Changes in Diagnostic Performance of Thyroid Cancer Screening before and after the Korean Thyroid Imaging Reporting and Data System Revision / 가정의학회지

Background@#Since the era of “thyroid cancer epidemic,” many Korean academic societies discouraged the use of ultrasonography in healthy individuals and revised the Korean Thyroid Imaging Reporting and Data System to address the overscreening and overdiagnosis issues. This study aimed to evaluate the change in the diagnostic effectiveness of thyroid cancer screening over the last decade. @*Methods@#This single-center, retrospective observational study analyzed the data of 125,962 thyroid nodules obtained during cancer screening at the health promotion center of Seoul National University Bundang Hospital from 2010 to 2019. Only 327 thyroid cancer cases pathologically confirmed by fine-needle aspiration (FNA) were included in the study. The strength of the association between the number of FNA and (1) the number of thyroid cancer diagnoses, (2) the positive predictive values (PPVs), and (3) the difference in PPV from the previous year were evaluated using Pearson’s correlation analysis. @*Results@#The number of thyroid FNA biopsies as well as the thyroid cancer diagnoses decreased from 2010 to 2019 (166 to 48 [-71.1%] vs. 43 to 22 [-48.8%]). The PPV of FNA biopsies increased from 25.9% to 45.8% (+76.8%) and was negatively correlated with the number of FNA biopsies performed (R=-0.87, P<0.001). The difference in PPV from the previous year increased similarly but without statistical significance (R=-0.59, P=0.09). @*Conclusion@#The diagnostic efficiency of thyroid cancer screening has increased over the last decade, as evidenced by the increasing PPV of FNA biopsies.

Fruit Intake and Changes of Cardio-Metabolic Risk Factors in People with Obesity / 가정의학회지

Background@#This study aimed to explore the relationship between fruit intake, changes in fruit intake, and changes in cardiometabolic factors in people with obesity. @*Methods@#A total of 21,270 subjects (8,718 men, 12,552 women) aged 40 years and over, from the Korean-based Genome and Epidemiology Study, were followed up for an average of 4.4 years. Fruit intake was assessed using a food frequency questionnaire at baseline and the second follow-up. The beta coefficient and confidence intervals for changes in cardiometabolic risk factors according to fruit consumption were calculated using a linear regression model. @*Results@#In men, the abdominal circumference decreased with changes in fruit intake (P=0.029). Fruit intake and increased fruit intake in men were associated with a lower systolic blood pressure (P=0.012 and P=0.02, respectively) and lower triglyceride levels (P=0.002 and P<0.001, respectively). In women, abdominal circumference decreased with both fruit intake and increased fruit intake (P<0.001 and P=0.013, respectively). Systolic blood pressure and triglycerides tended to decrease only with fruit intake (P=0.048 and P<0.001, respectively). Unlike in men, fasting blood glucose tended to decrease in women with both fruit intake and increased fruit intake (P=0.011 and P=0.005, respectively). @*Conclusion@#Fruit intake and increased fruit intake may have beneficial effects on cardiometabolic risk factors among individuals who are obese.

Fruit Intake and Changes of Cardio-Metabolic Risk Factors in People with Obesity / 가정의학회지

Background@#This study aimed to explore the relationship between fruit intake, changes in fruit intake, and changes in cardiometabolic factors in people with obesity. @*Methods@#A total of 21,270 subjects (8,718 men, 12,552 women) aged 40 years and over, from the Korean-based Genome and Epidemiology Study, were followed up for an average of 4.4 years. Fruit intake was assessed using a food frequency questionnaire at baseline and the second follow-up. The beta coefficient and confidence intervals for changes in cardiometabolic risk factors according to fruit consumption were calculated using a linear regression model. @*Results@#In men, the abdominal circumference decreased with changes in fruit intake (P=0.029). Fruit intake and increased fruit intake in men were associated with a lower systolic blood pressure (P=0.012 and P=0.02, respectively) and lower triglyceride levels (P=0.002 and P<0.001, respectively). In women, abdominal circumference decreased with both fruit intake and increased fruit intake (P<0.001 and P=0.013, respectively). Systolic blood pressure and triglycerides tended to decrease only with fruit intake (P=0.048 and P<0.001, respectively). Unlike in men, fasting blood glucose tended to decrease in women with both fruit intake and increased fruit intake (P=0.011 and P=0.005, respectively). @*Conclusion@#Fruit intake and increased fruit intake may have beneficial effects on cardiometabolic risk factors among individuals who are obese.

