PURPOSE: This descriptive study attempted to identify the influence of internal marketing perception, empowerment, and job satisfaction on customer orientation of clinical nurses. METHODS: The subjects were 411 nurses with over one year working experience in a university hospital, located in I-city. The data were collected from April 20 to 30, 2012. using a self-report questionnaire. The data were analyzed using hierarchical multiple regression with the SPSS/WIN 17.0 program. RESULTS: There were significant differences in customer orientation depending on general characteristics(age, marital status, education, position, clinical experience, and department). Internal marketing perception, empowerment, and job satisfaction correlated with customer orientation. As the results of hierarchical multiple regression analysis for impact factors on nurses' customer orientation show, factors are the outpatient department in working places(beta=.10), education and training in internal marketing perception(beta=.12) and empowerment(beta=.44), which accounted for 31.1% of customer orientation. CONCLUSION: Therefore, nurse managers should identify the needs to perceive nurses as internal customers, and the internal marketing strategy should be performed to empower nurses. Also, it is needed to place nurses with high customer orientation at the outpatient department.
Humans ; Hypogonadism ; Job Satisfaction ; Marital Status ; Marketing ; Mitochondrial Diseases ; Nurse Administrators ; Ophthalmoplegia ; Orientation ; Outpatients ; Power (Psychology) ; Surveys and Questionnaires

With an increasing trend toward low birth rates and premature births, the importance of managing the health of high-risk infants has received constant emphasis. It is necessary to establish a family-centered care culture in neonatal intensive care units where high-risk infants are hospitalized. This study is intended to examine the current status of family-centered care and the direction of the role played by healthcare professionals, focusing on the characteristics of high-risk infants and their families. Healthcare professionals should listen to the needs of the family and facilitate their involvement to improve the performance of family-centered care and systematic support. Specific guidelines are required to strengthen the competence and leadership of healthcare professionals. The paradigm shift toward family-centered care for high-risk infants is a challenge for healthcare professionals and parents, but it will serve as a vision and strategy to improve the health of high-risk infants and their families by including the family in the healthcare process.

We report a 57-year-old man with bilateral cranial nerve IX and X palsies who presented with severe dysphagia. After a mild head injury, the patient complained of difficult swallowing. Physical examination revealed normal tongue motion and no uvular deviation. Cervical X-ray findings were negative, but a brain computed tomography revealed a skull fracture involving bilateral jugular foramen. Laryngoscopy indicated bilateral vocal cord palsy. In a videofluoroscopic swallowing study, food residue remained in the vallecula and pyriform sinus, and there was reduced motion of the pharynx and larynx. Electromyography confirmed bilateral superior and recurrent laryngeal neuropathy.
Brain ; Brain Injuries* ; Cranial Nerve Diseases ; Craniocerebral Trauma ; Deglutition ; Deglutition Disorders ; Electromyography ; Glossopharyngeal Nerve ; Humans ; Laryngoscopy ; Larynx ; Middle Aged ; Paralysis* ; Pharynx ; Physical Examination ; Pyriform Sinus ; Skull Fracture, Basilar ; Skull Fractures ; Tongue ; Vocal Cord Paralysis

PURPOSE: This study was done to investigate the relationship of family function, self-esteem, life satisfaction, and general characteristics to loneliness in community dwelling Korean elders and identify factors affecting loneliness. METHOD: With a cross-sectional causal-relationship design and a convenience sample, 205 elders residing in three districts of the city of Seoul, S. Korea were recruited. Participants were assessed using the Family APGAR Score, Self-Esteem Scale, Life-Satisfaction Scale, and Revised UCLA Loneliness Scale. RESULTS: The mean score for degree of loneliness (Mean=39.61, SD=10.09) was just below the mean for the scale (Possible range 20-80). Loneliness had significant negative correlations with family function (r= -.400, p<.001), self-esteem (r= -.399, p<.001), and life satisfaction (r= -.644, p<.001). Other general characteristics that had significant or nearly significant relationships with loneliness were perceived current financial and health status, whether doing any exercise or physical activities, degree of close relationship with family members, and length of living in current residence. Among variables, life satisfaction (Standardized beta = -.589, p<.001) and length of living in current residence (Standardized beta = -.136, p<.05) significantly predicted degree of loneliness. CONCLUSION: Findings of this study allow a comprehensive understanding of loneliness and related factors among community dwelling elders in Korea. However, further studies with a larger random sample from various living environments are necessary.
Apgar Score ; Humans ; Korea ; Loneliness* ; Motor Activity ; Seoul

