Status of Quality Control for Laboratory Tests of Medical Institutions in Korea: Analysis of 10 Years of Data on External Quality Assessment Participation

External quality assessment (EQA) is a commonly used tool to track the performance of laboratory tests. In Korea, EQA participation is not mandatory, and even basic data about EQA participation are not available. We used data of a 10-year period extracted from two databases (2009-2018): (1) the database of the National Health Insurance Service to calculate the number of medical institutions that claimed health insurance benefits, and (2) the database of the Korean Association of External Quality Assessment Service to calculate the number of medical institutions participating in EQA. The proportion of institutions that made claims for the performance of laboratory testing throughout the 10 years were 73.6%-76.0% for clinics, 91.9%-97.5% for long-term care hospitals, 97.9%-99.5% for small to medium hospitals, 99.6%-100% for general hospitals, and 100% for tertiary hospitals. The mean EQA participation rate of institutions that performed laboratory testing for the 10 years was 1.9% for clinics, 3.1% for long-term care hospitals, 27.7% for small to medium hospitals, 96.6% for general hospitals, and 100% for tertiary hospitals. The mean EQA participation of clinics, long-term care hospitals, and small to medium hospitals are increasing but is still not sufficient. Regulatory approaches are needed to increase participation rates. This result would be used for health policymaking on the quality improvement of laboratory tests.ope

The relationship between metabolic syndrome and the incidence of colorectal cancer

Objectives This study evaluated the incidence of colorectal cancer (CRC) according to the number of metabolic syndrome (MetS) components. Methods Using health checkup and insurance claims data of 6,365,409 subjects, the occurrence of CRC according to stage of MetS by sex was determined from the date of the health checkup in 2009 until December 31, 2018. Results Cumulative incidence rates (CIR) of CRC in men and women was 3.9 and 2.8 per 1000 (p < 0.001), respectively. CIR of CRC for the normal, pre-MetS, and MetS groups in men was 2.6, 3.9, and 5.5 per 1000 (p < 0.001) and CIR in women was 2.1, 2.9, and 4.5 per 1000 (p < 0.001), respectively. Compared with the normal group, the hazard ratio (HR) of CRC for the pre-MetS group was 1.25 (95% CI 1.17-1.33) in men and 1.09 (95% CI 1.02-1.17) in women, and the HR of CRC for the MetS group was 1.54 (95% CI 1.43-1.65) in men and 1.39 (95% CI 1.26-1.53) in women after adjustment. Conclusions We found that MetS is a risk factor for CRC in this study. Therefore, the prevention and active management of MetS would contribute to the prevention of CRC.ope

The New Diagnosis-Related Group Reimbursement System and Laboratory Test Quality in Korea: Analysis of External Quality Assessment Results

Korea introduced a new diagnosis-related group (NDRG), which is a mixed-bundle reimbursement system. We evaluated the effects of NDRGs on laboratory test quality by analyzing data over three years (2016-2018) from the Korean Association of External Quality Assessment Service (KEQAS). A total of 42 NDRG-participating hospitals (CASE), 84 non-participating similar size-hospitals (CON-1), and 42 tertiary hospitals (CON-2) were included. We assumed the proportion of KEQAS results with a larger than 2 standard deviation index (SDI) to be a bad laboratory quality marker (BLQM). CASE BLQMs were lower than CON-1 BLQMs for more than 2 years in alkaline phosphatase (ALP), alanine aminotransferase (ALT), chloride, glucose, sodium, and total protein, and higher in creatinine. CASE BLQMs were higher than CON-2 BLQMs for more than 2 years in ALP, chloride, creatinine, glucose, lactate dehydrogenase (LDH), phosphorus, potassium, sodium, total calcium, total cholesterol, triglyceride, and uric acid. Mean SDIs for general chemistry tests were not significantly different depending on NDRG participation. However, the NDRG is currently a pilot program that compensates the amount of each institution's reimbursement based on the fee-for-service system, and most participants were public hospitals. Thus, the effects of NDRGs on laboratory test quality should be re-evaluated after the NDRG program has stabilized and more private hospitals are participating.ope

Age-Standardized Breast Cancer Detection Rates of Breast Cancer Screening Program by Age Group in Korea; Comparison with Age-Standardized Incidence Rates from the Korea Central Cancer Registry

To compare the epidemiological characteristics of a breast cancer screening program of patients between 40-69 years of age and >= 70 years of age, we calculated the age-standardized detection rate of the breast cancer screening program and compared it with the age-standardized incidence rate from the Korea Central Cancer Registry. The data of the breast cancer screening program from January 2009 to December 2016 and the data of the health insurance claims from January 2006 to August 2017 were used. In the 40-69 year age group, the age-standardized detection rate of breast cancer increased annually from 106.1 in 2009 to 158.6 in 2015 and did not differ from the age-standardized incidence rate. In the >= 70 year age group, the age-standardized detection rate of breast cancer increased annually from 65.7 in 2009 to 120.3 in 2015 and was 1.9 to 2.7 fold of the age-standardized incidence rate. It shows that the early detection effect of breast cancer screening was greater for patients over 70 years old. Further studies are needed to evaluate the effect of breast cancer detection in the >= 70 year age group on all-cause mortality or breast cancer mortality.ope

Application of an Internet of Medical Things (IoMT) to Communications in a Hospital Environment

