Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.
Aged ; Airway Obstruction ; Analgesics, Opioid ; Asthma ; Diagnosis, Differential ; Female ; Femur Neck ; Fentanyl* ; Humans ; Intensive Care Units ; Lung Diseases, Obstructive ; Muscle Rigidity ; Oxygen ; Periprosthetic Fractures ; Physical Examination ; Thoracic Wall* ; Thorax* ; Ventilation

BACKGROUND: Pregnancy induced hypertension (PIH) is a common cause of maternal morbidity and death in late pregnancy. Pulmonary edema, although infrequently encountered, may cause death in severe cases of PIH. However, the mechanisms that account for pulmonary edema have not been clarified. Mobilization of peripheral edema, excess fluid intake, myocardial dysfunction, and reduced plasma protein concentration are factors that have been postulated as contributing to the development of pulmonary edema in this syndrome. Colloid osmotic pressure is a principal regulator of capillary fluid exchange. METHODS: In a study of 50 normotensive and severe PIH patients who underwent cesarean section, peripartum plasma colloid osmotic pressure, serum albumin, and total serum protein were compared. RESULTS: Both groups exhibited significantly lower plasma colloid osmotic pressure in the postpartum period than that measured antepartum (p<0.05). The mean antepartum plasma colloid osmotic pressure in severe PIH patients was significantly lower than in normotensive subjects (p<0.05). CONCLUSIONS: We believe that serial COP measurments may be helpful to guide optimal fluid management in severe PIH patients.
Capillaries ; Cesarean Section ; Colloids* ; Edema ; Female ; Humans ; Hypertension, Pregnancy-Induced ; Osmotic Pressure* ; Peripartum Period ; Plasma ; Postpartum Period ; Pregnancy* ; Pulmonary Edema ; Serum Albumin

PURPOSE: The aim of this study was to examine the effect of self-assertive training applying the reality therapy techniques (SATART) on self-esteem and internalized stigma of schizophrenia patients. METHODS: This study was a non-equivalent control group pretest-posttest design and enrolled 55 people with schizophrenia (experimental group=27, control group=28) from two community mental health centers. The SATART was offered twice a week for 6 weeks in a total 12 sessions. Data were collected from February to April, 2017, using the Korean version of the Internalized Stigma of Mental Illness Scale and Rosenberg Self-Esteem Scale. The collected data was analyzed using χ2 test, independent t-test, one-way ANCOVA, and repeated measures ANOVA with using the SPSS/WIN 22.0 program. RESULTS: The experimental group showed significant improvements in self-esteem and recudction of internalized stigma compared to the control group. However, there was no significant improvement on stigma resistance measurement among the subscales of internalized stigma between two groups. CONCLUSION: The findings indicate that the SATART program is effective and could be recommended as a psychosocial intervention for self-esteem enhancement and internalized stigma reduction of people with schizophrenia.
Assertiveness ; Community Mental Health Centers ; Humans ; Reality Therapy ; Schizophrenia ; Self Concept ; Social Stigma

The purpose of this study was to investigate basic data on the degree of parents' recognition and satisfaction with the use of environment-friendly agricultural products. The conclusions of this study are as follows. The survey on the use of environment-friendly products in households showed that 68.7% of the respondents used environment-friendly products at home. The frequency of purchasing organic products by household consumers showed that 25.1% of the respondents bought organic products one to two times per week. The most popular items of the environment-friendly agricultural products used were vegetables, comprising 63.9%. The households with more than 3,000,000 won of monthly income tended to consume more domestic livestock products (p < 0.05). In comparison to general agricultural products, environment-friendly agricultural products users showed higher satisfaction level with a better quality in term of safety, quality, nutrition, taste, appearance, diversity and price. The degree of satisfaction with safety was the highest (3.8 +/- 0.68), and price showed the lowest (2.76 +/- 0.79). The degree of parents' recognition of the governmental support for environment-friendly agricultural products showed that those who were aware of the supporting policy were 44.5%, but 55.5% of them didn't know about the fact that 46.6% of the respondents agreed that environment-friendly agricultural products should be used in more than 50% of the foods used for school food service. The respondents pointed out that vegetables (45%) sprayed with pesticide are the most urgent food item that need to be replaced by environment-friendly farm products.
Surveys and Questionnaires ; Family Characteristics ; Food Services ; Humans ; Livestock ; Vegetables

A culture of the Leptospira species and the microscopic agglutination test (MAT) are considered as the reference standard for the diagnosis of leptospirosis, but both tests are imperfect for early diagnosis. We describe 4 patients diagnosed with leptospirosis using nested polymerase chain reaction (N-PCR) that targeted the 16S rRNA gene and the passive hemagglutination assay (PHA). In our 4 cases, Leptospira DNA in the urine, plasma, or cerebrospinal fluid (CSF), was detected by N-PCR in the early phase of leptospirosis, except in the sample from the buffy coat. Especially, case 3 showed that N-PCR with the urine and CSF was positive 8 days after symptom onset, but not for the plasma or buffy coat. We report 4 cases of leptospirosis that were diagnosed by N-PCR that targeted the 16S rRNA gene with urine, plasma, or CSF, but not the buffy coat. Three were cured by doxycycline but the case 4 was fatal. Detection of Leptospira DNA by PCR from the urine and CSF, in addition to plasma, may be helpful to confirm the diagnosis.

