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Key Points Question What is the association between the Hospital-Acquired Conditions Present on Admission program by the Centers for Medicare & Medicaid Services pay-for-performance program and surgical care quality and costs? Findings In this cross-sectional study, the Hospital-Acquired Conditions Present on Admission program was associated with a decreased incidence of surgical site infection (0.3 percentage points) in the targeted procedures and a reduction in length of stay (0.5 days) and hospital costs (8.1%). Deep vein thrombosis and in-hospital mortality did not improve. Meaning The findings of this study suggest that the pay-for-performance program was associated with improvement on several dimensions of surgical care, including small reductions in surgical site infection and length of stay, and moderate reductions in hospital costs., Importance Surgical complications increase hospital costs by approximately $20 000 per admission and extend hospital stays by 9.7 days. Improving surgical care quality and reducing costs is needed for patients undergoing surgery, health care professionals, hospitals, and payers. Objective To evaluate the association of the Hospital-Acquired Conditions Present on Admission (HAC-POA) program, a mandated national pay-for-performance program by the Centers for Medicare & Medicaid Services, with surgical care quality and costs. Design, Setting, and Participants A cross-sectional study of Medicare inpatient surgical care stays from October 2004 through September 2017 in the US was conducted. The National Inpatient Sample and a propensity score–weighted difference-in-differences analysis of hospital stays with associated primary surgical procedures was used to compare changes in outcomes for the intervention and control procedures before and after HAC-POA program implementation. The sample consisted of 1 317 262 inpatient surgical episodes representing 1 198 665 stays for targeted procedures and 118 597 stays for nontargeted procedures. Analyses were performed between November 1, 2020, and May 7, 2021. Exposures Implementation of the HAC-POA program for the intervention procedures included in this study (fiscal year 2009). Main Outcomes and Measures Incidence of surgical site infections and deep vein thrombosis, length of stay, in-hospital mortality, and hospital costs. Analyses were adjusted for patient and hospital characteristics and indicators for procedure type, hospital, and year. Results In our propensity score–weighted sample, the intervention procedures group comprised 1 047 351 (88.5%) individuals who were White and 742 734 (60.6%) women; mean (SD) age was 75 (6.9) years. The control procedures group included 94 715 (88.0%) individuals who were White, and 65 436 (60.6%) women; mean (SD) age was 75 (7.1) years. After HAC-POA implementation, the incidence of surgical site infections in targeted procedures decreased by 0.3 percentage points (95% CI, −0.5 to −0.1 percentage points; P = .02) compared with nontargeted procedures. The program was associated with a reduction in length of stay by 0.5 days (95% CI, −0.6 to −0.4 days; P, This cross-sectional study examines the outcomes of Medicare patients who underwent surgery before and after implementation of the Hospital-Acquired Conditions Present on Admission program.

This study's aim was to discern the nursing organizational culture and job stress, induced by infection control nurses (ICNs)' working together, affects ICNs' turnover intentions. Job stress was the most significant factor affecting ICNs' turnover intention. To reduce ICNs' turnover intention, their task stress needs to be lowered and managed. In particular, efforts should be made to establish a relation-oriented organizational culture that values positive relationships while enhancing their community spirit at the organization level.

Background During lumbar spine surgery, patients are placed in the prone position for surgical access. The prone position has various effects on cardiac and pulmonary function, including a decreased cardiac index (CI), decreased dynamic lung compliance (Cdyn), and increased peak inspiratory pressure (Ppeak). In this study, we compared the volume-controlled ventilation mode (VCV) and pressure-controlled ventilation with volume guaranteed mode (PCV-VG) based on hemodynamic and pulmonary variables in the prone position during lumbar spine surgery. Methods Thirty-six patients scheduled for lumbar spine surgery in the prone position were enrolled in this prospective, randomized clinical trial. The patients were randomly assigned to receive VCV or PCV-VG. Hemodynamic variables, respiratory variables, and arterial blood gases were measured in the supine position 15 min after the induction of anesthesia, 15 min after placement in the prone position, 30 min after placement in the prone position, and 15 min after placement in the supine position at the end of anesthesia. Results The hemodynamic variables and arterial blood gas results did not differ significantly between the two groups. Lower Ppeak values were observed in the PCV-VG group than in the VCV group (p = 0.045). The Cdyn values in the VCV group were lower than those in the PCV-VG group (p = 0.040). Conclusion PCV-VG led to lower Ppeak and improved Cdyn values compared with VCV, showing that it may be a favorable alternative mode of mechanical ventilation for patients in the prone position during lumbar spine surgery. Trial registration The study was retrospectively registered at ClinicalTrials.gov (NCT 03571854). The initial registration date was 6/18/2018.

