Journal of Korean Medical Science最新文献

Background: Injuries pose a significant global health challenge due to their high incidence and mortality rates. Although injury surveillance is essential for prevention, it is resource-intensive. This study aimed to develop and validate locally deployable large language models (LLMs) to extract core injury-related information from Emergency Department (ED) clinical notes.

Methods: We conducted a diagnostic study using retrospectively collected data from January 2014 to December 2020 from two urban academic tertiary hospitals. One served as the derivation cohort and the other as the external test cohort. Adult patients presenting to the ED with injury-related complaints were included. Primary outcomes included classification accuracies for information extraction tasks related to injury mechanism, place of occurrence, activity, intent, and severity. We fine-tuned a single generalizable Llama-2 model and five distinct Bidirectional Encoder Representations from Transformers (BERT) models for each task to extract information from initial ED physician notes. The Llama-2 model was able to perform different tasks by modifying the instruction prompt. Data recorded in injury registries provided the gold standard labels. Model performance was assessed using accuracy and macro-average F1 scores.

Results: The derivation and external test cohorts comprised 36,346 and 32,232 patients, respectively. In the derivation cohort's test set, the Llama-2 model achieved accuracies (95% confidence intervals) of 0.899 (0.889-0.909) for injury mechanism, 0.774 (0.760-0.789) for place of occurrence, 0.679 (0.665-0.694) for activity, 0.972 (0.967-0.977) for intent, and 0.935 (0.926-0.943) for severity. The Llama-2 model outperformed the BERT models in accuracy and macro-average F1 scores across all tasks in both cohorts. Imposing constraints on the Llama-2 model to avoid uncertain predictions further improved its accuracy.

Conclusion: Locally deployable LLMs, trained to extract core injury-related information from free-text ED clinical notes, demonstrated good performance. Generative LLMs can serve as versatile solutions for various injury-related information extraction tasks.

Background: In patients with metastatic renal cell carcinoma (mRCC), sites of metastatic involvement have been reported to be associated with a difference in survival. However, the frequency and survival according to different sites of metastases in Korean patients with mRCC remain unclear. Therefore, this study aimed to assess the frequency of metastatic site involvement and the association between sites of metastatic involvement and survival in Korean patients with mRCC.

Methods: This retrospective study used the multicenter cohort of the Korean Renal Cancer Study Group mRCC database to identify patients who started targeted therapy between December 2005 and March 2018. Data on the frequency of metastatic organ involvement at the time of mRCC diagnosis and oncologic outcomes according to different sites of metastasis were analyzed.

Results: A total of 1,761 patients were eligible for analysis. Of the 1,761 patients, 1,564 (88.8%) had clear cell RCC, and 1,040 (59.1%) had synchronous metastasis. The median number of metastasis sites was 2 (interquartile range [IQR], 1-6). The median age at the initiation of systemic therapy was 60 years (IQR, 29-88), 1,380 (78.4%) were men, and 1,341 (76.1%) underwent nephrectomy. Based on the International Metastatic Renal Cell Carcinoma Database Consortium model, patients were stratified into favorable-, intermediate-, and poor-risk groups with 359 (20.4%), 1,092 (62.0%), and 310 (17.6%) patients, respectively. The lung (70.9%), lymph nodes (37.9%), bone (30.7%), liver (12.7%), adrenal gland (9.8%), and brain (8.2%) were the most common sites of metastasis, followed by the pancreas, pleura, peritoneum, spleen, thyroid, and bowel. Among the most common sites of metastasis (> 5%), the median cancer-specific survival (CSS) ranged from 13.9 (liver) to 29.1 months (lung). An association was observed between liver, bone, and pleural metastases and the shortest median CSS (< 19 months).

Conclusion: In Korean patients with mRCC, metastases to the lung, lymph nodes, bone, liver, adrenal gland, and brain were more frequent than those to other organs. Metastases to the liver, bone, and pleura were associated with poor CSS. The findings of this study may be valuable for patient counseling and guiding future study designs.

Background: Evaluate the impact of chest X-ray (CXR) screening on mortality and treatment adherence by comparing pulmonary tuberculosis (PTB) cases detected through screening and those routinely diagnosed at healthcare facilities.

