Purpose: In the Fourth Industrial Revolution, nursing education will change in a different way than before. The purpose of this study was to analyze characteristics of qualitative research on learning experiences for nursing students, and to suggest directions for nursing education geared to the needs of the future. Methods: An integrative review method was used. Based on Whittemore & Knafl’s approach, five steps were applied. Results: Eleven papers met the selection criteria and had above average ratings in quality appraisals. Three characteristics related to the learning experiences of nursing students were derived: (1) overcoming difficulties in the learning process and concentrating on problem-solving, (2) improving self-efficacy through experiencing achievement in the learning process, (3) establishing nursing professionalism, (4) identifying the importance of self-directed and self-reflected learning, and (5) developing teamwork. Conclusion This review found that various learning experiences were conducted for practical experience and learner-oriented learning. Nursing students overcame difficulties to achieve their learning outcomes, and developed their professionalism. Further study is required to comprehensively explore research including other countries, and the experiences of instructors.

PURPOSE: The aim of this study is to assess the short-term outcome of intraoperative colonic irrigation and primary anastomosis and to suggest the usefulness of the procedure when a preoperative mechanical bowel preparation is inappropriate. METHODS: This retrospective study included 38 consecutive patients (19 male patients) who underwent intraoperative colonic irrigation and primary anastomosis for left colon disease between January 2010 and December 2016. The medical records of the patients were reviewed to evaluate the patients' characteristics, operative data, and postoperative short-term outcomes. RESULTS: Twenty-nine patients had colorectal cancer, 7 patients had perforated diverticulitis, and the remaining 2 patients included 1 with sigmoid volvulus and 1 with a perforated colon due to focal colonic ischemia. A diverting loop ileostomy was created in 4 patients who underwent a low anterior resection. Complications occurred in 15 patients (39.5%), and the majority was superficial surgical site infections (18.4%). Anastomotic leakage occurred in one patient (2.6%) who underwent an anterior resection due sigmoid colon cancer with obstruction. No significant difference in overall postoperative complications and superficial surgical site infections between patients with obstruction and those with peritonitis were noted. No mortality occurred during the first 30 postoperative days. The median hospital stay after surgery was 15 days (range, 8–39 days). CONCLUSION: Intraoperative colonic irrigation and primary anastomosis seem safe and feasible in selected patients. This procedure may reduce the burden of colostomy in patients requiring a left colon resection with an inappropriate preoperative mechanical bowel preparation.
Anastomotic Leak ; Colon* ; Colon, Sigmoid ; Colorectal Neoplasms ; Colostomy ; Diverticulitis ; Humans ; Ileostomy ; Intestinal Volvulus ; Ischemia ; Length of Stay ; Male ; Medical Records ; Mortality ; Peritonitis ; Postoperative Complications ; Retrospective Studies ; Sigmoid Neoplasms ; Surgical Wound Infection

Purpose: To evaluate the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy for managing symptoms of the version 1.0 item bank in Korea. Methods: This study consisted of two phases: first, developing the Korean version of the item bank following the translation guidelines; and second, performing a cross-sectional study to evaluate its psychometric properties using the item response theory. This study enrolled 323 patients with type 2 diabetes mellitus between July and August 2020. Cronbach's α was used to assess the reliability of this item bank. Confirmatory factor analysis, using diagonally weighted least squares, was used to identify the assumptions of item response theory. Item parameter estimates including discrimination and thresholds were derived using the graded response model of the item response theory to reflect patient-reported outcomes as individualized responses. Results: The Korean version of the item bank demonstrated good reliability (Cronbach's α = .98) and its discrimination ranged from 1.82 to 4.93. The thresholds resulted in the establishment of a category response curve for each item. However, no overlap was observed among the category curves. Moreover, the differential item functioning was not significant for age, gender, and income variables. Conclusion The graded response model and differential item functioning provided qualitative evidence that demonstrated acceptable psychometric properties of symptom management self-efficacy among patients. This item bank is expected to provide adequate assessments of self-efficacy of symptom management for patients with a chronic disease, which can contribute to nursing research and intervention.

