PURPOSE: This study was designed to assess the degree of Positive psychological capital, Organizational commitment, Customer orientation of clinical nurses, and to identify correlations between these variables. METHODS: Participants were 230 nurses working in three hospitals located in Seoul. Data were analyzed using descriptive statistics, t-test, ANOVA, Scheffe test, Pearson Correlation, and Multiple Regression. RESULTS: Mean scores were 3.32 (5 point scale) for Positive psychological capital, 3.03 (5 point scale) for Organizational commitment, 3.71 (5 point scale) for Customer orientation. Positive psychological capital correlated positively with Organizational commitment (r=.29, p<.001) and Customer orientation (r=.58, p<.001). Organizational commitment correlated positively with Customer orientation (r=.28, p<.001). Positive psychological capital had a significant influence on Customer orientation. and these combinations explained 34.2% of the variance in Customer orientation (F=25.68, p<.001). Organizational commitment had a mediating effect between Positive psychological capital and Customer orientation. CONCLUSION: The results of this study suggest a need for strategies to improve Customer orientation by enhancing the Positive psychological capital of nurses. Furthermore, study to develop and apply a Positive psychological capital promotion program should be conducted.
Negotiating ; Seoul

PURPOSE: To evaluate post-ablation syndrome after radiofrequency thermal ablation of malignant hepatic tumors. MATERIALS AND METHODS: Forty-two patients with primary (n=29) or secondary (n=13) hepatic tumors under-went radiofrequency thermal ablation. A total of 65 nodules ranging in size from 1.1 to 5.0 (mean, 3.1) cm were treated percutaneously using a 50W RF generator with 15G expandable needle electrodes. We retrospec-tively evaluated the spectrum of post-ablation syndrome including pain, fever(> or =38 C degrees), nausea, vomiting, right shoulder pain, and chest discomfort according to frequency, intensity and duration, and the findings were cor-related with tumor location and number of ablations. We also evaluated changes in pre-/post-ablation serum aminotransferase(ALT/AST) and prothrombin time, and correlated these findings with the number of abla-tions. RESULTS: Post-ablation syndrome was noted in 29 of 42 patients (69.0%), and most symptoms improved with conservative treatment. The most important of these were abdominal pain (n=20, 47.6%), fever (n=8, 19.0%), and nausea (n=7, 16.7%), and four of 42 (9.5%) patients complained of severe pain. The abdominal pain lasted from 3 hours to 5.5 days (mean; 20.4 hours), the fever from 6 hours to 5 days (mean; 63.0 hours). and the nau-sea from 1 hour to 4 days (mean; 21.0 hours). Other symptoms were right shoulder pain (n=6, 14.3%), chest discomfort (n=3, 7.1%), and headache (n=3, 7.1%). Seventeen of 20 patients (85%) with abdominal pain had a subcapsular tumor of the liver. There was significant correlation between pain, location of the tumor, and number of ablations. After ablation, ALT/AST was elevated more than two-fold in 52.6%/73.7% of patients, respectively but there was no significant correlation with the number of ablation. CONCLUSION: Post-ablation syndrome is a frequent and tolerable post-procedural process after radiofrequency thermal ablation. The spectrum of this syndrome provides a useful guideline for the post-ablation management.
Abdominal Pain ; Electrodes ; Fever ; Headache ; Humans ; Liver ; Nausea ; Needles ; Prothrombin Time ; Shoulder Pain ; Thorax ; Vomiting

BACKGROUND: The delta neutrophil index (DNI) is a useful marker for diagnosing and predicting the prognosis of sepsis. The purpose of this study was to investigate the usefulness of DNI as a prognostic marker in patients within the pediatric intensive care unit (PICU), as well as its association with other prognostic factors. METHODS: A total of 516 children admitted to Severance Children's Hospital PICU from December 2009 to February 2015 were analyzed. DNI was measured on the day of PICU admission. Mortality was defined as death within 28 days following PICU admission. RESULTS: The median value of DNI was 1.2% (interquartile range [IQR] 0-4.3%) in the survivor group and 9.5% (IQR 2.3-20.8%) in the non-survivor group, and the difference was statistically significant (p < 0.001). DNI was significantly positively correlated with ICU scores such as Pediatric Index of Mortality 3 and Pediatric Risk of Mortality III, as well as with C-reactive protein and lactate levels. The area under the receiver operating characteristic curve of DNI for mortality was 0.748 (95% CI: 0.687-0.808) and the cut-off value was 4.95%. CONCLUSIONS: The initial DNI level can be considered a useful indicator for predicting prognosis in PICU patients.
C-Reactive Protein ; Child ; Critical Care* ; Humans ; Intensive Care Units* ; Lactic Acid ; Mortality ; Neutrophils* ; Prognosis ; ROC Curve ; Sepsis ; Survivors

