Currently, antimicrobial resistance (AMR) is a major threat to global public health. The antimicrobial stewardship program (ASP) has been proposed as an important approach to overcome this crisis. ASP supports the optimal use of antimicrobials, including appropriate dosing decisions, administration duration, and administration routes. In Korea, efforts are being made to overcome AMR using ASPs as a national policy. The current study aimed to develop core elements of ASP that could be introduced in domestic medical facilities. A Delphi survey was conducted twice to select the core elements through expert consensus.The core elements for implementing the ASP included (1) leadership commitment, (2) operating system, (3) action, (4) tracking, (5) reporting, and (6) education. To ensure these core elements are present at medical facilities, multiple departments must collaborate as teams for ASP operations. Establishing a reimbursement system and a workforce for ASPs are prerequisites for implementing ASPs. To ensure that ASP core elements are actively implemented in medical facilities, it is necessary to provide financial support for ASPs in medical facilities, nurture the healthcare workforce in performing ASPs, apply the core elements to healthcare accreditation, and provide incentives to medical facilities by quality evaluation criteria.

PURPOSE: To investigate the hemodynamic risk factors for necrotizing enterocolitis (NEC), we analyzed the characteristics of descending aorta (DA) blood flow in preterm neonates, who later developed NEC. METHODS: This was an observational case-control study on 53 preterm neonates at a tertiary referral center. Clinical and echocardiographic data were collected from 23 preterm neonates with NEC (NEC group), and compared with those of 30 preterm neonates without NEC (control group). Echocardiography was done at a median (interquartile range) of 5 (3–9) days after birth and 2 (1–2.5) days before the diagnosis of NEC. RESULTS: Basic clinical characteristics including gestational age, birth weight, Apgar score, breast feeding status, use of umbilical catheters, and mode of invasive ventilator care were similar between the groups. Compared with the control group, the lowest diastolic velocity of DA was significantly decreased, whereas the diastolic reverse flow and the ratio of diastolic reverse to systolic forward flows were significantly increased in the NEC group. In addition, the resistive index (RI) of DA was significantly increased in the NEC group and showed a positive association with the development of NEC. Multivariate logistic regression analysis showed that increasing RI of DA was an independent risk factor for the development of NEC (P=0.008). CONCLUSION: Significant changes in DA flow characteristics including decreased diastolic velocity and increased diastolic reverse flow along with increased peripheral vascular resistance were observed before the development of NEC in preterm neonates. These findings may help clinicians stratify in advance neonates at a risk of developing NEC and may help improve outcomes in these neonates.
Aorta, Thoracic* ; Apgar Score ; Birth Weight ; Breast Feeding ; Case-Control Studies ; Catheters ; Critical Care ; Diagnosis ; Echocardiography ; Enterocolitis, Necrotizing* ; Gestational Age ; Hemodynamics ; Humans ; Infant, Newborn* ; Logistic Models ; Parturition ; Risk Factors ; Splanchnic Circulation ; Tertiary Care Centers ; Vascular Resistance ; Ventilators, Mechanical

This study was conducted to evaluate applicability of job standards for diabetes nutrition management by hospital clinical dietitians. In order to promote the clinical nutrition services, it is necessary to present job standards of clinical dietitian and to actively apply these standardized tasks to the medical institution sites. The job standard of clinical dietitians for diabetic nutrition management was distributed to hospitals over 300 beds. Questionnaire was collected from 96 clinical dietitians of 40 tertiary hospitals, 47 general hospitals, and 9 hospitals. Based on each 5-point scale, the importance of overall duty was 4.4 ± 0.5, performance was 3.6 ± 0.8, and difficulty was 3.1 ± 0.7. ‘Nutrition intervention’ was 4.5 ± 0.5 for task importance, ‘nutrition assessment’ was 4.0 ± 0.7 for performance, and ‘nutrition diagnosis’ was 3.4 ± 0.9 for difficulty. These 3 items were high in each category. Based on the grid diagram, the tasks of both high importance and high performance were ‘checking basic information,’‘checking medical history and therapy plan,’‘decision of nutritional needs,’‘supply of foods and nutrients,’ and ‘education of nutrition and self-management.’ The tasks with high importance but low performance were ‘derivation of nutrition diagnosis,’‘planning of nutrition intervention,’‘monitoring of nutrition intervention process.’ The tasks of both high importance and high difficulty were ‘derivation of nutrition diagnosis,’‘planning of nutrition intervention,’‘supply of foods and nutrients,’‘education of nutrition and self-management,’ and ‘monitoring of nutrition intervention process.’ The tasks of both high performance and high difficulty were ‘documentation of nutrition assessment,’‘supply of foods and nutrients,’ and ‘education of nutrition and self-management.’
Hospitals, General ; Nutritionists* ; Tertiary Care Centers

