Barriers to neurosurgery for medical students: a national study focused on the intersectionality of gender and race

OBJECTIVE

Despite 51.2% of medical school graduates being female, only 29.8% of neurosurgery residency applicants are female. Furthermore, only 12.6% of neurosurgery applicants identify as underrepresented in medicine (URM). Evaluating the entry barriers for female and URM students is crucial in promoting the equity and diversity of the neurosurgical workforce. The objective of this study was to evaluate barriers to neurosurgery for medical students while considering the interaction between gender and race.

METHODS

A Qualtrics survey was distributed widely to US medical students, assessing 14 factors of hesitancy toward neurosurgery. Likert scale responses, representing statement agreeability, converted to numeric values on a 7-point scale were analyzed by Mann-Whitney U-test and ANOVA comparisons with Bonferroni correction.

RESULTS

Of 540 respondents, 68.7% were female and 22.6% were URM. There were 22.6% male non-URM, 7.4% male URM, 53.5% female non-URM, and 15.2% female URM respondents. The predominant reasons for hesitancy toward neurosurgery included work/life integration, length of training, competitiveness of residency position, and perceived malignancy of the field. Females were more hesitant toward neurosurgery due to maternity/paternity needs (p = 0.005), the absence of seeing people like them in the field (p < 0.001), and opportunities to pursue health equity work (p < 0.001). Females were more likely to have difficulties finding a mentor in neurosurgery who represented their identities (p = 0.017). URM students were more hesitant toward neurosurgery due to not seeing people like them in the field (p < 0.001). Subanalysis revealed that when students were stratified by both gender and URM status, there were more reasons for hesitancy toward neurosurgery that had significant differences between groups (male URM, male non-URM, female URM, and female non-URM students), suggesting the importance of intersectionality in this analysis.

CONCLUSIONS

The authors highlight the implications of gender and racial diversity in the neurosurgical workforce on medical student interest and recruitment. Their findings suggest the importance of actively working to address these barriers, including 1) maternity/paternity policy reevaluation, standardization, and dissemination; and 2) actively providing resources for the creation of mentorship relationships for both women and URM students in an effort to create a workforce that aligns with the changing demographics of medical graduates to continue to improve diversity in neurosurgery.

Reliable Prediction of Discharge Disposition Following Cervical Spine Surgery With Ensemble Machine Learning and Validation on a National Cohort

STUDY DESIGN

A retrospective cohort study.

OBJECTIVE

The purpose of this study is to develop a machine learning algorithm to predict nonhome discharge after cervical spine surgery that is validated and usable on a national scale to ensure generalizability and elucidate candidate drivers for prediction.

SUMMARY OF BACKGROUND DATA

Excessive length of hospital stay can be attributed to delays in postoperative referrals to intermediate care rehabilitation centers or skilled nursing facilities. Accurate preoperative prediction of patients who may require access to these resources can facilitate a more efficient referral and discharge process, thereby reducing hospital and patient costs in addition to minimizing the risk of hospital-acquired complications.

METHODS

Electronic medical records were retrospectively reviewed from a single-center data warehouse (SCDW) to identify patients undergoing cervical spine surgeries between 2008 and 2019 for machine learning algorithm development and internal validation. The National Inpatient Sample (NIS) database was queried to identify cervical spine fusion surgeries between 2009 and 2017 for external validation of algorithm performance. Gradient-boosted trees were constructed to predict nonhome discharge across patient cohorts. The area under the receiver operating characteristic curve (AUROC) was used to measure model performance. SHAP values were used to identify nonlinear risk factors for nonhome discharge and to interpret algorithm predictions.

RESULTS

A total of 3523 cases of cervical spine fusion surgeries were included from the SCDW data set, and 311,582 cases were isolated from NIS. The model demonstrated robust prediction of nonhome discharge across all cohorts, achieving an area under the receiver operating characteristic curve of 0.87 (SD=0.01) on both the SCDW and nationwide NIS test sets. Anterior approach only, age, elective admission status, Medicare insurance status, and total Elixhauser Comorbidity Index score were the most important predictors of discharge destination.

CONCLUSIONS

Machine learning algorithms reliably predict nonhome discharge across single-center and national cohorts and identify preoperative features of importance following cervical spine fusion surgery.

A Century of Evolution in Spine Surgery Publications: A Bibliometric Analysis of the Field From 1900 to 2023

BACKGROUND AND OBJECTIVES

Spine surgery has advanced in concert with our deeper understanding of its elements. Narrowly focused bibliometric analyses have been conducted previously, but never on the entire corpus of the field. Using big data and bibliometrics, we appraised the entire corpus of spine surgery publications to study the evolution of the specialty as a scholarly field since 1900.

