• 제목/요약/키워드: risk selection

Search Result 767, Processing Time 0.025 seconds

Association of Arrhythmia in the Elderly Patients on Combination Therapy of CYP3A4 Substrates and Inhibitors with the Korean Claims Data (CYP3A4 기질과 억제제 약물의 병용 고령환자에서 부정맥 부작용 연관성)

  • Tae Woo Kim;Junhyuk Chang;Eunjung Choo;Rae Woong Park;Sukhyang Lee
    • Korean Journal of Clinical Pharmacy
    • /
    • v.33 no.4
    • /
    • pp.242-253
    • /
    • 2023
  • Background: Arrhythmia due to QT prolongation is one of the most serious adverse events with drug interactions in the elderly. This study aimed to examine the incidence of arrhythmia in Korean elderly patients who administered both cytochrome P450 3A4 (CYP3A4) substrates and inhibitors. Methods: Patients using CYP3A4 substrate and inhibitor were selected from the 2017 elderly patient dataset (the Korean Health Insurance Review and Assessment Service - Aged Population Sample). Selection criteria were patients with a medication possession ratio over 80%, medication duration of at least 7 days, and a follow-up period of 3 months or more. The patient's basic information is age, gender, health insurance type, and comorbidities. The top 50 drug pairs and comorbidity with high-incidence arrhythmia were presented. Results: In patients with drug combinations for over 7 days, there were 981 incidences of arrhythmia, and 351 incidences in those with combinations for over 30 days. The comorbidities of congestive heart failure and myocardial infarction had a significant association with incidence of arrhythmia. Among patients with 7 days or longer, the drug pairs [substrates-inhibitors] with significant adjusted odds ratio (aOR) were [propranolol-cimetidine] (aOR, 2.25; 95% confidence interval [CI], 1.66-3.04). Among patients with 30 days or longer, the drug pairs with significant aOR were [tramadol-amiodarone] (aOR, 2.87; 95% CI, 1.97-4.19). Conclusions: In elderly patients, the incidence of arrhythmia was high with drug interactions of CYP3A4 substrates and inhibitors. The comorbidity of congestive heart failure was the risk factor.

Deep-learning performance in identifying and classifying dental implant systems from dental imaging: a systematic review and meta-analysis

  • Akhilanand Chaurasia;Arunkumar Namachivayam;Revan Birke Koca-Unsal;Jae-Hong Lee
    • Journal of Periodontal and Implant Science
    • /
    • v.54 no.1
    • /
    • pp.3-12
    • /
    • 2024
  • Deep learning (DL) offers promising performance in computer vision tasks and is highly suitable for dental image recognition and analysis. We evaluated the accuracy of DL algorithms in identifying and classifying dental implant systems (DISs) using dental imaging. In this systematic review and meta-analysis, we explored the MEDLINE/PubMed, Scopus, Embase, and Google Scholar databases and identified studies published between January 2011 and March 2022. Studies conducted on DL approaches for DIS identification or classification were included, and the accuracy of the DL models was evaluated using panoramic and periapical radiographic images. The quality of the selected studies was assessed using QUADAS-2. This review was registered with PROSPERO (CRDCRD42022309624). From 1,293 identified records, 9 studies were included in this systematic review and meta-analysis. The DL-based implant classification accuracy was no less than 70.75% (95% confidence interval [CI], 65.6%-75.9%) and no higher than 98.19 (95% CI, 97.8%-98.5%). The weighted accuracy was calculated, and the pooled sample size was 46,645, with an overall accuracy of 92.16% (95% CI, 90.8%-93.5%). The risk of bias and applicability concerns were judged as high for most studies, mainly regarding data selection and reference standards. DL models showed high accuracy in identifying and classifying DISs using panoramic and periapical radiographic images. Therefore, DL models are promising prospects for use as decision aids and decision-making tools; however, there are limitations with respect to their application in actual clinical practice.