BACKGROUND/OBJECTIVES: Childhood obesity has increased in recent decades in Korea. This study was designed to examine differences in the eating habits, physical activity (PA), nutrition knowledge, and self-efficacy of children by obesity status. SUBJECTS/METHODS: Subjects were 5th-grade children from 70 elementary schools in 17 cities nationwide. Two-stage stratified cluster sampling was employed. Survey questionnaire included items related to general characteristics, eating habits, PA, nutrition knowledge and self-efficacy. Excluding incomplete responses, 3,531 data were analyzed using SPSS. Subjects were categorized into overweight·obesity (OW) and normal weight (NW) groups based on body mass index percentiles for age by sex. RESULTS: A total of 21.5% of subjects was overweight or obese. There were significant differences in gender, perceived stress, perception of body shape, body satisfaction, and interest in weight control between the OW and NW groups (P < 0.001). With respect to eating habits, the OW group ate breakfast (P < 0.05) and snacks (P < 0.01) less frequently, ate bigger meals (P < 0.001), and demonstrated less desirable behaviors during meals (P <0.05 in boys) compared to the NW group. The OW group participated in less PA than the NW group, especially boys. OW boys spent less time walking during weekdays (P < 0.05) or the weekend (P < 0.001), spent more time being sedentary during weekdays or the weekend (P < 0.001), and exercised a fewer number of days (P < 0.01). For girls, the OW group spent more time being sedentary during the weekend (P < 0.01) and exercised a fewer number of days by walking or bicycle riding (P < 0.05) than the NW group. Nutrition knowledge was not significantly different between the OW and NW groups. Self-efficacy (P < 0.01 in boys), especially PA self-efficacy (P < 0.01), was significantly lower in the OW than NW group. CONCLUSIONS: This study revealed differences in eating habits, PA, and self-efficacy between OW and NW children. Obesity management programs for children need to focus on increasing self-efficacy, modifying eating habits, and increasing PA.
Body Mass Index ; Breakfast ; Child ; Eating* ; Female ; Humans ; Korea ; Meals ; Motor Activity* ; Obesity* ; Overweight ; Pediatric Obesity ; Self Efficacy ; Snacks ; Walking

Dyslipidemia has significantly contributed to the increase of death and morbidity rates related to cardiovascular diseases. Clinical nutrition service provided by dietitians has been reported to have a positive effect on relief of medical symptoms or reducing the further medical costs. However, there is a lack of researches to identify key competencies and job standard for clinical dietitians to care patients with dyslipidemia. Therefore, the purpose of this study was to analyze the job components of clinical dietitian and develop the standard for professional practice to provide effective nutrition management for dyslipidemia patients. The current status of clinical nutrition therapy for dyslipidemia patients in hospitals with 300 or more beds was studied. After duty tasks and task elements of nutrition care process for dyslipidemia clinical dietitians were developed by developing a curriculum (DACUM) analysis method. The developed job standards were pretested in order to evaluate job performance, difficulty, and job standards. As a result, the job standard included four jobs, 18 tasks, and 53 task elements, and specific job description includes 73 basic services and 26 recommended services. When clinical dietitians managing dyslipidemia patients performed their practice according to this job standard for 30 patients the job performance rate was 68.3%. Therefore, the job standards of clinical dietitians for clinical nutrition service for dyslipidemia patients proposed in this study can be effectively used by hospitals.
Cardiovascular Diseases ; Curriculum ; Dyslipidemias* ; Humans ; Job Description ; Nutrition Therapy* ; Nutritionists ; Professional Practice

