This study aimed to determine whether the direction of arterial needle insertion and the bevel orientation during arteriovenous fistula (AVF) cannulation affect the recirculation rate and dialysis adequacy, thereby providing evidence relevant to dialysis nursing care. A single-group pretest-posttest design was employed. Methods: This study included 54 hemodialysis patients at Hallym University Sacred Heart Hospital from July 24 to September 16, 2023. Eligibility criteria included age ≥ 18, AVF use for ≥ 3 months, no recent vascular interventions, and AVF blood flow ≥ 600mL/min. The recirculation rate was measured with an HD03 monitor at 2-2.5 hours post-initiation, and dialysis adequacy was assessed via Kt/V. The paired t-test was used for analysis. Results: Among 54 participants, 57.4% were male, and 57.4% had been receiving hemodialysis for ≤ 5 years. The mean AVF blood flow was 982.52 mL/min. No significant differences in the recirculation rate or dialysis adequacy were found based on needle direction or bevel orientation. Conclusion: The findings suggest that arterial needle direction and bevel orientation during AVF cannulation do not significantly impact the recirculation rate or dialysis adequacy. These results support the standardization of AVF cannulation techniques, which would not pose concerns for altering dialysis efficiency. Further studies with larger samples are recommended.

This study aimed to determine whether the direction of arterial needle insertion and the bevel orientation during arteriovenous fistula (AVF) cannulation affect the recirculation rate and dialysis adequacy, thereby providing evidence relevant to dialysis nursing care. A single-group pretest-posttest design was employed. Methods: This study included 54 hemodialysis patients at Hallym University Sacred Heart Hospital from July 24 to September 16, 2023. Eligibility criteria included age ≥ 18, AVF use for ≥ 3 months, no recent vascular interventions, and AVF blood flow ≥ 600mL/min. The recirculation rate was measured with an HD03 monitor at 2-2.5 hours post-initiation, and dialysis adequacy was assessed via Kt/V. The paired t-test was used for analysis. Results: Among 54 participants, 57.4% were male, and 57.4% had been receiving hemodialysis for ≤ 5 years. The mean AVF blood flow was 982.52 mL/min. No significant differences in the recirculation rate or dialysis adequacy were found based on needle direction or bevel orientation. Conclusion: The findings suggest that arterial needle direction and bevel orientation during AVF cannulation do not significantly impact the recirculation rate or dialysis adequacy. These results support the standardization of AVF cannulation techniques, which would not pose concerns for altering dialysis efficiency. Further studies with larger samples are recommended.

This study aimed to determine whether the direction of arterial needle insertion and the bevel orientation during arteriovenous fistula (AVF) cannulation affect the recirculation rate and dialysis adequacy, thereby providing evidence relevant to dialysis nursing care. A single-group pretest-posttest design was employed. Methods: This study included 54 hemodialysis patients at Hallym University Sacred Heart Hospital from July 24 to September 16, 2023. Eligibility criteria included age ≥ 18, AVF use for ≥ 3 months, no recent vascular interventions, and AVF blood flow ≥ 600mL/min. The recirculation rate was measured with an HD03 monitor at 2-2.5 hours post-initiation, and dialysis adequacy was assessed via Kt/V. The paired t-test was used for analysis. Results: Among 54 participants, 57.4% were male, and 57.4% had been receiving hemodialysis for ≤ 5 years. The mean AVF blood flow was 982.52 mL/min. No significant differences in the recirculation rate or dialysis adequacy were found based on needle direction or bevel orientation. Conclusion: The findings suggest that arterial needle direction and bevel orientation during AVF cannulation do not significantly impact the recirculation rate or dialysis adequacy. These results support the standardization of AVF cannulation techniques, which would not pose concerns for altering dialysis efficiency. Further studies with larger samples are recommended.

