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Excessive accumulation of extravascular lung water impairs respiratory gas exchange and results in respiratory distress. Real-time radiofrequency signals of ultrasound can continuously and quantitatively monitor excessive lung water. This study aims to evaluate the availability of continuous real-time quantitative pulmonary edema monitoring using ultrasound radiofrequency signals and compare it with Pao2/Fio2 (PF) ratio, conventional lung ultrasound, and the Hounsfield unit of chest computed tomography (CT).Male Yorkshire pigs (40.5 ± 0.5 kg) were anesthetized and mechanically ventilated. A balanced crystalloid was administered to induce hydrostatic pulmonary edema. Three different infusion rates of 2, 4, and 6 ml/kg/min were tested to determine the infusion rate for the appropriate swine model. The chest CTs and ultrasonography with radiofrequency signals were taken every 5 minutes during the full inspiration. The ultrasonography with radiofrequency signals were measured at the intercostal space where the line crossing the two armpits and the right anterior axillary line intersected.The infusion rate of fluid for the pulmonary edema model was determined to be 6 ml/kg/min, and a total of 4 pigs were tested at an injection rate of 6 ml/kg. The adjusted R squared of regression analysis between the radiofrequency signal and computer tomography Hounsfield score was 0.990, 0.993, 0.988, and 0.993 (all p values0.05). All radiofrequency signal changes preceded changes in PaO2/FiO2 (PF ratio) or lung ultrasound changes. The area under the receiver operating characteristic curve of the radiofrequency signal for predicting PF ratio300 was 0.88 (95% confidence interval: 0.82-0.93).We evaluated ultrasound radiofrequency signals to assess pulmonary edema in a swine model that can worsen gradually and showed that quantitative ultrasound radiofrequency signal analysis could assess pulmonary edema and its progression prior to PF ratio or lung ultrasound changes.

Purpose To investigate whether cyclophosphamide (C) and adriamycin (A) induction therapy (IT) prior to nivolumab could enhance the efficacy of nivolumab in previously treated patients with non-squamous (NSQ) non–small-cell lung cancer (NSCLC) with less than 10% PD-L1 expression. Methods Patients received four cycles of CA-IT (C,500 mg/m2 and D, 50 mg/m2) every 3weeks. Nivolumab was given 360 mg every 3 weeks from the second cycle. After 4 cycles of CA-IT, nivolumab 480 mg was administered every 4 weeks. We collected blood samples for next-generation sequencing, fluorescence-activated Cell Sorting (FACS) to characterize immune cells, and liquid chromatography-tandem mass spectrometry to identify potential biomarkers. Results A total of 22 patients were enrolled. The median progression-free and overall survivals were 2.4 months (95% CI, 1.3–3.5) and 11.6 months (95% CI, 5.3–18.0), respectively. Two patients with a partial response received nivolumab for 2 years without disease progression. FACS revealed the lowest ratio of myeloid-derived suppressor cells (MDSCs) to CD8 + T-cell throughout the treatment in responders. Proteomic analysis identified a consistent upregulation of extracellular matrix-receptor interactions and phagosome pathways in the responders. Among the differentially expressed proteins, the transferrin receptor protein (TRFC), which mediates ferroptosis and phagocytosis, was higher in responders than in non-responders before treatment. Conclusions CA-IT did not improve nivolumab efficacy in NSQ-NSCLCs with low PD-L1 expression. However, CA-IT induced deceasing MDSC resulted in durable response. Higher baseline TRFC levels may predict favorable response to nivolumab in NSCLC with low PD-L1 expression. Trial Registration: NCT03808480

Supplementary Table 1 from Adiponectin-Activated AMPK Stimulates Dephosphorylation of AKT through Protein Phosphatase 2A Activation

Supplementary Figure 4 from Adiponectin-Activated AMPK Stimulates Dephosphorylation of AKT through Protein Phosphatase 2A Activation

Supplementary Figure Legends 1-4 from Adiponectin-Activated AMPK Stimulates Dephosphorylation of AKT through Protein Phosphatase 2A Activation

Supplementary Figure 3 from Adiponectin-Activated AMPK Stimulates Dephosphorylation of AKT through Protein Phosphatase 2A Activation

