Practice guidelines for managing extrahepatic biliary tract cancers.

Backgrounds/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions: The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

Survey on Value Elements Provided by Artificial Intelligence and Their Eligibility for Insurance Coverage With an Emphasis on Patient-Centered Outcomes.

OBJECTIVE: This study aims to explore the opinions on the insurance coverage of artificial intelligence (AI), as categorized based on the distinct value elements offered by AI, with a specific focus on patient-centered outcomes (PCOs). PCOs are distinguished from traditional clinical outcomes and focus on patient-reported experiences and values such as quality of life, functionality, well-being, physical or emotional status, and convenience. MATERIALS AND METHODS: We classified the value elements provided by AI into four dimensions: clinical outcomes, economic aspects, organizational aspects, and non-clinical PCOs. The survey comprised three sections: 1) experiences with PCOs in evaluating AI, 2) opinions on the coverage of AI by the National Health Insurance of the Republic of Korea when AI demonstrated benefits across the four value elements, and 3) respondent characteristics. The opinions regarding AI insurance coverage were assessed dichotomously and semi-quantitatively: non-approval (0) vs. approval (on a 1-10 weight scale, with 10 indicating the strongest approval). The survey was conducted from July 4 to 26, 2023, using a web-based method. Responses to PCOs and other value elements were compared. RESULTS: Among 200 respondents, 44 (22%) were patients/patient representatives, 64 (32%) were industry/developers, 60 (30%) were medical practitioners/doctors, and 32 (16%) were government health personnel. The level of experience with PCOs regarding AI was low, with only 7% (14/200) having direct experience and 10% (20/200) having any experience (either direct or indirect). The approval rate for insurance coverage for PCOs was 74% (148/200), significantly lower than the corresponding rates for other value elements (82.5%-93.5%; P ≤ 0.034). The approval strength was significantly lower for PCOs, with a mean weight ± standard deviation of 5.1 ± 3.5, compared to other value elements (P ≤ 0.036). CONCLUSION: There is currently limited demand for insurance coverage for AI that demonstrates benefits in terms of non-clinical PCOs.

Ir(tri-N-heterocyclic carbene)-catalyzed upgrading of glycerol: C-C bond formation for the synthesis of α-hydroxy acids.

Ir(triNHC) complexes catalyzed glycerol and alcohol dehydrogenative coupling, yielding diverse α-hydroxy acids. Unlike conventional conditions, Ir(triNHC) facilitated additional C-C bond formation after lactic acid production from glycerol, exhibiting high TOFs. This protocol successfully converted 1,2-propanediol and sorbitol into α-hydroxy acids, highlighting biomass-derived sources' potential as valuable platform chemicals.

Predictors of Sleep Quality in Spouse Caregivers of Community-Dwelling People With Dementia Using Propensity Score Matching Analysis.

BACKGROUND: Many family caregivers of people with dementia (PwDs) have sleep problems and poor sleep quality. Sleep may be negatively affected by caring for a family member with dementia, especially a spouse. PURPOSE: This study was designed to assess sleep quality in spouse caregivers of PwDs and determine the impact of care provision on their sleep quality. METHODS: A secondary analysis of 58,050 participants in the 2018 Korea Community Health Survey was conducted. To prevent selection bias, a propensity score matching analysis was performed. Multiple logistic regression analysis was conducted to investigate the predictors of sleep quality. RESULTS: After obtaining a propensity score matching threshold of 3:1, the percentage of poor sleepers was 24.2% in the control group and 33.3% in the spouse-caregiver group, which indicates a significant difference (χ 2 = 11.79, p = .001). After adjusting for depressive symptoms in the multiple logistic analyses, no intergroup difference was found in terms of risk of poor sleep quality (odds ratio = 1.12, 95% CI [0.90, 1.61]). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study support that spouse caregivers of PwDs have poorer sleep quality than their nonspouse peers and that management of depressive symptoms is important to improving the sleep quality of spouses providing care to PwDs. Nursing interventions such as light therapy and exposure to sunlight during daytime hours to both improve sleep quality and reduce depressive symptoms can improve sleep quality in this vulnerable caregiver group.

