Purpose: This study was conducted to investigate the nursing needs and workload of nurses according to nursing dependency for effective placement of nursing staff in the emergency department (ED). Methods: In June 2020, 256 adult patients who visited the ED were classified as two groups, suspected COVID-19 patients and general patients. The participants’electronic medical records were analyzed using descriptive statistics, t-test, x 2 -test, and Fisher's exact test using the SPSS. Results: The patient dependence score showed a significant difference between the two groups, with an average of 13.99±1.85 for the suspected COVID-19 patient group and 10.58±2.10 for the general patient group (t=12.42, p<.001). There were statistically significant differences in communication (t=3.28, p=.001), mobility (t=3.29, p=.001), nutrition, elimination, and personal care (t=7.34, p<.001) among the six domains of nursing dependency. In the domains of environment, safety, health, and social needs, the dependency score was 3 for all suspected COVID-19 patients and 1 for all general patients. Conclusion The results of this study confirmed that infection control activities of emergency patients who need isolation affect the patients’ nursing dependency on nursing care.

Purpose: This study was conducted to investigate the nursing needs and workload of nurses according to nursing dependency for effective placement of nursing staff in the emergency department (ED). Methods: In June 2020, 256 adult patients who visited the ED were classified as two groups, suspected COVID-19 patients and general patients. The participants’electronic medical records were analyzed using descriptive statistics, t-test, x 2 -test, and Fisher's exact test using the SPSS. Results: The patient dependence score showed a significant difference between the two groups, with an average of 13.99±1.85 for the suspected COVID-19 patient group and 10.58±2.10 for the general patient group (t=12.42, p<.001). There were statistically significant differences in communication (t=3.28, p=.001), mobility (t=3.29, p=.001), nutrition, elimination, and personal care (t=7.34, p<.001) among the six domains of nursing dependency. In the domains of environment, safety, health, and social needs, the dependency score was 3 for all suspected COVID-19 patients and 1 for all general patients. Conclusion The results of this study confirmed that infection control activities of emergency patients who need isolation affect the patients’ nursing dependency on nursing care.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Acetaminophen (APAP) is the most common antipyretic analgesic worldwide. However, APAP overdose causes severe liver injury, especially centrilobular necrosis, in humans and experimental animals. At therapeutic dosage, APAP is mainly metabolized by sulfation and glucuronidation, and partly by cytochrome P450–mediated oxidation. However, APAP overdose results in production of excess reactive metabolite, N-acetyl-p-benzoquinone imine (NAPQI), by cytochromes P450; NAPQI overwhelms the level of glutathione (GSH), which could otherwise detoxify it. NAPQI binds covalently to proteins, leading to cell death. A number of studies aimed at the prevention and treatment of APAP-induced toxicity are underway. Rats are more resistant than mice to APAP hepatotoxicity, and thus mouse models are mainly used. In the present study, we compared the toxic responses induced by APAP overdose in the liver of ICR mice obtained from three different sources and evaluated the usability of the Korl:ICR stock established by the National Institute of Food and Drug Safety Evaluation in Korea. Administration of APAP (300 mg/kg) by intraperitoneal injection into male ICR mice enhanced CYP2E1 protein expression and depleted hepatic GSH level 2 h after treatment accompanied with significantly increased level of hepatic malondialdehyde, a product of lipid peroxidation. Regardless of the source of the mice, hepatotoxicity, as evidenced by activity of serum alanine aminotransferase, increased from 8 h and peaked at 24 h after APAP treatment. In summary, hepatotoxicity was induced after the onset of oxidative stress by overdose of APAP, and the response was the same over time among mice of different origins.
Acetaminophen ; Alanine Transaminase ; Animals ; Cell Death ; Cytochrome P-450 CYP2E1 ; Cytochromes ; Glutathione ; Humans ; Injections, Intraperitoneal ; Korea ; Lipid Peroxidation ; Liver ; Male ; Malondialdehyde ; Mice ; Mice, Inbred ICR ; Necrosis ; Oxidative Stress ; Rats

