PURPOSE: We validated the performance of the San Francisco Syncope Rule (SFSR) for accurate identification of Korean emergency department (ED) syncope patients who will experience a short term serious outcome. METHODS: This retrospective study included patients over 16 years old who fulfilled the inclusion criteria according to the definition of syncope and visited the ED from January 2010 to June 2013. The authors excluded patients with alcohol or illicit drugs use seizure, stroke or transient ischemic attack, head trauma followed by loss of consciousness, or hypoglycemia. The patients were divided into two groups according to the SFSR for the purpose of performing a comparative analysis. The authors calculated sensitivity, specificity, positive predictive value, and negative predictive value of SFSR and analyzed other variables, except five predictor variables of SFSR. RESULTS: Of 1,235 visits screened, 409 were included. The average age of enrolled patients was 55.2+/-20.1 and male population accounted for 45.0%(n=184). A total of 93(27.7%) patients experienced serious outcomes; 41 of 287(14.3%) patients with a serious outcome were not identified as high risk according to the rule. The rule performed with a sensitivity of 55.9%, specificity of 77.8%, positive predictive value of 42.6%, and negative predictive value of 85.7%. CONCLUSION: In this retrospective validation study based on the standardized reporting guidelines for ED syncope risk stratification research, the SFSR performed with significantly lower sensitivity than previously reported. The results suggest that application of the original rule has limited generalizability and conduct of future studies will be needed in order to refine the SFSR.
Adolescent ; Craniocerebral Trauma ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypoglycemia ; Ischemic Attack, Transient ; Male ; Retrospective Studies ; Seizures ; Sensitivity and Specificity ; Street Drugs ; Stroke ; Syncope* ; Unconsciousness

PURPOSE: We validated the performance of the San Francisco Syncope Rule (SFSR) for accurate identification of Korean emergency department (ED) syncope patients who will experience a short term serious outcome. METHODS: This retrospective study included patients over 16 years old who fulfilled the inclusion criteria according to the definition of syncope and visited the ED from January 2010 to June 2013. The authors excluded patients with alcohol or illicit drugs use seizure, stroke or transient ischemic attack, head trauma followed by loss of consciousness, or hypoglycemia. The patients were divided into two groups according to the SFSR for the purpose of performing a comparative analysis. The authors calculated sensitivity, specificity, positive predictive value, and negative predictive value of SFSR and analyzed other variables, except five predictor variables of SFSR. RESULTS: Of 1,235 visits screened, 409 were included. The average age of enrolled patients was 55.2+/-20.1 and male population accounted for 45.0%(n=184). A total of 93(27.7%) patients experienced serious outcomes; 41 of 287(14.3%) patients with a serious outcome were not identified as high risk according to the rule. The rule performed with a sensitivity of 55.9%, specificity of 77.8%, positive predictive value of 42.6%, and negative predictive value of 85.7%. CONCLUSION: In this retrospective validation study based on the standardized reporting guidelines for ED syncope risk stratification research, the SFSR performed with significantly lower sensitivity than previously reported. The results suggest that application of the original rule has limited generalizability and conduct of future studies will be needed in order to refine the SFSR.
Adolescent ; Craniocerebral Trauma ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypoglycemia ; Ischemic Attack, Transient ; Male ; Retrospective Studies ; Seizures ; Sensitivity and Specificity ; Street Drugs ; Stroke ; Syncope* ; Unconsciousness

OBJECTIVES: This study evaluated the prevalence of asbestos exposure-induced pleural thickening on chest radiograph in repairing shipyard workers. METHODS: A total of 2,114 incumbent and retired workers in a shipyard underwent chest radiograph, questionnaire study, interview, and physical exam from 2005 to 2007. Finally, 1,702 workers were selected and classified into two groups according to asbestos exposure: exposure and non-exposure groups. The characteristics in the exposure group were investigated. RESULTS: The prevalence of pleural thickening on chest radiograph was 5.2 % and 3.1 % in the exposure and non-exposure groups, respectively (p<0.05). In those aged 50 years or above, the prevalence was 17.6 % and 8.7 % in the exposure and non-exposure groups, respectively (p<0.05). The prevalence was 16.5 % and 30.2 % and the odds ratio was 2.34 (95% CI; 1.15-4.77) and 2.95 (95%CI; 1.08-8.07) in the workers with an exposure duration of 20-29 years and more than 30 years, respectively. The prevalence was higher when considering tuberculosis history. CONCLUSIONS: The prevalence was increased with increasing exposure duration was more than 20 years. The authors therefore suggest that this group should be followed up periodically by special program and that a longitudinal study with repairing shipyard workers as the cohort should be undertaken.
Aged ; Asbestos ; Cohort Studies ; Humans ; Odds Ratio ; Prevalence ; Questionnaires ; Thorax ; Tuberculosis

