PURPOSE: There are few studies globally regarding the barriers to restraint-reduction. The purpose of this study was to describe the views of nursing staff (both nurses and geriatric care assistants) regarding the barriers to reducing physical restraint use in Korean nursing homes. METHODS: Forty registered nurse and geriatric care assistant informants participated in the first round of interviews and 16 of them participated in second confirmatory interviews. All interviews were conducted on site, one-on-one and face-to-face, using semi-structured interview protocols. Qualitative descriptive method was used and qualitative content analysis was employed. RESULTS: Six themes were identified: (a) being too busy, (b) lack of resources, (c) beliefs and concerns, (d) lack of education, (e) differences and inconsistencies, and (f) relationship issues. CONCLUSION: The findings of this study provide a valuable basis for developing restraint reduction education programs. Korean national leaders and nursing homes should develop and employ practice guidelines regarding restraints, support nursing staff to follow the guidelines, provide more practical and professional education, employ alternative equipment, use a multidisciplinary team approach, and engage volunteers in care support as well as employ more nursing staff to achieve restraint-free care.
Education, Professional ; Humans ; Nursing Homes ; Nursing Staff ; Qualitative Research ; Restraint, Physical

PURPOSE: The aim of study was to evaluate the usefulness of serum HER2 as a therapeutic response indicator in patients with HER2 positive metastatic breast cancer (MBC). MATERIALS AND METHODS: The levels of serum HER2 and CA15.3 were assayed in 148 serial serum samples from 50 HER2 positive MBC patients at both the baseline and follow-ups. The changes in the levels of serum HER2 and CA15.3 in relation to the tumor responses to the various chemotherapy regimens were monitored. RESULTS: The levels of serum HER2 and CA15.3 were elevated in 82% and 62% of tissue HER2 positive patients, respectively, prior to therapies, with the changes in both tumor markers showing statistical significance in relation to the tumor responses (p<0.01) in patients with elevated baseline serum markers. CONCLUSION: The level of serum HER2 could be a valuable response indicator, not only for trastuzumab containing therapy, but also for other common MBC chemotherapeutic agents. Also, as it is more frequently elevated, the serum level of HER2 may also be a more useful tumor marker than CA15.3 in HER2 positive MBC.
Biomarkers ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Follow-Up Studies ; Humans ; Biomarkers, Tumor ; Trastuzumab

To our knowledge, this is the first report of case of high-grade endometrial stromal sarcoma metastasized to the stomach. Endometrial stromal sarcoma is very rare, accounting for 0.2% of female genital tract malignancies. High-grade endometrial stromal sarcoma demonstrates more frequent infiltration into the muscle layer of the uterus or metastasis to other organs, having a poorer prognosis than low grade disease. During its clinical course, endometrial stromal sarcoma may involve ovary, fallopian tube and pelvic cavity. Distant metastasis to lung, liver, bladder, breast, heart, brain and bones have been reported. However, to the best of our knowledge, high-grade endometrial stromal sarcoma presenting with gastric metastasis has never been reported. We now report a case of a 52-year-old woman with previously diagnosed lung metastasis having stomach metastasis from endometrial stromal sarcoma of the uterus.
Accounting ; Brain ; Breast ; Endometrium ; Fallopian Tubes ; Female ; Heart ; Humans ; Liver ; Lung ; Middle Aged ; Muscles ; Neoplasm Metastasis ; Ovary ; Prognosis ; Sarcoma ; Sarcoma, Endometrial Stromal ; Stomach ; Urinary Bladder ; Uterus

