BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic

Pleomorphic (undifferentated) carcinoma is a rare histologic type of carcinomas of the gallbladder and an atypical carcinoid is thought to be an intermediated type between carcinoid tumor and small cell carcinoma. Dense core "neurosecretory" granules can be found in the above mentioned tumors. We experienced a case of a double tumor of the gallbladder in a 51-year old male patient. Grossly, a large solid mass, about 5.0 cm in diameter, was found in the fundic portion and the neck portion also had a small 1.5 cm-sized polypoid mass. Microscopically, these lesions had features of pleomorphic carcinoma and atypical carcinoid, respectively. Immunohistochemically, they manifested reactivity for neuron specific enolase. Ultrastructural study revealed neurosecretory granules in the cytoplasms of tumor cells of the fundic and neck masses. Although light microscopic features of these tumor masses are quite different, we consider that these tumors represent a spectrum of neuroendocrine differentiation.
Male ; Humans

No abstract available.
Emergencies* ; Emergency Medical Services*

No abstract available.
Head* ; Neck*

No abstract available.
Testis*

No Abstract Available.
Carpal Tunnel Syndrome* ; Collagen* ; Humans ; Ligaments*

BACKGROUND: The aim of this study was to establish the incidence, predictive factors, characteristics, and clinical outcomes of acute symptomatic seizures (ASS) after acute ischemic stroke (AIS). METHODS: In total, 2,528 consecutive patients with first-ever AIS were included. Patients with a history of epilepsy or provoked seizures due to tumor, head trauma, brain surgery, or high fever were excluded. Onset seizure (OS) and ASS were defined as seizures occurring within 24 hours and 7 days after AIS, respectively. The incidence of ASS, type of seizures, presence of late unprovoked seizure (LUS), MRI, and electroencephalogram were analyzed. RESULTS: ASS and OS occurred in 23 patients (0.9%) and 15 patients (0.6%), respectively; 20 of the patients with ASS (87.0%) had partial seizures and 4 (17.4%) developed status epilepticus. The incidence rates of ASS were 1.3%, 0.3%, and 0.2% in AIS caused by large-artery atherosclerosis, small-vessel occlusion, and cardioembolism, respectively. Of the 23 patients with ASS, the cortex was involved in 19 (82.6%), 16 patients (69.6%) had medium-sized to large lesions, the anterior circulation territory was involved in 21 patients (91.3%), and 4 patients (17.4%) developed MRI-confirmed hemorrhagic transformation of the lesions. Epileptiform discharges were observed in 9 (45%) of the 20 patients with ASS. Three of the 23 patients with ASS (13.0%) developed LUS. CONCLUSIONS: The incidence of ASS was 0.9% and was highest in the large-artery atherosclerosis group. The development of ASS was significantly associated with cortical involvement, medium-sized to large lesions, and lesions in the anterior circulation territory. Three of 23 patients (13%) developed LUS.
Atherosclerosis ; Brain ; Cerebral Infarction ; Craniocerebral Trauma ; Electroencephalography ; Epilepsy ; Equidae ; Fever ; Humans ; Incidence* ; Magnetic Resonance Imaging ; Seizures* ; Status Epilepticus ; Stroke*

Purpose: This study aims to explore and deeply understand the essence of the nursing experiences of ward nurses who have cared for foreign inpatients. Methods: In this study, in-depth interviews were conducted with 10 nurses at a tertiary hospital in Seoul from May 1 to June 30, 2023. The collected data were analyzed using Colaizzi’s phenomenological method. Results: The nursing experiences of ward nurses caring for foreign inpatients yielded five theme clusters-"A welcome yet challenging encounter," "A journey to navigate language barriers," "New competencies needed to face unfamiliar cultures," "Exerting every possible effort," and "Discovering and embracing the value of coexistence"-along with 11 themes. Ward nurses found caring for foreign inpatients challenging due to cultural differences and language barriers, which often felt burdensome.Nonetheless, they accepted it as a necessary duty, handling additional tasks beyond basic care to support patient recovery. Despite communication challenges, they strived to provide the best care, demonstrating self-efficacy in respecting cultural differences, which fostered a sense of accomplishment and pride in their roles. Conclusion This study identified the complex emotions and challenges experienced by ward nurses caring for foreign inpatients and the process of overcoming these obstacles and building a sense of pride. These findings can serve as an important reference for understanding how ward nurses adapt to their roles in caring for foreign patients and provide foundational data for improving nursing environments to enhance the quality of care for foreign inpatients.

Purpose: This study aims to explore and deeply understand the essence of the nursing experiences of ward nurses who have cared for foreign inpatients. Methods: In this study, in-depth interviews were conducted with 10 nurses at a tertiary hospital in Seoul from May 1 to June 30, 2023. The collected data were analyzed using Colaizzi’s phenomenological method. Results: The nursing experiences of ward nurses caring for foreign inpatients yielded five theme clusters-"A welcome yet challenging encounter," "A journey to navigate language barriers," "New competencies needed to face unfamiliar cultures," "Exerting every possible effort," and "Discovering and embracing the value of coexistence"-along with 11 themes. Ward nurses found caring for foreign inpatients challenging due to cultural differences and language barriers, which often felt burdensome.Nonetheless, they accepted it as a necessary duty, handling additional tasks beyond basic care to support patient recovery. Despite communication challenges, they strived to provide the best care, demonstrating self-efficacy in respecting cultural differences, which fostered a sense of accomplishment and pride in their roles. Conclusion This study identified the complex emotions and challenges experienced by ward nurses caring for foreign inpatients and the process of overcoming these obstacles and building a sense of pride. These findings can serve as an important reference for understanding how ward nurses adapt to their roles in caring for foreign patients and provide foundational data for improving nursing environments to enhance the quality of care for foreign inpatients.

Purpose: This study aims to explore and deeply understand the essence of the nursing experiences of ward nurses who have cared for foreign inpatients. Methods: In this study, in-depth interviews were conducted with 10 nurses at a tertiary hospital in Seoul from May 1 to June 30, 2023. The collected data were analyzed using Colaizzi’s phenomenological method. Results: The nursing experiences of ward nurses caring for foreign inpatients yielded five theme clusters-"A welcome yet challenging encounter," "A journey to navigate language barriers," "New competencies needed to face unfamiliar cultures," "Exerting every possible effort," and "Discovering and embracing the value of coexistence"-along with 11 themes. Ward nurses found caring for foreign inpatients challenging due to cultural differences and language barriers, which often felt burdensome.Nonetheless, they accepted it as a necessary duty, handling additional tasks beyond basic care to support patient recovery. Despite communication challenges, they strived to provide the best care, demonstrating self-efficacy in respecting cultural differences, which fostered a sense of accomplishment and pride in their roles. Conclusion This study identified the complex emotions and challenges experienced by ward nurses caring for foreign inpatients and the process of overcoming these obstacles and building a sense of pride. These findings can serve as an important reference for understanding how ward nurses adapt to their roles in caring for foreign patients and provide foundational data for improving nursing environments to enhance the quality of care for foreign inpatients.