Objectives: The objective of this study was to develop and validate a multicenter-based, multi-model, time-series deep learning model for predicting drug-induced liver injury (DILI) in patients taking angiotensin receptor blockers (ARBs). The study leveraged a national-level multicenter approach, utilizing electronic health records (EHRs) from six hospitals in Korea. Methods: A retrospective cohort analysis was conducted using EHRs from six hospitals in Korea, comprising a total of 10,852 patients whose data were converted to the Common Data Model. The study assessed the incidence rate of DILI among patients taking ARBs and compared it to a control group. Temporal patterns of important variables were analyzed using an interpretable timeseries model. Results: The overall incidence rate of DILI among patients taking ARBs was found to be 1.09%. The incidence rates varied for each specific ARB drug and institution, with valsartan having the highest rate (1.24%) and olmesartan having the lowest rate (0.83%). The DILI prediction models showed varying performance, measured by the average area under the receiver operating characteristic curve, with telmisartan (0.93), losartan (0.92), and irbesartan (0.90) exhibiting higher classification performance. The aggregated attention scores from the models highlighted the importance of variables such as hematocrit, albumin, prothrombin time, and lymphocytes in predicting DILI. Conclusions Implementing a multicenter-based timeseries classification model provided evidence that could be valuable to clinicians regarding temporal patterns associated with DILI in ARB users. This information supports informed decisions regarding appropriate drug use and treatment strategies.

Instant noodle is one of the most popular foods in Korea. The objective of this study was to examine the association of instant noodle consumption and food and nutrient intake among children and teenagers in Korea. We used dietary data from 24-h recall of 1,748 subjects aged 7-19 years who participated in the 2005 Korea National Health and Nutrition Examination Survey. Those who consumed instant noodle once or more during the survey period were categorized as "instant noodle consumer (INC)" and were compared for food and nutrient intakes with the others (non-INC). The average age of the INC was 13.4 and that of the non-INC was 12.4; girls consumed more instant noodles than boys (p < 0.05). There was no significant difference in BMI between the two groups. With the exception of grains, as compared to the non-INC, the INC consumed significantly less amounts of potatoes, vegetables, mush-rooms, fruits, spices, seafood, and milk and dairy products. With respect to nutrient intakes, the INC-group showed significantly higher nutrient intakes of energy, fat, carbohydrate, sodium, thiamine, and riboflavin; however, as compared to the non-INC-group, the INC-group showed significantly less intakes of calcium, niacin, and vitamin C. The overall result suggests that consuming instant noodles may lead to excessive intake of fat and sodium, but it may cause an increased intake of thiamine and riboflavin. Therefore, nutrition education that helps children and teenagers choose a balanced meal while consuming instant noodle should be carried out. In addition, manufactures of instant noodles should consider nutritional aspects in product development processes.
Adolescent ; Aged ; Ascorbic Acid ; Calcium ; Child ; Dairy Products ; Edible Grain ; Fruit ; Humans ; Korea ; Meals ; Milk ; Niacin ; Nutrition Surveys ; Riboflavin ; Seafood ; Sodium ; Solanum tuberosum ; Spices ; Thiamine ; Vegetables