Radiologist's Guide to Evaluating Publications of Clinical Research on AI: How We Do It.

Literacy in research studies of artificial intelligence (AI) has become an important skill for radiologists. It is required to make a proper assessment of the validity, reproducibility, and clinical applicability of AI studies. However, AI studies are generally perceived to be more difficult for clinician readers to evaluate than traditional clinical research studies. This special report-as an effective, concise guide for readers-aims to assist clinical radiologists in critically evaluating different types of clinical research articles involving AI. It does not intend to be a comprehensive checklist or methodological summary for complete clinical evaluation of AI or a reporting guideline. Ten key items for readers to check are described, regarding study purpose, function and clinical context of AI, training data, data preprocessing, AI modeling techniques, test data, AI performance, helpfulness and value of AI, interpretability of AI, and code sharing. The important aspects of each item are explained for readers to consider when reading publications on AI clinical research. Evaluating each item can help radiologists assess the validity, reproducibility, and clinical applicability of clinical research articles involving AI.

Cu(triNHC)-catalyzed polymerization of glycidol to produce ultralow-branched polyglycerol.

We have successfully synthesized a novel form of polyglycerol with an unprecedentedly low degree of branching (DB = 0.08-0.18), eliminating the need for glycidol protection. Leveraging the remarkable efficiency and selectivity of our Cu(triNHC) catalyst, comprising copper(i) ions and NHC ligands, we achieved a highly selective polymerization process. The proposed Cu-coordination mechanisms presented the formation of linear L1,3 units while effectively suppressing dendritic units. Consequently, our pioneering approach yielded polyglycerol with an ultralow DB and exceptional yields. To comprehensively assess the physical properties and topology of the synthesized polyglycerol, we employed 1H diffusion-ordered spectroscopy, size-exclusion chromatography, and matrix-assisted laser desorption/ionization-time of flight spectrometry. Remarkably, the ultralow-branched cyclic polyglycerol (DB = 0.08) synthesized at 0 °C showcased extraordinary characteristics, exhibiting the lowest diffusion coefficient and the highest molecular weight. This achievement establishes the significant potential of our polyglycerol with a low degree of branching, revolutionizing the field of biocompatible polymers.

Infection prevention and control practices and related factors among paramedics during the coronavirus disease 2019 outbreak in Korea.

This study aimed to investigate the coronavirus disease 2019 (COVID-19) infection prevention and control (IPC) practices and related factors among paramedics. We selected 249 paramedics using convenience sampling from three areas in Korea. Data on the demographics, infection-related characteristics, awareness, and practice of IPC were collected using self-reported questionnaires. The mean IPC practice score was 4.47 ± 0.54. The compliance with IPC practices was relatively high among those with a disease history (B = 0.194, p = 0.045) and who were aware of the safety management standard guidelines. Provision of sufficient protective equipment and infection prevention monitoring were associated with higher IPC practice scores. Education for increasing awareness of the recent IPC guidelines and the allocation of personal protective equipment would be helpful in improving the practice.

Methods for Clinical Evaluation of Artificial Intelligence Algorithms for Medical Diagnosis.

Adequate clinical evaluation of artificial intelligence (AI) algorithms before adoption in practice is critical. Clinical evaluation aims to confirm acceptable AI performance through adequate external testing and confirm the benefits of AI-assisted care compared with conventional care through appropriately designed and conducted studies, for which prospective studies are desirable. This article explains some of the fundamental methodological points that should be considered when designing and appraising the clinical evaluation of AI algorithms for medical diagnosis. The specific topics addressed include the following: (a) the importance of external testing of AI algorithms and strategies for conducting the external testing effectively, (b) the various metrics and graphical methods for evaluating the AI performance as well as essential methodological points to note in using and interpreting them, (c) paired study designs primarily for comparative performance evaluation of conventional and AI-assisted diagnoses, (d) parallel study designs primarily for evaluating the effect of AI intervention with an emphasis on randomized clinical trials, and (e) up-to-date guidelines for reporting clinical studies on AI, with an emphasis on guidelines registered in the EQUATOR Network library. Sound methodological knowledge of these topics will aid the design, execution, reporting, and appraisal of clinical evaluation of AI.

