ABSTRACT
Objectives@#Digital healthcare is expected to play a pivotal role in patient-centered healthcare. It empowers patients by informing, communicating, and motivating them. However, a pragmatic evaluation of the present status of digital healthcare has not been presented; therefore, we aimed to examine the status of digital healthcare in Korea. @*Methods@#This article discusses digital healthcare, examples of assessment in Korea and other countries, the implications of past examples, and future directions for development. @*Results@#Over the years, various clinical studies have used clinical evidence to assess the feasibility of digital healthcare. If feasible, it is actually clinically effective. If it is effective, can it be commercialized at an acceptable cost? These questions have been investigated in various evidence-based studies. In addition, great efforts are being made to secure ample evidence to assess various aspects of digital healthcare, such as safety, quality, end-user experience, and equity. @*Conclusions@#Digital healthcare requires a deep understanding of both the technical and medical aspects. To strengthen the competence of the medical aspect, medical staff, patients, and the government must work together with continuous interest in this goal.
ABSTRACT
Purpose@#Under the South Korea’s unique health insurance structure, any new surgical technology must be evaluated first by the government in order to consider whether that particular technology can be applied to patients for further clinical trials as categorized as ‘New Health Technology,’ then potentially covered by the insurance sometime later. The aim of this meta-analysis was to assess the safety and efficacy of transanal total mesorectal excision (TaTME) for rectal cancer, activated by the National Evidence-based Healthcare Collaborating Agency (NECA) TaTME committee. @*Methods@#We systematically searched Ovid-MEDLINE, Ovid-Embase, Cochrane, and Korean databases (from their inception until August 31, 2019) for studies published that compare TaTME with laparoscopic total mesorectal excision (LaTME). End-points included perioperative and pathological outcomes. @*Results@#Sixteen cohort studies (7 for case-matched studies) were identified, comprising 1,923 patients (938 TaTMEs and 985 LaTMEs). Regarding perioperative outcomes, the conversion rate was significantly lower in TaTME (risk ratio, 0.19; 95% confidence interval, 0.11–0.34; P < 0.001); whereas other perioperative outcomes were similar to LaTME. There were no statistically significant differences in pathological results between the 2 procedures. @*Conclusion@#Our meta-analysis showed comparable results in preoperative and pathologic outcomes between TaTME and LaTME, and indicated the benefit of TaTME with low conversion. Extensive evaluations of well-designed, multicenter randomized controlled trials are required to come to unequivocal conclusions, but the results showed that TaTME is a potentially beneficial technique in some specific cases. This meta-analysis suggests that TaTME can be performed for rectal cancer patients as a ‘New Health Technology’ endorsed by NECA in South Korea.
ABSTRACT
Objectives@#Digital healthcare is expected to play a pivotal role in patient-centered healthcare. It empowers patients by informing, communicating, and motivating them. However, a pragmatic evaluation of the present status of digital healthcare has not been presented; therefore, we aimed to examine the status of digital healthcare in Korea. @*Methods@#This article discusses digital healthcare, examples of assessment in Korea and other countries, the implications of past examples, and future directions for development. @*Results@#Over the years, various clinical studies have used clinical evidence to assess the feasibility of digital healthcare. If feasible, it is actually clinically effective. If it is effective, can it be commercialized at an acceptable cost? These questions have been investigated in various evidence-based studies. In addition, great efforts are being made to secure ample evidence to assess various aspects of digital healthcare, such as safety, quality, end-user experience, and equity. @*Conclusions@#Digital healthcare requires a deep understanding of both the technical and medical aspects. To strengthen the competence of the medical aspect, medical staff, patients, and the government must work together with continuous interest in this goal.
