Pro-Hemorrhagic Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy Associated with NOTCH3 p.R75P Mutation with Low Vascular NOTCH3 Aggregation Property.

OBJECTIVES: Intracerebral hemorrhage (ICH) and cerebral microbleeds (CMB) in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy are more common in East Asian populations than in people of white European ancestry. We hypothesized that the ethnic difference is explained by the East Asian-specific NOTCH3 p.R75P mutation. METHODS: This retrospective observational study included 118 patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy in Japanese and Korean cohorts. We investigated whether the p.R75P mutation is associated with symptomatic ICH and multiple CMB (>5) using quasi-Poisson regression models. We predicted the NOTCH3 extracellular domain protein structures in silico and graded NOTCH3 extracellular domain immunostaining in skin vessels of some patients, with subsequent comparisons between p.R75P and other conventional mutations. RESULTS: Among 63 Japanese patients (median age 55 years; 56% men), 15 had a p.R75P mutation, significantly associated with symptomatic ICH (adjusted relative risk 9.56, 95% CI 2.45-37.31), multiple CMB (3.00, 1.34-6.71), and absence of temporopolar lesions (4.91, 2.29-10.52) after adjustment for age, sex, hypertension, and antithrombotics. In the Korean cohort (n = 55; median age 55 years; 51% men), the p.R75P mutation (n = 13) was also associated with symptomatic ICH (8.11, 1.83-35.89), multiple CMB (1.90, 1.01-3.56), and absence of temporopolar lesions (2.32, 1.08-4.97). Structural analysis revealed solvent-exposed free cysteine thiols in conventional mutations, directly causing aggregation, whereas a stereochemically incompatible proline residue structure in p.R75P lowers correct disulfide bond formation probability, indirectly causing aggregation. Pathologically, the p.R75P mutation resulted in less vascular NOTCH3 extracellular domain accumulation than the other conventional mutations. INTERPRETATION: NOTCH3 p.R75P mutation is associated with hemorrhagic presentations, milder temporopolar lesions, and distinct mutant protein structure properties. ANN NEUROL 2024;95:1040-1054.

A Method of Generating Real-Time Natural Light Color Temperature Cycle for Circadian Lighting Service.

The light intensity and color temperature of natural light periodically change and promote the circadian entrainment of the human body. In addition, the color temperature cycle of natural light that is unique to each region is formed by its location and geographic and environmental factors, affecting the health of its residents. Research on lighting and construction to provide the color temperature of real-time natural light has continued to provide the beneficial effect of natural indoor lighting. However, lighting technology that provides the real-time color temperature of natural light could not be realized since it is challenging to select a color temperature cycle zone due to abrupt color temperature changes at sunrise and sunset. Such drastic shifts cause an irregular measurement of color temperature over time due to general weather or atmospheric conditions. In a previous study, a method of generating a color temperature cycle using deep learning was introduced, but the performance at the beginning and end of the color temperature cycle was unreliable. Therefore, this study proposes generating a real-time natural light color temperature cycle for the circadian lighting service. The characteristics of the daily color temperature cycle were analyzed based on the measured natural light characteristics database, and a data set for learning was established. To improve the color temperature cycle generation performance, a deep learning (TadGAN) model was implemented by searching for the lowest point of the color temperature at the start and end points of the color temperature cycle and applying the boot and ending datasets to these points. The color temperature cycle zone was accurately detected in real-time in the experiment, and the generation performance of the color temperature cycle was maintained at the beginning and end of the color temperature cycle. The mean absolute error decreased by about 67%, confirming the generation of a more accurate real-time color temperature cycle.

TadGAN-Based Daily Color Temperature Cycle Generation Corresponding to Irregular Changes of Natural Light.

This study to develop lighting is advanced for reproducing natural light color temperature beneficial to humans. Methods were introduced to provide daily color temperature cycles through formulas based on the measured natural light characteristics or real-time reproduction of natural light color temperature linking sensors. Analysis results for the measured natural light showed that irregular color temperature cycles were observed for more than 90% of the year due to the influence of regional weather and atmospheric conditions. Regular color temperature cycles were observed only on some clear days. The color temperature cycle dramatically affects the health of the occupants. However, since irregular color temperatures are difficult to predict and cannot easily generate cycles, only the color temperatures of some clear days are currently used, and the actual color temperature of natural light cannot be reproduced. There is little research on deriving real-time periodic characteristics and lighting services targeting irregular color temperatures of natural light. Therefore, this paper proposes a TadGAN (Time Series Anomaly Detection Using Generative Adversarial Networks)-based daily color temperature cycle generation method that responds to irregular changes in the natural light color temperature. A TadGAN model for generating the natural light color temperature cycle was built, and learning was performed based on the dataset extracted through the measured natural light characteristic Database. After that, the generator of TadGAN was repeatedly applied to generate a color temperature cycle close to the change of natural light. In the performance test of the proposed method, it was possible to generate periodic characteristics of the irregular natural light color temperature distribution.

