Purpose: This study aimed to identify the variables related to the organizational silence of Korean hospital nurses and to examine the effect sizes of correlations between the related variables and sub-types of organizational silence. Methods: Relevant studies were searched through a systematic search in six Korean electronic databases (RISS, ScienceON, KCI, DBpia, e-Article, and KISS) using June 2022 as the end date. Thirteen studies were identified through a systematic review and eight of them were meta-analyzed. The correlation effect size r (ESr) for each related variable was calculated. Results: Twenty-two related variables were identified from the systematic review. Of them, organizational culture was the most frequently examined. Seven variables (three organizational, two leader-member exchange, and two consequences of organizational silence) were found eligible for the meta-analysis. The intention of turnover (ESr=.39; 95% confidence interval, 95% CI=.32 to .45) and leader-member exchange (“manager’s leaderships” ESr=-.33, 95% CI= -.43 to -.21; “manager’s inclination to reject negative feedback” ESr=.32, 95% CI=.23 to .39) had larger correlation effect sizes than the other variables that related to organizational silence, in particular, acquiescent silence, which had the largest correlation effect size among the three sub-types of organizational silence. Conclusion These findings show that the intention of turnover and leader-member exchanges were the main factors that related to the organizational silence. This indicates that it is necessary to develop management and education programs, as well as communication systems that focus on reducing and managing organizational silence, especially acquiescent silence.

PURPOSE: The purpose of this study was to adapt, modify, and validate the Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM©) for Korean nursing students. METHODS: Participants were 183 nursing students with clinical practice experience in two nursing colleges. The construct validity and reliability of the final Korean version of the NASC-CDM© were examined using exploratory and confirmatory factor analyses and testing of internal consistency reliability. For adaptation and modification, the instrument was translated from English to Korean. Expert review and a cross-sectional survey were used to test the instrument's validity. RESULTS: The Korean version of the NASC-CDM© (KNASC-CDM) was composed of 23 items divided into four dimensions: (i) Listening fully and using resources to gather information; (ii) Using information to see the big picture; (iii) Knowing and acting; and (iv) Seeking information from clinical instructors. The instrument explained 60.1% of the total variance for self-confidence and 63.1% of the variance for anxiety; Cronbach's α was .93 for self-confidence and .95 for anxiety. CONCLUSION: The KNASC-CDM can be used to identify anxiety and self-confidence in nursing students' clinical decision-making in Korea. However, further research should be done to test this instrument, as it is classified differently from the original NASC-CDM© version.
Anxiety ; Clinical Decision-Making ; Cross-Sectional Studies ; Humans ; Korea ; Nursing ; Reproducibility of Results ; Students, Nursing

PURPOSE: The purpose of this study was to adapt, modify, and validate the Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM©) for Korean nursing students. METHODS: Participants were 183 nursing students with clinical practice experience in two nursing colleges. The construct validity and reliability of the final Korean version of the NASC-CDM© were examined using exploratory and confirmatory factor analyses and testing of internal consistency reliability. For adaptation and modification, the instrument was translated from English to Korean. Expert review and a cross-sectional survey were used to test the instrument's validity. RESULTS: The Korean version of the NASC-CDM© (KNASC-CDM) was composed of 23 items divided into four dimensions: (i) Listening fully and using resources to gather information; (ii) Using information to see the big picture; (iii) Knowing and acting; and (iv) Seeking information from clinical instructors. The instrument explained 60.1% of the total variance for self-confidence and 63.1% of the variance for anxiety; Cronbach's α was .93 for self-confidence and .95 for anxiety. CONCLUSION The KNASC-CDM can be used to identify anxiety and self-confidence in nursing students' clinical decision-making in Korea. However, further research should be done to test this instrument, as it is classified differently from the original NASC-CDM© version.

