Pub Date : 2023-08-01DOI: 10.3904/kjm.2023.98.4.179
Oh-Hyun Cho
The incidence rate of tuberculosis (TB) in Korea has been consistently decreasing, but the proportion of extrapulmonary tuberculosis (EPTB) remains relatively stable at around 20%. Diagnosing EPTB remains a challenge because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus reducing the sensitivity of diagnostic tests. Delayed diagnosis and treatment some form of EPTB, such as tuberculous meningitis, can lead to fatal outcomes. Therefore, it is crucial to have a high index of suspicion and perform appropriate testing early on. Obtaining a specimen from the lesion and conducting microbiological tests (acid-fast bacilli smear, mycobacterial culture, and nucleic acid amplification test) along with histopathological examination is essential. When the specimen is limited for all testing, mycobacterial culture test should be prioritized as it has the highest diagnostic yield and allows for drug susceptibility testing. All patients with presumed EPTB should be assessed for pulmonary TB to assess infectiousness and potentially assist with diagnosis.
{"title":"A 78-Year-Old Man with Weakness and Loss of Appetite for 2 Months","authors":"Oh-Hyun Cho","doi":"10.3904/kjm.2023.98.4.179","DOIUrl":"https://doi.org/10.3904/kjm.2023.98.4.179","url":null,"abstract":"The incidence rate of tuberculosis (TB) in Korea has been consistently decreasing, but the proportion of extrapulmonary tuberculosis (EPTB) remains relatively stable at around 20%. Diagnosing EPTB remains a challenge because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus reducing the sensitivity of diagnostic tests. Delayed diagnosis and treatment some form of EPTB, such as tuberculous meningitis, can lead to fatal outcomes. Therefore, it is crucial to have a high index of suspicion and perform appropriate testing early on. Obtaining a specimen from the lesion and conducting microbiological tests (acid-fast bacilli smear, mycobacterial culture, and nucleic acid amplification test) along with histopathological examination is essential. When the specimen is limited for all testing, mycobacterial culture test should be prioritized as it has the highest diagnostic yield and allows for drug susceptibility testing. All patients with presumed EPTB should be assessed for pulmonary TB to assess infectiousness and potentially assist with diagnosis.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88763523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.3904/kjm.2023.98.4.155
Yong-Soo Kwon
The treatment of multidrug- and rifampin-resistant tuberculosis (MDR/RR-TB) poses significant challenges, including frequent adverse drug reactions associated with complex treatment regimens involving multiple drugs administered over prolonged periods. However, recent clinical trials, such as Nix-TB, ZeNix, NExT, MDR-END, TB-PRACTECAL, and BEAT-India, have demonstrated that shorter oral regimens yield superior outcomes compared with conventional approaches. Furthermore, the World Health Organization guidelines for MDR/RR-TB treatment recommend a 6-month all-oral regimen that includes bedaquiline, pretomanid, linezolid, and moxifloxacin. However, the implementation of these shorter oral regimens in South Korea requires careful consideration. Health insurance coverage policies must be reviewed to include new TB drugs, such as pretomanid. The optimal dosage and treatment duration of linezolid should be determined to minimize side effects and prevent drug resistance; moreover, alternative regimens should be identified for patients who discontinue linezolid because of adverse drug reactions.
{"title":"Shorter Oral Regimen for Multidrug Resistant Tuberculosis in South Korea","authors":"Yong-Soo Kwon","doi":"10.3904/kjm.2023.98.4.155","DOIUrl":"https://doi.org/10.3904/kjm.2023.98.4.155","url":null,"abstract":"The treatment of multidrug- and rifampin-resistant tuberculosis (MDR/RR-TB) poses significant challenges, including frequent adverse drug reactions associated with complex treatment regimens involving multiple drugs administered over prolonged periods. However, recent clinical trials, such as Nix-TB, ZeNix, NExT, MDR-END, TB-PRACTECAL, and BEAT-India, have demonstrated that shorter oral regimens yield superior outcomes compared with conventional approaches. Furthermore, the World Health Organization guidelines for MDR/RR-TB treatment recommend a 6-month all-oral regimen that includes bedaquiline, pretomanid, linezolid, and moxifloxacin. However, the implementation of these shorter oral regimens in South Korea requires careful consideration. Health insurance coverage policies must be reviewed to include new TB drugs, such as pretomanid. The optimal dosage and treatment duration of linezolid should be determined to minimize side effects and prevent drug resistance; moreover, alternative regimens should be identified for patients who discontinue linezolid because of adverse drug reactions.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74704161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.3904/kjm.2023.98.4.151
Se Yoon Park
Antibiotic stewardship is a vital strategy to address antibiotic resistance by promoting responsible antibiotic use. It is aimed at improving patient outcomes, reducing resistance, minimizing adverse effects, and lowering healthcare costs. Collaborative efforts among healthcare professionals from various disciplines are crucial for its successful implementation. Recognizing value beyond immediate financial benefits is important. Committed leadership, designated pharmacists, action plans, tracking, reporting, and education are essential elements. Prioritizing and implementing comprehensive stewardship programs are necessary to combat antibiotic resistance and protect public health.
