PURPOSE: The purposes of this study are to evaluate clinical characteristics of malnourished patients who received nutritional therapy and to compare their clinical courses according to nutritional support team (NST) consultation in tertiary referral hospital in Korea. METHODS: From June 2014 to May 2015, 43,954 admitted patients who were more than 18 years old were retrospectively investigated. Characteristics of patients who received enteral nutrition (EN) or parenteral nutrition (PN) for more than 3 days (nutritional therapy group) were compared to the patients without nutritional therapy (control group). In addition, clinical courses according to NST consultation (NST group and non-NST group) were compared through propensity score matching (PSM). RESULTS: EN or PN was applied in 4,599 patients for more than 3 days (nutritional therapy group: 10.5%). For characteristics, there were significant differences between two groups (nutritional therapy group vs. control group) with age, male proportion, body weight, body mass index. All laboratory data at admission were significantly worse in nutritional therapy group. And for clinical courses, there were significant differences in length of stay (LOS), rate of intensive care unit (ICU) admission, LOS in ICU, Acute Physiology and Chronic Health Enquiry (APACHE II) score, days of nutritional therapy, mortality rate. NST consultation was made in 39% of nutritional therapy group. Among departments, Thoracic Surgery showed the highest rate of NST consultation (68.5%) otherwise Neurosurgery showed the lowest rate (18.7%). When PSM between NST group vs. non-NST group were made, significant differences was shown only in the rate of ICU admission, EN or PN support days, cholesterol at discharge. CONCLUSION: In tertiary referral hospital in Korea, more than 10% of patients still needed active nutritional therapy. NST consultation rate varies among departments. We failed to find significant differences between NST group and non-NST group.
Body Mass Index ; Body Weight ; Cholesterol ; Enteral Nutrition ; Humans ; Intensive Care Units ; Korea* ; Length of Stay ; Male ; Mortality ; Neurosurgery ; Nutrition Therapy ; Nutritional Support ; Parenteral Nutrition* ; Physiology ; Propensity Score ; Retrospective Studies ; Tertiary Care Centers* ; Thoracic Surgery ; Treatment Outcome

PURPOSE: Maintaining body temperature is a key vital function of human beings, but little is known about how body temperature of high-risk infants is sustained during early life after birth. The aim of this study was to describe hypothermia in high-risk infants during their first week of life and examine demographic, environmental, and clinical attributors of hypothermia. METHODS: A retrospective longitudinal study was done from January 1, 2013 to December 31, 2015. Medical records of 570 high-risk infants hospitalized at Neonatal Intensive Care Units (NICU) of a university affiliated hospital were examined. Body temperature and related factors were assessed for seven days after birth. RESULTS: A total of 336 events of hypothermia (212 mild and 124 moderate) occurred in 280 neonates (49.1%) and most events (84.5%) occurred within 24 hours after birth. Logistic regression analysis revealed that phototherapy (aOR=0.28, 95% CI=0.10-0.78), Apgar score at 5 minute (aOR=2.20, 95% CI=1.17-4.12), and intra-uterine growth retardation or small for gestational age (aOR=3.58, 95% CI=1.69-7.58) were statistically significant contributors to hypothermia. CONCLUSION: Findings indicate that high-risk infants are at risk for hypothermia even when in the NICU. More advanced nursing interventions are necessary to prevent hypothermia of high-risk infants.
Apgar Score ; Body Temperature ; Gestational Age ; Humans ; Hypothermia* ; Infant* ; Infant, Newborn ; Intensive Care Units, Neonatal ; Logistic Models ; Longitudinal Studies ; Medical Records ; Nursing ; Parturition ; Phototherapy ; Retrospective Studies