Background The aim of this systematic review is to assess if penalty-based pay-for-performance (P4P) programs are more effective in improving quality and cost outcomes compared to two other payment strategies (i.e., rewards and a combination of rewards and penalties) for surgical care in the United States. Penalty-based programs have gained in popularity because of their potential to motivate behavioral change more effectively than reward-based programs to improve quality of care. However, little is known about whether penalties are more effective than other strategies. Materials and methods A systematic literature review was conducted according to the PRISMA guideline to identify studies that evaluated the effects of P4P programs on quality and cost outcomes for surgical care. Five databases were used to search studies published from 2003 to March 1, 2020. Studies were selected based on the PRISMA guidelines. Methodological quality of individual studies was assessed based on ROBINS-I with GRADE approach. Results This review included 22 studies. Fifteen cross-sectional, 1 prospective cohort, 4 retrospective cohort, and 2 case-control studies were found. We identified 11 unique P4P programs: 5 used rewards, 3 used penalties, and 3 used a combination of rewards and penalties as a payment strategy. Five out of 10 studies reported positive effects of penalty-based programs, whereas evidence from studies evaluating P4P programs with a reward design or combination of rewards and penalties was little or null. Conclusions This review highlights that P4P programs with a penalty design could be more effective than programs using rewards or a combination of rewards and penalties to improve quality of surgical care., Highlights • Evidence on the effectiveness of pay-for-performance programs in quality improvement is mixed. • Five out of 10 studies reported positive effects of penalty-based programs. • Evidence from studies evaluating P4P programs with a reward design or combination of rewards and penalties was little or null. • The increasing use of penalty-based pay-for-performance programs has the potential to improve surgical care quality. • Penalties may induce stronger provider and hospital behavioral change than other payment strategies.

Backgrounds: Zika virus infection may cause severe complications in women of childbearing age. Female nursing college students, in the role of future nurses and women of childbearing age, can be ef...

Background: As the number of patients with Zika virus infection increases worldwide, nursing students who conduct clinical practice in hospitals tend to at risk of Zika virus infection. Therefore, this study was conducted to identify nursing students’ knowledge, attitudes, practices, and risk perceptions of infection prevention related to occupational exposure to Zika virus infection, and to identify correlations among the related variables. Methods: This cross-sectional study included 249 nursing students from 3 nursing colleges located in 3 Korean cities, with experience in hospital clinical practice. A questionnaire to assess the knowledge, attitudes, practices, and risk perceptions of Zika virus infection was developed through a literature review and was subjected to pilot testing and validation. Results: The level of infection-control knowledge for Zika virus was 54.5 of 100 points, and that of practice was 4.5 of 5 points. The infection-prevention attitude score was 4.4 of 5 points, and the risk-perception score was 2.3 of 5 points. Significant differences emerged in infection-prevention attitude toward Zika virus based on Zika virus vaccination intention. Additionally, practice and risk-perception scores differed significantly based on gender and Zika virus vaccination intention. Knowledge significantly correlated with attitude and attitude toward preventive behavior. Conclusion: Improvement in infection-control knowledge for Zika virus can help improve nurses’ related attitudes, which in turn could promote effective practice. Considering the characteristics of nursing students, it is necessary to develop and apply an effective and viable education program related to the prevention of Zika virus infection. Keywords: Zika, Nursing student, Knowledge, Attitude, Practice

The purpose of this study was to examine how nursing students' intention to comply with infection control practices (ICPs) is affected by their awareness of ICPs and by their observations of staff nurses' noncompliance with ICPs. The subjects were 350 nursing students from 8 universities in Korea. Hierarchical multiple linear regression analysis was used to determine the predictive factors of compliance intention with ICPs. We found that nursing students' awareness of ICPs was the most significant influencing factor affecting their compliance with ICPs. Students' observation of staff nurses' noncompliance with ICPs was the second most significant influencing factor.

This study examined female university students' menstrual-hygiene management and identified factors associated with genitourinary tract infections in this sample. This study was conducted as a descriptive survey. Participants were 383 female students from six universities in South Korea. Data were collected between April and June, 2017. Multiple logistic regression analysis was used to access the factors associated with genitourinary-tract infections. Multiple logistic regression revealed that genitourinary tract infections were significantly associated with low socioeconomic level, history of sexual intercourse, and vaginal douching during menstruation. We evaluated menstrual hygiene practices and their relation to genitourinary tract infections. Korean college students were relatively good at managing menstrual hygiene. However, some menstrual hygiene behaviors were improper. Therefore, school and community health agencies should provide education to maintain adequate menstrual hygiene and correct erroneous hygiene practices to prevent genitourinary tract infections.

WHAT IS KNOWN AND OBJECTIVE Dexmedetomidine has been a preferred sedative for patients undergoing regional anaesthesia and is mostly administered via conventional zero-order infusion. Recently, a pharmacokinetic-pharmacodynamic (PKPD) model of dexmedetomidine has been published, but no external validation has been reported in clinical trials. We aimed to administer target-controlled infusion (TCI) of dexmedetomidine at the effect-site concentration (Ce) to patients undergoing spinal anaesthesia and investigate the relationship between dexmedetomidine Ce and the sedative effects. METHODS Forty-five patients scheduled for orthopaedic surgery received spinal anaesthesia with 0.5% bupivacaine. After confirmation of sensory block level, we initiated effect-site TCI of dexmedetomidine using Colin's model and assessed sedation levels using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale and bispectral index (BIS) with each stepwise increase in the dexmedetomidine Ce. We used a non-linear mixed-effects model to determine the PD relationships between the dexmedetomidine Ce and sedation level. RESULTS The dexmedetomidine Ce associated with 50% probability (Ce50 ) of the MOAA/S scale ≤4, 3 and 2 was 0.57, 0.89 and 1.19 ng/mL, respectively. Mean dexmedetomidine Ce when BIS decreased ≤70 was 0.99 ± 0.15 ng/mL. As dexmedetomidine Ce increased, the MOAA/S scale decreased significantly (correlation coefficient [r] = -.832, P

