Background: Hospital environments, particularly shared rooms, are vulnerable to the transmission of carbapenem-resistant Enterobacterales (CRE). The incidence of CRE colonization in the Korean homeless population remains unknown. This study aimed to analyze the impact of targeted active surveillance of CRE in hospital wards following two outbreaks. Methods: This retrospective study was conducted in a homeless ward with shared rooms at a municipal hospital in Seoul. The CRE incidence was calculated from October 1, 2023, to May 31, 2024. Active surveillance was initiated on January 22, 2024. Poisson regression analysis was used to compare CRE incidence events at three months before and four months after the intervention. The risk factors for CRE colonization were also analyzed. Results: The CRE colonization rate decreased from 1.149 to 0.815 per 1,000 patient-days post-intervention; however, the change was not statistically significant (rate ratio: 0.986, 95% confidence interval (95% CI): 0.389-2.496, P=0.976). In contrast to the secondary cases, one acquired CRE case was detected after the intervention without an outbreak. The CRE colonization rate was higher in the homeless ward than in the general ward. CRE colonization was significantly associated with age (adjusted odds ratio (aOR), 1.071; 95% CI: 1.014-1.132;P=0.014), previous antibiotic exposure (aOR, 6.796; 95% CI: 1.215-38.029; P=0.029), and co-colonization with other multidrug resistant bacteria (aOR, 7.168; 95% CI: 2.224-23.096;P=0.001). Conclusion A relatively high incidence of CRE colonization was observed in the homeless ward. After active surveillance, no CRE outbreaks occurred following the implementation.

Background: Hospital environments, particularly shared rooms, are vulnerable to the transmission of carbapenem-resistant Enterobacterales (CRE). The incidence of CRE colonization in the Korean homeless population remains unknown. This study aimed to analyze the impact of targeted active surveillance of CRE in hospital wards following two outbreaks. Methods: This retrospective study was conducted in a homeless ward with shared rooms at a municipal hospital in Seoul. The CRE incidence was calculated from October 1, 2023, to May 31, 2024. Active surveillance was initiated on January 22, 2024. Poisson regression analysis was used to compare CRE incidence events at three months before and four months after the intervention. The risk factors for CRE colonization were also analyzed. Results: The CRE colonization rate decreased from 1.149 to 0.815 per 1,000 patient-days post-intervention; however, the change was not statistically significant (rate ratio: 0.986, 95% confidence interval (95% CI): 0.389-2.496, P=0.976). In contrast to the secondary cases, one acquired CRE case was detected after the intervention without an outbreak. The CRE colonization rate was higher in the homeless ward than in the general ward. CRE colonization was significantly associated with age (adjusted odds ratio (aOR), 1.071; 95% CI: 1.014-1.132;P=0.014), previous antibiotic exposure (aOR, 6.796; 95% CI: 1.215-38.029; P=0.029), and co-colonization with other multidrug resistant bacteria (aOR, 7.168; 95% CI: 2.224-23.096;P=0.001). Conclusion A relatively high incidence of CRE colonization was observed in the homeless ward. After active surveillance, no CRE outbreaks occurred following the implementation.

Background: Hospital environments, particularly shared rooms, are vulnerable to the transmission of carbapenem-resistant Enterobacterales (CRE). The incidence of CRE colonization in the Korean homeless population remains unknown. This study aimed to analyze the impact of targeted active surveillance of CRE in hospital wards following two outbreaks. Methods: This retrospective study was conducted in a homeless ward with shared rooms at a municipal hospital in Seoul. The CRE incidence was calculated from October 1, 2023, to May 31, 2024. Active surveillance was initiated on January 22, 2024. Poisson regression analysis was used to compare CRE incidence events at three months before and four months after the intervention. The risk factors for CRE colonization were also analyzed. Results: The CRE colonization rate decreased from 1.149 to 0.815 per 1,000 patient-days post-intervention; however, the change was not statistically significant (rate ratio: 0.986, 95% confidence interval (95% CI): 0.389-2.496, P=0.976). In contrast to the secondary cases, one acquired CRE case was detected after the intervention without an outbreak. The CRE colonization rate was higher in the homeless ward than in the general ward. CRE colonization was significantly associated with age (adjusted odds ratio (aOR), 1.071; 95% CI: 1.014-1.132;P=0.014), previous antibiotic exposure (aOR, 6.796; 95% CI: 1.215-38.029; P=0.029), and co-colonization with other multidrug resistant bacteria (aOR, 7.168; 95% CI: 2.224-23.096;P=0.001). Conclusion A relatively high incidence of CRE colonization was observed in the homeless ward. After active surveillance, no CRE outbreaks occurred following the implementation.

