Background: This study explores the pathways of nurse turnover in long-term care hospitals (LTCHs) and its underlying conditions in Korea. Although the factors of staying or leaving of nurses in LTCHs have been reported, few studies have examined the trajectory and conditions of nurses staying in and leaving LTCHs. Methods: A qualitative study design with a grounded theory approach was conducted. Data were collected in one-to-one interviews. Purposive and theoretical sampling led to the inclusion of 20 registered nurses from 15 LTCHs in South Korea. Results: Seeking work-life balance was the core category of the nurses' turnover pathway. The consequences of the nurses' turnover pathway were categorized into three groups: thriving, surviving, and leaving. Thriving nurses found meaning in their work, fostered good relationships, and saw opportunities for growth. Surviving nurses were enduring their jobs in LTCHs, having a work-life balance, and supportive nursing leaders. Leaving group nurses wished to leave LTCHs due to a lack of professional growth, unappealing work, continued conflict, and social stigma. Conclusion This study provided the trajectory and conditions for nurses to enter, stay, move, or leave. Understanding the pathways for staying or leaving can be used as a strategy for successful retention of registered nurses in LTCHs.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, health care workers (HCWs) have faced multiple physical and psychological challenges while carrying out their duties. In this study, we examined the experiences of specific groups of HCWs during the pandemic. Methods: From 18 November to 30 December 2020, we conducted a qualitative study using semi-structured, face-to-face interviews with four groups of 14 HCWs in three cities (Seoul, Daegu, and Gwangju) in South Korea. The HCWs who participated in the focus groups included physicians, nurses, medical practitioners, and cleaning staff who directly or indirectly cared for patients during the COVID-19 epidemic. Interviews were transcribed verbatim and analyzed using the consensual qualitative research approach. Results: Our qualitative data analysis revealed four main domains: work-related struggles, personal life-related struggles, psychological stress, and health-related struggles. Health care providers were challenged by working in critical situations and were overwhelmed by heavy workloads, fear of infection, lifestyle changes, and psychological and physical struggles. Conclusion Our findings could serve as a foundation for establishing health care systems and policies that help HCWs cope with occupational stress, thus increasing their ability to adapt to the ongoing COVID-19 pandemic.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, health care workers (HCWs) have faced multiple physical and psychological challenges while carrying out their duties. In this study, we examined the experiences of specific groups of HCWs during the pandemic. Methods: From 18 November to 30 December 2020, we conducted a qualitative study using semi-structured, face-to-face interviews with four groups of 14 HCWs in three cities (Seoul, Daegu, and Gwangju) in South Korea. The HCWs who participated in the focus groups included physicians, nurses, medical practitioners, and cleaning staff who directly or indirectly cared for patients during the COVID-19 epidemic. Interviews were transcribed verbatim and analyzed using the consensual qualitative research approach. Results: Our qualitative data analysis revealed four main domains: work-related struggles, personal life-related struggles, psychological stress, and health-related struggles. Health care providers were challenged by working in critical situations and were overwhelmed by heavy workloads, fear of infection, lifestyle changes, and psychological and physical struggles. Conclusion Our findings could serve as a foundation for establishing health care systems and policies that help HCWs cope with occupational stress, thus increasing their ability to adapt to the ongoing COVID-19 pandemic.

Human infection by Rhodococcus species is rare and mostly limited to immunocompromised hosts such as patients infected with the human immunodeficiency virus (HIV) or organ transplant recipients. The most common strain is R. equi, and the most common clinical presentation is pulmonary infection, reported in 80% of Rhodococcus spp. infections. The central nervous system is an uncommon infection site. We report a case of a patient with pneumonia, brain abscess, and recurrent meningitis caused by Rhodococcus spp. He initially presented with pneumonia with necrosis, which progressed to brain abscess and recurrent meningitis. Rhodococcus spp. was identified from the cerobrospinal fluid (CSF) collected during his fourth hospital admission. Despite prolonged treatment with appropriate antibiotics, meningitis recurred three times. Finally, in order to administer antibiotics directly into the CSF and bypass the blood-brain barrier, an Ommaya reservoir was inserted for administration of 90 days of intrathecal vancomycin and amikacin in conjunction with intravenous and oral antibiotics; the patient was finally cured with this treatment regimen.
Amikacin ; Anti-Bacterial Agents ; Blood-Brain Barrier ; Brain Abscess ; Central Nervous System ; HIV ; Humans ; Immunocompromised Host ; Injections, Spinal* ; Meningitis* ; Necrosis ; Pneumonia ; Rhodococcus* ; Transplants ; Vancomycin*

