ABSTRACT
Objective@#We aimed to assess the level of public awareness regarding dyslipidemia and its management among the Korean population. @*Methods@#We conducted a web- or mobile-based survey study targeting the general population, using various recruitment methods, between July 25, 2022 and August 26, 2022.The questionnaire consisted of 12 questions designed to collect demographic information and evaluate participants’ awareness and knowledge about dyslipidemia. @*Results@#In total, 2,882 participants who completed the survey were included in the analysis.Among the participants, a substantial majority (89.1%) were familiar with the concepts of “good cholesterol” and “bad cholesterol,” while a comparatively lower percentage (just 46.7%) were acquainted with the term “dyslipidemia.” Noticeable variations in understanding were observed when examining specific aspects of dyslipidemia management, including diet, exercise, and pharmacotherapy. @*Conclusion@#The results of this survey underscore the significance of enhancing public awareness about dyslipidemia within the context of health literacy, demonstrating the necessity for a more comprehensive approach that includes education and policymaking to effectively manage dyslipidemia.
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Kidney organoids derived from human pluripotent stem cells (hPSCs) contain multilineage nephrogenic progenitor cells and can recapitulate the development of the kidney. Kidney organoids derived from hPSCs have the potential to be applied in regenerative medicine as well as renal disease modeling, drug screening, and nephrotoxicity testing. Despite biotechnological advances, individual differences in morphological and growth characteristics among kidney organoids need to be addressed before clinical and commercial application. In this study, we hypothesized that an automated noninvasive method based on deep learning of bright-field images of kidney organoids can predict their differentiation status. Methods: Bright-field images of kidney organoids were collected on day 18 after differentiation. To train convolutional neural networks (CNNs), we utilized a transfer learning approach. CNNs were trained to predict the differentiation of kidney organoids on bright-field images based on the messenger RNA expression of renal tubular epithelial cells as well as podocytes. Results: The best prediction model was DenseNet121 with a total Pearson correlation coefficient score of 0.783 on a test dataset. W classified the kidney organoids into two categories: organoids with above-average gene expression (Positive) and those with below-average gene expression (Negative). Comparing the best-performing CNN with human-based classifiers, the CNN algorithm had a receiver operating characteristic-area under the curve (AUC) score of 0.85, while the experts had an AUC score of 0.48. Conclusion: These results confirmed our original hypothesis and demonstrated that our artificial intelligence algorithm can successfully recognize the differentiation status of kidney organoids.
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Background@#The risk of device thrombosis and device-oriented clinical outcomes with bioresorbable vascular scaffold (BVS) was reported to be significantly higher than with contemporary drug-eluting stents (DESs). However, optimal device implantation may improve clinical outcomes in patients receiving BVS. The current study evaluated mid-term safety and efficacy of Absorb BVS with meticulous device optimization under intravascular imaging guidance. @*Methods@#The SMART-REWARD and PERSPECTIVE-PCI registries in Korea prospectively enrolled 390 patients with BVS and 675 patients with DES, respectively. The primary endpoint was target vessel failure (TVF) at 2 years and the secondary major endpoint was patientoriented composite outcome (POCO) at 2 years. @*Results@#Patient-level pooled analysis evaluated 1,003 patients (377 patients with BVS and 626 patients with DES). Mean scaffold diameter per lesion was 3.24 ± 0.30 mm in BVS group.Most BVSs were implanted with pre-dilatation (90.9%), intravascular imaging guidance (74.9%), and post-dilatation (73.1%) at proximal to mid segment (81.9%) in target vessel.Patients treated with BVS showed comparable risks of 2-year TVF (2.9% vs. 3.7%, adjusted hazard ratio [HR], 1.283, 95% confidence interval [CI], 0.487–3.378, P = 0.615) and 2-year POCO (4.5% vs. 5.9%, adjusted HR, 1.413, 95% CI, 0.663–3.012,P = 0.370) than those with DES. The rate of 2-year definite or probable device thrombosis (0.3% vs. 0.5%, P = 0.424) was also similar. The sensitivity analyses consistently showed comparable risk of TVF and POCO between the 2 groups. @*Conclusion@#With meticulous device optimization under imaging guidance and avoidance of implantation in small vessels, BVS showed comparable risks of 2-year TVF and device thrombosis with DES.
