BACKGROUND: The aim of this study is to evaluate the influence of immunosuppressants on in-hospital mortality from sepsis. METHODS: Using data of the Health Insurance Review & Assessment Service, we collected data from patients who were admitted to the hospital due to sepsis from 2009 to 2013. Based on drugs commonly used for immunosuppression caused by various diseases, patients were divided into three groups; immunosuppressant group, steroid-only group, and control group. Patients with no history of immunosuppressants or steroids were assigned to the control group. To identify risk factors of in-hospital mortality in sepsis, we compared differences in patient characteristics, comorbidities, intensive care unit (ICU) care requirements, and immunodeficiency profiles. Subgroup analysis according to age was also performed. RESULTS: Of the 185,671 included patients, 13,935 (7.5%) were in the steroid-only group and 2,771 patients (1.5%) were in the immunosuppressant group. The overall in-hospital mortality was 38.9% and showed an increasing trend with age. The steroid-only group showed the lowest in-hospital mortality among the three groups except the patients younger than 30 years. The steroid-only group and immunosuppressant group received ICU treatment more frequently (p < 0.001), stayed longer in the hospital (p < 0.001), and showed higher medical expenditure (p < 0.001) compared to the normal group. Univariate and multivariate analyses revealed that age, male gender, comorbidities (especially malignancy), and ICU treatment had a significant effect on in-hospital mortality. CONCLUSIONS: Despite longer hospital length of stay and more frequent need for ICU care, the in-hospital mortality was lower in patients taking immunosuppressive drugs than in patients not taking immunosuppressive drugs.
Comorbidity ; Health Expenditures ; Hospital Mortality ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Insurance* ; Insurance, Health ; Intensive Care Units ; Korea* ; Length of Stay ; Male ; Mortality ; Multivariate Analysis ; Risk Factors ; Sepsis* ; Steroids

PURPOSE: This study was done to examine interpersonal relations, hope, professional self-concept and turnover intention according to adult attachment styles in early stage nurses. METHODS: A survey using a structured questionnaire was conducted with 245 nurses who work in one of six general hospitals. Additionally, a qualitative method was used to obtain data on experiences in interpersonal relations. Data were analyzed using SPSS/WINdows 14.0 and qualitative data from open question in the survey questionnaire were analyzed using content analysis. RESULTS: There was a significant difference in interpersonal relations, hope, and professional self-concept according to adult attachment styles. In the interpersonal relation of early stage nurses, 8 themes were identified, of which the most frequent were: a comfortable relationship with my co-workers (43%) and stress from the relationship (34%). CONCLUSION: Findings from this study should be useful in the development of programs to promote adult attachment and professional self-concept for early stage nurses.
Adult ; Hospitals, General ; Humans ; Intention ; Interpersonal Relations ; Object Attachment ; Personnel Turnover ; Surveys and Questionnaires

Impact and process evaluations were performed in order to verify the effectiveness of a public health nutrition program developed for child-bearing aged women in Korea. Participants included 58 high school girls who were divided into two groups. Each group received four 50 - 60 minute nutrition education lectures regarding healthy eating, osteoporosis, constipation and nutrition labeling in every two weeks. Each session took 50 - 60 minutes. Regarding nutrition knowledge, there was a significant increase of degree of perception (p = 0.0004), but no change in degree of accuracy after implementation (p = 0.9522). Nutrition education was also effective in attitude change, showing more participants were ready to change their eating behaviors in terms of meal regularity (p = 0.0455) and less processed food intake (p = 0.0143). After implementing nutrition education, effective behavioral changes were observed in milk consumption (p = 0.0037) and meal regularity (p = 0.0882) as well as daily activity such as stair use (p = 0.0701). However, nutrition education had no effect on body mass index and perceived health status. In process evaluation conducted by a 9 item questionnaire, grand mean score was 4.17 +/- 0.72 out of 5. Proportion of items with scores higher than 4 ranged 68-91%. These results suggest that the nutrition education program used in this study was effective and useful. For a wider use of this program, more research was recommend for a strategy development of program diffuse.
Body Mass Index ; Constipation ; Eating ; Education* ; Feeding Behavior ; Female* ; Food Labeling ; Humans ; Korea ; Lectures ; Meals ; Milk ; Osteoporosis ; Public Health* ; Surveys and Questionnaires