BACKGROUND: An oral glucose tolerance test (OGTT) is the current method used for screening and diagnosis of gestational diabetes mellitus (GDM). OGTT is a relatively complicated procedure and is expensive. Thus, new strategies that do not require fasting or more than a single blood draw may improve the diagnosis of GDM and increase the rate of GDM testing. We investigated the utility of monitoring glycosylated hemoglobin (HbA1c) levels for the diagnosis of GDM. METHODS: The data from 992 pregnant women with estimated gestational ages ranging from 24 to 28 weeks were retrospectively reviewed. There were 367 women with plasma glucose levels > or =140 mg/dL 1 hour after a 50-g OGTT. GDM was diagnosed according to the Carpenter-Coustan criteria for a 3-hour 100 g OGTT. A HbA1c assessment was performed at the same time. RESULTS: We enrolled 343 women in this study, and there were 109 women with GDM. The area under the curve the receiver operating characteristic curve for HbA1c detection of GDM was 0.852 (95% confidence interval, 0.808 to 0.897). A HbA1c cutoff value > or =5.35% had maximal points on the Youden index (0.581). The sensitivity was 87.2% and the specificity was 70.9% for diagnosing GDM. A threshold value > or =5.35% indicated that 163 patients had GDM and that 68 (41.7%) were false positive. The positive predictive value was 58.3% at this threshold value. CONCLUSION: Despite substantial progress in methodology, HbA1c values cannot replace OGTT for the diagnosis of GDM.
Blood Glucose ; Diabetes, Gestational* ; Diagnosis* ; Fasting ; Female ; Gestational Age ; Glucose Tolerance Test ; Hemoglobin A, Glycosylated* ; Humans ; Mass Screening ; Pregnancy ; Pregnant Women ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

Chondrosarcomas are malignant tumors of cartilage that rarely involve the sinonasal region, and myxoid chondrosarcoma is a rare histologic variant of chondrosarcoma that usually occurs in the soft tissue of extremities. Although several case reports and results of small series of chondrosarcomas in the sinonasal region in children are available, myxoid type chondrosarcoma is extremely rare. We recently experienced a case of low grade myxoid chondrosarcoma involving the sinonasal cavity in a 10-year-old boy, and here we report its radiologic-pathologic findings. In this case, chondroid calcification on CT and septal and marginal enhancement on MRI suggested a chondrosarcoma. Whole body PET-CT demonstrated no definite metastatic lesion and a low peak standardized uptake value primary tumor. However, no definite distinguishing imaging features were observed that distinguished low grade myxoid chondrosarcoma from conventional chondrosarcoma.
Bone Neoplasms/*diagnosis/radiotherapy/surgery ; Child ; Chondrosarcoma/*diagnosis/radiotherapy/surgery ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Myxosarcoma/*diagnosis/radiotherapy/surgery ; Nasal Cavity/*pathology/*radiography/surgery ; Paranasal Sinuses/*pathology/*radiography/surgery ; Positron-Emission Tomography ; Rare Diseases ; Tomography, X-Ray Computed ; Whole Body Imaging

BACKGROUND AND OBJECTIVES: According to the neurophysiologic model of tinnitus, emotion and autonomic nervous systems are closely related to generation of tinnitus. We performed this study to evaluate the treatment response of modified tinnitus retraining therapy (TRT) with medication in the patients with sensorineural tinnitus. SUBJECTS AND METHOD: Forty-three tinnitus patients who were diagnosed as sensorineural tinnitus through audiologic evaluation and have normal hearing in speech frequency were included in this study. Tinnitus and psychological status were measured by tinnitus questionnaire, Korean version of Brief Encounter Psychosocial Instrument (BEPSI) scale, Beck Depression Inventory (BDI), Spielberger State Trait Anxiety Inventory (STAI). Patients treated with anxiolytics and microcirculation enhancer were Group 1 and those treated with modified TRT and medications were Group 2. Short-term therapeutic response was analyzed and compared between two groups. RESULTS: Loudness, awareness, annoyance and effect on life of tinnitus and tinnitus handicap score were significantly decreased in Group 2. Relief of tinnitus in more than 2 of 4 subjective parameters was achieved in 4 patients (30.7%) in Group 1 and 15 patients (75%) in Group 2. Stress score was also decreased significantly after treatment in Group 2. CONCLUSION: Tinnitus patients in Group 2 treated with medication and modified TRT showed the higher compliance and the response rate of treatment than the patients in Group 1 treated with medication alone. Modified TRT, in addition to medical therapy, should be considered to increase the therapeutic response in patients with sensorineural tinnitus.
Anti-Anxiety Agents ; Anxiety ; Autonomic Nervous System ; Compliance ; Depression ; Hearing ; Humans ; Microcirculation ; Surveys and Questionnaires ; Tinnitus

