Objective: This study enrolls diverse hospitals and analyzes the differences in meal provision and nutrition management services for patients with dysphagia. Methods: A nationwide survey was conducted by mail and mobile for 850 medical institutions, and data were collected from 217 hospitals. We analyzed the status of the dysphagia diet and nutrition management by considering the type of hospital. Results: Among the hospitals surveyed, 167 (77%) provided texture-modified diets for dysphagia patients. The status of providing dysphagia diets and nutrition management for dysphagia differed depending on the institution. In particular, nutrition services for dysphagia patients in long-term care hospitals were poor. Difficulties in providing a dysphagia diet included the complexity of the cooking process, difficulty maintaining constant viscosity, difficulty in hygiene management, and low meal bills. Using commercial thickeners in cooking accounted for 72.5%, and only 41.9% of hospitals provided a commercial thickener with meals. Compared to the regular diet, the additional food cost to provide a single dysphagia diet meal was estimated to be 500-1,000 won. Based on a 5-point scale, we determined that the average scores for the importance and performance of nutrition management in patients with dysphagia were 4.29 and 3.19 points, respectively. Regardless of the type of hospital, performances of all the steps in the nutrition care process were significantly lower than their importance. Conclusion Several difficulties are encountered in meal provision and nutrition management for patients with dysphagia, including the burden of expenses and human resources. Thus, the medical fees for a dysphagia diet need to be reasonably increased. Moreover, national health insurance should additionally cover nutrition education for dysphagia patients.

PURPOSE: There are few reports from Asian countries about the long-term results of aromatase inhibitor adjuvant treatment for breast cancer. This observational study aimed to evaluate the long-term effects of letrozole in postmenopausal Korean women with operable breast cancer. METHODS: Self-reported quality of life (QoL) scores were serially assessed for 3 years during adjuvant letrozole treatment using the Korean version of the Functional Assessment of Cancer Therapy-Breast questionnaires (version 3). Changes in bone mineral density (BMD) and serum cholesterol levels were also examined. RESULTS: All 897 patients received the documented informed consent form and completed a baseline questionnaire before treatment. Adjuvant chemotherapy was administered to 684 (76.3%) subjects, and 410 (45.7%) and 396 (44.1%) patients had stage I and II breast cancer, respectively. Each patient completed questionnaires at 3, 6, 12, 18, 24, 30, and 36 months after enrollment. Of 897 patients, 749 (83.5%) completed the study. The dropout rate was 16.5%. The serial trial outcome index, the sum of the physical and functional well-being subscales, increased gradually and significantly from baseline during letrozole treatment (p<0.001). The mean serum cholesterol level increased significantly from 199 to 205 after 36 months (p=0.042). The mean BMD significantly decreased from −0.39 at baseline to −0.87 after 36 months (p<0.001). CONCLUSION: QoL gradually improved during letrozole treatment. BMD and serum cholesterol level changes were similar to those in Western countries, indicating that adjuvant letrozole treatment is well tolerated in Korean women, with minimal ethnic variation.
Aromatase ; Asian Continental Ancestry Group ; Bone Density ; Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Cholesterol ; Consent Forms ; Female ; Humans ; Observational Study ; Quality of Life*

Pincer nail deformity is a severe condition in which the nail bed becomes compressed and the nail shows an overcurvature. We retrospectively analyzed 13 pincer nail deformities treated using our nail plate and bed reconstruction technique. Visual analogue scale scores, the width of nail root, width of nail tip, height of nail tip, width index, and height index were assessed before and after surgery. The overcurvature was corrected after detachment of the nail plate. The nail fold was pushed underneath the nail plate and then fixed. The width of nail tip significantly increased after surgery (p < 0.05) and was maintained during follow-up. The height of nail tip decreased after surgery (p < 0.05). This nail plate and bed reconstruction technique is a simple and quick surgical method for correcting deformities and reduces risks of complications such as skin necrosis and infection compared to other existing surgical techniques. We recommend this efficient surgical technique for the treatment of pincer nails.
Congenital Abnormalities* ; Follow-Up Studies ; Methods ; Nails, Malformed ; Necrosis ; Retrospective Studies ; Skin

Diffuse pigmented villonodular synovitis (PVNS) involving ankle joint needs complete mass excision and total synovectomy to reduce recurrence rate, while surrounding ligaments can be easily damaged. So the concurrent ligament reconstruction should be considered for post-excisional instability in subtalar joint as well as lateral ankle joint. We describe our experience in the management of a diffuse type PVNS, invades lateral talocrural joint extended to subtalar joint and introduce a new technique of all-in-one reconstruction for anterior talofibular,calcaneofibular and cervical ligament. Our new reconstruction technique applying modified Chrisman and Snook technique is useful in stabilization for deficiencies of the ligament complexafter PVNS excisionat lateral ankle and subtalar joint.
Ankle Joint ; Ankle* ; Joints ; Ligaments* ; Recurrence ; Subtalar Joint* ; Synovitis, Pigmented Villonodular*

