PURPOSE: This study aims to investigate the relationships between knowledge on advance directive, attitudes towards the withdrawal of life-sustaining treatment and quality of life among hemodialysis patients. METHODS: A descriptive correlational study was conducted with 103 hemodialysis patients. Data were collected using a structured questionnaire from May to September of 2016, and analysed by using descriptive statistics, t-test, ANOVA and Pearson correlation coefficient. RESULTS: The participants' knowledge level on advance directive was 5.47±2.08 out of 9, the attitudes towards the withdrawal of life-sustaining treatment was 3.22±0.49 out of 5, and the quality of life was 3.35±0.92 out of 6. The knowledge on advance directive was positively correlated with attitudes towards the withdrawal of life-sustaining treatment (r=.21, p=.037) and quality of life (r=.21, p=.036). CONCLUSION: According to the results of this study, the level of knowledge on advance directive is preferred to improve the quality of life of hemodialysis patients. It is needed to support and maintain ongoing education opportunities in order to improve the level of knowledge on advance directive among patients undergoing hemodialysis.
Advance Directives* ; Education ; Humans ; Quality of Life* ; Renal Dialysis*

PURPOSE: The aim of this study was to investigate the relationships between the hemodialysis unit nurses' experience of verbal abuse, job stress, burnout, and turnover intention, and to identify the explained variances for turnover intention. METHODS: The research design was a descriptive survey using a probability sampling. The data were measured using self-report questionnaires from 231 hemodialysis unit nurses in seven cities in Korea and were analyzed with SPSS 20.0. RESULTS: The mean scores were 2.45±0.62 (out of 5) for experience of verbal abuse, 2.40±0.26 (out of 4) for job stress, 2.31±0.48 (out of 4) for burnout, and 3.16±0.05 (out of 5) for turnover intention. There were significant correlations among the experience of verbal abuse, job stress, burnout, and turnover intention within the hemodialysis unit nurses. Factors influencing turnover intention were 'burnout' (β=.42, p<.001) and 'job stress' (β=.17, p=.015)which explained 42% of the variance (F=15.98, p<.001). CONCLUSION: Results suggest that in order to reduce nurses' turnover intention, nurse managers should explore strategies to reduce nurses' burnout and job stress in nurses in hemodialysis units.
Humans ; Intention* ; Korea ; Nurse Administrators ; Renal Dialysis* ; Research Design

PURPOSE: The study was done to examine hemodialysis unit nurses' knowledge on blood-borne infections, compliance and barriers to control and predictors of compliance. METHODS: A descriptive correlational study was conducted with 122 nurses from hemodialysis units. Data were collected using a structured questionnaire. The data collection period was May to September, 2017. Data were analysed using descriptive statistics, t-test, ANOVA, Pearson correlation, and multiple linear regression. RESULTS: The mean score for knowledge on blood-borne infections was 15.41±2.01 out of 19 and the compliance with blood-borne infection control was 4.08±0.49 out of 5. Barriers to the performance of blood-borne infections control were lack of time and personal protective devices. Knowledge on blood-borne infection did not correlate with compliance on blood-borne infection control (r=.13, p=.171). Predictors of compliance on blood-borne infections control were 1) infection control education on injuries caused by injection needles (β=.23, p=.010), 2) infection control room (β=.24, p=.006) and 3) blood exposure experience over the past week (β=-.24, p=.005) and explained 22.2% of the variance (F=10.81, p < .001). CONCLUSION: Findings suggest that to improve the performance of blood-borne infectious disease management, customized education for nurses on blood-borne infection and systematic support related to the infection control room should be given priority.
Communicable Diseases ; Compliance ; Data Collection ; Education ; Humans ; Infection Control ; Linear Models ; Needles ; Protective Devices ; Renal Dialysis

PURPOSE: The purpose of the study was to identify effects of the BeHaS program on self esteem, fatigue and anxiety in postoperative care patients with breast cancer who had surgery with, chemotherapy, radiotherapy, with or without current hormone therapy. METHODS: This study was a 2-group quasi-experimental research study with a pre and post test design. Fifty-four patients with breast cancer were assigned to the experimental (n=29) or control group (n=25). The BeHaS program which strengthens self esteem through support over a 90-minute period, consists of theme activity (30 minutes), education (15 minutes), group support (15 minutes) and exercise (30 minutes). The experimental group participated in the program once a week for 10 weeks, but the control group was not involved. Data were gathered from October to December, 2008 using a questionnaire with measures of self esteem, fatigue and anxiety. Data were analyzed using t-test with SPSS Win 12.0 to identify differences between the groups. RESULTS: Self esteem was significantly increased (p= .001) and fatigue significantly decreased (p= .013) in the experimental group. But there was no significant difference in anxiety (p= .868). CONCLUSION: These results suggest that the BeHaS program for patients with breast cancer had beneficial effects on self esteem and fatigue.
Anxiety ; Breast ; Breast Neoplasms ; Fatigue ; Humans ; Postoperative Care ; Surveys and Questionnaires ; Self Concept