Cutoff Values for Diagnosing Hepatic Steatosis Using Contemporary MRI-Proton Density Fat Fraction Measuring Methods.

OBJECTIVE: To propose standardized MRI-proton density fat fraction (PDFF) cutoff values for diagnosing hepatic steatosis, evaluated using contemporary PDFF measuring methods in a large population of healthy adults, using histologic fat fraction (HFF) as the reference standard. MATERIALS AND METHODS: A retrospective search of electronic medical records between 2015 and 2018 identified 1063 adult donor candidates for liver transplantation who had undergone liver MRI and liver biopsy within a 7-day interval. Patients with a history of liver disease or significant alcohol consumption were excluded. Chemical shift imaging-based MRI (CS-MRI) PDFF and high-speed T2-corrected multi-echo MR spectroscopy (HISTO-MRS) PDFF data were obtained. By temporal splitting, the total population was divided into development and validation sets. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of the MRI-PDFF method. Two cutoff values with sensitivity > 90% and specificity > 90% were selected to rule-out and rule-in, respectively, hepatic steatosis with reference to HFF ≥ 5% in the development set. The diagnostic performance was assessed using the validation set. RESULTS: Of 921 final participants (624 male; mean age ± standard deviation, 31.5 ± 9.0 years), the development and validation sets comprised 497 and 424 patients, respectively. In the development set, the areas under the ROC curve for diagnosing hepatic steatosis were 0.920 for CS-MRI-PDFF and 0.915 for HISTO-MRS-PDFF. For ruling-out hepatic steatosis, the CS-MRI-PDFF cutoff was 2.3% (sensitivity, 92.4%; specificity, 63.0%) and the HISTO-MRI-PDFF cutoff was 2.6% (sensitivity, 88.8%; specificity, 70.1%). For ruling-in hepatic steatosis, the CS-MRI-PDFF cutoff was 3.5% (sensitivity, 73.5%; specificity, 88.6%) and the HISTO-MRI-PDFF cutoff was 4.0% (sensitivity, 74.7%; specificity, 90.6%). CONCLUSION: In a large population of healthy adults, our study suggests diagnostic thresholds for ruling-out and ruling-in hepatic steatosis defined as HFF ≥ 5% by contemporary PDFF measurement methods.

Capecitabine and temozolomide for metastatic intermediate to high-grade pancreatic neuroendocrine neoplasm: a single center experience.

BACKGROUND/AIMS: The combination of capecitabine and temozolomide (CAPTEM) is one of the treatment options for metastatic pancreatic neuroendocrine neoplasms (pNENs). This study aims to evaluate the efficacy of CAPTEM in patients with metastatic intermediate to high-grade pancreatic neuroendocrine tumor (pNET) or carcinoma (pNEC). METHODS: This study was conducted retrospectively in a single center. Patients were treated for intermediate to high-grade tumor with 750 mg/m² of capecitabine twice daily from day 1 to 14 and 200 mg/m² of temozolomide once daily from day 10 to 14, repeating twice in a cycle of 28 days. The primary outcomes were durations of overall survival (OS) and progression-free survival (PFS). The secondary outcomes consisted of objective response rate and disease control rate. RESULTS: A total of 12 patients (grade 2 NET in six, grade 3 NET in three, NEC in three patients) who received CAPTEM were included in this study. Patients received a median of five cycles (range, 2 to 46) of CAPTEM. The median dose combined 1,150 mg of capecitabine and 300 mg of temozolomide. The median OS and PFS were 41.2 months (range, 3.2 to 167) and 39.7 months (range, 2.1 to 100), respectively. Patients with NET had longer OS and PFS compared to those of patients with NEC (p = 0.002 and p = 0.028). High Ki-67 proliferative index (> 50%) was significantly associated with poor survival outcomes. CONCLUSION: CAPTEM showed favorable survival outcomes in patients with metastatic intermediate to high-grade pNENs. Our study supports that CAPTEM may be an effective treatment option for metastatic pNENs.