Low serum levels of adiponectin are a high risk factor for various types of cancer. Although adiponectin inhibits proliferation and metastasis of breast cancer cells, the underlying molecular mechanisms remain obscure. In this study, we show that adiponectin-activated AMPK reduces the invasiveness of MDA-MB-231 cells by stimulating dephosphorylation of AKT by increasing protein phosphatase 2A (PP2A) activity. Among the various regulatory B56 subunits, B56γ was directly phosphorylated by AMPK at Ser298 and Ser336, leading to an increase of PP2A activity through dephosphorylation of PP2Ac at Tyr307. We also show that both the blood levels of adiponectin and the tissue levels of PP2A activity were decreased in breast cancer patients and that the direct administration of adiponectin into tumor tissues stimulates PP2A activity. Taken together, these findings show that adiponectin, derived from adipocytes, negatively regulates the invasiveness of breast cancer cells by activating the tumor suppressor PP2A. [Cancer Res 2009;69(9):4018–26]

Supplementary Figure 1 from Adiponectin-Activated AMPK Stimulates Dephosphorylation of AKT through Protein Phosphatase 2A Activation

Supplementary Figure 2 from Adiponectin-Activated AMPK Stimulates Dephosphorylation of AKT through Protein Phosphatase 2A Activation

Objectives: An increasing emphasis has been placed on the integration of clinical data and patient-generated health data (PGHD), which are generated outside of hospitals. This study explored the possibility of using standard terminologies to represent PGHD for data integration.Methods: We chose the 2020 general health checkup questionnaire of the Korean Health Screening Program as a resource. We divided every component of the questionnaire into entities and values, which were mapped to standard terminologies—Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) version 2020-07-31 and Logical Observation Identifiers Names and Codes (LOINC) version 2.68.Results: Eighty-nine items were derived from the 17 questions of the 2020 health examination questionnaire, of which 76 (85.4%) were mapped to standard terms. Fifty-two items were mapped to SNOMED CT and 24 items were mapped to LOINC. Among the items mapped to SNOMED CT, 35 were mapped to pre-coordinated expressions and 17 to post-coordinated expressions. Forty items had one-to-one relationships, and 17 items had one-to-many relationships.Conclusions: We achieved a high mapping rate (85.4%) by using both SNOMED CT and LOINC. However, we noticed some issues while mapping the Korean general health checkup questionnaire (i.e., lack of explanations, vague questions, and overly narrow concepts). In particular, items combining two or more concepts into a single item were not appropriate for mapping using standard terminologies. Although it is not the case that all items need to be expressed in standard terminology, essential items should be presented in a way suitable for mapping to standard terminology by revising the questionnaire in the future.

It is not easy to ensure optimal prevention of hospital‐acquired pressure ulcer (HAPU) in crowded emergency departments (EDs). We hypothesised that a prolonged ED length of stay (LOS) is associated with an increased risk of HAPU. This is a single‐centre observational study. Prospectively collected HAPU surveillance data were analysed. Adult (aged ≥20 years) patients admitted through the ED from April 1, 2013 to December 31, 2016 were included. The primary outcome was the development of HAPU within a month. Covariates included demographics, comorbidities, conditions at triage, initial laboratory results, primary ED diagnosis, critical ED interventions, and ED dispositions. The association between ED LOS and HAPU was modelled using logistic and extended Cox regression. A total of 48 641 admissions were analysed. The crude odds ratio (OR) and hazard ratio (HR) for HAPU were increased to 1.44 (95% CI, 1.20‐1.72) and 1.21 (95% CI, 1.02‐1.45), respectively, in ED LOS ≥24 hours relative to ED LOS

The objective of this study was to evaluate physicochemical and sensory properties, the texture profile, and antioxidant activity of ginseng extract-supplemented quark cheese as a new cheese product intended to improve public health. After addition of less than 1.0% ginseng extract, the moisture content of quark significantly decreased, while fat and protein levels increased, although microbial counts and lactose and ash contents were not affected significantly (p0.05), suggesting that these products could help to promote public health as functional foods.

