PURPOSE: This study was to compare job stress and job satisfaction between ward nurses and outpatient nurses, and to identify the correlation between job stress and job satisfaction. METHODS: The subjects of this study were 200 ward nurses and 85 outpatient nurses in G and I University Hospital in Incheon. The data were collected in March 2010 and analyzed with t-test and Pearson correlation coefficient. RESULTS: There was no significant difference in overall job stress between two groups, but slightly higher stress level for ward nurses. In sub-area of job stress, 'nursing duty' was primary for both groups. And in 'nursing duty' (t=2.05, p=.041), 'conflict with patients' (t=2.73, p=.007), and 'working environment' (t=3.37, p<.001) ward nurses showed significant higher level of stress than outpatient nurses. For job satisfaction, outpatient nurses showed higher level significantly (t=-2.98, p=.003). And both groups of nurses' job satisfaction was negatively correlated with job stress significantly (r=-.31, p<.001). CONCLUSION: It will be possible to reduce job stress and promote job satisfaction level for both groups of nurses by adding staffs, and specifically for ward nurses by improving facilities for relax and appropriate supply, and for outpatient nurses by managing interpersonal stress and reducing side tasks.
Humans ; Job Satisfaction ; Outpatients

Purpose: To investigate the long-term clinical course and prognostic factors of branch retinal artery occlusion (BRAO). Methods: The medical records of patients diagnosed with BRAO were reviewed retrospectively. Visual acuity (VA) and central retinal thickness (CRT) at diagnosis were compared with those measured at the final visit. Patients with a decimal VA ≥ 0.6 (good prognosis group) were compared with those with a decimal VA ≤ 0.5 (poor prognosis group) at the final visit. Results: Fifty-five patients were enrolled and the mean follow-up period was 45.8 ± 27.8 months. The mean logarithm of minimum angle of resolution improved from 0.53 ± 0.57 at diagnosis to 0.36 ± 0.61 at the final visit (p = 0.026). The decimal VA was ≤ 0.1 in 13 (23.6%) patients, ≥ 0.2 and ≤ 0.5 in 16 (29.1%) patients, and ≥ 0.6 in 26 (47.3%) patients at diagnosis; the respective values were 9 (16.4%), 8 (14.5%), and 38 (69.1%) at the final visit. The mean CRT significantly decreased from 273.9 ± 34.7 µm at diagnosis to 248.9 ± 27.0 µm at the final visit (p < 0.001). The poor prognosis group (n = 17) was older (p = 0.044) and had a higher incidence of papillomacular bundle involvement (p < 0.001) than the good prognosis group (n = 38). Conclusions Patients with BRAO generally showed relatively favorable long-term outcomes. However, the final VA was ≤ 0.1 in 16.4% of them, suggesting the need for further treatment modalities to improve the outcome of patients with a poor prognosis.

Pheochromocytoma is derived from the chromaffin cells and patients with pheochromocytoma present with several signs and symptoms by producing, storing and secreting catecholamine. Spontaneous rupture or necrosis of pheochromocytoma is extremely rare, but it can be lethal because of the dramatic change in the circulation such as an acute abdominal emergency or shock. Spontaneous remission of the clinical symptoms due to necrosis of the pheochromocytoma is rare. We describe such a case that presented with cardiogenic shock due to extensive necrosis of the pheochromocytoma and this was followed by spontaneous remission of the clinical symptoms without removal of the pheochromocytoma.
Chromaffin Cells ; Emergencies ; Humans ; Necrosis ; Pheochromocytoma ; Remission, Spontaneous ; Rupture, Spontaneous ; Shock ; Shock, Cardiogenic

Purpose: To evaluate the clinical course of neovascular age-related macular degeneration (nAMD) that has shown limited response to ranibizumab and aflibercept. Methods: This retrospective study included 14 eyes with nAMD that showed a limited response to initial treatment using ranibizumab and aflibercept. The changes in visual acuity (VA) during the follow-up period and the incidence and timing of VA deterioration to the level of 0.1 or worse were identified. In cases involving bevacizumab treatment, the follow-up duration and the proportion of patients maintaining a VA of 0.2 or better were identified. Results: During the mean 43.3 ± 33.2 months of follow-up, the VA deteriorated significantly from a mean logarithm of minimum angle of resolution (logMAR) of 0.42 ± 0.34 at diagnosis to 0.91 ± 0.68 at the final follow-up (p = 0.021). A logMAR of 0.3 or greater degree of VA deterioration was noted in six eyes (42.9%). Among the 13 eyes exhibiting a VA of 0.2 or better after the initial treatment, a deterioration to a VA of 0.1 or worse was noted in 6 eyes (46.2%) at a mean 29.7 ± 18.3 months. In eight eyes undergoing bevacizumab treatment, four eyes (50.0%) maintained 0.2 or better VA during the 51.4 ± 35.5 months of follow-up. Conclusions The clinical course of patients with limited response to ranibizumab and aflibercept was generally unfavorable. However, a relatively long period was required for the deterioration in VA to reach 0.1 or worse. In addition, 0.2 or better VA was maintained in approximately half of the patients.

