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대한내과학회> The Korean Journal of Internal Medicine> Strategies for successful implementation and permanent maintenance of a rapid response system

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Strategies for successful implementation and permanent maintenance of a rapid response system

Myung Jin Song , Yeon Joo Lee
  • : 대한내과학회
  • : The Korean Journal of Internal Medicine 36권5호
  • : 연속간행물
  • : 2021년 09월
  • : 1031-1039(9pages)
The Korean Journal of Internal Medicine

DOI


목차

INTRODUCTION
KEY STRATEGIES IN THE AFFERENT LIMB: AN EFFECTIVE TRIGGERING SYSTEM AND A HOSPITAL CULTURE THAT EMBRACES THE RRS
KEY STRATEGIES FOR THE EFFERENT LIMB: QUALIFIED PRIMARY RESPONDERS AND DEDICATED PHYSICIANS
KEY STRATEGIES FOR IMPROVING QUALITY: REGULAR EVALUATION OF OUTCOMES AND FEEDBACK OF TEAM ACTIVITY
KEY STRATEGY FOR ADMINISTRATION: PROPER FUNDING SUPPORT
CONCLUSIONS
REFERENCES

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초록 보기

Rapid response systems (RRSs) have been introduced to intervene with patients experiencing non-code medical emergencies and operate widely around the world. An RRS has four components: an afferent limb, an efferent limb, quality improvement, and administration. A proper triggering system, a hospital culture that embraces the RRS from the afferent limb, experienced primary responders, and dedicated physicians from the efferent limb are key for successful implementation. After initial implementation, quality improvement through objective outcome measures and self-evaluation are crucial, which lead to a better outcome when this process is well performed. Furthermore, better outcomes lead to more investment, which is essential for effective development of the system. The RRS is successfully maintained when these four components are closely interconnected.

UCI(KEPA)

간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCI,SCOPUS
  • : 격월
  • : 1226-3303
  • : 2005-6648
  • : 학술지
  • : 연속간행물
  • : 1986-2021
  • : 2597


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KCI등재 SCI SCOPUS

1Strategies for successful implementation and permanent maintenance of a rapid response system

저자 : Myung Jin Song , Yeon Joo Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1031-1039 (9 pages)

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Rapid response systems (RRSs) have been introduced to intervene with patients experiencing non-code medical emergencies and operate widely around the world. An RRS has four components: an afferent limb, an efferent limb, quality improvement, and administration. A proper triggering system, a hospital culture that embraces the RRS from the afferent limb, experienced primary responders, and dedicated physicians from the efferent limb are key for successful implementation. After initial implementation, quality improvement through objective outcome measures and self-evaluation are crucial, which lead to a better outcome when this process is well performed. Furthermore, better outcomes lead to more investment, which is essential for effective development of the system. The RRS is successfully maintained when these four components are closely interconnected.

KCI등재 SCI SCOPUS

2Improving the care of inflammatory bowel disease (IBD) patients: perspectives and strategies for IBD center management

저자 : Jihye Park , Sinyoung Park , Shin Ae Lee , Soo Jung Park , Jae Hee Cheon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1040-1048 (9 pages)

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The incidence and prevalence rates of inflammatory bowel disease (IBD) have been increasing in East Asian countries over the past few decades. Accordingly, the general understanding and awareness of IBD among healthcare professionals has increased considerably in this region. This increase is ultimately associated with the evolving focus of IBD clinicians devoted to comprehensive patient care, especially in establishing IBD clinics/centers capable of providing multi-disciplinary counseling. Comprehensive IBD care at IBD clinics/centers usually includes surgical and medication decision-making, transition from pediatric to adult clinics, care of extraintestinal manifestations, care of infectious diseases in patients undergoing immunomodulatory or biologic therapies, and nutritional, psychosocial, socioeconomic, and pharmacological care. Team members com-prise specialists from various departments related to IBD and can be divided into core and ad hoc members. Usually, the scope of work in IBD clinics/centers involves patient care, patient outreach, and system management. Considering the environmental changes in IBD treatment, it is necessary to perform comprehensive IBD patient care in the form of a program based on competencies, rather than simply following the organization of previous IBD centers. The present review summarizes recent trends in IBD patient care and offers perspectives regarding IBD center management.

