OBJECTIVES: As endoscopic instrumentation, techniques and knowledges have significantly improved recently, endoscopic ear surgery has become increasingly popular. Transcanal endoscopic ear surgery (TEES) can provide better visualization of hidden areas in the middle ear cavity during congenital cholesteatoma removal. We aimed to describe outcomes for TEES for congenital cholesteatoma in a pediatric population. METHODS: Twenty-five children (age, 17 months to 9 years) with congenital cholesteatoma confined to the middle ear underwent TEES by an experienced surgeon; 13 children had been classified as Potsic stage I, seven as stage II, and five as stage III. The mean follow-up period was 24 months. Recurrence of congenital cholesteatoma and surgical complication was observed. RESULTS: Congenital cholesteatoma can be removed successfully via transcanal endoscopic approach in all patients, and no surgical complications occurred; only one patient with a stage II cholesteatoma showed recurrence during the follow-up visit, and the patient underwent revision surgery. The other patients underwent one-stage operations and showed no cholesteatoma recurrence at their last visits. Two patients underwent second-stage ossicular reconstruction. CONCLUSION: Although the follow-up period and number of patients were limited, pediatric congenital cholesteatoma limited to the middle ear cavity could be safely and effectively removed using TEES.
Child ; Cholesteatoma* ; Ear* ; Ear, Middle ; Endoscopy ; Follow-Up Studies ; Humans ; Minimally Invasive Surgical Procedures ; Recurrence

The purpose of this research is to introduce the best practice of the Japanese national dementia strategy and explore implications to the Korean national dementia strategy. Interview was conducted among professions those who is in charge of Kumamoto dementia care practice in Kumamoto province, upon review of related literature and public documents. The Kumamoto model is implemented by the department of neuropsychiatry in public university hospitals, which can offer dementia-specialized medical services. Medical centers for dementia in public university hospitals play a leading role for managing practice and training local dementia centers specialist, coordinating medical services among medical institutions and community welfare facilities. In reference to the Kumamoto model, the Korean national dementia strategy can find implications in the direction of current system, specifically its approaches toward policy governance.
Asian Continental Ancestry Group ; Dementia ; Hospitals, University ; Humans ; Japan ; Neuropsychiatry ; Practice Guidelines as Topic ; Specialization

BACKGROUND: Diabetes is a chronic disease that cause premature death worldwide. The rate of testing for diabetes among mentally ill patients is 1.5 times that of the general population, and intervention in diabetes care is needed for patient with severe mental illness and diabetes.METHODS: This study was conducted using cross-sectional surveys distributed to patient with severe mental illness (n=54) among those who visited and were hospitalized at the National Mental Health Center.RESULTS: According to the assessment of the knowledge level of diabetes in patient with severe mental illness accompanied by type 2 diabetes, the correct answer rate was lower than that in the general population. Education and income affected the level of diabetes knowledge, and as diabetes knowledge level increased, blood sugar level were observed to decrease. The linear regression model showed that self-efficacy and education level were found to be predictors of diabetes knowledge, and diabetes knowledge level were predictors of fasting blood sugar levels.CONCLUSION: The results of this study showed that the higher education level and self-efficacy of the patient with severe mental illness and diabetes increased the diabetes knowledge and affecting glycemic control.
Blood Glucose ; Chronic Disease ; Comorbidity ; Cross-Sectional Studies ; Diabetes Mellitus ; Education ; Fasting ; Humans ; Linear Models ; Mental Disorders ; Mental Health ; Mentally Ill Persons ; Mortality, Premature

Objectives: ：To identify the relationship between somatization, stress, depression, anxiety, and psychological symptoms risk for nurses working in the intensive care unit. Create clinical evidence of psychosomatic medicine research and complement the meaning of somatization. Methods: ：Seventy of the mental health checkups conducted by the National Mental Health Center among the nurses using tools including Perceived Stress scale, Fatigue Severity Scale, Patient Health questionnaire-15, Korean Beck Depression Inventory, Korean Beck Anxiety Inventory, and Symptom Checklist-90-Revision. Results: ：12.9% of the patients experienced more than moderate somatization. There was no statistical relationship between somatization and psychological stress perception, but feeling of anxiety and decreased selfconfidence were related to the level of somatization. The group with severe somatization experienced more de-pression and anxiety. The group with high physical fatigue also had no statistical relationship with psychological stress perception, but had an effect on the feeling of tension, stress, or decreased control. Physical fatigue level was increased by experience of depression, not by anxiety. For psychological symptoms the higher the level of somatization, the higher the obsession and hostility was explored. In the linear regression model, stress, depression, and anxiety accounted for 39.3% of somatization and 16.1% of physical fatigue symptoms. Conclusions ：We can estimate the decrease in stress cognitive symptoms, accompanying depression and anxiety, compulsion and hostility as characteristics of somatization. The causal relationship between somatiza-tion and psychological symptoms cannot be confirmed in this study, but the interrelationships are observed, canbe referred to mediation strategies.