Background Most depth of anesthesia (DOA) monitors rely on the temporal characteristics of a single-channel electroencephalogram (EEG) and cannot provide spatial or connectivity information. Phase lag entropy (PLE) reflects DOA by calculating diverse connectivity from temporal patterns of phase relationships. The aim of this study was to compare the performance of PLE and bispectral index (BIS) monitors for assessing DOA during anesthesia induction, nerve integrity monitoring (NIM), and anesthesia emergence. Methods Thirty-five patients undergoing elective thyroid surgery with recurrent laryngeal nerve NIM received propofol and remifentanil via target-controlled infusion. After applying PLE and BIS monitors, propofol infusion was initiated at a calculated effect site concentration (Ce) of 2 µg/mL and then increased in 1-µg/mL Ce increments. After propofol Ce reached 5 μg/mL, a remifentanil infusion was begun, and anesthesia induction was considered complete. During NIM, PLE and BIS values were compared at a specific time points from platysma muscle exposure to subcutaneous tissue closure. PLE and BIS values were recorded continuously from preanesthetic state to full recovery of orientation; bias and limits of agreement between monitors were calculated. Results PLE and BIS values decreased progressively with increasing propofol Ce during anesthetic induction and increased by stages during emergence. The prediction probabilities of PLE and BIS for detecting propofol Ce changes were 0.750 and 0.756, respectively, during induction and 0.749 and 0.746, respectively, during emergence. No aberrant PLE or BIS values occurred during NIM. Correlation coefficients for BIS and PLE were 0.98 and 0.92 during induction and emergence, respectively. PLE values were significantly higher than BIS values at full recovery of orientation. Estimated bias between monitors was −4.16 ± 8.7, and 95% limits of agreement were −21.21 to 12.89. Conclusion PLE is a reasonable alternative to BIS for evaluating consciousness and DOA during general anesthesia and during NIM. Trial Registration Clinical Research Information Service Identifier: KCT0003490, Graphical Abstract

Although hand hygiene (HH) monitoring by direct observation is considered to be a reliable method, it is labor intensive. The purpose of this study was to confirm regular HH use by collecting and analyzing HH data for Web- and mobile-application-based HH monitoring, as well as to establish a nationwide HH monitoring system. Users evaluated the Web-based report as being useful with regard to ease of access and use, data collection and analysis, and especially data comparison with other hospitals. Mobile applications were considered more difficult to use than the Web-based system.

Immigrants account for a significant proportion of the nursing workforce in the United States (U.S.). Although different cultural backgrounds may affect immigrant nurses’ perceptions of work and occupational health risks, little research has been conducted. Defining immigrant nurses as those who received initial nursing education in foreign countries, this study examined the differences in work-related perceptions and experiences of musculoskeletal (MS) symptoms and injuries between U.S.-educated and foreign-educated nurses. We analyzed data from a cross-sectional study using a statewide random sample of 419 California registered nurses. Foreign-educated nurses reported a more positive safety climate ( p = .017) and perceived their jobs as less demanding ( p = .008) than did U.S.-educated nurses. The prevalence of work-related MS symptoms was significantly lower in foreign-educated nurses than in U.S.-educated nurses ( p = .044), but the difference was not significant in the multivariable analyses. Positive safety climate was significantly associated with a decreased risk of work-related MS symptoms and injuries, and this relationship was greater among U.S.-educated nurses than among foreign-educated nurses. Our findings suggest that immigrant nurses may have different perceptions about safety climate and job demand, which may modify their occupational health risks.

Aim To assess the level of knowledge and awareness of Ebola virus disease infection control among infection control nurses and to identify a correlation between these factors. Methods The data were collected from 125 infection control nurses by using a self-report questionnaire. The data were collected on sociodemographic and hospital characteristics, as well as the level of knowledge and awareness of Ebola virus disease infection control. Results The respondents’ mean level of knowledge (correct-answer rate) was 87.7% and their mean level of awareness was 3.86 (1 = “not important at all” to 4 = “very important”). Knowledge of Ebola virus disease infection control was significantly higher among those nurses who had received some Ebola virus disease education. There was a significant positive correlation between the level of knowledge and the level of awareness. Conclusion The development of effective education and training systems is necessary to improve infection control nurses’ knowledge and awareness of Ebola virus disease infection control. Moreover, each hospital should build effective and systematic Ebola virus disease infection control strategies.

Since no course is offered in the area of professional ICT(Information & Communication Technology) in the high school curriculum, high school students do not have the opportunity to learn about the ICT engineering area and the possible career paths in the field. Due to this problem, high school students are not motivated to choose ICT majors at university level, and in turn, the ICT departments are struggling to recruit qualified students. In this paper, we present an R&E (research and education) model to mitigate this problem. We also present a case study on the program following the model offered by "H" university in collaboration with a local high school. Through the program we provided high school students with design and development experiences to solve engineering problems related to the ICT area and tried to attract their attention to ICT majors. The participants of the R&E program were able to experience the systematic engineering design process, ICT tools, teamwork, and communication skills through problem solving procedures. Based on three years of observation and the survey, it was found that more than 76% of students were motivated highly by ICT and engineering majors via the program. The main contribution of the paper is that we have proposed and proved the R&E program model and applied the ICT R&E model to a program to attract qualified students to ICT majors.

Offshore substructures have been developed to support structures against complex offshore environments. The load at offshore substructures is dominated by waves, and deformation of waves caused by interactions with the current is an important phenomena. Wave load simulation of fixed offshore substructures in waves with the presence of uniform current was carried out by numerical wave tank technique using the commercial software, FLUENT. The continuity and Navier-Stokes equations were applied as the governing equations for incompressible fluid motion, and numerical wavemaker was employed to reproduce offshore wave environment. Convergence test against grids number was carried out to investigate grid dependency and optimized conditions for numerical wave generation were derived including investigation of the damping effect against length of the damping domain. Numerical simulation of wave and current interactions with fixed offshore substructure was carried out by computational fluid dynamics, and comparison with other experiments and simulations results was conducted. Copyright (C) 2016 Society of Naval Architects of Korea. Production and hosting by Elsevier B.V.