KCI등재 SCI SCOPUS

3Young-onset type 2 diabetes in South Korea: a review of the current status and unmet need

저자 : Ye Seul Yang , Kyungdo Han , Tae Seo Sohn , Nam Hoon Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1049-1058 (10 pages)

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The prevalence of young-onset (diagnosis at age < 40 years) type 2 diabetes mellitus (T2DM) is increasing globally. Young-onset T2DM has a common pathophysiology of glucose dysregulation as in late-onset T2DM. However, it presents a greater association with obesity and a more rapid decline in β-cell function than late-onset T2DM. Accumulating evidence indicates that disease progression in young-onset T2DM is rapid, resulting in early and frequent development of microvascular and macrovascular complications, as well as premature death. Improper management and low adherence to medical therapy are important issues in young-onset T2DM. This review discusses the epidemiology, disease entity, and clinical issues associated with young-onset T2DM. We also present the prevalence and clinical characteristics of patients with young-onset T2DM in South Korea.

KCI등재 SCI SCOPUS

4Development of a Korean-specific cardiovascular risk model in a cohort at high-risk of hypertension

저자 : Il Suk Sohn

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1059-1060 (2 pages)

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KCI등재 SCI SCOPUS

5Nosocomial exposure to tuberculosis: a snapshot of South Korea

저자 : Hayoung Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1061-1062 (2 pages)

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KCI등재 SCI SCOPUS

6Second-look endoscopy findings after endoscopic submucosal dissection for colorectal epithelial neoplasms

저자 : Soo-kyung Park , Hyeon Jeong Goong , Bong Min Ko , Haewon Kim , Hyo Sun Seok , Moon Sung Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1063-1074 (12 pages)

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Background/Aims: Although second-look endoscopy (SLE) is frequently performed after gastric endoscopic submucosal dissection (ESD) to prevent bleeding, no studies have reported SLE findings after colorectal ESD. This study aimed to investigate SLE findings and their role in preventing delayed bleeding after colorectal ESD.
Methods: Post-ESD ulcer appearances were divided into coagulation (with or without remnant minor vessels) and clip closure groups. SLE findings were categorized according to the Forrest classification (high-risk ulcer stigma [type I and IIa] and low-risk ulcer stigma [type IIb, IIc, III, or clip closure]), and risk factors for high-risk ulcer stigma were analyzed.
Results: Among the 375 cases investigated, SLEs were performed in 171 (45.6%) patients. The incidences of high-risk ulcer stigma and low-risk stigma were 5.3% (9/171) and 94.7% (162/171), respectively. During SLE, endoscopic hemostasis was performed more frequently in the high-risk ulcer stigma group than in the low- risk ulcer stigma group (44.4% [4/9] vs. 1.9% [3/162], respectively; p < 0.001), but most of the endoscopic hemostasis in the high-risk ulcer stigma group (3/4, 75.0%) were prophylactic hemostasis. Post-ESD delayed bleeding occurred in three (0.8%) patients belonging to the SLE group, of which, one patient was from the high-risk stigma group and two were from the low-risk stigma group.
Conclusions: The incidence of high-risk ulcer stigma during SLE was low, and delayed bleeding occurred in, both, high-risk and low-risk groups of SLE. SLEs performed after colorectal ESD may not be effective in preventing delayed bleeding, and further prospective studies are needed to evaluate the efficacy of SLE in post-colorectal ESD.

KCI등재 SCI SCOPUS

7Risk stratification of patients with gastric lesions indefinite for dysplasia

저자 : Young Sin Cho , Il-kwun Chung , Yunho Jung , Su Jung Han , Jae Kook Yang , Tae Hoon Lee , Sang-heum Park , Sun-joo Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1074-1082 (9 pages)