ABSTRACT
Purpose@#Under the South Korea’s unique health insurance structure, any new surgical technology must be evaluated first by the government in order to consider whether that particular technology can be applied to patients for further clinical trials as categorized as ‘New Health Technology,’ then potentially covered by the insurance sometime later. The aim of this meta-analysis was to assess the safety and efficacy of transanal total mesorectal excision (TaTME) for rectal cancer, activated by the National Evidence-based Healthcare Collaborating Agency (NECA) TaTME committee. @*Methods@#We systematically searched Ovid-MEDLINE, Ovid-Embase, Cochrane, and Korean databases (from their inception until August 31, 2019) for studies published that compare TaTME with laparoscopic total mesorectal excision (LaTME). End-points included perioperative and pathological outcomes. @*Results@#Sixteen cohort studies (7 for case-matched studies) were identified, comprising 1,923 patients (938 TaTMEs and 985 LaTMEs). Regarding perioperative outcomes, the conversion rate was significantly lower in TaTME (risk ratio, 0.19; 95% confidence interval, 0.11–0.34; P < 0.001); whereas other perioperative outcomes were similar to LaTME. There were no statistically significant differences in pathological results between the 2 procedures. @*Conclusion@#Our meta-analysis showed comparable results in preoperative and pathologic outcomes between TaTME and LaTME, and indicated the benefit of TaTME with low conversion. Extensive evaluations of well-designed, multicenter randomized controlled trials are required to come to unequivocal conclusions, but the results showed that TaTME is a potentially beneficial technique in some specific cases. This meta-analysis suggests that TaTME can be performed for rectal cancer patients as a ‘New Health Technology’ endorsed by NECA in South Korea.
ABSTRACT
Objective@#This study aimed to compare the effects of high-flow nasal cannula (HFNC) treatment and conventional oxygen therapy (COT) in patients with heart failure (HF) admitted to the emergency department (ED). @*Methods@#This study was a single-center, retrospective, observational study. The subjects were divided into HFNC and COT groups. The characteristics were compared, and vital signs and arterial blood gas (ABG) results were analyzed. In addition, mortality, intubation rate, intensive care unit (ICU) admission, and length of stay (LOS) were analyzed for clinical outcome. @*Results@#Among 252 patients, 91 and 161 were treated with HFNC and COT. Two groups showed differences in vital signs, ABG results, and pulmonary edema. The HFNC group showed no difference in mortality and LOS, but more intubation and ICU admission were observed (P=0.005, P<0.001). Due to the changes in vital signs and ABG results, the HFNC group reduced blood pressure, heart rate and respiratory rate, improved SpO2, increased pH, and decreased PaCO2. @*Conclusion@#HFNC therapy effectively improved vital signs and ventilation when administered to relatively unstable patients with HF admitted to the ED.
ABSTRACT
Background@#Evaluation of bony union after bone grafting is very important in orthopedic surgery. The aim of this study was to verify inter- and intraobserver reliability of the Goldberg scoring system for radiographic evaluation of bony union after bone grafting in various situations of animal models. @*Methods@#Twenty-seven male C57/BL6 mice, which lack the ability to synthesize galactose-alpha-1,3-galactose (GalT KO mice), and 9 C57/BL6 mice carrying a wild-type gene were used as animal models. We divided the mice into four groups. In group 1, syngenic bone grafting and intramedullary fixation were performed (9 wild type C57BL/6 mice). In group 2, allogenic bone grafting was performed (9 GalT KO mice). In group 3, an alpha-galactosidase-treated porcine xenograft was transplanted into the femur to reduce the antigenicity (9 GalT KO mice). In group 4, a non-treated porcine xenobone grafting was performed (9 GalT KO mice). The level of radiographic bony union (Goldberg method) was assessed by three orthopedic surgeons. Intra- and interobserver reliability for radiographic evaluation was assessed. @*Results@#In the Goldberg scoring system, most of the radiographic measurements showed substantial to almost perfect intraobserver reliability. The total score showed substantial intraobserver reliability. The kappa coefficient (κ) of the first examiner was 0.603, the κ of the second examiner was 0.790, and the κ of the third examiner was 0.758. The scoring system showed substantial interobserver reliability. The κ of the first session was 0.641 and the κ of the second session was 0.649. @*Conclusions@#The Goldberg scoring system is a reliable tool for radiographic evaluation of bony union after bone grafting.