PURPOSE: The purpose of this study was to explore the role of clinical nursing instructors' lived experience in clinical practicum.METHODS: Data were collected from 11 clinical nursing instructors by in-depth interviews. The data were analyzed using content analysis of Downe-Wamboldt (1992).RESULTS: Four themes and twelve subthemes were extracted. 1) Recognizing and conducting the roles of clinical nursing instructor: ‘Helping and providing support for successful clinical practicum’, ‘Coordinating clinical activities in daily practice’, ‘Providing mentoring as an elder in life’; 2) Participating in improving integrative nursing competency: ‘Helping to improve cognitive competency’, ‘Helping to improve functional competency’, ‘Contributing to form desirable professionalism’, ‘Helping to deliberate the nature of nursing’; 3) Experiencing difficulties in performing the role of clinical nursing instructor: ‘Facing with difficulty from institutional limits’, ‘Recognizing difficulty from lack of personal knowledge and experience’; 4) Experiencing value of clinical nursing instructor and accomplishing personal growth: ‘Making efforts to widen personal knowledge and experience’, ‘Developing one's own educational competency’, ‘Making a chance to reflect oneself’.CONCLUSION: Despite the distinctive features of clinical nursing instructors, little is known of the characteristics. The results of this study could be used as a reference to improve the quality of clinical nursing education.
Education ; Education, Nursing ; Humans ; Mentors ; Nursing ; Preceptorship ; Qualitative Research

Pulmonary arteriovenous fistula (PAVF) is abnormally dilated vessels that provide a right-to-left shunt between pulmonary artery and pulmonary vein and is clinically divided into simple and complex type. Here, we report four cases of surgically resected sporadic PAVFs presenting various clinical and histologic spectrums. Cases 1 (a 57-old-female) and 2 (a 54-old-female) presented as incidentally identified single aneurysmal fistulas and the lesions were surgically removed without complication. On the other hand, case 3 (an 11-old-male) showed diffuse dilated vascular sacs involving both lungs and caused severe hemodynamic and pulmonary dysfunction. Embolization and surgical resection of the main lesion failed to relieve the symptoms. Case 4 (a 36-old-male) had a localized multiloculated cyst clinically mimicking congenital cystic adenomatoid malformation. Microscopically, the lesion consisted of dilated thick vessels, consistent with the diagnosis of fistulous arteriovenous malformation/hemangioma.
Aneurysm ; Arteriovenous Fistula* ; Arteriovenous Malformations ; Cystic Adenomatoid Malformation of Lung, Congenital ; Diagnosis ; Fistula ; Hand ; Hemodynamics ; Lung ; Pulmonary Artery ; Pulmonary Veins

Objectives: Academic electronic medical records (AEMRs) can be utilized for a variety of educational programs that can enhance nursing students’ nursing informatics and clinical reasoning competencies. This study aimed to identify the applicability and effectiveness of simulation education incorporating AEMRs. Methods: We developed simulation education scenarios incorporating AEMRs and evaluated them with 76 third- and fourth-year nursing students from five nursing schools using a mixed-methods design. We incorporated three simulation case scenarios involving preeclampsia, diabetes mellitus, and myocardial infarction into the AEMRs. After the simulation education, participants’ feedback on the usability of the AEMR system and their self-efficacy for AEMR utilization were collected via self-reported surveys. Subsequently, the simulation education incorporating AEMRs was evaluated through a focus group interview. The survey data were examined using descriptive statistics, and thematic analysis was done for the focus group interview data. Results: The average mean scores for the AEMR system’s usability and participants’ self-efficacy for AEMR utilization were 5.36 of 7 and 3.96 of 5, respectively. According to the focus group interviews, the participants were satisfied with the simulation education incorporating AEMRs and recognized their confidence in AEMR utilization. In addition, participants addressed challenges to simulation education incorporating AEMRs, including the need for pre-education and AEMR utilization difficulties. Conclusions Nursing students weresatisfied with and recognized the value of simulation education incorporating AEMRs. Although the actual application ofsimulation education incorporating AEMRs remains challenging, further research can help develop and implement this approachfor nursing students.

Fascial plane blocks are useful for multimodal analgesia after cardiac surgery since they can provide effective analgesia without the serious risks associated with conventional techniques such as neuraxial hematoma and pneumothorax. This narrative review covers blocks performed at the parasternal intercostal, interpectoral, pectoserratus, serratus anterior, erector spinae, and retrolaminar planes, which are targets for fascial plane blocks in cardiac surgery. Brief anatomical considerations, mechanisms, and currently available evidence are reviewed. Additionally, recent evidence on fascial plane blocks for subcutaneous-implantable cardioverter-defibrillator implantation are also reviewed.

