Conceptual Analysis of Career Anchors of Nurses

Purpose@#This study aimed to provide a theoretical basis for career anchors of nurses by defining and organizing its concept. @*Methods@#Using the Walker and Avant concept analysis, a total of 29 articles were analyzed through a literature search in this study. @*Results@#The career anchors of nurses are individual career choice motives, a self-concept where in competency and values are harmonized, which act as a desire for growth and development in nursing, and are actions that maintain careers. Additionally, they indicate the direction for achieving individual career goals and act as a core value expected of nurses by nursing organizations, indicating continuous and integrated professional growth and development of the nursing profession. @*Conclusion@#The career anchors of nurses identified in the results contribute to securing patient safety, providing quality care through policies, institutionalizing bases for career development, preventing nurse turnover, and retaining skilled nurses.

Experiences of Accessing Medical Services after Diagnosis in Breast Cancer Survivors / 재활간호학회지

Purpose@#This study comprehensively examined the experiences of breast cancer survivors' while accessing healthcare facilities for developing nursing intervention programs to enhance and maintain patients' health. @*Methods@#As part of this qualitative study, focus group interviews were conducted with six breast cancer survivors from December 30, 2020, to April 30, 2021. @*Results@#Qualitative data analysis revealed four themes and nine sub-themes using a medical institution after diagnosis in breast cancer survivors. Four themes were ‘burden that individuals still have to bear’, ‘hospital situation that is not patient-centered’, ‘alternative ways to get information and support from the other resources’, and ‘the journey of long-term treatment and management’. Discussion: To improve the quality of life in breast cancer survivors, it is vital to establish medical services that consider the characteristics of each stage of the disease, in addition to support hospitals and social policy programs that can address the unmet needs of the survivors.

Factors Influencing Self-Confidence in Performance of Infection Control for Multi-Drug Resistant Organisms among Nurses in Long-Term Care Hospitals / 기본간호학회지

Purpose@#This was a descriptive research survey study to assess support for resources, organizational culture, knowledge, and self-confidence in the performance of infection control of multidrug-resistant organism (MDROs) perceived by nurses in long-term care hospitals, and to confirm influencing factors of such perception on self-confidence in performance. @*Methods@#The participants were 192 nurses in 11 long-term care hospitals located in Daejeon Metropolitan City. Data collection was done from January 8 to February 17, 2020. Collected data were analyzed using independent sample t-test, one-way ANOVA, Pearson correlation coefficient, and multiple regression analysis with the IBM SPSS statistics 25.0 program. @*Results@#Organizational culture for infection control (β=.22), knowledge on MDROs infection control (β=.19), and experiences in education on MDROs infection control within the last year (β=.15) were found to be the factors most influencing self-confidence in performance of the nurses for MDROs infection control, and explained about 14.5%. @*Conclusion@#In order to increase self-confidence in performance of MDROs infection control, it is suggested a positive organizational culture be developed with regularly monitoring and feedback, and to develop an MDROs infection control theory and practical training intervention program.

Analysis of Health management Awareness and Practice Experience of Breast Cancer Survivors using Focus Group Interviews / 재활간호학회지

Purpose@#The purpose of the present study was to understand and identify, in depth, the position and perspectives of breast cancer survivors by comprehensively investigating their health management awareness and practice experience. @*Methods@#This study is a qualitative research using focus group interviews. Six breast cancer survivors voluntarily agreed to participate in the study in cooperation with the patient group in D city. Data were collected from May to August, 2019, in six sessions and analyzed using the content analysis method. @*Results@#The results showed that the health management awareness and practice experience of breast cancer survivors were concentrated in five areas: “improvement in lifestyle habits to recover health”, “discovering how to deal with psychosocial difficulties”, “multilateral efforts on treatment process or disease”, “pursuing changes in family and social relationships” and “changes in the perspectives of religious beliefs and death” as well as 10 sub-topics. @*Conclusion@#Breast cancer survivors were managing the health to prevent relapse and metastasis through various efforts to systematically manage these patients health, healthcare models should be developed, and policy support should be made available.

