Nonalcoholic Fatty Liver Disease as a Risk Factor for Prolonged Corrected QT Interval in Apparently Healthy Korean Women

BACKGROUND AND AIMS: Nonalcoholic fatty liver disease (NAFLD) is clinically important because of its association with an increased risk of sudden cardiac death as well as liver-related mortality. Most cases of sudden cardiac death could be mediated by an arrhythmogenic process. Thus, we aimed to determine the association between NAFLD and corrected QT (QTc) interval in apparently healthy Korean women. METHODS: This cross-sectional study included 764 women aged 20 to 74 years old who underwent a health examination program between 2014 and 2015. The QTc interval was calculated using Bazett's formula (QTc = QT/√RR). Multiple linear and logistic regression analysis were performed to assess independent relationships between NAFLD and QTc interval and prolonged QTc (≥ 450 milliseconds) was calculated after adjusting for confounding variables. RESULTS: The overall prevalence of NAFLD was 23.5% in general healthy women. The standardized β coefficient (95% confidence interval) of the QTc increment in patients with NAFLD was 6.4 milliseconds (1.2-11.8) through multiple linear regression analysis after adjusting for age, body mass index, smoking status, and regular exercise as well as mean arterial pressure, fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, aspartate aminotransferase, alanine aminotransferase, calcium, potassium levels and menopause status. Similarly, the odds ratio (95% confidence interval) of NAFLD for prolonged QTc was 2.05 (1.13-3.71) according to multiple logistic regression analysis after adjusting for the same covariables in women aged 20 to 74 years old. CONCLUSION: We demonstrated the arrhythmogenic potential of NAFLD, implying that careful monitoring of patient electrocardiograms is necessary to evaluate the possible arrhythmic risk in general healthy women with NAFLD.ope

Do Benign Pancreatic Cysts Increase the Incidence Risk of Pancreatic Cancer?: For Korean Aged over 40 Years

Background: Whether pancreatic cysts such as mucinous cystic neoplasm and intraductal papillary mucinous neoplasm have malignant potential is known. However, whether patients with benign pancreatic cysts have a higher risk of pancreatic cancer (PaCa) has not been established yet. Methods: We evaluated data from the National Health Insurance Service-National Sample Cohort (2002–2006) of the Korean National Health Insurance Service. Patients with pancreatic cysts detected on computed tomography/magnetic resonance imaging were identified using the Korean Classification of Diseases, 6th Edition. Patients aged >40 years with and those without pancreatic cystic lesions were followed up until 2010 (389,777 patients). Results: During the study period, PaCa was diagnosed in 2 of 71 patients with pancreatic cysts and in 1,605 of 389,706 patients without pancreatic cyst. The incidence rates of PaCa were 2.82% and 0.41%, respectively. The hazard ratio of PaCa in all the patients with cysts was 9.839 (95% confidence interval, 2.461–39.332; P=0.0012) when compared with the rest of the patients without cysts. Conclusion: Patients aged >40 years with pancreatic cysts have a significantly higher risk of PaCa

Physician’s Attitude toward Treating Breakthrough Cancer Pain in Korea

Purpose : Adequate control of breakthrough pain is essential for patients with cancer. Managing breakthrough pain mainly depends on understanding the concept of breakthrough pain and the proper usage of rescue medication by physicians. This study aims to assess the attitudes and practice patterns of palliative physicians in managing breakthrough pain for patients in Korea. Methods : This study was based on data from the 2014 breakthrough cancer pain survey conducted by the Korean Society for Hospice and Palliative Care. One hundred physicians participated in the online survey. Among total 33 self-reported questionnaires, twelve items were selected in this analysis. Results : Rapid onset of action is the main influencing factor in selecting rescue opioids. Oral oxycodone (65%) and parenteral morphine (27%) are commonly used. A few physicians (3%) prefer to use transmucosal fentanyl. The percentage of physicians prescribing oral oxycodone due to its rapid onset of action is just 21.5%, whereas the percentage of physicians using parenteral morphine is 81.5%. Two thirds of respondents (66%) answered that breakthrough pain is not well controlled with rescue medications. Conclusion : There is a gap between the needs of physicians in terms of the perceived difficulties of managing breakthrough cancer pain and their practice patterns selecting rescue medications.ope

