Background: Children, adolescents, and young adults (CAYAs) with severe illnesses require intensive treatment, often relying on medical devices and advanced medical services.Modern medical technology has improved the lifespans of these patients. In addition, CAYAs represent a vulnerable group, resulting in a significant caregiving burden on the entire family.This study examined patterns of medical utilization following diagnosis of a life-limiting condition (LLC). Methods: We establish a cohort of 176,236 CAYAs who were first diagnosed with an LLC using National Health Insurance data between 2011 and 2013. Patients diagnosed with an LLC within the 3 years preceding this period and those who had died were excluded, and only those receiving care at a general medical hospital were included. In total, 25,410,411 claims for medical expenses, outpatient visits, and lengths of stay for medical utilization over the approximately 10 years up to 2020 were investigated (2.3% inpatients, 97.7% outpatients). Results: The average annual medical utilization per LLC patient among CAYAs following initial diagnosis included medical expenses of $1,163, 16.8 outpatient visits, and 18.7 days of admission. Among inpatients, cancer patients averaged $5,340 for total medical expenses and 21.0 days of admission, while non-cancer patients averaged $3,013 and 18.1 days, respectively. The overall average medical expenses during the first year following diagnosis of an LLC were $3,012, whereas for cancer patients they were $5,962. In addition, there was a sharp increase in total medical expenses as death approached, particularly in the last month of life, with a considerable proportion attributable to critical-care treatments. Conclusion Our investigation into medical utilization by CAYAs with an LLC in Korea provides a foundation for healthcare policy development. Timely treatment at each stage and tailored policies that take into account the heterogeneity among diseases are of paramount importance.

Background: Despite the necessity of long-term management for fracture risk reduction, adherence to osteoporosis pharmacotherapy remains poor. We investigated the factors influencing adherence to pharmacotherapy among Korean patients with osteoporosis, with a particular focus on treatment with bisphosphonates (BPs). Methods: Data from 725,313 osteoporosis patients newly prescribed BPs or selective estrogen receptor modulators (SERMs) between 2012 and 2014, obtained from the Korean National Health Insurance Service, were analyzed. Adherence was assessed based on compliance and persistence over a two-year period, with factors associated with adherence identified using multivariable logistic regression. Results: Only 14.8% of the patients who started BPs or SERMs sustained medication compliance, with 15.8% persisting with treatment over the two-year follow-up. Compared with BPs, patients receiving SERMs showed better compliance and persistence (odds ratios [ORs], 1.44 and 1.48, respectively; P < 0.001); while patients receiving intravenous administration showed higher compliance and persistence (ORs, 2.08 and 1.76, respectively; P < 0.001) compared with those taking oral medications. Patients placed on a quarterly dosing schedule showed improved compliance and persistence (ORs, 1.55 and 1.31, respectively; P < 0.001) compared with those on other dosing intervals. Male gender, advanced age, living outside metropolitan areas, receiving treatment in non-general hospitals, and a history of previous fractures were associated with poorer two-year adherence. Conclusion This study underscores the complex nature of medication adherence among Korean osteoporosis patients, particularly those treated with BPs. These findings accordingly indicate that medication with more convenient administration regimens and fewer side effects, coupled with suitable follow-up durations, could contribute to enhancing treatment adherence.

Objective: : Korea’s healthcare system and policy promotes early, actively stroke treatment to improve prognosis. This study represents stroke epidemiology and outcomes in Korea. Methods: : This study investigated data from the Acute Stroke Assessment Registry. The registry collects data from over 220 hospitals nationwide, focusing on quality stroke service management. Data analysis included patient demographics, stroke severity assessment, and discharge prognosis measurement using standardized scales. Results: : Eighty-six thousand five hundred sixty-eight acute stroke patients were collected with demographic and clinical characteristics during 18 months from 2016, 2018, and between 2020 to 2021, focusing on acute subarachnoid hemorrhage (SAH), acute intracerebral hemorrhage (ICH), and acute ischemic stroke. Of these 86568 patients, 8.3% was SAH, 16.3% ICH, and 74.9% ischemic stroke. Trends showed decreasing SAH and increasing ICH cases over the years. 68.3% stroke patients had the clear onset time. 49.6% stroke patients arrived within 4.5 hours of symptom onset, with more patients treated at general hospitals. Good functional outcomes at discharge was obtained with 58.3% of acute stroke patients, 55.9% of SAH patients, 34.6% of ICH patients, and 63.8% of ischemic stroke patients. Conclusion : The results showed that ischemic stroke was the most common subtype, followed by ICH and SAH. Prognosis differed among subtypes, with favorable outcomes more common in ischemic stroke and SAH compared to ICH.

