Journal of Korean Medical Science最新文献

Background: Given the increased vulnerability of people with disabilities to poor health outcomes, we evaluated the impact of disability on long-term mortality among tuberculosis (TB) survivors.

Methods: We conducted a nationwide population-based cohort study using the linked national registry databases in the Republic of Korea. The study included 305,055 TB patients diagnosed between 2008 and 2016 who survived at least 1 year. The primary outcome was to compare long-term mortality after TB diagnosis between people with and without disabilities. Long-term mortality was defined as all-cause mortality at least 1 year after TB diagnosis. Cox proportional hazard models were used to evaluate the risk of long-term mortality. Subgroup and sensitivity analyses were performed based on disability type, severity, and cause of death.

Results: Disabilities were present in 10.1% of survivors and were associated with higher mortality rates (46.3 vs. 16.3 per 1,000 person-years, P < 0.001). Cox analysis revealed that disabilities increased long-term mortality risk, with severe disabilities posing the highest risk. Respiratory disabilities were strongly linked to deaths both related and unrelated to TB.

Conclusion: Long-term mortality risk is significantly higher in TB survivors with disabilities.

This prospective cohort study evaluated ultra-low-dose computed tomography (ULDCT) as a tool for quantifying airway and parenchymal abnormalities in 24 patients with asthma. Quantitative indices included the percentage of low-attenuation area (LAA%) for emphysema, parametric response mapping for functional small airway disease (PRM^fSAD), and Pi10 for airway thickening, assessed against spirometric parameters at baseline and 1-year follow-up. PRM^fSAD showed the strongest and most consistent associations with forced expiratory volume in 1 second (FEV₁) %pred, forced expiratory flow between 25% and 75% (FEF25-75) %pred, and the ratio of FEV₁ to forced vital capacity (FVC). The LAA% correlated mainly with the ratio of FEV₁ to FVC. Pi10 showed significant association only with FEF25-75%pred in the multivariable model. Despite dose-related variability in raw values, correlations with lung function parameters remained stable over time. These findings suggest that indices derived from ULDCT, particularly PRM^fSAD, provide practical low-radiation biomarkers of lung function abnormalities in asthma.

Background: Numerous studies have explored blood sugar management in patients with diabetes through telemedicine. However, since the implementation of the telemedicine pilot project, no studies have assessed changes in healthcare utilization for diabetes. This study examined medical outcomes and utilization among diabetes patients comparing telemedicine to traditional in-person care, focusing on medical utilization, care continuity, prescription adherence, and safety.

Methods: This study used data from the National Health Insurance Service to identify patients with diabetes who did or did not receive telemedicine. We analyzed medical utilization, medical sustainability, prescription continuity, and safety through propensity score matching (PSM). To evaluate the telemedicine pilot project's impact, changes and differences in outcome indicators were calculated using a Difference-in-Differences (DID) approach.

Results: After PSM, the total number of patients in the telemedicine group (Tele_G) and the face-to-face treatment group (Control_G) was 59,954 each. Medical utilization of telemedicine decreased in both groups, but the DID was 0.16 (-0.04 in Tele_G vs. -0.20 in Control_G, P < 0.001). Medical continuity also differed significantly between the Tele_G and Control_G (all P < 0.001). The DIDs for the ratio of diabetes medication prescription days and appropriate prescription continuation rate were 0.95 (-0.72 vs. -1.67, P < 0.001) and 1.26 (-1.80 vs. -3.07, P < 0.001), respectively, with statistically significant differences. There were no significant differences in hospitalization experience for safety assessment (DID = -0.14, P = 0.139) or emergency room visits (DID = 0.00, P = 0.950).

Conclusion: DID analysis revealed the potential of the telemedicine pilot project, with slightly lower continuity than face-to-face care; hence, it is acceptable as a supplementary service. To improve this, a telemedicine system specializing in diabetes and blood glucose management is needed, along with a clear protocol that allows patient blood glucose data to be integrated into the telemedicine platform.