Background: Hospital environments, particularly shared rooms, are vulnerable to the transmission of carbapenem-resistant Enterobacterales (CRE). The incidence of CRE colonization in the Korean homeless population remains unknown. This study aimed to analyze the impact of targeted active surveillance of CRE in hospital wards following two outbreaks. Methods: This retrospective study was conducted in a homeless ward with shared rooms at a municipal hospital in Seoul. The CRE incidence was calculated from October 1, 2023, to May 31, 2024. Active surveillance was initiated on January 22, 2024. Poisson regression analysis was used to compare CRE incidence events at three months before and four months after the intervention. The risk factors for CRE colonization were also analyzed. Results: The CRE colonization rate decreased from 1.149 to 0.815 per 1,000 patient-days post-intervention; however, the change was not statistically significant (rate ratio: 0.986, 95% confidence interval (95% CI): 0.389-2.496, P=0.976). In contrast to the secondary cases, one acquired CRE case was detected after the intervention without an outbreak. The CRE colonization rate was higher in the homeless ward than in the general ward. CRE colonization was significantly associated with age (adjusted odds ratio (aOR), 1.071; 95% CI: 1.014-1.132;P=0.014), previous antibiotic exposure (aOR, 6.796; 95% CI: 1.215-38.029; P=0.029), and co-colonization with other multidrug resistant bacteria (aOR, 7.168; 95% CI: 2.224-23.096;P=0.001). Conclusion A relatively high incidence of CRE colonization was observed in the homeless ward. After active surveillance, no CRE outbreaks occurred following the implementation.

Purpose: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors have greatly improved survival in EGFR-mutant (EGFRm) non–small cell lung cancer (NSCLC); however, their effects on the tumor microenvironment (TME) are unknown. We assessed the changes induced by neoadjuvant erlotinib therapy (NE) in the TME of operable EGFRm NSCLC. Materials and Methods: This was a single-arm phase II trial for neoadjuvant/adjuvant erlotinib therapy in patients with stage II/IIIA EGFRm NSCLC (EGFR exon 19 deletion or L858R mutations). Patients received up to 2 cycles of NE (150 mg/day) for 4 weeks, followed by surgery and adjuvant erlotinib or vinorelbine plus cisplatin therapy depending on observed NE response. TME changes were assessed based on gene expression analysis and mutation profiling. Results: A total of 26 patients were enrolled; the median age was 61, 69% were female, 88% were stage IIIA, and 62% had L858R mutation. Among 25 patients who received NE, the objective response rate was 72% (95% confidence interval [CI], 52.4 to 85.7). The median disease-free and overall survival (OS) were 17.9 (95% CI, 10.5 to 25.4) and 84.7 months (95% CI, 49.7 to 119.8), respectively. Gene set enrichment analysis in resected tissues revealed upregulation of interleukin, complement, cytokine, transforming growth factor β, and hedgehog pathways. Patients with upregulated pathogen defense, interleukins, and T-cell function pathways at baseline exhibited partial response to NE and longer OS. Patients with upregulated cell cycle pathways at baseline exhibited stable/progressive disease after NE and shorter OS. Conclusion NE modulated the TME in EGFRm NSCLC. Upregulation of immune-related pathways was associated with better outcomes.

Background: Pump-controlled retrograde trial off (PCRTO) is a safe, simple, and reversible method for weaning patients from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, few studies have compared PCRTO to conventional weaning methods. This retrospective study aimed to compare PCRTO to non-PCRTO methods. Methods: This study included patients who were weaned from VA-ECMO from January 2016 to December 2022 at our medical center. Demographic data, ECMO management, ECMO complications, survival to discharge, and cardiogenic shock after VA-ECMO weaning were compared between the 2 groups. Results: Seventy patients who were weaned from VA-ECMO using PCRTO and 85 patients who were weaned with conventional methods were compared. Patient characteristics were not significantly different between the 2 groups. The rate of survival to discharge was significantly higher in the PCRTO group than in the non-PCRTO group (90% vs. 72%, p=0.01). The rates of freedom from all-cause mortality at 10, 30, and 50 days after weaning from ECMO were 75%, 55%, and 35% in the non-PCRTO group and 62%, 60%, and 58% in the PCRTO group, respectively (p=0.1). The incidence of cardiogenic shock after weaning from VA-ECMO was significantly higher in the non-PCRTO group (16% vs. 5%, p=0.04). In logistic regression analysis, PCRTO was a significant factor for survival to discharge (odds ratio, 2.42; 95% confidence interval, 1.29–5.28; p=0.02). Conclusion Compared to conventional methods, PCRTO is a feasible and reversible method, and it serves as a useful predictor of successful VA-ECMO weaning through a preload stress test.