COVID-19-related anxiety and lifestyle changes.

This study aimed to identify factors that affect lifestyle changes and focused on coronavirus disease (COVID-19)-related anxiety since the COVID-19 outbreak in South Korea. Data from 213,848 individuals from the 2020 Korean Community Health Survey were analyzed using a complex sampling design. Descriptive statistics, t-tests, one-way ANOVA, and multiple regression analyses were performed. Participants reported a high level of COVID-19-related anxiety, with a score of 19.28 out of 25. The score of healthy behavioral change index was -0.51, indicating negative changes in physical activity, dietary habits, and sleep patterns. A slight positive change was reported for addictive behavioral change index, such as smoking and alcohol consumption, at 0.27 scores, indicating a decrease in these behaviors. COVID-19-related anxiety was an important factor that negatively affected health behavior. The high-risk groups that were vulnerable to anxiety included older adults and those who have little social support or few social encounters. Thus, identifying high-risk groups with the potential for worsened health behavior and providing interventions to reduce the anxiety caused by COVID-19 are necessary.

Surface activated zinc-glutarate for the copolymerization of CO2 and epoxides.

Zinc-glutarate (ZnGA) is a promising catalyst that can form polymers from CO2 and epoxides, thereby contributing to the development of CO2 utilization technologies and future sustainability. One of the obstacles to commercializing ZnGA in polymer industries is its low catalytic activity. In this study, we introduced activated two-dimensional (2D) ZnGA to improve its catalytic activity in polymerization. The morphology-controlled 2D ZnGA was treated with H3Co(CN)6, and a porous granular-type Co-modified ZnGA (Co-ZnGA) was prepared. The morphology of 2D ZnGA is a prerequisite for the activation by H3Co(CN)6. The catalytic properties of Co-ZnGA were evaluated by copolymerization of various epoxides and CO2, and exhibited catalytic activity of 855, 1540, 1190, and 148 g g-cat-1 with propylene oxide, 1,2-epoxyhexane, 1,2-epoxybutane, and styrene oxide, respectively. This study provided a new strategy using 2D ZnGA instead of conventional ZnGA for increasing the catalytic activity in CO2 polymerization.

The life experiences of living liver donors: A qualitative meta-synthesis.

As living liver transplantation has become a standard treatment method with a high success rate, many studies have investigated the experiences of living liver donors; however, their results have not been integrated. This qualitative meta-synthesis aimed to explore the life experiences of living liver donors to provide an in-depth understanding of meaningful common experiences. A comprehensive search on qualitative studies published in English or Korean was conducted in October 2021. The PRISMA statement was used for reporting each phase of the literature search, and MAXQDA2020 software was used for data analysis. Data synthesis was conducted using the three-step thematic synthesis method suggested by Thomas and Harden. Ten articles met the inclusion criteria. The analysis revealed five main themes: "Becoming an earnest donor," "Transitioning from a potential donor to an actual donor," "Difficulties in returning to normal life," "Re-examining the meaning of donation," and "Wishes for prospective donors." The study emphasizes that living liver donors need medical attention and intervention from multilateral perspectives as well as the need for systematic change in the society to enhance support for donors. This review provides comprehensive insights on how individuals became the living liver donor and the important aspects of living donation and other considerations in an integrated manner. Transplant teams, including nurses and coordinators, should have a comprehensive understanding of physical, psychological, and social experiences of donors ranging from decision-making to post donation health management.

