PURPOSE: Span of Control defines the scope of the managers' responsibilities to manage nursing staff. This study was done to measure span of control of front-line nurse managers (FLNMs) in Korea hospitals resulting in improvement in their work efficiency. METHODS: A sample of 203 FLNMs from five tertiary hospitals was recruited and completed the questionnaires. Data were analyzed using χ²-test, Fisher's exact test, independent t-test, ANOVA, Scheffé, and Pearson correlation coefficient. RESULTS: FLNMs had ‘narrow’ (n=8, 4.3%), ‘appropriate’ (n=161, 87.0%), and ‘wide’ (n=16, 8.6%) span of control. Span of control had significant correlations with the number of nurses (r=.63, p<.001), the number of non-nurses (r=.53, p<.001), units (r=.52, p<.001), staff (r=.83, p<.001), and programs (r=.67, p<.001). CONCLUSION: The research findings indicate that attention should be given to unit complexity, program diversity, total staff, and skills. Moreover, administrators of hospital and nursing departments need to provide systematic support in accordance with FLNMs’ wide span of control.
Administrative Personnel ; Humans ; Korea ; Nurse Administrators* ; Nursing ; Nursing Staff ; Personnel Management ; Tertiary Care Centers

BACKGROUND: The aim of this study was to evaluate the safety and analgesic efficacy of polmacoxib 2 mg versus placebo in a superiority comparison or versus celecoxib 200 mg in a noninferiority comparison in patients with osteoarthritis (OA). METHODS: This study was a 6-week, phase III, randomized, double-blind, and parallel-group trial followed by an 18-week, single arm, open-label extension. Of the 441 patients with knee or hip OA screened, 362 were randomized; 324 completed 6 weeks of treatment and 220 completed the extension. Patients were randomized to receive oral polmacoxib 2 mg (n = 146), celecoxib 200 mg (n = 145), or placebo (n = 71) once daily for 6 weeks. During the extension, all participants received open-label polmacoxib 2 mg. The primary endpoint was the change in Western Ontario and McMaster Universities (WOMAC)-pain subscale score from baseline to week 6. Secondary endpoints included WOMAC-OA Index, OA subscales (pain, stiffness, and physical function) and Physician's and Subject's Global Assessments at weeks 3 and 6. Other outcome measures included adverse events (AEs), laboratory tests, vital signs, electrocardiograms, and physical examinations. RESULTS: After 6 weeks, the polmacoxib-placebo treatment difference was −2.5 (95% confidence interval [CI], −4.4 to −0.6; p = 0.011) and the polmacoxib-celecoxib treatment difference was 0.6 (CI, −0.9 to 2.2; p = 0.425). According to Physician's Global Assessments, more subjects were “much improved” at week 3 with polmacoxib than with celecoxib or placebo. Gastrointestinal and general disorder AEs occurred with a greater frequency with polmacoxib or celecoxib than with placebo. CONCLUSIONS: Polmacoxib 2 mg was relatively well tolerated and demonstrated efficacy superior to placebo and noninferior to celecoxib after 6 weeks of treatment in patients with OA. The results obtained during the 18-week trial extension with polmacoxib 2 mg were consistent with those observed during the 6-week treatment period, indicating that polmacoxib can be considered safe for long-term use based on this relatively small scale of study in a Korean population. More importantly, the results of this study showed that polmacoxib has the potential to be used as a pain relief drug with reduced gastrointestinal side effects compared to traditional nonsteroidal anti-inflammatory drugs for OA.
Arm ; Celecoxib* ; Electrocardiography ; Hip ; Humans ; Knee ; Ontario ; Osteoarthritis* ; Outcome Assessment (Health Care) ; Physical Examination ; Vital Signs

Hemifacial spasm is defined as unilateral, involuntary, irregular twitching of all or parts of the muscles innervated by facial nerves. Here, we present a case of recurrent hemifacial spasm after microvascular decompression (MVD) treated with pulsed radiofrequency (PRF) treatment with good results. A 35-year-old woman suffered from recurrent hemifacial spasm after MVD that was refractory to medical treatment and botulinum toxin injections. We attempted a left facial nerve block twice. Then, we applied PRF at a maximum temperature of 42degrees C for 120 sec. Some response was observed, so we applied PRF two additional times. The frequency of twitch decreased from 3-4 Hz to < 0.5 Hz, and subjective severity on a visual analogue scale also decreased from 10/10 to 2-3/10. PRF treatment might be an effective medical treatment for refractory hemifacial spasm and has fewer complications and is less invasive compared with those of surgery.
Botulinum Toxins ; Facial Nerve ; Female ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery ; Muscles ; Pulsed Radiofrequency Treatment

