Purpose: This study aimed to identify the variables related to the organizational silence of Korean hospital nurses and to examine the effect sizes of correlations between the related variables and sub-types of organizational silence. Methods: Relevant studies were searched through a systematic search in six Korean electronic databases (RISS, ScienceON, KCI, DBpia, e-Article, and KISS) using June 2022 as the end date. Thirteen studies were identified through a systematic review and eight of them were meta-analyzed. The correlation effect size r (ESr) for each related variable was calculated. Results: Twenty-two related variables were identified from the systematic review. Of them, organizational culture was the most frequently examined. Seven variables (three organizational, two leader-member exchange, and two consequences of organizational silence) were found eligible for the meta-analysis. The intention of turnover (ESr=.39; 95% confidence interval, 95% CI=.32 to .45) and leader-member exchange (“manager’s leaderships” ESr=-.33, 95% CI= -.43 to -.21; “manager’s inclination to reject negative feedback” ESr=.32, 95% CI=.23 to .39) had larger correlation effect sizes than the other variables that related to organizational silence, in particular, acquiescent silence, which had the largest correlation effect size among the three sub-types of organizational silence. Conclusion These findings show that the intention of turnover and leader-member exchanges were the main factors that related to the organizational silence. This indicates that it is necessary to develop management and education programs, as well as communication systems that focus on reducing and managing organizational silence, especially acquiescent silence.

PURPOSE: To develop and test the validity and reliability of the Korean version of the Moral Distress Scale-Revised (KMDS-R) to assess its applicability to Korean hospital nurses. METHODS: The KMDS-R was articulated through forward-backward translation methods. Internal consistency reliability, construct and criterion validity was calculated using SPSSWIN(19.0). Survey data were collected from 188 nurses from a university hospital in Gangwon-do, South Korea. RESULTS: The KMDS-R showed reliable internal consistency with a Cronbach's alpha of .69-.87 and a Guttman Split-half of .69-.82 for the total scale. Factor loading of the 21 items on the five subscales ranged from .41-.80. The KMDS-R was validated by factor analysis and explained 63% of moral distress for Korean hospital nurses. Criterion validity compared to Yoo's MDS showed significant correlation. CONCLUSION: The results suggest promising evidence of the KMDS-R's reliability and validity. It is used to measure moral distress for Korean hospital nurses.
Gangwon-do ; Korea ; Reproducibility of Results*

PURPOSE: The purpose of this study was to adapt, modify, and validate the Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM©) for Korean nursing students. METHODS: Participants were 183 nursing students with clinical practice experience in two nursing colleges. The construct validity and reliability of the final Korean version of the NASC-CDM© were examined using exploratory and confirmatory factor analyses and testing of internal consistency reliability. For adaptation and modification, the instrument was translated from English to Korean. Expert review and a cross-sectional survey were used to test the instrument's validity. RESULTS: The Korean version of the NASC-CDM© (KNASC-CDM) was composed of 23 items divided into four dimensions: (i) Listening fully and using resources to gather information; (ii) Using information to see the big picture; (iii) Knowing and acting; and (iv) Seeking information from clinical instructors. The instrument explained 60.1% of the total variance for self-confidence and 63.1% of the variance for anxiety; Cronbach's α was .93 for self-confidence and .95 for anxiety. CONCLUSION The KNASC-CDM can be used to identify anxiety and self-confidence in nursing students' clinical decision-making in Korea. However, further research should be done to test this instrument, as it is classified differently from the original NASC-CDM© version.

PURPOSE: The purpose of this study was to adapt, modify, and validate the Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM©) for Korean nursing students. METHODS: Participants were 183 nursing students with clinical practice experience in two nursing colleges. The construct validity and reliability of the final Korean version of the NASC-CDM© were examined using exploratory and confirmatory factor analyses and testing of internal consistency reliability. For adaptation and modification, the instrument was translated from English to Korean. Expert review and a cross-sectional survey were used to test the instrument's validity. RESULTS: The Korean version of the NASC-CDM© (KNASC-CDM) was composed of 23 items divided into four dimensions: (i) Listening fully and using resources to gather information; (ii) Using information to see the big picture; (iii) Knowing and acting; and (iv) Seeking information from clinical instructors. The instrument explained 60.1% of the total variance for self-confidence and 63.1% of the variance for anxiety; Cronbach's α was .93 for self-confidence and .95 for anxiety. CONCLUSION: The KNASC-CDM can be used to identify anxiety and self-confidence in nursing students' clinical decision-making in Korea. However, further research should be done to test this instrument, as it is classified differently from the original NASC-CDM© version.
Anxiety ; Clinical Decision-Making ; Cross-Sectional Studies ; Humans ; Korea ; Nursing ; Reproducibility of Results ; Students, Nursing