Risk Factors of Cardiovascular Disease according to Alcohol Behavioral Change after Cancer Diagnosis / 가정의학회지

Background@#Problem drinking increases the incidence of all-cause mortality and specific cancers, and persistent drinking is associated with cardiovascular disease in certain cancer survivors. This study analyzed the cardiovascular risk factors before and after diagnosis in Korean cancer survivors. @*Methods@#Data for the period between 2002 and 2013 were collected from the National Health Insurance Service Health-Examinee Cohort Database. Among the 27,835 patients included, those with moderate alcohol consumption before and after cancer diagnosis were excluded. Problem drinking was defined as males under 65 years consuming over 14 glasses a week, and males over 65 years or females consuming over seven glasses a week. A t-test, chi-square test, and linear regression analysis were performed for differences in cardiovascular risk factors and differences according to cancer types. @*Results@#There was a difference in the body mass index, systolic and diastolic blood pressure, and total cholesterol among patients who became moderate drinkers after diagnosis, but fasting blood glucose did not show any significant changes. Risk factors for cardiovascular disease were analyzed in patients with liver, stomach, rectal, and breast cancer with improved drinking behavior, and there were significant differences in body mass index, systolic and diastolic blood pressure, fasting blood glucose, and total cholesterol in stomach cancer patients. @*Conclusion@#Moderate drinking can lower cardiovascular risk in cancer survivors, and among the many drinking-related cancers, stomach cancer patients demonstrated significantly reduced cardiovascular risk factors.

Usefulness of the Patient Health Questionnaire-2 in Screening for Depression

BACKGROUND: While various screening tools are available for depression, they are not feasible in clinical practice because of their excessive number of questions. The Patient Health Questionnaire-2 (PHQ-2) consists of two questions gauging the frequency of depressed mood and anhedonia over the past two weeks. This study aimed to assess the usefulness of the PHQ-2 as a brief screening tool for depression.METHODS: This study used Korean National Health and Nutrition Examination Survey data from 2014, and the study population consisted of 4,946 individuals. We analyzed the validity of the PHQ-2 compared with ‘depression by PHQ-9,’ and obtained the optimal cut point for screening depression. The agreement between PHQ-2 and depression by PHQ-9 and the agreement between PHQ-2 and ‘currently diagnosed as depression’ were analyzed using Cohen's kappa. The correlation between EuroQol-5D (EQ-5D) index scores and PHQ-2 scores was analyzed using Student's t-test.RESULTS: Using ‘depression by PHQ-9’ as the criterion standard, PHQ-2 scores ≥2 had a sensitivity of 89% and a specificity of 87%, and a receiver operating characteristic analysis identified PHQ-2≥2 as the optimal cut point for screening. The agreement between PHQ-2 and depression by PHQ-9 was 0.430 when PHQ-2 ≥2 was used as a cut point. The agreement between PHQ-2 and ‘depression by questionnaire’ was poor. The EQ-5D index score of the depressive group was significantly lower than that of the normal group.CONCLUSION: The PHQ-2 is an effective measure for screening depression and is expected to be useful in busy clinical settings.