METHODS

We queried Web of Science for all contents from 13 major publications dedicated to spine surgery. We next queried by topic [topic = (spine OR spinal OR vertebrae OR vertebral OR intervertebral OR disc OR disk)]; these results were filtered to include articles published by 49 other publications that were manually determined to contain pertinent articles. Articles, along with their metadata, were exported. Statistical and bibliometric analyses were performed using the Bibliometrix R package and various Python packages.

RESULTS

Eighty-five thousand five hundred articles from 62 journals and 134 707 unique authors were identified. The annual growth rate of publications was 2.78%, with a surge after 1980, concurrent with the growth of specialized journals. International coauthorship, absent before 1970, increased exponentially with the formation of influential spine study groups. Reference publication year spectroscopy allowed us to identify 200 articles that comprise the historical roots of modern spine surgery and each of its subdisciplines. We mapped the emergence of new topics and saw a recent lexical evolution toward outcomes- and patient-centric terms. Female and minority coauthorship has increased since 1990, but remains low, and disparities across major publications persist.

CONCLUSION

The field of spine surgery was borne from pioneering individuals who published their findings in a variety of journals. The renaissance of spine surgery has been powered by international collaboration and is increasingly outcomes focused. While spine surgery is gradually becoming more diverse, there is a clear need for further promotion and outreach to under-represented populations.

Health system-scale language models are all-purpose prediction engines

Physicians make critical time-constrained decisions every day. Clinical predictive models can help physicians and administrators make decisions by forecasting clinical and operational events. Existing structured data-based clinical predictive models have limited use in everyday practice owing to complexity in data processing, as well as model development and deployment1-3. Here we show that unstructured clinical notes from the electronic health record can enable the training of clinical language models, which can be used as all-purpose clinical predictive engines with low-resistance development and deployment. Our approach leverages recent advances in natural language processing4,5 to train a large language model for medical language (NYUTron) and subsequently fine-tune it across a wide range of clinical and operational predictive tasks. We evaluated our approach within our health system for five such tasks: 30-day all-cause readmission prediction, in-hospital mortality prediction, comorbidity index prediction, length of stay prediction, and insurance denial prediction. We show that NYUTron has an area under the curve (AUC) of 78.7-94.9%, with an improvement of 5.36-14.7% in the AUC compared with traditional models. We additionally demonstrate the benefits of pretraining with clinical text, the potential for increasing generalizability to different sites through fine-tuning and the full deployment of our system in a prospective, single-arm trial. These results show the potential for using clinical language models in medicine to read alongside physicians and provide guidance at the point of care.

Responder Analysis of Pain Relief After Surgery for the Treatment of Spinal Metastatic Tumors

BACKGROUND

Central tendency analysis studies demonstrate that surgery provides pain relief in spinal metastatic tumors. However, they preclude patient-specific probability of treatment outcome.

OBJECTIVE

To use responder analysis to study the variability of pain improvement.

METHODS

In this single-center, retrospective analysis, 174 patients were studied. Logistic regression modeling was used to associate preoperative characteristics with rating the Brief Pain Inventory (BPI) worst pain item 0 to 4. Linear regression modeling was used to associate preoperative characteristics with minimal clinically important improvement (MCI) in physical functioning defined by a 1-point decrease in the BPI Interference Construct score from preoperative baseline to 6 months postoperatively.

RESULTS

Patient-level analysis revealed that 60% of patients experienced an improvement in pain. At least half experienced a decrease in pain resulting in MCI in physical functioning. Cutpoint analysis revealed that 48% were responders. Increasing scores on the preoperative pain intensity BPI items, the MD Anderson Symptom Inventory (MDASI) Core Symptom Severity Construct, the MDASI Spine Tumor-Specific Construct, the presence of preoperative neurologic deficits, and postoperative complications were associated with lower probability of treatment success while increasing severity in all BPI pain items, and MDASI constructs were associated with increased probability of MCI in physical function. Significant mortality and loss to follow-up intrinsic to this patient population limit the strength of these data.

CONCLUSION

Although patients with milder preoperative symptoms are likely to achieve better pain relief after surgery, patients with worse preoperative symptom also benefit from surgery with adequate pain relief with an improvement in physical function.

