PURPOSE: To develop and test the validity and reliability of the Korean version of the Moral Distress Scale-Revised (KMDS-R) to assess its applicability to Korean hospital nurses. METHODS: The KMDS-R was articulated through forward-backward translation methods. Internal consistency reliability, construct and criterion validity was calculated using SPSSWIN(19.0). Survey data were collected from 188 nurses from a university hospital in Gangwon-do, South Korea. RESULTS: The KMDS-R showed reliable internal consistency with a Cronbach's alpha of .69-.87 and a Guttman Split-half of .69-.82 for the total scale. Factor loading of the 21 items on the five subscales ranged from .41-.80. The KMDS-R was validated by factor analysis and explained 63% of moral distress for Korean hospital nurses. Criterion validity compared to Yoo's MDS showed significant correlation. CONCLUSION: The results suggest promising evidence of the KMDS-R's reliability and validity. It is used to measure moral distress for Korean hospital nurses.
Gangwon-do ; Korea ; Reproducibility of Results*

Purpose: This study aimed to describe nurses’ perceived needs and barriers to pediatric palliative care (PPC). Methods: Mixed methods with an embedded design were applied. An online survey was conducted for nurses who participated in the End-of-Life Nursing Education Consortium- Pediatric Palliative Care (ELNEC-PPC) train-the-trainer program, of whom 63 responded. Quantitative data were collected with a survey questionnaire developed through the Delphi method. The 47 items for needs and 15 items for barriers to PPC were analyzed with descriptive statistics. Qualitative data were collected through openended questions and analyzed with topic modeling techniques. Results: The mean scores of most subdomains of the PPC needs were 3.5 or higher out of 4, and those of PPC barriers ranged from 3.22 to 3.56, indicating the items in the questionnaire developed in this study properly reflect each factor. The needs for PPC were divided into 4 categories: “children and adolescents,” “families,” “PPC management system,” and “community-based PPC.” Meanwhile, PPC barriers were divided into 3 categories: “healthcare delivery system,” “healthcare provider,” and “client.” The keywords derived from the topic modeling were perception, palliative, children, and education for necessities and lack, perception, medical care, professional care providers, service, and system for barriers to PPC. Conclusion In this study, by using mixed-methods, items of nurses’ perceived needs and barriers to PPC were identified, categorized, and weighted, and their meanings were explored. For the stable establishment of PPC, the priority should be given to improving perceptions of PPC, establishing an appropriate system, and training professional care providers.

Background: Dietary intake of n-3 fatty acids have been suggested for their protective role against cardiovascular disease. However, findings from recent studies have been inconsistent. Thus, we investigated the association between dietary intake of n-3 fatty acids and the 10-year risk of cardiovascular disease (CVD). Methods: We analyzed data from 17,390 adults who were aged 30–64 years and free of CVD using the Korea National Health and Nutrition Examination Survey, 2012–2016. Dietary intake of n-3 fatty acids was calculated by using food-frequency questionnaire, and the 10 year risk of CVD was calculated by Framingham general cardiovascular disease risk score (2008) model. We analyzed the odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression to evaluate the association between dietary intake of n-3 fatty acids and the 10-year risk of CVD. Results: Logistic regression anlaysis showed that dietary intake of n-3 fatty acids was not significantly associated with the 10-year risk of CVD, after adjusting for confounders (OR=0.91; 95% CI, 0.77–1.07). But higher dietary intake of n-3 fatty acids was associated with reduced the 10-year risk of CVD for the female (OR=0.74; 95% CI, 0.58–0.95). Conclusion Our research indicated no significant association between dietary intake of n-3 fatty acids and the 10-year risk of CVD. But the inverse association was observed in the female.

BACKGROUND: This study was conducted to examine the correlation between physical activity and estimated glomerular filtration rate (eGFR) in Korean adults.METHODS: We selected 6,546 adults aged >19 years from among the participants of the 2016 National Health and Nutrition Survey. Physical activity and sedentary time were measured using the global physical activity questionnaires developed by the World Health Organization. eGFR was calculated using the Modification of Diet in Renal Disease equation. After adjustment for covariates (age, marital status, hypertension, diabetes, myocardial infarction, drinking, smoking, total cholesterol level, body mass index, and C-reactive protein level), the correlations among physical activity, sedentary time, and eGFR were analyzed using multivariate linear regression analysis.RESULTS: No correlation was found between physical activity level and eGFR. However, sedentary time was significantly correlated with eGFR. The result showed that eGFR increased as sedentary time decreased.CONCLUSION: No correlation was found between physical activity level and eGFR in adults aged >19 years, but sedentary time was significantly correlated with eGFR. Further research is needed to clarify the relationship between physical activity and eGFR, using other physical activity indicators and changing the physical activity criteria.
Adult ; Body Mass Index ; C-Reactive Protein ; Cholesterol ; Diet ; Drinking ; Glomerular Filtration Rate ; Humans ; Hypertension ; Linear Models ; Marital Status ; Motor Activity ; Myocardial Infarction ; Nutrition Surveys ; Smoke ; Smoking ; World Health Organization