Influence of combined cognitive impairment and social frailty on physical frailty in community-dwelling older adults.

PURPOSE: This study aimed to identify the influence of combined cognitive impairment and social frailty on physical frailty. METHODS: This study analyzed secondary data from the 2020 National Survey of Older Koreans, which was collected nationwide from community-dwelling individuals aged ≥ 65 years. RESULTS: Combined cognitive impairment and social frailty (odds ratio (OR) =4.44, 95% confidence interval (CI)=3.14-6.28), cognitive impairment and social pre-frailty (OR =2.38, 95% CI =1.70-3.34), noncognitive impairment and social frailty (OR =2.16, 95% CI =1.54-3.04), and noncognitive impairment and social pre-frailty (OR =1.40, 95% CI =1.02-1.91) groups were more likely to be physically frail than noncognitive impairment and socially robust groups after adjusting for sociodemographic and health-related factors. CONCLUSION: Healthcare providers need to be aware that older adults who suffer from both cognitive impairment and social frailty may be vulnerable to physical frailty.

Factors influencing the stages of frailty among Korean older adults focusing on objective and subjective social isolation.

BACKGROUND: Although many studies have investigated the factors influencing frailty, few studies have confirmed the influence of social factors on the stages of frailty. This study was conducted to identify factors influencing the stages of frailty in Korean older adults, focusing on objective and subjective social isolation. METHODS: This study analyzed the data of 10,041 older adults from the 2017 National Survey of Older Koreans. Two multiple logistic regression analyses were performed to identify the factors influencing the frailty stages. Frailty was calculated using the FRAIL scale with the five domains: fatigue, resistance, ambulation, illness, and loss of weight. RESULTS: Among Korean older adults, 51.5% were in the robust stage, 42.5% in the pre-frail stage and 6.0% in the frail stage. As a multiple logistic regression analysis, participants with an intimate relationship (Odds ratio (OR) 0.93, 95% Confidential interval (CI) = 0.91-0.95) or objective social non-isolated participants were more likely to be in the robust group than the pre-frail group. Objective social-isolated participants were more likely to belong to the frail group than the pre-frail group: isolation from family member only (OR 1.57, 95% CI = 1.04-2.39), isolation from non-family member only (OR 1.75, 95% CI = 1.39-2.19), and isolation from both family and non-family member (OR 2.56, 95% CI = 1.67-3.92). CONCLUSIONS: This cross-sectional study showed that social isolation was associated with the stage of frailty. Therefore, researchers need to consider issues of social isolation of older adults in the development of frailty prevention and management intervention.

Factors Associated With Depressive Symptoms in Individuals Who Have Experienced COVID-19 Self-Quarantine.

The purpose of this study was to identify the factors associated with depressive symptoms in individuals who have experienced self-quarantine because of coronavirus disease exposure or infection using Lazarus and Folkman's stress, coping, and adaptation theory, and George's Social Antecedent Model of Depression. This was a cross-sectional study that used data from the 2020 Korean Community Health Survey. A complex sample design was used to analyze the data. Descriptive statistics, the Rao-Scott X2 test, and logistic regression analysis were conducted to identify factors associated with depressive symptoms. Approximately 5.3% of the subjects had depressive symptoms. The factors associated with depressive symptoms were age, level of education, household income, changes in daily life due to coronavirus disease, whether someone provided assistance during the self-quarantine, perceived health status, and hospital consultation due to depressive symptoms. The findings of this study will be utilized as basic data for the development of programs to alleviate and prevent depressive symptoms in self-quarantine individuals.

Synthesis of α-Hydroxy Acids via Dehydrogenative Cross-Coupling of a Sustainable C2 Chemical (Ethylene Glycol) with Alcohols.

