BACKGROUND/AIMS: Coronary vasospasms are one of the important causes of sudden cardiac death (SCD). Provocation of coronary vasospasms can be useful, though some results may lead to false positives, with patients potentially experiencing recurrent SCD despite appropriate medical treatments. We hypothesized that it is not coronary vasospasms but inherited primary arrhythmia syndromes (IPAS) that underlie the development of SCD. METHODS: We analyzed 74 consecutive patients (3.8%) who survived out-of-hospital cardiac arrest among 1,986 patients who had angiographically proven coronary vasospasms. Electrical abnormalities were evaluated in serial follow-up electrocardiograms (ECGs) during and after the index event for a 3.9 years median follow-up. Major clinical events were defined as the composite of death and recurrent SCD events. RESULTS: Forty five patients (60.8%) displayed electrocardiographic abnormalities suggesting IPAS: Brugada type patterns in six (8.2%), arrhythmogenic right ventricular dysplasia patterns in three (4.1%), long QT syndrome pattern in one (2.2%), and early repolarization in 38 (51.4%). Patients having major clinical events showed more frequent Brugada type patterns, early repolarization, and more diffuse multivessel coronary vasospasms. Brugada type pattern ECGs (adjusted hazard ratio [HR], 4.22; 95% confidence interval [CI], 1.16 to 15.99; p = 0.034), and early repolarization (HR, 2.97; 95% CI, 1.09 to 8.10; p = 0.034) were ultimately associated with an increased risk of mortality. CONCLUSIONS: Even though a number of aborted SCD survivors have coronary vasospasms, some also have IPAS, which has the potential to cause SCD. Therefore, meticulous evaluations and follow-ups for IPAS are required in those patients.
Arrhythmias, Cardiac* ; Arrhythmogenic Right Ventricular Dysplasia ; Coronary Vasospasm* ; Death, Sudden, Cardiac* ; Electrocardiography ; Follow-Up Studies ; Heart Arrest ; Humans ; Long QT Syndrome ; Masks* ; Mortality ; Out-of-Hospital Cardiac Arrest ; Survivors

PURPOSE: This study aimed to compare work-related musculoskeletal symptoms, occupational stress and nursing work environments of nurses working in patient-sitter wards and general wards. METHODS: The study surveyed 240 nurses with more than one year of experience working in both patient-sitter wards and general wards. The collected data then was analyzed by SPSS statistics version 22. RESULTS: As for the musculoskeletal symptoms, the survey showed that 85.2% and 67.8% of the nurses had such symptoms respectively in patient-sitter wards and general wards. In terms of occupational stress, no significant difference was observed between the patient-sitter ward and the general ward (t=-0.23, p=.821). Lastly, the study showed that there is a significant difference in terms of work environment considering the scores recorded 2.65 and 2.55 points respectively in patient-sitter ward and general ward (t=2.53, p=.012). CONCLUSION: Follow-up research should look at ways to lower the rate of experiencing work-related musculoskeletal symptoms; analyze work performances and establish work standards to lower occupational stress; and devise measures to improve the work environment for the nurses working in patient-sitter wards.
Follow-Up Studies ; Musculoskeletal Diseases ; Nursing* ; Patients' Rooms*

