PURPOSE: This study identifies the effects of the educational leadership of nursing unit managers on team effectiveness and the mediating effects of organizational communication satisfaction; it highlights the importance of educational leadership and organizational communication and provides the data needed to enhance the education capacity of managers. METHODS: The participants were 216 nurses working at unit with nursing unit managers of staff nurses at a tertiary hospital located in Cheongju city, South Korea, and nurses who had worked for more than 6 months at the same unit. This study was conducted using questionnaires on educational leadership, team effectiveness, and organizational communication satisfaction. Data analysis was performed with a t test, analysis of variance, Scheffé test, Pearson's correlation coefficient, and simple and multiple regression analyses using SPSS, version 23.0. Mediation analysis was tested using Baron and Kenny's regression analysis and a Sobel test. RESULTS: The mean score for the educational leadership of nursing unit managers was 3.74 (±0.68); for organizational communication satisfaction, 3.14 (±0.51); and for team effectiveness, 3.52 (±0.49). Educational leadership was significantly positively correlated with team effectiveness and organizational communication satisfaction. Organizational communication satisfaction demonstrated a complete mediating effect on the relationship between educational leadership and team effectiveness (β = .61, p < .001) and was significant (Sobel test; Z = 7.40, p < .001). CONCLUSION: The results indicate that the educational leadership of nursing unit managers increases communication satisfaction among nurses; this supports the idea that educational leadership can contribute to team effectiveness. This suggests that the educational leadership and communication capacity of nursing unit managers must be improved to enhance the performance of nursing organizations.
Chungcheongbuk-do ; Education ; Humans ; Korea ; Leadership* ; Negotiating* ; Nurse Administrators ; Nursing* ; Statistics as Topic ; Tertiary Care Centers

PURPOSE: The aim of this study was to determine the outcome and identify predictors of success of biofeedback therapy for rectocele. METHODS: Twenty four female patients (mean age 43.8 years) with rectal emptying difficulties and a rectocele greater than 2 cm at defecography were evaluated before hand with a standardized questionnaires, immediately after biofeedback therapy, and at follow up. Defecography, manometry, colon transit studies and electrophysiology were also analyzed. RESULTS: Follow up (mean 7.2; range 2~17 months) results were evaluated by an independent observer in 20 patients. At the end of biofeedback, 22 (92 percent) patients felt improvement in symptoms, including 13 (54 percent) with symptomatic relief. At follow-up, 14 (70 percent) patients felt improvement in symptoms, including 3 (15 percent) with complete relief of symptoms. There was a significant reduction in difficult defecation (from 79 to 29, 40 percent, from pre-biofeedback to post-biofeedback, at follow-up respectively; P<0.001, P<0.05), sensation of incomplete defecation (from 96 to 46, 60 percent; P<0.001, P<0.005), laxative use (from 54 to 25, 30 percent; P<0.05), enema use (from 21 to 0,0 percent; P<0.05), anal pain (from 21 to 0, 5 percent; P<0.05) and digitation (from 21 to 4, 5 percent). Normal spontaneous bowel movement was significantly increased from 50 percent pre-biofeedback to 83 post-biofeedback (P<0.05), 65 percent at follow-up. Abdominal pain (P<0.05) and digitation (P<0.05) related to poor results. High mean squeeze pressure (P<0.001) and high maximum squeeze pressure (P<0.05) on pre-biofeedback manometry were also related to a poor outcome. Age, duration of symptoms, parity, number of sessions of biofeedback, gynecologic surgery history, and rectocele size at defecography had no prognostic value. Anismus and colonic inertia did not influence the outcome of biofeedback. CONCLUSIONS: Biofeedback is an effective treatment option for patients with obstructed defecation due to rectocele.
Abdominal Pain ; Biofeedback, Psychology* ; Colon ; Constipation ; Defecation ; Defecography ; Electrophysiology ; Enema ; Female ; Follow-Up Studies ; Gynecologic Surgical Procedures ; Hand ; Humans ; Manometry ; Parity ; Surveys and Questionnaires ; Rectocele* ; Sensation

