OBJECTIVES: This study developed an algorithm for identifying pregnancy episodes and estimating the last menstrual period (LMP) in an administrative claims database and applied it to investigate the use of pregnancy-incompatible immunosuppressants among pregnant women with systemic lupus erythematosus (SLE). METHODS: An algorithm was developed and applied to a nationwide claims database in Korea. Pregnancy episodes were identified using a hierarchy of pregnancy outcomes and clinically plausible periods for subsequent episodes. The LMP was estimated using preterm delivery, sonography, and abortion procedure codes. Otherwise, outcome-specific estimates were applied, assigning a fixed gestational age to the corresponding pregnancy outcome. The algorithm was used to examine the prevalence of pregnancies and utilization of pregnancy-incompatible immunosuppressants (cyclophosphamide [CYC]/mycophenolate mofetil [MMF]/methotrexate [MTX]) and non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy in SLE patients. RESULTS: The pregnancy outcomes identified in SLE patients included live births (67%), stillbirths (2%), and abortions (31%). The LMP was mostly estimated with outcome-specific estimates for full-term births (92.3%) and using sonography procedure codes (54.7%) and preterm delivery diagnosis codes (37.9%) for preterm births. The use of CYC/MMF/MTX decreased from 7.6% during preconception to 0.2% at the end of pregnancy. CYC/MMF/MTX use was observed in 3.6% of women within 3 months preconception and 2.5% during 0-7 weeks of pregnancy. CONCLUSIONS This study presents the first pregnancy algorithm using a Korean administrative claims database. Although further validation is necessary, this study provides a foundation for evaluating the safety of medications during pregnancy using secondary databases in Korea, especially for rare diseases.

Purpose: Glyphosate herbicide (GH) is a widely used herbicide and has been associated with significant mortality as poisoned cases increases. One of the reasons for high toxicity is thought to be toxic effect of its ingredient with glyphosate. This study was designed to determine differences in the clinical course with the salt-type contained in GH. Methods: This was a retrospective study conducted at a single hospital between January 2013 and December 2017. We enrolled GH-poisoned patients visited the emergency department. According to salt-type, patients were divided into 4 groups: isopropylamine (IPA), ammonium (Am), potassium (Po), and mixed salts (Mi) groups. The demographics, laboratory variables, complications, and their mortality were analyzed to determine clinical differences associated with each salt-type. Addtionally, we subdivided patients into survivor and non-survivor groups for investigating predictive factors for the mortality. Results: Total of 348 GH-poisoned patients were divided as follows: IPA 248, Am 41, Po 10, and Mi 49 patients. There was no difference in demographic or underlying disease history, but systolic blood pressure (SBP) was low in Po group. The ratio of intentional ingestion was higher in Po and Mi groups. Metabolic acidosis and relatively high lactate level were presented in Po group.As the primary outcome, the mortality rates were as follows: IPA, 26 (10.5%); Am, 2 (4.9%); Po, 1 (10%); and Mi, 1 (2%). There was no statistically significant difference in the mortality and the incidence of complications. Additionally, age, low SBP, low pH, corrected QT (QTc) prolongation, and respiratory failure requiring mechanical ventilation were analyzed as independent predictors for mortality in a regression analysis. Conclusion There was no statistical difference in their complications and the mortality across the GH-salt groups in this study.

