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The ancient peoples of Greece and China represented themselves and others in diverse ways in their surviving literature and art. What appears to approximate a sense of collective ethnic identity and the ‘othering’ of those perceived to be different (i.e., foreigners) existed in both cultures. In the Greek context the collective ‘panhellenic’ identity of that ethnos, which was used to connect the highly fractious and heterogeneous Greek sub-ethne (Dorians, Ionians, Aeolians, etc.) across the Mediterranean and the Black Sea, was sometimes expressed via what modern scholars have termed polarity, an oppositional identity vis-à-vis the ‘Barbarian’. A host of scholarship has arisen to address the question of when exactly the notion of Greek-Barbarian polarity or antithesis first appeared. Some have associated its ‘invention’ with Athenian drama (Aeschylus in particular) in the context of Athenian propaganda vis-à-vis members of the Delian League in the fifth century bce.
We calculated the human resources required for an antimicrobial stewardship program (ASP) in Korean hospitals.
Multicenter retrospective study.
Eight Korean hospitals ranging in size from 295 to 1,337 beds.
The time required for performing ASP activities for all hospitalized patients under antibiotic therapy was estimated and converted into hours per week. The actual time spent on patient reviews of each ASP activity was measured with a small number of cases, then the total time was estimated by applying the determined times to a larger number of cases. Full-time equivalents (FTEs) were measured according to labor laws in Korea (52 hours per week).
In total, 225 cases were reviewed to measure time spent on patient reviews. The median time spent per patient review for ASP activities ranged from 10 to 16 minutes. The total time spent on the review for all hospitalized patients was estimated using the observed number of ASP activities for 1,534 patients who underwent antibiotic therapy on surveillance days. The most commonly observed ASP activity was ‘review of surgical prophylactic antibiotics’ (32.7%), followed by ‘appropriate antibiotics recommendations for patients with suspected infection without a proven site of infection but without causative pathogens’ (28.6%). The personnel requirement was calculated as 1.20 FTEs (interquartile range [IQR], 1.02–1.38) per 100 beds and 2.28 FTEs (IQR, 1.93–2.62) per 100 patients who underwent antibiotic therapy, respectively.
The estimated time required for human resources performing extensive ASP activities on all hospitalized patients undergoing antibiotic therapy in Korean hospitals was ~1.20 FTEs (IQR, 1.02–1.38) per 100 beds.
Several studies on the treatment of coronavirus disease (COVID-19) are being conducted, and various drugs are being tried; however, the results have not been uniform. Steroids have been widely used in the treatment of COVID-19, but their effects are controversial. As immunosuppressive and anti-inflammatory agents, steroids are considered to reduce lung damage by regulating various inflammatory responses. We report a case of severe acute respiratory syndrome coronavirus-2 pneumonia manifesting as a cryptogenic organizing pneumonia-like reaction and discuss its treatment, clinical course, and favorable outcomes after steroid administration.
Early replacement of a new central venous catheter (CVC) may pose a risk of persistent or recurrent infection in patients with a catheter-related bloodstream infection (CRBSI). We evaluated the clinical impact of early CVC reinsertion after catheter removal in patients with CRBSIs.
We conducted a retrospective chart review of adult patients with confirmed CRBSIs in 2 tertiary-care hospitals over a 7-year period.
To treat their infections, 316 patients with CRBSIs underwent CVC removal. Among them, 130 (41.1%) underwent early CVC reinsertion (≤3 days after CVC removal), 39 (12.4%) underwent delayed reinsertion (>3 days), and 147 (46.5%) did not undergo CVC reinsertion. There were no differences in baseline characteristics among the 3 groups, except for nontunneled CVC, presence of septic shock, and reason for CVC reinsertion. The rate of persistent CRBSI in the early CVC reinsertion group (22.3%) was higher than that in the no CVC reinsertion group (7.5%; P = .002) but was similar to that in the delayed CVC reinsertion group (17.9%; P > .99). The other clinical outcomes did not differ among the 3 groups, including rates of 30-day mortality, complicated infection, and recurrence. After controlling for several confounding factors, early CVC reinsertion was not significantly associated with persistent CRBSI (OR, 1.59; P = .35) or 30-day mortality compared with delayed CVC reinsertion (OR, 0.81; P = .68).
