Level of Complete Knowledge on Five Moments of Hand Hygiene among Nurses Working at Integrated Nursing Care Service Wards

Purpose@#This study aimed to identify the level of complete knowledge about hand hygiene indications among nurses working at integrated nursing care service wards. @*Methods@#A total of 127 nurses in eight integrated nursing care service wards completed structured sheets while observing a video based on six scenarios developed by the research team. Complete knowledge level was calculated as the percentage (%) of participants who responded correctly to all questions among participants. Complete knowledge levels according to the scenarios were calculated and compared according to general characteristics using the chi-squared test or Wilcoxon rank-sum test. @*Results@#The complete knowledge level for each scenario ranged from 7.9% (scenario 6) to 42.5% (scenarios 4 and 5), and no one had complete knowledge of all scenarios. Only 3.1% of participants demonstrated complete knowledge in more than four scenarios, and 26.0% had complete knowledge of four or more hand hygiene moments. Complete knowledge level per scenario did not differ depending on work experience at hospitals and study wards, or prior hand hygiene training in the last year. @*Conclusion@#As the complete knowledge level regarding hand hygiene moment is very low, it is suggested that regular hand hygiene training should be provided to nurses using video media that reflect real nursing tasks. Thus, they can acquire complete knowledge of when hand hygiene is needed or not during complex nursing work situations.

Level of Complete Knowledge on Five Moments of Hand Hygiene among Nurses Working at Integrated Nursing Care Service Wards

Purpose@#This study aimed to identify the level of complete knowledge about hand hygiene indications among nurses working at integrated nursing care service wards. @*Methods@#A total of 127 nurses in eight integrated nursing care service wards completed structured sheets while observing a video based on six scenarios developed by the research team. Complete knowledge level was calculated as the percentage (%) of participants who responded correctly to all questions among participants. Complete knowledge levels according to the scenarios were calculated and compared according to general characteristics using the chi-squared test or Wilcoxon rank-sum test. @*Results@#The complete knowledge level for each scenario ranged from 7.9% (scenario 6) to 42.5% (scenarios 4 and 5), and no one had complete knowledge of all scenarios. Only 3.1% of participants demonstrated complete knowledge in more than four scenarios, and 26.0% had complete knowledge of four or more hand hygiene moments. Complete knowledge level per scenario did not differ depending on work experience at hospitals and study wards, or prior hand hygiene training in the last year. @*Conclusion@#As the complete knowledge level regarding hand hygiene moment is very low, it is suggested that regular hand hygiene training should be provided to nurses using video media that reflect real nursing tasks. Thus, they can acquire complete knowledge of when hand hygiene is needed or not during complex nursing work situations.

Prognostic Value of Coronary CT Angiography forPredicting Poor Cardiac Outcome in Stroke Patientswithout Known Cardiac Disease or Chest Pain:The Assessment of Coronary Artery Disease in StrokePatients Study

Objective@#To assess the incremental prognostic value of coronary computed tomography angiography (CCTA) in comparison toa clinical risk model (Framingham risk score, FRS) and coronary artery calcium score (CACS) for future cardiac events in ischemicstroke patients without chest pain. @*Materials and Methods@#This retrospective study included 1418 patients with acute stroke who had no previous cardiac diseaseand underwent CCTA, including CACS. Stenosis degree and plaque types (high-risk, non-calcified, mixed, or calcified plaques) wereassessed as CCTA variables. High-risk plaque was defined when at least two of the following characteristics were observed:low-density plaque, positive remodeling, spotty calcification, or napkin-ring sign. We compared the incremental prognosticvalue of CCTA for major adverse cardiovascular events (MACE) over CACS and FRS. @*Results@#The prevalence of any plaque and obstructive coronary artery disease (CAD) (stenosis ≥ 50%) were 70.7% and 30.2%,respectively. During the median follow-up period of 48 months, 108 patients (7.6%) experienced MACE. Increasing FRS, CACS,and stenosis degree were positively associated with MACE (all p 0.05). @*Conclusion@#Assessment of stenosis degree and plaque type using CCTA provided additional prognostic value over CACS andFRS to risk stratify stroke patients without prior history of CAD better.