Objective A prospective, double-blind, randomized controlled trial to compare the effect of preoperative midazolam or ketamine on the incidence of emergence agitation (EA) following sevoflurane anaesthesia in children. Methods Paediatric patients (2–6 years old) undergoing ophthalmic surgery were allocated to receive premedication with either 0.1 mg/kg midazolam or 1 mg/kg ketamine. Incidence of EA and postoperative pain scores were recorded at 10-min intervals in the postanaesthetic care unit (PACU). The use of EA rescue medications (fentanyl or midazolam) was recorded. Results The incidence of EA was significantly lower in the ketamine group ( n = 33) than the midazolam group ( n = 34) at 10 and 20 min after transfer to PACU. There was no significant difference in overall incidence of EA. The frequency of midazolam use as rescue medication was significantly lower in the katamine group than in the midazolam group. Conclusion Premedication with ketamine is more effective than midazolam in preventing EA during the early emergence period after sevoflurane anaesthesia in children.

The aim of this study was to evaluate the competency level of Korean infection control nurses (ICNs) by comparing the self-perceived competency level based on Benner's framework and the core competency proposed by the Certification Board of Infection Control. Study subjects included 90 ICNs working in Korean hospitals with more than 300 beds. A questionnaire was used to measure self-perceived competency level and core competency level. Using descriptive analysis, the core competency level of ICNs was found to differ significantly according to self-perceived competency level, and core competency level showed a significant increase with the increase of self-perceived competency level. Self-perceived competency level could be useful in classifying the competency level of nursing specialties. These results illustrate the competency levels of Korean ICNs and could serve as a reference to evaluate and expand the application of competency measurement not only for ICNs but also other groups of nurse specialists.

Gastric duplication cyst is a rare congenital anomaly of the gastrointestinal tract and is especially uncommon in adults. Most cases in adults are discovered incidentally on radiological examination or gastric endoscopy. Accurate diagnosis of these cysts before resection is difficult. Differential diagnoses are varied. Malignant transformation of a gastric duplication cyst is very rare. We present three cases of asymptomatic noncommunicating gastric duplication cysts in adults.

This study was conducted to investigate the level of knowledge about and practice of respiratory hygiene/cough etiquette among the general population of Korea and to identify the factors that may influence the practice of respiratory hygiene and cough etiquette. The mean correct answer rate for knowledge of respiratory hygiene/cough etiquette was 56.1%. Predictors of respiratory hygiene/cough etiquette practice were carrying a handkerchief or tissues, prior education on respiratory hygiene/cough etiquette, awareness level of respiratory hygiene/cough etiquette, daily frequency of handwashing, and knowledge level of respiratory hygiene/cough etiquette.

Objective This study compared the activated clotting time (ACT) measured using the Hemochron Jr. Signature (HACT) with the ACT measured using the Medtronic ACT Plus (MACT) during cardiopulmonary bypass (CPB) with acute normovolemic haemodilution (ANH) in patients undergoing cardiac surgery. Methods The ACT was checked at baseline with both devices after inducing anaesthesia, and 400 to 800 mL of whole blood was withdrawn to induce moderate ANH. Before initiating CPB, a 300-IU/kg bolus dose of heparin was administered to maintain the HACT at >400 s; protamine was later given to reverse the anticoagulation. The ACT was checked using both devices at baseline, during heparinisation, and after protamine administration. Results In total, 106 pairs of samples from 29 patients were analysed. The ACT showed a good correlation between the two devices (r = 0.956). However, Bland–Altman analysis showed that the MACT was higher, particularly at baseline and during heparinisation. Multiple regression analysis showed that the blood glucose concentration significantly influenced the differences between the two ACT devices. Conclusions The HACT was lower than the MACT during CPB with ANH in patients undergoing cardiac surgery. Clinicians should be cautious when using each ACT device within generally accepted reference ACT values.

Background As a drug originally introduced for its anticonvulsant effects, gabapentin has been recently shown to be effective in the treatment of nausea and vomiting in various clinical settings. This study compared the antiemetic efficacy of oral gabapentin, intravenous ramosetron and gabapentin plus ramosetron in patients receiving fentanyl-based patient-controlled analgesia after laparoscopic gynecologic surgery. Methods One hundred and thirty two patients undergoing laparoscopic gynecologic surgery under general anesthesia were allocated randomly into three groups: group G received 300 mg oral gabapentin 1 h before anesthesia, group R received 0.3 mg intravenous ramosetron at the end of surgery, and group GR received a combination of 300 mg oral gabapentin 1 h before anesthesia and 0.3 mg intravenous ramosetron at the end of surgery. Postoperative nausea, retching, vomiting, rescue antiemetic drug use, pain, rescue analgesic requirements and adverse effects were assessed at 0–2, 2–24 and 24–48 h after surgery. Postoperative nausea and vomiting (PONV) was defined as the presence of nausea, retching or vomiting. Results The incidence of complete response (no PONV and no rescue antiemetics up to 48 h postoperatively) was significantly higher in group GR (26/40, 65%) than group G (16/40, 40%; P = 0.025) and group R (18/44, 41%; P = 0.027), whereas there was no significant difference between group G and group R (P = 0.932). There were no significant between-group differences in the incidence of emetic episodes, use of rescue antiemetics, severe emesis, use of rescue analgesics or any adverse effects. Postoperative pain scores were also similar among groups. Conclusions The combination with gabapentin and ramosetron is superior to either drug alone for prevention of PONV after laparoscopic gynecologic surgery. Trial registration ClinicalTrials.gov NCT02617121 , registered November 25, 2015.

