Necrotizing fasciitis is a life-threatening soft-tissue infection. It is useful to know the etiology of this disease in each community and region because this information can facilitate early diagnosis and treatment. We reviewed medical records of 217 consecutive patients with necrotizing fasciitis in South Korea. Etiologic organisms were documented in 171 (78.8%) patients. Gram-negative marine bacteria were the most common organisms (68.4%). Seasonal variation in incidence occurred during warmer periods. Liver cirrhosis and alcoholism were common underlying illnesses. Gastrointestinal symptoms were more common in persons infected with gram-negative marine bacteria (56.4% versus 29.6%). Gram-negative bacteria were the predominant pathogens in multiple site involvement. Acute Physiology and Chronic Health Evaluation II scores, marine bacteria, and medical treatment without surgery affected mortality. When necrotic areas included less than three extremities, fasciotomy improved the survival rate. In coastal areas, gram-negative marine bacteria are the most common pathogens associated with necrotizing fasciitis. Fasciotomy can improve survival of patients with necrotic areas that involve less than three sites in necrotizing fasciitis.

Reports on the clinical entity of hemorrhagic fever with renal syndrome (HFRS) have focused on acute renal failure. Data on the extrarenal manifestations are limited primarily to case reports. In this study, protean extrarenal manifestations involving the major organs occurred in one-third of patients with HFRS during various stages (i.e., febrile phase through diuretic phase). Pancreatobiliary manifestations and major bleeding occurred in 11% and 10% of patients, respectively. Cardiovascular and central nervous system manifestations developed during the febrile or oliguric phase, whereas pancreatobiliary manifestations and major bleeding were detected even in the diuretic phase. Thus, close monitoring of and additional knowledge about various extrarenal manifestations are needed.

Shewanella algae infections are rare in humans. Previously reported cases of S. algae have mainly been associated with direct contact with seawater. We report a case of primary S. algae bacteremia occurring after the ingestion of raw seafood in a patient with liver cirrhosis that presented a fulminent course of necrotizing fasciitis.

Delirium is a common neurobehavioral complication in hospitalized patients that can occur in the acute phase and lead to poor long-term outcomes. The purpose of this study was to identify non-pharmacological nursing interventions for the prevention and treatment of delirium in hospitalized adult patients. We conducted a systematic review to synthesize the findings of published studies. We searched the PubMed, EMBASE, CINAHL, and Cochrane Library CENTRAL databases for randomized controlled trials in January 2021. We report this systematic review according to the PRISMA 2009 checklist. The study was registered on PROSPERO (CRD42021226538). Nine studies were systematically reviewed for non-pharmacological nursing interventions for the prevention and treatment of delirium. The types of non-pharmacological nursing interventions included multicomponent intervention, multidisciplinary care, multimedia education, music listening, mentoring of family caregivers concerning delirium management, bright light exposure, ear plugs, and interventions for simulated family presence using pre-recorded video messages. These results could help nurses select and utilize non-pharmacological nursing interventions for the prevention and treatment of delirium in clinical nursing practice.

Critical reflection develops nurses’ critical thinking and clinical reasoning competency. It is necessary to develop a validated scale to measure critical reflection competency considering the clinical situation and nursing context. Therefore, this study analyzed the concept of critical reflection, developed a scale to measure critical reflection competency, and verified its validity and reliability. The concept of critical reflection and components of the scale were confirmed through literature review and results of previous studies on content analysis. A total of 64 preliminary items were derived on a 5-point Likert scale. The adequacy of vocabulary and expression was checked, and a content validity test was conducted. An I-CVI value of 0.88–1.00 was computed. Construct validity was conducted through an exploratory factor analysis, and data collected from 296 clinical nurses were analyzed. Five factors and nineteen items were derived, and the explanatory power was found to be 53.02%. Cronbach’s α of the scale was 0.853. Future studies need to develop a critical reflection education program and utilize this concept as an educational strategy. We propose a study to verify the effect of applying an educational program using the critical reflection competency scale developed in this study.