Acute multifocal bacterial nephritis is a severe form of acute renal infection in which heavy leucocytic infiltrates occurs throughout kidney. Therefore, in contrast to uncomplicated acute pyelonephritis, it frequently causes acute renal failure. We here report an unusual case of acute multifocal bacterial nephritis which caused acute real failure and massive proteinuria. A 44-year old man was referred to our hospital because of high fever and both flank pain and non-oliguric acute renal failure. He had pyuria and massive proteinuria(5.87g/day), and serum creatinine level of 3.6mg/dL. We initially suspected hemorrhagic fever with renal syndrome. But immunofluorescent antibody for Hantavirus was negative and E. coli was isolated at urine. Computed tomography showed multifocal areas of wedge-shaped low densities in both kidneys. Kidney biopsy revealed tubulointerstitial infiltration of leucocyte without glomerular change. After treatment of antibiotics, proteinuria completely disappeared and serum creatinine level decreased to 1.0mg/dL.
Acute Kidney Injury ; Adult ; Anti-Bacterial Agents ; Biopsy ; Creatinine ; Fever ; Flank Pain ; Hantavirus ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Kidney ; Nephritis* ; Proteinuria ; Pyelonephritis ; Pyuria

We report on a 64-year-old man with leptomeningeal metastasis (LM) from an epidermal growth factor receptor (EGFR)-mutated adenocarcinoma of the lung. He was treated with paclitaxel, cisplatin. After completion of chemotherapy, he complained of headache, nausea, and vomiting. EGFR-mutated tumor cells were identified from the cerebrospinal fluid (CSF). Second-line therapy with gefitinib, methotrexate was started. After receiving gefitinib for 4 weeks, he had no more headaches or vomiting. Eleven months after initiation of gefitinib, he developed headache and nausea. Chest computed tomography showed aggravation of bone metastasis. Third-line therapy was started with gemcitabine and carboplatin. Two weeks later, he experienced disorientation. After a fourth relapse within the central nervous system, the therapy was switched to erlotinib and significant improvement of LM was achieved. This case shows that LM can be diagnosed by detecting EGFR mutation in CSF and EGFR tyrosine kinase inhibitors are effective for LM from EGFR mutant non-small cell lung cancer.
Adenocarcinoma ; Carboplatin ; Carcinoma, Non-Small-Cell Lung ; Central Nervous System ; Cerebrospinal Fluid ; Cisplatin ; Drug Therapy ; Epidermal Growth Factor* ; Erlotinib Hydrochloride ; Headache ; Humans ; Lung Neoplasms* ; Lung* ; Methotrexate ; Middle Aged ; Nausea ; Neoplasm Metastasis* ; Paclitaxel ; Phosphotransferases* ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor* ; Recurrence ; Thorax ; Vomiting

Uremic patients undergoing hemodialysis (HD) therapy are prone to develop encephalopathy, but the cause is often unclear. Clinical signs of encephalopathy in the uremic patient often overlap with several other affections causing neurological disorders. Chorea or hemichorea occurs very rare, when basal ganglia are injured in HD patients. We hereby report a case of hemichorea of unknown cause in a hemodialysis patients. A 57-year-old diabetic HD patient was presented with sudden onset of right hemichorea. We could not find causes of hemichorea such as hyperglycemia, hepatic failure, drug, hyponatremia, and thiamine deficiency. T1-weighted MRI demonstrated hyperintense lesion limited to the left basal ganglion. Hemichorea disappeared completely 6 months after the onset with support care.

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
Acute Coronary Syndrome ; Cause of Death ; Consultants ; Coronary Disease ; Delivery of Health Care ; Heart ; Hospitals, General ; Hospitals, University ; Humans ; Insurance Benefits ; Korea ; Life Style ; Methods ; Mortality ; Myocardial Infarction ; Nutritionists ; Physical Therapists ; Preventive Medicine ; Recurrence ; Rehabilitation ; Secondary Prevention ; Specialization ; Sports Medicine ; Surgeons

BACKGROUND: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. RESULTS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. CONCLUSION: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
Acute Coronary Syndrome ; Cardiovascular Diseases ; Cause of Death ; Consultants ; Coronary Disease ; Delivery of Health Care ; Heart ; Hospitals, General ; Hospitals, University ; Humans ; Insurance Benefits ; Korea ; Life Style ; Methods ; Mortality ; Myocardial Infarction ; Nutritionists ; Physical Therapists ; Preventive Medicine ; Recurrence ; Rehabilitation ; Secondary Prevention ; Specialization ; Sports Medicine ; Surgeons