The integrity assurance of recorded video by car black boxes are necessary as the car black box is becoming more popular. In this paper, we propose a video data integrity assurance scheme reflecting the features of car black box. The proposed method can detect any kind of deletion, insertion, modification of frames by cyclic chaining using inter block relation. And, it provides the integrity assurance function consistently even in cases of file overwriting because of no more free space in storage, partial file data lost. And non-repudiation is supported. Experimental results with a car black box embedded system with A8 application processor show that our method has a feasible computational overhead to process full HD resolution video at 30 frames per second in a real time.

This study was conducted to increase the frequency and level of thoroughness of hand hygiene practice by nurses, and to assess the influence of the methicillin-resistant Staphylococcus aureus (MRSA) acquired incidence rate and the MRSA colonization pressure in a medical intensive care unit (MICU). A total of 24 MICU nurses received hand hygiene education and individual feedback of hand hygiene frequency and method after a session of education, and two posteducation evaluations were followed. The frequency of hand hygiene (P = 0.001) and the methodology score of hand hygiene increased significantly (P = 0.001). The MRSA acquisition rate decreased significantly, from 11.1% before the education to 0% after (P = 0.014). The MRSA colonization pressure decreased significantly from 39.5% to 8.6% after the education sessions (P = 0.001). This indicates that providing individual feedback after hand hygiene education was very effective in increasing nurses' hand hygiene frequency and improving hand hygiene method; furthermore, it was expected to decrease health care-associated infections.

Background This study investigated the self-perceived infection control (IC) knowledge and practice levels of professional standards competency (PSC) among Korean infection control nurses (ICNs) to identify factors that may influence PSC. Methods Using a self-reporting questionnaire method, we collected data from a total of 104 ICNs. Results The average self-perceived IC knowledge level was 3.1 ± 0.8, with hand hygiene scoring the highest at 3.7 ± 0.8. The total proportion of responders who did not meet the expected standard in 4 future-oriented domains was 51.7%. Of the 4 domains, technology had the highest number of respondents meeting the desired standard (57%). There were significant differences in self-perceived levels of PSC in relation to ICN specialist certification and continuing education (eg, extra coursework, conference attendance) in the field. Self-perceived practice levels of PSC also were significantly correlated with age, years of total clinical experience, years of ICN experience, hospital bed count, and IC knowledge. Predictors of self-perceived practice levels of PSC were knowledge and years of ICN experience. Conclusion Educational programs are needed to promote knowledge and competency, the lack of which was recognized by the ICNs. Also, various efforts are needed to prevent turnover of ICNs with a high level of competency.

We report an anesthetic experience in a clinically euthyroid patient with hyperthyroxinemia (elevated free thyroxine, fT4 and normal 3, 5, 3'-L-triiodothyronine, T3) and suspected impairment of conversion from T4 to T3. Despite marked hyperthyroxinemia, this patient's perioperative hemodynamic profile was suspected to be the result of hypothyroidism, in reference to the presence of T4 to T3 conversion disorder. We suspected that pretreatment with antithyroid medication before surgery, surgical stress and anesthesia may have contributed to the decreased T3 level after surgery. She was treated with liothyronine sodium (T3) after surgery which restored her hemodynamic profile to normal. Anesthesiologists may be aware of potential risk and caveats of inducing hypothyroidism in patients with euthyroid hyperthyroxinemia and T4 to T3 conversion impairment.

BACKGROUND/OBJECTIVES: Inflammatory bowel disease (IBD), including Crohn"s disease and ulcerative colitis, involves chronic inflammation of the gastrointestinal tract. Previously, Sasa quelpaertensis leaves have been shown to mediate anti-inflammation and anti-cancer effects, although it remains unclear whether Sasa leaves are able to attenuate inflammation-related intestinal diseases. Therefore, the aim of this study was to investigate the anti-inflammatory effects of Sasa quelpaertensis leaf extract (SQE) using an in vitro co-culture model of the intestinal epithelial environment. MATERIALS/METHODS: An in vitro co-culture system was established that consisted of intestinal epithelial Caco-2 cells and RAW 264.7 macrophages. Treatment with lipopolysaccharide (LPS) was used to induce inflammation. RESULTS: Treatment with SQE significantly suppressed the secretion of LPS-induced nitric oxide (NO), prostaglandin E2 (PGE2), IL-6, and IL-1β in co-cultured RAW 264.7 macrophages. In addition, expressions of inducible nitric oxide synthase (iNOS), cyclooxygenase (COX)-2, and tumor necrosis factor (TNF)-α were down-regulated in response to inhibition of IκBα phosphorylation by SQE. Compared with two bioactive compounds that have previously been identified in SQE, tricin and P-coumaric acid, SQE exhibited the most effective anti-inflammatory properties. CONCLUSIONS: SQE exhibited intestinal anti-inflammatory activity by inhibiting various inflammatory mediators mediated through nuclear transcription factor kappa-B (NF-kB) activation. Thus, SQE has the potential to ameliorate inflammation-related diseases, including IBD, by limiting excessive production of pro-inflammatory mediators.