Survey of Risk-Based Quality Management Status andEstablishment of Operational Model in Clinical Trials

Purpose@#With the release of the International Council for Harmonization of Technical Requirements for Pharmaceuticals for HumanUse E6 addendum, it is very important to establish risk-based quality management systems which meet good clinical practice.The aim of this research was to propose for risk-based quality management practices in the organizations that conduct clinicaltrials in South Korea. @*Materials and Methods@#The survey participant pool consisted of domestic or multinational pharmaceutical companies and fullserviceclinical research organizations operating in South Korea that had one or more clinical trials approved by the Korean Ministryof Food and Drug Safety in 2018. @*Results@#Of the 97 selected companies, a total of 61 companies completed the survey. A total of 42 companies (68.9%) had employeesdesignated to quality management activities. The minimum and maximum numbers of dedicated personnel for quality managementwere one and 12, respectively, and the average was three. Regarding the role of quality management personnel in companies,standard operating procedure management, issue/corrective action and preventive action (CAPA) management, and preparinginspection were selected the most (81%). The system considered to be the most important for risk management was monitoring system(41 companies, 67.2%), followed by both vendor management and CAPA management systems (17 companies, 27.9%). @*Conclusion@#In the future, organizations conducting clinical and subsequent pilot studies trials in South Korea should followthese quality management practice to share information with each other.

A New Healthcare Policy in Korea Part 1: Expanded Reimbursement Coverage of Brain MRI, Brain/Neck MRA, and Head and Neck MRI by National Health Insurance

In accordance with the new healthcare policy of government (Moon Jae-In Care) to strengthen health insurance coverage, the National Health Insurance (NHI) coverage of brain magnetic resonance imaging (MRI), braineck MR angiography (MRA), and head and neck MRI have been expanded since 2018 in Korea. This article has been reviewed focusing on the “Detailed matter concerning criteria and method for providing reimbursed services in the NHI. Some revisions” regarding reimbursement for MRI, which was revised from October 2018 to April 2020 and is currently in effect. It included the MRI reimbursement system in Korea, recent adjustment of the reimbursement coverage for patients with headache or dizziness, and reimbursement coverage, standard imaging, and radiologic report of brain MRI, braineck MRA and head and neck MRI. This article could help radiologists gain knowledge on health insurance to protect the expertise of the radiologist and to play a leading role in the hospital. As the policy changes, detailed matter concerning criteria and method for providing reimbursed services in the NHI may be revised. Therefore, radiologists should update issues related to insurance reimbursement for MRI continuously.

A large outbreak of Salmonella enterica serovar Thompson infections associated with chocolate cake in Busan, Korea / 한국역학회지

OBJECTIVES: This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak. METHODS: This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested. RESULTS: Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same. CONCLUSIONS: The source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.

A large outbreak of Salmonella enterica serovar Thompson infections associated with chocolate cake in Busan, Korea / 한국역학회지

OBJECTIVES@#This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak.@*METHODS@#This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested.@*RESULTS@#Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same.@*CONCLUSIONS@#The source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.

A large outbreak of Salmonella enterica serovar Thompson infections associated with chocolate cake in Busan, Korea / 한국역학회지

OBJECTIVES: This study aimed to reveal the epidemiologic characteristics of the outbreak of gastroenteritis caused by Salmonella enterica serovar Thompson in Busan Metropolitan City and to identify points for improvement to prevent of food-borne disease outbreak.METHODS: This was a case-control study. The control group comprised asymptomatic students in the same classes of the cases. The presence or absence of symptoms, ingestion of each food provided by school meal service, and commonly ingested foods in addition to those foods in meal service were investigated. Moreover, specimens collected from rectal swab, preserved foods, and environmental surface were tested.RESULTS: Of the 6,092 subjects, 1,111 (1,083 students, 22 school personnel, and 6 foodservice employees) were included in the case group; this corresponded to an 18.4% attack rate. Symptoms included diarrhea (n=1,051, 94.6%), abdominal pain (n=931, 83.8%), febrile sensation (n=502, 45.2%), and vomiting (n=275, 24.8%). The epidemic curves of each 10 schools were unimodal. Investigation of food intake showed a significantly high odds ratio for chocolate cake in 5 out of the 10 schools. Laboratory test detected Salmonella enterica serovar Thompson both in rectal swab specimens of 9 schools and in collected preserved chocolate cakes of 9 schools. Pulsed-field gel electrophoresis test result showed that Salmonella enterica seorvar Thompson isolated from human and foods were the same.CONCLUSIONS: The source of infection for the Salmonella enterica serovar Thompson outbreak in the 10 schools of Busan Metropolitan City is chocolate cake. Traceback investigation for origin of contaminated food in food-borne disease outbreak and safety control during food production should be more enhanced.

