Child* ; Female ; Growth Hormone ; Humans ; Korea ; Milk ; Parents ; Psychopathology*

BACKGROUND: The central physiological derangement of hemorrhagic fever with renal syndrome (HFRS) caused by hantaan virus (HTNV) is a vascular dysfunction, manifested by hemorrhage, impaired vascular tone and increased vascular permeability. Platelet activating factor (PAF), whose actions are mediated through a specific receptor, is a potent bioactive lipid. PAF has diverse biological functions in the vascular system, such as increasing vascular permeability, adhesion of leukocytes to the endothelium and reduction of cardiac output, which result in hypotension and shock. The goal of the present study was to investigate whether PAF is involved in the pathogenesis of HFRS. For this purpose, we evaluated the effect of HTNV on the expression of PAF receptor (PAF-R) and on the activity of PAF-acetylhydrolase (PAF-AH) instead of PAF because PAF is rapidly degraded by PAF-AH in vivo. MATERIALS AND METHODS: To evaluate the expression of PAF-R, we performed reverse-transcription PCR, western blot and FACS analyses using HTNV-infected human umbilical vein endothelial cells (HUVECs) and non-infected (control) HUVECs. In addition, we measured the activity of plasma PAF-AH in HFRS patients and normal healthy persons. RESULTS: The mRNA and protein expression of PAF-R was increased in HTNV-infected HUVECs compared with control HUVECs at 2 and 3 days post-infection (d.p.i.). FACS analysis showed that HTNV induced the surface expression of PAF-R in HUVECs from 2 d.p.i. The activity of plasma PAF-AH was 2.5-fold lower in HFRS patients than in normal healthy persons. CONCLUSION: Increased PAF-R expression by HTNV might increase the responsiveness to PAF in endothelial cells. Reduced PAF-AH activity in the blood of HFRS patients might delay PAF degradation. These results suggest that changes in PAF-R and PAF-AH by HTNV might influence to PAF activity and might be involved in the vascular dysfunction of HFRS.
Blood Platelets ; Blotting, Western ; Capillary Permeability ; Cardiac Output ; Endothelial Cells ; Endothelium ; Hantaan virus ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome ; Human Umbilical Vein Endothelial Cells ; Humans ; Hypotension ; Leukocytes ; Plasma ; Platelet Activating Factor ; Platelet Membrane Glycoproteins ; Polymerase Chain Reaction ; Receptors, G-Protein-Coupled ; RNA, Messenger ; Shock

PURPOSE: The purposes of this study were to examine the level of anger, anger expression, depression, psychosomatic symptom and perceived health status, and to identify the influencing factors of anger expression in shelter residents. METHODS: This study employed a descriptive correlational design. Data were collected from 407 homeless people residing at 27 shelters using structured instruments. RESULTS: The level of anger expression was different by age, educational level, existence of children, and duration of shelter residency. Anger expression was significantly correlated with depression, psychosomatic symptoms and perceived health status. The predictors of high-level anger expression was younger age, low educational level, duration of shelter residency in Model 1 (F=6.884, p<.001, Adj. R2=.065), and depression and psychosomatic symptoms in Model 2 (F=7.197, p<.001, Adj. R2=.113). CONCLUSION: This study suggested that the homeless in the shelters had various psychological vulnerabilities, and therefore more individualized programs based on their needs and psychological health status should be provided for the homeless.
Anger* ; Child ; Depression ; Homeless Persons ; Humans ; Internship and Residency

OBJECTIVE: To study the relationship between plantar pressure and diabetic foot ulcer and the assessment the usefulness of plantar pressure measurement in diabetic patients. METHOD: The total 94 diabetic patients were enrolled in this study. The plantar pressure was measured by using EMED-SF. And the nerve conduction studies, physical examination, and history taking were done. Patients were divided into 3 subgroups, Group A: without neuropathy and past ulcer history (n=31), Group B: with neuropathy and without past ulcer history (n=44), Group C: with neuropathy and past ulcer history (n=19). RESULTS: 1) There were significant increase in the maximum peak pressure (MPP) and the pressure-time integral (PTI) values in the Group C as compared with the Group A and B (p<0.05). 2) As compared among the groups for each areas, the MPP and the PTI significantly higher in group C for heel, medial fore-foot, and lateral fore-foot area than in another two groups (p<0.05). CONCLUSION: The high plantar pressure was significantly related with diabetic foot ulcer history. The plantar pressure measurement may be useful in diabetic patients as a predictive and management aids of diabetic foot ulcer.
Diabetes Mellitus ; Diabetic Foot ; Heel ; Humans ; Neural Conduction ; Physical Examination ; Ulcer

