Peripheral T-Cell Lymphoma Presenting as a Scalp Mass

Peripheral scalp T-cell lymphoma is a very rare disease. We report a case of a 22-year-old man who presented an indolent large scalp mass in the right frontal scalp region. The patient’s physical examination demonstrated no palpable mass in the chest, abdomen, and extremities. The brain CT revealed a high-density large scalp mass of the subgaleal layer in the right frontal and a small scalp mass of the subgaleal layer in the left frontal. The brain MRI showed multifocal enhancing masses in the bilateral dura, the subgaleal layer of the scalp, and the skull. The patient underwent removal of the tumor found in the right frontal scalp. The histologic diagnosis was peripheral T-cell lymphoma. Bone marrow aspiration showed the involvement of T-cell lymphoma. The patient received chemotherapy with cyclophosphamide, vincristine, doxorubicin, and prednisolone (CHOP protocol) for 3 cycles. The patient was discharged without neurological deficit. The patient showed no evidence of recurrence 15 months after surgery. We report a rare case of peripheral T-cell lymphoma mimicking benign scalp tumors.

Out-of-Hospital Data: Patient Generated Health Data / 임상당뇨병

Patient-generated health data (PGHD) are health-related data generated, recorded, and collected by patients or caregivers. Its main advantage is that patients can actively participate in their own health care, since the data-generating agents are patients and caregivers, not hospitals. Due to the development and popularization of information and communications technology and digital devices, the number of studies using PGHD for better health care is increasing. When PGHD was used in the outpatient setting, healthcare providers were better able to understand each patients’ condition using more accurate data, and to monitor patient health status between visits. In particular, to manage chronic diseases suchas diabetes, it is essential to monitor daily blood sugar and change nutrient intake in the context of medication, overall diet, and exercise. However, problems associated with data quality, data extraction, and insufficient evidence and research to guide use of this kind of data in clinical setting are yet to be solved. Further, the gap between patient and healthcare providers’ perceptions of PGHD persists. We suggest that PGHD, electronic medical record data in hospitals, and claims and genome data could be combined to good effect. This combination can help patients and healthcare providers make better decisions with respect to patient health and to maintain patient engagement. In addition, the collection of PGHD through sophisticated sensors, and data analysis through advanced portals could combine medical big data with daily big data. Eventually, a personalized healthcare automation system through PGHD-based algorithms could provide healthcare artificial intelligence services.

A study on nursing informatics competence of clinical nurses: Applying focus group interview / 한국간호교육학회지

Purpose@#This study is a content analysis to understand the nursing informatics competence of clinical nurses. @*Methods@#Focus group interviews were used to collect data. Two focus group interviews were held with a total of nine clinical nurses. All interviews were recorded and transcribed. Content analysis was used to analyze data. @*Results@#The five main categories of nursing informatics competence that emerged are 1) software program use, 2) use of nursing information, 3) use of information communication technology in nursing, 4) professional responsibilities and ethics, and 5) active attitudes and recognition. Next, there are three strategies to improve nursing informatics competence: 1) organizational approach, 2) opportunity of continuous education, 3) presentation of standards in nursing informatics competence. @*Conclusion@#Further studies such as educational program development and evaluation tool development are necessary. Moreover, there is a need to enhance clinical nurses' nursing informatics competence by using the proposed strategies.

Development and Usability Evaluation of a Healthy Lifestyle Coaching Chatbot Using a Habit Formation Model / 대한의료정보학회지

Objectives@#It is crucial to find ways to fit regular exercise into the daily lives of office workers. Non-exercise activity thermogenesis has been introduced as an effective form of daily exercise. This study aimed to develop a healthy lifestyle coaching program for office workers, to be delivered using a messenger application. @*Methods@#The interface was developed using KakaoTalk and Plus Friend. Performance feedback was developed using the IBM Watson conversation program. Twenty office workers used the application for three weeks. Afterward, a survey was conducted to assess the usability of and participants’ satisfaction with the application. @*Results@#The application delivered customized push alarms, provided information related to habit formation, allowed for one-on-one chats, and delivered rewards. The satisfaction measurement results for the application showed that extrinsic reward factors contributed the most to the performance of the activity, followed by reminders and intrinsic rewards. Regarding the usability test, the perceived usefulness of the Healthy Lifestyle Coaching Chatbot was highest, followed by the usage intent and the perceived ease of use. @*Conclusions@#This study found that coaching programs using chatbots can improve the effectiveness of performing simple, repetitive exercises.