Management and surgical outcomes of dystrophic scoliosis in neurofibromatosis type 1: a systematic review

OBJECTIVE

Neurofibromatosis type 1 (NF1) dystrophic scoliosis is an early-onset, rapidly progressive multiplanar deformity. There are few studies on the surgical management of this patient population. Specifically, perioperative morbidity, instrument-related complications, and quality-of-life outcomes associated with surgical management have not been systematically evaluated. In this study, the authors aimed to perform a systematic review on the natural history, management options, and surgical outcomes in patients who underwent NF1 dystrophic scoliosis surgery.

METHODS

A PubMed search for articles with “neurofibromatosis” and either “dystrophic” or “scoliosis” in the title or abstract was performed. Articles with 10 or more patients undergoing surgery for NF1 dystrophic scoliosis were included. Data regarding indications, treatment details, morbidity, and outcomes were summarized and analyzed with descriptive statistics.

RESULTS

A total of 310 articles were identified, 48 of which were selected for full-text review; 30 studies describing 761 patients met the inclusion criteria. The mean age ranged from 7 to 22 years, and 99.7% of patients were younger than 18 years. The mean preoperative coronal Cobb angle was 75.2°, and the average correction achieved was 40.3°. The mean clinical follow-up in each study was at least 2 years (range 2.2–19 years). All patients underwent surgery with the intent of deformity correction. The scoliosis regions addressed were thoracic curves (69.6%) and thoracolumbar (11.1%) and lumbar (14.3%) regions. The authors reported on a variety of approaches: posterior-only, combined anterior-posterior, and growth-friendly surgery. For fixation techniques, 42.5% of patients were treated with hybrid constructs, 51.5% with pedicle screw–only constructs, and 6.0% with hook-based constructs. Only 0.9% of patients underwent a vertebral column resection. The nonneurological complication rate was 14.0%, primarily dural tears and wound infections. The immediate postoperative neurological deficit rate was 2.1%, and the permanent neurological deficit rate was 1.2%. Ultimately, 21.5% required revision surgery, most commonly for implant-related complications. Loss of correction in both the sagittal and coronal planes commonly occurred at follow-up. Five papers supplied validated patient-reported outcome measures, showing improvement in the mental health, self-image, and activity domains.

CONCLUSIONS

Data on the surgical outcomes of dystrophic scoliosis correction are heterogeneous and sparse. The perioperative complication rate appears to be high, although reported rates of neurological deficits appear to be lower than clinically observed and may be underreported. The incidence of implant-related failures requiring revision surgery is high. There is a great need for multicenter prospective studies of this complex type of deformity.

Cortical stimulation parameters for functional mapping

PURPOSE

There is significant variation in how patients respond to cortical electrical stimulation. It has been hypothesized that individual demographic and pathologic factors, such as age, sex, disease duration, and MRI findings, may explain this discrepancy. The purpose of our study is to identify specific patient characteristics and their effect on cortical stimulation, and discover the extent of variation in behavioral responses that exists among patients with epilepsy.

METHOD

We retrospectively analyzed data from 92 patients with medically intractable epilepsy who had extra-operative cortical electrical stimulation. Mapping records were evaluated and information gathered about demographic data, as well as the thresholds of stimulation for motor, sensory, speech, and other responses; typical seizure behavior; and the induction of afterdischarges.

RESULTS

Ninety-two patient cortical stimulation mapping reports were analyzed. The average of the minimum thresholds for motor response was 4.15mA±2.67. The average of the minimum thresholds for sensory response was 3.50mA±2.15. The average of the minimum thresholds for speech response was 4.48mA±2.42. The average of the minimum thresholds for afterdischarge was 4.33mA±2.37. Most striking were the degree of variability and wide range of thresholds seen between patients and within the different regions of the same patient.

CONCLUSION

Wide ranges of thresholds exist for the different responses between patients and within different regions of the same patient. With multivariate analysis in these series, no clinical or demographic factors predicted physiological response or afterdischarge threshold levels.

