Journal of Korean Medical Science最新文献

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.

The availability of biologic agents and Janus kinase (JAK) inhibitors has expanded therapeutic options for rheumatic diseases, and international guidelines now recommend shared decision-making (SDM) to guide treatment selection. This study will evaluate whether a structured SDM model enhances patients' perceptions of SDM when selecting biologic agents or JAK inhibitors for rheumatoid arthritis (RA) and ankylosing spondylitis (AS), compared to standard care. This open-label, multicentre, stratified cluster-randomised trial will enrol 300 patients with RA or AS. Participants will be assigned in a 1:1:1 ratio to one of three groups: SDM Group I, SDM Group II, or standard care. In the SDM groups, the Three-Talk Model (Team Talk, Option Talk, and Decision Talk) will be implemented. SDM Group I will receive decision aids during Option Talk, while SDM Group II will receive both decision aids and an artificial intelligence-based chatbot. In the standard care group, treatment recommendations will be made at the physician's discretion. The primary outcome will be the Shared Decision-Making Questionnaire score. Secondary outcomes will include changes in the Decisional Conflict Scale, the Health Empowerment Scale, the Leeds Satisfaction Questionnaire, and the EuroQol-5 Dimension. Data will be collected using iCReaT (http://icreat.kr). This study will provide evidence on the effectiveness of structured SDM in selecting biologic agents and JAK inhibitors for RA and AS, with potential implications for improving treatment decisions and patient outcomes. Trial Registration: Clinical Research Information Service Identifier: KCT0011310.

Active surveillance (AS) is recommended for low-risk papillary thyroid microcarcinoma (PTMC) in many guidelines. However, while its clinical application requires incorporation of patient values, implementing shared decision-making (SDM) in practice remains challenging. To generate reliable evidence, facilitate the integration of SDM into routine PTMC managements and improve patient satisfaction, this study developed a PTMC-specific SDM model (SM group) and aims to evaluate whether it improves patient-reported outcomes (PROs) compared to usual care (UC group) in patients with low-risk PTMC. This multicenter, parallel-group, cluster-randomized controlled trial will enroll 310 patients with low-risk PTMC across seven academic hospitals in Korea. Participants will be assigned to either the SM group (model) or the UC group (control) through cluster randomization of 26 clinicians, stratified by specialty and AS experience. The SM group will receive structured counseling using a newly developed PTMC-specific SDM model, supported by decision aids such as educational videos, web-based card news, and illustrated leaflets regarding disease-information and patients' values. The UC group will receive standard counseling. The primary outcome is the Decisional Conflict Scale score. Secondary outcomes include satisfaction with decision-making process, decision regret, anxiety, and thyroid-specific quality of life. Data will be collected via the iCReaT v2.0 electronic Case Report Form, supplemented by electronic and paper-based PRO surveys. Assessments will be conducted at baseline, 1-4 weeks, and 6 months after the treatment decision. Trial Registration: ClinicalTrials.gov Identifier: NCT06730893.

Background: As digital transformation accelerates, individuals increasingly engage with digital health services and online medical resources, and digital health literacy (DHL) becomes increasingly important. While the Digital Health Literacy Instrument (DHLI) has been validated internationally, a Korean version applicable across all adult age groups remains limited. This study develops and validates the Korean DHLI, assessing its reliability and validity for broader applicability among Korean adults.

Methods: The DHLI was translated, culturally adapted, and reviewed by expert panels following World Health Organization guidelines. A cross-sectional nationwide web survey was conducted with 524 adults aged 19-69. A follow-up survey was administered to 134 participants after four weeks to assess test-retest reliability. Internal consistency and test-retest reliability were assessed. Construct validity was examined using confirmatory factor analysis (CFA) to determine the most appropriate factor structure in the Korean population. Convergent and discriminant validity were assessed, and hypothesis-testing construct validity was evaluated through correlations with age, health status, and eHealth literacy.

Results: The Korean version of the DHLI (K-DHLI) exhibited excellent psychometric properties. Internal consistency was high (α = 0.91), and test-retest reliability was deemed acceptable (intraclass correlation coefficient = 0.70). CFA demonstrated a 7-factor model, which showed a superior model fit (χ²/degrees of freedom = 2.14, comparative fit index = 0.966, root mean square error of approximation = 0.047) as compared to the 5-factor model. Convergent and discriminant validity were confirmed, with AVE values ranging from 0.7218 to 0.8947 and construct reliability values between 0.8837 and 0.9622. Hypothesis-testing construct validity was supported by hypothesized correlations between K-DHLI scores and age (r = -0.254, P < 0.001), health status (r = 0.252, P < 0.001), and eHealth literacy (r = 0.688, P < 0.001).

Conclusion: The K-DHLI is a reliable and valid instrument for assessing DHL in the Korean population. The findings confirm that the 7-factor structure demonstrates superior model fit and further support its applicability across diverse adult groups. This study provides a standardized instrument for assessing DHL in Korea and facilitates its use in national surveys, clinical screening, and research. It may help identify individuals with limited DHL, thereby supporting targeted interventions to reduce health disparities and improve access to care.