Journal of Korean Medical Science最新文献

Background: Hip fractures in older adults are associated with high rates of mortality, functional decline, and secondary fractures. Although Fracture Liaison Services (FLSs) have shown clinical benefits in many countries, a comprehensive, coordinator-based FLS model has not been widely implemented in Korea. This study aimed to evaluate the clinical impact of a newly introduced coordinator-based FLS in elderly hip fracture patients.

Methods: This prospective cohort study included patients aged 65 and older who were admitted with a hip fracture to a single tertiary hospital between June 2022 and February 2024. Patients were divided into two groups: those who received FLS after July 2023 (n = 105) and those who did not (n = 168). Clinical data were collected during hospitalization and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Variables included time to surgery, length of hospital stay, mortality, refracture rate, osteoporosis treatment rates, functional and nutritional outcomes, and patient satisfaction.

Results: The FLS group had significantly shorter time to surgery (2.5 ± 2.3 vs. 4.4 ± 5.5 days, P < 0.001) and hospital stay (20.0 ± 11.3 vs. 24.7 ± 18.0 days, P = 0.010). In-hospital mortality (1.0% vs. 4.2%), 6-month (4.8% vs. 6.5%), and 1-year mortality (8.6% vs. 12.5%) were all lower in the FLS group (P < 0.05). Refracture rates at 6 months (2.8% vs. 7.1%) and 1 year (5.7% vs. 10.7%) were also significantly lower in the FLS group (P < 0.05). Osteoporosis medication prescription (68.6% vs. 48.8%) and calcium/vitamin D supplementation (63.8% vs. 15.9%) were significantly higher in the FLS group (P < 0.001). Although no significant differences were observed in functional recovery, the FLS group showed a significant increase in serum albumin over 1 year (P = 0.022). Patient satisfaction exceeded 90% at all follow-up intervals.

Conclusion: The coordinator-based FLS service reduced the length of hospital stay and time from admission to surgery in elderly hip fracture patients, while also lowering the risk of postoperative mortality and refracture. It increased the prescription rate of osteoporosis medications and can improve patients' nutritional status. However, further research is needed to assess functional improvement.

Background: The integration of artificial intelligence, specifically large language models, into editorial processes, is gaining interest due to its potential to streamline manuscript assessments, particularly regarding ethical and transparency reporting in public health journals. This study aims to evaluate the capability and limitations of ChatGPT-4.0 in accurately detecting missing ethical and transparency statements in research articles published in high-ranked (Q1) versus low-ranked (Q4) public health journals.

Methods: Articles from top-tier (Q1) and low-tier (Q4) public health journals were analyzed using ChatGPT-4.0 for the presence of essential ethical components, including ethics approval, informed consent, animal ethics, conflicts of interest, funding notes, and open data sharing statements. Performance metrics such as sensitivity, recall, and precision were calculated.

Results: ChatGPT exhibited high sensitivity and recall across all evaluated components, accurately identifying all missing ethics statements. However, precision varied significantly between categories, with notably high precision for data availability statements (0.96) and significantly lower precision for funding statements (0.16). A comparative analysis between Q1 and Q4 journals showed a marked increase in missing ethics statements in the Q4 group, particularly for open data sharing statements (4 vs. 50 cases), ethics approval (2 vs. 5 cases), and informed consent statements (3 vs. 8 cases).

Conclusion: ChatGPT-4.0 in preliminary screening shows considerable promise, providing high accuracy in identifying missing ethics statements. However, limitations regarding precision highlight the necessity for additional human checks. A balanced integration of artificial intelligence and human judgment is recommended to enhance editorial checks and maintain ethical standards in public health publishing.

Background: Hypertension is a major global health concern, closely linked to cardiovascular disease risks. This study assesses prescribing trends for initial antihypertensive therapy in South Korea, with a particular focus on the shift towards combination therapies, including fixed-dose combinations, as advocated by recent guidelines.

Methods: We retrospectively analyzed data from 59,950 presumed treatment-naïve hypertension patients without significant comorbidities, sourced from the National Patient Sample of the Health Insurance Review and Assessment Service, spanning 2009 to 2020. The study examined the prevalence of monotherapy versus combination therapy and the preferred classes of antihypertensive drugs.

Results: The analysis revealed that 55.7% of patients received monotherapy, while 44.3% were initiated on combination therapy. Notably, 87.3% of the combination therapy cohort were prescribed fixed-dose combinations. The study observed a consistent increase in the use of fixed-dose combinations and a notable preference for angiotensin receptor blocker (ARB) and ARB/calcium channel blocker regimens over time. Factors such as age, sex, and specific comorbidities influenced the likelihood of receiving combination therapy.

Conclusion: The findings highlight a progressive shift towards combination antihypertensive therapies, particularly fixed-dose combinations, among presumed treatment-naïve patients in South Korea. This trend reflects a broader move in clinical practice towards more aggressive treatment strategies recommended by current hypertension guidelines. The study underscores the importance of personalized treatment approaches, taking into consideration individual patient characteristics.

