Ulcerative colitis (UC), a relapsing-remitting chronic inflammatory bowel disease (IBD), has a variable natural course but potentially severe disease course. Since the development of anti-tumor necrosis factor (TNF) agents has changed the natural disease course of moderate-to-severe UC, therapeutic options for patients who failed conventional treatments are expanding rapidly. IBD clinical trials have demonstrated the potential efficacy and safety of novel biologics such as anti-integrin α4β7 and anti-interleukin-12/23 monoclonal antibodies and small molecules such as a Janus kinase inhibitor. Anti-TNF biosimilars also have been approved and are widely used in IBD patients. Wise drug choices should be made considering evidence-based efficacy and safety. However, the best position of these drugs remains several questions, with limited data from direct comparative trials. In addition, there are still concerns to be elucidated on the effect of therapeutic drug monitoring and combination therapy with immunomodulators. The appropriate treatment regimens in acute severe UC and the risk of perioperative use of biologics are unclear. As novel biologics and small molecules have been approved in Korea, we present the Korean guidelines for medical management of adult outpatients with moderate-to-severe UC and adult hospitalized patients with acute severe UC, focusing on biologics and small molecules.

OBJECTIVE: To investigate the effects of different types of mammography equipment on screening outcomes by comparing the performance of film-screen mammography (FSM), computed radiography mammography (CRM), and digital mammography (DM).MATERIALS AND METHODS: We retrospectively enrolled 128756 sets of mammograms from 10 hospitals participating in the Alliance for Breast Cancer Screening in Korea between 2005 and 2010. We compared the diagnostic accuracy of the types of mammography equipment by analyzing the area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI); performance indicators, including recall rate, cancer detection rate (CDR), positive predictive value₁ (PPV₁), sensitivity, specificity, and interval cancer rate (ICR); and the types of breast cancer pathology.RESULTS: The AUCs were 0.898 (95% CI, 0.878–0.919) in DM, 0.860 (0.815–0.905) in FSM, and 0.866 (0.828–0.903) in CRM (p = 0.150). DM showed better performance than FSM and CRM in terms of the recall rate (14.8 vs. 24.8 and 19.8%), CDR (3.4 vs. 2.2 and 2.1 per 1000 examinations), PPV₁ (2.3 vs. 0.9 and 1.1%), and specificity (85.5 vs. 75.3 and 80.3%) (p < 0.001) but not in terms of sensitivity (86.3 vs. 87.4 and 86.3%) and ICR (0.6 vs. 0.4 and 0.4). The proportions of carcinoma in situ (CIS) were 27.5%, 13.6%, and 11.8% for DM, CRM, and FSM, respectively (p = 0.003).CONCLUSION: In comparison to FSM and CRM, DM showed better performance in terms of the recall rate, CDR, PPV₁, and specificity, although the AUCs were similar, and more CISs were detected using DM. The application of DM may help to improve the quality of mammography screenings. However, the overdiagnosis issue of CIS using DM should be evaluated.
Area Under Curve ; Breast Neoplasms ; Breast ; Carcinoma in Situ ; Korea ; Mammography ; Mass Screening ; Medical Overuse ; Pathology ; Radiography ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

BACKGROUND: Shift workers are increasing worldwide, and various negative health effects of shift work have been reported. This study aimed to evaluate the relationship between shift work and health behavior. METHODS: This cross-sectional study included a total of 11,680 Korean adults (6,061 men and 5,619 women) aged ≥20 years old who participated in the Fifth Korean National Health and Nutrition Examination Survey, 2010–2012. Multiple logistic regression analysis was performed to evaluate the association between shift work and health behavior after adjusting for covariates. RESULTS: In men, shift work was associated with an increased risk of inadequate sleep (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.00 to 1.40) compared to day work. In women, shift work was associated with an increased risk of smoking (OR, 1.73; 95% CI, 1.34 to 2.22) and inadequate sleep (OR, 1.24; 95% CI, 1.05 to 1.47) compared to day work. In an age-stratified subgroup analysis, female shift workers aged ≥50 years old demonstrated an increased risk of smoking (OR, 5.55; 95% CI, 3.60 to 8.55), alcohol consumption (OR, 2.22; 95% CI, 1.53 to 3.23), and inadequate sleep (OR, 1.50; 95% CI, 1.10 to 2.05) compared to female day workers. CONCLUSION: Shift work is associated with worse health behavior, and this is most evident in women aged ≥50 years. Targeted strategies to reduce the negative health effects of shift work should be implemented, with consideration of shift workers' demographic characteristics.
Adult ; Alcohol Drinking ; Alcoholism ; Cross-Sectional Studies ; Female ; Health Behavior* ; Humans ; Logistic Models ; Male ; Nutrition Surveys* ; Sleep Wake Disorders ; Smoke ; Smoking ; Work Schedule Tolerance