A 60-year-old man presented with pain on the left cheek and lateral nose. The patient had been diagnosed with facial herpes zoster in the left V2 area 6 months previously. Medical treatment was prescribed for 6 months but it had little effect. We blocked the left infraorbital nerve under ultrasound guidance, but pain relief was short term. Therefore, we performed pulsed radiofrequency treatment on the left infraorbital nerve under ultrasound guidance. Six months after the procedure, the reduction of pain was still maintained, and there was no need for further management.
Cheek ; Herpes Zoster ; Humans ; Nose ; Pulsed Radiofrequency Treatment

We present two cases of symptomatic lower pole moiety ureteropelvic junction obstruction (UPJO) in a partially duplicated collecting system that were successfully treated with minimally invasive endourologic procedures. In the first case, we performed retrograde endopyelotomy with the Acucise(R) ureteral cutting balloon device, and in the latter case, we performed percutaneous nephrolithotomy and antegrade endopyelotomy because of the presence of multiple renal stones. Subsequent intravenous pyelography confirmed marked resolution of the obstruction, and both patients remained asymptomatic during 1 year of follow-up.
Follow-Up Studies ; Humans ; Nephrolithiasis ; Nephrostomy, Percutaneous ; Surgical Procedures, Minimally Invasive ; Ureter ; Urography

PURPOSE: N-acetylcysteine (NAC) is a potent antioxidant, and a free radical scavenger. We investigated the possible effects of NAC after ischemia/reperfusion (I/R) of rat bladder. MATERIALS AND METHODS: I/R injury was induced by abdominal aorta clamping and ischemia for 60minutes, followed by 120minutes reperfusion. Twenty rats were divided into four groups: sham operation + saline group (S+S), sham operation + NAC group (S+NAC), I/R + saline group (I/R+S), I/R + NAC group (I/R+NAC). Blood levels of reactive oxygen species (ROS) were determined using the free oxygen radical tests (FORT). Superoxide generation was measured based on lucigenin-enhanced chemiluminescence. The level of malondialdehyde (MDA) was analyzed in order to measure lipid peroxidation. RESULTS: In I/R+S group, the isometric contractile responses to carbachol were significant lower than other groups and were reversed by the pretreatment with NAC. The level of FORT and MDA showed a marked increase in I/R+S group compared with S+S group. NADPH-stimulated superoxide production was also significantly increased. I/R+NAC decreased these parameters compared with I/R+S group. CONCLUSION: Our results suggest that treatment with NAC reversed the low contractile responses of rat bladder and prevented oxidative stress following I/R.
Acetylcysteine ; Animals ; Aorta, Abdominal ; Carbachol ; Constriction ; Ischemia ; Lipid Peroxidation ; Luminescence ; Malondialdehyde ; Oxidative Stress ; Oxygen ; Panax* ; Rats* ; Reactive Oxygen Species ; Reperfusion ; Superoxides ; Urinary Bladder*

BACKGROUND: This study was designed to evaluate the effects of continuous infusion of ondansetron on postoperative nausea and vomiting (PONV) in patients receiving intravenous patient controlled analgesia (IV-PCA) following laparoscopic gynecological surgery. METHODS: Sixty ASA class I and II patients scheduled for gynecological laparoscopic surgery were randomly divided into the following 3 groups that received the specified dosages of ondansetron mixed with IV-PCA: placebo (group 1), ondansetron 8 mg (group 2), ondansetron 16 mg (group 3). The incidences of nausea, vomiting, visual analogue scale (VAS), and side effects were then recorded in the recovery room, 24 h, 48 h and 72 h postoperatively. RESULTS: There were no significant differences in the occurrence of nausea between group 1 and 2. However, the incidence of nausea in group 3 was significantly lower than in group 1 at 24 h and 48 h after surgery. In addition, significant differences in the occurrence of vomiting were observed among the three groups. However, with the exception of pruritus, no side effects were observed in any of the groups. CONCLUSIONS: IV-PCA mixed with 16 mg of ondansetron effectively prevented nausea at 24 h and 48 h after gynecologic laparoscopic surgery.
Alfentanil ; Analgesia ; Analgesia, Patient-Controlled ; Female ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Laparoscopy ; Nausea ; Ondansetron ; Postoperative Nausea and Vomiting ; Pruritus ; Recovery Room ; Vomiting