Early CVC reinsertion in the setting of CRBSI may be safe. Replacement of a new CVC should not be delayed in patients who still require a CVC for ongoing management.
A disaster in the hospital is particularly serious and quite different from other ordinary disasters. This study aimed at analyzing the activity outcomes of a disaster medical assistance team (DMAT) for a fire disaster at the hospital.
The data which was documented by a DMAT and emergent medical technicians of a fire department contained information about the patient’s characteristics, medical records, triage results, and the hospital which the patient was transferred from. Patients were categorized into four groups according to results of field triage using the simple triage and rapid treatment method.
DMAT arrived on the scene in 37 minutes. One hundred and thirty eight (138) patients were evacuated from the disaster scene. There were 25 patients (18.1%) in the Red group, 96 patients (69.6%) in the Yellow group, and 1 patient (0.7%) in the Green group. One patient died. There were 16 (11.6%) medical staff and hospital employees. The injury of the caregiver or the medical staff was more severe compared to the family protector.
For an effective disaster-response system in hospital disasters, it is important to secure the safety of medical staff, to utilize available medical resources, to secure patients’ medical records, and to reorganize the DMAT dispatch system.
Delirium occur frequently in hospitalized patients. High-potency antipsychotic drugs have been used for the treatment of delirium; however, there is a risk of acute side effects. Therefore, atypical antipsychotic drugs could be used to the treatment of delirium.
The present study aimed to provide comparison of intramuscular injection of olanzapine and intramuscular injection of haloperidol for patients with delirium was conducted with a randomized, open prospective study.
Sixty-two patients admitted at the Catholic University of Korea Kangnam St. Mary's hospital, Seoul, South Korea were enrolled in this study. They were diagnosed as delirium by two independent psychiatrists using DSM-IV-TR. the Delirium Rating Scale-revised-98(DRS-R-98) and clinical global impression-severity (CGI-S) were checked daily. the Simpson-Angus Rating Scale, the Barnes Akathisia Rating Scale and the Abnormal Involuntary Movement Scale were used for the assessment of side effects.
The DRS-R-98 and CGI-S scores were significantly decreased over time in both treatment groups without any significant group difference and time by the group interaction effect (F=28.35, P< 0.0001). Adverse events occurred lower in olanzapine group. both treatments were well tolerated and there were no serious adverse events occurred by intramuscular olanzapine or haloperidol.
This study showed that either intramuscular olanzapine or intramuscular haloperidol would be effective and tolerable for treating delirium, however, olanzapine showed lower side effects than haloperidol. Adequately powered studies will be mandatory to draw any definite conclusion.
The number of Korean smartphone users exceeded 40 million in 2015, in which roughly 1 in 5 university students were expected to be addicted to their smartphone. Of importance is that smartphone addiction negatively affects physical and mental well-being and health. Sleep problems associated with smartphone is also a serious public concern; but the evidence is lacking. The aim of this study is to investigate the association between smartphone addiction proneness and sleep problems in Korean university students.
We conducted an online-survey which received responses from 608 university students. All participants completed questionnaires on the Korean smartphone addiction scale (K-SAS), the Pittsburgh Sleep Quality Index (PSQI), and personal characteristics. Based on the scores of the K-SAS, university students were classified into two groups–the addiction proneness group and the normal-user group.
The addiction proneness groups had a higher PSQI score than the normal-user group (7.5 vs. 6.7, P-value < 0.0001). After adjustment for potential covariates (i.e., age, income, and smoking), PSQI scores was significantly increased in the addiction proneness groups (Beta coefficient = 0.69; 95% CI : 0.29 ∼ 1.09). The risk of sleep problems was more increased in the addiction proneness groups (odds ratio = 1.99; 95% CI: 1.33 ∼ 2.98) than the normal-user groups.
