Delirium is described as a manifestation of acute brain injury and recognized as one of the most common complications in intensive care unit (ICU) patients. Although the causes of delirium vary widely among patients, delirium increases the risk of longer ICU and hospital length of stay, death, cost of care, and post-ICU cognitive impairment. Prevention and early detection are therefore crucial. However, the clinical approach toward delirium is not sufficiently aggressive, despite the condition's high incidence and prevalence in the ICU setting. While the underlying pathophysiology of delirium is not fully understood, many risk factors have been suggested. As a way to improve delirium-related clinical outcome, high-risk patients can be identified. A valid and reliable bedside screening tool is also needed to detect the symptoms of delirium early. Delirium is commonly treated with medications, and haloperidol and atypical antipsychotics are commonly used as standard treatment options for ICU patients although their efficacy and safety have not been established. The approaches for the treatment of delirium should focus on identifying the underlying causes and reducing modifiable risk factors to promote early mobilization.
Antipsychotic Agents ; Brain Injuries ; Critical Care ; Delirium* ; Early Ambulation ; Haloperidol ; Humans ; Incidence ; Intensive Care Units* ; Length of Stay ; Mass Screening ; Prevalence ; Risk Factors

PURPOSE: This study was to examine the relation between diabetes and cognitive function in older adults. METHODS: Eighty community-dwelling patients with diabetes and 506 subjects without diabetes were studied with cognitive function test. Cognitive function was measured by Full-scale IQ, Basic IQ, Executive IQ, Attention Function Index, Working Memory Index, Language Function Index, Visuospatial Function Index, Memory Function Index, and MMSE-K1. RESULTS: In model controlling for education, the diabetic group showed significantly lower scores than the non-diabetic group in in Full-scale IQ (p=.012), Basic IQ (p=.034), Executive IQ (p=.014), Attention Function Index (p=.002), Working Memory Index (p=.037), and Memory Function Index (p=.043). The diabetic and non-diabetic groups that were matched for gender, age, and education showed similar differences in 7 out of 9 cognitive measures. The impairments of Full-scale IQ and Memory Function Index in the diabetic group were, respectively, 2.7 and 2.8 times greater than that in the diabetic group. CONCLUSION: These results showed that diabetes should be considered to a factor of cognitive impairment in older adults.
Adult* ; Diabetes Mellitus ; Education ; Executive Function ; Humans ; Memory ; Memory, Short-Term

PURPOSE: The purpose of this study was to examine the validity of a single item scale by comparing a single item scale of health related quality of life to subscopes of the multi-item scales in the Medical Outcome Study Short Form-36 (SF-36), and Minnesota Living with Heart Failure Questionnaire (MLHFQ). METHOD: The data from 103 patients with heart failure were analyzed. The statistics program SPSS 12.0 used for descriptive statistics. RESULTS: Significant correlations were found between the single item scale and subscopes of SF-36, for physical functioning (r= .42), role physical (r= .22), general health perception (r= .46), vitality (r= .40), social functioning (r= .20) and mental health (r= .51), but not for body pain (r= .12) and role emotional (r= .06). Physical (r= -.41), emotional (r= -.49) and total scores (r= -.49) of MLHFQ were significantly related to the single item scale. CONCLUSION: The single item scale of health related quality of life showed low to moderate correlation with multi-item scales. Even though the single item scale was correlated with several subscopes of multi-item scales, the correlation was not high, so we have to use caution when using the single item scale instead of multi-item scales.
Heart ; Heart Failure ; Humans ; Mental Health ; Minnesota ; Outcome Assessment (Health Care) ; Quality of Life ; Surveys and Questionnaires ; Reproducibility of Results ; Weights and Measures