Primary lymphomas of the prostate are extremely rare and can mimic other more common prostatic lesions clinically. We report a case of primary diffuse large B-cell lymphoma of the prostate in an 81-year-old man. The patient presented with voiding difficulty as an initial symptom and enlargement of the prostate on rectal digital examination. Transurethral prostatic resection was performed. On microscopic examination, atypical lymphoid cells infiltrated and replaced the prostatic parenchyma. The tumor cells had large nuclei with irregular nuclear membrane and vesicular clumped chromatin. Nucleoli were not distinct and the cells had scanty cytoplasm. Immunohistochemically, the tumor cells were immunoreactive for CD20 and CD79a but not reactive for CD5, BCL-2 and BCL-6. Histopathological diagnosis was diffuse large B-cell lymphoma of the prostate. The patient received 5 cycles of chemotherapy after histologic diagnosis but died from pulmonary and scrotal metastases 6 months later.
Aged, 80 and over ; B-Lymphocytes* ; Chromatin ; Cytoplasm ; Diagnosis ; Drug Therapy ; Humans ; Lymphocytes ; Lymphoma ; Lymphoma, B-Cell* ; Neoplasm Metastasis ; Nuclear Envelope ; Prostate*

Paraffin-embedded tissue samples from 30 cases of non-Hodgkin's lymphoma(NHL) and 10 of reactive hyperplasia, were processed for interphase cytogenetic chromosomal study. We performed non-fluorescent in situ hybridization(NFISH) using the enzymatic method with digoxigenin-labeled DNA centromeric probes for chromosome 7,12,18 and X, and a painting probe for chromosome 18. Chromosomal aberrations were observed in 27(90%) out of 30 cases of NHL. The most commonly observed numerical aberration was extracopy of X chromosome. There were some characteristic aberrations corresponding to each grade and group of NHL by International Working Formulation: In low grade NHL(9 cases), a third were associated with extracopy of chromosome 12, and disomy X was frequently found in small lymphocytic lymphoma(75%). With intermediate grade(16 cases), tetraploidy(25%), translocation of chromosome 18(25%), and extracopy of chromosome 18(19%) were characteristically associated. These results suggest that interphase NFISH is an easily performable method in retrograde cytogenetic study of archival materials. Some specifically correlated chromosomal aberrations corresponding to the histopathologic grades and groups could provide us more valuable information for determining pathologic diagnosis and assessing the clinical outcome of NHL.
*Chromosome Aberrations ; Human ; Immunophenotyping ; *In Situ Hybridization ; Interphase ; Lymphoma, Non-Hodgkin/*genetics/pathology ; Paraffin Embedding ; Pseudolymphoma/genetics/pathology

BACKGROUND: In acute lymphoblastic leukemia (ALL), the importance of argyrophilic nucleolar organizer regions (AgNOR) is not established. METHODS: NOR silver staining was carried out in 74 ALL patients. We analyzed the AgNOR parameters ; counting parameters including number of AgNOR per cell, percentage of cells with one cluster, and area parameters including mean AgNOR area, total AgNOR area, and its percentage of nuclear area by morphometry. Cyclin A index was evaluated by immunohistochemical stain. We compared the AgNOR parameters with cyclin A index and evaluated the differences of AgNOR parameters in accordance with FAB classification, immunophenotype, a new classification of ALL (ALL with maturation), and response to induction chemotherapy. RESULTS: A positive correlation was found between cyclin A index and AgNOR area parameters and a significant negative correlation was found between mean AgNOR area and number of AgNOR per cell (r=-0.433, P=0.000). AgNOR area parameters revealed the highest value in L3. The number of AgNOR per cell in T cell ALL was higher than non-T cell ALL (P=0.011), and the percentage of cells with one cluster was lower (P=0.002). The number of AgNOR per cell in ALLm was lower (P=0.004) and the percentage of cells with one cluster was higher than in typical ALL (P=0.002). In cases achieved complete remission (CR) after induction chemotherapy, the number of AgNOR per cell was higher (P=0.005) and the percentage of cells with one cluster was much lower than in cases failed to achieve CR (P=0.013). CONCLUSIONS: Our study indicates that the AgNOR area parameters are helpful to predict the proliferating activity of leukemic blasts in ALL. It is suggested that the number of AgNOR per cell and the percentage of cells with one cluster provide a valuable information to estimate the response to chemotherapy in ALL.
Classification ; Cyclin A ; Drug Therapy ; Humans ; Induction Chemotherapy ; Nucleolus Organizer Region* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Silver Staining

