PURPOSE: This study is aimed to analyze and clarify the ambiguous concept of insight. METHOD: This study used the process of Walker & Avant's concept analysis. RESULTS: Insight can be defined in terms of its attributes as follows: Insight 1) comes as a release to the tension of inquiry, (2) is the outcome of the process to discover the overall structure of the problem situation and psychologically restructurize it, (3) comes suddenly and unexpectedly, (4) is to clearly perceive the solution of the abstract problem, and (5) promotes obtaining another new insight. The antecedents of insight include inquiry that can not be resolved easily and also a state where basic knowledge related to the inquiry can be utilized. The consequence of the insight is (1) a new judgement is made, (2) the problem is solved, (3) previous insight is retained and transferred, and it also facilitates the generation of fresh insight, and (4) it passes into the habitual texture of one's mind. CONCLUSION: Nurse educators need to facilitate nursing students and nurses to accumulate systematically, various information that can become the basis of insight and provide them with an opportunity to experience a variety of problems. In addition, it is important to provide questions to learners as an education strategy to allow them to gain insight into problem solving. From now on, insight needs to be studied in conjunction with critical thinking and questioning in order to enhance nurses' ability to resolve problems.
*Decision Making ; Education, Nursing ; Humans ; *Self Concept

OBJECTIVE: Splenectomy has been proposed to be the standard therapy for patients with steroid refractory immune thrombocytopenic purpura (ITP). This study aimed to describe valuable factors predicting the effect of splenectomy in patients with ITP. METHODS: A total of 51 adult patients who underwent splenectomy for steroid refractory ITP were evaluated their medical records retrospectively. The response to the treatment was classified on the basis of the platelet count. RESULTS: The responding group included 35 patients (68.8%), the partial-responding group included 4 patients (7.8%), and non-responding group was 12 patients (23.5%). On univariate analysis, the response of splenectomy correlated with only the intravenous immune globulin (IVIG) response (66.7%, P=0.006), but hemolysis, autoantibody, a presence of accessory spleen, the response of steroid were not significantly associated with the effect of splenectomy. On multivariate analysis, the response of IVIG and the amount of platelet transfusion were independent variables of the response of splenectomy. CONCLUSION: Patients with ITP who have good responses to IVIG are likely to have a good or favorable responses to splenectomy.
Adult ; Hemolysis ; Humans ; Immunoglobulins, Intravenous ; Medical Records ; Multivariate Analysis ; Platelet Count ; Platelet Transfusion ; Purpura* ; Purpura, Thrombocytopenic, Idiopathic ; Retrospective Studies ; Spleen ; Splenectomy* ; Thrombocytopenia*

Relapsing polychondritis is a rare autoimmune disease involving the cartilaginous structures of the whole body. Its diagnosis can be difficult when the typical clinical features such as auricular chondritis are absent. Here, we report on a case of a 51-year-old female who presented with cough, dyspnea, and polyarthritis. Chest computed tomography showed the diffuse involvement of tracheobronchial cartilage. According to Damiani's criteria, she was diagnosed as relapsing polychondritis even though there was no unique involvement of auricular cartilage, and high dose steroid and immunosuppressive therapy were then started. This case indicated that patients who have tracheobronchial cartilage involvement without definite auricular chondritis should be considered for relapsing polychondritis as a differential diagnosis.
Arthritis ; Autoimmune Diseases ; Cartilage ; Cough ; Diagnosis ; Diagnosis, Differential ; Dyspnea ; Ear Cartilage ; Female ; Humans ; Middle Aged ; Polychondritis, Relapsing* ; Thorax

OBJECTIVE: This cross-sectional study aimed to investigate the association between rheumatoid factor (RF) positivity and bone mineral density (BMD) in male Korean subjects without any history of joint disease. METHODS: Of 84,344 males who had undergone a comprehensive health checkup program in 2012, 1,390 male health examinees were recruited, whose BMD and RF results were available. A RF titer ≥20 IU/mL was considered positive. BMD was measured at lumbar spine (L1~L4) or hip (femoral neck and total hip) by dual-energy X-ray absorptiometry. RESULTS: The association between RF positivity and BMD was assessed by multiple linear regression analysis. The mean age was 52.7±10.9 years (range 19~88 years), and RF was detected in 64 subjects (4.6%). Demographics and laboratory data were not different between RF-positive and -negative subjects except hepatitis B surface antigen (HBsAg), which was more frequently seen in RF-positive subjects (15.6% vs. 4.3%, p=0.001). RF-positive subjects had significantly lower BMD compared to RF-negative subjects in lumbar spine but not in total hip regardless of the existence of HBsAg (1.17±0.16 g/cm2 vs. 1.10±0.18 g/cm2, p=0.002 in total subjects; 1.17±0.16 g/cm2 vs. 1.10±0.18 g/cm2, p=0.004 in HBsAg-negative subjects). After adjusting for multiple confounders, RF positivity was negatively associated with lumbar spine BMD (B=−0.088 and standard error=0.035, p=0.011). CONCLUSION: Our results show that the presence of RF could have an unfavorable impact on bone density in apparently normal males. Additional studies to elucidate the osteoimmunological mechanism of rheumatoid factor are warranted.
Absorptiometry, Photon ; Arthritis* ; Bone Density ; Cross-Sectional Studies ; Demography ; Hepatitis B Surface Antigens ; Hip ; Humans ; Joint Diseases ; Linear Models ; Male* ; Men's Health ; Neck ; Rheumatoid Factor* ; Spine