ABSTRACT
Objective@#An essay test is difficult to carry out because of the effort for hand scoring and the concerns about inter-rater reliability, even though the use of a rubric can increase inter-rater reliability. This study examined the feasibility of an essay test in medical school students and whether the use of a rubric increases inter-rater reliability. @*Methods@#An essay test was given to 51 undergraduate students in the third grade of emergency medicine clinical clerkship. Three raters assessed the essay test independently with a prepared rubric immediately after the test. They then did the same essay test without a rubric three months later. The researchers compared the Pearson’s correlation coefficients between raters. The researchers analyzed the validity comparing the correlation coefficient between the essay test and previous multiple-choice questions (MCQ) and feasibility by acceptance. @*Results@#Fifty-one students took the essay test. The Pearson’s correlation coefficient using rubric between raters 1 and 2, 1 and 3, and 2 and 3 were 0.898 (P<0.001), 0.896 (P<0.001), and 0.856 (P<0.001), respectively. Without a rubric, the correlation coefficients were 0.838 (P<0.001), 0.888 (P<0.001), and 0.824 (P<0.001), respectively. The new essay test showed a positive correlation (0.367) with the previous MCQ, and the evidence for validity and feasibility was acceptable. @*Conclusion@#In this study, the rubric did not increase the inter-rater reliability of the essay test. On the other hand, the inter-rater reliability was higher than 0.8, even without a rubric. In addition, the essay test showed evidence of validity and feasibility.
ABSTRACT
Two-point mutations (V419L and L925I) on the voltage-sensitive sodium channel of bed bugs (Cimex lectularius) are known to confer pyrethroid resistance. To determine the status of pyrethroid resistance in bed bugs in Korea, resistance allele frequencies of bed bug strains collected from several US military installations in Korea and Mokpo, Jeollanamdo, from 2009-2019 were monitored using a quantitative sequencing. Most bed bugs were determined to have both of the point mutations except a few specimens, collected in 2009, 2012 and 2014, having only a single point mutation (L925I). No susceptible allele was observed in any of the bed bugs examined, suggesting that pyrethroid resistance in bed bug populations in Korea has reached a serious level. Large scale monitoring is required to increase our knowledge on the distribution and prevalence of pyrethroid resistance in bed bug populations in Korea. Based on present study, it is urgent to restrict the use of pyrethroids and to introduce effective alternative insecticides. A nation-wide monitoring program to determine the pyrethroid resistance level in bed bugs and to select alternative insecticides should be implemented.
ABSTRACT
Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vascular tumor. The pathogenesis of ALHE is unknown; however, it may be linked to local trauma. ALHE predominantly occurs in areas of the preauricular region, forehead, and scalp; the masseter area is rarely involved. A 49-year-old man was referred for a mass in the right cheek region that was felt 2 months prior. Physical and imaging examination results suggested the presence of a benign tumor. Thus, surgical excision was performed. Pathologic findings confirmed an unexpected diagnosis of ALHE. This case was interesting, since the mass occurred at an unusual site with a misdiagnosis of an epidermal inclusion cyst.
ABSTRACT
Eruptive vellus hair cyst is a rare lesion of the vellus hair follicles as a result of developmental abnormality. This cyst is usually found in children, adolescents, and young adults most commonly involving the chest, upper and lower extremities, and abdomen. Herein, we introduce a 22-year-old male patient with a mass of nasal root, growing since childhood. The mass has grown over the years, causing the protruding of the nasal root contours, leading to decline in the patient’s aesthetic and mental quality of life. In response, we performed complete resection of the mass, which pathologically was a vellus hair cyst. The patient is now satisfied with his appearance and there was no local recurrence during follow up.