Developing a Scoring Guide for the Appraisal of Guidelines for Research and Evaluation II Instrument in Korea: A Modified Delphi Consensus Process

Korea has a relatively short history in the development and use of clinical practice guidelines (CPGs). Additionally, it has been difficult to employ the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument due to the lack of consensus and the presence of differences in Korean medical settings and in the Korean socio-cultural environment. An AGREE II scoring guide was therefore developed to reduce differences among evaluators using the same tool. In consideration of the importance of using a quantitative measure of satisfaction with the elements described in the AGREE II manual, a final draft was developed through a Delphi consensus process. Ninety-two draft scoring guides for anchor points 1, 3, 5, and 7 (full score) in 23 items were developed. Consensus was defined as agreement among at least 70% of the raters. Agreement on 88 draft scoring guidelines was reached in the first Delphi round, and agreement for the remaining four was achieved in the second round. The development of an AGREE II scoring guide in this study is expected to contribute to improving the CPG environment.ope

Defining Essential Topics and Procedures for Korean Family Medicine Residency Training

Background: This study aims to create a comprehensive list of essential topics and procedural skills for family medicine residency training in Korea. Methods: Three e-mailed surveys were conducted. The first and second surveys were sent to all board-certified family physicians in the Korean Academy of Family Medicine (KAFM) database via e-mail. Participants were asked to rate each of the topics (117 in survey 1, 36 in survey 2) and procedures (65 in survey 1, 19 in survey 2) based on how necessary it was to teach it and personal experience of utilizing it in clinical practice. Agreement rates of the responses were calculated and then sent to the 32 KAFM board members in survey 3. Opinions on potential cut-off points to divide the items into three categories and the minimum achievement requirements needed to graduate for each category were solicited. Results: Of 6,588 physicians, 256 responded to the first survey (3.89% response rate), 209 out of 6,669 to the second survey (3.13%), and 100% responded to the third survey. The final list included 153 topics and 81 procedures, which were organized into three categories: mandatory, recommended, and optional (112/38/3, 27/33/21). For each category of topics and procedures, the minimum requirement for 3-year residency training was set at 90%/60%/30% and 80%/60%/30%, respectively. Conclusion: This national survey was the first investigation to define essential topics and procedures for residency training in Korean family medicine. The lists obtained represent the opinions of Korean family physicians and are expected to aid in the improvement of family medicine training programs in the new competency-based curriculum.ope

Opioids use for chronic noncancer pain

The use of opioids for chronic noncancer pain has increased in recent years, although evidence for its long-term effectiveness is weak and its potential for harm is significant. Most reports suggest that chronic opioid therapy can be effective for the reduction of chronic pain and for the improvement of functioning and health-related quality of life. However, opioids are also associated with potentially serious harm including pharmacologic adverse effects and socioeconomic problems such as abuse, addiction, and diversion. Physicians should use a structured approach that includes a biopsychosocial evaluation and treatment plan that encourages patients to reach functional goals. There should be a comprehensive evaluation of the cause of pain, assessment for risk of opioid complications (including misuse and addiction), and a detailed treatment history including a review of medical records. Regular monitoring for safety and effectiveness is essential including regular checking of functional improvement and progress towards the pretreatment goals. Ineffective or unsafe opioid therapy should be promptly tapered or stopped. In Korea until now, there are no adequate recommendations for opioid prescription in the management of chronic noncancer pain. A Korean guideline or task force team should be established to provide personalized treatment for carefully selected and monitored patients.ope

Adult height is not associated with the risk of stomach cancer in a meta-analysis

