• 임상간호연구
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• 제29권3호
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• pp.211-222
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• 2023

Purpose: This study was conducted to update the existing evidence-based nursing clinical practice guideline for indwelling urinary catheterization (IUC). Methods: The guideline have been revised in 22 steps based on international standards. The quality of the practice guidelines to be used for revision was evaluated using the Appraisal of Guidelines for Research and Evaluation II. The evaluation of the content appropriateness and applicability of the draft recommendations of the revised practice guidelines was performed using the RAND/UCLA Appropriateness Method, a decision-making method developed by the RAND Corporation. Four guidelines were used for the revision. Results: The updated nursing practice guideline for IUC consisted of 9 domains and 134 recommendations. The numbers of recommendations in each domain were: 4 Assessment, 20 Equipment, 11 Catheter insertion, 52 Catheter maintenance, 4 Catheter and drainage bag change, 9 Catheter removal, 22 Complications management, 5 Education and consult, and 7 Hospital support. The recommended grade was 8.2% for A, 38.1% for B, and 53.7% for C. Among these, the major revision was done in 11 recommendations (8.2%). A total of 29 recommendations (21.6%) were newly added. 30 (22.4%) recommendations had minor revisions such as changes or addition for some words or sentences, and 13 (9.7%) recommendations were deleted. Conclusion: Revised nursing practice guideline is expected to serve as an evidence-based practice guideline for IUC in Korea. This guideline will provide health care providers, patients, and caregivers with information to help manage IUC, leading to improved patient outcomes.

• 의학교육논단
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• 제25권3호
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• pp.198-211
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• 2023

Health systems science (HSS) is recognized as the third pillar of medical education. alongside basic and clinical sciences. Today's physicians must also be systems thinkers who are able to discern how social, economic, environmental, and technological forces influence clinical decision-making. This study aimed to propose strategies for structuring an HSS curriculum that is tailored to the Korean healthcare and medical education context. First, the authors of this study conducted a survey to identify the present curricular contents of HSS related education at Korean medical schools. Second, a needs assessment was performed to determine the necessity of HSS competencies, as well as the prerequisites for the seamless integration of HSS into the existing curriculum. Third, literature reviews on HSS education at 14 US medical schools and expert consultations was conducted. We would like to propose a set of strategic approaches, classified into two levels: comprehensive and partial restructuring of the current medical curriculum to incorporate HSS. The partial restructuring approach entails a gradual, incremental incorporation of HSS content, while maintaining the current curricular structure. In contrast, a complete overhaul of the curriculum may be ideal to build HSS as the third pillar of medical education, but its feasibility remains relatively limited. The partial reorganization approach, however, has the advantage of being highly feasible. Collaborative efforts between professors and students are imperative to collectively devise effective methods for the seamless integration of HSS into the existing curriculum.

• Journal of Chest Surgery
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• 제57권1호
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• pp.36-43
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• 2024

Background: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory failure, which frequently necessitates invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, the limited availability of ECMO resources poses challenges to patient selection and associated decision-making. Consequently, this retrospective single-center study was undertaken to evaluate the characteristics and clinical outcomes of patients with COVID-19 receiving ECMO. Methods: Between March 2020 and July 2022, 65 patients with COVID-19 were treated with ECMO and were subsequently reviewed. Patient demographics, laboratory data, and clinical outcomes were examined, and statistical analyses were performed to identify risk factors associated with mortality. Results: Of the patients studied, 15 (23.1%) survived and were discharged from the hospital, while 50 (76.9%) died during their hospitalization. The survival group had a significantly lower median age, at 52 years (interquartile range [IQR], 47.5-61.5 years), compared to 64 years (IQR, 60.0-68.0 years) among mortality group (p=0.016). However, no significant differences were observed in other underlying conditions or in factors related to intervention timing. Multivariable analysis revealed that the requirement of a change in ECMO mode (odds ratio [OR], 366.77; 95% confidence interval [CI], 1.92-69911.92; p=0.0275) and the initiation of continuous renal replacement therapy (CRRT) (OR, 139.15; 95% CI, 1.95-9,910.14; p=0.0233) were independent predictors of mortality. Conclusion: Changes in ECMO mode and the initiation of CRRT during management were associated with mortality in patients with COVID-19 who were supported by ECMO. Patients exhibiting these factors require careful monitoring due to the potential for adverse outcomes.

