• Journal of Chest Surgery
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• v.55 no.5
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• pp.378-387
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• 2022

Background: Atrial fibrillation (Afib) is a marker of increased cardiovascular morbidity and mortality. Owing to the increased prevalence of Afib in patients undergoing cardiac surgery, assessing the effect of Afib on postsurgical outcomes is important. We aimed to analyze the effect of preoperative Afib on clinical outcomes in patients undergoing cardiac surgery using a large surgical database. Methods: This retrospective cohort study was based on the national health claims database established by the National Health Insurance Service of the Republic of Korea from 2009 to 2015. Diagnosis and procedure codes were used to identify diseases according to the International Statistical Classification of Diseases, 10th revision. Results: We included 1,037 patients (0.1%) who had undergone cardiac surgery from a randomized 1,000,000-patient cohort, and 15 patients (1.5%) treated with isolated surgical Afib ablation were excluded. Of these 1,022 patients, 412 (39.7%), 303 (29.2%), and 92 (9.0%) underwent coronary artery bypass, heart valve surgery, and Cox-maze surgery, respectively. Preoperative Afib was associated with higher patient mortality (p=0.028), regardless of the surgical procedure. Patients with preoperative Afib (n=190, 18.6%) experienced a higher cumulative risk of overall mortality (hazard ratio [HR], 1.435; 95% confidence interval [CI], 1.263-2.107; p=0.034). Subgroup analysis revealed a reduced risk of overall mortality with Cox-maze surgery in Afib patients (HR, 0.500; 95% CI, 0.266-0.938; p=0.031). Postoperative cerebral ischemia or hemorrhage events were not related to Afib. Conclusion: Preoperative Afib was independently associated with worse long-term postoperative outcomes after cardiac surgery. Concomitant Cox-maze surgery may improve the survival rate.

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.726-734
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• 2023

Objective : Chronic subdural hematoma (CSDH) patients using antithrombotic agents (AT) at high risk for cardiovascular disease are increasing. The authors aimed to analyze the factors influencing outcome by targeting patients using AT and to establish a desirable treatment strategy. Methods : A retrospective analysis was performed on data from 462 patients who underwent burr hole trephination (BHT) surgery for CSDH at five hospitals from March 2010 to June 2021. Outcomes included incidence of postoperative acute bleeding, recurrence rate, and morbidity or mortality rate. Patients were divided into the following four groups based on their history of AT use : no AT. Only antiplatelet agents (AP), only anticoagulants (AC), both of AP and AC. In addition, a concurrent literature review was conducted alongside our cohort study. Results : Of 462 patients, 119 (119/462, 25.76%) were using AT. AP prescription did not significantly delay surgery (p=0.318), but AC prescription led to a significant increase in the time interval from admission to operation (p=0.048). After BHT, AP or AC intake significantly increased the period required for an in-dwelling drain (p=0.026 and p=0.037). The use of AC was significantly related to acute bleeding (p=0.044), while the use of AP was not (p=0.808). Use of AP or AC had no significant effect on CSDH recurrence (p=0.517 and p=1.000) or reoperation (p=0.924 and p=1.000). Morbidity was not statistically correlated with use of either AP or AC (p=0.795 and p=0.557, respectively), and there was no significant correlation with mortality for use of these medications (p=0.470 and p=1.000). Conclusion : Elderly CSDH patients may benefit from maintenance of AT therapy during BHT due to reduced thromboembolic risk. However, the use of AC necessitates individualized due to potential postoperative bleeding. Careful post-operative monitoring could mitigate prognosis and recurrence impacts.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.2
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• pp.144-154
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• 2024

