The Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) is widely used for risk stratification in pheochromocytoma and paraganglioma (PPGL), but its clinical utility is limited by inter-observer variability of its parameters and inconsistent predictive performance. Methods: We conducted a multicenter retrospective study of 1,518 patients with PPGL from five tertiary referral centers in Korea. Prognostic utility of PASS system was assessed using logistic regression, Kaplan-Meier analysis, and receiver operating characteristic (ROC) curve analysis. Inter-observer variability was inferred by comparing area under the ROC curve (AUCs) across institutions. Simplified PASS systems were developed based on multivariable analysis of key histopathological parameters. Results: The PASS system was a significant predictor of adverse events and recurrence-free survival. Although the PASS system demonstrated only modest discriminative ability (AUC, 0.673), it showed a high negative predictive value (NPV, 0.885), supporting its usefulness as a screening tool for benign behavior. However, there was significant inter-institutional variability in PASS performance (AUC; range, 0.513 to 0.727; p < .05). The 3-factor Simple PASS, which incorporates necrosis, spindling, and mitotic figures, exhibited less inter-observer variation. The 4-factor Simple PASS, which adds vascular invasion to the 3-factor model, also showed reduced inter-observer variability and improved AUC and NPV compared to the original PASS system. Conclusions: In this multicenter cohort, the PASS system demonstrated high NPV and screening potential, but significant inter-observer variability remains a challenge. Simplification of the PASS system and enhanced pathologist training may improve reproducibility and clinical utility in PPGL risk stratification.

We report a case about successful surgical treatment of a granular cell tumor in the ascending colon. A 36-year-old man underwent screening colonoscopy. An endoscopic examination revealed a 10-mm yellowish and hemispheric mass in the ascending colon, and lower endoscopic ultrasonography revealed a hypoechoic-to-isoechoic mass invaded the submucosal layer. The mass was suspected to be a colonic carcinoid tumor. Based on the preoperative evaluation, endoscopic complete resection was considered difficult. Therefore, the lesion was removed via laparoscopic right hemicolectomy. Histological examination revealed that the tumor consisted of nests of polygonal cells with abundant granular eosinophilic cytoplasm. Immunohistochemical staining revealed diffuse positivity for S100 and CD68. Therefore, the tumor was diagnosed as a granular cell tumor. We suggest that surgical resection should be considered if it is located in the thin-walled ascending colon prone to perforation, difficult to rule out malignant tumor due to submucosal invasion, or to remove endoscopically.

Purpose: The purpose of this study was to investigate the actual utilization of clinical practice guidelines developed by Hospital Nurses Association. Methods: The subjects were 70 nurses who were in charge of guideline distributions in 70 advanced general hospital and general hospitals with 500 beds or more nationwide.Data were collected between June and August, 2020 by mail (return rate: 88.6%). Data were analyzed using descriptive statistics, t-test, and ANOVA with SPSS/WIN 24.0. Results: Among the clinical practice guidelines developed by Hospital Nurses Association, 72.9~90.1% were placed with book and electronic file in nursing department and 24.3~35.8% were placed with book and electronic file in each nursing unit at hospital. The average number of utilized clinical practice guidelines were 3.96±3.88, and average score of guideline utilization was score 2.85±0.79 which means ‘use sometimes’. Conclusion To improve the distribution and utilization of the clinical practice guidelines, it is necessary to enhance the recognition of values of evidence based nursing practice targeting head of nursing department and to stimulate the distribution and utilization of the clinical practice guidelines using diverse education programs for staff nurses.