OBJECTIVES: We aimed to identify the neuroimaging marker for prediction of the use of atypical antipsychotics (AAP) in dementia patients. METHODS: From April 2010 to March 2013, 31 patients who were diagnosed as dementia at the psychiatric department of Soonchunhyang University Hospital, completed the brain magnetic resonance imaging scan and cognitive test for dementia. Ten patients were treated with AAP for the improvement of behavioral and psychological symptoms of dementia (BPSD) and the other 21patients were not. Using T1 weighted and Fluid Attenuated Inversion Recovery (FLAIR) images of brain, areas of white matter (WM), gray matter (GM), cerebrospinal fluid (CSF) and white matter hyperintensities (WMH) have been segmented and measured. Multivariate logistic regression models were applied for assessment of association between AAP use and the GM/WM ratio, the WMH/whole brain (GM + WM + CSF) ratio. RESULTS: There was a significant association between AAP use and the GM/WM ratio (odds ratio, OR = 1.18, 95% confidence interval, CI 1.01-1.38, p = 0.037), while there was no association between AAP use and the WMH/whole brain ratio (OR = 0.82, 95% CI 0.27-2.48, p = 0.73). CONCLUSIONS: The GM/WM ratio could be a biological marker for the prediction of AAP use and BPSD in patients with dementia. It was more likely to increase as dementia progress since atrophy of WM was more prominent than that of GM over aging.
Aging ; Antipsychotic Agents* ; Atrophy ; Biomarkers ; Brain* ; Cerebrospinal Fluid ; Dementia* ; Humans ; Logistic Models ; Magnetic Resonance Imaging* ; Neuroimaging

No abstract available.
Cardiovascular Diseases

A 7-year-old spayed female Shih Tzu dog was presented for evaluation of recurrent hypoglycemia. Serum insulin levels during hypoglycemia were 35.3 μIU/mL. Ultrasonography and computed tomography showed a mesenteric nodule between the kidney and the portal vein, but no pancreatic mass was observed. During surgery, the nodule had neither anatomical adhesions nor vascular connections to the pancreas. Pancreatic inspection and palpation revealed no abnormalities. Hypoglycemia improved after resection of the nodule.Histopathological examination confirmed the nodule to be an islet cell carcinoma. Although extremely rare, ectopic insulinoma should be considered as a possible cause of insulininduced hypoglycemia in dogs.

Pneumocystis pneumonia (PCP) is a rare disease in healthy people but a potentiallyfatal opportunistic infection by Pneumocystis jirovecii in immunocompromisedpatients with organ transplantation. We present three cases of PCP after kidneytransplantation in pediatric patients. First case was a 4-year-old boy diagnosedwith Denys-Drash syndrome and received living-donor kidney transplantationfrom his mother at age of 1. Second case was a 19-year-old male, with polycystickidney disease, who received kidney transplantation from his mother at the age of18. Third case was a 19-year-old female with chronic kidney disease of unknownetiology, who received kidney transplantation from her father at age of 15. Thesethree patients who were on immunosuppressive therapy and completed ofroutine PCP prophylaxis for 6 months had presented with cough and dyspneamore than 1 year after transplantation. Chest x-ray all showed diffuse haziness ofboth lung fields, and bronchoalveolar lavage from bronchoscopy revealed Pneumocystisjirovecii infection. All patients showed clinical resolution with intravenoustrimethoprim-sulfamethoxazole (TMP-SMX) therapy for at least 3 weeks and hadcontinued secondary prophylaxis for another 6–12 months. This report suggeststhat clinicians should have suspicion for the possibilities of opportunistic infectionsuch as PCP after kidney transplantation in children.

The association between lung injury and exposure to humidifier disinfectant (HD) containing a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) has been controversial in South Korea. This study conducts a literature review in order to evaluate the likelihood of CMIT/MIT reaching the lower part of the respiratory tract and causing lung injury. A literature review focused on the inhalation risk of HD containing a mixture of CMIT and MIT. The major contents included the physicochemical properties of CMIT and MIT contained in HDs and methodological reviews on substance analysis, toxicity tests and clinical cases. HD products marketed in South Korea have been reported to contain approximately 1–2% CMIT and 0.2–0.6% MIT along with magnesium nitrate (20–25%), magnesium chloride (0.2–1.0%), and water (70–75%). The types of CMIT and MIT dispersed into the air and deposited in the respiratory tract are assumed to be either gaseous substances or nanoparticles mixed with magnesium salts. The result of the literature review including clinical cases of lung injury among CMIT/MIT HD product users, demonstrated that these chemicals likely reach the lower respiratory tract and accordingly cause lung injury.A number of humidifier disinfectant-associated lung injury cases with clinical evidence should be prioritized in risk assessment of HD containing CMIT and MIT, even though there might be insufficient evidence in all related areas, including inhalation exposure assessment studies, animal testing, and epidemiological studies.