The teaching of geriatric dentistry in South Korean dental schools.

OBJECTIVE: The purpose of this study was to investigate the curriculum of geriatric dentistry for undergraduates in Korean dental schools. BACKGROUND: For development purposes, it was necessary to compare geriatric dentistry education programmes in South Korea to programmes in the United States and Europe. METHODS: The most recent curriculum and related information on geriatric dentistry at the undergraduate level in all 11 dental schools in South Korea were collected by both official letter and e-mail. A symposium for gathering expert opinions to improve geriatric dentistry education in South Korea was also held. The collected data were analysed, and the expert opinions at the symposium were summarised. RESULTS: Six of 11 schools had a didactic course as compulsory and three schools as elective. The course was usually conducted as a form of integrated lectures, and the level of standardisation of lecture content was very low. There were no topics for older people who cannot access dental clinics due to functional frailty or disability. No dental school-affiliated hospitals had an independent department for geriatric dentistry. No schools provided clinical teaching for geriatric dentistry. There were no outreach programmes for geriatric dentistry. CONCLUSIONS: The educational curriculum for geriatric dentistry in South Korea was insufficient to cope with social and demographic changes. Curriculum content should include clinical practice education and needs to be focused on frail and dependent older adult patients. An essential educational curriculum and core competency for geriatric dentistry should be prepared.

Vasoactive-Inotropic Score as an Early Predictor of Mortality in Adult Patients with Sepsis.

Vasoactive and inotropic medications are essential for sepsis management; however, the association between the maximum Vasoactive-Inotropic score (VISmax) and clinical outcomes is unknown in adult patients with sepsis. We investigated the VISmax as a predictor for mortality among such patients in the emergency department (ED) and compared its prognostic value with that of the sequential organ failure assessment (SOFA) score. This single-center retrospective study included 910 patients diagnosed with sepsis between January 2016 and March 2020. We calculated the VISmax using the highest doses of vasopressors and inotropes administered during the first 6 h on ED admission and categorized it as 0-5, 6-15, 16-30, 31-45, and >45 points. The primary outcome was 30-day mortality. VISmax for 30-day mortality was significantly higher in non-survivors than in survivors. The mortality rates in the five VISmax groups were 17.2%, 20.8%, 33.3%, 54.6%, and 70.0%, respectively. The optimal cut-off value of VISmax to predict 30-day mortality was 31. VISmax had better prognostic value than the cardiovascular component of the SOFA score and initial lactate levels. VISmax was comparable to the APACHE II score in predicting 30-day mortality. Multivariable analysis showed that VISmax 16-30, 31-45, and >45 were independent risk factors for 30-day mortality. VISmax in ED could help clinicians to identify sepsis patients with poor prognosis.

Association of ischemia modified albumin with mortality in qSOFA positive sepsis patients by sepsis-3 in the emergency department.

BACKGROUND: The early detection and treatment of sepsis and septic shock patients in emergency departments are critical. Ischemia modified albumin (IMA) is a biomarker produced by ischemia and oxygen free radicals which are related to the pathogenesis of sepsis-induced organ dysfunction. This study aimed to investigate whether IMA was associated with short-term mortality in quick sequential organ failure assessment (qSOFA)-positive sepsis or septic shock patients screened by the sepsis management program. METHOD: From September 2019 to April 2020, patients who arrived at the emergency departments with qSOFA-positive sepsis or septic shock were included in this retrospective observational study. RESULTS: Among 124 patients analyzed, IMA was higher in the non-surviving group than in the surviving group (92.6 ± 8.1 vs. 86.8 ± 6.2 U/mL, p < 0.001). The area under the receiver operating characteristics curve was 0.703 (95% CI: 0.572-0.833, p < 0.001). The optimal IMA cutoff was 90.45 (sensitivity 60.9%, specificity 79.2%). IMA values were independently associated with 28-day mortality in the multivariate Cox proportional hazard model (adjusted hazard ratio (aHR) = 1.16, 95% CI: 1.06-1.27, p < 0.01). CONCLUSIONS: In this study, we showed that IMA in the emergency departments was associated with 28-day mortality in qSOFA-positive sepsis and septic shock patients. Further studies are needed to evaluate the clinical value of IMA as a useful biomarker in large populations and multicenter institutions.

Strategies to prevent COVID-19 transmission in the emergency department of a regional base hospital in Korea: From index patient until pandemic declaration.

