PURPOSE: This study aimed to explore professional autonomy, nursing work environment, and clinical decision making ability and to determine predictors of clinical decision making ability among clinical nurses. METHODS: A cross-sectional design was used in this study and 263 clinical nurses were selected from advanced-level hospitals with over 500 beds located in D metropolitan city. Independent t-test, ANOVA, Pearson's correlation coefficients and hierarchical multiple regression analyses were done with the SPSS/WIN 20.0 program. RESULTS: Clinical nurses reported moderate levels of professional autonomy, nursing work environment and clinical decision making ability. Marital status, professional autonomy and nursing work environment accounted for 25% of variance in clinical decision making ability required in various clinical settings. Importantly, being married, higher level of professional autonomy, and greater satisfaction with work environment were significantly associated with better decision making ability. CONCLUSION: Findings indicate that improving the quality of decision making in the healthcare settings requires awareness of the multiple effects of individual, occupational and environmental features. Nurses' ability to make effective clinical decisions may rely on personal characteristics, the degree of autonomy in their job, and nurses' satisfaction with their work environment.
Decision Making* ; Delivery of Health Care ; Humans ; Marital Status ; Nursing* ; Professional Autonomy*

PURPOSE: This study aimed to explore professional autonomy, nursing work environment, and clinical decision making ability and to determine predictors of clinical decision making ability among clinical nurses. METHODS: A cross-sectional design was used in this study and 263 clinical nurses were selected from advanced-level hospitals with over 500 beds located in D metropolitan city. Independent t-test, ANOVA, Pearson's correlation coefficients and hierarchical multiple regression analyses were done with the SPSS/WIN 20.0 program. RESULTS: Clinical nurses reported moderate levels of professional autonomy, nursing work environment and clinical decision making ability. Marital status, professional autonomy and nursing work environment accounted for 25% of variance in clinical decision making ability required in various clinical settings. Importantly, being married, higher level of professional autonomy, and greater satisfaction with work environment were significantly associated with better decision making ability. CONCLUSION: Findings indicate that improving the quality of decision making in the healthcare settings requires awareness of the multiple effects of individual, occupational and environmental features. Nurses' ability to make effective clinical decisions may rely on personal characteristics, the degree of autonomy in their job, and nurses' satisfaction with their work environment.
Decision Making ; Delivery of Health Care ; Humans ; Marital Status ; Nursing ; Professional Autonomy

For several decades, Radiofrequency lesioning has been used for intractable pain that originates from the spinal area. Heating of the tissue has been assumed to be the only mechanism that can cause this effect. There has never been the suggestion that the RF fields themselves can modify the neuro-cellular function independently of the thermal effect. Additionally, Radiofrequency machines can not be used in neuropathic pain because of their thermal effect. Recently, a modified type of Radiofrequency machine was developed, using a non-thermal pulse, and applying a relatively high voltage. Some authors have reported remarkable results using this technique recently. There are several possible mechanisms and several attempts have been tried to explain this therapeutic effect respectively, but none of them explain it fully. One possible mechanism is through an Electro-Magnetic Field (EMF) that doesn't produce high temperature in the tip area. This is done in a pulsed fashion to avoid the high temperature made during the active cycle. However there is no apparent mechanism that explains this therapeutic effect clearly. The patient whom we report now was a 23 year-old male who suffered from repetitive low back pain and radiculopathy. He failed to respond to other oral and invasive conventional therapies. We experienced a successful result in the treatment of his intractable neuropathic pain using this pulsed RF machine.
Heating ; Hot Temperature ; Humans ; Low Back Pain ; Male ; Neuralgia* ; Pain, Intractable ; Radiculopathy ; Young Adult

