摘要
Background@#The purpose of this study was to identify the changes in untreated subscapularis in patients who underwent supraspinatus repair and to evaluate the factors related to the changes in the subscapularis. @*Methods@#A cohort of patients who underwent isolated supraspinatus repair with preservation of the subscapularis was reviewed.Changes in the subscapularis, including any newly formed lesion and aggravation of an existing lesion, were evaluated 12 months postoperatively on magnetic resonance imaging along with an examination to identify causative factors after supraspinatus repair.Clinical scores were compared between patients with and without subscapularis changes. @*Results@#A total of 528 patients were reviewed. Changes in the subscapularis, including newly formed lesions and aggravation of an existing lesion, were shown in 90 patients (17.0%). Upon regression analysis, changes in the subscapularis were associated with the initial existence of a subscapularis lesion (grade I: p = 0.042, grade II: p = 0.025), an accompanying biceps lesion (p = 0.038), and a retear of the repaired supraspinatus (p = 0.024). No significant differences were shown in clinical scores between patients with and without subscapularis changes after supraspinatus repair. @*Conclusions@#Untreated asymptomatic subscapularis may undergo morphological changes even after repair of the torn supraspinatus. Preoperative subscapularis lesions, biceps long head pathology, and retears of the repaired supraspinatus were associated with subscapularis pathology in patients who underwent supraspinatus repair.
摘要
Background@#The population of Gangneung City in South Korea has shown a gradual increase in the proportion of individuals aged 65 years and older, and the most frequently reported diseases for several years have consistently been periodontal diseases, including gingivitis and periodontitis. The regional imbalance in the distribution of dental personnel and resources has emerged as a problem of inequality in the use of dental care. It has been advocated to identify areas with disadvantages in dental care and develop public dental policies based on that. This study aimed to develop a customized oral healthcare program for local seniors based on a Public-Private-Academic Partnership, and to evaluate the oral health status of older adults in Gangneung City. @*Methods@#The participants were residents aged 60 years and above in Gangneung City. A questionnaire including general information, systemic health status, and oral health status was administered to the participants. In addition, oral healthcare and education tailored to each individual’s health status were provided once or twice based on their oral health status. The collected data were analyzed using IBM SPSS Statistics 25 for descriptive statistical analysis. @*Results@#Among the older adults in Gangneung City, 75% had at least one prosthesis and exhibited symptoms of gingivitis or periodontitis. Additionally, the modified sulcus bleeding index decreased among participants who underwent the program twice.Over 90% of the participants expressed satisfaction with the program. @*Conclusion@#The program appeared to contribute positively to the oral health promotion among local seniors. Further oral healthcare programs should focus on seniors in rural and old urban areas to reduce disparities in oral health across regions.
摘要
Background@#To train dental hygienists to utilize knowledge in practice, an integrated curriculum based on the competencies of dental hygienists is expanding; however, in the field of basic dental hygiene the curriculum is still fragmented and based on segmented knowledge. This study developed an integrated curriculum based on the competencies of dental hygienists in Anatomy, Histology & Embryology, Physiology, which are subjects for basic dental hygiene that have high linkage and overlap. @*Methods@#After selecting the learning objectives for the integrated curriculum from those of Anatomy, Histology & Embryology, Physiology, the duties of the dental hygienist in relation to the learning objectives were analyzed. Learning objectives were combined with the duties of a dental hygienist to derive competencies for an integrated curriculum. Referring to the syllabus and learning objectives for each subject, the weekly educational content, learning objectives, and credits of the integrated curriculum were derived. After conducting a Delphi survey to validate the competency and content of the derived integrated curriculum, an integrated curriculum was developed. @*Results@#By using the first and second Delphi surveys, four competencies were developed for dental hygienists that can be achieved through an integrated basic dental hygiene curriculum. In addition, an integrated curriculum including the courses Anatomy, Histology & Embryology, Physiology, Structure and Function of the Human Body/Head/Neck, and Structure and Function of the Oral Cavity was established. @*Conclusion@#This study presents a specific example for developing a competency-based integrated curriculum that can be used as a framework to derive a competency-based integrated curriculum among subjects that can be integrated according to the linkage of learning contents and the competencies that can be achieved.
