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We evaluated the adequacy of microbiological tests in patients withholding or withdrawing life-sustaining treatment (WLST) at the end stage of life.
The study was conducted at 2 tertiary-care referral hospitals in Daegu, Republic of Korea.
Retrospective cross-sectional study.
Demographic findings, clinical and epidemiological characteristics, statistics of microbiological tests, and microbial species isolated from patients within 2 weeks before death were collected in 2 tertiary-care referral hospitals from January to December 2018. We also reviewed the antimicrobial treatment that was given within 3 days of microbiological testing in patients on WLST.
Of the 1,187 hospitalized patients included, 905 patients (76.2%) had WLST. The number of tests per 1,000 patient days was higher after WLST than before WLST (242.0 vs 202.4). Among the category of microbiological tests, blood cultures were performed most frequently, and their numbers per 1,000 patient days before and after WLST were 95.9 and 99.0, respectively. The positive rates of blood culture before and after WLST were 17.2% and 18.0%, respectively. Candida spp. were the most common microbiological species in sputum (17.4%) and urine (48.2%), and Acinetobacter spp. were the most common in blood culture (17.3%). After WLST determination, 70.5% of microbiological tests did not lead to a change in antibiotic use.
Many unnecessary microbiological tests are being performed in patients with WLST within 2 weeks of death. Microbiological testing should be performed carefully and in accordance with the patient’s treatment goals.
We report our experience with an emergency room (ER) shutdown related to an accidental exposure to a patient with coronavirus disease 2019 (COVID-19) who had not been isolated.
A 635-bed, tertiary-care hospital in Daegu, South Korea.
To prevent nosocomial transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. Severe acute respiratory coronavirus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction assays (RT-PCR) were performed for most patients requiring hospitalization. A universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented. We analyzed effects of these interventions.
From the pre-shutdown period (February 10–25, 2020) to the post-shutdown period (February 28 to March 16, 2020), the mean hourly turnaround time decreased from 23:31 ±6:43 hours to 9:27 ±3:41 hours (P < .001). As a result, the proportion of the patients tested increased from 5.8% (N=1,037) to 64.6% (N=690) (P < .001) and the average number of tests per day increased from 3.8±4.3 to 24.7±5.0 (P < .001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or nosocomial transmission. After the shutdown, several metrics increased. The median duration of stay in the ER among hospitalized patients increased from 4:30 hours (interquartile range [IQR], 2:17–9:48) to 14:33 hours (IQR, 6:55–24:50) (P < .001). Rates of intensive care unit admissions increased from 1.4% to 2.9% (P = .023), and mortality increased from 0.9% to 3.0% (P = .001).
Problematic accidental exposure and nosocomial transmission of COVID-19 can be successfully prevented through active isolation and surveillance policies and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during a severe COVID-19 outbreak.
Several factors associated with referral time to hospice and/or palliative care services have been identified, but there is no literature on the association between these services and the emotional status of the family caregivers (FCs). This article is intended to address that issue.
A semistructured interview was employed to collect data for a retrospective cohort study. The primary FCs of terminally ill cancer patients were interviewed at the time of the patient's referral to the palliative care unit. Interview data were combined with patients' medical record data for our analysis. The emotional status of the FCs was categorized into one of three groups according to their responses to the anticipated death of their family member: acceptance, anxious/depressed, and denial/angry. A Cox proportional hazard model was used to examine and identify the factors related to the length of stay (LOS) in the palliative care unit.
A total of 198 patient–FC pairs were identified. The median LOS was 18 days. A multivariate analysis with adjustment for potential variables revealed significant differences in LOS according to cancer type and time since cancer diagnosis. The denial/angry FC category was independently associated with a shorter LOS (vs. acceptance, adjusted hazard ratio (aHR) 2.11; 95% confidence interval (CI), 1.11–4.03).
Significance of Results:
We found that terminally ill cancer patients who were referred late had FCs who were in denial or were angry about the anticipated death of their loved one. The emotional status of FCs should be considered when patients with terminal cancer are referred to palliative care.
The diatoms are an ecologically important group of algae that have been extensively studied by ecologists and taxonomists. However, the large-scale patterns of diatom distribution and the factors underlying this distribution are largely unknown. The aims of this study were to identify the large-scale spatial patterns of benthic diatom assemblages in Korean streams and rivers, and to assess the importance of numerous environmental factors on diatom distribution. We classified 720 study sites based on diatom flora. Benthic diatoms, water chemistry, altitude, and riparian land cover and use were characterized by multivariate analyses, Monte Carlo permutation tests, and indicator species analysis. In total, we identified 531 diatom taxa. Diatom assemblages were mostly dominated by species of the genera Achnanthes, Navicula, Nitzschia, Cocconeis, Fragilaria (Synedra included), Cymbella, Gomphonema, and Melosira. Cluster analysis partitioned all 720 sites into eight groups based on diatom species composition. Canonical correspondence analysis indicated that altitude, land cover and use, current velocity, electrical conductivity, and nutrient levels explained a significant amount of the variation in the composition of assemblages of benthic diatoms. At the national scale, a downstream ecological gradient was apparent, from fast-flowing, mostly oligotrophic highland streams to slow-flowing, mostly eutrophic lowland rivers. Our data suggest that spatial factors explain some of the variation in diatom distribution. The present investigation of the spatial patterns of benthic diatoms, the ecological determinants of diatom occurrence, and the identification of diatom indicator species contributes to development of a program for assessing the biological integrity of lotic ecosystems in Korea.
Anthropogenic land use within watersheds has substantial effects on aquatic habitats and biological communities. From September 2006 to December 2008, we investigated the effects of land use on benthic macroinvertebrate communities by comparing Song Stream and Odae Stream, two adjacent mountain streams in Korea whose watersheds have different land use patterns. Song Stream is significantly disturbed by agricultural activities in the watershed, whereas Odae Stream is relatively undisturbed and is surrounded by a well-conserved forest area. Song Stream had significantly higher levels of all nutrients and sediment-related factors due to the adjacent agricultural area. As a result, Song Stream had markedly lower species community indices, such as taxa richness and abundance. In Song Stream, macroinvertebrate scrapers and predators were most adversely affected, whereas collector-gatherers became a dominant group. Based on correlation and multivariate analyses, total dissolved solids had the strongest negative relationship with macroinvertebrate assemblages, followed by electrical conductivity, total nitrogen, and pH. The proportion of cobble in stream substrate was positively related to the richness and abundance of macroinvertebrates. Our results indicate that disturbances caused by agricultural land use, particularly sand deposition, had significant adverse effects on macroinvertebrate habitats and on the biotic integrity of benthic macroinvertebrate communities.
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