PURPOSE: The purposes of this study were to investigate moral distress, job satisfaction and turnover intention of mental health nurses, and identified influencing factors on mental health nurses' turnover intention. METHODS: A descriptive survey was conducted with 85 mental health nurses working in mental medicine department closed wards of 5 hospitals in Busan Metropolitan City and Gyeongsangnam Province. Data were collected from December 1, 2015 to January 31, 2016 and analyzed using percentage, frequency analysis, average, standard deviation, t-test, ANOVA, Pearson correlation coefficient and multiple linear regression analysis, with SPSS/WIN 18.0. RESULTS: 1) Moral distress had a statistically significant positive relationship with turnover intention (r=.24, p=.023). Job satisfaction had a statistically significant negative relationship with turnover intention (r=−.45, p<.001). 2) Moral distress had a positive effect on turnover intention (β=.23, p=.018), and job satisfaction, a negative effect on turnover invention (β=−.44, p<.001). These variables explained 24.0% of the variance. CONCLUSION: Findings indicate that moral distress and job satisfaction are important variables influencing turnover intention in mental health nurses. Development and provision of intervention programs to reduce moral distress and increase job satisfaction will help to decrease nurses' turnover intention.
Busan ; Intention* ; Inventions ; Job Satisfaction* ; Linear Models ; Mental Health* ; Personnel Turnover ; Psychiatric Nursing

Cardiovascular disease (CVD) is the leading cause of death in renal allograft recipients with functioning graft. Our study aimed to determine the incidence and the risk factors of cardiovascular disease after renal transplantation in Korea. We retrospectively analyzed 430 adult recipients who underwent kidney transplantation between January 1997 and February 2007. CVD was defined as a composite outcome of ischemic heart disease, cerebrovascular accident and peripheral vascular disease. Mean age of recipients was 40.0+/-11.8 yr. Mean duration of follow-up was 72+/-39 months. The cumulative incidence of CVD after renal transplantation was 2.4% at 5 yr, 5.4% at 10 yr and 11.4% at 12 yr. Multivariate analysis revealed that recipient's age, diabetes mellitus and duration of dialysis before transplantation were associated with post-transplant CVD (hazard ratio 1.843 [95% CI, 1.005-3.381], 3.846 [95% CI, 1.025-14.432] and 3.394 [95% CI, 1.728-6.665] respectively). In conclusion, old age, duration of dialysis and diabetes mellitus are important risk factors for post-transplant CVD, although the incidence of post-renal transplant CVD is lower in Korea than that in western countries.
Adult ; Age Factors ; Cardiovascular Diseases/*epidemiology/etiology ; Diabetes Complications ; Female ; Humans ; Incidence ; *Kidney Transplantation ; Male ; Middle Aged ; Multivariate Analysis ; Renal Dialysis ; Republic of Korea ; Retrospective Studies ; Risk Factors

Potassium imbalances can be life-threatening and must be identified and corrected prior to surgery. Patients with hypokalemic periodic paralysis (hypoKPP) experience recurrent muscle weakness or paralysis due to hypokalemia. We present the management of a rare case of hypoKPP during surgery and discuss the general complications and perioperative management of the condition. A 70-year-old man with hypoKPP visited the emergency room with abdominal pain requiring a cholecystectomy. He had not experienced hypoKPP since 1993, 1 year after diagnosis. Preoperative examinations were normal, with a serum potassium level of 4.5 mEq/L. Surgery and recovery were uneventful, with potassium levels ≥ 3.3 mEq/L. The post-surgery serum potassium level was 4.3 mEq/L. The patient had no signs of hypokalemia until 1-week post-surgery. Thorough preoperative preparation, careful assessment of serum potassium levels, avoidance of triggering factors, and appropriate postoperative pain relief can help prevent a hypokalemic attack in patients with hypoKPP.

