Purpose: The purpose of this program is to develop an educational program to improve the nursing management competency of middle-level nursing managers. Methods: The program outline is based on the results of the Importance Performance Analysis (IPA) and Systematic Review (SR). Also performed the content validity accordingly. Results: The result of the concepts are derived from 6 competencies for planning process, 4 competencies for organizing process, 4 competencies for staffing process, 26 competencies for directing process, and 12 competencies for controlling process by integrating IPA and SR. This outline of the program was constructed according to the derived integrated concept and both content validity and structured outline were interpreted as valid. Conclusion This suggests that middle-level managers need a systematic program and support to effectively lead the organization by recognizing the importance rather than performance.

Posterior reversible leukoencephalopathy syndrome (PRES) is characterized by transient headache, altered mental functioning, seizures, and loss of vision associated with findings of predominantly posterior cerebral lesions on imaging studies. Magnetic resonance imaging typically shows bilateral hyperintensity on T2 weighted imaging and fluid attenuated inversion recovery imaging, predominantly in the parieto-occipital region. The common etiologies of PRES include eclampsia, renal impairment, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension. The prognosis is usually benign when adequate treatment is initiated immediately. Otherwise, delay in diagnosis and treatment may lead to permanent neurological sequelae. We report on the case of a 24-year-old man who presented with the characteristics of PRES with acute carbon monoxide poisoning.
Autoimmune Diseases ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Diagnosis ; Drug Therapy ; Eclampsia ; Female ; Headache ; Hypertension ; Leukoencephalopathies* ; Magnetic Resonance Imaging ; Poisoning ; Posterior Leukoencephalopathy Syndrome ; Pregnancy ; Prognosis ; Seizures ; Young Adult

Posterior reversible leukoencephalopathy syndrome (PRES) is characterized by transient headache, altered mental functioning, seizures, and loss of vision associated with findings of predominantly posterior cerebral lesions on imaging studies. Magnetic resonance imaging typically shows bilateral hyperintensity on T2 weighted imaging and fluid attenuated inversion recovery imaging, predominantly in the parieto-occipital region. The common etiologies of PRES include eclampsia, renal impairment, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension. The prognosis is usually benign when adequate treatment is initiated immediately. Otherwise, delay in diagnosis and treatment may lead to permanent neurological sequelae. We report on the case of a 24-year-old man who presented with the characteristics of PRES with acute carbon monoxide poisoning.
Autoimmune Diseases ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Diagnosis ; Drug Therapy ; Eclampsia ; Female ; Headache ; Hypertension ; Leukoencephalopathies* ; Magnetic Resonance Imaging ; Poisoning ; Posterior Leukoencephalopathy Syndrome ; Pregnancy ; Prognosis ; Seizures ; Young Adult

Objective: Delivery of prehospital defibrillation for shockable rhythms by emergency medical service providers is crucial for successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. The optimal range of prehospital defibrillation attempts for refractory shockable rhythms is unknown. This study evaluated the association between the number of prehospital defibrillation attempts and neurologic outcomes in OHCA patients. Methods: A retrospective observational study was conducted using the nationwide OHCA registry. Adult OHCA patients who were treated by emergency medical service providers due to presumed cardiac origin with initial shockable rhythm were enrolled from 2013 to 2016. The final analysis was performed on patients without on-scene return of spontaneous circulation. The number of prehospital defibrillation attempts was categorized as follows: 2–3, 4–5, and ≥6 attempts. The primary outcome was a good neurologic recovery at hospital discharge. Multivariate logistic regression analysis was performed to evaluate the association between neurologic outcomes and the number of prehospital defibrillation attempts. Results: A total of 4,513 patients were included in the final analysis. The numbers of patients for whom 2–3, 4–5, and ≥6 defibrillation attempts were made were 2,720 (60.3%), 1,090 (24.2%), and 703 (15.5%), respectively. Poorer outcomes were associated with ≥6 defibrillation attempts: survival to hospital discharge (adjusted odds ratio, 0.38; 95% confidence interval, 0.21–0.65) and good neurologic recovery (adjusted odds ratio, 0.42; 95% confidence interval, 0.21–0.84). Conclusion Six or more prehospital defibrillation attempts were associated with poorer neurologic outcomes in OHCA patients with an initial shockable rhythm who were unresponsive to on-scene defibrillation and resuscitation.

