PURPOSE: The purpose of this study was to evaluate food carving among hemodialysis patients and to identify factors affecting the food carving. METHODS: hemodialysis between March 15 and April 15, 2017. Measurement instruments included the general food craving questionnaire trait, the center for epidemiological studiesdepression scale, and stress response inventory-modified form. The statistical analysis included t-test, analysis of variance, pearson correlation analysis, and stepwise multiple regression analysis. RESULTS: Mean food craving score was 53.00±12.36. Food craving was higher in patients younger than 40 years (F=4.36 p=.006) and having occupation (t=2.18 p=.031). Patients receiving hemodialysis demonstrated higher levels of depression (21.37±9.62) and stress (39.68±15.95). Factors influencing food craving were depression (β=.52, p<.001), stress (β=.65, p<.001), and age 50~59 years old (β=−.28, p=.001) and 60~69 years old (β=−.19, p=.026), which accounted for 25.6% of total variance. CONCLUSION: Food craving among hemodialysis patients was influenced by patients' depression, stress and age. Assessment and management of depression and stress needs to be incorporated as a nursing strategy for dietary management for hemodialysis patients.
Craving ; Depression ; Humans ; Nursing ; Occupations ; Renal Dialysis ; Stress, Psychological

Organ transplantation has become a' widely accepted treatment modality for end-stage organ disease. The shortage of allogenic donors for organ transplantation has brought about the necessity of xenotransplantation as an unlimited source of organ donation. However, organ transplantation between different species have never been successful because of hyperacute rejection. Although the mechanism of this phenomenon is not fully understood, many researchers believe that the natural antibodies present in the recipient's serum may bind to the graft and induce the activation of complement cascade triggering the process of hyperacute rejection. ...continue...
Antibodies ; Complement System Proteins ; Heterografts ; Humans ; Organ Transplantation ; Tissue and Organ Procurement ; Tissue Donors ; Transplantation, Heterologous ; Transplants

Purpose: To identify the effect of a new leadership type by confirming the effect of clinical nurses' grit and nursing work environment on nursing performance and retention intention with the mediating effect of compassionate rationalism leadership in the process. Methods: A proportional stratified sampling method was used with 45 tertiary general hospitals nationwide as the sampling unit. An online survey targeting nurses who have been working continuously for more than one year was conducted from October 14 to November 9, 2022. The final analysis included 1,256 questionnaires. The correlation between the participants' variables was analyzed using Pearson's correlation coefficients. The mediating effect was confirmed using a regression analysis, and bootstrapping. Results: The compassionate rationalism leadership had a mediating effect on the relationship between grit and nursing performance (F=203.21, p<.001), nursing work environment and nursing performance (F=109.48, p<.001), grit and retention intention (F=149.90, p<.001), and nursing work environment and retention intention (F=25.14, p<.001). Conclusion The compassionate rationalism leadership of nursing managers had a positive effect on nursing performance and retention intention.Therefore, with the development and application of educational programs of compassionate rationalism leadership, it can be used to improve nursing performance and operate an efficient nursing organization.

Diabetes mellitus is a major risk factor for urinary tract infection (UTI); emphysematous pyelonephritis (EP), a complication of UTIs, often occurs in patients with underlying, poorly controlled diabetes mellitus. We report the case of an 87-year-old woman with EP in type 2 diabetes mellitus who developed pneumatosis cystoides intestinalis (PCI) with portal venous gas. PCI is a radiographic finding, which is found in a linear or cystic form of gas in the submucosa or subserosa of the bowel wall. PCI has two common presentations. Primary PCI is a benign idiopathic condition. Secondary PCI is associated with a wide variety of gastrointestinal and non-gastrointestinal diseases. PCI with portal venous gas in particular is associated with ischemic gastrointestinal disease. Initial pre-enhanced abdominopelvic computed tomography showed EP in the right kidney without PCI. Newly occurring PCI and hepatic portal venous gas were found in the right ascending colon after EP improved. This is a rare case of PCI accompanied by emphysematous pyelonephritis in type 2 diabetes mellitus. The patient's general condition improved with intravenous antibiotics and fluid therapy without a surgical approach. However, she was discharged without further treatment because the family refused any further evaluations and treatments.
Aged, 80 and over ; Anti-Bacterial Agents ; Colon, Ascending ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Female ; Fluid Therapy ; Gastrointestinal Diseases ; Humans ; Kidney ; Pneumatosis Cystoides Intestinalis* ; Pyelonephritis* ; Risk Factors ; Urinary Tract Infections