BACKGROUND: We evaluated the reliability and accuracy of the combined use of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) bacterial identification and Vitek 2 antimicrobial susceptibility testing (AST) for bacteria from positive blood culture bottles. METHODS: Direct identification and AST were performed in parallel to the standard methods in monomicrobial positive blood culture bottles. In total, 254 isolates grown on aerobic and/or anaerobic bottles were identified with MALDI-TOF Vitek MS (bioMerieux, France), and 1,978 microorganism/antimicrobial agent combinations were assessed. For isolates from anaerobic bottles, an aliquot of the culture broth was centrifuged, washed, and filtered through a nylon mesh. For isolates from aerobic/pediatric bottles, a lysis step using 9.26% ammonium chloride solution and 2% saponin solution was included. RESULTS: The overall correct identification rate was 81.8% (208/254) and that for gram-positive/gram-negative isolates was 73.9%/92.6%, respectively, and it was 81.8%, 87.6%, and 57.9% for isolates from aerobic, anaerobic, and pediatric bottles, respectively. Identification was not possible in 45 cases, and most of these isolates were streptococci (N=14) and coagulase-negative staphylococci (N=11). Misidentification occurred only in one case. Compared with standard methods, direct AST showed 97.9% (1,936/1,978) agreement with very major error of 0.25%, major error of 0.05%, and minor error of 1.8%. CONCLUSIONS: This simple and cost-effective sample preparation method gives reliable results for the direct identification and AST of bacteria. For the identification of streptococci and coagulase-negative staphylococci, the method should be further improved.
Adult ; Ammonium Chloride/chemistry ; Anti-Infective Agents/*pharmacology ; Child ; Gram-Negative Bacteria/drug effects/*isolation & purification/metabolism ; Gram-Positive Bacteria/drug effects/*isolation & purification/metabolism ; Humans ; Reagent Kits, Diagnostic ; Saponins/chemistry ; *Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

PURPOSE: To develop and test the validity and reliability of the Korean version of the Moral Distress Scale-Revised (KMDS-R) to assess its applicability to Korean hospital nurses. METHODS: The KMDS-R was articulated through forward-backward translation methods. Internal consistency reliability, construct and criterion validity was calculated using SPSSWIN(19.0). Survey data were collected from 188 nurses from a university hospital in Gangwon-do, South Korea. RESULTS: The KMDS-R showed reliable internal consistency with a Cronbach's alpha of .69-.87 and a Guttman Split-half of .69-.82 for the total scale. Factor loading of the 21 items on the five subscales ranged from .41-.80. The KMDS-R was validated by factor analysis and explained 63% of moral distress for Korean hospital nurses. Criterion validity compared to Yoo's MDS showed significant correlation. CONCLUSION: The results suggest promising evidence of the KMDS-R's reliability and validity. It is used to measure moral distress for Korean hospital nurses.
Gangwon-do ; Korea ; Reproducibility of Results*

PURPOSE: Vascular endothelial growth factor (VEGF) levels in malignant ascites have high diagnostic value for their discrimination from asictes of non-malignant origin. However, there have been no reports on the comparison of VEGF levels between malignant ascites of chemonaive and chemotreated patients. MATERIALS AND METHODS: VEGF levels were measured in 44 ascites patients (cirrhosis ascites, 10; chemonaive patients, 21; chemotreated patients, 13) and compared to the level of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). The diagnostic parameters of sensitivity, specificity, and correlation among 3 markers were evaluated. RESULTS: VEGF levels in malignant ascites of chemonaive and chemotreated patients were significantly higher than those in cirrhotic ascites (p<0.05). VEGF levels in ascites of chemonaive patients were significantly higher than those in chemotreated patients (p<0.05). A cutoff value of 10.4pg/mL was calculated using receiver operating characteristic curves (ROCs) for VEGF in chemotreated and chemonaive patients, which gave sensitivities of 75.0% and 53.8% and specificities of 69.6% and 47.1%, respectively. Positive correlations were observed between VEGF and CEA (r=0.353, p<0.05) as well as between VEGF and CA19-9 (r=0.367, p<0.05) in ascites. CONCLUSION: VEGF levels could be a useful tumor marker for malignant ascites, but its value should carefully be interpreted because of lesser reliability in chemotreated ones.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ascites/*drug therapy/*metabolism/pathology ; CA-19-9 Antigen/metabolism ; Carcinoembryonic Antigen/metabolism ; Child ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Tumor Markers, Biological/metabolism ; Vascular Endothelial Growth Factor A/*metabolism

