In a prehospital setting, the narrow therapeutic window of epinephrine necessitates its cautious administration to avoid anaphylaxis. In this case, a 46-year-old man presented severe anaphylactic symptoms. Following the standard protocol, the emergency medical technician (EMT) administered intramuscular epinephrine; however, symptoms persisted. Under the oversight of the emergency medical services (EMS) medical director, an additional intravenous bolus of epinephrine was administered, unfortunately leading to atrial fibrillation. This case underscores the potential risks of intravenous epinephrine, which is not typically recommended for anaphylaxis without continuous monitoring. Since 2019, Korea has initiated a pilot program to expand the EMT scope of practice, which gives them the authority to administer epinephrine for anaphylaxis. The ultimate decision regarding epinephrine use for anaphylaxis, emphasizing patient safety, rests with the EMS medical director. Proper training for EMTs, coupled with the EMS medical director’s comprehensive knowledge and meticulous protocol adherence, can ensure patient safety and optimal outcomes.

Purpose: This study aims to explore the trend of nursing education and major research themes in the Journal of Korean Academic Society of Nursing Education (JKASNE) over 30 years. Methods: A total of 1,026 articles, published in the JKASNE from 1995 to 2023, were analyzed using the Microsoft Excel program for descriptive statistics and NetMiner for a word cloud of Korean keywords. Results: Most research subjects were healthy people (n=841). Education-related research topics (n=619) were categorized into nine domains: educational methods, educational curriculum, study type and methods, knowledge level and contents, psychosocial variables related to knowledge and education, attitude, behavior, development and evaluation of educational programs, and effects of educational programs. Quantitative (n=835) and descriptive studies (n=497) were determined to be the most common research designs. Self-reported questionnaires were the most common method used in surveys (n=581) and experimental studies (n=153). Descriptive statistics, Pearson's correlation coefficient, and other statistical techniques were used. The keywords in the JKASNE reflected various aspects of nursing research. General terms related to nursing education, such as "nursing students," "nurses," and "nursing education," appeared with high frequency, while more specific terms and phrases reflecting educational competencies and characteristics, such as "self-efficacy," "clinical performance ability," and "communication knowledge," were also prominently featured. Conclusion The JKASNE has published mainly education-focused papers. Analyzing the full set of papers published in JKASNE and examining their characteristics is very meaningful and helpful for the future development of Korean nursing education.

In a prehospital setting, the narrow therapeutic window of epinephrine necessitates its cautious administration to avoid anaphylaxis. In this case, a 46-year-old man presented severe anaphylactic symptoms. Following the standard protocol, the emergency medical technician (EMT) administered intramuscular epinephrine; however, symptoms persisted. Under the oversight of the emergency medical services (EMS) medical director, an additional intravenous bolus of epinephrine was administered, unfortunately leading to atrial fibrillation. This case underscores the potential risks of intravenous epinephrine, which is not typically recommended for anaphylaxis without continuous monitoring. Since 2019, Korea has initiated a pilot program to expand the EMT scope of practice, which gives them the authority to administer epinephrine for anaphylaxis. The ultimate decision regarding epinephrine use for anaphylaxis, emphasizing patient safety, rests with the EMS medical director. Proper training for EMTs, coupled with the EMS medical director’s comprehensive knowledge and meticulous protocol adherence, can ensure patient safety and optimal outcomes.

Purpose: This study aims to explore the trend of nursing education and major research themes in the Journal of Korean Academic Society of Nursing Education (JKASNE) over 30 years. Methods: A total of 1,026 articles, published in the JKASNE from 1995 to 2023, were analyzed using the Microsoft Excel program for descriptive statistics and NetMiner for a word cloud of Korean keywords. Results: Most research subjects were healthy people (n=841). Education-related research topics (n=619) were categorized into nine domains: educational methods, educational curriculum, study type and methods, knowledge level and contents, psychosocial variables related to knowledge and education, attitude, behavior, development and evaluation of educational programs, and effects of educational programs. Quantitative (n=835) and descriptive studies (n=497) were determined to be the most common research designs. Self-reported questionnaires were the most common method used in surveys (n=581) and experimental studies (n=153). Descriptive statistics, Pearson's correlation coefficient, and other statistical techniques were used. The keywords in the JKASNE reflected various aspects of nursing research. General terms related to nursing education, such as "nursing students," "nurses," and "nursing education," appeared with high frequency, while more specific terms and phrases reflecting educational competencies and characteristics, such as "self-efficacy," "clinical performance ability," and "communication knowledge," were also prominently featured. Conclusion The JKASNE has published mainly education-focused papers. Analyzing the full set of papers published in JKASNE and examining their characteristics is very meaningful and helpful for the future development of Korean nursing education.

In a prehospital setting, the narrow therapeutic window of epinephrine necessitates its cautious administration to avoid anaphylaxis. In this case, a 46-year-old man presented severe anaphylactic symptoms. Following the standard protocol, the emergency medical technician (EMT) administered intramuscular epinephrine; however, symptoms persisted. Under the oversight of the emergency medical services (EMS) medical director, an additional intravenous bolus of epinephrine was administered, unfortunately leading to atrial fibrillation. This case underscores the potential risks of intravenous epinephrine, which is not typically recommended for anaphylaxis without continuous monitoring. Since 2019, Korea has initiated a pilot program to expand the EMT scope of practice, which gives them the authority to administer epinephrine for anaphylaxis. The ultimate decision regarding epinephrine use for anaphylaxis, emphasizing patient safety, rests with the EMS medical director. Proper training for EMTs, coupled with the EMS medical director’s comprehensive knowledge and meticulous protocol adherence, can ensure patient safety and optimal outcomes.

