PURPOSE: The purpose of this study was to investigate the influence of communication competence and burnout on nursing performance in intensive care units (ICU). METHOD: The participants were 209 nurses from four university hospitals. Measurements included a socio-demographic and job related survey, communication competence inventory, the Maslach burnout inventory and a nursing performance scale. Data were collected from February 6 to 24, 2012, with a self-report questionnaire. The statistical analyses were performed with SPSS 18.0 software. RESULTS: The mean scores for communication competence, burnout and nursing performance were 50.49, 84.72, and 62.18, respectively. Communication competence (r=.44, p<.001) and burn out (r=-.32, p<.001) were significantly correlated with nursing performance. In the multiple linear regression, factors influencing nursing performance were communication competence, age and burnout. These variables explained about 46% of the total variance of nursing performance. Communication competence (beta=.34, p%.001) was the most influential factor. CONCLUSION: Nurses' poor communication skills and burnout can influence the occurrences of medical errors in ICU nursing performance. The results suggest that good communication and burnout resolution skills programs should be implemented to improve nursing performance efficiency.
Burns ; Hospitals, University ; Critical Care ; Intensive Care Units ; Linear Models ; Medical Errors ; Mental Competency ; Surveys and Questionnaires

PURPOSE: To compare the MR findings of a sequestered disc with an extruded disc. MATERIALS AND METHODS: MR images of 28 patients with a sequestered disc and 18 patients with an extruded disc were retrospectively reviewed. Patients with sequestered discs were divided into two groups whether definite separation from the parent disc was or was not seen. In the latter group (definite separation not seen) and the extruded disc group of patients, the signal intensities of the herniated discs were compared with the signal intensities of the parent discs and were evaluated on T1- and T2-weighted images. We also assessed the presence of a notch within the herniated disc. RESULTS: In the sequestered disc group of patients (28 discs), only 5 discs (18%) showed obvious separation from the parent disc. Among the remaining 23 discs with indefinite separation, the notch was visible in 14 discs (61%) and 9 discs (39%) had no notch. In the extruded disc group (18 discs), the notch was visible in 2 (11%) discs and the difference between the two groups was statistically significant (p = 0.0002). The signal intensities of the herniated discs on T1-weighted images were isointense in both the sequestered and extruded discs. The difference of incidence of high signal intensities on T2-weighted images was not statistically significant (p = 0.125). CONCLUSION: It is necessary to consider the possibility of the presence of a sequestered disc when a herniated disc material shows a notch.
Humans ; Incidence ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging* ; Parents ; Retrospective Studies ; Spine*

BACKGROUND: Most studies on the incidence rate (IR) and post-exposure reporting rate (RR) of needle-stick injuries (NSIs) were performed using retrospective surveillance, which is vulnerable to recall bias. This study aimed to identify the agreement between IRs and RRs obtained from prospective and retrospective surveillance. METHODS: The prospective surveillance was performed with 716 nurses working at 3 hospitals from August to September in 2012. They prospectively reported when they experienced the NSIs, and the investigator retrospectively calculated the RR from records in the infection control unit or health care unit during the same periods when they reported the number of NSIs. The retrospective surveillance was carried out with 312 nurses who participated in the prospective surveillance. They retrospectively answered the question on the number of NSIs and post-exposure reporting after recalling the experienced NSI from August to September in 2012. RESULTS: The IR of NSIs was 9.8 per 100 nurses by the prospective surveillance and 36.4 per 100 nurses by the retrospective surveillance, which was statistically significantly different (P<0.001). The RR of NSIs was 14.3% by the prospective surveillance and 8.5% by the retrospective surveillance, which was not statistically significantly different. CONCLUSION: We recommend using a prospective approach for calculating the IR of NSIs to reduce the risk of recall bias. However, the RR of NSIs can be calculated using both prospective and retrospective approaches.
Bias (Epidemiology) ; Delivery of Health Care ; Humans ; Incidence* ; Infection Control ; Memory ; Needlestick Injuries* ; Prospective Studies* ; Research Personnel ; Retrospective Studies*