Lymph node metastasis in early colon cancer is relatively low. Furthermore, skip metastasis beyond principle lymph node is very rare. This is a case of early cecal cancer with skip metastasis to portocaval and retropancreatic space, without regional lymph node metastasis. A 69-year-old female diagnosed as cecal adenocarcinoma. The imaging study revealed as early cecal cancer without enlargement of regional lymph node. However, there is enlargement of portocaval lymph node and high fluorodeoxyglucose (FDG) uptake in positron emission tomography scan image. Right hemicolectomy with extended lymph node dissection was done including retropancreatic, portocaval and hepatoduodenal ligament lymph node. Though whole abdominal cavity exploration was done, there was no evidence of other synchronous cancer. The final pathologic findings revealed the poorly differentiated adenocarcinoma with invasion of submucosal layer and focally superficial layer of muscularis propria. Two of total 27 lymph nodes were involved by metastastatic adenocarcinoma which were from portocaval and retropancreatic space. The detailed preoperative imaging study could find unexpected lymph node metastasis beyond range of routine lymph node dissection. Even though the preoperative clinical stage is relatively early, the detailed and sufficient evaluation for clinical and imaging findings is important not to ignore skip metastasis.
Abdominal Cavity ; Adenocarcinoma ; Aged ; Cecal Neoplasms ; Colonic Neoplasms ; Female ; Humans ; Ligaments ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Metastasis ; Positron-Emission Tomography

Purpose: To compare the surgical outcomes of peritoneal irrigation versus suction alone during laparoscopic appendectomy and to identify the risk factors of surgical site infection in patients with uncomplicated acute appendicitis. Methods: Data from patients with uncomplicated acute appendicitis between January 2014 and March 2016 were reviewed. We compared the irrigation and suction alone groups with regard to the following parameters: postoperative complication incidence rate, length of hospital stay, operation time, time to flatus, time to diet commencement, and duration of postoperative antibiotic. Results: A total of 578 patients underwent laparoscopic appendectomy for uncomplicated acute appendicitis. Twenty-five patients were excluded from the analysis because of need for drain insertion, loss to follow-up, simultaneous surgery for another indication, presence of an appendix tumor, or pregnancy. A total of 207 patients (37.4%) had undergone irrigation, and 346 patients (62.6%) received suction alone during laparoscopic appendectomy. The preoperative fever rate was significantly higher in the irrigation group than in the suction alone group. Operative time was also significantly longer in the irrigation group than in the suction alone group (53.8 ± 18.5 minutes vs. 57.8 ± 21.4 minutes, P = 0.027). The postoperative complication rate was higher in the irrigation group than in the suction alone group (4.5% vs. 12.6%, P = 0.001). Multiple logistic regression analysis showed that irrigation and preoperative fever were risk factors for surgical site infection after laparoscopic appendectomy for uncomplicated acute appendicitis. Conclusion There is no advantage to irrigating the peritoneal cavity over suction alone during laparoscopic appendectomy for uncomplicated acute appendicitis. Irrigation may actually prolong the operative time and therefore be detrimental.

BACKGROUND/AIMS: Protein-losing enteropathy (PLE), characterized by severe hypoalbuminemia and peripheral edema, is a rare manifestation of systemic lupus erythematosus. This present study aimed to identify the distinctive features of lupus-related PLE and evaluate the factors related to the treatment response. METHODS: From March 1998 to March 2014, the clinical data of 14 patients with lupus PLE and seven patients with idiopathic PLE from a tertiary center were reviewed. PLE was defined as a demonstration of protein leakage from the gastrointestinal tract by either technetium 99m-labelled human albumin scanning or fecal alpha1-antitrypsin clearance. A positive steroid response was defined as a return of serum albumin to > or = 3.0 g/dL within 4 weeks after initial steroid monotherapy, and remission as maintenance of serum albumin > or = 3.0 g/dL for at least 3 months. A high serum total cholesterol level was defined as a level of > or = 240 mg/dL. RESULTS: The mean age of the lupus-related PLE patients was 37.0 years, and the mean follow-up duration was 55.8 months. Significantly higher erythrocyte sedimentation rate and serum total cholesterol levels were found for lupus PLE than for idiopathic PLE. Among the 14 patients with lupus PLE, eight experienced a positive steroid response, and the serum total cholesterol level was significantly higher in the positive steroid response group. A positive steroid response was associated with an initial high serum total cholesterol level and achievement of remission within 6 months. CONCLUSIONS: In lupus-related PLE, a high serum total cholesterol level could be a predictive factor for the initial steroid response, indicating a good response to steroid therapy alone.
Adult ; Aged ; Biomarkers/blood ; Cholesterol/blood ; Drug Therapy, Combination ; Edema/diagnosis/drug therapy/*etiology ; Female ; Glucocorticoids/therapeutic use ; Humans ; Hypoalbuminemia/diagnosis/drug therapy/*etiology ; Immunosuppressive Agents/therapeutic use ; Lupus Erythematosus, Systemic/*complications/diagnosis/drug therapy ; Male ; Middle Aged ; Protein-Losing Enteropathies/diagnosis/drug therapy/*etiology ; Remission Induction ; Risk Factors ; Serum Albumin/metabolism ; Tertiary Care Centers ; Time Factors ; Treatment Outcome