Purpose: Intensive IV insulin infusion therapy has been applied widely to critically ill patients. However, IV insulin protocols are complex, and require repeated calculations. The purpose of this study was to evaluate the safety and efficiency of a computerized insulin infusion (CII) protocol to replace manual insulin infusion protocols, for glucose control in critically ill patients. Methods: This was an observational study (September 2016 to January 2017) of 43 patients in ICU whose blood glucose level was between 140-180 mg/mL and could not be controlled by the conventional manual insulin protocol. The CII protocol was integrated in to the electronic medical record order system, and automatically calculated the insulin infusion dose and blood sugar test (BST) interval. BSTs were taken 48 hours pre- and post-initiation of the CII protocol. The proportion of BSTs in the normal (70-180 mg/mL), hypoglycemic (70 mg/mL), and severe hyperglycemic (> 250 mg/mL) range were recorded. Results: The mean number of BSTs performed before using the CII protocol was 10.3/person and 0.4/hour, and after implementing the protocol, increased to 21.7/person and 0.7/hour. The mean glucose level (281.4 mg/mL) decreased after using the CII protocol (195.5 mg/mL; p < 0.001). The percentage of BSTs within normal range increased from 22.5% to 44.9% after implementing the protocol (p < 0.001). Severe hyperglycemia (> 250 mg/mL) decreased from 47.3% to 17.9% after protocol implementation (p = 0.020). Conclusion The CII protocol safely and successfully maintained a normal glucose range, and decreased severe hyperglycemia in intensive care patients.

Purpose: Intensive IV insulin infusion therapy has been applied widely to critically ill patients. However, IV insulin protocols are complex, and require repeated calculations. The purpose of this study was to evaluate the safety and efficiency of a computerized insulin infusion (CII) protocol to replace manual insulin infusion protocols, for glucose control in critically ill patients. Methods: This was an observational study (September 2016 to January 2017) of 43 patients in ICU whose blood glucose level was between 140-180 mg/mL and could not be controlled by the conventional manual insulin protocol. The CII protocol was integrated in to the electronic medical record order system, and automatically calculated the insulin infusion dose and blood sugar test (BST) interval. BSTs were taken 48 hours pre- and post-initiation of the CII protocol. The proportion of BSTs in the normal (70-180 mg/mL), hypoglycemic (70 mg/mL), and severe hyperglycemic (> 250 mg/mL) range were recorded. Results: The mean number of BSTs performed before using the CII protocol was 10.3/person and 0.4/hour, and after implementing the protocol, increased to 21.7/person and 0.7/hour. The mean glucose level (281.4 mg/mL) decreased after using the CII protocol (195.5 mg/mL; p < 0.001). The percentage of BSTs within normal range increased from 22.5% to 44.9% after implementing the protocol (p < 0.001). Severe hyperglycemia (> 250 mg/mL) decreased from 47.3% to 17.9% after protocol implementation (p = 0.020). Conclusion The CII protocol safely and successfully maintained a normal glucose range, and decreased severe hyperglycemia in intensive care patients.

BACKGROUND: Toxin immunoassay is widely used for rapid diagnosis of Clostridium difficile-associated diarrhea. The aim of this study was to evaluate the performance of Tox A/B Quik Chek test (TECHLAB, Blacksburg, VA, USA) compared to toxigenic culture. METHODS: From September 2006 to August 2007, 959 stools were examined by Tox A/B Quik Chek test and toxigenic culture (C. difficile culture plus tcdB PCR using colonies obtained from culture). RESULTS: Compared to the results of toxigenic culture, the sensitivity and specificity of Tox A/B Quik Chek test were 47.5% and 97.5%, respectively. CONCLUSION: The sensitivity of Tox A/B Quik Chek test was not high, but the specificity was high. Although Tox A/B Quik Chek test alone is not sufficient to diagnose Clostridium difficile-associated diarrhea, it may aid rapid diagnosis, early treatment and prevention of nosocomial spread of the infection, if supplemented by C. difficile culture or tissue culture cytotoxin assay.
Bacterial Proteins ; Bacterial Toxins ; Boron Compounds ; Clostridium ; Clostridium difficile ; Diarrhea ; Early Diagnosis ; Enterotoxins ; Immunoassay ; Immunoenzyme Techniques ; Polymerase Chain Reaction ; Sensitivity and Specificity

