Purpose: This study aimed to investigate the nationwide intention to delegate clinical practice of medical specialists in accordance with the enactment of the scope of practice for advanced practice nurses (APNs). Methods: Data were collected from October to December 2021 using Google Surveys. In total, 147 medical specialists from 12 provinces responded to the survey. The survey questionnaire was categorized into four legislative draft duties, according to the scope of practice (a total of 41 tasks): Twenty-nine tasks on treatments, injects, etc., performed under the guidance of a physician and other activities necessary for medical treatment (treatment domain); two tasks on collaboration and coordination; six tasks on education, counseling, and quality improvement; four regarding other necessary tasks. Participants were asked whether they were willing to delegate the tasks to APN. Results: The intention to delegate tasks to APN was higher for non-invasive tasks such as blood sampling (97.3%) or simple dressing (96.6%). Invasive tasks such as endotracheal tube insertion (10.2%), sampling: bone marrow biopsy & aspiration (23.8%) showed low intention to delegate in the treatment domain. Participants who were older, male, and had more work careers with APN, showed a higher intention to delegate tasks. Conclusion To prevent confusion in the clinical setting, a clear agreement on the scope of APN practice as APN delegated by physicians should be established. Based on this study, legal practices that APN can perform legally should be established.

OBJECTIVE: Acupotomy is a modern acupuncture method that includes modern surgical methods. Since acupotomy is relatively more invasive than filiform acupuncture treatment, it is important to establish the safety profile of this practice. To justify further large-scale prospective observational studies, this preliminary study was performed to assess the feasibility of the approach and investigate the safety profile and factors potentially associated with adverse events (AEs). METHODS: This was a prospective pilot study that assessed the feasibility of a large-scale forthcoming safety study on acupotomy treatment in a real-world setting. The feasibility (call response rate, drop-out rate, response rate for each variable and recruitment per month) and safety profile (incidence, type, severity and causality of AEs, and factors potentially associated with AEs) were measured. RESULTS: A total of 28 participants joined the study from January to May 2018. A follow-up assessment was achieved in 258 (1185 treatment points) out of 261 sessions (1214 treatment points). The response rate via telephone on the day after treatment was 87.3%. There were 8 systemic AEs in all the sessions (8/258; 3.11%) and 27 local AEs on the total points treated (27/1185; 2.28%). Severe AEs did not occur. Total AE and local AE occurrence were associated with blade width and the number of needle stimulations per treatment point. CONCLUSION: The findings suggest that it could be feasible to analyze the safety of acupotomy in a real-world setting. Moreover, the primary data on some relevant AEs could be determined. We are planning large-scale prospective studies based on these findings. TRIAL REGISTRATION Clinical Research Information Service (CRIS) KCT0002849 (https://cris.nih.go.kr/cris/search/detailSearch.do/11487).
Humans ; Feasibility Studies ; Prospective Studies ; Pilot Projects ; Acupuncture Therapy/methods* ; Research Design ; Treatment Outcome

Purpose: : The purpose of this study was to understand and describe the experiences of the advanced nurse practitioner (APN) system used by healthcare providers including APNs, doctors who worked with APNs, and APN master’s course professors at a graduate school. Methods: : Qualitative data were collected via snowball sampling. The participants were nine APNs, six doctors, and three professors. They were divided into three focus groups, each of which consisted of all three types of healthcare providers. Data were collected via interviews with the three focus groups conducted from September to October 2019. All interviews were audiotaped and transcribed verbatim. The transcribed data then underwent qualitative content analysis. Results: : Based on the data, we extracted four themes and 14 categories. The themes were “Role and system of APNs started according to healthcare environment changes”, “Optimal healthcare provider to ensure quality of care”, “Confused role and system of APNs due to incomplete medical law”, and “Tasks for the stable operation of the APN system.” Conclusion : For quality treatment and safety of patients, a legal basis must be established for the APN system. For its stable operation, social consensus regarding legislation about APNs’ scope of practice is required. Finally, a discussion is necessary about the integration of APNs’ 13 fields.

Purpose: : The purpose of this study was to understand and describe the experiences of the advanced nurse practitioner (APN) system used by healthcare providers including APNs, doctors who worked with APNs, and APN master’s course professors at a graduate school. Methods: : Qualitative data were collected via snowball sampling. The participants were nine APNs, six doctors, and three professors. They were divided into three focus groups, each of which consisted of all three types of healthcare providers. Data were collected via interviews with the three focus groups conducted from September to October 2019. All interviews were audiotaped and transcribed verbatim. The transcribed data then underwent qualitative content analysis. Results: : Based on the data, we extracted four themes and 14 categories. The themes were “Role and system of APNs started according to healthcare environment changes”, “Optimal healthcare provider to ensure quality of care”, “Confused role and system of APNs due to incomplete medical law”, and “Tasks for the stable operation of the APN system.” Conclusion : For quality treatment and safety of patients, a legal basis must be established for the APN system. For its stable operation, social consensus regarding legislation about APNs’ scope of practice is required. Finally, a discussion is necessary about the integration of APNs’ 13 fields.