Purification of α-synuclein from human brain reveals an instability of endogenous multimers as the protein approaches purity

Despite two decades of research, the structure–function relationships of endogenous, physiological forms of α-synuclein (αSyn) are not well understood. Most in vitro studies of this Parkinson’s disease-related protein have focused on recombinant αSyn that is unfolded and monomeric, assuming that this represents its state in the normal human brain. Recently, we have provided evidence that αSyn exists in considerable part in neurons, erythrocytes, and other cells as a metastable multimer that principally sizes as a tetramer. In contrast to recombinant αSyn, physiological tetramers purified from human erythrocytes have substantial α-helical content and resist pathological aggregation into β-sheet rich fibers. Here, we report the first method to fully purify soluble αSyn from the most relevant source, human brain. We describe protocols that purify αSyn to homogeneity from nondiseased human cortex using ammonium sulfate precipitation, gel filtration, and ion exchange, hydrophobic interaction, and affinity chromatographies. Cross-linking of the starting material and the partially purified chromatographic fractions revealed abundant αSyn multimers, including apparent tetramers, but these were destabilized in large part to monomers during the final purification step. The method also fully purified the homologue β-synuclein, with a similar outcome. Circular dichroism spectroscopy showed that purified, brain-derived αSyn can display more helical content than the recombinant protein, but this result varied. Collectively, our data suggest that purifying αSyn to homogeneity destabilizes native, α-helix-rich multimers that exist in intact and partially purified brain samples. This finding suggests existence of a stabilizing cofactor (e.g., a small lipid) present inside neurons that is lost during final purification.

In vitro study of microencapsulated isoflavone and beta-galactosidase

This study was designed to find the optimum conditions for isoflavone or beta-galactosidase microencapsulation and to examine the release efficiency of microcapsules in simulated gastrointestinal conditions. Coating materials were either medium-chain triacylglycerol (MCT) or polyglycerol monostearate (PGMS). The highest rate of microencapsulation was found at 15:1 (w/w) ratio of MCT to isoflavone or beta-galactosidase as 70.2 or 75.4%, respectively. When PGMS was used as the coating material, 91.5% beta-galactosidase was microencapsulated with 15:1 mixture (w/w). In vitro study, less than 6.3-9.3% of isoflavone was released in simulated gastric fluid (pH 2-5) during 1 h incubation. Comparatively, isoflavone release increased dramatically to 87.8% at pH 8 for 1 h incubation in simulated intestinal fluid and was maintained thereafter. The release of beta-galactosidase showed a similar trend to that of isoflavone. It appeared in the range of 12.3-15.2% at pH 2-5; however, it increased significantly to 80.6% as the highest value at pH 8. Among the released isoflavones, 53.5% was converted into the aglycone form of isoflavone at pH 8 for 3 h incubation. The present study indicated that isoflavone or beta-galactosidase could be microencapsulated with fatty acid esters and released effectively in simulated intestinal condition.

Development of Gerontological Nursing Curriculum Model

PURPOSE

This study was conducted to develop gerontological curriculum model which reflects the need of Korean society.

METHOD

Three round Delphi survey method was applied to find consensus of gerontological nursing competencies (knowledge, attitudes and skills) for graduates of nursing schools from the panel of gerontological nursing practice experts. Important concepts in gerontological nursing were delineated from literature review and discussions of gerontological nursing educators. Based on these results the gerontological nursing curriculum model was developed and course structure outlined by the researchers as a group.

RESULT

As the result of delphi survey, 32 items of knowledge, 29 items of attitude, and 21 items of skill were identified. The curriculum model constructed around a cube with three plane- functional capacity levels, settings, and nursing practice. Specific knowledge, attitudes and skills for gerontological theory and practicum course were suggested. Competency items were assigned to theory and/or practice.

CONCLUSION

A curriculum model for gerontological nursing has been developed by a group of gerontological nursing educators. The curriculum model should be further tested and developed with detailed theory and practicum course outline and textbooks.

Macharistol, a new cytotoxic cinnamylphenol from the stems of Machaerium aristulatum

A new cinnamylphenol, macharistol (1), along with a known pterocarpan, (+)-medicarpin (2), were isolated as cytotoxic constituents from the stems of Machaerium aristulatum. In addition, a known pterocarpan, (+)-maackiain (3), and a known isoflavone, formononetin (4), were identified as inactive constituents. Compound 1 was evaluated in the in vivo hollow fiber assay with KB, Col-2, and hTERT-RPE1 cells and found to be inactive at the highest dose (25 mg/kg body weight) tested.

Knowledge and performance of the universal precautions by nursing and medical students in Korea

BACKGROUND

Like the health care workers, nursing and medical students have to go through clinical practices; accordingly, they run a high risk of being exposed to bloodborne diseases. But there are few studies on the realities of preventive education or measures to be taken after exposure to such diseases. The purpose of this study was to identify a knowledge of universal precautions and their performance in practice among the nursing and medical students in Korea.

