PURPOSE: The aim of the study was to explore nurses' experience of person-centered relational care in the context of critical care. METHODS: Key interview questions were developed based on the human-to-human relationship model suggested by Travelbee. Data were collected through in-depth interviews with a purposive sample of 11 nurses having more than 2 years of working experience in intensive care units. An interpretative phenomenological analysis was conducted to analyze the data. RESULTS: Four super-ordinate and nine sub-ordinate themes were identified. Emerged super-ordinate themes were as follows: (1) encountering a live person via patient monitoring systems; (2) deep empathic connection; (3) humanistic and compassionate care, and (4) accompanying the journey to the end. Study findings revealed that nurses in intensive care units experienced ‘balancing emotions’ and ‘authenticity’ in caring when entering human-to-human relationships with dying patients. The phenomenon of person-centered relational care in intensive care units was found to subsume intrinsic attributes of empathy, compassion, and trust, similar to the central concepts of Travelbee's theory. CONCLUSION: The interpretative findings in this study provide deeper understanding of Travelbee's human-to-human relationship model. The technological environment in intensive care units did not hinder experienced nurses from forming human-to-human relationships. These themes need to be emphasized in critical care nursing education as well as in nursing management. The results of this study will contribute to understanding nurse-patient caring relationships in depth, and help improve the quality of nursing care in intensive care units.
Critical Care Nursing ; Critical Care ; Education ; Empathy ; Humans ; Intensive Care Units ; Monitoring, Physiologic ; Nurse-Patient Relations ; Nursing ; Nursing Care ; Qualitative Research

PURPOSE: The aim of the study was to explore nurses' experience of person-centered relational care in the context of critical care. METHODS: Key interview questions were developed based on the human-to-human relationship model suggested by Travelbee. Data were collected through in-depth interviews with a purposive sample of 11 nurses having more than 2 years of working experience in intensive care units. An interpretative phenomenological analysis was conducted to analyze the data. RESULTS: Four super-ordinate and nine sub-ordinate themes were identified. Emerged super-ordinate themes were as follows: (1) encountering a live person via patient monitoring systems; (2) deep empathic connection; (3) humanistic and compassionate care, and (4) accompanying the journey to the end. Study findings revealed that nurses in intensive care units experienced ‘balancing emotions’ and ‘authenticity’ in caring when entering human-to-human relationships with dying patients. The phenomenon of person-centered relational care in intensive care units was found to subsume intrinsic attributes of empathy, compassion, and trust, similar to the central concepts of Travelbee's theory. CONCLUSION The interpretative findings in this study provide deeper understanding of Travelbee's human-to-human relationship model. The technological environment in intensive care units did not hinder experienced nurses from forming human-to-human relationships. These themes need to be emphasized in critical care nursing education as well as in nursing management. The results of this study will contribute to understanding nurse-patient caring relationships in depth, and help improve the quality of nursing care in intensive care units.

Korean National Health Insurance (NHI) was established during only 12 yr from its inception (1977-1989), providing universal medical coverage to the entire nation and making a huge contribution to medical security. However, the program now faces many challenges in terms of sustainability. The low birth rates, aging population, low economic growth, and escalating demands for welfare, as well as unification issues, all add pressure to the sustainability of NHI. The old paradigm of low contribution - low benefits coverage - low NHI's fee schedule needs to be replaced by a new paradigm of proper contribution - adequate benefit coverage - fair NHI's fee schedule. This new paradigm will require reform of NHI's operating system, funding, and spending.
Health Care Reform ; Humans ; National Health Programs/*economics ; Program Evaluation ; Republic of Korea ; Risk Factors ; Universal Coverage/economics

Objective: To demonstrate the effects of chin-down maneuver on swallowing by using high-resolution manometry (HRM). Methods: HRM data of 20 healthy subjects and 64 dysphagic patients were analyzed. Participants swallowed 5 mL of thin and honey-like liquids in neutral and chin-down positions. HRM was used to evaluate maximal velopharyngeal pressure/area, maximal tongue base pressure/area, maximal pharyngeal constrictor pressure, pre-/post-swallow upper esophageal sphincter (UES) peak pressure, minimal UES pressure, UES activity time, and nadir duration. Results: Compared to the neutral position, the chin-down maneuver significantly increased tongue base pressure in both normal and dysphagic groups as well as for both honey-like and thin viscosities, although the honey-like liquid did not reach statistical significance in the dysphagic group. Regarding pharyngeal constrictors and pre-swallow peak UES pressure, the healthy group showed a significant decrease in thin liquid swallowing and decreasing tendency in honeylike liquid swallowing. UES nadir duration was significantly decreased for honey-like liquid swallowing in the dysphagic group and for both thin and honey-like liquids in the healthy group. UES nadir duration of honey-like and thin flow swallowing in the dysphagia group was 0.26 seconds after the chin-down maneuver, which was severely limited. Conclusion This study showed a different kinetic effect of the chin-down maneuver between the healthy and dysphagic groups, as well as between thin and honey-like viscosities. The chin-down maneuver increased tongue base pressure and decreased UES nadir duration, which the latter was severely limited in dysphagic patients. Therefore, appropriate application of the chin-down maneuver in clinical practice is required.

