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Citkovitz C, Graca S, Anderson B, Conboy LA, Gold MA, Hirsch E, Lumiere K, Phelps S, Schnyer RN, Taylor-Swanson L. Acupuncture Practice-Based Research in the Age of Artificial Intelligence: Developments as of May, 2024. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38973572 DOI: 10.1089/jicm.2024.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Affiliation(s)
- Claudia Citkovitz
- New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts, USA
| | - Sandro Graca
- School of Health and Society, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
- Department of Research, Northern College of Acupuncture, York, United Kingdom
| | - Belinda Anderson
- College of Health Professions, Pace University, New York, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Lisa A Conboy
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Faculty, Seattle Institute of East Asian Medicine, Seattle, Washington, USA
| | - Melanie A Gold
- Mailman School of Public Health, Columbia University Irving Medical Center (CUIMC), New York, New York, USA
| | - Eric Hirsch
- Community Health Action, Staten Island, New York, USA
| | - Kathleen Lumiere
- Convergent Points: An East West Case Report Journal, Bastyr University, Kenmore, Washington, USA
| | - Scott Phelps
- Susan Samueli Integrative Health Institute, University of California, Irvine, Irvine, California, USA
| | - Rosa N Schnyer
- Austin School of Nursing, University of Texas, Austin, Texas, USA
| | - Lisa Taylor-Swanson
- College of Nursing, School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
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Choi KH, Kang D, Lee J, Park H, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Gwon HC, Cho J, Yang JH. Association between intensive care unit nursing grade and mortality in patients with cardiogenic shock and its cost-effectiveness. Crit Care 2024; 28:99. [PMID: 38523296 PMCID: PMC10962168 DOI: 10.1186/s13054-024-04880-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Despite the high workload of cardiac intensive care unit (ICU), there is a paucity of evidence on the association between nurse workforce and mortality in patients with cardiogenic shock (CS). This study aimed to evaluate the prognostic impact of the ICU nursing grade on mortality and cost-effectiveness in CS. METHODS A nationwide analysis was performed using the K-NHIS database. Patients diagnosed with CS and admitted to the ICU at tertiary hospitals were enrolled. ICU nursing grade was defined according to the bed-to-nurse ratio: grade1 (bed-to-nurse ratio < 0.5), grade2 (0.5 ≤ bed-to-nurse ratio < 0.63), and grade3 (0.63 ≤ bed-to-nurse ratio < 0.77) or above. The primary endpoint was in-hospital mortality. Cost-effective analysis was also performed. RESULTS Of the 72,950 patients with CS, 27,216 (37.3%) were in ICU nursing grade 1, 29,710 (40.7%) in grade 2, and 16,024 (22.0%) in grade ≥ 3. The adjusted-OR for in-hospital mortality was significantly higher in patients with grade 2 (grade 1 vs. grade 2, 30.6% vs. 37.5%, adjusted-OR 1.14, 95% CI1.09-1.19) and grade ≥ 3 (40.6%) with an adjusted-OR of 1.29 (95% CI 1.23-1.36) than those with grade 1. The incremental cost-effectiveness ratio of grade1 compared with grade 2 and ≥ 3 was $25,047/year and $42,888/year for hospitalization and $5151/year and $5269/year for 1-year follow-up, suggesting that grade 1 was cost-effective. In subgroup analysis, the beneficial effects of the high-intensity nursing grade on mortality were more prominent in patients who received CPR or multiple vasopressors usage. CONCLUSIONS For patients with CS, ICU grade 1 with a high-intensity nursing staff was associated with reduced mortality and more cost-effectiveness during hospitalization compared to grade 2 and grade ≥ 3, and its beneficial effects were more pronounced in subjects at high risk of CS.
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jin Lee
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Kim MG, Ooi SL, Kim GW, Pak SC, Koo BS. Effectiveness and Safety of Pattern Identification-Based Herbal Medicine for Alzheimer's Disease: A Systematic Review and Meta-Analysis. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:605-620. [PMID: 36971836 DOI: 10.1089/jicm.2022.0806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Objective: Alzheimer's disease (AD), the most common cause of dementia, has only symptomatic treatments in conventional Western medicine (WM). Disease-modifying drugs are still under development. This study evaluated the efficacy and safety of herbal medicine (HM) based on pattern identification (PI) as a whole system practice for treating AD. Methods: Thirteen databases were searched from inception to August 31, 2021. Twenty-seven randomized controlled trials (RCTs) with 2069 patients were included in the evidence synthesis. Results: The meta-analysis showed that, compared with WM, HM prescription based on PI, either alone or in combination with WM, could significantly improve the cognitive functions of AD patients (Mini-Mental State Examination [MMSE]-HM vs. WM: mean difference [MD] = 1.96, 95% confidence intervals [CIs]: 0.28-3.64, N = 981, I2 = 96%; HM+WM vs. WM: MD = 1.33, 95% CI: 0.57-2.09, N = 695, I2 = 68%) and their ability to perform activities of daily living (ADL-HM vs. WM: standardized mean difference [SMD] = 0.71, 95% CI: 0.04-1.38, N = 639, I2 = 94%; HM+WM vs. WM: SMD = 0.60, 95% CI: 0.27-0.93, N = 669, I2 = 76%). Duration-wise, 12 weeks of HM+WM were superior to 12 weeks of WM and 24 weeks of HM were superior to 24 weeks of WM. None of the included studies found any severe safety concerns. The odds of mild-to-moderate adverse events were marginally lower in HM than in WM (odds ratio = 0.34, 95% CI: 0.11-1.02, N = 689, I2 = 55%). Conclusion: Hence, prescribing PI-based HM is a safe and effective therapeutic option for AD, either as first-line therapy or adjuvant treatment. However, most of the included studies have a high or uncertain risk of bias. Thus, well-designed RCTs with proper blinding and placebo controls are needed.