The purpose of this study was to provide basic data to standardize the clinical dental hygiene curriculum, based on analysis of current clinical dental hygiene curricula in Korea. We emailed questionnaires to 12 schools to investigate clinical dental hygiene curricula, from February to March, 2017. We analyzed the clinical dental hygiene curricula in 5 schools with a 3-year program and in 7 schools with a 4-year program. The questionnaire comprised nine items on topics relating to clinical dental hygiene, and four items relating to the dental hygiene process and oral prophylaxis. The questionnaire included details regarding the subject name, the grade/semester/credit system, course content and class hours, the number of senior professors, and the number of patients available for dental hygiene clinical training purposes. In total, there were 96 topics listed in the curricula relating to clinical dental hygiene training, and topics varied between the schools. There was an average of 20.4 topic credits, and more credits and hours were allocated to the 4-year program than to the 3-year program. On average, the ratio of students to professors was 21.4:1. Course content included infection control, concepts for dental hygiene processes, dental hygiene assessment, intervention and evaluation, case studies, and periodontal instrumentation. An average of 2 hours per patient was spent on dental hygiene practice, with an average of 1.9 visits. On average, student clinical training involved 19 patients and 26.6 patients in the 3-year and 4-year programs, respectively. The average participation time per student per topic was 38.0 hours and 53.1 hours, in the 3-year and 4-year programs, respectively. Standardizing the clinical dental hygiene curricula in Korea will require consensus guidelines on topics, the number of classes required to achieve core competencies as a dental hygienist, and theory and practice time.
Consensus ; Curriculum* ; Dental Hygienists ; Electronic Mail ; Humans ; Infection Control ; Korea* ; Oral Hygiene*

The purpose of this study was to examine the validity of the content of an educational curriculum by understanding the opinions of experts in the development of weekly educational content for dental communication or communication-related subjects. It was composed of educational content on how to communicate with patients by cultivating a professional attitude through basic contents and a self-understanding of communication. Three experts were asked to evaluate the feasibility of educational contents and their appropriateness in order to evaluate the criteria for certification as a dental hygienist. The validity of the weekly educational contents and the period of education were awarded 4 points out of a maximum of 5 points; overall, the curriculum was evaluated to be valid and to be acceptable for use as criteria for certification evaluation. On the other hand, it was confirmed that not only should the contents be made appropriate for the grade level, but it should be complemented so that theoretical and practical learning can be achieved in a gradual and interrelated manner rather than as a one-time curriculum. Therefore, the result of this study can be considered for use as background data for curriculum development, and for standardization of the communication course in the dental hygiene department.
Awards and Prizes ; Certification ; Complement System Proteins ; Curriculum* ; Dental Hygienists ; Education ; Hand ; Humans ; Learning ; Oral Hygiene*

The aim of this study was to analyze in depth the standardized Clinical dental hygiene curriculum of the Fones School in the United States. We investigated the clinical dental hygiene curriculum in 2015~2016 including title, credit, hours, contents, goals, competencies, and evaluation. We obtained the course syllabus and data related to each subject, for each grade, from the professors and students at the university. The goals and competencies, of the clinical dental hygiene program, which were based on the goals of the Fones School and the mission of the University of Bridgeport, were developed in accordance with the dental hygienist practice standards proposed by the American Dental Hygienists Association. The curriculum consisted of theory to teach proper dental hygiene care procedures and incorporated practical exercises that modeled an actual clinical setting. The students had to document the procedures performed for each client/patient and improve their clinical competency through discussion with the professors. Dental hygiene care should be provided for children, adolescents, adults, elderly, and patients, which includes patients with moderate or severe periodontal status. Students were evaluated by a paper test or case study presentation and their clinical evaluation was based on their clinical competency. In particular, professors evaluated students on a rotational basis, so they could evaluate the level of achievement of clinical competency of all students and find ways to improve any weaknesses. Therefore, the current study suggested that clinical dental hygiene program in Korea could be improved if based on the curriculum of Fones School in the United States.
Adolescent ; Adult ; Aged ; Child ; Clinical Competence ; Curriculum* ; Dental Hygienists ; Exercise ; Humans ; Korea* ; Oral Hygiene* ; United States*

BACKGROUND/AIMS: Gastric pathology and Helicobacter pylori (H. pylori) infection among Asian patients with Crohn's disease (CD) are still unclear. We evaluated gastric histologic features and frequency of H. pylori infection in Korean patients with CD. METHODS: Among 492 patients with CD receiving upper gastrointestinal (GI) endoscopic evaluation in 19 Korean hospitals, we evaluated the endoscopic findings and gastric histopathologic features of 47 patients for our study. Histopathologic classification was performed using gastric biopsy tissues, and H. pylori infection was determined using the rapid urease test and histology. RESULTS: There were 36 men (76.6%), and the median age of patients at the time of upper GI endoscopy was 23.8 years (range, 14.2-60.5). For CD phenotype, ileocolonic disease was observed in 38 patients (80.9%), and non-stricturing, non-penetrating disease in 31 patients (66.0%). Twenty-eight patients (59.6%) complained of upper GI symptoms. Erosive gastritis was the most common gross gastric feature (66.0%). Histopathologically, H. pylori-negative chronic active gastritis (38.3%) was the most frequent finding. H. pylori testing was positive in 11 patients (23.4%), and gastric noncaseating granulomata were detected in 4 patients (8.5%). Gastric noncaseating granuloma showed a statistically significant association with perianal abscess/fistula (P=0.0496). CONCLUSIONS: H. pylori-negative chronic active gastritis appears to be frequent among Korean patients with CD. The frequency of H. pylori infection was comparable with previous studies. An association with perianal complications suggests a prognostic value for gastric noncaseating granuloma in patients with CD.
Asian Continental Ancestry Group ; Biopsy ; Classification ; Crohn Disease* ; Endoscopy ; Gastritis ; Granuloma ; Helicobacter pylori ; Humans ; Korea* ; Male ; Pathology ; Phenotype ; Stomach ; Urease