Objective: Delivery of prehospital defibrillation for shockable rhythms by emergency medical service providers is crucial for successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. The optimal range of prehospital defibrillation attempts for refractory shockable rhythms is unknown. This study evaluated the association between the number of prehospital defibrillation attempts and neurologic outcomes in OHCA patients. Methods: A retrospective observational study was conducted using the nationwide OHCA registry. Adult OHCA patients who were treated by emergency medical service providers due to presumed cardiac origin with initial shockable rhythm were enrolled from 2013 to 2016. The final analysis was performed on patients without on-scene return of spontaneous circulation. The number of prehospital defibrillation attempts was categorized as follows: 2–3, 4–5, and ≥6 attempts. The primary outcome was a good neurologic recovery at hospital discharge. Multivariate logistic regression analysis was performed to evaluate the association between neurologic outcomes and the number of prehospital defibrillation attempts. Results: A total of 4,513 patients were included in the final analysis. The numbers of patients for whom 2–3, 4–5, and ≥6 defibrillation attempts were made were 2,720 (60.3%), 1,090 (24.2%), and 703 (15.5%), respectively. Poorer outcomes were associated with ≥6 defibrillation attempts: survival to hospital discharge (adjusted odds ratio, 0.38; 95% confidence interval, 0.21–0.65) and good neurologic recovery (adjusted odds ratio, 0.42; 95% confidence interval, 0.21–0.84). Conclusion Six or more prehospital defibrillation attempts were associated with poorer neurologic outcomes in OHCA patients with an initial shockable rhythm who were unresponsive to on-scene defibrillation and resuscitation.

BACKGROUND: This study aimed to estimate the burden of acute pesticide poisoning and to determine its trend with recently implemented pesticide regulations. METHODS: Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) due to acute pesticide poisoning using the methods of the Global Burden of Disease Study 2013. The values of YLLs, YLDs, and DALYs were stratified by sex, age groups, intentionality of poisoning, and causative agents. RESULTS: From 2006 to 2014, DALYs decreased by 69% (from 69,550 to 21,742). The decreasing tendency of DALYs was especially marked from 2011. The total burden of acute pesticide poisoning was mainly caused by YLLs and intentional pesticide poisoning. The highest DALYs due to acute pesticide poisoning occurred in those in their 40s and 50s; however, the decreased rates of DALYs were higher in those aged 10–49 years than in those aged more than 50 years. Herbicides including paraquat contributed to the largest proportion of total DALYs. CONCLUSION: As this is the first study to quantify the burden of acute pesticide poisoning using DALYs, our results provide comprehensive evidence of the importance of using strict regulations to prevent public health hazards due to acute pesticide poisoning.
Agrochemicals ; Cost of Illness ; Herbicides ; Humans ; Intention ; Korea* ; Paraquat ; Poisoning* ; Public Health ; Social Control, Formal ; Suicide

Purpose: This study analyzes the clinical results of SNUCONE AF+II® (SNUCONE Implant) implants placed in the edentulous region to determine the implant survival rate and the marginal bone healing pattern in the healing process. Materials and Methods: Two hundred forty implants placed in 131 patients with SNUCONE AF+II® implant system from January 1, 2014 to December 31, 2014 at Cheongju Hankook General Hospital were followed up for 5 years.Result: We evaluated 240 SNUCONE AF+II® implants of 131 patients from January 1, 2014 to December 31, 2014 at Cheongju Hankook General Hospital, and the results are as following: 1) Three implants were failed out of 240 implants of 131 patients and the survival rate was 98.75%. 2) The marginal bone resorption was 0.95±1.84 mm for 4 years after prosthesis placement, showing favorable result. Conclusion Although long-term cumulative evaluations and studies should be performed in the future, SNUCONE AF+II® implants show high cumulative survival and low marginal bone resorption according to the results of this study, which believed to give outstanding result in various dental implant procedure.