PURPOSE: This study aimed to propose a common scope of practice (SOP) for 13 specialties of Advanced Practice Nurses (APNs) in Korea.METHODS: The first draft of a common SOP was extracted from domestic and international laws with a literature review by 17 experts from the Korean Association of Advanced Practice Nurses (KAAPN). Then, the common SOP was finalized after comparing the activities of APNs in clinical settings.RESULTS: A total of 70 duties were identified and six categories were suggested for the common SOP. The SOP proposed by the KAAPN featured the following: 1) identification of and discrimination between health problems; 2) prescription and implementation of diagnostic tests; 3) treatment of injuries and diseases while implementing measures to prevent exacerbation; 4) prescription of medicinal products in line with 1) to 3); 5) referral and consultation; and 6) education and counseling. It was then confirmed that the proposed six categories in the common SOP reflected all the duties performed by APNs in clinical practice, including all 40 activities.CONCLUSION: The results of this study can be used as evidence for the legalization of a common SOP for APNs. Given the increasing multidisciplinary team approach adopted in Korean hospitals, it may be desirable to establish a broader SOP to reflect the diverse duties of APNs.
Counseling ; Diagnostic Tests, Routine ; Discrimination (Psychology) ; Education ; International Law ; Korea ; Prescriptions ; Professional Practice ; Referral and Consultation

In order to discover lifespan-extending compounds made from natural resources, activity-guided fractionation of Zingiber officinale Roscoe (Zingiberaceae) ethanol extract was performed using the Caenorhabditis elegans (C. elegans) model system. The compound 6-gingerol was isolated from the most active ethyl acetate soluble fraction, and showed potent longevity-promoting activity. It also elevated the survival rate of worms against stressful environment including thermal, osmotic, and oxidative conditions. Additionally, 6-gingerol elevated the antioxidant enzyme activities of C. elegans, and showed a dose-depend reduction of intracellular reactive oxygen species (ROS) accumulation in worms. Further studies demonstrated that the increased stress tolerance of 6-gingerol-mediated worms could result from the promotion of stress resistance proteins such as heat shock protein (HSP-16.2) and superoxide dismutase (SOD-3). The lipofuscin levels in 6-gingerol treated intestinal worms were decreased in comparison to the control group. No significant 6-gingerol-related changes, including growth, food intake, reproduction, and movement were noted. These results suggest that 6-gingerol exerted longevity-promoting activities independently of these factors and could extend the human lifespan.
Caenorhabditis elegans* ; Caenorhabditis* ; Eating ; Ethanol ; Ginger* ; Heat-Shock Proteins ; Humans ; Lipofuscin ; Longevity* ; Natural Resources ; Reactive Oxygen Species ; Reproduction ; Superoxide Dismutase ; Survival Rate

BACKGROUND/AIMS: We compared the efficacy and safety of the second-generation everolimus-eluting stent (EES) and the third generation biolimus-eluting stent (BES) in patients with acute myocardial infarction (AMI). METHODS: We analyzed 629 consecutive patients (mean age 65.1 +/- 11.2 years, 426 males) with AMI undergoing percutaneous coronary intervention from February 2008 to April 2012. They were divided into two groups according to stent type (EES group, n = 426; BES group, n = 203). The primary end-point was 2-year major adverse cardiac events (MACEs), defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, non-target vessel revascularization and target lesion revascularization. The secondary end-point was 2-year target lesion failure (TLF). RESULTS: There were no significant differences in baseline characteristics, except that the patients with EES had a significantly higher prevalence of diabetes mellitus (34.7 vs. 22.7%, p = 0.002) and were older (67.1 +/- 11.3 vs. 64 +/- 12.9 years, p = 0.039) compared with the patients with BES. After propensity score matching, 2-year clinical outcomes showed no differences in composite MACEs or TLF between the two groups. Multivariate Cox regression analysis showed that stent type was not a predictor of 2-year mortality or MACEs. However, older age (hazard ratio [HR] 1.037, 95% confidence interval [CI] 1.014-1.060, p = 0.001), diabetes mellitus (HR 2.247, 95% CI 1.426-3.539, p = 0.001) and a left ventricular ejection fraction < or = 45% (HR 3.007, 95% CI 1.978-4.573, p = 0.001) were independent predictors for 2-year MACEs in patients undergoing EES or BES. CONCLUSIONS: Patients with BES had similar clinical 2-year outcomes compared with EES patients with AMI.
Diabetes Mellitus ; Humans ; Mortality ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Prevalence ; Prognosis ; Propensity Score ; Stents* ; Stroke Volume