BACKGROUND: Vascular endothelial growth factor-C (VEGF-C) is a novel growth factor that regulates lymphangiogenesis and/or angiogenesis via binding to the vascular endothelial growth factor receptor-3 (VEGFR-3) or VEGFR-2. Recent studies have suggested that VEGF-C may play a role in lymph node metastasis. This study was conducted to examine whether the expression of VEGF-C is associated with the clinicopathologic parameters, and especially lymph node metastasis, of invasive ductal carcinoma. METHODS: Immunohistochemical staining was performed for VEGF-C and CD31 in the surgically resected specimens from 83 patients with invasive breast carcinoma. RESULTS: Of the 83 breast carcinomas, 61 (74%) cases showed cytoplasmic VEGF-C imunoreactivity. VEGF-C expression was associated with lymph node metastasis (p=0.03), but it did not correlate with tumor size, the histologic grade, and the presence of estrogen receptor or progesteron receptor. The mean microvessel density in the cases without VEGF-C expression was 51.9+/-30.1 and it was 72.9+/-33.0 in the cases with 2+ expression for VEGF-C (p=0.07). CONCLUSIONS: This study suggests that VEGF-C expression may have an association with lymph node metastasis in the patients with breast carcinoma.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Cytoplasm ; Estrogens ; Humans ; Lymph Nodes ; Lymphangiogenesis ; Microvessels ; Neoplasm Metastasis ; Vascular Endothelial Growth Factor C* ; Vascular Endothelial Growth Factor Receptor-2 ; Vascular Endothelial Growth Factor Receptor-3

OBJECTIVES: This study aimed to examine the effect of biofeedback treatment on the clinical symptoms and stress responses in chronic headache patients. METHODS : We recruited 18 chronic headache patients who were treated with 8 sessions of biofeedback treatment and 18 age and sex-matched control headache patients. All subjects consisted of patients with chronic tension headache and migraine headache. Stress responses were measured using Symptoms of stress (SOS) inventory and all subjects performed Beck depression inventory (BDI), Spielberger state anxiety inventory (STAIS), and visual analogue scale (VAS). Biofeedback physiological variables including frontal and forearm EMG, electrodermal response (EDR) and skin temperature at pre-and post-treatment were also measured in all subjects. RESULTS : Compared with control patients, patients on biofeedback treatment showed significant reduction in scores of STAIS (t=3.705, p<.001), and VAS (t=3.392, p=.001) as well as SOS subscales;peripheral manifestations (t=1.788, p=.042), habitual patterns (t=2.008, p=.027), depression (t=2.081, p=.023), anxiety (t=1.990, p=.028), and total score (t=2.045, p=.025). There was a significant increase of skin temperature (t=-1.835, p=.038) only in the biofeedback treatment group. CONCLUSION : These results suggest that biofeedback treatment may be effective in relieving chronic headache by reducing psychological and physiological stress responses.
Anxiety ; Biofeedback, Psychology ; Depression ; Forearm ; Galvanic Skin Response ; Headache ; Headache Disorders* ; Humans ; Migraine Disorders ; Relaxation* ; Skin Temperature ; Stress, Physiological ; Tension-Type Headache

Endovascular aneurysm repairs for a ruptured AAA (EVAR for r-AAA) have been reported with limited results although endovascular aneurysm repairs for elective AAA (EVAR for e-AAA) have shown good early and late results. In this case report, the authors described successful EVAR for r-AAA. A 93-year-old female underwent emergent EVAR for r-AAA. An aortic occlusion balloon was inserted before general anesthesia for hemodynamic stability. Zenith endograft was deployed under general anesthesia. Completion angiography showed no endoleak but there was coverage of the right renal artery. She was discharged 2 weeks after overcoming transient acute renal insufficiency. We concluded that EVAR for r-AAA can be an alternative option for the treatment of ruptured AAA.
Acute Kidney Injury ; Anesthesia, General ; Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal ; Endoleak ; Female ; Hemodynamics ; Humans ; Renal Artery ; Rupture ; Stents

