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1.
Article in English | WPRIM | ID: wpr-926380

ABSTRACT

We reported a case of acute intoxication by tramadol and zolpidem, resulting in QT prolongation in a patient. A 38-year-old male patient presented to the emergency department (ED) because of poisoning from 3 g of tramadol and 50 mg of zolpidem 4 hours before. During supportive treatment, he developed QT prolongation without clinical manifestations. He was discharged 5 days after admission without any sequelae. We measured the blood and urine concentrations of tramadol and zolpidem at various time points, which revealed a blood tramadol concentration-dependent change in QT intervals and an increased blood tramadol concentration at 8 hours after the ED visit. Tramadol and zolpidem were metabolized by the same enzyme, cytochrome P450 3A4. Therefore, competitive inhibition may increase drug toxicity. In addition, the blood concentration of tramadol may increase and result in QT prolongation even after appropriate initial treatment.

2.
Article in English | WPRIM | ID: wpr-925509

ABSTRACT

Purpose@#Microinvasive breast cancer (MIBC) is an invasive carcinoma with a tumor dimension not exceeding 1 mm. Owing to its low incidence, the rate of axillary node metastasis and its management are not well established. The aim of this study was to assess the incidence of lymph node metastasis (LNM) and identify variables associated with LNM, as well as to evaluate the need for axillary staging in MIBC patients by analyzing nationwide data. @*Methods@#The Korean Breast Cancer Society registry was searched to identify MIBC patients diagnosed between January 1996 and April 2020. Patients without neoadjuvant chemotherapy experiences, systemic metastasis, and missing or discordant data were eligible for the analysis. The incidence rate of LNM was determined, and variables associated with LNM were identified by multivariable regression analysis. @*Results@#Of 2,427 MIBC patients identified, 98 (4.0%) had LNM and 12 (0.5%) had N2/3 disease. Type of breast operation (odds ratio [OR], 2.093; 95% confidence interval [CI], 1.332–3.290; P = 0.001), age (OR, 2.091; 95% CI, 1.326–3.298; P = 0.002), hormone receptor status (OR, 2.220; 95% CI, 1.372–3.594; P = 0.001), and lymphovascular invasion (OR, 11.143; 95% CI, 6.354–19.540; P < 0.001) were significantly related to LNM. @*Conclusion@#The incidence of LNM in MIBC patients was only 4.0% in our study, suggesting that de-escalation of axillary surgical interventions could be carefully considered. The indications for axillary staging should be individualized considering tumor volume, age, hormone receptor status, and lymphovascular invasion to improve the quality of life of MIBC survivors.

3.
Journal of Breast Cancer ; : 175-182, 2021.
Article in English | WPRIM | ID: wpr-891278

ABSTRACT

Purpose@#Li-Fraumeni syndrome (LFS) is a rare autosomal cancer syndrome caused by a germline mutation in the TP53 gene. Breast cancer in LFS patients is of various subtypes;however, limited data are available on the clinicopathological features of these subtypes and their appropriate treatments. This study aimed to review the clinical features and treatments for breast cancer in South Korean patients with germline TP53 mutations. @*Methods@#Data on the clinicopathological features and treatment of all breast cancer patients with LFS were collected retrospectively from the available database of 4 tertiary hospitals in the Republic of Korea. @*Results@#Twenty-one breast cancer cases in 12 unrelated women with confirmed germline TP53 mutations were included in the study. The median age at diagnosis was 33.5 years. The histopathological diagnosis included invasive ductal carcinoma (n = 16), ductal carcinoma in situ (n = 3), and malignant phyllodes tumor (n = 2). While 42% and 31% of the cases were positive for estrogen and progesterone receptors, respectively, 52.6% were human epidermal growth factor receptor 2 (HER2) positive, and 21% were triple-negative. The treatments included mastectomy (52%) and breast-conserving surgery (38%). Five patients underwent radiotherapy (RT). The median follow-up period was 87.5 (8–222) months. There were 3 ipsilateral and 4 contralateral breast recurrences during the follow-up, and 8 patients developed new primary cancers. In the post-RT subgroup, there were 2 ipsilateral and 2 contralateral breast recurrences in 1 patient, and 4 patients had a new primary cancer. @*Conclusion@#As reported in other countries, breast cancer in LFS patients in South Korea had an early onset and were predominantly but not exclusively positive for HER2.A multidisciplinary approach with adherence to the treatment guidelines, considering mastectomy, and avoiding RT is encouraged to prevent RT-associated sequelae in LFS patients.

