Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: There are few safe effective ways to relieve osteoarthritis (OA) pain; as a result, off-label psychotropic drug prescriptions have increased worldwide. This study examined the change in psychotropic drug prescriptions for patients with OA from 2011 to 2020 using the Korean National Health Insurance Service dataset. Methods: The study population consisted of patients with hip or knee OA aged ≥ 65 years.Psychotropic drugs included opioids, benzodiazepines, non-benzodiazepine hypnotics (Z-drugs), anti-epileptics, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), typical antipsychotics, atypical antipsychotics, and anxiolytics. The prevalence and long-term (> 3 months) prescription rates of psychotropic drugs in OA patients were calculated. Results: The study included 1,821,158 patients with OA (mean age 71.7 years; 65.32% female).Of the cohort, 49% had comorbidities for which psychotropics were indicated. The prevalence of psychotropic prescriptions decreased from 58.2% to 52.0% in 2018 and then leveled off.The long-term prescription rate remained constant until 2018 and then increased slightly.The most commonly prescribed psychotropics were opioids and long- and short-acting benzodiazepines. The prescription rates of opioids and long-acting benzodiazepines decreased from 2011 to 2020. For those with psychiatric co-morbidities, the prescription rates of anti-epileptics and SNRIs increased, while the prescription rates of anti-epileptics, SSRIs, other antidepressants, and atypical psychotropics increased for those without such co-morbidities. The most commonly prescribed psychotropics were diazepam and alprazolam, excluding tramadol and tramadol–acetaminophen combination. For those with psychiatric co-morbidities, the prescription rates of gabapentin and fentanyl increased, while for those without such co-morbidities, the prescription rates of lorazepam, fentanyl, escitalopram and quetiapine increased. Conclusion A significant number of older Korean patients with OA were prescribed psychotropic drugs in the absence of comorbidities requiring such drugs, including drugs that have little effect on OA and unfavorable safety profiles in older adults.

Objective: : Korea’s healthcare system and policy promotes early, actively stroke treatment to improve prognosis. This study represents stroke epidemiology and outcomes in Korea. Methods: : This study investigated data from the Acute Stroke Assessment Registry. The registry collects data from over 220 hospitals nationwide, focusing on quality stroke service management. Data analysis included patient demographics, stroke severity assessment, and discharge prognosis measurement using standardized scales. Results: : Eighty-six thousand five hundred sixty-eight acute stroke patients were collected with demographic and clinical characteristics during 18 months from 2016, 2018, and between 2020 to 2021, focusing on acute subarachnoid hemorrhage (SAH), acute intracerebral hemorrhage (ICH), and acute ischemic stroke. Of these 86568 patients, 8.3% was SAH, 16.3% ICH, and 74.9% ischemic stroke. Trends showed decreasing SAH and increasing ICH cases over the years. 68.3% stroke patients had the clear onset time. 49.6% stroke patients arrived within 4.5 hours of symptom onset, with more patients treated at general hospitals. Good functional outcomes at discharge was obtained with 58.3% of acute stroke patients, 55.9% of SAH patients, 34.6% of ICH patients, and 63.8% of ischemic stroke patients. Conclusion : The results showed that ischemic stroke was the most common subtype, followed by ICH and SAH. Prognosis differed among subtypes, with favorable outcomes more common in ischemic stroke and SAH compared to ICH.

Objective: The Daegu region experienced the first wave of the pandemic at the beginning of the coronavirus disease 2019 (COVID-19) outbreak in Korea. Other non-COVID-19-related treatments during a community outbreak, such as cardiovascular diseases, were expected to impact emergency departments. In acute myocardial infarctions, time is an important factor affecting the patient outcome. This study examined how community COVID-19 outbreak affected STsegment elevated myocardial infarction (STEMI) care in emergency departments. Methods: A retrospective analysis was performed on patients visiting five emergency departments in the Daegu area who were diagnosed with STEMI from February 18 to April 17 each year from 2018 to 2020. The demographic characteristics, prehospital variables, in-hospital time variables, and treatment results were collected. The cases were divided into the pre-COVID period and the COVID period for comparison. Results: The study included 254 patients (194 pre-COVID, 60 during COVID). The symptom-to-door time did not differ. Although the door-to-first doctor time was shortened (4 min vs. 2 min, P=0.01), the rate of coronary angiogram along with the door-to-angiogram time and the door-to-balloon time did not change. The length of stay in the emergency department was delayed during COVID-19 (median, 136 min vs. 404 min; P<0.01). The in-hospital length of stay and mortality were similar in both groups. Conclusion The time to treat STEMI was not delayed significantly during the first wave of the COVID-19 outbreak in the Daegu area compared with the pre-pandemic period. Mortality did not change. The length of stay was elongated significantly in the emergency department but not in the hospital.

Purpose: Inotuzumab ozogamicin (INO) has demonstrated a safe bridging role to allogeneic hematopoietic stem cell transplantation (HSCT) in patients with relapsed or refractory B-cell acute lymphoblastic leukemia (R/R B-ALL). How‑ ever, hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is frequently observed. This study aimed to identify significant features of INO-associated VOD/SOS. Methods: We reviewed seven cases of hepatic VOD/SOS that developed either during INO salvage or after alloge‑ neic HSCT following INO-induced complete remission (CR). Diagnosis and severity grading of VOD/SOS were based on the revised criteria from the European Society for Blood and Marrow Transplantation. Defibrotide was used to treat severe to very severe cases. Results: Four patients developed VOD/SOS during INO salvage therapy (at 21 and 36 days post-INO1, 77 days postINO3, and 21 days post-INO5), while three were diagnosed at 2, 5, and 10 days post-HSCT following INO-induced CR.Doppler ultrasonography revealed preserved portal vein flow (range 10.2–26.0 cm/sec) and normal hepatic artery resistive index (RI, range 0.56–0.74) in all but one patient (RI 0.83). Despite this, all patients presented with massive ascites and progressively elevated total bilirubin levels. All cases were classified as severe to very severe; six were treated with defibrotide and one underwent liver transplantation. Most patients ultimately died owing to VOD/SOS progression. Conclusion Post-INO VOD/SOS manifested as two different clinical settings and was characterized by preserved portal vein flow, which complicated diagnosis. Despite timely defibrotide administration, clinical outcomes were poor.These findings emphasize the need for vigilance and potential consideration of prophylactic strategies for prevention of INO-associated VOD/SOS.