OBJECTIVES: The aim of this study was to assess the effectiveness of the Smart Care service for the diabetes management. METHODS: Fifty-six patients with diabetes mellitus were recruited in Daegu, Korea. All participants completed a diabetes management education course (diet, exercise, and complications) for their self-care and received access to a care management website through a netbook and smartphone. The website accepts uploads of glucose level, body weight, HbA1c, low-density lipoprotein cholesterol level, and blood pressure. Participants communicated with the care manager through the internal management system of the website. The intervention was applied for 6 months. RESULTS: Participants receiving the Smart Care service had lower blood glucose and HbA1c during 6 months follow-up when 1-month values (p < 0.001) were compared. There was no significant difference in body weight and body mass index between 1 month and 6 months. The average number of remote consultation with the Smart Care service per person was 10.4 by nurses, 3.0 by nutritionists, and 1.6 by sports curers. Regression analysis indicated that the number of times counseling was offered by nurses influences body weight and that the number of minutes of telephone counseling influences both body weight and body mass index. CONCLUSIONS: We have confirmed that the Smart Care service might be an effective system for reduction in blood glucose and HbA1c. We expect that the Smart Care service will contribute to delaying diabetes complications and improving the quality of life of patients with diabetes.
Blood Glucose ; Blood Pressure ; Body Mass Index ; Body Weight ; Cholesterol ; Counseling ; Daegu ; Diabetes Complications ; Diabetes Mellitus ; Education ; Follow-Up Studies ; Glucose ; Health Services ; Humans ; Korea ; Lipoproteins ; Medical Informatics ; Nutritionists ; Quality of Life ; Remote Consultation ; Self Care ; Sports ; Telemedicine ; Telephone

Preoperative assessment and optimization of a patient's condition are important components of anesthesia practice. Improvements in evaluation and management can potentially reduce adverse events, improve patient and caregiver satisfaction, and reduce costs. Although routine preoperative laboratory tests are ordered in many institutions, history taking and physical examination provide more information about patients than laboratory tests do. Therefore, history taking and physical examination should be used to direct test ordering, and a test should be ordered only if the results will impact the decision to proceed with the planned procedure or alter the care plans. Preoperative laboratory tests without specific indications lack clinical usefulness and may actually lead to patient injury because of unnecessary interventions, delay of surgery, anxiety, and even inappropriate therapies. After sufficient discussion between anesthesiologists and surgeons in each institution, diagnostic testing guidelines for the preoperative evaluation should be developed to improve patient care, standardize clinical practice, improve efficiency, and reduce costs. For preoperative management for infants, preoperative evaluation is similar to that for the adult, but reducing anxiety of patients and their parents is especially important. Although many nonpharmacologic methods are used to reduce anxiety, the pharmacologic methods are more effective than nonparmacologic methods. The administration of sedative premedication to infants who are about to undergo anesthesia and surgery can result in beneficial effects during the preoperative and postoperative periods by decreasing anxiety, increasing cooperation during anesthesia induction, and reducing negative postoperative behavioral responses.
Adult ; Anesthesia ; Anxiety ; Caregivers ; Diagnostic Tests, Routine ; Humans ; Infant* ; Parents ; Patient Care ; Physical Examination ; Postoperative Period ; Preanesthetic Medication ; Premedication ; Preoperative Care

Vaccination is the most successful immunological practice that improves the quality of human life and health. Vaccine materials include antigens of pathogens and adjuvants potentiating the effectiveness of vaccination. Vaccines are categorized using various criteria, including the vaccination material used and the method of administration. Traditionally, vaccines have been injected via needles. However, given that most pathogens first infect mucosal surfaces, there is increasing interest in the establishment of protective mucosal immunity, achieved by vaccination via mucosal routes. This review summarizes recent developments in mucosal vaccines and their associated adjuvants.
Humans ; Immunity, Mucosal ; Methods ; Needles ; Vaccination ; Vaccines*

Vaccination is one of the most successful applications of immunology and for a long time has depended on parenteral administration protocols. However, recent studies have pointed to the promise of mucosal vaccination because of its ease, economy and efficiency in inducing an immune response not only systemically, but also in the mucosal compartment where many pathogenic infections are initiated. However, successful mucosal vaccination requires the help of an adjuvant for the efficient delivery of vaccine material into the mucosa and the breaking of the tolerogenic environment, especially in oral mucosal immunization. Given that M cells are the main gateway to take up luminal antigens and initiate antigen-specific immune responses, understanding the role and characteristics of M cells is crucial for the development of successful mucosal vaccines. Especially, particular interest has been focused on the regulation of the tolerogenic mucosal microenvironment and the introduction of the luminal antigen into the lymphoid organ by exploiting the molecules of M cells. Here, we review the characteristics of M cells and the immune regulatory factors in mucosa that can be exploited for mucosal vaccine delivery and mucosal immune regulation.
Administration, Oral ; Animals ; Antigens, Bacterial/*immunology ; Antigens, Viral/*immunology ; Bacterial Vaccines/administration & dosage/*immunology ; Humans ; Immunity, Mucosal ; Intestinal Mucosa/cytology/*immunology ; Peyer's Patches/cytology/*immunology ; Viral Vaccines/administration & dosage/*immunology