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Affiliation(s)
- Man Gi Kim
- Department of Oriental Neuropsychiatry, Dongguk University Ilsan Oriental Hospital, Goyang, South Korea
- Department of Oriental Neuropsychiatry, Graduate School of Dongguk University, Seoul, South Korea
| | - Soo Liang Ooi
- School of Dentistry and Medical Sciences, Charles Sturt University, Bathurst, Australia
| | - Geun-Woo Kim
- Department of Oriental Neuropsychiatry, Graduate School of Dongguk University, Seoul, South Korea
| | - Sok Cheon Pak
- School of Dentistry and Medical Sciences, Charles Sturt University, Bathurst, Australia
| | - Byung Soo Koo
- Department of Oriental Neuropsychiatry, Dongguk University Ilsan Oriental Hospital, Goyang, South Korea
- Department of Oriental Neuropsychiatry, Graduate School of Dongguk University, Seoul, South Korea
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Cho HB, Sung WS, Hong J, Kang Y, Kim EJ. A Survey on Perceptions of the Direction of Korean Medicine Education and National Licensing Examination. Healthcare (Basel) 2023; 11:1685. [PMID: 37372803 DOI: 10.3390/healthcare11121685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Recent changes in medical education and assessment led to a focus on occupational competency, and this study investigated the perceptions of Korean medicine doctors (KMDs) on the national licensing examination for KMDs (NLE-KMD). The survey aimed to understand KMDs' recognition of the current situation, items to improve, and items to emphasize in the future. We conducted the web-based survey from 22 February to 4 March 2022, and 1244 among 23,338 KMDs answered voluntarily. Through this study, we found the importance of competency-related clinical practice and Korean standard classification of disease (KCD), and the presence of a generation gap. KMDs considered clinical practice (clinical tasks and clinical work performance) and the item related to the KCD important. They valued (1) the focus on KCD diseases that are frequently seen in clinical practice and (2) the readjustment and introduction of the clinical skills test. They also emphasized KCD-related knowledge and skills for the assessment and diagnosis of KCD diseases, especially those frequently treated at primary healthcare institutes. We confirmed the generation gap in the subgroup analysis according to the license acquisition period, and the ≤5-year group emphasized clinical practice and the KCD, while the >5-year group stressed traditional KM theory and clinical practice guidelines. These findings could be used to develop the NLE-KMD by setting the direction of Korean medicine education and guiding further research from other perspectives.
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Affiliation(s)
- Han-Byul Cho
- Department of Neuropsychiatry, Graduate School, College of Korean Medicine, Dongguk University, Seoul 04620, Republic of Korea
| | - Won-Suk Sung
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si 13601, Republic of Korea
| | - Jiseong Hong
- Teaching & Learning, 7 Days Inc., Seoul 06247, Republic of Korea
| | - Yeonseok Kang
- Department of Medical History, College of Korean Medicine, Wonkwang University, Iksan-si 54538, Republic of Korea
| | - Eun-Jung Kim
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si 13601, Republic of Korea
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Lee JW, Hwang J, Hyun MK. Prevalence and Treatment Patterns of Sleep Disorders in the Under 20 Population: analysis using a national health insurance claims database. J Pharmacopuncture 2022; 25:276-289. [PMID: 36186096 PMCID: PMC9510137 DOI: 10.3831/kpi.2022.25.3.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives Child and adolescent sleep is an important factor for brain and physical development. Therefore, it is necessary to investigate the prevalence of sleep disorders and nonorganic sleep disorders in children and adolescents and determine the type of utilization of medical institutions. This study analyzed the prevalence and type of medical institutions in Korean children and adolescents with sleep disorders and nonorganic sleep disorders. Methods This study used data recorded in the Health Insurance Review and Assessment-National Patient Sample (HIRA-NPS) database from 2010 to 2017. Details of medical institution type and patient’s sex, age, and treatment type were extracted for patients younger than 20 years with sleep disorders and nonorganic sleep disorders. Results Among 2,536,478 patients under age 20, we identified 3,772 patients with sleep disorders or nonorganic sleep disorders. From 2010 to 2017, the prevalence of sleep disorders in children and adolescents was 0.07% to 0.09%. The utilization rate of Korean medical institutions was 30.47%. The prevalence of nonorganic sleep disorders and the utilization rate of Korean medical institutions were 0.06% to 0.08% and 45.99%, respectively. Conclusion The prevalence of sleep disorders and nonorganic sleep disorders in the under-20 population was 0.14% to 0.16%. More than 70% of patients with nonorganic sleep disorder who were younger than 9 years used Korean medical institutions.
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Affiliation(s)
- Jang Won Lee
- Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Jinseub Hwang
- Department of Statistics, Daegu University, Gyeongsan, Republic of Korea
| | - Min Kyung Hyun
- Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
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Trends of Medical Service Utilization for Tinnitus: Analysis Using 2010–2018 Health Insurance Review and Assessment Service National Patient Sample Data. Healthcare (Basel) 2022; 10:healthcare10081547. [PMID: 36011204 PMCID: PMC9408172 DOI: 10.3390/healthcare10081547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Given the increasing prevalence of tinnitus and expenditure related to its treatment, it is important to identify the efficacy of different treatment methods used for its diagnosis and treatment. To this end, this study analyzed the trends of medical service utilization for tinnitus in adult patients from 2010 to 2018 based on a national sample of medical claims data from the Health Insurance Review and Assessment Service National Patient Samples database. A total of 94,323 patients with tinnitus were identified in Korea between 2010 and 2018. The results confirmed that the number of patients, claim numbers, and expenditures steadily increased during the nine-year period. Blood circulation agents were the most commonly used drug therapy; however, the frequency of their use gradually decreased, whereas that of tinnitus and vertigo medicines gradually increased. Total and average expenditure per patient nearly doubled in this period. The study showed that medication trends are changing from blood circulation agents to tinnitus or vertigo medicines. The findings of this study may be helpful for clinicians and researchers in the study, treatment, and management of tinnitus.