Potassium imbalances can be life-threatening and must be identified and corrected prior to surgery. Patients with hypokalemic periodic paralysis (hypoKPP) experience recurrent muscle weakness or paralysis due to hypokalemia. We present the management of a rare case of hypoKPP during surgery and discuss the general complications and perioperative management of the condition. A 70-year-old man with hypoKPP visited the emergency room with abdominal pain requiring a cholecystectomy. He had not experienced hypoKPP since 1993, 1 year after diagnosis. Preoperative examinations were normal, with a serum potassium level of 4.5 mEq/L. Surgery and recovery were uneventful, with potassium levels ≥ 3.3 mEq/L. The post-surgery serum potassium level was 4.3 mEq/L. The patient had no signs of hypokalemia until 1-week post-surgery. Thorough preoperative preparation, careful assessment of serum potassium levels, avoidance of triggering factors, and appropriate postoperative pain relief can help prevent a hypokalemic attack in patients with hypoKPP.

Pancreatic neuroendocrine microtumor (PNEMT) is a neuroendocrine tumor (NET) < 0.5 cm in diameter, and it is considered benign. We report a PNEMT with high-grade transformation (HGT). A man in his 60s with von Hippel-Lindau syndrome underwent surgical resection of a NET. A second sub-centimeter nodule with a nodule-in-nodule pattern was discovered. The 0.4 cm outer nodule contained clear columnar cells with round nuclei and indistinct nucleoli, while the 0.1 cm inner nodule had eosinophilic cells with an increased nuclear to cytoplasmic ratio, vesicular nuclei, and prominent nucleoli. Tumor cells in the outer and inner nodules were synaptophysin and chromogranin positive. Only the inner nodule was p53 positive, while the outer nodule was exclusively positive for carbonic anhydrase 9 and vimentin. The Ki-67 labeling indices for the outer and inner nodules were 2.1% (grade 1) and 44.3% (grade 3), respectively. This nodule was determined to be a PNEMT with HGT. Our findings suggest that a PNEMT may not always be benign and can undergo HGT.

PURPOSE: For the treatment of residual visible tributaries following minimally invasive saphenous vein ablation procedures such as endovenous laser treatment (EVLT) and radiofrequency ablation (RF), a variety of options including observation, sclerotherapy, ultrasonography-guided sclerotherapy, stab phlebectomy (SP) and additional laser therapy have been developed. We performed endovenous laser treatment combined with stab phlebectomy and we evaluated the early results to assess the efficacy and safety of this procedure. METHODS: Between February 2003 and February 2006, one hundred twelve venous insufficiencies of the lower limbs in 106 patients (46 men and 60 women; mean age: 51.7 years) were treated with EVLT combined with SP. According to the CEAP classification, 103 limbs were C2, and nine were C3/C4. 810-nm diode laser energy was delivered percutaneously into the saphenous veins (86 GSVs, 20 SSVs, 6 GSV+SSVs). All patients were followed up on an outpatient basis and duplex ultrasonography (US) was performed 3 months after operation. RESULTS: The mean follow-up period was 2.92 months. All the patients had symptomatic improvement and immediately returned to normal daily activities. The overall complication rate was 36.6% (41 cases), and most of them were minor problems including ecchymosis in 22, paresthesia in 8, induration in 5 and excessive pain in 2. Three cases of cellulitis or thrombophlebitis were present and this resolved with drainage and antibiotics. One case of foot drop developed, but this improved with active physiotherapy within a few months. No postprocedural symptomatic deep vein thrombosis occurred. The recurrence rate of tributaries at 3 months was 13.6%, but these were easily controlled by sclerotherapy if needed. The duplex US-confirmed saphenous vein recanalization rate at 3 months was 5.9%. CONCLUSION: EVLT combined with SP could be a novel minimally invasive modality for treating lower extremity varicose veins with an acceptable complication rate and a low recanalization rate of the saphenous veins. It could lessen the possibility of additional treatments for the residual visible tributaries and so improve the satisfaction index, along with the cosmetic and economic advantages. However, long-term follow up and postoperative duplex US with an additional objective index examination are required to confirm the effectiveness and durability of this operative procedure.
Anti-Bacterial Agents ; Catheter Ablation ; Cellulitis ; Classification ; Drainage ; Ecchymosis ; Extremities ; Female ; Follow-Up Studies ; Foot ; Humans ; Laser Therapy ; Lasers, Semiconductor ; Lower Extremity* ; Male ; Outpatients ; Paresthesia ; Recurrence ; Saphenous Vein ; Sclerotherapy ; Surgical Procedures, Operative ; Thrombophlebitis ; Ultrasonography ; Varicose Veins* ; Venous Insufficiency ; Venous Thrombosis

