Purpose: There is a high possibility of trauma patients being referred to an unsuitable medical institution for their rehabilitation treatment since the decision is made by them. This study sought to develop a standardized scale to evaluate the need for specialized rehabilitation in patients with multiple traumas and evaluate the effectiveness of the developed scale. Methods: This study employed a systematic review of existing literature to inform the development of a specialized rehabilitation evaluation scale. An expert panel consisting of trauma surgeons, orthopedic surgeons, and rehabilitation medicine physicians collaborated to create a discharge-planning checklist by assessing the need for specialized rehabilitation. The checklist was validated using retrospective data from trauma patients treated at Seoul National University Hospital. Results: We identified 12 studies, providing factors influencing the discharge location and rehabilitation needs of trauma patients. The checklist was developed through expert consensus and comprised 3 criteria: discharge feasibility to specialized rehabilitation facilities, diagnostic eligibility for specialized rehabilitation, and functional assessment. Validation of the checklist demonstrated that the percentage agreement, likelihood ratio of a positive test, and Cohen’s kappa value were 82.1%, 5.21, and 0.375, respectively when comparing whether the checklist was met and the actual discharge location, indicating its effectiveness. Conclusion This study established standardized criteria for assessing the need for specialized rehabilitation in trauma patients, offering a practical tool for clinical use. Implementation of this assessment scale has the potential to improve the trajectory of trauma survivors by facilitating access to appropriate rehabilitation services.

Purpose: There is a high possibility of trauma patients being referred to an unsuitable medical institution for their rehabilitation treatment since the decision is made by them. This study sought to develop a standardized scale to evaluate the need for specialized rehabilitation in patients with multiple traumas and evaluate the effectiveness of the developed scale. Methods: This study employed a systematic review of existing literature to inform the development of a specialized rehabilitation evaluation scale. An expert panel consisting of trauma surgeons, orthopedic surgeons, and rehabilitation medicine physicians collaborated to create a discharge-planning checklist by assessing the need for specialized rehabilitation. The checklist was validated using retrospective data from trauma patients treated at Seoul National University Hospital. Results: We identified 12 studies, providing factors influencing the discharge location and rehabilitation needs of trauma patients. The checklist was developed through expert consensus and comprised 3 criteria: discharge feasibility to specialized rehabilitation facilities, diagnostic eligibility for specialized rehabilitation, and functional assessment. Validation of the checklist demonstrated that the percentage agreement, likelihood ratio of a positive test, and Cohen’s kappa value were 82.1%, 5.21, and 0.375, respectively when comparing whether the checklist was met and the actual discharge location, indicating its effectiveness. Conclusion This study established standardized criteria for assessing the need for specialized rehabilitation in trauma patients, offering a practical tool for clinical use. Implementation of this assessment scale has the potential to improve the trajectory of trauma survivors by facilitating access to appropriate rehabilitation services.

Purpose: There is a high possibility of trauma patients being referred to an unsuitable medical institution for their rehabilitation treatment since the decision is made by them. This study sought to develop a standardized scale to evaluate the need for specialized rehabilitation in patients with multiple traumas and evaluate the effectiveness of the developed scale. Methods: This study employed a systematic review of existing literature to inform the development of a specialized rehabilitation evaluation scale. An expert panel consisting of trauma surgeons, orthopedic surgeons, and rehabilitation medicine physicians collaborated to create a discharge-planning checklist by assessing the need for specialized rehabilitation. The checklist was validated using retrospective data from trauma patients treated at Seoul National University Hospital. Results: We identified 12 studies, providing factors influencing the discharge location and rehabilitation needs of trauma patients. The checklist was developed through expert consensus and comprised 3 criteria: discharge feasibility to specialized rehabilitation facilities, diagnostic eligibility for specialized rehabilitation, and functional assessment. Validation of the checklist demonstrated that the percentage agreement, likelihood ratio of a positive test, and Cohen’s kappa value were 82.1%, 5.21, and 0.375, respectively when comparing whether the checklist was met and the actual discharge location, indicating its effectiveness. Conclusion This study established standardized criteria for assessing the need for specialized rehabilitation in trauma patients, offering a practical tool for clinical use. Implementation of this assessment scale has the potential to improve the trajectory of trauma survivors by facilitating access to appropriate rehabilitation services.