Dietary Patterns Assessed by the Diet Quality Index-International Among Cancer Survivors Compared with Healthy Control Subjects: Using the Korea National Health and Nutrition Examination Surveys 2013–2015

BACKGROUND: Dietary patterns have a significant impact on prognosis, recurrence, and survival in patients with cancer. This study investigated dietary patterns using the Diet Quality Index-International (DQI-I) in cancer survivors compared to those in the general population without cancer.METHODS: Using the Korea National Health and Nutrition Examination Survey VI data, cancer survivors were defined as those diagnosed with cancer more than 1 year before the survey. The associations between possible predictors and the DQI-I score were examined using t-tests and analysis of variance. Adjusted multiple linear regression analysis was performed to compare the differences in DQI-I scores between cancer survivors and controls.RESULTS: In univariate analysis of 9,351 subjects (433 cancer survivors and 8,918 controls), age, sex, body mass index, marital status, education level, income, residential area, smoking status, and alcohol consumption were associated with the DQI-I score (each P-value < 0.05). After adjustment, cancer survivors showed higher DQI-I scores than the controls (67.40±8.90 vs. 65.50±9.40, P-value=0.007). In subgroup analysis, cancer survivors within 5 years after cancer diagnosis showed higher DQI-I scores than the controls (68.70±8.30 vs. 65.50±9.40, P-value=0.034), whereas those who survived beyond 5 years post-diagnosis did not show significant differences from the controls (66.70±9.20 vs. 65.50±9.40, P-value=0.063).CONCLUSION: Cancer survivors within 5 years of cancer diagnosis showed better dietary patterns than those in the general population. However, the differences were not observed after 5 years post-diagnosis. To reduce the risks of second primary cancer and mortality, targeted inventions for dietary habits are necessary for long-term survivors of cancer.

Comparing the Certification Criteria for CCHIT-Certified Ambulatory EHR with the SNUBH's EHR Functionalities / 대한의료정보학회지

OBJECTIVES: This study aims to investigate the suitability of electronic health record (EHR) systems in Korea for global certification and to propose functions for future global systems by comparing and analyzing the certification criteria for Certification Commission for Health Information Technology (CCHIT) Certified Ambulatory EHR with BESTCare, which is the EHR system at Seoul National University Bundang hospital. METHODS: Domain expert groups were formed to analyze the inclusion of BESTCare functions and the types of differences for each of the CCHIT Certified 2011 Ambulatory EHR Certification Criteria. The types of differences were divided into differences in functions (F), differences in business processes (B), and differences in government policies (P). RESULTS: Generally, the criteria that showed differences in functions pertained to the connection between the diagnosis/problem list and order, the alert and warning functions for medication-diagnosis interactions, and the reminder/instruction/notification messages related to the patient's immunization status; these absent functions were enhanced clinical decision support system (CDSS) functions related to patient safety and healthcare quality. Differences in government policies were found in the pharmacy's electronic prescription functions, while differences in business processes were found in the functions constrained by the local workflow or internal policy, which require some customization. CONCLUSIONS: Functions that differed between the CCHIT certification criteria and the BESTCare system in this study should be considered when developing a global EHR system. Such a system will need to be easily customizable to adapt to various government policies and local business processes. These functions should be considered when developing a global EHR system certified by CCHIT in the future.

Monitor Preference for Electronic Medical Record in Outpatient Clinic / 대한의료정보학회지

OBJECTIVES: The objective of this paper is to assess which wide type monitor configurations are preferred when physicians use an Electronic Medical Record (EMR) system in an outpatient clinic setting. METHODS: We selected three kinds of monitor configurations available for adoption at outpatient clinics with reference to monitor market trends. Fifteen attending physicians of the Seoul National University Bundang Hospital used each monitor configuration in their outpatient clinics. After completing the outpatient sessions, they selected the best monitor configuration for criteria described in five questionnaire items. We counted the number of votes and reviewed opinions of participants. RESULTS: The Wide Quad High Definition (WQHD) 27-inch single monitor configuration was most preferred for all questionnaire items. All participants answered that the WQHD 27-inch single monitor configuration was the best for desk space utilization. Eleven out of fifteen participants chose the WQHD 27-inch single monitor configuration as the most suitable monitor for outpatient practice. CONCLUSIONS: This study found that physicians preferred the WQHD 27-inch single monitor configuration in outpatient clinic settings. Healthcare organizations need to consider this finding when they purchase wide type monitors for EMR systems instead of the standard type monitor.

