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Objective@#To systematically translate the Duchenne muscular dystrophy Functional Ability Self-Assessment Tool (DMDSAT) into Korean and verify the reliability and validity of the Korean version (K-DMDSAT). @*Methods@#The original DMDSAT was translated into Korean by two translators and two pediatric physiatrists. A total of 88 patients with genetically confirmed Duchenne muscular dystrophy (DMD) participated in the study. They were evaluated using the K-DMDSAT once as a self-assessment and once by an interviewer. The interviewer evaluated the K-DMDSAT again 1 week later using a test-retest approach. The intraclass correlation coefficient (ICC) was used to verify the interrater and test-retest reliabilities. Pearson correlation analysis between the K-DMDSAT and the Brooke or Vignos scales were used to assess validity. @*Results@#The total score and all domains of the K-DMDSAT showed excellent interrater and test-retest reliability, with an ICC for total scores of 0.985 and 0.987, respectively. All domains had an ICC >0.90. From the Pearson correlation analysis, the total K-DMDSAT score was significantly correlated with the Vignos and Brooke scales (r=0.918 and 0.825, respectively; p<0.001), and each domain of K-DMDSAT showed significant correlation with either the Vignos or Brooke scales. @*Conclusion@#DMDSAT was systematically translated into Korean, and K-DMDSAT was verified to have excellent reliability and validity. K-DMDSAT can help clinicians easily describe and categorize various functional aspects of patients with DMD through the entire disease progression.
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Objective@#To investigate the association among the electrode placement method, electrode type, and local tumor progression (LTP) following percutaneous radiofrequency ablation (RFA) for small hepatocellular carcinomas (HCCs) and to assess the risk factors for LTP. @*Materials and Methods@#In this retrospective study, we enrolled 211 patients, including 150 males and 61 females, who had undergone ultrasound-guided RFA for a single HCC < 3 cm. Patients were divided into four combination groups of the electrode type and placement method: 1) tumor-puncturing with an internally cooled tip (ICT), 2) tumor-puncturing with an internally cooled wet tip (ICWT), 3) no-touch with ICT, and 4) no-touch with ICWT. Univariable and multivariable Cox proportional-hazards regression analyses were performed to evaluate the risk factors for LTP. The major RFA-related complications were assessed. @*Results@#Overall, 83, 34, 80, and 14 patients were included in the ICT, ICWT, no-touch with ICT, and no-touch with ICWT groups, respectively. The cumulative LTP rates differed significantly among the four groups. Compared to tumor puncturing with ICT, tumor puncturing with ICWT was associated with a lower LTP risk (adjusted hazard ratio [aHR] = 0.11, 95% confidence interval [CI] = 0–0.88, P = 0.034). However, the cumulative LTP rate did not differ significantly between tumorpuncturing with ICT and no-touch RFA with ICT (aHR = 0.34, 95% CI = 0.03–1.62, P = 0.188) or ICWT (aHR = 0.28, 95% CI = 0–2.28, P = 0.294). An insufficient ablative margin was a risk factor for LTP (aHR = 6.13, 95% CI = 1.41–22.49, P = 0.019). The major complication rates were 1.2%, 0%, 2.5%, and 21.4% in the ICT, ICWT, no-touch with ICT, and no-touch with ICWT groups, respectively. @*Conclusion@#ICWT was associated with a lower LTP rate compared to ICT when performing tumor-puncturing RFA. An insufficient ablation margin was a risk factor for LTP.
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Purpose@#This study aimed to assess the incidence of and factors associated with major complications, delayed discharge, and emergency room (ER) visits or readmission after percutaneous radiofrequency ablation (RFA) for single hepatocellular carcinoma (HCC) <3 cm in a recent cohort at a tertiary cancer center. @*Methods@#A total of 188 patients with treatment-naïve single HCCs <3 cm who underwent RFA between January 2018 and April 2021 were included in the analysis. Univariable and multivariable logistic regression analyses were performed to identify the factors associated with major complications, delayed discharge, and ER visits or readmission. Local tumor progression (LTP) and overall survival were estimated using the Kaplan-Meier method and Cox proportional-hazards regression analysis. @*Results@#Major complications occurred in 3.2% (6/188) of the patients. The longest diameter of the ablation zone was significantly larger in patients with major complications (P=0.023). Delayed discharge occurred in 5.8% (9/188) of the patients, for which albumin-bilirubin grade 3 was identified as an important determinant. No variables other than major complications were significantly associated with ER visits or readmission, which occurred in 7.0% (13/188) of the patients. Major complications, delayed discharge, and ER visits or readmission were not substantially related to the post-treatment outcomes of LTP and overall survival. @*Conclusion@#This study confirmed RFA as a highly safe procedure for single HCCs <3 cm, despite the rapidly changing RFA techniques in the most recent cohort. A large ablation zone and poor liver function were predictors of major complications and delayed discharge, respectively.