Spatiotemporal Protein Atlas of Cell Death-Related Molecules in the Rat MCAO Stroke Model

Ischemic stroke and cerebral infarction triggered by the blockage of blood supply can cause damage to the brain via a complex series of pathological changes. Recently, diverse therapies have emerged as promising candidates for the treatment of stroke. These treatments exert therapeutic effects by acting on diverse target molecules and cells in different time windows from the acute to chronic phases. Here, using immunohistochemistry, we show pathophysiological changes in the brain microenvironment at the hyperacute (within 6 h), acute (1~3 days), subacute (7 days), and chronic (1 month) phases following ischemic injury. Ischemic injury in rats was induced by occluding the middle cerebral artery and was validated by magnetic resonance imaging. The progression of damage to the brain was evaluated by immunohistochemistry for NeuN⁺ neurons, GFAP⁺ astrocytes, and Iba1⁺ microglia, and by the emergence of the cell death-related molecules such as AIF, FAF1, and activated caspase-3. Our data regarding the spatial and temporal information on pathophysiological changes may warrant the investigation of the timing of administration of therapeutic treatments in preclinical studies with an animal model of stroke.

Post-bevacizumab Clinical Outcomes and the Impact of Early Discontinuation of Bevacizumab in Patients with Recurrent Malignant Glioma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Bevacizumab±irinotecan is effective for treatment of recurrent malignant gliomas. However, the optimal duration of treatment has not been established. MATERIALS AND METHODS: Ninety-four consecutive patients with recurrent malignant glioma who were treated with bevacizumab at our institutions were identified. Patients who continued bevacizumab until tumor progression were enrolled in a late discontinuation (LD) group, while those who stopped bevacizumab before tumor progression were enrolled in an early discontinuation (ED) group. Landmark analyses were performed at weeks 9, 18, and 26 for comparison of patient survival between the two groups. RESULTS: Among 89 assessable patients, 62 (69.7%) and 27 (30.3%) patients were categorized as the LD and ED groups, respectively. According to landmark analysis, survival times from weeks 9, 18, and 26 were not significantly different between the two groups in the overall population. However, the LD group showed a trend toward increased survival compared to the ED group among responders. In the ED group, the median time from discontinuation to disease progression was 11.4 weeks, and none of the patients showed a definite rebound phenomenon. Similar median survival times after disease progression were observed between groups (14.4 weeks vs. 15.7 weeks, p=0.251). Of 83 patients, 38 (45.8%) received further therapy at progression, and those who received further therapy showed longer survival in both the LD and ED groups. CONCLUSION: In recurrent malignant glioma, duration of bevacizumab was not associated with survival time in the overall population. However, ED of bevacizumab in responding patients might be associated with decreased survival.

Transesophageal echocardiographic guidance for percutaneous closure of aortic pseudoaneurysm using a type II Amplatzer vascular plug: a case report / 대한마취과학회지

Aortic pseudoaneurysm after cardiac surgery is a rare entity, but it is potentially fatal due to its clinical course along with higher morbidity and mortality rates. Instead of open surgical repair, percutaneous procedures have been introduced as other options for managing an aortic pseudoaneurysm. In this case report, we describe transesophageal echocardiography guidance for successful percutaneous closure of an aortic pseudoaneurysm located in the left ventricular outflow tract by using a type II Amplatzer vascular plug in a patient in whom open surgical repair was not recommended.

Anesthetic experience of patient with isolated left ventricular noncompaction: a case report / 대한마취과학회지

Isolated left ventricular noncompaction (LVNC) is a rare primary genetic cardiomyopathy characterized by prominent trabeculation of the left ventricular wall and intertrabecular recesses. Perioperative management of the patient with LVNC might be challenging due to the clinical symptoms of heart failure, systemic thromboembolic events, and fatal left ventricular arrhythmias. We conducted real time intraoperative transesophageal echocardiography in a patient with LVNC undergoing general anesthesia for ovarian cystectomy.