Outcomes of Extracorporeal Membrane Oxygenation in COVID-19: A Single-Center Study

  • Sahri Kim;Jung Hyun Lim;Ho Hyun Ko;Hong Kyu Lee;Yong Joon Ra;Kunil Kim;Hyoung Soo Kim
    • Journal of Chest Surgery
    • /
    • v.57 no.1
    • /
    • pp.36-43
    • /
    • 2024
  • Background: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory failure, which frequently necessitates invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, the limited availability of ECMO resources poses challenges to patient selection and associated decision-making. Consequently, this retrospective single-center study was undertaken to evaluate the characteristics and clinical outcomes of patients with COVID-19 receiving ECMO. Methods: Between March 2020 and July 2022, 65 patients with COVID-19 were treated with ECMO and were subsequently reviewed. Patient demographics, laboratory data, and clinical outcomes were examined, and statistical analyses were performed to identify risk factors associated with mortality. Results: Of the patients studied, 15 (23.1%) survived and were discharged from the hospital, while 50 (76.9%) died during their hospitalization. The survival group had a significantly lower median age, at 52 years (interquartile range [IQR], 47.5-61.5 years), compared to 64 years (IQR, 60.0-68.0 years) among mortality group (p=0.016). However, no significant differences were observed in other underlying conditions or in factors related to intervention timing. Multivariable analysis revealed that the requirement of a change in ECMO mode (odds ratio [OR], 366.77; 95% confidence interval [CI], 1.92-69911.92; p=0.0275) and the initiation of continuous renal replacement therapy (CRRT) (OR, 139.15; 95% CI, 1.95-9,910.14; p=0.0233) were independent predictors of mortality. Conclusion: Changes in ECMO mode and the initiation of CRRT during management were associated with mortality in patients with COVID-19 who were supported by ECMO. Patients exhibiting these factors require careful monitoring due to the potential for adverse outcomes.

Operational Process and Success Factors of Corporate Venture in a Chinese Company: A Case Study of Haier (중국기업의 사내벤처 운영과정과 성공요인: 하이얼(Haier) 중심으로)

  • Yu-Rou Hou;Yuan-Jing Jin;Moon-Gu Huh
    • Asia-Pacific Journal of Business
    • /
    • v.14 no.4
    • /
    • pp.87-113
    • /
    • 2023
  • Purpose - Focusing on Haier, a successful corporate venture in China, we analyse the operating mechanism and success factors of corporate venture, and reveal the necessary factors for the successful implementation of corporate venture. Design/methodology/approach - This study is a single case study centred on Haier, a successful corporate venture in China. Findings - The operational process of Haier's corporate venture includes six key aspects: project selection, team building, resource allocation and support, project implementation, risk control measures, performance evaluation and rewards. In terms of success factors, the support of top management with leadership capability of value creation and sharing is very important for the success of corporate venture. Secondly, a multi reward mechanism can be introduced to motivate employees and improve performance. Thirdly, it is important to integrate corporate culture into the operating mechanism of an corporate venture. Fourthly, flexible operations that break down rigid organisational boundaries and transform the organisation into a more open platform for entrepreneurship can increase the likelihood of success. Finally, empowering employees with operational discretion can also have a positive impact on the success of an Corporate Venture. Research implications or Originality - This study contributes to theory and practice by analysing the success conditions of corporate venture, providing new understanding and drawing new perspectives, especially from the experience of Haier. The results suggest strategies and flexibility for successfully pursuing corporate venture, and provide important experience for international companies to help them gain competitive advantage in global competition. It also helps corporate leaders to promote new directions and innovations and improve their strategies to respond to dynamic environments.

Health Behavior Level and Related Factors of Survivors After Urological Cancer Surgery in a University Hospital (일개 대학병원에서 비뇨기계 암 생존자의 수술 후 건강행태 수준 및 관련요인)

  • Hyunjoon Cho;Hyeongsu Kim;Park Hyeonggeun;Choi wooseok;Jung Sungwon
    • Journal of agricultural medicine and community health
    • /
    • v.49 no.2
    • /
    • pp.102-110
    • /
    • 2024
  • Objective: This study evaluated the health behavior level of urological cancer survivors after surgery. Understand the experience of change and identify the factors that affect it for health. Selection of the best intervention steps and effective intervention adopt a lifestyle. It is intended to contribute to the creation of basic data for development of guidelines. Methods: The study was conducted with patients diagnosed with urological cancer at a hospital in Seoul. Study data were obtained by having 100 patients who agreed to the study self-fill out a questionnaire through interviews, and the 2018 World Cancer Research Fund and American Institute for Cancer Research Score (2018 WCRF/AICR SCORE) was used to estimate the level of health behavior. Results: The study examines health behavior among urolgical cancer survivors based on the 2018 WCRF/AICR SCORE. Higher household income and younger age were associated with better health behavior scores, with those under 60 and earning over 3 million won being more likely to have higher scores. Conclusion: Based on these results, this study requires comprehensive data collection considering the missing variables, suggesting that high household income and young age can positively affect healthy behavior. In addition, we conclude that education for cancer survivors and development of strategies to bridge the health gap for low-income and elderly populations are necessary.