PURPOSE: To investigate the effect of early enteral trophic feeding within 24 hours after birth compared with being started within 7 days after birth in extremely low birth weight infants (ELBWIs). METHODS: We retrospectively analyzed the medical records of all ELBWIs with gestational age of 26 weeks and less, and birth weight below 1,000 g, admitted within 24 hours after birth to neonatal intensive care unit of Samsung Medical Center from January 2000 to June 2006 who were alive at the time of discharge. Data for nutritional status and morbidities were compared between Era 1 (n=76), in which early enteral trophic feeding was started within 7 days after birth and Era 2 (n=46), started within 24 hours after birth. RESULTS: Compared to era 1, despite that gestational age and enteral feeding strarting time of ELBWIs was significantly earlier (25(+4)+/-0(+6) vs. 24(+6)+/-1(+5) weeks, 4.5+/-5.1 vs. 0.7+/-1.3 days), the time to achieve full enteral feeding was significantly shorter, and the weight gain at corrected age of 36 weeks was significantly higher in era 2. Also the incidence of early and total confirmed sepsis, total parenteral nutrition induced cholestasis, was lower and the duration of hospitalization was significantly shorter in era 2 compared to era 1, without differences in the incidence of NEC, moderate to severe BPD, and severe IVH (> or =Gr III) between two eras. CONCLUSION: Early enteral trophic feeding in ELBWI within 24 hours after birth was safe and beneficial.
Birth Weight* ; Cholestasis ; Enteral Nutrition ; Gestational Age ; Hospitalization ; Humans ; Incidence ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Nutritional Status ; Parenteral Nutrition, Total ; Parturition* ; Retrospective Studies ; Sepsis ; Weight Gain

PURPOSE: To analyze the controversies surrounding therapeutic decision-making and the withholding of life- sustaining treatments, values held concerning therapeutic interventions of terminal cancer patients are compared between physicians and family members. MATERIALS AND METHODS: 42 advanced or terminal stage cancer patients were enrolled for the study. The questionnaires were administered to the duty doctor and the family of the patients. Questions included whether to use new agents with a 15% partial efficacy and whether to use opioid analgesics, intravenous nutrition, a feeding tube, antibiotics, and hemodialysis. Additionally, we asked about the administration of CPR, ventilator application, and euthanasia. If the family permitted, the same questionnaires were given to the patients. RESULTS: Of the 42 cases, 5 families refused to answer the questionnaire. Of the available 37 families, only 5 families permitted access to the patients. Of the 5 patients, 2 patients refused the questionnaire. Only 67.6% and 8.1% of families and the patients clearly understood the stage of cancer. The use of a new agent was accepted by 45.2% of the physicians and 45.9% of the families. The rankings of the acceptance of treatment in the physicians and in the families were similar. The concordance rate between the physicians and the families was lowest on ventilator application and CPR. 31% of the physicians and 43.2% of the families agreed on the issue of euthanasia. CONCLUSION: Values held on issues like therapeutic decision-making and the withholding of life-sustaining treatments in terminal cancer patients are discordant between physicians and family members. In order to resolve controversies on the role of physicians in end-of-life decisions, the values of physicians as well as patients and their family members should be considered in the final decision-making process.
Analgesics, Opioid ; Anti-Bacterial Agents ; Cardiopulmonary Resuscitation ; Euthanasia ; Humans ; Medical Futility ; Renal Dialysis ; Ventilators, Mechanical ; Withholding Treatment ; Surveys and Questionnaires