Unmet Needs for Job Maintenance of Breast Cancer Survivors / 기본간호학회지

Purpose@#To develop and apply an integrative model for breast cancer survivors’ return to work, survivors’unsatisfied demands for job maintenance were identified. @*Methods@#This study was a qualitative research that used a focus group to investigate breast cancer survivors’ unsatisfied demands for job maintenance. Data collection was conducted four times from February to October 2019 with six participants. @*Results@#The study showed that the six participants identified the following unsatisfied demands for breast cancer survivors who returned to work: the individual’s physical and psychological condition, attitudes and support from family, work-related characteristics, the healthcare system, and social (political) issues. Thirteen sub-topics were identified. @*Conclusion@#This study provided necessary data to prepare a strategy for breast cancer survivors to return to work and proposed to develop an integrative model and a professional training program in further research.

Neurodevelopmental Prognostic Factors in 73 Neonates with the Birth Head Injury / 대한신경손상학회지

OBJECTIVE: The objective of this study was to reinterpret the neurodevelopmental prognostic factors that are associated with birth head injury by performing a long-term follow-up. METHODS: Seventy-three neonates with head injuries were retrospectively analyzed after a duration of 10.0±7.3 years to determine the correlations between perinatal factors, including gender, head circumference, gestational age, body weight, and mode of delivery, and head injury factors from radiologic imaging with social, fine motor, language, and motor developmental quotients. RESULTS: There was a statistically significant difference between perinatal factors and head injury factors with respect to head circumference, body weight, gestational age, mode of delivery, Apgar scores at 1 min, cephalohematoma, subdural hemorrhage, subarachnoid hemorrhage, and hypoxic injury, but no direct correlation by regression analysis was observed between perinatal factors and developmental quotients. Of the head injury factors, falx hemorrhage showed a significant indirect relationship with the language and motor developmental quotients. Mode of delivery, subgaleal hematoma, cephalohematoma, greenstick skull fracture, epidural hemorrhage (EDH), tentorial hemorrhage, brain swelling, and hypoxic injury showed an indirect relationship with social development. CONCLUSION: In terms of perinatal factors and head injury factors, mode of delivery, subgaleal hematoma, cephalohematoma, greenstick skull fracture, EDH, tentorial hemorrhage, falx hemorrhage, brain swelling, and hypoxic injury displayed an indirect relationship with long-term development, and therefore these factors require particular attention for perinatal care.

Masked inherited primary arrhythmia syndromes in sudden cardiac death patients accompanied by coronary vasospasm

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.

Analgesic and anti-inflammatory effects of UP1304, a botanical composite containing standardized extracts of Curcuma longa and Morus alba / 中西医结合学报

<p><b>OBJECTIVE</b>Though the initial etiologies of arthritis are multifactorial, clinically, patients share the prime complaints of the disease, pain. Here the authors assessed the analgesic and anti-inflammatory effects of UP1304, a composite that contains a standardized blend of extracts from the rhizome of Curcuma longa and the root bark of Morus alba, on rats with carrageenan-induced paw edema.</p><p><b>METHODS</b>A plant library was screened for bradykinin receptor antagonists. In vivo, the anti-inflammatory and analgesic effects of the standardized composite, UP1304, were evaluated in rats with carrageenan-induced paw edema using oral dose ranges of 100-400 mg/kg. Ibuprofen, at a dose of 200 mg/kg, was used as a reference compound. In vitro, cyclooxygenase (COX) and lipoxygenase (LOX) inhibition assays were performed to evaluate the degree of inflammation.</p><p><b>RESULTS</b>Statistically significant improvements in pain resistance and paw edema suppression were observed in animals treated with UP1304, when compared to vehicle-treated rats. Results from the highest dose of UP1304 (400 mg/kg) were similar to those achieved by ibuprofen treatment at 200 mg/kg. In vitro, UP1304 showed dose-dependent inhibition of the enzymatic activities of COX and LOX. A half-maximal inhibitory concentration of 9.6 μg/mL for bradykinin B1 inhibition was calculated for the organic extract of C. longa. Curcumin showed Ki values of 2.73 and 58 μg/mL for bradykinin receptors B1 and B2, respectively.</p><p><b>CONCLUSION</b>Data presented here suggest that UP1304, analgesic and anti-inflammatory agent of botanical origin, acted as a bradykinin receptor B1 and B2 antagonist, and inhibited COX and LOX enzyme activities. This compound should be considered for the management of symptoms associated with arthritis.</p>