PURPOSE: To analyse clinical outcome and prognostic factors according to treatment modality, this paper report our experience of retrospective study of patients with esophageal cancer. MATERIALS AND METHODS: One hundred and ten patients with primary esophageal cancer who were treated in Presbyterian Medical Center from May 1985 to December 1992. We analysed these patients retrospectively with median follow up time of 28 months, one hundred and four patients(95%) were followed up from 15 to 69 months. In methods, twenty-eight patients were treated with median radiation dose irradiated 54.3Gy only. Fifty-six patients were treated with combined chemoradiotherapy. Sixteen cases of these patients were treated with concurrent chemoradiation and the other patients(forty cases) were treated sequential chemoradiotherapy. In concurrent chemoradiotherapy group, patients received 5-FU continuous IV infusion for 4 days. Cisplatin IV bolus, and concurrent esophageal irradiation to 30 Gy. After that patients received 5-Fu continuous IV, Cisplatin bolus injection and Mitomycin-C bolus IV, Bleomycin continuous IV, and irradiation to 20 Gy. In sequential chemoradiotherapy group, the chemotherapy consisted of 5-FU 1,000 mg/m2 administered as a continuous 24 hour intravenous infusion during five days and Cisplatin 80-100 mg/m2 bolus injected, or Bleomycin, Vinblastine, Cisplatin, Methotrexate were used of 1 or 2 cycles. After preoperative concurrent chemoradiation, twenty-six patients underwent radical esophagectomy. RESULTS: ninety-three patients could be examined for response assessment. By treatment modality, response rates were 85.1% for radiation alone group and 86.3% for combined chemoradiation group. But in operation group, after one cycle of concurrent chemoradiation treatment, response rate was 61.9%. Ther pathologic complete response were 15.4% in operation group. Overall median survival was 11 months and actuarial 5-year survival rate was 8%. The median survival interval was 6 months for radiation alone group, 11 months for combined chemoradiation group and 19 months for operation group. And also median survival was 19 months for complete responder group that 8 months for noncomplete responder group. In univariative analysis, statistically significant prognositc factors were tumor size, clinical stage, tumor response, and operation. In multivariative analysis, siginificantly better survival was associated with clinical stage, tumor response, radiation dose, and peration. CONCLUSION: Compared with radiotherapy alone, combined mulimodlity may improve the median survival in patients with localized carcinoma of the esophagus and toxicity is acceptable.
Bleomycin ; Chemoradiotherapy ; Cisplatin ; Drug Therapy ; Esophageal Neoplasms* ; Esophagectomy ; Esophagus ; Fluorouracil ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Methotrexate ; Mitomycin ; Protestantism ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Vinblastine

Transfusion-related acute lung injury (TRALI) is a noncardiogenic pulmonary edema that occurs during or within 6 hours after transfusion. Risk factors for TRALI, which is relatively common in critically ill patients, include recent surgery, hematologic malignancy, and sepsis. Here, we report a case of TRALI induced by anti-human leukocyte antigen (anti-HLA) class II antibodies (HLA-DR) occurring after transfusion of platelet concentrates in a patient with acute leukemia. Although most patients with TRALI show improvement within 48-96 hours, our patient's condition rapidly worsened, and he did not respond to supportive treatment. TRALI is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management.
Acute Lung Injury ; Antibodies ; Blood Group Incompatibility ; Blood Platelets ; Critical Illness ; Hematologic Neoplasms ; Humans ; Leukemia ; Leukocytes ; Pulmonary Edema ; Risk Factors ; Sepsis

Purpose: The incidence and prevalence of neurodevelopmental disorders have rapidly increased, indicating an urgent need for assistance through parenting interventions. This study aimed to evaluate the effects of a sociodrama-based communication enhancement program on mothers of children with neurodevelopmental disorders.Method: A non-randomized controlled experimental study design was employed. The experimental and control groups had 16 and 18 participants, respectively. The once-a-week six-session intervention was conducted from September to November 2017, in South Korea. The effects of group, time, and group-by-time interactions among the groups were verified using generalized estimating equations with an autoregressive correlation structure. Results: There was a significant decrease in the parenting burden, alongside a significant improvement in parent-child communication and parenting competence in the experimental group compared to the control group. Conclusion The sociodrama-based communication enhancement program was found to positively influence the parenting burden, communication, and parenting competence of mothers of children with neurodevelopmental disorders. These findings suggest that sociodrama-based programs may be an effective intervention strategy for parents of children with neurodevelopmental disorders. The sociodrama-based communication enhancement program can be applied to decrease parenting burden and improve parent-child communication and parenting competence. Through continuous parenting interventions, an improvement in expressive language and an increase in the attachment behaviors of children with neurodevelopmental disabilities could be expected.