PURPOSE: The incidence of axillary lymph node metatasis in patients with T1 breast carcinoma has been reported by incidence of 6-31%. Axillary node involvement is the single most prognostic factor and a guideline for adjuvant treatment. But the necessity of routine axillary dissection for staging is recently been questioned. We studied to investigate the possibility of using clinicopathologic characteristics to predict axillary node status of T1 breast carcinoma sparing routine axillary dissection. MATERIALS AND METHODS: Five hundreds fourteen patients with T1 breast cancer whose pathological diagnosis were invasive ductal carcinoma NOS, were elligible for this study. All patients underwent axillary dissection by modified radical mastectomy or conservative surgery in the period between Jan. 1990 and Dec. 1998 at department of surgery, Seoul National University Hospital. The clinicopathologic characteristics of primary tumor include age (35>, < or =35), tumour size, unclear grade, histologic grade, hormone receptor status, lymphatic vessel invasion (LVI), and various tumor markers (p53, cerbB2, cathepsinD, bcl-2, and ki67) were evaluated according to lymph node status. RESULTS: Frequency of axillary lymph node matastases in T1 invasive ductal carcinomas was 34% of 514 patients. In about 78% of patients, the size of primary tumors was over 1cm. And the mean number of metastatic lymph node was 3.7. Age35 or less and lymphatic analysis (p=0.004, p<0.001). However, in mulivariate analysis, lymphatic vessel invasion was the only significant predictor for lymph node metastases. CONCLUSIONS: Lymphatic vessel invasion was the only significant predictor for lymph node metastases in T1 invasive breast cacinoma. There is sill limitations to advocate sparing axillary lymph node dissection because of insufficient predictors for axillary lymph node metastases and relatively high incidence of lymph node metastases. New prognostic indicators must be investigated for predicting axillary lymph node status.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Diagnosis ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Vessels ; Mastectomy, Modified Radical ; Neoplasm Metastasis* ; Seoul ; Biomarkers, Tumor

PURPOSE: The detection of axillary lymph-node micrometastases (ALNM) in breast cancer by using the reverse transcriptase-polymerase chain reaction (RT-PCR) may provide a good guide for postoperative therapy. Expression of the mammaglobin gene has been noted to be restricted to the mammary gland, and the gene is present at higher levels in breast tumors than in nonmalignant breast tissues. Based on its breast specific pattern of expression, we studied its predictive value for detecting ALNM in breast cancer. METHODS: RT-PCR amplifications of mammaglobin and keratin- 19 were done on 39 lymph nodes collected from 39 breast cancer patients, 25 pathologically node-positive cases and 14 node-negative cases by using H&E staining; then a comparison between both gene expressions of lymph nodes according with the pathological report was done. RESULTS: In the 25 pathologically positive cases, mammaglobin and keratin-19 expressions were positive in 22 cases (88.0%) and 23 cases (92.0%), each. In the 14 pathologically negative cases, mammaglobin and keratin-19 expressions were positive in 5 cases (35.7%) and 7 cases (50%), each. The concordance rate between mammaglobin expression and H&E staining, between keratin-19 and H&E staining, and between mammaglobin expression and keratin-19 expression were 79.5%, 76.9%, and 82.1%, each. In pathologically negative cases, mammaglobin expression was related to larger size (p=0.034), poor nuclear grade (p=0.027) and histologic grade (p=0.077) of primary tumor. CONCLUSION: From the fact that mammaglobin expression is confined to only breast tissues and from the results that the concordance rate between mammaglobin expression and H&E staining is the same as that between keratin-19 and H&E staining, mammaglobin can be used as a marker of breast-cancer ALNM.
Breast Neoplasms* ; Breast* ; Gene Expression ; Humans ; Keratin-19 ; Lymph Nodes* ; Mammary Glands, Human ; Neoplasm Micrometastasis* ; RNA, Messenger*

PURPOSE: The detection of axillary lymph-node micrometastases in breast-cancer patients by using the reverse transcriptase-polymerase chain reaction (RT-PCR) may provide a good guide for postoperative therapy. To evaluate effectiveness of RT-PCR for the detection of micrometastasis, we have compared the results of conventional, immunohistochemical (IHC) staining with those of RT-PCR. Breast cancer, Lymph node micrometastases, MUC1, Cytokeratin 19, RT-PCR ] METHODS: We conducted RT-PCR amplifications of MUC1 and cytokeratin (CK) 19 on lymph nodes from 40 breast- cancer patients and conducted IHC staining for cytokeratin. The results of histological examination and cytokeratin IHC staining were compared with the RT-PCR results for the detection of lymph-node micrometastases. RESULTS: Nineteen of 40 cases (47.5%) were lymph-node positive and twenty-one cases (52.5%) were lymph-node negative. Using RT-PCR MUC1 and CK19 expressions were detected in all positive lymph nodes and in 4 (19.0%) and 5 (23.8%), in negative nodes, respectively. Not all positive nodes were stained by IHC (94.7%), and none of the negative lymph nodes were stained by IHC. Thus, IHC staining was ineffective in detecting micrometastases. CONCLUSION: Detection of MUC1 and CK19 by using RT- PCR can be a more accurate and useful method than IHC staining for the detection of axillary lymph-node micrometastases in breast cancer.
Breast Neoplasms* ; Breast* ; Humans ; Keratin-19* ; Keratins* ; Lymph Nodes* ; Neoplasm Micrometastasis* ; Polymerase Chain Reaction