Background: A healthcare system’s collapse due to a pandemic, such as the coronavirus disease 2019 (COVID-19), can expose healthcare workers (HCWs) to various mental health problems. This study aimed to investigate the impact of the COVID-19 pandemic on the depression and anxiety of HCWs. Methods: A nationwide questionnaire-based survey was conducted on HCWs who worked in healthcare facilities and public health centers in Korea in December 2020. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure depression and anxiety. To investigate factors associated with depression and anxiety, stepwise multiple logistic regression analysis was performed. Results: A total of 1,425 participating HCWs were included. The mean depression score (PHQ-9) of HCWs before and after COVID-19 increased from 2.37 to 5.39, and the mean anxiety score (GAD-7) increased from 1.41 to 3.41. The proportion of HCWs with moderate to severe depression (PHQ-9 ≥ 10) increased from 3.8% before COVID-19 to 19.5% after COVID-19, whereas that of HCWs with moderate to severe anxiety (GAD-7 ≥ 10) increased from 2.0% to 10.1%. In our study, insomnia, chronic fatigue symptoms and physical symptoms after COVID-19, anxiety score (GAD-7) after COVID-19, living alone, and exhaustion were positively correlated with depression. Furthermore, post-traumatic stress symptoms, stress score (Global Assessment of Recent Stress), depression score (PHQ-9) after COVID-19, and exhaustion were positively correlated with anxiety. Conclusion In Korea, during the COVID-19 pandemic, HCWs commonly suffered from mental health problems, including depression and anxiety. Regularly checking the physical and mental health problems of HCWs during the COVID-19 pandemic is crucial, and social support and strategy are needed to reduce the heavy workload and psychological distress of HCWs.

Purpose: This study evaluated the validity and reliability of Shively and colleagues’ self-efficacy for HIV disease management skills (HIVSE) among Korean participants. Methods: The original HIV-SE questionnaire, comprising 34 items, was translated into Korean using a translation and back-translation process. To enhance clarity and eliminate redundancy, the author and expert committee engaged in multiple discussions and integrated two items with similar meanings into a single item. Further, four HIV nurse experts tested content validity. Survey data were collected from 227 individuals diagnosed with HIV from five Korean hospitals. Construct validity was verified through confirmatory factor analysis. Criterion validity was evaluated using Pearson’s correlation coefficients with the new general self-efficacy scale. Internal consistency reliability and test-retest were examined for reliability. Results: The Korean version of HIV-SE (K-HIV-SE) comprises 33 items across six domains: “managing depression/mood,” “managing medications,” “managing symptoms,” “communicating with a healthcare provider,” “getting support/help,” and “managing fatigue.” The fitness of the modified model was acceptable (minimum value of the discrepancy function/degree of freedom = 2.49, root mean square error of approximation = .08, goodnessof-fit index = .76, adjusted goodness-of-fit index = .71, Tucker-Lewis index = .84, and comparative fit index = .86). The internal consistency reliability (Cronbach’s α = .91) and test-retest reliability (intraclass correlation coefficient = .73) were good. The criterion validity of the K-HIV-SE was .59 (p < .001). Conclusion This study suggests that the K-HIV-SE is useful for efficiently assessing self-efficacy for HIV disease management.

Background and Objectives: The left atrial appendage (LAA) can contribute significantly to LA mechanical contraction. Nevertheless, the preventive effect of LAA occlusion during the maze procedure against cerebral infarction remains controversial. In this study, we compared the surgical, cardiac hemodynamic, and neurologic outcomes between LAA preservation and occlusion performed during the maze procedure. Methods: Between January 2015 and August 2021, 252 patients underwent the maze procedure using cryoablation at our medical center. After excluding patients according to our exclusion criteria (i.e., mechanical prosthesis implantation, preexisting LAA thrombus), LAA was preserved in 113 patients (non-occlusion group) and occluded in 75 patients (occlusion group). Outcomes were compared using propensity score matching (PSM). Results: PSM did not reveal significant intergroup differences in baseline characteristics between the non-occlusion (n=53) and occlusion (n=53) groups. During a median follow-up of 44 months, 2 patients in the non-occlusion group (3.8%) experienced ischemic strokes.There was no significant difference in the rate of freedom from stroke (p=0.19) and major adverse cardiac events (p=0.43) between the 2 groups. Through echocardiography at 1-year follow-up, a statistically significant difference in LA mechanical contraction was observed between the non-occlusion group and occlusion group (24 of 33 [72.7%] vs. 18 of 37 [48.6%], respectively; p=0.04). Conclusions In this study, preservation of the LAA during the maze procedure resulted in better LA function than LAA occlusion, with similar rates of stroke.

While the coronavirus disease 2019 pandemic is ongoing, monkeypox has been rapidly spreading in non-endemic countries since May 2022. Accurate and rapid laboratory tests are essential for identifying and controlling monkeypox. Korean Society for Laboratory Medicine and the Korea Disease Prevention and Control Agency have proposed guidelines for diagnosing monkeypox in clinical laboratories in Korea. These guidelines cover the type of tests, selection of specimens, collection of specimens, diagnostic methods, interpretation of test results, and biosafety. Molecular tests are recommended as confirmatory tests. Skin lesion specimens are recommended for testing in the symptomatic stage, and the collection of both blood and oropharyngeal swabs is recommended in the presymptomatic or prodromal stage.