Objectives: ：To identify the relationship between somatization, stress, depression, anxiety, and psychological symptoms risk for nurses working in the intensive care unit. Create clinical evidence of psychosomatic medicine research and complement the meaning of somatization. Methods: ：Seventy of the mental health checkups conducted by the National Mental Health Center among the nurses using tools including Perceived Stress scale, Fatigue Severity Scale, Patient Health questionnaire-15, Korean Beck Depression Inventory, Korean Beck Anxiety Inventory, and Symptom Checklist-90-Revision. Results: ：12.9% of the patients experienced more than moderate somatization. There was no statistical relationship between somatization and psychological stress perception, but feeling of anxiety and decreased selfconfidence were related to the level of somatization. The group with severe somatization experienced more de-pression and anxiety. The group with high physical fatigue also had no statistical relationship with psychological stress perception, but had an effect on the feeling of tension, stress, or decreased control. Physical fatigue level was increased by experience of depression, not by anxiety. For psychological symptoms the higher the level of somatization, the higher the obsession and hostility was explored. In the linear regression model, stress, depression, and anxiety accounted for 39.3% of somatization and 16.1% of physical fatigue symptoms. Conclusions ：We can estimate the decrease in stress cognitive symptoms, accompanying depression and anxiety, compulsion and hostility as characteristics of somatization. The causal relationship between somatiza-tion and psychological symptoms cannot be confirmed in this study, but the interrelationships are observed, canbe referred to mediation strategies.

Objectives: ：To identify the relationship between somatization, stress, depression, anxiety, and psychological symptoms risk for nurses working in the intensive care unit. Create clinical evidence of psychosomatic medicine research and complement the meaning of somatization. Methods: ：Seventy of the mental health checkups conducted by the National Mental Health Center among the nurses using tools including Perceived Stress scale, Fatigue Severity Scale, Patient Health questionnaire-15, Korean Beck Depression Inventory, Korean Beck Anxiety Inventory, and Symptom Checklist-90-Revision. Results: ：12.9% of the patients experienced more than moderate somatization. There was no statistical relationship between somatization and psychological stress perception, but feeling of anxiety and decreased selfconfidence were related to the level of somatization. The group with severe somatization experienced more de-pression and anxiety. The group with high physical fatigue also had no statistical relationship with psychological stress perception, but had an effect on the feeling of tension, stress, or decreased control. Physical fatigue level was increased by experience of depression, not by anxiety. For psychological symptoms the higher the level of somatization, the higher the obsession and hostility was explored. In the linear regression model, stress, depression, and anxiety accounted for 39.3% of somatization and 16.1% of physical fatigue symptoms. Conclusions ：We can estimate the decrease in stress cognitive symptoms, accompanying depression and anxiety, compulsion and hostility as characteristics of somatization. The causal relationship between somatiza-tion and psychological symptoms cannot be confirmed in this study, but the interrelationships are observed, canbe referred to mediation strategies.

BACKGROUND: Diabetes is a chronic disease that cause premature death worldwide. The rate of testing for diabetes among mentally ill patients is 1.5 times that of the general population, and intervention in diabetes care is needed for patient with severe mental illness and diabetes.METHODS: This study was conducted using cross-sectional surveys distributed to patient with severe mental illness (n=54) among those who visited and were hospitalized at the National Mental Health Center.RESULTS: According to the assessment of the knowledge level of diabetes in patient with severe mental illness accompanied by type 2 diabetes, the correct answer rate was lower than that in the general population. Education and income affected the level of diabetes knowledge, and as diabetes knowledge level increased, blood sugar level were observed to decrease. The linear regression model showed that self-efficacy and education level were found to be predictors of diabetes knowledge, and diabetes knowledge level were predictors of fasting blood sugar levels.CONCLUSION: The results of this study showed that the higher education level and self-efficacy of the patient with severe mental illness and diabetes increased the diabetes knowledge and affecting glycemic control.
Blood Glucose ; Chronic Disease ; Comorbidity ; Cross-Sectional Studies ; Diabetes Mellitus ; Education ; Fasting ; Humans ; Linear Models ; Mental Disorders ; Mental Health ; Mentally Ill Persons ; Mortality, Premature

OBJECTIVES: This study tried to explore the prevalence of chronic physical diseases in patients with schizophrenia and its effects on total medical costs. METHODS: The Health Insurance Review and Assessment Service data in 2014–2015 was employed. Only the injuries and diseases, identically diagnosed 3 times or more as a major or minor injury and disease, were classified into chronic physical diseases to improve data accuracy. Total medical costs included out-of-pocket and insurer's costs from health care system perspective. RESULTS: It was shown that 24.5%, 17.3% and 23.4% of schizophrenia patients had one, two and three or more chronic physical diseases, respectively. There was a high prevalence of not only metabolic, but also musculoskeletal, diseases in those patients. The amount of 2015 total medical costs of patients with schizophrenia in 2014 was about 1.08 trillion won. The factors affecting the costs included sex, age, number of chronic physical diseases, and health insurance status. CONCLUSIONS: It is considered that clinical practice guidelines based on personal diseases may not sufficiently solve the problems for comorbidities in schizophrenia patients. Accordingly, it should be required to develop models for new types of medical systems capable of treating and caring varied illnesses at the same time.
Comorbidity ; Data Accuracy ; Delivery of Health Care ; Humans ; Insurance, Health ; Prevalence ; Schizophrenia