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Hwang S, Kang D, Park H, Kim Y, Guallar E, Jeon J, Lee JE, Huh W, Suh GY, Cho J, Jang HR. Impact of Renal Replacement Therapy on Mortality and Renal Outcomes in Critically Ill Patients with Acute Kidney Injury: A Population-Based Cohort Study in Korea between 2008 and 2015. J Clin Med 2022; 11:jcm11092392. [PMID: 35566518 PMCID: PMC9105681 DOI: 10.3390/jcm11092392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
The outcomes depending on the type of renal replacement therapy (RRT) or pre-existing kidney disease in critically ill patients with acute kidney injury (AKI) have not been fully elucidated. All adult intensive care unit patients with AKI in Korea from 2008 to 2015 were screened. A total of 124,182 patients, including 21,165 patients with pre-existing kidney disease, were divided into three groups: control (no RRT), dialysis, and continuous RRT (CRRT). In-hospital mortality and progression to end-stage kidney disease (ESKD) were analyzed according to the presence of pre-existing kidney disease. The CRRT group had a higher risk of in-hospital mortality. Among the patients with pre-existing kidney disease, the dialysis group had a lower risk of in-hospital mortality compared to other groups. The risk of ESKD was higher in the dialysis and CRRT groups compared to the control group. In the CRRT group, the risk of ESKD was even higher in patients without pre-existing kidney disease. Although both dialysis and CRRT groups showed a higher incidence of ESKD, in-hospital mortality was lower in the dialysis group, especially in patients with pre-existing kidney disease. Our study supports that RRT and pre-existing kidney disease may be important prognostic factors for overall and renal outcomes in patients with AKI.
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Affiliation(s)
- Subin Hwang
- Department of Internal Medicine, Seoul Paik Hospital, Inje University School of Medicine, Seoul 04551, Korea;
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (D.K.); (H.P.); (Y.K.); (E.G.)
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul 06531, Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (D.K.); (H.P.); (Y.K.); (E.G.)
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul 06531, Korea
| | - Youngha Kim
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (D.K.); (H.P.); (Y.K.); (E.G.)
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul 06531, Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (D.K.); (H.P.); (Y.K.); (E.G.)
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
| | - Junseok Jeon
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.-E.L.); (W.H.)
| | - Jung-Eun Lee
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.-E.L.); (W.H.)
| | - Wooseong Huh
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.-E.L.); (W.H.)
| | - Gee-Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (D.K.); (H.P.); (Y.K.); (E.G.)
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul 06531, Korea
- Correspondence: (J.C.); (H.-R.J.); Tel.: +82-2-3410-1448 (J.C.); +82-2-3410-0782 (H.-R.J.)
| | - Hye-Ryoun Jang
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea; (J.J.); (J.-E.L.); (W.H.)
- Correspondence: (J.C.); (H.-R.J.); Tel.: +82-2-3410-1448 (J.C.); +82-2-3410-0782 (H.-R.J.)
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Cho Y, Yeo J, Lee YS, Kim EJ, Nam D, Park YC, Ha IH, Lee YJ. Healthcare Utilization for Lateral Epicondylitis: A 9-Year Analysis of the 2010–2018 Health Insurance Review and Assessment Service National Patient Sample Data. Healthcare (Basel) 2022; 10:healthcare10040636. [PMID: 35455814 PMCID: PMC9030966 DOI: 10.3390/healthcare10040636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 01/01/2023] Open
Abstract
This retrospective cross-sectional study examined healthcare utilization among 213,025 patients with lateral epicondylitis over a nine-year period using the 2010–2018 Health Insurance Review and Assessment Service (HIRA) data (ICD code M771). Healthcare utilization, types of treatment, and the route of the visit were analyzed with frequency analysis for Western medicine (WM) and Korean medicine (KM). The findings revealed that the number of patients visiting WM and KM facilities for lateral epicondylitis rose every year from 2010 to 2018. Over this period, the age distribution of patients was 45–54 years (39.93%), 55–64 (23.12%), and 35–44 years (21.07%), and there were slightly more female patients (53.66%) than male patients (46.34%). The number of claims for lateral epicondylitis tended to increase with decreasing average monthly temperature; an increased proportion of middle-aged patients (45–64 years) was the most evident. The most frequently performed interventions in WM were subcutaneous or intramuscular injection (injection), deep heat therapy (physical therapy), and spinal peripheral nerve block-axillary nerve block (treatment/operation); the most frequently performed intervention in KM was acupuncture (injection). For pharmacological treatment, analgesics and anti-inflammatory medications were most frequently prescribed. The findings can be useful for health policymakers and as foundational data for clinicians and researchers.
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Affiliation(s)
- Yujin Cho
- Jaseng Hospital of Korean Medicine, 536 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea;
| | - Jiyoon Yeo
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea; (J.Y.); (Y.-S.L.); (I.-H.H.)
| | - Ye-Seul Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea; (J.Y.); (Y.-S.L.); (I.-H.H.)
| | - Eun Jung Kim
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Dongguk University, Gyeongju 13601, Korea;
| | - Dongwoo Nam
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea;
| | - Yeon-Cheol Park
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea;
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea; (J.Y.); (Y.-S.L.); (I.-H.H.)
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul 06110, Korea; (J.Y.); (Y.-S.L.); (I.-H.H.)
- Correspondence:
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Medical Health Records-Based Mild Cognitive Impairment (MCI) Prediction for Effective Dementia Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179223. [PMID: 34501812 PMCID: PMC8431613 DOI: 10.3390/ijerph18179223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022]
Abstract
Dementia is a cognitive impairment that poses a global threat. Current dementia treatments slow the progression of the disease. The timing of starting such treatment markedly affects the effectiveness of the treatment. Some experts mentioned that the optimal timing for starting the currently available treatment in order to delay progression to dementia is the mild cognitive impairment stage, which is the prior stage of dementia. However, medical records are typically only available at a later stage, i.e., from the early or middle stage of dementia. In order to address this limitation, this study developed a model using national health information data from 5 years prior, to predict dementia development 5 years in the future. The Senior Cohort Database, comprising 550,000 samples, were used for model development. The F-measure of the model predicting dementia development after a 5-year incubation period was 77.38%. Models for a 1- and 3-year incubation period were also developed for comparative analysis of dementia risk factors. The three models had some risk factors in common, but also had unique risk factors, depending on the stage. For the common risk factors, a difference in disease severity was confirmed. These findings indicate that the diagnostic criteria and treatment strategy for dementia should differ depending on the timing. Furthermore, since the results of this study present new dementia risk factors that have not been reported previously, this study may also contribute to identification of new dementia risk factors.