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A Clostridioides difficile infection (CDI) is one of the major nosocomial diarrheal diseases. Pseudomembranous colitis (PMC) is a characteristic endoscopic finding of CDI, manifested by white or yellowish plaque covering the colonic mucosa. Ischemic colitis is inflammation of the colon manifested by mucosal denudation and friability. Ischemic colitis is rarely associated with CDI. The treatment response might be delayed when CDI is complicated with other diseases that cause diarrhea. Thus far, reports of CDI concomitant with Cytomegalovirus (CMV) colitis are rare. This paper reports a case of PMC and ischemic colitis associated with CDI and CMV infection. After two weeks of oral vancomycin and intravenous metronidazole, the patient’s diarrhea was not improved. Follow-up sigmoidoscopy was performed, and a CMV infection was identified at areas of broad ulceration where ischemic colitis occurred.Finally, the patient was cured with ganciclovir. Follow-up sigmoidoscopy showed an improvement in ischemic colitis.
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Listeria monocytogenes is a rare cause of bacterial meningitis, particularly beyond the neonatal period. This article describes a 16-month-old girl who presented with a new-onset febrile status epilepticus, and subsequently developed altered mentality and lethargy. L. monocytogenes was detected on a point-of-care, multiplex polymerase chain reaction using the cerebrospinal fluid. On day 3, she developed a rapidly progressive hydrocephalus. Her consciousness improved after placement of an external ventricular drain. After 3-week antibiotic therapy, she was successfully discharged without residual complications.
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Digital pathology is being gradually adopted in hospitals due to technological advances. We propose that digital pathology can be used in Mohs micrographic surgery (Mohs surgery) to precisely check residual tumor cells in frozen tumor margin tissues. This would aid surgeons and pathologists in accurately recording tumor margins and give patients the benefit of shorter operation time.
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Purpose@#The aim of this study was to assess the incidence and causes of percutaneous radiofrequency ablation (RFA) infeasibility in cases of metastatic colorectal cancer and to evaluate factors affecting the invisibility of the tumor on planning ultrasonography (US). @*Methods@#This study screened 386 patients who underwent planning US using fusion imaging and/or contrast-enhanced US for percutaneous RFA for suspected metastatic colorectal cancer between January 2013 and December 2020, from whom 136 patients with a single hepatic metastasis from colorectal cancer measuring <3 cm were included. The factors related to the infeasibility of percutaneous RFA were investigated. Univariate and multivariate analyses were performed to assess the factors associated with tumor invisibility on planning US. @*Results@#Among the 136 patients, percutaneous RFA was considered infeasible in 24.3% (33/136) due to a high risk of the heat-sink effect caused by the abutment of a large vessel (n=12), an inconspicuous tumor on planning US (n=11), a high risk of collateral thermal damage to an adjacent organ (n=8), and the absence of a safe electrode path (n=2). In univariate and multivariate analyses, tumor size was a statistically significant factor affecting invisibility on planning US (P=0.003 and P=0.018, respectively). @*Conclusion@#Percutaneous RFA was infeasible in approximately one-fourth of patients with metastatic colorectal cancer. The reason for the infeasibility was mainly an unfavorable tumor location and invisibility on planning US. Small tumor size was the sole significant factor affecting the invisibility of hepatic metastases on planning US.
