PURPOSE: The purpose of this study was to identify factors that affect reality shock in new nurses. METHODS: Participants were 216 newly graduated nurses with less than 1 year experience in 5 university and 10 general hospitals in Busan, Ulsan and Gyeongnam, A self-report questionnaire was completed by the nurses between November 18 and December 25, 2013. Data were analyzed using t-test, ANOVA and hierarchial multiple regression analysis with the SPSS/WIN 21.0 Program. RESULTS: Average scores for work environment and environmental reality shock were 2.63+/-0.33 and 2.66+/-0.43 points respectively. Regression analysis showed that with the nurses' demographic and work characteristics controlled, work environment explained 4.2% of the reality shock. Factors significantly affecting reality shock included nurses' changing residence because of job (beta=.21, p=.001), whether they were able to work on the unit of their choice (beta=-.13, p=.031) and whether they had a choice in days off (beta=-.14, p=.038). CONCLUSION: When these factors are considered, reduction in nurses' reality shock requires improvement in work environment, placing new nurses in a department of their choice and allowing them a choice in off-duty days. These measures would also help achieve organizational goals and develop the new nurses as professional nurses.
Busan ; Hospitals, General ; Organizational Objectives ; Surveys and Questionnaires ; Shock* ; Ulsan

PURPOSE: The purpose of this study was to identify the factors influencing Symptoms of Stress among hospital staff nurses. METHOD: Data was collected by questionnaires from 249 hospital staff nurses in three General Hospital. The data were analyzed using descriptive statistics, pearson correlation coefficients, and stepwise multiple regression. RESULTS: The score of the symptoms of stress showed a significantly positive correlation with the score of work stress(r=.22, p=.00). The symptoms of stress showed a significantly negative correlation with the score of social support(r=-.28, p=.00), self efficacy(r=-.31, p=.00), and hardiness(r=-.24, p=.00). The most powerful predictor of symptoms of stress was social support and the variance explained was 16%. A combination of social support, ways of coping, and work stress account for 32% of the variance in symptoms of stress among hospital staff nurses. CONCLUSION: This study suggests that social support, ways of coping, self efficacy, hardiness, and work stress are significantly influencing factors on symptoms of stress among hospital staff nurses.
Adaptation, Psychological ; Adult ; Female ; Humans ; Nursing Staff, Hospital/*psychology ; Self Efficacy ; Social Support ; Stress, Psychological/diagnosis/etiology/*psychology

PURPOSE: To evaluate various sepsis screening tests, individually and in combination, to formulate a guideline for the diagnosis of neonatal sepsis. METHODS: The study was a retrospective cohort study. It took place at the neonatal intensive care unit of the Paediatric Department, Il Sin Christian Hospital, Busan, Korea, over a period of 68 months from 1st, April, 2001 to 31st, December, 2005. This study evaluated 100 neonates having clinical features of sepsis and 100 normal asymptomatic neonates and used screening tests including C-reactive protein (CRP), total leukocyte count (TLC), absolute neutrophil count (ANC), immature neutrophils to total neutrophil count ratio (I/T ratio), thrombocytopenia, degenerative changes in the neutrophils and gastric aspirate cytology (GAC) for the diagnosis of neontal sepsis. RESULTS: The sensitivity of CRP and ANC was high. CRP had 86 percent sensitivity for group-A (proven sepsis) and 74 percent sensitivity for group-B (probable sepsis) and 94 percent specificity for group-A, B. ANC had sensitivity of 72 percent for group-A and 62 percent for group-B and 86 percent specificity for group-A, B. For group-A, sensitivity, specificity of GAC for polymorphs was 74 percent and 94 percent respectively. As for sensitivity, specificity of platelet count for group-A was 64 percent and 89 percent respecively. The sensitivity, specificity and predictive values (PV) of the individual tests and different test combinations were also calculated for group-A and B. CONCLUSION: For the detection of culture negative cases in neonatal sepsis, screening tests including CRP, TLC, ANC, thrombocytopenia, cytoplasmic vacuolization in the neutrophils and GAC for polymorphs have high sensitivity. A combination of three tests has higher sensitivity.
Busan ; C-Reactive Protein ; Cohort Studies ; Cytoplasm ; Diagnosis ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Leukocyte Count ; Mass Screening* ; Neutrophils ; Platelet Count ; Retrospective Studies ; Sensitivity and Specificity ; Sepsis* ; Thrombocytopenia

Adrenal cysts are rare lesion that usually present themselves as an incidental finding during surgery, or at the time of autopsy. The cysts are usually small, seldom exceeding 10cm in diameter, and are generally asymptomatic. However, they present a difficult problem in differentiation between benign and malignant lesions of the adrenal gland. In the differential diagnosis, other cystic lesions of the upper abdomen must also be considered, including hepatic, splenic, renal and pancreatic cysts. Herein we report a case of endothelial cyst of lymphangiomatous type of the adrenal gland which was detected in a 44-year-old male patient during a routine health examination by ultrasonography as a pancreatic pseudocyst. Gross examination revealed multiple separate but continuous cysts, measuring 10.6x8x7cm in dimension. Within the wall, compressed adrenal cortex was noted. Microscopically, fibrous wall containing hypertrophied smooth muscle lined by endothelial cells was also noted. We reviewed literatures of the adrenal cyst and report a case.
Male ; Humans ; Cysts

