Exploring helix structures of γ-peptides based on 2-(aminomethyl)cyclopentanecarboxylic acid.

Conformational search and density functional theory calculations were performed to explore the preferences of helical structures for chiro-specific oligo-γ-peptides of 2-(aminomethyl)cyclopentanecarboxylic acid (γAmc5 ) with a cyclopentyl constraint on the Cα -Cß bond in solution. The dimer and tetramer of γAmc5 (1) with homochiral (1S, 2S) configurations exhibited a strong preference for the 9-membered helix foldamer in solution, except for the tetramer in water. However, the oligomers of γAmc5 (1) longer than tetramer preferentially adopted a right-handed (P)-2.614 -helix (H1 -14) as the peptide sequence becomes longer and as solvent polarity increases. The high stabilities for H1 -14 foldamers of γAmc5 (1) in solution were ascribed to the favored solvation free energies. The calculated mean backbone torsion angles for H1 -14 helix foldamers of γAmc5 (1) were similar to those calculated for oligomers of other γ-residues with cyclopentane or cyclohexane rings. However, the substitution of cyclopentane constraints on the Cα -Cß bond of the γAmc5 (1) residue resulted in different conformational preferences and/or handedness of helix foldamers. In particular, the pyrrolidine-substituted analogs of the H1 -14 foldamers of γAmc5 (1) with adjacent amine diads substituted at a proximal distance are expected to be potential catalysts for the crossed aldol condensation in nonpolar and polar solvents.

Prognosis and Adjusting Factors in Elderly Patients With Triple-Negative Breast Cancer: Comparing With Young and Middle Age Groups.

PURPOSE: Proper breast cancer screening and treatment should be considered in the elderly population; however, some tend to be less proactive. Our study aimed to investigate the impact of old age on treatment and prognosis in triple-negative breast cancer (TNBC). METHOD: The study included patients with primary TNBC stage I-III diagnosed from 2002 to 2019 in single institution and retrospectively analyzed. We defined young (< 40 years), middle and old (> 70 years) groups. Clinicopathological factors, treatment, and prognosis were analyzed according to age group of TNBC patients. RESULT: TNBC patients aged 70 and above were 3.3 times more likely (P = .019) to have lymph node metastasis at the time of diagnosis compared to younger patients, but were found to be 0.24 times less likely to receive chemotherapy. (P = .003) Old TNBC patients have an expected likelihood 2.2 times higher of undergoing mastectomy rather than breast-conserving surgery. (P = .042) The 5-year prognosis is poorer in young and old group. (61%, 86%, and 65% in young, middle, and old groups). (P < .001). In subanalysis, old group of stages I and II received fewer chemotherapy compared to youngers (P < .05), but not in stage III. In Cox regression analysis, age and stage had significant impact on prognosis (hazard ratio 2-3), but treatment factors did not. However, in stratified analysis of adjuvant therapy and stage, prognosis of Old TNBC patients in stage II was improved when they underwent neo or adjuvant chemotherapy. CONCLUSION: TNBC presents challenges in older patients, who receive less aggressive treatment and have poorer outcomes. The primary cause of poor prognosis in old TNBC patients is the high disease stage at diagnosis, underscoring the need for promotion and education on early screening. Additionally, it is suggested that a more proactive approach to adjuvant chemotherapy is necessary for stage II old TNBC patients.

Job satisfaction and moral distress of nurses working as physician assistants: focusing on moderating role of moral distress in effects of professional identity and work environment on job satisfaction.