(1) Background: Sepsis is a life-threatening disease, and various demographic and socioeconomic factors affect outcomes in sepsis. However, little is known regarding the potential association between health insurance status and outcomes of sepsis in Korea. We evaluated the association of health insurance and clinical outcomes in patients with sepsis. (2) Methods: Prospective cohort data of adult patients with sepsis and septic shock from March 2016 to December 2018 in three hospitals were retrospectively analyzed. We categorized patients into two groups according to their health insurance status: National Health Insurance (NHI) and Medical Aid (MA). The primary end point was in-hospital mortality. The multivariate logistic regression model and propensity score matching were used. (3) Results: Of a total of 2526 eligible patients, 2329 (92.2%) were covered by NHI, and 197 (7.8%) were covered by MA. The MA group had fewer males, more chronic kidney disease, more multiple sources of infection, and more patients with initial lactate &gt, 2 mmol/L. In-hospital, 28-day, and 90-day mortality were not significantly different between the two groups and in-hospital mortality was not different in the subgroup analysis. Furthermore, health insurance status was not independently associated with in-hospital mortality in multivariate analysis and was not associated with survival outcomes in the propensity score-matched cohort. (4) Conclusion: Our propensity score-matched cohort analysis demonstrated that there was no significant difference in in-hospital mortality by health insurance status in patients with sepsis.

Purpose: Immune checkpoint inhibitor(ICI) therapies are a standard treatment for advanced non-small-cell lung cancer(NSCLC). However, the beneficial effects are limited to a small subset of patients. Primary resistance to ICIs has been attributed to various kinds of suppressive immune regulatory cells in tumor-microenvironment. Different strategies have thus been explored to escape from immune evasion by depleting and/or inactivating these regulatory cells. Given the immune-modulating effects of low doses of cyclophosphamide and adriamycin (CA), we assessed the efficacy of CA induction therapy to modulate the antitumor effect of the nivolumab in advanced NSCLC. Methods: This was a single center, open-label, single arm, phase II trial of nivolumab after CA induction therapy in previously treated advanced non-squamous NSCLC with PD-L1 Results: A total of 22 patients were enrolled; the median age, 61 years old; female, 81%; adenocarcinoma histology, 76.2%; and current or former smoker, 26.9%. The ORR and disease control rate (DCR) were 9.1% (95% confidence interval [CI], 1.9 -26.1)) and 22.7% (95% CI, 9.2-42.9) respectively. The median PFS and OS were 2.4 months (95% CI, 1.3-3.5) and 11.6 months (95% CI, 5.3-18.0) respectively. Though there were no significant safety signals during the trial, 72% of patients had grade 3 or 4 hematologic toxicities including neutropenia and anemia during CA combination. Regarding MDSC (HLA-DR-Lin-CD11b+CD33+) level, two patients with good response correlatively maintained the low ratio ( Conclusions: Our study didn’t meet the primary endpoint. However, CA induction prior to nivolumab showed an immune-modulating potential by decreasing MDSC in two responders. Further augmentation studies for enhancing ICIs response are warranted. As more patients gets ICIs, combination strategy with various immune modulator harbors great potential to eliminate the immunosuppressive mechanism within the tumor microenvironment architecture. Citation Format: Beung-Chul Ahn, Hyae Young Kim, Geon Kook Lee, Sang-Jin Lee, Ji-Eun Hwang, Kyoungsuk Kwon, Youngjoo Lee, Ji-Youn Han. Nivolumab after cyclophosphamide and doxorubicin induction therapy in previously treated advanced non-squamousl non-small cell lung cancer with PD-L1

Introduction In South Korea, a bill requesting the implementation of graphic health warning labels (GHWLs) on tobacco products was adopted at the Assembly Plenary Session on 29 May 2015, and the law was implemented on 23 December 2016. During the period, a plan of the technical details of GHWLs, such as the making of graphic warnings, was examined by the Regulatory Reform Committee (RRC). This study aims to investigate what the media reported over that period and whether the RRC’s policy decisions changed. Methods We conducted a content analysis of online media reports from the first legislative examination (22 April 2016) to the re-examination (13 May 2016). We coded 150 news reports according to two types (news and opinions) and three slants in terms of being in favor of or opposed to the initially government’s implementation plan of GHWLs: positive, negative, and neutral. Results At the first legislative examination, some committee members recommended placing pictorial warnings at the bottom of a cigarette pack as opposed to the plan. Initially, the media reported the results of the committee decisions neutrally. However, over time, positive news and opinions on tobacco control policy and support for positioning the GHWLs at the top of packages increased before the committee carried out the re-examination. Only 15 (10.0%) news reports adopted a negative slant, while the reports with positive (n=101; 67.3%) and neutral slants (n=34; 22.7%) comprised the majority. At the re-examination, the committee withdrew their earlier recommendation to position the GHWLs at the bottom of cigarette packs, finally deciding that the pictorial warnings should be located at the top of the packs, as per the original government’s plan. Conclusions The friendly media coverage of the tobacco control policy suggests that the media would be a major factor in the policymakers’ decision. Because the media play an important role in defining social issues in the policy-decision process, garnering support from the media is important in the tobacco control legislative process.