BACKGROUND: Inorganic arsenic trioxide (As2O3) has emerged as a new drug of choice for refractory acute promyelocytic leukemia (APL). But, the curable disease spectrum and the arsenic resistance in association with the expression of multidrug resistance (MDR) proteins are not yet to be established. METHODS: Five de novo APL and 20 refractory acute leukemia cases were selected. Leukemic cells were cultured for 24 hr in media with various As2O3 concentrations. Apoptotic cells or damaged cells were measured by a morphologic examination after Wright stain and flow cytometry using annexin V/propidium iodide (PI) stain. The lowest concentration of As2O3 at which greater than 90% of leukemic cells were damaged morphologically was defined as the morphologic arsenic sensitivity of leukemic cells. MDR protein markers including multidrug resistance associated protein (MRP), lung resistance protein (LRP), P-glycoprotein (PGP) and glutathinoe-S-transferase (GST) were analyzed by flow cytometry. RESULTS: The leukemic cells from de novo APLs (in 3 of 5) were sensitive to arsenic trioxide, compared to refractory acute leukemia (only 1 of 20). Of the five MDR proteins examined, only PGP was expressed more in the arsenic resistant cases (in 8 of 21) than in the sensitive cases (none of 4) (P=.032). CONCLUSIONS: Refractory acute leukemia had a variable arsenic sensitivity, but were more resistant than de novo APL. The arsenic resistance seems to be related to PGP expression.
Arsenic ; Drug Resistance, Multiple ; Flow Cytometry ; Leukemia* ; Leukemia, Promyelocytic, Acute* ; Lung ; Multidrug Resistance-Associated Proteins ; P-Glycoprotein

Serratia marcescens is the most important member of the genus Serratia and causes opportunistic infections, particularly pneumonia and septicemia in patients with malignancy, renal failure (acute and chronic), and diabetes mellitus. The most common portals of entry are known to be, in descending order, lung, genitourinary tract, intravenous line, gastrointestinal tract, and skin. S. marcescens rarely causes skin infection because it does not normally colonize human skin. Only six cases of S. marcescens cellulitis were reported. Five of them were immunocompromised patients. We have experienced a case of skin abscess caused by S. marcescens, which was found in a 59-year-old woman. She was undergoing prior antibiotic treatment after insulinoma surgery. S. marcescens was isolated from the skin abscess as a sole organism. She was treated with appropriate antibiotics that exhibited sensitivities for the organism and cured without any complication. The authors report a case of S. marcescens infection on the skin of a 59-year-old woman and review the literature concerning this organism as a causative agent.
Abscess* ; Anti-Bacterial Agents ; Cellulitis ; Colon ; Diabetes Mellitus ; Female ; Gastrointestinal Tract ; Humans ; Immunocompromised Host ; Insulinoma ; Lung ; Middle Aged ; Opportunistic Infections ; Pneumonia ; Renal Insufficiency ; Sepsis ; Serratia marcescens* ; Serratia* ; Skin*

BACKGROUND: Microscopic examination of the bone marrow (BM) smear has been a major method for the diagnostic and post-therapeutic evaluation of hematologic disease but is laborious and imprecise due to small number of cells counted. Recently, automated reticulocyte counting is available by the automated hematology analyzer. We analyzed the bone marrow aspirates using Coulter GEN S (GEN S) automated hematology analyzer and compared the results with those by the microscopic examination. METHODS: Total nucleated cells (TNC), leukocyte subpopulations, red cell count, hemoglobin and reticulocyte indices of the peripheral blood (PB) and the BM aspirates, were measured by GEN S in 392 samples including 142 normal control samples. Differential counts by microscopic examination of Wright stained BM films were used as a reference. RESULTS: TNC of the BM obtained by automated hematology analyzer correlated with the BM cel-lularity estimated by microscopic examination (r=0.587, P=0.000). The differential counts of neutrophils and monocytes correlated between these two methods (r=0.582, P=0.000, r=0.309, P=0.000). In acute leukemia, TNC of the PB and the BM, and the BM lymphocyte fraction were increased and the BM neutrophil fraction was decreased. In chronic myelogenous leukemia, TNC of the PB and the BM were high but distribution of leukocyte subpopulations was normal. In normal control group, the number of erythroid precusors correlated with the percentages of reticulocyte in the PB (r=0.425, P=0.000), and in patients with increased erythropoiesis, it showed strong correlation with immature reticulocyte fraction (IRF) of the PB (r=0.708, P=0.033). In aplastic anemia, IRF of the PB was reversely correlated to hemoglobin level, but in myelodysplastic syndrome, reticulocyte indices of the PB and the BM had no correlation with hemoglobin level. In patients with increased erythropoiesis, the percentages of reticulocyte in the PB were increased and those of the BM were decreased in proportion to reduction of hemoglobin level in the PB. CONCLUSIONS: Analysis of the BM aspirates using automated hematology analyzer will be useful in screening of pathological hematologic diseases and in estimating the bone marrow cellularity objectively before those by the microscopic examination. In anemia, this study could provide an additional information to evaluate the ineffective hematopoiesis using reticulocyte indices of the PB and the BM.
Anemia ; Anemia, Aplastic ; Bone Marrow* ; Cell Count ; Erythropoiesis ; Hematologic Diseases ; Hematology* ; Hematopoiesis* ; Humans ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukocytes ; Lymphocytes ; Mass Screening ; Monocytes ; Myelodysplastic Syndromes ; Neutrophils ; Reticulocyte Count ; Reticulocytes