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Educational Needs and Priorities of People with Diabetes and Healthcare Providers in South Korea: A Mixed-Methods Study
No full textIntroduction: Effective self-care for managing diabetes requires culturally sensitive and patient-centered education. This study explored the educational needs and priorities of people with diabetes (PWD) and healthcare providers (HCPs). Method: A mixed-methods approach was employed with participants from a university-affiliated hospital in South Korea. Descriptive and content analyses were used for the questionnaire and interview data. Results: Both PWD (n=33) and HCPs (n=42) ranked diabetes-related side-effect management and medication purpose as the most important aspects of diabetes education. PWD had higher educational needs regarding diagnosed diseases and lifestyle modifications than HCPs. Three themes were revealed: incorporating lifestyle changes and medication taking, collaborating with HCPs and caregivers and providing care to meet person-centered mental health needs, and enhancing education on disease and complications. Discussion: Culturally sensitive and patient-centered education programs that recognize communal values, reflect individual preferences and needs, and promote lifestyle changes by leveraging technologies for Korean PWD are crucial
Effectiveness of a pelvic Binder-Only protocol for early stabilization in hemodynamically unstable pelvic ring injuries
No full textBACKGROUND: Hemodynamically unstable pelvic ring injuries pose significant challenges in trauma care. Although external fixation is traditionally used for initial stabilization, pelvic binders have emerged as potential alternatives. Therefore, this study aimed to evaluate the feasibility and safety of maintaining pelvic binders alone as a temporary stabilization method in patients with hemodynamically unstable pelvic ring injuries. METHODS: This retrospective cohort study included 114 patients with hemodynamically unstable pelvic ring injuries treated at two Level 1 trauma centers. The patients were divided into two groups: Binder-Only (n = 53) and External Fixation (n = 61). Outcomes including complications, intensive care unit (ICU) length of stay, and mechanical ventilation duration were compared. RESULTS: Baseline characteristics and injury severity were comparable between the two groups. There were no significant differences in complication rates (22.6% vs. 26.2%, p = 0.657), ICU length of stay (8 [3-16] vs. 10 [6-19] days, p = 0.257), or mechanical ventilation duration (3 [1-6] vs. 5 [2-9] days, p = 0.098) between the Binder-Only and External Fixation groups. The Binder-Only group achieved anterior fixation earlier than the External Fixation group (2 [1-2] vs. 4 [2-5] days, p < 0.001). Logistic regression analysis confirmed that group allocation was not associated with complications. The independent predictors of complications included diabetes mellitus, initial lactate level, and packed red blood cells transfusion within 4 h. CONCLUSIONS: Pelvic binders provide sufficient temporary stabilization in hemodynamically unstable pelvic ring injuries, with outcomes comparable to those of external fixation. This strategy offers a practical alternative that avoids the complications and logistical challenges associated with external fixation
Riemannian Geometric-based Meta Learning
No full textMeta-learning, or “learning to learn,” aims to enable models to quickly adapt to new tasks with minimal data. While traditional methods like Model-Agnostic Meta-Learning (MAML) optimize parameters in Euclidean space, they often struggle to capture complex learning dynamics, particularly in few-shot learning scenarios. To address this limitation, we propose Stiefel-MAML, which integrates Riemannian geometry by optimizing within the Stiefel manifold, a space that naturally enforces orthogonality constraints. By leveraging the geometric structure of the Stiefel manifold, we improve parameter expressiveness and enable more efficient optimization through Riemannian gradient calculations and retraction operations. We also introduce a novel kernel-based loss function defined on the Stiefel manifold, further enhancing the model’s ability to explore the parameter space. Experimental results on benchmark datasets—including Omniglot, Mini-ImageNet, FC-100, and CUB—demonstrate that Stiefel-MAML consistently outperforms traditional MAML, achieving superior performance across various few-shot learning tasks. Our findings highlight the potential of Riemannian geometry to enhance meta-learning, paving the way for future research on optimizing over different geometric structures
Proposed Denosumab Biosimilar SB16 vs Reference Denosumab in Postmenopausal Osteoporosis: Phase 3 Results Up to Month 12
