PURPOSE: Nurses' knowledge regarding advance directives may affect their administration of and confidence towards end of life care. This study aimed to describe the relationships of knowledge, confidence, and learning needs with advance directives among hospital nurses.METHOD: This cross-sectional study was performed at a tertiary university hospital in Seoul between September 25 and October 14, 2017. Convenience sampling was used to recruit nurses who provided bedside care and had at least 1 year of clinical experience. We used a validated self-report questionnaire.RESULTS: The mean score of knowledge, confidence and learning needs were 5.00±1.73, 29.81±7.52, and 64.54±8.48 respectively. Hospital nurses' knowledge, confidence and learning needs were significantly different according to age, job position, educational level and perceived advance directives. Knowledge regarding advance directives was significantly associated with confidence (r = .27, p < .001) and learning needs (r = .16, p = .005).CONCLUSION: Knowledge regarding advance directives was relatively low compared to the findings of previous studies. Therefore, nurses should be knowledgeable and encouraged to initiate advance directives. It is necessary to develop a standardized educational program regarding advance directives based on Korean cultures.
Advance Directives ; Cross-Sectional Studies ; Learning ; Methods ; Seoul ; Terminal Care

PURPOSE: To report a case of migraine attacks with aura that occurred after percutaneous closure of an atrial septal defect (ASD) with the Amplatzer septal occluder device. CASE SUMMARY: A 58-year-old female presented with glare and scintillation that lasted 3 days. She had a history of percutaneous ASD intervention 3 weeks prior. Because ophthalmologic examination revealed nothing remarkable, the patient underwent observation. However, two months later, she revisited our department, presenting with aggravated glare, scintillation, and severe photophobia. Also, she presented with scintillation followed by a headache starting from the right temporal area extending to the occipital area. The patient was diagnosed with migraine with aura, which was newly developed after percutaneous ASD closure. After switching medication from acetylsalicylic acid to clopidogrel, the frequency and intensity of the headaches were reduced. No recurrence of ophthalmic symptoms or headache was observed during the 1-year follow-up. CONCLUSIONS: Percutaneous closure of ASD can be complicated by the appearance of migraine attacks with aura. When patients present with glare and scintillation, ophthalmologists must consider the possibility of migraine with aura and migraine induced by secondary causes. Thus, detailed history taking should be taken in order to make an early diagnosis of migraine.
Aspirin ; Early Diagnosis ; Epilepsy ; Female ; Follow-Up Studies ; Glare ; Headache ; Heart Septal Defects, Atrial* ; Humans ; Middle Aged ; Migraine Disorders* ; Migraine with Aura* ; Photophobia ; Recurrence ; Septal Occluder Device

High intakes of sodium may increase the risk of hypertension or cardiovascular diseases. According to the 2010 Korea National Health and Nutrition Survey, the average intake of sodium was 4,878 mg/day with salt, kimchi, soy sauce, fermented soybean paste and Ramyeon being the five main sources of sodium. In order to identify solutions to reduce the intake of sodium, we investigated the intake patterns and eating behaviors of Ramyeon among 347 college students (male 146, female 201) using survey questionnaires. The average age of study subjects was 23.7 years for males and 20.5 years for females. The average Body Mass Index (kg/m2) was 21.9 for males and 20.1 for females. The average frequency of Ramyeon intake was 2.0 times/week. The main reason for eating Ramyeon was convenience (56%), followed by good taste (27%), low price (11%) and other reasons (9%). The criteria for choosing Ramyeon were taste (72%), convenience (14%), price (7%), nutrition (1%), and the other factors (2%). Males' average intake of Ramyeon soup (61%) was higher than that of the females (36%). The estimated intake of Ramyeon soup by survey showed a positive correlation with the measured intake of Ramyeon soup. Sodium contents of Ramyeon were measured separately for the noodles and the soup, which were 1,185 mg/serving and 1,148 mg/serving each. Therefore, the amount of sodium intake can be reduced if students eat less Ramyeon soup. Also, we observed that dietary behaviors and soup intakes of Ramyeon between the sexes were different. Appropriate nutritional education for proper eating habits may help decrease the intake of sodium.
Body Mass Index ; Cardiovascular Diseases ; Eating ; Feeding Behavior ; Female ; Humans ; Hypertension ; Korea ; Male ; Nutrition Surveys ; Surveys and Questionnaires ; Sodium ; Soy Foods ; Soybeans