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Background/Aims: There are no definite guidelines for the management of gastric lesions diagnosed as indefinite for dysplasia (IND) by endoscopic forceps biopsy (EFB). Therefore, this study aimed to evaluate the clinical outcomes of gastric IND and predictive factors for gastric neoplasm.
Methods: This study included 457 patients with a first diagnosis of gastric IND by EFB between January 2005 and December 2013. Patient characteristics and endoscopic and pathological data were reviewed and compared.
Results: Of the 457 gastric IND patients, 128 (28%) were diagnosed with invasive carcinoma, 21 (4.6%) with high-grade dysplasia, 31 (6.8%) with low-grade dysplasia, and 277 (60.6%) as negative for dysplasia. Of lesions observed, 180 (39.4%) showed upgraded histology. Multivariate analysis revealed that surface erythema (odds ratio [OR], 2.804; 95% confidence interval [CI], 1.741 to 4.516), spontaneous bleeding (OR, 2.618; 95% CI, 1.298 to 5.279), lesion size ≥ 1 cm (OR, 5.762; 95% CI, 3.459 to 9.597), and depressed morphology (OR, 2.183; 95% CI, 1.155 to 4.124) were significant risk factors for high-grade dysplasia or adenocarcinoma. The ORs associated with 2 and ≥ 3 risk factors were 7.131 and 34.86, respectively.
Conclusions: Precautions should be taken in the management of gastric IND patients, especially when risk factors, including surface erythema, spontaneous bleeding, lesion size ≥ 1 cm, and depressed morphology are present. Considering the combined effect of the presence of multiple risk factors on the incidence of high-grade dysplasia or adenocarcinoma, endoscopic resection should be recommended if a gastric IND patient has at two or more of these factors.

KCI등재 SCI SCOPUS

8Risk of colorectal cancer in patients with positive results of fecal immunochemical test performed within 5 years since the last colonoscopy

저자 : Yoon Suk Jung , Jinhee Lee , Chang Mo Moon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1083-1091 (9 pages)

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Background/Aims: Annual fecal immunochemical tests (FITs) are often repeated within the recommended colonoscopy surveillance intervals. However, it remains unclear whether interval FITs are useful. To answer this question, we assessed the risk of colorectal cancer (CRC) according to the interval from the last colonoscopy to an FIT.
Methods: Using the Korean National Cancer Screening Program database, we collected data on patients who underwent FITs in 2011. Patients with positive FIT results were classified into three groups according to their previous colonoscopy interval: 0.5 to 5 years (group 1), 5 to 10 years (group 2), and ≥ 10 years or no colonoscopy (group 3). CRC incidence was defined as CRC diagnosed within 1 year after an FIT.
Results: Among 177,660 patients with positive FIT results, the incidence of CRC in groups 1, 2, and 3 was 0.72% (n = 214/29,575), 1.28% (n = 116/9,083), and 3.88% (n = 5,387/139,002), respectively. The age- and sex-adjusted risk for CRC was higher in groups 2 (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.43 to 2.25) and 3 (OR, 5.56; 95% CI, 4.85 to 6.38) than in group 1. Among patients who did and did not undergo a polypectomy during the previous colonoscopy, those in group 2 had a higher rate of CRC than those in group 1 (without polypectomy: 1.15% vs. 0.63%; OR, 1.79; 95% CI, 1.37 to 2.34) (with polypectomy: 2.37% vs. 0.93 %; OR, 2.30; 95% CI, 1.44 to 3.69).
Conclusion: In patients with positive FIT results who had undergone a colonoscopy within the past 5 years, the risk of CRC is very low, regardless of whether a polypectomy was performed, suggesting that interval FITs are not useful.

KCI등재 SCI SCOPUS

9Impact of liver cirrhosis on the clinical outcomes of patients with COVID-19: a nationwide cohort study of Korea

저자 : Dongsub Jeon , Minkook Son , Jonggi Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1092-1104 (13 pages)