Purpose: To report the long-term outcomes of patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO) and to explore the ME incidence and factors associated with ME resolution. Methods: We retrospectively studied patients with ME secondary to CRVO. The visual acuity at baseline was compared to that at the final visit. The incidence and timing of ME resolution during treatment were evaluated and the visual outcomes of patients who did and did not experience ME resolution were compared. We also identified factors predictive of ME resolution. Results: We included 79 patients; the mean follow-up time was 50.1 ± 14.3 months. The mean logarithm of the minimal angle of resolution (logMAR) of visual acuity was 0.94 ± 0.75 at diagnosis and 1.00 ± 0.84 at the final visit (p = 1.000). A logMAR visual loss of 0.3 or greater was noted in 28 patients (35.4%). During follow-up, ME resolution was evident in 40 eyes (50.6%) at a mean of 16.9 ± 17.4 months. Visual improvement was greater in patients who evidenced ME resolution than in those who did not (p < 0.001). The ME resolution rate was higher in patients younger than 60 years (p = 0.039) and in those who lacked subretinal fluid at diagnosis (p < 0.001). Conclusions In patients with ME secondary to CRVO, the risk of long-term recurrent ME was higher in older patients and those evidencing subretinal fluid at diagnosis indicating that such patients require close follow-up and aggressive treatment.

Purpose: To evaluate long-term visual prognosis and changes in the retinal microstructure in patients with macular telangiectasia type 2. Methods: Retrospective analysis of medical records were performed for 61 eyes (32 patients) diagnosed with macular telangiectasia type 2. The visual acuity at diagnosis was compared with that at the final visit. In addition, cases were classified into three grades based on optical coherence tomography (OCT) findings: grade 1, inner retinal cavities only; grade 2, outer retinal cavities with ellipsoid zone disruption; and grade 3, ellipsoid zone disruption with proliferation of retinal pigment epithelium. Change in the grade during the follow-up was verified. In addition, visual acuities were compared between eyes with and without a change in grade. Results: The mean follow-up period was 41.5 ± 33.2 months. Visual acuity had deteriorated significantly from the mean logarithm of the minimal angle of resolution 0.23 ± 0.26 at diagnosis to a mean of 0.31 ± 0.31 at the final visit (p < 0.001). When classified using OCT, 65.6%, 22.9%, and 11.5% were grades 1, 2, and 3, respectively, at diagnosis and 47.5%, 36.1%, and 16.4% at the final visit. Progression of grade was noted in 22.9%. A higher degree of visual deterioration was noted in eyes showing progression than in eyes without (p = 0.002). Conclusions During the long-term follow-up period, visual deterioration was noted in patients with macular telangiectasia type 2. However, the degree of deterioration was not high. Progression in the disruption of the retinal microstructure was the likely cause of visual deterioration.

Purpose: To evaluate the proportion of bevacizumab and the reason for its usage in wet age-related macular degeneration (AMD). Methods: Retrospective analysis of medical records was performed for 1,541 patients who received ranibizumab, aflibercept, or bevacizumab injection to treat wet AMD. The proportion of bevacizumab among the entire set of injections was identified. The reason for selecting bevacizumab was additionally identified. Results: During the study period, a total of 2,929 anti-vascular endothelial growth factor (anti-VEGF) injections were performed; 2,236 (76.3%) were ranibizumab or aflibercept injections and 693 (23.7%) were bevacizumab injections. The most common reason for bevacizumab usage was ‘having a 0.1 or worse best-corrected visual acuity or being unable to assure reimbursement due to the development of extensive scarring or geographic atrophy’ (297 bevacizumab injections, 42.9%). The second most common reason was ‘the inability to assure reimbursement such as extrafoveal choroidal neovascularization (CNV) or early CNV without definite fluid in the foveal region’ (201 bevacizumab injections, 29.0%). Conclusions Bevacizumab was used in 23.7% of the anti-VEGF injections to treat wet AMD. When analyzing patients’ treatment burden and financial impact, the results of the present study may provide useful information. Further multi-center studies are required to evaluate more precisely the usage of anti-VEGF drugs.