This study aimed to determine whether the direction of arterial needle insertion and the bevel orientation during arteriovenous fistula (AVF) cannulation affect the recirculation rate and dialysis adequacy, thereby providing evidence relevant to dialysis nursing care. A single-group pretest-posttest design was employed. Methods: This study included 54 hemodialysis patients at Hallym University Sacred Heart Hospital from July 24 to September 16, 2023. Eligibility criteria included age ≥ 18, AVF use for ≥ 3 months, no recent vascular interventions, and AVF blood flow ≥ 600mL/min. The recirculation rate was measured with an HD03 monitor at 2-2.5 hours post-initiation, and dialysis adequacy was assessed via Kt/V. The paired t-test was used for analysis. Results: Among 54 participants, 57.4% were male, and 57.4% had been receiving hemodialysis for ≤ 5 years. The mean AVF blood flow was 982.52 mL/min. No significant differences in the recirculation rate or dialysis adequacy were found based on needle direction or bevel orientation. Conclusion: The findings suggest that arterial needle direction and bevel orientation during AVF cannulation do not significantly impact the recirculation rate or dialysis adequacy. These results support the standardization of AVF cannulation techniques, which would not pose concerns for altering dialysis efficiency. Further studies with larger samples are recommended.

BACKGROUND: The vanA gene is the most frequently encountered gene among isolates, causing vancomycin-resistant Enterococci (VRE) infections in humans, and it is part of the transposable element Tn1546. Knowledge of the diversity of Tn1546 is important to distinguish between the dissemination of a single VRE clone and the transmission of a particular Tn1546 type through a genetically divergent population of enterococci. Recently, we studied molecular diversity of Tn1546-related elements in enterococci isolated in one hospital to facilitate understanding of the molecular epidemiology of vancomycin resistance. METHODS: Nineteen VanA-type VRE clinical isolates, collected in one university hospital during 1997 and 1999, were investigated for characteristics such as antibiotic resistance, structure of vanA gene cluster and genomic DNA type by means of antibiotic susceptibility test, PCR amplified length polymorphism of vanA gene cluster and pulse-field gel electrophoresis (PFGE), respectively. RESULTS: Nine (A, B1 to B5, C, D and E) different vanA gene cluster types were identified. Three isolates were grouped into vanA gene cluster type A, similar to that of Tn1546 prototype, and twelve isolates were grouped into type B that has an insertion of IS1216V at vanX-Y intergenic region. Type B was further subdivided into B1 to B5 according to the size variation of vanX-Y intergenic region, which was resulted from the insertion of IS1216V and deletions associated with the insertion. Both vanY and vanZ were deleted in three isolates, suggesting that these genes are not essential for vancomycin resistance. Notably, three E. faecalis and three E. faecium strains isolated during the same period were shown to carry the same vanA gene cluster, showing intergenic transmission of vancomycin resistance. CONCLUSION: The presence of variable types of vanA gene cluster among VRE strains isolated in one hospital suggests that several evolutionary changes of vanA gene clusters have occurred during the horizontal spread of resistance gene in the hospital environment. This approach may be useful for monitoring the evolution of VanA resistance.
Clone Cells ; DNA ; DNA Transposable Elements ; DNA, Intergenic ; Drug Resistance, Microbial ; Electrophoresis ; Humans ; Molecular Epidemiology ; Multigene Family* ; Polymerase Chain Reaction ; Vancomycin Resistance

BACKGROUND: The vanA gene is the most frequently encountered gene among isolates, causing vancomycin-resistant Enterococci (VRE) infections in humans, and it is part of the transposable element Tn1546. Knowledge of the diversity of Tn1546 is important to distinguish between the dissemination of a single VRE clone and the transmission of a particular Tn1546 type through a genetically divergent population of enterococci. Recently, we studied molecular diversity of Tn1546-related elements in enterococci isolated in one hospital to facilitate understanding of the molecular epidemiology of vancomycin resistance. METHODS: Nineteen VanA-type VRE clinical isolates, collected in one university hospital during 1997 and 1999, were investigated for characteristics such as antibiotic resistance, structure of vanA gene cluster and genomic DNA type by means of antibiotic susceptibility test, PCR amplified length polymorphism of vanA gene cluster and pulse-field gel electrophoresis (PFGE), respectively. RESULTS: Nine (A, B1 to B5, C, D and E) different vanA gene cluster types were identified. Three isolates were grouped into vanA gene cluster type A, similar to that of Tn1546 prototype, and twelve isolates were grouped into type B that has an insertion of IS1216V at vanX-Y intergenic region. Type B was further subdivided into B1 to B5 according to the size variation of vanX-Y intergenic region, which was resulted from the insertion of IS1216V and deletions associated with the insertion. Both vanY and vanZ were deleted in three isolates, suggesting that these genes are not essential for vancomycin resistance. Notably, three E. faecalis and three E. faecium strains isolated during the same period were shown to carry the same vanA gene cluster, showing intergenic transmission of vancomycin resistance. CONCLUSION: The presence of variable types of vanA gene cluster among VRE strains isolated in one hospital suggests that several evolutionary changes of vanA gene clusters have occurred during the horizontal spread of resistance gene in the hospital environment. This approach may be useful for monitoring the evolution of VanA resistance.
Clone Cells ; DNA ; DNA Transposable Elements ; DNA, Intergenic ; Drug Resistance, Microbial ; Electrophoresis ; Humans ; Molecular Epidemiology ; Multigene Family* ; Polymerase Chain Reaction ; Vancomycin Resistance

