Factors related to polypharmacy and hyper-polypharmacy for the elderly: A nationwide cohort study using National Health Insurance data in South Korea.

Polypharmacy may cause adverse health outcomes in the elderly. This study examined the prevalence of continuous polypharmacy and hyper-polypharmacy, factors associated with polypharmacy, and the most frequently prescribed medications among older adults in South Korea. This was a retrospective observational study using National Health Insurance claims data. In total, 7,358,953 Korean elderly patients aged 65 years and older were included. Continuous polypharmacy and hyper-polypharmacy were defined as the use of ≥5 and ≥10 medications, respectively, for both ≥90 days and ≥180 days within 1 year. A multivariate logistic regression analysis was conducted with adjustment for general characteristics (sex, age, insurance type), comorbidities (12 diseases, number of comorbidities, and Elixhauser Comorbidity Index [ECI] classification), and healthcare service utilization. Among 7.36 million elderly patients, 47.8% and 36.9% had polypharmacy for ≥90 and ≥180 days, and 11.9% and 7.1% of patients exhibited hyper-polypharmacy for ≥90 and ≥180 days, respectively. Male sex, older age, insurance, comorbidities (cardio-cerebrovascular disease, diabetes mellitus, depressive disorder, dementia, an ECI score of ≥3), and healthcare service utilization were associated with an increased probability of polypharmacy. The therapeutic class with the most prescriptions was drugs for acid-related disorders (ATC A02). The number of outpatient visit days more strongly influenced polypharmacy than hospitalizations and ED visits. This study provides health policymakers with important evidence about the critical need to reduce polypharmacy among older adults.

Aging and the Prevalence of Polypharmacy and Hyper-Polypharmacy Among Older Adults in South Korea: A National Retrospective Study During 2010-2019.

Background: Polypharmacy has become a global health problem and is associated with adverse health outcomes in the elderly. This study evaluated the prevalence of polypharmacy and hyper-polypharmacy in elderly patients in South Korea during 2010-2019. Methods: We analyzed the outpatient care of persons aged ≥65 years covered by National Health Insurance (NHI) using NHI claims data from 2010 to 2019. Polypharmacy was defined as the use of ≥5 medications, and hyper-polypharmacy was defined as the use of ≥10 medications, and we examined them over periods of ≥90 days and ≥180 days. The average annual percent change (AAPC) was calculated using Joinpoint statistical software. Results: The prevalence of polypharmacy among ≥90 days of medication use elderly decreased from 42.5% in 2010 to 41.8% in 2019, and the prevalence of hyper-polypharmacy for ≥90 days increased from 10.4% to 14.4%. The prevalence of polypharmacy for ≥180 days increased from 37.8% in 2010 to 38.1% in 2019, and the prevalence of hyper-polypharmacy for ≥180 days increased from 6.4% to 9.4%. The prevalence of polypharmacy for ≥90 days and ≥180 days steadily increased among elderly patients, with AAPCs of 3.7 and 4.5, respectively. Conclusion: The prevalence of polypharmacy for ≥90 days and ≥180 days remained stably high, with rates of about 42 and 38%, respectively, and hyper-polypharmacy increased over the past 10 years in South Korea. Therefore, strategies to address polypharmacy need to be implemented. Further research is also required to identify the clinical outcomes (including mortality risks) associated with polypharmacy.

Prevalence of systemic lupus erythematosus in South Korea: an administrative database study.