BACKGROUND: Physician assistant was created in response to a shortage of physicians. However, this profession is not officially recognized in Korea. Many nurses are working as physician assistants. Their job satisfaction was low due to role conflict. Job satisfaction plays a major role in providing high quality nursing. This study aimed to investigate effects of work environment and professional identity on job satisfaction and identify the mediating role of moral distress in such effects. METHODS: Participants were 112 nurses working as physician assistants. They were recruited from three General Hospitals. A questionnaire scale was used to collect data. Data were analyzed using frequency, descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation, and Macro Model 4 with SPSS Statistics. RESULTS: Job satisfaction of nurses working as physician assistants had a score of 3.08 out of 5. It showed significant associations with work environment and professional identity. Moral distress had a partial mediating role in relationships of job satisfaction with work environment and professional identity. CONCLUSION: Many nurses are working as physician assistants, although physician assistant as a profession is not officially recognized in Korea. Nurses working as physician assistants experience confusion about their professional identity and moral distress. For better nursing outcomes, physician assistant policy should be improved, and various strategies should be provided to improve their job satisfaction.

Simulation Education Incorporating Academic Electronic Medical Records for Undergraduate Nursing Students: A Pilot Study.

OBJECTIVES: Academic electronic medical records (AEMRs) can be utilized for a variety of educational programs that can enhance nursing students' nursing informatics and clinical reasoning competencies. This study aimed to identify the applicability and effectiveness of simulation education incorporating AEMRs. METHODS: We developed simulation education scenarios incorporating AEMRs and evaluated them with 76 third- and fourth-year nursing students from five nursing schools using a mixed-methods design. We incorporated three simulation case scenarios involving preeclampsia, diabetes mellitus, and myocardial infarction into the AEMRs. After the simulation education, participants' feedback on the usability of the AEMR system and their self-efficacy for AEMR utilization were collected via self-reported surveys. Subsequently, the simulation education incorporating AEMRs was evaluated through a focus group interview. The survey data were examined using descriptive statistics, and thematic analysis was done for the focus group interview data. RESULTS: The average mean scores for the AEMR system's usability and participants' self-efficacy for AEMR utilization were 5.36 of 7 and 3.96 of 5, respectively. According to the focus group interviews, the participants were satisfied with the simulation education incorporating AEMRs and recognized their confidence in AEMR utilization. In addition, participants addressed challenges to simulation education incorporating AEMRs, including the need for pre-education and AEMR utilization difficulties. CONCLUSIONS: Nursing students were satisfied with and recognized the value of simulation education incorporating AEMRs. Although the actual application of simulation education incorporating AEMRs remains challenging, further research can help develop and implement this approach for nursing students.

What topics are women interested in during pregnancy: exploring the role of social media as informational and emotional support.

BACKGROUND: Social media plays an important role as a source for obtaining or sharing health information. It is frequently used as a resource by pregnant women who seek information and emotional support regarding their physical and role changes. To provide high-quality support for pregnant women, it is important to determine what topics they want information on from social media during their pregnancy, and what effects they expect from each topic. This study investigates what topics pregnant women are interested in according to their stage of pregnancy and need for informational or emotional support from each topic of interest. METHODS: An online survey was conducted with 302 pregnant Korean women. The survey questionnaires included information sources and experience of social media. Along with the questionnaires, they were asked to describe three to ten health topics that they were most interested in in the last two weeks. RESULTS: Social media (72.85%) and search engines (72.85%) were found to be most frequently used for pregnancy-related health information. The topics of interest slightly differed by stage, but mainly postpartum care, pregnancy symptoms, and daily life issues ranked high. Mood related topics appeared frequently among women in their first trimester or post-partum stage of pregnancy. Informational support was mostly needed for daily life issues, and emotional support needs centered mostly around stories about family and mood during pregnancy. CONCLUSIONS: Pregnant women have different needs for informational or emotional support, depending on their stage of pregnancy and their topics of interest. Therefore, social media support should be delivered with varying content and platforms tailored to women's needs at each trimester.

Validation of a Korean version of mobile app rating scale (MARS) for apps targeting disease management.

The mobile app rating scale (MARS) is a widely used instrument for evaluating smartphone app quality. We aimed to examine the reliability and validity of the Korean version of MARS (MARS-K). Two independent raters performed the assessment using the translated 23-item questionnaire. We applied intraclass correlation coefficient analysis (ICC) to examine inter-rater reliability, Omega, and item-total correlation for internal consistency, and Pearson's r for test-retest reliability and correlation between subscales and the total score of MARS-K. Most items showed moderate to good ICC (0.447-1.000). The MARS-K showed excellent internal consistency and all subscales exceeded the acceptable level of omega. Results indicated MARS-K to be a valid and reliable instrument for evaluating disease management apps offered in the Korean app store. However, upgrades are recommended to further improve MARS-K's rating accuracy and reliability.