With the rapid spread of coronavirus disease 2019 (COVID-19), a particularly sharp increase in the number of confirmed cases in Daegu and Gyeongbuk regions at the end of February, Korea faced an unprecedented shortage of medical resources, including hospital beds. To cope with this shortage, the government introduced a severity scoring system for patients with COVID-19 and designed a new type of quarantine facility for treating and isolating patients with mild symptoms out of the hospital, namely, the Residential Treatment Center (RTC). A patient with mild symptoms was immediately isolated in the RTC and continuously monitored to detect changes in symptoms. If the symptoms aggravate, the patient was transferred to a hospital. RTCs were designed by creating a quarantine environment in existing lodging facilities capable of accommodating > 100 individuals. The facilities were entirely divided into a clean zone (working area) and contaminated zone (patient zone), separating the space, air, and movement routes, and the staff wore level D personal protective equipment (PPE) in the contaminated zone. The staffs consisted of medical personnel, police officers, soldiers, and operation personnel, and worked in two or three shifts per day. Their duty was mainly to monitor the health conditions of quarantined patients, provide accommodations, and regularly collect specimens to determine if they can be released. For the past two months, RTCs secured approximately 4,000 isolation rooms and treated approximately 3,000 patients with mild symptoms and operated stably without additional spread of the disease in and out of the centers. Based on these experience, we would like to suggest the utilization of RTCs as strategic quarantine facilities in pandemic situations., Graphical Abstract

Introduction Well-designed health warnings on tobacco packaging enhance costeffectively public awareness of the risks of using tobacco products. However, many countries have experienced difficulties in implementing pictorial warnings. The purpose of this study is to present the topics that arose during the legislative process that preceded implementation of graphic health warning labels (GHWLs) on tobacco products in South Korea, and discuss the outcomes. Methods We used qualitative content analysis to analyze lawmakers’ statements, and those of committee members in meetings that preceded the drafting of the legislative document pertaining to GHWLs in South Korea. Results In discussions surrounding the adoption of the GHWLs, the main point of contention was the level of disgust induced by pictorial warnings. When discussing how warnings should be inscribed on packaging after adoption of GHWLs, lawmakers disagreed regarding the physical position of the warnings. Because of continuous objections raised by some lawmakers, implementation of GHWLs was delayed, and, when actually introduced, the warnings were toned down. Some lawmakers communicated with tobacco companies; thus the companies participated in the legislative process in South Korea. Conclusions To prevent tobacco companies from negatively influencing tobacco control efforts, it is essential that all communications with such companies be publicly disclosed and that the tobacco industry be prohibited from contacting lawmakers involved in the legislative process of tobacco control.

Background This study examined the extent to which visitors to convenience stores remember the cigarette advertisements they encounter in these stores and investigated the relationships between how advertisements are recalled and attitudes toward them. Methods Exit surveys of 1007 visitors to three convenience stores located in Seoul, Korea, were conducted between 25 November 2015 and 7 December 2015. Results Of the respondents, 23.4% (n = 236) freely recalled the cigarette advertisement in the store just visited. However, the percentage of participants who correctly recalled the advertisement increased to 55.2% (n = 556) after we presented them with a card showing options for the advertisement (i.e. a cued recall task). Regardless of sex or purchasing cigarettes, free recall performance was significantly associated with age, number of weekly visits to the convenience store and current smoking status. In addition, free recall increased with having a positive attitude toward cigarette advertisements. Conclusions Repeated visits to convenience stores may continue to expose individuals to cigarettes and their advertisements; such exposure may subconsciously affect recall of the advertisements and maintenance of a positive attitude toward cigarette advertisements. Therefore, to denormalize smoking in society, cigarette advertising and displays at points of sale including convenience stores, should be banned.