{"title":"Antibiotic Stewardship: A Key Strategy to Combat Antibiotic Resistance","authors":"Se Yoon Park","doi":"10.3904/kjm.2023.98.4.151","DOIUrl":"https://doi.org/10.3904/kjm.2023.98.4.151","url":null,"abstract":"Antibiotic stewardship is a vital strategy to address antibiotic resistance by promoting responsible antibiotic use. It is aimed at improving patient outcomes, reducing resistance, minimizing adverse effects, and lowering healthcare costs. Collaborative efforts among healthcare professionals from various disciplines are crucial for its successful implementation. Recognizing value beyond immediate financial benefits is important. Committed leadership, designated pharmacists, action plans, tracking, reporting, and education are essential elements. Prioritizing and implementing comprehensive stewardship programs are necessary to combat antibiotic resistance and protect public health.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136072187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.3904/kjm.2023.98.4.162
J. Seo, Se Hwa Kim, Yang Jae Yoo, Ah Young Lee, Sang Jong Park
In recent years, the incidence of portal vein thrombosis (PVT) in patients with cirrhosis has increased; the thrombosis ranges from asymptomatic partial to complete occlusion. Treatment is difficult. Anticoagulation therapy may be the optimal first-line treatment for patients with acute PVT who lack variceal bleeding or mesenteric ischemia. Minimally invasive treatment options include mechanical thrombectomy, chemical thrombolysis, and stent placement. However, the effectiveness and timing of anticoagulation and interventional therapies remain unclear.
{"title":"Epidemiology, Diagnosis, and Treatment of Portal Vein Thrombosis","authors":"J. Seo, Se Hwa Kim, Yang Jae Yoo, Ah Young Lee, Sang Jong Park","doi":"10.3904/kjm.2023.98.4.162","DOIUrl":"https://doi.org/10.3904/kjm.2023.98.4.162","url":null,"abstract":"In recent years, the incidence of portal vein thrombosis (PVT) in patients with cirrhosis has increased; the thrombosis ranges from asymptomatic partial to complete occlusion. Treatment is difficult. Anticoagulation therapy may be the optimal first-line treatment for patients with acute PVT who lack variceal bleeding or mesenteric ischemia. Minimally invasive treatment options include mechanical thrombectomy, chemical thrombolysis, and stent placement. However, the effectiveness and timing of anticoagulation and interventional therapies remain unclear.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90069970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.3904/kjm.2023.98.4.185
Hanwool Cho, Jeong A. Kim
Clonal hematopoiesis (CH) is associated with somatic mutations of the hematopoietic stem cells responsible for red blood cell formation. The incidence of CH increases with age and negative environmental factors. It is particularly common in patients on chemotherapy, and is associated with a greater than 10-fold increased risk for hematological malignancy. It also increases the risk for cardiovascular disease. Despite recent advances in molecular and genetic research, the clinical and translational aspects of disease require more attention. However, as data accumulate, prevention of disease onset and progression will improve.
{"title":"Clinical Significance of Clonal Hematopoiesis","authors":"Hanwool Cho, Jeong A. Kim","doi":"10.3904/kjm.2023.98.4.185","DOIUrl":"https://doi.org/10.3904/kjm.2023.98.4.185","url":null,"abstract":"Clonal hematopoiesis (CH) is associated with somatic mutations of the hematopoietic stem cells responsible for red blood cell formation. The incidence of CH increases with age and negative environmental factors. It is particularly common in patients on chemotherapy, and is associated with a greater than 10-fold increased risk for hematological malignancy. It also increases the risk for cardiovascular disease. Despite recent advances in molecular and genetic research, the clinical and translational aspects of disease require more attention. However, as data accumulate, prevention of disease onset and progression will improve.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86255718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.3904/kjm.2023.98.4.173
Yejee Lim
The hospital is the optimal setting for conducting research on healthcare quality improvement and patient safety, and hospital medicine is an auspicious field for career growth. Integrating clinical practice with non-clinical activities, including education and scholarly endeavors, has the potential to enhance job satisfaction and mitigate the risk of burnout. As a hospitalist, it is imperative to establish a professional growth plan, and to identify and prioritize core values. This review discusses strategies for engaging in research, fostering career progression, and preventing burnout among hospitalists.
