Background: Barriers to treatment with intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) in South Korea remain incompletely characterized. We analyze a nationwide prospective cohort to determine patient-level features associated with delayed presentation and non-treatment of potential IVT-eligible patients. Methods: We identified consecutive patients with AIS from 01/2011 to 08/2023 from a multicenter and prospective acute stroke registry in Korea. Patients were defined as IVT candidates if they presented within 4.5 hours from the last known well, had no lab evidence of coagulopathy, and had National Institute of Health Stroke Scale (NIHSS) ≥ 4. Multivariable generalized linear mixed regression models were used to investigate the associations between their characteristics and the IVT candidates or the use of IVT among the candidates. Results: Among 84,103 AIS patients, 41.0% were female, with a mean age of 69 ± 13 years and presentation NIHSS of 4 [interquartile range, 1–8]. Out of these patients, 13,757 (16.4%) were eligible for IVT, of whom 8,179 (59.5%) received IVT. Female sex (adjusted risk ratio [RR], 0.90; 95% confidence interval [CI], 0.86–0.94) and lower years of education (adjusted RR, 0.90; 95% CI, 0.84–0.97 for 0–3 years, compared to ≥ 13 years) were associated with a decreased likelihood of presenting as eligible for IVT after AIS; meanwhile, young age (adjusted RR, 1.12; 95% CI, 1.01–1.24 for ≤ 44 years, compared to 75–84 years) was associated with an increased likelihood of being an IVT candidate. Among those who were eligible for IVT, only age was significantly associated with the use of IVT (adjusted RR, 1.09; 95% CI, 1.03–1.16 for age 65–74 and adjusted RR, 0.83; 95% CI, 0.76–0.90 for ≥ 85 years, respectively). Conclusion Most patients with AIS present outside IVT eligibility in South Korea, and only 60% of eligible patients were ultimately treated. We identified increased age, female sex and lower education as key features on which to focus interventions for improving IVT utilization.

Background: The proportion of women doctors has been rising globally and South Korea mirrors this trend. Despite this growth, women doctors’ representation in leadership roles in academic medical fields remains scarce. This study investigates the representation and trends of women doctors’ leadership in editorial boards of South Korean medical journals, and compares the gender ratio of specialists. Methods: This non-clinical data analysis examined the editorial boards of 45 major medical academic journals published in 2015, 2020, and 2024 to investigate women leadership within journal editorial boards, compares the gender ratio of specialists, and observed changes over time. Results: The study included data from 1,475 members in 2015, 1,598 in 2020, and 2,531 in 2024.In 2020, 23.8% of specialists were women, but only 19.5% of editorial board members were women (P < 0.001). Nine journals had less than 10% women representation on their editorial boards. Over nine years, women representation on editorial boards increased from 16.8% in 2015 to 21.3% in 2024 (P = 0.001), with significant increases in societies of clinical medicine (14.6% vs. 20.0%; P < 0.001) but not in basic medicine. Journals with women editors-in-chief had significantly higher women representation on their boards compared to ones with male editorsin-chief (36.7 ± 13.5% vs. 18.4 ± 10.9%, P < 0.001). The proportion of women senior editorial roles and that of women executive society members showed a significant positive correlation with the proportion of women on editorial boards (P < 0.001 and P < 0.001, respectively). Conclusion The study highlights the considerable underrepresentation of women in editorial leadership compared to their presence as specialists. However, the number of women editorial board members has increased over the past decade, especially in clinical medicine. Women doctors’ leadership positively correlates with higher women participation on boards, which suggests that promoting women leaders could enhance gender diversity in academic medicine. Further qualitative research is needed to explore the impact of women doctors’ leadership on medical research and patient outcomes. This study provides critical insights into gender disparities in South Korean medical academia and underscores the need for policies to promote women doctors’ leadership.

This study examined the variability in the length of stay (LOS) and daily medical expenses (DME) for hypertension and pneumonia inpatient care. Using 10 years of National Health Insurance Service data (2010–2019), a multilevel analysis assessed variability at the patient and institutional levels. During the study period, the mean LOS decreased, whereas the DME increased for both hypertension and pneumonia. Institutional level variability in the LOS increased during the study period, demonstrating greater variability than that for pneumonia. For both conditions, institutional-level variability was more marked in smaller institutions (hospitals and clinics) than in larger institutions (general and tertiary hospitals).These findings indicate a need for standardized healthcare service protocols to promote consistent and efficient patient care.

Background: Extracorporeal membrane oxygenation (ECMO) is a medical intervention employed to provide life-sustaining support for patients. YouTube is a dynamic and widely utilized platform for distributing health-related information. The aim of this study was to evaluate ECMO-related videos on YouTube and assess the frequency of misleading information in the accumulation of ECMO videos. Methods: On September 17, 2024, an in-depth examination on YouTube was conducted using search phrases “Extracorporeal Membrane Oxygenation” and “ECMO treatment.”The study included 55 selected videos. Video parameters and sources were analyzed.Content assessments were conducted utilizing the Global Quality Scale (GQS), the modified DISCERN instrument, the Journal of the American Medical Association (JAMA) Benchmark Criteria, and the Patient Education Materials Assessment Tool for Audio/Visual Materials (PEMAT-A/V).The authors conducted comparisons among quality groups. Results: Among the 55 videos analyzed, 30.9% (n = 17) were categorized as low quality, 21.8% (n = 12) as intermediate quality, and 47.3% (n = 26) as high quality. Physicians (75%) provided the most high-quality videos. News outlets (83.3%) provided the most low-quality videos. No statistically significant difference was observed between quality groups in daily views, likes, and comments (P > 0.05). Significant correlations were identified between video duration and GQS (r = 0.585), modified DISCERN questionnaire (r = 0.557), JAMA Benchmark Criteria (r = 0.511), PEMAT-A/V Understandability (r = 0.530), and PEMAT-A/V Actionability scores (r = 0.433) (P < 0.001 for all correlation analyses). Conclusion There is a wide variety in the quality of YouTube ECMO videos. Although YouTube content created by physicians is more likely to provide accurate and beneficial information, substandard videos present a significant public health threat by disseminating misinformation.The critical role of quality control methods on social media platforms in ensuring the accurate and high-quality transmission of health-related information is readily evident.