BACKGROUND: Atrophic gastritis is a well known risk factor for gastric adenocarcinoma. Its confirmatory diagnosis requires histology via endoscopy, which is an invasive method; therefore, periodic follow up evaluation as a screening method is difficult to perform. We evaluated the clinical utility of serum pepsinogens (PG) as a biomarker for screening of atrophic gastritis. METHODS: The study population consisted of 130 selected dyspeptic patients (M:F=52:78; age, 16-105 yrs; mean age, 50.8 yrs) who had undergone a diagnostic endoscopy. The serum pepsinogen test was performed by a latex turbidimetric immunoassay method (HBI, Korea) using Toshiba-200FR automatic analyzer. The PGI, II level and PGI:PGII ratio of non-atrophic gastritis group were compared with those of atrophic gastritis group, and a correlation with Helicobacter pylori infection was examined. Cut-off points for screening of atrophic gastritis were determined. RESULTS: The mean serum concentration of PGI showed a decline from normal (60.7 ng/mL), nonatrophic gastritis (54.2 ng/mL), and atrophic gastritis (51.8 ng/mL) to gastric adenocarcinoma (32.6 ng/mL). The mean ratio of PGI:PGII was lower in atrophic gastritis (3.2) compared to non-atrophic gastritis (4.7) (P=0.021). In patients with H. pylori infection, the mean serum PGII level was higher and the PGI:PGII ratio was lower than those in patients without H. pylori infection, and the differences were statistically significant. For screening of atrophic gastritis, the best cut-off point of PGI:PGII ratio was 4, with a sensitivity of 82.6% and specificity of 91.7%. CONCLUSIONS: The serum pepsinogen test is a useful biomarker for screening of atrophic gastritis, a well-known precancerous lesion of gastric adenocarcinoma. Measuring both pepsinogen I and II concentrations simultaneously to obtain pepsinogen I/II ratio provides a clinically useful information for the detection of atrophic gastritis.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Gastritis, Atrophic/*diagnosis ; Helicobacter Infections/diagnosis ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Nephelometry and Turbidimetry ; Pepsinogen A/*blood ; Pepsinogen C/*blood ; ROC Curve ; Reagent Kits, Diagnostic ; Sensitivity and Specificity

The bovine leukemia virus (BLV) is the causative agent of enzootic bovine leucosis. This study investigated the presence of the BLV in leukemia (179 acute lymphoblastic leukemia, 292 acute myeloid leukemia and 46 chronic myelogenous leukemia cases) and 162 lung cancer patients (139 adenocarcinoma, 23 squamous cell carcinoma) to determine if the BLV is a causative organism of leukemia and lung cancer in Koreans. A BLV infection was confirmed in human cells by PCR using a BLV-8 primer combination. All 517 cases of human leukemia and 162 lung cancer were negative for a PCR of the BLV proviral DNA. In conclusion, although meat has been imported from BLV endemic areas, the BLV infection does not appear to be the cause of human leukemia or lung cancer in Koreans. These results can be used as a control for further studies on the BLV in Koreans.
Acute Disease ; Adenocarcinoma/virology ; Cell Line ; DNA, Viral/*genetics/isolation & purification ; Humans ; Korea ; Leukemia/*virology ; Leukemia Virus, Bovine/*genetics ; Leukemia, Lymphocytic, Acute/virology ; Leukemia, Myeloid/virology ; Leukemia, Myeloid, Chronic/virology ; Lung Neoplasms/*virology ; Polymerase Chain Reaction/methods ; Proviruses/*genetics