PURPOSE: This study was performed to identify the mediating effect of empowerment in the relationship between head nurses' servant leadership and organizational commitment among clinical nurses. METHODS: A cross-sectional survey design was used. A convenience sample of 249 nurses was recruited from three hospitals located in J province, South Korea. Data were collected by self-report questionnaires, including general characteristics, servant leadership, empowerment, and organizational commitment. Data were analyzed with descriptive statistics, Pearson correlation coefficients, independent t-test, One-way ANOVA, and linear regression using the SPSS 22.0 program. RESULTS: Head nurses' servant leadership perceived by clinical nurses significantly influenced their organization commitment. Empowerment partly mediated the effect of servant leadership on organizational commitment. CONCLUSION: The findings suggest the importance of improving nurse managers' servant leadership and empowering nurses to increase their organizational commitment.
Cross-Sectional Studies ; Head* ; Korea ; Leadership* ; Linear Models ; Negotiating* ; Power (Psychology)*

Using the Korean public health insurance database, we analyzed patients diagnosed as benign prostatic hyperplasia (BPH) from 2004 to 2008. Age and year-specific amount and seasonal variation of hospital visits (HV), duration of treatment (DT), the total and per capita amount of insurance payment (TAIP, PCIP) were evaluated. A total of 12,088,995 HV were studied. Total HV increased 1.7 times and DT almost doubled in 2008 compared to those in 2004. HV, DT, and TAIP showed linearly increasing patterns year by year. In a time series analysis, HV increased in winter and demonstrated seasonality in a 12-month cycle. In a Poisson regression analysis, the annual variations of HV, DT, TAIP, and PCIP were different by age groups. In patients older than 40 yr, HV significantly increased 1.10-1.16 times compared to that of the previous year. DT markedly increased in their 60s and 80s patients. The rate of increase in PCIP was steeper in patients 50 yr and older than in the others.Health care utilization due to BPH was rapidly increasing in Korea and it was remarkable in the elderly population. Seasonal variation of HV demonstrated that health care utilization increased in winter.
Adult ; Aged ; Aged, 80 and over ; Cost of Illness ; Health Care Costs ; Humans ; Insurance, Health/*economics/statistics & numerical data ; Male ; Middle Aged ; Patient Acceptance of Health Care/*statistics & numerical data ; Prostatic Hyperplasia/*economics/*epidemiology/therapy ; Republic of Korea/epidemiology ; Retrospective Studies ; Seasons ; Young Adult

Using the Korean public health insurance database, we analyzed patients diagnosed as benign prostatic hyperplasia (BPH) from 2004 to 2008. Age and year-specific amount and seasonal variation of hospital visits (HV), duration of treatment (DT), the total and per capita amount of insurance payment (TAIP, PCIP) were evaluated. A total of 12,088,995 HV were studied. Total HV increased 1.7 times and DT almost doubled in 2008 compared to those in 2004. HV, DT, and TAIP showed linearly increasing patterns year by year. In a time series analysis, HV increased in winter and demonstrated seasonality in a 12-month cycle. In a Poisson regression analysis, the annual variations of HV, DT, TAIP, and PCIP were different by age groups. In patients older than 40 yr, HV significantly increased 1.10-1.16 times compared to that of the previous year. DT markedly increased in their 60s and 80s patients. The rate of increase in PCIP was steeper in patients 50 yr and older than in the others.Health care utilization due to BPH was rapidly increasing in Korea and it was remarkable in the elderly population. Seasonal variation of HV demonstrated that health care utilization increased in winter.
Adult ; Aged ; Aged, 80 and over ; Cost of Illness ; Health Care Costs ; Humans ; Insurance, Health/*economics/statistics & numerical data ; Male ; Middle Aged ; Patient Acceptance of Health Care/*statistics & numerical data ; Prostatic Hyperplasia/*economics/*epidemiology/therapy ; Republic of Korea/epidemiology ; Retrospective Studies ; Seasons ; Young Adult