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Park E, Park H, Kang D, Chung CR, Yang JH, Jeon K, Guallar E, Cho J, Suh GY, Cho J. Health disparities of critically ill children according to poverty: the Korean population-based retrospective cohort study. BMC Public Health 2021; 21:1274. [PMID: 34193092 PMCID: PMC8243750 DOI: 10.1186/s12889-021-11324-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/18/2021] [Indexed: 01/09/2023] Open
Abstract
Background There is a lack of nationwide studies on critically ill patients’ health disparity under the National Health Insurance (NHI) system. We evaluated health disparities in intensive care unit (ICU) admission, outcomes, and readmission in impoverished children. Methods We conducted a retrospective cohort study using a national database from the Korean NHI and Medical Aid Program (MAP). MAP supports the population whose household income is lower than 40% of the median Korean household income. We defined poverty as being a MAP beneficiary and compared the poverty and non-poverty groups. Patients between 28 days and 18 years old who were admitted to the ICU were included. Hospital mortality and readmission were analyzed with adjustment for patient characteristics, hospital type, and management procedures. Results Out of 17,893 patients, 1153 (6.4%) patients were in poverty. The age-standardized ICU admission rate was higher in the poverty group (126.9 vs. 80.2 per 100,000 person-years). There was more age-standardized mortality in the poverty group (11.8 vs. 4.3 per 100,000 person-years). Patients in the poverty group did not have a statistically different risk of adjusted in-hospital mortality to those in the non-poverty group (odds ratio: 1.15, confidence interval [CI]: 0.84–1.55) but had a higher readmission rate (hazard ratio 1.25, CI 1.09–1.42). Conclusion Under the NHI system, the disparity in pediatric critical care outcomes according to poverty is not definite, but the healthcare disparity in pre- and post-hospital care is a concern. Further studies are required to improve pre- and post-hospital healthcare quality of impoverished children. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11324-4.
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Affiliation(s)
- Esther Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.,Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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11
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Kim JS, Seo DW, Kim YJ, Hong SI, Kang H, Kim SJ, Han KS, Lee SW, Moon S, Kim WY. Emergency Department as the Entry Point to Inpatient Care: A Nationwide, Population-Based Study in South Korea, 2016-2018. J Clin Med 2021; 10:jcm10081747. [PMID: 33920592 PMCID: PMC8072932 DOI: 10.3390/jcm10081747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
(1) Background: The emergency department provides lifesaving treatment and has become an entry point to hospital admission. The purpose of our study was to describe the characteristics and outcomes of patients who were admitted through the emergency department to the intensive care unit or general ward. (2) Methods: We performed a retrospective, cross-sectional, descriptive analysis using the National Emergency Department Information System, analyzing patient data including disease category, diagnosis, and mortality from 1 January 2016, to 31 December 2018. (3) Results: During the study period, about 13.6% were admitted through the emergency department. Of these, the overall in-hospital mortality was 4.6%. The frequent disease class for the intensive care unit admissions was the cardiovascular system, and the classes for the general ward admissions were as follows: injury and toxicology, digestive system, and respiratory system. Cardiovascular system-related emergencies were the predominant cause of death among patients admitted to the intensive care unit; however, oncologic complications were the leading cause of death in the general ward. (4) Conclusions: Emergency departments are incrementally utilized as the entry point for hospital admission. Health care providers need to understand emergency department admission epidemiology and prepare for managing patients with certain common diagnoses.
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Affiliation(s)
- June-sung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-s.K.); (D.W.S.); (Y.-J.K.); (S.I.H.)
| | - Dong Woo Seo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-s.K.); (D.W.S.); (Y.-J.K.); (S.I.H.)
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-s.K.); (D.W.S.); (Y.-J.K.); (S.I.H.)
| | - Seok In Hong
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-s.K.); (D.W.S.); (Y.-J.K.); (S.I.H.)
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul 04763, Korea;
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.J.K.); (K.S.H.); (S.W.L.)
| | - Kap Su Han
- Department of Emergency Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.J.K.); (K.S.H.); (S.W.L.)
| | - Sung Woo Lee
- Department of Emergency Medicine, Korea University College of Medicine, Seoul 02841, Korea; (S.J.K.); (K.S.H.); (S.W.L.)
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan 15355, Korea;
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-s.K.); (D.W.S.); (Y.-J.K.); (S.I.H.)
- Correspondence: ; Tel.: +82-2-3010-3350
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12
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Lee S, Choi JY, Yoon JH, Lee W. Effect of Severe External Airborne Agents' Exposure on Dementia. J Clin Med 2020; 9:jcm9124069. [PMID: 33348601 PMCID: PMC7766205 DOI: 10.3390/jcm9124069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022] Open
Abstract
The impact of occupational and environmental exposure to external airborne agents on cognitive function, especially in incidence of dementia, is understudied. The present study was conducted to elucidate the association between severe external airborne agents' exposure and incidence of dementia among an elderly population and to explore the effects of exposure to severe external airborne agents on preclinical dementia using the screening test of dementia. From the National Health Insurance Service-Health Screening Cohort (NHIS-HealS, 2002-2015), 514,580 participants were used for data analysis. We estimated the standardized incidence ratio (SIR) according to the exposure to external airborne agents. Of the total participants (n = 514,580), 1340 (0.3%) experienced severe external airborne agents exposure, and 26,050 (5.1%) had been diagnosed with dementia. The SIRs (95%CI) of dementia in Alzheimer's disease, vascular dementia, dementia in other diseases, and unspecific dementia were 1.24 (1.01-1.49), 0.88 (0.37-1.32), 1.16 (0.01-2.77), and 0.69 (0.36-1.02), respectively. The risk of testing positive in the dementia screening significantly increased with exposure to severe external airborne agents after adjusting for all confounding variables. This study found that exposure to severe external airborne agents is a potential risk factor for dementia, especially in Alzheimer's disease. It is essential to create international awareness regarding the effect of airborne agents' exposure on dementia.