For the treatment of multidrug-resistant (MDR) tuberculosis, maintenance of appropriate antituberculous agents is essential because of its low cure rate and high dropout rate. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced systemic hypersensitivity response resulting in cessation of causative agents. In cases of second-line antituberculous agent-induced DRESS, it is extremely difficult to find other replacement medications to cure MDR tuberculosis. A 53-year-old male who had taken the second-line antituberculous agents (cycloserine, streptomycin, p-aminosalicylic acid, and prothionamide) as well as pyrazinamide for 5 weeks experienced DRESS syndrome accompanying hepatic coma. His symptoms improved with discontinuation of antituberculous agents and administration of high-dose methylprednisolone for 1 month. To resume the antituberculous medication, second-line antituberculous agents were administered one by one using a rapid desensitization protocol. While kanamycin, levofloxacin, and cycloserine were successfully readministered, p-aminosalicylic acid- and prothionamide-induced cutaneous hypersensitivity symptoms were relatively mild compared to previous reactions. Herein, we report a case of successfully treated MDR tuberculosis having a history of fatal DRESS syndrome to antituberculous agents using the rapid desensitization protocol.
Aminosalicylic Acid ; Antitubercular Agents ; Cycloserine ; Desensitization, Immunologic ; Drug Hypersensitivity Syndrome* ; Hepatic Encephalopathy ; Humans ; Hypersensitivity ; Kanamycin ; Levofloxacin ; Male ; Methylprednisolone ; Middle Aged ; Patient Dropouts ; Pyrazinamide ; Streptomycin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

PURPOSE: Although severe cutaneous adverse drug reactions (SCARs) are rare, they are associated with high morbidity and mortality, and thus early diagnosis and treatment are critical for improving prognoses. However, few studies have reported the characteristics of SCARs in children. Thus, we aimed to evaluate the clinical characteristics, current management and prognosis of pediatric SCARs. METHODS: We analyzed pediatric data in the Korean SCARs registry, which was built retrospectively in 2016 with SCAR cases treated in 34 tertiary referral university hospitals during 2010–2015. Using these cases, we descriptively analyzed detailed data regarding etiology, clinical and laboratory features, treatment strategies, and prognosis. RESULTS: Forty-seven pediatric SCAR cases from 15 tertiary referral hospitals were included. The median patient age was 10 (interquartile range, 3-15.5) years and 68.1% (n = 32) were males. The culprit drug was identified in 95.7% (n = 45) of the patients; antibiotics (44.7%) and antiepileptic drugs (19.1%) were the most common and second most common culprits, respectively. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) cases presented with the largest area of skin involvement without permanent sequelae. Stevens-Johnson syndrome (SJS) cases involved relatively small areas of skin but serious sequelae in two children. Of 4 patients with toxic epidermal necrolysis (TEN), 1 died. Of all patients assessed, 36 (76.6%) received systemic steroids and 21 (44.7%) received intravenous immunoglobulin (IVIG). Thirteen (27.7%) received both systemic steroids and IVIG. Cyclosporine was administered to only 1 patient along with a systemic steroid. CONCLUSIONS: In patients with pediatric SCARs, including those with DRESS, SJS and TEN, clinical presentations were variable. Thus, there was no clear continuous disease spectrum. Although the mortality rate was low (2.1%), clinical suspicion may be the best tool for proactive SCAR management.
Anti-Bacterial Agents ; Anticonvulsants ; Child ; Cicatrix ; Cyclosporine ; Drug Eruptions ; Drug Hypersensitivity Syndrome ; Drug-Related Side Effects and Adverse Reactions ; Early Diagnosis ; Hospitals, University ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Korea ; Male ; Mortality ; Prognosis ; Referral and Consultation ; Retrospective Studies ; Skin ; Steroids ; Stevens-Johnson Syndrome ; Tertiary Care Centers

Stenotrophomonas maltophilia is an emerging pathogen associated with morbidity and mortality in hospitalized patients. The treatment of S. maltophilia infection is challenging because clinical isolates are frequently resistant to most antimicrobial agents except trimethoprim-sulfamethoxazole (TMP-SMX). S. maltophilia osteomyelitis is a rare disease and requires a prolonged treatment with TMP-SMX. Here, we report an interesting case of a patient with S. maltophilia osteomyelitis who developed a delayed hypersensitivity reaction during TMP-SMX treatment and successfully treated after desensitization. TMP-SMX desensitization should be considered in patients with hypersensitivity to TMP-SMX, especially when there are no effective alternative drugs in S. maltophilia infection.
Anti-Infective Agents ; Desensitization, Immunologic ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Mortality ; Osteomyelitis* ; Rare Diseases ; Stenotrophomonas maltophilia ; Trimethoprim, Sulfamethoxazole Drug Combination*