Analysis of Characteristics of Peripheral Arterial Ischemia in Premature Babies and Effects of Nitroglycerin Patch Application

Purpose@#The aim of this retrospective study was to analyze the characteristics of peripheral arterial ischemia and tissue necrosis in premature babies, as well as the effects of nitroglycerin. @*Methods@#In total, 513 newborns were enrolled who were admitted to the neonatal intensive care unit with a gestational age of 34 weeks or younger. Data were collected on general personal and clinical information, peripheral arterial ischemia, and nitroglycerin patch application in the premature infants. The collected data were analyzed using the x2 test, t-test, Mann-Whitney U test, logistic regression. @*Results@#Thirty-six (7.0%) infants had peripheral arterial ischemia, while 477 (93.0%) infants did not. Lower gestational age (x2=35.97, p<.001), lower birth weight (x2=29.40, p<.001), lower blood pressure (x2=23.10, p<.001), and insertion of an umbilical artery catheter (p<.001) were significantly associated with the occurrence of peripheral arterial ischemia. Among the preterm infants in whom nitroglycerin patches were applied, 30 (83.3%) premature infants without necrosis improved without complications, 4 (11.1%) showed hypotension, and 2 (5.6%) showed skin damage. @*Conclusion@#Based on a review of our experiences with nitroglycerin patches, we recommend closely observing skin color and using nitroglycerin patches on the skin to help improve flow in premature infants with peripheral arterial ischemia.

Out-of-Hospital Data: Patient Generated Health Data / 임상당뇨병

Patient-generated health data (PGHD) are health-related data generated, recorded, and collected by patients or caregivers. Its main advantage is that patients can actively participate in their own health care, since the data-generating agents are patients and caregivers, not hospitals. Due to the development and popularization of information and communications technology and digital devices, the number of studies using PGHD for better health care is increasing. When PGHD was used in the outpatient setting, healthcare providers were better able to understand each patients’ condition using more accurate data, and to monitor patient health status between visits. In particular, to manage chronic diseases suchas diabetes, it is essential to monitor daily blood sugar and change nutrient intake in the context of medication, overall diet, and exercise. However, problems associated with data quality, data extraction, and insufficient evidence and research to guide use of this kind of data in clinical setting are yet to be solved. Further, the gap between patient and healthcare providers’ perceptions of PGHD persists. We suggest that PGHD, electronic medical record data in hospitals, and claims and genome data could be combined to good effect. This combination can help patients and healthcare providers make better decisions with respect to patient health and to maintain patient engagement. In addition, the collection of PGHD through sophisticated sensors, and data analysis through advanced portals could combine medical big data with daily big data. Eventually, a personalized healthcare automation system through PGHD-based algorithms could provide healthcare artificial intelligence services.

Analysis of Interactive E-Health Tools on United Arab Emirates Patient Visited Hospital Websites / 대한의료정보학회지

OBJECTIVES: This study is to scrutinize the website of Seoul National University Hospital in Korea, Clinique Valmont in Switzerland, Medical Center of the University of Munich in Germany, Cleveland Clinic Abu Dhabi in the United Arab Emirates (UAE) to suggest successful communication factors to the medical service providers who deal with Middle Eastern patients. METHODS: Using content analysis and in-depth interviews, this research examines four hospitals commonly visited by Middle East patients. The four hospitals approaches to implementing interactive e-health tools on their web sites are reviewed. Four hospitals selection criterion was process by focus group interview of government officials in UAE health sectors. RESULTS: The way of providing medical information differed by hospitals that used e-health tools. The analysis of each website shows a different way providing medical information, services and education. There are important differences among hospitals. These include decision-making, planning processes and outcomes of implementing e-health tools online, as well as potential obstacles to such implementation. Thus, hospitals can learn and design effective interactive tools by applying e-health tools on their websites. CONCLUSIONS: Each website showed different interactive tools such as traditional functional tools, core e-business tools, patient support tools, visitor related tools, emerging functional tools. By applying the interactive e-health tools sets an objective view for e-health strategy and vision for the hospitals conveying information through the website. According to the type of hospitals and its location different methods of strategy should be applied. Targeting not only the patients but also the general website users will eventually improve health information accessibility.