Backgrounds/Aims: Socioeconomic determinants of health are incompletely characterized in cholangiocarcinoma (CCA). We assessed how socioeconomic status influences initial treatment decisions and survival outcomes in patients with CCA, additionally performing multiple sub-analyses based on anatomic location of the primary tumor. Methods: Observational study using the 2018 submission of the Surveillance, Epidemiology, and End Results (SEER)-18 Database. In total, 5,476 patients from 2004-2015 with a CCA were separated based on median household income (MHI) into low income (< 25th percentile of MHI) and high income (> 25th percentile of MHI) groups. Seventy-three percent of patients had complete follow up data, and were included in survival analyses. Survival and treatment outcomes were calculated using R-studio. Results: When all cases of CCA were included, the high-income group was more likely than the low-income to receive surgery, chemotherapy, and local tumor destruction modalities. Initial treatment modality based on income differed significantly between tumor locations. Patients of lower income had higher overall and cancer-specific mortality at 2 and 5 years. Non-cancer mortality was similar between the groups. Survival differences identified in the overall cohort were maintained in the intrahepatic CCA subgroup. No differences between income groups were noted in cancer-specific or overall mortality for perihilar tumors, with variable differences in the distal cohort. Conclusions: Lower income was associated with higher rates of cancer-specific mortality and lower rates of surgical resection in CCA. There were significant differences in treatment selection and outcomes between intrahepatic, perihilar, and distal tumors. Population-based strategies aimed at identifying possible etiologies for these disparities are paramount to improving patient outcomes.

• The Korean journal of internal medicine
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• v.39 no.3
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• pp.501-512
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• 2024

Background/Aims: Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL). Methods: This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson's Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS). Results: The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, p < 0.001; fit vs. frail, HR 4.61, p < 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30-3.53, p = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI < 62.4%. Conclusions: This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.

• Dementia and Neurocognitive Disorders
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• v.21 no.1
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• pp.30-41
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• 2022

Background and Purpose: In this study we aimed to find the association between neuropsychological performance and body mass index (BMI) in patients with mild cognitive impairment (MCI). In addition, we investigated the effects of the apolipoprotein E (APOE) genotype in the relationship between the BMI and cognition in MCI. Methods: We enrolled a cohort of 3,038 subjects with MCI aged 65-90 from the Clinical Research Center for Dementia of South Korea and a dementia cohort of the Ewha Womans University Mokdong Hospital. MCI patients were classified into three subgroups according to the Asian standard of BMI. We compared cognitive performances between groups by one-way analysis of variance. To investigate the effects of the APOE genotype, we used multivariate linear regression models after adjusting for possible confounders. Results: Even though normal BMI groups were younger, had more females, and had less comorbidities, the higher BMI groups had better cognitive functions. Among subjects with APOE ε4 carriers, there was a positive relationship between the BMI and the memory task alone. Conclusions: Our findings suggested that higher BMI in patients with MCI were associated with better cognitive performance. The effects of the APOE ε4 genotype in the associations between BMI and cognition were distinguishing. Therefore, according to physical status, APOE ε4 genotype-specific strategies in the assessments and treatments may be necessary in elderly patients with MCI.

• Korean Journal of Health Education and Promotion
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• v.29 no.2
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• pp.1-12
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• 2012

Objectives: Several practice guidelines recommended both medication and behavior modification to control hypertension. The objective of this study was to analyze ambulatory care utilization pattern and related factors. Methods: A retrospective cohort study was conducted among 45,267 new users who initiated treatment with hypertensive drugs in 2003. Korean National Health Insurance Claims Data was used to study the medical care utilization behavior and related factors after treatment initiation for up to four years. Taking prescription was considered as medical care utilization. Results: More than 20% of patients discontinued visiting physicians for prescription after initiating antihypertensive drug therapy. The average number of institutions visited by patients was about 1.3 annually. Clinic was the most frequently visited institution by patients. In GEE analysis, probability of continuous visit one institution after initiating antihypertensive drug treatment increased in patients who were women, old, have comorbidity, visited clinic or hospital mainly in previous year. Conclusions: Young hypertensive male patients who have no major comorbidity showed high possibility to discontinue medical service utilization. It is necessary to educate these targeted patients about importance of hypertension management in early stage after treatment initiation.

