• Journal of the Korean Society of Radiology
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• v.81 no.6
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• pp.1504-1510
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• 2020

In this case report, we present the radiologic and pathologic findings of atypical ductal hyperplasia (ADH) in the male breast. It is well known that a high-risk lesion such as ADH is a precursor of breast cancer in females. However, the clinical significance of these lesions in the male breast is still uncertain because male breasts mainly consist of ducts without lobule formation, unlike the female breast. To our knowledge, imaging findings of ADH in the male breast have not been reported previously, except for a few studies on the pathologic findings of these lesions. Through this paper, we would like to present the possible imaging features of this high-risk lesion in the male breast and review the related literature.

• Korean Journal of Radiology
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• v.23 no.7
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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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• v.27 no.1
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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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• v.52 no.8
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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.

• Journal of the Korean Society of Radiology
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• v.85 no.4
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• pp.693-704
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• 2024

Artificial intelligence (AI) technology is actively being applied for the interpretation of medical imaging, such as chest X-rays. AI-based software medical devices, which automatically detect various types of abnormal findings in chest X-ray images to assist physicians in their interpretation, are actively being commercialized and clinically implemented in Korea. Several important issues need to be considered for AI-based detection assistant tools to be applied in clinical practice: the evaluation of performance and efficacy prior to implementation; the determination of the target application, range, and method of delivering results; and monitoring after implementation and legal liability issues. Appropriate decision making regarding these devices based on the situation in each institution is necessary. Radiologists must be engaged as medical assessment experts using the software for these devices as well as in medical image interpretation to ensure the safe and efficient implementation and operation of AI-based detection assistant tools.

• Journal of Trauma and Injury
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• v.37 no.3
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• pp.209-213
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• 2024

Purpose: Trauma patients are at an elevated risk of developing venous thromboembolism (VTE), with the subsequent mortality in patients requiring intensive care unit admission ranging from 25% to 38%. There remains significant variability in clinical practice related to VTE prophylaxis in trauma patients due to the frequent presence of contraindications impacting the timing and consistency of application. This study aimed to assess the effectiveness of the current practice of chemical VTE prophylaxis in trauma patients at a single Australian center. Methods: A prospective review was conducted on patients admitted to the ACT Trauma Service (Canberra, Australia) from July to November 2022. The included patients were 18 years or older, without a direct contraindication to anticoagulation, who received chemical VTE prophylaxis with low-molecular-weight heparin (enoxaparin) for at least three doses and underwent subsequent testing of anti-factor Xa (aFXa) levels. Results: During the study period, 187 patients were admitted, of whom 63 were included in the study. Of these, 47 patients achieved therapeutic levels of anticoagulation as determined by their aFXa levels, while 16 were subtherapeutic. The only statistically significant difference between the two groups was in weight, with patients in the subtherapeutic group weighing an average of 91.9 kg compared to 79.1 kg in the therapeutic group (P<0.05). Conclusions: A fixed-dose enoxaparin regimen was utilized, with limited individualization based on patient factors, such as injuries, comorbidities, and other biological factors. Sixteen patients (25%) had subtherapeutic VTE prophylaxis, as measured by aFXa levels. Higher weight was significantly correlated with inadequate VTE prophylaxis dosing. While age, sex, and smoking status might play important roles in clinical decision-making, weight-based dosing of low-molecular-weight heparin may be more effective in achieving adequate VTE prophylaxis.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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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.

• Journal of Korean Academy of Nursing Administration
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• v.4 no.1
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• pp.193-214
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• 1998

The purpose of the present study was to examine the causal model of nurses' organizational commitment. Based on literature review and Fishbein's behavioral intentions model ((Fishbein. 1967: Fishbein & Ajzen. 1975). the organizational commitment was conceptualized within a motivational framework that mediate between antecedents variables and outcome variables. Antecedent variables were pay, promotional chances. continuing education opportunity. rigidity of the administration. paticipative decision making, latitude, group support, role conflict, work load, need for achievement. experience and pride for professional nursing. Outcome variable was turnover intention. The subjects were 373 nurses who were working at 2 large general hospitals located in Seoul. It represents a response rate of 94%. Data for this study was collected from August 29 to September 22 in 1997 by Questionnaire. Path analysis with LISREL 7.16 prigram was used to test the fit of the proposed conceptual model to data and to examine the causal relationships among variables. The result showed that both the proposed model and the modified model fit the data excellently. It needs to be notified, however. that path analysis can not count measurment errors: measurement error can attenuate estimates of coefficient and explanatory power. Nontheless the model revealed considerable explanatory power for organizational commitment (58%), pride for professional nursing (50%) and turnover intention(40%). In predicting nurses' organizational commitment, the findings of this study clearly demonstrated 'the pride for professional nursing' might be the most important variables of all the antecedent variables. Group support, role conflict, need for achievement were also found to be important determinants for the organizational commitment and turnover intention, The result showed experience might be a predictor for 'pride for professional nursing' and 'turnover intention' but not 'organizational commitment', 'Rigidity of the administration' and latitude were also found to have important roles in predictingr the organizational commitment, while participative decision making might have an impact on turnover intention. On the other hand promotional chance had an influence on all the outcome variables, while pay only on turnover intention. In predicting turnover intention, the result clearly revealed 'the pride for professional nursing' and 'organizational commitment' might be the most powerful predictors among all the variables. Theses results were discussed, including directions for the future research and practical implications drawn from the research were suggested.

