Purpose: : This study aimed to investigate changes in critical nursing activities from 2009 to 2020 and explore the relationship between nurse staffing and such activities in intensive care units. Methods: : A total of 446,445 adult patients admitted to intensive care units in tertiary and general hospitals from 2009 to 2020 were identified using the National Health Insurance claims database. The Critical Nursing Activities Index was calculated based on the following critical nursing activities: ventilator, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). Trend analysis was performed to analyze changes in critical nursing activities over 12 years and to assess linear trends across different staffing levels. Results: : The annual utilization days for ventilators, ECMO, and CRRT, as well as the Critical Nursing Activities Index significantly increased over the study period (p-for-trend＜.001) in tertiary and general hospitals, except for ventilator use in general hospitals. Ventilator, ECMO, and CRRT utilization exhibited a significant upward trend with higher nurse staffing levels (Bonferroni adjusted p-for-trend＜.001). The Critical Nursing Activities Index was significantly higher in hospitals with higher staffing levels compared to those with lower staffing levels (Bonferroni adjusted p ＜.05). Conclusion : The findings underscore the need for improved nurse staffing levels in intensive care units. Government policies should ensure that staffing levels align with critical nursing activities among critically ill patients to uphold the quality of care.

OBJECTIVES: An efficient clinical process guideline (CPG) modeling service was designed that uses an enhanced intelligent search protocol. The need for a search system arises from the requirement for CPG models to be able to adapt to dynamic patient contexts, allowing them to be updated based on new evidence that arises from medical guidelines and papers. METHODS: A sentence category classifier combined with the AdaBoost.M1 algorithm was used to evaluate the contribution of the CPG to the quality of the search mechanism. Three annotators each tagged 340 sentences hand-chosen from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) clinical guideline. The three annotators then carried out cross-validations of the tagged corpus. A transformation function is also used that extracts a predefined set of structural feature vectors determined by analyzing the sentential instance in terms of the underlying syntactic structures and phrase-level co-occurrences that lie beneath the surface of the lexical generation event. RESULTS: The additional sub-filtering using a combination of multi-classifiers was found to be more effective than a single conventional Term Frequency-Inverse Document Frequency (TF-IDF)-based search system in pinpointing the page containing or adjacent to the guideline information. CONCLUSIONS: We found that transformation has the advantage of exploiting the structural and underlying features which go unseen by the bag-of-words (BOW) model. We also realized that integrating a sentential classifier with a TF-IDF-based search engine enhances the search process by maximizing the probability of the automatically presented relevant information required in the context generated by the guideline authoring environment.
Data Mining ; Humans ; Hypertension ; Imidazoles ; Joints ; Knowledge Bases ; Natural Language Processing ; Nitro Compounds ; Search Engine

BACKGROUND AND PURPOSE: Knowledge of a patient's cerebral vascular status is essential for accurately classifying stroke. However, vascular evaluations have been incomplete in previous studies, and a stroke registry based on the results of such vascular investigations has not been reported. The purpose of the present study was to classify ischemic strokes based on vascular imaging data. METHODS: Between May 2001 and August 2003, 1,264 patients with acute (< 7 days) ischemic stroke were admitted to Asan Medical Center. Among them, 1,167 patients (750 men and 417 women; mean age 63.3 years) underwent an angiogram (mostly a magnetic resonance angiogram) and were included in this study. Electrocardiography and computed tomography/magnetic resonance imaging were performed in all patients, while 31.2% underwent echocardiography. The subtypes were categorized with the aid of a modification of the Trial of ORG 10172 in the Acute Stroke Treatment classification. RESULTS: Large-artery atherosclerosis (LAA) was the most frequent subtype (42%), followed by small-vessel occlusion (SVO, 27%), cardiogenic embolism (CE, 15%), undetermined etiology (15%), and other determined etiology (1.5%). Risk factors included hypertension (71%), cigarette smoking (35%), diabetes mellitus (30%), history of previous stroke (22.7%), emboligenic cardiac diseases (20%), and hypercholesterolemia (11%). Hypertension was more common in patients with SVO than in those with other subtypes (p<0.05), and the case-fatality rate was higher in patients with CE than in those with other subtypes (p<0.01). The functional outcome was worse in patients with LAA than in those with other stroke subtypes (p<0.01). CONCLUSION: According to the stroke registry based on vascular imaging results, LAA was the most common stroke subtype followed by SVD. The high incidence of LAA is probably related to the increased identification of the presence of intracranial atherosclerosis by MR angiogram.
Atherosclerosis ; Chungcheongnam-do ; Classification ; Diabetes Mellitus ; Diagnosis ; Echocardiography ; Electrocardiography ; Embolism ; Female ; Heart Diseases ; Humans ; Hypercholesterolemia ; Hypertension ; Incidence ; Intracranial Arteriosclerosis ; Male ; Risk Factors ; Smoking ; Stroke*