ABSTRACT
Subject(s)
Humans , Anti-Bacterial Agents , Benchmarking , Dataset , Delivery of Health Care , Drug Prescriptions , Electronic Health Records , Electronic Prescribing , Health Care Evaluation Mechanisms , Hospitals, General , Korea , National Health Programs , Polypharmacy , Prescriptions , Primary Health Care , Quality of Health Care , Surveys and QuestionnairesABSTRACT
No abstract available.
Subject(s)
Delivery of Health Care , Ethics , Informatics , PublicationsABSTRACT
BACKGROUND: Buttock pain is common, and there are no fixed guidelines for its diagnosis and treatment. This study compared a selective nerve root block and a facet joint block for patients with degenerative spinal disease and buttock pain. METHODS: Patients with degenerative spinal disease who presented with buttock pain, received a selective nerve root block (group A) or a facet joint block (group B) from June 2017 to September 2017, and were able to be followed up for more than 3 months were prospectively enrolled. Clinical results were assessed using a visual analog scale for comparative analysis. RESULTS: One day after the procedure, an excellent response was found in 7% and 6% of groups A and B, respectively; a good response was found in 41% and 13% of groups A and B, respectively. Two weeks later, an excellent response was found in 11% and 4% of groups A and B, respectively; a good response was found in 41% and 20% of groups A and B, respectively. Six weeks later, an excellent response was found in 11% and 7% of groups A and B, respectively, and a good response was found in 41% and 20% of groups A and B, respectively. At the final follow-up, more than 47% and 46% of patients showed a good response in groups A and B, respectively. In group A, the visual analog scale score improved compared to the pre-procedure value of 5.01 to 2.74 on day 1, 2.51 at week 2, 2.38 at week 6, and 2.39 at week 12. In group B, the visual analog scale score improved compared to the preprocedure value of 5.24 to 3.94 on day 1, 3.99 at week 2, 3.24 at week 6, and 2.59 at week 12. On day 1 and at weeks 2 and 6, group A showed a significantly better outcome than group B (p < 0.05). CONCLUSIONS: The selective nerve root block showed superior results up to 6 weeks post-procedure. Considering that the selective nerve root block is effective for treating radiculopathy, the primary cause of buttock pain can be thought to be radiculopathy rather than degenerative changes of the facet joint.
Subject(s)
Humans , Buttocks , Diagnosis , Follow-Up Studies , Nerve Block , Pain, Referred , Prospective Studies , Radiculopathy , Spinal Diseases , Spinal Stenosis , Visual Analog Scale , Zygapophyseal JointABSTRACT
BACKGROUND: Parotidectomy is the treatment of choice in many parotid tumors. Due to the extensive nature of the procedure, unfavorable complications such as gustatory sweating, surgical site depression are common. Various techniques using fascia, muscle or AlloDerm have been developed but debate still remains regarding its availability and affordability. We applied a newly developed acellular dermal matrix (Insuregraf) to the parotidectomy field to act as a physical barrier and to provide adequate filling effect for prevention of functional and aesthetic complications. METHODS: From March 2010 to March 2017, 30 patients with parotid tumors underwent superficial parotidectomy. Twenty patients underwent only superficial parotidectomy. Ten patients had Insuregraf applied to the surgical site after superficial parotidectomy. We evaluated the incidence of Frey’s syndrome, surgical site depression, and patient satisfaction rate in both groups. RESULTS: The incidence of Frey’s syndrome was lower in the Insuregraf group (0 vs. 2). Surgical site depression was also lower in the Insuregraf group (2 vs. 20). Satisfaction score for facial contour in Insuregraf group was 9.2 out of 10, which was comparable to 6.2 out of 10 in the control group. CONCLUSION: Application of Insuregraf after superficial parotidectomy is an effective surgical procedure to prevent complications such as Frey’s syndrome and surgical site depression. This technique is affordable and safe with no immune reactions. Above all this surgical method should be considered as an option for patients who are concerned about the contour of the face after surgery.
