Background/Aims: Exercise is a key component of the management of axial spondyloarthritis (axSpA), providing symptomatic relief and helping prevent ankylosis. However, there is a lack of quantitative studies evaluating daily exercise patterns in patients with axSpA. This study assessed the types, frequency, and duration of exercises performed by these patients through a structured questionnaire. Methods: This cross-sectional study included radiographic axSpA patients who visited a rheumatology clinic between September 2014 and March 2016 and provided informed consent to participate. The survey captured information on four types of exercise: high-intensity exercise, moderate-intensity exercise, strength training, and walking. Disease activity and functional status were evaluated using the Bath ankylosing spondylitis disease activity index (BASDAI) and the Bath ankylosing spondylitis functional index (BASFI), respectively. Results: A total of 645 patients participated in the study. Among them, 25.1% engaged in high-intensity exercise, 36.0% in moderate-intensity exercise, 81.2% in walking, and 32.8% in strength training. The median weekly exercise frequency was 3.0 days (interquartile range [IQR], 2.0-4.0) for high-intensity exercise, 3.0 days (IQR, 2.0-5.0) for moderate-intensity exercise, 5.5 days (IQR, 4.0-7.0) for walking, and 3.0 days (IQR, 2.0-5.0) for strength training. The median daily exercise duration was 60 minutes (IQR, 60-120) for high-intensity exercise, 60 minutes (IQR, 30-90) for moderate-intensity exercise, 30 minutes (IQR, 20-60) for walking, and 30 minutes (IQR, 20-60) for strength training. Comparisons by disease activity showed that BASFI scores were more strongly associated with differences in exercise patterns than BASDAI scores. Conclusion Radiographic axSpA patients predominantly engaged in low-intensity activities, particularly walking, typically for short durations. Given the observed variations in exercise patterns based on disease activity, personalized exercise education and guidance should be prioritized in clinical practice to optimize axSpA management.

This review describes a psychological support service designed to address post-traumatic stress disorder in workers impacted by workplace injuries, assisting in their recovery and facilitating their return to work. It explores the rationale and context behind establishing trauma counseling centers for these individuals, along with the status, roles, future directions, and recommendations for these centers. The review details the operational framework and functions of the workplace injury trauma management program, the scope of the impacts of such injury, the groups targeted for crisis intervention, and the psychological interventions tailored to each stage of recovery. Initiated as a pilot project in 2018, trauma counseling centers for workers have gradually become more common, with 23 centers in operation across Korea as of 2024.

This review describes a psychological support service designed to address post-traumatic stress disorder in workers impacted by workplace injuries, assisting in their recovery and facilitating their return to work. It explores the rationale and context behind establishing trauma counseling centers for these individuals, along with the status, roles, future directions, and recommendations for these centers. The review details the operational framework and functions of the workplace injury trauma management program, the scope of the impacts of such injury, the groups targeted for crisis intervention, and the psychological interventions tailored to each stage of recovery. Initiated as a pilot project in 2018, trauma counseling centers for workers have gradually become more common, with 23 centers in operation across Korea as of 2024.

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: Dementia is a multifaceted disorder that affects cognitive function, necessitating accurate diagnosis for effective management and treatment. Although the Mini-Mental State Examination (MMSE) is widely used to assess cognitive impairment, its standalone efficacy is debated. This study examined the effectiveness of the MMSE alone versus in combination with other cognitive assessments in predicting dementia diagnosis, with the aim of refining the diagnostic accuracy for dementia. Methods: A total of 2,863 participants with subjective cognitive complaints who underwent comprehensive neuropsychological assessments were included. We developed two random forest models: one using only the MMSE and another incorporating additional cognitive tests.These models were evaluated based on their accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC) on a 70:30 training-to-testing split. Results: The MMSE-alone model predicted dementia with an accuracy of 86% and AUC of 0.872. The expanded model demonstrated increased accuracy (88%) and an AUC of 0.934.Notably, 17.46% of the cases were reclassified from dementia to non-dementia category upon including additional tests. Higher educational level and younger age were associated with these shifts. Conclusion The findings suggest that although the MMSE is a valuable screening tool, it should not be used in isolation to determine dementia severity. The addition of diverse cognitive assessments can significantly enhance diagnostic precision, particularly in younger and more educated populations. Future diagnostic protocols should integrate multifaceted cognitive evaluations to reflect the complexity of dementia accurately.

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: Dementia is a multifaceted disorder that affects cognitive function, necessitating accurate diagnosis for effective management and treatment. Although the Mini-Mental State Examination (MMSE) is widely used to assess cognitive impairment, its standalone efficacy is debated. This study examined the effectiveness of the MMSE alone versus in combination with other cognitive assessments in predicting dementia diagnosis, with the aim of refining the diagnostic accuracy for dementia. Methods: A total of 2,863 participants with subjective cognitive complaints who underwent comprehensive neuropsychological assessments were included. We developed two random forest models: one using only the MMSE and another incorporating additional cognitive tests.These models were evaluated based on their accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC) on a 70:30 training-to-testing split. Results: The MMSE-alone model predicted dementia with an accuracy of 86% and AUC of 0.872. The expanded model demonstrated increased accuracy (88%) and an AUC of 0.934.Notably, 17.46% of the cases were reclassified from dementia to non-dementia category upon including additional tests. Higher educational level and younger age were associated with these shifts. Conclusion The findings suggest that although the MMSE is a valuable screening tool, it should not be used in isolation to determine dementia severity. The addition of diverse cognitive assessments can significantly enhance diagnostic precision, particularly in younger and more educated populations. Future diagnostic protocols should integrate multifaceted cognitive evaluations to reflect the complexity of dementia accurately.

