Dynamic analysis of acute deterioration in chronic liver disease patients using modified quick sequential organ failure assessment.

BACKGROUND/AIMS: Quick sequential organ failure assessment (qSOFA) is believed to identify patients at risk of poor outcomes in those with suspected infection. We aimed to evaluate the ability of modified qSOFA (m-qSOFA) to identify high-risk patients among those with acutely deteriorated chronic liver disease (CLD), especially those with acute-onchronic liver failure (ACLF). METHODS: We used data from both the Korean Acute-on-Chronic Liver Failure (KACLiF) and the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) cohorts. qSOFA was modified by replacing the Glasgow Coma Scale with hepatic encephalopathy, and an m-qSOFA ≥2 was considered high. RESULTS: Patients with high m-qSOFA had a significantly lower 1-month transplant-free survival (TFS) in both cohorts and higher organ failure development in KACLiF than those with low m-qSOFA (Ps<0.05). Subgroup analysis by ACLF showed that patients with high m-qSOFA had lower TFS than those with low m-qSOFA. m-qSOFA was an independent prognostic factor (hazard ratios, HR=2.604, 95% confidence interval, CI 1.353-5.013, P=0.004 in KACLiF and HR=1.904, 95% CI 1.484- 2.442, P<0.001 in AARC). The patients with low m-qSOFA at baseline but high m-qSOFA on day 7 had a significantly lower 1-month TFS than those with high m-qSOFA at baseline but low m-qSOFA on day 7 (52.6% vs. 89.4%, P<0.001 in KACLiF and 26.9% vs. 61.5%, P<0.001 in AARC). CONCLUSION: Baseline and dynamic changes in m-qSOFA may identify patients with a high risk of developing organ failure and short-term mortality among CLD patients with acute deterioration.

Quality assessment of systematic reviews with meta-analysis in undergraduate nursing education.

BACKGROUND: Little attention has been given to the methodological quality of meta-analyses in nursing education. This warrants further improvements in meta-analyses in nursing education. OBJECTIVE: This study aimed to assess the methodological quality of meta-analysis in the field of undergraduate nursing education. DESIGN: This was a methodological study to review the methodological quality of systematic reviews (SRs) with meta-analysis. METHODS: Exhaustive literature searches were performed using five comprehensive databases. Between 1994 and 2022, 11,827 studies were identified, and 41 full-text articles met the inclusion criteria. Two researchers extracted data using A Measurement Tool to Assess Systematic Reviews (AMSTAR)-2. The Chi-square test was conducted to make comparisons before and after 2017, the year AMSTAR-2 was released. RESULTS: A comprehensive literature retrieval strategy, inclusion and exclusion criteria, literature selection, and data extraction were observed in nursing education more than in other disciplines. Improvements to be made include pre-specifying the protocol, providing a list of excluded studies with their exclusion reasons, reporting the source of funding for the included studies, assessing and discussing the potential impact of risk of bias, as well as investigating and discussing publication bias and its impact. CONCLUSIONS: The number of SRs with meta-analyses in nursing education is increasing. This warrants efforts to improve the quality of research. In addition, guidelines for reporting SRs in the field of nursing education should be constantly updated.

Insight into the Economic Effects of a Severe Korean PRRSV1 Outbreak in a Farrow-to-Nursery Farm.

Porcine reproductive and respiratory syndrome (PRRS) is a disease that has inflicted economic losses in the swine industry. The causative agent, porcine reproductive and respiratory syndrome virus (PRRSV), is known to have a high genetic diversity which leads to heterogeneous pathogenicity. To date, the impact of PRRS outbreaks on swine production and the economy of the swine industry in South Korea has been rarely reported. In this study, we compare the reproductive performance in the breeding-farrowing phase and growth performance in the nursery phase, in two 27-week periods, one before and one after a PRRSV1 outbreak on a 650-sow farrow-to-nursery farm caused by a Korean PRRSV1 isolate which was genetically distinct from vaccine strains or other global strains. The reproductive performance of sows and the growth performance of nursery pigs were compared using row data consisting of 1907 mating records, 1648 farrowing records, and 17,129 weaning records from 32 breeding batches. The following variables were significantly different between the pre-PRRS outbreak period and the post-PRRS outbreak period: the farrowing rate (−7.1%, p < 0.0001), the abortion rate (+3.9%, p < 0.0001), the return rate (+2.9%, p = 0.0250), weaning to estrus interval days (+1.9 days, p < 0.0001), total piglets born (−1.2 pigs/litter, p < 0.0001), piglets born alive (−2.2 pigs/litter, p < 0.0001), weaned piglets (−2.7 pigs/litter, p < 0.0001), pre-weaning mortality (+7.4%, p < 0.0001), weaning weight (−0.9 kg/pig, p = 0.0015), the mortality rate (+2.8%, p < 0.0001), average daily gain (−69.8 g/d, p < 0.0001), and the feed conversion ratio (+0.26, p = 0.0036). Economic losses for a period of 27 weeks after a PRRS outbreak were calculated at KRW 99,378 (USD 82.8) per mated female for the breeding-farrowing phase, KRW 8,968 (USD 7.5) per pig for the nursery growth phase, and KRW 245,174 (USD 204.3) per sow in the post-outbreak period. In conclusion, the farrow-to-nursery farm in our study suffered extensive production and economic losses as a result of a PRRSV1 outbreak.

