Purpose: This study aims to explore the factors influencing nursing professionalism among nursing students, focusing on the image of nurses, satisfaction with their major, and career metacognition. Methods: We conducted a descriptive survey with 185 nursing students from D city and K region on June 10–30, 2024. Data were analyzed using IBM SPSS ver. 27.0 (IBM Corp.), employing descriptive statistics, t tests, one-way ANOVA, Scheffé tests, Pearson’s correlation coefficients, and regression analysis. Multiple linear regression analysis was used to identify factors affecting nursing professionalism among nursing students. Results: The regression analysis revealed that the image of nurses (β=.69, p<.001) and monitoring aspect of career metacognition (β=.13, p=.025) were significant predictors of nursing professionalism, accounting for 64.5% of the variance. Conclusion The findings indicate that the image of nurses and monitoring component of career metacognition are critical in shaping nursing professionalism among nursing students. Therefore, nursing education programs should aim to improve the image of nurses and promote self-reflective career practices as strategies to foster professionalism among nursing students.

Objectives: . Thyroid cancer is the most common endocrine tumor, with rapidly increasing incidence worldwide. However, its transcriptomic characteristics associated with immunological signatures, driver fusions, and recurrence markers remain unclear. We aimed to investigate the transcriptomic characteristics of advanced papillary thyroid cancer. Methods: . This study included 282 papillary thyroid cancer tumor samples and 155 normal samples from Chungnam National University Hospital and Seoul National University Hospital. Transcriptomic quantification was determined by high-throughput RNA sequencing. We investigated the associations of clinical parameters and molecular signatures using RNA sequencing. We validated predictive biomarkers using the Cancer Genome Atlas database. Results: . Through a comparison of differentially expressed genes, gene sets, and pathways in papillary thyroid cancer compared to normal tumor-adjacent tissue, we found increased immune signaling associated with cytokines or T cells and decreased thyroid hormone synthetic pathways. In addition, patients with recurrence presented increased CD8+ T-cell and Th1-cell signatures. Interestingly, we found differentially overexpressed genes related to immune-escape signaling such as CTLA4, IDO1, LAG3, and PDCD1 in advanced papillary thyroid cancer with a low thyroid differentiation score. Fusion analysis showed that the PI3K and mitogen-activated protein kinase (MAPK) signaling pathways were regulated differently according to the RET fusion partner genes (CCDC6 or NCOA4). Finally, we identified HOXD9 as a novel molecular biomarker that predicts the recurrence of thyroid cancer in addition to known risk factors (tumor size, lymph node metastasis, and extrathyroidal extension). Conclusion . We identified a high association with immune-escape signaling in the immune-hot group with aggressive clinical characteristics among Korean thyroid cancer patients. Moreover, RET fusion differentially regulated PI3K and MAPK signaling depending on the partner gene of RET, and HOXD9 was found to be a recurrence marker for advanced papillary thyroid cancer.

Antithrombotic therapy is a cornerstone of acute ischemic stroke (AIS) management and secondary stroke prevention. Since the first version of the Korean Clinical Practice Guideline (CPG) for stroke was issued in 2009, significant progress has been made in antithrombotic therapy for patients with AIS, including dual antiplatelet therapy in acute minor ischemic stroke or high-risk transient ischemic stroke and early oral anticoagulation in AIS with atrial fibrillation. The evidence is widely accepted by stroke experts and has changed clinical practice. Accordingly, the CPG Committee of the Korean Stroke Society (KSS) decided to update the Korean Stroke CPG for antithrombotic therapy for AIS. The writing members of the CPG committee of the KSS reviewed recent evidence, including clinical trials and relevant literature, and revised recommendations. A total of 35 experts were invited from the KSS to reach a consensus on the revised recommendations. The current guideline update aims to assist healthcare providers in making well-informed decisions and improving the quality of acute stroke care. However, the ultimate treatment decision should be made using a holistic approach, considering the specific medical conditions of individual patients.

Background/Aims: We examined the concordance rate among fasting plasma glucose (FPG), 2-hour post-challenge glucose (2hr PG), and hemoglobin A1c (HbA1c) in the diagnosis of diabetes in a population with a high-risk for type 2 diabetes mellitus (T2DM) in Korea. Methods: Among the participants from the Korean Diabetes Prevention Study, individuals with FPG ≥ 100 mg/dL, body mass index (BMI) ≥ 23.0 kg/m2, and no previous history of T2DM were consecutively enrolled after a 75 g glucose tolerance test. We analyzed the differences in the clinical characteristics in subjects with stage 1 (FPG, 100 to 109 mg/dL) and stage 2 (FPG, 110 to 125 mg/dL) impaired fasting glucose (IFG). Results: Of 1,637 participants, 27.2% had T2DM and 59.3% had IFG and/or impaired glucose tolerance (IGT). The mean age was 55.0 ± 8.1 years and the mean BMI was 26.3 ± 2.7 kg/m2. Based on FPG criteria, 515 (31.4%) and 352 (21.5%) subjects were classified as having stage 1 and stage 2 IFG, respectively. The 19.0% of stage 1 and 43.5% of stage 2 subjects showed 2hr PG levels in the diabetic range. Even for those in the normal FPG range, 63 (9.5%) participants showed a 2hr PG level of ≥ 200 mg/dL. Of 446 subjects with newly-diagnosed diabetes, 340 (76.2%) showed FPG levels < 126 mg/dL. Conclusions The oral glucose tolerance test should be actively considered for Korean adults who are overweight or obese with the IFG range (FPG, 100 to 125 mg/ dL) to allow for early detection of diabetes and prompt intervention.

