Purpose: This study aimed to evaluate the association between triglyceride-glucose (TyG)–related parameters and the incidence of diabetes mellitus in Korean adults. Data were obtained from the Korean Genome and Epidemiology Study (KoGES). Methods: This secondary analysis examined data from 6,816 adults aged 40–69 years who participated in the KoGES from 2001 to 2020. TyG–related parameters, including the TyG index, TyG–body mass index (TyG–BMI), TyG–waist circumference (TyG–WC), and TyG–waist-to-height ratio (TyG–WHtR), were assessed. Cox proportional hazards models were employed to determine the association between these parameters and the incidence of diabetes mellitus, with adjustments made for demographic, lifestyle, and health-related characteristics. Results: Higher levels of all TyG–related parameters were significantly associated with an increased risk of developing diabetes mellitus. Specifically, participants in the highest quartile of the TyG index, TyG–BMI, TyG–WC, and TyG–WHtR exhibited significantly higher hazard ratios for diabetes mellitus incidence compared with those in the lowest quartile (p<.001 for all). Notably, the TyG index demonstrated a stronger predictive value for diabetes mellitus than traditional measures such as the homeostatic model assessment of insulin resistance. Conclusion TyG–related parameters are robust predictors of diabetes mellitus incidence in Korean adults. These findings support the incorporation of TyG–related measures into clinical settings for the early identification and intervention of high-risk populations. Utilizing these parameters for early diagnosis and preventive strategies may significantly enhance diabetes mellitus management.

This study investigated the relationships among grit, empathy, communication competence, and clinical competence in nursing students and aimed to determine the factors influencing their clinical competence during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The participants were 157 third- and fourth-year nursing students from Andong National University in Andong and Choonhae College of Health Sciences in Ulsan, both in South Korea. Data were collected using a self-report questionnaire and analyzed using the SPSS version 23.0 program. Results: Clinical competence was positively correlated with grit (r = .26, p = .001), empathy (r = .29, p < .001) and communication competence (r = .53, p < .001). Female sex (β = −.20, p = .009) and communication competence (β = .31, p = .004) were found to predict nursing students’ clinical competence, explaining 39.1% of the variance in clinical competence (F = 7.07, p < .001). Conclusion: The results imply that nursing students’ communication competence must be increased to improve their clinical competence. Additionally, it is important to develop training programs that consider changes in the educational environment in the post-COVID-19 era.

Purpose: This study was conducted to update the practice guidelines for intravenous infusion therapy published in 2017, focusing on the most recent evidence for peripheral intravenous infusion therapy. Methods: The guideline update was conducted using the 22-step methodology. Results: The updated guidelines consist of 17 domains and 235 recommendations (including 284 sub-recommendations). The domains are as follows: general instructions (5 items), peripheral catheter selection (7), catheter insertion site selection (11), management during peripheral catheter insertion (10), post-insertion management (30), perfusion and locking (17), blood sampling via peripheral catheters(6), exchange and removal of peripheral catheters (6), infusion set management (14), add-on devices (32), complications (25), chemotherapy infusions (10), PCA infusions (7), parenteral nutrition (20), transfusion therapy (23), education (5), and documentation and reporting (7). The evidence levels for these recommendations are as follows: 27(9.5%) at level I, 3 (1.1%) at level I A/P, 118 (41.5%) at level II, and 136 (47.9%) at level III.Recommendation grades are categorized as follows: 30 (10.6%) at level A, 118 (41.5%) at level B, and 136(47.9%) at level C. Of these, 73 (25.7%) recommendations were newly developed, 49 (17.3%) underwent major revisions, and 147 (51.7%) underwent minor revisions. Conclusion The updated practice guideline, based on the latest evidence, is anticipated to enhance nursing practice related to peripheral intravenous infusion therapy.