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Background@#To investigate the clinical findings of choroideremia patients and perform genetic analysis by whole-exome sequencing (WES). @*Methods@#A total of 94 patients initially diagnosed with retinitis pigmentosa (RP) at another hospital, and who visited our hospital for genetic analysis by WES, were included in the study, along with 64 family members. All subjects underwent comprehensive ophthalmic evaluation, including best-corrected visual acuity, slit lamp examination, fundus photography, fundus autofluorescence (FAF), fluorescein angiography (FAG), visual field (VF), electroretinogram (ERG), and optical coherence tomography (OCT). @*Results@#In six male patients with suspected choroideremia, extensive retinal pigment epithelium (RPE) and severe loss of choroid were observed in the fundus, but not in the macula. CHM gene mutation was confirmed in five patients. A novel single nucleotide variant at a splice site was observed in one patient. OCT showed marked thinning of the outernuclear layer and choroid, except in the macula. FAF showed a small area of hyperfluorescence in the posterior pole. In addition, characteristic interlaminar bridges were observed in four patients. On FAG, hypofluorescence was seen up to the far-peripheral retina in five patients. @*Conclusion@#Of the 94 patients initially diagnosed with RP, CHM mutation was identified in five (5.3%) by WES. Choroideremia should be considered as a differential diagnosis of RP.WES would be useful for identifying the causes of hereditary retinal disease.
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Purpose@#To analyze 10-year trends in utilization of visual field tests for adult glaucoma or glaucoma-suspect patients using the Korean Health Insurance Review and Assessment data. @*Methods@#Health claims for the years 2010 to 2019, as recorded via Korea’s Health Insurance Review and Assessment service, were accessed. We identified glaucoma patients using the glaucoma diagnostic codes H40 (glaucoma) and H42 (glaucoma in other diseases classified elsewhere). For verification of the glaucoma diagnosis, information on any antiglaucoma medication prescriptions and ocular surgery history also was obtained. Visual field testing data was isolated using procedural codes E6690 (kinetic perimetry) and E6691 (standard automated perimetry [SAP]) performed in tertiary hospitals. Any changes in visual field test utilization were identified using regression trend analysis. @*Results@#From 2010 to 2019, the total number of SAP procedures performed in tertiary hospitals for either glaucoma or glaucoma-suspect patients increased gradually from 93,459 to 216,433. With regard to kinetic perimetry examinations, the total number decreased gradually from 6,364 to 3,792. The yearly average SAP number per patient showed a slight increase, from 1.168 to 1.248 (ß = 0.008, R2 = 0.669, p = 0.004). Meanwhile, the yearly average number of kinetic perimeter examinations per patient showed a significant decrease, from 1.093 to 0.940 (ß = -0.013, R2 = 0.580, p = 0.010). @*Conclusions@#Between 2010 and 2019, the yearly average number of SAP procedures performed per glaucoma or glaucoma-suspect patient increased in Korea. Meanwhile, the yearly average number of kinetic perimetry examinations per patient significantly decreased.
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Purpose@#We report a case of keratitis that improved after removal of a causative plant foreign body from below the posterior surface of an opaque cornea. The foreign body was revealed by anterior segment optical coherence tomography (AS-OCT) and gonioscopy.Case summary: A 79-year-old woman was referred with an impression of left-eye keratitis; the eye had been injured by a branch of a tangerine tree 1 month prior. She had been given the usual topical antibiotics by a local clinic, but they were ineffective. At her initial visit, her visual acuity was only hand motion in the left eye; slit-lamp examination revealed a 3 × 3-mm corneal infiltration with a hypopyon in the anterior chamber. Despite administration of strong topical antibiotics on an hourly basis, the corneal lesion worsened. AS-OCT and gonioscopy revealed a small foreign body below the posterior surface of the cornea; this was surgically removed. The corneal opacity and corneal epithelial defects dramatically improved, and the hypopyon disappeared. @*Conclusions@#The possibility of a residual foreign body should be considered if trauma precedes infectious keratitis that does not improve with conventional treatment and the posterior surface of the cornea is not visible because of corneal opacity. In such a case, AS-OCT and gonioscopy can be useful.
