Background: Large-scale studies about epidemiologic characteristics of renal infarction (RI) are few. In this study, we aimed to analyze the incidence and prevalence of RI with comorbidities in the South Korean population. Methods: We investigated the medical history of the entire South Korean adult population between 2013 and 2019 using the National Health Insurance Service database (n = 51,849,591 in 2019). Diagnosis of RI comorbidities were confirmed with International Classification of Disease, Tenth Revision, Clinical Modification codes. Epidemiologic characteristics, distribution of comorbidities according to etiologic mechanisms, and trend of antithrombotic agents were estimated. Results: During the 7-years, 10,496 patients were newly diagnosed with RI. The incidence rate increased from 2.68 to 3.06 per 100,000 person-years during the study period.The incidence rate of RI increased with age peaking in the 70s with 1.41 times male predominance. The most common comorbidity was hypertension, followed by dyslipidemia and diabetes mellitus. Regarding etiologic risk factor distribution, high embolic risk group, renovascular disease group, and hypercoagulable state group accounted for 16.6%, 29.1%, and 13.7% on average, respectively. For the antithrombotic treatment of RI, the prescription of antiplatelet agent gradually decreased from 17.0% to 13.0% while that of anticoagulation agent was maintained around 35%. The proportion of non-vitamin K antagonist oral anticoagulants remarkably increased from only 1.4% to 17.6%. Conclusion Considering the progressively increasing incidence of RI and high prevalence of coexisting risk factors, constant efforts to raise awareness of the disease are necessary. The current epidemiologic investigation of RI would be the stepping-stone to establishing future studies about clinical outcomes and optimal treatment strategies.

Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Purpose: : The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients’ nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). Methods: : In a cross-sectional survey conducted in September 2017, 1,786 patients’ WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients’ nursing care needs were calculated. Results: : The mean WMSCN scores were 109.50±17.17 in tertiary hospitals and 96.38±19.26 in general hospitals. Nursing hours per patient day were 12.47±2.80 in tertiary hospitals and 11.01±2.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. Conclusion : Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients’ nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.

Purpose: A critical indicator of the overall survival of patients with high-grade glioma is the successful isolation of tumor mesenchymal stem-like cells (tMSLCs), which play important roles in glioma progression. However, attempts to isolate tMSLCs from surgical specimens have not always been successful, and the reasons for this remain unclear. Considering that the amount of surgical high-grade glioma specimens varies, we hypothesized that larger surgical specimens would be better for tMSLC isolation. Materials and Methods: We assessed 51 fresh, high-grade glioma specimens and divided them into two groups according to the success or failure of tMSLC isolation. The success of tMSLC isolation was confirmed by plastic adherence, presenting antigens, tri-lineage differentiation, and non-tumorigenicity. Differences in characteristics between the two groups were tested using independent two sample t-tests, chi-square tests, or Kaplan-Meier survival analysis. Results: The mean specimen weights of the groups differed from each other (tMSLC-negative group: 469.9±341.9 mg, tMSLC positive group: 546.7±618.9 mg), but the difference was not statistically significant. The optimal cut-off value of specimen weight was 180 mg, and the area under the curve value was 0.599. Conclusion Our results suggested a minimum criterion for specimen collection, and found that the specimen amount was not deeply related to tMSLC detection. Collectively, our findings imply that the ability to isolate tMSLCs is determined by factors other than the specimen amount.

Purpose: A critical indicator of the overall survival of patients with high-grade glioma is the successful isolation of tumor mesenchymal stem-like cells (tMSLCs), which play important roles in glioma progression. However, attempts to isolate tMSLCs from surgical specimens have not always been successful, and the reasons for this remain unclear. Considering that the amount of surgical high-grade glioma specimens varies, we hypothesized that larger surgical specimens would be better for tMSLC isolation. Materials and Methods: We assessed 51 fresh, high-grade glioma specimens and divided them into two groups according to the success or failure of tMSLC isolation. The success of tMSLC isolation was confirmed by plastic adherence, presenting antigens, tri-lineage differentiation, and non-tumorigenicity. Differences in characteristics between the two groups were tested using independent two sample t-tests, chi-square tests, or Kaplan-Meier survival analysis. Results: The mean specimen weights of the groups differed from each other (tMSLC-negative group: 469.9±341.9 mg, tMSLC positive group: 546.7±618.9 mg), but the difference was not statistically significant. The optimal cut-off value of specimen weight was 180 mg, and the area under the curve value was 0.599. Conclusion Our results suggested a minimum criterion for specimen collection, and found that the specimen amount was not deeply related to tMSLC detection. Collectively, our findings imply that the ability to isolate tMSLCs is determined by factors other than the specimen amount.