4.
Journal of Breast Cancer ; : 164-174, 2021.
Article in English | WPRIM | ID: wpr-891277

ABSTRACT

Purpose@#In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. @*Methods@#In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. @*Results@#Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. @*Conclusion@#Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

5.
Article in English | WPRIM | ID: wpr-875171

ABSTRACT

Background@#Shoulder surgery in the beach chair position frequently causes hypotensive bradycardic events (HBEs), which are potentially associated with an increased risk of cerebral hypoperfusion. Here, we aimed to investigate the incidence and characteristics of symptomatic HBEs that require pharmacological interventions, and to identify specific risk factors associated with symptomatic HBEs. @*Methods@#We retrospectively examined the records of all patients aged ≥ 18 years who underwent shoulder arthrotomy in the beach chair position between January 2011 and December 2018 at Samsung Medical Center. For patients who experienced HBEs while in the beach chair position, the minimum heart rate and systolic blood pressure were noted, as was the total dose of ephedrine or atropine. @*Results@#Symptomatic HBEs occurred in 61.0% of all cases (256/420). Two patients with symptomatic HBEs experienced postoperative neurological complications. Multivariable logistic regression analysis showed that preoperative interscalene brachial plexus block (ISB) and advanced age were risk factors associated with symptomatic HBEs (odds ratio [OR]: 3.240, 95% CI: 2.003, 5.242, P < 0.001; OR: 1.060 for each 1-year increase, 95% CI: 1.044, 1.076, P < 0.001, respectively). Receiver operating curve analysis revealed that a threshold of 62 years of age had a moderate degree of accuracy for predicting symptomatic HBEs (area under curve: 0.764, 95% CI: 0.720, 0.804, P < 0.001). @*Conclusions@#Considering the increasing risk of neurocognitive complications with aging, proactive hemodynamic management is needed, especially for elderly patients undergoing shoulder surgery in the beach chair position using ISB.

6.
Journal of Breast Cancer ; : 175-182, 2021.
Article in English | WPRIM | ID: wpr-898982

ABSTRACT

Purpose@#Li-Fraumeni syndrome (LFS) is a rare autosomal cancer syndrome caused by a germline mutation in the TP53 gene. Breast cancer in LFS patients is of various subtypes;however, limited data are available on the clinicopathological features of these subtypes and their appropriate treatments. This study aimed to review the clinical features and treatments for breast cancer in South Korean patients with germline TP53 mutations. @*Methods@#Data on the clinicopathological features and treatment of all breast cancer patients with LFS were collected retrospectively from the available database of 4 tertiary hospitals in the Republic of Korea. @*Results@#Twenty-one breast cancer cases in 12 unrelated women with confirmed germline TP53 mutations were included in the study. The median age at diagnosis was 33.5 years. The histopathological diagnosis included invasive ductal carcinoma (n = 16), ductal carcinoma in situ (n = 3), and malignant phyllodes tumor (n = 2). While 42% and 31% of the cases were positive for estrogen and progesterone receptors, respectively, 52.6% were human epidermal growth factor receptor 2 (HER2) positive, and 21% were triple-negative. The treatments included mastectomy (52%) and breast-conserving surgery (38%). Five patients underwent radiotherapy (RT). The median follow-up period was 87.5 (8–222) months. There were 3 ipsilateral and 4 contralateral breast recurrences during the follow-up, and 8 patients developed new primary cancers. In the post-RT subgroup, there were 2 ipsilateral and 2 contralateral breast recurrences in 1 patient, and 4 patients had a new primary cancer. @*Conclusion@#As reported in other countries, breast cancer in LFS patients in South Korea had an early onset and were predominantly but not exclusively positive for HER2.A multidisciplinary approach with adherence to the treatment guidelines, considering mastectomy, and avoiding RT is encouraged to prevent RT-associated sequelae in LFS patients.