Delirium is described as a manifestation of acute brain injury and recognized as one of the most common complications in intensive care unit (ICU) patients. Although the causes of delirium vary widely among patients, delirium increases the risk of longer ICU and hospital length of stay, death, cost of care, and post-ICU cognitive impairment. Prevention and early detection are therefore crucial. However, the clinical approach toward delirium is not sufficiently aggressive, despite the condition's high incidence and prevalence in the ICU setting. While the underlying pathophysiology of delirium is not fully understood, many risk factors have been suggested. As a way to improve delirium-related clinical outcome, high-risk patients can be identified. A valid and reliable bedside screening tool is also needed to detect the symptoms of delirium early. Delirium is commonly treated with medications, and haloperidol and atypical antipsychotics are commonly used as standard treatment options for ICU patients although their efficacy and safety have not been established. The approaches for the treatment of delirium should focus on identifying the underlying causes and reducing modifiable risk factors to promote early mobilization.
Antipsychotic Agents ; Brain Injuries ; Critical Care ; Delirium ; Early Ambulation ; Haloperidol ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Mass Screening ; Prevalence ; Risk Factors

PURPOSE: Femoral intertrochanteric fractures are common in the elderly. Appropriate surgical fixation of trochanteric fracture fragments can restore normal anatomical structure and ambulation, and can aid in the recovery of biomechanical function of the hip. We evaluated clinical outcomes of bipolar hemiarthroplasty using a wiring technique for trochanteric fracture fragment fixation. MATERIALS AND METHODS: From September 2006 to February 2015, a total of 260 cases underwent simultaneous bipolar hemiarthroplasty and wire fixation. A total of 65 patients (69 hips) with an average age of 78 years and more than one year of follow-up was included in the study. Using pre-, postoperative and follow-up radiograms, we evaluated wire fixation failure and also assessed changes in walking ability. RESULTS: Loosening or osteolysis around the stem was not observed; however, we did observe bone growth around the stem (54 cases), cortical hypertrophy (6 cases), a wide range of sclerotic lines but no stem subsidence (1 case), wire breakage (9 cases), and fracture fragment migration with no significant functional deficiency (2 cases). CONCLUSION: Our study showed that additional wiring for trochanteric fracture fragment fixation following bipolar hemiarthroplasty can help restore normal anatomy. The added stability results in faster rehabilitation, and good clinical and radiographic outcomes. We recommend this procedure in this type of fracture.
Aged ; Bone Development ; Bone Wires ; Clinical Study* ; Femur* ; Follow-Up Studies ; Fracture Fixation ; Hemiarthroplasty* ; Hip ; Hip Fractures ; Humans ; Hypertrophy ; Osteolysis ; Rehabilitation ; Walking

Patients with Pierre Robin syndrome are characterized by micrognathia, retrognathia, glossoptosis, and respiratory obstruction and are prone to have a difficult-to-intubate airway. The McGrath(R) MAC video laryngoscope provides a better view of the glottis than a Macintosh laryngoscope, but it is not easy to insert an endotracheal tube through the vocal cords because a video laryngoscope has a much greater curvature than that of a conventional direct laryngoscope and an endotracheal tube has a different curvature. The Frova Intubating Introducer is used as a railroad for an endotracheal tube in cases of a difficult airway. We thought that a combination of these two devices would make it easy to insert an endotracheal tube through the vocal cords, as a McGrath(R) MAC video laryngoscope provides a better glottic view and the Frova Intubating Introducer is a useful device for placing an endotracheal tube through the glottis. We report a successful endotracheal intubation with use of the McGrath(R) MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome.
Airway Management ; Glottis ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes* ; Pierre Robin Syndrome* ; Railroads ; Retrognathia ; Vocal Cords