Objectives: ：To identify the relationship between somatization, stress, depression, anxiety, and psychological symptoms risk for nurses working in the intensive care unit. Create clinical evidence of psychosomatic medicine research and complement the meaning of somatization. Methods: ：Seventy of the mental health checkups conducted by the National Mental Health Center among the nurses using tools including Perceived Stress scale, Fatigue Severity Scale, Patient Health questionnaire-15, Korean Beck Depression Inventory, Korean Beck Anxiety Inventory, and Symptom Checklist-90-Revision. Results: ：12.9% of the patients experienced more than moderate somatization. There was no statistical relationship between somatization and psychological stress perception, but feeling of anxiety and decreased selfconfidence were related to the level of somatization. The group with severe somatization experienced more de-pression and anxiety. The group with high physical fatigue also had no statistical relationship with psychological stress perception, but had an effect on the feeling of tension, stress, or decreased control. Physical fatigue level was increased by experience of depression, not by anxiety. For psychological symptoms the higher the level of somatization, the higher the obsession and hostility was explored. In the linear regression model, stress, depression, and anxiety accounted for 39.3% of somatization and 16.1% of physical fatigue symptoms. Conclusions ：We can estimate the decrease in stress cognitive symptoms, accompanying depression and anxiety, compulsion and hostility as characteristics of somatization. The causal relationship between somatiza-tion and psychological symptoms cannot be confirmed in this study, but the interrelationships are observed, canbe referred to mediation strategies.

This study aimed to characterize patients experiences as service recipients, and to examine their satisfaction with the Community-based Primary Care Project and its efficacy. To achieve these aims, qualitative data were collected from 13 patients through a semi-structured in-depth interview. Four trained researchers extracted each theme separately and discussed them, at which point they were subjected to thematic analysis. Patient satisfaction was found to be associated with the doctor-patient relationship, comprehensive chronic disease care, face-to-face education, standardized education material, and computer-based education modules. Education allowed patients to strengthen their knowledge and establish their motivations, which brought about behavioral change and improved health conditions. In addition to these effects, patients also reported improved perceptions of the quality of primary care based on experiences with clinical team coordination. The findings of this study emphasize that community-based primary care services should be considered to be an effective chronic disease management strategy.
Chronic Disease ; Education ; Health Promotion ; Humans ; Patient Satisfaction ; Physician-Patient Relations ; Primary Health Care*

BACKGROUND: Patient-centered care (PCC) and integrative care approach are widely advocated. However, their implementation usually requires an extended consultation time. Despite significant advances in medical diagnosis and treatment, no studies have examined consultation time and patient centeredness in Korea. METHODS: We conducted a “15-Minute Consultation” for first-time patients in outpatient clinics of 13 departments. A control group was selected from the same physicians' first-time patients, adjusting for age and gender. A total of 275 patients were selected for receiving in-depth consultation and 141 control patients were selected for regular consultation. Data were collected from patients using a questionnaire comprising a patient-centeredness scale and items on potential predictors such as socio-demographic and clinical factors. We also investigated the participating physician's professionalism. RESULTS: As compared to the control group, the in-depth consultation group scored higher on 5 variables associated with PCC, including (patients' perception of) medical professionals, wait and consultation times, treatment, patient advocacy, and patient satisfaction. While 92.4% of patients in the in-depth consultation group reported that the consultation time was sufficient, only 69.0% of those in the control group reported the same (P < 0.01). In the in-depth consultation group, scores on satisfaction level were the highest for the department of internal medicine, followed by departments of surgery and pediatrics. Participating physicians' improved satisfaction following the intervention proved that in-depth consultation facilitated building a rapport with patients. CONCLUSION: This study illustrated that the provision of sufficiently long consultation for serious and rare diseases could improve PCC and physicians' professionalism. Health authorities should reshuffle the healthcare delivery system and provide sufficient consultation time to ensure PCC and medical professionalism.
Ambulatory Care Facilities ; Delivery of Health Care ; Diagnosis ; Humans ; Internal Medicine ; Korea ; Outpatients ; Patient Advocacy ; Patient Satisfaction ; Patient-Centered Care ; Pediatrics ; Professionalism ; Rare Diseases ; Tertiary Care Centers