BACKGROUND: Because of the relative paucity of data regarding the clinical outcome in adult patients with acute lymphocytic leukemia (ALL) in Korea, we analyzed clinical courses in adult ALL patients treated with VPD (L) regimen (vincristine, prednisolone, daunorubicin, L-asparaginase) at the Seoul National University Hospital, and evaluated prognostic factors influencing the outcome. METHODS: Patients with ALL newly diagnosed between October 1994 and June 2000 at our hospital were analyzed retrospectively. Fifty-three patients were evaluable. Induction chemotherapy consisted of VPD with (46 cases) or without L-asparaginase (7 cases). After complete remission (CR), consolidation therapy, CNS prophylaxis and maintenance chemotherapy were administered. RESULTS: Ages ranged from 16 to 67 (median 30). CR rate was 86.8% (46/53) and no significant prognostic factor was found for the CR rate. With a median follow-up time of 27.2 months (range 12.9~83.0 months) in living patients, the median overall survival (OS) for all cases was 16.7 months (13.4~20.1 months, 95% C.I.) and the estimated 4-year OS rate was 25.4%+/-8.9%. The median relapse-free survival (RFS) was 12.2 months (8.4~16.0 months, 95% C.I.), and 3-year RFS rate was 29.9%+/-10.2%. Poor prognostic factors for OS were Ph chromosome (p=0.005) and T-cell immunophenotype (p=0.03). For RFS they were Ph chromosome (p=0.01) and the presence of a mediastinal mass (p=0.03). CONCLUSION: Despite an initial excellent response to the VPD (L) regimen, newer therapeutic strategies, including more intensive postremission therapies, are urgently needed because of the high relapse rate. Future therapeutic approaches need to be stratified according to several prognostic factors.
Administration, Oral ; Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*administration & dosage/adverse effects ; Asparaginase/*administration & dosage/adverse effects ; Disease-Free Survival ; Dose-Response Relationship, Drug ; Doxorubicin/*administration & dosage/adverse effects ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Male ; Maximum Tolerated Dose ; Middle Aged ; Multivariate Analysis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis/*drug therapy/*mortality ; Prednisone/*administration & dosage/adverse effects ; Probability ; Remission Induction ; Retrospective Studies ; Survival Analysis ; Treatment Outcome ; Vincristine/*administration & dosage/adverse effects

BACKGROUND: Irinotecan is an active agent in colorectal cancer, producing 30~40% response rates when combined with 5-fluorouracil and leucovorin in metastatic colorectal cancer as first line therapy, however, the best combination schedules are not determined yet. We investigated the efficacy and toxicity of irinotecan combined with bolus 5-fluorouracil, continuous infusion 5-fluorouracil, and high-dose leucovorin every two weeks (LV5FU2 regimen) in recurrent or metastatic colorectal cancer in Korean patients. METHODS: Twenty-two patients with measurable diseases previously untreated with chemotherapy other than adjuvant chemotherapy for advanced colorectal cancer were enrolled onto this study and received the study drugs between June 2000 and December 2001. Treatment consisted of irinotecan (180 mg/m2 over two hours on day 1) followed by leucovorin (200 mg/m2 over two hours), bolus 5-fluorouracil 400 mg/m2 and continuous infusion of 5-fluorouracil (600 mg/m2 over next 22 hours) on day 1 and 2. Chemotherapy was repeated every two weeks until progressive disease. RESULTS: Of the 20 patients evaluable for response, 8 partial responses were observed with a response rate of 40%. Six additional patients achieved stable disease as their best response, and six progressed. The median time to progression was 5.0 months and median overall survival was 17.3 months. The most frequently observed grade 3~4 toxicities were neutropenia (18%) and diarrhea (4.8%). Two mortalities occurred, though not clearly related to treatment, before the end of chemotherapy. CONCLUSION: Irinotecan combined with LV5FU2 regimen was effective in advanced colorectal cancer with manageable side effects. Caution should be paid to elderly and poor performance patients to prevent treatment related mortality and morbidity.
Aged ; Appointments and Schedules ; Chemotherapy, Adjuvant ; Colorectal Neoplasms* ; Diarrhea ; Drug Therapy ; Drug Therapy, Combination* ; Fluorouracil* ; Humans ; Leucovorin* ; Mortality ; Neutropenia