PURPOSE: Many end-of-life care studies are based on the assumption that there is a shared definition of language concerning the stage of cancer. However, studies suggest that patients and their families often misperceive patients' cancer stages and prognoses. Discrimination between advanced cancer and terminal cancer is important because the treatment goals are different. In this study, we evaluated the understanding of the definition of advanced versus terminal cancer of the general population and determined associated socio-demographic factors. MATERIALS AND METHODS: A total of 2,000 persons from the general population were systematically recruited. We used a clinical vignette of a hypothetical advanced breast cancer patient, but whose cancer was not considered terminal. After presenting the brief history of the case, we asked respondents to choose the correct cancer stage from a choice of early, advanced, terminal stage, and don't know. Multinomial logistic regression analysis was performed to determine sociodemographic factors associated with the correct response, as defined in terms of medical context. RESULTS: Only 411 respondents (20.6%) chose "advanced," while most respondents (74.5%) chose "terminal stage" as the stage of the hypothetical patient, and a small proportion of respondents chose "early stage" (0.7%) or "don't know" (4.4%). Multinomial logistic regression analysis found no consistent or strong predictor. CONCLUSION: A large proportion of the general population could not differentiate advanced cancer from terminal cancer. Continuous effort is required in order to establish common and shared definitions of the different cancer stages and to increase understanding of cancer staging for the general population.
Breast Neoplasms ; Data Collection ; Delivery of Health Care* ; Discrimination (Psychology) ; Humans ; Logistic Models ; Neoplasm Staging ; Prognosis

PURPOSE: Eosinophilic inflammation is a key component of severe asthma (SA). However, there has been no reliable serum biomarker for the eosinophilic inflammation of SA. We hypothesized that serum eosinophil-derived neurotoxin (EDN) could predict the eosinophilic inflammation of SA in adult asthmatics. METHODS: Severe asthmatics (n = 235), nonsevere asthmatics (n = 898), and healthy controls (n = 125) were enrolled from Ajou University Hospital, South Korea. The serum levels of EDN and periostin were measured by enzyme-linked immunosorbent assay and compared between severe and nonsevere asthmatics. Their associations with total eosinophil count (TEC) and clinical parameters were evaluated; clinical validation of the K-EDN kit for the measurement of serum EDN was evaluated. RESULTS: Severe asthmatics were older and had longer disease duration with significantly lower levels of forced expiratory volume in 1 second and methacholine PC20 than nonsevere asthmatics. Significant differences were found in TEC or sputum eosinophil count (%) between the groups. The serum levels of EDN and periostin were significantly higher in severe asthmatics than in nonsevere asthmatics and in healthy controls (all P < 0.05). Although significant correlations were found between serum EDN levels measured by the 2 kits (ρ = 0.545, P < 0.0001), higher correlation coefficients between serum EDN levels measured by the K-EDN kit and TEC were higher (ρ = 0.358, P < 0.0001) than those between serum EDN levels measured by the MBL kit and TEC (ρ = 0.319, P < 0.0001) or serum periostin level (ρ = 0.222, P < 0.0001). Multivariate regression analysis demonstrated that serum EDN levels measured by the K-EDN kit predicted the phenotype of SA (P = 0.003), while 2 other biomarkers did not. CONCLUSIONS: The serum EDN level may be a useful biomarker for assessing asthma severity in adult asthmatics.
Adult ; Asthma ; Biomarkers ; Enzyme-Linked Immunosorbent Assay ; Eosinophil-Derived Neurotoxin ; Eosinophils ; Forced Expiratory Volume ; Humans ; Inflammation ; Korea ; Methacholine Chloride ; Phenotype ; Sputum