{"title":"Building a Sustainable Career in Hospital Medicine: Strategies for Research and Preventing Burnout","authors":"Yejee Lim","doi":"10.3904/kjm.2023.98.4.173","DOIUrl":"https://doi.org/10.3904/kjm.2023.98.4.173","url":null,"abstract":"The hospital is the optimal setting for conducting research on healthcare quality improvement and patient safety, and hospital medicine is an auspicious field for career growth. Integrating clinical practice with non-clinical activities, including education and scholarly endeavors, has the potential to enhance job satisfaction and mitigate the risk of burnout. As a hospitalist, it is imperative to establish a professional growth plan, and to identify and prioritize core values. This review discusses strategies for engaging in research, fostering career progression, and preventing burnout among hospitalists.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"156 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73461323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.3904/kjm.2023.98.3.108
Han Joo Kim
Antibody-drug conjugates (ADCs) are target-specific conjugates that consist of a monoclonal antibody connected to a cytotoxic payload using a stable linker. These conjugates combine the highly specific targeting ability and potent killing effect to accurately and efficiently eliminate cancer cells, which has ushered in a new era of targeted therapy. Since the first approval by the United States Food and Drug Administration in 2000, ADCs have experienced rapid development, with 14 of them receiving market approval. In this review, we examine the history, molecular structure, and pharmacological principles of ADCs, describing clinical trials and discussing the current challenges and future perspectives for the development of next-generation ADCs.
{"title":"Review of Antibody-Drug Conjugates","authors":"Han Joo Kim","doi":"10.3904/kjm.2023.98.3.108","DOIUrl":"https://doi.org/10.3904/kjm.2023.98.3.108","url":null,"abstract":"Antibody-drug conjugates (ADCs) are target-specific conjugates that consist of a monoclonal antibody connected to a cytotoxic payload using a stable linker. These conjugates combine the highly specific targeting ability and potent killing effect to accurately and efficiently eliminate cancer cells, which has ushered in a new era of targeted therapy. Since the first approval by the United States Food and Drug Administration in 2000, ADCs have experienced rapid development, with 14 of them receiving market approval. In this review, we examine the history, molecular structure, and pharmacological principles of ADCs, describing clinical trials and discussing the current challenges and future perspectives for the development of next-generation ADCs.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74428734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.3904/kjm.2023.98.3.99
S. Kim
Whether artificial intelligence (AI) can replace the role of doctors has seriously been discussed since the appearance of Chat Generative Pretrained Transformer (ChatGPT). Unlike past expectations that limit the role of AI in the medical field, doctors seem to both admire and be threatened by recent advances in AI models. Because previously developed and approved AI models have been managed and reviewed by medical experts during the preparation, refining, annotation, and verification of data, those systems can be considered to be based on evidence-based medicine. However, the current version of the ChatGPT model derives the most meaningful results from unverified open data. This approach enhances the accessibility to new information but is significantly different from the methodology of evidence-based medicine. Like all AI models developed to date, ChatGPT needs a system that can be rigorously verified and regulated by doctors to facilitate its use in the medical field.
{"title":"In the Era of ChatGPT, Can Medical Artificial Intelligence Replace the Doctor?","authors":"S. Kim","doi":"10.3904/kjm.2023.98.3.99","DOIUrl":"https://doi.org/10.3904/kjm.2023.98.3.99","url":null,"abstract":"Whether artificial intelligence (AI) can replace the role of doctors has seriously been discussed since the appearance of Chat Generative Pretrained Transformer (ChatGPT). Unlike past expectations that limit the role of AI in the medical field, doctors seem to both admire and be threatened by recent advances in AI models. Because previously developed and approved AI models have been managed and reviewed by medical experts during the preparation, refining, annotation, and verification of data, those systems can be considered to be based on evidence-based medicine. However, the current version of the ChatGPT model derives the most meaningful results from unverified open data. This approach enhances the accessibility to new information but is significantly different from the methodology of evidence-based medicine. Like all AI models developed to date, ChatGPT needs a system that can be rigorously verified and regulated by doctors to facilitate its use in the medical field.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81295488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.3904/kjm.2023.98.3.117
J. Seo, J. Ahn
It is important to evaluate Helicobacter pylori (H. pylori) infection based on endoscopic results because numerous studies have shown a link between H. pylori infection and upper gastrointestinal conditions, such as gastric cancer. The association between H. pylori infection and gastritis is fully described in the Kyoto classification of gastritis. Typical endoscopic findings in the absence of H. pylori infection are a regular arrangement of collecting venules, fundic gland polyps, red streaks, and other similar features. By contrast, typical endoscopic findings in individuals with active H. pylori infection include diffuse mucosal erythema, atrophy, intestinal metaplasia, inflated or tortuous folds, discharge of sticky mucus, mucosal nodularity, foveolar hyperplastic polyps, and/or xanthomas. Patchy mucosal redness and map-like mucosal redness are typical endoscopic findings in previously infected people. Because of its straightforward application in standard clinical practice, this categorization can reflect the risk of stomach cancer and be useful for both primary care physicians and experienced endoscopists.