Clinical Implications of Sulcal Enhancement on Postcontrast Fluid Attenuated Inversion Recovery Images in Patients with Acute Stroke Symptoms

OBJECTIVE: Hyperintense acute reperfusion marker (HARM) without diffusion abnormalities is occasionally found in patients with an acute stroke. This study was to determine the prevalence and clinical implications of HARM without diffusion abnormalities. MATERIALS AND METHODS: There was a retrospective review of magnetic resonance images 578 patients with acute strokes and identified those who did not have acute infarction lesions, as mapped by diffusion-weighted imaging (DWI). These patients were classified into an imaging-negative stroke and HARM without diffusion abnormalities groups, based on the DWI findings and postcontrast fluid attenuated inversion recovery images. The National Institutes of Health Stroke Scale (NIHSS) scores at admission, 1 day, and 7 days after the event, as well as clinical data and risk factors, were compared between the imaging-negative stroke and HARM without diffusion abnormalities groups. RESULTS: Seventy-seven acute stroke patients without any DWI abnormalities were found. There were 63 patients with an imaging-negative stroke (accounting for 10.9% of 578) and 13 patients with HARM without diffusion abnormalities (accounting for 2.4% of 578). The NIHSS scores at admission were higher in HARM without diffusion abnormalities group than in the imaging-negative stroke group (median, 4.5 vs. 1.0; p < 0.001), but the scores at 7 days after the event were not significantly different between the two groups (median, 0 vs. 0; p = 1). The patients with HARM without diffusion abnormalities were significantly older, compared with patients with an imaging-negative stroke (mean, 73.1 years vs. 55.9 years; p < 0.001). CONCLUSION: Patients with HARM without diffusion abnormalities are older and have similarly favorable short-term neurological outcomes, compared with the patients with imaging-negative stroke.

Quantitative Magnetic Resonance Angiography in Internal Carotid Artery Occlusion with Primary Collateral Pathway / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Quantitative magnetic resonance angiography (Q-MRA) enables direct measurement of volume flow rate (VFR) of intracranial arteries. We aimed to evaluate the collateral flows in internal carotid artery (ICA) occlusion with primary collateral pathway via circle of Willis using Q-MRA, and to compare them between patients who recently developed ipsilateral symptomatic ischemia and those who did not. METHODS: Between 2012 and 2014, 505 patients underwent Q-MRA in our institution. Among these, 33 patients who had unilateral ICA occlusion with primary collateral pathway were identified, and grouped into asymptomatic patients, stable patients with chronic infarction, and symptomatic patients with acute/subacute infarction. Mean VFR (mVFR) in intracranial arteries was measured and compared between the patients' groups. Kruskal-Wallis test was used for statistical analysis. RESULTS: Six patients were asymptomatic, fifteen with chronic infarction were stable, and twelve with acute/subacute infarction were symptomatic. The mVFR of ipsilateral middle cerebral artery in symptomatic patients was significantly lower than those in stable or asymptomatic patients (73.7+/-45.6 mL/min vs. 119.9+/-36.1 mL/min vs. 121.8+/-42.0 mL/min; P = 0.04). Total sum of the mVFR of ipsilateral anterior, middle, and posterior cerebral arteries was significantly lower in symptomatic patients than those in other groups (229.3 +/- 51.3 mL/min vs. 282.0+/-68.6 mL/min vs. 314.0+/-44.4 mL/min; P = 0.02). CONCLUSIONS: Q-MRA could be helpful to demonstrate the difference in the degree of primary collateral flow in ICA occlusion between the patients with recent symptomatic ischemia and those without.

Successful management in a pregnant woman with Eisenmenger's syndrome undergoing emergency cesarean section under general anesthesia / 대한마취과학회지

No abstract available.

Successful management in a pregnant woman with Eisenmenger's syndrome undergoing emergency cesarean section under general anesthesia / 대한마취과학회지

No abstract available.

Imaging Findings of Brain Death on 3-Tesla MRI

OBJECTIVE: To demonstrate the usefulness of 3-tesla (3T) magnetic resonance imaging (MRI) including T2-weighted imaging (T2WI), diffusion weighted imaging (DWI), time-of-flight (TOF) magnetic resonance angiography (MRA), T2*-weighted gradient recalled echo (GRE), and susceptibility weighted imaging (SWI) in diagnosing brain death. MATERIALS AND METHODS: Magnetic resonance imaging findings for 10 patients with clinically verified brain death (group I) and seven patients with comatose or stuporous mentality who did not meet the clinical criteria of brain death (group II) were retrospectively reviewed. RESULTS: Tonsilar herniation and loss of intraarterial flow signal voids (LIFSV) on T2WI were highly sensitive and specific findings for the diagnosis of brain death (p < 0.001 and < 0.001, respectively). DWI, TOF-MRA, and GRE findings were statistically different between the two groups (p = 0.015, 0.029, and 0.003, respectively). However, cortical high signal intensities in T2WI and SWI findings were not statistically different between the two group (p = 0.412 and 1.0, respectively). CONCLUSION: T2-weighted imaging, DWI, and MRA using 3T MRI may be useful for diagnosing brain death. However, SWI findings are not specific due to high false positive findings.