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

Biobank Impact Factor (BIF), which is a very effective criterion to evaluate the activity of biobanks, can be estimated by the citation information of biobanks from scientific papers. We have developed a program, ManBIF, to investigate the citation information from PDF files in the literature. The program manages a dictionary for expressions to represent biobanks and their resources, mines the citation information by converting PDF files to text files and searching with a dictionary, and produces a statistical report file. It can be used as an important tool by biobanks.
Mining

Background: and Purpose Fingolimod (FTY) inhibits lymphocyte egress from lymphoid organs to cause lymphopenia, but the clinical implications of FTY-induced lymphopenia are not fully understood. We aimed to determine the frequency and severity of lymphopenia during FTY treatment among Korean patients with multiple sclerosis (MS), and its association with infections. Methods: We retrospectively reviewed the medical records of patients with MS treated using FTY from 12 referral centers in South Korea between March 2013 and June 2021. Patients were classified according to their nadir absolute lymphocyte count (ALC) during treatment:grade 1, 800–999/μL; grade 2, 500–799/μL; grade 3, 200–499/μL; and grade 4, <200/μL. Results: FTY treatment was administered to 69 patients with a median duration of 18 months (range=1–169 months), with 11 patients being treated for ≥7 years. During FTY treatment, mean ALCs were reduced after the first month (653.0±268.9/μL, mean±standard deviation) (p<0.0001) and remained low during treatment lasting up to 84 months. During follow-up, 41 (59.4%) and 7 (10.1%) patients developed grade-3 and grade-4 lymphopenia, respectively.No significant difference was found in age at FTY initiation, sex, baseline ALC, body mass index, or prior disease-modifying treatment between patients with and without grade-4 lymphopenia. Infections were observed in 11 (15.9%) patients, and the frequencies of patients with and without grade-4 lymphopenia were similar. Conclusions FTY treatment induced grade-4 lymphopenia in 10% of South Korean patients with MS, but did not appear to be associated with an increased infection risk.

Background and Objectives: Evidence remains limited on the real-world prescription of very low-dose oral anticoagulation among frail patients with atrial fibrillation (AF). We described the practice patterns, effectiveness, and safety of very low-dose edoxaban (15 mg once daily). Methods: Patients with AF prescribed edoxaban 15 mg once daily in 2 tertiary hospitals between 2016 and September 2022 were included. Baseline clinical characteristics and clinical outcomes of interest were thromboembolic and bleeding events. Results: A total of 674 patients were included (mean age 78.3±9.1, 49.7% aged ≥80 years, 49.3% women, median follow-up 1.0±1.2 years). Mean CHA 2 DS 2 -VASc score was 3.9±1.6, and the modified HAS-BLED score was 2.0±1.1. Between 2016 and 2022, the number of very lowdose edoxaban prescriptions increased. The main reasons for the prescription of very lowdose were low body weight (55.5% below 60 kg), anaemia (62.8%), chronic kidney disease (40.2%), active cancer (15.3%), concomitant anti-platelet use (26.7%), and prior major bleeding (19.7%). During a median follow-up duration of 8 (interquartile range 3–16) months, overall thromboembolic and bleeding events occurred in 16 (2.3%) and 88 (13.1%) patients, respectively. Compared to the expected event rates on the established risk scoring systems, patients receiving very low-dose edoxaban demonstrated a 61% reduction in ischemic stroke, a 68% reduction of ischemic stroke/transient ischemic attack/systemic embolism, whereas a 49% increase in major bleeding. Conclusions The prescription of very low-dose edoxaban was increased over time, attributable to various clinical factors. The use of very low-dose edoxaban reduced the expected risk of thromboembolic events.