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Affiliation(s)
- Seunghyun Lee
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan;
| | - Joon Yul Choi
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Jin-Ha Yoon
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: (J.-H.Y.); (W.L.)
| | - Wanhyung Lee
- Department of Occupational and Environmental Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea
- Correspondence: (J.-H.Y.); (W.L.)
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13
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Jung M, Park H, Kang D, Park E, Jeon K, Chung CR, Yang JH, Suh GY, Guallar E, Cho J, Cho J. The effect of bed-to-nurse ratio on hospital mortality of critically ill children on mechanical ventilation: a nationwide population-based study. Ann Intensive Care 2020; 10:159. [PMID: 33257997 PMCID: PMC7703514 DOI: 10.1186/s13613-020-00780-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the high workload of mechanical ventilation, there has been a lack of studies on the association between nurse workforce and mortality in mechanically ventilated patients. We evaluated the association of the bed-to-nurse ratio with mortality in ventilated pediatric patients admitted to an intensive care unit (ICU). METHODS We conducted a nationwide retrospective analysis by using the Korean National Health Insurance database, which categorizes the bed-to-nurse ratio into 9 grades according to the number of beds divided by the number of full-time equivalent registered nurses in a unit. Patients of ages between 28 days and 18 years were enrolled. Multiple admissions and transfers from other hospitals were excluded. We evaluated the odds ratios (ORs) of in-hospital mortality using 4 groups (Grade 1: bed-to-nurse < 0.50, Grade 2: < 0.63, Grade 3: < 0.77, Grade 4 or above > 0.77) with adjustment of patient factors, hospital factors, and treatment requirements. RESULTS Of the 27,849 patients admitted to ICU, 11,628 (41.8%) were on mechanical ventilation. The overall in-hospital mortality rates in Grade 1, Grade 2, Grade 3, and Grade 4 or above group were 4.5%, 6.8%, 6.9%, and 4.7%, respectively. The adjusted ORs (95% CI) for in-hospital mortality of mechanically ventilated patients in the Grade 2, Grade 3, and Grade 4 or above compared to those in Grade 1 were 2.73 (95% CI 1.51-4.95), 4.02 (95% CI 2.23-7.26), and 7.83 (4.07-15.07), respectively. However, for patients without mechanical ventilation, the adjusted ORs of in-hospital mortality were not statistically significant. CONCLUSION In mechanically ventilated patients, the adjusted mortality rate increased significantly, as the bed-to-nurse ratio of the ICU increased. Policies that limit the number of ventilated patients per nurse should be considered. Trial registration retrospectively registered.
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Affiliation(s)
- Minyoung Jung
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Republic of Korea
| | - Hyejeong Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Esther Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.,Departments of Epidemiology and Department of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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14
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Yang G, Jung B, Kim MR, Koh W, Kim N, Lee EK, Ha IH. Acromioplasty rates in patients with shoulder disorders with and without acupuncture treatment: a retrospective propensity score-matched cohort study. Acupunct Med 2020; 38:255-263. [PMID: 32310005 DOI: 10.1177/0964528419895529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This retrospective propensity score-matched cohort study aimed to examine the frequency of acromioplasty among patients with shoulder disorders receiving and not receiving acupuncture, based on Korea National Health Insurance Service-National Sample Cohort (NHIS-NSC) data. METHODS We included cases of high-frequency shoulder disorders-adhesive capsulitis, rotator cuff syndrome, shoulder impingement syndrome, and sprain and strain of the shoulder joint-stratified from the Korea NHIS-NSC database between 2002 and 2013; cases were classified into two groups based on a history of acupuncture treatment performed at least twice within 6 weeks (acupuncture group: n = 111,561; control group: n = 71,340). We examined propensity scores and hazard ratios (HRs) for the frequency of acromioplasty, within 2 years of the first treatment or first examination in the acupuncture and control groups, respectively; cumulative survival rates were estimated using Kaplan-Meier survival analysis. RESULTS Following propensity score matching, no differences were observed between the acupuncture and control groups for variables including sex, age, income and the Charlson comorbidity index. In addition, the incidence rates of acromioplasty within 2 years were lower in the acupuncture group than in the control group (HR 0.264; 95% confidence interval 0.224-0.311). Based on differences in sensitivity analyses for the numbers of acupuncture sessions and treatment duration, the frequency of acromioplasty within 2 years was lower in the acupuncture group than in the control group. CONCLUSION This study found that the frequency of acromioplasty was reduced in patients with shoulder disorders who had been treated with acupuncture. Although the findings need to be verified by prospective randomized clinical trials, these results imply that acupuncture may be effective at reducing the incidence rate of shoulder surgery.
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Affiliation(s)
- Gujin Yang
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Boyoung Jung
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Me-Riong Kim
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Wonil Koh
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Namkwen Kim
- Center for Comparative Effectiveness Research & Economic Evaluation in Korean Medicine, Pusan National University, Yangsan, Gyeongnam, Republic of Korea
| | - Eun-Kyoung Lee
- Research Department, Research Institute of Korean Medicine Policy, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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15
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Park YH, Ko RE, Kang D, Park J, Jeon K, Yang JH, Park CM, Cho J, Park YS, Park H, Cho J, Guallar E, Suh GY, Chung CR. Relationship between Use of Rehabilitation Resources and ICU Readmission and ER Visits in ICU Survivors: the Korean ICU National Data Study 2008-2015. J Korean Med Sci 2020; 35:e101. [PMID: 32301293 PMCID: PMC7167400 DOI: 10.3346/jkms.2020.35.e101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 02/19/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite the increasing importance of rehabilitation for critically ill patients, there is little information regarding how rehabilitation therapy is utilized in clinical practice. Our objectives were to evaluate the implementation rate of rehabilitation therapy in the intensive care unit (ICU) survivors and to investigate the effects of rehabilitation therapy on outcomes. METHODS A retrospective nationwide cohort study with including > 18 years of ages admitted to ICU between January 2008 and May 2015 (n = 1,465,776). The analyzed outcomes were readmission to ICU readmission and emergency room (ER) visit. RESULTS During the study period, 249,918 (17.1%) patients received rehabilitation therapy. The percentage of patients receiving any rehabilitation therapy increased annually from 14% in 2008 to 20% in 2014, and the percentages for each type of therapy also increased over time. The most common type of rehabilitation was physical therapy (91.9%), followed by neuromuscular electrical stimulation (29.6%), occupational (28.6%), respiratory, (11.6%) and swallowing (10.3%) therapies. After adjusting for confounding variables, the risk of 30-day ICU readmission was lower in patients who received rehabilitation therapy than in those who did not (P < 0.001; hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.65-0.75). And, the risk of 30-day ER visit was also lower in patients who received rehabilitation therapy (P < 0.001; HR, 0.83; 95% CI, 0.77-0.88). CONCLUSION In this nationwide cohort study in Korea, only 17% of all ICU patients received rehabilitation therapy. However, rehabilitation is associated with a significant reduction in the risk of 30-day ICU readmission and ER visit.