Background Intrathecal labor analgesia using new local anesthetics such as ropivacaine or levobupivacaine becomes more popular by virtues of their safety and decreased motor weakness. However, the analgesic efficacy of the clinically effective intrathecal doses of these new local anesthetics combined with fentanyl has yet to be determined. Methods Sixty parturients who requested neuraxial analgesia in early active labor were randomly assigned to either ropivacaine (group R, n = 30) or levobupivacaine (group L, n = 30) group. Group R received 3 mg of intrathecal ropivacaine and the group L received 3 mg of intrathecal levobupivacaine mixed with 20 µg of fentanyl as part of a combined spinal-epidural (CSE) technique. The associated block parameters, such as pain scores, duration of analgesia, the highest levels of the sensory block and motor block scores 30 mins after the injection were compared between two groups. Results Intrathecal ropivacaine offered shorter analgesia (87 ± 41 min vs. 122 ± 56 min, P < 0.05) with lower sensory height (T8.5 vs. T6, P < 0.05) and led to lower incidence of complete analgesia (73 vs. 97%, P < 0.05) compared with intrathecal levobupivacaine. Although motor weakness was comparable in both groups, significantly weak perineal squeezing was noticed in Group L (7 of 30 parturients vs. 16 of 30, P < 0.05). Conclusions Clinically relevant doses of intrathecal levobupivacaine in combination with fentanyl as part of a CSE technique provides more effective analgesia than equivalent doses of intrathecal ropivacaine in early labor, but is accompanied by slight motor weakness.

The objective of this study was to analyze the awareness and satisfaction regarding Korean traditional foods in elementary, middle, and high school students. In a survey of 1,030 students, 55.9% of the total respondents stated that traditional Korean food is `Korean food that uses unique Korean recipes` (p

Purpose: This study was undertaken to identify the knowledge and compliance level of nursing students. It was based on self-administered questionnaires about multidrug-resistant organisms (MDROs). Methods: The test group was 184 nursing students who had contact with MDROs during clinical practice. The study was conducted from May 1 to September 16, 2011. Results: The average knowledge level of MDROs was 16.20 (correct answer rate: 67.5%). The nurses' compliance level of MDROs infection control was on average 40.50 (range: 13-52). "Hand hygiene" ranked highest in the compliance level of MDROs infection control. The lowest level of MDRO infection control was the wearing of disposable aprons or gowns. Conclusion: This study demonstrated the nursing students' knowledge and the compliance level of infection control. We suggest that nursing students receive mandated systematic education of MDROs in the nursing curriculum. And clinical practice experience of MDROs infection control is required in hospitals. These steps will help prevent transmission of MDROs in nursing settings.

Purpose: This study was designed to identify knowledge and performance level of infection control among oriental medical doctors and nurses and further to identify factors that may influence practice. Methods: Data were collected using the survey method. Two hundred and forty two healthcare workers (HCW) from five oriental medicine university hospitals in Korea (140 physicians and 102 nurses) completed a survey about infection control. The study was conducted from February 1 to 28, 2011. Results: The average knowledge level of infection control among HCW was 0.75 ± 0.13 (score range 0~1) and the average performance level of infection control was 3.16 ±1.05 (score range 0~5). ‘Disinfection and sterilization’ were ranked the highest in both the knowledge and performance level. In the knowledge level, ‘hand washing/hand hygiene’ were ranked the lowest. ‘Bloodstream infection prevention’was the lowest among the infection control categories in performance. Total average knowledge and performance level of nurses was significantly higher than that of the physicians. Conclusion: This study demonstrated the oriental medical doctors and nurses’knowledge and performance level of infection control differed. The education on infection control is required to oriental medical doctors and nurses and it would contribute to preventing healthcare associated infections in oriental medicine hospitals.

Kwak YG, Lee S-O, Kim TH, Choo EJ, Jeon M-H, Jun J-B, Kim K-M, Jeong JS, Kim YS. International Journal of Nursing Practice 2012; 18: 77–83 The use of multidose vials and fingerstick blood sampling devices in Korean emergency departments and intensive care units This study was performed to compare compliance with standard precautions for the use of multidose vials (MDVs) and fingerstick devices in emergency departments (EDs) and intensive care units (ICUs). Between December 2007 and February 2008, 389 nurses from the EDs or ICUs of six university-affiliated hospitals in Korea were asked to complete the questionnaire. A total of 338 (86.9%) nurses completed the survey, corresponding to 159 of 184 ED and 179 of 205 ICU nurses. A comparison of MDV use in EDs and ICUs indicated a significant difference only in disinfection of the rubber septum of heparin vials; 88.1% of ED nurses and 96.6% of ICU nurses stated that they always disinfected the rubber septum of heparin vials whenever drawing medication (P = 0.003). The use of separate fingerstick devices for each patient (71.7% vs. 54.5%) and disinfection of these devices after each use (36.5% vs. 26.0%) were more common in ED nurses. The rate of good hand hygiene was lower in ED nurses, both before (43.7% vs. 74.3%) and after (64.6% vs. 91.6%) the use of fingerstick devices (P

