PURPOSE: The purpose of this study was to describe differences in turnover intention according to work period for new nurses and to explore factors influencing differences in turnover intention.METHODS: A longitudinal survey design was used. A structured questionnaire regarding CC (Clinical competence), MNC (Missed Nursing Care), WE (Work Engagement) and turnover intention was administered twice(at 2 months and 5 months of employment) to 98 new nurses working at a tertiary hospital.RESULTS: The regression model with each of the differences for MNC, WE, and subjective satisfaction with department against differences of turnover intention was statistically significant (F=11.98, p < .001). This model explained 26% of differences in turnover intention (Adj. R²=.26). Especially, differences in WE (β=-.43, p < .001), and differences in MNC (β=.18 p=.044) were identified as factors influencing differences in turnover intention.CONCLUSION: The turnover intention of new nurses decreased between the first 2 months and 5 months and this difference was influenced by WE and MNC. Therefore, it is necessary to provide social and institutional supports such as effective adaptation programs with sufficient periods of time for newly graduated nurses.
Clinical Competence ; Intention ; Longitudinal Studies ; Nursing ; Tertiary Care Centers

Background: and Purpose An insertable cardiac monitor (ICM) has been demonstrated to be a useful tool for detecting subclinical atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS). This study aimed to identify the clinical predictors of AF in ESUS patients with ICMs. Methods: We retrospectively selected consecutive patients with an ICM implanted for AF detection following ESUS. The primary endpoint was defined as any AF episode lasting for longer than 5 min. The atrial ectopic burden (AEB) was calculated as the percentage of the number of conducted QRS from atrial ectopy on Holter monitoring. Results: This study included 136 patients. AF lasting ≥5 min was detected in 20 patients (14.7%) during a median follow-up period of 6.6 months (interquartile range, 3.3–10.8 months).AF patients had a higher AEB (0.20% vs. 0.02%,p<0.001) and a larger left atrial diameter (LAD, 41.0 mm vs. 35.3 mm, p<0.001) than those without AF. The areas under the receiver operating characteristic curves were 0.795 and 0.816 for the LAD and log-transformed AEB, respectively, for the best cutoff values of 38.5 mm for LAD and 0.050% for AEB. AF lasting ≥5 min was detected in 34.6% (9/26) of patients with LAD ≥38.5 mm and AEB ≥0.050%, and in 0% (0/65) of those with LAD <38.5 mm and AEB <0.050%. Conclusions AF was detected in a significant proportion of ESUS patients during a 6.6-month follow-up. The LAD and AEB are good predictors of AF and might be useful for AF risk stratification in ESUS patients.

Background: and Purpose An insertable cardiac monitor (ICM) has been demonstrated to be a useful tool for detecting subclinical atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS). This study aimed to identify the clinical predictors of AF in ESUS patients with ICMs. Methods: We retrospectively selected consecutive patients with an ICM implanted for AF detection following ESUS. The primary endpoint was defined as any AF episode lasting for longer than 5 min. The atrial ectopic burden (AEB) was calculated as the percentage of the number of conducted QRS from atrial ectopy on Holter monitoring. Results: This study included 136 patients. AF lasting ≥5 min was detected in 20 patients (14.7%) during a median follow-up period of 6.6 months (interquartile range, 3.3–10.8 months).AF patients had a higher AEB (0.20% vs. 0.02%,p<0.001) and a larger left atrial diameter (LAD, 41.0 mm vs. 35.3 mm, p<0.001) than those without AF. The areas under the receiver operating characteristic curves were 0.795 and 0.816 for the LAD and log-transformed AEB, respectively, for the best cutoff values of 38.5 mm for LAD and 0.050% for AEB. AF lasting ≥5 min was detected in 34.6% (9/26) of patients with LAD ≥38.5 mm and AEB ≥0.050%, and in 0% (0/65) of those with LAD <38.5 mm and AEB <0.050%. Conclusions AF was detected in a significant proportion of ESUS patients during a 6.6-month follow-up. The LAD and AEB are good predictors of AF and might be useful for AF risk stratification in ESUS patients.