Background: With growing elderly populations, management of patients with acute stroke is increasingly important. In South Korea, the Acute Stroke Quality Assessment Program (ASQAP) has contributed to improving the quality of stroke care and practice behavior in healthcare institutions. While the mortality of hemorrhagic stroke remains high, there are only a few assessment indices associated with hemorrhagic stroke. Considering the need to develop assessment indices to improve the actual quality of care in the field of acute stroke treatment, this study aims to investigate the current status of human resources and practices related to the treatment of patients with acute stroke through a nationwide survey. Methods: For the healthcare institutions included in the Ninth ASQAP of the Health Insurance Review and Assessment Service (HIRA), data from January 2022 to December 2022 were collected through a survey on the current status and practice of healthcare providers related to the treatment of patients with acute stroke. The questionnaire consisted of 19 items, including six items on healthcare providers involved in stroke care and 10 items on the care of patients with acute stroke. Results: In the treatment of patients with hemorrhagic stroke among patients with acute stroke, neurosurgeons were the most common providers. The contribution of neurosurgeons in the treatment of ischemic stroke has also been found to be equivalent to that of neurologists. However, a number of institutions were found to be devoid of healthcare providers who perform definitive treatments, such as intra-arterial thrombectomy for patients with ischemic stroke or cerebral aneurysm clipping for subarachnoid hemorrhage. The intensity of the workload of healthcare providers involved in the care of patients with acute stroke, especially those involved in definitive treatment, was also found to be quite high. Conclusion Currently, there are almost no assessment indices specific to hemorrhagic stroke in the ASQAP for acute stroke. Furthermore, it does not reflect the reality of the healthcare providers and practices that provide definitive treatment for acute stroke. The findings of this study suggest the need for the development of appropriate assessment indices that reflect the realities of acute stroke care.

Background: There are few safe effective ways to relieve osteoarthritis (OA) pain; as a result, off-label psychotropic drug prescriptions have increased worldwide. This study examined the change in psychotropic drug prescriptions for patients with OA from 2011 to 2020 using the Korean National Health Insurance Service dataset. Methods: The study population consisted of patients with hip or knee OA aged ≥ 65 years.Psychotropic drugs included opioids, benzodiazepines, non-benzodiazepine hypnotics (Z-drugs), anti-epileptics, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), typical antipsychotics, atypical antipsychotics, and anxiolytics. The prevalence and long-term (> 3 months) prescription rates of psychotropic drugs in OA patients were calculated. Results: The study included 1,821,158 patients with OA (mean age 71.7 years; 65.32% female).Of the cohort, 49% had comorbidities for which psychotropics were indicated. The prevalence of psychotropic prescriptions decreased from 58.2% to 52.0% in 2018 and then leveled off.The long-term prescription rate remained constant until 2018 and then increased slightly.The most commonly prescribed psychotropics were opioids and long- and short-acting benzodiazepines. The prescription rates of opioids and long-acting benzodiazepines decreased from 2011 to 2020. For those with psychiatric co-morbidities, the prescription rates of anti-epileptics and SNRIs increased, while the prescription rates of anti-epileptics, SSRIs, other antidepressants, and atypical psychotropics increased for those without such co-morbidities. The most commonly prescribed psychotropics were diazepam and alprazolam, excluding tramadol and tramadol–acetaminophen combination. For those with psychiatric co-morbidities, the prescription rates of gabapentin and fentanyl increased, while for those without such co-morbidities, the prescription rates of lorazepam, fentanyl, escitalopram and quetiapine increased. Conclusion A significant number of older Korean patients with OA were prescribed psychotropic drugs in the absence of comorbidities requiring such drugs, including drugs that have little effect on OA and unfavorable safety profiles in older adults.

Objective: : Korea’s healthcare system and policy promotes early, actively stroke treatment to improve prognosis. This study represents stroke epidemiology and outcomes in Korea. Methods: : This study investigated data from the Acute Stroke Assessment Registry. The registry collects data from over 220 hospitals nationwide, focusing on quality stroke service management. Data analysis included patient demographics, stroke severity assessment, and discharge prognosis measurement using standardized scales. Results: : Eighty-six thousand five hundred sixty-eight acute stroke patients were collected with demographic and clinical characteristics during 18 months from 2016, 2018, and between 2020 to 2021, focusing on acute subarachnoid hemorrhage (SAH), acute intracerebral hemorrhage (ICH), and acute ischemic stroke. Of these 86568 patients, 8.3% was SAH, 16.3% ICH, and 74.9% ischemic stroke. Trends showed decreasing SAH and increasing ICH cases over the years. 68.3% stroke patients had the clear onset time. 49.6% stroke patients arrived within 4.5 hours of symptom onset, with more patients treated at general hospitals. Good functional outcomes at discharge was obtained with 58.3% of acute stroke patients, 55.9% of SAH patients, 34.6% of ICH patients, and 63.8% of ischemic stroke patients. Conclusion : The results showed that ischemic stroke was the most common subtype, followed by ICH and SAH. Prognosis differed among subtypes, with favorable outcomes more common in ischemic stroke and SAH compared to ICH.