Objective The Korean Triage and Acuity Scale (KTAS) was implemented in our emergency department (ED) in May 2016 and is fully integrated into the electronic medical record (EMR) system. Our objective was to determine whether the KTAS is associated with changes in admissions to the hospital, admission disposition, inpatient mortality and length of stay (LOS). Design Quasi-experimental, uncontrolled before-and-after study. Setting The urban tertiary teaching hospital with 1100 beds and receives approximately annual 90 000 ED visits. Participants 122 370 patients who visited the ED during the before-and-the after period. Interventions ED staff were educated on the KTAS for 1 month, after which the KTAS evaluation period began. Admission, disposition, mortality and LOS were compared between the ‘before’ period (1 June 2015 to 30 April 2016) and the ‘after’ period (1 June 2016 to 30 April 2017). Main outcome measures Admissions to the hospital, admission disposition, inpatient mortality and LOS. Results A total of 59 220 and 63 150 patients were included in the before-and-after periods of KTAS implementation, respectively. The pattern of admission and disposition changed significantly after implementation of the KTAS. The mean LOS was 343 min (standard deviation [SD] = 432 min) during the before period, which significantly decreased to 289 min (SD = 333 min) after implementation (P < 0.001). The total mortality rate was significantly reduced after implementation of the KTAS (213 (0.36%) vs. 179 (0.28%), P = 0.020). Conclusion Implementation of the KTAS changed admission and disposition patterns and reduced the LOS and mortality in the ED.

Panax ginseng marc is produced from fresh ginseng roots during processing and is generally treated as industrial waste. The primary aim of this study was to improve its utilization in the dairy industry as a potential high-value resource. Yogurt was prepared from 11% skim milk powder, 0.1% pectin, 10% sucrose, and ginseng marc ethanol extract (GME, 0.5% and 1.0%) in milk, and was inoculated with a 0.02% yogurt culture (Lactobacillus acidophilus, Bifidobacterium longum, and Streptococcus thermophilus). After fermentation at 40°C for 6-8 h, the physicochemical properties of samples were analyzed by the AOAC, Kjeldahl, and Soxhlet methods. Sensory evaluation was performed based on consumer acceptability scores with a 7-point scale, and antimicrobial effects were measured by the agar plate method. The moisture, crude protein, crude fat, and ash contents of yogurt supplemented with 1% GME were 85.06±0.06%, 4.41±0.01%, 4.30±0.05%, and 0.81±0.03%, respectively, with no significant changes noted from those of yogurt without GME (control), except for an increase in the crude fat content. The sensory scores of color, flavor, texture, overall taste, and overall acceptance of yogurt supplemented with below 1% GME did not differ significantly (p

We report a one-pot synthesis of hyperbranched polyglycerols possessing amino functionality by using a novel Boc-protected aminoethanol glycidyl ether monomer (BAG). A series of hyperbranched Boc-protected polyamino glycerols (PBAG) were prepared through a one-pot anionic ring opening multibranching polymerization to yield PBAG with controlled molecular weights (3500–17400 g/mol). Subsequent deprotection of PBAG yielded hyperbranched polyamino glycerols (PAG) with a globular polymeric structure that comprises a randomly branched structure with a large number of functional amine and hydroxyl groups. 1H, 13C, and 15N-NMR, GPC, and MALDI-TOF measurements confirmed the successful polymerization of the hyperbranched PAG polymers. With its superior biocompatibility of PAG, we anticipate the prospective potentials for the applications in biological and biomedical fields. © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2017, 55, 4013–4019

This study aimed to improve the antioxidant and nitric oxide scavenging activities of ginseng marc fermented by Pediococcus acidilactici, thereby creating a biofunctional resource with improved anti-inflammatory capability. P. acidilactici was inoculated in 1% ginseng marc extract; cell viability, pH, and total titratable acidity were measured. Total phenolic and flavonoid contents were measured using Folin–Ciocalteu reagent and colorimetric method. Ferric reducing antioxidant power (FRAP), β-carotene, and sodium nitroprusside (SNP) assays were used to evaluate functionality. Polyphenols and flavonoids totaled 33.7 ± 0.4 and 10.0 ± 0.4 mg/g of solid, respectively, at 24 h fermentation. P. acidilactici had 40 nM β-galactosidase and 20 nM β-glucosidase activities. Antioxidative activities increased up to 34.5 and 10.2%, respectively, as measured via FRAP and β-carotene assays. Anti-inflammatory activity of the fermented extract—as measured via SNP assay—increased 342%, suggesting that ginseng marc fermented by P. acidilactici could be used in food or pharmaceutical industries.