The fundamental principles for treating ankle fractures, as with other intra-articular fractures, are anatomical reduction and stable internal fixation. Despite successful reduction, between 14% and 40% of patients continue to experience persistent pain or unsatisfactory functional outcomes. Furthermore, approximately 1% of patients progress to post-traumatic arthritis, necessitating further surgical intervention. Ankle fractures are frequently accompanied by intra-articular injuries, including osteochondral lesions, ligament tears, and syndesmosis injuries. Arthroscopy is becoming increasingly prevalent in managing acute ankle fractures by assessing intra-articular damage and facilitating accurate reduction. This review examined the role and indications for arthroscopy in ankle fractures, particularly emphasizing its benefits in diagnosing and managing associated injuries, including osteochondral lesions, syndesmosis, and deltoid ligament injuries. Furthermore, arthroscopy facilitates fracture reduction, offering a minimally invasive approach with a shorter recovery period and enhanced visualization. Its use extends to pediatric fractures and complex cases such as Maisonneuve and calcaneal fractures, potentially improving outcomes while minimizing complications. Understanding the evolving indications and benefits of arthroscopy for ankle fractures can lead to improved clinical outcomes and reduced complications.

Background: Barriers to treatment with intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) in South Korea remain incompletely characterized. We analyze a nationwide prospective cohort to determine patient-level features associated with delayed presentation and non-treatment of potential IVT-eligible patients. Methods: We identified consecutive patients with AIS from 01/2011 to 08/2023 from a multicenter and prospective acute stroke registry in Korea. Patients were defined as IVT candidates if they presented within 4.5 hours from the last known well, had no lab evidence of coagulopathy, and had National Institute of Health Stroke Scale (NIHSS) ≥ 4. Multivariable generalized linear mixed regression models were used to investigate the associations between their characteristics and the IVT candidates or the use of IVT among the candidates. Results: Among 84,103 AIS patients, 41.0% were female, with a mean age of 69 ± 13 years and presentation NIHSS of 4 [interquartile range, 1–8]. Out of these patients, 13,757 (16.4%) were eligible for IVT, of whom 8,179 (59.5%) received IVT. Female sex (adjusted risk ratio [RR], 0.90; 95% confidence interval [CI], 0.86–0.94) and lower years of education (adjusted RR, 0.90; 95% CI, 0.84–0.97 for 0–3 years, compared to ≥ 13 years) were associated with a decreased likelihood of presenting as eligible for IVT after AIS; meanwhile, young age (adjusted RR, 1.12; 95% CI, 1.01–1.24 for ≤ 44 years, compared to 75–84 years) was associated with an increased likelihood of being an IVT candidate. Among those who were eligible for IVT, only age was significantly associated with the use of IVT (adjusted RR, 1.09; 95% CI, 1.03–1.16 for age 65–74 and adjusted RR, 0.83; 95% CI, 0.76–0.90 for ≥ 85 years, respectively). Conclusion Most patients with AIS present outside IVT eligibility in South Korea, and only 60% of eligible patients were ultimately treated. We identified increased age, female sex and lower education as key features on which to focus interventions for improving IVT utilization.

Background: Serum calcium and magnesium levels are a key factor of the coagulation cascade and may potentially contribute to the pathophysiology of intracerebral hemorrhage (ICH) expansion. The aim of this study was to attain and sustain target levels of serum calcium and magnesium for three days following admission. Methods: A single-blind, prospective, multicenter randomized study was conducted from 2019 to 2022 years, enrolling acute ICH patients aged 18–80 years, with radiological diagnosis and without surgical intervention. Participants were randomly assigned in a 1:1 ratio to either the study group or the control group. In the study group, the target serum levels of calcium (9–10.2 mg/dL) and magnesium (2–3 mg/dL) were actively achieved and maintained for a duration of 3 days following admission. The primary outcome was the expansion of ICH volume within the first 3 days between the study group and the control groups. Results: After implementing inclusion/exclusion criteria, 105 of 354 patients remained in the study. There were no significant differences in ICH volume on hospital days 2 and 3 between the groups. Admission factors including Glasgow coma scale score, hemoglobin level, ICH volume, and spot sign showed significant correlations in multivariate analysis. On the third day of hospitalization, admission serum magnesium levels showed a significant correlation with ICH expansion, whereas calcium levels did not. Conclusion Admission serum magnesium levels were found to correlate with hematoma expansion in patients with acute ICH. While magnesium itself may not be a direct therapeutic target, it could serve as a valuable indicator for identifying potential therapeutic strategies aimed at preventing ICH volume increase.

