PURPOSE: The purposes of this study were to develop and test a prediction model for caregiving experiences including caregiving satisfaction and burden in dementia family caregivers. METHODS: The stress process model and a two factor model were used as the conceptual frameworks. Secondary data analysis was done with 320 family caregivers who were selected from the Seoul Dementia Management Survey (2014) data set. In the hypothesis model, the exogenous variable was patient symptomatology which included cognitive impairment, behavioral problems, dependency in activity of daily living and in instrumental activity of daily living. Endogenous variables were caregiver's perception of dementia patient's unmet needs, caregiving satisfaction and caregiving burden. Data were analysed using SPSS/WINdows and AMOS program. RESULTS: Caregiving burden was explained by patient symptomatology and caregiving satisfaction indicating significant direct effects and significant indirect effect from unmet needs. The proposed model explained 37.8% of the variance. Caregiving satisfaction was explained by patient symptomatology and unmet needs. Mediating effect of unmet needs was significant in the relationship between patient symptomatology and caregiving satisfaction. CONCLUSION: Results indicate that interventions focusing on relieving caregiving burden and enhancing caregiver satisfaction should be provided to caregivers with high levels of dementia patients' unmet needs and low level of caregiving satisfaction.
Caregivers* ; Cognition Disorders ; Cost of Illness ; Dataset ; Dementia* ; Humans ; Negotiating ; Personal Satisfaction ; Problem Behavior ; Seoul ; Statistics as Topic

We report a case of calcific tendinopathy of the gluteus medius initially misdiagnosed as a lumbar herniated intervertebral disc. It was successfully treated with barbotage under ultrasonographic guidance finally. A 56-year-old woman was referred to interventional pain clinic for right hip pain due to an L5-S1 disc herniation. Serial L5 and S1 spinal nerve root blocks and epidural steroid injections were administered. However, pain relief was sustained only for a very short period. Plain radiography of the right hip revealed a solid calcific nodule at adjacent to the insertion site of the gluteus medius tendon. Physical modalities and extracorporeal shock wave therapy failed to improve the pain. Therefore, we attempted ultrasound-guided barbotage of the calcification. Barbotage was performed twice serially and her pain was considerably improved. At 6-month follow-up, the calcification was completely resolved.
Female ; Follow-Up Studies ; Hip ; Humans ; Intervertebral Disc ; Middle Aged ; Pain Clinics ; Radiography ; Shock ; Spinal Nerve Roots ; Tendinopathy* ; Tendons

Dysphagia and voiding difficulty after hypoglycemic encephalopathy (HE) are not well described in the literature. Additionally, the effect of rehabilitation on outcomes of HE has not been discussed enough. Here we report two cases of HE, who underwent comprehensive rehabilitative management. A 76-year-old man with HE had cognitive dysfunction, dysphagia, poor standing balance, and voiding difficulty. After rehabilitation for about 20 days, the patient's swallowing, gait, and voiding function was improved remarkably, and he could eat a tolerable diet, walk independently, and void without catheterization. However, the cognitive function changed a little. A 75-year-old woman with HE had cognitive dysfunction, impaired gait, dysphagia, and voiding difficulty. After rehabilitation for one month, the patient made progress in swallowing and gait. However, the cognitive function changed a little. After rehabilitation, the recovery of swallowing and locomotor function was rapid and satisfactory in two cases, however, the progress of cognitive function was not definite.
Aged ; Catheterization ; Catheters ; Deglutition ; Deglutition Disorders* ; Diet ; Female ; Gait ; Humans ; Rehabilitation*

PURPOSE: The purpose of this study was to develop a prediction model for the characteristics of older adults with depression using the decision tree method. METHODS: A large dataset from the 2008 Korean Elderly Survey was used and data of 14,970 elderly people were analyzed. Target variable was depression and 53 input variables were general characteristics, family & social relationship, economic status, health status, health behavior, functional status, leisure & social activity, quality of life, and living environment. Data were analyzed by decision tree analysis, a data mining technique using SPSS Window 19.0 and Clementine 12.0 programs. RESULTS: The decision trees were classified into five different rules to define the characteristics of older adults with depression. Classification & Regression Tree (C&RT) showed the best prediction with an accuracy of 80.81% among data mining models. Factors in the rules were life satisfaction, nutritional status, daily activity difficulty due to pain, functional limitation for basic or instrumental daily activities, number of chronic diseases and daily activity difficulty due to disease. CONCLUSION: The different rules classified by the decision tree model in this study should contribute as baseline data for discovering informative knowledge and developing interventions tailored to these individual characteristics.
Activities of Daily Living ; Aged ; Aged, 80 and over ; Chronic Disease ; Data Mining ; Decision Trees ; Depression/*psychology ; Female ; Health Behavior ; Health Status ; Humans ; Leisure Activities ; Male ; Middle Aged ; Quality of Life ; Socioeconomic Factors

High-riding right brachiocephalic and subclavian arteries are often asymptomatic and rare vascular variations. We present a patient with high-riding right brachiocephalic and subclavian arteries that caused compressive pharyngeal and cervical esophageal dysphagia. An 82-year-old woman presented to our hospital with dysphagia that worsened with solid food. A pulsatile lump was observed on the right neck side. A videofluoroscopic swallowing study showed a deviated food bolus movement anterolaterally from the normal vertical pharyngoesophageal transition, with a filling defect in the lower pharynx through the upper esophagus. Neck computed tomography (CT) showed high-riding right brachiocephalic and subclavian arteries and a tortuous right common carotid artery located adjacent to the trachea in the cervical area. The cervical midline structures were deviated to the left neck side. A neck mass with vascular variation should be considered as a cause of dysphagia that worsens with solid food; CT should be considered to determine its cause.