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Background/Aims: The impact of liver cirrhosis (LC) on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) remains elusive. This study evaluated the association between LC and the development of severe complications from COVID-19.
Methods: We used the National Health Insurance claims data of Korea. We included 234,427 patients older than 19 years who tested for severe acute respiratory syndrome coronavirus 2. Patients with LC who were infected with COVID-19 (n = 67, LC+ COVID+) were matched with those with cirrhosis only (n = 332, LC+ COVID-) and those with COVID-19 only (n = 333, LC- COVID+) using a propensity score in a 1:5 ratio. The primary outcome was the development of severe complications.
Results: Of the matched patients, the mean age was 60 years and 59.7% were male. Severe complications occurred in 18, 54, and 60 patients in the LC+ COVID+, LC+ COVID-, and LC- COVID+ groups, respectively. After adjusting for comorbidities, there was no significant difference in the risk of developing severe complications from COVID-19 between the LC+ COVID+ and LC- COVID+ groups but significant difference exists between the LC+ COVID+ and LC+ COVID-. Older age, hypertension, cancer, chronic obstructive pulmonary disease, and a higher Charlson comorbidity index were associated with a higher risk of severe complications in patients with cirrhosis and COVID-19.
Conclusions: Our study suggests that LC was not independently associated with the development of severe complications, including mortality, in patients with COVID-19. Our results need to be evaluated through a large, prospective study.

KCI등재 SCI SCOPUS

10Clinical features and predictors of masked uncon-trolled hypertension from the Korean Ambulatory Blood Pressure Monitoring Registry

저자 : Hyun-jin Kim , Jeong-hun Shin , Yonggu Lee , Ju Han Kim , Sun Ho Hwang , Woo Shik Kim , Sungha Park , Sang Jae Rhee , Eun Mi Lee , Sang Hyun Ihm , Wook Bum Pyun , Jinho Shin

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1102-1119 (18 pages)

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Background/Aims: The clinical characteristics of patients with masked uncontrolled hypertension (MUCH) have been poorly defined, and few studies have investigated the clinical predictors of MUCH. We investigated the demographic, clinical, and blood pressure (BP) characteristics of patients with MUCH and pro-posed a prediction model for MUCH in patients with hypertension.
Methods: We analyzed 1,986 subjects who were enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) Registry and taking antihypertensive drugs, and classified them into the controlled hypertension (n = 465) and MUCH (n = 389) groups. MUCH was defined as the presence of a 24-hour ambulatory mean systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg in patients treated with antihypertensive drugs, having normal office BP.
Results: Patients in the MUCH group had significantly worse metabolic profiles and higher office BP, and took significantly fewer antihypertensive drugs com-pared to those in the controlled hypertension group. Multivariate logistic regression analyses identified high office systolic BP and diastolic BP, prior stroke, dyslipidemia, left ventricular hypertrophy (LVH, ≥ 116 g/㎡ for men, and ≥ 96 g/㎡ for women), high heart rate (≥ 75 beats/min), and single antihypertensive drug use as independent predictors of MUCH. A prediction model using these predictors showed a high diagnostic accuracy (C-index of 0.839) and goodness-of-fit for the presence of MUCH.
Conclusions: MUCH is associated with a high-normal increase in office BP and underuse of antihypertensive drugs, as well as dyslipidemia, prior stroke, and LVH, which could underscore achieving optimal BP control. The proposed model accurately predicts MUCH in patients with controlled office BP.

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KCI등재SCISCOUPUS

1Strategies for successful implementation and permanent maintenance of a rapid response system

저자 : Myung Jin Song , Yeon Joo Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1031-1039 (9 pages)

다운로드

(기관인증 필요)

초록보기

Rapid response systems (RRSs) have been introduced to intervene with patients experiencing non-code medical emergencies and operate widely around the world. An RRS has four components: an afferent limb, an efferent limb, quality improvement, and administration. A proper triggering system, a hospital culture that embraces the RRS from the afferent limb, experienced primary responders, and dedicated physicians from the efferent limb are key for successful implementation. After initial implementation, quality improvement through objective outcome measures and self-evaluation are crucial, which lead to a better outcome when this process is well performed. Furthermore, better outcomes lead to more investment, which is essential for effective development of the system. The RRS is successfully maintained when these four components are closely interconnected.