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Objective@#To categorize multiparametric MRI features of Bacillus Calmette–Guérin (BCG)-related granulomatous prostatitis (GP) and discover potential manifestations for its differential diagnosis from prostate cancer. @*Materials and Methods@#The cases of BCG-related GP in 24 male (mean age ± standard deviation, 66.0 ± 9.4 years; range, 50–88 years) pathologically confirmed between January 2011 and April 2019 were retrospectively reviewed. All patients underwent intravesical BCG therapy followed by a MRI scan. Additional follow-up MRI scans, including diffusion-weighted imaging (DWI), were performed in 19 patients. The BCG-related GP cases were categorized into three: A, B, or C. The lesions with diffusion restriction and homogeneous enhancement were classified as type A. The lesions with diffusion restriction and a poorly enhancing component were classified as type B. A low signal intensity on high b-value DWI (b = 1000 s/mm2 ) was considered characteristic of type C. Two radiologists independently interpreted the MRI scans before making a consensus about the types. @*Results@#The median lesion size was 22 mm with the interquartile range (IQR) of 18–26 mm as measured using the initial MRI scans. The lesion types were A, B, and C in 7, 15, and 2 patients, respectively. Cohen’s kappa value for the inter-reader agreement for the interpretation of the lesion types was 0.837. On the last follow-up MRI scans of 19 patients, the size decreased (median, 5.8 mm; IQR, 3.4–8.5 mm), and the type changed from A or B to C in 11 patients. The lesions resolved in four patients. In five patients who underwent prostatectomy, caseous necrosis on histopathology matched with the non-enhancing components of type B lesions and the entire type C lesions. @*Conclusion@#BCG-related GP demonstrated three imaging patterns on multiparametric MRI. Contrast-enhanced T1-weighted imaging and DWI may play a role in its differential diagnosis from prostate cancer.
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Purpose@#This study investigated the utility of second-line contrast-enhanced ultrasonography (CEUS) using Sonazoid in Liver Imaging Reporting and Data System category 3 (LR-3) and 4 (LR-4) observations on gadoxetate-enhanced magnetic resonance imaging (MRI). @*Methods@#This retrospective study included LR-3 or LR-4 observations on gadoxetate-enhanced MRI subsequently evaluated with CEUS from 2013 to 2017. The presence of MRI features, CEUSarterial phase hyperenhancement (CEUS-APHE), and Kupffer phase defect (KPD) was evaluated. Multivariable logistic regression analysis was performed to identify significant imaging features associated with the diagnosis of hepatocellular carcinoma (HCC). The optimal diagnostic criteria were investigated using the McNemar test. @*Results@#In total, 104 patients with 104 observations (63 HCCs) were included. The presence of both CEUS-APHE and KPD on CEUS enabled the additional detection of 42.3% (11/26) of LR-3 HCCs and 78.4% (29/37) of LR-4 HCCs. Transitional phase (TP) hypointensity (adjusted odds ratio [OR], 10.59; P<0.001), restricted diffusion (adjusted OR, 7.55; P=0.004), and KPD (adjusted OR, 7.16; P=0.003) were significant imaging features for HCC diagnosis. The presence of at least two significant imaging features was optimal for HCC diagnosis (sensitivity, specificity, and accuracy: 88.9%, 78.1%, and 84.6%, respectively), with significantly higher sensitivity than the presence of both CEUS-APHE and KPD (sensitivity, specificity, and accuracy: 63.5% [P=0.001], 92.7% [P=0.077], and 75.0% [P=0.089], respectively). @*Conclusion@#The combined interpretation of gadoxetate-enhanced MRI and second-line CEUS using Sonazoid, focusing on TP hypointensity, restricted diffusion, and KPD, may be optimal for further characterizing LR-3 and LR-4 observations.
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Second-look ultrasonography (US) is a targeted breast US examination that evaluates suspicious lesions detected on magnetic resonance imaging (MRI). It is a useful tool for determining the probability of malignancy and facilitating US-guided biopsy. Lesions detected on MRI and US should be correlated accurately, which is challenging in some cases. This article documents second-look US and MRI findings that are correlated with the pathology, and suggests helpful approaches for correlating between the two modalities.
