Five-Year Community Management Rate for Dementia Patients: A Proposed Indicator for Dementia Policies

Background@#and Purpose There is no specific indicator for monitoring dementia management. We propose an auxiliary indicator called the community management rate, defined as the proportion of dementia patients who receive informal care from close caregivers or themselves within their community population. The 5-year community management rate is the percentage of dementia patients who are receiving community management at 5 years after they were diagnosed. The aim of this study was to identify how the community management rate has changed over time and how the 5-year community management rate differs according to age, sex, income, residence area, and comorbidities. @*Methods@#We analyzed customized research database of the Korean National Health Insurance Services from 2003 to 2018. The 5-year community management rate was calculated annually with newly diagnosed dementia patients, and compared among subgroups according to age, sex, income, residence area, and comorbidities. @*Results@#This study analyzed 549,297 patients. Among those newly diagnosed with dementia in 2003, the mean duration of community management during the 15-year follow-up was 5.98 years. The community management rate decreased rapidly from 2003 to 2006, after which it increased. A low 5-year community management rate was associated with older age, higher comorbidity burden, nonmetropolitan residence, and low income. @*Conclusions@#The community management rate seems to reflect diverse patient factors. Efforts are needed to reduce the comorbidity burden and differences in the 5-year community management rate according to residence area and income. This study indicates the need for further investigations into the use of this indicator to monitor the management of dementia patients.

An Update on Sepsis Biomarkers

Sepsis is a dysregulated systemic reaction to a common infection, that can cause lifethreatening organ dysfunction. Over the last decade, the mortality rate of patients with sepsis has decreased as long as patients are treated according to the recommendations of the Surviving Sepsis Campaign, but is still unacceptably high. Patients at risk of sepsis should therefore be identified prior to the onset of organ dysfunction and this requires a rapid diagnosis and a prompt initiation of treatment. Unfortunately, there is no gold standard for the diagnosis of sepsis and traditional standard culture methods are time-consuming.Recently, in order to overcome these limitations, biomarkers which could help in predicting the diagnosis and prognosis of sepsis, as well as being useful for monitoring the response to treatments, have been identified. In addition, recent advances have led to the development of newly identified classes of biomarkers such as microRNAs, long-non-coding RNAs, and the human microbiome. This review focuses on the latest information on biomarkers that can be used to predict the diagnosis and prognosis of sepsis.

Clinical and Laboratory Predictors associated with Complicated Scrub Typhus

BACKGROUND@#Scrub typhus, a mite-borne disease caused by bites of Orientia tsutsugamushi-infected chiggers, is endemic in Asia-Pacific countries. In Korea, it is a seasonal disease prevalent in autumn and one of the important causes of acute undifferentiated febrile illness. The purpose of this study was to identify the risk factors for the prediction of the severe clinical course of scrub typhus and to investigate the differences in the clinical and laboratory findings of hospitalized elderly and non-elderly patients with scrub typhus.@*MATERIALS AND METHODS@#This study retrospectively reviewed the medical records of patients diagnosed with scrub typhus.@*RESULTS@#A total of 710 patients were enrolled and 43.9% of them were elderly patients. The number of patients with complicated scrub typhus was 168 (23.7%) and the most common complication of severe scrub typhus was hepatic dysfunction (10.7%) followed by pneumonia (7.2%), acute kidney injury (4.9%) and shock (2.4%). Blood urea nitrogen ≥20 mg/dL, adenosine deaminase (ADA) ≥100 IU/L, pulmonary edema or pleural effusion, lactate dehydrogenase ≥500 U/L, alkaline phosphatase ≥400 IU/L, ferritin ≥500 ng/mL and absence of skin rash were independently associated with severe scrub typhus. There was no significant difference in the incidence of complicated scrub typhus between elderly and non-elderly patients. Absence of skin rash, pulmonary edema, pleural effusion, serum creatinine ≥1.5 mg/dL, total bilirubin ≥1.5 mg/dL, ADA ≥100 IU/L and ferritin ≥500 ng/mL were significantly associated with a longer hospitalization (≥10 days).@*CONCLUSION@#The several independent predictors of complicated scrub typhus were identified in this study. Absence of skin rash, the increased levels of serum ADA and ferritin were identified as the predictors of complicated scrub typhus, which were also associated with a prolonged hospitalization.