Risk factors influencing COVID-19 mortality rate in OECD countries: A cross-sectional study.

SUMMARY: The coronavirus disease (COVID-19) has spread globally; however, the COVID-19 mortality rate varies largely across countries. The purpose of this study was to investigate the factors affecting mortality and increase in mortality rate by time trends in 30 member countries of the Organization for Economic Co-operation and Development (OECD). These countries have different national health and medical characteristics in terms of health care use, health equipment, health resource, health risk, and health status at different time points. The results revealed that the lower 25% of countries had an increase in the mortality rate of 27.21% which was higher than the upper 25% of countries' increase in the mortality rate of 20.51%. Therefore, the affected countries should strengthen their medical infrastructure to prepare for such large-scale outbreaks in the future. It is imperative to reduce the health inequality between population groups and achieve health equity, regardless of the income gap, rather than vaccination of specific countries. This will require the management of non-communicable diseases, a solid health insurance system, a stable supply of medical supplies, and strengthening the competency of health care workers.

Methyl p­hydroxycinnamate exerts anti­inflammatory effects in mouse models of lipopolysaccharide­induced ARDS.

Methyl p­hydroxycinnamate (MH), an esterified derivative of p­Coumaric acid exerts anti­inflammatory effects on lipopolysaccharide (LPS)­stimulated RAW264.7 macrophages. Based on these effects, the present study investigated the protective role of MH in a mouse model of LPS­induced acute respiratory distress syndrome (ARDS). The results demonstrated that administration of LPS (5 mg/kg intranasally) markedly increased the neutrophil/macrophage numbers and levels of inflammatory molecules (TNF­α, IL­6, IL­1ß and reactive oxygen species) in the bronchoalveolar lavage fluid (BALF) of mice. On histological examination, the presence of inflammatory cells was observed in the lungs of mice administered LPS. LPS also notably upregulated the secretion of monocyte chemoattractant protein­1 and protein content in BALF as well as expression of inducible nitric oxide synthase in the lungs of mice; it also caused activation of p38 mitogen­activated protein kinase (MAPK) and NF­κB signaling. However, MH treatment significantly suppressed LPS­induced upregulation of inflammatory cell recruitment, inflammatory molecule levels and p38MAPK/NF­κB activation, and also led to upregulation of heme oxygenase­1 (HO­1) expression in the lungs of mice. In addition, the ability of MH to induce HO­1 expression was confirmed in RAW264.7 macrophages. Taken together, the findings of the present study indicated that MH may exert protective effects against airway inflammation in ARDS mice by inhibiting inflammatory cell recruitment and the production of inflammatory molecules.

Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement.

The Korean Endocrine Society (KES) published clinical practice guidelines for the treatment of acromegaly in 2011. Since then, the number of acromegaly cases, publications on studies addressing medical treatment of acromegaly, and demands for improvements in insurance coverage have been dramatically increasing. In 2017, the KES Committee of Health Insurance decided to publish a position statement regarding the use of somatostatin analogues in acromegaly. Accordingly, consensus opinions for the position statement were collected after intensive review of the relevant literature and discussions among experts affiliated with the KES, and the Korean Neuroendocrine Study Group. This position statement includes the characteristics, indications, dose, interval (including extended dose interval in case of lanreotide autogel), switching and preoperative use of somatostatin analogues in medical treatment of acromegaly. The recommended approach is based on the expert opinions in case of insufficient clinical evidence, and where discrepancies among the expert opinions were found, the experts voted to determine the recommended approach.

Online-based interventions for sexual health among individuals with cancer: a systematic review.

BACKGROUND: Online interventions have the advantages of being widely available, accessible, comfortable, cost effective, and they can provide tailored information and support. Despite these benefits, the effects of specifically devised online intervention programs for cancer patients' sexual problems are somewhat unclear. The aim of this review is to describe online-based interventions and to assess their effects on sexual health among cancer survivors and/or their partners. METHODS: We investigated the effects of online sexual interventions among individuals with cancer or their partners. Among these, we considered 4 eligible articles. RESULTS: Despite the diversity of contents of the interventions, the identified modes of delivery among most of the interventions were as follows: education, interactive methods, cognitive behavior therapy, tailored information, and self-monitoring. Methods of monitoring the interventions, including the utilization of the web site and post-treatment program rating, were reported. All the online intervention programs incorporated a focus on physical, psychological, cognitive, and social aspects of sexual health. Significant effects on patient sexual function and interest and the psychological aspect of sexual problems were reported. CONCLUSION: This study provides evidence that online-based interventions would be effective in improving the psycho-sexual problems of cancer survivors and their partners.