PURPOSE: Chlamydia pneumoniae (CP) infection seems to be related to atherosclerotic diseases. A prospective sero- epidemiologic study was performed to analyze the relationship between CP infection and peripheral vascular disease in Korean patients. The aims of this study were to find the prevalences of CP antibody in the serum and CP antigens in the vascular tissues, and to analyze the differences between several disease groups. METHODS: Our subjects included a total of 61 patients (76 vascular tissues) who had undergone operative procedures for peripheral vascular diseases. They were classified into 3 groups: Group 1; 14 abdominal aortic aneurysm, Group 2; 15 atherosclerosis obliterans, and Group 3; 32 varicose vein cases. The CP antibody titers were determined using the microimmunofluorescence test (MIF) and the CP antigen in the vascular tissues with a semi-nested polymerase chain reaction (PCR) and an in situ hybridization technique (ISH). RESULTS: The prevalences of chronic or past CP infection from the MIF (IgG antibody titer > or = 1: 32) in Groups 1, 2 and 3 were 78.6, 73.3, and 68.8% respectively, but with statistically significant differences. The prevalences of PCR- positive tissues in Groups 1, 2 and 3 were 21.4, 6.7, and 0% respectively. There was no CP DNA detected in the venous tissue. CP DNA was detected more frequently in aneurysmal disease than atherosclerosis obliterans, but this was not statistically significant(p=0.265). In comparison with the varicose veins, aortic aneurysms showed a significantly higher PCR positivity ratio (p=0.002), and a similar result was seen with ISH. There was no relationship between CP antigen positivity and the known risk factors for atherosclerosis. CONCLUSION: A high prevalence of CP antibodies was observed in the serum of Korean patients with vascular disease, which matched that in western populations. CP DNA was also detected in atherosclerotic tissues, which was especially high in aneurysmal disease, implying a possible causative role of CP infection in the pathogenesis of the atherosclerotic disease. This is the first report on the prevalence of CP in vascular tissues in Korean population.
Aneurysm ; Antibodies ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Arterial Occlusive Diseases* ; Atherosclerosis ; Chlamydia* ; Chlamydophila pneumoniae* ; DNA ; Epidemiologic Studies ; Humans ; In Situ Hybridization ; Peripheral Vascular Diseases ; Polymerase Chain Reaction ; Prevalence ; Prospective Studies ; Risk Factors ; Surgical Procedures, Operative ; Varicose Veins ; Vascular Diseases

Most preschool children in Korea attend kindergarten (KG) or a child care center (CCC). CCCs, which focus on caring for the child, belong to the ministry of health and welfare. On the other hand, KGs are responsible for education, and belong to the ministry of education, science and technology. In order to resolve the decline in population due to low birthrates, the government is expanding the free child care and education policies. CCCs and KGs are combined together to form the 'NURI curriculum' and supporting funds have been increased in both governmental departments. In addition, economic support is provided for homeschooling households. Because this is a nationwide policy and applies to every single household, thorough preparation regarding the effect and side effects must be made. This policy is currently being implemented, and as child and adolescent psychiatrists, great consideration should be given to the influence on the population. Therefore, the Korean Academy of Child and Adolescent Psychiatry intends to investigate the effects and problems of the nationwide policy by analyzing the current condition of Korea's free child care and education and foreign policies. In the current paper, we reviewed the developmental process of Korea's free child care and education policy, as well as suggested future directions.
Adolescent ; Adolescent Psychiatry ; Child ; Child Care ; Child, Preschool ; Chlormequat ; Family Characteristics ; Financial Management ; Hand ; Humans ; Korea ; Mental Health ; Psychiatry