Multivisceral organ transplantation involves the transplantation of three or more abdominal organs, including small bowel, duodenum, stomach, liver, pancreas, colon, and so on. The large amounts of cold and acidic loading into systemic circulation from the graft during multivisceral organ transplantation may result in severe post-reperfusion syndrome (PRS). We describe here a 6-year-old pediatric patient with chronic intestinal pseudo-obstruction who experienced prolonged PRS and severe metabolic acidosis during seven abdominal organ transplantation including the liver, spleen, stomach, duodenum, small bowel, colon and pancreas. The hypotensive period lasted approximately 10 minutes after graft reperfusion and was accompanied by severe metabolic acidosis and hypothermia. Since PRS can be easily associated with adverse outcomes, such as poor early graft function and primary non-function, not only meticulous surveillance for aggravating factors for PRS but also their immediate correction were necessary in managing a pediatric patient undergoing multivisceral organ transplantation.
Acidosis ; Child ; Colon ; Duodenum ; Humans ; Hypothermia ; Intestinal Pseudo-Obstruction ; Intestines ; Liver ; Organ Transplantation* ; Pancreas ; Primary Graft Dysfunction ; Reperfusion ; Spleen ; Stomach ; Transplantation ; Transplants*

BACKGROUND: Although it is well known that bone mineral density (BMD) loss occurs after menopausal transition, there are only few previous studies that describe differences of BMD and biochemical bone markers in women of pre- and postmenopausal periods. The purpose of this study was to find factors that contribute to loss of BMD after menopause and to show changes of BMD and biochemical bone markers during pre- and postmenopausal periods by retrospective cohort study. METHODS: This retrospective cohort study was performed from Jan. 1995 to Jan. 2001 at a health promotion center. Twenty one healthy perimenopausal women were enrolled. BMD and biochemical bone markers were checked more than two times during the study period. Changes of BMD and biochemical bone markers between pre- and postmenopausal state were compared by paired t-test. Pearson correlation and multiple regression were performed to find the contributing factors to loss of BMD after menopause. RESULTS: Postmenopausal BMD (164.65 36.34 mg/cm3) was significantly decreased to 16.49 16.91 mg/cm3 (P<0.001) as compared with premenopausal BMD (181.14 40.81 mg/cm3). In biochemical bone markers only urine deoxypyridinoline had a significant difference (3.30 3.97 nMDP/mMcre, P<0.05) Only premenopausal BMD contributed to decreasing rate of BMD between the two states and the loss of BMD after menopause (P<0.05). CONCLUSION: In perimenopausal healthy women, postmenopausal BMD was significantly decreased as compared with premenopausal BMD. And only premenopausal BMD was shown to be a contributing factor to decreasing rate of BMD between the two states and the loss of BMD after menopause. It suggests that premenopausal BMD is important in predicting postmenopausal osteoporosis and efforts to prevent loss of BMD before menopause can prevent progress of postmenopausal osteoporosis.
Bone Density* ; Cohort Studies* ; Female ; Health Promotion ; Humans ; Menopause ; Osteoporosis, Postmenopausal ; Postmenopause ; Retrospective Studies*

BACKGROUND: We investigated the protective effects of propofol in the HK-2 cell line of human kidney proximal tubular cells against hydrogen peroxide (H2O2)-induced oxidative stress. METHODS: After pretreatment with different concentrations of propofol (0 microM, 10 microM, 25 microM and 50 microM) for 30 minutes, HK-2 cells were exposed to 8 mM H2O2 for 4 hours. Cell death was assessed by measuring the percentage of lactate dehydrogenase (LDH) release and by counting viable cells. The nature of cell death was assessed by doubles-taining cells with fluorescein isothiocyanate-labeled Annexin V and propidium iodide, and then analyzing the cells using flow cytometry. RESULTS: After exposure to 8 mM H2O2 for 4 hours, the percentage of LDH release was 45.1 +/- 4.2% and the number of viable HK-2 cells was 5.2 +/- 6.0%. Pretreatment with propofol suppressed H2O2-induced LDH release in a concentration-dependent manner, reducing the percentage of LDH release to 38.1 +/- 5.6%, 33.5 +/- 6.3%, and 26.2 +/- 3.8% of the controls at 10 microM, 25 microM and 50 microM propofol, respectively. Numbers of viable cells increased following propofol pretreatment, with 11.4 +/- 10.9%, 19.5 +/- 16.1%, and 32.4 +/- 23.3% cell survival rates after pretreatment with 10 microM, 25 microM and 50 microM propofol, respectively. Analyses of flow cytometry showed that the propofol pretreatment decreased the percentage of necrotic and late apoptotic cells. CONCLUSIONS: Propofol protects HK-2 human kidney proximal tubular cells against H2O2-induced oxidative stress.
Annexin A5 ; Cell Death ; Cell Line ; Cell Survival ; Flow Cytometry ; Fluorescein ; Humans ; Hydrogen ; Hydrogen Peroxide ; Kidney ; L-Lactate Dehydrogenase ; Oxidative Stress ; Propidium ; Propofol