Purpose: The purpose of this study was to develop a Korean Nurse Residency Program (KNRP) in order to facilitate new nurses’ transition to clinical practice working at tertiary hospitals in Korea. Methods: The KNRP was developed through a literature review, investigation of NRP cases in United States, two rounds of expert consultation, and appropriateness survey. For appropriateness survey of the program, a questionnaire with 118 items and 14 subcategories including overview and operation of KNRP, education programs, staffing criteria for new nurses’ education, preceptor supporting strategies, evaluation standards for new nurse’s education, infrastructure, and KNRP benefits was used. Data were collected from 369 nurses including nurse educators, nurse managers, preceptors, and new nurses working at 43 tertiary hospitals in Korea from February 16, 2021 to March 22, 2021. Data were analyzed with descriptive statistics. Results: Appropriateness score of KNRP was 3.42±0.31 (out of 4) and those of 14 subcategories ranged from 3.18±0.47 to 3.58±0.46. The final version of the KNRP postulated is a one-year program, which is composed of off-job training and on-site training including preceptorship over 3 months, and competency reinforcement and adaptation supporting programs. Conclusion The application of the one-year KNRP will facilitate new graduate nurses’ transition to clinical practice. In order for effective application of the KNRP, cooperative efforts of the government, professional associations, and hospitals are needed.

Purpose: The purpose of this study was to develop a Korean Nurse Residency Program (KNRP) in order to facilitate new nurses’ transition to clinical practice working at tertiary hospitals in Korea. Methods: The KNRP was developed through a literature review, investigation of NRP cases in United States, two rounds of expert consultation, and appropriateness survey. For appropriateness survey of the program, a questionnaire with 118 items and 14 subcategories including overview and operation of KNRP, education programs, staffing criteria for new nurses’ education, preceptor supporting strategies, evaluation standards for new nurse’s education, infrastructure, and KNRP benefits was used. Data were collected from 369 nurses including nurse educators, nurse managers, preceptors, and new nurses working at 43 tertiary hospitals in Korea from February 16, 2021 to March 22, 2021. Data were analyzed with descriptive statistics. Results: Appropriateness score of KNRP was 3.42±0.31 (out of 4) and those of 14 subcategories ranged from 3.18±0.47 to 3.58±0.46. The final version of the KNRP postulated is a one-year program, which is composed of off-job training and on-site training including preceptorship over 3 months, and competency reinforcement and adaptation supporting programs. Conclusion The application of the one-year KNRP will facilitate new graduate nurses’ transition to clinical practice. In order for effective application of the KNRP, cooperative efforts of the government, professional associations, and hospitals are needed.

Purpose: To determine an appropriate surgical technique, it is important to predict pathological results for patientswith clinically localized prostate cancer (PCa) eligible for nerve-sparing radical prostatectomy (NSRP). Severalstudies have highlighted that serum testosterone level was associated with aggressive features of PCa. Therefore,we analyzed factors, including serum testosterone, to predict upstaging and upgrading after surgery for patientswith clinically localized PCa eligible for NSRP. Materials and Methods: We retrospectively evaluated patients who underwent radical prostatectomy (RP) betweenJanuary 2015 and May 2018 at our institution. Patients with Gleason grade group 1 or 2 on biopsy,prostate-specific antigen<10, and ≤clinical/radiologic stage T2 were included in this study. Upstaging andupgrading were defined as pathological stage≥T3a and Gleason grade group≥3, respectively. We evaluatedthe patients’ demographics and outcomes according to upstaging and upgrading after surgery. Predictive factorsfor upstaging and upgrading were analyzed using a multivariate logistic regression model. Results: Of 108 patients included in the study, upstaging and upgrading after surgery were observed in 24 (22.2%)and 36 (33.3%), respectively. Low serum testosterone level, small prostate size, and positive core number≥3on biopsy were identified as predictive factors for upstaging in multivariate analysis. Although serum testosteronewas associated with upgrading in univariate analysis, only clinical/radiologic stage and biopsy Gleason grade groupwere observed as predictive factors for upgrading in multivariate analysis. Conclusions Serum testosterone level was identified as a predictive factor for upstaging after RP for clinicallylocalized PCa eligible for NSRP.

