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Effect of motivated physicians and elderly patients with hypertension or type 2 diabetes mellitus in prepared communities on health behaviours and outcomes: A population-based PS matched retrospective cohort study during five-year follow-up period
Get PDFEffective chronic disease management requires the active participation of patients, communities, and physicians. The objective of this study was to estimate the effectiveness of the Community-based Registration and Management for elderly patients with Hypertension or Type 2 Diabetes mellitus Project (CRMHDP) by using motivated primary care physicians and patients supported by prepared communities, to utilise healthcare and health outcomes in four cities in South Korea. We conducted a propensity score-matched retrospective cohort study using 2010–2011 as the baseline years, alongside a follow-up period until 2015/2016, based on the Korean National Health Insurance database. Both a CRMHDP group (n = 46,865) and a control group (n = 93,730) were applied against healthcare utilisation and difference-in-differences estimations were performed. For the health outcome analysis, the intervention group (n = 27,242) and control group (n = 54,484) were analysed using the Kaplan–Meier method and Cox proportional hazard regression. Results: The difference-in-differences estimation of the average annual clinic visits per person and the average annual days covered were 1.26 (95% confidence interval, 1.13–1.39) and 22.97 (95% CI, 20.91–25.03), respectively, between the intervention and control groups. The adjusted hazard ratio for death in the intervention group, compared to the control group, was 0.90 (95% CI, 0.86–0.93). For stroke and chronic renal failure, the adjusted hazard ratios for the intervention group compared to the control group were 0.94 (95% CI, 0.88–0.99) and 0.80 (95% CI 0.73–0.89), respectively. Our study suggests that for effective chronic disease management both elderly patients and physicians need to be motivated by community support
국내 학대뇌손상 환아의 안과 소견: 2011-2022년 단일권역외상센터 자료
Get PDFPurpose: To investigate the ophthalmic findings associated with abusive head trauma (AHT) at a major trauma center in Korea. Methods: We retrospectively reviewed the medical records of 14 children with AHT referred for an ophthalmologic examination at a large regional trauma center from January 2011 to December 2022. We analyzed pertinent findings for AHT and its sequelae on brain computed tomography, skeletal surveys obtained using X-ray, external photographs, and fundus photographs taken with a portable fundus camera. Results: Among 14 patients (mean age, 7.4 months) with subdural hematoma from AHT, nine (64.3%) had retinal hemorrhages. Eight of these patients (88.9%) required neurosurgery, while only one child (20.0%) among the five without retinal hemorrhages needed drainage for brain hemorrhages. All patients with retinal hemorrhages (mean age, 6.0 months) presented with numerous multilayered hemorrhages across the entire retina including dome-shaped hemorrhages (six patients), perimacular ridges (one patient), and retinal hemorrhages at different stages of healing (one patient). The retinal hemorrhages resolved within an average of 2.4 months without necessitating retinal surgery. In five patients followed for an average of 28.2 months, there were instances of optic disc pallor in three, cortical visual impairment in one, and fovea scarring in one. Conclusions: More than half of the Korean children with AHT had extensive retinal hemorrhages leading to ophthalmic sequelae in the majority. These findings support the need for long-term active ophthalmic follow-up in AHT cases.목적: 국내 단일권역외상센터에서 학대뇌손상으로 확인된 환아의 안과 소견을 알아보고자 하였다.
대상과 방법: 2011년 1월부터 2022년 12월까지 본원 권역외상센터에서 학대뇌손상으로 확인되어 안과로 의뢰된 환아 14명의 의무기록을 후향적으로 조사하였다. 뇌 전산화단층촬영, X선 골격촬영, 정면사진, 휴대용 안저카메라를 이용한 안저촬영에서 학대뇌손상과 관련된 소견과 그 후유증을 조사하였다.
결과: 평균 7.4개월에 학대뇌손상으로 인한 경막하출혈이 있었던 14명 가운데 망막출혈은 9명(64.3%)에서 관찰되었다. 이 가운데 8명(88.9%)이 신경외과수술을 하였으나, 망막출혈이 없었던 5명 가운데 1명(20.0%)만 뇌출혈 배액술을 받았다. 망막출혈이 있었던 환아는 평균 6.0개월이었고, 모두 두 눈에서 광범위하게 망막의 여러 층에서 다량의 출혈이 있었으며 돔모양 망막출혈(6명), 황반부 주변 융기된 망막주름(1명), 발생 시기가 다른 망막출혈이 동시에 관찰되는 경우(1명)가 있었다. 망막출혈은 평균 2.4개월 후 모두 흡수되어 망막수술이 필요하지 않았다. 평균 28.2개월 경과 관찰한 5명에서 시신경유두창백 3명, 피질시각장애 1명, 황반부 망막흉터 1명이 관찰되었다.
