Objective: This study was undertaken to assess the appropriateness of transfer of patients from a long-term care hospital to the emergency department (ED). Methods: We conducted a retrospective study in a Wide Regional Emergency Center in Gyeongsangnam-do between January 2019 and December 2019. The patients were divided into groups (direct visit, transferred from other hospitals, and transferred from long-term care hospitals [LTCHs]). The baseline characteristics, Korean Triage and Acuity Scale (KTAS), vital signs, length of stay, ED disposition, cost, clinical outcome, and instances of application of the “Act on decisions on life-sustaining treatment” were collected. Results: A total of 30,142 patients were enrolled during the study period. Twenty-one thousand, nine hundred and sixty-five patients were in the direct visit group, 7,057 patients were transferred from other hospitals, and 1,120 patients were transferred from LTCHs. Hospital admission was higher in cases of transfer from other hospitals and LTCHs (LTCHs, 63.8%; transferred from other hospitals, 64.1%, direct visit, 30.1%; P<0.001). Re-transfer and mortality in the ED were much higher (re-transfer: LTCHs, 11.0%; transferred from other hospitals 3.8%, direct visit 1.9%; P<0.001 and mortality in ED: 2.9%, 0.8%, 1.4%; respectively P<0.001). In the LCTH group after admission, mortality was higher (mortality: 16.2%, 5.4%, 7.1% for LTCH transfers and direct respectively; P<0.001). The implementation rate of the “Act on decisions on life-sustaining treatment”, the well-dying law, was higher in the LTCHs (26.6%, 12.5%, and 11.4% LTCH transfers, and direct respectively; P<0.001). Conclusion In the LTCH group, re-transfer, mortality, and the implementation rate of the “Act on decisions on life-sustaining treatment” were higher than in the other groups.

Menopause is a normal phenomenon in a woman’s life cycle involving multiple health-related issues that contribute to physical instability. Changes in the immune system in postmenopausal women are caused by estrogen deprivation along with age. Increased proinflammatory serum marker levels, cytokine responses in body cells, decreased CD4 T and B lymphocyte levels, and natural killer cell cytotoxic activity are also observed during postmenopause. Moreover, vitamin D, in addition to its classical effects on calcium homeostasis and bone density, plays an important role. Current evidence indicates that vitamin D regulates innate and adaptive immune responses; however, vitamin D deficiency is linked to increased autoimmune activity and infection susceptibility. This review provides an overview of the consequences of immune alterations as an outcome of aging in postmenopausal women and the benefit of vitamin D supplementation.

PURPOSE: The Palliative Performance Scale (PPS) is a widely used prognostic tool in patients with advanced cancer. This study examines the association between changes in PPS score and survival in patients with advanced cancer. METHODS: We identified a cohort of 606 inpatients who died at a Korean university hospital's hospice/palliative care center. For each patient, the PPS score was measured twice according to a standard procedure: 1) upon admission, and 2) three days after admission (D3). “Change on D3” was defined as a difference between initial PPS and PPS on D3. We used a Cox regression modeling approach to explore the association between this score change and survival. RESULTS: The changes in scores were associated with survival. A score change of >30% yielded a hazard ratio for death of 2.66 (95% CI 2.19~3.22), compared to a score change of ≤30%. PPS of ≤30 on D3 also independently predicted survival, with a hazard ratio of 1.67 (95% CI 1.38~2.02) compared to PPS of >30. CONCLUSION: A change of over 30% in PPS appears to predict survival in hospitalized patients with terminal cancer, even after adjustment for confounders. Changes in PPS may be a more sensitive indicator of impending death than a single PPS measured on the day of admission in terminal cancer patients. Further prospective study is needed to examine this important finding in other populations.
Cohort Studies ; Hospice Care ; Humans ; Inpatients ; Palliative Care ; Prognosis ; Prospective Studies

We report a patient who developed subarachnoid hemorrhage (SAH) just after coronary angiography (CAG) with non-ionic contrast media (CM) and minimal dose of heparin. The 55-year-old man had a history of acute ST elevation myocardial infarction that had been treated with primary percutaneous coronary intervention and was admitted for a follow-up CAG. The CAG was performed by the transradial approach, using 1000 U of unfractionated heparin for the luminal coating and 70 mL of iodixanol. At the end of CAG, he complained of nausea and rapidly became stuporous. Brain CT showed a diffusely increased Hounsfield unit (HU) in the cisternal space, similar to leakage of CM. The maximal HU was 65 in the cisternal space. No vascular malformations were detected on cerebral angiography. The patient partially recovered his mental status and motor weakness after 2 days. Two weeks later, subacute SAH was evident on magnetic resonance imaging. The patient was discharged after 28 days.
Brain ; Cerebral Angiography ; Contrast Media ; Coronary Angiography ; Follow-Up Studies ; Heparin ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Myocardial Infarction ; Nausea ; Percutaneous Coronary Intervention ; Phenobarbital ; Stupor ; Subarachnoid Hemorrhage ; Triiodobenzoic Acids ; Vascular Malformations