PURPOSE: To determine the incidence and pattern of peritumoral hyperemia at CT after radiofrequency thermal ablation of hepatic tumors, as well as its correlation with local marginal recurrence. MATERIALS AND METHODS: Forty-five tumor nodules in 28 patients with hepatocellular carcinoma (n=34) or metastasis (n=11) were treated by RF thermal ablation. Serial follow-up contrast- enhanced CT scans were reviewed by three radiologists for 1) the presence, 2) the morphological characteristics [circumferential, THAD (transient hepatic attenuation difference), nodular form], and 3) the temporal course (acute, persistent, delayed onset pattern) of peritumoral hyperemia after RF thermal ablation. These findings were correlated with the frequency of recurrence at the margin of the treated tumors. RESULTS: The frequency of acute hyperemia observed on immediate follow-up CT scans after RF ablation was 71% (32/45). There was the local recurrence in nine of 32 tumors (28%) with hyperemia and in one of 13 (8%) without hyperemia (p>0.05). Among 32 tumors, the circumferential form was observed in 22 (69%); the THAD form in eight (25%); and the nodular form in two (6%). Marginal recurrence was noted in five of 22 tumors circumferential tumors (23%), in three of eight (38%) with the THAD form, and in one of two (50%) which were nodular. Among 32 nodules, an acute transient pattern was noted in 21 (66%), a persistent pattern in nine (28%), and a nodular pattern in two (6%). There was marginal recurrence in two (10%) of 21 tumors with acute transient hyperemia, in six (67%) of nine with persistent hyperemia, and in both tumors with delayed-onset hyperemia. There was significant correlation between the pattern of persistent/delayed-onset hyperemia and marginal tumor recurrence of (p=0.001). CONCLUSION: Although peritumoral hyperemia after RF thermal ablation therapy is a frequent transient finding at follow-up imaging studies, its temporal pattern may help detect early marginal tumor recurrence.
Carcinoma, Hepatocellular ; Follow-Up Studies ; Humans ; Hyperemia* ; Incidence ; Liver Neoplasms ; Neoplasm Metastasis ; Recurrence ; Tomography, X-Ray Computed

PURPOSE: To analyse the causes of coagulopathy and determine the effect of embolotherapy on acute gastrointestinal(GI) bleeding coexisting with coagulopathy. MATERIALS AND METHODS: Between June 1991 and December 1998, 29 patients with acute GI bleeding (M:F =21:8, mean age, 57.8 years) underwent percutaneous embolotherapy and immediate cessation of bleeding was confirmed. The patients were divided into two groups: control (n =16) and those with coagulopathy (n =13), group membership being determined according to the criteria of >+/-2SD of normal prothrombin time (PT) and activated partial thromboplastin time (aPTT) ( PT >23 seconds, aPTT >40 seconds) at the time at which embolization was requested. Embolotherapy was, defined as clinically successful, if the patient was stable for at least three days, without bleeding, after technically successful embolization. The clinical success rate of embolization and the mortality rate were compared between the two groups, and the causes of coagulopathy statistically analysed. RESULTS: The clinical success rate of embolization was 75% (n =12) in the control group, compared with 38.5% (n =5) in the coagulopathic group (p < 0.05), while the mortality rate for the two groups was 6.3% (n =1) and 53.8% (n =7), respectively (p < 0.005). Statistically, massive transfusion and sustained shock before embolization were the causes of coagulopathy (p < 0.05). CONCLUSION: In coagulopathic patients with acute GI bleeding, embolotherapy induces transient bleeding control, but is unlikely to save lives.
Embolization, Therapeutic* ; Hemorrhage* ; Humans ; Mortality ; Partial Thromboplastin Time ; Prothrombin Time ; Shock