摘要
Background@#This study aimed to evaluate ChatGPT’s performance accuracy in responding to questions from the national dentalhygienist examination. Moreover, through an analysis of ChatGPT’s incorrect responses, this research intended to pinpoint the predominant types of errors. @*Methods@#To evaluate ChatGPT-3.5’s performance according to the type of national examination questions, the researchers classified 200 questions of the 49th National Dental Hygienist Examination into recall, interpretation, and solving type questions. The researchers strategically modified the questions to counteract potential misunderstandings from implied meanings or technical terminology in Korea. To assess ChatGPT-3.5’s problem-solving capabilities in applying previously acquired knowledge, the questions were first converted to subjective type. If ChatGPT-3.5 generated an incorrect response, an original multiple-choice framework was provided again. Two hundred questions were input into ChatGPT-3.5 and the generated responses were analyzed.After using ChatGPT, the accuracy of each response was evaluated by researchers according to the types of questions, and the types of incorrect responses were categorized (logical, information, and statistical errors). Finally, hallucination was evaluated when ChatGPT provided misleading information by answering something that was not true as if it were true. @*Results@#ChatGPT’s responses to the national examination were 45.5% accurate. Accuracy by question type was 60.3% for recall and 13.0% for problem-solving type questions. The accuracy rate for the subjective solving questions was 13.0%, while the accuracy for the objective questions increased to 43.5%. The most common types of incorrect responses were logical errors 65.1% of all. Of the total 102 incorrectly answered questions, 100 were categorized as hallucinations. @*Conclusion@#ChatGPT-3.5 was found to be limited in its ability to provide evidence-based correct responses to the Korean nationaldental hygiene examination. Therefore, dental hygienists in the education or clinical fields should be careful to use artificial intelligence-generated materials with a critical view.
摘要
Background/Aims@#Bleeding events after percutaneous coronary intervention (PCI) have important prognostic implications. Data on the influence of an abnormal ankle-brachial index (ABI) on both ischemic and bleeding events in patients undergoing PCI are limited. @*Methods@#We included patients who underwent PCI with available ABI data (abnormal ABI, ≤ 0.9 or > 1.4). The primary endpoint was the composite of all-cause death, myocardial infarction (MI), stroke, and major bleeding. @*Results@#Among 4,747 patients, an abnormal ABI was observed in 610 patients (12.9%). During follow-up (median, 31 months), the 5-year cumulative incidence of adverse clinical events was higher in the abnormal ABI group than in the normal ABI group: primary endpoint (36.0% vs. 14.5%, log-rank test, p < 0.001); all-cause death (19.4% vs. 5.1%, log-rank test, p < 0.001); MI (6.3% vs. 4.1%, log-rank test, p = 0.013); stroke (6.2% vs. 2.7%, log-rank test, p = 0.001); and major bleeding (8.9% vs. 3.7%, log-rank test, p < 0.001). An abnormal ABI was an independent risk factor for all-cause death (hazard ratio [HR], 3.05; p < 0.001), stroke (HR, 1.79; p = 0.042), and major bleeding (HR, 1.61; p = 0.034). @*Conclusions@#An abnormal ABI is a risk factor for both ischemic and bleeding events after PCI. Our study findings may be helpful in determining the optimal method for secondary prevention after PCI.