7.
Journal of Breast Cancer ; : 164-174, 2021.
Article in English | WPRIM | ID: wpr-898981

ABSTRACT

Purpose@#In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. @*Methods@#In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. @*Results@#Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. @*Conclusion@#Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

8.
Article in English | WPRIM | ID: wpr-897022

ABSTRACT

Purpose@#The Breast Imaging Reporting and Data System (BI-RADS) is a systematic and standardized scheme of the radiological findings of breast. However, there were different BI-RADS categories between breast cancers as the clinical characteristics in previous studies. We analyzed the association of BI-RADS categories with the clinicopathological characteristics and prognosis of breast cancer. @*Methods@#A total of 44,184 patients with invasive breast cancers assigned to BI-RADS category 3, 4, or 5 in preoperative mammography or ultrasonography were analyzed retrospectively using large-scale data from the Korean Breast Cancer Society registration system. The difference in the clinicopathological factors and prognoses according to the BI-RADS categories (BI-RADS 3–4 and BI-RADS 5) were compared between the mammography and ultrasonography groups. Comparisons of the clinicopathological factors in both groups were made using logistic regression analysis, while the prognoses were based on the breast cancer-specific survival using the Kaplan-Meier method and Cox proportional hazards model. @*Results@#The factors associated with BI-RADS were T stage, N stage, palpability, histology grade, and lymphovascular invasion in the mammography group; and N stage, palpability, histology grade, and lymphovascular invasion in the ultrasonography group. In the survival analysis, there were significant differences in the breast cancer-specific survival of the BI-RADS category groups in both of the mammography (hazard ratio [HR], 3.366; P < 0.001) and ultrasonography (HR, 2.877; P < 0.001) groups. @*Conclusion@#In this study, the BI-RADS categories of preoperative mammography and ultrasonography of patients with invasive breast cancer were associated with prognosis and could be an important factor in making treatment decisions.

9.
Article in English | WPRIM | ID: wpr-918613

ABSTRACT

BACKGROUND/OBJECTIVES@#Premenstrual syndrome (PMS) is a disorder characterized by repeated emotional, behavioral, and physical symptoms before menstruation, and the exact cause and mechanism are uncertain. Hyperprolactinemia interferes with the normal production of estrogen and progesterone, leading to PMS symptoms. Thus, we judged that the inhibition of prolactin hypersecretion could mitigate PMS symptoms.MATERIALS/METHODS: Hordeum vulgare L. extract (HVE), Chrysanthemum zawadskii var. latilobum extract (CZE), and Lomens-P0 the mixture of these extracts were tested in subsequent experiments. The effect of extracts on prolactin secretion at the in vitro level was measured in GH3 cells. Nitric oxide and pro-inflammatory mediator expression were measured in RAW 264.7 cells to confirm the anti-inflammatory effect. Also, the hyperprolactinemic Institute for Cancer Research (ICR) mice model was used to measure extract effects on prolactin and hormone secretion and uterine inflammation. @*RESULTS@#Anti-inflammatory effects of and prolactin secretion suppress by HVE and CZE were confirmed through in vitro experiments (P < 0.05). Treatment with Lomens-P0 inhibited prolactin secretion (P < 0.05) and restored normal sex hormone secretion in the hyperprolactinemia mice model. In addition, extracts significantly inhibited the expression of pro-inflammatory biomarkers, including interleukin-1β, and -6, tumor necrosis factor-α, inducible nitric oxide synthase, and cyclooxygenase-2 (P < 0.01). We used high-performance liquid chromatography analyses to identify tricin and chlorogenic acid as the respective components of HVE and CZE that inhibit prolactin secretion. The Lomens-P0, which includes tricin and chlorogenic acid, is expected to be effective in improving PMS symptoms in the human body. @*CONCLUSIONS@#The Lomens-P0 suppressed the prolactin secretion in hyperprolactinemia mice, normalized the sex hormone imbalance, and significantly suppressed the expression of inflammatory markers in uterine tissue. This study suggests that Lomens-P0 may have the potential to prevent or remedy materials to PMS symptoms.