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Affiliation(s)
- Yun Hee Park
- Department of Physical and Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ryoung Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Jinkyeong Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sook Park
- Department of Physical and Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hyejung Park
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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16
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Kang TW, Kong SY, Kang D, Kang MW, Kim YK, Kim SH, Sinn DH, Kim YA, Choi KS, Lee ES, Woo SM, Back JH, Guallar E, Cho J. Use of Gadoxetic Acid-enhanced Liver MRI and Mortality in More than 30 000 Patients with Hepatocellular Carcinoma: A Nationwide Analysis. Radiology 2020; 295:114-124. [PMID: 32013789 DOI: 10.1148/radiol.2020190639] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The impact on survival of gadoxetic acid-enhanced MRI in addition to multiphase contrast material-enhanced CT for initial staging in patients with hepatocellular carcinoma (HCC) is unknown. Purpose To compare all-cause mortality in patients with HCC who underwent CT only, CT plus non-gadoxetic acid-enhanced MRI, or CT plus gadoxetic acid-enhanced MRI as part of their initial diagnostic work-up. Materials and Methods The authors performed a nationwide retrospective cohort study of patients diagnosed with HCC in South Korea between January 2008 and December 2010. Follow-up extended through December 2014. The primary outcome was all-cause mortality. Cox proportional hazards regression model with adjustment of confounding factors was used to estimate hazard ratios (HRs) for all-cause mortality. Results Among 30 023 patients with HCC (mean age ± standard deviation, 58.5 years ± 10.7, 23 978 men), the proportions of patients in whom HCC was diagnosed using CT only, CT plus non-gadoxetic acid-enhanced MRI, and CT plus gadoxetic acid-enhanced MRI were 56.1%, 12.9%, and 31.0%, respectively. In adjusted analysis using CT only as the reference category, the HR for mortality for CT plus gadoxetic acid-enhanced MRI was 0.64 (95% confidence interval [CI]: 0.62, 0.67; P < .001), and the HR for CT plus non-gadoxetic acid-enhanced MRI was 0.71 (95% CI: 0.68, 0.75; P < .001). Use of CT plus gadoxetic acid-enhanced MRI was associated with lower mortality compared with CT plus non-gadoxetic acid-enhanced MRI (adjusted HR, 0.90; 95% CI: 0.85, 0.95; P < .001), but this survival advantage was restricted to patients with localized disease. Conclusion In patients with hepatocellular carcinoma, additional use of contrast-enhanced MRI was associated with lower mortality. Furthermore, CT plus gadoxetic acid-enhanced MRI was associated with better survival than CT plus non-gadoxetic acid-enhanced MRI but only in patients with localized disease. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Kim in this issue.
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Affiliation(s)
- Tae Wook Kang
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Sun-Young Kong
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Danbee Kang
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Min Woong Kang
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Young Kon Kim
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Seong Hyun Kim
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Dong Hyun Sinn
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Young Ae Kim
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Kui Son Choi
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Eun Sook Lee
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Sang Myung Woo
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Joung Hwan Back
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Eliseo Guallar
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
| | - Juhee Cho
- From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea (T.W.K., Y.K.K., S.H.K.); Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea (S.Y.K., E.S.L., S.M.W.); Department of Laboratory Medicine, Hospital, National Cancer Center, Goyang, South Korea (S.Y.K.); Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea (D.K., E.G., J.C.); Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K., M.W.K., E.G., J.C.); Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.H.S.); National Cancer Control Institute, National Cancer Center, Goyang, South Korea (Y.A.K., K.S.C.); Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea (K.S.C.); Center for Breast Cancer, Hospital, National Cancer Center, Goyang, South Korea (E.S.L.); Center for Liver Cancer, Hospital, National Cancer Center, Goyang, South Korea (S.M.W.); Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, South Korea (J.H.B.); and Department of Epidemiology, and Welch Center for Epidemiology, Prevention, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E Monument St, Baltimore, MD 21205 (E.G., J.C.)
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Kim CH, Yoon DE, Lee YS, Jung WM, Kim JH, Chae Y. Revealing Associations between Diagnosis Patterns and Acupoint Prescriptions Using Medical Data Extracted from Case Reports. J Clin Med 2019; 8:E1663. [PMID: 31614636 PMCID: PMC6832135 DOI: 10.3390/jcm8101663] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The optimal acupoints for a particular disease can be determined by analysis of diagnosis patterns. The objective of this study was to reveal the association between such patterns and the acupoints prescribed in clinical practice using medical data extracted from case reports. METHODS This study evaluated online virtual diagnoses made by currently practicing Korean medical doctors (N = 80). The doctors were presented with 10 case reports published in Korean medical journals and were asked to diagnose the patients and prescribe acupoints accordingly. A network analysis and the term frequency-inverse document frequency (tf-idf) method were used to analyse and quantify the relationship between diagnosis patterns and prescribed acupoints. RESULTS The network analysis showed that ST36, LI4, LR3, and SP6 were the most frequently used acupoints across all diagnoses. The tf-idf values showed the acupoints used for specific diseases, such as BL40 for bladder disease and LU9 for lung disease. CONCLUSIONS The associations between diagnosis patterns and prescribed acupoints were identified using an online virtual diagnosis modality. Network and text mining analyses revealed commonly applied and disease-specific acupoints in both qualitative and quantitative terms.