Malnutrition associated vitamin D deficiency contributes to the calcium loss from bone and results in osteoporosis and osteomalacia at final stage. Osteomalacia is characterized with softening of bone secondary to defective bone mineralization. Here, we report a case of possible osteomalacia caused by prolonged lactation and severe malnutrition in 35-year-old female. She was a housewife and her body mass index was 11.8 kg/m2. She was diagnosed with severe osteoporosis in regular health check-up 2 years ago, but did not take any medication. Nine months ago, she had been treated with anti-tuberculosis medications for 6 month due to active pulmonary tuberculosis. After complete remission of pulmonary tuberculosis, she had lost her appetite severely. Furthermore, she felt gait difficulty and suffered from generalized bone pain. On serologic examination, hypocalcemia, hypophosphatemia, high alkaline phosphatase, low vitamin D3 and high parathyroid hormone level were seen. In the bone mineral density, Z-score from her lumbar spine was -6.5. She was treated with oral calcium and vitamin D3 intramuscularly. After 1 year treatment, she felt significant improvement in bone pain and could walk alone. Also her serum calcium, phosphate and vitamin D3 level are all normalized.
Adult ; Alkaline Phosphatase ; Appetite ; Body Mass Index ; Bone Density* ; Calcification, Physiologic ; Calcium ; Cholecalciferol ; Female ; Gait ; Humans ; Hypocalcemia ; Hypophosphatemia ; Lactation* ; Malnutrition* ; Osteomalacia ; Osteoporosis ; Parathyroid Hormone ; Spine ; Tuberculosis, Pulmonary ; Vitamin D ; Vitamin D Deficiency*

Heterotopic pancreas is an uncommon condition that commonly occurs in the gastrointestinal tract such as the stomach and small bowel. It is defined as the presence of pancreatic tissue outside its usual location and lacking anatomical and vascular continuity with the pancreas. A heterotopic pancreas is usually found incidentally and is mostly silent; however, it rarely causes abdominal pain, weight loss, bleeding, or ileus. A 49-year-old male presented with intermittent abdominal pain for 4 weeks. We report a case with submucosal features of a jejunal heterotopic pancreas with the aid of capsule endoscopy and a histological confirmation through a single port laparoscopic segmental jejunectomy.
Abdominal Pain ; Capsule Endoscopy ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileus ; Jejunum ; Male ; Middle Aged ; Pancreas ; Stomach ; Weight Loss

BACKGROUND: The significance of adiponectin levels in elderly individuals with prediabetes has yet to be determined. Thus, the present study was performed to evaluate the relationships between adiponectin levels and anthropometric variables, body composition parameters, insulin sensitivity, and lipid profiles in elderly prediabetic patients. METHODS: The present study included 120 subjects with prediabetes who were >65 years of age and were selected from among 1,993 subjects enrolled in the Korea Rural Genomic Cohort Study. All subjects underwent a 75 g oral glucose tolerance test and tests for measurement of insulin sensitivity. All diagnoses of prediabetes satisfied the criteria of the American Diabetes Association. RESULTS: Plasma adiponectin levels were lower in elderly prediabetic subjects than elderly subjects with normal glucose tolerance (P<0.01) as well as in elderly prediabetic patients with metabolic syndrome (MetS) than in those without MetS (P<0.02). When the subjects were categorized into two groups according to plasma adiponectin levels, the waist-to-hip ratio and 2-hour insulin levels were significantly lower in individuals with high plasma adiponectin levels than in those with low plasma adiponectin levels. Additionally, the plasma adiponectin levels of elderly prediabetic subject were inversely correlated with body mass index (BMI), waist circumference (WC), waist-to-hip ratio, visceral fat, visceral fat ratio, and 2-hour insulin levels. CONCLUSION: The present findings demonstrated that the major factors correlated with adiponectin levels in elderly prediabetic subjects were BMI, WC, waist-to-hip ratio, visceral fat, visceral fat ratio, and 2-hour insulin levels.
Adiponectin* ; Aged* ; Body Composition ; Body Mass Index ; Cohort Studies ; Diagnosis ; Glucose ; Glucose Tolerance Test ; Humans ; Insulin ; Insulin Resistance ; Intra-Abdominal Fat ; Korea ; Plasma* ; Prediabetic State* ; Waist Circumference ; Waist-Hip Ratio