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Purpose@#The purpose of this study is three-fold: 1) to evaluate factors influencing hearing aid (HA) satisfaction; 2) to provide a profile of HA satisfaction in daily life; and 3) to examine the reasons why people gave up using HAs. @*Materials and Methods@#Data for 1148 respondents were statistically analyzed and reported. @*Results@#In the study, age (β=-0.03, p<0.01), level of education (β=1.21, p<0.01), HA purchase price (β=1.50, p<0.01), bilateral amplification (β=1.23, p<0.01), wearing time (β=0.28, p<0.01), and HA fitting and fine tuning on a regular basis (β=1.71, p<0.01) significantly influenced HA satisfaction. In addition, the authors observed that the most satisfactory factors were clarity of sound (53.5%), people’s trust in their HA (61.7%), and listening from a quiet environment (72.8%) in the domains of sound quality, HA features, and listening environments, respectively. Finally, with multiple choices being possible, 65% of the 40 respondents who no longer used HAs answered that their HAs ended up in a drawer since the background noise was annoying and distracting. @*Conclusion@#This study is significant in that it is a large-scale multi-center research to comprehensively examine the factors influencing HA satisfaction in South Korea. This data will provide helpful information that could lead to the successful rehabilitation of hearing loss with HAs.
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Objective@#We aimed to develop a Korean version of the Family Accommodation Scale-Self-Rated (FAS-SR), to investigate its reliability and validity and to study the clinical correlates of family accommodation in families with obsessive compulsive disorder (OCD) patient. @*Methods@#The FAS-SR was translated into Korean under the original author’s supervision. Forty-two patients with OCD and their closest relatives participated. The internal consistency was estimated using Cronbach’s alpha and the split half method. Convergent and divergent validity were identified by measuring with other clinical variables. Test-retest reliability was also calculated. @*Results@#The reliability analyses showed that Korean version of the FAS-SR demonstrated excellent internal consistency (Cronbach’s alpha=0.91) and test-retest reliability (Intraclass correlation coefficient=0.93). It showed good convergent validity when simultaneously assessed OCD symptom severity, global functioning and relative’s psychological distress. @*Conclusion@#The findings suggest that Korean version of the FAS-SR is a reliable and valid tool for assessing family accommodation in Korean patients with OCD in both research and clinical settings.
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Objective@#To compare the therapeutic outcomes of laparoscopic hepatic resection (LHR) and laparoscopic radiofrequency ablation (LRFA) for single subcapsular hepatocellular carcinoma (HCC). @*Materials and Methods@#We screened 244 consecutive patients who had received either LHR or LRFA between January 2014 and December 2016. The feasibility of LRFA in patients who underwent LHR was retrospectively assessed by two interventional radiologists. Finally, 60 LRFA-feasible patients who had received LHR and 29 patients who had received LRFA as the first treatment for a solitary subcapsular HCC between 1 cm and 3 cm were finally included. We compared the therapeutic outcomes, including local tumor progression (LTP), recurrence-free survival (RFS), and overall survival (OS) between the two groups before and after propensity score (PS) matching. Multivariable Cox proportional hazard regression was also used to evaluate the difference in OS and RFS between the two groups for all 89 patients. @*Results@#PS matching yielded 23 patients in each group. The cumulative LTP and OS rates were not significantly different between the LHR and LRFA groups after PS matching (p = 0.900 and 0.003, respectively). The 5-year LTP rates were 4.6% and 4.4%, respectively, and OS rates were 100% and 90.7%, respectively. The RFS rate was higher in LHR group without statistical significance (p = 0.070), with 5-year rates of 78.3% and 45.3%, respectively. OS was not significantly different between the LHR (reference) and LRFA groups in multivariable analyses, with a hazard ratio (HR) of 1.33 (95% confidence interval, 0.12–1.54) (p = 0.818). RFS was higher in LHR (reference) than in LRFA without statistical significance in multivariable analysis, with an HR of 2.01 (0.87–4.66) (p = 0.102). @*Conclusion@#There was no significant difference in therapeutic outcomes between LHR and LRFA for single subcapsular HCCs measuring 1–3 cm. The difference in RFS should be further evaluated in a larger study.