Nursing Students' Observation Experiences During Operations

PURPOSE: This study aimed to explore nursing students' experiences of observing surgeries in the operating room. METHODS: The data were collected through written scripts of nursing students who participated in the operating room practice. Data were analyzed via qualitative content analysis. RESULTS: Five themes emerged from the data: ‘preparing with the thrilled hearts toward unknown area’, ‘drawing back in front of the mirror of realities’, ‘becoming an audience at a lifesaving orchestra’, ‘reaching a tipping point of knowing’, and ‘redrawing the trajectory of dream to be a nurse. CONCLUSION: This study will prove helpful in describing their needs for systemic and emotional support. Findings indicated that major contributions of surgical observations to nursing students are more integrated understandings of nursing and the determinations of their career preferences.

Fecal microbiota transplantation for refractory Crohn's disease

Approximately one-third of patients with Crohn's disease do not respond to conventional treatments, and some experience significant adverse effects, such as serious infections and lymphoma, and many patients require surgery due to complications. Increasing evidence suggests that specific changes in the composition of gut microbiota, termed as dysbiosis, are a common feature in patients with inflammatory bowel disease (IBD). Dysbiosis can lead to activation of the mucosal immune system, resulting in chronic inflammation and the development of mucosal lesions. Recently, fecal microbiota transplantation, aimed at modifying the composition of gut microbiota to overcome dysbiosis, has become a potential alternative therapeutic option for IBD. Herein, we present a patient with Crohn's colitis in whom biologic therapy failed previously, but clinical remission and endoscopic improvement was achieved after a single fecal microbiota transplantation infusion.

Is a Preoperative Gastrointestinal Endoscopy for Second Primary Cancer Detection in Head and Neck Cancer Necessary? Ten-year Registry Data / 대한소화기학회지

BACKGROUND/AIMS: In head and neck squamous cell carcinoma, second primary gastrointestinal tumors are not uncommon. However, it is unclear whether a screening endoscopy is needed for detecting gastrointestinal neoplasm in patients with head and neck cancer. Therefore, we analyzed the prevalence and independent risk factors for second primary gastrointestinal neoplasm in head and neck squamous cell carcinoma. METHODS: A consecutive series of 328 patients with primary head and neck squamous cell carcinoma that underwent esophagogastroduodenoscopy or colonoscopy were included using our registry. An age- and sex-matched group of 328 control subjects was enrolled. We assessed risk factors of synchronous gastrointestinal cancer. RESULTS: The prevalence of esophageal cancer with head and neck squamous cell carcinoma was significantly higher than that of the control group (1.5% vs. 0.0%, p=0.011). An age of 54 years or more (OR, 1.033; 95% CI, 1.008-1.059; p=0.009) and male gender (OR, 4.974; 95% CI, 1.648-15.013; p=0.004) were risk factors for concomitant colorectal cancer or adenomas in the head and neck squamous cell carcinoma patients. CONCLUSIONS: Preoperative colonoscopy can be recommended for detecting synchronous second primary colorectal lesions in head and neck squamous cell carcinoma patients with male sex regardless of age, and esophagogastroduodenoscopy is necessary in all head and neck squamous cell carcinoma patients for detecting esophageal cancer.

Acquired Pure Red Cell Aplasia following Autoimmune Hemolytic Anemia in Systemic Lupus Erythematosus / 대한내과학회지

Pure red cell aplasia (PRCA) is a rare hematological disorder characterized by severe normochromic normocytic anemia and reticulocytopenia due to erythroid progenitor depletion in an otherwise normal bone marrow. Autoimmune hemolytic anemia (AIHA) is caused by autoantibodies directed against red blood cells with normocytic or macrocytic anemia with reticulocytosis. Both diseases can develop in conjunction with various underlying diseases, such as immunological disorders. Although rare, there have been a few cases of AIHA followed by PRCA. Here, we report a patient who developed PRCA following AIHA and was later diagnosed with systemic lupus erythematosus.

Effects of Rainfall on Microbial Water Quality on Haeundae and Gwangan Swimming Beach

The associations between storm events, urban runoff and costal water quality have not been well investigated in Korea. A temporal and spatial analysis during summer, 2015 was conducted to determine associates between urban runoff and fecal indicator bacteria (Escherichia coli, Enterococcus) levels at two popular coastal beaches (Gwanganri beach and Haundae beach) in Busan. In this study, a clear relationship between rainfall and elevated number of indicators was observed. Two beaches met the costal beach water health standards after less than 3.0 mm of rain. Only for storms less than 2.5 mm was no observable rainfall effect. Our results revealed that exceedances were greatest in 5 hours following 41.0~45.5 rainfall, then declined the bacterial concentrations in 8 hours after the storm and they generally returned to levels below water health standards within 10~14 hours. But it took 2.7 days to get the level of water quality of dry days. The time required for water quality recovery depends on the intensity and duration of rainfall. In the event of intense rainfall issuance of beach closure by public authorities is warranted to protect public health.

