Background: Since November 2019, long-term care hospitals have been able to provide patients with discharging programs to support the elderly in the community. This study aimed to identify both patient- and hospital-level factors that affect successful community discharge from long-term care hospitals. Methods: A multilevel logistic regression model was performed using hospitals as a clustering unit. The dependent variable was whether a patient stayed in the community for at least 30 days after discharge from a long-term care hospital. As for the patient-level independent variables, an agreement between a patient and the family about discharge, length of hospital stay, patient category, and residence at discharge were included. The number of beds and the ratio of long-stay patients were selected for the hospital-level factors. The sample size was 1,428 patients enrolled in the discharging program from November 2019 to December 2020. Results: The number of patients who were discharged to the community and stayed at least for 30 days was 532 (37.3%). The intraclass correlation coefficient was 22.9%, indicating that hospital-level factors had a significant impact on successful community discharge. The odds ratio (OR) of successful community discharge increased by 1.842 times when the patients and their families agreed on discharge. The ORs also increased by 3.020 or 2.681 times, respectively when the patients planned to discharge to their own house or their child’s house compared to those who didn’t have a plan for residence at discharge. The ORs increased by 1.922 or 2.250 times when the hospitals were owned by corporate or private property compared to publicly owned hospitals. The ORs decreased by 0.602 or 0.520 times when the hospital was sized over 400 beds or located in small and medium-sized cities compared to less than 200 bedded hospitals or located in metropolitan cities. Conclusion The results of the study showed that the patients’ and their family’s willingness for discharge had a great impact on successful community discharge and the hospital-level factors played a significant role in it. Therefore, it is important to acknowledge and support long-term care hospitals to involve active in the patient discharge planning process.

This study aimed to analyze the association of midpalatal suture (MPS) maturation stages with skeletal maturation and age and to obtain references for establishing a treatment plan for rapid maxillary expansion (RME).Cone-Beam Computed Tomography (CBCT) images from 480 children (240 boys, 240 girls) aged 7 – 15 years were obtained. MPS maturation stages and cervical vertebral maturation indicator (CVMI) were evaluated, and the correlations between MPS maturation stages, CVMI, and age were determined using the Spearman's correlation test. The positive likelihood ratio (LHR) of CVMI for MPS maturation stages was calculated.MPS maturation stages and CVMI showed a strong correlation. Especially, CVMI 1 – 3 showed positive LHR greater than 10 for the diagnosis of stages A – C. MPS maturation stages and age were correlated strongly in girls and moderately in boys.Conventional RME produces the most favorable skeletal effect at CVMI 1 – 3 or those up to 12 years of age and fewer skeletal effects at CVMI 4 or at 13 years of age in girls and 13 – 15 years in boys. It is recommended to evaluate MPS maturation stages using CBCT before RME application at CVMI 5, 6 or at 14, 15 years of age in girls.
Adolescent ; Child ; Cone-Beam Computed Tomography ; Diagnosis ; Female ; Humans ; Palatal Expansion Technique ; Sutures

This study aimed to assess the skeletal age of skeletal maturational indicator (SMI) and middle phalanx of the middle finger (MP3) stages and to predict the SMI and MP3 stages corresponding to pubertal growth spurt in boys and girls respectively.The skeletal age was assessed from hand-wrist radiographs of 363 children (182 boys, 181 girls) aged 7 to 16 years by radiologists using the Korean standard bone age chart. Also, SMI and MP3 stages were evaluated from the radiographs. From these records, the mean skeletal age of SMI and MP3 stages was calculated.The stages including pubertal growth spurt were SMI 4 – 5, MP3 FG – G stages in boys and SMI 3 – 4, MP3 F – FG stages in girls.
Child ; Female ; Fingers ; Humans