OBJECTIVES: This study evaluated the prevalence of asbestos exposure-induced pleural thickening on chest radiograph in repairing shipyard workers. METHODS: A total of 2,114 incumbent and retired workers in a shipyard underwent chest radiograph, questionnaire study, interview, and physical exam from 2005 to 2007. Finally, 1,702 workers were selected and classified into two groups according to asbestos exposure: exposure and non-exposure groups. The characteristics in the exposure group were investigated. RESULTS: The prevalence of pleural thickening on chest radiograph was 5.2 % and 3.1 % in the exposure and non-exposure groups, respectively (p<0.05). In those aged 50 years or above, the prevalence was 17.6 % and 8.7 % in the exposure and non-exposure groups, respectively (p<0.05). The prevalence was 16.5 % and 30.2 % and the odds ratio was 2.34 (95% CI; 1.15-4.77) and 2.95 (95%CI; 1.08-8.07) in the workers with an exposure duration of 20-29 years and more than 30 years, respectively. The prevalence was higher when considering tuberculosis history. CONCLUSIONS: The prevalence was increased with increasing exposure duration was more than 20 years. The authors therefore suggest that this group should be followed up periodically by special program and that a longitudinal study with repairing shipyard workers as the cohort should be undertaken.
Aged ; Asbestos ; Cohort Studies ; Humans ; Odds Ratio ; Prevalence ; Questionnaires ; Thorax ; Tuberculosis

No abstract available.

BACKGROUND/AIMS: Indications for submucosal saline-epinephrine injection (SSEI) for prevention of postpolypectomy bleeding, in the colon, is variable among endoscopists. The aim of this study was to determine the proper indication for SSEI. METHODS: Clinical data of 1,745 polypectomies was evaluated. Postpolypectomy bleeding after snare polypectomy were evaluated in 1,039 polypectomies. Subgroup analysis was performed in 4 subgroups by size (< or = 8 mm or >8 mm) and gross morphology (pedunculated or sessile), also. RESULTS: Submucosal saline-epinephrine injection was used in 679 snare polypectomies. The size of polyps was 9.5+/-4.3 mm. Distribution of polyps showed left side shift in the colon. Sessile polyps (79.4%) and benign adenoma (75.3%) were predominant. Twenty seven episodes (2.6%) of bleeding occurred after snare polypectomy. Rectal polyp, malignant polyp and procedure without SSEI increased bleeding after snare polypectomy with odds ratio 4.71, 10.48 and 3.44, respectively. However, SSEI significantly reduced the bleeding only in patients who had >8 mm sized sessile polyps with odds ratio 16.41 regardless of location and histopathology. CONCLUSIONS: SSEI should be performed in colonoscopic snare polypectomy for >8 mm sized sessile polyps, and might be performed in others for prevention of bleeding at the discretion of the clinician.
Adenoma

BACKGROUND: A prolonged-release formulation of oxycodone/naloxone has been shown to be effective in European populations for the management of chronic moderate to severe pain. However, no clinical data exist for its use in Korean patients. The objective of this study was to assess efficacy and safety of prolonged-release oxycodone/naloxone in Korean patients for management of chronic moderate-to-severe pain. METHODS: In this multicenter, single-arm, open-label, phase IV study, Korean adults with moderate-to-severe spinal disorder-related pain that was not satisfactorily controlled with weak opioids and nonsteroidal anti-inflammatory drugs received prolonged-release oral oxycodone/naloxone at a starting dose of 10/5 mg/day (maximum 80/40 mg/day) for 8 weeks. Changes in pain intensity and quality of life (QoL) were measured using a numeric rating scale (NRS, 0–10) and the Korean-language EuroQol-five dimensions questionnaire, respectively. RESULTS: Among 209 patients assessed for efficacy, the mean NRS pain score was reduced by 25.9% between baseline and week 8 of treatment (p < 0.0001). There was also a significant improvement in QoL from baseline to week 8 (p < 0.0001). The incidence of adverse drug reactions was 27.7%, the most common being nausea, constipation, and dizziness; 77.9% of these adverse drug reactions had resolved or were resolving at the end of the study. CONCLUSIONS: Prolonged-release oxycodone/naloxone provided significant and clinically relevant reductions in pain intensity and improved QoL in Korean patients with chronic spinal disorders. (ClinicalTrials.gov identifier: NCT01811238)
Adult ; Analgesia ; Analgesics, Opioid ; Chronic Pain* ; Constipation ; Dizziness ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Incidence ; Nausea ; Quality of Life ; Spine

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.