Invasive Primary Colonic Aspergillosis in the Immunocompetent Host without Classical Risk Factors

Invasive aspergillosis (IA), generally considered an opportunistic infection in immunocompromised hosts, is associated with high morbidity and mortality. IA commonly occurs in the respiratory tract with isolated reports of aspergillosis infection in the nasal sinuses, central nervous system, skin, liver, and urinary tract. Extra-pulmonary aspergillosis is usually observed in disseminated disease. To date, there are a few studies regarding primary and disseminated gastrointestinal (GI) aspergillosis in immunocompromised hosts. Only a few cases of primary GI aspergillosis in non-immunocompromised hosts have been reported; of these, almost all of them involved the upper GI tract. We describe a very rare case of IA involving the lower GI tract in the patient without classical risk factors that presented as multiple colon perforations and was successfully treated by surgery and antifungal treatment. We also review related literature and discuss the characteristics and risk factors of IA in the immunocompetent hosts without classical risk factors. This case that shows IA should be considered in critically ill patients, and that primary lower GI aspergillosis may also occur in the immunocompetent hosts without classical risk factors.

Prevalence of Antibiotic Use for Pediatric Acute Upper Respiratory Tract Infections in Korea

This study was conducted to estimate the prevalence of antimicrobial prescribing for acute upper respiratory tract infections (URI) among pediatric outpatients and to identify the national patterns of its use from 2009 to 2011 in Korea. Using National Patients Sample database from 2009 to 2011, we estimated the frequency of antibiotics prescribing for URI in pediatric outpatients with diagnoses of acute nasopharyngitis (common cold), acute sinusitis, acute pharyngitis, acute tonsillitis, acute laryngitis/tracheitis, acute obstructive laryngitis/epiglottitis, and acute upper respiratory infections of multiple and unspecified sites. The proportions of each antibiotic class were calculated by year and absolute and relative differences were estimated. Also, we investigated daily amount of prescribed antibiotics per defined population according to the type of medical care institution, physician specialty, and geographic region. The overall antibiotic prescribing proportion was 58.7% and its annual proportion slightly decreased (55.4% in 2011 vs. 60.5% in 2009; adjusted odds ratio, 0.82; 95% confidence interval, 0.82-0.83). Variations by the type of medical care institution were observed. Tertiary hospitals (45.0%) were less likely to prescribe antibiotics than primary care clinics (59.4%), hospitals (59.0%), and general hospitals (61.2%); they showed different tendencies in choosing antibiotics. Variations by physician specialty and region were also observed. Prevalence of antimicrobial prescribing for pediatric URI is still considered higher than that of western countries and varies by the type of medical care institution, physician specialty, and geographic region.

A Case of Colitis by Giardia lamblia Infection with Atypical Presentation / 대한내과학회지

Giardia lamblia infection, giardiasis, is the leading waterborne diarrhea-causing disease. It is common in most countries of the world, including South Korea and Japan. Giardia lamblia can cause asymptomatic infection but also acute abdominal discomfort with diarrhea. In addition, it may lead to chronic diarrhea associated with villous atrophy and impaired epithelial barrier in the small intestine. In the present case, a 45-year-old woman presented with lower abdominal discomfort in the absence of diarrhea. Colonoscopy showed diffuse mucosal edema, erythema, and erosions with exudate in the cecum and ascending colon. Colonoscopic biopsy and stool examination revealed trophozoites of Giardia lamblia. Colitis resolved after metronidazole therapy. Our case suggests that giardiasis should be included in the differential diagnosis of colitis, even if the patient does not present with diarrhea.

The relationship between Intake of Health Foods and Dietary Behavior in Middle-Aged Women / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to investigate the health food consumption patterns and their relationship to dietary behavior in middle-aged women (45-60 years). METHODS: The exclusive face-to-face interviews by well-trained interviewers guaranteed a scientific data collection and the quality of survey data of 731 women. Subjects were divided into two groups according to the intake of the health foods, 'Intake' group (> or = 3.2, n = 488) and 'Non-intake' group (n = 243). Data were analyzed using the SPSS 20.0 program. RESULTS: The average age of the subjects was 49.8 years and 66.8% of subjects were taking the health foods. Vitamins and minerals were consumed by the subjects. The major reason for intake of health foods was that they provide nutrient supplements may prevent diseases. More than 70% of the subjects reported checking nutrition information, ingredients, recommended daily intakes, instructions, when they bought the health foods. The average dietary life score of the intake group was significantly higher (p < 0.05) than that of the non-intake group. In analysis of exploratory factors of dietary life, the intake group showed significantly higher score (p < 0.001) in 'moderation of food intake' among the 4 exploratory factors. CONCLUSIONS: These results showed that women who took health foods had better dietary behavior than others suggesting a positive relation between the dietary behavior and the health food consumption. Therefore, we suggest that developing guidelines and then educating women about those guidelines could improve the ability of choosing health foods appropriately for their own benefit.