10.
Journal of Breast Cancer ; : 569-577, 2021.
Article in English | WPRIM | ID: wpr-914822

ABSTRACT

Purpose@#Intraoperative frozen section biopsy is used to reduce the margin positive rate and re-excision rate and has been reported to have high diagnostic accuracy. A majority of breast surgeons in the Republic of Korea routinely perform frozen section biopsy to assess margins intraoperatively, despite its long turnaround time and high resource requirements. This study aims to determine whether omitting frozen section biopsy for intraoperative margin evaluation in selected patients is non-inferior to performing frozen section biopsy in terms of resection margin positivity rate. @*Methods@#This study is a phase III, randomized controlled, parallel-group, multicenter non-inferiority clinical trial. Patients meeting the inclusion criteria and providing written informed consent will be randomized to the “frozen section biopsy” or “frozen section biopsy omission” group after lumpectomy. Patients with clinical stage T1–T3 disease who are diagnosed with invasive breast cancer by core-needle biopsy and plan to undergo breast-conserving surgery will be included in this study. If a daughter nodule, non-mass enhancement, or microcalcification is identified on preoperative imaging, these features must be within 1 cm of the main mass for inclusion in the trial. The target sample size is 646 patients per arm. The primary endpoint will be the resection margin positive rate, and the secondary endpoints include the reoperation rate, operating time, residual cancer after reoperation, residual cancer after re-excision according to the frozen section biopsy result, resection volume, patient quality of life, and cost-effectiveness.Discussion: This is the first randomized clinical trial utilizing frozen section biopsy for intraoperative margin evaluation and aims to determine the non-inferiority of omitting frozen section biopsy in selected patients compared to performing frozen section biopsy.We expect that this trial will help surgeons perform the procedure more efficiently while ensuring patient safety.

11.
Health Communication ; (2): 25-33, 2021.
Article in English | WPRIM | ID: wpr-914419

ABSTRACT

Background@#: Emergency physicians are increasingly participating in brain-death organ tissue donation (OTD).It is difficult communication to inform family members about suspected brain-death and potential donor.This study sought to explore the experiences and communication of emergency physicians in brain-death OTD. @*Methods@#: This is a qualitative study that interviewed 10 experienced emergency physicians with brain-death OTD and analyzed the data by thematic analysis method. @*Results@#: The study revealed 20 subthemes and 5 themes; 1) Families who are invited to donate organs make decisions after long periods of consideration by the entire family, 2) It is uncomfortable to recommend organ donation, 3) Explaining and obtaining consent is ‘the hardest job’ for the attending physician, 4) The way the attending physician does ‘the hardest job’ is by explaining, 5) Passively solicit donation. @*Conclusion@#: The experienced emergency physicians with brain-death OTD were using methods of communication to understand and sympathized with the family members and had abundant experiences. The findings of this study will help inexperienced emergency physicians with brain-death OTD.

12.
Article in English | WPRIM | ID: wpr-913509

ABSTRACT

Purpose@#This study was performed to identify the risk of mortality in patients diagnosed with human epidermal growth factor receptor 2 (HER2)-positive ductal carcinoma in situ (DCIS). @*Methods@#We selected 2,592 patients with HER2-positive DCIS from Korean Breast Cancer Society (KBCS) database between January 1997 and December 2019. Patients who received neoadjuvant chemotherapy were excluded. Logistic regression analysis was used to determine the association between clinical factors and overall death after adjusting for tumor and clinical characteristics. Mortality data were modified using the Statistics Korea data. @*Results@#Thirty deaths (1.2%) were identified out of 2,592 patients in the KBCS database. In the univariate logistic regression analysis, older age, higher body mass index (BMI), type of breast surgery (mastectomy), estrogen receptornegative, progesterone receptor-negative, and exposure to endocrine therapy were significant clinical factors associated with death. In the multivariate analysis, age (hazard ratio [HR], 1.062; 95% confidence interval [CI], 1.015–1.111; P = 0.006), BMI (HR, 1.179; 95% CI, 1.032–1.347, P = 0.016), breast surgery type (mastectomy vs. lumpectomy; HR, 0.285; 95% CI, 0.096–0.844; P = 0.024), and endocrine therapy (HR, 0.314; 95% CI, 0.099–0.995; P = 0.049) were significant risk factors for mortality. @*Conclusion@#Advanced age, higher BMI, mastectomy, and the absence of endocrine therapy were factors associated with poor survival of patients with HER2-positive DCIS. This finding requires further validation combined with additional analysis of large databases.