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Affiliation(s)
- Cheol-Han Kim
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea.
| | - Da-Eun Yoon
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea.
| | - Ye-Seul Lee
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea.
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam 13120, Korea.
| | - Won-Mo Jung
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea.
| | - Joo-Hee Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju 26339, Korea.
| | - Younbyoung Chae
- Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea.
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Kim B, Kim J, Jo YH, Lee JH, Hwang JE. The change in age distribution of CAP population in Korea with an estimation of clinical implications of increasing age threshold of current CURB65 and CRB65 scoring system. PLoS One 2019; 14:e0219367. [PMID: 31415581 PMCID: PMC6695142 DOI: 10.1371/journal.pone.0219367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/21/2019] [Indexed: 01/26/2023] Open
Abstract
Background CURB65 and CRB65 score are simple and popular methods to estimate the mortality in patients with community-acquired pneumonia (CAP). Although there has been a global increase in life expectancy and population ageing, we are still using the same age threshold derived from patients in late 1990s to calculate the scores. We sought to assess the implication of using higher age threshold using Korean population data and a single center hospital records. Methods Using Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC), we analyzed annual age distribution of CAP patients in Korea from 2005 to 2013 and report how patients aged >65 years increased over time. We also assessed annual change in test characteristics of various age threshold in Korean CAP population. Using a single center hospital registry of CAP patients (2008–2017), we analyzed test characteristics of CURB65 and CRB65 scores with various age thresholds. Results 116,481 CAP cases were identified from NHIS-NSC dataset. The proportion of patients aged >65 increased by 1.01% (95% CI, 0.70%-1.33%, P<0.001) every year. In the sample Korean population dataset, age threshold showed its peak AUROC (0.829) at 70. In the hospital dataset, 7,197 cases were included for analysis. The AUROC of both CRB65 and CURB65 was maximized at 71. When CRB71 was applied instead of CRB65 for hospital referral using score <1 to define a low-risk case, the potential hospital referral was significantly decreased (72.9% to 64.6%, P<0.001) without any significant increase in 1-month mortality in the low risk group (0.6% to 0.7%, P = 0.690). Conclusion There was a significant age shift in CAP population in Korea. Increasing the current age threshold of CURB65 (or CRB65) could be a viable option to reduce ever-increasing hospital referrals and admissions of CAP patients.
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Affiliation(s)
- Byunghyun Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
- * E-mail:
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ji Eun Hwang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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19
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Changes in acute kidney injury epidemiology in critically ill patients: a population-based cohort study in Korea. Ann Intensive Care 2019; 9:65. [PMID: 31175471 PMCID: PMC6555834 DOI: 10.1186/s13613-019-0534-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background Although no specific treatment facilitates renal tubular regeneration in acute kidney injury (AKI), the rapid increase in aging populations with more comorbidities and advances in critical care management are expected to change the epidemiology of AKI. However, few recent studies dissected the current epidemiologic characteristics of critically ill patients with AKI. We investigated recent epidemiologic changes in severe AKI in critically ill patients. Methods All adult admissions to intensive care units (ICUs) in Korea from 2008 to 2015 were screened using the national health insurance review and assessment database, and 1,744,235 patients were included. Clinical characteristics and changes in AKI incidence and mortality rate were analyzed.
Results The incidence of AKI increased from 7.4% in 2008 to 8.3% in 2015 (p for trend < 0.001). Age-standardized AKI rate was 7018.6 per 100,000 person-years. In-hospital mortality significantly decreased from 39.1% in 2008 to 37.2% in 2015 (p for trend < 0.001) with 2427.6 deaths per 100,000 person-years. Patients with AKI showed higher in-hospital mortality, prolonged ICU length of stay, and higher total cost. Multivariable analysis showed increased risk of in-hospital mortality (adjusted odds ratio [OR] 3.74), mechanical ventilation (OR 2.87), ECMO (OR 6.99), and vasopressor requirement (OR 2.75) in patients with AKI. Conclusions Recent advances in medical management for AKI have improved in-hospital mortality of critically ill patients with AKI despite increases in the elderly population and AKI incidence. Electronic supplementary material The online version of this article (10.1186/s13613-019-0534-7) contains supplementary material, which is available to authorized users.
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Tay CK, Cho YH, Park J, Yang JH, Chung CR, Sung K, Cho J, Kang D, Park H, Suh GY. Extracorporeal membrane oxygenation in Korea – Trends and impact of hospital volume on outcome: Analysis of national insurance data 2009–2014. J Crit Care 2019; 49:1-6. [DOI: 10.1016/j.jcrc.2018.09.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/30/2018] [Accepted: 09/30/2018] [Indexed: 12/20/2022]
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Park SJ, Park H, Kang D, Park TK, Park J, Cho J, Chung CR, Jeon K, Guallar E, Cho J, Suh GY, Yang JH. Association of statin therapy with clinical outcomes in patients with vasospastic angina: Data from Korean health insurance review and assessment service. PLoS One 2019; 14:e0210498. [PMID: 30699150 PMCID: PMC6353127 DOI: 10.1371/journal.pone.0210498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/22/2018] [Indexed: 11/18/2022] Open
Abstract
There is conflicting evidence for the clinical benefit of statin therapy in patients with vasospastic angina (VSA). We investigated the association of statin therapy with clinical outcomes in relatively large populations with clinically suspected VSA from a nationwide population-based database. Data were collected from the Health Insurance Review and Assessment database records of 4,099 patients that were in an intensive care unit with VSA between January 1, 2008 and May 31, 2015. We divided the patients into a statin group (n = 1,795) and a non-statin group (n = 2,304). The primary outcome was a composite of cardiac arrest and acute myocardial infarction (AMI). The median follow-up duration was 3.8 years (interquartile range: 2.2 to 5.8 years). Cardiac arrest or AMI occurred in 120 patients (5.2%) in the statin group, and 97 patients (5.4%) in the non-statin group (P = 0.976). With inverse probability of treatment weighting, there was no significant difference in the rate of cardiac arrest or AMI between the two groups (adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.76–1.30; P = 0.937), or even between the non-statin group and high-intensity statin group (adjusted HR, 1.08; 95% CI, 0.69–1.70; P = 0.75). The beneficial association of statin use with the primary outcome was consistently lacking across the various comorbidity types. Statin therapy was not associated with reduced cardiac arrest or AMI in patients with VSA, regardless of statin intensity. Prospective, randomized trials will be needed to confirm our findings.