This study was performed to select the proper assessing methods for learning outcomes in undergraduate education of medical humanities (MH), and to evaluate whether student assessments in MH curricula are related to the graduate outcomes (GO)and/or periodic phase outcomes (PO). We searched the reasonable assessing methods for GO and PO of MH curricula of Keimyung University School of Medicine (KUSM). The outcomes are composed of six competencies including patient care, communication, patient support, professionalism, problem solving and research, and self-development. Then, we analyzed whether student assessments carried out during formal MH curricula properly achieved their PO, furthermore their GO. Four competencies including communication, patient support, professionalism, self-development were lightened to be closely related to outcomes for MH. Only the component of problem solving was settled to be related to MH in the competency of problem solving and research. The competency of patient care was excluded from the relationship with MH. The assessing methods for the GO and three PO recommended from educational experts, and there were various available assessing methods based on medical situations and clinical contexts including direct observation of clinical skills, 360 degree feedback, peer review, self-assessment, project-based assessment, portfolio-based assessment, discussion & presentation-based assessment, log-based assessment. For the outcome-achieving from formal MH curricula, the MH programs of phase-1 (1st and 2nd grades) almost accomplished the PO of communication, patient supporting and professionalism, and considerably accomplished the PO of problem solving and self-development. The MH programs of phase-2 (3rd and 4th grades) accomplished considerably their PO as the competencies of professionalism and problem solving, and partially as communication, patient supporting and self-development. However, as only one program, public health law, was provided for MH program in phase-3 (5th and 6th grades), the extra methods to evaluate their MH outcomes are needed. Many assessing methods can be available for the most MH competencies consisting of the GO of KUSM, and the proper assessing methods for each MH competency should be selected based on programs and learning contexts in MH education. While formal MH curricula of the school variously accomplished the MH competencies of GO according to periodic phases of curricula, it is recommended to enhance the feasibility and effectiveness of evaluation for GO in MH curricula of the school.

Background: The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods: This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results: Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53%) and infection (44%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

BACKGROUND: This study aims to analyze quality of and satisfaction with Korea medical services and identify factors affecting medical service satisfaction, revisit, and recommendation intention among international patients. METHODS: Secondary analysis of survey data conducted by Korea Health Industry Development Institute from June 10th to July 17th in 2013 was done using multiple regression and logistic regression analysis. The 191 international patients from 9 medical institutions in Seoul were enrolled. RESULTS: The results showed that international patients were satisfied with 85.6 points out of 100.0 points. International patients appraised higher in staff service rather than other services. Factors influencing medical service satisfaction were gender, religion, medical specialty, length of stay, and quality of medical services. Quality of medical service explained 29.8% of medical service satisfaction and especially, ‘doctor's care’ and ‘communication and patient respect‘ were significantly related to medical service satisfaction. Medical specialty had a significant influence on revisit intention. There were no statistically significant influencing factors of recommendation intention. Additionally, more satisfied patients were associated with higher revisit and recommendation intention. CONCLUSION: This study implies that quality of medical services is a critical factor for patient satisfaction and that satisfaction with medical services is an important factor for increasing revisit and recommendation intention among international patients. In addition, health care providers should consider cultural differences to enhance satisfaction with medical services for international patients. Therefore, multidimensional strategy is required to strengthen the cultural competency of healthcare providers.
Cultural Competency ; Health Personnel ; Health Services ; Humans ; Intention* ; Korea* ; Length of Stay ; Logistic Models ; Patient Satisfaction ; Seoul

The objective of this study was to conduct a meta-analysis to determine risk factors that may facilitate patient selection for radical resections or additional resections after a polypectomy. Eligible articles were identified by searches of PUBMED, Cochrane Library and Korean Medical Database using the terms (early colorectal carcinoma [ECC], lymph node metastasis [LNM], colectomy, endoscopic resection). Thirteen cohort studies of 7,066 ECC patients who only underwent radical surgery have been analysed. There was a significant risk of LNM when they had submucosal invasion (> or = SM2 or > or = 1,000 microm) (odds Ratio [OR], 3.00; 95% confidence interval [CI], 1.36-6.62, P = 0.007). Moreover, it has been found that vascular invasion (OR, 2.70; 95% CI, 1.95-3.74; P < 0.001), lymphatic invasion (OR, 6.91; 95% CI, 5.40-8.85; P < 0.001), poorly differentiated carcinomas (OR, 8.27; 95% CI, 4.67-14.66; P < 0.001) and tumor budding (OR, 4.59; 95% CI, 3.44-6.13; P < 0.001) were significantly associated with LNM. Furthermore, another analysis was carried out on eight cohort studies of 310 patients who underwent additional surgeries after an endoscopic resection. The major factors identified in these studies include lymphovascular invasion on polypectomy specimens (OR, 5.47; 95% CI, 2.46-12.17; P < 0.001) and poorly or moderately differentiated carcinomas (OR, 4.07; 95% CI, 1.08-15.33; P = 0.04). For ECC patients with > or = SM2 or > or = 1,000 microm submucosal invasion, vascular invasion, lymphatic invasion, poorly differentiated carcinomas or tumor budding, it is deemed that a more extensive resection accompanied by a lymph node dissection is necessary. Even if the lesion is completely removed by an endoscopic resection, an additional surgical resection should be considered in patients with poorly or moderately differentiated carcinomas or lymphovascular invasion.
Colectomy ; Colorectal Neoplasms/*pathology/surgery ; Endoscopy ; Female ; Humans ; Intestinal Polyps/surgery ; Lymphatic Metastasis ; Male ; Neoplasm Invasiveness