Evaluation of User Experience of New Defense Medical Information System / 대한의료정보학회지

OBJECTIVES: This study aimed to investigate the user experience (UX) of the New Defense Medical Information System (N-DEMIS), which was introduced in 2012 as part of an effort to improve the old system of armed forces hospitals and ultimately bring their standards up to those of civilian hospitals. METHODS: In this study, the dependent variable was the UX of N-DEMIS and was composed of usability, affect, and user value. The questionnaire comprised 41 questions: nine on general characteristics, 20 on usability, four on affect, and eight on user value. The data collection period was from April 15 to April 30, 2018. Overall, 85 responses were received; of these, three insincere responses were excluded, and the remaining 82 responses were used in the analysis. RESULTS: The overall value of Cronbach's alpha was 0.917, indicating an overall high-reliability. There was a significant difference between user value and usability, but there was no significant differences between the other pairs. We observed a significant effect on UX for length of time working in an armed forces hospital and employment type. CONCLUSIONS: The results of our survey showed an even distribution of scores across the three elements of UX, showing that no particular aspect of N-DEMIS is superior to the others in terms of user satisfaction. However, the overall UX score of around 60% indicates the need for future improvements. Rather than focusing improvements on a specific area, improvements should be spread across usability, affect, and user value.

Health Information Technology Trends in Social Media: Using Twitter Data / 대한의료정보학회지

OBJECTIVES: This study analyzed the health technology trends and sentiments of users using Twitter data in an attempt to examine the public's opinions and identify their needs. METHODS: Twitter data related to health technology, from January 2010 to October 2016, were collected. An ontology related to health technology was developed. Frequently occurring keywords were analyzed and visualized with the word cloud technique. The keywords were then reclassified and analyzed using the developed ontology and sentiment dictionary. Python and the R program were used for crawling, natural language processing, and sentiment analysis. RESULTS: In the developed ontology, the keywords are divided into ‘health technology‘ and ‘health information‘. Under health technology, there are are six subcategories, namely, health technology, wearable technology, biotechnology, mobile health, medical technology, and telemedicine. Under health information, there are four subcategories, namely, health information, privacy, clinical informatics, and consumer health informatics. The number of tweets about health technology has consistently increased since 2010; the number of posts in 2014 was double that in 2010, which was about 150 thousand posts. Posts about mHealth accounted for the majority, and the dominant words were ‘care‘, ‘new‘, ‘mental‘, and ‘fitness‘. Sentiment analysis by subcategory showed that most of the posts in nearly all subcategories had a positive tone with a positive score. CONCLUSIONS: Interests in mHealth have risen recently, and consequently, posts about mHealth were the most frequent. Examining social media users' responses to new health technology can be a useful method to understand the trends in rapidly evolving fields.

Pan-Pim Kinase Inhibitor AZD1208 Suppresses Tumor Growth and Synergistically Interacts with Akt Inhibition in Gastric Cancer Cells / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Pim kinases are highly conserved serine/threonine kinases, and different expression patterns of each isoform (Pim-1, Pim-2, and Pim-3) have been observed in various types of human cancers, including gastric cancer. AZD1208 is a potent and selective inhibitor that affects all three isoforms of Pim. We investigated the effects of AZD1208 as a single agent and in combination with an Akt inhibitor in gastric cancer cells. MATERIALS AND METHODS: The antitumor activity of AZD1208 with/without an Akt inhibitor was evaluated in a large panel of gastric cancer cell lines through growth inhibition assays. The underlying mechanism was also examined by western blotting, immunofluorescence assay, and cell cycle analysis. RESULTS: AZD1208 treatment decreased gastric cancer cell proliferation rates and induced autophagy only in long-term culture systems. Light chain 3B (LC3B), a marker of autophagy, was increased in sensitive cells in a dose-dependent manner with AZD1208 treatment, which suggested that the growth inhibition effect of AZD1208 was achieved through autophagy, not apoptosis. Moreover, we found that cells damaged by Pim inhibition were repaired by activation of the DNA damage repair pathway, which promoted cell survival and led the cells to become resistant to AZD1208. We also confirmed that the combination of an Akt inhibitor with AZD1208 produced a highly synergistic effect in gastric cancer cell lines. CONCLUSION: Treatment with AZD1208 alone induced considerable cell death through autophagy in gastric cancer cells. Moreover, the combination of AZD1208 with an Akt inhibitor showed synergistic antitumor effects through regulation of the DNA damage repair pathway.

