Primary care plays a crucial role in the United Kingdom’s healthcare system. General practitioners (GPs) serve as the first point of contact with healthcare system and act as gatekeepers to secondary care. Recent reforms have aimed to enhance integration and efficiency to address resource constraints and improve service coordination. Before 2022, Clinical Commissioning Groups emphasized patient-centered service delivery but faced challenges related to fragmentation. To address this limitation, Integrated Care System (ICS) was introduced to strengthen the integration of healthcare and social services at the regional level. It comprises 42 systems, further divided into smaller units based on geographic regions and population size. ICS collaborates with local authorities, public health agencies, and social care providers to plan and implement healthcare services tailored to regional needs. Primary Care Network (PCN) system fosters collaboration among primary care providers, with approximately 1,250 PCNs, each serving around 50,000 people. PCNs improve accessibility and preventive care while facilitating multidisciplinary teamwork. Financial incentives encourage GP clinics to participate in PCN activities. The UK’s primary care reimbursement system includes global sum payments and performance-based payments, particularly through the Quality and Outcomes Framework (QOF). Global sum payments compensate GP clinics based on the number of registered patients, adjusted for demographic and regional characteristics. Meanwhile, QOF provides performance-based incentives to individual GP clinics based on quality indicators for chronic disease management and preventive care. These reforms offer valuable insights for strengthening South Korea’s primary care system, particularly in terms of regional healthcare integration and performance-based incentives.

Background: An ideal lung allocation system should reduce waiting list deaths, improve transplant survival, and ensure equitable organ allocation. This study aimed to develop a novel lung allocation score (LAS) system, the MaxBenefit LAS, to maximize transplant benefits. Methods: This study retrospectively analyzed data from the Korean Network for Organ Sharing database, including 1,599 lung transplant candidates between September 2009 and December 2020. We developed the MaxBenefit LAS, combining a waitlist mortality model and a post-transplant survival model using elastic-net Cox regression, was assessed using area under the curve (AUC) values and Uno’s C-index. Its performance was compared to the US LAS in an independent cohort. Results: The waitlist mortality model showed strong predictive performance with AUC values of 0.834 and 0.818 in the training and validation cohorts, respectively. The post-transplant survival model also demonstrated good predictive ability (AUC: 0.708 and 0.685). The MaxBenefit LAS effectively stratified patients by risk, with higher scores correlating with increased waitlist mortality and decreased post-transplant mortality. The MaxBenefit LAS outperformed the conventional LAS in predicting waitlist death and identifying candidates with higher transplant benefits. Conclusion The MaxBenefit LAS offers a promising approach to optimizing lung allocation by balancing the urgency of candidates with their likelihood of survival post-transplant. This novel system has the potential to improve outcomes for lung transplant recipients and reduce waitlist mortality, providing a more equitable allocation of donor lungs.

Background: The accuracy of Logical Observation Identifiers Names and Codes (LOINC) mappings is reportedly low, and the LOINC codes used for research purposes in Korea have not been validated for accuracy or usability. Our study aimed to evaluate the discrepancies and similarities in interoperability using existing LOINC mappings in actual patient care settings. Methods: We collected data on local test codes and their corresponding LOINC mappings from seven university hospitals. Our analysis focused on laboratory tests that are frequently requested, excluding clinical microbiology and molecular tests. Codes from nationwide proficiency tests served as intermediary benchmarks for comparison. A research team, comprising clinical pathologists and terminology experts, utilized the LOINC manual to reach a consensus on determining the most suitable LOINC codes. Results: A total of 235 LOINC codes were designated as optimal codes for 162 frequent tests.Among these, 51 test items, including 34 urine tests, required multiple optimal LOINC codes, primarily due to unnoted properties such as whether the test was quantitative or qualitative, or differences in measurement units. We analyzed 962 LOINC codes linked to 162 tests across seven institutions, discovering that 792 (82.3%) of these codes were consistent. Inconsistencies were most common in the analyte component (38 inconsistencies, 33.3%), followed by the method (33 inconsistencies, 28.9%), and properties (13 inconsistencies, 11.4%). Conclusion This study reveals a significant inconsistency rate of over 15% in LOINC mappings utilized for research purposes in university hospitals, underlining the necessity for expert verification to enhance interoperability in real patient care.

Background: Community acquired lower respiratory tract infection (LRTI) is a leading cause for hospitalization in children and important cause for antibiotic prescription. We aimed to describe the aetiology of LRTI in children and analyse factors associated with bacterial or viral infection. Methods: Patients aged < 19 years with a diagnosis of LRTI were identified from the Observational Medical Outcomes Partnership Common Data Model Database of Seoul National University Bundang Hospital from January 2005–July 2019, and their clinical characteristics were obtained from the electronic medical records and retrospectively reviewed. Results: Among 5,924 cases of LRTI, 74.2% were pneumonia and 25.8% were bronchiolitis/ bronchitis. Patients’ median age was 1.8 (interquartile range, 3.1) years and 79.9% were < 5 years old. Pathogens were identified in 37.8%; 69.1% were viral and 30.9% were bacterial/ Mycoplasma pneumoniae. Respiratory syncytial virus was most common (70.9%) among viruses and M. pneumoniae (94.6%) was most common among bacteria. Viral LRTI was associated with winter, age < 2 years, rhinorrhoea, dyspnoea, lymphocytosis, thrombocytosis, wheezing, stridor, chest retraction, and infiltration on imaging. Bacteria/ M. pneumoniae LRTI was associated with summer, age ≥ 2 years, fever, decreased breathing sounds, leucocytosis, neutrophilia, C-reactive protein elevation, and positive imaging findings (consolidation, opacity, haziness, or pleural effusion). Conclusion In children with LRTI, various factors associated with viral or bacterial/ M. pneumoniae infections were identified, which may serve as guidance for antibiotic prescription.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