Ontology-Based Natural Language Processing of Social Media Data in the Assessment of Health Information Sought During Pregnancy.

This study analyzed collected social media data from South Korea containing keywords related to "pregnancy" using ontology-based natural language processing. Of the 504,725 documents, those containing concepts related to "maternal emotion" were the most frequent, followed by "family support". Social media were used as a means of exchanging information and expressing emotions.

Systematic Review of Prediction Models for Preterm Birth Using CHARMS.

OBJECTIVE: This study sought to evaluate prediction models for preterm birth (PTB) and to explore predictors frequently used in PTB prediction models. METHODS: A systematic review was conducted. We selected studies according to the PRISMA, classified studies according to TRIPOD, appraised studies according to the PROBAST, and extracted and synthesized the data narratively according to the CHARMS. We classified the predictors in the models into socio-economic factors with demographic, psychosocial, biomedical, and health behavioral factors. RESULTS: Twenty-one studies with 27 prediction models were selected for the analysis. Only 16 models (59.3%) defined PTB outcomes as 37 weeks or less, and seven models (25.9%) defined PTB as 32 weeks or less. The PTB rates varied according to whether high-risk pregnant women were included and according to the outcome definition used. The most frequently included predictors were age (among demographic factors), height, weight, body mass index, and chronic disease (among biomedical factors), and smoking (among behavioral factors). CONCLUSION: When using the PTB prediction model, one must pay attention to the outcome definition and inclusion criteria to select a model that fits the case. Many studies use the sub-categories of PTB; however, some of these sub-categories are not correctly indicated, and they can be misunderstood as PTB (≤ 37 weeks). To develop further PTB prediction models, it is necessary to set the target population and identify the outcomes to predict.

Animal-Assisted Therapy as an Intervention for Older Adults: A Systematic Review and Meta-Analysis to Guide Evidence-Based Practice.

BACKGROUND: Animal-assisted therapy (AAT) can ameliorate diverse health problems in older adults. However, applications of AAT have been limited because of the lack of intervention guidelines for older adults. AIMS: This study aimed to explore applications of AAT to older adults, analyze its health effects, and provide evidence for future interventions. METHODS: A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data were analyzed based on both a narrative synthesis and a meta-analysis specifically for depression. RESULTS: A total of 47 studies were selected for analysis. About 45% focused on older adults with diseases such as dementia, and 57.4% selected dog(s) as an intervention animal. About 34.0% delivered interventions once a week, and the behavioral outcome domain was the most frequently investigated. The meta-analysis showed that the effect sizes of the AAT group were -1.310 (95% CI [-1.900, -.721]). LINKING EVIDENCE TO ACTION: This review provides evidence for AAT as an intervention in the physiological, psychosocial, cognitive, and behavioral domains of older adults. When planning interventions for older adults, nurses should consider intended health outcomes, appropriate therapeutic animals, and the consequent intervention contents.

An Ontology for Assessing Health Information Needed During Pregnancy.

In this study we developed an ontology for accessing online health information related to pregnancy. Social media data and the categories in the literature on pregnancy information were used to collect terms for identifying class and class hierarchy. The developed ontology included 241 classes and 788 synonyms, with six superclasses. This ontology can be used to provide appropriate information based on a needs assessment.

Use of electronic critical care flow sheet data to predict unplanned extubation in ICUs.

