Potential Biomarkers to Improve the Prediction of Osteoporotic Fractures

Osteoporotic fracture (OF) is associated with high disability and morbidity rates. The burden of OF may be reduced by early identification of subjects who are vulnerable to fracture. Although the current fracture risk assessment model includes clinical risk factors (CRFs) and bone mineral density (BMD), its overall ability to identify individuals at high risk for fracture remains suboptimal. Efforts have therefore been made to identify potential biomarkers that can predict the risk of OF, independent of or combined with CRFs and BMD. This review highlights the emerging biomarkers of bone metabolism, including sphongosine-1-phosphate, leucine-rich repeat-containing 17, macrophage migration inhibitory factor, sclerostin, receptor activator of nuclear factor-κB ligand, and periostin, and the importance of biomarker risk score, generated by combining these markers, in enhancing the accuracy of fracture prediction.

Inhaled Corticosteroids and Placebo Treatment Effects in Adult Patients With Cough: A Systematic Review and Meta-analysis

PURPOSE: Inhaled corticosteroids (ICSs) are often considered an empirical therapy in the management of patients with cough. However, ICS responsiveness is difficult to interpret in daily clinical practice, as the improvements may include placebo effects or self-remission. We aimed to evaluate ICS and placebo treatment effects in adult patients with cough. METHODS: Electronic databases were searched for studies published until June 2018, without language restriction. Randomized controlled trials reporting the effects of ICSs compared with placebo in adult patients with cough were included. Random effects meta-analyses were conducted to estimate the treatment effects. Therapeutic gain was calculated by subtracting the percentage change from baseline in the cough score in the ICS treatment group from that in the placebo treatment group. RESULTS: A total of 9 studies were identified and 8 studies measuring cough severity outcomes were included for meta-analyses. Therapeutic gain from ICSs ranged from −5.0% to +94.6% across the studies included; however, it did not exceed +22%, except for an outlier reporting very high therapeutic gains (+45.6% to +94.6%, depending on outcomes). Overall ICS treatment effects in cough severity outcomes were small-to-moderate (standardized mean difference [SMD], −0.38; 95% confidence interval [CI], −0.54, −0.23), which were comparable between subacute and chronic coughs. However, pooled placebo treatment effects were very large in subacute cough (SMD, −2.58; 95% CI, −3.03, −2.1), and modest but significant in chronic cough (SMD, −0.46; 95% CI, −0.72, −0.21). CONCLUSIONS: Overall therapeutic gain from ICSs is small-to-moderate. However, placebo treatment effects of ICS are large in subacute cough, and modest but still significant in chronic cough. These findings indicate the need for careful interpretation of ICS responsiveness in the management of cough patients in the clinic, and also for rigorous patient selection to identify ICS-responders.

Impact of Middle East respiratory syndrome outbreak on the use of emergency medical resources in febrile patients

OBJECTIVE: Outbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources. METHODS: An ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea. RESULTS: Following the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attendances. This effect was more prominent in the children under five years. The duration of the chief complaint before ED arrival and the length of ED stay were significantly increased among younger pediatric patients. Decreased body temperature on arrival was observed in younger pediatric patients. CONCLUSION: MERS outbreak appears to have had a significant effects on ED use by febrile patients. The use of emergency care services by pediatric patients makes them more vulnerable to an outbreak of a transmissable disease. An effective strategy to control emergency center visits by non-urgent febrile patients and provide proper medical services is urgently needed.

The Effect of Emergency Department Expansion on the Emergency Department Length of Stay in a Tertiary Hospital

PURPOSE: In this study, we aimed to measure the effects of emergency department (ED) expansion at a tertiary hospital on overall ED length of stay (LOS). METHODS: This study was a before and after study using data from a tertiary medical center in Seoul, a large metropolis. We used electronic medical records and administrative databases obtained from the ED. The control period (before expansion) was defined as from January 1 to April 31, 2016. The study period (after expansion) was defined as from May 1 to August 31, 2016. The number of ED beds increased from 42 to 74 after the expansion. After adjusting individual characteristics and institutional characteristics, multivariate regression analysis was carried out to evaluate the effects of expansion on overall ED LOS. RESULTS: A total of 45,632 patients visited the emergency medical center: 20,592 patients before and 25,040 after the expansion. Although the absolute number of patients increased, the portion of medical patients, portion of non-referral patients, and ambulatory patients decreased during the study period (all p<0.001). Average visit number increased from 170.2 (standard deviation [SD], 27.3) to 203.6 (SD, 21.3) (p<0.001). The overall ED LOS increased from 332.2 (SD, 473.4) to 391.0 minutes (SD, 649.5). After adjusting for potential confounders, we found that ED expansion was associated with an increase in ED LOS by 75.8 minutes (95% confidence interval, 63.5 to 88.2). CONCLUSION: We found that the ED expansion was associated with a significant increase in ED LOS.

