Exposure of the angle of His (AOH) with liver retraction is one of the key processes during laparoscopic sleeve gastrectomy (LSG). A new internal liver retractor, the LiVac (LiVac, Pty Ltd.) has recently been introduced. This study was conducted to evaluate the feasibility of the LiVac in LSG. We applied the LiVac in 20 patients who received LSG. The feasibility was assessed by exposure of the AOH, operation time, complications, and changes of aspartate transaminase and alanine transaminase. In all 20 patients, exposure of the AOH was successful. The mean operation time was 88 minutes. The changes in preoperative and postoperative aspartate transaminase and alanine transaminase levels were 18.6 and 9.1 U/L, respectively. There were no related morbidities. In LSG, exposure of the AOH using the LiVac was technically feasible.

Exposure of the angle of His (AOH) with liver retraction is one of the key processes during laparoscopic sleeve gastrectomy (LSG). A new internal liver retractor, the LiVac (LiVac, Pty Ltd.) has recently been introduced. This study was conducted to evaluate the feasibility of the LiVac in LSG. We applied the LiVac in 20 patients who received LSG. The feasibility was assessed by exposure of the AOH, operation time, complications, and changes of aspartate transaminase and alanine transaminase. In all 20 patients, exposure of the AOH was successful. The mean operation time was 88 minutes. The changes in preoperative and postoperative aspartate transaminase and alanine transaminase levels were 18.6 and 9.1 U/L, respectively. There were no related morbidities. In LSG, exposure of the AOH using the LiVac was technically feasible.

Clinical reasoning, which is based on an understanding of the pathophysiological mechanisms of diseases, is a core nursing competency that involves analyzing patient-related data and providing appropriate nursing practices. Simulation-based education is effective in improving clinical reasoning competencies and communication skills. This study evaluated the effectiveness of virtual simulation-based learning in improving the communication skills and clinical reasoning competencies of undergraduate nursing students. Methods: This study used a single-group pretest and posttest quasi-experimental design to evaluate the effectiveness of virtual simulation-based learning. Data were collected from June to September 2020. Thirty-six nursing students in their third and fourth years of study who understood the purpose of this study were selected as participants. The collected data were analyzed using SPSS Statistics 25.0 and Winsteps 3.68.2. Results: The communication skills (t = −12.80, p < .001) and clinical reasoning competency (t = −4.67, p < .001) of the undergraduate nursing students who participated in the virtual simulation-based learning program improved significantly after participation. Additionally, a Rasch model analysis revealed that the overall clinical reasoning competency of undergraduate nursing students improved. Conclusion: Virtual simulation-based learning programs for nursing students should be developed and implemented.

Clinical reasoning, which is based on an understanding of the pathophysiological mechanisms of diseases, is a core nursing competency that involves analyzing patient-related data and providing appropriate nursing practices. Simulation-based education is effective in improving clinical reasoning competencies and communication skills. This study evaluated the effectiveness of virtual simulation-based learning in improving the communication skills and clinical reasoning competencies of undergraduate nursing students. Methods: This study used a single-group pretest and posttest quasi-experimental design to evaluate the effectiveness of virtual simulation-based learning. Data were collected from June to September 2020. Thirty-six nursing students in their third and fourth years of study who understood the purpose of this study were selected as participants. The collected data were analyzed using SPSS Statistics 25.0 and Winsteps 3.68.2. Results: The communication skills (t = −12.80, p < .001) and clinical reasoning competency (t = −4.67, p < .001) of the undergraduate nursing students who participated in the virtual simulation-based learning program improved significantly after participation. Additionally, a Rasch model analysis revealed that the overall clinical reasoning competency of undergraduate nursing students improved. Conclusion: Virtual simulation-based learning programs for nursing students should be developed and implemented.

