Impact of a delirium prevention project among older hospitalized patients who underwent orthopedic surgery: a retrospective cohort study.

BACKGROUND: Postoperative delirium (POD) is a common clinical syndrome with significant negative outcomes. Thus, we aimed to evaluate the feasibility and effectiveness of a delirium screening tool and multidisciplinary delirium prevention project. METHODS: A retrospective cohort study was conducted at a single teaching center in Korea. A cohort of patients who underwent a delirium prevention program using a simple delirium screening tool from December 2018 to February 2019 (intervention group, N = 275) was compared with the cohort from the year before implementation of the delirium prevention program (December 2017 to February 2018) (control group, N = 274). Patients aged ≥65 years who were admitted to orthopedic wards and underwent surgery were included. The incidence rates of delirium before and after implementation of the delirium prevention program, effectiveness of the delirium screening tool, change in the knowledge score of nurses, and length of hospital stay were assessed. RESULTS: The sensitivity and specificity of the screening tool for the incidence of POD were 94.1 and 72.7%, respectively. The incidence rates of POD were 10.2% (control group) and 6.2% (intervention group). The odds ratio for the risk reduction effect of the project related to the incidence of POD was 0.316 (95% confidence interval: 0.125-0.800, p = 0.015) after adjustment for possible confounders. The delirium knowledge test score increased from 40.52 to 43.24 out of 49 total points (p < 0.001). The median length of hospital stay in the intervention and control groups was 6.0 (interquartile range, 4-9) and 7.0 (interquartile range, 4-10) days, respectively (p = 0.062). CONCLUSION: The screening tool successfully identified patients at a high risk of POD at admission. The POD prevention project was feasible to implement, effective in preventing delirium, and improved knowledge regarding delirium among the medical staff. TRIAL REGISTRATION: None.

An Event-related Potential Study of Error-monitoring Deficits in Female College Students Who Participate in Binge Drinking.

OBJECTIVE: This study investigated error-monitoring deficits in female college students with binge drinking (BD) using event-related potentials (ERPs) and the modified Flanker task. METHODS: Participants were categorized into BD (n=25) and non-BD (n=25) groups based on the scores of the Korean-version of the Alcohol Use Disorder Identification Test (AUDIT-K) and the Alcohol Use Questionnaire (AUQ). The modified Flanker task, consisting of congruent (target and flanker stimuli are the same) and incongruent (target and flanker stimuli are different) conditions, was used to evaluate error-monitoring abilities. RESULTS: The BD group exhibited significantly shorter response times and more error rates on the Flanker task, as well as reduced error-related negativity (ERN) amplitudes compared with the non-BD group. Additionally, ERN amplitudes measured at FCz and Cz were significantly correlated with scores on the AUDIT-K and AUQ in the whole participants. The BD and non-BD groups did not show any significant differences in error positivity amplitudes. CONCLUSION: The present results indicate that college students with BD have deficits in error-monitoring, and that reduced ERN amplitudes may serve as a biological marker or risk factor of alcohol use disorder.

The Association Between Age-Related Hearing Impairment and Metabolic Syndrome in Korean Women: 5-Year Follow-Up Observational Study.

BACKGROUND: Although several observational studies showed a relationship between various conditions of metabolic syndrome (MetS) and hearing threshold, there are no studies about longitudinal audiometric results related MetS. The aim of this study was to investigate the association between MetS and age-related hearing impairment (ARHI) through a large, average 5-year longitudinal follow-up, clinical comparative analysis. MATERIALS AND METHODS: We recruited 1381 women older than 50 years who were enrolled in 2007 and reevaluated in 2012. They had normal or symmetrical sensorineural hearing loss. For the evaluation of the independent impact of MetS on hearing, multivariate analysis was used. RESULTS: The average follow-up period was 5.0 ± 0.2 years. Subjects with MetS had higher hearing thresholds than subjects without MetS. The loss in high-frequency hearing (≥2000 Hz) progressed more rapidly in women with MetS over a 5-year period. CONCLUSION: Our analysis using longitudinal and large data revealed that MetS is associated with ARHI in women 50 years and older. High-frequency hearing loss tended to be greater in women with MetS than in those without MetS at the 5-year follow-up. Therefore, older women with MetS should be followed up closely for hearing evaluation.