BACKGROUND: It has been reported that nontuberculosis mycobacterium(NTM) isolates account for approximately 10% of patients with a positive Acid-Fast Bacilli(AFB) smear. Therefore, it is necessary to consider NTM pulmonary disease when such a positive test is encountered. The aim of this study was to evaluate the etiologies and clinical characteristics of patients with NTM pulmonary disease who had been treated at a national tuberculosis hospital. METHODS: The NTM isolates were recovered from the sputum or bronchial washing specimens submitted to a clinical laboratory of National Masan TB Hospital from August 2002 to July 2003. All samples were identified using a polymerase chain reaction-restriction fragment length polymorphism analysis method, which amplifies the rpoB gene. The patients were diagnosed with NTM disease according to the American Thoracic Society diagnostic criteria. RESULTS: One hundred NTM isolates were recovered from 57 patients. Of the 100 isolates, M. avium complex(MAC) was the most common species, which was found 55%(n=55) of patients, followed by M. abscessus(n=25), and M. fortuitum(n=9). 26(45.6%) patients had NTM disease. Twenty-six (45.6%) patients had NTM disease according to The American Thoracic Society classification. The main organisms involved in NTM disease were MAC(n=19, 73.1%) and M. abscessus(n=5, 19.2%). The pathogenic potential was 67.9% in M. intracellulare and 41.7% in M. abscessus. The predictive factors related to NTM disease were a positive sputum smear (OR 6.4, p=0.02) and the isolation of either MAC or M. abscessus(OR 6.9, p=0.007). Fifteen patients(57.7%) were cured. There were no significant factors associated with the treatment success. CONCLUSION: There was a relatively high proportion of NTM disease in NTM isolates and the common species were MAC and M. abscessus. The predictive factors for NTM disease were a positive sputum smear and the isolation of either MAC or M. abscessus.
Classification* ; Hospitals, Chronic Disease* ; Humans ; Lung Diseases* ; Mycobacterium avium Complex ; Nontuberculous Mycobacteria ; Sputum ; Tuberculosis*

No abstract available.
Thorax*

We experienced a case where extracorporeal membrane oxygenation ECMO was used for a cardiac arrest that occurred during spinal anesthesia. An 84-year-old man underwent total hip replacement surgery. The patient developed sudden cardiac arrest at around 40 minutes after the administration of spinal anesthesia. The cardiac arrest was difficult to manage with ordinary CPR (cardiopulmonary resuscitation) and went on to complete cardiac arrest. ECMO (venoarterial ECMO from the right femoral artery to the right femoral vein) was immediately applied while performing cardiac massage. Heparin was infused with ACT (activated coagulation time) monitoring during ECMO. We also found multiple rib fractures and hemothorax resulting from the chest massage as seen on a chest X-ray. On the third day after resuscitation, communication with the patient was possible. Hemodialysis was performed due to acute renal failure on the same day. On the seventh day, the vital signs became stable. The flow of the pump was lowered and the patient was weaned from ECMO. However, the patient could not be weaned from ventilatory support due to the hemothorax caused by the CPR. Thereafter, weaning from ventilatory support was delayed due to a decline of pulmonary function. The patient organ functions (kidney, lung, liver, heart) were gradually getting worse. The patient expired due to multiple organ failure on day 92. ECMO can be considered in case of cardiac arrest due to reversible causes.
Acute Kidney Injury ; Aged, 80 and over ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip ; Cardiopulmonary Resuscitation ; Death, Sudden, Cardiac ; Extracorporeal Membrane Oxygenation* ; Femoral Artery ; Heart Arrest* ; Heart Massage ; Hemothorax ; Heparin ; Humans ; Liver ; Lung ; Massage ; Membranes* ; Multiple Organ Failure ; Renal Dialysis ; Resuscitation ; Rib Fractures ; Thorax ; Vital Signs ; Weaning

PURPOSE: A The purpose of this retrospective study was to evaluate the results of compression plating and autogenous iliac bone graft in the management of humeral diaphyseal nonunion. MATERIALS AND METHODS: Twenty patients who underwent the surgical treatments between May. 1998 and May. 2002 were included in this study. Nine of them are males and the others are females. The average age of them, when they was on operation, was 45 years. The symptoms lasted 23 months on average. They have been followed up for 33 months at an average. Treatment of nonunion consisted of resecting the atrophic nonunion, shortening the bone, apposing bleeding diaphyseal surface. Rigid fixation was then achieved using a compression plate and autogenous bone graft. RESULTS: Solid bony union was achieved in all patients. In one patient, the bone was not healed at the first operation of plating and autogenous bone graft, but achieved union after the use of intramedullary nailing. In another patient, because of infected nonunion, we achieved union after several surgical debridement and stabilization by internal fixation. CONCLUSION: This study documents that compression plate fixation with autogenous cancellous bone graft is a viable option with predictable and satisfactory results for humerus diaphyseal nonunion.
Debridement ; Female ; Fracture Fixation, Intramedullary ; Hemorrhage ; Humans ; Humerus* ; Male ; Retrospective Studies ; Transplants*

OBJECTIVE: To evaluate the effects of high frequency repetitive transcranial magnetic stimulation (rTMS) of the affected hemisphere on the motor recovery and spasticity in chronic post-stroke hemiplegic patients. METHOD: Thirteen chronic stroke hemiplegic patients were randomized to receive real and sham rTMS. rTMS was carried out 10 times at a frequency of 10 Hz with 10 s stimulation followed by 50 s rest, totalling 1,000 stimulations to the affected primary motor cortex using an intensity of 100% of resting motor threshold of unaffected hemisphere. Median nerve H-reflex, modified Ashworth scale (MAS) at elbow and wrist, and manual function test (MFT) were measured at baseline and after 2 weeks of treatment. RESULTS: High frequency rTMS resulted in increased H-reflex latency and decreased H-reflex amplitude and H/M ratio. Also MAS decreased and MFT score increased after 2 weeks of treatment. CONCLUSION: High frequency rTMS in the affected motor cortex might facilitate motor recovery and reduce spasticity in chronic stroke patients.
Elbow ; H-Reflex ; Humans ; Median Nerve ; Motor Cortex ; Muscle Spasticity ; Salicylamides ; Stroke ; Transcranial Magnetic Stimulation ; Wrist