Background: Factors influencing the decline in forced expiratory volume in one second (FEV1 )/forced vital capacity (FVC) for chronic obstructive pulmonary disease (COPD) progression remain uncertain. We aimed to identify risk factors associated with rapid FEV1 / FVC decline in patients with COPD. Methods: This multi-center observational study was conducted from January 2012 to December 2022. Eligible patients were monitored with symptoms, spirometric tests, and treatment patterns over 3 years. Rapid FEV1 /FVC decliners were defined as the quartile of patients exhibiting the highest annualized percentage decline in FEV1 /FVC. Results: Among 1,725 patients, 435 exhibited rapid FEV1 /FVC decline, with an annual change of −2.5%p (interquartile range, −3.5 to −2.0). Rapid FEV1 /FVC decliners exhibited lower body mass index (BMI), higher smoking rates, elevated post-bronchodilator (BD) FEV1 , higher post-BD FEV1 / FVC, and a lower prevalence of Staging of Airflow Obstruction by Ratio (STAR) stage IV. Rapid FEV1 /FVC decline was not linked to the annual exacerbation rate, but there was an association with symptom deterioration and FEV1 decline. In multivariable analyses, low BMI, current smoking, increased modified Medical Research Council dyspnoea score, low post-BD FEV1 , low STAR stage, high forced mid-expiratory flow (FEF 25-75% ), accelerated FEV1 decline, and not initiating dual BD therapy were identified as independent risk factors for rapid FEV1 /FVC decline. Conclusion We identified the risk factors for rapid FEV1 /FVC decline, including BMI, smoking, symptoms deterioration, FEV1 decline, and adherence to standard inhaler treatment. Our findings underscore the potential benefits of maintaining consistent use of long-acting beta-agonist/long-acting muscarinic antagonist even in the presence of worsening symptoms, in attenuating FEV1 /FVC decline.

Background: Tinnitus is a multifactorial condition with no universally accepted assessment guidelines. The Korean Tinnitus Study Group previously established consensus statements on the definition, classification, and diagnostic tests for tinnitus. As a continuation of this effort, this study aims to establish expert consensus on tinnitus assessment and treatment outcome evaluation, specifically tailored to the Korean clinical context. Methods: A modified Delphi method involving 26 otology experts from across Korea was used. A two-round Delphi survey was conducted to evaluate statements related to tinnitus assessment before and after treatment. Statements were rated on a scale of 1 to 9 for the level of agreement. Consensus was defined as ≥ 70% agreement (score of 7–9) and ≤ 15% disagreement (score of 1–3). Statistical measures such as content validity ratio and Kendall’s coefficient of concordance (W) were calculated to assess agreement levels. Results: Of the 46 assessment-related statements, 17 (37%) reached consensus, though overall pre-treatment assessments showed weak agreement (Kendall’s W = 0.319). Key areas of agreement included the use of the visual analogue scale, numeric rating scale, and validated questionnaires for pre-treatment evaluation. Five statements, such as the use of computed tomography, magnetic resonance imaging, and angiography for diagnosing pulsatile tinnitus, achieved over 90% agreement. For treatment outcome measurements, 8 of 12 statements (67%) reached a consensus, with moderate agreement (Kendall’s W = 0.513). Validated questionnaires and psychoacoustic tests were recommended for evaluating treatment effects within 12 weeks. While standardized imaging for pulsatile tinnitus and additional clinical tests were strongly recommended, full consensus was not achieved across all imaging modalities. Conclusion This study provides actionable recommendations for tinnitus assessment and treatment evaluation, emphasizing the use of standardized tools and individualized approaches based on patient needs. These findings offer a practical framework to enhance consistency and effectiveness in tinnitus management within Korean clinical settings.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

The applicability of the Phoenix criteria and Phoenix Sepsis Score in higher-resource pediatric intensive care units (PICUs) outside the United States requires further validation. A retrospective cohort study analyzed electronic health records of 1,304 PICU admissions under 18 years old with suspected infection between February 2017 and December 2023. The score was calculated using two methods: 24-hour assessment, based on worst sub-scores within 24 hours of admission, and prompt assessment, using values closest to admission within 6 hours before or after. Based on the 24-hour assessment, in-hospital mortality was 8.3% for sepsis and 10.3% for septic shock. The score demonstrated an area under the precision-recall curve of 0.42 (95% confidence interval, 0.31–0.55) for in-hospital mortality. Results were consistent across both assessment methods. The Phoenix criteria and the Phoenix Sepsis Score are reliable predictors of mortality outcomes. Further investigation in diverse clinical settings is warranted.