BACKGROUND/AIMS: Gout is a common inf lammatory arthritis triggered by the crystallization of uric acid in the joints. Serum uric acid levels are highly heritable, suggesting a strong genetic component. Independent studies to confirm the genetic associations with gout in various ethnic populations are warranted. We investigated the association of polymorphisms in the ABCG2 and SLC2A9 genes with gout in Korean patients and healthy individuals. METHODS: We consecutively enrolled 109 patients with gout and 102 healthy controls. The diagnosis of gout was based on the preliminary criteria of the America College of Rheumatology. Genomic DNA was extracted from whole blood samples. We identified single nucleotide polymorphism (SNP) changes in the ABCG2 and SLC2A9 genes using a direct sequencing technique. rs2231142 in ABCG2 and rs6449213 and rs16890979 in SLC2A9 and nearby regions were amplified by polymerase chain reaction. RESULTS: Patients with gout had significantly higher A/A genotype (29.3% vs. 4.9%, respectively) and A allele (52.8% vs. 26.5%, respectively) frequencies of rs2231142 in ABCG2 than did controls (chi2 = 29.42, p < 0.001; odds ratio, 3.32; 95% confidence interval, 2.11 to 5.20). We found novel polymorphisms (c.881A>G and c.1002+78G>A) in the SLC2A9 gene. The univariate logistic regression analysis revealed that the c.881A>G and c.1002+78G>A SNPs were significantly higher in patients than in controls. CONCLUSIONS: We demonstrated a significant association between rs2231142 in the ABCG2 gene and gout and identified novel SNPs, c.881A>G and c.1002+78G>A, in the SLC2A9 gene that may be associated with gout in a Korean population.
ATP-Binding Cassette Transporters/*genetics ; Arthritis, Gouty/blood/diagnosis/ethnology/*genetics ; Asian Continental Ancestry Group/genetics ; Biomarkers/blood ; Case-Control Studies ; Chi-Square Distribution ; Gene Frequency ; Genetic Association Studies ; Genetic Predisposition to Disease ; Glucose Transport Proteins, Facilitative/*genetics ; Haplotypes ; Humans ; Logistic Models ; Neoplasm Proteins/*genetics ; Odds Ratio ; Phenotype ; *Polymorphism, Single Nucleotide ; Republic of Korea ; Risk Factors ; Uric Acid/blood

PURPOSE: Endoplasmic reticulum (ER) stress has recently been observed to activate NF-kappaB and induce inflammatory responses such as asthma. Activating transcription factor 6beta (ATF6B) is known to regulate ATFalpha-mediated ER stress response. The aim of this study is to investigate the associations of ATF6B genetic variants with aspirin-exacerbated respiratory disease (AERD) and its major phenotype, % decline of FEV1 by aspirin provocation. METHODS: Four common single nucleotide polymorphisms (SNPs) of ATF6B were genotyped and statistically analyzed in 93 AERD patients and 96 aspirin-tolerant asthma (ATA) as controls. RESULTS: Logistic analysis revealed that 2 SNPs (rs2228628 and rs8111, P=0.008; corrected P=0.03) and 1 haplotype (ATF6B-ht4, P=0.005; corrected P=0.02) were significantly associated with % decline of FEV1 by aspirin provocation, whereas ATF6B polymorphisms and haplotypes were not associated with the risk of AERD. CONCLUSIONS: Although further functional and replication studies are needed, our preliminary findings suggest that ATF6B may be related to obstructive phenotypes in response to aspirin exposure in adult asthmatics.
Adult ; Aspirin* ; Asthma ; Endoplasmic Reticulum ; Haplotypes ; Humans ; Methods ; NF-kappa B ; Phenotype ; Polymorphism, Single Nucleotide ; Transcription Factors

PURPOSE: UGT1A1, UGT2B7, and UGT2B15 are well-known pharmacogenes that belong to the uridine diphosphate glucuronyltransferase gene family. For personalized drug treatment, it is important to study differences in the frequency of core markers across various ethnic groups. Accordingly, we screened single nucleotide polymorphisms (SNPs) of these three genes and analyzed differences in their frequency among five ethnic groups, as well as attempted to predict the function of novel SNPs. MATERIALS AND METHODS: We directly sequenced 288 subjects consisting of 96 Korean, 48 Japanese, 48 Han Chinese, 48 African American, and 48 European American subjects. Subsequently, we analyzed genetic variability, linkage disequilibrium (LD) structures and ethnic differences for each gene. We also conducted in silico analysis to predict the function of novel SNPs. RESULTS: A total of 87 SNPs were detected, with seven pharmacogenetic core SNPs and 31 novel SNPs. We observed that the frequencies of UGT1A1 *6 (rs4148323), UGT1A1 *60 (rs4124874), UGT1A1 *93 (rs10929302), UGT2B7 *2 (rs7439366), a part of UGT2B7 *3 (rs12233719), and UGT2B15 *2 (rs1902023) were different between Asian and other ethnic groups. Additional in silico analysis results showed that two novel promoter SNPs of UGT1A1 -690G>A and -689A>C were found to potentially change transcription factor binding sites. Moreover, 673G>A (UGT2B7), 2552T>C, and 23269C>T (both SNPs from UGT2B15) changed amino acid properties, which could cause structural deformation. CONCLUSION: Findings from the present study would be valuable for further studies on pharmacogenetic studies of personalized medicine and drug response.
Asian Continental Ancestry Group/genetics ; European Continental Ancestry Group/genetics ; Female ; Gene Frequency/genetics ; Glucuronosyltransferase/*genetics ; Haplotypes/genetics ; Humans ; Linkage Disequilibrium/genetics ; Male ; Polymorphism, Single Nucleotide/*genetics