Background/aim Ninjurin1 is a 17-kDa membrane protein that is highly expressed in circulating tumor cells (CTCs) obtained from locally-advanced prostate cancer patients. As CTCs are implicated in the initiation of distant metastasis, we examined the potential contribution of Ninjurin1 to the motility of prostate cancer cells. Materials and methods Ninjurin1 expression was evaluated in CTCs harvested from seven locally advanced patients with no metastatic hallmarks using real-time polymerase chain reaction (PCR). The role of Ninjurin1 in cell motility was investigated using small interfering RNA (siRNA), neutralizing antibodies against Ninjurin1 and Ninjurin1-overexpressing adenoviruses. Results Ninjurin1 was ranked as the most significantly up-regulated adhesion protein identified by RNA-Seq analysis. Both Ninjurin1 down-regulation by siRNA and neutralizing antibodies blocking Ninjurin1 homophilic interactions effectively inhibited cell motility. In contrast, cell motility was enhanced in prostate cancer cells infected with adenovirus enabling Ninjurin1 overexpression. Conclusion Ninjurin1-neutralizing antibodies or Ninjurin1-targeting siRNA merit further development for patients with metastatic potential.

Objective Smoking in an apartment building causes disputes between neighbors and damages from second-hand smoke. To prevent this, the smoke free apartment was implemented in September 2016, in which corridors, staircases, elevators and underground parking lots of apartments were designated as non-smoking areas if more than one-half of residents approved the system. Therefore, an analysis was conducted through Naver Trends and news articles to understand the interest and effectiveness of the smoke free apartment. Methods From January 1, 2016 to September 30, 2018, extract the search volume of ‘Smoke-Free Apartment’ via Naver Trends and looked at changes in search volume over time. In addition, the contents of 2,315 newspaper articles reported were analyzed to determine the cause of the high search volume. The article was selected as a report from Korea's 13 major daily newspapers and 12 media outlets nationwide. Results Analysis of the linkage of 9 peaks and 2,315 articles over two years and eight months showed that trends were related to the topic of the article rather than the number of articles. All the articles featured in peak1, 2 and 3 where people searched the most for ‘Smoke Free Apartments’ were articles related to the smoking cessation fines. It was also important in which medium the article was written. The number of searches has increased when it is aired on national news outlets. Conclusions People's interest in smoke free apartments showed a surge after news and newspapers were reported. Particularly, it shows that they are interested in content that directly affects people such as fines. However, this interest has not been sustained and often ended in a single event. Therefore, it is necessary to conduct massive publicity campaigns to attract people's attention and response.

BackgroundCURB65 and CRB65 score are simple and popular methods to estimate the mortality in patients with community-acquired pneumonia (CAP). Although there has been a global increase in life expectancy and population ageing, we are still using the same age threshold derived from patients in late 1990s to calculate the scores. We sought to assess the implication of using higher age threshold using Korean population data and a single center hospital records.MethodsUsing Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC), we analyzed annual age distribution of CAP patients in Korea from 2005 to 2013 and report how patients aged >65 years increased over time. We also assessed annual change in test characteristics of various age threshold in Korean CAP population. Using a single center hospital registry of CAP patients (2008-2017), we analyzed test characteristics of CURB65 and CRB65 scores with various age thresholds.Results116,481 CAP cases were identified from NHIS-NSC dataset. The proportion of patients aged >65 increased by 1.01% (95% CI, 0.70%-1.33%, PConclusionThere was a significant age shift in CAP population in Korea. Increasing the current age threshold of CURB65 (or CRB65) could be a viable option to reduce ever-increasing hospital referrals and admissions of CAP patients.