BACKGROUND: Direct observation of healthcare workers is commonly used in hospitals to investigate hand hygiene compliance. However, the hand hygiene compliance rate may increase due to the Hawthorne effect, which is the modification of behavior simply because subjects become aware that they are being observed. The objective of this study was to investigate the occurrence of the Hawthorne effect when directly observing hand hygiene compliance in intensive care unit (ICU) healthcare personnel. METHODS: A total of 87 staff members from the coronary care unit and cardiac surgery ICU of a general hospital in Seoul were included in this study: 24 residents and interns, 55 nurses, and 8 nursing assistants. Both covert and overt observations, where subjects were either unaware or aware of any direct observation, were performed on separate occasions. RESULTS: A total of 1,052 covert and 1,336 overt observations were documented over 30 and 34 occasions, respectively. Overall hand hygiene compliance was significantly higher with overt observation than with covert observation (1,041/1,336, 77.9% vs. 659/1,052, 62.6%, P<0.001). The Hawthorne effect was present in all professions and behaviors, with the exception of nursing assistants, and prior to touching a patient. CONCLUSION: Direct observation of hand hygiene compliance was associated with the Hawthorne effect when observations were made overtly and this was likely to contribute to an overestimation of compliance rate.
Compliance ; Coronary Care Units* ; Delivery of Health Care* ; Effect Modifier, Epidemiologic* ; Hand Hygiene* ; Health Personnel ; Hospitals, General ; Humans ; Intensive Care Units* ; Nursing ; Seoul ; Thoracic Surgery*

PURPOSE: Purpose of this study was to examine the impact of group dynamic imagery therapy on job stress and psychosocial stress of female nurses. METHODS: The research questions were tested through a quasi-experimental research with a non-equivalent pretest-posttest design. Seventy-seven female nurses from G University Hospital in J City participated in this study; 38 of them were assigned to the experimental group, and the rest were assigned to the control group. Once a week for 8 continuous weeks, participants in the experimental group had 90-minute group dynamic imagery therapies. RESULTS: 1) The level of job stress was significantly lower in the experimental group than the control group, and 2) The level of Psychosocial stress was also significantly lower in the experimental group than the control group. CONCLUSION: The results of the study indicate that group dynamic imagery therapy can be an effective intervention against job stress and psychosocial stress of female nurses.
Female ; Humans

PURPOSE: This study was conducted to develop and test the effects of an elder health promotion program and apply strategies for elder health leader training sessions with elders at senior citizen halls. METHODS: A nonequivalent control group pretest-posttest design was used. Participants were 49 elders at a senior citizen hall (intervention: 27, control: 22). The elder health promotion program consisted of health education and exercise. A professional leader led the program for 4 weeks, and then an elder health leader and research assistant led for 8 weeks (total 12 weeks). Scales for elder health promoting behaviors, perceived health status, life satisfaction and senior citizen hall capability were used and physical fitness levels were measured. Data were collected between April 21 and July 28, 2010 and analyzed using Chi-square, Fisher's exact test, t-test, and repeated measure ANOVA with SPSS/WIN 12.0. RESULTS: Health promoting behaviors, physical fitness, perceived health status, and senior citizen hall capacity were significantly better in the experimental group after the intervention compared to the control group. CONCLUSION: Study findings indicate that elder health promotion programs applying strategies of elder health leader training are effective and can be recommended as nursing interventions for health promotion of these elders.
Aged ; Aged, 80 and over ; Attitude to Health ; Exercise ; Female ; Health Education ; *Health Promotion ; Health Status ; Humans ; *Leadership ; Male ; Physical Fitness ; Program Evaluation