Primary intestinal lymphoma is a rare disease. It accounts for approximately 1~4% of gastrointestinal malignancy. Extranodal lymphoma of the intestine mainly arises from B cells. Diffuse large B-cell lymphoma is the most common type of the disease. Approximately 40% of intestinal lymphoma can be cured, while 60% have varied disease progression. Ki-67 proliferation has been recently used as an index of cell growth to predict the progression of the disease. Reported herein is a case of a rapidly progressive small bowel diffuse large B-cell lymphoma in a 51-year-old man with a high Ki-67 expression level. He visited the emergency department because of hematochezia. Abdominal computed tomography revealed distal small bowel segmental wall thickening. He underwent operation due to spontaneous small bowel perforation. The result of the pathological examination of the resected specimen was compatible with diffuse large B-cell lymphoma. The Ki-67 index within 5 months was 90%.
B-Lymphocytes ; Disease Progression ; Emergency Service, Hospital ; Gastrointestinal Hemorrhage ; Humans ; Intestine, Small ; Intestines ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; Middle Aged ; Rare Diseases

Purpose: For patients with time-critical acute coronary syndrome, reporting electrocardiogram (ECG) findings is the most importantcomponent of the treatment process. We aimed to develop and validate an automated Fast Healthcare InteroperabilityResources (FHIR)-based 12-lead ECG mobile alert system for use in an emergency department (ED). Materials and Methods: An automated FHIR-based 12-lead ECG alert system was developed in the ED of an academic tertiarycare hospital. The system was aimed at generating an alert for patients with suspected acute coronary syndrome based on interpretationby the legacy device. The alert is transmitted to physicians both via a mobile application and the patient’s electronic medicalrecord (EMR). The automated FHIR-based 12-lead ECG alert system processing interval was defined as the time from ED arrivaland 12-lead ECG capture to the time when the FHIR-based notification was transmitted. Results: During the study period, 3812 emergency visits and 1581 12-lead ECGs were recorded. The FHIR system generated 155alerts for 116 patients. The alerted patients were significantly older [mean (standard deviation): 68.1 (12.4) years vs. 59.6 (16.8)years, p<0.001], and the cardiac-related symptom rate was higher (34.5% vs. 19%, p<0.001). Among the 155 alerts, 146 (94%) weretransmitted successfully within 5 minutes. The median interval from 12-lead ECG capture to FHIR notification was 2.7 min [interquartilerange (IQR) 2.2–3.1 min] for the group with cardiac-related symptoms and 3.0 min (IQR 2.5–3.4 min) for the group withnon-cardiac-related symptoms. Conclusion An automated FHIR-based 12-lead ECG mobile alert system was successfully implemented in an ED.

Objective: : While balanced crystalloid (BC) could be a relevant fluid regimen with buffer system compared with normal saline (NS), there have been no studies on the optimal fluid for surgery of an unruptured intracranial aneurysm (UIA). This study aimed to compare the effects of fluid regimens between NS and BC on the metabolic and clinical outcomes of patients who underwent surgery for UIA. Methods: : This study was designed as a propensity score matched retrospective comparative study and included adult patients who underwent UIA clipping. Patient groups were categorized as NS and BC groups based on the types of pre-operative fluid and the amount of fluid administered during surgery. The primary outcomes were defined as electrolyte imbalance and acidosis immediately after surgery. The secondary outcomes were the length of stay in the intensive care unit (ICU) and duration from the end of the operation to extubation. Results: : A total of 586 patients were enrolled in this study, with each of 293 patients assigned to the NS and BC groups, respectively. Immediately after surgery, serum chloride levels were significantly higher in the NS group. Compared to the NS group, the BC group had lower incidence rates of acidemia (6.5% vs. 11.6%, p=0.043) and metabolic acidosis (0.7% vs. 4.4%, p=0.007). As compared to NS group, BC group had significantly shorter duration from the end of the operation to extubation (250±824 vs. 122±372 minutes, p=0.016) and length of stay in ICU (1.37±1.11 vs. 1.12±0.61 days, p=0.001). Throughout multivariable analysis, use of BC was found to be significant factor for favorable post-operative results. Conclusion : This study showed that the patients who received BC during UIA clipping had lower incidence of metabolic acidosis, earlier extubation and shorter ICU stay compared to those who received NS. Therefore, using BC as a peri-operative fluid can be recommended for patients who undergo surgery for UIA.