PURPOSE: The purpose of this study was to identify awareness of hospital safety culture (AHSC) and safety activities (SA) of workers in a tertiary care hospital, and the factors influencing safety activities. METHODS: 303 Participants from the tertiary care hospital in Seoul were invited. Collected data were analyzed using SPSS 18.0. RESULTS: The level of AHSC and SA was 3.61 and 4.17, respectively. There were differences between AHSC and SA according to gender, religion, employment status, job class, working period, safety education, need for safety education, and number of safety accident reports. There was a positive relationship between AHSC and SA. The factors influencing SA were communication and process, employment status, and safety accident reports. CONCLUSION: AHSC and SA are important factors to improve hospital safety, as well as increasing chances to receive hospital accreditation.
Accreditation ; Education ; Employment ; Humans ; Safety Management* ; Seoul ; Tertiary Healthcare*

PURPOSE: Individuals' view of multiculturalism can be varied. The purpose of this study was to survey subjective view of and attitude toward multiculturalism in first-year undergraduate nursing students who had completed a multicultural subject. METHODS: The Q methodology, which integrates quantitative andqualitative methods, was used. Forty one Q-statements selected from each of the 40 participants were classified into theshape of normal distribution using a nine-point scale. The collected data were analyzed using the QUANL program. RESULTS: Two types of view of multiculturalism were identified: 'domestic type-constructive view' and 'global type-advanced view.' CONCLUSION: The findings show how nursing students think about multiculturalism and provide a basis for further research and education.
Cultural Diversity* ; Education ; Humans ; Nursing* ; Students, Nursing*

BACKGROUND: The origin of hematologic malignancies has been known to be monoclonal. In most cases, the same or obviously related chromosomal abnormliaties are found and cytogenetically unrelated clones are uncommon. We evaluated the prevalence and clinical significance of patients with cytogenetically unrelated clones in hematologic malignancies. METHODS: Included in the study were 324 patients who had been diagnosed with the following hematologic malignancies at Ewha Womans University, Mokdong Hospital: AML (93 cases), MDS (27), CML (51), myeloproliferative disorder (38), acute biphenotypic leukemia (8), ALL (44), CLL (9), multiple myeloma (MM, 40), and Non-Hodgkin's lymphoma with bone marrow involvement (14). RESULTS: The overall prevalence of hematologic malignancies with cytogenetically unrelated clones at diagnosis was 0.9% (3/324). Of AML patients, 1.1% (1/93) had unrelated clones, CLL 11.1% (1/9), and MM 2.5% (1/40). The other hematologic malignancies did not show cytogenetically unrelated clones. The AML patient had add(11)(q23)/add(1)(p36.3); the CLL patient had +12/ del(13)(q22); and the MM patient had +der(1)t(1;13)(p12;q12), -13/-X, +5, +7, -8, -12, -13, add(14) (q32), +15, -16, +19, -20, -22, -22. We also detected an unrelated clone of trisomy 8 in Philadelphia chromosome negative cells from a CML patient who was treated with imatinib mesylate. CONCLUSIONS: Hematologic malignancies with cytogenetically unrelated clones are uncommon. This report highlights the importance of the conventional chromosomal analysis in that an unrelated clone in philadelphia chromosome negative cells may be detected in a CML case.
Bone Marrow ; Clone Cells* ; Diagnosis ; Female ; Hematologic Neoplasms* ; Humans ; Leukemia, Biphenotypic, Acute ; Lymphoma, Non-Hodgkin ; Mesylates ; Multiple Myeloma ; Myeloproliferative Disorders ; Philadelphia Chromosome ; Prevalence ; Trisomy ; Imatinib Mesylate