The purpose of this study was to develop a dental communication course in dental hygiene schools that included theory, practice, and skill for effective dental communication. Thirty-six senior dental hygiene students in a dental hygiene school took a dental communication course and responded to a questionnaire. The instrument used in the study was a modified form of Kim's communication skill self-assessment sheet. The self-assessment questionnaire about communication competencies was administered before and after the class, and the difference between scores at each time point was analyzed using the Wilcoxon signed rank sum test. Among seven elements of dental communication competencies, the competency of “information gathering” was significantly improved (p=0.008). Students' scores on perception of the importance (p=0.019) and necessity (0.016) of a communication course significantly increased after the course. Competencies in communication are essential requirement for dental hygienists. This study showed the possibility of communication skill training. An objective evaluation tool regarding students' communication competencies should be developed. Further studies with larger samples size are needed to develop a standardized comprehensive communication course in dental hygiene schools.
Curriculum ; Dental Hygienists ; Health Communication ; Health Education ; Humans ; Learning* ; Oral Hygiene* ; Self-Assessment

PURPOSE: The efficacy of stenting for the right-side colonic malignant obstruction is unknown. The purpose of this study was to evaluate the safety and feasibility of self-expandable metallic stent insertion for the right-side colonic malignant obstruction and its clinical benefits. METHODS: We retrospectively reviewed clinical data from 460 patients who underwent right hemicolectomy for right-side colon cancer from January 2006 to January 2014 at Korea University Anam Hospital. Twenty four patients who developed malignant obstruction in the right -side colon were identified and analyzed. RESULTS: Self-expandable metallic stent insertion was attempted in 14 patients, and initial technical success was achieved in 13 patients (92.9%). No immediate stent-related complications were reported. Complete relief of obstruction was achieved in all of the 13 patients. Eleven patients who failed stenting underwent emergency operation. All of the 13 patients with stent underwent laparoscopic surgery and only one case was converted to open. Only three patients in the emergency group underwent laparoscopic surgery but one was converted. Operative time and number of retrieved lymph nodes did not differ between the two groups. Postoperative hospital stay (9.8+/-3.2 in stent group vs. 16.3+/-10.9 days in emergency group, p=0.082) tended to be shorter in the stent group. Estimated blood loss (38.5+/-138.7 in stent group vs. 381.8+/-411.9 in emergency group, p=0.010) and duration for resuming diet (3.2+/-2.2 in stent group vs. 6.6+/-7.0 days in emergency group, p=0.017) were significantly better in the stent group. CONCLUSION: Self-expandable metallic stent appears to be safe and feasible in the right-side colonic malignant obstruction. It facilitates minimally invasive surgery and may result in better short-term surgical outcome.
Colon* ; Colonic Neoplasms ; Diet ; Emergencies ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Retrospective Studies ; Stents* ; Surgical Procedures, Minimally Invasive

BACKGROUND/AIMS: A self-report questionnaire is frequently used to measure symptoms reliably and to distinguish patients with functional gastrointestinal disorders (FGIDs) from those with other conditions. We produced and validated a cross-cultural adaptation of the Rome III questionnaire for diagnosis of FGIDs in Korea. METHODS: The Korean version of the Rome III (Rome III-K) questionnaire was developed through structural translational processes. Subsequently, reliability was measured by a test-retest procedure. Convergent validity was evaluated by comparing self-reported questionnaire data with the subsequent completion of the questionnaire by the physician based on an interview and with the clinical diagnosis. Concurrent validation using the validated Korean version of the Short Form-36 Health Survey (SF-36) was adopted to demonstrate discriminant validity. RESULTS: A total of 306 subjects were studied. Test-retest reliability was good, with a median Cronbach's alpha value of 0.83 (range, 0.71-0.97). The degree of agreement between patient-administered and physician-administered questionnaires to diagnose FGIDs was excellent; the kappa index was 0.949 for irritable bowel syndrome, 0.883 for functional dyspepsia and 0.927 for functional heartburn. The physician's clinical diagnosis of functional dyspepsia showed the most marked discrepancy with that based on the self-administered questionnaire. Almost all SF-36 domains were impaired in participants diagnosed with one of these FGIDs according to the Rome III-K. CONCLUSIONS: We developed the Rome III-K questionnaire though structural translational processes, and it revealed good test-retest reliability and satisfactory construct validity. These results suggest that this instrument will be useful for clinical and research assessments in the Korean population.
Dyspepsia ; Gastrointestinal Diseases* ; Health Surveys ; Heartburn ; Humans ; Irritable Bowel Syndrome ; Surveys and Questionnaires*