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Affiliation(s)
- So Jin Park
- Department of Pharmaceutical Services, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinkyeong Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Gee Young Suh
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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22
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Park TK, Gwag HB, Park SJ, Park H, Kang D, Park J, Cho J, Chung CR, Jeon K, Suh GY, Guallar E, Cho J, Yang JH. Differential prognosis of vasospastic angina according to presentation with sudden cardiac arrest or not: Analysis of the Korean Health Insurance Review and Assessment Service. Int J Cardiol 2018; 273:39-43. [PMID: 30282600 DOI: 10.1016/j.ijcard.2018.09.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The long-term prognosis of vasospastic angina (VSA) patients presenting with aborted sudden cardiac death (ASCD) is still unknown. We sought to compare the long-term clinical outcomes between VSA patients presenting with and without ASCD by retrospective analysis of a nationwide population-based database. METHODS A total of 6972 patients in the Health Insurance Review and Assessment database who were hospitalized in the intensive care unit with VSA between July 1, 2007 and May 31, 2015 were enrolled. Primary outcome was the composite of cardiac arrest and acute myocardial infarction after discharge. RESULTS Five hundred ninety-eight (8.6%) VSA patients presented with ASCD. On inverse probability of treatment weighting, ASCD patients had a significantly increased risk of the composite of cardiac arrest and acute myocardial infarction (adjusted hazard ratio, 2.52; 95% confidence interval, 1.72-3.67; p < 0.001) during the median follow-up duration of 4 years. The association of ASCD presentation with a worse outcome in terms of primary outcome was consistent across various subgroups, including comorbidity type and use of vasodilators (all p-values for interaction: non-significant). ASCD patients treated with an implantable cardioverter defibrillator (ICD) had a lower incidence of the composite of cardiac arrest and acute myocardial infarction during follow-up than those without an ICD (p = 0.009). CONCLUSIONS VSA patients that present with ASCD are at increased risk of cardiac arrest or myocardial infarction during long-term follow-up despite adequate vasodilator therapy. An ICD is a potential therapeutic option for secondary prevention.
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Affiliation(s)
- Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Bin Gwag
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Jin Park
- Department of Pharmaceutical Services, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Jinkyeong Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Republic of Korea; Departments of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Risk of Pneumonia After Vertebral Compression Fracture in Women With Low Bone Density: A Population-Based Study. Spine (Phila Pa 1976) 2018; 43:E830-E835. [PMID: 29283958 DOI: 10.1097/brs.0000000000002536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective large population-based study. OBJECTIVE The aim of this study is to elucidate the association between vertebral compression fractures (VCFs) and pneumonia. SUMMARY OF BACKGROUND DATA VCF is known to be associated with impaired pulmonary function. However, the risk of developing pneumonia after new-onset VCF has not been evaluated. METHODS The data source was the National Health Screening Program Cohort, a population-based sample cohort of national health screening enrolees. Elderly women with low bone density identified during the life transition period health check-up were target population. Patients with newly diagnosed isolated VCF after the health check-up except those with cervical VCF were included as exposure group. Matched individuals still free of any type of VCF from the same population were included as control group with case/control ratio 3:1. The time to first occurrence of pneumonia were analyzed with Cox-regression analysis. RESULTS From the target population (N = 24,773), we matched 867 patients exposed to new-onset isolated VCFs with 2601 controls. In a multivariable Cox-regression analysis, isolated VCF was identified as an independent risk factor for development of a pneumonia (adjusted hazard ratio, 1.48; 95% confidence interval 1.14-1.91). Among the subtypes of VCF, thoracic/thoracolumbar VCF was independently associated with increased risk of pneumonia (adjusted hazard ratio, 2.13; 95% confidence interval 1.47-3.08). CONCLUSION Isolated VCF, especially those involving thoracic region, was associated with increased risk of pneumonia. LEVEL OF EVIDENCE 4.
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Park J, Jeon K, Chung CR, Yang JH, Cho YH, Cho J, Park CM, Park H, Cho J, Guallar E, Suh GY. A nationwide analysis of intensive care unit admissions, 2009-2014 - The Korean ICU National Data (KIND) study. J Crit Care 2017; 44:24-30. [PMID: 29028553 DOI: 10.1016/j.jcrc.2017.09.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate unbiased information on the characteristics, procedures, and outcomes of intensive care unit (ICU) admissions in a long-term nationwide study. MATERIALS AND METHODS Cohort study of all ICU admissions in patients >18years of age in Korea between August 1, 2009 and September 30, 2014 (1,553,673 ICU admissions in 1,265,509 patients). RESULTS From August 2009 to September 2014, the age-standardized ICU admission rate was 744.6 per 100,000 person-years (869.5 per 100,000 person-years in men and 622.0 per 100,000 person-years in women). The overall in-hospital mortality was 13.8% (14.1% in men and 13.5% in women). Among all Koreans, the ICU mortality rate was 102.9 per 100,000 person-years (122.5 per 100,000 person years in men and 83.8 per 100,000 person years in women). The median ICU and hospital length of stay were 4 and 13days, respectively. The median cost per ICU admission was $5051, which increased steadily over the study period. There were marked differences by gender in ICU admission rates, aggressive support, and outcomes. CONCLUSIONS Our study identified increasing trends in ICU admissions and utilization of advance life support systems that add to the burden of care in a developed society.
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Affiliation(s)
- Jinkyeong Park
- Department of Critical Care Medicine in Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine in Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine in Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine in Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hyun Cho
- Department of Critical Care Medicine in Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joongbum Cho
- Department of Critical Care Medicine in Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi-Min Park
- Department of Critical Care Medicine in Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyejeong Park
- Department of Critical Care Medicine in Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Republic of Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Republic of Korea; Departments of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gee Young Suh
- Department of Critical Care Medicine in Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Republic of Korea.
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