Objectives: This study investigated a cluster of secondary human-to-human transmission of severe fever with thrombocytopenia syndrome (SFTS) in a hospital setting, focusing on infection risk factors and the role of personal protective equipment (PPE). Methods: A descriptive epidemiological investigation was conducted following the death of anindex patient with laboratory-confirmed SFTS. A total of 27 close contacts, including healthcareworkers and a funeral director, were monitored for symptoms. Suspected cases underwent real-time reverse transcription polymerase chain reaction testing. Clinical features, PPE use, and exposure histories were analyzed. The Fisher exact test was used to assess associations between PPE use and infection. Viral genotyping and sequence analyses were performed to evaluate transmission routes. Results: The index patient deteriorated rapidly and died after repeated cardiopulmonaryresuscitation (CPR), during which 8 secondary cases occurred. Most infections were identifiedamong individuals involved in CPR or postmortem care without adequate PPE. Although notstatistically significant, infection rates were higher among those who did not wear masks or who used low-filtration masks. Proper use of gloves, gowns, and goggles was associated withlower infection rates. Cycle threshold values in secondary cases (range, 34–39) were higherthan in the index case (14.07), suggesting lower viral loads. Sequence analysis demonstrated99.6%–100% homology between the index and secondary cases; all isolates were genotype B, indicating direct transmission. Conclusion This study provides molecular and epidemiological evidence of nosocomial SFTS transmission. Inadequate PPE use during aerosol-generating procedures likely facilitated infection, underscoring the importance of strict adherence to PPE protocols and reinforced infection control practices.

Subarachnoid hemorrhage (SAH) is a stroke subtype with high mortality and poor functional outcomes. Prompt occlusion of a ruptured aneurysm at an early stage is crucial to prevent rebleeding, which can result in even higher mortality and more severe disabilities. The most critical initial decision in SAH management is the choice of treatment method with surgical clipping or endovascular coiling. We aimed to develop an evidence-based clinical guideline to select the optimal initial treatment in patients with SAH. We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer two population, intervention, comparison, outcome questions comparing clipping and coiling. The risk of bias was assessed using ROB 2.0 and the Newcastle-Ottawa Scale. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcome and mortality. We included six randomized control trials (RCTs) and 58 observational studies. Meta-analysis of RCTs showed that coiling improved functional outcomes compared to clipping (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.86–0.97). No significant mortality difference was observed in RCTs (OR, 1.38; 95% CI, 0.91–2.09), but non-RCTs favored clipping for reduced mortality (OR, 0.77; 95% CI, 0.69–0.86). However, it is difficult to generalize these findings to all clinical situations, as patients with SAH have a highly variable clinical course. Final treatment decision should be tailored to the individual patient’s status, including aneurysm location, morphology, and the expertise available at the treatment center. Such decisions are best made by specialists such as a board-certified physician and should be explained to the patient and their caregivers, along with the rationale for selecting the most appropriate treatment at the given hospital. Korea has many certified endovascular neurosurgeons, cerebrovascular surgeons, and certified cerebrovascular centers. Proper selection of the most suitable treatment method by certified physicians and centers would greatly benefit patient outcomes and healthcare professionals.

Accurate and early identification of stroke and large vessel occlusion (LVO) in emergency settings is essential for improving patient outcomes and ensuring the efficient allocation of medical resources. This clinical practice guideline systematically reviews domestic and international literature and conducts meta-analyses to evaluate the utility and diagnostic accuracy of stroke assessment tools used in prehospital emergency medical services (EMS). We developed a guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted to evaluate the usefulness of diagnostic EMS assessment tools for diagnosing stroke and LVO. Overall, 70 non-randomized control studies were selected for this study. A meta-analysis was conducted with a subgroup analysis to distinguish between patients with stroke and those with LVO. EMS tools demonstrated high sensitivity but low specificity for diagnosing stroke. In the prehospital setting, using validated EMS stroke assessment tools is recommended for the early identification of stroke and LVO. Upon hospital arrival, stroke specialists should conduct further evaluation and triage to confirm the diagnosis and guide appropriate management. Delays in diagnosing LVO are frequently unacceptable. While experts advocate for the use of EMS assessment tools to facilitate early identification of LVO, these tools alone lack adequate sensitivity. Therefore, further diagnostic evaluations and consultation with stroke specialists upon hospital arrival are recommended.