• 대한두개안면성형외과학회지
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• 제25권3호
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• pp.116-122
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• 2024

Background: Due to the importance of evidence-based research in plastic surgery, the authors of this study aimed to assess the accuracy of ChatGPT in generating novel systematic review ideas within the field of craniofacial surgery. Methods: ChatGPT was prompted to generate 20 novel systematic review ideas for 10 different subcategories within the field of craniofacial surgery. For each topic, the chatbot was told to give 10 "general" and 10 "specific" ideas that were related to the concept. In order to determine the accuracy of ChatGPT, a literature review was conducted using PubMed, CINAHL, Embase, and Cochrane. Results: In total, 200 total systematic review research ideas were generated by ChatGPT. We found that the algorithm had an overall 57.5% accuracy at identifying novel systematic review ideas. ChatGPT was found to be 39% accurate for general topics and 76% accurate for specific topics. Conclusion: Craniofacial surgeons should use ChatGPT as a tool. We found that ChatGPT provided more precise answers with specific research questions than with general questions and helped narrow down the search scope, leading to a more relevant and accurate response. Beyond research purposes, ChatGPT can augment patient consultations, improve healthcare equity, and assist in clinical decision-making. With rapid advancements in artificial intelligence (AI), it is important for plastic surgeons to consider using AI in their clinical practice to improve patient-centered outcomes.

• 대한영상의학회지
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• 제81권6호
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• pp.1504-1510
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• 2020

이 증례 보고는, 남성 유방에서의 비정형유관증식증 소견에 대한 영상의학적, 병리학적 소견을 담고 있다. 비정형유관증식증은 고위험 병변에 속하며 유방암의 전구 병변으로 잘 알려져 있다. 하지만, 이런 병변이 남성 유방에서 어떠한 임상적 의미를 갖는지는 잘 알려져 있지 않다. 남성 유방은 여성 유방과 달리 유관이 소엽을 구성하지 않기 때문이다. 지금까지 이러한 전구 병변의 영상 소견과 병리학적 소견을 다룬 문헌은 극소수이다. 이 증례 보고를 통해, 우리는 남성 유방에서 유방암 전구 병변의 가능한 영상 및 병리 소견을 제시하고, 문헌고찰을 하고자 한다.

• Korean Journal of Radiology
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• 제23권7호
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• pp.763-772
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• 2022

Objective: Preoperative differential diagnosis of follicular-patterned lesions is challenging. This multicenter cohort study investigated the clinicoradiological characteristics relevant to the differential diagnosis of such lesions. Materials and Methods: From June to September 2015, 4787 thyroid nodules (≥ 1.0 cm) with a final diagnosis of benign follicular nodule (BN, n = 4461), follicular adenoma (FA, n = 136), follicular carcinoma (FC, n = 62), or follicular variant of papillary thyroid carcinoma (FVPTC, n = 128) collected from 26 institutions were analyzed. The clinicoradiological characteristics of the lesions were compared among the different histological types using multivariable logistic regression analyses. The relative importance of the characteristics that distinguished histological types was determined using a random forest algorithm. Results: Compared to BN (as the control group), the distinguishing features of follicular-patterned neoplasms (FA, FC, and FVPTC) were patient's age (odds ratio [OR], 0.969 per 1-year increase), lesion diameter (OR, 1.054 per 1-mm increase), presence of solid composition (OR, 2.255), presence of hypoechogenicity (OR, 2.181), and presence of halo (OR, 1.761) (all p < 0.05). Compared to FA (as the control), FC differed with respect to lesion diameter (OR, 1.040 per 1-mm increase) and rim calcifications (OR, 17.054), while FVPTC differed with respect to patient age (OR, 0.966 per 1-year increase), lesion diameter (OR, 0.975 per 1-mm increase), macrocalcifications (OR, 3.647), and non-smooth margins (OR, 2.538) (all p < 0.05). The five important features for the differential diagnosis of follicular-patterned neoplasms (FA, FC, and FVPTC) from BN are maximal lesion diameter, composition, echogenicity, orientation, and patient's age. The most important features distinguishing FC and FVPTC from FA are rim calcifications and macrocalcifications, respectively. Conclusion: Although follicular-patterned lesions have overlapping clinical and radiological features, the distinguishing features identified in our large clinical cohort may provide valuable information for preoperative distinction between them and decision-making regarding their management.

• Journal of Hospice and Palliative Care
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• 제27권1호
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• pp.1-10
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• 2024

This article underscores the importance of integrating comprehensive palliative care for noncancer patients who are undergoing hemodialysis, with an emphasis on the aging populations in Asian nations such as Taiwan, Japan, the Republic of Korea, and China. As the global demographic landscape shifts towards an aging society and healthcare continues to advance, a marked increase has been observed in patients undergoing hemodialysis who require palliative care. This necessitates an immediate paradigm shift to incorporate this care, addressing the intricate physical, psychosocial, and spiritual challenges faced by these individuals and their families. Numerous challenges impede the provision of effective palliative care, including difficulties in prognosis, delayed referrals, cultural misconceptions, lack of clinician confidence, and insufficient collaboration among healthcare professionals. The article proposes potential solutions, such as targeted training for clinicians, the use of telemedicine to facilitate shared decision-making, and the introduction of time-limited trials for dialysis to overcome these obstacles. The integration of palliative care into routine renal treatment and the promotion of transparent communication among healthcare professionals represent key strategies to enhance the quality of life and end-of-life care for people on hemodialysis. By embracing innovative strategies and fostering collaboration, healthcare providers can deliver more patient-centered, holistic care that meets the complex needs of seriously ill patients within an aging population undergoing hemodialysis.

