Many medical institutions have adopted a massive transfusion protocol (MTP) for the effective management of hemorrhagic shock. However, in medical institutions where severe trauma patients are infrequently admitted, the use of MTP is rare, potentially leading to deficiencies in staff proficiency and confidence when responding to severe hemorrhage events. This study introduced simulation training to improve staff skills and confidence and assess the current state of the MTP. Healthcare professionals, including physicians, nurses, medical technologist, and support staff from emergency medical center and blood bank, participated in two simulation training sessions.The Red Blood Cell (RBC) turnaround time (TAT) failed to meet the 5-minute target in both sessions, with recorded times of 10 minutes and 9 minutes, respectively. The fresh frozen plasma (FFP) TAT exceeded the 20-minute target in the first session but achieved the goal with a time of 19 minutes in the second session. Consequently, the RBC TAT target was adjusted to a more realistic 10 minutes. Operational changes, such as installing a blood product refrigerator in the emergency department and prioritizing MTP activities, were suggested to further reduce TAT. Simulation-based training can improve compliance with MTP procedures and increase staff confidence. For institutions where MTP activation is infrequent, regular simulation training and the dissemination of educational materials are crucial to ensuring a prompt and accurate response in actual severe hemorrhage events.

Although transfusion is a globally prevalent medical procedure, there are knowledge gaps among physicians due to inadequate education on this topic. Our study sought to evaluate the level of understanding and awareness among medical students at Soonchunhyang University College of Medicine, Asan, Korea regarding transfusion medicine and patient blood management (PBM). The findings revealed a critical need to strengthen areas of education related to alternative treatments for various types of anemia, the impact of underlying conditions on anemia, and the implementation of PBM strategies in non-emergency situations. This underscores the imperative need for expanded and improved educational programs to ensure optimal patient outcomes and the safe use of blood products.

Many medical institutions have adopted a massive transfusion protocol (MTP) for the effective management of hemorrhagic shock. However, in medical institutions where severe trauma patients are infrequently admitted, the use of MTP is rare, potentially leading to deficiencies in staff proficiency and confidence when responding to severe hemorrhage events. This study introduced simulation training to improve staff skills and confidence and assess the current state of the MTP. Healthcare professionals, including physicians, nurses, medical technologist, and support staff from emergency medical center and blood bank, participated in two simulation training sessions.The Red Blood Cell (RBC) turnaround time (TAT) failed to meet the 5-minute target in both sessions, with recorded times of 10 minutes and 9 minutes, respectively. The fresh frozen plasma (FFP) TAT exceeded the 20-minute target in the first session but achieved the goal with a time of 19 minutes in the second session. Consequently, the RBC TAT target was adjusted to a more realistic 10 minutes. Operational changes, such as installing a blood product refrigerator in the emergency department and prioritizing MTP activities, were suggested to further reduce TAT. Simulation-based training can improve compliance with MTP procedures and increase staff confidence. For institutions where MTP activation is infrequent, regular simulation training and the dissemination of educational materials are crucial to ensuring a prompt and accurate response in actual severe hemorrhage events.

Many medical institutions have adopted a massive transfusion protocol (MTP) for the effective management of hemorrhagic shock. However, in medical institutions where severe trauma patients are infrequently admitted, the use of MTP is rare, potentially leading to deficiencies in staff proficiency and confidence when responding to severe hemorrhage events. This study introduced simulation training to improve staff skills and confidence and assess the current state of the MTP. Healthcare professionals, including physicians, nurses, medical technologist, and support staff from emergency medical center and blood bank, participated in two simulation training sessions.The Red Blood Cell (RBC) turnaround time (TAT) failed to meet the 5-minute target in both sessions, with recorded times of 10 minutes and 9 minutes, respectively. The fresh frozen plasma (FFP) TAT exceeded the 20-minute target in the first session but achieved the goal with a time of 19 minutes in the second session. Consequently, the RBC TAT target was adjusted to a more realistic 10 minutes. Operational changes, such as installing a blood product refrigerator in the emergency department and prioritizing MTP activities, were suggested to further reduce TAT. Simulation-based training can improve compliance with MTP procedures and increase staff confidence. For institutions where MTP activation is infrequent, regular simulation training and the dissemination of educational materials are crucial to ensuring a prompt and accurate response in actual severe hemorrhage events.