PURPOSE: This study was designed to investigate differences in ultrasonographic findings between malignant and benign mammary duct ectasia. METHODS: From January 2003 to June 2005, 54 surgically proven mammary duct ectasia lesions depicted on sonograms were included in this study. We evaluated the ultrasonographic (US) findings in terms of involved ductal location, size, margin, intraductal echogenicity, presence of an intraductal nodule, calcification, ductal wall thickening and echo changes of the surrounding breast parenchyma. The US findings were correlated with the pathological features. RESULTS: Of the 54 lesions, 46 lesions were benign and eight lesions were malignant. Benign lesions included an inflammatory change (n=7), ductal epithelial hyperplasia (n=7), fibrocystic change (n=18), intraductal papilloma (n=11), atypical ductal hyperplasia (n=2) and sclerosing adenosis (n=1). Malignant lesions included ductal carcinoma in situ (DCIS) (n=6), infiltrating ductal carcinoma (n=1) and mucinous carcinoma (n=1). On US images, the peripheral ductal location, an ill-defined margin, ductal wall thickening and a hypoechoic change of the surrounding parenchyma were features significantly associated with malignant duct ectasia. CONCLUSION: For ill-defined peripheral duct ectasia with ductal wall thickening and surrounding hypoechogenicity as depicted on US, the possibility of malignancy should be considered and radiologists should not hesitate to recommend a prompt biopsy.
Adenocarcinoma, Mucinous ; Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Dilatation, Pathologic ; Hyperplasia ; Papilloma, Intraductal ; Ultrasonography, Mammary

PURPOSE: To evaluate the usefulness and complications of ultrasonography (US)-guided vacuum assisted biopsy (VAB) for the removal of benign breast lesions, and the short- and long-term changes after VAB as shown on follow-up US. MATERIALS AND METHODS: From January 2007 to May 2008, 110 sonographically benign lesions in 62 patients were sampled via US-guided VAB. We prospectively evaluated the sonographic findings 1 week and 6 months after VAB in all patients to determine the presence of residual tumors, hematomas and scarring. We evaluated the prevalence of hematoma, pain, skin dimpling, fibrotic scarring and residual tumors after US-guided VAB, and determined if correlation existed between complications, size of the lesions and lesion pathology. RESULTS: The age of the patients was 15-65 years, with a mean age of 36.5 years. The pathologic diagnoses were fibroadenomas (41.8%, n = 46), fibrocystic changes (30.9%, n = 34), fibroadenomatoid hyperplasias (13.6%, n = 15), fibroadenomatoid mastopathies (6.3%, n = 7), adenoses (3.6%, n = 4), hamartomas (1.8%, n = 2) and phyllodes tumors (1.8%, n = 2). Complications 1 week after the US-guided VAB included hematomas (n = 39, 35.4%), pain (n = 23, 20.9%), fibrotic scars (n = 26, 23.68%), residual tumors (n = 4, 3.6%) and skin dimplings (n = 4, 3.6%). Complications 6 months after the US-guided VAB included hematomas (n = 12, 10.9%), pain (n = 3 2.7%), fibrotic scars (n = 14, 12.7%), and residual tumors (n = 17, 15.4%). Residual tumor after US-guided VAB existed in association with 15.2% of fibroadenomas (7/46), 14.7% of fibrocystic changes (5/34), 13.3% of fibroadenomatoid hyperplasias (2/15), 25% of adenoses (1/4), and 100% of phyllodes tumors (2/2). CONCLUSION: US-guided VAB is an effective procedure for removal of benign breast lesion. Periodic follow up studies at 1week and 6months after the VAB are useful to assess Post-VAB complications.
Biopsy ; Breast ; Cicatrix ; Fibroadenoma ; Follow-Up Studies ; Hamartoma ; Hematoma ; Humans ; Hyperplasia ; Neoplasm, Residual ; Phyllodes Tumor ; Prevalence ; Prospective Studies ; Skin ; Vacuum