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Objective@#This study aimed to determine a factor for predicting suboptimal image quality of the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI in patients with extrahepatic bile duct (EHD) cancer before MRI examination. @*Materials and Methods@#We retrospectively evaluated 259 patients (mean age ± standard deviation: 68.0 ± 8.3 years; 162 male and 97 female) with EHD cancer who underwent gadoxetic acid-enhanced MRI between 2011 and 2017. Patients were divided into a primary analysis set (n = 184) and a validation set (n = 75) based on the diagnosis date of January 2014. Two reviewers assigned the functional liver imaging score (FLIS) to reflect the HBP image quality. The FLIS consists of the sum of three HBP features, each scored on a 0–2 scale: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. Patients were classified into low-FLIS (0–3) or high-FLIS (4–6) groups. Multivariable analysis was performed to determine a predictor of low FLIS using serum biochemical and imaging parameters of cholestasis severity. The optimal cutoff value for predicting low FLIS was obtained using receiver operating characteristic analysis, and validation was performed. @*Results@#Of the 259 patients, 140 (54.0%) and 119 (46.0%) were classified into the low-FLIS and high-FLIS groups, respectively. In the primary analysis set, total bilirubin was an independent factor associated with low FLIS (adjusted odds ratio per 1-mg/dL increase, 1.62; 95% confidence interval [CI], 1.32–1.98). The optimal cutoff value of total bilirubin for predicting low FLIS was 2.1 mg/dL with a sensitivity of 95.1% (95% CI: 88.9–98.4) and a specificity of 89.0% (95% CI: 80.2–94.9). In the validation set, the total bilirubin cutoff showed a sensitivity of 92.1% (95% CI: 78.6–98.3) and a specificity of 83.8% (95% CI: 68.0–93.8). @*Conclusion@#Serum total bilirubin before acquisition of gadoxetic acid-enhanced MRI may help predict suboptimal HBP image quality in patients with EHD cancer.
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Objective@#To intraindividually compare hepatocellular carcinoma (HCC) washout between MRIs using hepatobiliary agent (HBA) and extracellular agent (ECA). @*Materials and Methods@#This study included 114 prospectively enrolled patients with chronic liver disease (mean age, 55 ± 9 years; 94 men) who underwent both HBA-MRI and ECA-MRI before surgical resection for HCC between November 2016 and May 2019. For 114 HCCs, the lesion-to-liver visual signal intensity ratio (SIR) using a 5-point scale (-2 to +2) was evaluated in each phase. Washout was defined as negative visual SIR with temporal reduction of visual SIR from the arterial phase. Illusional washout (IW) was defined as a visual SIR of 0 with an enhancing capsule. The frequency of washout and MRI sensitivity for HCC using LR-5 or its modifications were compared between HBA-MRI and ECA-MRI. Subgroup analysis was performed according to lesion size ( 0.999). @*Conclusion@#Extracellular phase washout for HCC diagnosis was comparable between MRIs with both contrast agents, except for tumors < 20 mm. Adding IW could improve the sensitivity for HCC on ECA-MRI in tumors < 20 mm.
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Purpose@#This study aimed to analyze the mass and social media contents and structures related to particulate matter before and after the policy enforcement of the comprehensive countermeasures for particulate matter, derive nursing implications, and provide a basis for designing health policies. @*Methods@#After crawling online news articles and posts on social networking sites before and after policy enforcement with particulate matter as keywords, we conducted topic and semantic network analysis using TEXTOM, R, and UCINET 6. @*Results@#In topic analysis, behavior tips was the common main topic in both media before and after the policy enforcement. After the policy enforcement, influence on health disappeared from the main topics due to increased reports about reduction measures and government in mass media, whereas influence on health appeared as the main topic in social media. However semantic network analysis confirmed that social media had much number of nodes and links and lower centrality than mass media, leaving substantial information that was not organically connected and unstructured. @*Conclusion@#Understanding of particulate matter policy and implications influence health, as well as gaps in the needs and use of health information, should be integrated with leadership and supports in the nurses’ care of vulnerable patients and public health promotion.