Use of Robots as a Creative Approach in Healthcare ICT / 대한의료정보학회지

No abstract available.

Multimodal Assessment of Neural Substrates in Computerized Cognitive Training: A Preliminary Study

BACKGROUND AND PURPOSE: Several studies have validated the clinical efficacy of computerized cognitive training applications. However, few studies have investigated the neural substrates of these training applications using simultaneous multimodal neuroimaging modalities. We aimed to determine the effectiveness of computerized cognitive training and corresponding neural substrates through a multimodal approach. METHODS: Ten patients with mild cognitive impairment (MCI), six patients with subjective memory impairment (SMI), and 10 normal controls received custom-developed computerized cognitive training in the memory clinic of a university hospital. All of the participants completed 24 sessions of computerized cognitive training, each lasting 40 minutes and performed twice weekly. They were assessed using neuropsychological tests (both computerized and conventional), electroencephalography, fluorodeoxyglucose positron-emission tomography (FDG-PET), volumetric magnetic resonance imaging (MRI), and diffusion-tensor imaging (DTI) at pre- and posttraining. RESULTS: The patients with MCI exhibited significant improvements in the trail-making test–black & white-B, and memory domain of the computerized cognitive assessment. Subjects with normal cognition exhibited significant improvements in scores in the language and attention-/psychomotor-speed domains. There were no significant changes in subjects with SMI. In the pre- and posttraining evaluations of the MCI group, FDG-PET showed focal activation in the left anterior insula and anterior cingulate after training. Volumetric MRI showed a focal increase in the cortical thickness in the rostral anterior cingulate. DTI revealed increased fractional anisotropy in several regions, including the anterior cingulate. CONCLUSIONS: The anterior cingulate and anterior insula, which are parts of the salience network, may be substrates for the improvements in cognitive function induced by computerized cognitive training.

Factors Influencing on the Happiness in Community-dwelling Older Adults in Korea / 재활간호학회지

PURPOSE: The purpose of this study was to investigate the influencing factors on the happiness of community-dwelling older adults in Korea. METHODS: A convenience sample of older adults (N=191) who did not enrolled in any specific exercise programs participated in this cross-sectional correlational study. The data were collected from July to August, 2017. Participants were asked to respond to fill questionnaires including depression, physical activity, and happiness. Physical activity was classified according to physical activity scores(inactivity, minimally activity, health enhancing physical activity). Data were analyzed with descriptive statistics, independent t-test, χ² test, one-way analysis of variance (ANOVA) and hierarchical multiple regression with SPSS (ver. 24.0). RESULTS: The influencing factors on happiness were depression (β=−.64, p < .001), physical activities (minimally activity=1; β=−.15, p=.014), and religion (have=1; β=.10, p=.029). Hierarchical multiple regression analysis showed that the determinant variables accounted for 58% of the variation in the happiness (F=53.37, p < .001). CONCLUSION: These findings indicate that depression, physical activity and subjective health status influence the happiness of older adults who did not involved in any exercise program. Effective healthcare programs for managing depression and increasing the level of physical activity could increase the level of happiness among older adults.