摘要
Background@#Acquired von Willebrand syndrome (AVWS) has not been investigated in Korean patients with Philadelphia chromosome-negative myeloproliferative neoplasm. @*Methods@#This study analyzed the prevalence at diagnosis and clinical features of AVWS in patients with essential thrombocythemia (ET), polycythemia vera (PV), prefibrotic/early primary myelofibrosis (pre-PMF), or overt PMF (PMF) diagnosed between January 2019 and December 2021 at Chungam National University Hospital, Daejeon, Korea. AVWS was defined as below the lower reference limit (56%) of ristocetin cofactor activity (VWF:RCo). @*Results@#Sixty-four consecutive patients (36 with ET, 17 with PV, 6 with pre-PMF, and 5 with PMF;30 men and 34 women) with a median age of 67 years (range, 18‒87 yr) were followed for a median of 25.1 months (range, 2.6‒46.4 mo). AVWS was detected in 20 (31.3%) patients at diagnosis and was most frequent in ET patients (41.4%), followed by patients with pre-PMF (33.3%) and PV (17.6%) patients. VWF:RCo was negatively correlated with the platelet count (r=0.937; P =0.002). Only one episode of minor bleeding occurred in a patient with ET and AVWS. Younger age (＜50 yr) [odds ratio (OR), 7.08; 95% confidence interval (CI), 1.27‒39.48; P =0.026] and thrombocytosis (＞600×10 9 /L) (OR, 13.70; 95% CI, 1.35‒138.17; P =0.026) were independent risk factors for developing AVWS. @*Conclusion@#AVWS based on VWF:RCo was common in patients with ET and pre-PMF, but less common in patients with PV in the Korean population. Clinically significant bleeding is rare in these patients.
摘要
Background@#Reverse total shoulder arthroplasty (RTSA) has become the treatment of choice for the management of massive rotator cuff tears combined with cuff tear arthropathy, and many novel designs have been proposed to overcome the shortcomings of classic RTSA. This study sought to evaluate and compare RTSA outcomes among patients with cuff tear arthropathy treated by a medialized inlay humerus implant with a neck shaft angle of 155° or a lateralized onlay implant with a neck shaft angle of 145°. @*Methods@#A retrospective review of 32 inlay implants and 32 onlay implants was performed. The active range of motion (ROM), visual analog scale (VAS) for pain, motor power for elevation and external rotation, and functional scores including the American Shoulder and Elbow Surgeons score, Constant score, and Korean Shoulder Scoring system were assessed before surgery, at 3, 6, and 12 months after surgery, and at the last follow-up at least 24 months after surgery. Scapular notching, lateral humeral offset, and deltoid wrapping offset were assessed for radiographic evaluation. @*Results@#The preoperative demographic data of both groups showed no significant differences (p > 0.05). The mean follow-up period was 24.9 months. Significant improvements in forward flexion, functional scores, and pain VAS score were observed in both groups at the last follow-up. No significant differences in ROM or functional scores were found between two groups at each time point, except that the onlay implant group exhibited a significantly greater range of external rotation at 3 and 12 months after surgery and at the last follow-up. The rate of scapular notching and the final power improvement did not show significant differences between the groups. @*Conclusions@#Primary RTSA using inlay or onlay humerus implants was associated with recovery from pseudoparalysis and good clinical outcomes. However, RTSA with onlay humerus implantation led to clinically superior results in terms of external rotation.
摘要
Purpose@#: This study aims to investigate the status of delirium intervention in adult intensive care unit (ICU) patients and the perception of this delirium by medical staff. @*Methods@#: This retrospective study involves 185 patients, whereas, a descriptive survey is conducted with 197 medical staff members. @*Results@#: The delirium group includes 100 patients (54.1%). The incidence of delirium is 64.9% in the medical ICU, 65.9% in the surgical ICU, 42.4% in the neuro ICU, and 46.5% in the cardiac ICU. The percentages of delirium prevention intervention differs between the two groups: 65.0% in the delirium group and 95.3% in the non-delirium group. The medical staff recognize that delirium is a common problem in the ICU (100.0%) and requires active medical intervention (98.5%). @*Conclusion@#: The length of stay at the ICU is longer in the delirium group than in the non-delirium group. It is necessary to standardize delirium prevention and treatment protocols to be equally applicable to all ICU patients.
