This scoping review aimed to systematically explore the complex and nuanced perceptions of residents entrusted with significant responsibilities by their supervisors in the clinical context. We conducted a comprehensive search strategy targeting six major electronic databases. Data were extracted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist and a scoping review protocol. Resident perceptions regarding entrustment and its impact on learning and professional development were categorized. This review elucidated the role of supervisor entrustment in shaping residents’ clinical performance, notably influencing autonomy, self-confidence, responsibility for patients, learning needs and goals, uncertainty management, and professional identity formation. Residents identified factors that promote and hinder performance and entrustment development resulting from supervisor entrustment and distinguished between appropriate supervision and over- or under-supervision. Our review suggests that residents’ perceptions of supervisor entrustment, as bestowed by supervisors, serves as a catalyst for enhancing autonomy, thereby exerting a significant influence on clinical performance, and fostering the development of a professional identity. However, residents’ views on appropriate supervision differ in some ways from supervisors’ perspectives. Further research is needed to bridge the gap between residents’ expectations of autonomy and what they are given, and to explore the intricate relationship between autonomy and entrustment.

Objectives: Intradiscal steroid injection (ISI) use has been proven as a low-risk and rapid treatment for disc degeneration disease (DDD). However, the histological effects of steroids on human discs remain poorly understood. The purpose of this study is to investigate whether ISI induces histologic degeneration of the disc. Methods: In this study, a histological analysis was carried out on the nucleus pulposus obtained from 150 patients who underwent posterior lumbar interbody fusion. Among these individuals, 59 received ISI before the surgery, while 91 did not. After staining with hematoxylin and eosin, the histological classification was performed based on chondrocyte proliferation (C1, C2, and C3) and granular matrix change (M1 and M2). Logistic regression analysis was used to identify the main factors influencing chondrocyte proliferation and granular matrix change.Additionally, histological differences between the ISI group and the non-ISI group were analyzed. Results: Chondrocyte proliferation and granular matrix changes were not significantly different between the ISI and non-ISI groups. The logistic regression analysis indicated that age is the most significant risk factor for both chondrocyte proliferation (P = 0.02) and granular matrix changes (P < 0.01). Conclusions The most crucial factor in disc degeneration is age. ISI does not accelerate the histological degeneration of chondrocyte proliferation and granular matrix. Therefore, the ISI could be considered as a histologically safe alternative in patients with DDD.

Objectives: As the Fourth Industrial Revolution advances, there is a growing interest in digital technology. In particular, the use of digital therapeutics (DTx) in healthcare is anticipated to reduce medical expenses. However, analytical research on DTx is still insufficient to fuel momentum for future DTx development. The purpose of this article is to analyze representative cases of different types of DTx from around the world and to propose a classification system. Methods: In this exploratory study examining DTx interaction types and representative cases, we conducted a literature review and selected seven interaction types that were utilized in a large number of cases. Then, we evaluated the specific characteristics of each DTx mechanism by reviewing the relevant literature, analyzing their indications and treatment components. A representative case for each mechanism was provided. Results: Cognitive behavioral therapy, distraction therapy, graded exposure therapy, reminiscence therapy, art therapy, therapeutic exercise, and gamification are the seven categories of DTx interaction types. Illustrative examples of each variety are provided. Conclusions Efforts from both the government and private sector are crucial for success, as standardization can decrease both the expense and the time required for government-led DTx development. The private sector should partner with medical facilities to stimulate potential demand, carry out clinical research, and produce scholarly evidence.

Purpose: This study aimed to analyze the tasks of midwives who lead natural childbirth in hospitals using the DACUM technique. Methods: Data were collected from 42 hospital midwives between August 23 to October 12, 2022, and the importance, frequency, and professional difficulty of hospital midwives' tasks were assessed. The collected data were analysed using the IBM SPSS Statistics ver. 22.0 program as the average and standard deviation for the importance, difficulty, and frequency of performance the analyzed tasks. The importance, difficulty, and frequency of performance each task were indicated as high, medium, or low,; furthermore, the importance and difficulty were multiplied and analyzed using the coefficient of determination.Result: Midwives’ tasks in natural childbirth in hospitals were classified into 8 duties, 138 tasks, and 49 task elements. Duties were classified into ‘before childbirth,’ ‘during childbirth,’ ‘after childbirth,’ ‘management of high-risk pregnant women,’ ‘goods management,’ ‘administrative work,’ ‘self-development,’ and ‘newborn care.’ The most important and difficult tasks with the highest coefficient of determination were performing neonatal resuscitation if necessary (11.25), transporting and managing emergency patients (10.46), requesting hospitals to transfer patients in case of emergency (10.43), and transferring patients to a tertiary hospital in case of maternal of neonatal emergency (10.30). Conclusion In this novel study in Korea, the role of a midwife in a hospital for natural childbirth were defined, and task according to duties were analyzed.

Desmoplastic Spitz nevus is a rare variant of Spitz nevus characterized by predominantly spindle-shaped or epithelioid nevus cells within the fibrotic stroma that can be confused with fibrous lesions. A 43-year-old woman presented with a 1-cm-sized dome-shaped papule on the dorsum of her left foot. The lesion showed histopathological features of a desmoplastic Spitz nevus with structures that resemble adenoma. Immunohistochemical staining was positive for S-100 protein, Melan-A, and SOX-10. Herein, we report this case because desmoplastic Spitz nevus is rare and can lead to confusion regarding the diagnosis of adnexal neoplasms.