Chlamydospore Induction from Conidia of Cylindrocarpon destructans Isolated from Ginseng in Korea

Cylindrocarpon destructans causes root rot disease in ginseng and can survive for a long time, producing chlamydospores. We optimized conditions to induce chlamydospore production from the conidia of C. destructans, isolated from Korean ginseng. This will provide the basis for testing the efficacy of control agents targeting these chlamydospores.

Cariogenic Activity in Saliva of Korean Head and Neck Cancer Patients

The purpose of this study is to evaluate salivary flow rate, salivary pH, and cariogenic activity using unstimulated saliva of the head and neck cancer patients. Twenty three cancer patients (19 males, 4 females) who had undergone chemotherapy and radiation therapy and twenty four healthy volunteers (14 males, 10 females) as a control were included. Salivary flow rate, salivary pH, and cariogenic activity using unstimulated saliva were examined. Compared to saliva of the control group, salivary flow rate (p<0.001) and salivary pH (p<0.001) were significantly lower in head and neck cancer patients. The colony counts of Lactobacilli was higher in head and neck cancer patients (p<0.05) than in control group. These salivary factors and cariogenic activity can increase the prevalence of dental caries in head and neck cancer patients.

Relationships among Burnout, Job Satisfaction, Organizational Commitment and Turnover Intention to Resign in Hospital Nurses / 한국직업건강간호학회지

PURPOSE: This study aims to find out ultimate forecasting factors of intention to resign by examining the degree of burnout, job satisfaction, organizational commitment and turnover intention to resign in hospital nurses and to look into the differences among them according to general characteristics. METHODS: This study used investigation of relationships to analyze relations among burnout, job satisfaction, organizational commitment and turnover intention to resign in hospital nurses to find out factors influencing turnover intention to resign in hospital nurses. RESULTS: This study revealed that the higher job dissatisfaction and burnout of hospital nurses, the higher turnover intention to resign. This study also showed that the higher burnout caused the lower job satisfaction which led to resignation and a forecasting factor that influenced turnover intention to resign was burnout. CONCLUSION: It is necessary to conduct continuous and systematic research and to seek ways that can prevent the resignation of nurses and improve job satisfaction in hospital nurses.

Peroxisome proliferator-activated receptor gamma agonist suppresses human telomerase reverse transcriptase expression and aromatase activity in eutopic endometrial stromal cells from endometriosis / 대한생식의학회지

OBJECTIVE: To investigate the effect of peroxisome proliferator activated receptor gamma (PPARgamma) agonist on the cell proliferation properties and expression of human telomerase reverse transcriptase (hTERT) and aromatase in cultured endometrial stromal cell (ESC) from patients with endometriosis. METHODS: Human endometrial tissues were obtained from women with endometriosis and healthy women (controls) using endometrial biopsy. Isolated ESCs were cultured and the cell proliferation was measured by 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide assay and expression of hTERT, aromatase, and cyclooxygenase (COX)-2 by western blotting according to the addition of rosiglitazone (PPARgamma agonist). RESULTS: We demonstrate that the cultured ESCs of endometriosis showed hTERT protein overexpression and increased cellular proliferation, which was inhibited by rosiglitazone, in a dose-dependent manner. At the same time, PPARgamma agonist also inhibited aromatase and COX-2 expression, resulting in decreased prostaglandin E2 production in the ESCs of endometriosis. CONCLUSION: This study suggests that PPARgamma agonist plays an inhibitory role in the proliferative properties of eutopic endometrium with endometriosis by down-regulation of hTERT and COX-2 expression; this could be a new treatment target for endometriosis.