Urticarial vasculitis is a rare disorder that principally manifests with recurrent urticarial, sometimes hemorrhagic, skin lesions and/or angioedema. Its clinical presentation is not always limited to cutaneous lesions and it can potentially affect other organs, such as the joints, lungs, kidneys, and eyes. Systemic involvement can either be present at the onset of disease or develop over time. In cases with systemic manifestations, urticarial vasculitis is more likely to be associated with a low complement level. We present the case of a teenage boy with hypocomplementemic urticarial vasculitis syndrome (HUVS) that occurred shortly following swine-origin influenza A virus infection in 2009. Afterwards, HUVS was systemically complicated with myositis and membranous nephropathy that developed several months and about 2 years after its onset, respectively. A combination of glucocorticoid and immunosuppressive agents has been used to effectively control disease activity.
Angioedema ; Complement System Proteins ; Glomerulonephritis, Membranous* ; Humans ; Immunosuppressive Agents ; Influenza A virus ; Joints ; Kidney ; Lung ; Male ; Myositis ; Skin ; Vasculitis*

Purpose: To analyze growth patterns over 2 years after birth according to preterm infant birth weight and length percentiles. Methods: Anthropometric measurements of 82 preterm infants were retrospectively reviewed. Preterm infants with birth weight or length below the 10th percentile were classified as small for gestational age (SGA) (n=19) and those between the 10th and 89th percentile as appropriate for gestational age (AGA) (n=63). The association between the length standard deviation score (SDS) at 2 years of corrected age and clinical factors were analyzed. Results: The length SDS of the SGA group was significantly increased at 6 months (-1.30±1.71) and 24 months (-0.97±1.06) of corrected age. The length SDS was lower in the SGA group than those in the AGA group at 6 months (-1.30±1.71 vs. -0.25±1.15, P=0.004), 18 months (-0.97±1.39 vs. -0.03±1.29, P=0.015), and 24 months (-0.97±1.06 vs. -0.29±1.12, P=0.022,). The percentage of children with a length SDS of <-2 (growth failure) at 24 months was 15.8% in the SGA group and 4.8% in the AGA group (P=0.108). Multiple linear regression analysis demonstrated that length at 24 months of corrected age was negatively correlated with birth length below the 10th percentile (coefficient β=-0.91, P=0.001) and duration of stay in the neonatal intensive care unit (NICU) (coefficient β=-0.01, P=0.001). Conclusion Despite the fact that catch-up growth occurs during the early period of infancy in a large portion of preterm SGA infants, a significant portion of these infants show growth failure at 24 months of age. Growth over 2 years after birth is affected by birth length and duration of stay in the NICU in preterm children.

Background/Aims: Patients with advanced hepatocellular carcinoma (HCC) have a poor prognosis due to the lack of effective systemic therapies. Epithelial-to-mesenchymal transition (EMT) is a pivotal event in tumor progression, during which cancer cells acquire invasive properties. In this study, we investigated the effects of phosphatidylinositol 3-kinase (PI3K) inhibitors, including LY294002 and idelalisib, on the EMT features of HCC cells in vitro. Methods: Human HCC cell lines, including Huh-BAT and HepG2, were used in this study. Cell proliferation was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide, and cell cycle distributions were evaluated using a flow cytometer by propidium iodide staining. Immunofluorescence staining, quantitative real-time polymerase chain reaction, and immunoblotting were performed to detect EMT-associated changes. Results: PI3K inhibitors suppressed the proliferation and invasion of HCC cells and deregulated the expression of EMT markers, as indicated by increased expression of E-cadherin, an epithelial marker, and decreased expression of N-cadherin, a mesenchymal marker, and Snail, a transcription factor implicated in EMT regulation. Furthermore, LY294002 and idelalisib inhibited the phosphorylation of GSK-3β and induced the nuclear translocation of GSK-3β, which corresponded to the downregulation of Snail and β-catenin expressions in Huh-BAT and HepG2 cells. Conclusions The inhibition of PI3K/Akt signaling decreases Snail expression by enhancing the nuclear translocation of GSK-3β, which suppresses EMT in HCC cells, suggesting the potential clinical application of PI3K inhibitors for HCC treatment.