Purpose: Urothelial carcinoma has various molecular subtypes, each with different tumor characteristics. Although it is known that molecular changes occur during tumor progression, little is known about the specifics of these changes. In this study, we performed transcriptional analysis to understand the molecular changes during tumor progression. Materials and Methods: Formalin-fixed, paraffin-embedded tumor tissues were obtained from 12 patients with muscle-invasive bladder cancer (MIBC). The invasive and non-invasive papillary areas were identified in papillary urothelial carcinoma specimens.Immunohistochemistry (IHC) and mRNA sequencing were performed for each tumor area. Results: Patients with CK5/6-negative and CK20-positive non-invasive papillary areas were selected and classified into the IHC switch subgroup (CK5/6-positive and CK20-negative in the invasive area) and the IHC unchanged subgroup (CK5/6-negative and CK20-positive in the invasive area) according to the IHC results of the invasive area. We identified differences in the mRNA expression between the non-invasive papillary and invasive areas of the papillary MIBC tissue samples. In both the non-invasive papillary and invasive areas, the IHC switch subgroup showed basal subtype gene expression, while the IHC unchanged subgroup demonstrated luminal subtype gene expression. Conclusions The non-invasive papillary area showed a gene expression pattern similar to that of the invasive area. Therefore, even if the non-invasive papillary area exhibits a luminal phenotype on IHC, it can have a basal subtype gene expression depending on the invasive area.

Purpose: : The demand for skilled critical care nurses and the significant impact of the practice-readiness gap underscore the need for educational programs bridging nursing education and clinical practice. This would ensure safe, high-quality patient care and a stable workforce. This study aimed to explore the educational needs of critical care nurses to develop an essential nursing education program for nursing students, addressing the practice-readiness gap they may encounter as new nurses. Methods: : The study espoused a qualitative approach by utilizing focus group interviews conducted in South Korea in April and May 2022. A total of 11 nurses participated in the study. Data were collected from three focus groups, each consisting of three to four nurses from intensive care units. Focus group interviews were conducted using a semi-structured questionnaire. Content analysis was performed on the interview data using thematic analysis. Ethical approval for the study was obtained from the institutional review board. Results: : Nursing education programs in intensive care units should prioritize fundamental nursing competencies such as basic nursing and physical examinations. Participants’ critical care nursing education needs were categorized into four main themes: holistic nursing competency, advancement of practical education, skilled communication, and systematic critical care nursing education. Conclusion : The study’s findings provide valuable insights and guidelines for developing critical and intensive care nursing education programs tailored for nursing students.

Purpose: In the present study, we aimed to establish a liquid biopsy-based monitoring method using peripheral blood cell-free DNA (cfDNA) for patients with cervical cancer who underwent radical radiotherapy (RT). Materials and Methods: Twenty-five patients with cervical cancer were prospectively recruited and treated with external beam RT and brachytherapy. In all patients, except one, chemotherapy was administered concurrently during RT. Whole peripheral blood samples were obtained at least twice from each patient. We performed next-generation sequencing (NGS) for the target-captured libraries (67 oncogenes and human papillomavirus [HPV] type 16/18) using 64 plasma cfDNA samples from the 25 participants. The ratio of HPV cfDNA and the variant allele frequency (VAF) in cfDNA was calculated, and their dynamic changes were monitored. The median follow-up duration was 25.4 months. Results: In total, we identified 21,866 cfDNA variants. ARID1A and frameshift variants occupied the largest portion of altered genes and HIGH-grade variant types, respectively. In most cases, tumor shrinkage was followed by a decrease in the HPV ratio; however, an increase in HPV ratio indicated distant metastasis, despite the reduced tumor size. The initial HPV ratio reflecting the tumor burden was likely associated with treatment outcomes (p = 0.16). We did not determine a role for serial changes in the VAF in cfDNA. Conclusion Our findings suggest that the HPV cfDNA ratio, calculated after targeted NGS, may be valuable for monitoring and predicting treatment responses. Accordingly, further validation of these findings is warranted.

Background/Aims: Metachronous recurrence incidences and risk factors following endoscopic submucosal dissection (ESD) for gastric adenocarcinoma and dysplasias were investigated. Methods: Retrospective review of electronic medical records of patients who underwent gastric ESD at The Catholic University of Korea, Yeouido St. Mary’s Hospital. Results: A total of 190 subjects were enrolled for analysis during the study period. The mean age was 64.4 years-old and the male sex occupied 73.7%. The mean observation period following ESD was 3.45 years. The annual incidence rate of metachronous gastric neoplasms (MGN) was about 3.96%. The annual incidence rate was 5.36% for the low-grade dysplasia group, 6.47% for the high-grade dysplasia group, and 2.74% for the EGC group. MGN was more frequent in the dysplasia group than in the EGC group (p<0.05). For those with MGN development, the mean time interval from ESD to MGN was 4.1 (±1.8) years. By using the Kaplan–Meier model, the estimated mean MGN free survival time was 9.97 years (95% confidence interval, 8.53–11.40) The histological types of MGN were not related to the primary histology types. Conclusions MGN following ESD developed in 3.96% annually and MGN was more frequent in the dysplasia group. The histological types of MGN did not correlate with those of primary neoplasm.