PURPOSE: The purpose of this study was to describe the essential structure of the lived experience of working mothers' parenting burden in Korea. METHODS: Eight working mothers with young children were interviewed. The Colaizzi analysis of phenomenological research was applied. RESULTS: Seven theme clusters were extracted: a life with constant conflict, sense of guilt, feeling anxious because of lack of information about education for their children, social stigma as a deficient mother, family relationship becoming distant, a life being exhausted, day to day struggle. CONCLUSION: These results provide an opportunity to have a better understanding of the experiences of working mothers related to parenting their young children. It would also serve as a medium for the formulation of appropriate nursing intervention relevant to burdens of parenthood.
Child ; Family Relations ; Guilt ; Humans ; Korea ; Mothers ; Parenting ; Parents ; Social Stigma

Vibrio vulnificus is a gram-negative bacterium that can cause serious, potentially fatal infections. V. vulnificus causes three distinct syndromes: an overwhelming primary septicemia caused by consuming contaminated seafood, wound infections acquired when an open wound is exposed to contaminated warm seawater, and gastrointestinal tract-limited infections. Case-fatality rates are higher than 50% for primary septicemia, and death typically occurs within 72 hours of hospitalization. Risk factors for V. vulnificus infection include chronic liver disease, alcoholism, and hematological disorders. When V. vulnificus infection is suspected, appropriate antibiotic treatment and surgical interventions should be performed immediately. Third-generation cephalosporin with doxycycline, or quinolone with or without third-generation cephalosporin, may be potential treatment options for patients with V. vulnificus infection.
Alcoholism ; Diagnosis ; Doxycycline ; Hospitalization ; Humans ; Liver Diseases ; Prognosis ; Public Health* ; Risk Factors ; Seafood ; Seawater ; Sepsis ; Vibrio vulnificus* ; Vibrio* ; Wound Infection ; Wounds and Injuries

Epidermal cysts are common benign subcutaneous lesions that occur in or on the skin. It is not very difficult to diagnose subcutaneous epidermal cysts using ultrasound imaging because they exhibit typical sonographic features. However, the differential diagnosis can be confused when epidermal cysts are found in unusual sites. The authors report a case involving a 4-year-old girl who presented with an intramuscular epidermal cyst in the gluteus maximus muscle. Magnetic resonance imaging revealed characteristic internal features of the epidermal cyst, despite being in an uncommon site, and was very useful in the preoperative diagnosis.

Objective: To investigate the effect of low frequency cerebellar repetitive transcranial magnetic stimulation (rTMS) on balance impairment in patients with cerebral infarction. Methods: Thirty-two patients were randomly divided into two groups: rTMS group (n=16) and control (n=16). In the rTMS group, treatment was performed five times per week for 2 weeks (10 sessions), and in the control group, a sham coil was used with the sound and sensation of scalp similar to the rTMS coil. Patients in both groups underwent a conventional rehabilitation program. Berg Balance Scale (BBS) was used as the primary outcome measurement. Timed Up and Go test (TUG), 10-m walk test (10mWT), and Activity-specific Balance Confidence scale (ABC) were used as the secondary outcome measurement. All scales were measured at baseline (T0), after 10 sessions of rTMS (T1), and at 4 weeks after treatment completion (T2) by therapists with over 5 years of clinical experience. Results: There were significant improvements between T0 and T1, and between T0 and T2, for all assessed items in the rTMS group. Whereas there were significant improvements between T0 and T1, and between T0 and T2, for the BBS and 10mWT in the control group. TUG (-4.87±5.05 vs. -0.50±2.97 seconds) and ABC score (8.10±8.33 vs. 0.16±0.97) were observed significant differences in comparison of the changes from T0 to T1 between the two group. BBS score (4.40±3.66 vs. 1.88±3.14), TUG (-4.87±4.56 vs. -0.62±2.96 seconds) and ABC score (8.22±7.70 vs. -0.09±0.86) differed significantly from T0 to T2 between the two groups. Conclusion Our findings suggest that low-frequency cerebellar rTMS is helpful for improving balance in patients with cerebral infarction, and maybe a beneficial treatment for these patients.

PURPOSE: This study aimed to identify multidimensional factors influencing burnout in intensive care unit(ICU) nurses. METHODS: A descriptive cross-sectional design was used. Data were collected during February 2016 from a convenience sample of 222 tertiary hospital ICU nurses and analyzed using t-test, ANOVA, correlation analysis, and multiple regression analysis. RESULTS: Burnout correlated positively with compassion fatigue (CF)(r=.37, p < .001), and negatively with compassion satisfaction (CS)(r=-.66, p < .001). The regression model explained 57% of the variance in burnout. For individual characteristics in the model, perceived health status (β=-.27, p < .001) and gender (β=.14, p=.028) were the most influential factors for ICU nurses' burnout. In the model with added work-related characteristics, nursing environment (β=-.22, p=.001), perceived health status (β=-.20, p=.001), and satisfaction with department (β=-.19, p=.007) were the most influential factors. Finally, for the model with psychological characteristics added, CS (β=-.56, p < .001) and CF (β=.35, p < .001) were the most influential factors. CONCLUSION: Results reveal that most ICU nurses have a moderate level of CF and a moderate to high level of CS and burnout, and that individual, work-related and psychological factors are relevant in ICU nurses' burnout. Programs or interventions to reduce burnout should be developed taking into account these multidimensional factors.
Compassion Fatigue ; Critical Care ; Empathy ; Intensive Care Units ; Nursing ; Personal Satisfaction ; Psychology ; Tertiary Care Centers