Ir(NHC) (NHC, N-heterocyclic carbene)-catalyzed dehydrogenative coupling of sustainable ethylene glycol and various bioalcohols can produce industrially valuable α-hydroxy acids (AHAs). This study is the first to report the sustainable synthesis of higher Cn AHAs, in addition to glycolic acid (C2 AHA) and lactic acid (C3 AHA). This catalytic system can be recycled to the seventh cycle while maintaining good yields. A reaction mechanism, including facile dehydrogenation of each alcohol and fast cross-coupling of dehydrogenated aldehydes forming products, was proposed based on 18O- and 2H-labeling experiments and electron spray ionization-mass spectrometry (ESI-MS) and NMR spectral analyses.

Exploring Unmet Information Needs of People with Parkinson's Disease and Their Families: Focusing on Information Sharing in an Online Patient Community.

This study aimed to examine the unmet information needs of people with Parkinson's disease and their family members by analyzing Parkinson's disease-related posts in online communities. Data were collected from one of the largest online people with Parkinson's disease communities used in South Korea. The word cloud, the main questions from the free-posting messages, as well as the frequently asked symptoms and side effects of the medication, were analyzed using content analysis. The commonly mentioned main questions from the free-posting messages have pertained to treatment-related information, such as effects and side effects of medication, deep brain stimulation, and complementary and alternative medicine. People with Parkinson's disease and their families depend not only on health care providers but also on using online communities to find the information that they need. However, there is a need for treatment-specific information, such as anti-Parkinson drugs, deep brain stimulation, and complementary alternative therapies. As for the method of providing information for people with Parkinson's disease and their families, it will be effective to provide tailored education services using online communities and social media by using their information needs and preferred resources.

A Phenomenological Study of Nurses' Experience in Caring for COVID-19 Patients.

This study aimed to understand and describe the experiences of nurses who cared for patients with COVID-19. A descriptive phenomenological approach was used to collect data from individual in-depth interviews with 14 nurses, from 20 October 2020 to 15 January 2021. Data were analyzed using the phenomenological method of Colaizzi. Five theme clusters emerged from the analysis: (1) nurses struggling under the weight of dealing with infectious disease, (2) challenges added to difficult caring, (3) double suffering from patient care, (4) support for caring, and (5) expectations for post-COVID-19 life. The findings of this study are useful primary data for developing appropriate measures for health professionals' wellbeing during outbreaks of infectious diseases. Specifically, as nurses in this study struggled with mental as well as physical difficulties, it is suggested that future studies develop and apply mental health recovery programs for them. To be prepared for future infectious diseases and contribute to patient care, policymakers should improve the work environment, through various means, such as nurses' practice environment management and incentives.

Development and validation of the Scale for Staff-Family Partnership in Long-term Care (SSFPLC).

BACKGROUND: A partnership between staff and families is crucial to maintain nursing home residents' health and promote quality of care, and currently, there is a need for a measurement tool to assess the partnership. OBJECTIVES: This study aimed to develop a tool for assessing the partnership between staff and the families of older adult nursing home residents from the perspective of staff members and to verify its reliability and validity. METHODS: The instrument was developed in the following four stages: (1) generation of an item pool via literature review and focus group interview, (2) experts' content validity analysis of 32 items, (3) a preliminary survey on 30 staff members and (4) validity and reliability tests of the instrument on 346 staff members in nursing homes between July and October 2018. RESULTS: The final instrument consists of 17-items in four categories (family's trust and support, collaborative relationship and communication, encouragement to participate in care and professional care). Each item was rated on a 4-point Likert scale, and the higher scores indicating better partnership between staff and families of nursing home residents. The reliability of the instrument was 0.90, and the test-retest intra-class correlation coefficient was 0.96. CONCLUSION: The Scale for Staff-Family Partnership in Long-term Care (SSFPLC) showed acceptable reliability and validity as an instrument to assess the partnership between nursing home staff and families. IMPLICATIONS FOR PRACTICE: This tool can be used for evaluating staff and family partnerships within nursing homes.