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A Barrow type D of complex cavernous sinus dural arteriovenous fistula (CS-dAVF) was completely obliterated by using coils, n-butyl 2-cyanoacrylate (NBCA) and Onyx via transvenous approach. Especially in this case, after transvenous coil embolization of the pathologic cavernous sinus (CS), transvenous injection of NBCA was done to obliterate residual shunts recruited into CS. The complex CS-dAVF was completely obliterated without periprocedural complications. Transvenous injection of NBCA could be considered as a feasible option for obliteration of pathologic CS in a case of incompletely obliterated complex CS-dAVF after transvenous coil embolization.
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Background/Aims@#Tacrolimus has been used as an immunosuppressive agent in organ transplantation. Despite the therapeutic benefits, tacrolimus’s use is limited due to its nephrotoxicity. To reduce tacrolimus nephrotoxicity, effective humanized experimental models may be helpful. Here, we modeled tacrolimus nephrotoxicity using kidney organoids derived from human inducible pluripotent stem cells (iPSCs) in vitro. @*Methods@#Kidney organoids were differentiated from the CMC11 iPSC cell line, re-seeded in 96-well plates, and treated with tacrolimus at doses of 0, 30, or 60 μM for 24 hours. This in vitro model was compared to a mouse model of tacrolimus nephrotoxicity and the associated mechanisms were investigated. @*Results@#The size of the kidney organoids and cell viability decreased in dose-dependent manners after treatment with tacrolimus. The number of tubular cells decreased with a loss of polarity, similar to the effects seen in mouse tacrolimus nephrotoxicity. Ultrastructural analysis showed numerous vacuoles in the proximal tubular cells of the kidney organoids treated with tacrolimus. Tacrolimus treatment induced oxidative stress and mitochondrial dysfunction, and autophagic activity was enhanced in the kidney organoids. Rapamycin, an autophagy inducer, accelerated cell death in the kidney organoid model of tacrolimus nephrotoxicity, which was attenuated by treatment with 3-methyladenine, an autophagy inhibitor. These findings indicate that the augmentation of autophagy by rapamycin treatment accelerated tacrolimus nephrotoxicity. @*Conclusions@#Our data suggest that human kidney organoids are an effective in vitro model of tacrolimus nephrotoxicity and that autophagy plays a critical role in tacrolimus nephrotoxicity.
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Background@#Lung adenocarcinoma (LUAD) with ground-glass opacity (GGO) can become aggravated, but the reasons for this aggravation are not fully understood. The goal of this study was to analyze the genetic features and causes of progression of GGO LUAD. @*Methods@#LUAD tumor samples and normal tissues were analyzed using an Illumina HiSeq 4000 system. After the tumor mutational burden (TMB) was calculated, the identified mutations were classified as those found only in GGO LUAD, those present only in nonGGO LUAD, and those common to both tissue types. Ten high-frequency genes were selected from each domain, after which protein interaction network analysis was conducted. @*Results@#Overall, 227 mutations in GGO LUAD, 212 in non-GGO LUAD, and 48 that were common to both tumor types were found. The TMB was 8.8 in GGO and 7.8 in non-GGO samples. In GGO LUAD, mutations of FCGBP and SFTPA1 were identified. FOXQ1, IRF5, and MAGEC1 mutations were common to both types, and CDC27 and NOTCH4 mutations were identified in the non-GGO LUAD. Protein interaction network analysis indicated that IRF5 (common to both tissue types) and CDC27 (found in the non-GGO LUAD) had significant biological functions related to the cell cycle and proliferation. @*Conclusion@#In conclusion, GGO LUAD exhibited a higher TMB than non-GGO LUAD. No clinically meaningful mutations were found to be specific to GGO LUAD, but mutations involved in the epithelial-mesenchymal transition or cell cycle were found in both tumor types and in non-GGO tissue alone. These findings could explain the non-invasiveness of GGO-type LUAD.