Diffuse hepatic hemangiomatosis without extrahepatic involvement in an adult patient.

We report an extremely rare case of a diffuse hepatic hemangiomatosis without extrahepatic involvement in an adult. The imaging findings of this tumor were similar to those of a hepatic hemangioma and included contrast enhancement with a centripetal filling pattern of the entire hepatic tumor on the delayed phase of a dynamic CT and inhomogeneous diffuse uptake of the entire tumor on blood-pool images obtained five hours later on a 99mTc-labeled red blood cell scan. Despite its rarity, diffuse hepatic hemangiomatosis can be suggested in adult patients with diffusely involved hepatic tumors showing the radiological findings of a hepatic hemangioma.

Biogenetic temperament and character profiles and attention deficit hyperactivity disorder symptoms in Korean adolescents with problematic Internet use.

The objective of this study was to evaluate the biogenetic temperament and character profiles in Korean adolescents with problematic Internet use. Six hundred eighty-six high school students completed the Internet Addiction Test (IAT), Junior Temperament and Character Inventory (JTCI), and Conners/Wells Adolescent Self-Report Scale: Short Form (CASS: Short). The problematic Internet use group showed higher scores in the Self-Directedness and Cooperativeness profiles and lower scores in the Novelty Seeking and Self-Transcendence profiles of the JTCI, compared with the nonproblematic Internet use group, after controlling for the ADHD symptoms. The results of this study suggest that temperament/character patterns should be considered in accounts of the etiology of problematic Internet use.

Associations between symptoms of attention deficit hyperactivity disorder, depression, and suicide in Korean female adolescents.

The objective of this study was to examine the associations between symptoms of attention-deficit/hyperactivity disorder (ADHD), depression, and suicide in Korean female adolescents. It was hypothesized that the relationship between ADHD symptoms and suicidal ideation would be mediated by the level of depressive symptoms. Seven hundred and eighty-eight high school girls completed the Conners/Wells Adolescent Self-Report Scale: Short Form, Children's Depression Inventory, and Reynolds Suicidal Ideation Questionnaire. Path analyses were conducted using the statistical program, AMOS version 4.0, to determine the best fitting model. The conduct, cognitive, and hyperactivity problems of the ADHD symptoms in each domain were associated positively with the depressive symptoms, with the depressive symptoms being associated with suicidal ideation. This initially proposed model represented an acceptable fit to the data (root mean square error of approximation, RMSEA=0.077; normed fit index, NFI=0.998; non-NFI, NNFI=0.990; comparative fit index, CFI=0.998). The inclusion of a direct path from the conduct problems of ADHD symptoms to suicidal ideation significantly improved the model fit (RMSEA=0, NFI=1, NNFI=1, CFI=1). The results of our study suggest that depressive symptoms partially mediate the relationship between ADHD symptoms and suicidal ideation, and that the conduct problems of ADHD symptoms are associated with suicidal ideation both directly and indirectly via the depressive symptoms in Korean female adolescents.

Iatrogenic aorto-cisterna chyli fistula during percutaneous balloon aortoplasty in a patient with Takayasu's arteritis: a case report.

We present a case of iatrogenic aorto-cisterna chyli fistula that developed during percutaneous transluminal aortoplasty in a 16-year old girl with Takayasu's arteritis. The aorto-cisterna chyli fistula was angiographically confirmed and treated using a stent-graft, which successfully occluded the fistula. Her claudication then improved, although follow-up CT angiography at 10 months revealed mild recurrent aortic stenosis.