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Purpose@#We aimed to investigate the effect of metal ions from oral prostheses (OPs) released into the saliva of patients with oral lichenoid lesions (OLLs). @*Materials and Methods@#Subjects (n=183) were divided into four groups according to the presence or absence of OLL and OP.Concentrations of the metal ions titanium, chromium (Cr), cobalt (Co), nickel (Ni), palladium (Pd), silver (Ag), platinum (Pt), gold (Au), and zirconium (Zr) were measured using a laser-ablation microprobe inductively coupled to a plasma mass spectrometer. Saliva levels of interleukin (IL)-6, IL-1β, IL-8, and tumor necrosis factor-α were detected using an enzyme-linked immunosorbent assay. The reticulation/keratosis, erythema, and ulceration (REU) scoring system was used to assess the severity of OLL. @*Results@#Mean concentrations of IL-6 and IL-8 were statistically higher in OLL patients with OPs. The concentration of Ni was high in OLL groups. The concentrations of Cr, Ni, and Au ions in the saliva were positively correlated with IL-8. REU scores were positively correlated with salivary concentrations of IL-6 and IL-8, as well as with concentrations of Cr, Ni, and Au. @*Conclusion@#Increased concentrations of metal ions, especially Ni, in saliva were positively correlated with IL-8 and showed positive correlations with the severity of OLL.
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Objective@#To intraindividually compare hepatocellular carcinoma (HCC) washout between MRIs using hepatobiliary agent (HBA) and extracellular agent (ECA). @*Materials and Methods@#This study included 114 prospectively enrolled patients with chronic liver disease (mean age, 55 ± 9 years; 94 men) who underwent both HBA-MRI and ECA-MRI before surgical resection for HCC between November 2016 and May 2019. For 114 HCCs, the lesion-to-liver visual signal intensity ratio (SIR) using a 5-point scale (-2 to +2) was evaluated in each phase. Washout was defined as negative visual SIR with temporal reduction of visual SIR from the arterial phase. Illusional washout (IW) was defined as a visual SIR of 0 with an enhancing capsule. The frequency of washout and MRI sensitivity for HCC using LR-5 or its modifications were compared between HBA-MRI and ECA-MRI. Subgroup analysis was performed according to lesion size ( 0.999). @*Conclusion@#Extracellular phase washout for HCC diagnosis was comparable between MRIs with both contrast agents, except for tumors < 20 mm. Adding IW could improve the sensitivity for HCC on ECA-MRI in tumors < 20 mm.
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Purpose@#This study aimed to develop an evidence-based nursing practice guideline for preventing postoperative pulmonary complications (PPCs). @*Methods@#The guideline adaptation process was conducted through the 24 steps based on the guideline adaptation manual of Korean Hospital Nurses Association. @*Results@#The newly developed guideline to prevent PPCs consisted of four domains and 30 recommendations. The number of recommendations in each domain was 7 for assessment of PPCs, 17 for nursing interventions to prevent PPCs after general anesthesia, 4 for education (intended for patients and medical staff), and 2 for monitoring and recording. @*Conclusion@#The developed guidelines will contribute in standardization of nursing practice and PPCs prevention and management. We recommend the dissemination and utilization of these guidelines nationwide to improve the quality of postoperative pulmonary complication prevention.
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Purpose@#This study was conducted to assess public awareness and policy challenges faced by practicing nurses. @*Methods@#After collecting nurse-related news articles published before and after ‘the Thanks to You Challenge’ campaign (between December 31, 2019, and July 15, 2020), keywords were extracted via preprocessing. A three-step method keyword analysis, latent Dirichlet allocation topic modeling, and keyword network analysis was used to examine the text and the structure of the selected news articles. @*Results@#Top 30 keywords with similar occurrences were collected before and after the campaign. The five dominant topics before the campaign were: pandemic, infection of medical staff, local transmission, medical resources, and return of overseas Koreans. After the campaign, the topics ‘infection of medical staff’ and ‘return of overseas Koreans’ disappeared, but ‘the Thanks to You Challenge’ emerged as a dominant topic. A keyword network analysis revealed that the word of nurse was linked with keywords like thanks and campaign, through the word of sacrifice. These words formed interrelated domains of ‘the Thanks to You Challenge’ topic. @*Conclusion@#The findings of this study can provide useful information for understanding various issues and social perspectives on COVID-19 nursing. The major themes of news reports lagged behind the real problems faced by nurses in COVID-19 crisis. While the press tends to focus on heroism and whole society, issues and policies mutually beneficial to public and nursing need to be further explored and enhanced by nurses.