Objectives: This paper provides evidence for the improvement of the local and national longterm psychiatric emergency response system by analyzing emergency response cases for psychiatric crisis intervention conducted over three years at the Jeonbuk State Mental Health Welfare Center. Methods: From August 1, 2020, to December 31, 2023, 314 cases of emergency response for psychiatric crisis intervention were analyzed. The analysis included factors such as gender, age, marital status, location, classification of psychiatric crises, referral pathways, intervention response time, counseling history, location of intervention, types of mental health issues, types of suicidal issues, psychiatric treatment history, suicide plans and attempts, outcomes of major interventions, levels of depression, alcohol consumption, and suicidal behavior. Results: The emergency response for psychiatric crisis intervention had a higher proportion of suicide counseling compared to general mental health emergencies, and most cases were referred through administrative agencies such as the police and fire department. The majority of intervention targets were first-time counselees, classified as high-risk individuals because of depression, alcohol consumption, and suicidal behavior, and either discontinued or were maintaining medication treatment. Conclusion This study illustrated the major role of emergency response in psychiatric crisis intervention and the need for strengthening networks with police, fire departments, and relevant agencies, and improving the treatment of care staff and public awareness. In addition, this study provides evidence for predicting risk factors and offering preventive and preemptive measures.

Objectives: This paper provides evidence for the improvement of the local and national longterm psychiatric emergency response system by analyzing emergency response cases for psychiatric crisis intervention conducted over three years at the Jeonbuk State Mental Health Welfare Center. Methods: From August 1, 2020, to December 31, 2023, 314 cases of emergency response for psychiatric crisis intervention were analyzed. The analysis included factors such as gender, age, marital status, location, classification of psychiatric crises, referral pathways, intervention response time, counseling history, location of intervention, types of mental health issues, types of suicidal issues, psychiatric treatment history, suicide plans and attempts, outcomes of major interventions, levels of depression, alcohol consumption, and suicidal behavior. Results: The emergency response for psychiatric crisis intervention had a higher proportion of suicide counseling compared to general mental health emergencies, and most cases were referred through administrative agencies such as the police and fire department. The majority of intervention targets were first-time counselees, classified as high-risk individuals because of depression, alcohol consumption, and suicidal behavior, and either discontinued or were maintaining medication treatment. Conclusion This study illustrated the major role of emergency response in psychiatric crisis intervention and the need for strengthening networks with police, fire departments, and relevant agencies, and improving the treatment of care staff and public awareness. In addition, this study provides evidence for predicting risk factors and offering preventive and preemptive measures.

Objectives: This paper provides evidence for the improvement of the local and national longterm psychiatric emergency response system by analyzing emergency response cases for psychiatric crisis intervention conducted over three years at the Jeonbuk State Mental Health Welfare Center. Methods: From August 1, 2020, to December 31, 2023, 314 cases of emergency response for psychiatric crisis intervention were analyzed. The analysis included factors such as gender, age, marital status, location, classification of psychiatric crises, referral pathways, intervention response time, counseling history, location of intervention, types of mental health issues, types of suicidal issues, psychiatric treatment history, suicide plans and attempts, outcomes of major interventions, levels of depression, alcohol consumption, and suicidal behavior. Results: The emergency response for psychiatric crisis intervention had a higher proportion of suicide counseling compared to general mental health emergencies, and most cases were referred through administrative agencies such as the police and fire department. The majority of intervention targets were first-time counselees, classified as high-risk individuals because of depression, alcohol consumption, and suicidal behavior, and either discontinued or were maintaining medication treatment. Conclusion This study illustrated the major role of emergency response in psychiatric crisis intervention and the need for strengthening networks with police, fire departments, and relevant agencies, and improving the treatment of care staff and public awareness. In addition, this study provides evidence for predicting risk factors and offering preventive and preemptive measures.