OBJECTIVES: Awareness of attention-deficit/hyperactivity disorder (ADHD) in adults has significantly increased; however, clinical data specific to the Korean population are insufficient. Clinical experience of ADHD may differ based on whether psychiatrists have received pediatric psychiatry-specific training. In order to prepare a practice parameter for adult ADHD patients in Korea, we examined questionnaire data to observe how pediatric psychiatry training could affect clinical practice for adults with ADHD. METHODS: A questionnaire about the diagnosis and treatment process was distributed to both general psychiatrists (GPsy) and child and adolescent psychiatrists (CAP) at the summer and winter workshop meetings of Korean Academy of Child and Adolescent Psychiatry. RESULTS: In total, 142 psychiatrists participated in the survey (86 GPsy, 56 CAP). GPsy and CAP preferred pharmacotherapy (GPsy 82.40%, CAP 64.30%) as the primary treatment option and answered that the clinical psychiatric interview is the most necessary step in diagnostic assessment (GPsy 22.16%, CAP 19.00%). The GPsy responded with an optimal and average treatment duration that was shorter than that reported by CAP. CONCLUSION: Identification of the initial presenting symptom as the correct diagnosis and the optimal duration of pharmacotherapy differed between GPsy and CAP in practice, whereas concepts in diagnosis and treatment of ADHD in adults were similar for both groups. These results suggest the urgent need for the Continuing Medical Education program for psychiatrists treating adults with ADHD.
Adolescent ; Adolescent Psychiatry ; Adult ; Attention Deficit Disorder with Hyperactivity ; Child ; Child Psychiatry ; Child ; Diagnosis ; Drug Therapy ; Education ; Education, Medical, Continuing ; Humans ; Korea ; Psychiatry

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide. It is characterized by the accumulation of lipids without alcohol intake and often progresses to non-alcoholic steatohepatitis (NASH), liver fibrosis, and end-stage liver diseases such as cirrhosis or cancer. Although animal models have greatly contributed to the understanding of NAFLD, studies on the disease progression in humans are still limited. In this study, we used the recently reported high-fat L-methionine-defined and choline-deficient (HFMCD) diet to rapidly induce NASH and compared the responses to HFMCD in ICR mice from three different countries: Korea (supplied by the National Institute of Food and Drug Safety Evaluation), USA, and Japan during 6 weeks. Feeding HFMCD did not cause significant differences in weight gain in comparison with mice fed control diet. Relative weight of the liver increased gradually, while the relative weight of the kidneys remained unchanged. The parameters of liver injury (serum activities of alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase) increased rapidly from 1 week and remained elevated for as long as 6 weeks. Histopathological analysis showed that the accumulation of hepatic lipids induced by HFMCD was prominent at 1 week after diet supplementation and increased further at 6 weeks. Inflammatory markers were significantly increased in a time-dependent manner by HFMCD. The mRNA levels of TNF-α and IL-6 were elevated approximately 15-fold relative to control diet and that of IL-1β was increased more than 20-folds at 6 week after the onset of HFMCD intake. In addition, mRNA expression of fibrosis markers such as α-SMA, TGFβ1, and Col1a1 were also significantly increased at 6 week. In summary, the responses of Korl:ICR mice by intake of HFMCD diet were similar to those of ICR mice from other sources, which suggests that Korl:ICR mice is also a useful resource to study the pathogenesis of diet-induced NAFLD.

Patients with inflammatory bowel disease (IBD) have an elevated risk of venous thromboembolism compared with the general population. The most common sites of venous thromboembolism in IBD patients are the deep veins of the legs, the pulmonary system, and portal and mesenteric veins. However, cerebral venous thrombosis is rarely associated with IBD. This report describes a case of cerebral venous thrombosis in a patient with Crohn's disease. A 17-year-old girl, diagnosed 4 years earlier with Crohn's disease, presented with headache and vomiting. Magnetic resonance imaging of the brain with venography showed venous thrombosis in the cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. The patient immediately started anticoagulation therapy with intravenous heparin infusion followed by daily oral rivaroxaban 10 mg. Follow-up imaging after 2 weeks showed resolution of the thrombosis, with recanalization of the cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. She continued rivaroxaban therapy for 6 months, and remained well, without neurologic sequelae. A high level of concern for cerebral venous thrombosis may be important when treating active IBD patients, because anticoagulation treatment can prevent fatal complications.
Adolescent ; Brain ; Crohn Disease* ; Female ; Follow-Up Studies ; Headache ; Heparin ; Humans ; Inflammatory Bowel Diseases ; Jugular Veins ; Leg ; Magnetic Resonance Imaging ; Mesenteric Veins ; Phlebography ; Rivaroxaban ; Superior Sagittal Sinus ; Thrombosis ; Veins ; Venous Thromboembolism ; Venous Thrombosis* ; Vomiting

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal (GI) tract. These tumors are frequently small, asymptomatic and found incidentally. GI bleeding is a common complication of these tumors, but small sized, very low risk GIST rarely complicated with fatal bleeding. In this report, we describe a 42-year-old woman with a jejunal GIST accompanied by severe GI bleeding. She presented with melena and an angiographic embolization was performed for a jejunal mass with bleeding. However, rebleeding was suspected after an angiographic embolization and an emergent segmental resection for the bleeding mass was performed. She was finally diagnosed as a 1.8 cm sized very low risk GIST in jejunum. In conclusion, physician should consider that even very low risk GIST can be the cause of GI bleeding when there is severe bleeding.
Adult ; Female ; Gastrointestinal Stromal Tumors* ; Hemorrhage* ; Humans ; Jejunum* ; Melena