BACKGROUND: Enterococci exhibit intrinsic resistance or high-level minimum inhibitory concentration (MIC) to beta-lactams than other streptococci. This appears to be due to low affinity of penicillin-binding proteins and rarely production of beta-lactamase, which gives the reason of testing beta-lactamase for blood and cerebrospinal fluid isolates. Ampicillin is more effective than penicillin in vitro, and MIC of ampicillin is generally 1 dilution lower than that of penicillin. The purpose of this study is to detect beta-lactamase producing enterococci an6 to compare MICs of ampicillin and penicillin by Vitek system (bioMerieux, Hazelwood, MO, USA) with those by agar dilution method. METHODS: We collected 110 isolates of Enterococcus faecalis and 51 isolates of E. faecium from clinical specimens in 1998. MICs of antibiotics were determined by agar dilution method and Vitek system. We also performed beta-lactamase test by the Cefinase (Becton Dickinson, USA) for 512 isolates of E. faecalis and 189 isolates of E. faecium collected in 1998. RESULTS: The most common sites of isolates were blood, bile, surgical/traumatic wounds, closed and open pus and urine. MICs of ampicillin were 1 to 2 dilution lower than those of penicillin for E. faecalis (P=0.03). But there were no significant differences in MICs for E. faecium (P=0.19). Five isolates (4 E. faecalis and 1 E. faecium) were susceptible to ampicillin but resistant to penicillin. There were no beta-lactamase producing enterococci among 701 isolates tested. CONCLUSIONS: MIC by Vitek system tends to be 1 to 2 dilution lower than MIC by agar dilution method to beta-lactams, and MIC of ampicillin is 1 to 2 dilution lower than MIC of penicillin, which could result in discrepancy in interpretation of susceptibilty tests. A beta-lactamase test for enterococci is not recommeneded for routine test in Korea.
Agar ; Ampicillin ; Anti-Bacterial Agents* ; beta-Lactamases ; beta-Lactams ; Bile ; Cerebrospinal Fluid ; Enterococcus faecalis ; Enterococcus* ; Korea ; Microbial Sensitivity Tests ; Penicillin-Binding Proteins ; Penicillins ; Suppuration ; Wounds and Injuries

BACKGROUND: Urography(IVU) is considered the best first investigation in patient with suspected urinary calculi, but recently ultrasonography(USG), combined with a plain film of the abdomen, has been suggested as an alternative. METHODS: We undertaken study to see if this approch can be used in emergency patients and outpatients by radiologists with different amounts of ultrasound experence. Some 192 patients with suspected urinary colic presenting to Koo Hospital Emergency Department and Youngnam Universith Hospital outward Department(IM, URO, FM) over 12-month period were studied. They had a plain abdominal film(KUB) and USG examination of the kidney, ureter, bladder following hydration and subsequently underwent IVU. Of these, 22 patients passed a stone before their IVU. The data analysis was performed on the remaining 170 patients. Urography was used as the gold standard. RESULTS: Some 170 patients subsequently underwent IVU at a mean interval of 1.8 days after the ultrasound examination. In 91 of 170 patients the IVU was positive. In 97 of 170 patients the combination of JUB plus USG was positive, leaving three false negative KUB plus USG. Thus the sensitivity of KUB plus USG was 97%, specificity was 89%, positive predictive value was 91%, and negative predictive value was 96%. CONCLUSIONS: Our findings in this study suggest that in the hydrated patient the combination of KUB plus US is a very sensitive and relative specific screening test. Because of the high negative predictive value of KUB plus US, urography is not likely to be helpful when KUB plus US are negative. Urography is indicated only if KUB plus US findings are equivocal or if intervention is necessa.ry.
Abdomen ; Colic ; Emergencies ; Emergency Service, Hospital ; Humans ; Kidney ; Mass Screening ; Outpatients ; Sensitivity and Specificity ; Statistics as Topic ; Ultrasonography* ; Ureter ; Urinary Bladder ; Urinary Calculi* ; Urography*

PURPOSE: Brain metastases are the most frequent metastatic neurologic complication of systemic cancer. Even if the prognosis of brain metastases is grave, with available treatments, most patients experience effective palliation of neurologic symptoms and meaningful extension of life. We evaluated the clinical features and prognostic factors of the patients who were diagnosed as solid tumors with brain metastasis and received radiotherapy for brain metastases. MATERIALS AND METHODS: Between January 1987 and January 1998, 71 patients with brain metastases from solid malignancy were included. We reviewed neurologic symptoms and signs of patients and evaluated improvememt of neurologic symptoms and signs. Survival durations after brain metastasis were analysed according to several factors such as age, performance status, primary malignancies, the presence of brain metastasis at initial diagnosis of primary tumor, multiplicity of brain metastass, the presence of metastases other than brain, and treatment method. RESULTS: Frequent symptoms associated with brain metastasis were headache (47.9%), motor weakness (40.8%), nausea and vomiting (19.7%) and mental change (19.7%). Palliation of these symptoms was accomplished in 64.9% of cases. The overall median survival time was 16 weeks and 1- and 2-year survival rates were 15.0% and 5.1% respectively. Patients without extracranial metastases (n=27) had longer median survival than patients with extracranial metastases (33 weeks vs 10 weeks, p=0.0018). In patients with single brain metastasis (n=37), the median survival time was longer in patients treated with surgery plus radiotherapy than in patients treated with radiotherapy alone (40 weeks vs 16 weeks, p=0.0438). CONCLUSION: Patients who has brain metastases only constitute a prognostically favorable group and they may be benefited from radiotherapy and surgery if indicated.
Brain* ; Diagnosis ; Headache ; Humans ; Nausea ; Neoplasm Metastasis* ; Neurologic Manifestations ; Prognosis ; Radiotherapy* ; Survival Rate ; Vomiting