Objectives: Greenhouse workers synthesize less vitamin D because ultraviolet light is blocked by the vinyl that covers the greenhouses. This study aimed to investigate the vitamin D status and bone health of postmenopausal women working in greenhouses. Methods: This observational study enrolled women living in urban (n = 70, group 1) and rural areas (n = 91, group 2) and those working in greenhouses (n = 112, group 3). Serum levels of total and bioavailable 25-hydroxy-vitamin D [25(OH)D] and vitamin D binding protein were measured. T-scores of the lumbar spine and femur neck were measured by dual-energy X-ray absorptionetry. Results: Heights were shorter in group 2 and group 3 than in group 1. Bioavailable 25(OH)D levels were higher and T-scores of the spine and femur were lower in both group 2 and 3 than in group 1. T-scores of the femur in group 3 were lower than those in group 2. The linear regression analysis showed that levels of bioavailable 25(OH)D significantly correlated with the spine T-scores but not with the femur T-scores. The prevalence of spinal osteoporosis was higher in both groups 2 and 3 compared to group 1. Group 3 demonstrated greater femur osteoporosis compared to groups 1 and 2. Conclusions Vitamin D plays an important role in spinal bone health. Moreover, working conditions are likely to play an important role in femur bone health. Therefore, appropriate working conditions and nutrition are paramount to improve bone health in postmenopausal women working in greenhouses.

OBJECTIVE: The current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommends early reperfusion with a door to balloon (DTB) time of 90 minutes or less in patients undergoing primary percutaneous coronary intervention (PPCI). Therefore, the focus of most studies has been the DTB time. On the other hand, the ischemic time is related to the symptom to balloon (STB) time rather than the DTB time. This study examined the clinical effects of the STB time as well as the social and clinical factors affecting the STB time in STEMI patients. METHODS: This study analyzed 286 patients diagnosed with STEMI from December 2008 to December 2016. The STB time (≤4 hours and>4 hours, ≤12 hours, and >12 hours) in the groups was compared. The mortality and ejection fraction were investigated. In addition, the characteristics of patients and socioeconomic factors affecting STB were analyzed. RESULTS: The SBT time is inversely associated with the ejection fraction (R=−0.126, P=0.033), and the ejection fraction of the ≤12 hours group was higher than that of the >12 hours group (54% vs. 50%, P=0.047). On the other hand, there was no significant difference in mortality between the two groups (3.26% vs. 4.84%, P=0.506). In multivariate analysis, the variable related to SBT was only typical chest pain (adjusted odd ratio, 1.931; 95% confidential interval, 1.014-3.792; P=0.045). CONCLUSION The results of the study support the prognostic value of SBT in STEMI undergoing PPCI. Therefore, efforts should be made to shorten the STB time.

Esophagopericardial fistula (EPF) is a rare and serious medical condition induced by benign and malignant causes. Surgery is the main stay of treatment for benign EPF. However, there have been few reports of benign EPF treated by endoscopic stent insertion. We performed a laparoscopic total gastrectomy for treatment of a gastric cancer located at the cardia in a 62-year-old patient. A benign EPF occurred as a postoperative complication 14 days after surgery. We successfully managed the EPF through emergent laparoscopic pericardial window formation and insertion of a fully covered self-expendable metal stent during operation. The patient is being followed up without complications in the outpatient department after stent removal.
Cardia ; Fistula* ; Gastrectomy* ; Humans ; Middle Aged ; Outpatients ; Postoperative Complications ; Stents* ; Stomach Neoplasms*

PURPOSE: Laparoscopic gastrectomy has oncologic unreliability, technical problems, and is expensive. To overcome these drawbacks, we performed operations through a small laparotomy without using a laparoscopic procedure. METHODS: From March to August, 2003, we successfully performed distal gastrectomy with minilaparotomy for 21 patients diagnosed with early gastric cancer in our hospital. An additional 24 patients with advanced gastric cancer underwent conventional laparotomy for distal gastrectomy. We performed distal gastrectomy with lymph node dissection, moving the abdominal window to the surgical site. We compared BMI, operating time, bleeding volume, and postoperative pain, and followed minilaparotomy patients for an average of 48 months. RESULTS: There were no postoperative complications in minilaparotomy patients. The minilaparotomy group had a shorter hospital stay lower analgesic use than conventional laparotomy, but there were no differences in BMI, bleeding volume, or the number of harvested lymph nodes. Minilaparotomy alleviated the severity of postoperative pain, and there were no recurrences during follow-up. CONCLUSION: Minilaparotomy for early gastric cancer improved postoperative outcome without oncologic inadequacy compared with conventional laparotomy. Therefore, distal gastrectomy via a minilaparotomy may become a minimally invasive therapeutic strategy for early gastric cancer.
Bleeding Time ; Gastrectomy ; Hemorrhage ; Humans ; Laparotomy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Pain, Postoperative ; Postoperative Complications ; Recurrence ; Stomach Neoplasms