{"title":"Endoscopic Features According to Helicobacter pylori Infection Status","authors":"J. Seo, J. Ahn","doi":"10.3904/kjm.2023.98.3.117","DOIUrl":"https://doi.org/10.3904/kjm.2023.98.3.117","url":null,"abstract":"It is important to evaluate Helicobacter pylori (H. pylori) infection based on endoscopic results because numerous studies have shown a link between H. pylori infection and upper gastrointestinal conditions, such as gastric cancer. The association between H. pylori infection and gastritis is fully described in the Kyoto classification of gastritis. Typical endoscopic findings in the absence of H. pylori infection are a regular arrangement of collecting venules, fundic gland polyps, red streaks, and other similar features. By contrast, typical endoscopic findings in individuals with active H. pylori infection include diffuse mucosal erythema, atrophy, intestinal metaplasia, inflated or tortuous folds, discharge of sticky mucus, mucosal nodularity, foveolar hyperplastic polyps, and/or xanthomas. Patchy mucosal redness and map-like mucosal redness are typical endoscopic findings in previously infected people. Because of its straightforward application in standard clinical practice, this categorization can reflect the risk of stomach cancer and be useful for both primary care physicians and experienced endoscopists.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72809232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.3904/kjm.2023.98.3.137
Y. Jang, Min Jung Kim, Borim Ryu, Ji Yu Sun, K. Moon, K. Shin
Background/Aims: Irrespective of socioeconomic status, urate lowering therapy (ULT) is crucial for all chronic gout patients. We investigated the presence of missed opportunities for ULT among underprivileged patients treated at a major public hospital in Korea after a severe gout flare.Methods: We first collected information on patients admitted under the diagnosis of gout (International Classification of Diseases 10th Revision code M10) at a major public hospital from March 2011 to February 2022. De-identified patient data, including sociodemographic status, uric acid levels, list of medications, and outpatient follow-up data, were extracted. The patients were grouped into frail patients, who were living alone and were admitted to the specialized ward (SPE), and those who were admitted to the general ward (GEN). Primary endpoints were the outpatient visit rate immediately after discharge and the rate of ULT maintenance after a year.Results: Acute gouty arthritis was the chief event during admission in 136 cases. The mean (± standard deviation) age was 60.1 (± 16.1) years, and 95% of the patients were male. Only 18% of the patients were on ULT before admission. The patients were divided into the SPE (n = 25) and GEN (n = 111) groups. Body mass index in the SPE group was lower than in the GEN group (23.4 [± 4.4] and 25.1 [± 3.7], respectively, p = 0.082). The uric acid levels at admissio in the SPE and GEN groups were 9.6 (± 2.7) and 7.6 (± 2.3), respectively (p = 0.0023). After discharge, 80% and 95.5% of the SPE and GEN group participants presented to the outpatient department within 1 month, respectively (p = 0.019). ULT was continued or initiated in 85% of the patients. However, fewer patients continued colchicine for at least 3 months in the SPE group compared to the GEN group (25.0% and 43.4%, respectively). After 1 year, the SPE group had a higher rate of loss to follow-up (32.0% vs. 23.4%), higher uric acid levels (7.4 [± 3.8] vs. 6.2 [± 2.1]), and fewer ULT users (41.2% vs. 50.6%) compared to the GEN group, but the differences were not statistically significant.Conclusions: Frail patients who lived alone, even in the metropolitan area, missed opportunities for ULT and long-term gout care. Joint efforts on the part of health authorities and social workers are necessary to devise a strategy for better access and management among underprivileged gout patients.