This study utilized critical care flow sheet data to develop prediction models for unplanned extubation. A total of 5180 patients with 5412 cases of endotracheal tube extubation treated in a tertiary care teaching hospital were evaluated. A total of 60 extubation cases were classified as unplanned, and 5352 as planned. Features documented in the critical care flow sheet for the 24 h prior to extubation were grouped into those with recording frequencies ≤3 and >3. The nearest values to the extubation were identified for all features. For features recorded >3 times, the maximum, minimum, mean, and recording frequencies were calculated. Univariate analyses were performed to select features for inclusion in multivariate analyses. Three multivariate logistic regression models were compared. Model 1 contained only the nearest value, Model 2 added a recording frequency, and Model 3 replaced the nearest value with the maximum, minimum, or mean that had the highest effect size for each feature recorded >3 times. Univariate analyses showed that 18 features differed significantly between the unplanned extubation and control groups. These included vital signs (e.g., pulse and respiration rates, body temperature), ventilator parameters (e.g., minute volume, peak pressure), and consciousness indicators (e.g., Glasgow coma scale score, Richmond agitation sedation scale score, motor power). On all three multivariate analyses, the Glasgow coma scale score, pulse rate, and peak pressure were statistically significant. The frequency of patient positioning (Model 2) and the minimum respiration rate (Model 3) were also significant. Area under the curve, sensitivity, and positive and negative predictive values improved slightly from Model 1 to Model 2 and from Model 2 to Model 3. This study found that minute volume, peak pressure, and motor power are significant risk factors for unplanned extubation that have not been previously reported. Recording frequency, which reflects how often nursing activities were provided, was also a useful predictor. The indicators identified in this study may help to predict and prevent unplanned extubation in clinical settings.

Relationships between determinants of adjuvant endocrine therapy adherence in breast cancer.

BACKGROUND: Interventions that promote adjuvant endocrine therapy (AET) adherence are critical to improve breast cancer survival. The development of interventions would benefit from a better understanding of the reasons for adherence and the causal relationships of determinants using theoretical or model approaches. The aim of the present study was to identify reasons for AET adherence in breast cancer patients with sequential relationships and inter-relationships. METHODS: A total of 210 participants with estrogen receptor positive breast cancer who received AET completed a questionnaire assessing demographic/medical, psychological, and endocrine therapy (ET)-specific factors. A descriptive analysis was performed to identify meaningful variables. Selected variables were subjected to hierarchical regression and path analyses. The path model was tested and modified based on the research framework and the results of regression weights and model fit. RESULTS: Analysis of sequential effects showed that ET-specific factors contributed the largest proportion of variance (13.4%) to predict AET adherence, followed by psychological factors (4.6%) and demographic/medical factors (3.1%). Analysis of inter-relationships showed that demographic/medical factors such as AET regimen type and cancer stage have direct effects on AET adherence, whereas psychological factors contribute indirectly through the mediating effects of ET-specific factors. CONCLUSION: Assessments and interventions that encompass the patient's medication beliefs, self-efficacy, and depression are needed to promote AET adherence.

Evaluating test-retest reliability in patient-reported outcome measures for older people: A systematic review.

OBJECTIVES: This study aimed to evaluate the components of test-retest reliability including time interval, sample size, and statistical methods used in patient-reported outcome measures in older people and to provide suggestions on the methodology for calculating test-retest reliability for patient-reported outcomes in older people. DESIGN: This was a systematic literature review. DATA SOURCES: MEDLINE, Embase, CINAHL, and PsycINFO were searched from January 1, 2000 to August 10, 2017 by an information specialist. REVIEW METHODS: This systematic review was guided by both the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and the guideline for systematic review published by the National Evidence-based Healthcare Collaborating Agency in Korea. The methodological quality was assessed by the Consensus-based Standards for the selection of health Measurement Instruments checklist box B. RESULTS: Ninety-five out of 12,641 studies were selected for the analysis. The median time interval for test-retest reliability was 14days, and the ratio of sample size for test-retest reliability to the number of items in each measure ranged from 1:1 to 1:4. The most frequently used statistical methods for continuous scores was intraclass correlation coefficients (ICCs). Among the 63 studies that used ICCs, 21 studies presented models for ICC calculations and 30 studies reported 95% confidence intervals of the ICCs. Additional analyses using 17 studies that reported a strong ICC (>0.09) showed that the mean time interval was 12.88days and the mean ratio of the number of items to sample size was 1:5.37. CONCLUSIONS: When researchers plan to assess the test-retest reliability of patient-reported outcome measures for older people, they need to consider an adequate time interval of approximately 13days and the sample size of about 5 times the number of items. Particularly, statistical methods should not only be selected based on the types of scores of the patient-reported outcome measures, but should also be described clearly in the studies that report the results of test-retest reliability.