National examination for dietitian's license should be reliable and valid to appreciate the ability to carry out the duty as dietitians in diverse area. Thus, it is necessary to investigate whether the present examination accomplishes the task of the evaluation of ability to perform the minimum duty for dietitians. To analyzes the situation, professor in the university, who educate future dietitians, and currently employed dietitians are surveyed for their opinions about the validity of national examination and future directions. Also dietitian's duty analysis, foreign national system for dietitians license, current educational system, and duty analysis in different areas are analyzed. With results of data analysis and the public hearing, subjects for dietitians examination are proposed. The result are following. About current national examination, the average score of survey was 3.14 for overall examination, 3.54 for the reflection of current education, 2.98 for the minimum ability for the dietitian, 2.47 for the problem solving ability, 2.58 for the ability to adapt the environment, 3.27 for knowledge of the study which is necessary for dietitian, 3.27 for the comprehension, 3.18 for the application, 2.74 for the analysis, 2.84 for synthesis and 2.79 for evaluation. Professors and dietitians show the difference which was statistically significant(p<0.05). Among current 9 subjects for examination, food sanitation and clinical dietary therapy had high scores for validity. In the duty analysis (year 2000), distribution for each subjects were 55.58% for nutrition, 33.15% for food service and hygiene, 6.57% for foundation and 3.83% for food and cookery. By the survey result of dietitian in the food service and clinical setting with the duty analysis, distributions for subject which has above 2.0 score for the validity , difficulty, importance, and frequency , were 59.14% for nutrition, 22.43% for food service and hygiene, 10.26% for foundation, 4.03% for food and cookery, and the other appeared with 3.15%. With the fact that items for duty are composed of attitude items 18%, knowledge items 53%, and technical items 29%, current national examination which mostly evaluate knowledge has only 53% degree of the evaluation for the ability to perform at the job. The proportion of opinion which approves the integration of subjects was 80.3% for professors and 78.7% for dietitians. It was visible as approval, the approval rate of the whole 79.6%. For integrations of subjects for the examination and in what kind of form it was done, the investigation of opinion results in 4 subjects areas of foundation, nutrition, food and cookery, and food service and hygienic field. It was the opinion for 31.4% of the respondent.. With these results, it referred to the national examination and set to the making items in 4 subjects areas of foundation, nutrition, food and cookery, and food service and hygienic field. In the future, it is recommended that, even if subjects for the national examination of dietitians are not changed, the number of questions in the examination, the proportion in the item pool, management of pools, should be adjusted by the 4 subject areas.
Comprehension ; Cooking ; Surveys and Questionnaires ; Education ; Food Services ; Hearing ; Hygiene ; Korea* ; Licensure* ; Nutritionists ; Problem Solving ; Sanitation ; Statistics as Topic

OBJECTIVE: HL7(Health Level 7) develops standards for the representation of clinical documents like discharge and consultation notes. The goal of the present study is to develop XML(eXtensible Markup Language)-based communication standard for discharge note. METHODS: This paper presents the use of XML for electronic communication in a document-based EMR, first, as a format for the exchange of structured message, and second, as a comprehensible way to represent patient document. A retrospective analysis of 1165 discharge notes, from the department Seoul National University Hospital, were extracted by querying OCS(Order Communication System) and taking every discharge note of main disease issued over one year period (2003.01.01~2003.12.31). RESULTS: An XML-based prototype for discharge note has been put into place representing the required "section" and "specific instance". In addition, a subset of the CDA(Clinical Document Architecture) Level One details has been described and integrated. CONCLUSION: Through the introduction of definitions for sections and specific instances, progress in the development of CDA Level Two and Three might be realized. An XML-based prototype was implemented, allowing a special view on XML data to generate this document type.
Electronic Health Records ; Health Level Seven ; Humans ; Retrospective Studies ; Seoul

Primary hypothyroidism and type 2 diabetes are both typically associated with the increased level of triglycerides. To date, there have been only a few case reports of type 2 diabetes patients with both type V hyperlipoproteinemia and eruptive xanthomas, but there have been no reports of hypothyroidism patients associated with eruptive xanthomas. We report here on a case of a 48-yr old female patient who was diagnosed with type 2 diabetes and primary hypothyroidism associated with both type V hyperlipoproteinemia and eruptive xanthomas. We found rouleaux formation of RBCs in peripheral blood smear, elevated TSH, and low free T4 level, and dyslipidemia (total cholesterol 18.1 mM/L, triglyceride 61.64 mM/L, HDL 3.0 mM/L, and LDL 2.54 mM/L). She has taken fenofibrate, levothyroxine, and oral hypoglycemic agent for 4 months. After treatment, both TSH level and lipid concentration returned to normal range, and her yellowish skin nodules have also disappeared.
Antilipemic Agents/therapeutic use ; Diabetes Mellitus, Type 2/blood/*complications/drug therapy ; Erythrocyte Aggregation ; Female ; Humans ; Hyperlipidemia/blood ; Hyperlipoproteinemia Type V/blood/*complications/drug therapy ; Hypoglycemic Agents/therapeutic use ; Hypothyroidism/blood/*complications/drug therapy ; Middle Aged ; Procetofen/therapeutic use ; Research Support, Non-U.S. Gov't ; Skin Diseases/blood/complications/drug therapy ; Thyrotropin/blood/therapeutic use ; Thyroxine/blood ; Treatment Outcome ; Xanthomatosis/blood/*complications/drug therapy

