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BACKGROUND: Pressure ulcers (PUs) are a common and serious complication in patients who are immobile in health care settings. Nurses play a fundamental role in the prevention of PUs; however, novice nurses lack experience in clinical situations. Virtual reality (VR) is highly conducive to clinical- and procedure-focused training because it facilitates simulations. OBJECTIVE: We aimed to explore the feasibility of a novel PU management VR simulation (PU-VRSim) program using a head-mounted display for novice nurses and to investigate how different types of learning materials (ie, VR or a video-based lecture) impact learning outcomes and experiences. METHODS: PU-VRSim was created in the Unity 3D platform. This mixed methods pilot quasi-experimental study included 35 novice nurses categorized into the experimental (n=18) and control (n=17) groups. The PU-VRSim program was applied using VR in the experimental group, whereas the control group received a video-based lecture. The PU knowledge test, critical thinking disposition measurement tool, and Korean version of the General Self-Efficacy Scale were assessed before and after the intervention in both groups. After the intervention, the experimental group was further assessed using the Clinical Judgment Rubric and interviewed to evaluate their experience with PU-VRSim. RESULTS: The results compared before and after the intervention showed significant improvements in PU knowledge in both the experimental group (P=.001) and control group (P=.005). There were no significant differences in self-efficacy and critical thinking in either group. The experimental group scored a mean of 3.23 (SD 0.44) points (accomplished) on clinical judgment, assessed using a 4-point scale. The experimental group interviews revealed that the VR simulation was realistic and helpful for learning about PU management. CONCLUSIONS: The results revealed that PU-VRSim could improve novice nurses' learning of PU management in realistic environments. Further studies using VR for clinical training are recommended for novice nurses.

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AIM: To examine self-care behaviours among older adults with hypertension and identify related factors, including cognitive function, religious belief and comorbidities. DESIGN: A cross-sectional study. METHODS: Self-care behaviours included diet and health. Participants completed a survey including items on demographics, disease-related characteristics and self-care behaviours and underwent cognitive function tests. Data were analysed using descriptive statistics, and multiple regression analysis was performed to analyse the factors affecting self-care. RESULTS: Regarding diet behaviour, older religious adults and those with higher scores on the Montreal Cognitive Assessment-Korean version had higher levels of self-care scores according to the HBP-SC. Regarding health behaviour, older adults with no comorbidities had higher levels of self-care scores according to the HBP-SC. CONCLUSION: Factors affecting self-care diet behaviour include religion and Montreal Cognitive Assessment-Korean version scores and those affecting health behaviour include comorbidities among older adults with hypertension. Therefore, to improve their self-care behaviours, their religious practices and comorbidities should be considered, cognitive function should be assessed, and tailored education should be provided. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study investigated factors affecting self-care behaviours of hypertensive older adults in South Korea. The self-care was divided into diet and health behaviours. The factors influencing diet behaviour were religion and Montreal Cognitive Assessment-Korean version scores, and the factor influencing health behaviour was comorbidities. We also investigated self-care behaviour patterns. Older adults with hypertension were good at controlling alcohol consumption and did not forget to fill prescriptions. However, they were poor at reading nutrition labels to check on sodium content and checking blood pressure at home. Therefore, nurses could develop interventions considering these influencing factors and behavioural patterns to improve self-care behaviours and enhance health for older adults with hypertension. IMPACT: Hypertension in older adults affects their health conditions and performance of self-care behaviours. Nurses could assess self-care based on diet and health behaviours. Additionally, further developing tailored programmes is recommended considering factors like religious belief, cognitive function and comorbidities. REPORTING METHOD: This study followed the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: This study used a convenience sample of 105 participants aged ≥ 65 years recruited from a Korean hospital.

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We report a case of salvage lymphadenectomy for an isolated metastatic lesion in the para-aortic lymph node (LN) in a 49-year old woman with a history of cervical cancer, initially treated with radical hysterectomy and adjuvant radiotherapy. Preoperative 3-dimensional (3D) computed tomography (CT) angiography clearly revealed a huge retro-crural metastatic LN with distinct demarcation. A metastatic lesion, more than 10 cm in size, was located behind the vena cava, aorta, and left kidney, encompassing the left renal and lumbar arteries. The metastatic LN was excised along with the left kidney. On histologic examination, the tumor was found to have invaded the pelvis of the left kidney. Compared with conventional imaging techniques, 3D CT angiography can more clearly visualize such lesions. Thus, 3D CT angiography provides useful anatomical information, such as the exact size and location, and provides clear visualization and demarcation.

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15-Deoxy-Delta(12,14)-prostaglandin J(2) (15-deoxy-PGJ(2)), a naturally occurring ligand, activates the peroxisome proliferator-activated receptor-gamma (PPAR-gamma). Activation of PPAR-gamma has been found to induce cell differentiation in such cells as adipose cells and macrophages. Herein, we investigated whether 15-deoxy-PGJ(2) has neuronal cell differentiation and possible underlying molecular mechanisms. Dopaminergic differentiating PC-12 cells treated with 15-deoxy-PGJ(2) (0.2 to 1.6 microM) alone showed measurable neurite extension and expression of neurofilament, a marker of cell differentiation. However, a much greater extent of neurite extension and expression of neurofilament was observed in the presence of NGF (50 ng/ml). In parallel with its increasing effect on the neurite extension and expression of neurofilament, 15-deoxy-PGJ(2) enhanced NGF-induced p38 MAP kinase expression and its phosphorylation in addition to the activation of transcription factor AP-1 in a dose-dependent manner. Moreover, pretreatment of 4-(4-fluorophenyl)-2-(4-methylsulfinylphenyl)-5-(pyridyl)1H-imidazole (SB203580), a specific inhibitor of p38 MAP kinase, inhibited the promoting effect of 15-deoxy-PGJ(2) (0.8 microM) on NGF-induced neurite extension. This inhibition correlated well with the ability of SB203580 to inhibit the enhancing effect of 15-deoxy-PGJ(2) on the expression of p38 MAP kinase and activation of AP-1. The promoting ability of 15-deoxy-PGJ(2) did not occur through PPAR-gamma because synthetic PPAR-gamma agonist and antagonist did not change the neurite-promoting effect of 15-deoxy-PGJ(2). In addition, contrast to other cells (embryonic midbrain and neuroblastoma SK-N-MC cells), PPAR-gamma was not expressed in PC-12 cells. Other structure-related prostaglandins (PGD(2) and PGE(2)) acting via a cell surface G-protein-coupled receptor (GPCR) did not increase basal or NGF-induced neurite extension. Moreover, GPCR (PGE(2) and PGD(2) receptors) antagonists did not alter the promoting effect of 15-deoxy-PGJ(2) on neurite extension and activation of p38 MAP kinase, suggesting that the promoting effect of 15-deoxy-PGJ(2) may not be mediated by GPCR either. These data demonstrate that activation of p38 MAP kinase in conjunction with AP-1 signal pathway may be important in the promoting activity of 15-deoxy-PGJ(2) on the differentiation of PC-12 cells.

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