PURPOSE: To determine whether radiofrequency thermal ablation can be used to treat benign cystic lesions in a porcine gallbladder model. MATERIALS AND METHODS: This experimental study of radiofrequency thermal ablation involved the use of 15 exvivo porcine gallbladders and 15-G expandable needle electrodes. To investigate optimal temperature parame-ters,three groups of five were designated according to target temperature: Group A: 70 degrees C; Group B: 80 degrees C; Group C: 90 degrees C. After the target temperature was reached, ablation lasted for one minute. Gallbladder width, height and length were measured before and after ablation, and the estimated volume reduction ratios of the three groups were compared. Whether adjacent liver parenchyma around the gallbladder fossa was ablated by heat conducted from hot bile was also determined, and the thickness of the ablated area of the liver was measured. RESULTS: The volume reduction ratio in Group A, B and C was 42.7%, 41.7% and 42.9%, respectively (p>.05). In all 15 cases, gallbladder walls lost their transparency and elasticity at about 70 degrees C. In nine of ten cases in Groups B and C, the hepatic capsule around the gallbladder fossa was retracted at about 80 degrees C. The mean thickness of liver parenchymal damage adjacent to the gallbladder was 5.4 mm in Group B and 9.8 mm in Group C. In Group A livers, only one case showed minimal gradual parenchymal change. Microscopically, all three groups showed complete coagulation necrosis of the wall. CONCLUSION: On the basis of this feasibility study, radiofrequency thermal ablation is potentially suitable for the ultrasound-guided treatment of symptomatic cystic lesions including benign hepatic or renal cyst.
Bile ; Catheter Ablation ; Elasticity ; Electrodes ; Feasibility Studies ; Gallbladder* ; Hot Temperature ; Liver ; Necrosis ; Needles ; Pilot Projects*

OBJECTIVE: The aim of this study was to examine how many Korean rheumatoid arthritis (RA) patients fulfilling the 2008 American College of Rheumatology (ACR) recommendation, 2007 British Society for Rheumatology (BSR) guideline and 2010 Japan College of Rheumatology (JCR) guideline for TNF-alpha blocker, meet the Korean National Health Insurance reimbursement criteria and to evaluate the reasons for failing the Korean National Health Insurance reimbursement criteria. METHODS: Data were obtained from a registry of RA patients who visited rheumatology clinics of Hallym university affiliated hospitals. Patients who were previously prescribed with methotrexate or leflunomide for more than 3 months and had at least one DAS28 examination were included in the present study. RESULTS: Of 642 patients included, 118 episodes meeting ACR guideline for using TNF-alpha blocker were identified in 88 patients (13.7%). In addition, 19 episodes meeting BSR guideline in 17 patients (2.6%) and 21 episodes meeting JCR guideline in 21 patients (6.2%) were identified. Four episodes (4.8%) meeting ACR recommendation, 0 episodes meeting BSR criteria and 5 episodes (12%) meeting JCR criteria, respectively, were eligible for TNF-alpha blocker according to the Korean National Health Insurance reimbursement guideline. The most common reason for failing the Korean National Health Insurance reimbursement criteria was the number of active joint counts (92.6%). CONCLUSION: Our results show that the majority of RA patients satisfying the ACR guideline, BSR and JCR guideline for use of the TNF-alpha blocker did not meet the Korean National Health Insurance reimbursement criteria. Patients most often failed due to active joint count criteria.
Arthritis, Rheumatoid ; Humans ; Isoxazoles ; Japan ; Joints ; Methotrexate ; National Health Programs ; Rheumatology ; Tumor Necrosis Factor-alpha

PURPOSE: To assess the usefulness of radiofrequency (RF) thermal ablation with combined chemotherapy for the treatment of metastatic liver tumors. MATERIALS AND METHODS: A non-randomized, comparative study was performed in 21 patients with metastatic liver tumors. Inclusion criteria were that these should be less than five in number and less than 6 cm in diameter. Two groups were designed for comparison of the local and remote (new intrahepatic or extrahepatic) tumor control rate (Group A: RF alone, n=11; Group B: RF+combined chemotherapy, n=10). There was no significant difference in age, sex, and mass size between the two groups (p>0.05). All ablations were performed percutaneously with a 50W RF generator and 15G-needle electrode (RITA Medical System Inc.) under US guidance. In group B, six cycles of systemic chemotherapy were performed every month immediately after RF ablation. Follow-up CT scans were obtained within 24 hours of ablation and were compared with the findings of pre-ablation CT scanning. If an ablated lesion covered the mass without any residual enhancing foci, this was defined as complete ablation. Three and six months after ablation, local and remote tumor control rates were compared between the two groups (follow up: range 4 -17 (mean, 10.2) months. RESULTS: In group A, the local tumor control rate was 43.8% (7/16) and 31.2% (5/16) at 3 and 6 months follow-up, respectively, while in group B, the corresponding rates were both 75% (15/20). At three months, the difference in this rate between the two groups was not significantly different (p>0.05), but at 6 months there was significant difference (p<0.05). At 6 months follow-up, the remote tumor control rate for Group A and Group B was 27.3% (3/11) and 80.0% (8/10), respectively, reflecting a significant difference between the two groups (p<0.05). CONCLUSION: In patients with metastatic liver tumor, radiofrequency thermal ablation with combined chemotherapy may be superior to RF thermal ablation alone for both local and remote tumor control.
Drug Therapy* ; Electrodes ; Follow-Up Studies ; Humans ; Liver* ; Tomography, X-Ray Computed