OBJECTIVE: To investigate the effect of action related visual and auditory stimuli on the motor evoked potential (MEP) of hand. METHOD: Right handed fifteen healthy adults without neurological deficit were included. Visual lingual stimulation was given on the computer monitor with the sentence and auditory lingual stimulation was given 10 repetitions of the above sentence using computer speaker with eyes closed. MEPs from transcranial and transcervical magnetic stimulation were recorded on the abductor pollicis brevis of the right hand. RESULTS: The latency of MEPs was shortened and the amplitude of MEPs with transcranial magnetic stimulation after lingual stimulation (p<0.05). However, the latency and amplitude of with transcervical stimulation did not show significant changes. CONCLUSION: Cortical excitability was enhanced by action related visual or auditory stimuli. Exercise accompanied by visual or auditory lingual stimulation rather than simple exercise might be useful for facilitating cortical excitability.
Adult ; Evoked Potentials, Motor ; Eye ; Hand ; Humans ; Magnetics ; Magnets ; Organothiophosphorus Compounds ; Transcranial Magnetic Stimulation

BACKGROUND: In order to develop the acute heart failure model for the animal experiment of the pneumatic ventricular assist device, we decided to use young pig whose coronary artery distribution is almost the same as humans and also very cheap in price. The purpose of this study is to develop stable, reproducible acute ischemic heart failure model in swine using coronary artery ligation method. MATERIAL AND METHOD: Five young pigs whose weights are the same as adult humans are under experiment. Each pig was under endotracheal intubation and connected to a mechanical ventilator. Through left lateral thoracotomy, we exposed the heart and induced ischemic heart failure by coronary artery ligation. The ligation began at the distal part of the left anterior descending coronary artery. After 5 minutes of initial ligation we reperfused the artery and then re-ligated. Before and after each ligation-reperfusion procedure we assessed the left ventricular end-diastolic pressure, arterial pressure, and cardiac index. We also measured left ventricular end-diastolic dimension, end-systolic dimension, fractional shortening, ejection fraction using intraoperative epicardial echocardiography. After appropriate heart failure was established with sequential (from distal part of LAD to proximal location) ligation-reperfusion-ligation procedure, we inserted the ventricular assist device and operated. RESULT: We established stable acute ischemic heart failure in 3 of 5 young pigs with this sequential ligation-reperfusion-ligation procedure, and could maintained 50% less ejection fraction before the procedure according to intraoperative epicardial echocardiography. We also observed no ventricular arrhythmia usually associated with simple coronary artery ligation in large animals and no cardiac arrest associated with ventricular arrhythmia or myocardial stunning. In pathologic specimen, we observed scattered ischemic myocardium in all around the ischemic field induced by coronary artery ligation. CONCLUSION: Under the concept of ischemic preconditioning, we developed safe and reproducible acute ischemic heart failure model in swine using sequential coronary artery ligation-reperfusion-ligation method.
Adult ; Animal Experimentation ; Animals ; Arrhythmias, Cardiac ; Arterial Pressure ; Arteries ; Coronary Vessels ; Echocardiography ; Heart Arrest ; Heart Failure* ; Heart* ; Heart-Assist Devices* ; Humans ; Intubation, Intratracheal ; Ischemic Preconditioning ; Ligation ; Models, Animal ; Myocardial Stunning ; Myocardium ; Swine* ; Thoracotomy ; Ventilators, Mechanical ; Weights and Measures

We report two cases with progressive dysphagia and foreign body sensation resulted from severe cervical ossification of the anterior longitudinal ligament (OALL). A 63-years-old male presented progressive dysphagia and foreign body sensation with neck pain. Cervical computed tomography (CT) and magnetic resonance images (MRI) revealed diffuseOALL from C2 to C7 with esophageal compression by most severe OALL of C5, C6, C7 and spondylotic stenosis of C5- 6, C6-7. OALL removal of C5, 6, 7 and discectomy with interbody fusion via anterior approach was performed. The other 56-years-old female presented progressive dysphagia with foreign body sensation. Cervical CT and MRI revealed severe OALL of C4, 5, 6, 7 with esophageal compression and surgical removal was performed. In both patients, dysphagia and foreign body sensation was immediately relieved after operation and the distance between trachea and each cervical body was increased than preoperative distance in cervical lateral view.
Constriction, Pathologic ; Deglutition Disorders ; Diskectomy ; Female ; Foreign Bodies ; Humans ; Ligaments ; Longitudinal Ligaments ; Magnetic Resonance Spectroscopy ; Male ; Neck Pain ; Sensation ; Trachea