Purpose: The study aimed to clarify the concept of spiritual self-care in hospice team members. Methods: To analyze the concept of spiritual self-care of hospice care team, the study was carried out using Schwartz-Barcott and Kim's hybrid model including theoretical, fieldwork and final analytic stages. In the theoretical stage, 'spirituality', 'spiritual well-being', 'spiritual health', 'spiritual care', and 'self-care' were set as search terms, and the resulting 107 related works of domestic and international literature were analyzed. In the field survey stage, data were collected from nurses and spiritual experts with more than 5 years of experience in spiritual self-care. Results: The concept of spiritual self-care is to realize the meaning and purpose of life while constantly maintaining relationships with oneself, neighbors, communities, and the absolute, utilize transcendence and internal resources, strengthen professional competence, maintain work-life balance, and achieve spiritual well-being. It was identified as a dynamic state to realize. The quality attributes of the concept of spiritual self-care were found to have 5 attributes and 15 indicators. Conclusion The attributes and indicators derived through this study will be helpful in understanding the concept of hospice team members' spiritual self-care. In addition, as a way to continuously grow and train professional hospice team members, it can be used to develop a spiritual self-care assessment tool and an educational program to prevent burnout.

Purpose: The isocitrate dehydrogenase (IDH) family plays an essential role in metabolism and energy production. The relative expression levels of IDH isoforms (IDH1, IDH2, and IDH3) have prognostic significance in several malignancies, including breast carcinoma. However, the IDH isozyme expression levels in different cancer stages and types have not been determined in breast carcinoma tissues. Methods: We analyzed the messenger RNA (mRNA) and protein levels of IDH (IDH1, IDH2, and IDH3A) and α-ketoglutarate (α-KG) in 59 breast carcinoma tissues. Results: The mRNA level of IDH2 was significantly increased at stages 2 and 3 in triple-negative and (ER-/PR-/HER+) breast cancers. However, the elevated α-KG level was only observed in stages 2 and 3, with no differences in the various breast carcinoma types. Western blotting analysis showed that IDH2 protein expression increased in the patient tissues and cell lines. An in vitro study showed IDH2 downregulation in the triple-negative breast cancer cell line MDA-MB-231 that inhibited cell proliferation and migration and induced cell cycle arrest in the G0/G1 phase. Conclusion These findings suggest that different from IDH1 and IDH3, IDH2 is more highly expressed in stages 2 and 3 breast cancer tissues, especially in triple-negative breast cancer. IDH2 potentially serves as a target to detect unknown mechanisms in breast cancer.

Objectives: The purpose of this study was to explore new ways of creating value in the medical field and to derive recommendations for the role of medical institutions and the government. Methods: In this paper, based on expert discussion, we classified Internet of Things (IoT) technologies into four categories according to the type of information they collect (location, environmental parameters, energy consumption, and biometrics), and investigated examples of application. Results: Biometric IoT diagnoses diseases accurately and offers appropriate and effective treatment. Environmental parameter measurement plays an important role in accurately identifying and controlling environmental factors that could be harmful to patients. The use of energy measurement and location tracking technology enabled optimal allocation of limited hospital resources and increased the efficiency of energy consumption. The resulting economic value has returned to patients, improving hospitals’ cost-effectiveness. Conclusions Introducing IoT-based technology to clinical sites, including medical institutions, will enhance the quality of medical services, increase patient safety, improve management efficiency, and promote patient-centered medical services. Moreover, the IoT is expected to play an active role in the five major tasks of facility hygiene in medical fields, which are all required to deal with the COVID-19 pandemic: social distancing, contact tracking, bed occupancy control, and air quality management. Ultimately, the IoT is expected to serve as a key element for hospitals to perform their original functions more effectively. Continuing investments, deregulation policies, information protection, and IT standardization activities should be carried out more actively for the IoT to fulfill its expectations.

Purpose: Smoking is a way of coping with anxiety and stress. This study aimed to identify the effects of forest-thermal combined therapy on anxiety and depression in smokers who desire to quit smoking. Methods: Thirty participants were included in the study, 15 in the experimental group and 15 in the control group. Those in the experimental group participated in a three-day forest-thermal combined therapy program. The program includes forest walks, meditation and thermal therapy in the charcoal kiln. Results: Before and after the program, physiological indicators such as cortisol, heart rate variability, and serotonin anxiety level using the state-trait anxiety inventory (STAI), and stress level using the psychosocial well-being index (PWI) were measured in both groups. The differences in STAI (p = .012) and PWI (p = .006) scores between the experimental and control groups were statistically significant. However, cortisol, heart rate variability, and serotonin were not significantly different between the two groups after the program. Conclusion These results show that forest-thermal combination therapy effectively reduces anxiety and stress in smokers. It suggests that forest-thermal therapy can potentially increase smoking cessation rates.

Objectives: Smart hospitals involve the application of recent information and communications technology (ICT) innovations to medical services; however, the concept of a smart hospital has not been rigorously defined. In this study, we aimed to derive the definition and service types of smart hospitals and investigate cases of each type. Methods: A literature review was conducted regarding the background and technical characteristics of smart hospitals. On this basis, we conducted a focus group interview with experts in hospital information systems, and ultimately derived eight smart hospital service types. Results: Smart hospital services can be classified into the following types: services based on location recognition and tracking technology that measures and monitors the location information of an object based on short-range communication technology; high-speed communication network-based services based on new wireless communication technology; Internet of Things-based services that connect objects embedded with sensors and communication functions to the internet; mobile health services such as mobile phones, tablets, and wearables; artificial intelligence-based services for the diagnosis and prediction of diseases; robot services provided on behalf of humans in various medical fields; extended reality services that apply hyper-realistic immersive technology to medical practice; and telehealth using ICT. Conclusions Smart hospitals can influence health and medical policies and create new medical value by defining and quantitatively measuring detailed indicators based on data collected from existing hospitals. Simultaneously, appropriate government incentives, consolidated interdisciplinary research, and active participation by industry are required to foster and facilitate smart hospitals.