BACKGROUND: The purpose of this study is to know the healthcare-associated infection (HAI)s in small and medium sized hospitals, less than 400 beds. METHODS: We had web based surveillance for HAIs in 27 hospitals from August to October 2010. The surveillance performed in 1-2 ICUs and 1 general ward in each hospitals by CDC definition. And for the multi-drug resistant organisms (MDROs), we reviewed all of blood culture results. RESULTS: We identified 319 HAIs among 269,436 patients days. The HAIs rate was 1.18 (CI 1.05-1.32)/1,000 patient-days. Urinary tract infection was the most common HAI (52.4%) in this study followed by pneumonia (18.9%), blood-stream infections (14.2%), surgical site infection (7.9%), and others (6.6%). There were 76.5% of device associated infections in UTI, 46.7% in BSI, and 18.3% in pneumonia. The rate of HAIs in ICU was higher than that of in general ward (4.6 vs 0.9/1,000 patient-days). However, the indwelling catheter associated urinary tract infection rate was lower in ICU (2.6 vs 4.4/1,000 device days). There were no significant differences in central line-associated blood stream infection rate (1.5 vs 1.8) and ventilator-associated pneumonia rate (3.0 vs 0.0). The common microorganisms found in HAIs were Escherichia coli (19.8%), Staphylococcus aureus (13.1%), and Pseudomonas aeruginosa (12.7%). Moreover, 90.9% of S. aureus were resistant to methicillin, and 38.2% of P. aeruginosa and 44.4% of Acinetobacter baumannii were resistant to imipenem. Total of 66 MDROs were isolated from blood culture and the result shows that the MRSA was 84.6% (56 case), carbapenmen-resistant Acinetobacter spp. was 10.6% (7 case), and vancomycin-resistant enterococci was 4.6% (3 case). CONCLUSION: The characteristics of HAIs in small and medium sized hospitals will be contributed to the decision making of governance policy for infection control and to provide comparable data for these hospitals.
Acinetobacter ; Acinetobacter baumannii ; Catheters, Indwelling ; Centers for Disease Control and Prevention (U.S.) ; Decision Making ; Escherichia coli ; Humans ; Imipenem ; Infection Control ; Methicillin ; Methicillin-Resistant Staphylococcus aureus ; Patients' Rooms ; Pneumonia ; Pneumonia, Ventilator-Associated ; Pseudomonas aeruginosa ; Rivers ; Staphylococcus aureus ; Urinary Tract Infections

OBJECTIVE: To compare inhibition of cell growth and apoptosis in human cervical cancer cell lines (CaSki) by paclitaxel, cisplatin, arsenic trioxide and tetraarsenic oxide. METHODS: Inhibition of cell growth was determined by the water-soluble tetrazolium salts (WSTs) -1 assay. For apoptosis analysis in CaSki cell line treated with single or combination of two agents, CaSki cell line treated with each agent was stained with annexin-V/PI and flow cytometry was performed. RESULTS: Progression of apoptosis in CaSki cell line treated with paclitaxel, cisplatin, arsenic trioxide, and tetraarsenic oxide was time dependent. Inhibition of cell growth in CaSki cell line by paclitaxel, cisplatin, arsenic trioxide, and tetraarsenic oxide was dose and time dependent. Especially, tetraarsenic oxide was more effective in inhibition of CaSki cell growth compared to arsenic trioxide. Group treated with combination of cisplatin and tetraarsenic oxide showed more progressive apoptosis compared to other combination group. CONCLUSION: Tetraarsenic oxide has more potent anti-tumor effects than other agents on CaSki cell line. We need to consider further study about antitumor effect of tetraarsenic oxide through clinical study.
Apoptosis ; Arsenic ; Arsenicals ; Cell Line ; Cisplatin ; Flow Cytometry ; Humans ; Oxides ; Paclitaxel ; Tetrazolium Salts ; Uterine Cervical Neoplasms

BACKGROUND: This study evaluated the clinical characteristics and risk factors associated with community and hospital onset MRSA isolated from patients admitted to a tertiary care teaching hospital. METHODS: The study was carried out on MRSA isolated from clinical specimens of patients admitted into the wards and the intensive care unit in a 2,200-bed tertiary care teaching hospital from January 1st through December 31st, 2007. In order to identify the risk factors associated with MRSA acquisition, the medical records were reviewed. All statistics were computed using SPSS version 14.0. RESULTS: Of the 835 MRSA isolates, 179 (21.4%) were CO-MRSA and 656 (78.6%) were HO-MRSA. Of the 179 CO-MRSA isolates, 6 (3.4%) were CA-MRSA. Multiple logistic regression analysis showed that a history of using medical device or antibiotics within 1 year before the isolation of MRSA were significant risk factors for HO-MRSA, and a history of hospitalization within 1 year before the isolation of MRSA was a significant risk factor for CO-MRSA. Analysis on the antibiotics administered within 1 year before the isolation of MRSA showed that levofloxacin, macrolides, 1st generation cephalosporins, 3rd generation cephalosporins, 4th generation cephalosporins, vancomycin, metronidazole, and carbapenem were all significant risk factors for HO-MRSA and that TMP/SMX was a significant risk factor for CO-MRSA. Of the 6 (3.4%) CA-MRSA isolates, 1 (16.7%) was the pathogen responsible for soft tissue infection. No patients died from the CA-MRSA infection. CONCLUSION: MRSA isolated from clinical specimens of patients admitted into the wards and the ICU in a tertiary care teaching hospital was usually HO-MRSA, CO-MRSA and HO-MRSA usually had at least one of the risk factors associated with MRSA acquisition, and CO-MRSA was mainly HACO-MRSA.
Anti-Bacterial Agents ; Cephalosporins ; Hospitalization ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Logistic Models ; Macrolides ; Medical Records ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Metronidazole ; Ofloxacin ; Risk Factors ; Soft Tissue Infections ; Tertiary Healthcare ; Vancomycin