BACKGROUND/AIMS: Delay in symptom-to-door time (SDT) in patients with acute ST-segment elevation myocardial infarction (STEMI) is the most important factor in the prediction of short and long-term mortality. The purpose of this study was to investigate the social and clinical factors affecting SDT in patients with STEMI. METHODS: We analyzed 784 patients (61.0 +/- 13.2 years, 603 male) diagnosed with STEMI from November 2005 to February 2012. The patients were divided into four groups according to SDT: Group I (n = 163, < or = 1 h), Group II (n = 183, 1-2 h), Group III (n = 142, 2-3 h) and Group IV (n = 296, > 3 h). RESULTS: Delay in SDT increased with age (Group I, 58.4 +/- 12.0; Group II, 59.4 +/- 13.3; Group III, 62.0 +/- 12.8; Group IV, 63.0 +/- 13.8 years, p = 0.001). In 119 patients, transportation was less frequently used as the delay in SDT (41.7% vs. 29.0% vs. 26.1% vs. 9.8%, p < 0.001). By multiple logistic regression analysis, family history [OR, 0.488; CI, 0.248-0.959; p = 0.037], previous ischemic heart disease [OR, 0.572; CI, 0.331-0.989; p = 0.045], no occupation [OR, 1.600; CI, 1.076-2.380; p = 0.020] and method of transportation [OR, 0.353; CI, 0.239-0.520; p < 0.001] were independent predictors of delay in SDT. CONCLUSIONS: Our study shows that general education about cardiovascular symptoms and a prompt emergency call could be important to reduce SDT in STEMI.
Education ; Emergencies ; Humans ; Logistic Models ; Mortality ; Myocardial Infarction* ; Myocardial Ischemia ; Occupations ; Transportation

OBJECTIVES: This cross-sectional study was performed to examine if the serum gamma-glutamyltransferase (GGT) level that is within its normal range is associated with the risk of type 2 diabetes and if the association between the waist hip ratio (WHR) and type 2 diabetes is different depending on the serum GGT levels. METHODS: The study subjects were 23,436 persons aged 40 years or older and who participated in regular health check-ups at 11 hospitals (males: 5,821, females: 17,615). The gender-specific quintiles of the serum GGT and WHR were used to examine the associations with type 2 diabetes. RESULTS: The serum GGT levels within their normal range were positively associated with type 2 diabetes only in women. The adjusted odds ratios (ORs) were 1.0, 1.0, 1.4, 2.1, and 2.5 according to the quintiles of the serum GGT (p(trend)<0.01). The WHR was more strongly associated with the prevalence of diabetes among the women with a high-normal serum GGT level as compared with those with a low-normal serum GGT level (p for interaction=0.02). For example, the adjusted ORs for women with a low normal serum GGT level were 1.0, 1.2, 1.5, 2.2, and 2.4 according to the quintiles of the WHR, while those figures were 1.0, 2.4, 3.6, 5.0, and 8.3 among the women with a high normal serum GGT level. However, in men, the serum GGT was very weakly associated with type 2 diabetes and the association between the WHR and type 2 diabetes was not different depending on the serum GGT level. CONCLUSIONS: Serum GGT within its normal range was positively associated with type 2 diabetes, and central obesity was more strongly associated with the prevalence of type 2 diabetes when the serum GGT level was high-normal. However, these associations were observed only in women, which is different from the previous findings. The stronger relation between central obesity and type 2 diabetes among women with a high-normal serum GGT level can be useful for selecting a group that is at high risk for type 2 diabetes irregardless of whatever the underlying mechanism is.
Blood Glucose ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/blood/enzymology/*epidemiology ; Epidemiologic Studies ; Female ; Humans ; Male ; Middle Aged ; Obesity, Abdominal/*epidemiology ; Odds Ratio ; Prevalence ; Republic of Korea/epidemiology ; *Waist-Hip Ratio ; gamma-Glutamyltransferase/*blood

Cobb's syndrome, or cutaneomeningospinal angiomatosis, is a combination of the vascular skin nevus and angioma in the spinal cord within a corresponding segment or two to the dermatoms involved. A 15 year old girl showed the portwine nevus at T2-T11 dermatomes and multilevel spinal angioma at C7-L3 levels. She had suffered from a slowly progressive weakness of both lower extremities. Motor weakness of lower extremities improved after the combined rehabilitation management and radiation therapy for 4 months. We report the typical manifestations of Cobb's syndrome in a 15 year old girl with the brief review of literatures.
Adolescent ; Angiomatosis ; Female ; Hemangioma ; Humans ; Lower Extremity ; Nevus ; Rehabilitation ; Skin ; Spinal Cord