Methods: A retrospective analysis of 10% randomly sampled National Health Insurance Service claims data assessed PTB cases diagnosed during 2004-2020. Patients were categorized as 'screening-detected (ACF, active case finding)' or 'routinely detected (PCF, passive case finding)' based on CXR screening history. Cox proportional hazards model determined the association between screening and all-cause or tuberculosis (TB)-specific mortality. Treatment adherence was also measured.

Results: Among 84,828 PTB patients, 18.76% were ACF (15,916), and 81.24% were PCF (68,912). ACF exhibited lower risks in all-cause mortality (adjusted hazard ratio [aHR], 0.70; 95% confidence interval [CI], 0.67-0.73) and TB-specific mortality (aHR, 0.38; 95% CI, 0.32-0.46) compared to PCF. In the ACF group, 91.39% initiated anti-TB treatment, with 45.99% adherence. For PCF, 92.87% initiated treatment, and only 45.44% were adherent.

Conclusion: Individuals undergoing CXR screening have a lower risk of both all-cause and TB-specific mortality compared to PCF, but treatment adherence is similar between the two groups, emphasizing the need to improve the linkage between screening, diagnosis, and treatment for the screened population.

Background: Olfactory dysfunction is a frequently encountered sensory disorder that increases with aging, assessed magnetic resonance imaging (MRI); however, reference quantitative values for associated anatomical structures have rarely been suggested. The aim of this study was to assess the parameters of the olfactory bulbs (OBs) and olfactory sulcus (OS) in Korean adults according to age, along with their olfactory function.

Methods: We retrospectively evaluated 217 consecutive patients (104 men, 113 women; mean age, 52.4 ± 15.6 years) who underwent sellar MRI and olfactory function testing before transsphenoidal approach at a single tertiary center from March 2022 to December 2023. Based on the T2-weighted MRI, we evaluated the quantitative size parameters and morphological features of patients' OB and OS, along with their olfactory function test scores. We assessed the relationship between OB volume and age in pairwise correlations.

Results: The mean OB volume was 45.6 ± 15.3 mm³ in all patients. The patients' mean Korean version of the Sniffin' Sticks (KVSS) test II score was 26.8 ± 4.1. OB volume (P < 0.001), height (P < 0.001), and anteroposterior diameter (APD) (P < 0.001) differed significantly among the different age groups. Reduced OB volume was significantly associated with aging (r = -0.58, P < 0.001) and a decline in olfactory function scores (r = 0.34, P < 0.001).

Conclusion: Based on MRI, we proposed reference OB and OS values in adults of different age groups, highlighting the reduction in OB parameters, especially height and APD along with volume associated with aging and olfactory decline. These values can be useful for evaluating adult patients undergoing MRI for olfactory dysfunction.

Tobacco control efforts in Korea began nearly three decades ago with the enactment of the National Health Promotion Act in 1995. Monitoring smoking prevalence is crucial for evaluating the effectiveness of tobacco control measures, as reductions in smoking rates reflect the impact of anti-smoking policies. This review aims to provide an updated overview of the epidemiology of tobacco use in Korea, outline the nation's advancements in tobacco control, and emphasize emerging challenges in tobacco use. The data sources included statistics and reports from the World Health Organization (WHO) and the Organization for Economic Co-operation and Development (OECD), the Korea National Health and Nutrition Examination Survey, as well as various national statistics and reports on tobacco use and control in Korea. Over the past quarter-century, there was a notable 49.6% reduction in the prevalence of cigarette smoking among Korean adults, with a particularly pronounced decline among men (1998: 66.3% vs. 2022: 30.0%; a 54.8% decrease). However, the reduction among women was more modest, with only a 1.5 percentage point decrease (1998: 6.5% vs. 2022: 5.0%; a 23.1% decrease), and an increase in smoking prevalence was observed among women in their 20s and 30s. Overall use of any tobacco product, including cigarettes, heated tobacco products, electronic nicotine delivery systems, and others, was 6.6 percentage points higher among males and 2.2 percentage points higher among females compared to cigarette smoking alone. In 2019, there were 58,036 deaths attributed to direct smoking in Korea, with an estimated socioeconomic cost of smoking amounting to 12,191.3 billion Korean won. Furthermore, critical issues in tobacco use persist in Korea, including significant disparities in tobacco use related to age, gender, and disability, the growing use of novel tobacco and nicotine products among adolescents and younger adults, and regulatory blind spots. The reduction in smoking rates in Korea reflects the impact of expanded tobacco control policies and public health initiatives. However, for Korea to advance to the next level in tobacco control policies, it is essential to implement the WHO Framework Convention on Tobacco Control's MPOWER measures more thoroughly.