Clinical reasoning, which is based on an understanding of the pathophysiological mechanisms of diseases, is a core nursing competency that involves analyzing patient-related data and providing appropriate nursing practices. Simulation-based education is effective in improving clinical reasoning competencies and communication skills. This study evaluated the effectiveness of virtual simulation-based learning in improving the communication skills and clinical reasoning competencies of undergraduate nursing students. Methods: This study used a single-group pretest and posttest quasi-experimental design to evaluate the effectiveness of virtual simulation-based learning. Data were collected from June to September 2020. Thirty-six nursing students in their third and fourth years of study who understood the purpose of this study were selected as participants. The collected data were analyzed using SPSS Statistics 25.0 and Winsteps 3.68.2. Results: The communication skills (t = −12.80, p < .001) and clinical reasoning competency (t = −4.67, p < .001) of the undergraduate nursing students who participated in the virtual simulation-based learning program improved significantly after participation. Additionally, a Rasch model analysis revealed that the overall clinical reasoning competency of undergraduate nursing students improved. Conclusion: Virtual simulation-based learning programs for nursing students should be developed and implemented.

Clinical reasoning, which is based on an understanding of the pathophysiological mechanisms of diseases, is a core nursing competency that involves analyzing patient-related data and providing appropriate nursing practices. Simulation-based education is effective in improving clinical reasoning competencies and communication skills. This study evaluated the effectiveness of virtual simulation-based learning in improving the communication skills and clinical reasoning competencies of undergraduate nursing students. Methods: This study used a single-group pretest and posttest quasi-experimental design to evaluate the effectiveness of virtual simulation-based learning. Data were collected from June to September 2020. Thirty-six nursing students in their third and fourth years of study who understood the purpose of this study were selected as participants. The collected data were analyzed using SPSS Statistics 25.0 and Winsteps 3.68.2. Results: The communication skills (t = −12.80, p < .001) and clinical reasoning competency (t = −4.67, p < .001) of the undergraduate nursing students who participated in the virtual simulation-based learning program improved significantly after participation. Additionally, a Rasch model analysis revealed that the overall clinical reasoning competency of undergraduate nursing students improved. Conclusion: Virtual simulation-based learning programs for nursing students should be developed and implemented.

OBJECTIVES: This study aimed to identify the characteristics of depression in early dementia and mild cognitive impairment patients. METHODS: We included 412 community-dwelling elderly. They were assessed with Mini-Mental Status Examination in the Korean version of the CERAD Assessment Packet (MMSE-KC), Clinical Dementia Rating Scale (CDR), Korean version of Geriatric Depression Scale (GDS) and Korean version of Hamilton Depression Rating Scale (HDRS). All patients were divided three groups, nondemented group (ND), mild cognitive impairment group (MCI), and early dementia group (ED). We compared depressive symptoms between three groups using each items of HDRS. RESULTS: Prevalence of depression (GDS> or =16) was 24.6% in ND, 33.3% in MCI and 41% in ED. Several items of HDRS, depressed mood, feeling of guilt, loss of work & interests, psychomotor retardation, psychomotor agitation, psychic anxiety, somatic anxiety, and gastrointestinal symptoms, were significantly associated with cognitive decline in all subjects. However, no item of HDRS was significantly associated with cognitive decline in depressive patients. CONCLUSION: This study suggests that the prevalence of depression may increase as cognitive function declines. There was no difference in depressive symptoms between three groups.
Aged ; Alzheimer Disease* ; Anxiety ; Dementia ; Depression* ; Guilt ; Humans ; Mild Cognitive Impairment* ; Prevalence* ; Psychomotor Agitation