BACKGROUND: When using the data based on history, ECG and cardiac enzyme, two to eight percent of patients with acute chest pain are incorrectly perceived as being at low risk and therefore sent home mistakenly. It is known that changes of Doppler parameters appear first, before regional asynergy in 2D-echocardiography, electrocardiographic change and chest pain. however, the clinical application of Doppler information in the diagnosis of acute myocardial infarction remains uncertain, especially in elderly patients. METHODS: From March 1998 to March 1999, pulsed wave Doppler echocardiography was performed in patients with acute myocardial infarction within 6 hours, and Doppler parameters were evaluated. Each Doppler parameters were compared between elderly (age > or =65) and young(age < 65) groups. RESULT: E peak velocity & E/A ratio showed significant differences between two groups(p<0.05). especially, Stroke volume, isovolumic relaxtion time & myocardial performace index showed marked difference(p<0.01). CONCLUSION: Diastolic Doppler parameters of elderly group were significantly changed than younger group. however systolic Doppler parameters were relatively preserved. Among Doppler parameters, myocardial performance index is a conceptrally new, simple and reproducible Doppler index of combined systolic and diastolic myocardial performance, and it may be useful as screening test for patients with AMI in elderly patients.
Aged ; Chest Pain ; Diagnosis ; Echocardiography, Doppler ; Electrocardiography ; Humans ; Mass Screening ; Myocardial Infarction* ; Stroke Volume

PURPOSE: The early parity that reduces the risk of developing breast cancer indicates that hormonal conditions might play an important role in its prevention. Both pregnancy and hCG treatment are considered essential for the inhibiting breast cancer. The purpose of this study is to investigate the incidence of beta-hCG expression in breast cancer and to access its relationship with the other biologic parameters. METHODS: Three hundred and thirty-four cases of formalin-fixed, paraffin embedded tissue blocks were selected, and then immunostained for beta-hCG. HCG expression was compared with ER, PR, HER-2/neu, the tumor characteristics and recurrence. RESULTS: Forty-four cases (13.2%) showed positivity for beta-hCG. HCG positivity was observed in 12.0% of infiltrating ductal carcinomas (32/267), 13.3% of intraductal carcinomas (4/30), 11.1% of infiltrating lobular carcinomas (1/9), 80.0% of apocrine carcinomas (4/5) and 13.0% of the other types of carcinomas (3/23). HCG expression was statistically significant between the histological tumor types (p=0.001), but not with the patient's age (p=0.696), tumor grade (p=0.255), tumor size (p=0.510), lymph node status (p=0.620), ER (p=0.498), PR (p=0.421), HER-2/neu oncogene expression (p=0.483) and tumor recurrence (p=0.181). HCG was focally expressed in the cytoplasm of the conventional types, but the apocrine type displayed diffusely intense cytoplasmic staining. CONCLUSION: Although beta-hCG expression was statistically insignificant between the tumor recurrence (p=0.181) and biological parameters, it may be of interest in the future to correlate the presence of beta-hCG expression with a possible therapeutic response in patients of the breast cancer.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Chorion* ; Cytoplasm ; Female ; Humans* ; Immunohistochemistry ; Incidence ; Lymph Nodes ; Oncogenes ; Paraffin ; Parity ; Pregnancy ; Prognosis ; Recurrence