BACKGROUND: Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder characterized by the simultaneous occurrence of endocrine tumors in target tissues (mainly the pituitary, endocrine pancreas, and parathyroid glands). MEN1 is caused by mutations in the MEN1 gene, which functions as a tumor suppressor and consists of one untranslated exon and nine exons encoding the menin protein. This condition is usually suspected when we encounter patients diagnosed with tumors in multiple endocrine organs, as mentioned above. METHODS: A 65-year-old woman who underwent surgery for a pancreatic tumor (serous cystadenoma) 5 years previously was referred to our hospital due to neurologic symptoms of diplopia and left ptosis. Brain magnetic resonance imaging revealed a 3.4-cm lesion originating from the cavernous sinus wall and extending into the sellar region. It was thought to be a nonfunctioning tumor from the results of the combined pituitary function test. Incidentally, we found that she also had a pancreatic tumor, indicating the necessity of genetic analysis for MEN1. RESULTS: Genomic analysis using peripheral leukocytes revealed a heterozygous c.1621G>A mutation in the MEN1 gene that was previously reported to be either a pathogenic mutation or a simple polymorphism. We pursued a stereotactic approach to the pituitary lesion, and microscopic findings of the tumor revealed it to be an intrasellar cavernous hemangioma, a rare finding in the sellar region and even rarer in relation to oculomotor palsy. The patient recovered well from surgery, but refused further evaluation for the pancreatic lesion. CONCLUSION: There is great emphasis placed on genetic testing in the diagnosis of MEN1, but herein we report a case where it did not assist in diagnosis, hence, further discussion on the role of genetic testing in this disease is needed. Also, in cases of pituitary tumor with cranial nerve palsy, despite its low prevalence, intrasellar cavernous hemangioma could be suspected.
Aged ; Brain ; Cavernous Sinus ; Cranial Nerve Diseases ; Diagnosis ; Diagnostic Errors* ; Diplopia ; Exons ; Female ; Genetic Testing ; Hemangioma, Cavernous* ; Humans ; Islets of Langerhans ; Leukocytes ; Magnetic Resonance Imaging ; Multiple Endocrine Neoplasia Type 1* ; Neurologic Manifestations ; Paralysis ; Pituitary Function Tests ; Pituitary Neoplasms ; Prevalence

BACKGROUND: The aim of this study was to assess the psychological well-being and treatment satisfaction in patients with type 2 diabetes mellitus in a general hospital in Korea. METHODS: This study included 440 type 2 diabetes patients above 20 years of age. Well-Being Questionnaire-12 (WBQ-12) and Diabetes Treatment Satisfaction Questionnaire were used to survey well-being and treatment satisfaction, respectively. WBQ-12 consists of 4 categories: negative well-being (NWB), energy (ENE), positive well-being (PWB), and general well-being (GWB). RESULTS: There were significant associations between NWB scores and women, low education, low-income, and number of hospital admissions. Significant associations were also identified between ENE scores and men, higher education, insulin nonusers, high-income, compliance with recommended exercise, number of medications, satisfaction with treatment time, and poor glycemic control. PWB scores were significantly associated with high-income, satisfaction with waiting and treatment times, compliance with recommended diet and exercise, and number of medications. GWB scores were significantly associated with men, higher education, high-income, satisfaction with waiting and treatment times, compliance with recommended exercise, and number of medications. Treatment satisfaction was significantly associated with age, satisfaction with waiting and treatment times, compliance with recommended diet and exercise, and duration of diabetes. CONCLUSION: Diabetes care requires psychosocial support in addition to medical care. Unlike Western studies, our study found that satisfaction with waiting and treatment times had a strong correlation with well-being and treatment satisfaction in diabetes patients.
Compliance ; Diabetes Mellitus, Type 2 ; Diet ; Education ; Female ; Hospitals, General* ; Humans ; Insulin ; Korea* ; Male ; Morinda ; Outpatients*