PURPOSE: Enteral nutrition is recommended in critically ill patients. On the other hand, the recommendation of nutritional support is limited and often controversial in critically ill patients in the prone position. Therefore, this study evaluated the clinical outcomes of nutritional support in critically ill patients in the prone position. METHODS: A retrospective evaluation of the electronic medical records was conducted, including adult patients who were in the medical intensive care unit (ICU) in the prone position in Seoul National University Bundang Hospital from May 1, 2015 to June 30, 2017. The patients' characteristics, nutritional support status while they were in the prone position, mortality in ICU and during hospitalization, ICU length of stay, mechanical ventilation days, and complications, such as ventilator associated pneumonia (VAP) and vomiting were collected. RESULTS: In total, 100 patients were included. Of these, 12 received enteral nutrition and parenteral nutrition and 88 received only parenteral nutrition. The groups were similar in terms of age, sex, number of comorbidity, weight, PaO₂/FiO₂, hours of prone position, Simplified Acute Physiology Score II (SAPS II), Acute Physiologic and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score. No differences were observed in ICU mortality (75.0% vs. 46.6%; P=0.065), hospital mortality (83.3% vs. 58.0%; P=0.081), ICU length of stay (22.2±14.6 vs. 18.2±21.2; P=0.128) and mechanical ventilation days (19.3±14.8 vs. 14.5±19.1; P=0.098). In addition, there were no differences in the possible complications of the prone position, such as VAP (8.3% vs. 4.5%; P=0.480) and vomiting (8.3% vs. 1.1%; P=0.227). CONCLUSION: No significant differences in the clinical outcomes were observed. Further studies will be needed to confirm the way of nutrition support while in the prone position.
Adult ; Comorbidity ; Critical Illness* ; Electronic Health Records ; Enteral Nutrition ; Hand ; Hospital Mortality ; Hospitalization ; Humans ; Intensive Care Units ; Length of Stay ; Mortality ; Nutritional Support ; Parenteral Nutrition ; Physiology ; Pneumonia, Ventilator-Associated ; Prone Position* ; Respiration, Artificial ; Retrospective Studies ; Seoul ; Vomiting

Objective: The rising number of carbapenemase-resistant Enterobacteriaceae (CRE) cases has become a concern worldwidely. This study investigated patient characteristics with CRE and analyzed the risk factors associated with its acquisition. Methods: A retrospective review of the electronic medical records of the Kangbuk Samsung Medical Center from May 2016 to April 2019 was performed. The inclusion criterion was hospitalized patients aged ≥18 years with confirmed CRE acquisition. Patients were divided by CRE acquired and non-required patients. CRE acquired patients were those with CRE confirmed by their active surveillance cultures, while non-acquired patients were those with carbapenemase-sensitive Enterobacteriaceae (CSE). If CRE was isolated more than once during hospitalization, only the first isolation was used for data analysis. Patient characteristics, antibiotic used, and the duration of use were compared between two groups using univariate analysis, and the risk factors associated with CRE were analyzed using multiple logistic regression analysis. Results: Among the 73 CRE acquired patients, 44 (60.3%) were positive for carbapenemase-producing Enterobacteriaceae (CPE). Infection from Klebsiella pneumonia (42 cases, 57.5%), Escherichia coli (17 cases, 23.3%), and Enterobacter cloacae (5 cases, 6.8%). The risk of CRE acquisition was significantly increased by 4.99 times [confidence interval (CI), 1.40-17.78; p=0.013] with mechanical ventilation, 3.86 times (CI, 1.59-9.36; p=0.003) with penicillin administration, and 21.19 times (CI, 6.53-68.70; p<0.001) with carbapenem administration. Conclusions Proper antibiotic use including the selection, frequency, and duration, and patients on mechanical ventilators need close monitoring.

This study was aimed at investigating the possible effects of phytoceramide (Pcer) on learning and memory and their underlying mechanisms. Phytoceramide was orally administered to ICR mice for 7 days. Memory performances were assessed using the passive avoidance test and Y-maze task. The expressions of phosphorylated cAMP response element binding protein (pCREB), brain-derived neurotrophic factor (BDNF) were measured with immunoblot. The incorporation of 5-bromo-2-deoxyuridine (BrdU) in hippocampal regions was investigated by using immunohistochemical methods. Treatment of Pcer enhanced cognitive performances in the passive avoidance test and Y-maze task. Immunoblotting studies revealed that the phosphorylated CREB and BDNF were significantly increased on hippocampus in the Pcer-treated mice. Immunohistochemical studies showed that the number of immunopositive cells to BrdU was significantly increased in the hippocampal dentate gyrus regions after Pcer-treatment for 7 days. These results suggest that Pcer contribute to enhancing memory and BDNF expression and it could be secondary to the elevation of neurogenesis.
Animals ; Brain-Derived Neurotrophic Factor* ; Bromodeoxyuridine ; Cyclic AMP Response Element-Binding Protein ; Dentate Gyrus ; Hippocampus* ; Immunoblotting ; Learning ; Memory* ; Methods ; Mice* ; Mice, Inbred ICR ; Neurogenesis