13.
Article in English | WPRIM | ID: wpr-889318

ABSTRACT

Purpose@#The Breast Imaging Reporting and Data System (BI-RADS) is a systematic and standardized scheme of the radiological findings of breast. However, there were different BI-RADS categories between breast cancers as the clinical characteristics in previous studies. We analyzed the association of BI-RADS categories with the clinicopathological characteristics and prognosis of breast cancer. @*Methods@#A total of 44,184 patients with invasive breast cancers assigned to BI-RADS category 3, 4, or 5 in preoperative mammography or ultrasonography were analyzed retrospectively using large-scale data from the Korean Breast Cancer Society registration system. The difference in the clinicopathological factors and prognoses according to the BI-RADS categories (BI-RADS 3–4 and BI-RADS 5) were compared between the mammography and ultrasonography groups. Comparisons of the clinicopathological factors in both groups were made using logistic regression analysis, while the prognoses were based on the breast cancer-specific survival using the Kaplan-Meier method and Cox proportional hazards model. @*Results@#The factors associated with BI-RADS were T stage, N stage, palpability, histology grade, and lymphovascular invasion in the mammography group; and N stage, palpability, histology grade, and lymphovascular invasion in the ultrasonography group. In the survival analysis, there were significant differences in the breast cancer-specific survival of the BI-RADS category groups in both of the mammography (hazard ratio [HR], 3.366; P < 0.001) and ultrasonography (HR, 2.877; P < 0.001) groups. @*Conclusion@#In this study, the BI-RADS categories of preoperative mammography and ultrasonography of patients with invasive breast cancer were associated with prognosis and could be an important factor in making treatment decisions.

14.
Article in English | WPRIM | ID: wpr-892070

ABSTRACT

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

15.
Article | WPRIM | ID: wpr-834884

ABSTRACT

Objective@#This study investigated the characteristics of elderly pneumonia patients transferred from long-term care hospitals(LTCH). @*Methods@#The initial emergency department (ED) data of patients, who were transferred from other hospitals and over 65years old and hospitalized from 2014 to 2018 for pneumonia management through the ED, were extracted from the electronicmedical records. The differences in the initial status and prognosis between the LTCH group and non-LTCH groupwere compared, and the initial ED variables that affect the in-hospital mortality of the LTCH group were investigated. @*Results@#The total number of patients was 1,032; 423 (41.0 %) were included in the LTCH group. Compared to the non-LTCH group, the following severity indices, some laboratory data, and mortality were worse in the LTCH group: systemicinflammatory reaction syndrome (SIRS) criteria ≥2 (65.0% vs. 56.7%, P=0.008), quick Sequential Organ FailureAssessment score ≥2 (48.2% vs. 20.4%, P<0.001), CURB-65 (Confusion, Urea nitrogen, Respiration rate, Blood pressure,Age≥65 years) criteria ≥3 (51.8% vs. 29.2%, P<0.001), pneumonia severity index (PSI) class ≥4 (86.5% vs.61.2%, P<0.001), modified early warning score ≥5 (38.8% vs. 18.4%, P<0.001), serum albumin (median [IQR], 2.6 [2.2-2.9] g/dL vs. 2.8 [2.4-3.2] g/dL; P<0.001), blood urea nitrogen/albumin (B/A) ratio (median [IQR], 8.0 [5.0-12.8] vs. 6.6[4.4-10.4]; P<0.001), and in-hospital mortality (26.0% vs. 15.9%, P<0.001). Multivariate regression analysis revealed thealbumin grade, B/A ratio grade, PSI class, and SIRS criteria to independently affect the in-hospital mortality of the LTCHgroup. @*Conclusion@#The LTCH group had poorer initial severity indices and higher in-hospital mortality than the non-LTCHgroup. In addition, the albumin grade, B/A ratio grade, could be used for the severity index of pneumonia patients transferredfrom the LTCH.

16.
Article | WPRIM | ID: wpr-834880

ABSTRACT

Objective@#In Korea, many hospitals have recently changed the process of internal medicine management in the emergencydepartment (ED) because of reduced manpower, raising concerns regarding the decreased quality of medicalcare. The process of medical management in the ED was streamlined to resolve the reduced manpower. Thus, this studycompared the pneumonia treatment effectiveness before and after the process changes. @*Methods@#This study included patients who were diagnosed with pneumonia in the ED and hospitalized from January2014 to December 2016. They were divided into two groups based on before and after the changes. The disease severity,management adequacy, and prognosis were compared using the initial quick sequential organ failure assessmentscore (qSOFA), systemic inflammatory response syndrome criteria (SIRS), CURB-65 score, door-to-antibiotic time(DAT), length of stay (LOS), hospitalization period (HP), and in-hospital mortality, were collected retrospectively from themedical records. @*Results@#The qSOFA, SIRS, and CURB-65 scores did not differ between the two groups. The median (interquartilerange) DAT, LOS, and HP were reduced after the process changes: DAT (160.0 minutes [111.0-230.0] vs. 120.0 minutes[74.0-175.0], P<0.001), LOS (7.6 hours [4.8-15.8] vs. 4.7 hours [3.2-6.8], P<0.001), and HP (9.0 days [6.0-16.0] vs. 8.0days [5.0-15.0], P=0.011). On the other hand, the in-hospital mortality was similar in the two groups (14.1% vs. 11.2%,P=0.162). @*Conclusion@#The DAT, LOS, and HP decreased after the process changes, but the in-hospital mortality did not worsen.This shows that pneumonia management in the ED was not compromised, but rather improved, after the changes.

