Background: Although intravenous nefopam has been used for opioid-sparing strategy and pain relief, randomized controlled trials (RCTs) have shown inconsistent findings. Methods: We searched core databases, PubMed, EMBASE, and the Cochrane library for RCTs on this research question in December 2022. Standardized mean difference (SMD) and weighted mean difference (WMD) were calculated using a random-effects meta-analysis. Results: Of 708 studies identified from the databases, a total of 17 RCTs (n=1,173 patients) that met the inclusion criteria were included in the final meta-analysis. Overall, the consumption of cumulative opioid analgesics was significantly lower in the nefopam group than the control group, on arrival in the postanesthesia care unit (PACU) (SMD, −0.70; 95% confidence interval [CI], −1.01 to −0.39; I2= 55.1%; n=7), at 24 hours (SMD, −0.65; 95% CI, −1.09 to −0.20; I2=87.4%; n=9), and 48 hours (SMD, −0.82; 95% CI, −1.40 to −0.24; I2=85.6%; n=6) after surgery. It also showed a significant lower pain score, on arrival in the PACU (WMD, −0.80; 95% CI, −1.27 to −0.32; I2=69.6%; n=7) and 24 hours (WMD, −0.48; 95% CI, −0.79 to −0.16; I2=0.0%, n=5). However, publication bias was observed (asymmetrical funnel plot and P for bias=0.005). Conclusions Intravenous nefopam showed an opioid-sparing effect and pain relief in the management of patients with acute postoperative pain.

Objective: This study aimed to identify the utility of risk-rescue rating scale (RRRS), a psychological scale, and certain biomarkers in determining the disposition of patients visiting the emergency department (ED) after their suicide attempts. Methods: We retrospectively reviewed the medical records of patients who visited the ED after attempting suicide. The patients were classified into three groups for comparison: the discharged (DC) group, the general ward (GW) admission group, and the intensive care unit (ICU) admission group. Results: This study included 454 patients, with 344 patients in the DC group (75.8%), 63 patients in the GW admission group (13.9%), and 47 patients in the ICU admission group (10.3%). The three groups showed statistically significant differences in age, time of visit, physical status, presumptive diagnosis, the RRRS, mental status, C-reactive protein, neutrophil-lymphocyte ratio (NLR), and systemic immune inflammation index. Multivariate logistic regression analysis showed that predictors of the GW admission included the time of visit, mental status, and the RRRS. A receiver operating characteristic curve analysis of RRRS for the decision to admit to GW and ICU showed a cut-off value of 36.5 and 44.5, respectively. However, no inflammatory biomarkers were identified as factors predicting GW and ICU admissions. Conclusion The RRRS is useful in determining the disposition of patients who visited the ED after suicide attempts.

Objective: This study aimed to identify the utility of risk-rescue rating scale (RRRS), a psychological scale, and certain biomarkers in determining the disposition of patients visiting the emergency department (ED) after their suicide attempts. Methods: We retrospectively reviewed the medical records of patients who visited the ED after attempting suicide. The patients were classified into three groups for comparison: the discharged (DC) group, the general ward (GW) admission group, and the intensive care unit (ICU) admission group. Results: This study included 454 patients, with 344 patients in the DC group (75.8%), 63 patients in the GW admission group (13.9%), and 47 patients in the ICU admission group (10.3%). The three groups showed statistically significant differences in age, time of visit, physical status, presumptive diagnosis, the RRRS, mental status, C-reactive protein, neutrophil-lymphocyte ratio (NLR), and systemic immune inflammation index. Multivariate logistic regression analysis showed that predictors of the GW admission included the time of visit, mental status, and the RRRS. A receiver operating characteristic curve analysis of RRRS for the decision to admit to GW and ICU showed a cut-off value of 36.5 and 44.5, respectively. However, no inflammatory biomarkers were identified as factors predicting GW and ICU admissions. Conclusion The RRRS is useful in determining the disposition of patients who visited the ED after suicide attempts.

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
Acute Coronary Syndrome ; Cause of Death ; Consultants ; Coronary Disease ; Delivery of Health Care ; Heart ; Hospitals, General ; Hospitals, University ; Humans ; Insurance Benefits ; Korea ; Life Style ; Methods ; Mortality ; Myocardial Infarction ; Nutritionists ; Physical Therapists ; Preventive Medicine ; Recurrence ; Rehabilitation ; Secondary Prevention ; Specialization ; Sports Medicine ; Surgeons

BACKGROUND: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. RESULTS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. CONCLUSION: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
Acute Coronary Syndrome ; Cardiovascular Diseases ; Cause of Death ; Consultants ; Coronary Disease ; Delivery of Health Care ; Heart ; Hospitals, General ; Hospitals, University ; Humans ; Insurance Benefits ; Korea ; Life Style ; Methods ; Mortality ; Myocardial Infarction ; Nutritionists ; Physical Therapists ; Preventive Medicine ; Recurrence ; Rehabilitation ; Secondary Prevention ; Specialization ; Sports Medicine ; Surgeons