PURPOSE: The purpose of this study was to identify the influencing factors on mental health related quality of life (MHRQoL) in adults across the lifespan. METHODS: A total of 688 Korean adults aged 19 years and older were selected. Data were collected by personal interviews or self report using structured questionnaires. For data analysis, t-test, ANOVA, Pearson's correlation coefficients and Stepwise multiple regression were used. RESULTS: Mental health related quality of life (MHRQoL) differed significantly according to life cycle, especially showing a lower score in the elderly than others. In addition, elderly adulthood reported the highest stress and depression. The most significant predictors of MHRQoL in young and middle aged people were stress, depression, and subjective health status. Predictors of MHQoL in the elderly were stress and religion. CONCLUSION: The results indicate that MHRQoL of adult is associated with stress and depression. When the programs are developed to enhance mental health in elderly adulthood, religion should be considered as well as stress.
Adult ; Aged ; Depression ; Humans ; Life Cycle Stages ; Mental Health ; Middle Aged ; Quality of Life ; Surveys and Questionnaires ; Self Report ; Statistics as Topic

An abdominal pregnancy is defined as an ectopic pregnancy, which implants in the peritoneal cavity and can be classified as either primary or secondary. The incidence of abdominal pregnancy is increased after IVF or GIFT, induced abortion, endometriosis, and intrauterine devices may also contribute to an increased incidence. Early diagnosis and appropriate surgical management, regardless of stage of gestation, appear to be important in achieving good results. A case of early primary abdominal pregnancy which was implanted on the left uterosacral ligament. We report the case and brief review of literature.
Abortion, Induced ; Early Diagnosis ; Endometriosis ; Female ; Incidence ; Intrauterine Devices ; Ligaments ; Peritoneal Cavity ; Pregnancy ; Pregnancy, Abdominal* ; Pregnancy, Ectopic

PURPOSE: Ileostomy may affect various aspects of life style of the patient. Moreover the complication after ileostomy formation or closure may lower the life quality of the patient. The purpose of this study is to investigate ileostomy related complications and elucidate associated factors. METHODS: We recruited 103 patients who underwent ileostomy in Asan Medical Center between July 1989 and June 2000. All ileostomies are constructed through the rectus muscle at the right lower quadrant of the abdomen. To mnimize peristomal skin irritation, at least two to three centimeters of the ileum lies above the skin level. We analyzed complications after ileostomy formation in relation to underlying diseases, types and purpose of ileostomy. Also, we analyzed complication after ileostomy closure in relation to underlying diseases, time interval and method of take-down. Results are compared using chi-square test. Statistical significance was assigned to a P value of<0.05. RESULTS: Complications of ileostomy formation were developed in 17 (16.5%) cases; 8 peristomal dermatitis, 3 wound infection, 2 prolapse, 1 stenosis, 1 perforation, 1 bleeding, 1 high output ileostomy. There was no significant difference of complication rate in relation to underlying diseases, types and purpose of ileostomy. Ileostomy take-down was performed in 55 (53.4%) cases of 103 patients. Complications related with ileostomy take-down were developed in 18 (32.7%) cases; 7 wound infection, 5 intestinal obstruction, 2 incisional hernia, 2 enterocutaneous fistula, 1 anastomosis leakage, 1 bleeding. There was no significant difference of complication rate in relation to time interval or method of take-down. However, complication rate of ileostomy take-down was significantly increased in patient with inflammatory bowel disease. CONCLUSIONS: Ileostomy formation is simple and safe surgical procedure. We couldn't find any factor affecting the morbidity of ileostomy formation or closure. However, complication rate after ileostomy closure, especially in patient with inflammatory bowel disease, is relatively high.
Abdomen ; Chungcheongnam-do ; Constriction, Pathologic ; Dermatitis ; Hemorrhage ; Hernia ; Humans ; Ileostomy* ; Ileum ; Inflammatory Bowel Diseases ; Intestinal Fistula ; Intestinal Obstruction ; Life Style ; Prolapse ; Quality of Life ; Skin ; Wound Infection