No abstract available.
Blood Transfusion

OBJECTIVES: To find work related factors affecting perceived fatigue among male metal product assemblers. METHODS: The study subjects were metal product assemblers from three metal product companies (476 car parts assemblers, 610 car engine assemblers, 454 ship engine assemblers). From the total of 1,540 subjects, 1,136 (73.8%) were included and 38 respondents with insufficient replies were excluded. Associations between fatigue score and other variables (general characteristics, job related factors, workload, job stresses) were investigated in terms of the concept of multidimensional fatigue construct by self administered questionnaire. Using MFS (Multidimensional Fatigue Scale), JCQ (Job Content Questionnaire), and Borg's scale, we estimated the fatigue, job stress, and workload, respectively. Fatigue score was estimated by 'sum of fatigue' in MFS. Associations were tested by linear regression analysis using SAS v.8.0. RESULTS: In this study, the fatigue related factors were older age, longer working hours per week, higher workload, higher job demand, lower decision latitude, and lower supervisor support. CONCLUSIONS: Prolonged working hours, higher workload, higher job demand, poor supervisor support and lower decision latitude were fatigue related factors among the male metal product assemblers of this study.
Data Collection ; Fatigue* ; Humans ; Linear Models ; Male* ; Questionnaires ; Ships

We studied a Monte Carlo simulation of the proton beam delivery system at the National Cancer Center (NCC) using the Geant4 Monte Carlo toolkit and tested its feasibility as a dose verification framework. The Monte Carlo technique for dose calculation methodology has been recognized as the most accurate way for understanding the dose distribution in given materials. In order to take advantage of this methodology for application to externalbeam radiotherapy, a precise modeling of the nozzle elements along with the beam delivery path and correct initial beam characteristics are mandatory. Among three different treatment modes, double/single.scattering, uniform scanning and pencil beam scanning, we have modeled and simulated the double.scattering mode for the nozzle elements, including all components and varying the time and space with the Geant4.8.2 Monte Carlo code. We have obtained simulation data that showed an excellent correlation to the measured dose distributions at a specific treatment depth. We successfully set up the Monte Carlo simulation platform for the NCC proton therapy facility. It can be adapted to the precise dosimetry for therapeutic proton beam use at the NCC. Additional Monte Carlo work for the full proton beam energy range can be performed.
Proton Therapy ; Protons* ; Radiotherapy

The differential diagnosis of acute lymphoblastic leukemia (ALL) from other small round blue cell tumors in children is very important for proper treatment, but sometimes difficult. CD45 is expressed on almost all-human leukocytes and not expressed on other small round blue cell tumors. Moreover, CD19 is expressed on all stages of B lineage cells and loss of this antigen is very rare in precursor B-cell ALL. We report a case of ALL with atypical morphology and immunophenotype. A 6-yr-old girl presented with fever and weight loss. Many abnormal cells with variable sized, high nuclearcytoplasmic ratio and distinct nucleoli were counted 23% in bone marrow. The results of immunophenotyping were negative for CD45, CD19, CD10, CD20, CD3, CD5, CD7, CD56/16, CD13, and CD33 and positive for CD22, TdT, and CD34. The immunohistochemical staining of bone marrow biopsies was positive for CD79a, CD10, TdT and CD99. The cytogenetic study showed normal karyotype but amplification of MLL (myeloid/lymphoid or mixed lineage leukemia) gene was suggestive in the fluorescent in situ hybridization. The patient received the standard chemotherapy for acute lymphoblastic leukemia and reached complete remission.
Acute Disease ; Antigens, CD19/*analysis ; Antigens, CD45/*analysis ; Bone Marrow/*pathology ; Child ; Female ; Humans ; In Situ Hybridization ; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/diagnosis/*pathology

We report a patient with massive eosinophilia and a complex karyotype that was initially misdiagnosed as chronic eosinophilic leukemia (CEL), but later diagnosed as anaplastic large cell lymphoma (ALCL) masked by massive eosinophilia. The complex karyotype observed at initial diagnosis remained unchanged later, after the evidence of bone marrow involvement of ALCL was obtained. At diagnosis, genetic aberrations corresponding to metaphase cytogenetics were not identified by interphase fluorescence in situ hybridization, although abnormal results were noted at follow-up. Together, these observations indicate that the complex karyotype at initial work-up has been derived from a low proportion of lymphoma cells with high mitotic ability that were not identified by microscopy, rather than from massive eosinophils. These findings suggest that our patient had ALCL with secondary eosinophilia rather than CEL since initial diagnosis.
Bone Marrow ; Cytogenetics ; Diagnosis ; Eosinophilia* ; Eosinophils* ; Fluorescence ; Follow-Up Studies ; Humans ; Hypereosinophilic Syndrome* ; In Situ Hybridization ; Interphase ; Karyotype* ; Lymphoma ; Lymphoma, Large-Cell, Anaplastic* ; Masks ; Metaphase ; Microscopy