• Korean Journal of Adult Nursing
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• v.28 no.3
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• pp.288-301
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• 2016

Purpose: The purpose of this study was to identify association between maternal depression and multiple contextual factors in 1,519 mothers in Korea who participated in the 2009 Panel Study of Korean Children (PSKC). Methods: The second wave data which was a comprehensive longitudinal data set with a nationally representative birth cohort was analyzed using SAS 9.3 software. Kessler depression scale was used for this study. Results: Of the mothers, 23.0% reported being mild to moderate depression and 4.5% of the mothers reported severe depression. The factors influencing maternal depression include; mother's self-efficacy, mother's marital conflict, mother's social support, infant's and toddler's emotionality, mother's smoking and infant's feeding & eating of daily routine. These variables explained 39.5% of maternal depression. Conclusion: The results of this study suggest that the identified factors for maternal depression should be included in an intervention program to reduce the risk of depression.

• Journal of Korean Academy of Nursing
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• v.41 no.3
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• pp.423-431
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• 2011

Purpose: The study was designed to determine the discriminating ability of a Bayesian network (BN) for predicting risk for pressure ulcers. Methods: Analysis was done using a retrospective cohort, nursing records representing 21,114 hospital days, 3,348 patients at risk for ulcers, admitted to the intensive care unit of a tertiary teaching hospital between January 2004 and January 2007. A BN model and two logistic regression (LR) versions, model-I and .II, were compared, varying the nature, number and quality of input variables. Classification competence and case coverage of the models were tested and compared using a threefold cross validation method. Results: Average incidence of ulcers was 6.12%. Of the two LR models, model-I demonstrated better indexes of statistical model fits. The BN model had a sensitivity of 81.95%, specificity of 75.63%, positive and negative predictive values of 35.62% and 96.22% respectively. The area under the receiver operating characteristic (AUROC) was 85.01% implying moderate to good overall performance, which was similar to LR model-I. However, regarding case coverage, the BN model was 100% compared to 15.88% of LR. Conclusion: Discriminating ability of the BN model was found to be acceptable and case coverage proved to be excellent for clinical use.

• Journal of Families and Better Life
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• v.33 no.6
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• pp.51-63
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• 2015

This study explored the effects of after-school services on whether they reduced the possibility of self-care of children. In terms of characteristics of the use of after-school services, it focused on the 1) types, 2) diversity, and 3) use patterns of the after-school services. For the analysis, it used data of the cohort of elementary-school children from the Korean Children and Youth Panel Survey. The main findings are as follows. First, private mentoring and after-school services provided by welfare centers reduced the possibility of self-care. Second, when the total amount of educational time was controlled, the diversity of participating after-school services did not explain the possibility of self-care. Third, when the total amount of educational time was controlled, the use patterns of after-school services did not explain the possibility of self-care. Based on these findings, it suggested policy implications and future research.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.15 no.4
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• pp.531-538
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• 2008

Purpose: The purpose of this study was to identify factors influencing Vancomycin-resistant enterococcus infection control among nurses in intensive care units. Method: Data were collected from August 15 to October 14, 2007 from 188 nurses working in intensive care units. The nurses answered a 26 item-questionnaire, which included management of the cohort (14 items), hand washing (6 items) and management of the environment (6 items). Descriptive statistics, t or F test, ANOVA, and multiple regression analysis were used with SPSS PC+ 14.0 to analyze the data. Results: The participant's level of awareness of Vancomycin-resistant enterococcus infection control was 3.87; that of compliance was 3.74. Significant factors influencing the level of compliance with Vancomycin-resistant enterococcus infection control were'the level of the awareness' and 'the type of intensive care unit'. These two variables accounted for 21.0% of variance for compliance with the Vancomycin-resistant enterococcus infection control among the participants. Conclusion: In order to develop a strategy to increase the compliance with Vancomycin-resistant enterococcus infection control, it is necessary to be concerned about 'the level of the awareness', 'the type of intensive care unit;', and 'experiences of caring for patients with Vancomycin-resistant enterococcus'.