Purpose: Given the notable increase in the incidence of multiple myeloma (MM) in Asia and advent of innovative treatments, this study aims to provide a comprehensive understanding of the treatment patterns, outcomes, and eco‑ nomic burden of MM across the lines of therapy (LOTs) in South Korea. Methods: This retrospective cohort study was conducted using data from the National Health Insurance claims data provided by the Health Insurance Review and Assessment Database. An identification algorithm was developed to detect the regimens and LOTs. Treatment patterns and outcomes were assessed as real-world treatment sequence, treatment duration (rwTD), time to next-line treatment (rwTTNT), and overall survival (rwOS). Economic burden was assessed as healthcare resource utilization (HCRU) and the cost incurred per person per month. Results: This study included 11,450 patients who were newly diagnosed with MM between January 2010 and December 2019. The observed real-world LOT patterns reflect the changes in South Korea’s reimburse‑ ment scheme. Mean treatment-free intervals decreased from 11.59 months (SD 16.23) to 2.77 months (SD 6.14) from the first LOT (LOT 1) to LOT 5. Median rwTTNT decreased from 26.61 months (95% CI: 25.69-27.57) to 12.40 months (95% CI: 11.55-13.49), and median rwOS decreased from 61.88 months (95% CI: 59.11-65.46) to 13.65 months (95% CI: 11.88-16.22). The HCRU and associated costs increased substantially with the LOT advancement. Conclusion This large-scale observational study offers comprehensive insights into the real-world treatment of MM in South Korea. The study findings highlight the progressive nature of MM and increasing economic burden of advanced lines of treatment, underscoring the necessity for optimized treatment strategies.

Purpose: Given the notable increase in the incidence of multiple myeloma (MM) in Asia and advent of innovative treatments, this study aims to provide a comprehensive understanding of the treatment patterns, outcomes, and eco‑ nomic burden of MM across the lines of therapy (LOTs) in South Korea. Methods: This retrospective cohort study was conducted using data from the National Health Insurance claims data provided by the Health Insurance Review and Assessment Database. An identification algorithm was developed to detect the regimens and LOTs. Treatment patterns and outcomes were assessed as real-world treatment sequence, treatment duration (rwTD), time to next-line treatment (rwTTNT), and overall survival (rwOS). Economic burden was assessed as healthcare resource utilization (HCRU) and the cost incurred per person per month. Results: This study included 11,450 patients who were newly diagnosed with MM between January 2010 and December 2019. The observed real-world LOT patterns reflect the changes in South Korea’s reimburse‑ ment scheme. Mean treatment-free intervals decreased from 11.59 months (SD 16.23) to 2.77 months (SD 6.14) from the first LOT (LOT 1) to LOT 5. Median rwTTNT decreased from 26.61 months (95% CI: 25.69-27.57) to 12.40 months (95% CI: 11.55-13.49), and median rwOS decreased from 61.88 months (95% CI: 59.11-65.46) to 13.65 months (95% CI: 11.88-16.22). The HCRU and associated costs increased substantially with the LOT advancement. Conclusion This large-scale observational study offers comprehensive insights into the real-world treatment of MM in South Korea. The study findings highlight the progressive nature of MM and increasing economic burden of advanced lines of treatment, underscoring the necessity for optimized treatment strategies.