We found that the smartphone addiction proneness was associated with sleep problems in university students. Although our findings are further confirmed by elucidating causal relationships between smartphone uses and sleep habits, smartphone addiction proneness may be a risk factor for poor sleep quality.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We aimed to identify the association of hydration status with insulin resistance (IR) and body fat distribution. A total of 14 344 adults participated in the Korea National Health and Nutrition Examination Survey 2008–2010. We used urine specific gravity (USG) to indicate hydration status, and HOMA-IR (homoeostasis model assessment of IR) and trunk:leg fat ratio (TLR) as primary outcomes. In multivariate logistic regression, the OR per 0·01 increase in USG for high IR was 1·303 (95 % CI 1·185, 1·433; P < 0·001). In multivariate generalised additive model plots, increased USG showed a J-shaped association with logarithmic HOMA-IR, with the lowest Akaike’s information criterion score of USG 1·030. Moreover, increased USG was independently associated with increased trunk fat, decreased leg fat and increased TLR. In mediation analysis, the proportion of mediation effects of USG on TLR via IR was 0·193 (95 % CI 0·132, 0·285; P < 0·001), while the proportion of mediation effects of USG on IR via TLR was 0·130 (95 % CI 0·086, 0·188; P < 0·001). Increased USG, a sign of low hydration status and presumably high vasopressin, was associated with IR and poor fat distribution. Direct effect of low hydration status may be more dominant than indirect effect via IR or fat distribution. Further studies are necessary to confirm our findings.
Vocabulary represents a key barrier to language and literacy development for many English learners. This study examined the relationship between Spanish-speaking English learners’ conceptually scored Spanish–English vocabulary, academic English proficiency, and English reading comprehension. Second- and fourth-grade English learners (N = 62) completed standardized conceptually scored vocabulary measures in the fall and state-administered standardized measures of academic English proficiency and English reading comprehension in the spring. Conceptually scored vocabulary measures are designed to tap knowledge of the number of known concepts, regardless of the specific language (Spanish or English) used to label the concept. Regression analyses revealed that academic English proficiency and English reading comprehension were not predicted by the conceptually scored measure of receptive vocabulary. However, both academic English proficiency and English reading comprehension were predicted by the conceptually scored measure of expressive vocabulary. In addition, the relationship between conceptually scored expressive vocabulary and English reading comprehension remained after controlling for academic English proficiency. Results underscore the utility of measures that incorporate English learners’ first and second language skills in understanding the vocabulary knowledge English learners bring to English language and literacy learning tasks.
Recent hospital fire incidents in South Korea have heightened the importance of patient evacuation. Moving patients from an intensive care unit (ICU) or emergency department (ED) setting is a challenge due to the complexity of moving acutely unwell patients who are reliant on invasive monitoring and organ support. Despite the importance of patient evacuation, the readiness of ICU and ED for urgent evacuation has not been assessed.
To enhance the readiness and competencies of workers from ICU and ED in the evacuation of patients during a simulated tabletop fire exercise.
A tabletop simulation exercise was developed by the Center for Disaster Relief, Training, and Research referencing the fire evacuation manual developed by the hospital’s ICU and ED. The scenario consisted of evacuating patients horizontally and vertically from each department. The participants’ actions were assessed using a checklist. A debriefing was completed after the exercise to discuss the gaps observed. A post-survey questionnaire was used to evaluate the exercise and assess the perception changes of the participants. All pre-to-post differences within subjects were analyzed with paired t-tests.