• Korean Circulation Journal
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• 제52권8호
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• pp.563-575
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• 2022

Hypertrophic cardiomyopathy (HCM) is one of the most common inheritable cardiomyopathies. Contemporary management strategies, including the advent of implantable cardioverter-defibrillators and effective anticoagulation, have substantially improved the clinical course of HCM patients; however, the disease burden of HCM is still high in Korea. Sudden cardiac death (SCD), atrial fibrillation and thromboembolic risk, dynamic left ventricular outflow tract (LVOT) obstruction, and heart failure (HF) progression remain important issues in HCM. SCD in HCM can be effectively prevented with implantable cardioverter-defibrillators. However, appropriate patient selection is important for primary prevention, and the 5-year SCD risk score and the presence of major SCD risk factors should be considered. Anticoagulation should be initiated in all HCM patients with atrial fibrillation regardless of the CHA2DS2-VASc score, and non-vitamin K antagonist oral anticoagulants are the first option. Symptomatic dynamic LVOT obstruction is first treated medically with negative inotropes, and if symptoms persist, septal reduction therapy is considered. The recently approved myosin inhibitor mavacamten is promising. HF in HCM is usually related to diastolic dysfunction, while about 5% of HCM patients show reduced left ventricular ejection fraction <50%, also referred to as "end-stage" HCM. Myocardial fibrosis plays an important role in the progression to advanced HF in patients with HCM. Patients who do not respond to guideline-directed medical therapy can be considered for heart transplantation. The development of imaging techniques, such as myocardial deformation on echocardiography and late gadolinium enhancement on cardiac magnetic resonance, can provide better risk evaluation and decision-making for management strategies in HCM.

• 대한영상의학회지
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• 제85권4호
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• pp.693-704
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• 2024

흉부 X선은 인공지능 기술이 활발히 적용되고 있는 대표적인 영상 검사이다. 흉부 X선 영상에서 다양한 이상 소견을 자동으로 검출하여 의사의 판독을 보조하는 인공지능 기반 소프트웨어 의료기기들이 국내에서 시판되고 있고, 임상 적용이 활발히 이루어지고 있다. 이러한 흉부 X선 인공지능 검출 보조 의료기기의 임상 도입에 있어, 도입 전 성능 및 유효성 평가, 적용 대상, 분석 결과 제공의 대상 및 방식, 도입 후 모니터링, 법적 책임 문제 등 다양한 현실적인 사항에 대한 고려가 필요하고, 각 의료기관의 상황에 따른 적절한 의사결정이 필요하다. 인공지능 검출 보조 의료기기의 안전하고 효율적인 도입 및 운영을 위해서는 전문 지식을 갖춘 영상의학과 전문의의 적극적인 역할이 필수적이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.6.1-6.10
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• 2019

Background: Osteomyelitis is an intraosseous inflammatory disease characterized by progressive inflammatory osteoclasia and ossification. The use of quantitative analysis to assist interpretation of osteomyelitis is increasingly being considered. The objective of this study was to perform early diagnosis of osteomyelitis on digital panoramic radiographs using basic functions provided by picture archiving and communication system (PACS), a program used to show radiographic images. Methods: This study targeted a total of 95 patients whose symptoms were confirmed as osteomyelitis under clinical, radiologic, pathological diagnosis over 11 years from 2008 to 2017. Five categorized patients were osteoradionecrosis, bisphosphonate-related osteonecrosis of jaw (BRONJ, suppurative and sclerosing type), and bacterial osteomyelitis (suppurative and sclerosing type), and the control group was 117 randomly sampled. The photographic density in a certain area of the digital panoramic radiograph was determined and compared using the "measure area rectangle," one of the basic PACS functions in INFINITT PACS^® (INFINITT Healthcare, Seoul, South Korea). A conditional inference tree, one type of decision making tree, was generated with the program R for statistical analysis with SPSS^®. Results: In the conditional inference tree generated from the obtained data, cases where the difference in average value exceeded 54.49 and the difference in minimum value was less than 54.49 and greater than 12.81 and the difference in minimum value exceeded 39 were considered suspicious of osteomyelitis. From these results, the disease could be correctly classified with a probability of 88.1%. There was no difference in photographic density value of BRONJ and bacterial osteomyelitis; therefore, it was not possible to classify BRONJ and bacterial osteomyelitis by quantitative analysis of panoramic radiographs based on existing research. Conclusions: This study demonstrates that it is feasible to measure photographic density using a basic function in PACS and apply the data to assist in the diagnosis of osteomyelitis.