Purpose: To evaluate the proportion and reasons for ineligibility to re-register for extended health insurance at 5 years in patients diagnosed with neovascular age-related macular degeneration (AMD) and registered for extended health insurance. Methods: This retrospective study was performed in patients diagnosed with neovascular AMD and registered for extended health insurance with follow-up for at least 5 years. The criteria for re-registration for extended health insurance were determined along with the ineligibility for re-registration. Results: In total, 263 patients were included in the analysis. Of these, 148 (56.3%) did not satisfy the criteria for re-registration. No active treatment was performed in 98 patients during the last 6 months of the study period (no recurrence, 51 patients; additional treatment was not considered beneficial due to retinal damage even without disciform scar formation, 44 patients). Macular disciform scar formation was noted in 50 patients (33.8%). Older age (p = 0.013), poor visual acuity (p = 0.004), and retinal angiomatous proliferation (p < 0.001) were associated with ineligibility for re-registration due to severe retinal damage. Conclusions Among the patients who were initially registered for extended health insurance, 56.3% failed to satisfy the re-registration criteria. The primary reason was advanced retinal damage. The results of this study provide useful information for patient education and to establish long-term treatment strategies.

Purpose: The long-term clinical outcomes of cataract surgery in patients with retinitis pigmentosa (RP) were evaluated. Methods: A retrospective analysis of medical records was performed for patients who were diagnosed with RP and underwent cataract surgery. Preoperative best-corrected visual acuity (BCVA) was compared with BCVA at 1 month postoperatively and at the final visit. The proportion of patients with cystoid macular edema development or aggravation after surgery was evaluated, as was the proportion of patients with intraocular lens subluxation/dislocation. For patients who underwent optical coherence tomography, factors associated with a BCVA of 0.5 or better at 1 month were analyzed. Results: In total, 133 eyes were included and the mean follow-up period was 58.7 months. The mean logarithm of minimal angle of resolution BCVA was 0.69 ± 0.65 at diagnosis. The BCVA was significantly improved to 0.51 ± 0.47 at 1 month postoperatively (p < 0.001). However, the BCVA at the final visit (0.70 ± 0.81) was similar to the baseline value (p = 1.000). Cystoid macular edema development or aggravation was noted in 8 eyes (6.0%) and intraocular lens subluxation/dislocation was noted in 4 eyes (3.0%). A subgroup analysis involving 108 eyes revealed that preoperative BCVA (p < 0.001) and ellipsoid zone status (p = 0.001) were associated with postoperative visual acuity. Conclusions Short-term outcomes of cataract surgery in patients with RP were comparatively good. However, long-term visual deterioration was noted with disease progression. Preoperative BCVA and ellipsoid zone status are useful markers for predicting short-term visual outcomes.

Purpose: To investigate the limited response to aflibercept after switching to aflibercept in neovascular age-related macular degeneration (AMD). Methods: This retrospective study included 70 eyes with neovascular AMD that were initially treated with ranibizumab and then switched to aflibercept. The incidence and timing of the limited response to aflibercept were identified and visual outcome was compared between eyes with and without limited response. In addition, factors predictive of limited response were analyzed. Results: A limited response to aflibercept was noted in approximately 1/5 of the patients who underwent switching to aflibercept in neovascular AMD. Switching to aflibercept was performed at a mean of 16.2 ± 12.7 months after diagnosis. During the mean 34.7 months of follow-up after switching, limited response was noted in 15 eyes (21.4%) at a mean of 22.0 ± 13.9 months after switching. The degree of reduction in visual acuity was mean logMAR 0.34 ± 0.41 in eyes with limited response and mean 0.06 ± 0.20 in eyes without (p = 0.002). In addition, the duration between the diagnosis and the switching was shorter (p = 0.012), and the number of ranibizumab injections before switching was lower (p = 0.016) in eyes with limited response than in eyes without. Conclusions Patients who showed limited response to aflibercept after switching to aflibercept showed a worse visual outcome. The probability of having a limited response is higher when the switching is performed earlier.