BACKGROUND: This cross-sectional study aimed to evaluate the prevalence of depressive disorders and factors associated in long-term cancer survivors. METHODS: A total of 702 long-term cancer survivors over 5-years in remission were recruited in a university-affiliated tertiary hospital in Korea. Self-report using the Patient Health Questionnaire-2 and the Fatigue Severity Scale assessed depression and fatigue, respectively. Demographic characteristics, cancer-related clinical characteristics, comorbidity, health behaviors, and physical symptoms were assessed through the review of medical records or a structured self-administered questionnaire. RESULTS: We identified 26.1% of patients who had a depressed mood or displayed a loss of interest. The most prevalent primary site of cancer was the stomach (65.2%), followed by lung, breast, colorectal, and thyroid cancer. We also found that 5.7% of subjects experienced double or triple primary cancers. Larger proportion among depressive group (89.1%) complained at least one physical problem than among non-depressive group (53.2%). Physical symptoms including sleep problems, dry mouth, indigestion, pain, decreased appetite, and febrile sense were more frequent in the depressive group than in the non-depressive group. The Fatigue Severity Scale scores were higher in the depressive group than in the non-depressive group (P<0.001). Multiple logistic regression analysis showed that the highest tertile level of fatigue (odds ratio, 7.31; 95% confidence interval, 3.81-14.02) was associated with the increased risk of depression. CONCLUSION: These findings suggest that careful concern about depression is necessary in long-term cancer survivors. Fatigue may be a surrogate sign for depression, and warrants further evaluation.
Appetite ; Asian Continental Ancestry Group ; Breast ; Comorbidity ; Cross-Sectional Studies ; Depression* ; Depressive Disorder ; Dyspepsia ; Fatigue ; Health Behavior ; Humans ; Korea ; Logistic Models ; Lung ; Medical Records ; Mouth ; Prevalence ; Stomach ; Survivors* ; Tertiary Care Centers ; Thyroid Neoplasms

Richter's syndrome refers to the development of aggressive lymphoma in a patient with chronic lymphocytic leukemia (CLL). It occurs in about 2% to 10% of patients with CLL. The most frequent manifestation of Richter's syndrome is diffuse large B cell lymphoma (DLBCL). Extranodal involvement is rare but can occur. The prognosis of Richter's syndrome is very poor. We herein report a case of a rare presentation of Richter's syndrome. A 42-year-old man diagnosed with CLL 2 years previously developed nodules on the bilateral thighs and buttocks. A positron emission tomography (PET)-CT scan revealed high fluorodeoxyglucose uptake in multiple lymph nodes, skeletal muscles, and the myocardium. An ultrasonography-guided biopsy confirmed Richter's syndrome from CLL to DLBCL. The patient was treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy. After six cycles of chemotherapy, we performed a PET-CT scan that revealed a complete response. However, 3 months later, the syndrome recurred. The patient was undergoing salvage chemotherapy at the time of this writing.
Adult ; Biopsy ; Buttocks ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Humans ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymph Nodes ; Lymphoma ; Lymphoma, B-Cell* ; Muscle, Skeletal ; Myocardium ; Positron-Emission Tomography ; Prednisone ; Prognosis ; Thigh ; Vincristine ; Writing ; Rituximab

Recently, the Well-dying Act was legislated in Korea, and it will come into force in 2018. The rapid aging of this society has made many older patients and their families suffer from pain and disability for a long time towards the end of life. Hospice care, when compared to life-sustaining treatment, can relieve such burdens. Regarding the decision of choosing hospice care at the end of life, advance care planning and advance directives can help people express their preference beforehand. In Korea, hospice care is still not actively used and most patients endure life-sustaining treatment until death. Many patients want hospice care, but there has not been a legal basis for such a decision, leading to social conflict and many legal problems. The Well-dying Act will provide a legal basis for such a decision. This will help establish and promote hospice care in Korea. However, sufficient discussion and preparation are required before enforcing the Act.
Advance Care Planning ; Advance Directives ; Aging ; Hospice Care ; Humans ; Korea*