PURPOSE: This study was conducted to evaluate the relationship of the biological parameters for survival after tumor recurrence or metastases for breast cancer patients. METHODS: Fifty patients with local recurrence or distant metastases after their treatment for breast cancer were selected for our study. RESULTS: These patients constituted 16.9% (50/296) of all the patients with breast cancer who were treated during the investigation period. Survival was correlated with the lymph node status (p = 0.036) and the disease free interval (DFI) (p < 0.001), but patient survival was not correlated with the patient's age (p = 0.586), the tumor type (p = 0.360), tumor grade (p = 0.353), tumor size (p = 0.886), extensive intraductal component (EIC) (p = 0.295), lymphatic invasion (p = 0.880), estrogen receptor (ER) status (p = 0.408), androgen receptor (AR) status (p = 0.386), the HER-2/neu expression (p = 0.291), the operative methods (p = 0.880), adjuvant therapy (p = 0.551) and metastatic organs and recurrence (p = 0.070). The overall median length of the DFI was 25.9 months. The 16 dead patients (32.0%) had a shorter mean DFI (19.7 months) than the mean DFI (28.8 months) of the 34 live patients (68.0%). The overall 5-year survival rate was 10.0%. CONCLUSION: We found the clinicopathological features of the presenting primary tumors that predicted a worse clinical outcome with recurrence or metastases, and these factors can be used in these types of cases as indicators for the prognosis.
Breast Neoplasms* ; Breast* ; Estrogens ; Humans ; Lymph Nodes ; Neoplasm Metastasis* ; Prognosis ; Receptors, Androgen ; Recurrence* ; Survival Rate

BACKGROUND: Asthma is one of the most prevalent diseases in Korea. Although the guidelines of asthma management were reported in Korea, the present pattern of asthma management by primary physicians has not been studied. The purpose of this study is to elucidate the pattern of asthma management by primary physicians. METHODS: In November 2002, 710 primary physicians specializing in internal medicine in Seoul, Korea were provided with two scenarios of asthmatic patients, one mild and the other severe. By mail or interview, the physicians were asked several questions about their present pattern of asthma management for the patients in each scenario. RESULTS: Among 710 primary physicians, we obtained the answers from 325 physicians (response rate 46%). The most preferred prescription was oral theophylline. 71% and 81% of the physicians answered that they would prescribe oral theophylline for the mild and severe asthmatics, respectively. The next prescription preferred were mucolytics and oral beta2-agonist, in that order. However, 36% and 56% of the physicians answered that they would prescribe inhaled steroids for the mild and severe asthmatics, respectively. Among diagnostic tests, physicians preferred pulmonary function test to the rank next tochest radiography. CONCLUSION: The primary physicians in Seoul prefer oral bronchodilators to inhaled steroids in asthma management. More efforts should be made to reduce the difference between the present pattern of asthma management by primary physicians and the asthma guidelines.
Asthma* ; Bronchodilator Agents ; Diagnostic Tests, Routine ; Expectorants ; Humans ; Internal Medicine ; Korea ; Postal Service ; Prescriptions ; Radiography ; Respiratory Function Tests ; Seoul* ; Steroids ; Theophylline

BACKGROUND: S Phase Kinase Associated Protein 2 (Skp2), an F-box protein necessary for DNA replication, has recently been demonstrated to be an oncogene. The purpose of this study was to examine the Skp2 expression and to investigate its association with expressions of estrogen receptor (ER), androgen receptor (AR) and HER-2, as well as clinicopathological variables including tumor recurrence. METHODS: The expressions of Skp2, ER and AR were examined by immunohistochemistry and HER-2 amplification by chromogenic in situ hybridization (CISH) in 117 cases of breast carcinoma. RESULTS: Skp2 was expressed in 26 patients (22.2%) and was significantly correlated with tumor type (p=0.031), tumor grade (p=0.017) and ER expression (p=0.038). Twenty four (20.5%) of 117 patients had a tumor recurrence, and 6 patients (5.1%) died of multifocal metastases. Tumor recurrence was significantly correlated with histological grade (p=0.041) and lymph node status (p<0.001). CONCLUSIONS: Although Skp2 expression was statistically insignificant in association with tumor recurrence, it might be useful as a biologic predictor in breast cancer. The simple and reliable immunohistochemical assay presented in this study can be a routine part of breast cancer evaluation and may influence patient management.
Breast Neoplasms* ; Breast* ; DNA Replication ; Estrogens ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Lymph Nodes ; Neoplasm Metastasis ; Oncogenes ; Receptors, Androgen ; Recurrence ; S Phase* ; S-Phase Kinase-Associated Proteins*