A DNN-Based UVI Calculation Method Using Representative Color Information of Sun Object Images.

As outdoor activities are necessary for maintaining our health, research interest in environmental conditions such as the weather, atmosphere, and ultraviolet (UV) radiation is increasing. In particular, UV radiation, which can benefit or harm the human body depending on the degree of exposure, is recognized as an essential environmental factor that needs to be identified. However, unlike the weather and atmospheric conditions, which can be identified to some extent by the naked eye, UV radiation corresponds to wavelength bands that humans cannot recognize; hence, the intensity of UV radiation cannot be measured. Recently, although devices and sensors that can measure UV radiation have been launched, it is very difficult for ordinary users to acquire ambient UV radiation information directly because of the cost and inconvenience caused by operating separate devices. Herein, a deep neural network (DNN)-based ultraviolet index (UVI) calculation method is proposed using representative color information of sun object images. First, Mask-region-based convolutional neural networks (R-CNN) are applied to sky images to extract sun object regions and then detect the representative color of the sun object regions. Then, a deep learning model is constructed to calculate the UVI by inputting RGB color values, which are representative colors detected later along with the altitude angle and azimuth of the sun at that time. After selecting each day of spring and autumn, the performance of the proposed method was tested, and it was confirmed that accurate UVI could be calculated within a range of mean absolute error of 0.3.

Mobile Deep Learning System That Calculates UVI Using Illuminance Value of User's Location.

Ultraviolet rays are closely related with human health and, recently, optimum exposure to the UV rays has been recommended, with growing importance being placed on correct UV information. However, many countries provide UV information services at a local level, which makes it impossible for individuals to acquire user-based, accurate UV information unless individuals operate UV measurement devices with expertise on the relevant field for interpretation of the measurement results. There is a limit in measuring ultraviolet rays' information by the users at their respective locations. Research about how to utilize mobile devices such as smartphones to overcome such limitation is also lacking. This paper proposes a mobile deep learning system that calculates UVI based on the illuminance values at the user's location obtained with mobile devices' help. The proposed method analyzed the correlation between illuminance and UVI based on the natural light DB collected through the actual measurements, and the deep learning model's data set was extracted. After the selection of the input variables to calculate the correct UVI, the deep learning model based on the TensorFlow set with the optimum number of layers and number of nodes was designed and implemented, and learning was executed via the data set. After the data set was converted to the mobile deep learning model to operate under the mobile environment, the converted data were loaded on the mobile device. The proposed method enabled providing UV information at the user's location through a mobile device on which the illuminance sensors were loaded even in the environment without UVI measuring equipment. The comparison of the experiment results with the reference device (spectrometer) proved that the proposed method could provide UV information with an accuracy of 90-95% in the summers, as well as in winters.

Method of Calculating Short-Wavelength-Ratio-Based Color Temperature Supporting the Measurement of Real-Time Natural Light Characteristics through RGB Sensor.

The characteristics of natural light are mostly collected through specialized measuring equipment, such as a spectroradiometer, and some suggested measurement methods through a small RGB sensor. However, specialized measuring equipment presents difficulty in its high cost, and the RGB-sensor-based method has the limitation of being unable to measure the wavelength characteristics of natural light that are needed to implement lighting that supports circadian rhythms. This paper presents a method for calculating the short-wavelength-ratio-based color temperature of natural light in real time. First, an analysis of the correlation between the characteristics of natural light collected through a spectroradiometer was performed to determine the factors that were needed to accurately measure the color temperature of natural light. Then, the short-wavelength ratio of natural light was calculated through chromaticity coordinates (x and y), which are output values of the RGB sensor, and an equation for calculating the color temperature of natural light was derived through the short-wavelength ratio. Furthermore, after producing an RGB-sensor-based device, the derived equation was applied to calculate the color temperature of real-time natural light that reflects the wavelength characteristics. Then, as a result of the performance evaluation of the proposed method, the color temperature of natural light was accurately calculated within 1% of the average error rate.