PURPOSE: To determine the patterns of evaluation and treatment in patients with breast cancer after mastectomy and treated with radiotherapy. A nationwide study was performed with the goal of improving radiotherapy treatment. MATERIALS AND METHODS: A web-based database system for the Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Randomly selected records of 286 eligible patients treated between 1998 and 1999 from 17 hospitals were reviewed. RESULTS: The ages of the study patients ranged from 20 to 80 years (median age 44 years). The pathologic T stage by the AJCC was T1 in 9.7% of the cases, T2 in 59.2% of the cases, T3 in 25.6% of the cases, and T4 in 5.3% of the cases. For analysis of nodal involvement, N0 was 7.3%, N1 was 14%, N2 was 38.8%, and N3 was 38.5% of the cases. The AJCC stage was stage I in 0.7% of the cases, stage IIa in 3.8% of the cases, stage IIb in 9.8% of the cases, stage IIIa in 43% of the cases, stage IIIb in 2.8% of the cases, and IIIc in 38.5% of the cases. There were various sequences of chemotherapy and radiotherapy after mastectomy. Mastectomy and chemotherapy followed by radiotherapy was the most commonly performed sequence in 47% of the cases. Mastectomy, chemotherapy, and radiotherapy followed by additional chemotherapy was performed in 35% of the cases, and neoadjuvant chemoradiotherapy was performed in 12.5% of the cases. The radiotherapy volume was chest wall only in 5.6% of the cases. The volume was chest wall and supraclavicular fossa (SCL) in 20.3% of the cases; chest wall, SCL and internal mammary lymph node (IMN) in 27.6% of the cases; chest wall, SCL and posterior axillary lymph node in 25.9% of the cases; chest wall, SCL, IMN, and posterior axillary lymph node in 19.9% of the cases. Two patients received IMN only. The method of chest wall irradiation was tangential field in 57.3% of the cases and electron beam in 42% of the cases. A bolus for the chest wall was used in 54.8% of the tangential field cases and 52.5% of the electron beam cases. The radiation dose to the chest wall was 45~59.4 Gy (median 50.4 Gy), to the SCL was 45~59.4 Gy (median 50.4 Gy), and to the PAB was 4.8~38.8 Gy, (median 9 Gy) CONCLUSION: Different and various treatment methods were used for radiotherapy of the breast cancer patients after mastectomy in each hospital. Most of treatment methods varied in the irradiation of the chest wall. A separate analysis for the details of radiotherapy planning also needs to be followed and the outcome of treatment is needed in order to evaluate the different processes.
Breast Neoplasms ; Breast* ; Chemoradiotherapy ; Drug Therapy ; Humans ; Korea* ; Lymph Nodes ; Mastectomy* ; Mastectomy, Radical ; Radiotherapy ; Thoracic Wall

BACKGROUND: The single-breath carbon monoxide diffusion capacity (DLCO) and the per unit alveolar volume (KCO; DLCO/VA) gave discordant values when there was an abnormal alveolar volume (VA). However, the clinical significance of the discordant values in patients with airflow limitation has not been examined. This study investigated the DLCO and KCO changes after improving the airflow limitation. METHOD: The baseline DLCO and KCO with lung volume were measured in patients with an airflow obstruction. The effective alveolar volume was measured using the single-breath CH4 dilution method. The patients divided into two groups according to the baseline values: (1) increased KCO in comparison with the DLCO (high discordance) (2) decreased or not increased KCO in comparison with the DLCO (low discordance). The diffusion capacity and lung volume were measured after treatment. RESULTS: There was no significant difference in the baseline lung volumes including the FEV1 and FVC between the two groups. The FEV1 and FVC were significantly increased in the high discordance group compared with the low discordance group after treating the airflow limitation. The DLCO and alveolar volume were significant higher in the high discordance group compared with the low discordance group while the TLC was not. CONCLUSION: The discordance between the DLCO and KCO could be translated into an airflow reversibility in patients with an airflow limitation
Carbon Monoxide* ; Carbon* ; Diffusion ; Humans ; Lung ; Lung Diseases, Obstructive ; Respiratory Function Tests