Background Electronic health record (EHR) systems have been widely adopted in hospitals. However, since current EHRs mainly focus on lowering the number of paper documents used, they have suffered from poor search function and reusability capabilities. To overcome these drawbacks, structured clinical templates have been proposed; however, they are not widely used owing to the inconvenience of data entry. Objective This study aims to verify the usability of structured templates by comparing data entry times. Methods A Korean tertiary hospital has implemented structured clinical templates with the modeling of clinical contents for the last 6 years. As a result, 1238 clinical content models (ie, body measurements, vital signs, and allergies) have been developed and 492 models for 13 clinical templates, including pathology reports, were applied to EHRs for clinical practice. Then, to verify the usability of the structured templates, data entry times from free-texts and four structured pathology report templates were compared using 4391 entries from structured data entry (SDE) log data and 4265 entries from free-text log data. In addition, a paper-based survey and a focus group interview were conducted with 23 participants from three different groups, including EHR developers, pathology transcriptionists, and clinical data extraction team members. Results Based on the analysis of time required for data entry, in most cases, beginner users of the structured clinical templates required at most 70.18% more time for data entry. However, as users became accustomed to the templates, they were able to enter data more quickly than via free-text entry: at least 1 minute and 23 seconds (16.8%) up to 5 minutes and 42 seconds (27.6%). Interestingly, well-designed thyroid cancer pathology reports required 14.54% less data entry time from the beginning of the SDE implementation. In the interviews and survey, we confirmed that most of the interviewees agreed on the need for structured templates. However, they were skeptical about structuring all the items included in the templates. Conclusions The increase in initial elapsed time led users to hold a negative opinion of SDE, despite its benefits. To overcome these obstacles, it is necessary to structure the clinical templates for optimum use. In addition, user experience in terms of ease of data entry must be considered as an essential aspect in the development of structured clinical templates.

BACKGROUND Electronic health record (EHR) systems have been widely adopted in hospitals. However, since current EHRs mainly focus on lowering the number of paper documents used, they have suffered from poor search function and reusability capabilities. To overcome these drawbacks, structured clinical templates have been proposed; however, they are not widely used owing to the inconvenience of data entry. OBJECTIVE This study aims to verify the usability of structured templates by comparing data entry times. METHODS A Korean tertiary hospital has implemented structured clinical templates with the modeling of clinical contents for the last 6 years. As a result, 1238 clinical content models (ie, body measurements, vital signs, and allergies) have been developed and 492 models for 13 clinical templates, including pathology reports, were applied to EHRs for clinical practice. Then, to verify the usability of the structured templates, data entry times from free-texts and four structured pathology report templates were compared using 4391 entries from structured data entry (SDE) log data and 4265 entries from free-text log data. In addition, a paper-based survey and a focus group interview were conducted with 23 participants from three different groups, including EHR developers, pathology transcriptionists, and clinical data extraction team members. RESULTS Based on the analysis of time required for data entry, in most cases, beginner users of the structured clinical templates required at most 70.18% more time for data entry. However, as users became accustomed to the templates, they were able to enter data more quickly than via free-text entry: at least 1 minute and 23 seconds (16.8%) up to 5 minutes and 42 seconds (27.6%). Interestingly, well-designed thyroid cancer pathology reports required 14.54% less data entry time from the beginning of the SDE implementation. In the interviews and survey, we confirmed that most of the interviewees agreed on the need for structured templates. However, they were skeptical about structuring all the items included in the templates. CONCLUSIONS The increase in initial elapsed time led users to hold a negative opinion of SDE, despite its benefits. To overcome these obstacles, it is necessary to structure the clinical templates for optimum use. In addition, user experience in terms of ease of data entry must be considered as an essential aspect in the development of structured clinical templates.

Objective Red cell distribution width (RDW) is associated with mortality in patients with community-acquired pneumonia (CAP). However, little is known about the effect of changes in RDW during treatment on mortality. Thus, the objective of this study was to evaluate the association between RDW changes and mortality in hospitalized patients with CAP. Methods Retrospective analyses were performed using medical records of patients hospitalized for CAP from April 2008 to February 2014. The abstracted laboratory values included RDW (from days one to four), clinical variables, and pneumonia severity index (PSI) scores. The ΔRDWn-1 was defined as the change in RDW calculated as: (RDWday1-RDWday-n)/RDWday1×100 (%), where ‘day n’ refers to hospital day. Results During the study period, a total of 1,069 patients were hospitalized for CAP. The 30-day mortality was 100/1,069 (9.4%). The median RDW at baseline was 14.1% (range, 11.1 to 30.2) and differed significantly between survivors and non-survivors (P