Purpose: Critically ill patients often require multidisciplinary treatment for both acute illnesses and pre-existing medical conditions. Since different medical conditions are managed in the intensive care unit (ICU), consultation is often required. This study aimed to identify the frequency and type of consultation required and analyze changes in consultation patterns after the introduction of intensivist-directed care in the surgical ICU (SICU). Methods: Between June 2006 and December 2013, a retrospective cohort study was conducted to identify the frequency and type of consultation at 3 different ICUs. Consultations for patients who were admitted to the ICUs for more than 48 consecutive hours were included. The pattern of consultations in each ICU was investigated. In addition, the pattern of consultations before and after the implementation of intensivist-directed care in the SICU was compared. Results: During the study, 11,053 consultations were requested for 7,774 critically ill patients in a total of 3 ICUs. Consultations with the Departments of Cardiology, Infectious Diseases, and Pulmonology were requested most frequently in the SICU. However, after the implementation of the intensivist-directed care approach, there was an increase in the frequency of consultation requests to the Department of Neurology, followed by the Departments of Cardiology, and Infectious Diseases. Conclusion Analysis of consultation patterns is an important method of assessing the complexity and severity of illnesses, and of evaluating the needs of available health system resources. Based on our findings, we suggest the development of an appropriate protocol for frequently consulted services.

Background: The lack of headforms that accurately reflect the head characteristics of Koreans and the demographic composition of the Korean population can lead to inadequate FFR testing and reduced effectiveness of FFRs.MethodDirect measurements of 5,110 individuals and 3D measurements of 2,044 individuals, aged between 9 and 69 years, were sampled from the data pool of Size Korea surveys based on the age and gender ratios of the Korean resident demographics. Seven head dimensions were selected based on the ISO 16976-2, availability of Size Korea measurements, and their relevance to the fit performance of FFRs. A principal component analysis (PCA) was performed using the direct measurements to extract the main factors explaining the head characteristics and then the main factors were standardized and remapped to 3D measurements, creating five size categories representing Korean head shapes. Lastly, representative 3D headforms were constructed by averaging five head shapes for each size category. Results: The study identified two main factors explaining Korean head characteristics by the PCA procedure specified in ISO 16976-2 and developed five representative headforms reflecting the anthropometric features of Korean heads: medium, small, large, short & wide, and long & narrow. Conclusion This study developed representative headforms tailored to the Korean population for conducting total inward leakage (TIL) tests on filtering facepiece respirators (FFRs). The representative headforms can be used for TIL testing by employing robotic headforms to enhance the performance of FFRs for the Korean target population.

BACKGROUND: Thalidomide has been reported to have antitumor activity for treating metastatic hepatocellular carcinoma (HCC). We evaluated the safety and efficacy of using thalidomide for treating selected patients with unresectable or metastatic HCC, and their disease was refractory to systemic chemotherapy. METHODS: Eight patients with measurable and metastatic HCC that had progressed with prior systemic chemotherapy and who desired further active therapy were enrolled in this study. Thalidomide was given orally at bedtime and it was started at 200 mg/day with no further dose escalation. The response was measured at 2-month intervals. RESULTS: The median age was 44 years (range: 34-52 years) and all the patients had received doxorubicin-based systemic chemotherapy prior to their enrollment. Each patient received thalidomide for a median of 152 days (range: 5-422 days). One partial response was observed (12.5%, 95% CI; 0-42%) along with 4 cases of stable diseases. The most commonly encountered toxicity was somnolence; grade 3 somnolence was noted for one patient, which led to treatment discontinuation. Skin rash was observed in one responding patient. CONCLUSIONS: The results indicate that thalidomide may feasibly offer disease stabilization to metastatic HCC patients. Further dose escalation of thalidomide, or its combination with other chemotherapeutic agents, may be of interest and this should be investigated for treating patients with metastatic HCC.
Treatment Outcome ; Thalidomide/*therapeutic use ; Retrospective Studies ; Pilot Projects ; Middle Aged ; Male ; Lymphatic Metastasis ; Lung Neoplasms/drug therapy/*secondary ; Liver Neoplasms/*drug therapy/pathology ; Immunosuppressive Agents/*therapeutic use ; Humans ; Follow-Up Studies ; Female ; Carcinoma, Hepatocellular/*drug therapy/secondary ; Bone Neoplasms/drug therapy/*secondary ; Adult