Background: Children, adolescents, and young adults (CAYAs) with severe illnesses require intensive treatment, often relying on medical devices and advanced medical services.Modern medical technology has improved the lifespans of these patients. In addition, CAYAs represent a vulnerable group, resulting in a significant caregiving burden on the entire family.This study examined patterns of medical utilization following diagnosis of a life-limiting condition (LLC). Methods: We establish a cohort of 176,236 CAYAs who were first diagnosed with an LLC using National Health Insurance data between 2011 and 2013. Patients diagnosed with an LLC within the 3 years preceding this period and those who had died were excluded, and only those receiving care at a general medical hospital were included. In total, 25,410,411 claims for medical expenses, outpatient visits, and lengths of stay for medical utilization over the approximately 10 years up to 2020 were investigated (2.3% inpatients, 97.7% outpatients). Results: The average annual medical utilization per LLC patient among CAYAs following initial diagnosis included medical expenses of $1,163, 16.8 outpatient visits, and 18.7 days of admission. Among inpatients, cancer patients averaged $5,340 for total medical expenses and 21.0 days of admission, while non-cancer patients averaged $3,013 and 18.1 days, respectively. The overall average medical expenses during the first year following diagnosis of an LLC were $3,012, whereas for cancer patients they were $5,962. In addition, there was a sharp increase in total medical expenses as death approached, particularly in the last month of life, with a considerable proportion attributable to critical-care treatments. Conclusion Our investigation into medical utilization by CAYAs with an LLC in Korea provides a foundation for healthcare policy development. Timely treatment at each stage and tailored policies that take into account the heterogeneity among diseases are of paramount importance.

Background: Despite the necessity of long-term management for fracture risk reduction, adherence to osteoporosis pharmacotherapy remains poor. We investigated the factors influencing adherence to pharmacotherapy among Korean patients with osteoporosis, with a particular focus on treatment with bisphosphonates (BPs). Methods: Data from 725,313 osteoporosis patients newly prescribed BPs or selective estrogen receptor modulators (SERMs) between 2012 and 2014, obtained from the Korean National Health Insurance Service, were analyzed. Adherence was assessed based on compliance and persistence over a two-year period, with factors associated with adherence identified using multivariable logistic regression. Results: Only 14.8% of the patients who started BPs or SERMs sustained medication compliance, with 15.8% persisting with treatment over the two-year follow-up. Compared with BPs, patients receiving SERMs showed better compliance and persistence (odds ratios [ORs], 1.44 and 1.48, respectively; P < 0.001); while patients receiving intravenous administration showed higher compliance and persistence (ORs, 2.08 and 1.76, respectively; P < 0.001) compared with those taking oral medications. Patients placed on a quarterly dosing schedule showed improved compliance and persistence (ORs, 1.55 and 1.31, respectively; P < 0.001) compared with those on other dosing intervals. Male gender, advanced age, living outside metropolitan areas, receiving treatment in non-general hospitals, and a history of previous fractures were associated with poorer two-year adherence. Conclusion This study underscores the complex nature of medication adherence among Korean osteoporosis patients, particularly those treated with BPs. These findings accordingly indicate that medication with more convenient administration regimens and fewer side effects, coupled with suitable follow-up durations, could contribute to enhancing treatment adherence.

Objective: : Korea’s healthcare system and policy promotes early, actively stroke treatment to improve prognosis. This study represents stroke epidemiology and outcomes in Korea. Methods: : This study investigated data from the Acute Stroke Assessment Registry. The registry collects data from over 220 hospitals nationwide, focusing on quality stroke service management. Data analysis included patient demographics, stroke severity assessment, and discharge prognosis measurement using standardized scales. Results: : Eighty-six thousand five hundred sixty-eight acute stroke patients were collected with demographic and clinical characteristics during 18 months from 2016, 2018, and between 2020 to 2021, focusing on acute subarachnoid hemorrhage (SAH), acute intracerebral hemorrhage (ICH), and acute ischemic stroke. Of these 86568 patients, 8.3% was SAH, 16.3% ICH, and 74.9% ischemic stroke. Trends showed decreasing SAH and increasing ICH cases over the years. 68.3% stroke patients had the clear onset time. 49.6% stroke patients arrived within 4.5 hours of symptom onset, with more patients treated at general hospitals. Good functional outcomes at discharge was obtained with 58.3% of acute stroke patients, 55.9% of SAH patients, 34.6% of ICH patients, and 63.8% of ischemic stroke patients. Conclusion : The results showed that ischemic stroke was the most common subtype, followed by ICH and SAH. Prognosis differed among subtypes, with favorable outcomes more common in ischemic stroke and SAH compared to ICH.