Purpose: Using a new robotic endoscopic platform system developed for retrograde intrarenal surgery (RIRS) called easyUretero (ROEN Surgical Inc.), we evaluated the feasibility and safety of renal stone retrieval in a porcine model. Materials and Methods: Six female pigs were used for our in vivo study. First, 0.3-cm-sized phantom stones were inserted into the kidneys of each pig via the ureteral access sheath. Next, renal stone retrieval was attempted using manual RIRS in three pigs and robotic RIRS in three pigs. Three surgeons performed extraction of 10 stones in each session. Results: The mean stone retrieval time by manual RIRS was significantly shorter than that by robotic RIRS (399.9±185.4 sec vs. 1127.6±374.5 sec, p=0.001). In contrast, the questionnaire regarding usability showed high satisfaction in the surgeons’ fatigue category for surgeons using robotic RIRS. The radiation exposure dose was also lower in robotic RIRS than in manual RIRS (0.14 μSv vs. 45.5 μSv). Postoperative ureteral injury assessment revealed Grade 0 in manual RIRS cases and Grades 0, 1, and 2 in robotic RIRS cases. Conclusion The easyUretero system is a new robotic RIRS system that was developed in Korea. The results of the present study suggest that using easyUretero for stone retrieval during RIRS is safe and ergonomic.

BACKGROUND: Histologically, nonalcoholic steatohepatitis (NASH) is categorized into adult-type (type 1) and pediatric-type (type 2). The origination of the histological difference between the two types and how they differ clinically remain uncertain. We aimed to understand the incidence and clinical characteristics of the two types of NASH in Korean children, and to investigate the association between their pathological type and clinical characteristics, using anthropometric and laboratory data. METHODS: In 38 children with confirmed NASH, we investigated hepatic pathological findings, and correlating factors between pathological type and laboratory and anthropometric data (weight percentile, body mass index (BMI) z-score, and blood pressure percentile). Adult-type NASH was noted in 21 patients and pediatric-type in 17 patients. RESULTS: Age, sex, BMI, transaminase levels, and insulin resistance were not significantly different between the two groups. Triglyceride (TG) levels were higher in adult-type NASH (P = 0.033). Hematocrit and albumin levels were lower in adult-type NASH (P = 0.016 and 0.013, respectively). Hepatic fibrosis was more common in pediatric-type. The fibrosis scores in patients with adult-type were mostly 0 and 1, whereas the score was 3 in patients with pediatric-type (P = 0.024, 0.004, and < 0.010, respectively). Anthropometric data, liver function, and insulin resistance scores did not differ between the two pathological NASH types. TG, hematocrit, and albumin may be potential factors to predict pathological types. Fibrosis was observed more frequently in pediatric-type NASH. CONCLUSION: Monitoring children with pediatric-type NASH for progression to fibrosis or cirrhosis is recommended.
Blood Pressure ; Body Mass Index ; Child ; Fibrosis ; Hematocrit ; Humans ; Incidence ; Insulin Resistance ; Liver ; Non-alcoholic Fatty Liver Disease ; Pathology ; Triglycerides

BACKGROUND: This study evaluated the efficacy of ulinastatin for attenuating organ injury and the release of proinflammatory cytokines due to cardiopulmonary bypass (CPB) during cardiac surgery. METHODS: Patients undergoing valvular heart surgery employing CPB were assigned to receive either ulinastatin (group U, n = 13) or a placebo (group C, n = 11) before the commencement of CPB. Hemodynamic data, parameters of major organ injury and function, and proinflammatory cytokines were measured after the induction of anesthesia (T1), after CPB (T2), at the end of anesthesia (T3), and at 24 hours after surgery (POD). RESULTS: The demographic data, CPB duration, and perioperative transfusions were not different between the groups. PaO2/FiO2 in group U was significantly higher than that in group C at T3 (3.8 +/- 0.8 vs. 2.8 +/- 0.7, P = 0.005) and at POD (4.0 +/- 0.7 vs. 2.8 +/- 0.7, P < 0.001). Creatine kinase-MB at POD in group U was significantly lower than that in group C (17.7 +/- 8.3 vs. 33.7 +/- 22.1, P = 0.03), whereas troponin I at POD was not different between the groups. Creatinine clearance and the extubation time were not different between the groups at POD. The dopamine infusion rate during the post-CPB period in group U was significantly lower than that in group C (1.6 +/- 1.6 vs. 5.5 +/- 3.3 microg/kg/min, P = 0.003). The interleukin-6 and tumor necrosis factor-alpha concentrations at T1, T2, and T3 as well as the incidences of postoperative cardiac, pulmonary and kidney injuries were not different between the groups. CONCLUSIONS: Ulinastatin pretreatment resulted in an improved oxygenation profile and reduced inotropic support, probably by attenuating the degree of cardiopulmonary injury; however, it did not reduce the levels of proinflammatory cytokines.
Anesthesia ; Cardiopulmonary Bypass ; Creatine ; Creatinine ; Cytokines ; Dopamine ; Glycoproteins ; Hemodynamics ; Humans ; Incidence ; Interleukin-6 ; Kidney ; Oxygen ; Thoracic Surgery ; Troponin I ; Tumor Necrosis Factor-alpha