결론: 국내 학대뇌손상 환아에서도 광범위한 망막출혈이 절반 이상에서 관찰되었고, 대부분 안과적 후유증이 남았다. 학대뇌손상에서 장기적이고 적극적인 안과 경과 관찰이 필요하겠다
중환자실 신규간호사를 위한 환자안전 시뮬레이션 프로그램 개발
Get PDFIntensive care units (ICUs) are departments that use high-risk drugs and medical devices. Therefore, patient safety is especially important in ICUs. However, new nurses in ICUs often lack patient safety competencies. Thus, it is necessary to improve patient safety competencies for new nurses working in ICUs. Methods: This methodological study was designed to develop a simulation program to improve patient-safety competencies among new nurses working in ICUs. To develop a patient-safety simulation program, we conducted a survey on educational needs and reviewed the core competencies of patient safety applicable to healthcare providers. Additionally, we conducted an expert validation process and a pilot test. Results: A simulation-based patient safety program was developed that spanned 4 weeks (240 minutes). Conclusion: The patient safety simulation program, which considered the characteristics and competence levels of new nurses working in ICUs, was found to be appropriate. This program is expected to improve the patient safety competencies of new intensive care nurses, thereby contributing to the creation of a safer ICU environment
Risk factors for pubic ramus fracture nonunion after conservative treatment of pelvic ring injuries: a retrospective cohort multicenter study
No full textPurpose: To determine the incidence of nonunion, clinical and radiological outcomes, and risk factors for nonunion in conservatively treated pubic ramus fractures among patients diagnosed with pelvic ring injury. Methods: A total of 546 patients (192 men, 354 women) diagnosed with pubic ramus fracture, treated conservatively, and who had completed > 1 year follow-up at three level 1 trauma centers between January 2014 and December 2020, were enrolled. Clinical and radiological evaluations were compared between union and nonunion groups. Logistic regression and Kaplan–Meier analyses were used. Result: At the final follow-up, 527 (96.5%) and 19 (3.5%) patients had union and nonunion of fractures, respectively. The union and nonunion groups exhibited statistically significant differences in posterior injury (p = 0.040), bilateral ramus fracture (p < 0.001), initial displacement (p < 0.001), and clinical result (p < 0.001). In the multivariate logistic regression analysis, initial displacement (odds ratio, 4.727; p = 0.005) was analyzed as a risk factor for nonunion. According to the Kaplan–Meier analysis, the median initial displacement of nonunion occurrence was 17.9 mm (standard error, 1.211; 95% confidence interval 15.526–20.274), and nonunion patients were included if the displacement was > 15.9 mm (standard error, 1.305) on the 75th percentile. Conclusion: Conservative treatment is ineffective in some ramus fracture cases with pelvic ring injury. As ramus nonunion causes functional deterioration, active treatment is required if the displacement is ≥ 16 mm
Oblique lateral interbody fusion for lumbosacral fractional curve correction in degenerative lumbar scoliosis
No full textPurpose: In combined anterior–posterior adult spinal deformity surgery, the optimal combination of anterior and posterior procedures remains unclear. We aimed to demonstrate the radiological outcomes and relevant factors in oblique lateral interbody fusion (OLIF) for lumbosacral fractional curve (FC) correction combined with open posterior surgery in degenerative lumbar scoliosis (DLS). Methods: This study involved 42 consecutive patients with DLS who had a major curve (MC) ≥ 20° and an FC (L4 to S1) ≥ 10°, and underwent a combined anterior–posterior surgery Changes in the MC, FC, coronal balance distance, type of coronal imbalance, coronal/sagittal disc angle at L4-5 and L5-S1, L4 and L5 tilt, and sagittal parameters were examined. The associations between FC correction and demographic, surgical, and radiological factors were analysed. Results: The FC decreased from 16.9 ± 7.3° preoperatively to 6.6 ± 4.4° at the last follow-up (P < 0.001). The coronal disc angle at L4-5 and L5-S1 were, respectively, 6.8 ± 2.2° and 6.0 ± 4.1° preoperatively and decreased to 2.2 ± 2.1 and 1.2 ± 1.3° at the last follow-up (both P < 0.001). The changes in FC were greater in uppermost instrumented level > T10 (P < 0.001), and associated with the preoperative FC (r = 0.820, P < 0.001), L4 tilt (r = 0.434, P = 0.007), and L5 tilt (r = 0.462, P = 0.003). Conclusion: OLIF at the FC combined with open posterior surgery is an effective combined anterior–posterior correction strategy in DLS