Outcomes of liver transplantation for hepatocellular carcinoma: Experiences from a Vietnamese center

  • Khai Viet Ninh;Dang Hai Do;Trung Duc Nguyen;Phuong Ha Tran;Tuan Hoang;Dung Thanh Le;Nghia Quang Nguyen
    • Annals of Hepato-Biliary-Pancreatic Surgery
    • /
    • v.28 no.1
    • /
    • pp.34-41
    • /
    • 2024
  • Backgrounds/Aims: Liver transplantation (LT) provides a favorable outcome for patients with hepatocellular carcinoma (HCC) and was launched in Vietnam in 2004. In this study, we evaluated the short-term and long-term outcomes of LT and its risk factors. Methods: This retrospective study analyzed HCC patients who underwent LT at Viet Duc University hospital, Vietnam, from 01/2012-03/2022. The following data were gathered: demographics, virus infection, tumor characteristics, alpha-fetoprotein (AFP) level, Child-Pugh and MELD scores, selection criteria, type of LT, complications, 30-day mortality, and disease-free and overall survival (DFS and OS). Results: Fifty four patients were included, the mean age was 55.39 ± 8.46 years. Nearly 90% had hepatitis B virus-related HCC. The median (interquartile range) AFP level was 16.2 (88.7) ng/mL. The average MELD score was 10.57 ± 5.95; the rate of Child-Pugh A and B were 70.4% and 18.5%, respectively. Nearly 40% of the patients were within Milan criteria, brain-dead donor was 83.3%. Hepatic and portal vein thrombosis occurred in 0% and 1.9%, respectively; hepatic artery thrombosis 1.9%, biliary leakage 5.6%, and postoperative hemorrhage 3.7%. Ninety-day mortality was 5.6%. Five-year DFS and OS were 79.3% and 81.4%, respectively. MELD score and ChildPugh score were predictive factors for DFS and OS (p < 0.05). In multivariate analysis, Child-Pugh score was the only significant factor (p < 0.05). Conclusions: In Vietnam, LT is an effective therapy for HCC with an acceptable complication rate, mortality rate, and good survival outcomes, and should be further encouraged.

Rotatable sphincterotome as a rescue device for endoscopic retrograde cholangiopancreatography cannulation: a single-center experience

  • Takeshi Okamoto;Takashi Sasaki;Tsuyoshi Takeda;Takafumi Mie;Chinatsu Mori;Takaaki Furukawa;Yuto Yamada;Akiyoshi Kasuga;Masato Matsuyama;Masato Ozaka;Naoki Sasahira
    • Clinical Endoscopy
    • /
    • v.57 no.1
    • /
    • pp.96-104
    • /
    • 2024
  • Background/Aims: Selective bile duct or pancreatic duct cannulation remains a significant initial hurdle in endoscopic retrograde cholangiopancreatography (ERCP) despite advances in endoscopy and accessories. This study evaluated our experience with a rotatable sphincterotome in cases of difficult cannulation. Methods: We retrospectively reviewed ERCP cases using TRUEtome, a rotatable sphincterotome, as a rescue device for cannulation at a cancer institute in Japan from October 2014 to December 2021. Results: TRUEtome was used in 88 patients. Duodenoscopes were used for 51 patients, while single-balloon enteroscopes (SBE) were used for 37 patients. TRUEtome was used for biliary and pancreatic duct cannulation (84.1%), intrahepatic bile duct selection (12.5%), and strictures of the afferent limb (3.4%). Cannulation success rates were similar in the duodenoscope and SBE groups (86.3% vs. 75.7%, p=0.213). TRUEtome was more commonly used in cases with steep cannulation angles in the duodenoscope group and in cases requiring cannulation in different directions in the SBE group. There were no significant differences in adverse events between the two groups. Conclusions: The cannulation sphincterotome was useful for difficult cannulations in both unaltered and surgically altered anatomies. It may be an option to consider before high-risk procedures such as precut and endoscopic ultrasound-guided rendezvous techniques.