The variant B.1.1.7 of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the RNA virus causing the pandemic more than a year worldwide, was reported from United Kingdom (UK) in late December 2020. It was reported that mortality increases by 65% and transmissibility increases by 70%, which may result in an increase of reproduction number to 1.13−1.55 from 0.75−0.85. To analyze the global increasing trend of the variant B.1.1.7, we extracted results of B.1.1.7 from GISAID on May 11 and May 12, 2021, and conducted a doseresponse regression. It took 47 days to reach 20% and 121 days to reach 50% among the sequence submitted from UK. In Korea, cases of B.1.1.7 have increased since the first report of three cases on December 28, 2020. Positive rate of B.1.1.7 in Korea was 21.6% in the week from May 9 to May 15, 2021. Detection rate of the variants is expected to increase further and new variants of SARS-CoV-2 are emerging, so a close monitoring and control would be maintained for months.

Noonan syndrome is characterized by distinctive facial features, short stature, and congenital heart disease. It is a congenital genetic disorder with a prevalence of between 1/1,000 and 1/2,500 in both genders.An 11-year-old boy with Noonan syndrome visited the hospital with an ectopically positioned tooth. A pulmonary stenosis was diagnosed and his growth and development were delayed. In many cases of this diseases there is obvious hemostasis, which he was not experiencing. His facial appearance showed characteristic features of Noonan syndrome. The patient showed a dental class II relationship, labioversion of the upper anterior teeth, and a shallow overbite. Radiographic examination revealed that the upper right canine was ectopically positioned, which led to root resorption of the upper right lateral incisor. A lateral cephalometric radiograph revealed a craniofacial pattern that was within normal limits. Surgical opening and button attachment on the impacted upper right canine were performed and traction was applied on the impacted tooth using a removable appliance.This patient was mildly affected by Noonan syndrome and showed some dental problems. However, few studies have reported the oral characteristics of Noonan syndrome despite its high incidence. Thus, this case report describes the oral features and management of Noonan syndrome.
Child ; Growth and Development ; Heart Defects, Congenital ; Hemostasis ; Humans ; Incidence ; Incisor ; Male ; Noonan Syndrome ; Overbite ; Prevalence ; Pulmonary Valve Stenosis ; Root Resorption ; Tooth ; Tooth, Impacted ; Traction

The variant B.1.1.7 of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the RNA virus causing the pandemic more than a year worldwide, was reported from United Kingdom (UK) in late December 2020. It was reported that mortality increases by 65% and transmissibility increases by 70%, which may result in an increase of reproduction number to 1.13−1.55 from 0.75−0.85. To analyze the global increasing trend of the variant B.1.1.7, we extracted results of B.1.1.7 from GISAID on May 11 and May 12, 2021, and conducted a doseresponse regression. It took 47 days to reach 20% and 121 days to reach 50% among the sequence submitted from UK. In Korea, cases of B.1.1.7 have increased since the first report of three cases on December 28, 2020. Positive rate of B.1.1.7 in Korea was 21.6% in the week from May 9 to May 15, 2021. Detection rate of the variants is expected to increase further and new variants of SARS-CoV-2 are emerging, so a close monitoring and control would be maintained for months.

PURPOSE: The aim of this study is to identify the status of clerkship education and its evaluation in Korea. METHODS: Questionnaires were sent to 943personnel in 23clinical departments of 41medical schools nationwide from April, 1 to April 10, 2004. We analyzed the 638 questionnaires that were collected from 39medical schools. RESULTS: The most frequently used methodologies for clerkship education were small group lecture(17.1%), observation of ambulatory care(15.7%), seminar(12.9%), observation and support of operation(12.4%), ward rounding(12.1%). The relative proportion of educational methodologies was varied according to the type of clinical departments. Most of the clinical clerkship activity was conducted in the university hospital. Also, the clerkship activities were educated by professors(57.8%), fellows(9.1%), residents(30.6%) and others(2.5%). The evaluation methods were written exam(21.8%), attendance(17.5%), report(14.0%), and oral exam(12.0%). In terms of evaluating items, acquirement of clinical knowledge has been mainly tested. However, students' ability to communicate, build human relationship, and clinical skills has been less frequently evaluated in most of medical schools. CONCLUSION: It is most likely that the current status of clerkship education and its evaluation in Korea is focused on the education and assessment of clinical knowledge. To improve this, the following areas need to be enriched: interaction between faculty and students, experience-based clerkship, effective feedback, time management, objectivity of evaluation, performance evaluation.
Clinical Clerkship ; Clinical Competence ; Education* ; Evaluation Studies as Topic ; Humans ; Korea ; Schools, Medical* ; Time Management ; Surveys and Questionnaires