Seoul National University Bundang Hospital's Electronic System for Total Care / 대한의료정보학회지

OBJECTIVES: Seoul National University Bundang Hospital, which is the first Stage 7 hospital outside of North America, has adopted and utilized an innovative and emerging information technology system to improve the efficiency and quality of patient care. The objective of this paper is to briefly introduce the major components of the SNUBH information system and to describe our progress toward a next-generation hospital information system (HIS). METHODS: SNUBH opened in 2003 as a fully digital hospital by successfully launching a new HIS named BESTCare, "Bundang hospital Electronic System for Total Care". Subsequently, the system has been continuously improved with new applications, including close-loop medication administration (CLMA), clinical data warehouse (CDW), health information exchange (HIE), and disaster recovery (DR), which have resulted in the achievement of Stage 7 status. RESULTS: The BESTCare system is an integrated system for a university hospital setting. BESTCare is mainly composed of three application domains: the core applications, an information infrastructure, and channel domains. The most critical and unique applications of the system, such as the electronic medical record (EMR), computerized physician order entry (CPOE), clinical decision support system (CDSS), CLMA, CDW, HIE, and DR applications, are described in detail. CONCLUSIONS: Beyond our achievement of Stage 7 hospital status, we are currently developing a next-generation HIS with new goals of implementing infrastructure that is flexible and innovative, implementing a patient-centered system, and strengthening the IT capability to maximize the hospital value.

Seoul National University Bundang Hospital's Electronic System for Total Care / 대한의료정보학회지

OBJECTIVES: Seoul National University Bundang Hospital, which is the first Stage 7 hospital outside of North America, has adopted and utilized an innovative and emerging information technology system to improve the efficiency and quality of patient care. The objective of this paper is to briefly introduce the major components of the SNUBH information system and to describe our progress toward a next-generation hospital information system (HIS). METHODS: SNUBH opened in 2003 as a fully digital hospital by successfully launching a new HIS named BESTCare, "Bundang hospital Electronic System for Total Care". Subsequently, the system has been continuously improved with new applications, including close-loop medication administration (CLMA), clinical data warehouse (CDW), health information exchange (HIE), and disaster recovery (DR), which have resulted in the achievement of Stage 7 status. RESULTS: The BESTCare system is an integrated system for a university hospital setting. BESTCare is mainly composed of three application domains: the core applications, an information infrastructure, and channel domains. The most critical and unique applications of the system, such as the electronic medical record (EMR), computerized physician order entry (CPOE), clinical decision support system (CDSS), CLMA, CDW, HIE, and DR applications, are described in detail. CONCLUSIONS: Beyond our achievement of Stage 7 hospital status, we are currently developing a next-generation HIS with new goals of implementing infrastructure that is flexible and innovative, implementing a patient-centered system, and strengthening the IT capability to maximize the hospital value.

Implementation of a Videoconferencing System between Multiple Family Medicine Departments / 가정의학회지

Attending conferences is important for doctors and residents in family medicine. Nevertheless, departments of family medicine at many hospitals find it difficult to hold regular conferences. Holding joint videoconferences between Family Medicine Departments of several hospitals through a videoconferencing system could solve this problem. Therefore, Family Medicine Departments of Seoul National University Hospital, Seoul National University Bundang Hospital, and Kangwon National University Hospital decided to hold regular joint videoconferences via a videoconferencing system. Eighty-one joint videoconferences were held from April 1 to October 29, 2010. PowerPoint slideshows were transferred to the other two locations in the same resolution as presenter's monitor. Image and voice of the speaker were transferred in real time and in acceptable quality. Joint videoconferences are feasible, satisfactory and useful for medical education, especially when individual family medicine departments are small and lack resources to hold face-to-face conferences. We expect that more family medicine departments will choose to participate in implementing similar joint videoconferencing systems in the future.