Background: Radiologic adjacent segment pathology (R-ASP) is a significant consequence following lumbar spinal fusion, potentially resulting from compromised integrity of posterior structures. Few studies have directly compared the incidence of R-ASP between minimally invasive lateral lumbar interbody fusion (LLIF) and conventional posterior lumbar interbody fusion (PLIF). Thus, the objective of this study was to analyze risk factors for R-ASP and compare clinical outcomes between minimally invasive LLIF supplemented with percutaneous pedicle screw fixation and open conventional PLIF.

Methods: This study included 107 patients who underwent one- or two-segment spinal fusion for degenerative lumbar disease. Fifty-one patients underwent minimally invasive LLIF and 56 received conventional PLIF. Factors related to occurrence of R-ASP were investigated by analyzing demographic profiles, radiological results, and clinical outcomes. Correlations between clinical results were determined based on fusion methods and the presence of R-ASP. Patient-related factors, preoperative spinal diagnosis, number of fused segments, and radiologic findings were analyzed. Clinical outcomes were also assessed. Cox regression survival analysis was performed to determine risk factors for R-ASP. Annual incidence and cumulative survival rate of R-ASP were calculated using the life-table method and Kaplan-Meier survival curve.

Results: Cox proportional hazards regression analysis identified three significant risk factors for R-ASP: PLIF over LLIF (P = 0.028; hazard ratio [HR], 2.321; 95% confidence interval [CI], 1.096-4.913), postoperative pelvic incidence-lumbar lordotic angle mismatch ≥ 10° (P = 0.022; HR, 2.280; 95% CI, 1.126-4.617), and preoperative facet arthropathy grade ≥ 2 (P = 0.016; HR, 3.491; 95% CI, 1.266-9.629). The predicted incidence of R-ASP was 48.7% (95% CI, 42.1-55.2%) at 5 years post-fusion and 80.7% (95% CI, 73.0-88.5%) at 8 years. Clinical outcomes showed that the final visual analog scale for lower back pain was significantly lower in patients who underwent LLIF and in patients who did not develop R-ASP.

Conclusion: Minimally invasive fusion techniques that preserve posterior structures might slow the progression of degenerative changes in adjacent segments. To reduce R-ASP, preoperative assessment of facet degeneration and adequate restoration of sagittal balance during surgery are crucial considerations.

Background: Global insomnia prevalence increased during the coronavirus disease 2019 (COVID-19) pandemic, driving higher demand for sedative-hypnotics. The objective of this study was to compare sedative-hypnotic prescription patterns in South Korea from 2010 to 2022 and assess the potential impact of the COVID-19 pandemic.

Methods: This population-based cohort study from January 1, 2010, to December 31, 2022, used the Korean National Health Insurance's Health Insurance Sharing Service database of 8,136,437 (60.4% female) unique insomnia patients aged 18 and older. Prescriptions for sedative-hypnotic groups (benzodiazepines, non-benzodiazepines, antidepressants, and antipsychotics), number of patients prescribed sedative-hypnotics, and predicted and observed prescription rates by sex, age, and sedative-hypnotic group were analyzed.

Results: The number of prescriptions per 1,000 population increased across all sedative-hypnotic groups before and during the pandemic. Women and the elderly had higher prescriptions for all sedative-hypnotic groups compared to men and other age groups. Antidepressant prescriptions saw the highest percentage increase (men 38.6%; women 37.1%) in 1st half of 2020 compared to 2019, followed by antipsychotics (men 28.9%; women 25.7%). Antidepressant prescriptions showed the largest increase relative to predicted levels across all age groups from 2020 to 2021, while non-benzodiazepines exhibited the smallest increase (men 5.6%; women 4.5%). In the 18-29 age group, prescriptions for all sedative-hypnotic groups exceeded predicted numbers in 2021.

Conclusion: This study found that sedative-hypnotic prescriptions steadily increased from 2010 to 2022, with the trend becoming more pronounced during the COVID-19 pandemic, when prescription rates tended to exceed predicted levels in Korea. Monitoring the use of sedative-hypnotics for insomnia in women, the elderly, and young adults is essential for potential adverse effects and associated mental problems.

