Background: The workload of organ transplant coordinators is increasing as administrative tasks become more diverse with changing laws and regulations. These changes have heightened the demand for organ transplant coordinators with expertise in the field. This study aimed to determine the status of human resources of organ transplant coordinators and conduct job analysis using the Developing A Curriculum (DACUM) method. Methods: We conducted a questionnaire survey with 107 transplant coordinators employed at medical centers across Korea. The questionnaire gathered data on general and job-related characteristics of organ transplant coordinators and assessed the importance, difficulty, and frequency of their task elements. Results: The job of organ transplantation was categorized into five duties, 14 tasks, and 97 task elements. These duties included recipient management, donor management, organ donation activation management, organ transplantation administration, and professional capability development. We noted statistically significant differences in the importance scores of organ donation activation based on age, as well as in the difficulty scores for recipient management and administrative tasks based on work experience. Furthermore, the frequency of task performance varied significantly according to the number of coworkers and the total number of transplants conducted. Conclusions This study confirmed the current status of the workforce and task performance of organ transplant coordinators. The findings will serve as basic data to enhance the expertise of coordinators in the future.

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

Purpose: This study aimed to investigate the impact of a nurse shift improvement pilot project on nurses' shift adjustment, work-life balance, and turnover intention, as well as nurses' experiences of participating in the pilot project. Methods: An explanatory sequential mixed-methods study was performed. Survey data was collected from a total of 1,051 nurses both in participant and non-participant groups. For the qualitative study, focus group interviews were conducted with 22 nurses who participated in the shift improvement pilot, including 12 staff nurses, 7 nurse managers, and 3 substitute nurses. Results: There were significant positive effects on the key variables of nurses’ shift adjustment, work-life balance, and turnover intention in the group that participated in the nurse shift improvement pilot project. Based on the qualitative study, participants in the shift improvement pilot project indicated that it enabled nurses to recover their circadian rhythm, and achieve a better work-life balance, and they wanted to continue working as a nurse, and hoped expanded application of the pilot project. Conclusion In order for expanded implementation of the pilot project and continued improvement in the shift system, we recommend establishing compensation standard, systematizing the use of substitute nurses, developing guidelines for shift schedules, and expanding the shift improvement pilot project to other departments such as the emergency room.

Objectives: This study aimed to investigate the clinical characteristics of adolescents hospitalized through the emergency room for intentional self-harm or suicide attempts. Methods: This retrospective study used data from the Korean National Hospital Discharge In-depth Injury Survey conducted between 2006 and 2018 for individuals aged 10–24 years. The clinical characteristics of the patients were analyzed and compared across sex and age groups using the Rao-Scott chi-square tests and multiple logistic regression analysis for complex survey data. Results: The most common psychiatric diagnosis was mood disorder (22.0%), and more female patients were diagnosed with it than male patients (p=0.010). The 19–24 years age group was diagnosed with mood disorder the most compared to other younger groups (p=0.012). Male patients used lethal methods more than female patients (p=0.008), and the 19–24 years age group used more drug poisoning and cutting or piercing (p<0.001) for intentional self-harm or suicide attempts than younger groups. Conclusion Adolescents hospitalized for intentional self-harm or suicide attempts showed significant differences in clinical characteristics across sex and age groups. These findings suggest that measures for preventing self-harm or suicide attempts need to be differentiated according to the sex and age of adolescents.

Background: There are various reports on the effects of the anesthetic method on neurologic complications. A population-based study was conducted to estimate the effect of anesthetic method on the incidence of postoperative delirium in patients that underwent total hip replacement arthroplasty in South Korea. Methods: The Korean National Health Insurance claims database was used to retrospectively identify and analyze 24,379 cases of total hip replacement arthroplasty, defined as patients having a claim record with the operation code ‘N0711,’ from January 2008 to December 2017. Patients were divided into two groups, a general anesthesia group (n = 9,921) and a regional anesthesia group (n = 14,458). The incidence of delirium was assessed in cases when patients used medications for delirium, such as haloperidol, chlorpromazine, olanzapine, and risperidone. Results: Of the 9,921 patients receiving general anesthesia and 14,458 receiving regional anesthesia, 142 (1.43%) and 209 (0.86%) experienced postoperative delirium after total hip replacement arthroplasty, respectively. There was no significant difference between the groups (P = 0.92). In logistic regression analysis, sex (P = 0.038) and patients with acquired immune deficiency syndrome (P = 0.008) were predictors of postoperative delirium. Conclusions Our results revealed that the anesthetic method was not associated with the incidence of postoperative delirium. In addition, the results suggest that male patients and patients with acquired immune deficiency syndrome undergoing total hip replacement arthroplasty carefully managed for postoperative delirium after surgery.