Background: The diagnosis of tuberculous pleural effusion (TPE) often relies on pleural fluid adenosine deaminase (ADA) levels. The diagnostic utility of ADA, however, is influenced by the prevalence of tuberculosis (TB) in local populations. Malignant pleural effusion (MPE) cases can exhibit moderately elevated ADA levels comparable to those seen in TPE. As population aging potentially impacts ADA levels, global TB incidence is decreasing whereas the burden of malignancy is on the rise. Consequently, epidemiological shifts and temporal changes in ADA distribution complicate the differential diagnosis between TPE and MPE when ADA levels are within the 40–70 IU/L range. Nonetheless, data specific to this subset are scarce. Methods: This retrospective study included consecutive patients aged > 18 years with confirmed TPE and MPE, spanning from 2012 to 2023. ADA levels in pleural fluid were categorized into three groups: < 40 IU/L, 40–70 IU/L, and > 70 IU/L. The study examined annual trends in the frequency of new cases and ADA level distributions over time and identified discriminating factors between TPE and MPE in cases with ADA levels of 40–70 IU/L. Results: In total, 297 TPE and 369 MPE cases were included in this study. Over the study period, the frequency of TPE progressively declined, while that of MPE increased. In the most recent four-year period, new TPE and MPE cases with ADA levels of 40–70 IU/L occurred at comparable numbers. Multivariable analysis identified pleural fluid carcinoembryonic antigen (CEA) levels and the number of focal pleural nodules as independent predictors for MPE. Specifically, the presence of either CEA levels > 15.7 ng/mL or more than eight pleural nodules yielded the highest diagnostic accuracy with a sensitivity of 88%, specificity of 100%, and an area under the curve of 0.95. Conclusion The differential diagnosis between TPE and MPE with pleural ADA levels of 40–70 IU/L has become increasingly critical due to evolving epidemiological patterns and ADA distribution changes over time. Pleural fluid CEA levels and the characteristics of pleural nodules may offer valuable guidance in distinguishing between TPE and MPE within this diagnostic gray zone.

Background: Fluorescein angiography (FA) is a diagnostic procedure that is crucial for conditions such as age-related macular degeneration and diabetic retinopathy, and due to its importance, the use of conventional and wide-angle FA (wide FA) is on the rise. This study aimed to analyze the annual trends of conventional and wide FA and the trends of healthcare institutions performing these examinations in Korea. Methods: This retrospective study examined data from the Health Insurance Review and Assessment Service’s Health and Medical Big Data Open Portal. We investigated the number of patients who underwent conventional and wide FA procedures performed in Korea from 2014 to 2023, categorized by age group and type of healthcare facility. Additionally, trends in healthcare expenditures were analyzed. Results: The number of patients undergoing conventional FA consistently declined, while those receiving wide FA increased steadily, keeping the overall patient count relatively stable.Healthcare costs related to conventional FA gradually decreased, whereas expenses for wide FA rose steadily, contributing to an increase in total medical expenses. Analysis of ten-year age intervals revealed that patients in their 60s were the most frequent recipients of wide FA in every year, except for 2014. The prevalence of wide FA at primary healthcare facilities has been steadily increasing. Conclusion The use of wide FA has been steadily increasing, gradually replacing conventional FA, particularly in primary healthcare settings. Overall, medical expenses continue to rise. The findings of this study provide valuable evidence for the efficient allocation of medical resources in the future.

Background: This study aimed to investigate the size and characteristics of pediatric clinic closure during the coronavirus disease 2019 (COVID-19) period and what career paths pediatricians chose after closure. Methods: This study utilized database of the Health Insurance Review and Assessment Service from 2013 to 2022. We examined the trend of the number of pediatric clinics in operation over the past 10 years. Additionally, the study identified factors associated with the closure of pediatric clinics during the COVID-19 pandemic. Furthermore, the affiliations of representatives who closed their clinics during the pandemic were tracked as of December 2022. Results: In 2019, there were 2,229 pediatric clinics. During the COVID-19 pandemic, 364 (16.3%) of these clinics closed. Factors associated with the closure of pediatric clinics included pediatricians over the age of 65, operational periods of less than 5 years, and lower levels of medical expenses. As of 2022, among the 364 clinics that closed, 108 pediatricians (29.7%) retired or ceased working, and 127 pediatricians (34.9%) still employed in pediatricrelated healthcare institutions. A concerning phenomenon is that the remaining 129 pediatricians (35.4%) transitioned to unrelated healthcare institutions. Conclusion We have identified the magnitude and factors contributing to pediatric clinic closures. A more pressing issue is that over one-third of the pediatricians have transitioned to non-specialty fields following the closure of their clinics. Pediatrics represents a critical and essential medical field. Health authorities must develop strategies to prevent the avoidable collapse and subsequent exodus of pediatricians.