Association between circulating ECM-associated molecules and cardiovascular outcomes in hemodialysis patients: a multicenter prospective cohort study
Get PDFHemodialysis patients are susceptible to cardiovascular remodeling, which increases the risk of cardiovascular morbidity and mortality. Circulating extracellular matrix (ECM)-associated molecules increase during cardiovascular remodeling and can be potential biomarkers of adverse cardiovascular outcomes. However, their clinical significance in patients undergoing hemodialysis remain unclear. This study aimed to elucidate the association between circulating ECM-associated molecules and cardiovascular outcomes in patients undergoing hemodialysis. To this end, we measured levels of plasma matrix metalloproteinase (MMP)-2, MMP-9, tenascin-C, and thrombospondin-2 in 372 patients with hemodialysis. Plasma MMP-2 levels were significantly higher in patients with future cardiovascular events than in those without future cardiovascular events (P = 0.004). All measured molecules had significant correlations with amino-terminal pro-brain natriuretic peptide levels, but the correlation coefficient was the strongest for plasma MMP-2 (rho = 0.317, P < 0.001). High plasma MMP-2 levels were predictive of left ventricular (LV) diastolic dysfunction (adjusted odds ratio per a standard deviation increase = 1.48, 95% confidence interval [CI] = 1.05–2.08) and were independently associated with an increased risk of composite cardiovascular events (adjusted hazard ratio per a standard deviation increase = 1.30, 95% CI = 1.04–1.63). In conclusion, high plasma MMP-2 levels are associated with LV diastolic dysfunction and an increased risk of adverse cardiovascular outcomes in hemodialysis patients
Skip-GANomaly++: Skip Connections and Residual Blocks for Anomaly Detection (Student Abstract)
No full textAnomaly detection is a critical task across various domains. Fundamentally, anomaly detection models offer methods to identify unusual patterns that do not align with expected behaviors. Notably, in the medical field, detecting anomalies in medical imagery or biometrics can facilitate early diagnosis of diseases. Consequently, we propose the Skip-GANomaly++ model, an enhanced and more efficient version of the conventional anomaly detection models. The proposed model's performance was evaluated through comparative experiments. Experimental results demonstrated superior performance across most classes compared to the previous models
Cannabinoid receptor 2 as a regulator of inflammation induced oleoylethanolamide in eosinophilic asthma
No full textBackground: Oleoylethanolamide (OEA), an endogenously generated cannabinoid-like compound, has been reported to be increased in patients with severe asthma and aspirin-exacerbated respiratory disease. Recruitment of activated eosinophils in the airways is a hallmark of bronchial asthma. Objective: We explored the direct contribution of cannabinoid receptor 2 (CB2), a cognate receptor of OEA, which induces eosinophil activation in vitro and in vivo. Methods: We investigated OEA signaling in the eosinophilic cell line dEol-1 in peripheral blood eosinophils from people with asthma. In order to confirm whether eosinophil activation by OEA is CB2 dependent or not, CB2 small interfering RNA and the CB2 antagonist SR144528 were used. The numbers of airway inflammatory cells and the levels of cytokines were measured in bronchoalveolar lavage fluid, and airway hyperresponsiveness was examined in the BALB/c mice. Results: CB2 expression was increased after OEA treatment in both peripheral blood eosinophils and dEol-1 cells. It was also elevated after OEA-induced recruitment of eosinophils to the lungs in vivo. However, SR144528 treatment reduced the activation of peripheral blood eosinophils from asthmatic patients. Furthermore, CB2 knockdown decreased the activation of dEol-1 cells and the levels of inflammatory and type 2 cytokines. SR144528 treatment alleviated airway hyperresponsiveness and eosinophil recruitment to the lungs in vivo. Conclusion: CB2 may contribute to the pathogenesis of eosinophilic asthma. Our results provide new insight into the molecular mechanism of signal transduction by OEA in eosinophilic asthma