Purpose: The aim of this study was to develop a simulation-based High Flow Nasal Cannula Oxygen Therapy training program based on NLN/ISF to identify the effect on knowledge, clinical performance, and educational satisfaction compared to a group who had traditional High Flow Nasal Cannula Oxygen Therapy training after applying it to clinical nurses. Methods: 31 experimental groups and 33 control groups were conducted from August 2019 to September 2019 for inexperienced nurses over 4 months to 5 years with no experience using high-flow oxygen therapy. Educational programs were developed in scenarios according to Airvo2 and Optiflow, such as facilitator, participant, educational condition, design, characteristics, and educational outcomes. The education application was conducted in advanced for knowledge and clinical performance ability after watching therapy video. Since then, a total of 90 minutes have been conducted for respiratory failure theory training, airvo2 and optiflow simulation training, and debriefing. After applying the education, the medical institution measured nurses’ knowledge, clinical performance, and education satisfaction. Data were analyzed using descriptive statistics, with the SPSS/WIN 22.0 program. Results: Both knowledge and educational satisfaction were higher in the experimental group than in the control group (t=-14.09, p<.001), (t=-12.99, p<.001). The clinical performance for both use of Optiflow and Airvo2 were higher in the experimental group than in the control group (t=-11.39, p<.001), (t=-11.38, p<.001) . Conclusion Results showed that the simulation-based High Flow Nasal Cannula Oxygen Therapy training was effective with the experimental group having increased scores for every area of this study.

PURPOSE: The aim of this study was to investigate the satisfaction of newly graduated nurses with educational programs and their experiences in role transition. METHODS: Data were collected from November 1 to December 15, 2018 and 483 new graduate nurses working at 15 tertiary hospitals and 10 general hospitals participated. For data collection, self-report questionnaires including the Casey-Fink Graduate Nurse Experience Survey tool and satisfaction with education were used. Data were analyzed using descriptive statistics, t-test, and one-way analysis of variance. RESULTS: Satisfaction with education ranged from 3.09 to 3.27, and satisfaction with preceptors was 3.45(maximum 4). The skill that new nurses ranked as most difficult during the first 3 months was charting/documentation, and throughout a whole year, the top 4 difficult skills were cardiopulmonary resuscitation/emergency response, ventilator care, end-of-life care, and prioritization/time management. In comfort/confidence, new graduates felt most comfortable with support and least comfortable with patient safety. More than 50 percent of new graduates experienced stress during role transition, and the most frequently experienced stressors were related to job performance and personal life. Levels of satisfaction with education and comfort/confidence differed according to the hospital type and number of preceptors for new nurses. CONCLUSION In order to facilitate the transition of new graduate nurses to professional nurse, an extended period of education, systematic and standardized transition programs, and continuous support during the first year of practice are required.

PURPOSE: The aim of this study was to investigate and identify the influence of nurses' followership types and ego-resilience on job embeddedness. METHODS: Self-reported questionnaires were distributed to 546 nurses working at hospitals with 400 to 700 beds in Seoul and Gangwon Province, and 520 sincere questionnaires were analyzed using SPSS / WIN ver 23.0 program. RESULTS: The job embeddedness, ego-resilience and followership types of the participants showed significant correlation with each other. In hierarchical multiple regression analysis, nurses' followership types and ego-resilience were identified as predictors of job embeddedness (Adj. R2=0.34, p < .001). CONCLUSION: Findings of this study indicate that nurses need to develop their followership and ego-resilience to increase job embeddedness. Future studies should explore ways to improve followership and ego-resilience.
Gangwon-do ; Seoul

Familial renal glycosuria (FRG) is an inherited disorder characterized by persistent glycosuria in the absence of hyperglycemia. It is caused by mutations in the sodium-glucose co-transporter, leading to increase in the renal excretion of glucose and sodium. However, there have been no studies on the role of fasting and postprandial changes in the urinary sodium excretion in patients with FRG. We report a case of renal glycosuria, which was confirmed by a SLC5A2 mutation via gene sequencing, and compared the postprandial urinary glucose and sodium excretion. A 26-year-old man sometimes experienced glycosuria on routine screening; however, other laboratory findings were normal. His fasting and postprandial urinary glucose excretion levels were 295mg/dL and 2,170mg/dL, respectively. The fasting and postprandial urinary sodium excretion levels were 200mEq/L and 89mEq/L, respectively. In patients with FRG, excessive diuresis might be prevented by a compensatory mechanism that reduces postprandial sodium excretion.
Adult ; Diuresis ; Fasting ; Glucose ; Glycosuria* ; Glycosuria, Renal ; Humans ; Hyperglycemia ; Mass Screening ; Renal Elimination ; Sodium ; Sodium-Glucose Transport Proteins