Purpose: Women are more vulnerable to post-traumatic stress (PTS) than men, causing several health problems. Nurses should understand and work with women who have experienced trauma and provide interventions to promote their physical, social, and mental health. Methods: This quasi-experimental pilot study used a one-group pre-test/post-test design. Data were collected from 14 women recruited between December 2019 and May 2020 from a self-sufficiency support center in South Korea for sexually-exploited women who had experienced trauma. The program consisted of six one-on-one intervention sessions per week for six weeks. Each session averaged 60~120 minutes. Participants were assessed at pre-test, post-test, and one-month follow-up. Changes in outcome variables over time were analyzed using the Wilcoxon signed-rank and Friedman tests. Results: The caring program for health promotion was divided into six sessions: understanding the self, sharing traumatic events and negative emotions, reframing the meaning of traumatic events, identifying thoughts and physical and emotional responses, developing health promotion activities, and maintaining a positive attitude during the process of change. As a result of the caring program, PTS (F = 36.33, p < .001), depression (F = 24.45, p < .001), health-promoting behaviors (F = 7.06, p = .004), and self-esteem (F = 19.74, p < .001) among the participants differed significantly at pre-test, post-test, and follow-up. Conclusion This study provides foundational information for the implementation of a theory-driven program by nurses in clinical and community settings to provide comprehensive care for women who have experienced trauma.

Objective: Harmful drinking has increased, especially among younger women. To prevent this, we comprehensively understand its related factors. We aimed to examine the ecological factors that affect harmful drinking among Female College Students (FCS) based on the conceptual framework of McLeroy, et al.’s ecological model. Methods: The participants were 229 FCS aged 18-29 years from eight universities in South Korea. Results: We identified factors influencing harmful drinking among the participants using hierarchical logistic regression analysis. Stress relief was the highest among intrapersonal factors associated with harmful drinking (Odds Ratio (OR): 5.380), and those who engaged in social or school activities were more involved in harmful drinking (OR: 4.523). Finally, for college and community factors, the better one’s access to exercise facilities (such as gyms), the lower and the level of harmful drinking (OR: 0.411). When only individual factors were considered, the explanatory power was 49.2%; when both individual and interpersonal factors were input, it was 55%, and the explanatory power of the model-including individual, interpersonal, organizational, and regional factors-was 64.2%. Conclusion It is important to improve the drinking culture and environment among FCS through continuous monitoring of harmful drinking and university and locality policies. In particular, activities and facilities inside and outside the university should be expanded so that students can maintain healthy social relationships without drinking. Further, psychiatric professionals should develop an intervention program from an integrated perspective.

Purpose: This study applied in-depth research methods on the level of securing mental health nurses in mental medical institutions targeting a group of experts in mental health nursing personnel, and sought paths toward revising enforcement regulations of the Mental Health Welfare Act in the future. Methods: Focus group interviews were conducted with experts experienced in conducting research on mental nursing staffing or policy development for nursing staffing. Results: Many experts in the field of psychiatric nursing must obtain additional accurate and valid support data to focus attention on the level of securing psychiatric nurses and discussing active efforts and short-and long-term strategies. Conclusion It is important to prepare evidence for the quality level of psychiatric nursing, as well as to secure adequate manpower for psychiatric nurses. In the future, it is necessary to actively use these data for policies and research relative to psychiatric nurse workforce planning.

Purpose: The purpose of this study is to investigate the patient safety status and patient safety education contents and methods perceived by nurses working in psychiatric hospitals. Methods: Data were collected using a semi-structured questionnaire for psychiatric hospital nurses who had worked for more than one year. A total of 157 questionnaires were filled and were used for analysis using descriptive statistics. Open-ended questions about the contents and methods of patient safety education were classified by each researcher and a reclassification was conducted by consensus through discussions. Results: Overall, 142 nurses (90.4%) experienced patient safety accident during the previous 1 month. Among those who experienced a patient safety accident, profanity, violence, and aggression-related accident counted for the highest percentage (82.8%). The demand for education on workplace stress management and education on psychiatric medication were the highest. Required education methods included case-by-case education on patient safety accidents, regular and continuous education, and small-scale face-to-face education. Conclusion In the future, it is necessary to actively utilize the results of this study as basic data for in-depth research on the causes of patient safety accidents, accident prevention, and the workload of nursing personnel.

Purpose: The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Koreaby assessing National Health Insurance claims data. Methods: The dataset included 70,136 patients aged 19 years who were inpatientsin psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia,schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registerednurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomesincluded length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint,and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and systemcharacteristics using multilevel modeling. Results: Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatientsper registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission.More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnoticsuse but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injectedpsycholeptics for chemical restraint. Conclusion Lower nurse staffing levels are associated with negative health outcomes of psychiatricinpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatricinpatients in Korea.

Purpose: This study was conducted to review the web-based trauma-education programs for mental-health professionals reported in English and Korean. Methods: A systematic literature search was conducted using the PubMed, CINALH, EMBASE, Cochrane Library, PsycINFO, Web of Science, RISS, KISS, NDSL, US National Library of Medicine, Clinical Research Information Service, and Virginia Henderson International Nursing Library. The database search identified 11,852 articles. The selection of articles involved a three-phase process, in which duplications were identified and, titles and abstracts of retrieved articles were determined according to inclusion criteria, followed by full-text reading of articles identified. Finally, a total of three studies were included in this review, which published in the United States in 2011, 2014, and 2019. One was a pilot randomized controlled trial and two were pre- and post- studies. Only one included nurses as participants. Selected studies were rated for quality assessment using the Risk of Bias tool of Cochrane’s collaboration. Results: Although the specific content of the programs was unknown, they improved mental health professionals' knowledge level, performance confidence, satisfaction, and education-completion rate. Conclusion More well-designed studies are needed of the optimal content for web-based education programs in mediating trauma for a broad spectrum of mental-health professionals.