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Objective@#: Despite widespread use of flow diverters (FDs) to treat aneurysms, the exact healing mechanism associated with FDs remains poorly understood. We aim to describe the healing process of aneurysms treated using FDs by demonstrating the histopathologic progression in a canine aneurysm model. @*Methods@#: Twenty-one side wall aneurysms were created in common carotid artery of eight dogs and treated with two different FDs. Angiographic follow-ups were done immediately after placement of the device, 4 weeks and 12 weeks. At last follow-up, the aneurysm and the device-implanted parent artery were harvested. @*Results@#: Histopathologic findings of aneurysms at 4 weeks follow-up showed intra-aneurysm thrombus formation in laminating fashion, and neointimal thickening at the mid-segment of aneurysm. However, there are inhomogenous findings in aneurysms treated with the same type of FD showing same angiographic outcomes. At 12 weeks, aneurysms of complete and near-complete occlusion revealed markedly shrunken aneurysm filled with organized connective tissues with thin neointima. Aneurysms of incomplete occlusion at 12 weeks showed small amount of organized thrombus around fringe neck and large empty space with thick neointmal formation. Neointimal thickness and diameter stenosis was not significantly different between the groups of FD specification and follow-up period. @*Conclusion@#: Intra-aneurysmal thrombus formation and organization seem to be an important factor for the complete occlusion of aneurysms treated using the FD. Neointimal formation could occur along the struts of the FD independently of intra-aneurysmal thrombus formation. However, neointimal formation could not solely lead to complete aneurysm healing.
ABSTRACT
Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
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OBJECTIVE: To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR).METHODS: A single-plane DSA system with 3-dimensional rotational angiography, cone-beam computed tomography (CBCT), and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of cerebrovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorized into three subcategorical procedures : combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, and frameless stereotaxic operation.RESULTS: Forty-nine of 191 procedures were performed using hybrid techniques. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial hemorrhage (ICH) were treated by partial embolization and surgical clipping. Six cases of ruptured arteriovenous malformation with ICH were treated by Onyx embolization of nidus and subsequent surgical removal of nidus and ICH. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolization. In one (0.8%) complicated case of 103 intra-arterial thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. In 27 cases of ICH, frameless stereotaxic hematoma aspiration was performed using XperGuide® system (Philips Medical Systems, Best, the Netherlands). All procedures were performed in single sessions without any procedural complications.CONCLUSION: Hybrid OR with a fully equipped DSA system could provide precise and safe treatment strategies for cerebrovascular diseases. Especially, we could suggest a strategy to cope flexibly in complex lesions or unexpected situations in hybrid OR. CBCT with real-time navigation software could augment the usefulness of hybrid OR.
Subject(s)
Aneurysm , Aneurysm, Ruptured , Angiography , Angiography, Digital Subtraction , Arteries , Arteriovenous Malformations , Blister , Cerebrovascular Disorders , Cone-Beam Computed Tomography , Embolectomy , Embolization, Therapeutic , Emergencies , Hematoma , Intracranial Hemorrhages , Operating Rooms , Retrospective Studies , Rupture , Surgical Instruments , ThrombectomyABSTRACT
PURPOSE: To report a case of chemical injury of the cornea caused by high-dose ethanol during orbital wall fracture repair. CASE SUMMARY: A 56-year-old male presented with pain after blowout fracture repair surgery. During the surgery, 2% hexethanol solution (2% chlorhexidine and 72% ethanol mixture), which was used for disinfection of the face, flowed into the left eye. Conjunctival injection in the left limbus, a large corneal epithelial defect, and severe stromal edema were subsequently observed. The patient was treated with topical antibiotics, steroids, and autologous serum eye drops. After 1 week, the corneal epithelial defect was improved, but at the second month of therapy, recurrent corneal erosion with deterioration of the endothelial cell function occurred. Anterior stromal puncture and laser keratectomy were performed. The corneal epithelial defect and erosion improved, but the endothelial cell density was severely decreased. CONCLUSIONS: The 2% hexethanol solution is usually used for preoperative skin disinfection, but it contains a high concentration of ethanol. The surgeon should be aware that high concentrations of ethanol may result in severe corneal damage, including corneal endothelial dysfunction and limbal cell deficiency.
