PURPOSE: The purpose of this study was to suggest the projected manpower of hospice and palliative care nurses & APNs(advanced practice nurses)needed in the future. METHOD: Need model, ratio model and expert opinion were used for projecting the number of hospice and palliative care nurses & APNs. RESULT: 1. The number of Korean hospice facilities was 64 in 2002. The number of hospice nurses in 2001 was 194 and that of beds was 407. 2. The number of hospice target patients was estimated at a minimum of 16,415 to a maximum of 25,254 in 2002, 12,366 to 26,389 in 2005, and 14,057 to 30,000 in 2020. 3. The number of hospice and palliative nurses needed to meet the demands in 2002, 2005 and 2020 was estimated at a minimum of 1,136 to maximum of 1,748, 1,187 to 1,826, and 1,349 to 2,076, respectively. 4. The number of hospice & palliative care APNs needed to meet the demands in 2002, 2005 and 2020 was estimated at 232, 242, and 274, respectively. CONCLUSION: The legalization of hospice is expected to increase demands for hospice nurses and advanced practice hospice and palliative care nurses in the future.
Expert Testimony ; Hospices* ; Humans ; Korea* ; Palliative Care*

No abstract available.
Fetus* ; Nuchal Translucency Measurement* ; Pregnancy*

No abstract available.
Crohn Disease*

PURPOSE: The purpose of this study was to assess chemotherapy induced peripheral neuropathy (CIPN) and to examine the relationship between CIPN and depression. METHODS: A purposive sample of 105 patients treated with chemotherapy were recruited in the cross-sectional survey design. Data were collected using self-report questionnaires. The instruments used were the Chemotherapy Induced Peripheral Neuropathy Assessment Tool (CIPNAT) and Hospital Anxiety Depression Scale (HADS). RESULTS: The most frequent suffering symptom of CIPN was 'tingling feeling in the hand and foot'. Of the motor symptoms, 'muscle weakness' was the most frequent symptom and 'muscle or joint aches' was the strongest suffering symptom of CIPN. The mean score for suffering of CIPN was 4.1. The mean score was 1.04 for depression and the prevalence was 48.5%. CIPN was significantly positively correlated with depression (r=.38, p<.001). The result of simple regression analysis revealed that CIPN was predictive of depression (R2=.136, p<.001). CONCLUSION: Based on the findings of this study, nursing intervention programs focusing on CIPN management and alleviating depression are recommended.
Anxiety ; Cross-Sectional Studies ; Depression* ; Drug Therapy ; Hand ; Humans ; Joints ; Nursing ; Peripheral Nervous System Diseases* ; Prevalence

PURPOSE: The purpose of this study was to examine the mediation of psychological distress in the relationship between disturbance in ADL from chemotherapy induced peripheral neuropathy and quality of life in order to provide a basis for planning nursing interventions to improve the quality of life in cancer patients. METHODS: A purposive sample of 130 patients treated with chemotherapy were recruited in the cross-sectional survey design. Data were collected using self-report questionnaires. The instruments were the Chemotherapy Induced Peripheral Neuropathy Assessment Tool (CIPNAT), Hospital Anxiety Depression Scale (HADS), and Functional Assessment of Cancer Therapy-General (FACT-G). RESULTS: The mean score for disturbance in ADL from chemotherapy induced peripheral neuropathy was 3.30. Overall quality of life was 2.48. The mean score was 1.04 for psychological distress. The prevalence was 35.4% for anxiety and 47.7% for depression. There were significant correlations among the three variables, disturbance in ADL from chemotherapy induced peripheral neuropathy, psychosocial distress, and quality of life. Psychosocial distress had a complete mediating effect (beta= -.74, p <.001) in the relationship between disturbance in ADL from chemotherapy induced peripheral neuropathy and quality of life (Sobel test: Z= -6.11, p <.001). CONCLUSION: Based on the findings of this study, nursing intervention programs focusing on disturbance of ADL management, and decrease of psychological distress are highly recommended to improve quality of life in cancer patients.
*Activities of Daily Living ; Adult ; Aged ; Antineoplastic Agents/*adverse effects/therapeutic use ; Anxiety ; Cross-Sectional Studies ; Depression/etiology ; Female ; Humans ; Male ; Middle Aged ; Neoplasms/drug therapy/pathology/*psychology ; Peripheral Nervous System Diseases/*etiology ; *Quality of Life ; Self Report ; Stress, Psychological ; Surveys and Questionnaires