Effects of Intensive Clinical Training for Nursing Students in Nursing Practice on their Clinical Competence, State Anxiety, and Clinical Practice Stress / 기본간호학회지

PURPOSE: The purpose of this study was to examine the effects of a intensive clinical training programfor nursing practice on the clinical competence, state anxiety, clinical practice stress in nursing students who were beginning their first clinical practice. METHODS: This practice has been processed as a ‘Pre-Post design with a non-equivalent control group’. The participants were 177 students in a college of nursing. The students were divided into two groups: 89 students in the experimental group and 88 students in the control group. RESULTS: The experimental group showed significant improvement in their clinical competence scores compared to the control group. The difference between the two groups was also significant. State anxiety in the experimental group significantly decreased compared to the control group. However, scores for stress during practice were not significantly different. CONCLUSION: The findings in this research reveal that the program, ‘Close clinical practice training for nursing students’ practice entry, contributes to improving students' overall ability and performance, and reduces anxiety of nursing students as they start their first clinical practice. These findings can be utilized in helping nursing students improve the quality of their performance.

Emergency Department Visits in Hemophilia Patients / 임상소아혈액종양

BACKGROUND: Hemophilia A and hemophilia B are characterized by prolongation of bleeding and hemorrhages in the joints and soft tissues. There is no ultimate treatment, if patients did not properly manage who can lead to chronic disease and lifelong disabilities. Many patients with hemophilia continue to seek medical attention, for several reasons in the emergency department (ED). In this retrospective study, we examined the overall ED use by patients with hemophilia in a single center, particularly in order to examine visits related to clinical characteristics. METHODS: There were 210 patients with hemophilia for a 16-year period. Among them, 96 patients visited the ED. We evaluated the history, laboratory findings, image study, clinical course. RESULTS: There are 170 hemophilia A, 40 hemophilia B. Bleeding is the most common reason for ED visits. Bleeding site is joint, intracranial, muscle, subcutaneous, gastrointestinal in regular sequence. Life threatening bleeding was reported 23 episodes of Intracranial hemorrhage (ICH), 12 episodes of gastrointestinal hemorrhage, 6 episodes of iliopsoas bleeding and 2 episodes of pulmonary hemorrhage. In the case of ICH, seizure is usual symptom. In the case of gastrointestinal bleeding, hematochezia is the common symptom. In the case of iliopsoas bleeding, lower extremity pain and edema, limitation of motion are common symptoms. CONCLUSION: In order to minimize complications, we must perform fast, accurate judgement and treatment when the patients with hemophilia visit ED.

Emergency Department Visits in Hemophilia Patients / 임상소아혈액종양

BACKGROUND: Hemophilia A and hemophilia B are characterized by prolongation of bleeding and hemorrhages in the joints and soft tissues. There is no ultimate treatment, if patients did not properly manage who can lead to chronic disease and lifelong disabilities. Many patients with hemophilia continue to seek medical attention, for several reasons in the emergency department (ED). In this retrospective study, we examined the overall ED use by patients with hemophilia in a single center, particularly in order to examine visits related to clinical characteristics. METHODS: There were 210 patients with hemophilia for a 16-year period. Among them, 96 patients visited the ED. We evaluated the history, laboratory findings, image study, clinical course. RESULTS: There are 170 hemophilia A, 40 hemophilia B. Bleeding is the most common reason for ED visits. Bleeding site is joint, intracranial, muscle, subcutaneous, gastrointestinal in regular sequence. Life threatening bleeding was reported 23 episodes of Intracranial hemorrhage (ICH), 12 episodes of gastrointestinal hemorrhage, 6 episodes of iliopsoas bleeding and 2 episodes of pulmonary hemorrhage. In the case of ICH, seizure is usual symptom. In the case of gastrointestinal bleeding, hematochezia is the common symptom. In the case of iliopsoas bleeding, lower extremity pain and edema, limitation of motion are common symptoms. CONCLUSION: In order to minimize complications, we must perform fast, accurate judgement and treatment when the patients with hemophilia visit ED.

Emergency Department Visits in Hemophilia Patients / 임상소아혈액종양

BACKGROUND: Hemophilia A and hemophilia B are characterized by prolongation of bleeding and hemorrhages in the joints and soft tissues. There is no ultimate treatment, if patients did not properly manage who can lead to chronic disease and lifelong disabilities. Many patients with hemophilia continue to seek medical attention, for several reasons in the emergency department (ED). In this retrospective study, we examined the overall ED use by patients with hemophilia in a single center, particularly in order to examine visits related to clinical characteristics.METHODS: There were 210 patients with hemophilia for a 16-year period. Among them, 96 patients visited the ED. We evaluated the history, laboratory findings, image study, clinical course.RESULTS: There are 170 hemophilia A, 40 hemophilia B. Bleeding is the most common reason for ED visits. Bleeding site is joint, intracranial, muscle, subcutaneous, gastrointestinal in regular sequence. Life threatening bleeding was reported 23 episodes of Intracranial hemorrhage (ICH), 12 episodes of gastrointestinal hemorrhage, 6 episodes of iliopsoas bleeding and 2 episodes of pulmonary hemorrhage. In the case of ICH, seizure is usual symptom. In the case of gastrointestinal bleeding, hematochezia is the common symptom. In the case of iliopsoas bleeding, lower extremity pain and edema, limitation of motion are common symptoms.CONCLUSION: In order to minimize complications, we must perform fast, accurate judgement and treatment when the patients with hemophilia visit ED.