Background: This study analyzed the status of community-based practice in public healthcare institutions in Korean medical schools and identified related needs. Methods: We conducted an online cross-sectional survey in which 32 of 40 medical schools (80.0%) participated between March and April 2023. We developed questionnaire items aimed at ascertaining the status and perceptions of community-based practice and analyzed the response data using frequency analysis, the Mann-Whitney U test, and content analysis with word clouds. Results: Of the 32 medical schools analyzed, 23 (71.9%) offered practical courses, and of those, 12 (52.2%) implemented practice lessons within courses. Among 20 schools, 18 (90.0%) required students to complete practical courses and over 50% offered these courses in the third and fourth years of the clerkship phase. Perceptions of community practice showed no significant differences based on whether courses were offered. Many schools have proposed that practice should be a continuous curricular element from the premedical to medical years. The primary challenges facing community-based practice were identified as faculty development, collaboration, and compensation of practice institutions. The following words were extracted from the respondents’ comments: practice, community, institution, student, education, faculty, university, and public. Conclusion This study identified the limitations of community-based education provided by Korean medical schools and we report findings that highlight areas of improvement. Notable among these is the need to continuously incorporate community-based practice into medical education while engaging in discussions and conducting research toward developing a comprehensive and systematic curriculum.

Background and Objectives: Evidence remains limited on the real-world prescription of very low-dose oral anticoagulation among frail patients with atrial fibrillation (AF). We described the practice patterns, effectiveness, and safety of very low-dose edoxaban (15 mg once daily). Methods: Patients with AF prescribed edoxaban 15 mg once daily in 2 tertiary hospitals between 2016 and September 2022 were included. Baseline clinical characteristics and clinical outcomes of interest were thromboembolic and bleeding events. Results: A total of 674 patients were included (mean age 78.3±9.1, 49.7% aged ≥80 years, 49.3% women, median follow-up 1.0±1.2 years). Mean CHA 2 DS 2 -VASc score was 3.9±1.6, and the modified HAS-BLED score was 2.0±1.1. Between 2016 and 2022, the number of very lowdose edoxaban prescriptions increased. The main reasons for the prescription of very lowdose were low body weight (55.5% below 60 kg), anaemia (62.8%), chronic kidney disease (40.2%), active cancer (15.3%), concomitant anti-platelet use (26.7%), and prior major bleeding (19.7%). During a median follow-up duration of 8 (interquartile range 3–16) months, overall thromboembolic and bleeding events occurred in 16 (2.3%) and 88 (13.1%) patients, respectively. Compared to the expected event rates on the established risk scoring systems, patients receiving very low-dose edoxaban demonstrated a 61% reduction in ischemic stroke, a 68% reduction of ischemic stroke/transient ischemic attack/systemic embolism, whereas a 49% increase in major bleeding. Conclusions The prescription of very low-dose edoxaban was increased over time, attributable to various clinical factors. The use of very low-dose edoxaban reduced the expected risk of thromboembolic events.

Purpose: This study analyzed the career paths of medical school graduates in the Daejeon, Sejong, and Chungcheongnam-do (DSC) region of South Korea, focusing on career choice factors at each career path. The ultimate goal was to derive practical insights to improve career guidance in the medical field and enhance professionalism. Methods: Data were collected through in-depth interviews with 10 medical school graduates working in the DSC region. A semi-structured questionnaire was used to explore their career paths, and factors influencing their career decisions. The collected qualitative data were analyzed using the constant comparative method to identify themes and categories. Results: The study results categorized career stages into three phases: “entering medical school,” “choosing a specialty after graduation,” and “choosing a workplace after training.” Career choice factors were classified into “personal factors,” “social factors,” and “job and work environment factors.” The factors influencing career choices differed across each career path. Conclusion This study holds significance in its in-depth analysis of career choice factors across different career paths from a long-term perspective. The findings suggest that effective support for career decision-making in the medical field requires a tailored approach that considers the distinct needs and influencing factors at each career path.

Long coronavirus disease (COVID) is a condition in which coronavirus disease 2019 (COVID-19) symptoms persist for over 3 months, and currently poses a global public health challenge. Due to varying manifestations and lack of standardized definitions, diagnostic methods, and treatments, comprehensive clinical guidelines are required. This review article, summarizing research and expert consensus up to June 2023, provides recommendations for diagnosis and long-term management of long COVID symptoms. It emphasizes thorough patient evaluation, including medical history, physical examinations, and tests, and advocates vaccination and antiviral treatments to reduce risk. Guidelines for long COVID will be updated as new knowledge emerges.