Purpose: : The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients’ nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). Methods: : In a cross-sectional survey conducted in September 2017, 1,786 patients’ WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients’ nursing care needs were calculated. Results: : The mean WMSCN scores were 109.50±17.17 in tertiary hospitals and 96.38±19.26 in general hospitals. Nursing hours per patient day were 12.47±2.80 in tertiary hospitals and 11.01±2.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. Conclusion : Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients’ nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.
Advisory Committees ; Bias (Epidemiology) ; Carcinoma, Squamous Cell ; Counseling ; Expert Testimony ; Humans ; Mouth Neoplasms ; Neck ; Republic of Korea

Gastric cancer with double metastasis to the orbit and duodenum is extremely rare. We report the case of a patient with gastric adenocarcinoma who presented with synchronous orbital and duodenal metastases at the time of initial diagnosis. A 60-year-old man presented with a 1-month history of visual disorder and pain in his right eye. He underwent ophthalmological examinations. The biopsy results suggested intraocular metastatic carcinoma. We conducted a systemic evaluation to identify primary malignancy. Finally, a diagnosis of advanced gastric adenocarcinoma with multi-organ metastasis was made. He planned to be treated with systemic chemotherapy.
Adenocarcinoma ; Biopsy ; Choroid ; Diagnosis ; Drug Therapy ; Duodenum ; Humans ; Middle Aged ; Neoplasm Metastasis ; Orbit ; Stomach Neoplasms ; Vision Disorders

PURPOSE: It is difficult to develop a good defense system that can prevent nurses from experiencing physical and verbal violence from patients and families in intensive care units, which are closed spaces. This study aimed to identify intensive care nurses' experience of violence from patients and families and investigate their coping methods, if there are any, in a tertiary hospital in South Korea. METHODS: This study used a mixed methods design using both a survey for collecting quantitative data and individual interviews for a qualitative one. A total of 200 intensive care nurses participated in the survey, with 30 of them taking part in individual interviews. Survey data were analyzed using SPSS 21.0 program, and qualitative data were analyzed by qualitative content analysis method. RESULTS: In the survey, 99.5% of the nurses reported that they had experienced violence from the patients, and 67.5% of the nurses reported that they had experienced violence from their visitors (families or relatives). Verbal violence were reported more than physical ones. They showed moderate or severe responses to violence, scoring an average of 2.98 ± 0.63 of 5. The qualitative data were analyzed to draw four themes, eight categories, and 17 subcategories. The four themes were perception of violence, coping with violence experience, coping resources, and caring mind after violence experience. CONCLUSION: While intensive care nurses experience unpredicted violence from patients and their visitors, they fail to cope well with the experience. The safe working environment of intensive care units is expected to contribute to quality care and an improvement of expertise in nursing.
Critical Care* ; Humans ; Intensive Care Units* ; Korea* ; Methods* ; Nursing ; Tertiary Care Centers ; Violence*

PURPOSE: This study aimed to identify the view of life and death among ICU nurses and to analyze the problems related to end-of-life care in the current ICUs. METHODS: A descriptive study design was used. The participants were 975 nurses working in the intensive care units of 16 general hospitals. Using a descriptive survey design, data were collected from August to December in 2016 and were analyzed using descriptive statistics, t-test, ANOVA, correlation analysis, and multiple regression analysis. RESULTS: As a result of a correlation analysis of the data, Death perception had a significant positive correlation with EOL of nursing attitudes(r=.100, p=.002), and negative correlation with EOL stress care(r=−.221, p= < .001). The regression model explained for individual characteristics in the model, age(β=.126, p < .001) and death perception(β=.182, p < .001), Satisfaction of the EOL care(β=.173, p < .001), Healing training needs on the EOL(β=−.144, p < .001) were the most influential factors for EOL stress. CONCLUSION: Results reveal that ICU nurses have a moderate level of EOL stress, and that individual, age, death perception, Satisfaction of the EOL care, Healing traning needs on the EOL relevant in ICU nurses' EOL stress. Programs or interventions to reduce EOL stress and to should be developed taking into account these multidimensional factors.
Critical Care ; Hospitals, General ; Intensive Care Units ; Nursing ; Stress, Psychological ; Terminal Care