BACKGROUND: Inorganic arsenic trioxide (As2O3) has emerged as a new drug of choice for refractory acute promyelocytic leukemia (APL). But, the curable disease spectrum and the arsenic resistance in association with the expression of multidrug resistance (MDR) proteins are not yet to be established. METHODS: Five de novo APL and 20 refractory acute leukemia cases were selected. Leukemic cells were cultured for 24 hr in media with various As2O3 concentrations. Apoptotic cells or damaged cells were measured by a morphologic examination after Wright stain and flow cytometry using annexin V/propidium iodide (PI) stain. The lowest concentration of As2O3 at which greater than 90% of leukemic cells were damaged morphologically was defined as the morphologic arsenic sensitivity of leukemic cells. MDR protein markers including multidrug resistance associated protein (MRP), lung resistance protein (LRP), P-glycoprotein (PGP) and glutathinoe-S-transferase (GST) were analyzed by flow cytometry. RESULTS: The leukemic cells from de novo APLs (in 3 of 5) were sensitive to arsenic trioxide, compared to refractory acute leukemia (only 1 of 20). Of the five MDR proteins examined, only PGP was expressed more in the arsenic resistant cases (in 8 of 21) than in the sensitive cases (none of 4) (P=.032). CONCLUSIONS: Refractory acute leukemia had a variable arsenic sensitivity, but were more resistant than de novo APL. The arsenic resistance seems to be related to PGP expression.
Arsenic ; Drug Resistance, Multiple ; Flow Cytometry ; Leukemia* ; Leukemia, Promyelocytic, Acute* ; Lung ; Multidrug Resistance-Associated Proteins ; P-Glycoprotein

BACKGROUND: Microscopic examination of the bone marrow (BM) smear has been a major method for the diagnostic and post-therapeutic evaluation of hematologic disease but is laborious and imprecise due to small number of cells counted. Recently, automated reticulocyte counting is available by the automated hematology analyzer. We analyzed the bone marrow aspirates using Coulter GEN S (GEN S) automated hematology analyzer and compared the results with those by the microscopic examination. METHODS: Total nucleated cells (TNC), leukocyte subpopulations, red cell count, hemoglobin and reticulocyte indices of the peripheral blood (PB) and the BM aspirates, were measured by GEN S in 392 samples including 142 normal control samples. Differential counts by microscopic examination of Wright stained BM films were used as a reference. RESULTS: TNC of the BM obtained by automated hematology analyzer correlated with the BM cel-lularity estimated by microscopic examination (r=0.587, P=0.000). The differential counts of neutrophils and monocytes correlated between these two methods (r=0.582, P=0.000, r=0.309, P=0.000). In acute leukemia, TNC of the PB and the BM, and the BM lymphocyte fraction were increased and the BM neutrophil fraction was decreased. In chronic myelogenous leukemia, TNC of the PB and the BM were high but distribution of leukocyte subpopulations was normal. In normal control group, the number of erythroid precusors correlated with the percentages of reticulocyte in the PB (r=0.425, P=0.000), and in patients with increased erythropoiesis, it showed strong correlation with immature reticulocyte fraction (IRF) of the PB (r=0.708, P=0.033). In aplastic anemia, IRF of the PB was reversely correlated to hemoglobin level, but in myelodysplastic syndrome, reticulocyte indices of the PB and the BM had no correlation with hemoglobin level. In patients with increased erythropoiesis, the percentages of reticulocyte in the PB were increased and those of the BM were decreased in proportion to reduction of hemoglobin level in the PB. CONCLUSIONS: Analysis of the BM aspirates using automated hematology analyzer will be useful in screening of pathological hematologic diseases and in estimating the bone marrow cellularity objectively before those by the microscopic examination. In anemia, this study could provide an additional information to evaluate the ineffective hematopoiesis using reticulocyte indices of the PB and the BM.
Anemia ; Anemia, Aplastic ; Bone Marrow* ; Cell Count ; Erythropoiesis ; Hematologic Diseases ; Hematology* ; Hematopoiesis* ; Humans ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukocytes ; Lymphocytes ; Mass Screening ; Monocytes ; Myelodysplastic Syndromes ; Neutrophils ; Reticulocyte Count ; Reticulocytes