摘要
Background@#Forced expiratory volume in 1 second (FEV1 )/forced vital capacity (FVC) naturally decreases with age; however, an excessive decline may be related with increased morbidity and mortality. This study aimed to evaluate the FEV1 /FVC decline rate in the Korean general population and to identify whether rapid FEV1 /FVC decline is a risk factor for obstructive lung disease (OLD) and all-cause and respiratory mortality. @*Methods@#We evaluated individuals aged 40−69 years who underwent baseline and biannual follow-up spirometric assessments for up to 18 years, excluding those with airflow limitations at baseline. Based on the quartiles of the annual FEV1 /FVC decline rate, the most negative FEV1 /FVC change (1 st quartile of annual FEV1 /FVC decline rate) was classified as rapid FEV1 / FVC decline. We investigated the risk of progression to OLD and all-cause and respiratory mortality in individuals with rapid FEV1 /FVC decline. @*Results@#The annual FEV1 /FVC decline rate in the eligible 7,768 patients was 0.32 percentage point/year. The incidence rate of OLD was significantly higher in patients with rapid FEV1 / FVC decline than in those with non-rapid FEV1 /FVC decline (adjusted incidence rate, 2.119; 95% confidence interval [CI], 1.932–2.324). Rapid FEV1 /FVC decline was an independent risk factor for all-cause mortality (adjusted hazard [HR], 1.374; 95% CI, 1.105–1.709) and respiratory mortality (adjusted HR, 1.353; 95% CI, 1.089–1.680). @*Conclusion@#The annual FEV1 /FVC decline rate was 0.32%p in the general population in Korea. The incidence rate of OLD and the hazards of all-cause and respiratory mortality were increased in rapid FEV1 /FVC decliners.
摘要
Purpose@#Evidence in favor of adding docetaxel in treatment of metastatic hormone-sensitive prostate cancer (mHSPC) has led to docetaxel in conjunction with androgen deprivation therapy (ADT) as standard therapy. The aim of this study was to examine the effectiveness of docetaxel with ADT for Korean patients with mHSPC in real-world practice. @*Materials and Methods@#A retrospective cohort study was performed at six Korean hospitals for patients with mHSPC treated with docetaxel plus ADT. Patients were treated every 3 weeks for up to six cycles with 75 mg/m 2 of docetaxel. The primary endpoint was time to castration resistant prostate cancer (CRPC). @*Results@#This study included 46 eligible patients from June 2016 to February 2021. Median age was 68.5 years (range, 52–84) and all patients present with de novo M1 with high-volume disease. The median prostate-specific antigen (PSA) level at ADT initiation was 205.4 (7.7–1933) ng/mL, and time from ADT to docetaxel was 2.4 months (0–5.3). All six planned cycles of docetaxel were delivered in 36 patients (78%), 7 patients (15%) discontinued treatment due to adverse events, and 3 patients (7%) discontinued due to progression. At the time of the analysis, CRPC had developed in 34 patients (74%), and the median time to CRPC was 18.0 (95% confidence interval, 14.1–21.9) months. PSA <0.2 ng/mL was achieved in 11 patients (24%) after 6 months of ADT and in 10 patients (22%) after 12 months. At last follow-up, 35 patients (76%) were alive; the median overall survival was not reached. @*Conclusion@#The effect of docetaxel combined with ADT for Korean patients with mHSPC is comparable with prior results in Western studies.
摘要
Background@#Although atherosclerosis is likely to be involved in the development of arterial thrombotic events in patients with essential thrombocythemia (ET), abdominal aortic calcification (AAC) has rarely been investigated. We evaluated the prevalence and clinical relevance of AAC at the time of ET diagnosis. @*Methods@#This retrospective study included patients newly diagnosed with ET who underwent abdominal computed tomography (CT) at the time of diagnosis between January 2002 and December 2021 at Chungnam National University Hospital, Daejeon, Korea. CT images were reviewed and an aortic calcification score was assigned. @*Results@#Of the 94 patients (median age, 62 yr; range, 18‒90 yr), AAC was detected in 62 (66.0%).AAC was most commonly mild (33.0%), followed by moderate (22.7%) and severe (5.3%).Old age [odds ratio (OR), 34.37; 95% confidence interval (CI), 12.32‒95.91; P ＜0.001] was an independent risk factor for AAC. The patients with AAC had a higher WBC count (11.8±4.7 vs. 9.7±2.9×109 /L, P =0.017), higher neutrophil-to-lymphocyte ratio (4.3±2.7 vs. 3.1±1.5, P=0.039), and higher JAK2V617F positivity (81.5% vs. 58.8%, P=0.020) compared to those without AAC. AAC was an independent risk factor for arterial thrombotic vascular events that occurred before or at diagnosis of ET (OR, 4.12; 95% CI, 1.11‒15.85; P=0.034). @*Conclusion@#AAC is common in patients with ET and is associated with arterial thrombotic events.