Background: According to the recent coronavirus disease 2019 (COVID-19) pandemic experience, many emergency departments experience difficulties in responding to emerging infectious diseases and this has led to a public health crisis. Our emergency department (ED) is designed to respond to mass outbreaks of infection. Three major preparations were taken to respond to infectious disease; first, to improve the emergency department facilities;second, to created programs to respond to each phase of an epidemic of COVID-19; lastly, to implemented education and training to promote the safety of medical staff. We would like to share the actual responses and statistics of patients visiting emergency department during COVID-19 periods of pandemic. Materials and Methods: This research was conducted through a retrospective chart analysis provided by a public medical center with 502 beds since the first report of a COVID-19 confirmed case on January 19, 2020 to June 15, 2020 in Seoul, the capital of Korea. Our emergency department was designed based on Korean Regional Emergency Center Facility Standards, and modified throughout each phases of COVID-19 outbreak. Patients suspected to be infectious are screened in the triage, separating them from general patients, and then receive isolation treatment in isolated wards. Results: A total of 4,352 patients visited the ED. 3,202 screenings were conducted with 5 confirmed cases. Another 1,150 patients were treated with general emergent symptoms.There were no problems such as closure of the emergency department or isolation of medical staff while managing COVID-19 confirmed patients. Conclusion Improving emergency department facilities, create an operational program to respond to each phase of COVID-19 outbreak and implement educational programs enabled large number of screening tests and hospitalization for COVID-19 suspected patients while maintaining general medical services. Research in emergency department designs and operational programs should increase to combine research data with better ideas to respond not only during regular periods but also during periods of pandemic.

Background: According to the recent coronavirus disease 2019 (COVID-19) pandemic experience, many emergency departments experience difficulties in responding to emerging infectious diseases and this has led to a public health crisis. Our emergency department (ED) is designed to respond to mass outbreaks of infection. Three major preparations were taken to respond to infectious disease; first, to improve the emergency department facilities;second, to created programs to respond to each phase of an epidemic of COVID-19; lastly, to implemented education and training to promote the safety of medical staff. We would like to share the actual responses and statistics of patients visiting emergency department during COVID-19 periods of pandemic. Materials and Methods: This research was conducted through a retrospective chart analysis provided by a public medical center with 502 beds since the first report of a COVID-19 confirmed case on January 19, 2020 to June 15, 2020 in Seoul, the capital of Korea. Our emergency department was designed based on Korean Regional Emergency Center Facility Standards, and modified throughout each phases of COVID-19 outbreak. Patients suspected to be infectious are screened in the triage, separating them from general patients, and then receive isolation treatment in isolated wards. Results: A total of 4,352 patients visited the ED. 3,202 screenings were conducted with 5 confirmed cases. Another 1,150 patients were treated with general emergent symptoms.There were no problems such as closure of the emergency department or isolation of medical staff while managing COVID-19 confirmed patients. Conclusion Improving emergency department facilities, create an operational program to respond to each phase of COVID-19 outbreak and implement educational programs enabled large number of screening tests and hospitalization for COVID-19 suspected patients while maintaining general medical services. Research in emergency department designs and operational programs should increase to combine research data with better ideas to respond not only during regular periods but also during periods of pandemic.

Purulent pericarditis is a rare condition with a high mortality rate. We report a case of purulent pericarditis subsequently caused by Candida parapsilosis, Peptostreptococcus asaccharolyticus, Streptococcus anginosus, Staphylococcus aureus, Prevotella oralis, and Mycobacterium tuberculosis in a previously healthy 17-year-old boy with mediastinal tuberculous lymphadenitis. The probable route of infection was a bronchomediastinal lymph node-pericardial fistula. The patient improved with antibiotic, antifungal, and antituberculous medication in addition to pericardiectomy.
Adolescent ; Bronchial Fistula ; Candida ; Coinfection ; Fistula* ; Humans ; Male ; Mortality ; Mycobacterium tuberculosis ; Peptostreptococcus ; Pericardiectomy ; Pericarditis* ; Pericarditis, Tuberculous ; Prevotella ; Staphylococcus aureus ; Streptococcus anginosus ; Tuberculosis, Lymph Node*