Subject(s)
Humans , Acellular Dermis , Architectural Accessibility , Collagen , Depression , Facial Asymmetry , Fascia , Incidence , Methods , Parotid Neoplasms , Patient Satisfaction , Sweating, GustatoryABSTRACT
OBJECTIVE: Greater occipital nerve block (GONB) is a widely accepted treatment of primary headaches. Two ultrasound (US)-guided blockade techniques exist: 1) the classical distal nerve block technique performed medial to the occipital artery at the superior nuchal line, and 2) the new proximal nerve block technique performed at the obliquus capitis inferior muscle at the level of C2. Our study aim was to perform a head-to-head comparative study of these two US-guided techniques.METHOD: Forty-nine patients with primary headache treated in our university hospital were recruited. Patients were randomized into two groups of the classical nerve block and the new proximal nerve block techniques. The headache questionnaire was made to assess the intensity of the pain of headache attacks, number of days they experience headache, duration of headache, and amount of pain medication they consumed.RESULTS: In both groups, a decrease in the severity and frequency of the headache was observed. There was no measurable difference in outcome between the two groups.CONCLUSION: Our study showed that the classic and new proximal techniques are equally effective in decreasing the headache severity and frequency.
Subject(s)
Humans , Arteries , Headache , Methods , Nerve Block , UltrasonographyABSTRACT
Subject(s)
Humans , Cicatrix , Coinfection , Eucalyptus , Follow-Up Studies , Pigmentation , Pliability , Pruritus , Sensation , Silicon , Silicones , Skin Transplantation , Skin , Thigh , Tissue Donors , Transplant Donor Site , Transplants , Wound HealingABSTRACT
Primary malignant lymphoma rarely presents as a mass in the salivary gland. It accounts for about 1% of salivary gland tumors. The lymphomas of the parotid gland are mainly non-Hodgkin's lymphoma of B-cell follicular type. It usually occurs in male adults and is very rare in children. In contrast to the intractable disease course of adult parotid follicular lymphoma, when occurred in children or adolescent, its prognosis is very good when it is first treated with surgical excision. Thus, a solitary follicular lymphoma in an extranodal site that has occurred in children is termed separately as pediatric follicular lymphoma (PFL). We share our treatment experience of a 16-year-old PFL patient through surgical removal combined with superficial parotidectomy. In line with the few previous case reports of PFL, we suggest that active surgical removal should be undertaken for solitary, extranodal follicular lymphoma of the pediatric and adolescent population.
Subject(s)
Adolescent , Adult , Child , Humans , Male , B-Lymphocytes , Lymphoma , Lymphoma, Follicular , Lymphoma, Non-Hodgkin , Parotid Gland , Parotid Neoplasms , Prognosis , Salivary GlandsABSTRACT
Signal transducer and activator of transcription 3 (STAT3) has a crucial role in various autoimmune disorders including, inflammatory bowel disease (IBD). Our previous study demonstrated that STAT3 activation by IL-6 in colonic epithelial cells exacerbates experimental ulcerative colitis. Activated T lymphocytes are also found in ulcerative colitis patients with intestinal inflammation, but the role of STAT3 in T cells remains elusive. To determine the STAT3 function of T cells in intestinal inflammation, we generated T cell-specific STAT3 knockout (KO) mice and used dextran sulfate sodium (DSS) to induce colitis. In this study, we demonstrated that T cell-specific STAT3 deletion alleviated DSS-induced colitis in mice, resulting in reduced histological scores and myeloperoxidase (MPO) activity. Importantly, the population of T cells in the spleen and lymph nodes was significantly decreased in the control and DSS-induced groups of STAT3 KO mice. In addition, STAT3 deficiency in T cells markedly reduced the production of interferon (IFN)-γ, IL-6, and IL-17A, whereas IL-10 secretion was increased. Collectively, the results suggest that STAT3 in T cells may be a therapeutic target in ulcerative colitis by balancing the immune response through T cell homeostasis.