OBJECTIVE: This study aimed to describe the timely strategies used to prevent the spread of the emerging coronavirus disease 2019 (COVID-19) and present the activities performed in a regional base hospital in South Korea, from the identification of the index patient until the pandemic declaration. METHODS: This is a descriptive study detailing the step-by-step guidelines implemented to manage COVID-19 in a regional tertiary base hospital from January to March 2020. We described our three-phase response to the COVID-19 outbreak as per the national and global quarantine procedures applied during each critical event and highlighted the activities implemented from the perspective of public health crisis preparedness involving emerging infectious diseases. RESULTS: During the COVID-19 outbreak in Korea, we improved and implemented a rapid and flexible screening system for visiting patients using patient history and radiological testing and created a separate isolation zone for patients under investigation. This active identification-isolation strategy has been effectively applied in the COVID-19 outbreak. CONCLUSIONS: The step-by-step enforced strategies to prevent the spread of COVID-19, though not perfect, adequately reduced the risk of transmission of the highly contagious infectious disease in the hospital while maintaining the emergency medical system.

Stability of unilateral sagittal split ramus osteotomy for correction of facial asymmetry: long-term case series and literature review.

Bilateral sagittal split ramus osteotomy is considered a standard technique in mandibular orthognathic surgeries to reduce unexpected bilateral stress in the temporomandibular joints. Unilateral sagittal split ramus osteotomy (USSO) was recently introduced to correct facial asymmetry caused by asymmetric mandibular prognathism and has shown favorable outcomes. If unilateral surgery could guarantee long-term postoperative stability as well as favorable results, operation time and the incidence of postoperative complications could be reduced compared to those in bilateral surgery. This report highlights three consecutive cases with long-term follow-up in which USSO was used to correct asymmetric mandibular prognathism. Long-term postoperative changes in the condylar contour and ramus and condylar head length were analyzed using routine radiography and computed tomography. In addition, prior USSO studies were reviewed to outline clear criteria for applying this technique. In conclusion, patients showing functional-type asymmetry with predicted unilateral mandibular movement of less than 7 mm can be considered suitable candidates for USSO-based correction of asymmetric mandibular prognathism with or without maxillary arch surgeries.

Towards clinical use of a laser-induced microjet system aimed at reliable and safe drug delivery.

An Er:YAG laser with 2940-nm wavelength and 250-µs pulse duration is used to generate a microjet that is ejected at ∼50 m/s in air. The strength of the microjet depends on the bubble dynamics from the beam-water interaction within the driving chamber as well as the discharging of the drug solution underneath the elastic membrane that separates the drug from the driving liquid. The jet characteristics, such as velocity, volume, and level of atomization, are obtained by high-speed camera images taken at 42,000 fps. The enhancements in jet volume (dosage) and repeated jet generation, which are aimed at making the injector suitable for general clinical applications, are achieved. The generation of repeated microjets is achieved with the help of a stepping motor that provides a uniform pressure within the drug reservoir before an ejection occurs through a micro nozzle. Also, two types of human growth hormones are used for monitoring any potential thermal damage to the drug solution due to a repeated laser ablation when driving the microjet. We provide strong evidence to support that the drugs, as they are injected to porcine skins, are free of the damage associated with the present delivery method.

A retrospective analysis of 20 surgically corrected bimaxillary protrusion patients.

This paper presents a retrospective review and analysis of 20 bimaxillary protrusion patients who visited the authors' hospital between 1986 and 1998 following surgical correction. The lateral cephalometric radiographs of each patient were taken preoperatively (T0), within 1 week after surgery (T1), and at least 1 postoperative year later (T2). Hard and soft tissue analysis was performed on each cephalometric radiograph. The matched pair t test was employed for T0-T1, T1-T2, and T0-T2 periods. The sample consisted of 20 Korean adult patients with bimaxillary protrusion (18 women and 2 men), aged 21 to 33 years. The first premolars were removed in 18 of the 20 cases. The Wunderer method was selected in 18 of the 20 maxillary cases, and the anterior subapical osteotomy was selected in all mandibular cases. Augmentation genioplasty was combined in 3 cases, and reduction glossoplasty was combined in 2 cases. Orthodontic treatment was accompanied in 8 cases. The statistical analysis of all the variables revealed that, except for overbites, there were significant differences between T1-T2 and between T0-T2 periods (P < .01). This suggests that most of the bimaxillary patients want instant esthetic facial results and that their soft tissue profiles were improved significantly. However, the postoperative course should be cautiously observed.