Many medical institutions have adopted a massive transfusion protocol (MTP) for the effective management of hemorrhagic shock. However, in medical institutions where severe trauma patients are infrequently admitted, the use of MTP is rare, potentially leading to deficiencies in staff proficiency and confidence when responding to severe hemorrhage events. This study introduced simulation training to improve staff skills and confidence and assess the current state of the MTP. Healthcare professionals, including physicians, nurses, medical technologist, and support staff from emergency medical center and blood bank, participated in two simulation training sessions.The Red Blood Cell (RBC) turnaround time (TAT) failed to meet the 5-minute target in both sessions, with recorded times of 10 minutes and 9 minutes, respectively. The fresh frozen plasma (FFP) TAT exceeded the 20-minute target in the first session but achieved the goal with a time of 19 minutes in the second session. Consequently, the RBC TAT target was adjusted to a more realistic 10 minutes. Operational changes, such as installing a blood product refrigerator in the emergency department and prioritizing MTP activities, were suggested to further reduce TAT. Simulation-based training can improve compliance with MTP procedures and increase staff confidence. For institutions where MTP activation is infrequent, regular simulation training and the dissemination of educational materials are crucial to ensuring a prompt and accurate response in actual severe hemorrhage events.

Breast cancer is the most common type of female cancer. Tamoxifen, a selective estrogen receptor modulator, is widely used to decrease breast cancer recurrence and mortality among patients. However, it also increases the risk of endometrial cancer. This study aimed to assess knowledge and decisional conflict regarding tamoxifen use. Between June and October 2014, breast cancer patients using tamoxifen were consecutively screened and requested to complete a survey including the EQ-5D, Satisfaction with Decision Scale (SWD), Decisional Conflict Scale (DCS), and a self-developed, 15-item questionnaire measuring tamoxifen-related knowledge. The study sample comprised 299 patients. The mean total knowledge score was 63.4 of a possible 100.0 (range, 13.3-93.3). While 73.9% of the participants knew that tamoxifen reduces the risk of breast cancer recurrence, only 57.9% knew that the drug increases endometrial cancer risk. A higher education level (> or =college) was associated with a higher, total knowledge score (beta = 4.291; P = 0.017). A higher knowledge score was associated with a decreased DCS score (beta = -0.366; P < 0.001). A higher SWD score was also associated with decreased decisional conflict (beta = -0.178; P < 0.001). In conclusion, the breast cancer patients with higher levels of tamoxifen-related knowledge showed lower levels of decisional conflict regarding tamoxifen use. Clinicians should provide the exact information about tamoxifen treatment to patients, based on knowledge assessment results, so as to aid patients' decision-making with minimal conflict.
Adult ; Aged ; Antineoplastic Agents, Hormonal/adverse effects/therapeutic use ; Breast Neoplasms/*drug therapy/epidemiology ; Consent Forms/*statistics & numerical data ; Decision Making ; Endometrial Neoplasms/*chemically induced/epidemiology/prevention & control ; Female ; Health Knowledge, Attitudes, Practice ; Health Surveys ; Humans ; Middle Aged ; Patient Education as Topic/*statistics & numerical data ; Patient Participation/statistics & numerical data ; Prevalence ; Republic of Korea ; Risk Assessment ; Tamoxifen/*adverse effects/*therapeutic use