BACKGROUND: Gastric cancer remains the main cause of cancer-related death in Korea. Accurate preoperative staging of gastric cancer is essential to predict prognosis and to plan optimal treatment. Although there are many reports dealing with the diagnostic values of conventional methods, controversies are still present especially in the field of preoperative staging. In this study, we evaluated the accuracy of gastroscopy and upper gastrointestinal series(UGI) for diagnosis of gastric cancer, and determined the usefulness of ultrasonography and computed tomography for preoperative staging. METHODS: One hundred twenty-three patients, who underwent operation from Aug. 1991 to Mar. 1995 under the diagnosis of gastric cancer were analyzed. We excluded 15 patients because their postoperative definitive stagings were undetemined. RESULTS: 1) Among 123 patients, the proportion of early gastric cancer was 26.0%(32/123) and that of the advanced gastric cancer was 74.0%(91/123). 2) The sensitivity of endoscopic diagnosis of gastric cancer was 96.7%(119/123), and the accuracy to determine the depth of invasion was 82.9% (102/123). 3) The sensitivity of UGI study for gastric cancer was 89.9%(98/109), and the accuracy to determine the depth of invasion was 61.5%(61/109). 4) The sensitivity of abdominal ultrasonography to detect the tumor was 11.3%(8/71), the accuracy to determine the T stage was 29.2%(28/96), and the sensitivity and specificity to detect lymph node metastasis was 13.6%(8/59), 100%(37/37), respectively. 5) The sensitivity of abdominal CT to detect the tumor was 74.3%(26/35), the accuracy to determine the T stage was 32.5%(13/40), and the sensitivity and specificity to detect lymph node metastasis were 34.5%(9/29), 72.7%(8/11), respectively. 6) The accuracy of preoperative staging was 45.5%(56/123). The 49.6%(62/123) of gastric cancer was downstaged, whereas only 4.1%(5/123) was overstaged. CONCLUSION: Our results show that high accuracy for diagnosis of gastrie cancer with the gastroscopy and UGI. However preoperative staging with ultrasonography and computed tomograpy was often underestimated, which could be concluded that the usefulness of the radiologic methods was limited.
Diagnosis* ; Gastroscopy ; Humans ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Sensitivity and Specificity ; Stomach Neoplasms* ; Tomography, X-Ray Computed ; Ultrasonography

We report a case of advanced gastric cancer with Virchow's node and lung metastasis that responded remarkably to preoperative chemotherapy. A 47-year-old female patient was diagnosed as having incurable advanced gastric cancer with Virchow's node and multiple lung metastasis. Preoperative chemotherapy with Taxotere, CDDP and 5FU was carried out. After four courses of the regimen, the Virchow's node and the lung metastasis had disappeared, and a marked reduction of the gastric lesion was observed on the CT scan. Consequently, the patient underwent a total gastrectomy with D2 lymph node dissection. On histopathological examination, cancer cells were found to have infiltrated up to the muscle layer of the gastric wall, and 42 out of 60 resected lymph nodes were found to be metastatic. The patient received another two courses of chemotherapy after the operation
Drug Therapy* ; Female ; Fluorouracil* ; Gastrectomy ; Humans ; Lung* ; Lymph Node Excision ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis* ; Stomach Neoplasms* ; Tomography, X-Ray Computed

Prolymphocytic leukemia (PL) is usually derived from B cells and shares some features with chronic lymphocytic leukemia (CLL), but it is clearly a distinct entity and defined to have more than 55% prolymphocytes. Chronic lymphocytic leukemia/prolymphocytic leukemia (CLL/PL) is a mixed type of CLL and is defined to have 11~55% prolymphocytes with intermediate features between CLL and PL. We experienced two different cases of leukemia PL and CLL/PL. On physical examination, PL (stage II, B) patient showed multiple cervical lymph node enlargement and 5cm sized splenomegaly and hepatomegaly. But CLL/PL (stage III, C) patient showed 10cm sized splenomegaly and no lymph node enlargement. On immunological phenotyping, surface markers showed 72% CD5 (+), 85% CD19 (+), and 40% SmIg (+) in PL patient and 3% CD5 (+), 90% CD19 (+) and SmIg (-) in CLL/PL patient. PL patient was refractory to chlorambucil and prednisolone chemotherapy and showed poor prognosis. CLL/PL patient did not show remarkable response to chlorambucil and prednisolone therapy.
B-Lymphocytes ; Chlorambucil ; Drug Therapy ; Hepatomegaly ; Humans ; Leukemia* ; Leukemia, Lymphocytic, Chronic, B-Cell ; Leukemia, Prolymphocytic ; Lymph Nodes ; Physical Examination ; Prednisolone ; Prognosis ; Splenomegaly