METHOD

This study was based on survey questionnaires with a total of 714 nursing and medical students for the period between November 2, 1998, and April 30, 2000.

RESULTS

The average knowledge level of the universal precautions was 267.8 +/- 21.3 (scores ranged from 150 to 300). The knowledge level of the universal precautions of the nursing students (270.4 +/- 19.4) was higher than that of the medical students (261.0 +/- 24.4; P =.000). The average performance level of the universal precautions was 52.7 +/- 6.2 (scores ranged from 14 to 70). The students of the nursing college showed a higher performance level of the universal precautions (53.2 +/- 5.9; P =.002). The correlation between knowledge and performance of the universal precautions showed a weak and positive correlation (r =.317; P=.000).

CONCLUSION

The study demonstrated that the knowledge level of the nursing students about universal precautions was relatively higher than that of medical students. The group that receives education about universal precautions has a higher level of knowledge and performance of the universal precautions than that group that receives no such education. The education about universal precautions is indispensable; it is desirable to raise the relative importance for the curriculum of both nursing and medical colleges.

Isolation of symlandine from the roots of common comfrey (Symphytum officinale) using countercurrent chromatography

Three pyrrolizidine alkaloids, symlandine, symphytine, and echimidine (1-3), were isolated from the roots of Symphytum officinale using a one-step countercurrent chromatography procedure. The structures of 1-3 were confirmed by several spectroscopic techniques including 2D NMR methods. This is the first description of the separation of symlandine (1) from its stereoisomer, symphytine (2).

Activity of triterpenoid glycosides from the root bark of Mussaenda macrophylla against two oral pathogens

Four new triterpenoid glycosides were isolated from the root bark of Mussaenda macrophylla. Their structures were determined as 3-O-beta-D-glucopyranosyl-28-O-alpha-L-rhamnopyranosyl-16alpha- hydrox y-23-deoxyprotobassic acid (1), 28-O-beta-D-glucopyranosyl-16alpha-hydroxy-23-deoxyprotobassic+ ++ acid (2), 3-O-beta-D-glucopyranosyl-28-O-alpha-L-rhamnopyranosyl-16alpha- hydrox yprotobassic acid (3), and 3-O-¿[beta-D-glucopyranosyl-(1-->6)]-O-alpha-L-rhamnopyranosyl-(1-->2 )-O-beta-D-glucopyranosyl-(1-->2)¿-O-beta-D-glucopyranosyl-(1-->3)-O- beta-D-glucopyranosyl-cycloarta-22,24-dien-27-oic acid (mussaendoside W, 4). Four known triterpenoids [3-O-acetyloleanolic acid (5), 3-O-acetyldaturadiol (6), rotundic acid (7), and 16alpha-hydroxyprotobassic acid (8)] were also isolated. The structures of 1-4 were determined by several spectroscopic techniques including 2D NMR methods. Compounds 1-6 showed inhibitory activity against a periodontopathic bacterium, Porphyromonas gingivalis, but were inactive against the cariogenic organism, Streptococcus mutans.

Semisynthesis of abrusoside A methyl ester

Abrusoside A methyl ester was prepared from abrusogenin through methylation (CH2N2) and a subsequent coupling reaction with 1-chloro-2,3,4,6-tetra-O-acethylglucopyranose in the presence of AgOTf and TMU in CH2Cl2, followed by deacetylation using K2CO3 in MeOH-H2O.

The effect of thermal biofeedback and progressive muscle relaxation training in reducing blood pressure of patients with essential hypertension

In order to assess the effectiveness of the thermal biofeedback training combined with the progressive muscle relaxation therapy in the treatment of patients with essential hypertension, blood pressure decline was measured on the treatment group who had the combined thermal biofeedback and progressive muscle relaxation training (N = 11), and on the control group who had only the progressive muscle relaxation training (N = 8). Baseline blood pressure was measured four times for two weeks on both groups. For the treatment group, blood pressure was measured twice before and after each of eight sessions of thermal biofeedback training for four weeks. For the control group, blood pressure was measured every two visits to a clinic for progressive muscle relaxation self-training twice before and after the self-training. A significant decline of the systolic blood pressure by 20.6 mmHg and of the diastolic blood pressure by 14.4 mmhg was observed in the treatment group. There was a tendency for both blood pressures to increase in the control group.