BACKGROUND: Systemic lupus erythematosus (SLE) is a rare autoimmune disease for which a population-based survey on the prevalence of the disease in South Korea has not yet been conducted. Our goal was to estimate the nationwide prevalence of SLE. METHODS: The International Classification of Diseases, Tenth Revision (ICD-10) code for SLE diagnosis-M32-was tentatively given when patients were suspected to have SLE before 2009. As such, the positive predictive value (PPV) of the M32 code shown in medical bills reflecting true SLE was uncertain. We attempted to estimate the prevalence of SLE in South Korea using national administrative database data from 2004-2006. We approximated the actual number of SLE patients by analyzing a list of SLE-coded patients provided by the National Health Insurance (NHI) and Health Insurance Review and Assessment Service. Prevalence was estimated by multiplying the PPV of the M32 diagnostic code by the number of patients receiving the code. The PPV was determined by three methods: direct investigation of the medical records of patients randomly selected from the SLE-coded patients list; assessment of all SLE patients treated at 56 selected hospitals in South Korea; and extrapolation from sub-groups at a single institute to the sub-groups of the national NHI data. RESULTS: The estimated number of national SLE cases was between 9000 and 11,000, depending on the method of ascertainment, corresponding to a prevalence of 18.8-21.7 per 100,000 people. CONCLUSIONS: This is the first report of a nationwide prevalence survey of SLE in South Korea. National databases may serve as a resource for epidemiologic studies of rare autoimmune diseases like SLE.

Perception of medical students on real-time class evaluation using mobile phone survey system.

PURPOSE: The aim of this study is to investigate the advantage of real-time class evaluation over course evaluation in integrated courses and to explore the usefulness and availability of a mobile phone survey system as a real-time class evaluation tool. METHODS: In six integrated courses at the preclinical second year both course and class evaluations were performed. Class evaluations were carried out 206 times right after every class by a mobile phone survey system that depended on mobile phones to send information. A survey was performed to identify students' perception on real-time class evaluation and the mobile phone survey system. RESULTS: The course evaluation score was found to have greater than 95% confidence interval of class evaluations at 5 of 6 courses. Class evaluations yielded more information on educational content and teaching strategy than course evaluations. A higher score was given in class evaluation regarding effectiveness on improving quality of education (3.77 vs. 2.15) and sincerity during evaluation (3.87 vs. 2.49). Of the three major evaluation tools, such as paper, web and mobile phone, majority of students preferred mobile phones especially in terms of accessibility (89%), familiarity (75.3%), and time (74%). CONCLUSION: In integrated courses, real-time class evaluations could yield more information and better sincerity than course evaluations. Real-time class evaluations could be successfully performed through a mobile phone survey system compared with that of paper- or web-based methods.

Methods of effective team-based learning administration and expected effects on medical education.

PURPOSE: The aim of this study was to analyze the results of quantitative and qualitative student evaluations of team-based learning (TBL) and student achievement evaluations during TBL. METHODS: Questionnaires that evaluated medical student perception and self-assessment of the TBL experience included 38 questions on the TBL process. Also, we used scores from the TBL session to investigate student academic achievement. RESULTS: Our results showed that the more proper the educational environments were, the more focused students were on team learning. According to the distribution period for preliminary assignments, there was a difference in self-directed learning. In addition, team members had the opportunity to learn new knowledge by interacting with each other, and when they had the experience of feedback, they understood the instruction topics through team learning better. With regard to peer evaluation, the students who recognized the importance of assessment studied more sincerely and honestly. By experiencing the TBL process, every team showed a high significance in the group readiness assurance test score compared with the individual readiness assurance test score, and student satisfaction with the TBL and expectation levels about capacity strengthening increased as well. CONCLUSION: TBL is an effective teaching and learning method and has positive impacts on student academic achievement. A study on student academic achievement and perception of TBL is expected to provide medical educators with suggestions on planning teaching strategies for effective TBL administration.

Statistical inference methods for detecting altered gene associations.

The higher incidence of liver disease in the Asian population raises a great concern to clinicians. To understand the gene functions involved in different stages of the disease, microarray expression data of histological progressive grades, starting from the dysplastic nodule in cirrhotic liver to hepatocellular carcinoma Edmonson grade III are analyzed. The statistical procedures are divided into two parts: First, microarray data are suitably normalized, including a method of analysis of variance (ANOVA). There are great differences of opinion regarding the currently used normalization methods. In order to proceed to the second part of statistical analyses of gene-pair associations, these normalization methods need first to be compared. Based on the assumption that a union set of significant genes from these normalization methods includes sufficiently general and well-defined, differentially expressed genes, one must carry out the second part of statistical analyses of searching for evidence of altered gene-gene relationships with progression of the disease. Significantly altered gene-pair associations are identified with the ratio of gene-pair correlations. The methods are illustrated with replicated microarray expression data.