Objectives: This paper provides evidence for the improvement of the local and national longterm psychiatric emergency response system by analyzing emergency response cases for psychiatric crisis intervention conducted over three years at the Jeonbuk State Mental Health Welfare Center. Methods: From August 1, 2020, to December 31, 2023, 314 cases of emergency response for psychiatric crisis intervention were analyzed. The analysis included factors such as gender, age, marital status, location, classification of psychiatric crises, referral pathways, intervention response time, counseling history, location of intervention, types of mental health issues, types of suicidal issues, psychiatric treatment history, suicide plans and attempts, outcomes of major interventions, levels of depression, alcohol consumption, and suicidal behavior. Results: The emergency response for psychiatric crisis intervention had a higher proportion of suicide counseling compared to general mental health emergencies, and most cases were referred through administrative agencies such as the police and fire department. The majority of intervention targets were first-time counselees, classified as high-risk individuals because of depression, alcohol consumption, and suicidal behavior, and either discontinued or were maintaining medication treatment. Conclusion This study illustrated the major role of emergency response in psychiatric crisis intervention and the need for strengthening networks with police, fire departments, and relevant agencies, and improving the treatment of care staff and public awareness. In addition, this study provides evidence for predicting risk factors and offering preventive and preemptive measures.

Background: and Purpose Patients with cluster headache (CH) exhibit impaired health-related quality of life (HRQoL). However, there have been few studies related to the HRQoL of patients with CH from Asian backgrounds. This study aimed to determine the impact of CH on HRQoL and to identify the factors affecting HRQoL in patients with CH during cluster periods. Methods: This prospective study enrolled patients with CH from 17 headache clinics in South Korea between September 2016 and February 2021. The study aimed to determine HRQoL in patients with CH using the EuroQol 5 Dimensions (EQ-5D) index and the time trade-off (TTO) method. Age- and sex-matched headache-free participants were recruited as a control group. Results: The study included 423 patients with CH who experienced a cluster period at the time. EQ-5D scores were lower in patients with CH (0.88±0.43, mean±standard deviation) than in the controls (0.99±0.33, p<0.001). The TTO method indicated that 58 (13.6%) patients with CH exhibited moderate-to-severe HRQoL deterioration. The HRQoL states in patients with CH were associated with current smoking patterns, headache severity, frequency, and duration, and scores on the Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire 9-item scale (PHQ-9), 6-item Headache Impact Test, and 12-item Allodynia Symptom Checklist. Multivariable logistic regression analyses demonstrated that the HRQoL states in patients with CH were negatively correlated with the daily frequency of headaches, cluster period duration, and GAD-7 and PHQ-9 scores. Conclusions Patients with CH experienced a worse quality of life during cluster periods compared with the headache-free controls, but the degree of HRQoL deterioration varied among them. The daily frequency of headaches, cluster period duration, anxiety, and depression were factors associated with HRQoL deterioration severity in patients with CH.

Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway obstruction during sleep. To reduce the morbidity of OSA, sleep specialists have explored various methods of managing the condition, including manifold positive airway pressure (PAP) techniques and surgical procedures. Nasal obstruction can cause significant discomfort during sleep, and it is likely that improving nasal obstruction would enhance the quality of life and PAP compliance of OSA patients. Many reliable studies have offered evidence to support this assumption. However, few comprehensive guidelines for managing OSA through nasal surgery encompass all this evidence. In order to address this gap, the Korean Society of Otorhinolaryngology-Head and Neck Surgery (KORL-HNS) and the Korean Society of Sleep and Breathing designated a guideline development group (GDG) to develop recommendations for nasal surgery in OSA patients. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. The types of nasal surgery included septoplasty, turbinate surgery, nasal valve surgery, septorhinoplasty, and endoscopic sinus surgery. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians’ grading system. The GDG developed 10 key action statements with supporting text to support them. Three statements are ranked as strong recommendations, three are only recommendations, and four can be considered options. The GDG hopes that this clinical practice guideline will help physicians make optimal decisions when caring for OSA patients. Conversely, the statements in this guideline are not intended to limit or restrict physicians’ care based on their experience and assessment of individual patients.

Water beads are dangerous foreign bodies causing intestinal obstruction in young children because the beads absorb water and are radiolucent. Although the features lead to progressive intestinal obstruction, it is difficult to diagnose ingestion of the beads by imaging studies. For the diagnosis, ultrasonography is safe, fast, and accurate. The imaging modality can show intestinal water beads as spherical, anechoic, smoothly demarcated cysts. This characteristic finding may be more useful in rapid and accurate diagnosis than computed tomography scan. We report a case of an 8-month-old boy who obtained a timely sonographic diagnosis of water bead-induced small bowel obstruction in the emergency department.