Various cancer types have been associated with cancer-related cerebral infarction. In this study, we describe the first case of cancer-related cerebral infarction in which the underlying disease was primary bone marrow lymphoma (PBML). A 79-year-old man presented with abruptly developed bilateral lower extremity weakness and confusion. Diffusion-weighted imaging on admission showed multiple cortical and subcortical embolic infarction lesions in multiple vascular territories. Diagnostic evaluations to determine the embolic source revealed no abnormalities. Laboratory testing demonstrated elevated D-dimer (2.59 μg/mL) but no other prothrombotic abnormalities. In suspicion of cancer-related stroke, we performed chest CT, abdomen CT, and FDG-PET to detect the hidden malignancy. Findings revealed no evidence of cancer; however, they did reveal signs of anemia (hemoglobin 9.0 g/dL). Bone marrow aspiration biopsy showed large atypical B cell involvement suggestive of high-grade B cell lymphoma. The patient was diagnosed with primary bone marrow diffuse large B-cell lymphoma initially presenting with ischemic stroke. Our case suggests that primary bone marrow cancer may be a candidate for the differential diagnosis of hidden malignancy in patients with suspected cancer-related stroke. Bone marrow biopsy may be essential for establishing an appropriate differential diagnosis in patients with abnormal hematologic findings.

PURPOSE: The purpose of this study was to develop an e-Learning program about medication for nurses to enhance nurses' medication performance ability and to analyze learners' responses after studying with this program. METHOD: For the development of the e-Learning program, the NBISD(Network Based Instructional Systems Design) model, suggested by Jung(1999) was applied as a basic model and the instruction design theory of Gagne & Briggs(1979) and ARCS theory of Keller(1983) were applied. After the operation of this program for one month to 34 new nurses, learners' responses were analyzed. RESULT: Learners' knowledge of medication was greatly improved after this program. In addition learners' satisfaction with the overall education program, help in field applicability, ease of screen shift and exploration, and tutor activities were high and the contents were regarded suitable for e-Learning. Many things were advantageous such as easy accessibility, easy understandability with pictures and flash animation, practical cases and feedback from a tutor. Provision of a supplementary handout and improvement of a tight time schedule were pointed out as things to be improved. CONCLUSION: This e-Learning program can be used effectively for medication education for registered nurses, student nurses, and new nurses.
*Pharmaceutical Preparations ; *Internet ; Humans ; Female ; *Education, Nursing ; *Computer-Assisted Instruction ; Adult

Celiac plexus neurolysis is performed to relieve intractable upper abdominal pain. Since Kappis had performed splanchnic nerve block in 1919, many methods and its modifications of celiac plexus block have been introduced. In 1983, Ischia and in 1990, Lieberman has introduced the transaortic technique of celiac plexus block. We employed a transaortic approach with some modification of the original method in 12 patients, in which a single needle was advanced from a left posterior paramedian approach through the aorta to deposit the drug directly onto the celiac plexus. After needle has punctured anterior wall of aorta, 50% alcohol 20ml was injected and after retracting the needle to the posterior wall of aorta, also 50% alcohol 20ml was injected. 11 patients experienced marked pain relief and no major complication was encountered. The authors think that our method has some theoretical benefits in effectiveness than the original transaortic method.
Abdominal Pain ; Aorta ; Celiac Plexus* ; Humans ; Needles* ; Splanchnic Nerves

Syringoid eccrine carcinoma (SEC) is a rare cutaneous malignant tumor thought to be derived from eccrine sweat glands. It is usually present in the scalp and face and often occurs in the fourth to seventh decades of life. A 76-year-old female patient visited our department with a 3-year history of a lesion showing a 5×4 cm-sized erythematous firm plaque with ulceration on her right shoulder. Histological findings revealed a tumor consisting of numerous proliferating tubular structures with two layers of basaloid cells with cellular atypia. Some ductal structures showed a tadpole appearance. Based on these findings, the final diagnosis was SEC. The patient was treated with slow Mohs micrographic surgery and a full-thickness skin graft and did not show any recurrence during the follow-up period of 6 months. Herein, we report a very rare case of a 76-year-old woman diagnosed with SEC that developed on the right shoulder.

Vulvar melanosis (VM) is clinically characterized by asymmetric macules or patches of varying size with a tan to black color and irregular borders. VM is more commonly found among perimenopausal women with a median age of 42 years. The exact pathogenesis of VM is not well understood. The proposed etiological factors for VM include oral contraceptive use, infection with human papillomavirus, and chronic inflammatory skin diseases such as lichen sclerosus et atrophicus. Histologic examination can easily differentiate mucosal lentiginosis from melanoma, but VM superimposed on a background of anogenital lichen sclerosus, both clinically and histologically, may mimic malignant melanoma. There have been two cases of VM associated with Dowling-Degos disease in the Korean dermatologic literature. To the best of our knowledge, this is the first case of VM associated with lichen sclerosus et atrophicus in the Korean dermatologic literature.