Objective: To evaluate the prognostic implications of preoperative magnetic resonance imaging (MRI) features of hepatocellular carcinoma (HCC) with a focus on those with targetoid appearance based on the Liver Imaging Reporting and Data System (LI-RADS), as well as known microvascular invasion (MVI) features. Materials and Methods: This retrospective study included 242 patients (190 male; mean age, 57.1 years) who underwent surgical resection of a single HCC (≤ 5 cm) as well as preoperative gadoxetic acid-enhanced MRI between January 2012 and March 2015. LI-RADS category was assigned, and the LR-M category was further classified into two groups according to rim arterial-phase hyperenhancement (APHE). The imaging features associated with MVI were also assessed. The overall survival (OS), recurrence-free survival (RFS), and their associated factors were evaluated. Results: Among the 242 HCCs, 190 (78.5%), 25 (10.3%), and 27 (11.2%) were classified as LR-4/5, LR-M with rim APHE, and LR-M without rim APHE, respectively. LR-M with rim APHE (vs. LR-4/5; hazard ratio [HR] for OS, 5.48 [p = 0.002]; HR for RFS, 2.09 [p = 0.042]) and tumor size (per cm increase; HR for OS, 6.04 [p = 0.009]; HR for RFS, 1.77 [p = 0.014]) but not MVI imaging features (p > 0.05) were independent factors associated with OS and RFS. Compared to the 5-year OS and RFS rates in the LR-4/5 group (93.9% and 66.8%, respectively), the LR-M with rim APHE group had significantly lower rates (68.0% and 45.8%, respectively, both p < 0.05), while the LR-M without rim APHE group did not significantly differ in the survival rates (91.3% and 80.2%, respectively, both p > 0.05). Conclusion Further classification of LR-M according to the presence of rim APHE may help predict the postoperative prognosis of patients with a single HCC.

BACKGROUND/AIMS: As the prevalence of diabetes mellitus and its complications increase rapidly, diabetic foot ulcers (DFUs), which are a major diabetic complication, are expected to increase. For prevention and effective treatment, it is important to understand the clinical course of DFUs. The aim of this study was to investigate the natural course and predictors of amputation in patients with DFUs who required hospitalization. METHODS: A total of 209 patients with type 2 diabetes, aged 30 to 85 years, who visited emergency department or needed hospitalization due to DFUs were consecutively enrolled from May 2012 to January 2016, by retrospective medical record review. The main outcome was lower extremity amputation (LEA). RESULTS: Among 192 patients who completed follow-up, 113 patients (58.9%) required LEAs. Compared to patients without amputation, baseline levels of white blood cell counts and C-reactive protein were higher in patients with amputation. In addition, bone and joint involvement was more frequently observed in patients with amputation. Multivariable regression analysis revealed that combined infection (odds ratio [OR], 11.39; 95% confidence interval [CI], 2.55 to 50.93; p = 0.001) and bone or joint involvement (OR, 3.74; 95% CI, 1.10 to 12.70; p = 0.035) were significantly associated with an increased risk of LEA. CONCLUSIONS: The depth of the wound and combined infection of DFU, rather than the extent of the wound, were significant prognostic factors of LEAs in patients with type 2 diabetes.
Amputation* ; C-Reactive Protein ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Foot* ; Emergency Service, Hospital ; Follow-Up Studies ; Hospitalization ; Humans ; Joints ; Leukocyte Count ; Lower Extremity* ; Medical Records ; Prevalence ; Prognosis ; Retrospective Studies ; Ulcer* ; Wounds and Injuries

PURPOSE: Adverse drug events (ADEs) are associated with high health and financial costs and have increased as more elderly patients treated with multiple medications emerge in an aging society. It has thus become challenging for physicians to identify drugs causing adverse events. This study proposes a novel approach that can improve clinical decision making with recommendations on ADE causative drugs based on patient information, drug information, and previous ADE cases. MATERIALS AND METHODS: We introduce a personalized and learning approach for detecting drugs with a specific adverse event, where recommendations tailored to each patient are generated using data mining techniques. Recommendations could be improved by learning the associations of patients and ADEs as more ADE cases are accumulated through iterations. After consulting the system-generated recommendations, a physician can alter prescriptions accordingly and report feedback, enabling the system to evolve with actual causal relationships. RESULTS: A prototype system is developed using ADE cases reported over 1.5 years and recommendations obtained from decision tree analysis are validated by physicians. Two representative cases demonstrate that the personalized recommendations could contribute to more prompt and accurate responses to ADEs. CONCLUSION: The current system where the information of individual drugs exists but is not organized in such a way that facilitates the extraction of relevant information together can be complemented with the proposed approach to enhance the treatment of patients with ADEs. Our illustrative results show the promise of the proposed system and further studies are expected to validate its performance with quantitative measures.
Aged ; Aging ; Clinical Decision-Making ; Complement System Proteins ; Data Mining ; Decision Trees ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Learning* ; Prescriptions