• Journal of Korean Academy of Nursing Administration
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• v.4 no.1
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• pp.183-214
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• 1998

The purpose of the present study was to examine the causal model of nurses' organizational commitment. Based on literature review and Fishbein's behavioral intentions model ((Fishbein, 1967;Fishbein & Ajzen. 1975), the organizational commitment was conceptualized within a motivational framework that mediate between antecedents variables and outcome variables. Antecedent variables were pay, promotional chances, continuing education opportunity, rigidity of the administration, paticipative decision making, latitude, group support, role conflict, work load, need for achievement, experience and pride for professional nursing. Outcome variable was turnover intention. The subjects were 373 nurses who were working at 2 large general hospitals located in Seoul. It represents a response rate of 94%. Data for this study was collected from August 29 to September 22 in 1997 by Questionnaire. Path analysis with LISREL 7.16 prigram was used to test the fit of the proposed conceptual model to data and to examine the causal relationships among variables. The result showed that both the proposed model and the modified model fit the data excellently. It needs to be notified, however, that path analysis can not count measurement errors; measurement error can attenuate estimates of coefficient and explanatory power. Nontheless the model revealed considerable explanatory power for organizational commitment (58%). pride for professional nursing (50%) and turnover intention(40%). In predicting nurses' organizational commitment. the findings of this study clearly demonstrated 'the pride for professional nursing' might be the most important variables of all the antecedent variables. Group support. role conflict, need for achievement were also found to be important determinants for the organizational commitment and turnover intention. The result showed experience might be a predictor for 'pride for professional nursing' and 'turnover intention' but not 'organizational commitment'. 'Rigidity of the administration' and latitude were also found to have important roles in predictor for the organizational commitment, while participative decision making might have an impact on turnover intention. On the other hand promotional chance had an influence on all the outcome variables, while pay only on turnover intention. In predicting turnover intention, the result clearly revealed 'the pride for professional nursing' and 'organizational commitment' might be the most powerful predictors among all the variables. Theses results were discussed, including directions for the future research and practical implications drawn from the research were suggested.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.9 no.1
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• pp.41-49
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• 2011

This study purposes to conduct visual feedback and body posture control training on stroke patients with pusher syndrome in order to reduce their pusher syndrome. This study also examines changes resulting from the training and applies the guidelines necessary for documentation of patient/customer management. The participant for this study was one patient with pusher syndrome. The study progressed from a medical examination of the subject followed by evaluation, diagnosis, prognosis, intervention and treatment plan, and finally re-examination in order of precedence. Problems in the participant's functional activities, difficulties in changes from sitting postures into standing postures, and maintaining standing postures were determined as primary restrictions on activities and the improvement of these activities was set up as a goal through discussions with the patient. Interventions were mainly implemented to reduce the pusher syndrome with visual feedback provided using mirrors and exercises focusing on leaning in order to maintain posture while sitting. Changes from supine postures to sitting postures and the degree of changes in maintaining standing postures were compared between before and after the intervention by measuring times in the same environment and the degree of pusher syndrome was measured using the SCP tool. The process of this clinical practice was documented. The SCP score that indicates the degree of changes in the participant's pusher syndrome changed from 3.75 points to 0.8 point indicating a decrease in pushing. Among functional activities, posture changes from sitting postures to standing postures and maintaining standing postures were improved. In addition, since the patient could maintain standing postures, the patient could walk indoors. In this case study, mirrors and body posture control training used as interventions to relieve pusher syndromes can be easily applied in clinics to examine the form of functional recovery. The results indicated that these intervention methods were effective and thus it is thought that the results can be used as basic data to utilize these intervention methods diversely. In addition, the documentation of patient/client management was applied as actual documentation in Korean and based on the results, we could show decision making processes for patients' functional goals and objectively explain problems, prognoses and changes made through the interventions.