PURPOSE: Second-generation tyrosine kinase inhibitors (second TKIs) such as nilotinib and dasatinib control the activity of most ABL kinase domain mutations observed in patients with imatinib resistance. Although in vitro data show that both agents can inhibit all mutations except T315I, some discrepancies have been observed in a small subset of mutation clones. Cytogenetic clonal evolution is the important resistance mechanism of chronic myeloid leukemia (CML). Accordingly, we observed the clinical significance of coexisting with clonal evolution and BCR-ABL mutant in CML patients treated with second TKIs. MATERIALS AND METHODS: We monitored BCR-ABL transcript kinetics, interrelationship of clones expressing non-mutated and mutant transcripts and clonal aberrations within Philadelphia (Ph) positive and negative clones, respectively, in eight patients with CML receiving dasatinib or nilotinib for 3~41 months. RESULTS: Clinical responses were correlated with in vitro sensitivity of the BCR-ABL mutants to the second TKIs in four patients. Four patients showed resistance to the second TKIs as compared to in vitro observations; three of them developed chromosomal abnormalities in the Ph chromosome positive or negative metaphases. Another patient lost the original mutation but acquired a more resistant new mutation and became resistant to the second TKI. CONCLUSION: Cytogenetic clonal evolution is an independent poor prognostic factor in CML, which could explain the onset of mechanisms for second TKIs resistance to ABL kinase domain mutations. The results indicate that an additional evaluation of chromosomal abnormalities is warranted when BCR-ABL mutants are more resistant than indicated by in vitro data.
Benzamides ; Chromosome Aberrations ; Clonal Evolution ; Clone Cells ; Cytogenetics ; Dasatinib ; Humans ; Hydrogen-Ion Concentration ; Kinetics ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Metaphase ; Philadelphia ; Phosphotransferases ; Piperazines ; Protein-Tyrosine Kinases ; Pyrimidines ; Thiazoles ; Tyrosine ; Imatinib Mesylate

A refractory and resistant disease to conventional induction chemotherapy and relapsed disease are considered as the most important adverse prognostic factors for acute myeloid leukemia (AML). Sixty-one patients (median age, 33.6 yr) with relapsed or refractory AML were treated with the FLAG regimen that consisted of fludarabine (30 mg/m2, days 1-5), cytarabine (2.0 g/m2, days 1-5) and granulocyte colony-stimulating factor. Of the treated patients 29 patients (47.5%) achieved complete remission (CR). Higher CR rates were observed for patients with a first or second relapse as compared to patients with a primary refractory response or relapse after stem cell transplantation (HSCT). There was a significant difference in the response rates according to the duration of leukemia-free survival (pre-LFS) before chemotherapy (P=0.05). The recovery time of both neutrophils (> or =500/microL) and platelets (> or =20,000/microL) required a median of 21 and 18 days, respectively. Treatment-related mortality (TRM) occurred in seven patients (11.4%), of which 71.4% of TRM was caused by an invasive aspergillosis infection. After achieving CR, 18 patients underwent consolidation chemotherapy and six patients underwent allogeneic HSCT. In conclusion, FLAG chemotherapy without idarubicin is a relatively effective and well-tolerated regimen for relapsed or refractory AML and the use of FLAG chemotherapy has allowed intensive post-remission therapy including HSCT.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Cytarabine/*therapeutic use/toxicity ; Disease-Free Survival ; Female ; Granulocyte Colony-Stimulating Factor/*therapeutic use/toxicity ; Humans ; Idarubicin/therapeutic use ; Leukemia, Myeloid, Acute/*drug therapy/mortality ; Male ; Middle Aged ; Recurrence ; Treatment Outcome ; Vidarabine/*analogs & derivatives/therapeutic use/toxicity

A refractory and resistant disease to conventional induction chemotherapy and relapsed disease are considered as the most important adverse prognostic factors for acute myeloid leukemia (AML). Sixty-one patients (median age, 33.6 yr) with relapsed or refractory AML were treated with the FLAG regimen that consisted of fludarabine (30 mg/m2, days 1-5), cytarabine (2.0 g/m2, days 1-5) and granulocyte colony-stimulating factor. Of the treated patients 29 patients (47.5%) achieved complete remission (CR). Higher CR rates were observed for patients with a first or second relapse as compared to patients with a primary refractory response or relapse after stem cell transplantation (HSCT). There was a significant difference in the response rates according to the duration of leukemia-free survival (pre-LFS) before chemotherapy (P=0.05). The recovery time of both neutrophils (> or =500/microL) and platelets (> or =20,000/microL) required a median of 21 and 18 days, respectively. Treatment-related mortality (TRM) occurred in seven patients (11.4%), of which 71.4% of TRM was caused by an invasive aspergillosis infection. After achieving CR, 18 patients underwent consolidation chemotherapy and six patients underwent allogeneic HSCT. In conclusion, FLAG chemotherapy without idarubicin is a relatively effective and well-tolerated regimen for relapsed or refractory AML and the use of FLAG chemotherapy has allowed intensive post-remission therapy including HSCT.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Cytarabine/*therapeutic use/toxicity ; Disease-Free Survival ; Female ; Granulocyte Colony-Stimulating Factor/*therapeutic use/toxicity ; Humans ; Idarubicin/therapeutic use ; Leukemia, Myeloid, Acute/*drug therapy/mortality ; Male ; Middle Aged ; Recurrence ; Treatment Outcome ; Vidarabine/*analogs & derivatives/therapeutic use/toxicity