The Simple Predictors of Pseudomembranous Colitis in Patients with Hospital-Acquired Diarrhea: A Prospective Observational Study

BACKGROUND/AIMS: As the incidence rate of and mortality from pseudomembranous colitis (PMC) are increasing worldwide, it is important to study the simple predictive risk factors for PMC among patients with hospital-acquired diarrhea (HAD). This study focused on identifying the clinical risk factors that can easily predict PMC. METHODS: The presumed HAD patients were prospectively recruited at the Hallym University Kangdong Sacred Heart Hospital. RESULTS: Age of 70 and older (adjusted odds ratio [OR], 1.76; 95% confidence interval [CI], 1.12 to 0.75), use of proton pump inhibitors (adjusted OR, 4.07; 95% CI, 2.512 to 6.57), use of cephalosporins (adjusted OR, 2.99; 95% CI, 1.82 to 4.94), and underlying cancer (adjusted OR, 1.72; 95% CI, 1.04 to 2.82) were independent risk factors for PMC in the multivariate logistic regression analysis. The prevalence of PMC was very low in the patients with HAD who exhibited no risk factors. CONCLUSIONS: The risk factors for PMC in patients with HAD included cephalosporin use, proton pump inhibitor use, old age, and cancer. Considering the strongly negative predictive values of these risk factors, endoscopic evaluation can be delayed in patients with HAD without risk of developing PMC.

Presence of multiple peripheral circadian oscillators in the tissues controlling voiding function in mice

Circadian clocks are the endogenous oscillators that harmonize a variety of physiological processes within the body. Although many urinary functions exhibit clear daily or circadian variation in diurnal humans and nocturnal rodents, the precise mechanisms of these variations are as yet unclear. In the present study, we demonstrate that Per2 promoter activity clearly oscillates in neonate and adult bladders cultured ex vivo from Per2::Luc knock-in mice. In subsequent experiments, we show that multiple local oscillators are operating in all the bladder tissues (detrusor, sphincter and urothelim) and the lumbar spinal cord (L4-5) but not in the pontine micturition center or the ventrolateral periaqueductal gray of the brain. Accordingly, the water intake and urine volume exhibited daily and circadian variations in young adult wild-type mice but not in Per1-/- Per2-/- mice, suggesting a functional clock-dependent nature of the micturition rhythm. Particularly in PDK mice, the water intake and urinary excretion displayed an arrhythmic pattern under constant darkness, and the amount of water consumed and excreted significantly increased compared with those of WT mice. These results suggest that local circadian clocks reside in three types of bladder tissue and the lumbar spinal cord and may have important roles in the circadian control of micturition function.

Agreement of Label Information on Anxiolytics and Antidepressants for Pregnant Women: Comparison among Korea, the USA, the UK and Japan / 대한정신약물학회지

OBJECTIVE: Anxiolytics and antidepressants are commonly used to treat depressive disorders in pregnant women. Specific and clear evidence is required when managing pregnant patients with such medications to ensure safety. However, information provided by approval label information is insufficient and often different among many countries. By analyzing label information of approval label and other references, this study aims to show the limitations and suggest appropriate directions for retrieving safety information. METHODS: We selected five anxiolytics and eleven antidepressants, which belongs to Korea drug classification codes 117 (psychotropic agents). We chose four countries, Korea, the United States of America (USA), the United Kingdom, Japan and collected safety information for pregnant women in label information. We evaluated the safety information based on recommendation level and evidence level. Then, kappa value and overall agreement were calculated using SAS 9.3. to assess data homogeneity. We further searched Reprotox and a textbook about contraindicated drugs in label information. RESULTS: Recommendation level and evidence level was different in each country. The number of commonly contraindicated drug in label information of four countries was none, and contraindicated drugs in labels were different respectively. Kappa value of evidence level between label information of Korea and Japan, the USA and Japan was 0.61, 0.43 respectively, corresponding to 'substantial agreement' and 'moderate agreement'. The overall agreement was 75%, 62.5% respectively. The information of label was different from that of other references, Reprotox and a textbook in terms of the clinical evidences and recommendation levels. CONCLUSION: Safety information of anxiolytics and antidepressants in label information needs to be updated on a regular basis both for health professionals and patients. With the implication of the inconsistent guidance for the safety information in pregnant women, reliable safety information in pregnant women would be needed.