Development of a UV Index Sensor-Based Portable Measurement Device with the EUVB Ratio of Natural Light.

Ultraviolet (UV) rays are electromagnetic waves that account for about 5% of solar light, and when overexposed, they pose malevolent effects on human skin and health. However, with recent reports on the beneficial effects of some wavelength bands of UV rays, people's interest in UV information has increased. This has resulted in requiring not just simple information, such as the amount of UV or UV index (UVI), but detailed UV information that directly affects health, such as EUVB (erythemally weighted UVB). However, calculating EUVB, which can be done by applying the erythemal weighted function on the intensity value in wavelength, requires specialized optical measurement devices, which cannot be easily accessed by the general public; furthermore, public institutions' UV information services do not offer EUVB information for individuals. Therefore, the present study proposes a UVI sensor-based portable measurement device, with which the general public can have easy access to UV-related information. The proposed device comprises a UVI sensor that can measure the intensity of erythemal UV radiation, a Bluetooth Low Energy (BLE) module that supports communication, and a micro controller unit (MCU) for key operations. In addition, it applies the ratio of EUVB by month/time, resulting from the actual analysis of natural light to calculate the EUVB and provides the amount of UVI and EUVB to check if they meet conditions required for outdoor activities through the device and smartphone applications. The applicability of the proposed device was verified by the measurement performance comparison test with the standard device, a spectrometer (CAS 140 CT), which showed an average error of 0.045 for UVI and 0.0014 W/m². The proposed device's offering of UV-related information such as UVI and EUVB to the user is expected to prevent potential damage due to exposure to UV and to support healthy outdoor activities.

Nuclear Expression of GS28 Protein: A Novel Biomarker that Predicts Prognosis in Colorectal Cancers.

Aims: GS28 (Golgi SNARE protein, 28 kDa), a member of the soluble N-ethylmaleimide-sensitive factor attachment protein receptors (SNARE) protein family, plays a critical role in mammalian endoplasmic reticulum (ER)-Golgi or intra-Golgi vesicle transport. To date, few researches on the GS28 protein in human cancer tissues have been reported. In this study, we assessed the prognostic value of GS28 in patients with colorectal cancer (CRC). Methods and results: We screened for GS28 expression using immunohistochemistry in 230 surgical CRC specimens. The CRCs were right-sided and left-sided in 28.3% (65/230) and 71.3% (164/230) of patients, respectively. GS28 staining results were available in 214 cases. Among these, there were 26 nuclear predominant cases and 188 non-nuclear predominant cases. Stromal GS28 expression was noted in 152 cases of CRC. GS28 nuclear predominant immunoreactivity was significantly associated with advanced tumour stage (p = 0.045) and marginally associated with perineural invasion (p = 0.064). Decreased GS28 expression in the stromal cells was significantly associated with lymph node metastasis (N stage; p = 0.036). GS28 expression was not associated with epidermal growth factor receptor (EGFR) immunohistochemical positivity or KRAS mutation status. Investigation of the prognostic value of GS28 with Kaplan-Meier analysis revealed a correlation with overall survival (p = 0.004). Cases with GS28 nuclear predominant expression had significantly poorer overall survival than those with a non-nuclear predominant pattern. Conclusions: Taken together, these results indicate that GS28 nuclear predominant expression could serve as a prognostic marker for CRC and may help in identifying aggressive forms of CRC.

Syndecan-1 expression is associated with tumor size and EGFR expression in colorectal carcinoma: a clinicopathological study of 230 cases.

BACKGROUND: Syndecan-1 (SDC1) is reported to modulate several key processes of tumorigenesis and has variable expression in many cancers. To date, the cause of altered expression has not been elucidated. In this study, we compared SDC1 expression with various clinicopathological parameters and molecular markers to evaluate its clinical significance in colorectal carcinoma. METHODS: We screened for SDC1 expression using immunohistochemistry in 230 surgical specimens of primary colorectal carcinoma from patients consecutively treated between 2008 and 2011 at Seoul St. Mary's Hospital, The Catholic University of Korea. The relationship between SDC1 expression and various clinicopathological parameters and molecular markers was analyzed. RESULTS: The tumors were principally located in the left colon (71.3%) and rectum (33.5%). There were 216 (93.9%) adenocarcinomas, 10 (4.3%) mucinous adenocarcinomas, and 4 other tumors. Most of the carcinomas were pT3 (68.3%) and pT4 (22.2%). There was regional lymph node metastasis in 140 patients. SDC1 expression was identified in the cancer cells of 212 (96.8%) colon cancer cases. Of the SDC1-positive cases, 131 showed predominantly membranous immunopositivity, and 81 showed a predominantly cytoplasmic staining pattern. Mixed membranous and cytoplasmic staining was observed in 154 cases. In 93 cases, stromal SDC1 reactivity was noted. Epithelial SDC1 immunopositivity was significantly associated with tumor size (p=0.016) and epidermal growth factor receptor expression (p=0.006). However, it was not significantly correlated with lymph node metastasis, distant metastasis, lymphatic or vascular invasion, or KRAS mutation. In addition, stromal SDC1 immunopositivity was significantly associated with the male sex (p=0.018). CONCLUSIONS: The expression profile of SDC1 may be of clinical value in colorectal cancer and may help in identifying aggressive forms of colorectal carcinoma. Further studies are needed in order to better understand the role of SDC1 in the progression and invasiveness of colorectal carcinoma.