Korean Guidelines for Pediatric Procedural Sedation and Analgesia

Procedural sedation and analgesia (below PSA), which is used for induction of appropriate sedation and elimination of pain during many procedures, is particularly essential for children. Many other countries have pediatric PSA guidelines. PSA guidelines are also needed in Korea. We have developed pediatric PSA guidelines for Korea by reference review of pediatric PSA for standard and safe PSA practice in Korea. Pharmacologic and non-pharmacologic methods could be used for performance of ideal pediatric PSA. Pre sedation phase included assessment of patients, with accompanying personnel who have adequate knowledge and experience, and informed consent. For sedation phase, the route of medication should be determined, along with monitoring of patients and evaluation of the depth of sedation. This phase also included writing all of the PSA process, adverse events, and intervention. Considering the pain of the procedures, the time of procedures, necessity for immobilization, and characteristics of PSA medication, we decided on the PSA method. Procedures were categorized into three types according to the level of pain, anxiety, and immobilization. The first type was radiologic imaging, which requires immobilization. The second type of procedure involves a high level of anxiety and a low level of pain, such as simple suturing and lumbar puncture. The third type of procedure involves a high level of anxiety and a high level of pain, such as reduction of fracture and dislocation. After performance of the procedure, patients must be observed and monitored at a location where oxygen and airway management can be applied until they reach full recovery. Discharge information should be provided to competent parents. The main characteristics of Korean guidelines for pediatric PSA were as follows: 1. We emphasized assessment and monitoring of patients during and after PSA. 2. We suggested selection of medication by categorization of procedures according to the level of pain and anxiety. 3. We suggest that PSA be performed by two healthcare personnel; one should have adequate knowledge and experience in performance of PSA. More equipment, locations, and specialized personnel are needed for conduct of safe pediatric PSA practice in Korea.

The Effects of A Day Care Rehabilitation Program on Physical and Emotional Function of Patients with Job-related Injury / 재활간호학회지

PURPOSE: The purpose of this study was to examine the effects of a day care rehabilitation program managed by nurses on physical and emotional function of patients with job-related injuries. METHOD: A one group pre-test and post-test quasi-experimental design was used. Thirty patients participated in a day care rehabilitation program and 9% of those were unable to complete the 16 weeks program due to absence. The physiotherapist, occupational therapist, and clinical psychologist offered the day care rehabilitation program, 5 times a week for 16 weeks. Outcome measures included physical and emotional function. RESULTS: The program participants had significantly greater motor function (t=-2.85, p=.008) and activity of daily living (t=-5.34, p<.001), and lower depression (t=5.20, p<.001), state anxiety (t=4.71, p<.001), and trait anxiety (t=4.40, p<.001). CONCLUSION: The nurse managed day care rehabilitation program significantly improved physical and emotional function in patients with job-related injuries. The program should be further tested in a larger sample to validate the findings.

Concept Analysis of Patient Safety

PURPOSE: This study was conducted to investigate the clear concept of patient safety and obtain theoretical evidences. METHODS: Research was conducted using Walker & Avant's conceptual analysis process. RESULTS: Patient safety was defined as an activity that minimizes and removes possible errors and injuries to patients. It includes a basic desire to secure the patient's right to safety, and the legal regulations and duties of medical teams. The results of the establishment of a safety culture are patient-centered medical treatment and caring. Antecedents were found to be open and clear communications, continuous education and training for health care personnel, sufficient allocation of qualified personnel, cooperation among departments, improvements in the recognition of patient safety. Consequences were found to be the provision of high quality medical care and treatment, and increase in patient satisfaction. CONCLUSION: Patient safety as defined by the results of this study will contribute to the foundation of institutionalization of the pursuit of patient safety and creation of a hospital culture focusing on patient safety as a first priority.