This study was aimed to elucidate the effects of K(ATP) activation during IPC on the PKC-epsilon, NF-kappaB and AP-1 in ischemia-reperfused rat hearts. SD male rats weighting from 300 to 350 g were split into 9 groups, such as sham control (S), IPC, 3 cycles of 5 min ischemia and 5 min reperfusion, continuous preconditioning (CP), 8 cycles of 5 min ischemia and 5 min reperfusion, K(ATP) opening (KO) with pinacidil (1.0 mg/kg), K(ATP) blocking with glibenclamide (1.0 mg/kg) injection, ischemia (IS), 30 min ischemia, IPC followed by IS, 8) K(ATP) blocking and IPC followed by IS (KB+IPC+IS), IS and K(ATP) opening (KO+IS). Heart were subjected to ligation of left descending coronary artery and reperfusion in groups of IPC, CP, IS with or without IPC. Immunohistochemistry and Western blotting for PKC-epsilon, NF-kappaB and AP-1 were performed at 3, 6, 24 hours after reperfusion or treatment. Immunoreactivities against PKC-epsilon antibody were observed stronger in the groups of IPC, KO, IPC+IS and KO+IS than groups of KB, IS and KB+IPC+IS. NF-kappaB activation and translocation were only observed in the groups of including 30 min ischemia and reperfusion. AP-1 activation and translocation were opposite to the results of PKC-epsilon activation. In the group of CP, KB, IS and KB+IPC+IS, reactivities of AP-1 antibody were stronger than IPC+IS, KO+IS, and weaker in the groups of S, IPC and KO. These results suggest that K(ATP) opening with IPC or pharmacological methods may direct effect on the PKC-epsilon activation and that K(ATP) blocking has effect on the AP-1 activation and translocation in the heart of ischemiareperfused of rats.
Animals ; Blotting, Western ; Coronary Vessels ; Glyburide ; Heart* ; Humans ; Immunohistochemistry ; Ischemia ; Ischemic Preconditioning* ; Ligation ; Male ; NF-kappa B* ; Pinacidil ; Rats* ; Reperfusion ; Transcription Factor AP-1*

Acute respiratory failure from mycoplasma pneumonia is uncommon, because community-acquired pneumonia from mycoplasma pneumonia is typically not severe in patients without underlying disease. In addition, alveolar hemorrhage is a rare manifestation in these cases. We describe a case of acute respiratory failure that required mechanical ventilation due to diffuse alveolar hemorrhage in an immunocompetent patient with mycoplasma pneumonia.
Hemorrhage ; Humans ; Mycoplasma ; Pneumonia ; Pneumonia, Mycoplasma ; Respiration, Artificial ; Respiratory Insufficiency

A hiccup is caused by involuntary, intermittent, and spasmodic contractions of the diaphragm and intercostal muscles. It starts with a sudden inspiration and ends with an abrupt closure of the glottis. Even though a hiccup is thought to develop through the hiccup reflex arc, its exact pathophysiology is still unclear. The etiologies include gastrointestinal disorders, respiratory abnormalities, psychogenic factors, toxic-metabolic disorders, central nervous system dysfunctions and irritation of the vagus and phrenic nerves. Most benign hiccups can be controlled by traditional empirical therapy such as breath holding and swallowing water. However, though rare, a persistent hiccup longer than 48 hours can lead to significant adverse effects including malnutrition, dehydration, insomnia, electrolyte imbalance, and cardiac arrhythmia. An intractable hiccup can sometimes even cause death. We herein describe a patient with non-small cell lung cancer who was severely distressed by a persistent hiccup.
Arrhythmias, Cardiac ; Breath Holding ; Carcinoma, Non-Small-Cell Lung ; Central Nervous System ; Chlorpromazine ; Contracts ; Deglutition ; Dehydration ; Diaphragm ; Glottis ; Hiccup ; Humans ; Intercostal Muscles ; Lung Neoplasms ; Malnutrition ; Phrenic Nerve ; Reflex ; Sleep Initiation and Maintenance Disorders ; Water

Hypereosinophilic syndrome (HES) is characterized by a sustained eosinophilia of 1,500/mm3 or more in the absence of any known causes or the signs and symptoms of organ involvement. We report a 64-year-old man with HES initially presenting with involvement of the liver and bone marrow. Despite controlling the eosinophilia by corticosteroid, he developed a cerebral infarction and later progressive interstitial pneumonia. Brain angiography revealed a severe stenosis of the proximal right internal carotid artery (ICA) and a complete obstruction of the intracranial ICA. An open lung biopsy revealed fibrosis and lymphoplasma cell infiltration without eosinophils, which were consistent with nonspecific interstitial pneumonia.
Angiography ; Biopsy ; Bone Marrow ; Brain ; Carotid Artery, Internal ; Cerebral Infarction ; Constriction, Pathologic ; Eosinophilia ; Eosinophils ; Fibrosis ; Humans ; Hypereosinophilic Syndrome* ; Liver ; Lung Diseases, Interstitial ; Lung* ; Middle Aged