BACKGROUND: Rapid-sequence intubation is a common technique to reduce anesthetic complication. Due to side effects of succinylcholine, nondepolarizing muscle relaxants have been tried. Rocuronium is a new nondepolarizing muscle relaxant with a brief onset of action, but devoid of the adverse reaction associated with succinylcholine. Most local anesthetics decrease neuromuscular transmission and pontentiate neuromuscular blocks of muscle relaxants. The purpose of this study was to examine the effect of lidocaine on the onset time of rocuronium-induced neuromuscular blockade in adults. METHODS: Fourty five patients, ASA physical status I or II, were randomly divided into three groups. Anesthetic induction with thiopental 5 mg/kg was made. Succinylcholine (1.0 mg/kg) was administered intravenously in group 1. Rocuronium (0.6 mg/kg) was given in group 2, additional lidocaine (1.0 mg/kg) was given intravenously 1 minute prior to the administration of rocuronium in group 3. Neuromuscular blockade was assessed by train-of-four at the adductor pollicis muscle with supramaximal stimulation of the ulnar nerve (2 Hz, 0.2 msec) every 10 seconds. The condition of intubation, the appearance of arrhythmias, side effects of drugs, and the changes of mean arterial pressure and heart rate were checked and compared in peri-induction periods. RESULTS: The onset time of group 1 (55.1 14.9 sec) was faster than that of group 2 (137.8 46.0 sec) and group 3 (139.3 41.0 sec), but there was no difference between the onset time of group 2 and that of group 3. Intubating conditions were good or excellent in all groups, but group 1 and 3 were better than group 2. There was no difference between the three groups in hemodynamics. More adverse effects were observed in group 1, that of group 2 and 3 were observed in only one case. CONCLUSIONS: The authors concluded that lidocaine is not effective on the onset time of rocuronium, but improves the intubating condition. Rocuronium is devoid of side effects of succinylcholine, but not a alternative to succinylcholine because its onset time is too slow when compared with succinylcholine.
Adult* ; Anesthetics, Local ; Arrhythmias, Cardiac ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Lidocaine* ; Neuromuscular Blockade* ; Succinylcholine ; Thiopental ; Ulnar Nerve

BACKGROUND: Rapid-sequence intubation is a common technique to reduce anesthetic complication. Due to side effects of succinylcholine, nondepolarizing muscle relaxants have been tried. Rocuronium is a new nondepolarizing muscle relaxant with a brief onset of action, but devoid of the adverse reaction associated with succinylcholine. Most local anesthetics decrease neuromuscular transmission and pontentiate neuromuscular blocks of muscle relaxants. The purpose of this study was to examine the effect of lidocaine on the onset time of rocuronium-induced neuromuscular blockade in adults. METHODS: Fourty five patients, ASA physical status I or II, were randomly divided into three groups. Anesthetic induction with thiopental 5 mg/kg was made. Succinylcholine (1.0 mg/kg) was administered intravenously in group 1. Rocuronium (0.6 mg/kg) was given in group 2, additional lidocaine (1.0 mg/kg) was given intravenously 1 minute prior to the administration of rocuronium in group 3. Neuromuscular blockade was assessed by train-of-four at the adductor pollicis muscle with supramaximal stimulation of the ulnar nerve (2 Hz, 0.2 msec) every 10 seconds. The condition of intubation, the appearance of arrhythmias, side effects of drugs, and the changes of mean arterial pressure and heart rate were checked and compared in peri-induction periods. RESULTS: The onset time of group 1 (55.1 14.9 sec) was faster than that of group 2 (137.8 46.0 sec) and group 3 (139.3 41.0 sec), but there was no difference between the onset time of group 2 and that of group 3. Intubating conditions were good or excellent in all groups, but group 1 and 3 were better than group 2. There was no difference between the three groups in hemodynamics. More adverse effects were observed in group 1, that of group 2 and 3 were observed in only one case. CONCLUSIONS: The authors concluded that lidocaine is not effective on the onset time of rocuronium, but improves the intubating condition. Rocuronium is devoid of side effects of succinylcholine, but not a alternative to succinylcholine because its onset time is too slow when compared with succinylcholine.
Adult* ; Anesthetics, Local ; Arrhythmias, Cardiac ; Arterial Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Lidocaine* ; Neuromuscular Blockade* ; Succinylcholine ; Thiopental ; Ulnar Nerve