Background: There are potential concerns of depression associated with the use of gastric acid suppressants. This study compared associations of potassium competitive acid blockers (PCABs) and proton pump inhibitors (PPIs) with the development of depressive disorder.

Methods: Patients newly prescribed five PPIs (omeprazole, pantoprazole, lansoprazole, rabeprazole, and esomeprazole) and one PCAB (tegoprazan) from January 2020 to April 2022 were identified by Health Insurance Review and Assessment Service. Primary outcome was diagnosis of depression with more than 60 prescription days of antidepressants. Multivariable logistic regression and survival curve analysis with Kaplan-Maier method were performed with two models to calculate the risk of depression with all PPIs (model 1) or each individual PPIs (model 2) compared to tegoprazan. Sensitivity analyses using propensity score matching (PSM) and subgroup analyses stratified by treatment duration were followed.

Results: A total of 6,104,743 patients aged 18-80 years were included. The occurrence of depression was higher in all PPI groups (adjusted odds ratio for all PPIs, 1.34; 95% confidence interval, 1.24-1.44; lansoprazole, 1.80; pantoprazole, 1.42; esomeprazole, 1.32; rabeprazole, 1.22; omeprazole, 1.15) than in the PCAB group. Cumulative incidence of depression up to 1200 days after beginning prescription was significantly higher in PPI groups (all P < 0.001) than in the PCAB group. Sensitivity and subgroup analyses using PSM replicated significance except for esomeprazole.

Conclusion: In this national longitudinal study, PCAB users had a lower likelihood of developing depression than PPI users. Additional studies on the biological mechanism for the risk of depression and gastric acid suppressants are needed.

This corrects the article on p. e106 in vol. 40, PMID: 40098493.

Background: The Columbia-Suicide Severity Rating Scale (C-SSRS) is the gold standard for assessing suicidal ideation, behavior, and risk. However, it is unclear whether the Patient Health Questionnaire-9 (PHQ-9) item 9 alone is sufficient for detecting suicidal ideation among patients with breast cancer. This study aimed to assess the validity of PHQ-9 item 9 compared to C-SSRS in female breast cancer patients undergoing psychiatric treatment.

Methods: In this study, we evaluated the validity of PHQ-9 item 9 compared to C-SSRS for identifying suicidal ideation among 176 female patients with breast cancer receiving psychiatric treatment, using self-reported questionnaires and leveraging demographic, clinical data, and statistical analyses to refine suicide risk assessment methods.

Results: Among 176 patients, 35.2% showed a positive response to PHQ-9 item 9, 41.0% and 17.0% of them showed a response indicating wish for death and active suicidal ideation based on C-SSRS, respectively. The areas under the ROC curves for wish for death and active suicidal ideation were 0.840 and 0.842, respectively, indicating good discriminatory power with an optimal cut-off of 1/3 for both criteria.

Conclusion: Although PHQ-9 item 9 may have limited utility in detecting active suicidal ideation among patients with breast cancer, it may serve as a valuable screening tool for identifying those at risk of having thoughts of suicide accompanied by wish for death.

Background: The incidence of preterm birth in Korea increased from 6.5% in 2013 to 9.7% in 2020. Very low birth weight (VLBW) infants, defined as those weighing < 1,500 g, are particularly vulnerable to numerous health risks. Breast milk provision reduces the incidence of complications in this vulnerable population. The objective of this study was to examine the rate and factors associated with breast milk provision at neonatal intensive care unit (NICU) discharge and to investigate its potential effects on growth and developmental outcomes at 18-24 months corrected age (CA).

Methods: We conducted this cohort study using data from over 70 NICUs participating in the Korean Neonatal Network. VLBW infants born between January 2019 and December 2020 at a gestational age of 23⁺⁰ to 31⁺⁶ weeks were included. Discharge feeding types were analyzed of 2,490 infants, while follow-up assessments of growth and neurodevelopmental outcomes at 18-24 months of CA were available for 1,426 infants. Propensity score matching was used for comparative analysis.

Results: The rate of breast milk provision at discharge among VLBW infants was 55.9% in 2019 and 56.5% in 2020. Factors that were positively associated with breast milk feeding included higher maternal education level and antenatal steroid use. In contrast, maternal hypertensive disorders, cesarean section, and severe neonatal morbidities (e.g., necrotizing enterocolitis) were correlated with lower breast milk feeding rates at the time of discharge. The provision of breast milk at discharge was not associated with a higher risk of suboptimal growth (below two standard deviations) compared to control infants at 18-24 months of CA. Neurodevelopmental assessments indicated that breast milk was associated with a reduced risk of developmental delay (adjusted odds ratio, 0.72; 95% confidence interval, 0.56-0.94) at follow-up.

Conclusion: Breast milk provision to VLBW infants at NICU discharge in Korea was comparable to that in other countries. This nationwide study highlights the critical role of breast milk in promoting the neurodevelopment of VLBW infants. Future efforts should focus on identifying the barriers to breast milk provision to improve health outcomes in vulnerable populations.

This corrects the article on p. e88 in vol. 37, PMID: 35315599.