Purpose: We explored emergency nurses’ experiences of coping with moral distress. Methods: A qualitative research design was used. We conducted in-depth interviews with 11 nurses working at a regional emergency medical center in South Korea. Data were analyzed using conventional content analysis. Results: The main theme of nurses’ coping with moral distress was “a passive emotion-based response.” We also extracted three categories of coping strategies: “uncritical adaptation to anguished situation,” “self-justification for not acting,” and “flight from ethical decision making.” Conclusion Nurses coped with moral distress in a passive and emotional way, possibly because of perceived incompetence and compliance to an organizational hierarchy. The findings imply that effective approaches to addressing moral distress in emergency nurses are needed at the individual and organizational levels.

Ultrasonography (US) is being used increasingly to guide diagnostic and therapeutic musculoskeletal injections. Intra-articular injection is an important mainstay in the treatment of joint diseases, including rheumatoid arthritis (RA) and osteoarthritis (OA). However, blind or palpation-based injection can result in inaccurate needle placement and can be challenging for small joints or difficult-to-access joints such as the hip joint. The correct position of the needle with guidance in the target area would improve the efficacy of the procedure and greatly improve the outcome. Compared to conventional fluoroscopic guidance, the advantages of US are that it avoids radiation exposure and the equipment is readily available and less expensive. Knowledge of anatomy and probe positioning, as well as the ability to coordinate the probe and needle are necessary when injecting patients under US guidance. This review describes the general considerations for intra-articular injections under US guidance and includes practical suggestions for the injection of individual joints.
Arthritis, Rheumatoid ; Hip Joint ; Humans ; Injections, Intra-Articular* ; Joint Diseases ; Joints ; Needles ; Osteoarthritis ; Ultrasonography

No abstract available.
De Lange Syndrome*

As noe of causes of epipora, anatomic abnormality of nasolacrimal duct, has been treated with dacryocystorhinostomy. Recently, the development of nasal endoscopy has made it easy to observe the intranasal sturcture. Thus, authors investigated the effect of nasal endoscopic dacryocystorhinostomy used in combination with microdrill and nasal endoscopy in those patients, with nasolcrimal obsturction at the time of dacryocystorhinography. From 1995 to April 1997, twenty-four patients have been treated by the intranasal dacryocystorhinostomy using the microdrill with follow up more than six months. All patients had been tested by preoperative intranasal exam and was measured radiologically preoperative`s size of lacrimal sac. The nasal endoscopy using microdrill had shown success rate of 83.3 percent and the surgerywas more successful as the size of preoperative lacrimal sac was larer without any complication. The formation of accurate bone foramen did not remarkably differ from the skin incisio at the time of operation. Therefore, dacryocystorhinostomy using microdrill can be useful for the treatment of lacrimal canal obstruction, especially with the proper operating equipment.
Dacryocystorhinostomy* ; Endoscopy ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Nasolacrimal Duct ; Skin

Growing body of evidence has suggested that bipolar disorder in the elderly is important issue of mental health care. While older bipolar patients show different clinical features and response to treatment compared to younger patients, there are few studies focused on the older bipolar patients. Authors reviewed clinical features and treatment issues for bipolar disorder in the elderly.
Aged ; Bipolar Disorder ; Humans ; Mental Health ; Mood Disorders

BACKGROUND: Tuberculous pleurisy treatment improve symptoms such as fever, chest pain, cough, and prevents the progression to active pulmonary tuberculosis and the development of residual pleural thickening that decrease diaphragm and rib cage movement. This study investigated how the degree of residual pleural thidkening affects the pulmonary function. METHODS: Fifty seven patients who were initially diagnosed as having tuberculous pleurisy, were treated with anti-tuberculous medication for 6 months and had residual pleural thickening between May 1998 and January 2000 at the Eulji university hospital were reviewed. A chest X-ray and pulmonary function test(PFT, Sensormedics 2200) were perfored. The predicted value (%) of the forced vital capacity(FVC), forced inspiratory vital capacity(FIVC) and total lung capacity(TLC) were measured. The residual pleural thickening was defined the average of the summation in the lateral chest at the level of the imaginary line intersecting from the cardiophrenic angle to the diaphragmatic dome and the lowest part of the costophrenic angle between them. The results were sorted into three grades according to pleural thickness; <2mm(grade I), 2~10mm(grade II), 10mm(grade III). RESULTS: 1. FVC(% pred) and FIVC(% pred) were statistically different between grade I and III, and II and III. However, there was no difference between the TLC(% pred) between each of the groups. 2. The pleural thickness that cause restrictive dysfunction(FVC<80%) and a statisticall difference, is 3 mm. CONCLUSION: The larger the extent of the residual pleural thickness after antituberculous medication, the greater the reduction in the FVC, FIVC, TLC. A pleural thickness of 3 mm is recommended as a guideline for diagnosing a restrictive pulmonary dysfunction.
Chest Pain ; Cough ; Diaphragm ; Fever ; Humans ; Lung ; Respiratory Function Tests ; Ribs ; Thorax ; Tuberculosis, Pleural* ; Tuberculosis, Pulmonary