Association of Proteinuria with Metabolic Syndrome in Korean Adults / 가정의학회지

BACKGROUND: Proteinuria is a predictor of chronic kidney disease and a common risk factor for cardiovascular disease. Previous studies have reported that a urinary albumin-creatinine ratio and a glomerular filtration rate was related to the metabolic syndrome. However, there have been few studies on association between the metabolic syndrome and proteinuria by the urine dip-stick test. We examined the association between the metabolic syndrome and the proteinuria by the urine dip-stick test. METHODS: The subject of this study included 20,075 adults aged more than 18 years old who visited the Health Promotion Center of the Seoul National University Hospital from April 2001 to March 2007. The metabolic syndrome was defined according to the criteria of the American Heart Association and National Heart, Lung and Blood Institute, and proteinuria was defined as a dipstick test above the '1+' level. The crude and multivariated-adjusted odds ratios of proteinuria were calculated by using logistic regression models with each component of the metabolic syndrome. RESULTS: Proteinuria was noticed in 5.7% of the subjects with metabolic syndrome, and 2.7% without metabolic syndrome. The multivariate-adjusted odds ratios of proteinuria in participants with elevated blood pressure level, elevated plasma glucose level and high triglyceride level were 2.23 (95% confidence interval [CI], 1.95 to 2.55), 2.33 (95% CI, 2.06 to 2.62), 1.64 (95% CI, 1.45 to 1.84). The multivariate-adjusted odds ratio of proteinuria in participants with the metabolic syndrome compared with participants without the metabolic syndrome was 2.30 (95% CI, 1.91 to 2.76), respectively. CONCLUSION: These findings suggest that proteinuria by the urine dip-stick test might be an important predictor in the metabolic syndrome.

A Clinical Study on Examination of Tubercle Bacilli in Renal Tuberculosis / 대한비뇨기과학회지

Comparative studies were performed between discovery of tubercle bacilli from prenephrectomy bladder urine and other clinical tests as performed on all 19 patients with renal tuberculosis who had been admitted to the Department of Urology at Seoul National University Hospital for the period of April 1958 hrough February 1959. The results in this study were summarized as follows: 1. Modes of antituberculosis medications prior to admission on these patients were as follow: SM only, 4 cases; combined use of SM and PAS, a cases; SM, PAS and INHcombined, 1 cases; unknown, 4 cases, and not used in 3 cases. 2. Durations of antituberculosis medications were as follow: Less one month, 4 cases, less than 6 months, 7 cases; over 6 months, 1 case; unknown, 4 cases, and not used in 3 cases. 3. Positivity rate for microscopic examination was 79% on prenephrectomy bladder urine and when two cases who also developed prostatic tuberculosis were excluded the positivity rate was 76% 4. Discovery of tubercle bacilli was not easy even on urine specimen which showed much protein and many white blood cells. 5. Cases which did not reveal tubercle bacilli on microscopic examination from caseous material of tuberculous renal cavity again showed microscopical negativity from prenephrectomy bladder urine. 6. The presence of the severe lesion of bladder wall was not related with ease with which tubercle bacilli being found from prenephrectomy bladder uriue. 7. Adverse effect was to be foundfrom antituberculosis medication as to the tubercle bacilli on prenephrectomy urine. Cases who had used antituberculosis drugs for less than one month showed high positivity rate equal to the cases who never did. 8. It was deemed unnecessary to stop using antituberculosis medication of less than two months' duration in order to discover tubercle bacilli on prenephrectomy bladder urine. 9.Inability to discover tubercle bacilli on prenephrectomy bladder urine was not wholly due to the previous use of antituberculosis drugs and to raise the positivity rate repeated examination would be indicated.