PURPOSE: This study was aimed to evaluate the clinical features of bacterial and aseptic meningitis in neonates. METHODS: Seventy seven neonates who diagnosed with meningitis at Inha University Hospital from June 1996 to August 2010 were enrolled in this study. The subjects were classified into either bacterial or aseptic meningitis and their medical records were retrospectively analyzed. RESULTS: Among the 77 cases, 18 cases were bacterial and 59 cases were aseptic. The main symptoms of both groups were fever, moaning in order. In bacterial meningitis, Group B streptococci (GBS) was the most common causative organism (12/18. 75%). In peripheral blood exam, patients with bacterial meningitis were more likely to show leukocytosis (WBC >20,000/mm3) and leukopenia (WBC <5,000/mm3) than those with aseptic meningitis. CRP was also significantly increased in the group of bacterial meningitis. In CSF analysis, 61.2% revealed pleocytosis more than 1,000/mm3 in bacterial meningitis and 8.5% did in aseptic meningitis. CSF glucose were <40 mg/dL in 72.2% of the group of bacterial meningitis and 35.6% of the group of aseptic meningitis. Mean CSF protein was 289.6+/-221.2 mg/dL in bacterial meningitis and 107.6+/-73.9 mg/dL in aseptic meningitis. Abnormal radiologic findings were found in 44.4% of bacterial meningitis and 8.4% of aseptic meningitis. The treatments were empirically initiated with ampicillin and cefotaxime in 60 cases, ampicillin and aminoglycosides in 12 cases. CONCLUSION: Although the clinical features of bacterial and aseptic meningitis are similar, peripheral blood and CSF exams revealed significant differences. Based on these differences, appropriate antibiotic treatment can be selected before the identification of causative agents.
Aminoglycosides ; Ampicillin ; Cefotaxime ; Fever ; Glucose ; Humans ; Infant, Newborn ; Leukocytosis ; Leukopenia ; Medical Records ; Meningitis ; Meningitis, Aseptic ; Meningitis, Bacterial ; Retrospective Studies

PURPOSE: We investigated the efficacy of transurethral injection of Macroplastique bulking agent (Uroplasty) for male stress urinary incontinence (SUI) after prostate surgery. MATERIALS AND METHODS: This retrospective review included men with SUI treated by transurethral injection for symptoms resulting from prostate surgery. Patients were evaluated at 1 month and 6 months after injection by determining the number of pads used per day and changes in incontinence symptoms. Treatment success was defined as use of 1 pad or fewer per day combined with subjective symptom improvement. RESULTS: The study population comprised 30 men with a mean age of 66.1+/-5.3 years. Of the 30 patients, 24 (80.0%) underwent prostate cancer surgery and the remaining 6 (20.0%) underwent surgery for benign prostatic hyperplasia. The preinjection pad number was 2.9+/-1.9 pads per day. After injection treatment, the mean follow-up period was 9.3+/-12.7 months and the success rate was 43% (13/30) at 1 month and 32% (6/19) at 6 months. Injection was more likely to result in a successful outcome in patients with no preinjection radiation treatment history and higher abdominal leak point pressure (ALPP) than in those with a previous history of radiation treatment and lower ALPP, although this result was not statistically significant. Acute urinary retention occurred in 5 patients (17%). CONCLUSIONS: Transurethral Macroplastique injection treatment is a relatively non-invasive treatment method for male SUI with a success rate of 43% at 1 month and 32% at 6 months. Patients with a higher ALPP and no previous history of radiation therapy may experience better treatment outcomes.
Dimethylpolysiloxanes ; Follow-Up Studies ; Humans ; Male ; Methods ; Prostate ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Retrospective Studies ; Urethra ; Urinary Incontinence ; Urinary Retention

Purpose: Various predictive tools have been developed to predict insignificant prostate cancer (PCa) for active surveillance, however, these models cannot reflect all the refinements of current medicine. Thus, we aimed to develop a novel model to predict clinically insignificant PCa incorporating these factors. Materials and Methods: We developed a novel nomogram to predict the probability of insignificant PCa (total tumor volume less than 2.5 cm3, index tumor volume less than 1.3 cm3, organ confined disease and no Gleason pattern 4 or 5) using preoperative data of 790 Korean patients who underwent radical prostatectomy. To evaluate the predictive accuracy, the area under the receiver operating characteristic curve (AUC) was calculated. Next, the predicted probability versus the actual probability was compared. This examination was performed by calibration plotting using 1,000 bootstrap resamples. Results: Of the 790 patients, 668 (84.6%) had clinically significant PCa, and 122 (15.4%) had insignificant PCa. We developed a novel predictive model for clinically insignificant PCa using clinical stage less than T2a, biopsy Gleason sum less than 7, ratio of positive biopsy cores less than 10%, neutrophil-to-lymphocyte ratio, and multiparametric magnetic resonance imaging (mpMRI) visibility, which discriminated patients with clinically insignificant PCa from those with significant PCa with an AUC of 0.9135 (95% confidence interval, 0.9127–0.9143). The calibration plot showed a well-calibrated prediction that had little over- or underestimation. Conclusions We proposed a novel predictive model for insignificant PCa to more accurately select patients for active surveillance using the results from mpMRI and prebiopsy laboratory marker.