Sclerosing Polycystic Adenosis of the Parotid Gland: A Case Report

Sclerosing polycystic adenosis (SPA) of the salivary glands is a rare entity analogous to fibrocystic disease of the breast. Less than 50 cases of SPA have been published in the literature. We report the first Korean case of SPA of the right parotid gland. A 34-year-old man presented with a slowly growing right parotid mass. Computed tomography showed a relatively well-demarcated, heterogeneously enhancing mass with multiple small calcifications. Fine needle aspiration showed cohesive sheets of epithelial cells with granular oncocytic cytoplasm and scattered lymphocytes. The parotidectomy specimen showed a 3 cm-sized solid nodular lesion with small cysts. Microscopically, the lesion was an unencapsulated mass of sclerotic fibrous tissue with cystic ducts, multiple calcifications, and lymphoplasma cell infiltration. Sclerosing adenosis and cystic ducts with frequent apocrine-like cells were noted. Familiarity with the cytologic and histological features of SPA is very important making the correct diagnosis.

Sclerosing Polycystic Adenosis of the Parotid Gland: A Case Report

Sclerosing polycystic adenosis (SPA) of the salivary glands is a rare entity analogous to fibrocystic disease of the breast. Less than 50 cases of SPA have been published in the literature. We report the first Korean case of SPA of the right parotid gland. A 34-year-old man presented with a slowly growing right parotid mass. Computed tomography showed a relatively well-demarcated, heterogeneously enhancing mass with multiple small calcifications. Fine needle aspiration showed cohesive sheets of epithelial cells with granular oncocytic cytoplasm and scattered lymphocytes. The parotidectomy specimen showed a 3 cm-sized solid nodular lesion with small cysts. Microscopically, the lesion was an unencapsulated mass of sclerotic fibrous tissue with cystic ducts, multiple calcifications, and lymphoplasma cell infiltration. Sclerosing adenosis and cystic ducts with frequent apocrine-like cells were noted. Familiarity with the cytologic and histological features of SPA is very important making the correct diagnosis.

Heart-type Fatty Acid Binding Protein as an Adjunct to Cardiac Troponin-I for the Diagnosis of Myocardial Infarction

We hypothesized that when used in combination with cardiac troponins, heart-type fatty acid binding protein (H-FABP) would have greater diagnostic value than conventional markers for the early diagnosis of myocardial infarction (MI). Patients with typical chest pain at a single emergency department were consecutively enrolled. Initial blood samples were drawn for H-FABP, myoglobin, creatine kinase isoenzyme MB (CK-MB), and cardiac troponin-I (cTnI) measurements. MI was defined by serial cTnI measurements. To evaluate the adjunctive role of biochemical markers, we derived and compared logistic regression models predicting MI in terms of their discrimination (area under the receiver operating characteristics curve, AUC) and overall fit (Bayesian information criterion, BIC). Seventy-six of 170 patients were diagnosed as having MI. The AUC of cTnI, H-FABP, myoglobin, and CK-MB were 0.863, 0.827, 0.784, and 0.772, respectively. A logistic regression model using cTnI (P = 0.001) and H-FABP (P < 0.001) had the biggest AUC (0.900) and the best fit determined by BIC. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of this model at 30% probability were 81.6%, 80.9%, 4.26, and 0.23, respectively. H-FABP has a better diagnostic value than both myoglobin and CK-MB as an adjunct to cTnI for the early diagnosis of MI.

Heart-type Fatty Acid Binding Protein as an Adjunct to Cardiac Troponin-I for the Diagnosis of Myocardial Infarction