PURPOSE: Recent studies have shown that the expression of mucin is organ- and cell-type specific and it is increasingly possible that its change could result from oncogene activation.To evaluate histogenesis and prognostic factors for gastric carcinoma, we studied the oncoprotein expression in gastric cancer cells classified by mucin phenotye. MATERIALS AND METHODS: Mucin histochemistry and immunohistochemistry for ras, c-erbB2, and p53 oncoprotein expression were performed in 101 surgically resected gastric carcinoma specimens. PAS-Con A, GOS, and HID-AB staining techniques were employed in identifying mucosubstances, RESULTS: Of the 101 specimens studied, 73(72.3%) revealed as having mixture of various mucin-secreting cancer cells. Overall, ras immunoreactivity was observed in 72(71.3%), c-erbB2 in 7(6.9%), and p53 in 47(46.5%). Of the 73 mucus-secreting carcinomas, the surface mucous cell type were shown in 65 (89.0%), the pyloric gland cell type in 48(65,8%), the sialomucin type in 47(64.4%), and the sulfomucin type in 54(74.0%). There was significant association between mucin secretion and ras expression, but not c-erbB2 and p53 expression. There was no significant association between mucin secreting cell types and Lauren classification. Ras expression was correlated with serosal invasion, lymph node metastasis and poor prognosis. CONCLUSION: The phenotypic expression by mucin histochemistry may be not more important for studying of histogenesis in gastric carcinoma than Lauren classification. Ras expression is a poor prognostic indicator and may be correlated with phenotypic expression of surface mucous cell and intestinal cell type in gastric carcinoma.
Classification ; Gastric Mucosa ; Humans* ; Immunohistochemistry ; Lymph Nodes ; Mucins* ; Neoplasm Metastasis ; Oncogenes ; Prognosis ; Sialomucins ; Stomach Neoplasms

PURPOSE: The aim of the present study was: (a) to determine the frequency of p53 mutations by single strand conformational polymorphism analysis of polymerase chain reaction products (PCR-SSCP), Non-Isotopic RNase Cleavage Assay (NIRCA) and immunohistochemical staining with monoclonal antibody; and (b) to compare the correlations among these methods. MATERIALS AND METHODS: Abberations of the p53 gene in 24 primary gastric carcinomas were examined by PCR-SSCP, NIRCA and immunohistochemical staining. Of these surgically resected gastric adenocarcinomas, 23 were advanced gastric carcinomas and 1 was early gastric cancer. Using PCR-SSCP and NIRCA, the presence of mutations in exons 4-9 was evaluated. Using the mouse specific anti-human p53 monoclonal antibody, we also looked for overexpression of the p53 protein in tissue sections. RESULTS: In 5 cases shifted bands were reproducibly identified by PCR-SSCP, and two mutations were identified in exon 4 and three in 5 & 6. The mutations of exon 4 were detected by NIRCA in 5 cases, exon 5 & 6 in 6 cases, and exon 7 in 2 cases. The p53 mutations detected by PCR-SSCP were also detected by NIRCA except one case. Thirteen of the tumor samples were positively stained with the monoclonal antibody for p53 protein. There was no correlation between p53 mutations detected by NIRCA and expression of p53 protein by immunohistochemical staining. CONCLUSIONS: Our results in this group of patients suggest that NIRCA is more sensitive than PCR-SSCP in detecting p53 mutations, and expression of p53 protein by immunohistochemical staining does not directely represent the genetic changes of p53 gene.
Adenocarcinoma ; Animals ; Exons ; Genes, p53* ; Humans ; Mice ; Polymerase Chain Reaction ; Ribonucleases* ; Stomach Neoplasms*