PURPOSE: To evaluate the effect of inhaled hypertonic saline solution in hospitalized infants with bronchiolitis. METHODS: A randomized double blind trial was performed from October 2003 to May 2004. A total of eighty patients <1 year of age with a clinical diagnosis of acute viral bronchiolitis were enrolled and assigned to receive either of the following:inhalation of 2 mL(0.5 mg) fenoterol added to 2 mL of 0.9 percent saline solution(group 1; n=40) or 2 mL(0.5 mg) fenoterol added to 2 mL of 3 percent saline solution(group 2; n=40). This therapy was repeated at six hours interval after admission. They were evaluated daily just before and 20 minutes after nebulization. The outcome measures included changes in clinical severity score(based on respiratory rate, presence of wheezing, retraction, and general condition) after nebulization and duration of hospitalization. RESULTS: In the clinical severity score, a significant improvement was observed during the 72 hours of hospitalization in both groups(P<0.05). The basic clinical severity scores before inhalation were decreased significantly faster in group 2 as compared to group 1 on each day of treatment(P<0.05). The mean duration of hospital stay was significantly reduced in group 2 than group 1(5.9+/-1.9 days versus 7.4+/-2.0 days, P<0.05). No adverse effects were associated with inhaled therapy. CONCLUSION: These results suggest that a nebulized 3 percent saline solution plus 0.5 mg fenoterol may be more effective than a 0.9 percent saline solution plus 0.5 mg fenoterol in accelerating the clinical recovery of infants with viral bronchiolitis.
Bronchiolitis* ; Bronchiolitis, Viral ; Diagnosis ; Fenoterol* ; Hospitalization ; Humans ; Infant* ; Inhalation ; Length of Stay ; Outcome Assessment (Health Care) ; Respiratory Rate ; Respiratory Sounds ; Saline Solution, Hypertonic* ; Sodium Chloride

A 56-year-old male with a gastrointestinal stromal tumor (GIST) underwent surgical resection of the tumor. Nine months after surgery, imatinib therapy was initiated because of the discovery of metastatic tumors in the left adrenal gland and in a lymph node of the peritoneum. Seventeen months later, the patient achieved complete remission (CR) and imatinib therapy was continued. However, 48 months after initiation of imatinib therapy, computed tomography scans revealed a left adrenal gland metastasis and the patient underwent left adrenalectomy. Immunohistochemical staining indicated that the spindle-shaped cells of the resected tumor were positive for C-kit, thus confirming metastasis of the GIST. This is the first report from Korea of an adrenal gland metastasis from a GIST. Worldwide, only two such cases have been reported. Here, we describe the first case of a distant recurrence of a GIST in the left adrenal gland after CR had been achieved with the aid of surgical resection and imatinib therapy.
Adrenal Glands* ; Adrenalectomy ; Gastrointestinal Stromal Tumors* ; Humans ; Imatinib Mesylate ; Korea ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis* ; Peritoneum ; Recurrence

Primary cardiac tumors are rare, with a prevalence of 0.001–0.2%. Among such tumors, cardiac hemangioendotheliomas are some of the most uncommon. In Korea, there have been no reports of hemangioendothelioma occurring in the heart of infants. We herein report a case of an infant that was admitted to our medical center and presented with cough and a runny nose. The initial diagnosis was acute bronchiolitis. Cardiomegaly was observed on chest radiography. Echocardiography revealed a tumor measuring 3.5×4.0 cm in the right atrium. The infant was transferred to a tertiary medical center for tumor excision. The excised lesion was 3.8×3×3.2 cm in size, and biopsy confirmed a diagnosis of hemangioendothelioma. In this case report, we describe our experience with a rare case involving cardiac tumor in an infant with an upper respiratory tract infection.
Biopsy ; Bronchiolitis ; Cardiomegaly ; Cough ; Diagnosis ; Echocardiography ; Heart ; Heart Atria ; Heart Neoplasms ; Hemangioendothelioma ; Humans ; Infant ; Korea ; Nose ; Prevalence ; Radiography ; Respiratory Tract Infections ; Thorax ; Twins

Pyriform sinus perforation is uncommon in children and most cases are secondary to iatrogenic causes such as endotracheal intubations. Due to this rarity, the management of these injuries is controversial. We report a case of pyriform sinus perforation in a 14-month-old boy who fell down with a spoon handle in the mouth and was successfully treated by transoral laryngomicrosurgery. Two hours after falling down, the patient had breathing difficulties and started vomiting. A chest X-ray showed subcutaneous emphysema and pneumomediastium. Esophagogram revealed leakage of contrast media at the hypopharynx. Although air leakage was reduced the next day, his fever became frequent even with conservative management of antibiotics. On the 4th hospital day, closure of pyriform sinus perforation was done by transoral laryngomicrosurgery. The patient became apyrexial by the 2nd post-operative day. On the 21th hospital day, the child was able to consume food orally without problems and was allowed to go home.
Anti-Bacterial Agents ; Child ; Contrast Media ; Fever ; Humans ; Hypopharynx ; Intubation, Intratracheal ; Mouth ; Pyriform Sinus ; Respiration ; Subcutaneous Emphysema ; Thorax ; Vomiting