The effect of setup uncertainties on CTV dose and the correlation between setup uncertainties and setup margin were evaluated by Monte Carlo based numerical simulation. Patient specific information of IMRT treatment plan for rectal cancer designed on the VARIAN Eclipse planning system was utilized for the Monte Carlo simulation program including the planned dose distribution and tumor volume information of a rectal cancer patient. The simulation program was developed for the purpose of the study on Linux environment using open source packages, GNU C++ and ROOT data analysis framework. All misalignments of patient setup were assumed to follow the central limit theorem. Thus systematic and random errors were generated according to the gaussian statistics with a given standard deviation as simulation input parameter. After the setup error simulations, the change of dose in CTV volume was analyzed with the simulation result. In order to verify the conventional margin recipe, the correlation between setup error and setup margin was compared with the margin formula developed on three dimensional conformal radiation therapy. The simulation was performed total 2,000 times for each simulation input of systematic and random errors independently. The size of standard deviation for generating patient setup errors was changed from 1 mm to 10 mm with 1 mm step. In case for the systematic error the minimum dose on CTV Dstat/Dmin was decreased from 100.4 to 72.50% and the mean dose Dsyst was decreased from 100.45% to 97.88%. However the standard deviation of dose distribution in CTV volume was increased from 0.02% to 3.33%. The effect of random error gave the same result of a reduction of mean and minimum dose to CTV volume. It was found that the minimum dose on CTV volume Drand/Dmin was reduced from 100.45% to 94.80% and the mean dose to CTV Drand was decreased from 100.46% to 97.87%. Like systematic error, the standard deviation of CTV dose DeltaDrand was increased from 0.01% to 0.63%. After calculating a size of margin for each systematic and random error the "population ratio" was introduced and applied to verify margin recipe. It was found that the conventional margin formula satisfy margin object on IMRT treatment for rectal cancer. It is considered that the developed Monte-carlo based simulation program might be useful to study for patient setup error and dose coverage in CTV volume due to variations of margin size and setup error.
Humans ; Rectal Neoplasms ; Statistics as Topic ; Tumor Burden ; Uncertainty

Background: Tacrolimus, a calcineurin inhibitor, is an immunosuppressant used in post-transplantation maintenance therapy. The drug has a narrow therapeutic range and requires periodic therapeutic drug monitoring. Although many studies have reported the effects of intrapatient variability of tacrolimus on survival, rejection, and complications in renal transplant recipients, very few studies have reported these effects in liver transplant recipients. The purpose of this study was to evaluate the effect of intrapatient variability of tacrolimus on clinical outcomes after liver transplantation. Methods: Intrapatient variability was calculated using individual, averaged tacrolimus concentrations. Patients were divided into two groups according to their median variability value:high-variability and low-variability groups. The rate of deviation from the therapeutic range, incidence of acute rejection, posttransplant diabetes, incidence of infection, and estimated glomerular filtration rate (eGFR) after transplantation were compared between the groups. Results: Of the total patients (n=82), the high-variability group (n=41) exhibited significantly greater deviation from the therapeutic range (65.92% vs. 56.84%; p<0.001). There was no significant difference in acute rejection or posttransplantation diabetes incidence or eGFR; however, the number of infection in the first 6 months was significantly lower in the low-variability group (0.4 vs. 0.9 times; p=0.039). Multiple linear regression analysis showed that the number of infection significantly increased as intrapatient variability increased (p=0.015). Conclusion High intrapatient variability in tacrolimus concentrations was strongly associated with an increased frequency of deviation from the suggested therapeutic range and an increased number of infection.