Advances in anesthetic and surgical management, such as deep hypothermic circulatory arrest and temporary clipping, have improved outcomes for intracranial aneurysm patients. However, these techniques are associated with significant risks. We report on two cases in which adenosine administration was used to induce transient periods of cardiac asystole during intracranial aneurysm surgery. This asystole resulted in profound hypotension and collapse of the aneurysm, which facilitated its safe clipping.
Adenosine ; Aneurysm ; Circulatory Arrest, Deep Hypothermia Induced ; Heart Arrest ; Humans ; Hypotension ; Intracranial Aneurysm

BACKGROUND: Association between obesity and family communication was a controversial issue in previous studies. Previous studies were done on adolescents and adults in overall. This study was done to figure out association between obesity of medical school students specifically and their family function including communication and to help them on the treatment of obese patients.METHODS: A self-reported questionnaire was filled in by 97 medical school students in Busan. They were asked to answer forty different questions including their height and weight. Association between BMI and family communication was studied using FACE III, Family APGAR and KOBES.RESULTS: Among 97 correspondents, 30 of them were found to be overweight to obese. There was a significant difference in number of siblings, amount of food intake, meal time and recent weight reduction trial among overweight-obese group and normal group. The mean Family APGAR score of normal group was higher than overweight-obese group. Flexibility and connectivity score in FACE III of normal group was also higher than overweight-obese group. Among all the factors considered, recent weight reduction trial was the only factor that was statistically significant in accordance with normal weight.CONCLUSION: There was significant relation between flexibility and connectivity of family function with overweight and obesity. In order to investigate further relation and significance on separate gender, larger study samples are needed. Future studies are suggested regarding gender differences on relationship between overweight-obesity and family function in medical school students.
Adolescent ; Adult ; Apgar Score ; Body Mass Index ; Busan ; Eating ; Humans ; Meals ; Obesity ; Overweight ; Pliability ; Schools, Medical ; Siblings ; Students, Medical ; Weight Loss

PURPOSE: The oncologic safety of immediate breast reconstruction (IBR) has been demonstrated. However, the outcome of IBR for locally advanced breast cancer (LABC) is still under debate. We compared the survival outcome of LABC patients who underwent IBR vs. mastectomy alone. METHODS: We retrospectively analyzed a total of 248 patients with stage III breast cancer who were treated with mastectomy between 2004 and 2015. The study subjects were divided into 2 groups: patients who received IBR (n=77) or mastectomy alone (MA) (n=171). We compared disease-free survival (DFS) of both groups. RESULTS: Median follow-up duration was 49 months and the mean age of patients was 49 years. Patients in the IBR group were significantly younger and had lower body mass index (BMI) than those in the MA group. In a univariate analysis, IBR group showed better DFS than the MA group (DFS 81.3 months vs. 49.8 months, p<0.001). There was no delay in adjuvant treatment in the IBR group. In a multivariate analysis, IBR was associated with better DFS (hazard ratio (HR) for recurrence: 0.37, 95% CI 0.20–0.69, p=0.002) when adjusted for potential prognostic factors. In a subgroup analysis performed according to disease stage (IIIA and IIIB/IIIC), DFS was significantly better in IBR than MA group in both stage subgroups (p<0.001). CONCLUSION We demonstrated that patients who underwent IBR showed better DFS outcome compared with patients who underwent mastectomy alone. Our results can help surgeons to determine if IBR is an option in patients with LABC.

The efficacy and safety of endovascular treatment (EVT) for moyamoya disease (MMD) have rarely been investigated. The objective of this study was to summarize the clinical outcomes of EVT for MMD and determine the potential role of EVT in treating symptomatic steno-occlusive lesions in MMD. Reports from January 2000 to December 2021 describing EVT in MMD were collected through a literature search. The search terms included “moyamoya”, “stent”, “angioplasty”, and “endovascular”. Data regarding baseline demographics, previous medical history, treated vessel, periprocedural complications, and angiographical recurrence were retrieved. This review included 10 studies with details of 19 patients undergoing a total of 31 EVT procedures. Twenty-one EVTs were performed as initial treatments for MMD, and 10 were performed as additional treatments for angiographical recurrence. The mean follow-up period of the initial EVTs was 9.0±11.9 months, with angiographical recurrence in 11 (68.8%) cases. The mean follow-up period of additional EVTs was 4.3±3.9 months, and seven (70.0%) EVTs showed restenosis of the re-treated vessel. Across all initial and additional EVTs, there were no differences in characteristics between the recurrence and non-recurrence groups. Overall, two periprocedural complications (9.5%) occurred, one vessel rupture and one massive intracerebral hemorrhage with subarachnoid hemorrhage. EVT plays a limited role in the management of symptomatic intracranial arterial steno-occlusive lesions of MMD. Recent advances in understanding the pathomechanism of MMD may urge neuro-interventionists to find a new endovascular approach with better balloon angioplasty or stenting mechanisms.