BACKGROUND: This study was to evaluate a nationwide nosocomial infection rate and antimicrobial resistance in intensive care units(ICUs) in Korea. METHODS: The study was carried out at 16 university-affiliated teaching hospitals from July through October 2004. We performed a prospective multicenter study to investigate nosocomial infection rates, device-associated infection rated, and causative pathogens and their antimicrobial resistance. RESULTS: The urinary tract was the most commonly involved site. Nosocomial infection rate was 12.48 in medical. ICU (MICU), 9.59 in medical surgical ICU (MSICU), 14.76 in surgical ICU (MSICU), and 11.60 in other lCU. Device-associated infection rates were as follow: 1) rates of urinary catheter-associated urinary tract infection were 4.26 in MICU, 3.17 in SICU, 4.88 in MSICU, and 5.87 in other ICU; 2) rates of central line-associated bloodstream infection were 3.24 in MICU, 1.56 in SlCU, 2.36 in MSICU, and 1.78 in other ICU; 3) rates of ventilator-associated pneumonia were 3.61 in MlCU, 13.05 in SICU, 1.68 in MSICU, and 4.84 in other lCU. Staphylococcus aureus was the most frequently identified microorganism in this study; 93% of S. aurues were resistant to methicillin; 17% of Pseudomonas aeruginosa isolated were resistant to imipenem; 11% of Enterococcus faecium and 18% of Enterococcus faecalis showed resistance to vancomycin. Over a half of Acinetobacter spp, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Escherichia coli showed resistant to fluoroquinolone. Conclusion: This study shows the seriousness of antimicrobial resistance and the importance of infection control in the lCU in Korea. This study should provide a theoretical strategy to enforce the infection control.
Acinetobacter ; Cross Infection* ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Hospitals, Teaching ; Hospitals, University* ; Imipenem ; Infection Control ; Intensive Care Units* ; Critical Care* ; Klebsiella pneumoniae ; Korea* ; Methicillin ; Pneumonia, Ventilator-Associated ; Prospective Studies ; Pseudomonas aeruginosa ; Staphylococcus aureus ; Stenotrophomonas maltophilia ; Urinary Tract ; Urinary Tract Infections ; Vancomycin

Congenital solitary nonparasitic cysts of the liver are rare condition in all age groups. Since 1856, only approximately 900 cases having been reported in the world literature. Epidermoid cysts of the liver are extremely rare type of congenital nonparasitic hepatic cysts, characterized by a fibrous wall entirely lined with stratified squamous epithelium, but lacking hair or skin appendages. This condition has yet to be reported in Korea. Because they have a potential for malignant transformation, it is important to totally resect the epidermoid cyst of the liver. Recently, we experienced a case of 44-year-old female patient with epidermoid cyst of the liver, which condition was complicated by a secondary infection. For this patient, an enucleation of entire cyst was performed. Given the rarity of this case, the following is a report of this case and a review of the relevant literature.
Adult ; Coinfection ; Epidermal Cyst* ; Epithelium ; Female ; Hair ; Humans ; Korea ; Liver* ; Skin