Background: Small dense low-density lipoprotein (sdLDL) is recognized as a reliable predictor of atherosclerotic vascular diseases and is also associated with the severity of diabetes. Vascular status directly affects tissue perfusion, indicating that sdLDL could serve as a potential marker for tissue perfusion in diabetic feet. However, an alternative possibility exists. In patients with diabetes, discrepancies can occur between vascular status and actual tissue perfusion due to complications related to diabetes such as neuropathy and hematologic changes in red blood cells. In such instances, sdLDL may not consistently correlate with tissue perfusion. Tissue perfusion is a crucial element in managing diabetic foot conditions. Despite acknowledging its importance, no studies to date have explored the relationship between sdLDL levels and tissue perfusion in diabetic feet. This prospective study seeks to explore this correlation.

Methods: Fifty patients with diabetes were enrolled in the study. Tissue perfusion was assessed by measuring the foot's transcutaneous oxygen pressure (TcPO₂). SdLDL levels were determined based on the mean low-density lipoprotein (LDL) particle size, proportion of sdLDL as a percentage of total LDL, and LDL subfraction score. Correlations between TcPO₂ and each variable were evaluated through scatter plots, and correlation coefficients (R) with corresponding P values were calculated. Statistical analyses were conducted for all participants and further stratified into two subgroups based on a TcPO₂ threshold of ≥ 40 mmHg and < 40 mmHg.

Results: In the overall analysis (n = 50), no statistically significant relationships were detected between TcPO₂ and sdLDL size, sdLDL percentage, or LDL subfraction score. Nevertheless, in the TcPO₂ ≥ 40 mmHg subgroup (n = 29), a statistically significant positive correlation was found between mean LDL particle size and TcPO₂ (R = 0.414, P = 0.026). In contrast, statistically significant negative correlations emerged between sdLDL percentage and TcPO₂ (R = -0.415, P = 0.025), as well as between LDL subfraction score and TcPO₂ (R = -0.419, P = 0.024).

Conclusion: This study identified a significant correlation between sdLDL levels and tissue perfusion in diabetic feet with TcPO₂ ≥ 40 mmHg, but no significant correlation in those with TcPO₂ < 40 mmHg.

Background: To compare the post-acute sequelae of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection (PASC) index and the National Academies of Sciences, Engineering, and Medicine (NASEM) criteria in identifying long coronavirus disease (COVID) among adults with confirmed coronavirus disease 2019.

Methods: A prospective cohort study was conducted from November 2022 to February 2025 at a single tertiary care hospital in Seoul, Korea. Adults aged 18 years or older with confirmed SARS-CoV-2 infection were enrolled, yielding a total of 183 participants. Follow-up assessments took place at 1-, 3-, 6-, and 12-months post-infection. The primary outcome was the prevalence of long COVID at 12 months, measured using the PASC index (≥ 12 points across specified symptoms) and the NASEM criteria (≥ 1 symptom persisting for at least 3 months).

Results: Of 183 participants, 26.2% (48/183) met the PASC index, whereas 47.5% (87/183) fulfilled the NASEM criteria. Of the 48 patients who met the PASC index, 44 (91.7%) also met the NASEM criteria.

Conclusion: The NASEM criteria classified nearly half of participants with long COVID and covered those with PASC index, while the PASC index identified about one quarter. Although the NASEM criteria capture a broader range of persistent symptoms, the PASC index may offer a more stringent threshold, potentially informing targeted research and clinical decision-making.

Shared decision-making (SDM) is an essential component of patient-centered care, yet its implementation in South Korea remains limited due to a persistent physician-centered clinical culture. This project, supported by the Ministry of Health and Welfare, aims to establish a foundation for nationwide SDM implementation by developing a culturally adapted Korean SDM model and creating a framework to support its institutionalization and widespread clinical adoption. This four-year project consists of five interlinked work packages (WPs) organized into two phases, each lasting two years. Using a multi-method approach-comprising nationwide surveys, systematic literature reviews, and psychometric validation studies-we will assess the current landscape (WP1) and develop standardized SDM evaluation tools for primary stakeholders (WP2). A clinical research data management system will be designed and implemented to support data integration and monitoring (WP3). The central component involves developing a Korean SDM conceptual model and corresponding implementation strategies (WP4). Economic evaluations and legal analyses will inform the design of a pilot reimbursement framework to support sustainable system-level integration (WP5). The project is expected to produce the following outcomes: i) an analysis of domestic and international SDM trends; ii) validated SDM assessment tools and guidelines tailored for the Korean context; iii) a standardized and interoperable SDM data management system; iv) a culturally grounded Korean SDM model with evidence-based implementation strategies; and v) policy proposals, including a reimbursement model, to facilitate system-wide adoption. This work will provide the theoretical, empirical, and policy basis required to advance SDM within the Korean healthcare system. By addressing cultural characteristics and structural barriers, the resulting SDM model and policy recommendations are expected to support the sustainable institutionalization of SDM and strengthen patient autonomy and the quality of clinical practice in Korea.