摘要
Purpose@#This study attempted to analyze the staffing level and critical care nursing fees of intensive care units at tertiary and general hospitals and to provide a professional judgment-based recommendation on staffing level and critical care nursing fee schedules. Methods: Staffing grades and critical care nursing fee schedules for the first quarter of 2017~2020 and the fourth quarter of 2020~2022 were analyzed. A survey was conducted on nursing managers and nurses about the current and appropriate staffing levels. A total of 77 nurse managers and 708 nurses working in Intensive Care Unit(ICU)s at tertiary and general hospitals participated in the study. @*Results@#Grade 1 staffing increased from 25.6% in 2017 to 92.1% in 2022 at tertiary hospitals and from 0.8% in 2017 to 28.4% in 2022 at general hospitals. The current staffing ratios of tertiary and general hospitals were 1:2.21 and 1:2.77, respectively. The appropriate staffing ratio according to nurse managers and nurses was 1:1.00 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in tertiary hospitals, and it was 1:1.25 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in general hospitals, respectively. @*Conclusion@#The appropriate staffing level was suggested from 1:1.0 to 1:2.0. The new nursing fee schedules were suggested from 1:1.0 (Grade 1) to 1:3.0 (Grade 5) and recommended to be paid based on the staffing grade, minimum number of nurses, and standard annual working days. It is expected to increase staffing levels and provide a better nursing work environment.
摘要
Background@#Information on myelofibrotic and leukemic transformations in Korean Philadelphia chromosome-negative myeloproliferative neoplasms (Ph ‒ MPNs) is limited. @*Methods@#This study retrospectively analyzed transformations in patients diagnosed with essential thrombocythemia (ET), polycythemia vera (PV) prefibrotic/early primary myelofibrosis (pre-PMF), or overt primary myelofibrosis (PMF) based on the 2016 World Health Organization criteria between January 1996 and December 2020 at Chungam National University Hospital, Daejeon, Korea. @*Results@#A total of 351 patients (144 with ET, 131 with PV, 45 with pre-PMF, and 31 with PMF;204 men and 147 women) with a median age of 64 years (range, 15‒91 years) were followed for a median of 4.6 years (range, 0.2‒24.8 years). The 10-year incidence of overt myelofibrosis was higher in pre-PMF than in ET (31.3% and 13.7%, respectively; P =0.031) and PV (12.2%; P =0.003). The 10-year incidence of leukemic transformation was significantly higher in PMF than in ET (40.0% and 7.9%, respectively; P =0.046), pre-PMF (4.7%; P =0.048), and PV (3.2%; P =0.031). The 5-year incidence of leukemic transformation was higher in patients with secondary myelofibrosis (SMF) than in those with PMF (19.0% and 11.4%, respectively; P =0.040). The 5-year overall survival of patients with SMF was significantly worse than that of patients with pre-PMF (74% and 93%, respectively; P =0.027) but did not differ from that of patients with PMF (57%; P =0.744). @*Conclusion@#The rates and clinical courses of myelofibrotic and leukemic transformations in Korean patients with Ph ‒ MPN did not differ from those in Western populations.