PROPOSE: Ureteral stents are commonly placed after routine ureteroscopic procedures to prevent acute obstruction. However, stents can cause significant symptoms and they can require a secondary procedure for removal; further, they may possibly be forgotten. In order to overcome these problems, a temporary ureteral drainage stent capable of dissolving spontaneously was developed to evaluate the tissue reaction and toxicity. MATERIALS AND METHODS: We developed a dissolvable ureteral catheter composed of polydioxanone (PDO). We evaluated the toxicity and tissue reaction by hematologic (CBC, aminotransferase/alanine transaminase (AST/ALT), blood urea nitrogen, creatinine (BUN, Cr), alkaline phosphatase) and histologic examination (ureter, kidney and liver tissue). Twelve rabbits were placed into groups of four rabbits each: the uninserted control group, group I that had a dissolvable ureteral catheter inserted with harvest at four weeks, group II that had a dissolvable ureteral catheter inserted with harvest at eight weeks, and group III that had a dissolvable ureteral catheter inserted with harvest at twelve weeks. RESULTS: On histologic examination, the ureter had a normal appearance of transitional cells and it contained the dissolvable ureteral catheter in the ureteral lumen without any inflammatory change. The ureteral surface cells appeared normal after contact with the dissolvable ureteral catheter during the 12 weeks. Liver and kidney tissue showed mild focal inflammatory change, but no definitive difference was noted between the control and groups I, II and III. On the hematologic examination, there was no significant change of the value of CBC, AST/ALT, BUN, Cr and alkaline phosphatase due to the inserted dissolvable ureteral catheter during the 12 weeks. CONCLUSIONS: A dissolvable ureteral catheter appeared to have no toxic effect, as evidenced by histological and hematological examination. However, further study is warranted in order to overcome the catheter's limitations like for its flexibility.
Alkaline Phosphatase ; Blood Urea Nitrogen ; Creatinine ; Drainage ; Kidney ; Liver ; Pliability ; Polydioxanone ; Rabbits ; Stents ; Ureter* ; Urinary Catheterization ; Urinary Catheters*

PURPOSE: We studied the voiding dysfunction after surgical treatment of female stress urinary incontinence and diagnosis and treatment. MATERIALS AND METHODS: Three hundred women with stress urinary incontinence underwent surgical procedure between January 1998 and December 2004. Ninety two patients(30.6%) experienced the postoperative voiding dysfunction. As the primary procedure for the management of postoperative voiding dysfunction alpha-blockers medication and clean intermittent catheterization(CIC) were performed. Then, hegar dilation and urethral pull-down procedure were performed as a secondary measure. For the patients who showed persistent obstructed symptoms, cutting of mesh or sling materials were performed. RESULTS: In 57 patients, symptoms improved by alpha-blockers medication and CIC. The others were received hegar dilation and urethral pull-down procedure, and 29 patients were improved. 6 patients were not controlled by conservative treatment, of which 3 patients underwent cutting of mesh or sling. De novo urgency was developed in 12 patients. Anticholinergics were taken, symptoms were diminished in 10 patients after 5 months of medication. CONCLUSION: Most voiding dysfunction after surgery may be effectively managed by conservative treatment. In cases of failure, hegar dilation and urethral pull-down procedure may be useful within postoperative first weak. Finally, cutting of mesh or sling must be considered in patient whose the secondary measure is failed.
Cholinergic Antagonists ; Diagnosis ; Female* ; Humans ; Urinary Incontinence*

The combination of Congenital central hypoventilation syndrome with Hirschsprung's disease, also known as Haddad syndrome, belongs to the family of diseases now designated as Neurocristopathies. We have experienced a case of Haddad syndrome in a male infant who presented with repetitive abdominal distension, bilious vomiting, and sleep apnea. Following colon study and rectal biopsy disclosed the absence of the ganglion cell. And the infant could not be weaned from mechanical ventilation since birth because of the absence of effective, spontaneous respiration during sleep. As he was diagnosed as Haddad syndrome, tracheostomy and ileostomy were performed consecutively. At the age of 4 months, he was relatively healthy but remained ventilator-dependent. We report the first Korean case of Haddad syndrome with a brief review of the related literature.
Biopsy ; Colon ; Ganglion Cysts ; Hirschsprung Disease ; Humans ; Hypoventilation ; Ileostomy ; Infant ; Male ; Parturition ; Respiration ; Respiration, Artificial ; Sleep Apnea Syndromes ; Tracheostomy ; Vomiting