OBJECTIVE: For the effective retrieval of clinical information, the elaborate indexing is essential. Two major types of indexing are the human indexing and the automatic or machine indexing. Human indexing shows higher quality but is time consuming, labor-intensive and inconsistent in term assignment activity. METHODS: Using the Unified Medical Language System (UMLS) MetaMap program, we mapped the free text from the diagnosis section of radiology reports into UMLS concepts. To improve the precision of UMLS concept indexing by MetaMap, we evaluated the UMLS subset mapping and semantic type filtering methods, determining the best combination for improved precision. RESULTS: After calculating the candidates from subset combinations, we obtained more enhanced results by semantic-type filtering. CONCLUSION: The results may be improved for the complete automation of indexing process.
Abstracting and Indexing as Topic* ; Automation ; Diagnosis ; Humans ; Semantics ; Unified Medical Language System*

This study was conducted as a part of project developing the standards of the national board test for dietitian's licences. The purpose of this study was to define the job specification for dietitian's job description based on the knowledge, skill, attitude and related to the curriculum. The study team established the research team which composed of 11 person(7 professor in the university and 4 dietitians in hospitals, schools and private firms). The job description composed of 17 duties, 99 tasks and 576 task elements. For each element, the job specifications are written, which composed of introduction, process, required equipments, and required ability. Required ability included knowledge, skill and attitudes. The relations of the knowledge, skill and attitudes with the possible curriculum currently operated in the college or university were analyzed, also. Job specifications for 576 task elements are analyzed and framed.
Curriculum ; Humans ; Job Description* ; Nutritionists

This study was conducted a part of the project developing the standards of national board test for the dietitian's licence. The purpose of this study was to verify the dietitian's job description. To do this the survey was carried out for the frequency, criticality and difficulty of each job description with 4 point scales. The subjects was 521 dietitians, who have been working over 3 years at their position. The results are following ; 1. The each duty, task and task elements are verified with survey results. 2. Duties with high frequency and criticality were menu management, purchasing, storage and stock management, operational management for cooking, system management for distribution and sanitation management. 3. Duties with middle frequency and high criticality were managing equipment and facility, food service management, human resources management and self-development. 4. Duties with low frequency and high criticality were nutritional assessment for life cycles, nutrition therapy, nutrition education and disease management. 5. For difficulty, food service area show lower than of nutrition service area.
Cooking ; Disease Management ; Education ; Food Services ; Humans ; Job Description* ; Life Cycle Stages ; Nutrition Assessment ; Nutrition Therapy ; Nutritionists ; Sanitation ; Weights and Measures

This study was conducted as a part of the project developing the standards of national board test for the dietitian's licence. The purpose of this study was to define the job description of dietitians, and to describe the task elements based on the detailed analysis of the dietitians' work. This study team established the research team which was composed of food and nutrition experts, 7 of registered dietitians and 3 of university professors. Draft job description form was made to fully explain the dietitians' task elements, process and sequence by the research team. Final job description form was confirmed after the validity of 576 task elements was reevaluated upon 4 point scale test based on the frequency, importance, and difficulty by 21 field registered dietitian by the study team. It was also confirmed by the university. This form was formated by following DACUM method which analyzed the job description containing duty, task and task elements. It was organized to include every dietitians' work and to describe the every detailed process of work. Duty was defined as the specific and independent work as a dietitian, and was composed of 17 parts, i.e 10 parts in food supply management area and 6 parts in nutritional care service area and self promotion area. Duties were also divided into 99 tasks containing the 576 detailed task elements to describe definite action, steps and decisions. Seventeen parts are following; menu planning, storage and inventory control, food production, meal service, waste management, sanitation, equipment and facility management, human resource management, financial management, nutrition assessment of life cycle, nutritional assessment of several disease, nutritional assessment in specific condition, medical nutrition therapy, nutritional education, public health nutrition and self promotion. If these protocols are properly performed and presented, they can provide the likelihood that dietetics professionals work as a primary contributors in promoting health care and preventing disease nationally.
Delivery of Health Care ; Dietetics ; Education ; Financial Management ; Food Supply ; Humans ; Job Description ; Life Cycle Stages ; Meals ; Menu Planning ; Nutrition Assessment ; Nutrition Therapy ; Nutritionists ; Public Health ; Sanitation ; Waste Management