Background: and Purpose Parkinson’s disease (PD) is characterized by various prodromal symptoms, and these symptoms are mostly investigated retrospectively. While some symptoms such as rapid eye movement sleep behavior disorder are highly specific, others are common. This makes it challenging to predict those at risk of PD based solely on less-specific prodromal symptoms. The prediction accuracy when using only less-specific symptoms can be improved by analyzing the vast amount of information available using sophisticated deep-learning techniques. This study aimed to improve the performance of deep-learning-based screening in detecting prodromal PD using medical-claims data, including prescription information. Methods: We sampled 820 PD patients and 8,200 age- and sex-matched non-PD controls from Korean National Health Insurance cohort data. A deep-learning algorithm was developed using various combinations of diagnostic codes, medication codes, and prodromal periods. Results: During the prodromal period from year -3 to year 0, predicting PD using only diagnostic codes yielded a high accuracy of 0.937. Adding medication codes for the same period did not increase the accuracy (0.931–0.935). For the earlier prodromal period (year -6 to year -3), the accuracy of PD prediction decreased to 0.890 when using only diagnostic codes. The inclusion of all medication-codes data increased that accuracy markedly to 0.922. Conclusions A deep-learning algorithm using both prodromal diagnostic and medication codes was effective in screening PD. Developing a surveillance system with automatically collected medical-claims data for those at risk of developing PD could be cost-effective. This approach could streamline the process of developing disease-modifying drugs by focusing on the most-appropriate candidates for inclusion in accurate diagnostic tests.

Conversion therapy is a treatment strategy that shifts from palliative systemic therapy to curative surgical treatment for primary and/or metastatic stage IV gastric cancer (GC).To address its clinical statements, the Korean Gastric Cancer Association aims to present a consensus on conversion therapy among experts attending KINGCA WEEK 2024. The KINGCA Scientific Committee and Development Working Group for Korean Practice Guidelines prepared preformulated topics and 9 clinical statements for conversion therapy.The Delphi method was applied to a panel of 17 experts for consensus and opinions. The final comments were announced after the statement presentation and discussed during the consensus meeting session of KINGCA WEEK 2024. Most experts agreed that conversion herapy provides a survival benefit for selected patients who respond to systemic therapy and undergo R0 resection (88.3%). Patients with limited metastases were considered good candidates (94.2%). The optimal timing was based on the response to systemic therapy (70.6%). The regimen was recommended to be individualized (100%) and the duration to be at least 6 months (88.3%). A minimally invasive approach (82.3%) and D2 lymph node dissection (82.4%) were considered for surgery. However, resection for metastases with a complete clinical response after systemic therapy was not advocated (41.2%). All experts agreed on the need for large-scale randomized-controlled trials for further evidence (100%).Recent advancements in treatment may facilitate radical surgery for patients with stage IV GC. Further evidence is warranted to establish the safety and efficacy of conversion therapy.

Purpose: Adjuvant chemotherapy (AC) is recommended for muscle-invasive or lymph node-positive upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). However, disease recurrences are frequently observed in pT1 disease, and AC may increase the risk of overtreatment in pT2 UTUC patients. This study aimed to validate a risk-adapted scoring model for selecting UTUC patients with ≤pT2 disease who would benefit from AC. Materials and Methods: We retrospectively analyzed 443 ≤pT2 UTUC patients who underwent RNU. A risk-adapted scoring model was applied, categorizing patients into low- or high-risk groups. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed according to risk group. Results: Overall, 355 patients (80.1%) and 88 patients (19.9%) were categorized into the low- and high-risk groups, respectively, with the latter having higher pathological stages, concurrent carcinoma in situ, and synchronous bladder tumors. Disease recurrence occurred in 45 patients (10.2%), among whom 19 (5.4%) and 26 (29.5%) belonged to the low- and high-risk groups, respectively (p<0.001). High-risk patients had significantly shorter RFS (64.3% vs. 93.6% at 60 months; hazard ratio [HR] 13.66; p<0.001) and worse CSS (80.7% vs. 91.5% at 60 months; HR 4.25; p=0.002). Multivariate analysis confirmed that pT2 stage and the high-risk group were independent predictors of recurrence and cancer-specific death (p<0.001). Decision curve analysis for RFS showed larger net benefits with our model than with the T stage model. Conclusions The risk-adapted scoring model effectively predicts recurrence and identifies optimal candidates for AC post RNU in non-metastatic UTUC.