Factor for The Dissatisfaction of Patient for Emergency Department Services

PURPOSE: To evaluate patient satisfaction with emergency department (ED) services and to identify factors influencing dissatisfaction. METHODS: Direct interviews with questionnaires were administered at 18 EDs during a 6-day period from July 26 to July 31, 2006. All patients and accompanying persons who visited the ED during the survey period were included. Questionnaires consisted of 14 questions regarding the patient's characteristics (determinants), 9 questions about ED services (components) evaluated on a 5-point Likert scale, and 2 questions to gauge overall ED satisfaction rated on a 5-point Likert scale and a visual analogue scale (VAS). Overall dissatisfaction was modeled using logistic regression. RESULTS: Of the 708 patients visiting ED during the survey period, 322 patients consented to an interview (response rate: 45.5%), including 286 who gave complete responses. Among the 286 complete responses, 177 indicated an overall satisfaction of ED service, rating it at 79.2% on the VAS. The determinant "number of ED visits >1 for last 1 year" and all questions in the components category were related to overall dissatisfaction. In logistic regression modeling, the determinants "age> or =45 years" and "number of ED visits >1 for last 1 year" correlated with overall dissatisfaction. In the final model, dissatisfaction with the comfort of the waiting room (OR=2.6, 95% CI:1.3-5.0), care received from the physicians (OR=4.0, 95% CI:2.0-8.3), care received from the nurses (OR=3.6, 95% CI:1.6-7.7), and waiting time to receipt of treatment (OR=5.8, 95% CI:2.9-11.3) were all related to overall dissatisfaction. CONCLUSION: In order to reduce dissatisfaction with ED services, EMS policies should be formulated to improve care by physicians and nurses and to decrease the perceived waiting time.

Factors Affecting Emergency Department Length of Stay in Traumatic Surgical Critically Ill Patients

PURPOSE: Prolonged emergency department (ED) lengthof-stay (LOS) may cause ED overcrowding and worse outcome in traumatic surgical critically ill patients. In this study, we examined characteristics to be associated with prolonged ED LOS, including use of CT scanning and other ED-based special procedures (eg, radiologic diagnostic tests or therapeutic procedures performed in the ED). METHODS: A retrospective cohort study was conducted at an academic medical center with 458 traumatic surgical critically ill patients from 2003 to 2004. Critical care patients were defined as those sent to the operating room (OR) or intensive care unit (ICU) directly from the ED. Information was extracted from each ED chart on use and the number of CT scanning, other special radiologic diagnostic procedures (eg, magnetic resonance imaging, angiogram, cystogram), the number of plain radiographs performed, the emergent therapeutic procedures (intubation, closed thoracotomy, central venous line), the waiting times and number of consultants called, and holding times for decision of admission. ED LOS was defined as the time from presentation until transfer to the OR or ICU. To assess the effect of multiple simultaneous factors affecting ED LOS, a Cox proportional hazard model of time-to-ED discharge was used. RESULTS: The average overall ED LOS was 256.4+/-153.2 minutes (16 to 1465 minutes). Use of special radiologic diagnostic procedures was most strongly associated with an increased ED LOS. Use of either CT scanning or emergent therapeutic procedures, the number of plain radiographs, waiting times and numbers of consultants, and holding times for decision of admission were also affected a prolonged ED LOS independently. CONCLUSION: ED-based patient management decisions such as use of CT and ED-based special diagnostic and therapeutic procedures strongly associated affected ED LOS in traumatic surgical critically ill patients.

Comparison of Dietary Intakes and Plasma Lipid Levels in Diabetes and Control Elderly / 대한지역사회영양학회지

ABSTRACT This study was done to investigate and compare the nutritional status and plasma lipids in the diabetes and control elderly. Subjects were 105 persons (male 32, female 73) aged over 65 years and visited public health centers in Ulsan area. The subjects were divided into 2 groups, diabetes and control group. Athropometric measurement, dietary intakes, and plasma biochemical indices were examined. Body Mass Index (BMI), Percentage of Ideal Body Weight (PIBW) and Waist-Hip Ratio (WHR) of diabetes group were higher than those of control group. Overall eating behavior were worse in diabetes group than those of control group. There was no significant difference in smoking and exercise status among groups. The ratio of drinkers was significantly higher in control group. But the amount of alcohol consumed at once was higher in the diabetes group. There was no significant difference in most nutrient intakes between males and females. The intakes of fiber, natrium (Na), vitamin A, and beta-carotene were significantly higher in diabetes group than control groups while that of potassium (K) was lower in diabetes group. Diabetes group had the higher levels in triglyceride, VLDL-cholesterol, Chol/HDL-cholesterol ratio, LDL/HDL-cholesterol ratio, while they had lower HDL-cholesterol level. Overall results might imply that the elderly with diabetes have to be more careful to their meals and health-related behaviors to increase the likelihood of a healthier life.