Comparative Interrupted Time Series Analysis of Medical Expenses in Patients with Intertrochanteric Fracture Who Underwent Internal Fixation and Hemiarthroplasty

  • Seung-Hoon Kim;Yonghan Cha;Suk-Yong Jang;Bo-Yeon Kim;Hyo-Jung Lee;Gui-Ok Kim
    • Hip & pelvis
    • /
    • v.36 no.2
    • /
    • pp.144-154
    • /
    • 2024
  • Purpose: The objective of this study was to assess postoperative direct medical expenses and medical utilization of elderly patients who underwent either hemiarthroplasty (HA) or internal fixation (IF) for treatment of a femoral intertrochanteric fracture and to analyze differences according to surgical methods and age groups. Materials and Methods: Data from the 2011 to 2018 Korean National Health Insurance Review & Assessment Service database were used. Risk-set matching was performed for selection of controls representing patients with the same sex, age, and year of surgery. A comparative interrupted time series analysis was performed for evaluation of differences in medical expenses and utilization between the two groups. Results: A total of 10,405 patients who underwent IF surgery and 10,405 control patients who underwent HA surgery were included. Medical expenses were 18% lower in the IF group compared to the HA group during the first year after the fracture (difference-in-difference [DID] estimate ratio 0.82, 95% confidence interval [CI] 0.77-0.87, P<0.001), and 9% lower in the second year (DID estimate ratio 0.91, 95% CI 0.85-0.99, P=0.018). Length of hospital stay was significantly shorter in the IF group compared to the HA group during the first two years after time zero in the age ≥80 group. Conclusion: A noticeable increase in medical expenses was observed for patients who underwent HA for treatment of intertrochanteric fractures compared to those who underwent IF over a two-year period after surgery. Therefore, consideration of such findings is critical when designing healthcare policy support for management of intertrochanteric fractures.

A Study about Development of Environment Printing Technology and $CO_2$ (환경 인쇄 기술의 발전과 인쇄물의 $CO_2$ 발생량에 관한 연구)

  • Lee, Mun-Hag
    • Journal of the Korean Graphic Arts Communication Society
    • /
    • v.30 no.3
    • /
    • pp.89-114
    • /
    • 2012
  • For as to world, the concern about the environment problem is enhanced than any other time in the past because of being 21 century. And the environment problem is highlighted as the world-wide issue. The time of the environment problem intimidates the alive of the mankind and presence of an earth over the time. It becomes the essentiality not being selection in the personal living or the economical viewpoint now to prepare for the climatic modification. As to the company management, the green growth period which it excludes the environment management considering an environment, cannot carry on the company the continued management comes. That is, in the change center of the management paradigm, there is the environment management. Nearly, the greenhouse gas which the publication industry is the environmental toxic material like all industries is generated. The greenhouse gas is ejected in the process of running the manufacturing process and print shop of the various kinds material used as the raw material of the book. Particularly, the tree felling for getting the material of the paper is known to reach the direct influence on the global warming. This study does according to an object it considers and organizes the environment parameter based on this kind of fact as to the publication industry. And it is determined as the reference which is used as the basic materials preparing the case that carbon exhaust right transaction(CAP and TRADE) drawing are enforced in all industries and is sustainable the management of the publication industry and reduces the environmental risk among the company many risk management elements and plans and enforces the publication related policy that there is a value. In the printing publication industry, this study tried to inquire into elements discharging the environmental pollutant or the greenhouse gas. Additionally, in the printed publication production process, it tried to inquire into the effort for an environment-friendly and necessity at the printing paper and the printers ink, regarded as the element discharging the greenhouse gas all kinds of the printing materials, operation of the print shop and all kinds of the machines and recycle process, and etc. These considerations make these industrial field employees aware of the significance about a conservation and environmental protection. They try to give a help in the subsequent study producing quantitatively each environmental parameter emission of green house gas. This makes the calculation of the relative $CO_2$ output reproached ultimately possible. Meanwhile, in a sense, many research protects and improving an environment in connection with the contents of research at the printing publication industrial field is in progress. There will be the voluntary human face that it has to protect an environment but this can not do by the outside factor according to all kinds of environment related law and regulation. Anyway, because of acting on company management as the factor of oppression, the increase of this environment-related correspondence cost could know that the research that the environment loading relates with a procurement and development, environment management system introduction, quality control standard, including, normalizing including a material, and etc. through the part of the effort to reduce the cost low was actively in progress. As to the green growth era, as follows, this paper prescribed the subject and alternative of the print publication industry. It is surrounded by the firstly new digital environment and the generation of the subject. And secondly the printing industry is caused by the point of time when the green growth leaves by the topic which is largest in the global industry and it increases. The printing publication industry has to prepare the bridgehead for the environment-friendly green growth as the alternative for this resolution with first. The support blown in each industry becomes the obligation not being selection. Prestek in which the print publishing was exposed to spend many energies and which is known as the practice of the sustainable print publishing insisted that it mentioned importance of the green printing through the white pages in 2008 and a company had to be the green growth comprised through the environment-friendly activity. The core management for the sustainable printing publication industry presented from Presstack white pages is compacted to 4 words that it is a remove, reduce, recover, and recycle. Second, positively the digital printing(POD) system should be utilized. In the worldwide print out market, the digital printing area stops at the level of 10% or so but the change over and growth of the market of an analog-to-digital will increase rapidly in the future. As to the CEO Jeff Hayes of the Infoland, the offset print referred to that it of the traditional method got old and infirm with the minor phase of the new printing application like the customer to be wanted publication and the print of the digital method led the market. In conclusion, print publishers have to grasp well the market flow in the situation where a digitalization cannot be generalized and a support cannot avoid. And it keeps pace with the flow of the digital age and the recognition about the effort for the development and environment problem have to be raised. Particularly, the active green strategy is employed for the active green strategy.