Background: New genome sequencing technologies with enhanced diagnostic efficiency have emerged. Rapid and timely diagnosis of treatable rare genetic diseases can alter their medical management and clinical course. However, multiple factors, including ethical issues, must be considered. We designed a targeted sequencing platform to avoid ethical issues and reduce the turnaround time. Methods: We designed an automated sequencing platform using dried blood spot samples and a NEOseq_ACTION panel comprising 254 genes associated with Mendelian diseases having curable or manageable treatment options. Retrospective validation was performed using data from 24 genetically and biochemically confirmed patients. Prospective validation was performed using data from 111 patients with suspected actionable genetic diseases. Results: In prospective clinical validation, 13.5% patients presented with medically actionable diseases, including short- or medium-chain acyl-CoA dehydrogenase deficiencies (N=6), hyperphenylalaninemia (N=2), mucopolysaccharidosis type IVA (N=1), alpha thalassemia (N=1), 3-methylcrotonyl-CoA carboxylase 2 deficiency (N=1), propionic acidemia (N=1), glycogen storage disease, type IX(a) (N=1), congenital myasthenic syndrome (N=1), and citrullinemia, type II (N=1). Using the automated analytic pipeline, the turnaround time from blood collection to result reporting was <4 days. Conclusions This pilot study evaluated the possibility of rapid and timely diagnosis of treatable rare genetic diseases using a panel designed by a multidisciplinary team. The automated analytic pipeline maximized the clinical utility of rapid targeted sequencing for medically actionable genes, providing a strategy for appropriate and timely treatment of rare genetic diseases.

Objective: Suicide attempts (SAs) in adolescents are difficult to predict although it is a leading cause of death among adolescents. This study aimed to develop and evaluate SA prediction models based on six different machine learning (ML) algorithms for Korean adolescents using data from online surveys. Methods: Data were extracted from the 2011−2018 Korea Youth Risk Behavior Survey (KYRBS), an ongoing annual national survey. The participants comprised 468,482 nationally representative adolescents from 400 middle and 400 high schools, aged 12 to 18. The models were trained using several classic ML methods and then tested on internal and external independent datasets; performance metrics were calculated. Data analysis was performed from March 2020 to June 2020. Results: Among the 468,482 adolescents included in the analysis, 15,012 cases (3.2%) were identified as having made an SA. Three features (suicidal ideation, suicide planning, and grade) were identified as the most important predictors. The performance of the six ML models on the internal testing dataset was good, with both the area under the receiver operating characteristic curve (AUROC) and area under the precision−recall curve (AUPRC) ranging from 0.92 to 0.94. Although the AUROC of all models on the external testing dataset (2018 KYRBS) ranged from 0.93 to 0.95, the AUPRC of the models was approximately 0.5. Conclusion The developed and validated SA prediction models can be applied to detect high risks of SA. This approach could facilitate early intervention in the suicide crisis and may ultimately contribute to suicide prevention for adolescents.

Purpose: To report a rare case of slow progression of carotid cavernous fistula (CCF) with central retinal vein occlusion (CRVO).Case summary: A 66-year-old man presented with conjunctival injection and proptosis in the right eye. Best-corrected visual acuity was 0.8 and 0.5 in the right and left eye, respectively, and conjunctival vessel enlargement and subconjunctival hemorrhage were observed in the right eye on slit lamp examination. Due to suspicion of CCF, computed tomography, computed tomography angiography, magnetic resonance imaging, and magnetic resonance angiography were performed. These analyses showed no vascular abnormalities associated with arteriovenous shunt, so the patient was followed up closely. About 1 month later, his conjunctival vessel engorgement became severe and CRVO derived from venous stasis by CCF occurred, so transfemoral cerebral angiography was performed and a diagnosis of CCF was made. Intravitreal anti-vascular endothelial growth factor injection was performed for CRVO, and best corrected visual acuity improved to 1.0 in the right eye. Conclusions Slowly progressing CCF can be accompanied with rare intraocular disease, such as CRVO, so appropriate diagnosis through detailed evaluation is important for treatment.