Purpose: Given the notable increase in the incidence of multiple myeloma (MM) in Asia and advent of innovative treatments, this study aims to provide a comprehensive understanding of the treatment patterns, outcomes, and eco‑ nomic burden of MM across the lines of therapy (LOTs) in South Korea. Methods: This retrospective cohort study was conducted using data from the National Health Insurance claims data provided by the Health Insurance Review and Assessment Database. An identification algorithm was developed to detect the regimens and LOTs. Treatment patterns and outcomes were assessed as real-world treatment sequence, treatment duration (rwTD), time to next-line treatment (rwTTNT), and overall survival (rwOS). Economic burden was assessed as healthcare resource utilization (HCRU) and the cost incurred per person per month. Results: This study included 11,450 patients who were newly diagnosed with MM between January 2010 and December 2019. The observed real-world LOT patterns reflect the changes in South Korea’s reimburse‑ ment scheme. Mean treatment-free intervals decreased from 11.59 months (SD 16.23) to 2.77 months (SD 6.14) from the first LOT (LOT 1) to LOT 5. Median rwTTNT decreased from 26.61 months (95% CI: 25.69-27.57) to 12.40 months (95% CI: 11.55-13.49), and median rwOS decreased from 61.88 months (95% CI: 59.11-65.46) to 13.65 months (95% CI: 11.88-16.22). The HCRU and associated costs increased substantially with the LOT advancement. Conclusion This large-scale observational study offers comprehensive insights into the real-world treatment of MM in South Korea. The study findings highlight the progressive nature of MM and increasing economic burden of advanced lines of treatment, underscoring the necessity for optimized treatment strategies.

Background: This study aims to evaluate factors influencing assessment results in the new Health Technology Assessment (nHTA) in Korea. Methods: We analyzed publicly available nHTA reports obtained from the program’s website. A total of 258 reports, encompassing 305 technologies, were included. Reported details were categorized into three main areas: technical characteristics, evaluation methods, and publication types. To investigate differences in evidence level (high, medium, or low) and assessment results (pass or fail) according to these categories, we employed a chi-squared test. Univariate and multivariate logistic regression analyses were further conducted to identify factors associated with evidence level and assessment results. Results: nHTA reports employing meta-analysis and included randomized trials for evidence synthesis exhibited a higher likelihood of achieving high evidence level (odds ratio [OR], 5.008; 95% confidence interval [CI], 1.265- 18.826 and OR, 27.052; 95% CI, 7.802-103.330, respectively). Increasing evidence level was significantly associated with a higher possibility of passing the assessment (OR 2.789; 95% CI, 1.284-6.057). However, in univariate analysis, neither performing meta-analysis nor including randomized trials, both of which were associated with evidence level, demonstrated a statistically significant association with assessment results. Conclusion This study represents the first systematic analysis of factors influencing nHTA assessment results in Korea. While increased evidence level was associated with positive assessment outcomes, factors affecting the evidence level itself did not directly influence assessment results. This suggests the need for further efforts to effectively integrate high-level evidence into assessment decisions within the nHTA program.

The Korean Society of Infectious Diseases has been regularly developing guidelines for adult immunization since 2007. In 2023, the guidelines for the following seven vaccines were revised: influenza, herpes zoster, pneumococcal, tetanus-diphtheria-pertussis (Tdap), human papillomavirus (HPV), meningococcal, and rabies vaccines. For the influenza vaccine, a recommendation for enhanced vaccines for the elderly was added. For the herpes zoster vaccine, a recommendation for the recombinant zoster vaccine was added. For the pneumococcal vaccine, the current status of the 15-valent pneumococcal conjugate vaccine and 20-valent PCV was described. For the Tdap vaccine, the possibility of using Tdap instead of tetanus-diphtheria vaccine was described. For the HPV vaccine, the expansion of the eligible age for vaccination was described. For the meningococcal vaccine, a recommendation for the meningococcal B vaccine was added. For the rabies vaccine, the number of pre-exposure prophylaxis doses was changed. This manuscript documents the summary and rationale of the revisions for the seven vaccines. For the vaccines not mentioned in this manuscript, the recommendations in the 3rd edition of the Vaccinations for Adults textbook shall remain in effect.

In this study, almost complete genomic sequences of PPV1 and PPV4 circulating in commercial pig farms in South Korea were obtained and analyzed. Important mutations that may be precursors to host changes, such as premature stop codons of PPV1 and frameshift mutations of PPV4, were observed in these sequences. A 27a-like strain of PPV1, known to show a lack of cross-neutralization against existing commercial vaccine strains, was identified by phylogenetic analysis. Given the active genetic evolution, the additional precursors to host changes and emerging new genotypes of PPVs need to be monitored through continuous sampling and genetic analysis.