Severe knee osteoarthritis (KOA) involves complex, preference-sensitive treatment decisions, ranging from non-operative to surgical options. However, despite the preference-sensitive nature of KOA, existing shared decision-making (SDM) processes often lack clarity in effectively incorporating patients' values and preferences into treatment decisions. Moreover, most SDM models have been developed in western contexts, which may limit their applicability in other cultural settings. To address these limitations, a Korean Shared Decision-Making Model for KOA (K-SDM-KOA) has been developed using a culturally adapted, five-step framework that integrates a web-based decision-support platform and age-friendly educational media. The K-SDM-KOA model is designed to support preference-sensitive decision-making through a pragmatic, multicenter cohort framework involving 1,300 patients with Kellgren-Lawrence grade 3-4 across five hospitals. Within this framework, patients receive either standard care or the K-SDM-KOA intervention, which combines pre-consultation preparation (step 1-3) with in-clinic deliberation and decision-making (step 4-5). The primary outcome is patient-perceived SDM measured using the Korean-validated 9-item Shared Decision Making Questionnaire, reported on a 0-100 scale, with higher scores indicating greater SDM. Secondary outcomes include patients' preferred role in decision-making, decisional conflict, decision regret, and knowledge gain related to KOA. Additionally, a nested cohort of 50 patients undergoing contralateral total knee arthroplasty will provide paired analyses of early pain and function (visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society Score) at baseline, 3 months, and 12 months. Analyses will follow an intention-to-treat principle and employ linear mixed-effect models and appropriate statistical tests to assess between group differences. This article presents a culturally tailored, technology-supported SDM model designed to enhance decision quality and early patient-reported outcomes in severe KOA. Findings may provide a foundation for future empirical studies and support the broader adoption of structured SDM in Korea's healthcare system.

Treatment decisions for teeth with poor periodontal prognosis are often complicated, requiring careful balancing of clinical evidence and patient values. Shared decision-making (SDM) is increasingly recognized as a beneficial approach to align clinical judgment with patient preferences. However, structured SDM implementation in dental settings remains limited. This study was designed to evaluate the effectiveness of a structured SDM protocol compared to usual care decision-making for patients with severe periodontitis and hopeless-prognosis teeth. A multicenter, before-and-after clinical trial will be conducted across 12 dental centers in South Korea. Each center will apply usual care decision-making for the first six months, followed by the SDM intervention for the subsequent six months. The SDM process involves a three-step model: team talk, option talk (aided by web-based decision aids), and decision talk. Eligible participants include patients with stage III or IV periodontitis and at least one hopeless-prognosis tooth. Each patient follows a three-visit schedule. Primary outcome is the rate of tooth preservation decisions. Secondary outcomes include measures related to SDM (SDM-Q-9, SDM-Q-Doc), patient experience (Perceived Involvement in Care Scale [PICS], Decisional Regret Scale [DRS], treatment adherence), and clinical measures (periodontal condition and treatment costs). Data are collected via Research Electronic Data Capture, and statistical analyses include McNemar's test for binary outcomes and repeated-measures analysis of variance for continuous data. This study is expected to provide evidence supporting the integration of structured SDM protocols in dental practice. By evaluating both patient-centered and clinical outcomes, the research aims to advance personalized, participatory approaches in managing severe periodontitis. Trial Registration: Clinical Research Information Service Identifier: KCT0010405.