Prognostic significance of S100A4 mRNA and protein expression in colorectal cancer.

BACKGROUND AND OBJECTIVES: The calcium-binding protein S100A4 promotes tumor progression and metastasis. We investigated the expression of S100A4 in colorectal cancer and its clinicopathologic significance in colorectal cancer. METHODS: A total of 526 colorectal cancer patients were examined for S100A4 protein by immunohistochemistry using tissue microarrays. S100A4 mRNA was subsequently investigated by in situ hybridization. RESULTS: S100A4 protein was expressed in various cell types including tumor cells, but S100A4 mRNA was only expressed in tumor cells. Cytoplasmic expression of S100A4 protein was seen in 127 (24.1%) of 526 tumors and significantly correlated with older age, depth of invasion, lymph node metastasis, and worse overall survival. Nuclear expression of S100A4 protein was observed in 136 (25.9%) tumors and significantly related to the depth of invasion, perineural invasion, and worse overall survival. However, there was no correlation between S100A4 mRNA expression and clinicopathological parameters. Upon multivariate analysis nuclear expression of S100A4 protein was found to be an independent prognostic factor of poor survival. CONCLUSIONS: Expression of S100A4 protein in colorectal cancers may indicate tumor progression and lymph node metastasis and can be useful for prediction of overall survival of patients with colorectal cancers.

A simple method to improve the quality and yield of human pluripotent stem cell-derived cerebral organoids.

The development of cerebral organoid technology has allowed the human neural tissue to be collected for studying human brain development and neurological diseases. Human pluripotent stem cell-derived cerebral organoids (hCOs) are a theoretically infinite source of fresh human brain tissue for various research purposes. However, hCOs have limitations, including core necrotic cell death. To solve this problem, we tested a simple method, which has been previously overlooked. In this study, we mechanically cut 70-day-old hCOs with a scalpel blade into 2 to 4 pieces, each depending on their original size. After culturing cut hCOs for additional 7 days, their size was less variable and smaller than uncut hCOs and there were no histological differences between uncut and cut hCOs. Note that hypoxia-inducible factor (HIF)-1α was expressed in the central area of uncut hCOs but not in cut hCOs. Uncut hCOs, therefore, showed broad core areas stained with terminal deoxynucleotidyl transferase dUTP nick end-labeling (TUNEL), whereas cut hCOs did not. In conclusion, this simple mechanical cutting method allowed us to acquire a larger number of hCOs without a necrotic core.

Effect of stellate ganglion block on the cerebrovascular system: magnetic resonance angiography study.

BACKGROUND: Several studies have shown that stellate ganglion block (SGB) is an effective treatment for certain cerebrovascular related diseases; however, the direct effect of SGB on the cerebral vasculature is still unknown. The present study investigated the effect of SGB on the cerebral vascular system using magnetic resonance angiography. METHODS: Time-of-flight magnetic resonance angiography images of 19 healthy female volunteers (mean ages of 46.4 ± 8.9 yr) were obtained before and after SGB with 1.5-T magnetic resonance imaging. The authors determined successful interruption of sympathetic innervation to the head with the appearance of Horner syndrome and conjunctival injection. We measured changes in the average signal intensity and diameter of the major intracranial and extracranial arteries and their branches, which were presented with mean (±SE). RESULTS: The signal intensity changes were observed mainly in the ipsilateral extracranial vessels; the external carotid artery (11.2%, P < 0.001) and its downstream branches, such as the occipital artery (9.5%, P < 0.001) and superficial temporal artery (14.1%, P < 0.001). In contrast, the intensities of the intracranial arteries did not change with the exception of the ipsilateral ophthalmic artery, which increased significantly (10.0%, P = 0.008). After SGB, only the diameter of the ipsilateral external carotid artery was significantly increased (26.5%, P < 0.001). CONCLUSIONS: We were able to observe significant changes in the extracranial vessels, whereas the intracranial vessels were relatively unaffected (except for the ophthalmic artery), demonstrating that both perivascular nerve control and sympathetic nerve control mechanisms may contribute to the control of intracranial and extracranial blood vessels, respectively, after SGB.