The mothership (MS) model, where patients are directly transferred to a thrombectomy-capable center, and the drip-and-ship (DS) model, where thrombolysis is initiated at the nearest primary stroke center before transfer for thrombectomy, are the primary transport modes for patients with stroke. We aimed to establish guidelines for selecting the appropriate transfer strategy based on emergent large vessel occlusion (LVO). We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer three Population, Intervention, Comparison, and Outcome questions comparing MS and DS models. The risk of bias was assessed using the Newcastle-Ottawa Scale. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcomes, mortality, and successful recanalization. Twenty-six non-randomized controlled studies showed that the MS model improved good functional outcomes by approximately 14% compared with the DS model (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.00–1.30). Fifteen studies reported that mortality in the MS and DS models showed no significant differences (OR, 0.97; 95% CI, 0.84–1.11). Twenty-four studies revealed no significant difference in successful recanalization between the MS and DS models (OR, 0.87; 95% CI, 0.68–1.10). The MS model should be considered first to improve the functional outcome of patients with LVO. However, if thrombectomy cannot be performed immediately after thrombolysis, or if a thrombectomy-enabled hospital is not nearby, the DS model should be considered by stroke specialists depending on transportation time and regional factors. We suggest a mixed approach with the DS model based on specific circumstances or regions to ensure the optimum treatment of patients with acute ischemic stroke (AIS). Appropriate transport for patients with LVO improves the prognosis of AIS.

Purpose: Accumulating evidence suggests that seafood and its components, such as eicosapentaenoic acid and docosahexaenoic acid, are known to prevent cardiovascular disease (CVD). However, little is known about whether sleep quality, which has been recognized as a risk factor for CVD, might influence these associations. Therefore, the purpose of the study was to investigate the longitudinal associations between seafood consumption and CVD in Korean adults with or without insomnia. Methods: The data were collected from the Korean Genome and Epidemiology Study (KoGES) and included 3,168 participants aged 40–69 years. Dietary intake was measured by a validated 106-item food-frequency questionnaire, and insomnia was assessed using a questionnaire on sleep-related symptoms. The CVD events included myocardial infarction, coronary artery disease, congestive heart failure, cerebrovascular disease, and peripheral vascular disease. Associations of seafood consumption with CVD were assessed using timedependent Cox regression analyses to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) while adjusting for potential confounding factors. Results: During the 8-year follow-up period, the incidence of CVD was 5.1%. There was a positive association between seafood consumption and most food groups, as well as nutrients. In contrast, as seafood consumption increased, the consumption of grains decreased. Regarding nutrient intake, there was a negative association between seafood consumption and carbohydrate intake. After adjustment for confounding factors, the risk of CVD was inversely associated with seafood consumption, with a 56% lower risk (HRT3 vs. T1 , 0.44; 95% CI, 0.26–0.75; p = 0.002), only in the non-insomnia group. Conclusion Findings from this study suggest that seafood consumption might lead to more favorable outcomes against CVD if accompanied by good sleep quality.

Purpose: Accumulating evidence suggests that seafood and its components, such as eicosapentaenoic acid and docosahexaenoic acid, are known to prevent cardiovascular disease (CVD). However, little is known about whether sleep quality, which has been recognized as a risk factor for CVD, might influence these associations. Therefore, the purpose of the study was to investigate the longitudinal associations between seafood consumption and CVD in Korean adults with or without insomnia. Methods: The data were collected from the Korean Genome and Epidemiology Study (KoGES) and included 3,168 participants aged 40–69 years. Dietary intake was measured by a validated 106-item food-frequency questionnaire, and insomnia was assessed using a questionnaire on sleep-related symptoms. The CVD events included myocardial infarction, coronary artery disease, congestive heart failure, cerebrovascular disease, and peripheral vascular disease. Associations of seafood consumption with CVD were assessed using timedependent Cox regression analyses to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) while adjusting for potential confounding factors. Results: During the 8-year follow-up period, the incidence of CVD was 5.1%. There was a positive association between seafood consumption and most food groups, as well as nutrients. In contrast, as seafood consumption increased, the consumption of grains decreased. Regarding nutrient intake, there was a negative association between seafood consumption and carbohydrate intake. After adjustment for confounding factors, the risk of CVD was inversely associated with seafood consumption, with a 56% lower risk (HRT3 vs. T1 , 0.44; 95% CI, 0.26–0.75; p = 0.002), only in the non-insomnia group. Conclusion Findings from this study suggest that seafood consumption might lead to more favorable outcomes against CVD if accompanied by good sleep quality.