We retrospectively reviewed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections who wereadmitted to an intensive care unit in Daegu, South Korea. The outcomes of patients who did (cases) or did not (controls) receivedarunavir-cobicistat (800–150 mg) therapy were compared. Fourteen patients received darunavir-cobicistat treatment, and 96 receivedother antiviral therapy (controls). Overall, the darunavir-cobicistat group comprised patients with milder illness, and thecrude mortality rate of all patients in the darunavir-cobicistat group was lower than that in the controls [odds ratio (OR) 0.20, 95%confidence interval (CI) 0.04–0.89, p=0.035]. After 1:2 propensity-score matching, there were 14 patients in the darunavir-cobicistatgroup, and 28 patients in the controls. In propensity score-matched analysis, the darunavir-cobicistat group had lower mortalitythan the controls (OR 0.07, 95% CI 0.01–0.52, p=0.009). In conclusion, darunavir-cobicistat therapy was found to be associatedwith a significant survival benefit in critically ill patients with SARS-CoV-2 infection.

Some cases of Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) infection presented renal function impairment after the first MERS-CoV patient died of progressive respiratory and renal failure. Thus, MERS-CoV may include kidney tropism. However, reports about the natural courses of MERS-CoV infection in terms of renal complications are scarce. We examined 30 MERS-CoV patients admitted to National Medical Center, Korea. We conducted a retrospective analysis of the serum creatinine (SCr), estimated glomerular filtration rate (eGFR), urine dipstick tests, urinary protein quantitation (ACR or PCR), and other clinical parameters in all patients. Two consecutive results of more than trace (or 1+) of albumin and blood on dipstick test occurred in 18 (60%) (12 [40%]) and 22 (73.3%) (19 [63.3%]) patients, respectively. Fifteen (50.0%) patients showed a random urine ACR or PCR more than 100 mg/g Cr. Eight (26.7%) patients showed acute kidney injury (AKI), and the mean and median durations to the occurrence of AKI from symptom onset were 18 and 16 days, respectively. Old age was associated with a higher occurrence of AKI in the univariate analysis (HR [95% CI]: 1.069 [1.013-1.128], P = 0.016) and remained a significant predictor of the occurrence of AKI after adjustment for comorbidities and the application of a mechanical ventilator. Diabetes, AKI, and the application of a continuous renal replacement therapy (CRRT) were risk factors for mortality in the univariate analysis (HR [95% CI]: diabetes; 10.133 [1.692-60.697], AKI; 12.744 [1.418-114.565], CRRT; 10.254 [1.626-64.666], respectively). Here, we report renal complications and their prognosis in 30 Korean patients with MERS-CoV.
Acute Kidney Injury/*etiology/mortality/therapy ; Adult ; Aged ; Coronavirus Infections/*complications/physiopathology ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; Hematuria/etiology ; Hospitals ; Humans ; Male ; Middle Aged ; Prognosis ; Proteinuria/etiology ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors

Mixed-species malaria infections are often unrecognized or underestimated. We hereby report the first described case of mixed infection with Plasmodium falciparum and Plasmodium ovale malaria in a returned traveller in Korea. In August 2016, a 25-year-old returned traveller from Cameroon and Democratic Republic of Congo presented with fever. He was diagnosed as P. falciparum malaria and successfully treated with artesunate. And 5 weeks after the completion of treatment, he presented with fever and diagnosed as P. ovale infection. P. ovale infection is a rare cause of malaria and often shows delayed presentation due to its dormant liver stage as hypnozoites. At re-presentation, the immunochromatographic test and microscopic examinations of our patient did not reveal P. ovale, which was only detected via polymerase chain reaction (PCR) assay. This case highlights the importance of considering malaria infection even in persons who have previously received malaria treatment. It also shows the usefulness of PCR testing for diagnosing P. ovale infections, which often present with a low level of parasitaemia.
Adult ; Cameroon ; Coinfection* ; Congo ; Fever ; Humans ; Korea* ; Liver ; Malaria ; Plasmodium falciparum* ; Plasmodium ovale* ; Plasmodium* ; Polymerase Chain Reaction