PURPOSE: Endovenous laser treatment (EVLT) of great saphenous vein (GSV) varicosities is a widely accepted procedure. However, EVLT of small saphenous vein (SSV) varicosities is not so popular due to concern about sural nerve damage and popliteal thrombosis. In addition, higher rates of recanalization and recurrence of tributaries make clinicians reluctant to use EVLT for SSV incompetence. The purpose of this study is to assess the safety and efficacy of SSV EVLT and the advantage of a combined high ligation and EVLT to reduce the complications and recurrence. METHOD: Between November 2003 and March 2006, 47 patients (55 limbs) with SSV incompetence and enlarged truncal varicosities, documented by duplex ultrasound, were included in the study. All patients were treated with an EVLT combined with ambulatory phlebectomy (AP) of the residual varicosities. High ligation of the sapheno-popliteal junction (SPJ) was performed in 26 limbs (47.3%, HL group); the EVLT without high ligation was performed in another 29 limbs (52.7%, NHL group). The patients were followed by clinical examinations at 1 week, 4 weeks and 12 weeks and with duplex ultrasound at 12 weeks after the operation. Symptomatic improvement, complications, recanalization of the SSV and recurrence of tributaries were recorded and compared between the two groups. RESULT: Mean follow-up was for 5.0 months. Most of the patients (95.4%) showed symptomatic improvement at 12 weeks with better venous clinical severity scores (VCSS). The overall complication rate was 27.3% (15 limbs), most of them were minor problems including 4 cases of transient sural nerve numbness (7.3%). The duplex US-confirmed saphenous vein recanalization rate and recurrence rate of tributaries at 3 months were 5.4% and 9.1%, respectively. There were no differences in the rate of symptomatic improvement and complications between the HL and NHL groups. However, the HL group showed a lower tendency for recanalization and recurrence compared to the NHL group. CONCLUSION: EVLT combined with AP might be an effective minimally invasive treatment modality for SSV varicosities with an acceptable complication rate and low recanalization rate of the saphenous veins. The simultaneous high ligation of the SPJ decreased the rates of recanalization and recurrence. Long-term data from large randomized prospective trials with more objective measure of the outcomes are needed to confirm the effectiveness and durability of this operative procedure.
Extremities ; Follow-Up Studies ; Humans ; Hypesthesia ; Ligation* ; Recurrence ; Saphenous Vein* ; Sural Nerve ; Surgical Procedures, Operative ; Thrombosis ; Ultrasonography ; Varicose Veins

BACKGROUND: For various reasons, kidney transplant recipients with autosomal dominant polycystic kidney disease (ADPKD) often undergo native nephrectomy in preparation for the transplantation. Simultaneous nephrectomy can result in hypotensive events perioperatively and affect transplant outcome adversely. Our aim was to evaluate the effect of simultaneous native nephrectomy (SNx) on perioperative blood pressure and graft outcome compared to non-nephrectomy (NNx) in renal transplant recipients with ADPKD. METHODS: Data regarding renal function and blood pressure were collected from 42 renal transplant recipients with ADPKD. The primary outcome was graft function over 1 year post-transplant. The secondary outcomes were patient and graft survival, postoperative hypotensive events, and blood pressure control. We compared units of anti-hypertensive medication used by transplanted ADPKD patients in the SNx and NNx groups. RESULTS: Patients with SNx during kidney transplantation showed similar rates of patient and graft survival and renal function. Although they had significantly more hypotensive events during the perioperative period (69.2% vs. 37.5% in NNx, P=0.045), no harmful influence on renal function was observed. No difference in mean blood pressure during the 1-year post-transplant period was observed between the two groups; however, the SNx group required fewer units of anti-hypertensive medication. CONCLUSIONS: SNx is a relatively safe procedure. Graft outcome in the SNx group was not inferior to that of the NNx group, and patients with SNx can have well-controlled blood pressure.
Blood Pressure* ; Graft Survival ; Humans ; Kidney ; Kidney Transplantation ; Nephrectomy* ; Perioperative Period ; Polycystic Kidney, Autosomal Dominant* ; Transplantation* ; Transplants*