Studies on Cultivation and Drug-Resistance of Tubercle Bacilli Isolated from Renal Tuberculosis / 대한비뇨기과학회지

Author performed clinical studies at random on 19 patients with renal tuberculosis who were admitted for the period of April 1958 through February 1959 to Department of Urology at Seoul National University Hospital as to tuberculosis bacterial cultures and their resistance tests using pre- and postnephrectomy urine and diseased tissue itself. The results in this study were summarized as follows: 1. All except one case had received antituberculosis medication for not more than 6 months. 2. To all cases beginning at the time of admission preoperation medications consisting of SM 1.0 gm, PAS 12gm, and INH 300mg, and these regimen were given throughout study. 3. The culture positivity rates were 79% in prenephrectomy bladder urine. 90% in caseous material from diseased renal cavity and 44% in postnephrectomy bladder urine. The lower were the culture positivity rate in prenephrectomy bladder urine, the longer the preceding period of antituberculosis drugs given. Culture positivity rate of caseous material from diseased renal cavity, however, was persistently high irrespective of the length of the antituberculosis medication and the culture positivity rate of postnephrectomy bladder urine appeared to be dependent more on the presence or absence of the remaining renal tuberculosis rather than on the period of antituberculosis medication. 5. From the repeated culture of prenephrectomy bladder urine over short period of time, in the same individual results were rather inconstant and this seemed to be independent upon the use of antituberculosis drugs. 6. Cultural studies on urine and diseased renal tissue yielded the same results whether it was checked on the day of specimen collection or after less than 7 day's refrigerated storage. 7. While doing cultural studies from prenephrectomy bladder urine on patients who received antituberculosis drugs one case was found to need more than two months to grow and this trend seemed to be more so in cases of cultures from diseased renal tissues. 8. Resistance was shown as to SM in 9 cases out of 10 cases on whom prenephrectomy bladder urines were checked, in 5 out of 6 cases on whom tuberculosis culturers were done from diseased renal caseous tissues and in 2 cases out of each group possessed resistance to PAS as well. 9. Resistance to SM was to be easily acquired and afterward the degree of resistance seemed to increase rapidly from the use of SM of short duration. 10. Cases with positive microscopic finding and negative cultures were seen only in prenephrectomy bladder urine and this fact was thought not to be specifically related to the antituberculosis treatment. 11. Cases with negative microscopic finding and positive cultures were seen in patient who received only long antituberculosis treatment and these were characterized by small number of colonies. 12. The appearance of resistant strain was found not to be specifically related with the status of microscopical finding on prenephrectomy bladder urine nor with cultural studies on the same specimen.

Clinical Study on Cases of Bladder Tumor / 대한비뇨기과학회지

1. Author has reviewed 41 cases of bladder tumor treated at Urological Department of Seoul National University during the period of 3 years and 9 months from August 1954 to May 1958. The clinical studies on above cases revealed following findings. 2. There were no specific relationships between family histories, past histories and occupations of patients and bladder tumor. 3. Among the series, 3 were recurrent, another 3 cases were metastatic while the rest of cases (35) were primary tumors. 4. 21 cases were treated as the in-patients, 11 cases out of 21 cases were treated by surgical procedures and 10 cases were found to be contraindicated for the surgical procedure because of the advancement of the malignancy. 5. There were 31 males and 9 females, the ratio being 4:1. 6. The youngest age was 26 and oldest age was 76. 80.5% of series ranged from 40 years of age to 69 years. 7. The 87.8% of chief complaints were hematuria, 78.0% were painful urination,37.1% were frequency. 8. The predominant initial symptom was hematuria among 78.0% of cases. 9. Since the time lapsed from the initial onset to first hospital visit was 6 months to 2 years in 48.7% of series. It showed marked difference from the fact that 43% of series reported by Drinker in the America visited hospital within 3 months from the initial onset. 10. According to cystoscopic findings, there were 19 cases of non-infiltrating type and 19 cases of infiltrating type while 3 metastatic type, 2 solitary and 20 multiple cases were present 11. As to the localization of tumor, 46.3% of series were on lateral wall of the bladder. 12. Out of 11 cases treated surgically 3 cases were treated by total cystectomy combined with ureterosigmoidostomy, 4 cases were electro-coagulation and 4 cases were partial resection of the bladder. 13. It seems to be feasible that estrogen could be administrated per os as a conservative procedure for an inoperable case and also estrogen could be combined as a pre-and post-operative medication for a surgical case.