17.
Article in English | WPRIM | ID: wpr-810957

ABSTRACT

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.


Subject(s)
Abdomen , Budgets , Chest Pain , Critical Care , Dyspnea , Emergencies , Heart , Heart Arrest , Insurance Coverage , Insurance , Insurance, Health , Korea , Medical Records , National Health Programs , Patient Care , Point-of-Care Systems , Prescriptions , Shock , Thorax , Ultrasonography
18.
Article in English | WPRIM | ID: wpr-899774

ABSTRACT

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

19.
Article in English | WPRIM | ID: wpr-896969

ABSTRACT

Purpose@#Sentinel lymph node biopsy (SLNB) is the standard axillary procedure in early breast cancer patients. In a randomized trial, the survival rates were not different when axillary lymph node dissection (ALND) was omitted in patients with 1 or 2 lymph node metastases who underwent breast conserving surgery. This study aimed to compare the outcomes in patients who underwent total mastectomy (TM) with 1 or 2 metastatic nodes according to the types of axillary surgery. @*Methods@#In total, 79,058 patients registered in the Korean Breast Cancer Society database who underwent TM were included in the analysis. The inclusion criteria were history of TM and SLNB, pathologic T stage 1 or 2, clinically negative axillary lymph nodes, 1 or 2 metastatic axillary lymph nodes, no radiation therapy, and no neoadjuvant therapy. We divided the patients into the SLNB only and SLNB + ALND groups. The groups were matched by propensity scores. We retrospectively analyzed the differences in the overall survival (OS) between the 2 groups. @*Results@#A total of 883 patients were matched in a 1:4 ratio for the SLNB only and SLNB + ALND groups in the cohort from 1999 to 2014. There were no significant differences in OS between the 2 groups (P = 0.413). Subgroup analysis revealed a significant survival benefit in the SLNB + ALND group in the T2 subgroup (P = 0.013). @*Conclusion@#OS did not differ between the 2 groups in early breast cancer patients with 1 or 2 metastatic axillary lymph nodes who underwent TM. Omission of ALND may be considered in selected patients.

20.
Article in English | WPRIM | ID: wpr-889265

ABSTRACT

Purpose@#Sentinel lymph node biopsy (SLNB) is the standard axillary procedure in early breast cancer patients. In a randomized trial, the survival rates were not different when axillary lymph node dissection (ALND) was omitted in patients with 1 or 2 lymph node metastases who underwent breast conserving surgery. This study aimed to compare the outcomes in patients who underwent total mastectomy (TM) with 1 or 2 metastatic nodes according to the types of axillary surgery. @*Methods@#In total, 79,058 patients registered in the Korean Breast Cancer Society database who underwent TM were included in the analysis. The inclusion criteria were history of TM and SLNB, pathologic T stage 1 or 2, clinically negative axillary lymph nodes, 1 or 2 metastatic axillary lymph nodes, no radiation therapy, and no neoadjuvant therapy. We divided the patients into the SLNB only and SLNB + ALND groups. The groups were matched by propensity scores. We retrospectively analyzed the differences in the overall survival (OS) between the 2 groups. @*Results@#A total of 883 patients were matched in a 1:4 ratio for the SLNB only and SLNB + ALND groups in the cohort from 1999 to 2014. There were no significant differences in OS between the 2 groups (P = 0.413). Subgroup analysis revealed a significant survival benefit in the SLNB + ALND group in the T2 subgroup (P = 0.013). @*Conclusion@#OS did not differ between the 2 groups in early breast cancer patients with 1 or 2 metastatic axillary lymph nodes who underwent TM. Omission of ALND may be considered in selected patients.

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