[A Methodological Quality Assessment of South Korean Nursing Research using Structural Equation Modeling in South Korea].

PURPOSE: The purpose of this study was to evaluate the methodological quality of nursing studies using structural equation modeling in Korea. METHODS: Databases of KISS, DBPIA, and National Assembly Library up to March 2014 were searched using the MeSH terms 'nursing', 'structure', 'model'. A total of 152 studies were screened. After removal of duplicates and non-relevant titles, 61 papers were read in full. RESULTS: Of the sixty-one articles retrieved, 14 studies were published between 1992 and 2000, 27, between 2001 and 2010, and 20, between 2011 and March 2014. The methodological quality of the review examined varied considerably. CONCLUSION: The findings of this study suggest that more rigorous research is necessary to address theoretical identification, two indicator rule, distribution of sample, treatment of missing values, mediator effect, discriminant validity, convergent validity, post hoc model modification, equivalent models issues, and alternative models issues should be undergone. Further research with robust consistent methodological study designs from model identification to model respecification is needed to improve the validity of the research.

Assessment of appendicular skeletal muscle mass by bioimpedance in older community-dwelling Korean adults.

It is crucial to investigate age-related body composition changes in geriatric medicine. Bioelectrical impedance analysis (BIA) is easy to perform, non-invasive, relatively inexpensive, and portable. However, the accuracy of measurement by BIA is questionable. To develop and cross-validate the predictive equation for estimated appendicular skeletal muscle mass (ASM) using BIA in older community-dwelling Korean adults, we include two cohorts: study participants aged 65-80 years in the Ansung cohort for the Korean Health and Genome Study (men, n=285; women, n=435) used as equation-generating group, and Korean Longitudinal Study of Health Aging (KLoSHA) as cross-validation group (men, n=202; women, n=208). Dual energy X-ray absorptiometry (DXA) and BIA were performed in both cohorts. Using multiple linear regression analysis, we drew a predictive equation for DXA-measured ASM by BIA resistance. From DXA and BIA measurements in the Ansung cohort, we generated the estimated equation ASM (kg)=[(Ht(2)/R×0.104)+(age×-0.050)+(gender×2.954)+(weight×0.055)]+5.663 where Ht is height in centimeters; R is BIA resistance in 250Ω; for gender, men=1 and women=0; and age is in years. We validated this equation in the KLoSHA. The r(2) of the estimated ASM was 0.890. This BIA equation provides valid estimates of ASM in older Korean adults.

[A quality assessment of meta-analyses of nursing in South Korea].

PURPOSE: The purpose of the study was to assess the quality of meta-analyses on nursing published in South Korea. METHODS: Relevant meta-analyses were identified through searches of the National Assembly Library, KISS (Korean Studies Information Service System), and the DBpia and RISS4U databases from 1990 to May 2013. Quality assessments were conducted using AMSTAR, a validated tool for assessing the quality of systematic reviews. RESULTS: Forty-two meta-analyses were included in this study. Twenty-nine published between 1990 and 2010, and 13, between 2011 and May 2013. Two high quality studies and 11 moderate quality studies were published in the latter period. The mean score for the reviews was 5.61 (range 3-10); 11 studies were rated as low quality, 29 as moderate quality, and two as high quality. CONCLUSION: Although an improvement in the quality of meta-analyses conducted by nursing researchers in South Korea was observed across the study period, the study results indicate a need to use of more rigorous research methods when conducting systematic reviews or meta-analyses.

Rasch analysis of the Center for Epidemiologic Studies Depression scale used for the assessment of community-residing patients with stroke.

PURPOSE: To use Rasch analysis to validate a Center for Epidemiologic Studies Depression scale (CES-D) for measuring the level of depression in community-residing patients with stroke. METHOD: This study involved 183 community-residing stroke survivors. Depression was measured using the CES-D. The data were analysed with Winsteps version 3.62 using a Rasch model to investigate the unidimentionality of the items' fit, the distribution of items' difficulty and reliability and appropriateness of the rating scale. RESULT: Three items for CES-D showed a misfit with the Rasch model. Misfitting items included 'I did not feel like eating; my appetite was poor', 'I felt hopeful about the future' and 'My sleep was restless'. The person separation was 2.58, reliability was 0.87 and the rating scale of the CES-D was appropriate for stroke patients. The cut-off point of 16 out of 60 equated to a logit score of 0.85, which when applied to the 17-item scale (with four categories) equated to a cut-off point of 14. CONCLUSION: At a new cut-off point of 14, the CES-D with 17 items was found to be reliable and valid as a screening tool for assessing depression in community-residing stroke patients. Moreover, it may not be appropriate to use a CES-D as it contains somatic factors for a population with physical dysfunctions.