We hypothesized that when used in combination with cardiac troponins, heart-type fatty acid binding protein (H-FABP) would have greater diagnostic value than conventional markers for the early diagnosis of myocardial infarction (MI). Patients with typical chest pain at a single emergency department were consecutively enrolled. Initial blood samples were drawn for H-FABP, myoglobin, creatine kinase isoenzyme MB (CK-MB), and cardiac troponin-I (cTnI) measurements. MI was defined by serial cTnI measurements. To evaluate the adjunctive role of biochemical markers, we derived and compared logistic regression models predicting MI in terms of their discrimination (area under the receiver operating characteristics curve, AUC) and overall fit (Bayesian information criterion, BIC). Seventy-six of 170 patients were diagnosed as having MI. The AUC of cTnI, H-FABP, myoglobin, and CK-MB were 0.863, 0.827, 0.784, and 0.772, respectively. A logistic regression model using cTnI (P = 0.001) and H-FABP (P < 0.001) had the biggest AUC (0.900) and the best fit determined by BIC. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of this model at 30% probability were 81.6%, 80.9%, 4.26, and 0.23, respectively. H-FABP has a better diagnostic value than both myoglobin and CK-MB as an adjunct to cTnI for the early diagnosis of MI.

Utility of quantitative procalcitonin level and abbreviated MEDS scoring system as prognostic factors of sepsis patients in the emergency department

PURPOSE: Procalcitonin (PCT) is a newly introduced marker of systemic bacterial infection. The MEDS (Mortality in Emergency Department Sepsis) scoring system has proven to be the most useful and appropriate clinical prediction tool in cases of systemic bacterial infection in the emergency department. There have been no studies comparing the PCT assay with the abbreviated MEDS scoring system (without neutrophil bands). This study aimed to determine the efficacy of quantitative PCT assay and the abbreviated MEDS score in predicting the 28-day mortality and intensive care unit (ICU) admission in emergency department patients with systemic inflammatory response syndrome (SIRS). METHODS: This study was carried out prospectively on 212 patients >18-years-of-age with the criteria of SIRS who had visited to the emergency department. They were included if they had an emergency department diagnosis of sepsis, two or more SIRS criteria. We checked the initial PCT concentration and calculated abbreviated MEDS score. The primary outcome was 28-day mortality and ICU admission. We evaluated the predictive abilities of the initial PCT assay and abbreviated MEDS score. Receiver operating characteristic (ROC) curves were used to identify the value of PCT and abbreviated MEDS scoring system that maximized the sum sensitivity and specificity. RESULTS: Among the 212 patients included in this study, the mortality rate was 21%(45 of 212 patients) and the ICU admission rate was 33%(70 of 212 patients). Non-survivor group had a significantly higher PCT concentration (median, interquartile range (IQR), 12.23 ng/mL, 2.33-39.77 vs. 0.58 ng/mL, 0.10-3.60, p=0.05) and a higher abbreviated MEDS score (12.62+/-4.33 vs. 5.53+/-3.57, p<0.05) than the survival group. ICU admission patients had a significantly higher PCT concentration (median, IQR, 7.75 ng/mL, 1.43-36.85 vs. 0.55 ng/mL, 0.08-3.03 p<0.05) and a higher abbreviated MEDS score (10.90+/-4.60 vs. 5.13+/-3.48, p<0.05) than general ward admission patients. ROC analysis showed the discriminative power of the abbreviated MEDS score and PCT assay in predicting ICU admission and 28-day mortality. For ICU admission, areas of under the curves (AUC) of abbreviated MEDS score and PCT were 0.842 and 0.749, respectively (p<0.05). For PCT, AUC of abbreviated MEDS and PCT were 0.888 and 0.784, respectively (p<0.05). The optimal PCT threshold in predicting ICU admission was 1.22 ng/mL (odds ratio (OR), 6.92; 95% confidence interval (CI), 3.51-13.63; p<0.05) and 1.90 ng/mL in predicting 28-day mortality (OR, 11.90; 95% CI, 4.76-29.74). The optimal threshold of abbreviated MEDS score in predicting ICU admission was 8 (OR, 10.95; 95% CI, 5.47-21.90; p<0.05) and 9 in predicting 28 day mortality (OR, 19.03; 95% CI, 8.28-43.78; p<0.05). CONCLUSION: Both abbreviated MEDS scoring system and single plasma PCT assays can be used as a useful marker in rapidly and accurately predicting poor prognosis in emergency department patients with sepsis.