Rectal cancer, which accounts for approximately 40% of colorectal cancers, remains a major clinical concern. Recent advances in diagnostic imaging, surgical techniques, radiotherapy, and systemic treatment have steadily improved rectal cancer outcomes. Considering this, the Korean Rectal Cancer Multidisciplinary (KRCM) Committee has aimed to provide clinicians and policymakers with up-to-date, evidence-based clinical practice guidelines to support optimal decision-making, reflecting current evidence, the Korean healthcare context, and patient values and preferences. The Clinical Practice Guidelines for Rectal Cancer version 2.0 were developed through multidisciplinary collaboration with related academic societies, building upon and updating the KRCM Clinical Practice Guidelines version 1.0 (titled “Multidisciplinary guidelines for the management of rectal cancer”). These consensus guidelines of the KRCM were established based on a comprehensive literature review, evidence synthesis, with recommendation development guided by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and consideration of applicability in real-world clinical practice under the national health insurance system. Each recommendation has been presented with its strength and level of evidence.

Purpose: Accurate data collection and analysis are crucial in clinical research, particularly for extracting information from unstructured medical records in cancer research. Traditional methods often struggle with this task. Large language models (LLMs) specializing in natural language processing (NLP), like ChatGPT (OpenAI), show potential for automating this process. This study evaluated whether GPT-4 could accurately extract clinical stages of colorectal cancer (CRC) from imaging reports. Methods: Using specific prompts based on the American Joint Committee on Cancer TNM staging system, GPT-4 was tested on the unstructured abdominal imaging reports of 100 CRC patients. The results were evaluated by a colorectal surgical oncologist and compared with data manually extracted by a nonspecialist data manager. Results: GPT-4 demonstrated high accuracy in extracting lesion locations (96.0%) and T (89.0%), N (90.0%), and M (85.0%) stages, with an overall TNM stage extraction accuracy of 69.0%. The combined accuracy for TNM stage and lesion location was 67.0%. Human data managers had similar TNM stage accuracy but lower lesion-location accuracy (76.0%). Higher accuracy was observed when reports directly mentioned stages and were in English only. Conclusion This study confirms that LLM-based NLP, with proper prompt engineering, can accurately extract clinical stages from CRC imaging reports, particularly in English-only contexts.

Purpose: This study evaluated the validity and reliability of therapeutic communication responses generated by GPT-5 by comparing different prompt-engineering strategies and identifying optimal methods for psychiatric nursing education. Methods: A methodological design compared four strategies—Zero-shot, Few-shot, Chain-of-Thought (CoT), and Role-prompt—applied to ten psychiatric nursing communication questions. Fourteen experts with over ten years of combined clinical and educational experience rated 40 anonymized responses using a 4-point scale. Inter-rater reliability was assessed with Fleiss' κ and Krippendorff's ⍺ from 400 repeated outputs. Semantic consistency was examined using cosine similarity. Analyses were conducted in Python. Results: Role-prompt showed the highest content validity (mean=3.54±0.39, S-CVI/Ave=0.95), followed by CoT and Zero-shot. Inter-rater agreement was slight (κ=0.07; ⍺=0.15). Semantic consistency was highest for CoT (0.76±0.12) and Role-prompt (0.75±0.11). A Friedman test indicated significant differences among strategies (x2(3)=11.88, p=.008). Conclusion Role-prompt yielded the most valid therapeutic responses, while CoT produced the most consistent outputs. These findings support the use of Role-prompt and CoT strategies to enhance the validity and reliability of therapy.

Baclofen, a gamma-aminobutyric acid-B receptor agonist, is commonly used for central-origin muscle spasticity and spasm and neuropathic pain. Baclofen toxicity has been reported to cause a range of symptoms including drowsiness, confusion, respiratory depression, seizures, and even coma, particularly with dosage significantly exceeding therapeutic levels. Given that the baclofen is predominantly eliminated through the kidneys, patients with renal failure are at substantial risk for neurotoxic effects. We report a case of baclofen-induced encephalopathy in a patient with end-stage renal disease, characterized by an altered mental state with myoclonus following the consumption of a low dose of baclofen.

Purpose: The COVID-19 pandemic significantly impacted clinical practicums for nursing students, especially in mental health nursing, resulting in cancellations due to infection risks. In response, online and VR simulations emerged as appealing alternatives that cater to the preferences of digital-native learners. This study aimed to evaluate a VR-based mental health nursing simulation program. Methods: The study utilized a non-equivalent control group pretest-posttest design and was conducted within nursing education institutions. Fifty-four fourth-year nursing students, who had theoretical knowledge but lacked clinical experience, participated after providing informed consent. The program consisted of six thematic modules that simulated real-world scenarios, and its effectiveness was assessed using repeated measures ANOVA. Results: The findings revealed significant improvements in knowledge related to mental health disorders, learning flow, and overall satisfaction. The program successfully bridged the gap between theoretical and practical learning, enhancing students' skills and confidence in patient interactions and therapeutic nursing interventions. Conclusion The simulation education program effectively served as a bridge between theoretical learning and practical application, providing students with a valuable educational experience. By improving students' abilities and confidence in engaging with patients and delivering therapeutic nursing interventions, the program demonstrated its potential to connect classroom learning with real-world clinical practice in mental health nursing.

Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients’ values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has led to significant global casualties. This study examines the postoperative impact of COVID-19 on patients who underwent gastrointestinal surgery, considering their heightened vulnerability to infections and increased morbidity and mortality risk. Methods: This retrospective observational study was conducted at a tertiary center and patients who underwent gastrointestinal surgery between January 2022 and February 2023 were included. Postoperative COVID-19 infection was defined as the detection of severe acute respiratory syndrome coronavirus 2 RNA by RT-PCR within 14 days after surgery. Propensity score matching was performed including age, sex, American Society of Anesthesiology physical status classification, and emergency operation between the COVID-19-negative (–) and -positive (+) groups. Results: Following 1:2 propensity score matching, 21 COVID-19(+) and 42 COVID-19(–) patients were included in the study. In the COVID-19(+) group, the postoperative complication rate was significantly higher (52.4% vs. 23.8%, P = 0.023).Mechanical ventilator requirement, intensive care unit (ICU) admission, and readmission rate did not significantly differ between the 2 groups. The median length of ICU (19 days vs. 4 days, P < 0.001) and hospital stay (18 vs. 8 days, P = 0.015) were significantly longer in the COVID-19(+) group. Patients with COVID-19 had a 2.4 times higher relative risk (RR) of major complications than patients without COVID-19 (RR, 2.37; 95% confidence interval, 1.254–4.467; P = 0.015). Conclusion COVID-19 infection during the postoperative period in gastrointestinal surgery may have adverse outcomes which may increase the risk of major complications. Preoperative COVID-19 screening and protocols for COVID-19 prevention in surgical patients should be maintained.

Background: and Purpose Patients with cluster headache (CH) exhibit impaired health-related quality of life (HRQoL). However, there have been few studies related to the HRQoL of patients with CH from Asian backgrounds. This study aimed to determine the impact of CH on HRQoL and to identify the factors affecting HRQoL in patients with CH during cluster periods. Methods: This prospective study enrolled patients with CH from 17 headache clinics in South Korea between September 2016 and February 2021. The study aimed to determine HRQoL in patients with CH using the EuroQol 5 Dimensions (EQ-5D) index and the time trade-off (TTO) method. Age- and sex-matched headache-free participants were recruited as a control group. Results: The study included 423 patients with CH who experienced a cluster period at the time. EQ-5D scores were lower in patients with CH (0.88±0.43, mean±standard deviation) than in the controls (0.99±0.33, p<0.001). The TTO method indicated that 58 (13.6%) patients with CH exhibited moderate-to-severe HRQoL deterioration. The HRQoL states in patients with CH were associated with current smoking patterns, headache severity, frequency, and duration, and scores on the Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire 9-item scale (PHQ-9), 6-item Headache Impact Test, and 12-item Allodynia Symptom Checklist. Multivariable logistic regression analyses demonstrated that the HRQoL states in patients with CH were negatively correlated with the daily frequency of headaches, cluster period duration, and GAD-7 and PHQ-9 scores. Conclusions Patients with CH experienced a worse quality of life during cluster periods compared with the headache-free controls, but the degree of HRQoL deterioration varied among them. The daily frequency of headaches, cluster period duration, anxiety, and depression were factors associated with HRQoL deterioration severity in patients with CH.

Purpose: This study aims to systematically review the literature and conduct a meta-analysis to thoroughly analyze the outcomes of studies on simulation programs in psychiatric nursing. Methods: We conducted an initial search from January 1, 2000, to September 30, 2023, using databases such as PubMed, EMBASE, CINAHL, the Cochrane Library, and Web of Science. A total of 2,571 articles were reviewed based on inclusion and exclusion criteria. We selected 35 articles for systematic literature review and subjected 20 of them to meta-analysis. Data analysis was conducted using descriptive statistics and the Comprehensive Meta-Analysis program. Results: The number of psychiatric nursing simulation programs has increased since 2015. The most common programs used Standard Patients (SP), but studies using Virtual Reality (VR), audio, video, and other methods have recently been reported. The programs addressed various mental health issues, including depression, suicide, violence, alcohol problems, and mood disorders. Overall, considering all the studies, a significant effect was observed with a pooled Hedges’s g value of 0.56 (95% CI: 0.35~0.78; p<.001). Conclusion These findings highlight the importance of incorporating simulation-based education into nursing curricula to equip professionals with the skills to provide high-quality care to individuals with mental health problems. Further research is needed to explore the long-term benefits of these educational interventions on patient care.