No full textCONTEXT: SB16 is a proposed biosimilar to reference denosumab (DEN; brand name: Prolia). OBJECTIVE: This phase 3 randomized, double-blind, multicenter study evaluated the biosimilarity of SB16 to DEN in women with postmenopausal osteoporosis (NCT04664959). DESIGN: The study included 457 postmenopausal osteoporosis patients who had a lumbar spine or total hip T-score between -2.5 and -4. Patients were randomized in a 1:1 ratio to receive either 60 mg of SB16 or DEN subcutaneously at month 0 and month 6. At month 12, patients were rerandomized to continue with the assigned treatment or switch from DEN to SB16 up to month 18. This report includes results up to month 12. METHODS: The primary endpoint was the percent change from baseline in lumbar spine bone mineral density (BMD) at month 12. Secondary endpoints including the percent change from baseline in BMD of the lumbar spine (except for month 12), total hip, and femoral neck; pharmacokinetic, pharmacodynamic (serum C-telopeptide of type I collagen, and procollagen type I N-terminal propeptide), safety, and immunogenicity profiles were measured up to month 12. RESULTS: The least-squares mean differences in percent change from baseline in lumbar spine BMD at month 12 were 0.33% (90% CI, -0.25 to 0.91) in the full analysis set and 0.39% (95% CI, -0.36 to 1.13) in the per-protocol set; both within the predefined equivalence margin. The secondary endpoints were comparable between the 2 treatment groups. CONCLUSION: The reported efficacy, pharmacokinetic, pharmacodynamic, safety, and immunogenicity data support the biosimilarity of SB16 to DEN
Anatomical analysis of dual iliopatellar band layers: Implication for knee joint stability
No full textBACKGROUND: The iliopatellar band (IPB) is an anterior extension of the iliotibial tract (ITT) that has been described as contributing to lateral knee stability. This study aimed to investigate the anatomical features of the IPB, focusing on its branching pattern from the ITT, the extent of patellar coverage, and its attachment. METHODS: We examined 64 specimens among 39 embalmed adult South Korean cadavers through dissection, microcomputed tomography, and sectioned images. RESULTS: The IPB consistently covered the patella and the patellar tendon but to different extents. Micro-CT revealed the division of the IPB into external and internal layers, each possibly having specific functions in force distribution and knee stability. The lateral patellofemoral ligament joined the internal layer or continuously attached to the lateral border of the patella, which possibly may assist in maintaining patellar alignment. CONCLUSIONS: These anatomical insights into the layered configuration and attachments of the IPB may support a better understanding of knee biomechanics and surgical approaches, particularly in the context of ITT tightness and lateral patellar tracking
Psychological Autopsy in Adolescent Suicide: Evaluating Risk Factors and Research Methods
No full textOBJECTIVE: The primary purpose of this literature review is to explore and integrate findings from various psychological autopsy (PA) studies to identify critical risk factors associated with adolescent suicide and evaluate the methodologies employed in these investigations. METHODS: A systematic review of 15 studies reporting psychological autopsies of adolescent suicides was conducted. Data sources included databases such as PubMed, Google Scholar, and RISS. Studies were selected based on empirical research focused on adolescent suicides, conducted since 1970, and written in English. Two reviewers independently screened and selected studies, with a third reviewer resolving any disagreements. The studies were analyzed for sample characteristics, included variables, and specific features of the PA methodology. RESULTS: The review identified consistent findings across studies, highlighting the significant role of mental illnesses and sociodemographic factors in adolescent suicides. Methodological variations were noted in interview timing, source selection, and the use of semi-structured interviews. The review also emphasized the importance of comprehensive data collection, including social network and mobile activity data, to better understand suicide risk factors. Key challenges identified include retrospective data bias and cultural differences affecting the generalizability of findings. CONCLUSION: The review underscores the need for standardized PA procedures, particularly tailored to adolescents, to improve the reliability and validity of findings. The consistent association of psychiatric disorders with suicide risk emphasizes the urgent need for effective mental health interventions. Future research should focus on developing ethical, culturally sensitive, and methodologically rigorous approaches to enhance the understanding and prevention of adolescent suicide
Digital Health Intervention Effect on Older Adults With Chronic Diseases Living Alone: Systematic Review and Meta-Analysis of Randomized Controlled Trials