Purpose: To assess risk factors of disease progression after salvage radiation therapy (SRT) with androgen deprivation therapy (ADT) in case of prostate-specific antigen (PSA) persistence after radical prostatectomy (RP). Materials and Methods: We analyzed 57 patients who received SRT with ADT between 2013 and 2019 due to PSA persistence after RP. The endpoint was disease progression defined by biochemical recurrence or clinical recurrence. Age, Pre-RP PSA level, Gleason score, pathologic stage, presence of pelvic lymph node dissection, surgical margins, and PSA at 6-8 weeks after RP were analyzed as predictive factors for disease progression. Kaplan-Meier method and Cox regression models were used for data analysis. Results: At a median follow-up of 38 months (interquartile range, 26–61), 17 patients had disease progression. Pathologic T stage (pT3b vs. pT3a or lower; hazard ratio [HR] = 9.20; p = 0.035) and PSA level at 6-8 weeks after RP (≥2.04 vs. <2.04 ng/mL; HR = 5.85; p = 0.002) were predictors of disease progression. The 5-year disease progression-free survival rate was 46.7% in pT3b group as compared to 92.9 % in pT3a or lower group, and 18.4% for PSA ≥2.04 ng/mL after RP as compared to 79.2% for PSA <2.04 ng/mL. Conclusion Pathological T stage (pT3b) and post RP PSA ≥2.04 ng/mL are independent risk factors of disease progression after SRT with ADT in patients with PSA persistence after RP.

Background: Medical students are known to be subjected to immense stress under competitive curricula and have a high risk of depression, burnout, anxiety and sleep disorders. There is a global trend of switching from norm-referenced assessment (NRA) to criterion-referenced assessment (CRA), and these changes may have influenced the quality of life (QOL), sleep phase, sleep quality, stress, burnout, and depression of the medical students. We hypothesized that there is a significant difference of QOL between CRA and NRA and that sleep, stress, burnout, and depression are the main contributors. Methods: By administering an online survey regarding QOL and its contributors to Korean medical students, 365 responses from 10 medical schools were recorded. To clarify the complex relationship between the multiple factors in play, we applied nonlinear machine learning algorithms and utilized causal structure learning techniques on the survey data. Results: Students with CRA had lower scores in stress (68.16 ± 11.29, 76.03 ± 12.38, P< 0.001), burnout (48.09 ± 11.23, 55.93 ± 13.07, P < 0.001), depression (12.77 ± 9.82, 16.44 ± 11.27, P = 0.003) and higher scores in QOL (95.79 ± 16.20, 89.65 ± 16.28, P < 0.001) compared with students with NRA. Multiple linear regression, permutation importance of the random forest model and the causal structure model showed that depression, stress and burnout are the most influential factors of QOL of medical students. Conclusion Medical students from schools that use CRA showed higher QOL scores, as well as lower burnout, stress and depression when compared with students from schools that use NRA. These results may be used as a basis for granting justification for the transition to CRA.

Purpose: The aim of this study was to identify factors related to the vaccination intentions of nursing students before clinical practice. Methods: A descriptive correlational study design was used. The participants were 129 nursing students who were enrolled in one college of nursing in Seoul and were scheduled for clinical training. Data collection was conducted from February 28 to March 7, 2022. The data were analyzed using descriptive statistics, a t-test, ANOVA, Pearson’s correlation coefficient, and a latitudinal regression analysis using the IBM SPSS statistics version 26.0 program. Results: The intention to vaccinate showed a significant correlation with vaccination attitude (r=.72, p<.001), subjective norms (r=.68, p<.001), and perceived behavioral control (r=.63, p<.001). The influencing factors on three intent to vaccinate were vaccination attitude (β=.36 p<.001), subjective norms (β=.31, p<.001), and perceived behavioral control (β=.36, p<.001). The explanatory power of these variables was 69.6%. Conclusion The vaccination rate before the clinical training of nursing students was related to economic burden, a lack of time, and transportation problems that nursing college students experienced during the vaccination process. Therefore, administrative and financial support is needed for improving the vaccination rates of nursing students.