A total of 22 and 29 people participated in the exercise from ICU and ED, respectively. Knowledge and confidence improved post-exercise for both ICU and ED scenarios (p<0.05). Course satisfaction was 7.9 and 8.7, respectively for ICU and ED exercise. Correct performance rates for ICU and ED were 59% and 58%, respectively. Common gaps noted for both ICU and ED were wearing protective masks, patient hand-over communication, and preparation for resources.
There need to be exercises to recognize system gaps in place for hospital fire evacuation preparedness. Tabletop simulation exercises are ideal tools for this purpose. Although this was a short 90-minute exercise, this increased familiarity with the evacuation plan, tested the plan, and allowed for identification of gaps.
South Korea experienced Middle East Respiratory Syndrome (MERS) outbreak in 2015. To mitigate the threat posed by MERS, the Ministry of Health and Center for Disease Control designated hospitals to be responsible for managing any suspected or confirmed infectious patient. These hospitals receive mandatory training in managing infectious patients, but many of the trainings lack practical skills practice and pandemic preparedness exercise.
To develop and evaluate a training course designed to train healthcare providers from designated hospitals to enhance their competencies in managing emerging infectious diseases and potential outbreaks.
A two-day course was developed by the Center for Disaster Relief, Training, and Research in collaboration with the Korea Health Promotion Institute using Kern’s 6-step approach. The course consisted of didactic lectures, technical skills training, tabletop simulation, and scenario-based simulation. Table-top simulation exercises consisted of cases involving a single infectious patient detected in the outpatient clinic and outbreak in the emergency department. Scenario-based simulation exercises involved managing a critically ill infectious patient in an isolated ward. A post-survey questionnaire was used to evaluate the course and assess the perception changes of the participants. All pre-to-post differences within subjects were analyzed with paired t-tests.
A total of 121 healthcare providers participated in three separate courses. The competencies for pandemic preparedness knowledge, skills, and attitude improved from pre- to post-course. The differences were all statistically significant (p<0.05). Overall course satisfaction in average for expectation, time, delivery method, and contents were 9.5, 9.2, 9.4, and 9.2, respectively.
There needs to be tests and exercises to recognize gaps of systems in place for pandemic preparedness. Simulation exercises are ideal tools for this purpose. Although this was only a two-day intensive course, this increased familiarity with workflows, tested the coordination of workflows between different disciplines and allowed the identification of gaps.
Depressive symptoms are common in bereaved caregivers; however, there have been few prospective studies using a structured interview. This study investigated the prevalence and preloss predictors of major depressive disorder (MDD) in bereaved caregivers of patients in a palliative care unit.
This prospective cohort study collected caregiver sociodemographic and psychological data before the death of a palliative care unit patient, including MDD, care-burden, coping style, and hopeful attitude. Postloss MDD was assessed 6 and 13 months after death, and a multivariate logistic regression analysis was conducted to identify its predictors.
Of 305 caregivers contacted, 92 participated in this study. The prevalence of preloss MDD was 21.8%; the prevalences of postloss MDD were 34.8% and 24.7% at 6 and 13 months, respectively. Preloss MDD predicted postloss MDD at 6 months (odds ratio [OR] = 5.38, 95% confidence interval [CI95%] = 1.29, 22.43); preloss nonhopeful attitude and unemployment status of caregivers predicted postloss MDD at 13 months (OR = 8.77, CI95% = 1.87, 41.13 and OR = 7.10, CI95% = 1.28, 39.36, respectively).
Significance of results
Approximately 35% of caregivers suffered from MDD at 6 months postloss, but the prevalence of MDD decreased to about 25% at 13 months. Preloss MDD significantly predicted postloss MDD at 6 months, whereas hopeful attitude and unemployment at baseline were significantly associated with postloss MDD at 13 months.
Bloodstream infection (BSI) occurred in 21 of 121 patients (17%) receiving venovenous extracorporeal membrane oxygenation within the median time of 6 days after initiation (interquartile range, 4–19 days). Longer duration of arterial catheterization and more blood transfusions were independently associated with BSI, which is associated with poor clinical outcomes.