2016 Year-in-Review of Clinical and Consumer Informatics: Analysis and Visualization of Keywords and Topics.

OBJECTIVES: The objective of this study was to review and visualize the medical informatics field over the previous 12 months according to the frequencies of keywords and topics in papers published in the top four journals in the field and in Healthcare Informatics Research (HIR), an official journal of the Korean Society of Medical Informatics. METHODS: A six-person team conducted an extensive review of the literature on clinical and consumer informatics. The literature was searched using keywords employed in the American Medical Informatics Association year-in-review process and organized into 14 topics used in that process. Data were analyzed using word clouds, social network analysis, and association rules. RESULTS: The literature search yielded 370 references and 1,123 unique keywords. 'Electronic Health Record' (EHR) (78.6%) was the most frequently appearing keyword in the articles published in the five studied journals, followed by 'telemedicine' (2.1%). EHR (37.6%) was also the most frequently studied topic area, followed by clinical informatics (12.0%). However, 'telemedicine' (17.0%) was the most frequently appearing keyword in articles published in HIR, followed by 'telecommunications' (4.5%). Telemedicine (47.1%) was the most frequently studied topic area, followed by EHR (14.7%). CONCLUSIONS: The study findings reflect the Korean government's efforts to introduce telemedicine into the Korean healthcare system and reactions to this from the stakeholders associated with telemedicine.

Development and validation of detailed clinical models for nursing actions in perinatal care.

OBJECTIVES: The aim of this study was to develop and evaluate detailed clinical models (DCMs) for nursing actions in perinatal care. We propose the use of action-target dyads as entities in DCMs for nursing actions. METHODS: We identified action and target concepts, attributes, and value sets by analyzing nursing documentation and reviewing the wider literature, in addition to published standards and models. We developed the DCMs by linking entities, attributes, and value sets. DCMs were classified by action type based on the Clinical Care Classification, and by target type based on the axes of the International Classification for Nursing Practice (ICNP). Attributes in the DCMs were also classified by ICNP axes. The quality of the DCMs was evaluated by domain experts, and their coverage was evaluated by mapping narrative nursing statements. RESULTS: Nursing DCMs consisting of 233 entities (dyads comprising 34 action and 212 target concepts), 214 attributes and 541 values were developed. The most frequent action type was hands-on care (43.3%). The focus axis was used most frequently for the targets (51.9%) and attributes (38.8%). The quality scores of the DCMs ranged from 0.80 to 0.96. Most (174/192; 90.6%) of the statements were fully mapped, while 7 (3.7%) were partially mapped and 11 (5.7%) were not mapped. We modified the DCMs in accordance with these results. CONCLUSIONS: In total, 240 DCMs were developed with action-target dyads as entities. The DCMs developed in this study could be implemented in an electronic nursing record system to enhance nursing practices and ensure semantic interoperability of nursing data.

Metrics for Electronic-Nursing-Record-Based Narratives: cross-sectional analysis.