The purpose of this study was to investigate the effect of ketamine on intubating conditions for tracheal intubation during anesthesia induction with sevoflurane and alfentanil in pediatric patients. After obtaining parental consents, 50 children, aged 3–10 years, were randomly allocated into two groups to receive either i.v. ketamine 0.5 mg/kg (ketamine group, n = 25) or i.v. saline 5 ml (control saline group, n = 25). One minute after injection of the study drug (ketamine or saline), anesthesia was induced with 5% sevoflurane, followed by injection of alfentanil 10 μg/kg 1 min later. The trachea was intubated 4 min after inhalational induction of anesthesia. Acceptable intubation was defined as excellent or good intubating conditions. Mean arterial pressure (MAP) and heart rate (HR) were recorded during the induction period. The percentage of patients with acceptable intubating conditions was higher in the ketamine group (87%) than in the control group (52%) (P = 0.0129). MAP before intubation was significantly lower in the control group than in the ketamine group (P = 0.001). This study demonstrated that administration of ketamine 0.5 mg/kg could improve intubating conditions for tracheal intubation without neuromuscular blockade and preserve hemodynamic stability during sevoflurane inhalation induction with alfentanil in children.

歯周病はプラークおよびその他の口腔内因子に起因する炎症性疾患である。歯周病の病因論に対する考え方がここ数十年間で大きく変化した結果, 歯周病の治療を成功に導くためには患者の口腔内管理状態の向上が重要であることが再認識されている。本研究の目的は, 動機づけに際して通常のブラッシング指導に加えて, 口臭測定および定量的PCR法による細菌検査を行うことによる口腔内への影響について検討することにある。被験者としては, 日本大学松戸歯学部付属病院歯周科に来院した60名の慢性歯周炎患者を選択した。60名の被験者は, N, A, B, C群の4つ(各群15名)に分け, 術前の歯周組織検査の結果から各群間の検査値の標準化を行い, ブラッシング指導前後の歯周組織検査の改善程度を比較検討した。N群は通常のブラッシング指導, A群は通常のブラッシング指導に加えてブレストロンを用いた口臭検査, B群は通常のブラッシング指導に加えてProphyromonas gingivalis, Tannerella forsythensis, Aggregatebacter actinomycetemcomitansについて定量的PCR法による細菌検査, C群は通常のブラッシング指導に加えて口臭検査と細菌検査を行った。歯周基本治療後の歯周組織検査の結果は, すべての群で初診時に比べ改善を認めた。各群間の比較ではPlaque control record(PCR %)はN群に比べA, B, C群で有意な減少を認めた(p

To assess the utility of makorin ring finger protein 1 (MKRN1) as a marker of cervical pathology. A PROspective specimen collection and retrospective Blinded Evaluation study was conducted. Liquid-based cytology samples were collected from 187 women, embedding all residuals as cell blocks for immunohistochemical staining of MKRN1 and P16 INK4a. Results of liquid-based cervical cytology, immunostained cell block sections, and human papillomavirus (HPV) hybrid capture (with real-time polymerase chain reaction) were analyzed. Clinical outcomes were analyzed overall and in subsets of specimens yielding atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions. Makorin ring finger protein 1 positivity and grades (1–3) of cervical intraepithelial neoplasia (CIN) increased in tandem (CIN1, 32.4%; CIN2, 60.0%; and CIN3, 80.0%), reaching 92.3% in invasive cancer. Sensitivity, specificity, positive predictive value, and negative predictive value in detecting CIN2+ via MKRN1 were 73.8%, 76.8%, 75.6%, and 75.0%, respectively. The performance of liquid-based cytology was poorer by comparison (61.3%, 69.5%, 66.2%, and 64.8%, respectively), and HPV assay (versus MKRN1 immunohistochemical staining) displayed lower specificity (67.7%). Combined HPV + MKRN1 testing proved highest in sensitivity, specificity, positive predictive value, and negative predictive value (71.8%, 85.5%, 82.3%, and 76.5%, respectively), whereas corresponding values for cytology + HPV (60.6%, 81.8%, 75.4%, and 69.2%) and cytology + MKRN1 (58.8%, 84.1%, 78.3%, and 67.7%) were all similar. In instances of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions, the HPV + MKRN1 combination performed best by above measures (100%, 72.7%, 73.9%, and 100%), followed by cytology + MKRN1 (100%, 50.0%, 60.7%, and 100%). Makorin ring finger protein 1 displayed greater sensitivity and specificity than liquid-based cytology and proved more specific than HPV assay. In combination testing, MKRN1 + HPV showed the highest sensitivity and specificity levels. The MKRN1 biomarker may be a useful adjunct in primary cervical cytology screening.

Background Our previous study suggested that licorice has anti-inflammatory activity in lipopolysaccharide-stimulated microglial cells and anti-oxidative activity in tert-butyl hydroperoxide–induced oxidative liver damage. In this study, we evaluated the effect of licorice on chronic alcohol-induced fatty liver injury mediated by inflammation and oxidative stress. Methods Raw licorice was extracted, and quantitative and qualitative analysis of its components was performed by using LC–MS/MS. Mice were fed a liquid alcohol diet with or without licorice for 4 weeks. Results We have standardized 70 % fermented ethanol extracted licorice and confirmed by LC-MS/MS as glycyrrhizic acid (GA), 15.77 ± 0.34 μg/mg; liquiritin (LQ), 14.55 ± 0.42 μg/mg; and liquiritigenin (LG), 1.34 ± 0.02 μg/mg, respectively. Alcohol consumption increased serum alanine aminotransferase and aspartate aminotransferase activities and the levels of triglycerides and tumor necrosis factor (TNF)-α. Lipid accumulation in the liver was also markedly induced, whereas the glutathione level was reduced. All these alcohol-induced changes were effectively inhibited by licorice treatment. In particular, the hepatic glutathione level was restored and alcohol-induced TNF-α production was significantly inhibited by licorice. Conclusion Taken together, our data suggests that protective effect of licorice against alcohol-induced liver injury may be attributed to its anti-inflammatory activity and enhancement of antioxidant defense. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-0997-0) contains supplementary material, which is available to authorized users.