BACKGROUND: We assessed the effects of stroke community-based education and advocacy on the time from stroke onset to hospital arrival in ischemic stroke patients. METHODS: Stroke community-based education and advocacy were implemented between May 2014 and December 2014 in Iksan, Jeollabukdo. The extent of ambulance utilization, time from stroke onset to hospital arrival, and proportions of arrivals within certain golden-time windows were compared with those of patients admitted from May to December 2013 (before vs. after intervention). RESULTS: The demographic and clinical characteristics did not differ significantly between the patients admitted in 2013 and 2014, nor did the proportion of ambulance utilization (33.6% and 39.4%, respectively; p=0.195). The median time from stroke onset to hospital arrival changed from 582 min in 2013 to 367 min in 2014, although not statistically significant (p=0.062). The proportion of hospital arrivals within 3 hours from stroke onset increased significantly from 28.5% in 2013 to 42.3% in 2014 (p=0.002). CONCLUSIONS: A comprehensive community-based stroke intervention may increase the probability of hospital arrival within the golden-time window, thereby leading to a better prognosis.
Ambulances ; Education* ; Health Education ; Humans ; Jeollabuk-do ; Prognosis ; Stroke* ; Time-to-Treatment

BACKGROUND/OBJECTIVES: Recently, there has been an increased interest in the importance of family meals on children's health and nutrition. This study aims to examine if the eating habits and eating behaviors of children are different according to the frequency of family dinners. SUBJECTS/METHODS: The subjects were third-grade students from 70 elementary schools in 17 cities nationwide. A two-stage stratified cluster sampling was employed. The survey questionnaire was composed of items that examined the general characteristics, family meals, eating habits, eating behaviors, and environmental influence on children's eating. The subjects responded to a self-reported questionnaire. Excluding the incomplete responses, the data (n = 3,435) were analyzed using chi2-test or t-test. RESULTS: The group that had more frequent family dinners (> or = 5 days/week, 63.4%), compared to those that had less (< or = 4 days/week, 36.6%), showed better eating habits, such as eating meals regularly, performing desirable behaviors during meals, having breakfast frequently, having breakfast with family members (P < 0.001), and not eating only what he or she likes (P < 0.05). Those who had more frequent family dinners also consumed healthy foods with more frequency, including protein foods, dairy products, grains, vegetables, seaweeds (P < 0.001), and fruits (P < 0.01). However, unhealthy eating behaviors (e.g., eating fatty foods, salty foods, sweets, etc.) were not significantly different by the frequency of family dinners. CONCLUSIONS: Having dinner frequently with family members was associated with more desirable eating habits and with healthy eating behaviors in young children. Thus nutrition education might be planned to promote family dinners, by emphasizing the benefits of having family meals on children's health and nutrition and making more opportunities for family meals.
Breakfast ; Edible Grain ; Child ; Dairy Products ; Eating* ; Education ; Family Characteristics ; Feeding Behavior* ; Fruit ; Humans ; Meals* ; Surveys and Questionnaires ; Vegetables

The aim of this study was to investigate the clinical characteristics of acute hepatitis A during a recent outbreak in Korea. Data of patients diagnosed with acute hepatitis A from 2007 to 2009 were collected from 21 tertiary hospitals retrospectively. Their demographic, clinical, and serological characteristics and their clinical outcomes were analyzed. A total of 4,218 patients (mean age 33.3 yr) were included. The median duration of admission was 9 days. The mean of the highest ALT level was 2,963 IU/L, total bilirubin was 7.3 mg/dL, prothrombin time INR was 1.3. HBsAg was positive in 3.7%, and anti-HCV positive in 0.7%. Renal insufficiency occurred in 2.7%, hepatic failure in 0.9%, relapsing hepatitis in 0.7%, and cholestatic hepatitis in 1.9% of the patients. Nineteen patients (0.45%) died or were transplanted. Complications of renal failure or prolonged cholestasis were more frequent in patients older than 30 yr. In conclusion, most patients with acute hepatitis A recover uneventfully, however, complication rates are higher in patients older than 30 yr than younger patients. Preventive strategies including universal vaccination in infants and active immunization of hepatitis A to adult population should be considered for prevention of community-wide outbreaks of hepatitis A in Korea.
Acute Disease ; Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Cholestasis/epidemiology/etiology ; Demography ; Hepatitis A/complications/*diagnosis/mortality ; Humans ; Kidney Failure, Chronic/epidemiology/etiology ; Liver Transplantation ; Middle Aged ; Morbidity ; Republic of Korea ; Retrospective Studies ; Tertiary Care Centers ; Young Adult