Subject(s)
Animals , Humans , Mice , Colitis , Colitis, Ulcerative , Colon , Cytokines , Dextran Sulfate , Dextrans , Epithelial Cells , Homeostasis , Inflammation , Inflammatory Bowel Diseases , Interferons , Interleukin-10 , Interleukin-17 , Interleukin-6 , Lymph Nodes , Peroxidase , Spleen , STAT3 Transcription Factor , T-LymphocytesABSTRACT
OBJECTIVES: Heart rate variability (HRV) has gained recognition as a noninvasive marker of autonomic activity. HRV is considered a promising tool in various clinical scenarios. The optimal electrocardiogram (ECG) sampling frequency required to ensure sufficient precision of R–R intervals for HRV analysis has not yet been determined. Here, we aimed to determine the acceptable ECG sampling frequency range by analyzing ECG signals from patients who visited an emergency department with the chief complaint of acute intoxication or overdose. METHODS: The study included 83 adult patients who visited an emergency department with the chief complaint of acute poisoning. The original 1,000-Hz ECG signals were down-sampled to 500-, 250-, 100-, and 50-Hz sampling frequencies with linear interpolation. R–R interval data were analyzed for time-domain, frequency-domain, and nonlinear HRV parameters. Parameters derived from the data on down-sampled frequencies were compared with those derived from the data on 1,000-Hz signals, and Lin's concordance correlation coefficients were calculated. RESULTS: Down-sampling to 500 or 250 Hz resulted in excellent concordance. Signals down-sampled to 100 Hz produced acceptable results for time-domain analysis and Poincaré plots, but not for frequency-domain analysis. Down-sampling to 50 Hz proved to be unacceptable for both time- and frequency-domain analyses. At 50 Hz, the root-mean-squared successive differences and the power of high frequency tended to have high values and random errors. CONCLUSIONS: A 250-Hz sampling frequency would be acceptable for HRV analysis. When frequency-domain analysis is not required, a 100-Hz sampling frequency would also be acceptable.
Subject(s)
Adult , Humans , Electrocardiography , Emergencies , Emergency Service, Hospital , Heart Rate , Heart , Poisoning , Signal Processing, Computer-AssistedABSTRACT
OBJECTIVE: To investigate the effect of pulsed radiofrequency (PRF) treatment on pain and balance in patients with lumbosacral radiculopathy.METHOD: This study included twenty-five patients who were diagnosed with chronic lumbosacral radiculopathy. They underwent PRF treatment in prone position under the fluoroscopic guidance. The effect of PRF was measured by the visual analog score (VAS). Patient ability to balance was evaluated by using the Tetra-ataxiometric posturography (Tetrax).RESULTS: After PRF all patients showed improvement in pain as measured by VAS (p < 0.001) and none of the patients reported any side effects. The posturographic balance, which was evaluated by Tetrax showed no significant decline after PRF treatment. The weight distribution index (WDI) with eyes open before treatment was 5.43 ± 2.88 and after treatment was 5.37 ± 2.65 (p=0.917). The mean stability index (SI) with eyes open before treatment was 16.52 ± 6.05 and after treatment was 16.61 ± 4.85 (p=0.906). The mean WDI with eyes closed before treatment was 5.66 ± 2.81 and after treatment was 5.16 ± 2.70 (p=0.470). Finally, the mean SI with eyes closed before was 25.88 ± 9.88 and after treatment was 25.99 ± 12.30 (p=0.962).CONCLUSION: The results suggest that PRF has an effect on pain in patients with chronic lumbosacral radiculopathy. The patients did not experience adverse effects, such as hypoesthesia, dysesthesia and decreased proprioception after PRF, and there were no significant declines in balance.