Current Status of Transcultural Nursing Education in Nursing Baccalaureate Programs / 한국간호교육학회지

PURPOSE: This study presents the current status of transcultural nursing education in nursing baccalaureate programs. METHODS: The nursing curricula from 185 out of 194 nursing colleges that received accreditation were collected and analyzed. RESULTS: 109 (58.9%) nursing colleges offered 117 transcultural nursing-related courses. The courses were offered as elective (68.4%) as well as major (78.6%) courses. All courses were offered as a theoretical delivery class without any field experiences. The courses were offered mainly for sophomore (41.9%) and freshman students (33.3%), and most of them (79.5%) were two-credit courses. Instead of the term “transcultural nursing,”“multicultural nursing” is mostly used in the title of courses. An inconsistency between the title of courses and their content was found. After analyzing the title of courses based on four nursing meta-paradigms, courses related to the environment were most common (41.9%). CONCLUSION: Transcultural nursing education has developed during the last decade. However, teaching methods and course content have not developed enough. Thus, a greater effort is needed to increase awareness of the importance of transcultural nursing education and to develop courses for it.

Fragment Analysis for Detection of the FLT3-Internal Tandem Duplication: Comparison with Conventional PCR and Sanger Sequencing

BACKGROUND: We evaluated a sensitive and quantitative method utilizing fragment analysis of the fms-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD), simultaneously measuring mutant allele burden and length, and verified the analytical performance. METHODS: The number and allelic burden of FLT3-ITD mutations was determined by fragment analysis. Serial mixtures of mutant and wild-type plasmid DNA were used to calculate the limit of detection of fragment analysis, conventional PCR, and Sanger sequencing. Specificity was evaluated using DNA samples derived from 50 normal donors. Results of fragment analysis were compared to those of conventional PCR, using 481 AML specimens. RESULTS: Defined mixtures were consistently and accurately identified by fragment analysis at a 5% relative concentration of mutant to wild-type, and at 10% and 20% ratios by conventional PCR and direct sequencing, respectively. No false positivity was identified. Among 481 AML specimens, 40.1% (193/481) had FLT3-ITD mutations. The mutant allele burden (1.7-94.1%; median, 28.2%) and repeated length of the mutation (14-153 bp; median, 49 bp) were variable. The concordance rate between fragment analysis and conventional PCR was 97.7% (470/481). Fragment analysis was more sensitive than conventional PCR and detected 11 additional cases: seven had mutations below 10%, three cases represented conventional PCR failure, and one case showed false negativity because of short ITD length (14 bp). CONCLUSIONS: The new fragment analysis method proved to be sensitive and reliable for the detection and monitoring of FLT3-ITD in patients with AML. This could be used to simultaneously assess ITD mutant allele burden and length.

Correction: Prerequisites for Effective Implementation of Telemedicine: Focusing on Current Situation in Korea / 대한의료정보학회지

The authors and their affiliation are incorrectly listed in the article. Also, the Acknowledgments section of the above article incorrectly omitted.

Current Status of Nursing Informatics Education in Korea / 대한의료정보학회지

OBJECTIVES: This study presents the current status of nursing informatics education, the content covered in nursing informatics courses, the faculty efficacy, and the barriers to and additional supports for teaching nursing informatics in Korea. METHODS: A set of questionnaires consisting of an 18-item questionnaire for nursing informatics education, a 6-item questionnaire for faculty efficacy, and 2 open-ended questions for barriers and additional supports were sent to 204 nursing schools via email and the postal service. Nursing schools offering nursing informatics were further asked to send their syllabuses. The subjects taught were analyzed using nursing informatics competency categories and other responses were tailed using descriptive statistics. RESULTS: A total of 72 schools (35.3%) responded to the survey, of which 38 reported that they offered nursing informatics courses in their undergraduate nursing programs. Nursing informatics courses at 11 schools were taught by a professor with a degree majoring in nursing informatics. Computer technology was the most frequently taught subject (27 schools), followed by information systems used for practice (25 schools). The faculty efficacy was 3.76 ± 0.86 (out of 5). The most frequently reported barrier to teaching nursing informatics (n = 9) was lack of awareness of the importance of nursing informatics. Training and educational opportunities was the most requested additional support. CONCLUSIONS: Nursing informatics education has increased during the last decade in Korea. However, the proportions of faculty with degrees in nursing informatics and number of schools offering nursing informatics courses have not increased much. Thus, a greater focus is needed on training faculty and developing the courses.