BACKGROUND/AIMS: The aim of this study was to identify the ability of Glasgow-Blatchford score (GBS) and pre-endoscopic Rockall score (pre-E RS) to predict the occurrence of hypotension in patients with non-variceal upper gastrointestinal bleeding who are initially normotensive at emergency department. METHODS: Retrospective observational study was conducted at Asan Medical Center emergency department (ED) in patients who presented with non-variceal upper gastrointestinal bleeding from January 1, 2011 to December 31, 2013. Study population was divided according to the development of hypotension, and demographics, comorbidities, and laboratory findings were compared. GBS and pre-E RS were estimated to predict the occurrence of hypotension. RESULTS: A total of 747 patients with non-variceal upper gastrointestinal bleeding were included during the study period, and 120 (16.1%) patients developed hypotesion within 24 hours after ED admission. The median values GBS and pre-E RS were statistically different according to the occurrence of hypotension (8.0 vs. 10.0, 2.0 vs. 3.0, respectively; p<0.001). In the receiver operating characteristic curve analysis of hypotension development, the area under the curve of GBS and pre-E RS were 66% and 64%, respectively. The sensitivity and the specificity of GBS using optimal cut-off value were 81% and 46%, respectively, while those based on the pre-E RS were 74% and 46%, respectively. CONCLUSIONS: GBS and pre-E RS were both not sufficient for predicting the occurrence of hypotension in non-variceal upper gastrointestinal bleeding. Development of other scoring systems are needed.
Adult ; Aged ; Area Under Curve ; Demography ; Emergency Service, Hospital ; Female ; Gastrointestinal Hemorrhage/complications/*diagnosis/pathology ; Humans ; Hypotension/epidemiology/*etiology ; Male ; Middle Aged ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Severity of Illness Index ; Upper Gastrointestinal Tract

A patient with encephalopathy associated with autoimmune thyroid disease (EAATD), which is one of the most important differential diagnoses of treatable dementia, presents with various neurological symptoms, such as repetitive epileptic seizures, altered mental status, and cognitive dysfunction. Steroid treatment is effective for EAATD. The incidence of EAATD increases considerably with age, particularly in female patients. Most patients with EAATD have normal thyroid function test results or mild hypothyroidism. Patients with EAATD with Graves' disease are very rarely reported. Here, we report a case of a 63-year-old woman who complained of declining cognitive ability and ataxia. She was diagnosed with EAATD accompanied by Graves' disease. Her neurological symptoms improved after intravenous steroid administration.
Ataxia ; Brain Diseases ; Dementia ; Diagnosis, Differential ; Epilepsy ; Female ; Graves Disease* ; Humans ; Hypothyroidism ; Incidence ; Middle Aged ; Thyroid Diseases* ; Thyroid Function Tests ; Thyroid Gland*

PURPOSE: The Surviving Sepsis Campaign recommend initiating broad spectrum antibiotics within the first hour of recognition of septic shock. An unknown proportion of the effectiveness of earlier antibiotics administration will remain in septic shock patients treated with an early quantitative resuscitation in emergency department (ED). We were to compare the 28-day mortality between earlier antibiotic administration (< or =1 hour) and early antibiotic administration (1 hour to 6 hour) in septic shock patients in ED. METHODS: A total of 536 consecutive septic shock patients were prospectively collected from January 2010 to June 2012. We identified 357 patients who were developed shock at initial assessment, and measured the time of initial antibiotics administration. The primary outcome was 28-day mortality. RESULTS: Mean age was 62.8+/-13.7 years old and 222 patients were male (62.2%). The median time from shock recognition-to-antibiotics administration was 94.0 min (IQR 47.0-150.0) and 28-day mortality rate was 20.2%. When the relationship of 28-day mortality between earlier antibiotic administration (< or =1 hour) and early antibiotic administration (1 hour to 6 hour) was compared, no significant difference was shown (19.5% vs. 20.5%, p=0.82). CONCLUSION: Earlier antibiotics administration may have no additional outcome value in septic shock patients treated with an early quantitative resuscitation in ED.
Anti-Bacterial Agents ; Emergency Service, Hospital* ; Humans ; Male ; Mortality* ; Prospective Studies ; Resuscitation ; Sepsis ; Shock ; Shock, Septic* ; Treatment Outcome