Masticator space abscess in a 47-day-old infant / 소아과

A 47-day-old male infant presented with fever, poor oral intake, irritability, and right-sided bluish buccal swelling. Contrast-enhanced computed tomography of the neck showed a round mass lesion of about 2.0x1.5 cm that suggested abscess formation in the right masticator space. Ultrasound-guided extraoral aspiration of the abscess at the right masseter muscle was successful. Staphylococcus aureus was identified in the culture from the aspirated pus and blood. Appropriate antibiotics were given and the patient recovered. The patient underwent follow-up ultrasonography that showed an improved state of the previously observed right masseter muscle swelling at about 1 month after hospital discharge. A masticator space abscess usually originates from an odontogenic infection in adults. We report a case of masticator space abscess in a 47-day-old infant in whom septicemia without odontogenic infection was suspected.

Deep Neck Abscesses in Children and Adolescents: 10 Year Experience in Two General Hospitals / 소아감염

PURPOSE: The purpose of this study was to review our recent experiences with deep neck abscesses in children and adolescents and to provide helpful information in treatment and diagnosis by comparing them with those in other available literatures. METHODS: Medical records of 36 children and adolescents admitted for deep neck abscess at two hospitals from January 2000 to October 2010 were reviewed retrospectively. RESULTS: Male to female ratio was 1.4 : 1 and the mean age was 6.5 years. Painful neck swelling and fever were the most frequent symptoms in patients under thirteen years of age whereas trismus and headache were frequent symptoms in patients over fourteen years of age. Submandibular space was the most common site of deep neck abscess in patients under thirteen years of age, whereas peritonsillar space was the most common site in patients over fourteen years of age. The results of bacterial cultures were positive in 61.5% of drained cases. Staphylococcus aureus was the most commonly identified bacteria in 6 patients (37.5%) and 5 of them were under 2 years of age. Twenty six patients received surgical drainage while the others were treated with antibiotics only. There were no statistically significant differences in the durations of admission, fever after admission, and antibiotic treatment between surgical and medical treatment groups. CONCLUSION: The common sites of deep neck abscess, associated symptoms, and causative organisms were different between children and adolescents. As there were no differences in durations of admission, fever, or antibiotics treatments between surgical and medical treatment groups, surgical drainage may be avoided by early recognition and suspicion. However, if there is no improvement of symptoms or size of abscesses within 48-72 hours of antibiotic treatment, surgical drainage should be considered.

THE EFFECT OF COMBINED EXERCISE TRAINING ON CAROTID ARTERY STRUCTURE AND FUNCTION, AND VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) IN OBESE OLDER WOMEN / 体力科学

The purpose of this study was to examine the influence of 12-week combined exercise program on carotid artery structure and function, and vascular endothelial growth factor (VEGF) in obese older women. All subjects were sixty years or older (66.90±4.2 years), performed the combined exercise training during 12-week consisting of aerobic exercise, band exercise, and yoga exercise for 70 minutes 3 times a week under the supervision of exercise specialist. Despite no statistically significant change in control group, percent body fat mass (3.26 %, p<.01), systolic blood pressure (6.2 mmHg, p<.05), diastolic blood pressure (5.6 mmHg, p<.001), and 10 m maximal walking time (0.56 sec, p<.05), TC (20.5 mg/dl, p<.05), and LDL-C (22.16 mg/dl, p<.05) were significantly decreased respectively after 12-week combined exercise in exercise group. In addition, sit-and-reach (3.6 cm, p<.01), oxygen uptake per weight (3.27 ml/kg/min, p<.05), VEGF (17.85 pg/dl, p<.001), and carotid artery LD (0.4 cm, p<.01), PFV (10.06 cm/sec, p<.05), EFV (6.04 cm/sec, p<.05) were significantly increased in the exercise group than in the control group. The VEGF had the significant correlation with LD (r=.389, p<.01), PFV (r=.427, p<.01), EFV (r=.264, p<.05). In conclusion, 12-week combined exercise program is effective to improve and/or physical function and body composition. And also, exercise can improve serum lipid metabolism, VEGF regulation, and carotid artery function and structure.