OBJECTIVE: The aim of this study was to compare posterior tooth inclinations, occlusal force, and contact area of adults with different sagittal malocclusions. METHODS: Transverse skeletal parameters and posterior tooth inclinations were evaluated using cone beam computed tomography images, and occlusal force as well as contact area were assessed using pressure-sensitive films in 124 normodivergent adults. A linear mixed model was used to cluster posterior teeth into maxillary premolar, maxillary molar, mandibular premolar, and mandibular molar groups. Differences among Class I, II, and III groups were compared using an analysis of variance test and least significant difference post-hoc test. Correlations of posterior dental inclinations to occlusal function were analyzed using Pearson's correlation analysis. RESULTS: In male subjects, maxillary premolars and molars had the smallest inclinations in the Class II group while maxillary molars had the greatest inclinations in the Class III group. In female subjects, maxillary molars had the smallest inclinations in the Class II group, while maxillary premolars and molars had the greatest inclinations in the Class III group. Occlusal force and contact area were not significantly different among Class I, II, and III groups. CONCLUSIONS Premolar and molar inclinations showed compensatory inclinations to overcome anteroposterior skeletal discrepancy in the Class II and III groups; however, their occlusal force and contact area were similar to those of Class I group. In subjects with normodivergent facial patterns, although posterior tooth inclinations may vary, difference in occlusal function may be clinically insignificant in adults with Class I, II, and III malocclusions.

BACKGROUND: Retinal degenerative disease (RDD), one of the most common causes of blindness, is predominantly caused by the gradual death of retinal pigment epithelial cells (RPEs) and photoreceptors due to various causes. Cell-based therapies, such as stem cell implantation, have been developed for the treatment of RDD, but potential risks, including teratogenicity and immune reactions, have hampered their clinical application. Stem cell-derived extracellular vesicles (EVs) have recently emerged as a cell-free alternative therapeutic strategy; however, additional invasiveness and low yield of the stem cell extraction process is problematic. METHODS: To overcome these limitations, we developed therapeutic EVs for the treatment of RDD which were extracted from tonsil-derived mesenchymal stem cells obtained from human tonsil tissue discarded as medical waste following tonsillectomy (T-MSC EVs). To verify the biocompatibility and cytoprotective effect of T-MSC EVs, we measured cell viability by co-culture with human RPE without or with toxic all-trans-retinal. To elucidate the cytoprotective mechanism of T-MSC EVs, we performed transcriptome sequencing using RNA extracted from RPEs. The in vivo protective effect of T-MSC EVs was evaluated using Pde6b gene knockout rats as an animal model of retinitis pigmentosa. RESULTS: T-MSC EVs showed high biocompatibility and the human pigment epithelial cells were significantly protected in the presence of T-MSC EVs from the toxic effect of all-trans-retinal. In addition, T-MSC EVs showed a dosedependent cell death-delaying effect in real-time quantification of cell death. Transcriptome sequencing analysis revealed that the efficient ability of T-MSC EVs to regulate intracellular oxidative stress may be one of the reasons explaining their excellent cytoprotective effect. Additionally, intravitreally injected T-MSC EVs had an inhibitory effect on the destruction of the outer nuclear layer in the Pde6b gene knockout rat. CONCLUSIONS Together, the results of this study indicate the preventive and therapeutic effects of T-MSC EVs during the initiation and development of retinal degeneration, which may be a beneficial alternative for the treatment of RDD.

Background: and Purpose: The SoUth Korea study to PrEvent cognitive impaiRment and protect BRAIN health through lifestyle intervention (SUPERBRAIN) proved the feasibility of multidomain intervention for elderly people. One-quarter of the Korean population over 65 years of age has mild cognitive impairment (MCI). Digital health interventions may be costeffective and have fewer spatial constraints. We aim to examine the efficacy of a multidomain intervention through both face-to-face interactions and video communication platforms using a tablet personal computer (PC) application in MCI. Methods: Three hundred participants aged 60–85 years, with MCI and at least one modifiable dementia risk factor, will be recruited from 17 centers and randomly assigned in a 1:1 ratio to the multidomain intervention and the waiting-list control groups. Participants will receive the 24-week intervention through the tablet PC SUPERBRAIN application, which encompasses the following five elements: managing metabolic and vascular risk factors, cognitive training,physical exercise, nutritional guidance, and boosting motivation. Participants will attend the interventions at a facility every 1–2 weeks. They will also engage in one or two self-administered cognitive training sessions utilizing the tablet PC application at home each week. They will participate in twice or thrice weekly online exercise sessions at home via the ZOOM platform. The primary outcome will be the change in the total scale index score of the Repeatable Battery for the Assessment of Neuropsychological Status from baseline to study end. Conclusions This study will inform the effectiveness of a comprehensive multidomain intervention utilizing digital technologies in MCI.