BACKGROUND/AIMS: Revaprazan (Revanex(R)) is a novel proton pump inhibitor (PPI) that has a somewhat different effect on proton pump compared with the other PPI's, also (called as 'acid pump antagonist'). We aimed to examine the false negative rate of 13C-urea breath test (UBT) in the patients with Helicobacter pylori (H. pylori) associated peptic ulcer disease who were treated with revaprazan and evaluate the anti-urease activity of revaprazan. METHODS: Total 55 patients were enrolled in this study. They received EGD examination between January 2009 and December 2009 and diagnosed histologically as H. pylori associated peptic ulcer disease. All patients took revaprazan only. Three patients were excluded because of underlying chronic disease and inappropriate breath sampling. The remaining 52 patients had UBT at 0, 2 and 4 weeks of revaprazan use. After 2 weeks of the cessation of revaprazan, they had the fourth UBT. RESULTS: At 2 and 4 weeks, the false negative rates of UBT were 5.8% and 23.1%, respectively (p=0.05). After 2 weeks of the cessation, the cases of the false negative result were five. Four out of five patients had prolonged negative results on two or three successive tests, and baseline 13C difference value did not predict the false negative results. CONCLUSIONS: False negative results of UBT were common and increased with prolonged use of acid pump antagonist. As PPI, it had also anti-urease activity and most patients (47/52, 90.4%) reverted to positive results by 2 weeks after the cessation of taking the medication.
*Breath Tests ; Carbon Isotopes ; False Negative Reactions ; Female ; Helicobacter Infections/complications/*diagnosis ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Peptic Ulcer/*drug therapy/microbiology ; Proton Pump Inhibitors/*therapeutic use ; Pyrimidinones/*therapeutic use ; Tetrahydroisoquinolines/*therapeutic use ; Urea/*diagnostic use

PURPOSE: Ego-integrity in Erikson's stage theory is used frequently among health team members related to the care of the elderly and has specific meanings within the context of quality of life in later life. However, the concept of ego-integrity in the elderly has not been well articulated in the literature. This study was conducted clarify and conceptualize the phenomena of ego-integrity in the elderly. METHOD: A Hybrid Model of concept development was applied to develop a concept of ego-integrity, which included a field study carried out in Seoul, South Korea using in-depth interviews with old adults who were admitted as a right person for research subject according to attributes of ego-integrity analysed in the theoretical phase. RESULTS: The concept of ego-integrity emerged as a complex phenomenon having meanings in several different dimensions which encompassed several attributes. CONCLUSIONS: Ego-integrity is a concept having needs that should be treated in a specific way and it is possible to enrich the meaning and methods to manage ego-integrity in nursing interventions for promoting quality of life so that its application may have effects that have positive impacts on the elderly's well being.
Adaptation, Psychological ; Aged/*psychology ; Aging/psychology ; *Ego ; Female ; Geriatric Nursing ; Humans ; Korea ; Male ; Superego

PURPOSE: Ego-integrity in older adults is the central concept related to quality of life in later life. Therefore, for effective interventions to enhance the quality of later life, a scale to measure ego-integrity in older adults is necessary. This study was carried out to develop a scale to measure ego-integrity in older adults. METHODS: This study utilized cronbach's alpha in analyzing the reliability of the collected data and expert group, and factor analysis and item analysis to analyze validity. RESULTS: Seventeen items were selected from a total of 21 items. Cronbach's alpha coefficient for internal consistency was .88 for the 17 items of ego-integrity in the older adults scale. Three factors evolved by factor analysis, which explained 50.71% of the total variance. CONCLUSIONS: The scale for measuring ego-integrity in Korean older adults in this study was evaluated as a tool with a high degree of reliability and validity.
Aged ; Aged, 80 and over ; *Ego ; Female ; Humans ; Korea ; Male ; Questionnaires ; Self Concept

PURPOSE: This study was conducted to examine the knowledge level and assessment experience of nurses in regards to delirium, and to utilize the study results as baseline data for planning delirium education programs for nurses. METHODS: Subjects were 465 nurses who were working in a general hospital. A 'delirium related knowledge and assessment experience' questionnaire was used to collect data. RESULTS: Knowledge levels regarding delirium averaged 70 out of 100, and at each domain, they scored 87 for etiology of delirium, 62 for symptoms, and 69 for nursing management. The knowledge level of delirium was significantly different according to educational level (F=3.851, p=.022), past education related to geriatrics(t=2.471, p=.014), and awareness of need for in-service education on geriatric nursing(F=2.663, p=.032). About 85% of nurses had past experience of dealing with delirious patients and only 7.7% of nurses used delirious state assessment tools. CONCLUSION: According to the above results, it is necessary, not only to provide delirium related educational programs for nurses, but also to emphasize the usefulness of applying the assessment tool.
Delirium* ; Education ; Hospitals, General ; Humans ; Nursing ; Surveys and Questionnaires