IoT technology is used in various industries, including the manufacturing, energy, finance, education, transportation, smart home, and medical fields. In the medical field, IoT applications can provide high-quality medical services through the efficient management of patients and mobile assets in hospitals. In this paper, we introduce an IoT system to the medical field using Sigfox, a low-power communication network for indoor location monitoring used as a hospital network. A proof-of-concept (PoC) was implemented to evaluate the effectiveness of medical device and patient safety management. Specific requirements should be considered when applying the IoMT system in a hospital environment. In this study, the location and temperature of various targets sending signals to the monitoring system using three different networks (Sigfox, Hospital and Non-Hospital) were collected and compared with true data, the average accuracy of which were 69.2%, 72.5%, and 83.3%, respectively. This paper shows the significance in the application of an IoMT using the Sigfox network in a hospital setting in Korea compared with existing hospital networks.ope

Feasibility and Efficacy of Morning Light Therapy for Adults with Insomnia: A Pilot, Randomized, Open-Label, Two-Arm Study

Background and Objectives: Light therapy (LT) is used as an adjunctive treatment for sleep problems. This study evaluates the impact of LT on sleep quality and sleep-related parameters in patients with sleep disorders. Materials and Methods: We performed a pilot, randomized, open-label clinical trial. Fourteen patients aged 20-60 years with insomnia were randomized into the control and LT groups (1:1 ratio). The LT group was instructed to use a device that provides bright LT (6000 K, 380 lux, wavelength 480 nm) for at least 25 min before 09:00 a.m. for two weeks. A self-reported questionnaire was used to evaluate circadian preference, mood, and sleep-related parameters. We analyzed serum cortisol levels and clock genes' expression. Results: The Epworth Sleepiness Scale (ESS), insomnia severity index(ISI), and Pittsburgh Sleep Quality index(PSQI) were significantly improved within the LT group only after the two-week period. When comparing the two groups, only the change in ESS was significant (mean difference, control: -0.14 vs. LT: -1.43, p = 0.021) after adjusting for the baseline characteristics. There were no significant differences in serum cortisol or clock genes' expression. Conclusions: LT can improve daytime sleepiness in patients with sleep disorders; however, further well-designed studies are warranted to confirm its efficacy.ope

COVID-19 and the ageing workforce: global perspectives on needs and solutions across 15 countries

Background: COVID-19 has a direct impact on the employment of older people. This adds to the challenge of ageism. The World Health Organization has started a worldwide campaign to combat ageism and has called for more research and evidence-based strategies that have the potential to be scaled up. This study specifically aims to identify solutions to combat the adverse effects of COVID-19 on the global ageing workforce. Methods: We present 15 case studies from different countries and report on what those countries are doing or not doing to address the impact of COVID-19 on ageing workers. Results: We provide examples of how COVID-19 influences older people's ability to work and stay healthy, and offer case studies of what governments, organizations or individuals can do to help ensure older people can obtain, maintain and, potentially, expand their current work. Case studies come from Australia, Austria, Canada, China, Germany, Israel, Japan, Nigeria, Romania, Singapore, Sweden, South Korea, Thailand, United Kingdom (UK), and the United States (US). Across the countries, the impact of COVID-19 on older workers is shown as widening inequalities. A particular challenge has arisen because of a large proportion of older people, often with limited education and working in the informal sector within rural areas, e.g. in Nigeria, Thailand and China. Remedies to the particular disadvantage experienced by older workers in the context of COVID are presented. These range from funding support to encouraging business continuity, innovative product and service developments, community action, new business models and localized, national and international actions. The case studies can be seen as frequently fitting within strategies that have been proven to work in reducing ageism within the workplace. They include policy and laws that have increased benefits to workers during lockdowns (most countries); educational activities such as coaching seniorpreneurship (e,g, Australia); intergenerational contact interventions such as younger Thai people who moved back to rural areas and sharing their digital knowledge with older people and where older people reciprocate by teaching the younger people farming knowledge. Conclusion: Global sharing of this knowledge among international, national and local governments and organizations, businesses, policy makers and health and human resources experts will further understanding of the issues that are faced by older workers. This will facilitate the replication or scalability of solutions as called for in the WHO call to combat ageism in 2021. We suggest that policy makers, business owners, researchers and international organisations build on the case studies by investing in evidence-based strategies to create inclusive workplaces. Such action will thus help to challenge ageism, reduce inequity, improve business continuity and add to the quality of life of older workers.ope

mFAST: Automatic Stoke Evaluation System for Time-Critical Treatment with Multimodal Feature Collection and Machine Learning Classification

In this paper, we introduce an automatic evaluation system, mFAST, for the examination of neurological deficits and personalized stroke prediction. The proposed system enables mobile monitoring of stroke patients utilizing sensors and machine learning techniques. This research is composed of objective and rapid measurement of neurological deficits of stroke patients; development of stroke-triage prediction; and data collection of monitored neurological deficits and personalized stroke prediction system to rapidly recognize the symptoms and enhance the treatment in hospitals. The research proposes to implement the mobile services for FAST (Face, Arm, Speech, Time) stroke activation to measure face palsy, arm weakness, speech disturbance and to analyze the automatically collected data. The measured FAST features can be used in the prediction of stroke scores including NIHSS (National Institute of Health for Stroke Scale), CPSS (Cincinnati Pre-hospital Stroke Scale), MRC (Medial Research Council) to enable stroke patients to be treated in a restricted time frame.restrictio