Background: This study aimed to investigate the obstetric and perinatal outcomes of singleton deliveries following frozen embryo transfer (FET) cycles using different endometrial preparation methods.

Methods: We analyzed data on 44,118 singleton pregnant women who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), resulting in delivery or abortion, from the South Korean National Health Insurance Service database. Stratification was based on the type of embryo transfer, viz. fresh embryo transfer and FET cycles, using International Classification of Diseases (Tenth Revision) diagnostic codes, national procedural codes, and prescription medication data within the IVF/ICSI pregnancy cohort. FET was subcategorized into artificial cycle-FET (AC-FET), natural cycle-FET (NC-FET), and stimulated cycle-FET (SC-FET) for comparative analyses of the pregnancy, obstetric, and perinatal outcomes.

Results: AC-FET was associated with higher risks of hypertensive disorders of pregnancy, preeclampsia, placenta accreta, and postpartum hemorrhage compared with NC-FET; the risk of macrosomia showed no significant differences. SC-FET was associated with a lower risk of miscarriage and higher rate of term birth beyond 37 weeks compared with NC-FET. However, SC-FET was associated with elevated risks of gestational hypertension and postpartum hemorrhage when compared to NC-FET.

Conclusion: The rate of adverse obstetric and perinatal outcomes was higher in AC-FET compared to NC-FET, highlighting NC-FET as a valuable option owing to better maternal and fetal safety. In cases where NC-FET is not feasible, SC-FET presented as a favorable alternative, exhibiting lower miscarriage rates than NC-FET and better obstetric outcomes than AC-FET.

We retrospectively examined current trends in ordering for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) testing. All claims corresponding to ESR and CRP testing for hospital visits in 2022 were obtained from a platform operated by the Health Insurance and Review Agency. The annual (2018-2022) utilization and cost of ESR and CRP, total inpatient days, and patient encounters with outpatients were retrieved. The number of ESR and CRP tests gradually increased over 5 years, except a slight decrease in 2020. The proportion of claims with co-ordering of ESR and CRP tests was 46.64%. More than 60% co-ordering claims were observed in orthopedic surgery, neurosurgery, and plastic surgery departments. The proportion of co-orders was relatively high in inpatient setting and primary hospitals. This study indicated frequent co-ordering patterns of ESR and CRP tests, highlighting an urgent need for diagnostic stewardship programs on ESR and CRP testing in Korea.

Background: The association between happiness and suicide behaviour across different gender and age groups remains unclear, with few studies identifying potential confounding or mediating factors that explain this association. We aimed 1) to examine the association of happiness with suicide ideation/attempt and 2) to assess the relative contribution of potential factors in explaining the associations in South Korea.

Methods: We used data from the Korea Community Health Survey 2021, with 214,070 respondents aged over 20 years. Happiness was measured by using Cantril's ladder of life satisfaction. Suicide ideation and suicide attempt were each measured by a single question. A hierarchical logistic regression model was used to identify the association between happiness and suicide ideation/attempt and estimate the relative importance of each socio-environmental, psychological, and health-related factor.

Results: Unhappiness was associated with suicide ideation/attempt across gender and age groups. The associations appeared stronger in younger rather than older adults, particularly for women aged 20-39 and 40-59 years. Psychological factors contributed the most to explaining the association across all genders and age groups. Socio-environmental factors explained the associations more among individuals aged 40-59 years and health-related factors were more pronounced in explaining the association among those aged 60 years and above, compared to other age groups.

Conclusion: Unhappiness is associated with suicide ideation/attempt. Psychological factors could largely explain this association, suggesting that improving population mental health could play an important role in increasing happiness and preventing suicide behaviour.