Background: Adult height has been suggested as a biomarker for a wide range of diseases. However, there are epidemiologic inconsistencies regarding the association between adult height and stomach cancer risk. Methods: We retrieved PubMed, EMBASE and Cochrane library databases to identify relevant studies assessing the relationship between height and risk of stomach cancer, published from inception to June 4, 2019. We pooled effect sizes for 5-cm height increments using a random-effect model and obtained the cumulative relative risk (RR) and 95% confidence interval (CI). Additionally, we performed subgroup investigation with sensitivity analysis and tested for publication bias using the Begg rank correlation test. Results: We analyzed 11 studies involving 137,451 cases. The summary of effect size (95% CI) of stomach cancer for a 5-cm-increase in adult height was 0.99 (0.95-1.02). A "leave-one-out" sensitivity analysis indicated that the heterogeneity decreased by a half and the result showed significance (RR, 0.972; 95% CI, 0.948-0.997). Subgroup analyses found no significant associations, with one exception. The exception also depended entirely on one study. We found no significant publication bias (P=0.276). Conclusions: Height is not associated with increased stomach cancer risk. Epidemiologic studies of potential confounders are needed to clarify the association.ope

Socioeconomic Factors Associated with High Risk Drinking of Cancer Survivors in Korea: The Korea National Health and Nutrition Examination Survey 2016–2017

Background: This study aimed to analyze the association between socioeconomic factors and high-risk drinking in cancer survivors. Methods: The study included 11,388 adults who participated in the 2016 and 2017 Korea National Health and Nutrition Examination Survey. We divided the study population by cancer status and analyzed the effects of socioeconomic factors on high-risk drinking using a chi-square test and multiple logistic regression. We used SPSS 23 for the analysis. Results: Binge drinkers occupied 27.2% of cancer patients, and 5.3% were found to be heavy drinkers. In cancer patients, low household income (<50%) was associated with binge drinking (heavy episodic drinking) (odds ratio [OR], 2.242; 95% confidence interval [CI], 1.220–4.120) and heavy drinking (OR, 3.497; 95% CI, 1.212–10.080). Meanwhile, job was associated with binge drinking (OR, 1.660; 95% CI, 1.479–1.864) and heavy drinking (OR, 1.535; 95% CI, 1.251–1.884) in the non-cancer population. Residence in an urban area and a low educational level were associated with binge drinking (OR, 1.243; 95% CI, 1.061–1.455) and heavy drinking (OR, 1.380; 95% CI, 1.059–1.798), respectively. Conclusion: In this study, we found that low income was significantly associated with high-risk drinking in cancer patients, whereas other factors including employment, low educational level, and residence in an urban area were associated with high-risk drinking in the general population. These findings suggest that more attention needs to be paid to educating cancer survivors with low income to prevent high-risk drinking and its effects.ope

Clinical Practice Guideline for Care in the Last Days of Life

A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients’ physical and mental symptoms, psychological support, appropriate decision- making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.ope

The diagnosis and treatment of lymphedema

Lymphedema is not uncommon, but it can often be undiagnosed until discomfort or complications occur. It tends to develop slowly, but is progressive without proper treatment. Lymphedema occurs when the lymphatic fluid load is greater than the ability of transport, resulting not only in excessive accumulation of tissue fluid but also in deformity of appearance, immobility, and more serious consequences. Stage I lymphedema can be improved by simply promoting drainage with elevation and compression garments. Stage II or III lymphedema should be managed intensively with complete decongestive therapy using a combination of skin care, exercise, elevation, manual lymph drainage, intermittent pneumatic compression, multilayer lymphedema bandaging and weight reduction. The safety and effectiveness of other treatment modalities for lymphedema such as liposuction, microsurgical lymphatic reconstruction, needle aspiration, stem cells, laser therapy, and iliac vein stenting should further be investigated. Since lymphedema is progressive, the diagnosis and treatment of lymphedema at the earliest possible stage is very important. Complete decongestive therapy is principal, and psychosocial support is an important element of the treatment of lymphedema.ope