We describe unusual manifestations of congenital cystic adenomatoid malformation ( C.C.A.M.) of the lung, such as movable fungal ball-like intracystic blood clots and hemoptysis, which were detected in previously healthy 23 years-old woman. We identified blood clots only after left upper lobectomy and could not distinguish from fungal ball with radiographic methods. CCAM of the lung, rare and lethal form of congenital pulmonary cystic disease, was initially introduced by Ch'in and Tang in 1949. The histogenesis of this lesion is characterized by polypoid glandular tissue proliferation and overgrowth of mesenchymal elements due to cessation of bronchiolar maturation which occured in after 16weeks intrauterine period. In 80-95% of reported cases, the lesion was confined to a single lobe and there was no lobe and right and left lung predilection. The clinical presentation may be widely variable, ranging from intrauterine fetal death to late discovery in childhood with recurrent pulmonary infection. But there's no reports which were misdiagnosed with intracystic fungal ball. The treatment choice is lobectomy of affected lobe. There's a few case reports with rhabdomyosarcoma, bronchiolar cell carcinoma and myxosarcoma arising in CCAM patients. Therefore, early resection is recommended even if asymtomatic cases. We experienced a rare case of CCAM of the lung in 23 years old female, and there were intracystic fungal ball-like movable blood clots in lower portion of left lung. After left upper lobectomy was performed, now she is discharged and followed up without any complications.
Cystic Adenomatoid Malformation of Lung, Congenital* ; Female ; Fetal Death ; Hemoptysis ; Hemorrhage ; Humans ; Lung* ; Myxosarcoma ; Rhabdomyosarcoma ; Young Adult

Hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome is a rare autosomal recessive urea cycle disorder. HHH is caused by a deficiency of the mitochondrial ornithine transporter protein, which is encoded by the solute carrier family 25, member 15 (SLC25A15) gene. Recently, government supported Korean newborn screening has been expanded to include a tandem mass spectrometry (MS/MS) measurement of ornithine level. We report a case of a neonate with HHH syndrome showing a normal MS/MS measurement of ornithine level. A female newborn was admitted to neonatal intensive unit due to familial history of HHH syndrome. Her parents were consanguineous Parkistani couple. The subject's older sister was diagnosed with HHH syndrome at age of 30 months based on altered mental status and liver dysfunction. Even though the subject displayed normal ammonia and ornithine levels based on MS/MS analysis, a molecular test confirmed the diagnosis of HHH syndrome. At 1 month of age, amino acid analysis of blood and urine showed high levels of ornithine and homocitrulline. After 11 months of follow up, she showed normal growth and development, whereas affected sister showed progressive cognitive impairment despite no further hyperammonemia after protein restriction and standard therapy. Our report is in agreement with a previous Canadian study, which showed that neonatal samples from HHH syndrome patients demonstrate normal ornithine levels despite having known mutations. Considering the delayed rise of ornithine in affected patients, genetic testing, and repetitive metabolic testing is needed to prevent patient loss in high risk patients.

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is the most common method of enteral nutrition for patients who require long term artificial nutrition. PEG has been used as a method of nutritional support; however, improvement of nutritional support via PEG has not yet been reported. In this study, we analyzed the efficacy of nutritional support via PEG. METHODS: We conducted a retrospective analysis of 196 consecutive patients who underwent PEG at Kyung Hee University Hospital in Gang Dong from 2006 to 2012. We analyzed clinical characteristics, the method of nutritional support, and the proportion of intake to establish recommendations for nutritional requirements and the duration needed to reach the level of appropriate nutrition. RESULTS: A total of 196 patients included 130 men and 66 women, and their mean age (standard deviation) was 69.1+/-14.0 years. Compared with caloric and protein supplementation before PEG, 113 kcal (13.8% of baseline) and 4.8 g of protein (17.5% of baseline) could be additionally supplied with PEG (P=0.001, respectively). The number of patients who could take more than 90% of the recommended requirements of caloric and protein supplementation after PEG showed increased caloric and protein intake by 25.4% and 20.2%, respectively, in comparison with those before PEG (P=0.001 and P=0.001, respectively). The mean duration of catch-up for more than 90% of the recommended caloric and protein intake was approximately 11 days. Procedure related complications and early mortality were reported in 8.1% and 0% of patients, respectively. CONCLUSIONS: PEG is an effective and safe nutritional support method for patients who require long term artificial nutrition.
Endoscopy ; Enteral Nutrition ; Female ; Gastrostomy ; Humans ; Male ; Nutritional Requirements ; Nutritional Status ; Nutritional Support ; Retrospective Studies