In this paper, we propose a novel electrode structure, which exhibits high-aperture ratio, in the super in-plane switching (SIPS) liquid crystal (LC) cell for high transmittance. Generally, the transmittance of the S-IPS LC cell is not superior to other LC mode using the multi domain effect because of the low aperture ratio. To improve the aperture ratio of the S-IPS cell, we found the method to minimize the black matrix (BM) area by applying the novel electrode structure which can move the disclination from the active area. As a result, we found that the proposed electrode structure could provide higher aperture ratio than that of the conventional type by reducing the BM area, so that we could achieve the high transmittance compared to the conventional structure. We used the commercial software ‘TechWiz LCD’ for calculation of the director configuration, which applies Q-tensor method.

// Jin Hyun Kim 1, 2 , Kyung Mi Kim 3 , Myeong Hee Jung 1 , Jung Hwa Jung 2, 4 , Ki Mun Kang 2, 5 , Bae Kwon Jeong 2, 5 , Jin Pyeong Kim 2, 3 , Jung Je Park 2, 3 , Seung Hoon Woo 2, 3 1 Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongnam, Republic of Korea 2 Institute of Health Science, Jinju, Gyeongnam, Republic of Korea 3 Department of Otolaryngology, Jinju, Gyeongnam, Republic of Korea 4 Department of Internal Medicine, Jinju, Gyeongnam, Republic of Korea 5 Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongnam, Republic of Korea Correspondence to: Seung Hoon Woo, email: lesaby@hanmail.net Keywords: alpha lipoic acid, salivary gland, radiation, Nox-2, complication Received: December 27, 2015 Accepted: March 16, 2016 Published: April 09, 2016 ABSTRACT Purpose: Radiation therapy is a treatment for patients with head and neck (HN) cancer. However, radiation exposure to the HN often induces salivary gland (SG) dysfunction. We investigated the effect of α-lipoic acid (ALA) on radiation-induced SG injury in rats. Results: ALA preserved acinoductal integrity and acinar cell secretary function following irradiation. These results are related to the mechanisms by which ALA inhibits oxidative stress by inhibiting gp91 mRNA and 8-OHdG expression and apoptosis of acinar cells and ductal cells by inactivating MAPKs in the early period and expression of inflammation-related factors including NF-κB, IκB-α, and TGF-β1 and fibrosis in late irradiated SG. ALA effects began in the acute phase and persisted for at least 56 days after irradiation. Materials and Methods: Rats were assigned to followings: control, ALA only (100 mg/kg, i.p.), irradiated, and ALA administered 24 h and 30 min prior to irradiation. The neck area including the SG was evenly irradiated with 2 Gy per minute (total dose, 18 Gy) using a photon 6-MV linear accelerator. Rats were killed at 4, 7, 28, and 56 days after radiation. Conclusions: Our results show that ALA could be used to ameliorate radiation-induced SG injury in patients with HN cancer.

Sevoflurane is commonly usedin pediatric anesthesia due to its non-irritating airway properties, and rapid induction and emergence. However, it is associated with emergence agitation (EA) in children. EA may cause injury to the child or damage to the surgical site and is a cause of stress to both caregivers and families. The efficacy of remifentanil and additional alfentanil on EA in the pediatric patients underwent ophthalmic surgery with sevofluraneanesthesiawas not well evaluated to date. This study was designed to compare the effects of remifentanil and remifentanil plus alfentanil on EA in children undergoing ophthalmic surgery with sevofluraneanesthesia. Children (aged 3–9 years) undergoing ophthalmic surgery undersevoflurane anesthesia were randomly assigned to group S (sevoflurane alone), group R (sevofluraneandremifentanil infusion, 0.1 μg/kg/min), or group RA (sevoflurane withremifentanil infusion and intravenous injection of alfentanil 5 μg/kg 10 min before the end of surgery). Mean arterial pressure (MAP), heart rate (HR), and sevoflurane concentration were checked every 15 min after induction of anesthesia. The incidence of EA, time to extubation from discontinuation of sevoflurane inhalation, and time to discharge from the postanesthesia care unit was assessed. The incidence of EA was significantly lower in groups R (32 %, 11/34; P = 0.01) and RA (31 %, 11/35; P = 0.008) than group S (64 %, 21/33). The time to extubation was prolonged in group RA (11.2 ± 2.3 min; P = 0.004 and P = 0.016) compared with groups S (9.2 ± 2.3 min) andR (9.5 ± 2.4 min). MAP and HR were similar in all three groups, apart from a reduction in HR at 45 min in groups R and RA. However, the sevoflurane concentration was lower in groups R and RA than group S (P

The purpose of this study was to evaluate the muscle activity patterns of the rectus femoris, tensor fascia latae and adductor longus activity during stepper strengthening exercise and stair walking. As a result, about the muscle activity of stair walking, the activity of rectus femoris, tensor fascia latae and adductor longus were higher than the muscle activity of stepper strengthening exercise. And the result shows significant difference that in the stepper strengthening group and stair walking group. In conclusion, this study demonstrated that stair walking has identical effects from stepper strengthening exercise of muscle strength improvement.