Few have reported fungal sinusitis confined in only sphenoidal sinus which caused orbital complication. Reportedly, early surgical treatment can lead to visual recovery especially in its involvement of optic nerve. We report a patients who was hospitalized due to sudden decrease in visual acuity and headache, and was histopathologically diagnosed as having aspergillosis confined in sphenoid sinus, but failed to show restoration of visual acuity after the operation using nasal endoscope.
Aspergillosis ; Endoscopes ; Headache ; Humans ; Optic Nerve* ; Orbit ; Sinusitis ; Sphenoid Sinus ; Sphenoid Sinusitis* ; Visual Acuity

PURPOSE: The purpose of this study was to identify the effects of cuff pressure on postoperative sore throat. METHODS: Data were collected from January 4 through May 15, 2008. Among the 60 patients, 30 patients were randomly assigned to the control group and the rest to the experimental group. Initial cuff pressure of both groups was set at 20 cmH2O. The experimental group was maintained at 20 cmH2O throughout the anesthesia, while the control group was not regulated further. Sore throat was assessed at postoperative 1, 24 and 72 hours. Data were analyzed using Mann-Whitney U test and Spearman's rho coefficients. RESULTS: Cuff pressure in the control group increased from 20 to 43 cmH2O within 3 hours after induction. However, the experimental group showed that there was apparently a reduced rate of sore throat at postoperative 24 hours (p = .048), and 72 hours (p = .002) than in the control group. However, no outstanding differences between both groups at postoperative 1 hour (p = .081) were detected. The correlation between cuff pressure and sore throat was statistically significant (r(s) = .590, p < .001). CONCLUSION: We conclude that maintaining cuff pressure at 20 cmH2O could be an effective means to reduce sore throat in surgical patients with inhalation anesthesia.
Air Pressure ; Anesthesia ; Anesthesia, Inhalation ; Humans ; Intubation, Intratracheal ; Nitrous Oxide ; Pharyngitis

A Macular hole may change in size of the hole; may increase in size with time and an epiretinal membrane may form. Rarely, a rhegmatogenous retinal detachment may occur with time and long term visual acuity usually remains stable or progressively worse. But to our knowledge spontaneous disappearance of a macular hole caused by development of an epiretinal membrane with improvement in vision rarely occurs. The traumatic, full-thickness macular hole in a 15-year-old man during 3 month follow-up period, changed its biomicroscopic appearance and fluorescein angiographic finding. Furthermore, visual acuity showed some improvement. The authors believe this spontaneous disappearance of macular hole is probably occured as a result of epiretinal membrane formation.
Adolescent ; Epiretinal Membrane ; Fluorescein ; Follow-Up Studies ; Humans ; Retinal Detachment ; Retinal Perforations* ; Visual Acuity

Retinal arteriovenous crossing sites are important because they are generally the points at which. in branch retinal obstruction, a blockage of venous blood flow occurs. We evaluated retrospectively the cases of 54 patiens wIth a recent temporal branch retinal vein occlusion to determine the relative anatomic position of the obstructed vein in relation to its crossing artery. In 54 (100%) of 54 eyes, the artery lay antenor to the vein, toward the vitreous cavity. In the control corssing site, the artery lay anterior to the vein 41.3% (J9/46) of the time (p<0.01) The second control group, which was obtained by examining all of the first-and second-order, without BRVO, consisted of 103 crossing sites. In this second control group's artenovenous crossmgs, the arteries were situated anteriorly in 83 (80.6%) of 103 crossing sites (p<0.005). Our observation that the artery lies anterior to the vein at the all of BRVO crossing sites contributes further evidence that mechanical factors play a prominent role in the causing BRVO.
Arteries ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retrospective Studies ; Veins