Rituximab is a chimeric monoclonal antibody that specifically targets the CD20 molecule on the B cell surface. Although rituximab was originally introduced for the treatment of lymphoid neoplasms such as non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL), it is now emerging as an effective and relatively safe therapeutic option for the patients with refractory immune thrombocytopenic purpura (ITP). We report here on a case of life-threatening toxic epidermal necrolysis (TEN) that was related with the use of rituximab in a patient with refractory ITP. The patient developed extensive erythematous papules and bullous lesions on his whole body associated with fever and visual disturbance during the second cycle of rituximab. The rituximab was discontinued and high dose intravenous immunoglobuline and steroid were administrated. Four weeks later, he fully recovered without any sequelae. A review of the literature reveals this to be the first reported case of TEN associated with rituximab injection in Korea.
Antibodies, Monoclonal, Murine-Derived ; Blister ; Epidermal Necrolysis, Toxic ; Fever ; Humans ; Immunoglobulins ; Korea ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymphoma, Non-Hodgkin ; Purpura, Thrombocytopenic, Idiopathic ; Rituximab

Primary non-Hodgkin's lymphoma of bone (PLB) is rare, and generally presents as a single extensive and destructive bone lesion. Histopathologically, most cases present as diffuse large B-cell lymphoma, and T-cell lymphoma is rare. By contrast, multiple myeloma is a disease defined as the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. We report a case of multiple myeloma that developed during treatment of PLB in a type of T-cell. A 48-yr-old man was diagnosed as T-cell PLB, stage IE, 18 months ago. The patient received the chemoradiotherapy and salvage chemotherapy for PLB. However, the lymphoma progressed with generalized bone pain, and laboratory findings showed bicytopenia and acute renal failure. On bone marrow biopsy, the patient was diagnosed as having multiple myeloma newly developed with primary T-cell lymphoma of bone. In spite of chemotherapy, the patient died of renal failure.
Bone Neoplasms/*complications/diagnosis/therapy ; Fatal Outcome ; Humans ; Kidney Failure, Acute/etiology ; Lymphoma, T-Cell/*complications/diagnosis/therapy ; Male ; Middle Aged ; Multiple Myeloma/*complications/diagnosis/therapy

This phase II study evaluated the efficacy and safety of combination chemotherapy with paclitaxel, cisplatin, and 5-fluorouracil (5-FU) in advanced gastric cancer. Patients with histologically confirmed gastric adenocarcinoma were eligible for the study. Paclitaxel (175 mg/m(2)) and cisplatin (75 mg/m(2)) were given as a 1-hr intravenous infusion on day 1, followed by 5-FU (750 mg/m(2)) as a 24-hr continuous infusion for 5 days. This cycle was repeated every 3 weeks. Forty-five eligible patients (median age, 56 yr) were treated in this way. Of the 41 patients in whom efficacy was evaluable, an objective response rate (ORR) was seen in 51.2% (95% CI, 0.35-0.67), a complete response in two, and a partial response in 19 patients. The median progression free survival was 6.9 months (95% CI, 5.86-7.94 months), and the median overall survival was 12.7 months (95% CI, 9.9-15.5). The main hematological toxicity was neutropenia and greater than grade 3 neutropenia was observed in twelve patients (54%). Febrile neutropenia developed in three patients (6.8%). The major non-hematological toxicities were asthenia and peripheral neuropathy, but most of patients showed grade 1 or 2. In conclusion, combination chemotherapy with paclitaxel, cisplatin, and 5-FU is a promising regimen, and was well tolerated in patients with advanced gastric cancer.
Adenocarcinoma/*drug therapy/mortality ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Cisplatin/administration & dosage ; Disease-Free Survival ; Female ; Fluorouracil/administration & dosage ; Humans ; Male ; Middle Aged ; Paclitaxel/administration & dosage ; Stomach Neoplasms/*drug therapy/mortality

BACKGROUND AND OBJECTIVES: Irregular RR intervals in atrial fibrillation (AF) results in beat to beat changes in hemodynamical parameters. Early diastolic mitral annulus velocity (E') is one of the parameters that represent diastolic function of the left ventricle (LV). In this study, we have investigated the effects of continuous changes of systolic functions in AF on the diastolic functions of the LV. SUBJECTS AND METHODS: E' (35-40 beats) was recorded in 31 AF patients that did not have significant valvular heart diseases. The relationships between preceding RR intervals (RR-1) or pre-preceding RR intervals (RR-2) and E's were obtained using a logarithmic function. RESULTS: Slopes between RR-1 and E' varied from -1.62 to 1.04 in total coordinates. In the logistic regression analysis patients with negative slopes were found to have a larger left atrial size than patients with positive slopes (5.5+/-0.67 cm vs. 4.9+/-0.56 cm, p=0.02). Slopes were negatively related with mean RR intervals in the Pearson correlation analysis (r=-0.40, p=0.028). Slopes between RR-2 and E' were also variable and were not associated with other parameters. CONCLUSION: Beat to beat changes in systolic functions derived from irregular RR intervals in AF had variable effects on diastolic functions among patients. The relationship between RR-1 and E' was associated with LA sizes and mean RR intervals.
Atrial Fibrillation ; Echocardiography, Doppler, Pulsed ; Electrocardiography ; Heart Valve Diseases ; Heart Ventricles ; Humans ; Logistic Models ; Ventricular Function, Left