Despite widespread coronavirus disease 2019 (COVID-19) vaccine use, research on the association between vaccines and cerebrovascular venous sinus thrombosis (CVST) in diverse populations is limited. This study aimed to address this gap. Data from the World Health Organization pharmacovigilance database (1968–2024; total reports = 8,909,484) were used.Reporting odds ratios (RORs) and information components (ICs) were calculated to assess the association between each drug and CVST. In total, 851 cases were identified as vaccineassociated CVST, of which 527 (61.93%) occurred in female patients. Only Ad5-vectored COVID-19 vaccines had the highest ROR and IC value with CVST (ROR, 4.78; 95% confidence interval, 4.34–5.28; IC, 2.15). The risk of CVST increased with age, with the 45–64-years age group having an IC of 1.35, while the 65 years and older group had a higher IC of 2.08.The findings highlight the need for clinicians to recognize the potential risks of CVST and prioritize rigorous monitoring and research to ensure patient safety.

Objective: : Patients with traumatic brain injury (TBI) commonly exhibit a poor mental health status and can easily develop aspiration pneumonia. Thus, early proper nutrition through oral or tube feeding is difficult to achieve, leading to malnutrition. However, evidence regarding early nutritional support in the intensive care unit (ICU) is lacking. We aimed to assess the effect of early nutrition in patients with TBI admitted to the ICU. Methods: : Data of adult patients with TBI admitted to the trauma ICU of a regional trauma center in Korea between 2022 and 2023 were retrospectively analyzed. Those with ICU stay <7 days, younger than 18 years, and with underlying diseases that could alter baseline metabolism, were excluded. Nutritional support on day 4 of ICU admission was measured. The patients were classified into mortality and survival groups, and risk factors for mortality were evaluated. Subgroup analyses were performed based on TBI severity. Results: : Overall, 864 patients were diagnosed with acute TBI, of whom 227 were included in this study. The mortality rate in the study population was 15% (n=34). Those in the survival group were younger, had longer hospital stays, had a higher initial Glasglow coma scale (GCS) score, and had a higher intake of calorie supplements than those in the mortality group. In a subgroup analysis of patients with non-severe TBI (GCS >8), total calorie intake (751.4 vs. 434.2 kcal, p=0.029), total protein intake (37.5 vs. 22.1 g, p=0.045), and ratio of supplied to target calories (0.49 vs. 0.30, p=0.047) were higher in the survival group than in the mortality group. Logistic regression analysis revealed that calorie intake (B=-0.002, p=0.040) and initial hemoglobin level (B=-0.394, p=0.005) were risk factors for mortality in patients with non-severe TBI. Conclusion : More calories were supplied to the survival group than the mortality group among patients with TBI. Additionally, logistic regression analysis showed that increased calorie supply was associated with reduced mortality in patients with non-severe TBI. The mortality group had low protein intake; however, this did not emerge as a risk factor for mortality. Early sufficient nutritional support improves the prognosis of patients with TBI.

While advances in cancer treatment have led to improved survival rates, cancer survivors are at a significant risk of developing atherosclerotic cardiovascular disease (ASCVD).This review examines the risk, diagnosis, and prevention of ASCVD in this population.Cancer survivors, especially those diagnosed with certain types, face a significantly higher risk of developing ASCVD than the general population. We introduce the “triad model” to explain this increased risk of ASCVD among cancer patients. This model includes three interconnected components: common catalysts, cancer influence, and treatment impact.The factors contributing to this model are the shared risk factors between cancer and ASCVD, such as smoking, obesity, and systemic inflammation; the direct effects of cancer on cardiovascular health through chronic systemic inflammation and endothelial damage;and the significant effects of anticancer treatments, including chemotherapy and radiation, which can worsen cardiovascular complications and hasten the progression of ASCVD.Furthermore, cancer survivors are at a higher risk of developing and dying from ASCVD, highlighting the necessity for tailored guidelines and strategies for ASCVD prevention and management in this population. The review explores the utility of diagnostic tools, such as coronary artery calcium scoring, in predicting and managing ASCVD risk. It also emphasizes the importance of prevention strategies that include regular cardiovascular monitoring and lifestyle modifications. Finally, the relationship between cancer survival and cardiovascular health highlights the importance of integrated and comprehensive care approaches.Continued research, the development of prediction models, and specific preventative strategies are essential to improve cancer survivors’ overall health outcomes.