摘要
Background@#Non-palpable splenomegaly in patients with polycythemia vera (PV) has seldom been addressed. In this retrospective study, we evaluated non-palpable, volumetric splenomegaly defined based on age- and body surface area (BSA)–matched criteria in patients with PV diagnosed according to the 2016 World Health Organization diagnostic criteria. @*Methods@#Patients with PV who underwent abdominal computed tomography (CT) and who had palpable splenomegaly at diagnosis from January 1991 to December 2020 at Chungnam National University Hospital were enrolled. The spleen volume of each patient was determined by volumetric analysis of abdominal CT and adjusted for the patient’s age and BSA. Then the degree of splenomegaly was classified as no splenomegaly, borderline volumetric splenomegaly, overt volumetric splenomegaly, or palpable splenomegaly. @*Results@#Of the 87 PV patients enrolled, 15 (17.2%) had no splenomegaly, whereas 17 (19.5%), 45 (51.7%), and 10 (11.5%) had borderline volumetric, overt volumetric, and palpable splenomegaly, respectively. The degree of splenomegaly did not affect the cumulative incidence of thrombotic vascular events (10-year incidence: 7.7%, 0%, 22.3%, and 50.7%, respectively, P = 0.414). By contrast, splenomegaly tended to adversely affect myelofibrotic transformation (10-year cumulative incidence: 0%, 0%, 7.1%, and 30.3%, respectively, P = 0.062). Moreover, the cumulative incidence of myelofibrotic transformation was significantly higher in patients with overt volumetric or palpable splenomegaly than those with no or borderline volumetric splenomegaly (10-year incidence: 0% vs. 10.3%, respectively; 15-year incidence: 0% vs. 26.3%, respectively, P = 0.020). Overall survival (OS) differed among patients with different degrees of splenomegaly (15-year OS: 100%, 78.6%, 71.7%, and 51.9%, respectively, P = 0.021). @*Conclusion@#The degree of splenomegaly, including volumetric splenomegaly, based on ageand BSA-matched reference spleen volumes at diagnosis reflects disease progression in PV patients. Therefore, volumetric splenomegaly should be evaluated at the time of diagnosis and taken into consideration when predicting the prognosis of patients with PV.
摘要
Multidrug resistance in bacteria is an important issue and is increasing in frequency worldwide because of the limitations of therapeutic agents. From 2010 to 2019, 14 new systemic antibiotics received regulatory approval in the United States. However, few new antibiotics have been introduced in Republic of Korea to combat multidrug-resistant pathogens. Here, we introduce six novel antibiotics for Gram-positive bacteria and five for Gram-negative bacteria approved by the United States Food and Drug Administration and the European Medicines Agency from 2009 to October 2021, and recommend that they be approved for use in Republic of Korea at the earliest possible date.
摘要
Background@#In the dental hygiene curriculum, efforts are being made to introduce an integrated curriculum based on the competency of a dental hygienist. Because there is a connection and overlap in learning contents between Dental Nutrition and Oral Biochemistry, which are basic dental hygiene subjects, it is possible to integrate these two subjects. This study aims to derive Nutritional Biochemistry as an integrated curriculum for Dental Nutrition and Oral Biochemistry, and to develop learning goals and competencies for Dental Nutritional Biochemistry. @*Methods@#The learning contents of the integrated curriculum were composed by referring to the contents of the Dental Nutrition and Oral Biochemistry textbooks, and learning goals were derived from the learning contents. Moreover, competency was developed by analyzing the duties of a dental hygienist that can be performed through the learning goals. The Delphi survey was conducted twice to verify the content validity ratio (CVR) of the competence and the learning goal of the integrated curriculum. @*Results@#In the first Delphi survey, the CVR for two competencies was 0.56 or higher. Moreover, it was revised based on expert’s opinions, and as a result of the second Delphi survey after the revision, the CVR was either increased or maintained. Eighty-five learning goals were derived by referring to the textbook. According to CVR and expert opinions, after the first Delphi survey, the number of learning goals was reduced to 69. After the second Delphi survey, 68 learning goals were finally derived. @*Conclusion@#The development process of the integrated curriculum conducted in this study can be utilized for integration between subjects in basic dental hygiene.
摘要
Background/Aims@#The risk factors and clinical impacts of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) remain controversial, and no data have been reported in Korea. This study aimed to investigate the epidemiology and importance of CAPA diagnostic efforts and to identify the predictors of CAPA and the impacts on clinical outcomes. @*Methods@#Between January 2020 and May 2021, data of severely to critically ill COVID-19 patients were extracted from seven hospitals of the Catholic Medical Center through a clinical data warehouse. Corticosteroid use was subcategorized into total cumulative dose, early 7-day dose, mean daily dose, and duration of use. @*Results@#A total of 2,427 patients were screened, and 218 patients were included. CAPA was diagnosed in 4.6% (10/218) of all hospitalized and 11.2% (10/89) of intensive care unit patients. Total cumulative dose (over 1,000 mg as methylprednisolone) and daily high-dose corticosteroid use (over 60 mg/day) were independent predictors but not early 7-day high-dose corticosteroid use (over 420 mg/week) (odds ratio [OR], 1.731; 95% confidence interval [CI], 0.350 to 8.571) nor prolonged use (OR, 2.794; 95% CI, 0.635 to 13.928). In-hospital overall mortality was 11.9% (26 of 218). CAPA itself did not affect the outcome; rather, daily high-dose steroid use significantly increased the 30-day mortality (hazard ratio, 5.645; 95% CI, 1.225 to 26.091). @*Conclusions@#CAPA was not uncommon, especially in critically ill patients. Daily high-dose corticosteroid use was the predictor of CAPA and associated with high mortality rates. High-dose corticosteroids use after early inflammatory phase should be avoided, and active surveillance methods for CAPA are essential for those high-risk patients.