BACKGROUND/AIMS: An ideal noninvasive diagnostic test for hepatic fibrosis should be simple, inexpensive, and accurate. We aimed to find the simple marker for predicting hepatic fibrosis and to compare the accuracy of AST, platelet, AST/ALT ratio and AST to platelet ratio index (APRI) in chronic hepatitis B patients without clinical evidence of cirrhosis. METHODS: A total of one hundred and twenty-six chronic hepatitis B patients who underwent liver biopsy at the Ajou University Hospital from August 1998 to December 2003 were enrolled. Hepatic fibrosis was assessed using the Ludwig classification. Significant fibrosis was defined as fibrosis score of 3 or more. The AST/ALT ratio and APRI were calculated and correlations with hepatic fibrosis were analyzed. RESULTS: APRI showed a significant correlation (r=0.501, p=0.000) with hepatic fibrosis, and was superior to AST, AST/ALT ratio and platelet in predicting fibrosis. Patients with significant fibrosis (fibrosis stage 3, 4) can be identified to have APRI=1 with sensitivity 71.2% and specificity 70.3%. The sensitivity and specificity of an APRI = 1.5 for cirrhosis (stage 4) were 83.3% and 75.0%. CONCLUSIONS: Simple index using AST and platelet value can predict the presence of significant fibrosis and cirrhosis in chronic hepatitis B patients without clinical evidence of cirrhosis.
Adult ; Alanine Transaminase/blood ; Aspartate Aminotransferases/*blood ; Female ; Hepatitis B, Chronic/blood/enzymology/*pathology ; Humans ; Liver/pathology ; Liver Cirrhosis/*pathology/virology ; Male ; *Platelet Count ; Sensitivity and Specificity

BACKGROUND: The epidural injection technique is a commonly used intervention in the management of chronic spinal pain, which has the advantage of delivering various drugs, such as local anesthetics or steroids, in higher concentrations to the inflamed nerve root. A guidewire-reinforced epidural catheter was introduced through a Tuohy needle during the caudal epidural procedure, with a catheter threaded into the affected nerve roots and the spread-pattern of contrast agents observed under fluoroscopy. METHODS: Sixty-seven patients with low back pain, who showed evidence of a herniated nucleus pulposus on magnetic resonance imaging, were included. All patients received fluoroscopically guided caudal epidural injections, with the guidewire-reinforced epidural catheter introduced through a Tuohy needle and threaded either to the right or left side toward the target nerve roots. After confirming the catheter tip position at the affected nerve root, 2 ml increments of contrast agents (up to 6 ml) were injected, and their corresponding AP fluoroscopic views were obtained. Three radiologists reviewed all the radiographic findings and measured the proportion of the area of contrast spread at the side of target nerve roots. RESULTS: Greater proportion of the area of contrast spread was observed at the side of the target nerve roots (P < 0.0001). At each level of contrast injection (2- , 4- and 6 ml), more than 70% of the spread of contrast dye was observed at the side of the target nerve roots in 85%, 70%, and 55% of cases, respectively. CONCLUSIONS: The combination of a caudal epidural injection and use of a guidewire-reinforced epidural catheter significantly enhances the target specificity, as revealed by the selective spread of contrast dye at the side of target nerves.
Anesthetics, Local ; Catheters* ; Contrast Media ; Fluoroscopy ; Humans ; Injections, Epidural* ; Low Back Pain ; Magnetic Resonance Imaging ; Needles ; Sensitivity and Specificity ; Steroids

BACKGROUND/AIMS: Advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT) has a poor prognosis. The aim of this study was to evaluate the efficacy and safety of repeated arterial infusions of low dose cisplatin and 5-fluorouracil (FU) in patients with advanced HCC with decompensated cirrhosis. METHODS: Between January 1995 and December 2003, a total of 79 decompensated cirrhotic patients having HCC and PVT were enrolled and divided into 2 groups. Group 1 (n=40) received intra-arterial infusion chemotherapy with cisplatin (10 mg for 5 days) and 5-FU (250 mg for 5 days) via an implanted chemoport every 4 weeks' and group 2 (n=39) was managed with only conservative treatment. RESULTS: The two groups were well matched with respect to the features relating to the prognosis, including age, gender and the Child- Pugh class. Although diffuse tumor involvement, main portal vein tumor thrombosis and bi-lobar involvement were more frequent in group 1, the median survival period of group 1 was significantly longer than group 2 (5 months vs. 3 months, respectively, P=0.016). Also, the 1-year survival rate of group 1 (7.5%) was higher than that of group 2 (5.1%) (P=0.016). When we analyzed the patients with the Child class B, the survival benefits of intra-arterial chemotherapy were more significant (P=0.008). CONCLUSIONS: Intra-arterial chemotherapy consisting of low dose 5-FU and cisplatin achieved favorable results for advanced HCC patients who had decompensated cirrhosis, and it showed better survival in selected patients. This therapy may be useful as a palliative treatment for HCC patients with decompensated cirrhosis.
Venous Thrombosis/complications ; Survival Rate ; Portal Vein ; Palliative Care ; Middle Aged ; Male ; Liver Neoplasms/complications/*drug therapy/mortality ; Liver Cirrhosis/complications ; *Infusions, Intra-Arterial ; Humans ; Fluorouracil/administration & dosage ; Female ; Disease-Free Survival ; Cisplatin/administration & dosage ; Carcinoma, Hepatocellular/complications/*drug therapy/mortality ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Aged ; Adult