Relationship among practicing healthy diet and metabolic syndrome indicators in adults - From the Korea National Health and Nutrition Examination Survey, 2013~2014 (성인 남녀에서 건강식생활 실천 여부와 대사증후군 지표와의 관련성 연구 : 2013~2014 국민건강영양조사 자료를 이용하여)

  • Bae, Yun-Jung
    • Journal of Nutrition and Health
    • /
    • v.49 no.6
    • /
    • pp.459-470
    • /
    • 2016
  • Purpose: The purpose of the present study is to identify the relationship between practicing healthy diet and metabolic syndrome indicators in Koreans. Methods: This research is a cross-sectional study based on the 2013~2014 Korea National Health and Nutritional Examination Survey. This study investigated 6,748 adults aged 19 to 64 yr (19~49 yr: n = 4,230, 50~64 yr: n = 2,518) to examine practice of healthy diet and metabolic syndrome indicators. In this study, according to practicing healthy diet, we classified subjects into the "Practicing healthy diet (PHD)" group (19~49 yr: n = 1,782, 50~64 yr: n = 937) and "Non-practicing healthy diet (NPHD)" group (19~49 yr: n = 2,448, 50~64 yr: n = 1,581). PHD score was determined by adding the number of practicing factors: adequate fat intake, sodium intake ${\leq}2,000mg/day$, fruit & vegetable intake ${\geq}500g/day$, and using nutrition label information in food selection. Results: Female adults had a larger proportion of subjects who practiced a healthy diet compared to male adults (p < 0.001), and the percentages of 19~49 yr and 50~64 yr were 40.46% and 37.07%, respectively. The PHD group consumed significantly more calcium, vitamin $B_1$, $B_2$, and vitamin C density compared to the NPHD group. In 50~64 yr females, the subjects practicing healthy diet (PHD score ${\geq}2$) was inversely associated with risk of abdominal obesity (OR: 0.71, 95% CI: 0.54~0.93, p value = 0.0131) and metabolic syndrome (OR: 0.70, 95% CI: 0.52~0.94, p value = 0.0166) after adjustments for multiple confounding factors, compared with the lower PHD score (PHD score ${\leq}1$). Conclusion: Good dietary practice such as adequate fat intake, sodium intake ${\leq}2,000mg/day$, sufficient fruit & vegetable intake, and using nutrition label information in food selection could be useful in decreasing metabolic syndrome risk of Korean adults.