Acceleration of somatic cell reprogramming into the induced pluripotent stem cell using a mycosporine-like amino acid, Porphyra 334.

Porphyra 334 (P334), a mycosporine-like amino acid (MAA), is a secondary metabolite found in diverse marine and terrestrial organisms and has several beneficial effects on fibroblast proliferation, wound healing, and antioxidant activity. Here, we report that P334 accelerates the cell reprogramming process of mouse tail-tip fibroblasts (TTFs) and human dermal papilla (HDP) cells into induced pluripotent stem cells (iPSCs). We found that P334 significantly improved the cell reprogramming efficiency by activating the tri-methylation of histone 3 lysine 4 (H3K4me3), which controls mesenchymal to epithelial transition (MET) during the reprogramming process. Thus, we found that P334 directly regulates epigenetic changes, providing an efficient approach for natural compound-based cell reprogramming.

Primary adenocarcinoma of the small intestine: presentation, prognostic factors and clinical outcome.

BACKGROUND: Malignant small intestine tumor accounts for 0.1-0.3% of all malignancies. Although primary adenocarcinoma is the most common histologic subtype, there is no report of the clinical characteristics and natural history in the Asian population. METHODS: We conducted retrospective analysis for the patients with the small intestine adenocarcinoma to explore the clinical characteristics and prognosis. All patients with adenocarcinoma of small intestine diagnosed between March 1997 and March 2007 in the Catholic Medical Center in Korea were identified through the cancer registry. The medical records were reviewed for patient characteristics, treatment and outcome data. RESULTS: Data on 53 patients were available. Twenty-six patients (49.0%) underwent curative resection and 13 patients receiving adjuvant chemotherapy. Fifteen patients received palliative chemotherapy. Median of overall survival of all patients was 12 months (95% confidence interval (CI): 8.5-15.1 months). Three-year survival and relapse-free survival rates after curative resection was 66.1 and 50.8%, respectively. Median survival of patients received palliative chemotherapy was 8.0 months (95% CI: 3.5-12.4). CONCLUSIONS: The prognosis of primary adenocarcinoma of small intestine was poor, especially in cases where curative resection could not to be performed. Further study on the methods for early detection and effective systemic chemotherapy should be investigated.

Postoperative delirium.

Delirium can be defined as an 'acute brain dysfunction.' Compared to dementia, which is a disease that deteriorates the brain function chronically, delirium shows very similar symptoms but is mostly ameliorated when the causative factors are normalized. Due to the heterogeneity in etiologies and symptoms, people including health care workers often mistake delirium for dementia or other psychiatric disorders. Delirium has attracted global interest increasingly and a vast amount of research on its management has been conducted. Experts in the field have constantly suggested that systematic intervention should be implemented through a team-based multicomponent approach aimed to reduce the incidence and duration of delirium. Surgery involves many health care workers with different expertise who are not familiar with delirium. For a team-based approach on the management of delirium, it is vital that all medical personnel concerned have a common understanding of delirium and keep in constant communication. Postoperative delirium is a common complication and exerts an enormous burden on patients, their families, hospitals, and public resources. To alleviate this burden, this article aimed to review general features and the latest evidence-based knowledge of delirium with a focus on postoperative delirium.

Effect of drug compliance on health care costs in newly-diagnosed dementia: Analysis of nationwide population-based data.