Subject(s)
Humans , Male , Middle Aged , Anti-Bacterial Agents , Chlorhexidine , Cornea , Corneal Injuries , Corneal Surgery, Laser , Disinfection , Edema , Endothelial Cells , Ethanol , Ophthalmic Solutions , Orbit , Punctures , Skin , SteroidsABSTRACT
PURPOSE: We report a case of toxic keratoconjunctivitis resulting from the self-application of human breast milk as a traditional folk remedy for allergic conjunctivitis. CASE SUMMARY: An 82-year-old woman presented with pain and conjunctival hyperemia in the right eye that had been worsening for three days. Two months previously, she was treated with antiallergic eye drops for allergic conjunctivitis at another eye clinic. However, the symptoms did not improve. She applied her daughter-in-law's breast milk into her right eye as a folk remedy for three days. The pain and conjunctival hyperemia worsened. At the initial visit, her corrected visual acuity was 0.3 in the right eye. Slit lamp examination demonstrated conjunctival hyperemia, punctate epithelial erosion at the central cornea, corneal keratic precipitates and white-colored deposits in the peripheral cornea combined with irregularly shaped small nodules. There was no anterior chamber inflammation. There was no medical history of rheumatoid arthritis or tuberculosis. Blood tests for serum and other infectious and inflammatory levels for infection and inflammatory markers were performed followed by application of topical steroids and antibiotics with artificial tears. After 3 weeks of treatment, conjunctival hyperemia and corneal deposits had almost resolved and best-corrected visual acuity improved to 1.0. CONCLUSIONS: The self-application of human breast milk may cause toxic keratoconjunctivitis. Therefore, efforts should be made, actively, to inform and educate the elderly in rural areas not to use human breast milk as a folk remedy.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Anterior Chamber , Anti-Bacterial Agents , Arthritis, Rheumatoid , Breast , Conjunctivitis, Allergic , Cornea , Hematologic Tests , Hyperemia , Inflammation , Keratoconjunctivitis , Lubricant Eye Drops , Medicine, Traditional , Milk, Human , Ophthalmic Solutions , Slit Lamp , Steroids , Tuberculosis , Visual AcuityABSTRACT
OBJECTIVE: To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). METHODS: A single-plane DSA system with 3-dimensional rotational angiography, cone-beam computed tomography (CBCT), and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of cerebrovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorized into three subcategorical procedures : combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, and frameless stereotaxic operation. RESULTS: Forty-nine of 191 procedures were performed using hybrid techniques. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial hemorrhage (ICH) were treated by partial embolization and surgical clipping. Six cases of ruptured arteriovenous malformation with ICH were treated by Onyx embolization of nidus and subsequent surgical removal of nidus and ICH. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolization. In one (0.8%) complicated case of 103 intra-arterial thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. In 27 cases of ICH, frameless stereotaxic hematoma aspiration was performed using XperGuide® system (Philips Medical Systems, Best, the Netherlands). All procedures were performed in single sessions without any procedural complications. CONCLUSION: Hybrid OR with a fully equipped DSA system could provide precise and safe treatment strategies for cerebrovascular diseases. Especially, we could suggest a strategy to cope flexibly in complex lesions or unexpected situations in hybrid OR. CBCT with real-time navigation software could augment the usefulness of hybrid OR.
Subject(s)
Aneurysm , Aneurysm, Ruptured , Angiography , Angiography, Digital Subtraction , Arteries , Arteriovenous Malformations , Blister , Cerebrovascular Disorders , Cone-Beam Computed Tomography , Embolectomy , Embolization, Therapeutic , Emergencies , Hematoma , Intracranial Hemorrhages , Operating Rooms , Retrospective Studies , Rupture , Surgical Instruments , ThrombectomyABSTRACT
BACKGROUND: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. RESULTS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. CONCLUSION: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
Subject(s)
Humans , Acute Coronary Syndrome , Cardiovascular Diseases , Cause of Death , Consultants , Coronary Disease , Delivery of Health Care , Heart , Hospitals, General , Hospitals, University , Insurance Benefits , Korea , Life Style , Methods , Mortality , Myocardial Infarction , Nutritionists , Physical Therapists , Preventive Medicine , Recurrence , Rehabilitation , Secondary Prevention , Specialization , Sports Medicine , SurgeonsABSTRACT
BACKGROUND@#Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea.@*METHODS@#This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified.@*RESULTS@#CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR.@*CONCLUSION@#Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
ABSTRACT
OBJECTIVE: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. PRINCIPAL CONCLUSIONS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
Subject(s)
Humans , Acute Coronary Syndrome , Cardiovascular Diseases , Cause of Death , Consultants , Coronary Disease , Delivery of Health Care , Heart , Hospitals, General , Hospitals, University , Insurance Benefits , Korea , Life Style , Methods , Mortality , Myocardial Infarction , Nutritionists , Physical Therapists , Preventive Medicine , Recurrence , Rehabilitation , Secondary Prevention , Specialization , Sports Medicine , SurgeonsABSTRACT
Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.