[Quality of life of middle aged persons who have cancer]

This descriptive study was under taken to explore relationships among the quality of life, health locus of control and perceived state of health persons with cancer to contribute theoretical understanding about these phenomenon of interest to the quality of nursing care. The subjects of this were 200 persons with cancer (100-in patients and 100-out patients), both male and female, between 30 and 59 years of age. Data were obtained using a convenience sample technique from two university hospitals in seoul from August, 1989, to June, 1990. The instruments used for this study were the Quality of life scale developed by Ro, You-Ja and the Health Locus of Control scale developed by Wallston & Wallston. Data were analyzed using a SAS program for ANOVA, t-test, Schefffé test, Pearson Correlation Coefficients and Stepwise multiple regression. The results were as follows: 1. The scores on the quality of life scale ranged from 95 to 191 with as mean of 147.85 (range 47 to 235). The Mean scores (range 1-5) on the different dimensions were family relationships 3.50, relationships with neighbours 3.48, self-esteem 3.17, physical state and function 2.99, economic life 2.93 and emotional life 2.91. 2. Significantly higher scores on the quality of life and demographic characteristics were as follows: the quality of life for women (t = 2.80, p = .006), for those without complications (t = 2.54, p = .013), and for those who perceived their illness as mild (F = 4.85, p = .009). Higher scores on quality of life were correlated with the following: 1) emotional state and the age group 50-59 (F = 3.43, p = .34). 2) economic life and higher income (F = 6.72, p = .002), those without complications (t = 2.68, p = .00), and those who perceived their illness as mild (F = 3.11, p = .05). 3) self-esteem and marriage (F = 3.64, p = .028), those without complications (t = 2.18, p = .03), and those who perceived their illness as mild (F = 7.72, p = .000). 4) physical state and function and the age group 30-39 (F = 4.65, p = .010), those without complications (t = 2.00, p = .05), and those who perceived their illness as mild (F = 3.38, p = .04). 5) family relationship and those who live with their spouse (t = 2.82, p = .005).(ABSTRACT TRUNCATED AT 400 WORDS)

[The effect of EMG level by EMG biofeedback with progressive muscle relaxation training on tension headache]

The purpose of this study is to assess if EMG biofeedback training with progressive muscle relaxation training is effective in reducing the EMG level in patients with tension headaches. This study which lasted from 23 October to 30 December 1989, was conducted on 10 females who were diagnosed as patients with tension headaches and selected from among volunteers at C. University in Seoul. The process of the study was as follows: First, before the treatment, the baseline was measured for two weeks and the level of EMG was measured five times in five minutes. And then EMG biofeedback training was used for six weeks, 12 sessions in all, and progressive muscle relaxation was done at home by audio tape over eight weeks. Each session was composed of a 5-minute baseline, two 5-minute EMG biofeedback training periods and a 5-minute self-control stage. Each stage was followed by a five minute rest period. So each session took a total of 40 minutes. The EMG level was measured by EMG biofeedback (Autogenic-Cyborg: M 130 EMG module). The results were as follows: 1. The average age of the subjects was 44.1 years and the average history of headache was 10.6 years (range: 6 months-20 years). 2. The level of EMG was lowest between the third and the fourth week of the training except in Cases I and IV. 3. The patients began to show a nonconciliatory attitude at the first session of the fifth week of the training.

[Discrepancy in the scores of uncertainty perceived by patients and nurses' interperson perception]

The purpose of this study was to assess and compare discrepancy in the scores of uncertainty perceived by patients and nurses' interperson perception. For this study, 124 hospitalized patients and the same numbered nurses assigned for direct care of each 124 patients were selected from general ward of C. University Hospital in Seoul during the time period from September to November 1987. Degree of uncertainty was measured by 27 items modified from Mishel Uncertainty in Illness Scale (M-UIS), and was utilized by a Likert type scale The data were analysed by Mcnemar-test, Unpaired t-test, ANOVA, Scheffé-test and Stepwise multiple regression. The results are summarized as follows: 1. The discrepancy in the scores of uncertainty perceived by patients and nurses' interperson perception showed significant differences in 23 of 27 items: 11 of 23 items showed that the scores of patients' perception of uncertainty were higher than that of nurses' interperson perception of uncertainty. but 12 of 23 items were revealed reversely. 2. With regard to nurse's demographic variables, the discrepancy scores were the highest in the group under 22 years of age (F = 3.20, p = .026) and in the group less than 1 year of nursing experience among 4 groups (F = 4.41, p = .006). 3. The discrepancy scores had a tendency to be lowered in the higher age group (r = .27, p = .0026) and in the longer experienced group (r = .25, p = .0052).(ABSTRACT TRUNCATED AT 250 WORDS)