PURPOSE: Previous studies have demonstrated the immunogenicity and safety of the co-administration of the trivalent inactivated influenza vaccine (IIV3) with the polysaccharide pneumococcal vaccine (PPV) or pneumococcal conjugate vaccine (PCV). However, there is no direct comparison study that evaluates the immunogenicity and safety of IIV3 given concomitantly with PCV13 or PPV23 in the elderly. MATERIALS AND METHODS: During the 2012-2013 influenza vaccination period, 224 healthy elderly volunteers aged 65 years and older randomly received IIV3 given concomitantly with either PCV13 (PCV13+IIV3) or PPV23 (PPV23+IIV3) in a 1:1 ratio. Serum hemagglutination-inhibiting antibodies for IIV3 were measured at the time of vaccination and 1 month after vaccination. Adverse events were recorded prospectively in a clinical diary during a 7-day period. RESULTS: A total of 220 participants blood samples for analysis of immunogenicity and kept a clinical diary for safety analysis (PCV13+IIV3, n=110; PPV23+IIV3, n=110). One month after vaccination, both groups satisfied the Committee for Medical Products for Human Use criteria for A/H1N1, A/H3N2 and B strains, showing comparable seroprotection rates, seroconversion rates and geometric mean titer fold. The assessments of immunogenicity were similar in both groups. The most common local and systemic reactions were pain at the injection site and generalized myalgia. They were generally mild or moderate in intensity. The adverse events were not statistically different between the two groups. CONCLUSION: PCV13+IIV3 and PPV23+IIV3 demonstrated similar immunogenicity and safety in the elderly.
Aged* ; Antibodies ; Humans ; Influenza Vaccines* ; Influenza, Human* ; Myalgia ; Prospective Studies ; Seroconversion ; Streptococcus pneumoniae ; Vaccination ; Volunteers

PURPOSE: To prepare for vaccine shortages under an influenza pandemic, several antigen-sparing strategies have been investigated. This study was aimed to evaluate the immunogenicity of influenza vaccine at reduced intradermal and full intramuscular dose. MATERIALS AND METHODS: We compared the effect of one-fifth and one-half intradermal doses to the full intramuscular dose on immunogenicity in healthy young adults, using a commercial influenza vaccine. A hemagglutination inhibition assay was used to compare the immunogenicity of the vaccination methods. RESULTS: The one-fifth intradermal dose (3 microg hemagglutinin antigen, HA) was given to 30 participants, the one-half intradermal dose (7.5 microg HA) was given to 30, and the full intramuscular dose (15 microg HA) was given to 32. No significant differences among injection routes and dosages were seen for seroprotection rate, seroconversion rate, or geometric mean titer (GMT) fold-increase for A/H1N1, A/H3N2, and B at around 4 weeks from vaccination. Although GMT for influenza B was significantly lower at six months for the one-fifth intradermal vaccination compared to the full-dose intramuscular vaccination (32.8 vs. 63.2, p=0.048), all three groups met the Evaluation of Medicinal Products (EMA) immunogenicity criteria through 1 to 6 months. CONCLUSION: Intradermal administration of a one-fifth dose of influenza vaccine elicited antibody responses comparable to the intradermal one-half dose and a conventional intramuscular vaccination at 1 month post-vaccination. The immunogenicity of the one-fifth intradermal dose was sufficient to meet the requirement for the EMA criteria at six months after influenza vaccination.
Adult ; Antibody Formation ; Hemagglutination ; Hemagglutinins ; Humans ; Influenza Vaccines ; Influenza, Human ; Injections, Intradermal ; Pandemics ; Vaccination ; Vaccines ; Young Adult