BACKGROUND: The cost-effectiveness of both cholinesterase inhibitors and memantine by delaying nursing home placement has been supported by numerous studies. The importance of sustained pharmacological treatment in dementia has been relatively less recognized by public health policies compared to early diagnosis. We investigated the effect of the drug (donepezil, rivastigmine, galantamine, and memantine) compliance on the health care costs in newly-diagnosed dementia. METHODS: National Health Insurance Service (NHIS) database which covers the entire population of South Korea was used for analysis. Health care expenditure of patients newly-diagnosed with dementia in between 2012 and 2014 was investigated for 3-5 years. For drug compliance, we used Medication Possession Ratio (MPR) that indicates the percentage of time a patient has access to medication. Multivariate linear regression analysis including generalized estimated equation and gamma distribution was used for statistical analysis. RESULTS: We identified 252,594 patients who were both prescribed with cognitive enhancers and newly diagnosed with dementia. When initial MPR increased 20%, total health care costs decreased 8.4% (RR = 0.916, 95%; CI 0.914 to 0.916). Same relationship was shown with medical costs related to dementia, admission to a general hospital, and emergency room visits. When MPR increased 20% compared to the previous year, the total health care costs, admission to a general hospital, emergency room visits, and admission to a nursing hospital decreased. CONCLUSIONS: This population-based retrospective cohort study provides evidence that patients newly-diagnosed with dementia who showed higher initial drug compliance or maintained antidementia drugs (Cholinesterase inhibitors and memantine) would benefit in total health-care costs.

Associated risk factors for psychological distress in patients with gastric epithelial neoplasm undergoing endoscopic submucosal dissection.

This study aimed to evaluate the psychological distress and associated risk factors for distress among patients with gastric epithelial neoplasm undergoing endoscopic submucosal dissection (ESD).A total of 91 patients treated with ESD for gastric epithelial neoplasm between May 2015 and June 2016 were prospectively enrolled. Sociodemographic factors, psychological distress, anxiety, depression, stress, and associated risk factors for psychological distress were evaluated the day before ESD.Twenty-six (28.6%) patients were identified as patients with psychological distress. The psychological distress group had a higher female ratio and more depression and anxiety symptoms than the non-distress group. Distress was also related to stress level. A multivariate analysis showed that unmarried status (odds ratio [OR], 4.94; 95% confidence interval [CI], 1.13-21.56, P = .034), anxiety (OR, 1.24; 95% CI, 1.12-1.39, P <.001), and stress (OR, 1.06; 95% CI, 1.01-1.12, P = .011) were associated with psychological distress.An unmarried status and a high level of anxiety and stress were associated with more psychological distress in patients undergoing gastric ESD. It could be helpful to screen and proactively monitor patients with such conditions before performing gastric ESD.

Pain and anxiety and their relationship with medication doses in the intensive care unit.

PURPOSE: Pain and anxiety are understudied despite their importance to the general medical condition. The aim of the present study was to examine the effects of pain and anxiety and their relationship to the doses of opioids and anxiolytics administered in intensive care unit (ICU) patients. METHODS: The subjects included 1349 conscious, critically ill patients admitted to an ICU. Psychiatrists evaluated the patients daily for pain and anxiety. Data regarding the doses of opioids and benzodiazepines administered were gathered. Linear mixed model was used for analysis. RESULTS: The pain and anxiety experienced by patients in the ICU were significantly correlated. Pain had significant main effects on the dose of opioids administered. No significant effects of anxiety on the daily dose of anxiolytics or opioids given were detected. CONCLUSIONS: Due to their closely linked relationship, pain and anxiety, can affect one another, and one can influence the other to appear more severe. In addition, anxiety can be underestimated in ICU patients. The present study suggests the need for precise evaluation and a comprehensive approach to the management of pain and anxiety. In addition, this study implies that management of anxiety may affect pain reduction, given the close correlation between the two.

The Effects of a Delirium Notification Program on the Clinical Outcomes of the Intensive Care Unit: A Preliminary Pilot Study.

BACKGROUND: Delirium is common among intensive care unit (ICU) patients, so recent clinical guidelines recommended routine delirium monitoring in the ICU. But, its effect on the patient's clinical outcome is still controversial. In particular, the effect of systems that inform the primary physician of the results of monitoring is largely unknown. METHODS: The delirium notification program using bedside signs and electronic chart notifications was applied to the pre-existing delirium monitoring protocol. Every patient was routinely evaluated for delirium, pain, and anxiety using validated tools. Clinical outcomes, including duration of delirium, ICU stay, and mortality were reviewed and compared for 3 months before and after the program implementation. RESULTS: There was no significant difference between the two periods of delirium, ICU stay, and mortality. However, anxiety, an important prognostic factor in the ICU survivor's mental health, was significantly reduced and pain tended to decrease. CONCLUSIONS: Increasing the physician's awareness of the patient's mental state by using a notification program could reduce the anxiety of ICU patients even though it may not reduce delirium. The results suggested that the method of delivering the results of monitoring was also an important factor in the success of the delirium monitoring program.