Purpose: Accumulating evidence suggests that seafood and its components, such as eicosapentaenoic acid and docosahexaenoic acid, are known to prevent cardiovascular disease (CVD). However, little is known about whether sleep quality, which has been recognized as a risk factor for CVD, might influence these associations. Therefore, the purpose of the study was to investigate the longitudinal associations between seafood consumption and CVD in Korean adults with or without insomnia. Methods: The data were collected from the Korean Genome and Epidemiology Study (KoGES) and included 3,168 participants aged 40–69 years. Dietary intake was measured by a validated 106-item food-frequency questionnaire, and insomnia was assessed using a questionnaire on sleep-related symptoms. The CVD events included myocardial infarction, coronary artery disease, congestive heart failure, cerebrovascular disease, and peripheral vascular disease. Associations of seafood consumption with CVD were assessed using timedependent Cox regression analyses to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) while adjusting for potential confounding factors. Results: During the 8-year follow-up period, the incidence of CVD was 5.1%. There was a positive association between seafood consumption and most food groups, as well as nutrients. In contrast, as seafood consumption increased, the consumption of grains decreased. Regarding nutrient intake, there was a negative association between seafood consumption and carbohydrate intake. After adjustment for confounding factors, the risk of CVD was inversely associated with seafood consumption, with a 56% lower risk (HRT3 vs. T1 , 0.44; 95% CI, 0.26–0.75; p = 0.002), only in the non-insomnia group. Conclusion Findings from this study suggest that seafood consumption might lead to more favorable outcomes against CVD if accompanied by good sleep quality.

Cerebral amyloid angiopathy (CAA) is one of the most common causes of lobar intracerebral hemorrhages. It characteristically occurs in persons aged ≥ 55 years. However, there are several reported cases of CAA occurring in those younger than 55 years. Herein, we report a case of a 46-year-old male patient who presented with cerebral infarction. The patient complained of repetitive right-side weakness. The patient was diagnosed with presumed CAA considering his clinical symptoms, brain MRI findings, and 18 F-flutemetamol brain positron-emission tomography findings.

BACKGROUND: The purpose of this study was to identify role ambiguity of comprehensive nursing care unit nurses. METHODS: A concept analysis method by Walker and Avant was used to understand role ambiguity of comprehensive nursing care unit nurses. RESULTS: The antecedents of role ambiguity of nurses at comprehensive nursing units were shortage of nurses, unclear admission criteria, and demands for customized nursing care according to severity. Attributes include ambiguity in role delegation, patient placement ambiguity, and professional ambiguity among nursing staff. The consequences were diminished job satisfaction due to excessive workload, difficulty in resolving role ambiguity due to the lack of work analysis studies, and poor outcome of nursing indicators. CONCLUSION Improvement of nationwide awareness for comprehensive nursing care unit is required. Clear division at scope of practice for nursing staff in accordance of each medical institution's characteristics is essential. Nurses at comprehensive nursing care unit should understand nature of role ambiguity that occurs as they work in large groups. Nurses should promote communications between nursing staff and they must have volition to improve status quo. An additional research of comprehensive nursing care on the causes of role ambiguity in the practice of nursing care for ward nurses is needed, and management measures should be sought at the organizational level.

BACKGROUND AND OBJECTIVES: The purpose of this study is to identify the prevalence of progressive dilation in patients with acute myocardial infarction (AMI) combined with heart failure (HF) and determine the prognostic significance and associated factors with a geometric change of an infarcted heart. SUBJECTS AND METHODS: A total of 1310 AMI patients with HF (63.9+/-12.5 years, 70% male) between November 2005 and April 2011 underwent echocardiography at admission and one year later. Left ventricular (LV) remodeling is defined as 20% progression, and left atria (LA) remodeling is 10% compared with the initial volume index. RESULTS: The prevalence of both LA and LV remodeling was 13.9%; LV only was 9.3%, LA only 22.8% and non-remodeling was 55.1%, respectively. In the non-remodeling group, Killip class II was more frequent (83.9%, p<0.001) whereas in other remodeling groups, Killip class III was more frequent. Initial wall motion score index, ejection fraction, maximal cardiac enzyme, high sensitive C-reactive protein, B type natriuretic peptide, and triglyceride serum levels were significantly associated with heart remodeling. All causes of death occurred in 168 cases (12.8%) during the follow-up period. Mortality was the highest in the LV and LA remodeling group (20.9%) and the lowest in the non-remodeling group (11.4%). During the period of follow-up, the cumulative survival rate was significantly lower in the groups of LA and LV remodeling than in others (log rank p=0.006). CONCLUSION: Total mortality was significantly increased in patients AMI with geometrically progressive LA and LV dilatation.
C-Reactive Protein ; Cause of Death ; Dilatation ; Echocardiography ; Follow-Up Studies ; Heart ; Heart Atria* ; Heart Failure ; Humans ; Mortality* ; Myocardial Infarction* ; Prevalence ; Prognosis ; Survival Rate ; Triglycerides ; Ventricular Remodeling