Purpose: This study aims to explore the trend of nursing education and major research themes in the Journal of Korean Academic Society of Nursing Education (JKASNE) over 30 years. Methods: A total of 1,026 articles, published in the JKASNE from 1995 to 2023, were analyzed using the Microsoft Excel program for descriptive statistics and NetMiner for a word cloud of Korean keywords. Results: Most research subjects were healthy people (n=841). Education-related research topics (n=619) were categorized into nine domains: educational methods, educational curriculum, study type and methods, knowledge level and contents, psychosocial variables related to knowledge and education, attitude, behavior, development and evaluation of educational programs, and effects of educational programs. Quantitative (n=835) and descriptive studies (n=497) were determined to be the most common research designs. Self-reported questionnaires were the most common method used in surveys (n=581) and experimental studies (n=153). Descriptive statistics, Pearson's correlation coefficient, and other statistical techniques were used. The keywords in the JKASNE reflected various aspects of nursing research. General terms related to nursing education, such as "nursing students," "nurses," and "nursing education," appeared with high frequency, while more specific terms and phrases reflecting educational competencies and characteristics, such as "self-efficacy," "clinical performance ability," and "communication knowledge," were also prominently featured. Conclusion The JKASNE has published mainly education-focused papers. Analyzing the full set of papers published in JKASNE and examining their characteristics is very meaningful and helpful for the future development of Korean nursing education.

An allergy skin test is used to diagnose certain allergies by identifying sensitized allergens. In other words, it is a test for patients who are already sensitized to certain allergens. Because of the prevailing perception that beta-lactam allergy can be dangerous and potentially lethal, the intradermal test has long been routinely performed before use to screen beta-lactam allergy in Korea. The prevalence of penicillin allergy is estimated to be 1% to 2%. However, only 14% of the subjects with perceived penicillin allergy is considered to have true penicillin allergy. Moreover, it is difficult to justify performing a skin test on subjects who are very unlikely to be sensitized to beta-lactam, such as those who never used beta-lactam or never experienced allergy after previous use of beta-lactam.Therefore, allergists recommend beta-lactam skin testing in those who have allergy after the use of beta-lactam. Nevertheless, many hospitals in Korea are conducting routine skin tests on patients regardless of a history of beta-lactam allergy, which are not clinically validated but consume considerable human and material resources. False-positive results can consequently result in inappropriate labeling of beta-lactam allergy, leading to the unnecessary restriction of medication prescriptions and the increase in medical expenses. Herein, the drug allergy working group affiliated with the Korean Academy of Asthma, Allergy, and Clinical Immunology announces an expert opinion on the preuse beta-lactam skin test for subjects without a history of beta-lactam allergy based on the objective evidence from the literature and clinical relevance.

Purpose: This study aimed to describe nurses’ perceived needs and barriers to pediatric palliative care (PPC). Methods: Mixed methods with an embedded design were applied. An online survey was conducted for nurses who participated in the End-of-Life Nursing Education Consortium- Pediatric Palliative Care (ELNEC-PPC) train-the-trainer program, of whom 63 responded. Quantitative data were collected with a survey questionnaire developed through the Delphi method. The 47 items for needs and 15 items for barriers to PPC were analyzed with descriptive statistics. Qualitative data were collected through openended questions and analyzed with topic modeling techniques. Results: The mean scores of most subdomains of the PPC needs were 3.5 or higher out of 4, and those of PPC barriers ranged from 3.22 to 3.56, indicating the items in the questionnaire developed in this study properly reflect each factor. The needs for PPC were divided into 4 categories: “children and adolescents,” “families,” “PPC management system,” and “community-based PPC.” Meanwhile, PPC barriers were divided into 3 categories: “healthcare delivery system,” “healthcare provider,” and “client.” The keywords derived from the topic modeling were perception, palliative, children, and education for necessities and lack, perception, medical care, professional care providers, service, and system for barriers to PPC. Conclusion In this study, by using mixed-methods, items of nurses’ perceived needs and barriers to PPC were identified, categorized, and weighted, and their meanings were explored. For the stable establishment of PPC, the priority should be given to improving perceptions of PPC, establishing an appropriate system, and training professional care providers.

Background: Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. Methods: Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. Results: Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. Conclusions In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

Background: Postoperative thyroid stimulating hormone (TSH) suppression therapy is recommended for patients with intermediate- and high-risk differentiated thyroid cancer to prevent the recurrence of thyroid cancer. With the recent increase in small thyroid cancer cases, the extent of resection during surgery has generally decreased. Therefore, questions have been raised about the efficacy and long-term side effects of TSH suppression therapy in patients who have undergone a lobectomy. Methods: This is a multicenter, prospective, randomized, controlled clinical trial in which 2,986 patients with papillary thyroid cancer are randomized into a high-TSH group (intervention) and a low-TSH group (control) after having undergone a lobectomy. The principle of treatment includes a TSH-lowering regimen aimed at TSH levels between 0.3 and 1.99 μIU/mL in the low-TSH group. The high-TSH group targets TSH levels between 2.0 and 7.99 μIU/mL. The dose of levothyroxine will be adjusted at each visit to maintain the target TSH level. The primary outcome is recurrence-free survival, as assessed by neck ultrasound every 6 to 12 months. Secondary endpoints include disease-free survival, overall survival, success rate in reaching the TSH target range, the proportion of patients with major cardiovascular diseases or bone metabolic disease, the quality of life, and medical costs. The follow-up period is 5 years. Conclusion The results of this trial will contribute to establishing the optimal indication for TSH suppression therapy in low-risk papillary thyroid cancer patients by evaluating the benefit and harm of lowering TSH levels in terms of recurrence, metabolic complications, costs, and quality of life.