Periodontal disease is a potential predictor of stroke and cognitive impairment. However, this association is unclear in adults aged 50 yr and above without a history of stroke or dementia. We evaluated the association between the number of teeth lost, indicating periodontal disease, and cognitive impairment in community-dwelling adults without any history of dementia or stroke. Dental examinations were performed on 438 adults older than 50 yr (315 females, mean age 63+/-7.8 yr; 123 males, mean age 61.5+/-8.5 yr) between January 2009 and December 2010. In the unadjusted analysis, odds ratios (OR) of cognitive impairment based on MMSE score were 2.46 (95% CI, 1.38-4.39) and 2.7 (95% CI, 1.57-4.64) for subjects who had lost 6-10 teeth and those who had lost more than 10 teeth, respectively, when compared with subjects who had lost 0-5 teeth. After adjusting for age, education level, hypertension, diabetes, hyperlipidemia, and smoking, the relationship remained significant (OR, 2.0; 95% CI, 1.08-3.69, P=0.027 for those with 6-10 teeth lost; OR, 2.26; 95% CI, 1.27-4.02, P=0.006 for those with more than 10 teeth lost). The number of teeth lost is correlated with cognitive impairment among community-dwelling adults aged 50 and above without any medical history of stroke or dementia.
Aged ; Aged, 80 and over ; Cognition Disorders/*diagnosis/etiology ; Cohort Studies ; Dementia/pathology ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Periodontal Diseases/complications ; Residence Characteristics ; Stroke/pathology ; *Tooth Loss

PURPOSE: Leukemic promyelocytes have the unique ability to undergo differentiation after exposure to retinoic acid and both differentiation and apoptosis after exposure to arsenic trioxide (ATO). Recent studies have shown that inhibition of Src family kinases (SFKs) resulted in enhancement of retinoic acid-induced myeloid differentiation. MATERIALS AND METHODS: In this study, we investigated the question of whether the SFK inhibitor PP2 enhanced the differentiation of NB4 cells when combined with ATO as well as when combined with all-trans-retinoic acid (ATRA). In addition, we attempted to determine the difference in retinoic acid-induced gene expression between cells treated with PP2 in combination with ATRA and in combination with ATO. RESULTS: SFK inhibitor PP2 induced significant enhancement of ATRA- or ATO-induced differentiation of NB4 cells. A significantly stronger synergistic effect was observed when PP2 was combined with ATRA than when combined with ATO. Flow cytometric analysis demonstrated a significant increase in CD11b-positive granulocytes up to 60.73% and 31.58%, respectively. These results were confirmed by nitroblue tetrazolium staining. These effects were not related to apoptosis. Results of Annexin-V-fluorescein staining revealed that PP2 combined with ATRA or PP2 combined with ATO did not induce apoptosis in NB4 cells. Retinoic acid-induced gene expression was different in both groups. Intercellular adhesion molecule-1 expression showed a significant increase in cells treated with PP2 in combination with ATRA, whereas cathepsin D expression showed a significant increase in cells treated with PP2 in combination with ATO. CONCLUSION: Our data showed that SFK inhibitor PP2 enhanced acute promyelocytic leukemia cell differentiation when combined with either ATRA or ATO with difference in activation of retinoic acid-induced genes.
Apoptosis ; Arsenic ; Arsenicals ; Cathepsin D ; Cell Differentiation ; Cell Line ; Gene Expression ; Granulocyte Precursor Cells ; Granulocytes ; Humans ; Intercellular Adhesion Molecule-1 ; Leukemia, Promyelocytic, Acute ; Nitroblue Tetrazolium ; Oxides ; Phosphotransferases ; Pyrimidines ; src-Family Kinases ; Tretinoin