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Background@#Paradoxical responses (PR) occur more frequently in lymph node tuberculosis (LNTB) than in pulmonary tuberculosis and present difficulties in differential diagnosis of drug resistance, new infection, poor patient compliance, and adverse drug reactions. Although diagnosis of mediastinal LNTB has become much easier with the development of endosonography, limited information is available. The aim of this study was to investigate the clinical course of mediastinal LNTB and the risk factors associated with PR. @*Methods@#Patients diagnosed with mediastinal LNTB via endosonography were evaluated retrospectively between October 2009 and December 2019. Multivariable logistic regression was applied to evaluate the risk factors associated with PR. @*Results@#Of 9,052 patients who underwent endosonography during the study period, 158 were diagnosed with mediastinal LNTB. Of these, 55 (35%) and 41 (26%) concurrently had pulmonary tuberculosis and extrapulmonary tuberculosis other than mediastinal LNTB, respectively. Of 125 patients who completed anti-tuberculosis treatment, 21 (17%) developed PR at a median of 4.4 months after initiation of anti-tuberculosis treatment. The median duration of anti-tuberculosis treatment was 6.3 and 10.4 months in patients without and with PR, respectively. Development of PR was independently associated with age < 55 years (adjusted odds ratio [aOR], 5.72; 95% confidence interval [CI], 1.81–18.14; P = 0.003), lymphocyte count < 800/μL (aOR, 8.59; 95% CI, 1.60–46.20; P = 0.012), and short axis diameter of the largest lymph node (LN) ≥ 16 mm (aOR, 5.22; 95% CI, 1.70–16.00; P = 0.004) at the time of diagnosis of mediastinal LNTB. @*Conclusion@#As PR occurred in one of six patients with mediastinal LNTB during antituberculosis treatment, physicians should pay attention to patients with risk factors (younger age, lymphocytopenia, and larger LN) at the time of diagnosis.
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Objective@#Studies using simulation-based programs for empathy enhancement have been conducted mostly for health profession students and medical care providers in Western countries. No empirical research has been conducted for non-medical care providers of older adults in community settings in Asian countries. The purposes of this mixed-methods study were: to explore experiences and perceived usability of non-medical care providers of older adults in a simulation-based empathy enhancement program; and to examine if the program is effective in improving empathy and relevant outcomes. @*Methods@#104 non-medical care providers of older adults in South Korea participated in a simulation-based empathy enhancement program in 2018. Data were collected using self-reported questionnaires for effectiveness testing, a program evaluation questionnaire, and individual interviews and analyzed using statistical tests and thematic analysis. @*Results@#Care providers showed higher levels of empathy and lower levels of stress and burnout after the program participation (p<0.05). Qualitative findings supported the improved attitude and care strategies, increased empathy towards older adults, preparing for their own aging, and restoration of emotional stability through the participation in the program. @*Conclusion@#This study suggests that the simulation-based program is useful in promoting empathic responses of non-medical care providers working with older adults.
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OBJECTIVE: Dysphagia is a major complication of stroke and causes serious problems, such as lung aspiration. Previous reviews of dysphagia treatments for stroke were limited due to a dearth of available studies. More trials have been published recently warranting a re-examination of the evidence. The purpose of this systematic review was to examine the effectiveness of interventions for dysphagia in adults following stroke. METHODS: The PRISMA Statement with a 27-item checklist was used as a general guide to conduct and report a quality systematic review. Five electronic databases were searched for randomized controlled trials published in English between 2008 and 2017 examining the effectiveness of dysphagia interventions following stroke. The search terms were entered by combining the keywords related to dysphagia, stroke, interventions, and randomized controlled trials. RESULTS: Fifteen articles were included; the most commonly used interventions were Transcranial Magnetic Stimulation (4 articles), Neuromuscular Electrical Stimulation (4 articles), and Pharyngeal electrical stimulation (4 articles). CONCLUSION: This review provides evidence of the effectiveness of interventions for people with dysphagia following stroke, but there were some mixed results. The heterogeneity of the outcome measures as well as the mixed results highlight the need for further research.