Current Status of Nursing Informatics Education in Korea / 대한의료정보학회지

OBJECTIVES: This study presents the current status of nursing informatics education, the content covered in nursing informatics courses, the faculty efficacy, and the barriers to and additional supports for teaching nursing informatics in Korea. METHODS: A set of questionnaires consisting of an 18-item questionnaire for nursing informatics education, a 6-item questionnaire for faculty efficacy, and 2 open-ended questions for barriers and additional supports were sent to 204 nursing schools via email and the postal service. Nursing schools offering nursing informatics were further asked to send their syllabuses. The subjects taught were analyzed using nursing informatics competency categories and other responses were tailed using descriptive statistics. RESULTS: A total of 72 schools (35.3%) responded to the survey, of which 38 reported that they offered nursing informatics courses in their undergraduate nursing programs. Nursing informatics courses at 11 schools were taught by a professor with a degree majoring in nursing informatics. Computer technology was the most frequently taught subject (27 schools), followed by information systems used for practice (25 schools). The faculty efficacy was 3.76 ± 0.86 (out of 5). The most frequently reported barrier to teaching nursing informatics (n = 9) was lack of awareness of the importance of nursing informatics. Training and educational opportunities was the most requested additional support. CONCLUSIONS: Nursing informatics education has increased during the last decade in Korea. However, the proportions of faculty with degrees in nursing informatics and number of schools offering nursing informatics courses have not increased much. Thus, a greater focus is needed on training faculty and developing the courses.

Performance Evaluation of Two Automated Quantitative Fecal Occult Blood Tests

BACKGROUND: The performance of the fecal occult blood test (FOBT) has recently improved with the use of quantitative immunochemical assays. We evaluated the two latest immunochemical FOBTs: OC-Sensor PLEDIA (Eiken Chemical, Japan) and NS-Prime (Alfresa Pharma, Japan). METHODS: The precision was evaluated by using the quality control materials at two levels and carry-over rates were measured at high and low concentrations of the sample, prepared from the calibrators. Linearity was measured by using five concentrations of human hemoglobin (0-1,000 ng/mL), prepared from erythrocyte lysates. Correlation between the two systems was analyzed by testing approximately 50 selected stool specimens per day and comparing the results obtained with those of the currently used analyzer, OC-Sensor DIANA (Eiken Chemical), for 10 consecutive working days. RESULTS: The variation for repeatability, between-run, between-day, and intermediate precision at both levels was 0.99 for both systems. In total, 499 stool specimens were analyzed, of which 127 (25.5%), 130 (26.1%), and 129 (25.9%) specimens tested positive by DIANA, PLEDIA, and NS-Prime, respectively. The agreement between PLEDIA and NS-Prime was 98.4%. Quantification by PLEDIA was linear to that by NS-Prime (y=1.0372x+17.744; r²=0.9064). CONCLUSIONS: The analytical performances of PLEDIA and NS-Prime warrant their use as diagnostic tests. They showed excellent categorical agreement; however, the quantitative value obtained by NS-Prime was lower than that obtained by PLEDIA.

Prerequisites for Effective Implementation of Telemedicine: Focusing on Current Situations in Korea / 대한의료정보학회지

OBJECTIVES: The practice of telemedicine requires social interventions and systems for efficient implementation. Further, it requires sufficient discussions among related parties because the purpose of telemedicine is diagnosis and treatment, and the participation of medical specialists is essential. Based on the characteristics of the healthcare structure of Korea, which has a low proportion of public healthcare and most patients are taken care of by a few large tertiary care hospitals, the fundamental issues need to be discussed. METHODS: A comparison was conducted with overseas cases to discuss the prerequisites for the effective implementation of telemedicine in South Korea under the current situation. We also examined the structural characteristics of the Korean medical community. RESULTS: The current paper recommends that an in-depth analysis and studies are conducted on the following aspects: a search for telemedicine services focused on public healthcare, a search of services for illnesses that impose high levels of burden on households, and the development and implementation of a telemedicine system for follow-up management at primary and secondary care hospitals after the patient undergoes surgery or treatment at tertiary care hospitals. CONCLUSIONS: As the technology develops, the focus should also be on factors such as safety, usefulness, availability, and how the functions will be realized in order to enable user communication. A clear system should be established to regulate and manage the lack of sufficient discussions. In addition, seeking projects and systems that reflect the characteristics of each country will facilitate the efficient implementation of telemedicine.