Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Purpose: In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. Methods: In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. Results: Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. Conclusion Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

The purpose of this study was to evaluate the structural characteristics of the thread length of orthodontic mini-screws and the effects of insertion and removal torques according to the formation of the cutting flute. Two types of mini-screws were made, with a thread length of 6.0 mm and a thread length of 3.3 mm. In order to examine the effect of flute formation, the experiment group was divided into a miniscrew test group with flute formation and an experiment group without flute formation. To evaluate the effect of flute formation, two flutes were formed at 180°on the circumference, and at the tip of the mini screw, up to 4 mm for thread length of 6.0 mm and 2.4 mm for thread length of 3.3 mm. A biomechanical test block formed of 2 mm cortical bone and 10 mm cancellous bone was used to eliminate the influence of the difference in cortical bone thickness and bone density according to the insertion site. 1 mm diameter guide hole was drilled on the test block and the mini-screw was placed vertically. Using a 0.1 N·cm precision digital torque gauge, the maximum torque value was recorded at this time by embedding it to the top of the screw under a static load of 1.2 kg and the value when it was removed in the opposite direction. The insertion torque values for the 6.0 mm and 3.3 mm length mini screws were (29.53±1.84) N·cm and (26.84±2.15) N·cm, and the removal torque values are (14.50±1.37) N·cm and (13.15±2.89) N·cm, respectively.There were no statistically significant differences (P>0.05). The flute of 6.0 mm mini-screws had no statistically significant difference in both insertion and removal torque values and increased to (30.13±1.97) N·cm and (18.65±1.10) N·cm (P>0.05). In experiments with 3.3 mm mini-screws, the insertion and removal torque values decreased to (20.99±3.94) N·cm and (11.32±2.03) N·cm, respectively, showing a statistically significant decrease only in the insertion torque values (P<0.05). The insertion and removal torque values of the mini-screw were not significantly increased even when the screw length was doubled, and the flute formation effect was different with the screw length.

Purpose: In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. Methods: In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. Results: Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. Conclusion Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

The purpose of this study was to evaluate the structural characteristics of the thread length of orthodontic mini-screws and the effects of insertion and removal torques according to the formation of the cutting flute. Two types of mini-screws were made, with a thread length of 6.0 mm and a thread length of 3.3 mm. In order to examine the effect of flute formation, the experiment group was divided into a miniscrew test group with flute formation and an experiment group without flute formation. To evaluate the effect of flute formation, two flutes were formed at 180°on the circumference, and at the tip of the mini screw, up to 4 mm for thread length of 6.0 mm and 2.4 mm for thread length of 3.3 mm. A biomechanical test block formed of 2 mm cortical bone and 10 mm cancellous bone was used to eliminate the influence of the difference in cortical bone thickness and bone density according to the insertion site. 1 mm diameter guide hole was drilled on the test block and the mini-screw was placed vertically. Using a 0.1 N·cm precision digital torque gauge, the maximum torque value was recorded at this time by embedding it to the top of the screw under a static load of 1.2 kg and the value when it was removed in the opposite direction. The insertion torque values for the 6.0 mm and 3.3 mm length mini screws were (29.53±1.84) N·cm and (26.84±2.15) N·cm, and the removal torque values are (14.50±1.37) N·cm and (13.15±2.89) N·cm, respectively.There were no statistically significant differences (P>0.05). The flute of 6.0 mm mini-screws had no statistically significant difference in both insertion and removal torque values and increased to (30.13±1.97) N·cm and (18.65±1.10) N·cm (P>0.05). In experiments with 3.3 mm mini-screws, the insertion and removal torque values decreased to (20.99±3.94) N·cm and (11.32±2.03) N·cm, respectively, showing a statistically significant decrease only in the insertion torque values (P<0.05). The insertion and removal torque values of the mini-screw were not significantly increased even when the screw length was doubled, and the flute formation effect was different with the screw length.

BACKGROUND: Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia. METHODS: This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and <500 mg/dL and LDL-C levels <110 mg/dL. Eligible subjects were randomized to ATOMEGA (OM3-FAs 4,000 mg plus atorvastatin calcium 20 mg) or atorvastatin 20 mg plus placebo groups. The primary efficacy endpoints were the percent changes in TG and non-HDL-C levels from baseline at the end of treatment. RESULTS: After 8 weeks of treatment, the percent changes from baseline in TG (−29.8% vs. 3.6%, P<0.001) and non-HDL-C (−10.1% vs. 4.9%, P<0.001) levels were significantly greater in the ATOMEGA group (n=97) than in the atorvastatin group (n=103). Moreover, the proportion of total subjects reaching TG target of <200 mg/dL in the ATOMEGA group was significantly higher than that in the atorvastatin group (62.9% vs. 22.3%, P<0.001). The incidence of adverse events did not differ between the two groups. CONCLUSION The addition of OM3-FAs to atorvastatin improved TG and non-HDL-C levels to a significant extent compared to atorvastatin alone in subjects with residual hypertriglyceridemia.

BACKGROUND: In firefighters, smoking management is important because they are exposed to various harmful substances in their occupational environment. Accurate surveys of smoking status are essential to control tobacco use. The main disadvantage of self-report questionnaires, which are commonly used for investigating smoking status, is the possibility that the subjects' response are invalid. If the validity of firefighters' answers on smoking questionnaires is not adequate, different methods will be needed for investigating smoking status in firefighters. METHODS: This study was conducted on 445 male firefighters from 9 fire stations in Daegu (the city in South Korea) who visited a medical institution for medical checkup in 2016. The urine cotinine test strip (DCT-102; CLIAwaived Inc., cut-off value = 200 ng/mL) was used to classify the actual smoking status and to assess the validity of self-reported smoking status on questionnaires. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the smoking questionnaires were analyzed. Subjects testing positive in the urine cotinine test (assumed the actual current smokers) were selected. The frequency at which actual current smokers were misclassified as current non-smokers by the questionnaire was calculated. Subjects' characteristics were analyzed for possible association with any discrepancy between self-reported smoking status and urine cotinine test results. RESULTS: The smoking rates among firefighters surveyed using the smoking questionnaire and the urine cotinine test were 22.47% and 51.24%, respectively. Of the all subjects, 29.66% (n = 132) were misclassified. The sensitivity of the smoking questionnaire was 42.98%, the specificity was 99.08%, the PPV was 98.00%, and the NPV was 62.32%. In the 228 subjects classified as current actual smokers by the urine cotinine test, 57.02% (n = 130) were misclassified on the questionnaire. The misclassification rate increased with age. The degree of misclassification also increased when subjects had a history of disease. CONCLUSIONS In present study, the validity of the smoking questionnaire for firefighters was not suitable for investigating smoking status due to low sensitivity. To increase the validity of smoking status monitoring in firefighters, consideration of the various factors like survey environment, subjects' characteristics, and occupational factors is needed.