摘要
Purpose@#Intrathecal analgesia (ITA) and transverse abdominis plane block (TAPB) are effective pain control methods in abdominal surgery. However, there is still no gold standard for postoperative pain control in minimally invasive colorectal surgery. This study aimed to investigate whether the analgesic effect could be increased when TAPB, which can further reduce wound somatic pain, was administered in low-dose morphine ITA patients. @*Methods@#Patients undergoing elective colorectal surgery were randomized into an ITA with TAPB group or an ITA group. Patients were evaluated for pain 0, 8, 16, 24, and 48 hours after surgery. The primary outcome was the total morphine milligram equivalents administered 24 hours after surgery. The secondary outcomes were pain scores, ambulatory variables, inflammation markers, hospital stay duration, and complications within 48 hours after surgery. @*Results@#A total of 64 patients were recruited, and 55 were compared. There was no significant difference in morphine use over the 24 hours after surgery in the 2 groups (ITA with TAPB, 15.3 mg vs. ITA, 10.2 mg; P = 0.270). Also, there was no significant difference in pain scores. In both groups, the average pain score at 24 and 48 hours was 2 points or less, showing effective pain control. @*Conclusion@#ITA for pain control in patients with colorectal surgery is an effective pain method, and additional TAPB was not effective.
摘要
Purpose@#The purpose of this study was to develop a Korean nursing work environment scale for critical care nurses (KNWES-CCN) and verify its validity and reliability. @*Methods@#A total of 46 preliminary items were selected using content validity analysis of experts on 64 candidate items derived through literature reviews and in-depth interviews with critical care nurses. 535 critical care nurses from 21 hospitals responded to the preliminary questionnaire from February to March 2021. The collected data were analysed using construct, convergent and discriminant validities, and internal consistency and test-retest reliability. @*Results@#The 23 items in 4 factors accounted for 55.6% of the total variance were identified through item analysis and exploratory factor analysis (EFA). EFA was performed with maximum likelihood method including direct oblimin method. In the confirmatory factor analysis, KNWES-CCN consisted of 21 items in 4 factors by deleting the items that were not meet the condition that the factor loading over .50 or the squared multiple correlation over .30. This model was considered to be suitable because it satisfied the fit index and acceptable criteria of the model [x2 =440.47 (p<.001), CMIN/DF=2.41, GFI=.86, SRMR=.06, RMSEA=.07, TLI=.90, CFI=.91]. The item total correlation values ranged form .32 to .73 and its internal consistency was Cronbach's ⍺=.92. The reliability of the test-retest correlation coefficient was .72 and the intra-class correlation coefficient was .83. @*Conclusion@#The KNWES-CCN showed good validity and reliability. Therefore, it is expected that the use of this scale would measure and improve nursing work environment for critical care nurses in Korea.
摘要
Lower back pain and sciatica are common symptoms in pregnancy. Treatment options for these conditions include physical therapy, medication, interventional treatment, and surgery. This case report involved a 32 weeks pregnant woman, who visited the emergency room with a three day history of lower back and right leg pain and a visual analogue scale (VAS) score of 9 - 10. Spinal computed tomography revealed lumbar 4/5 and 5/S1 disc protrusions. An epidural catheter was placed around the L3/4 vertebrae, and 6 ml of 0.15% ropivacaine was administered for pain control. Subsequently, her VAS score reduced to 2 - 3 and she was discharged five days later.