A human cell-based liver model capable of long-term expansion and mature hepatic function is a fundamental requirement for pre-clinical drug development. We previously established self-renewing and functionally mature human pluripotent stem cell-derived liver organoids as an alternate to primary human hepatocytes. In this study, we tested long-term prolonged culture of organoids to increase their maturity. Organoid growing at the edge of Matrigel started to deteriorate two weeks after culturing, and the expression levels of the functional mature hepatocyte marker ALB were decreased at four weeks of culture. Replating the organoids weekly at a 1：2 ratio in fresh Matrigel, resulted in healthier morphology with a thicker layer compared to organoids maintained on the same Matrigel and significantly increased ALB expression until three weeks, although, it decreased sharply at four weeks. The levels of the fetal hepatocyte marker AFP were considerably increased in long-term cultures of organoids. Therefore, we performed serial passaging of organoids, whereby they were mechanically split weekly at a 1：3∼1：5 ratio in fresh Matrigel. The organoids expanded so far over passage 55, or 1 year, without growth retardation and maintained a normal karyotype after long-term cryopreservation. Differentiation potentials were maintained or increased after long-term passaging, while AFP expression considerably decreased after passaging. Therefore, these data demonstrate that organoids can be exponentially expanded by serial passaging, while maintaining long-term functional maturation potential. Thus, hepatic organoids can be a practical and renewable cell source for human cell-based and personalized 3D liver models.

Heterotopic ossification (HO) around the hip joint is not uncommon following neurological injury. Often, surgical treatment is performed in patients with restricted motion and/or refractory pain due to grade III or IV HO according to Brooker classification. The major complication that occurs as a result of surgical HO removal is perioperative bleeding due to hyper-vascularization of the lesion. Here, we report a case of preoperative embolization in a 51-year-old male patient presenting with restricted bilateral hip range of motion (ROM) due to HO following a spinal cord injury. In the right hip without preoperative arterial embolization, massive bleeding occurred during surgical removal of HO. Thus, the patient received a transfusion postoperatively due to decreased serum hemoglobin levels. For surgery of the left hip, preoperative embolization of the arteries supplying HO was performed. Surgical treatment was completed without bleeding complications, and the patient recovered without a postoperative transfusion. This case highlights that, while completing surgical removal for ROM improvements, orthopedic surgeons should consider preoperative arterial embolization in patients with hip HO.
Arteries ; Classification ; Hemorrhage ; Hip Joint ; Hip ; Humans ; Male ; Middle Aged ; Orthopedics ; Ossification, Heterotopic ; Pain, Intractable ; Range of Motion, Articular ; Spinal Cord Injuries ; Surgeons

PURPOSE: Nurses' knowledge regarding advance directives may affect their administration of and confidence towards end of life care. This study aimed to describe the relationships of knowledge, confidence, and learning needs with advance directives among hospital nurses.METHOD: This cross-sectional study was performed at a tertiary university hospital in Seoul between September 25 and October 14, 2017. Convenience sampling was used to recruit nurses who provided bedside care and had at least 1 year of clinical experience. We used a validated self-report questionnaire.RESULTS: The mean score of knowledge, confidence and learning needs were 5.00±1.73, 29.81±7.52, and 64.54±8.48 respectively. Hospital nurses' knowledge, confidence and learning needs were significantly different according to age, job position, educational level and perceived advance directives. Knowledge regarding advance directives was significantly associated with confidence (r = .27, p < .001) and learning needs (r = .16, p = .005).CONCLUSION: Knowledge regarding advance directives was relatively low compared to the findings of previous studies. Therefore, nurses should be knowledgeable and encouraged to initiate advance directives. It is necessary to develop a standardized educational program regarding advance directives based on Korean cultures.
Advance Directives ; Cross-Sectional Studies ; Learning ; Methods ; Seoul ; Terminal Care

BACKGROUND: Patients with resectable colorectal lung oligometastasis (CLOM) demonstrate a heterogeneous oncological outcome. However, the parameters for predicting tumor aggressiveness have not yet been fully investigated in CLOM. This study was performed to determine the prognostic value of histological growth patterns in patients who underwent surgery for CLOM. METHODS: The study included 92 patients who were diagnosed with CLOM among the first resection cases. CLOMs grow according to three histological patterns: aerogenous, pushing, and desmoplastic patterns. The growth patterns were evaluated on archival hematoxylin and eosin–stained tissue sections. RESULTS: The aerogenous pattern was found in 29.4% (n=27) of patients, the pushing pattern in 34.7% (n=32), the desmoplastic pattern in 6.5% (n=6), and a mix of two growth patterns in 29.4% (n=27). The size of the aerogenous pattern was significantly smaller than that of metastases with other patterns (p=.033). Kaplan-Meier analysis demonstrated that patients showing an aerogenous pattern appeared to have a poorer prognosis, which was calculated from the time of diagnosis of the CLOM (p=.044). The 5-year survival rate from the diagnosis of colorectal cancer tended to be lower in patients with an aerogenous pattern than in those who had a non-aerogenous pattern; however, the difference was marginally significant (p=.051). In the multivariate Cox analysis, the aerogenous pattern appeared as an independent predictor of poor overall survival (hazard ratio, 3.122; 95% confidence interval, 1.196 to 8.145; p=.020). CONCLUSIONS: These results suggest that the growth patterns may play a part as a histology-based prognostic parameter for patients with CLOM.
Colorectal Neoplasms ; Diagnosis ; Hematoxylin ; Humans ; Kaplan-Meier Estimate ; Lung ; Neoplasm Metastasis ; Prognosis ; Survival Rate