No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal*

No abstract available.
Syncope* ; Urination*

PURPOSE: Today's clinical nurses deal with complex problems that need accurate evidence for practice and decision making. In this study the effectiveness of an EBP education program was examined. METHODS: A pre-posttest design was used for this study and participants were 46 nurses working at a tertiary hospital located in Suwon, Korea. Date collection was done before and after the education program, from July 27 to October 2, 2015. Data were analyzed using paired t-test and ANCOVA with SPSS 21.0. RESULTS: There were significant differences in scores before and after the EBP education program for EBP readiness: belief (t=-5.65, p<.001), implementation(t=-2.89, p=.006), competence (t=-4.21, p<.001), and for evidence-based decision making (t=-16.25, p<.001) by the nurses. CONCLUSION: The findings indicate that the EBP education program has positive effects on EBP belief, implementation, competence and evidence-based decision making. In the future, it is necessary to reinforce the content of the program in the clinical workplace and to provide continuous education for clinical nurses.
Decision Making* ; Education* ; Evidence-Based Practice* ; Gyeonggi-do ; Korea ; Mental Competency ; Tertiary Care Centers

PURPOSE: To analyze high-resolution CT findings(HRCT) of pulmonary lymphangitic carcinomtosis(PLC) and to correlated the HRCT findings with the results of pulmonary function test(PFT). MATERIALS AND METHODS: In Twenty eight patients with radiologically and clinically proved PLC, we retrospectively reviewed HRCT scans and PFT(N=12). PLC was classified by extent and distribution of metastatic nodules and interstitial thickenings on HRCT and the findings were correlated with the results of PFT and impairment of PFT according to the degree of FEVl(forced expiratory volume in one second). RESULTS: On the basis of distribution of PLC, HRCT findings showed 20 cases of peripheral type, 3 cases of central type, and 5 cases of mixed type. In the patients with PFT diffuse type was 10 cases and localized type was 2 cases. In diffuse types, the restrictive pattern occurred in 7 cases (p<0.05) and in localized types, restrictive pattern occurred in 2 cases. Marked impairment of vital capacity was shown as restrictive pattern in 7 cases all of which were diffuse type and were consisted of peripheral type in 4 cases and mixed type in 3 cases. CONCLUSION: HRCT findings of lymphangitic carcinomatosis correlated well the type and degree of impairment of PFT. Especially in diffuse type of lymphangitic carcinomatosis, the result of pulmonary function test were prominent restrictive patterns. Marked impairment of pulmonary function occurred in patients with diffuse type and types with peripheral interstitial thickening(periphral and mixed types).
Carcinoma* ; Humans ; Respiratory Function Tests* ; Retrospective Studies ; Vital Capacity

PURPOSE: This study was done to evaluate the effects of cognitive behavioral therapy in a victimized community district and to determine if the program is an effective nursing intervention to reduce posttraumatic stress disorder symptom, depression and state anxiety. METHODS: A nonequivalent control group design was used for the study. The participants, 32 elementary school students, were selected from grades 4, 5, 6 and each student was assigned to either the experimental (16) or control (16) group. Cognitive behavioral therapy was used as the experimental treatment from April 9 to May 28, 2009. The experimental group received cognitive behavior therapy intervention 8 times. Data analysis was done using ANCOVA with SPSS 17.0. RESULTS: After the intervention, the experimental group showed significantly lower levels of posttraumatic stress disorder symptoms than the control group. CONCLUSION: The findings from this study suggest that cognitive behavioral therapy is an effective nursing intervention to decrease the level of mental health problems of children in victimized district. Further research is required in order to identify the continuous effects of cognitive behavioral therapy.
Anxiety ; Child ; *Cognitive Therapy ; Depression ; Female ; Humans ; Male ; *Mental Health ; *Petroleum Pollution ; Program Evaluation ; Questionnaires ; Stress Disorders, Post-Traumatic/*therapy ; Stress, Psychological

Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.
Fetus ; Humans ; Incidence ; Infertility ; Ovulation Induction ; Parturition ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Twin ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted ; Triplets ; Twins

PURPOSE: The purpose of this study was to develop a tool for measuring the intra-operative caring as perceived by regional anesthesia patients. METHODS: A preliminary instrument with 54 questions, based on a literature review and semi-structured interviews with 11 regional anesthesia patients, was developed. A group of experts revised individual questions, and 34 questions were finally selected. This tool was tested with 137 regional anesthesia patients admitted to D university hospital in B city from August to October 2008. RESULTS: The validity and reliability of the tool were tested using factor analysis. After item analysis, one question with a correlation coefficient under .30 was discarded After performing factor analysis on the final 33 questions, 7 factors were identified; holistic needs fulfillment, consideration, protective environment, cautiousness, concern, information, physical comfort. The total variance shown in the test was 73.5%. A Cronbach alpha of 0.96 showed the reliability of the instrument. CONCLUSION: Results of this study indicate that the tool is statistically reliable and valid to measure the intraoperative caring perceived by regional anesthesia patients. This tool can be utilized usefully in assessing the effects of nursing interventions for regional anesthesia patients.
Adult ; Anesthesia, Conduction ; Female ; Humans ; Interviews as Topic ; Intraoperative Care ; Male ; Middle Aged ; Nursing Evaluation Research ; Nursing Staff, Hospital/psychology ; Patients/*psychology ; *Program Development ; Questionnaires