A Case of Primary Endobronchial Actinomycosis Presenting as a Complicated Parapneumonic Effusion

Endobronchial actinomycosis is a rare but important and challenging diagnosis to make. We report a case of 57 year-old man who presented with a fever and a right-sided chest pain diagnosed as an endobronchial actinomycosis. Chest computed tomography showed a segmental obstruction and consolidations in right middle lobe combined with an ipsilateral multiloculated pleural effusion. Bronchoscopic biopsy of a mass obstructing the medial segmental bronchus of right middle lobe revealed actinomycosis. This is the first reported case of primary endobronchial actinomycosis that presented with a chest pain and a complicated parapneumonic effusion. Primary endobronchial actinomycosis can be a cause of complicated parapneumonic effusion.

Circadian Rhythms in Urinary Functions: Possible Roles of Circadian Clocks? / 대한배뇨장애요실금학회지

Circadian clocks are the endogenous oscillators that harmonize a variety of physiological processes within the body. Although many urinary functions exhibit clear daily or circadian variation in diurnal humans and nocturnal rodents, the precise mechanisms of these variations are as yet unclear. In this review, we briefly introduce circadian clocks and their organization in mammals. We then summarize known daily or circadian variations in urinary function. Importantly, recent findings by others as well as results obtained by us suggest an active role of circadian clock genes in various urinary functions. Finally, we discuss possible research avenues for the circadian control of urinary function.

Acceptance of Disability and Related Factors of Hemiplegic Elderly and Non-Elderly / 성인간호학회지

PURPOSE: This study was conducted to study the acceptance of disability and influential factors between hemiplegic elderly and non-elderly after stroke. METHODS: Data were collected with questionnaires from 104 elderly and 134 non-elderly with hemiplegia. Data were analyzed by chi-square-test, t-test, ANOVA, ANCOVA, Pearson correlation coefficient, and multiple regression. RESULTS: Significant predictors of acceptance of disability were family support, activities of daily living, and age, and these factors accounted for 24.2% of variance in acceptance of disability in the hemiplegic elderly. On the other hand, the significant predictors were family support and employment, and these factors accounted for 32.3% of variance in acceptance of disability in the non-elderly. Family support was the most influential variable in both the elderly and the non-elderly. CONCLUSION: An acceptance of disability program for the hemiplegic elderly should be designed differently from that for the non-elderly.

The Clinical Competence and Related Factors of the Nursing Students: Focused on the Subjects Who Studied Problem-Based Learning / 성인간호학회지

PURPOSE: This study was to evaluate clinical competence in relation to self-directed learning, critical thinking disposition, and participating in PBL(Problem-Based Learning) group activities of nursing students. METHODS: Data were collected from 108 nursing students in Oct. 2006. RESULTS: Clinical competence had a significant positive correlation with self-directed learning, critical thinking disposition, and participation in PBL group activities. There was a significant difference in clinical competence according to interpersonal relationship. Participation in PBL group activities was the most influential factor of clinical competence(R2=.34). Also, the influence of clinical competence increased with the addition of self-directed learning(R2=.42). CONCLUSION: It is essential to encourage the self-directed learning and participation in PBL group activities for the improvement of clinical competence. It is relatively important for clinical competence to consider the educational environment systematically.

Step by step analysis of root canal instrumentation with ProTaper(R) / 대한치과보존학회지

The purpose of this study was to investigate influence of each file step of ProTaper(R) system on canal transportation. Twenty simulated canals were prepared with either engine-driven ProTaper(R) or manual ProTaper(R). Group R-resin blocks were instrumented with rotary ProTaper(R) and group M-resin blocks were instrumented with manual ProTaper(R). Pre-operative resin blocks and post-operative resin blocks after each file step preparation were scanned. Original canal image and the image after using each file step were superimposed for calculation of centering ratio. The image after using each file step and image after using previous file step were superimposed for calculation of the amount of deviation. Measurements were taken horizontally at five different levels (1, 2, 3, 4 and 5 mm) from the level of apical foramen. In rotary ProTaper(R) instrumentation group, centering ratio and the amount of deviation of each step at all levels were not significantly different (p > 0.05). In manual ProTaper(R) instrumentation group, centering ratio and the amount of deviation of each step at all levels except of 1 mm were not significantly different (p > 0.05). At the level of 1 mm, F2 file step had significantly large centering ratio and the amount of deviation (p < 0.05). Under the condition of this study, F2 file step of manual ProTaper(R) tended to transport the apical part of the canals than that of rotary ProTaper(R).