Purpose: The purpose of this study is to evaluate the usefulness of individualized metabolic surgery score for Korean patients in determining bariatric surgical procedures. Materials and Methods: A total of 135 patients with type 2 diabetes mellitus who underwent sleeve gastrectomy (n=19) or Roux-en-Y gastric bypass (n=116) at our institute with a 1-year follow up were analyzed for the predictive power of diabetes remission using the individualized metabolic surgery scoring system. Results: At the postoperative follow-up of 1 year, the remission of type 2 diabetes mellitus (HbA1C＜6.5%, off medications) was achieved in 88 (65.2%) patients. The remission rates showed no significant differences between patients who underwent sleeve gastrectomy and Roux-en-Y gastric bypass (63.2% versus 65.5%; P=0.84), regardless of the severity of type 2 diabetes mellitus. Although there was no statistically significant difference in the remission rate according to the bariatric surgery procedures (P＞0.99 in mild, P=0.11 in moderate, P＞0.99 in severe IMS score), remission rates were higher in moderate severity patients who underwent Roux-en-Y gastric bypass than in those who underwent sleeve gastrectomy (69.7% versus 37.5%). Conclusion The remission rates after bariatric surgery procedures were similar to that of the previously reported study. Despite the limitations of our data, the individualized metabolic surgery score can be used as a complement to other scoring systems in Korean patients.

Laparoscopic sleeve gastrectomy (LSG) has become a standalone primary procedure as a bariatric metabolic surgery since the early 2000s. The overall complication rate of LSG is reported to range from 2% to 15%. Staple line leakage (SLL) remains a major adverse event and occurs in approximately 1%–6% of patients. Choosing the optimal treatment modality is a complex process. Clinicians must understand that nutritional support and drainage of fluid collection are essential for initial management. Conservative endoscopic management and sufficient drainage can resolve approximately 70% of SLLs. Endoscopic management of bariatric complications has been rapidly evolving in recent years and can be considered in all patients who are hemodynamically stable. We will review the available endoscopic management techniques, including stent placement (self-expanding stents and bariatric-specific stents), clipping, tissue sealant application, and internal drainage (double-pigtail stents [DPS] placement, endoscopic vacuum therapy, and septotomy). Stent placement remains the mainstream treatment for SLLs. However, healing with stents requires multiple sessions/stents and a long course of recovery. Endoscopic internal drainage is gaining popularity and has the potential to be a superior method. The importance of early intervention and combined endoscopic methods should be recognized.

BACKGROUND/OBJECTIVES: Accumulating evidence has shown the beneficial effects of isoflavone on health. There is limited information on the usual isoflavone intake for Koreans.This study examined the usual intake of total isoflavone and its major food sources in Koreans according to age and gender. SUBJECTS/METHODS: The dietary intake data of 21,271 participants aged 1 yrs and older from the Korea National Health and Nutrition Examination Survey (KNHANES) VII 2016– 2018 were analyzed. The average isoflavone intake was estimated based on the 24-h dietary recall data in KNHANES and the isoflavone database from the Korea Rural Development Administration (RDA) and literatures. The usual isoflavone intake was estimated by applying the ratio of within- and between-participant variance estimated from the 2009 KNHANES data to the 7th KNHANES (2016–2018) data. The variance of the isoflavone intake was calculated using MIXTRAN macro with intake data for two days in the 2009 KNHANES.Complex sample analysis with stratified variables and integrated weights was conducted. RESULTS: The mean total isoflavone intake in the Korean population aged 1 yrs and older (n = 21,271) was 139.27 mg/d, which was higher than the usual intake of 47.44mg/d. Legumes were a major contributing food group (91%), with arrowroot being a major individual contributor to the isoflavone intake (67.2%), followed by 21.3% of soybean, 5.4% of bean sprouts, and 2.1% of tofu. The usual isoflavone intake was highest in the participants aged 50 to 64 yrs old and increased with age until 50 to 64 yrs and then decreased with further increases in age.The usual isoflavone intake of participants aged 65 yrs and older was higher for men than for women, showing gender differences. CONCLUSIONS The usual dietary intake of isoflavone varied according to age and gender in the Korean population. This study showed that the usual isoflavone intake was lower than the average isoflavone intake. The difference between percentiles of the usual isoflavone intake was similarly smaller than the average intake. An estimation of average intake can be hindered by the occasional consumption of foods high in isoflavones, suggesting that the usual intake estimation method can be more appropriate. Further research will be needed to establish isoflavone dietary guidelines regarding the effects of isoflavone intake on health outcomes.