Objective: To investigate the association of trunk fat and muscle composition, lumbar disc space narrowing, and low back pain in middle-aged farmers. Methods: Fat and muscle areas were identified using standard Hounsfield unit ranges for adipose tissue and skeletal muscle with computed tomography images at the mid-L4 vertebral level. Trunk fat mass, muscle mass, and fat/muscle mass ratio were calculated. Low back pain was assessed using the Oswestry Disability Index (ODI). The L4/5-disc space and low back pain were also assessed. Results: Male had a higher total trunk, back, psoas, and abdominal muscle mass, and visceral fat; female had a higher subcutaneous fat mass and fat/muscle ratio. Pearson correlation coefficients with ODI for waist circumference, total fat mass, visceral fat mass, and fat/muscle ratio were all significant in female; only the fat/muscle ratio was significant in male. Pearson correlation coefficients with L4/5-disc space narrowing grades for visceral fat mass, total, back, and psoas muscle mass, and fat/muscle ratio, were all significant in female; total and back muscle mass, and fat/muscle ratio in male. Conclusion There were significant relationships between: fat indicators with low back pain; trunk muscle mass with lumbar disc degeneration; and fat/muscle ratio with both lumbar disc degeneration and low back pain. The fat/muscle ratio may be a useful index for low back pain.

Objectives: Early hemorrhage detection in intensive care units (ICUs) enables timely intervention and reduces the risk of irreversible outcomes. In this study, we aimed to develop a machine learning model to predict hemorrhage by learning the patterns of continuously changing, real-world clinical data. Methods: We used the Medical Information Mart for Intensive Care databases (MIMIC-III and MIMIC-IV). A recurrent neural network was used to predict severe hemorrhage in the ICU. We developed three machine learning models with an increasing number of input features and levels of complexity: model 1 (11 features), model 2 (18 features), and model 3 (27 features). MIMIC-III was used for model training, and MIMIC-IV was split for internal validation. Using the model with the highest performance, external verification was performed using data from a subgroup extracted from the eICU Collaborative Research Database. Results: We included 5,670 ICU admissions, with 3,150 in the training set and 2,520 in the internal test set. A positive correlation was found between model complexity and performance. As a measure of performance, three models developed with an increasing number of features showed area under the receiver operating characteristic (AUROC) curve values of 0.61–0.94 according to the range of input data. In the subgroup extracted from the eICU database for external validation, an AUROC value of 0.74 was observed. Conclusions Machine learning models that rely on real clinical data can be used to predict patients at high risk of bleeding in the ICU.

PURPOSE: Many doctors have difficulty in deciding the treatment duration in trauma patients to write in the casualty medical certificate. We tried to find a solution for this problem by using abbreviated injury scale (AIS). METHODS: A total of 39 patients treated in our regional trauma center who requested an author to write treatment duration on casualty medical certificate from January 2014 to April 2017 were included. And the treatment duration was decided based on the PARK Formula (AIS). PARK Formula (AIS)=(AIS×2) ~ ([AIS×2]+2) RESULTS: Among 39 patients included and 36 (92.3%) had treatment duration on casualty medical certificate within the range of treatment duration calculated by PARK Formula (AIS). Compared to the PARK Formula (AIS), the mean value was 0.13 week (0.90 day) smaller. Comparing the treatment duration between Korean Medical Association (KMA) guideline and PARK Formula (AIS), only 22 patients (56.4%) showed agreement. The mean value was 1.02 week (7.18 days) smaller in KMA guideline. CONCLUSIONS For the decision of the treatment duration in trauma patients, utilizing worldwide used AIS scoring system is very efficient. Using PARK Formula (AIS), doctors can document the treatment duration in the casualty medical certificate with ease. KMA should provide more practical ‘treatment duration of each diagnosis in writing casualty medial certificate’ for the doctors. We recommend PARK Formula (AIS) as a good alternative for KMA guide.

Purpose: This study examined the effects of Sargassum horneri extracts on palmitic acid (PA)-induced endoplasmic reticulum (ER) stress in HepG2 cells. Methods: HepG2 cells were treated with varying concentrations of S. horneri extract or PA, and the cell viability was measured by water soluble tetrazolium salts analysis. The effective induction of ER stress and the effects of S. horneri were investigated through an examination of the ER stress-related genes, such as activating transcription factor 4 (ATF4), X-box binding protein (XBP1s), C/EBP homologous protein (CHOP), and 78-kDa glucose-regulated protein (GRP78) by quantitative reverse transcription polymerase chain reaction. The expression and activation levels of unfolded protein response (UPR) associated proteins, such as inositolrequiring enzyme-1α (IRE1α), eukaryotic translation initiation factor 2 alpha submit (eIF2α), and CHOP were examined by western blot analysis. Results: The treatment with PA increased the expression of UPR associated genes significantly and induced ER stress in a 12-hour treatment. Subsequent treatment with S.horneri reduced mRNA expression of ATF4, GRP78, and XBP1s. In addition, the protein levels of phosphate (p)-IRE1α, p-elF2α, and CHOP were also reduced by a treatment with S. horneri.An analysis of sirtuin (SIRT) mRNA expression in the S. horneri and PA-treated HepG2 cells showed that S. horneri increased the levels of SIRT2, SIRT6, and SIRT7, which indicates a possible role in reducing the expression of ER stress-related genes. Conclusion These data indicate thatS. horneri can exert an inhibitory effect on ER stress caused by PA and highlight its potential as an agent for managing various ER stress-related diseases.