OBJECTIVES: We aimed to determine the characteristics of quantitative metrics for nursing narratives documented in electronic nursing records and their association with hospital admission traits and diagnoses in a large data set not limited to specific patient events or hypotheses. METHODS: We collected 135,406,873 electronic, structured coded nursing narratives from 231,494 hospital admissions of patients discharged between 2008 and 2012 at a tertiary teaching institution that routinely uses an electronic health records system. The standardized number of nursing narratives (i.e., the total number of nursing narratives divided by the length of the hospital stay) was suggested to integrate the frequency and quantity of nursing documentation. RESULTS: The standardized number of nursing narratives was higher for patients aged ≥ 70 years (median = 30.2 narratives/day, interquartile range [IQR] = 24.0-39.4 narratives/day), long (≥ 8 days) hospital stays (median = 34.6 narratives/day, IQR = 27.2-43.5 narratives/day), and hospital deaths (median = 59.1 narratives/day, IQR = 47.0-74.8 narratives/day). The standardized number of narratives was higher in "pregnancy, childbirth, and puerperium" (median = 46.5, IQR = 39.0-54.7) and "diseases of the circulatory system" admissions (median = 35.7, IQR = 29.0-43.4). CONCLUSIONS: Diverse hospital admissions can be consistently described with nursing-document-derived metrics for similar hospital admissions and diagnoses. Some areas of hospital admissions may have consistently increasing volumes of nursing documentation across years. Usability of electronic nursing document metrics for evaluating healthcare requires multiple aspects of hospital admissions to be considered.

Mobile Apps Providing Tailored Nursing Interventions for Patients with Metabolic Syndrome.

OBJECTIVES: This study developed and evaluated four mobile applications (apps) that provide tailored nursing recommendations for metabolic syndrome management. METHODS: Mobile apps for obesity, gestational diabetes, hypertension, and hyperlipidemia management were developed according to the system development life cycle and evaluations by experts and users. RESULTS: Six lifestyle management and five disease-specific knowledge domains were extracted. Functions such as 'Log in' and 'Record data using diary' to be used in all of the apps were extracted, while disease-specific functions were also extracted, including 'Determine the goal' to be used in the obesity app. The proficiency and efficiency of the algorithms ranged from 69.0 to 100.0. In a heuristics evaluation all of the problems were resolved and all of the usability scores exceeded 3.5 out of 5. CONCLUSION: This study demonstrates that metabolic syndrome can be effectively managed using special functions provided by smartphones, such as automatic feedback, alerts, diaries, and social media integration. Future work will include integrating and harmonizing these four apps in order to improve their semantic interoperability.

Is the ISO Reference Terminology Model for Nursing Actions Enough to Describe Nursing Actions?

The aim of this study is to test the applicability of the International Standards Organization (ISO) Reference terminology model (RTM) for nursing action to describe Detailed Clinical Models (DCMs) for nursing action. All verb and target terms were mapped to 'Action' and 'Target' category of RTM for nursing actions. Among 72 attributes qualifying the verb terms, 50 attributes were mapped to Means, Route, Timing, or Site categories of the nursing action model. Among 142 attributes qualifying the target terms, 20 attributes were mapped to Means, Timing, or Site categories of the nursing action model and 6 attributes were mapped to Degree or Judgment categories of the nursing diagnosis model. The findings suggest the need for an integrated RTM for nursing.

Discovery of indirubin derivatives as new class of DRAK2 inhibitors from high throughput screening.

DRAK2 is a serine/threonine kinase belonging to the death-associated protein kinase (DAPK) family and has emerged as a promising drug target for the treatment of autoimmune diseases and cancers. To identify small molecule inhibitors for DRAK2, we performed a high throughput screening campaign using in-house chemical library and identified indirubin-3'-monoximes as novel class of DRAK2 inhibitors. Among the compounds tested, compound 16 exhibited the most potent inhibitory activity against DRAK2 (IC50=0.003µM). We also propose that compound 16 may bind to the ATP-binding site of the enzyme based on enzyme kinetics and molecular docking studies.

Remote Stereoinductive Intramolecular Nitrile Oxide Cycloaddition: Asymmetric Total Synthesis and Structure Revision of (-)-11ß-Hydroxycurvularin.

The first total synthesis and structure revision of (-)-11ß-hydroxycurvularin (1b), a macrolide possessing a ß-hydroxyketone moiety, were accomplished. The ß-hydroxyketone moiety in this natural product was introduced by cleavage of the N-O bond in an isoxazoline ring that was formed diastereoselectively in a 1,5-remote stereocontrolled fashion by employing intramolecular nitrile oxide cycloaddition.