Purpose: Various predictive tools have been developed to predict insignificant prostate cancer (PCa) for active surveillance, however, these models cannot reflect all the refinements of current medicine. Thus, we aimed to develop a novel model to predict clinically insignificant PCa incorporating these factors. Materials and Methods: We developed a novel nomogram to predict the probability of insignificant PCa (total tumor volume less than 2.5 cm3, index tumor volume less than 1.3 cm3, organ confined disease and no Gleason pattern 4 or 5) using preoperative data of 790 Korean patients who underwent radical prostatectomy. To evaluate the predictive accuracy, the area under the receiver operating characteristic curve (AUC) was calculated. Next, the predicted probability versus the actual probability was compared. This examination was performed by calibration plotting using 1,000 bootstrap resamples. Results: Of the 790 patients, 668 (84.6%) had clinically significant PCa, and 122 (15.4%) had insignificant PCa. We developed a novel predictive model for clinically insignificant PCa using clinical stage less than T2a, biopsy Gleason sum less than 7, ratio of positive biopsy cores less than 10%, neutrophil-to-lymphocyte ratio, and multiparametric magnetic resonance imaging (mpMRI) visibility, which discriminated patients with clinically insignificant PCa from those with significant PCa with an AUC of 0.9135 (95% confidence interval, 0.9127–0.9143). The calibration plot showed a well-calibrated prediction that had little over- or underestimation. Conclusions We proposed a novel predictive model for insignificant PCa to more accurately select patients for active surveillance using the results from mpMRI and prebiopsy laboratory marker.

Agrocybe cylindracea, an edible mushroom belonging to Bolbitiaceae, Agaricales, is widely used as invaluable medicinal material in the oriental countries. This study was initiated to find the genes expressed during the fruiting body formation of A. cylindracea. The cDNAs expressed differentially during fruiting body morphogenesis of A. cylindracea were isolated through subtractive hybridization between vegetative mycelia and fruiting bodies. The cDNAs expressed in the fruiting body morphogenesis of A. cylindracea were cloned and twenty genes were identified. Eleven were homologous to genes of known functions, three were homologous to genes in other organism without any function known. Six were completely novel genes specific to A. cylindracea so far examined. Some genes with known functions were a pleurotolysin, a self-assembling poreforming cytolysins; Aa-Pri1 and Pir2p, specifically induced genes during fruiting initiation of other mushroom, Agrocybe aegerita; an amino acid permease; a cytochrome P450; a MADS-box gene; a peptidylprolyl isomerase; and a serine proteinase. For other clones, no clear function was annotated so far. We believe the first report of the differentially expressed genes in fruiting process of A. cylindracea will be great helps for further research.
Agaricales ; Agrocybe* ; Amino Acid Transport Systems ; Clone Cells ; Cytochrome P-450 Enzyme System ; Cytotoxins ; DNA, Complementary ; Fruit* ; Gene Expression ; Morphogenesis ; Peptidylprolyl Isomerase ; Perforin ; Serine Proteases

Borrmann type 4 gastric is a malignant disease that shows enlarged gastric folds, and this is easily mistaken as a mucosal flare or as inflammation because a third of these patients show normal mucosa without mucosal defects and the lesion diffusively infiltrates into the submucosal area. Endoscopic ultrasonography is an effective tool for making the differential diagnosis of gastric subepithelial lesion and hypertrophic gastric fold when endoscopy is not suitable to use. Eosinophilic gastritis is a benign lesion with enlarged gastric folds and it shows pathologic eosinophil infiltration in the walls of the stomach. We report here on a case that was suspected to be Borrmann type 4 advanced gastric cancer according to the endoscopic ultrasonography and this was confirmed by abdominal operation. Otherwise, this condition would have been mistaken for eosinophilic gastritis.
Diagnosis, Differential ; Endoscopy ; Endosonography ; Enteritis ; Eosinophilia ; Eosinophils ; Gastritis ; Humans ; Inflammation ; Mucous Membrane ; Stomach ; Stomach Neoplasms

PURPOSE: To evaluate the quality and scientific accuracy of internet information regarding precocious puberty. METHODS: We identified websites by entering "precocious puberty" or "early puberty" into 5 search engines from May to July 2011. The top 50 websites from each search engine were included, excluding websites that were duplicate, inaccessible, or had poor information (containing fewer than two subjects of definition, causes, diagnosis, or treatment); 60 sites were identified. We classified the websites according to website author, evaluated the quality with the DISCERN instrument, giving a scientific accuracy with information score (IS) ranging from 0 to 30 points. RESULTS: Analysis of the quality with the DISCERN instrument showed that the majority of websites received low overall ratings regardless of the authors. Assessing the scientific accuracy, the mean IS of oriental websites (10.82) was significantly low compared to that of academic authors (22.61), physician authors (21.50), commercial authors (22.88), and other authors (27.00). CONCLUSION: With the exception of oriental websites, scientifically accurate information was provided on the websites regarding precocious puberty. Most of the analyzed websites showed low reliability. It is important to provide reliable information as well as scientifically accurate information
Internet ; Puberty, Precocious ; Quality of Health Care ; Search Engine