背景/目的:无论社会经济地位如何，尿酸降低疗法(ULT)对所有慢性痛风患者都至关重要。我们调查了在韩国一家大型公立医院接受严重痛风发作治疗的贫困患者中是否存在错过ULT治疗机会的情况。方法:首先收集2011年3月至2022年2月在某大型公立医院以痛风(国际疾病分类第十版修订代码M10)诊断入院的患者资料。提取未识别的患者数据，包括社会人口统计状况、尿酸水平、药物清单和门诊随访数据。这些患者被分为两组，一组是独居患者，住在专科病房(SPE)，另一组住在普通病房(GEN)。主要终点是出院后立即门诊就诊率和一年后ULT维持率。结果:急性痛风性关节炎是136例患者入院时的主要事件。平均(±标准差)年龄为60.1(±16.1)岁，95%为男性。只有18%的患者在入院前接受了ULT治疗。将患者分为SPE组(n = 25)和GEN组(n = 111)。SPE组体重指数低于GEN组(分别为23.4[±4.4]和25.1[±3.7]，p = 0.082)。SPE组和GEN组入院时尿酸水平分别为9.6(±2.7)和7.6(±2.3)，差异有统计学意义(p = 0.0023)。出院后，80%的SPE组和95.5%的GEN组患者在1个月内就诊(p = 0.019)。85%的患者继续或开始进行ULT治疗。然而，与GEN组相比，SPE组中持续使用秋水仙碱至少3个月的患者较少(分别为25.0%和43.4%)。1年后，与GEN组相比，SPE组的随访失失率更高(32.0% vs. 23.4%)，尿酸水平更高(7.4[±3.8]vs. 6.2[±2.1])，ULT使用者较少(41.2% vs. 50.6%)，但差异无统计学意义。结论:独居的体弱患者，即使在大都市地区，也错过了ULT和长期痛风护理的机会。卫生当局和社会工作者必须共同努力，制定一项战略，以便更好地接触和管理贫困的痛风患者。
{"title":"Missed Opportunities for Urate Lowering Therapy after Gout Flares in Frail Patients Living Alone","authors":"Y. Jang, Min Jung Kim, Borim Ryu, Ji Yu Sun, K. Moon, K. Shin","doi":"10.3904/kjm.2023.98.3.137","DOIUrl":"https://doi.org/10.3904/kjm.2023.98.3.137","url":null,"abstract":"Background/Aims: Irrespective of socioeconomic status, urate lowering therapy (ULT) is crucial for all chronic gout patients. We investigated the presence of missed opportunities for ULT among underprivileged patients treated at a major public hospital in Korea after a severe gout flare.Methods: We first collected information on patients admitted under the diagnosis of gout (International Classification of Diseases 10th Revision code M10) at a major public hospital from March 2011 to February 2022. De-identified patient data, including sociodemographic status, uric acid levels, list of medications, and outpatient follow-up data, were extracted. The patients were grouped into frail patients, who were living alone and were admitted to the specialized ward (SPE), and those who were admitted to the general ward (GEN). Primary endpoints were the outpatient visit rate immediately after discharge and the rate of ULT maintenance after a year.Results: Acute gouty arthritis was the chief event during admission in 136 cases. The mean (± standard deviation) age was 60.1 (± 16.1) years, and 95% of the patients were male. Only 18% of the patients were on ULT before admission. The patients were divided into the SPE (n = 25) and GEN (n = 111) groups. Body mass index in the SPE group was lower than in the GEN group (23.4 [± 4.4] and 25.1 [± 3.7], respectively, p = 0.082). The uric acid levels at admissio in the SPE and GEN groups were 9.6 (± 2.7) and 7.6 (± 2.3), respectively (p = 0.0023). After discharge, 80% and 95.5% of the SPE and GEN group participants presented to the outpatient department within 1 month, respectively (p = 0.019). ULT was continued or initiated in 85% of the patients. However, fewer patients continued colchicine for at least 3 months in the SPE group compared to the GEN group (25.0% and 43.4%, respectively). After 1 year, the SPE group had a higher rate of loss to follow-up (32.0% vs. 23.4%), higher uric acid levels (7.4 [± 3.8] vs. 6.2 [± 2.1]), and fewer ULT users (41.2% vs. 50.6%) compared to the GEN group, but the differences were not statistically significant.Conclusions: Frail patients who lived alone, even in the metropolitan area, missed opportunities for ULT and long-term gout care. Joint efforts on the part of health authorities and social workers are necessary to devise a strategy for better access and management among underprivileged gout patients.","PeriodicalId":84452,"journal":{"name":"Chungang uihak = The Korean central journal of medicine","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73948205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：