Invasive hemodynamic monitoring has become a valuable assessment parameters in critical care nursing in patients undergoing open heart surgery patients. During cardiac surgery, the Swan Ganz catheter is placed in the pulmonary artery. Critical care nurses routinely obtain cardiac output, cardiac index, and pulmonary arterial pressure in these patients. Traditionally, patients are positioned flat and supine for cardiac output measurement. Numerous studies have dealt with the effects of changing position on the hemodynamic variables. However, there are a few studies dealing with patients who undergo cardiac surgery in Korea. Thus, the purpose of this study was to determine the effects of changing position on cardiac output, PAP, CVP, BP, HR and discomfort in patients after cardiac surgery. A sample of 21 adults who had CABG and/or valve replacement with Swan Ganz catheters in place was studied. The data were collected in the cardiac ICU of a university hospital in Seoul during the period from July 28, 1999 to August 30. 1999. In this study, the independent variable is patient position in the supine, 30 degree, and 45 degree angles. Dependent variables are C.O., C.I., CVP, PAP, MAP, HR and patients' perceived discomforts. Subject discomfort was measured subjectively by visual analogue scale. Other hemodynamic data where collected by the thermodilution method and by direct measurement. The data were analyzed by percentile, t-test, ANOVA, Linear regression analysis using SPSS-/WIN program. The results are as follows: 1) Changes in cardiac output were absent in different angle positions, 0, 30, 45 degrees(F=0.070,P=0.932). Changes in cardiac index were absent in different angle positions, 0. 30, 45 degrees(p>0.05). 2) Changes in central venous pressure were absent in differentangle positions, 0, 30, 45 degree(p>0.05). 3) PAP had no change in different angle 0, 30, 45 degree positions; systolic PAP(p>0.05), diastolic PAP(p>0.05). 4) Changes in systolic blood pressure were absent in different angle positions, 0, 30, 45 degree(p>0.05). 5) Changes in heart rates were absent in different angle positions, 0, 30, 45 degree(p>0.05). 6) Patients' perceived discomfort was absent in different angle positions, 0, 30, 45 degree(p<0.05). In conclusion, critical care nurses can measure C.O., C.I., PAP, BP, & CVP in cardiac surgery patients at 30 degree or 45 degree positions. This can improve the patients' comfort.
Adult ; Arterial Pressure ; Blood Pressure ; Cardiac Output* ; Catheters ; Central Venous Pressure ; Critical Care ; Critical Care Nursing ; Heart Rate ; Hemodynamics ; Humans ; Korea ; Linear Models ; Pulmonary Artery ; Seoul ; Thermodilution ; Thoracic Surgery*

Background/Aims: Hypertension is considered a risk factor in immunoglobulin A nephropathy (IgAN). However, after IgAN diagnosis, the relationship between early blood pressure control and renal prognosis remains unclear. This study aimed to analyze the association between the prognosis of IgAN patients and a controlled status of hypertension within the first year of IgAN diagnosis. Methods: We retrospectively analyzed 2,945 patients diagnosed with IgAN by renal biopsy. The patients were divided into ‘normal,’ ‘new-onset,’ ‘well-controlled,’ and ‘poorly-controlled’ groups using blood pressure data from two consecutive measurements performed within a year. The Kaplan-Meier survival analysis and Cox proportional-hazards regression model were used to survey the independent association between recovery from hypertension and the risk of IgAN progression. The primary endpoint was IgAN progression defined as the initiation of dialysis or kidney transplantation. Results: Before IgAN diagnosis, 1,239 patients (42.1%) had been diagnosed with hypertension. In the fully adjusted Cox proportional-hazards models, the risk of IgAN progression increased by approximately 1.7-fold for the prevalence of hypertension. In the subgroup analyses, the ‘well-controlled’ group showed a statistically significant risk of IgAN progression (hazard ratio [HR], 3.19; 95% confidence interval [CI], 1.103 to 9.245; p = 0.032). Moreover, the ‘new-onset’ and ‘poorly-controlled’ groups had an increased risk of IgAN progression compared to the ‘normal’ group (HR, 2.58; 95% CI, 1.016 to 6.545; p = 0.046 and HR, 3.85;95% CI, 1.541 to 9.603; p = 0.004, respectively). Conclusions Although hypertension was well-controlled in the first year after IgAN diagnosis, it remained a risk factor for IgAN progression.