No full textBACKGROUND: The incidence of chronic diseases is increasing owing to the aging population; in particular, older adults living alone struggle with self-management and medical expenses. Digital health can contribute to medical cost management and health promotion, but its effectiveness for older adults living alone remains unclear. In a rapidly aging society, it is important to demonstrate the effect of digital health on improving the lives of older adults living alone and reducing the burden of chronic diseases. OBJECTIVE: This study aims to examine the intervention effects of digital health on self-management, quality of life, and medical factors for older adults living alone with common chronic diseases such as cardiovascular disease, respiratory disease, and musculoskeletal disorders through a systematic literature review and meta-analysis. METHODS: We searched the literature using 3 databases, including PubMed, CINAHL, and Cochrane CENTRAL, for literature published in overseas academic journals up to October 2024. The final 11 papers were used for analysis based on selection and exclusion criteria. Meta-analysis was used to calculate the mean difference and standardized mean difference (SMD) for the selected literature using RevMan (version 5.4; Cochrane). The effect size and heterogeneity were calculated through 95% CI. RESULTS: As a result of conducting a meta-analysis of 8 of 11 documents, there was a significant effect of self-management factors on moderate-to-vigorous physical activity (SMD=0.08; z=2.07; P=.04). However, among self-management factors, low-density lipoprotein cholesterol (SMD=-0.04; z=0.91; P=.36) did not show statistically significant results. Among the medical factors, general quality of life (SMD=0.11; z=0.93; P=.35), depression (SMD=-3.95; z=1.59; P=.11), and hospital days (SMD=-1.57; z=0.91; P=.36) also did not show statistically significant results. However, it was confirmed that they improved after a digital health intervention. CONCLUSIONS: This study demonstrated that digital health interventions are effective in improving physical activity in older adults with chronic diseases living alone. However, owing to the characteristics of older adults living alone, there is a need to further expand digital health to combine care services that can manage diseases at home
Novel Usefulness of M2BPGi for Predicting Severity and Clinical Outcomes in Hospitalized COVID-19 Patients
No full textBackground/Objectives: Mac-2 binding protein glycosylation isomer (M2BPGi) is a novel biomarker for liver fibrosis, and its prognostic role has never been explored in coronavirus disease 2019 (COVID-19). We compared the M2BPGi level simultaneously with age, severe/critical disease, the sequential organ failure assessment (SOFA) score, and the National Early Warning Score 2 (NEWS2) in a total of 53 hospitalized patients with COVID-19 (mild/moderate [n = 15] and severe/critical [n = 38]). Methods: M2BPGi levels were measured using the HISCL M2BPGi assay (Sysmex, Kobe, Japan) in an HISCL-5000 analyzer (Sysmex), and clinical outcomes were analyzed according to M2BPGi and the clinical variables, using the receiver operating characteristic (ROC) curve, Kaplan-Meier survival, and Cox proportional hazards regression analyses. Results: M2BPGi levels differed significantly according to disease severity, 30-day mortality, and 60-day mortality (p = 0.045, 0.011, and 0.002, respectively). In the ROC curve analysis, the M2BPGi, age, SOFA score, and NEWS2, except for severe/critical disease, significantly predicted clinical outcomes (all p < 0.01). In the survival analysis, the hazard ratios of M2BPGi added to each clinical variable were higher than that of each clinical variable alone, and M2BPGi was the only independent prognostic factor for the mortality. Conclusions: This study demonstrated that M2BPGi may be a useful biomarker for assessing disease severity and clinical outcomes in hospitalized COVID-19 patients. Combined with conventional clinical assessment, M2BPGi would provide objective and valuable information for prognosis prediction in these critically ill patients. Further studies are warranted to extend its utility in other clinical settings
A Stool DNA-Based SDC2 Methylation Test for the Early Detection of Colorectal Cancer in an Asymptomatic, High-Risk Population: A Multicenter Prospective Randomized Trial
No full textINTRODUCTION: Noninvasive stool DNA-based methylation testing has emerged as an effective strategy for the early colorectal cancer (CRC) detection. Syndecan-2 ( SDC2 ) methylation frequently occurs in all stages of CRC; therefore, the aim of this study was to evaluate the clinical performance of a stool DNA-based SDC2 methylation test for detecting CRC in asymptomatic or high-risk CRC populations. METHODS: This multicenter prospective study was conducted to determine the clinical performance of the SDC2 methylation test on stool DNA using real-time polymerase chain reaction. Stool samples were collected from asymptomatic individuals before colonoscopy, and the test results were independently analyzed through comparison with colonoscopic findings and pathological outcomes as reference standards. RESULTS: Of the 1,124 evaluable participants, 20 had CRC, 73 had advanced adenomatous polyps (>/=1.0 cm), 469 had nonadvanced adenomatous polyps (<1.0 cm), 178 had non-neoplastic polyps, and 384 had negative colonoscopy results. The stool SDC2 methylation test had a sensitivity and specificity of 95.0% and 81.5%, respectively, for detecting CRC, while the sensitivity for detecting advanced adenomatous polyps and CRC was 58.1%. The rate of adenoma detection increased with polyp size ( P < 0.01), and sensitivity was not associated with CRC stage ( P = 0.864). DISCUSSION: The stool DNA-based SDC2 methylation test attained a high sensitivity for CRC detection in an asymptomatic high-risk population. Further large-scale clinical studies are required to validate the clinical utility of this test as a population-based CRC screening tool