KCI등재SCISCOUPUS

2Improving the care of inflammatory bowel disease (IBD) patients: perspectives and strategies for IBD center management

저자 : Jihye Park , Sinyoung Park , Shin Ae Lee , Soo Jung Park , Jae Hee Cheon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1040-1048 (9 pages)

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(기관인증 필요)

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The incidence and prevalence rates of inflammatory bowel disease (IBD) have been increasing in East Asian countries over the past few decades. Accordingly, the general understanding and awareness of IBD among healthcare professionals has increased considerably in this region. This increase is ultimately associated with the evolving focus of IBD clinicians devoted to comprehensive patient care, especially in establishing IBD clinics/centers capable of providing multi-disciplinary counseling. Comprehensive IBD care at IBD clinics/centers usually includes surgical and medication decision-making, transition from pediatric to adult clinics, care of extraintestinal manifestations, care of infectious diseases in patients undergoing immunomodulatory or biologic therapies, and nutritional, psychosocial, socioeconomic, and pharmacological care. Team members com-prise specialists from various departments related to IBD and can be divided into core and ad hoc members. Usually, the scope of work in IBD clinics/centers involves patient care, patient outreach, and system management. Considering the environmental changes in IBD treatment, it is necessary to perform comprehensive IBD patient care in the form of a program based on competencies, rather than simply following the organization of previous IBD centers. The present review summarizes recent trends in IBD patient care and offers perspectives regarding IBD center management.

KCI등재SCISCOUPUS

3Young-onset type 2 diabetes in South Korea: a review of the current status and unmet need

저자 : Ye Seul Yang , Kyungdo Han , Tae Seo Sohn , Nam Hoon Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1049-1058 (10 pages)

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The prevalence of young-onset (diagnosis at age < 40 years) type 2 diabetes mellitus (T2DM) is increasing globally. Young-onset T2DM has a common pathophysiology of glucose dysregulation as in late-onset T2DM. However, it presents a greater association with obesity and a more rapid decline in β-cell function than late-onset T2DM. Accumulating evidence indicates that disease progression in young-onset T2DM is rapid, resulting in early and frequent development of microvascular and macrovascular complications, as well as premature death. Improper management and low adherence to medical therapy are important issues in young-onset T2DM. This review discusses the epidemiology, disease entity, and clinical issues associated with young-onset T2DM. We also present the prevalence and clinical characteristics of patients with young-onset T2DM in South Korea.

KCI등재SCISCOUPUS

4Development of a Korean-specific cardiovascular risk model in a cohort at high-risk of hypertension

저자 : Il Suk Sohn

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1059-1060 (2 pages)

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KCI등재SCISCOUPUS

5Nosocomial exposure to tuberculosis: a snapshot of South Korea

저자 : Hayoung Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1061-1062 (2 pages)

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KCI등재SCISCOUPUS

6Second-look endoscopy findings after endoscopic submucosal dissection for colorectal epithelial neoplasms

저자 : Soo-kyung Park , Hyeon Jeong Goong , Bong Min Ko , Haewon Kim , Hyo Sun Seok , Moon Sung Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1063-1074 (12 pages)

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Background/Aims: Although second-look endoscopy (SLE) is frequently performed after gastric endoscopic submucosal dissection (ESD) to prevent bleeding, no studies have reported SLE findings after colorectal ESD. This study aimed to investigate SLE findings and their role in preventing delayed bleeding after colorectal ESD.
Methods: Post-ESD ulcer appearances were divided into coagulation (with or without remnant minor vessels) and clip closure groups. SLE findings were categorized according to the Forrest classification (high-risk ulcer stigma [type I and IIa] and low-risk ulcer stigma [type IIb, IIc, III, or clip closure]), and risk factors for high-risk ulcer stigma were analyzed.
Results: Among the 375 cases investigated, SLEs were performed in 171 (45.6%) patients. The incidences of high-risk ulcer stigma and low-risk stigma were 5.3% (9/171) and 94.7% (162/171), respectively. During SLE, endoscopic hemostasis was performed more frequently in the high-risk ulcer stigma group than in the low- risk ulcer stigma group (44.4% [4/9] vs. 1.9% [3/162], respectively; p < 0.001), but most of the endoscopic hemostasis in the high-risk ulcer stigma group (3/4, 75.0%) were prophylactic hemostasis. Post-ESD delayed bleeding occurred in three (0.8%) patients belonging to the SLE group, of which, one patient was from the high-risk stigma group and two were from the low-risk stigma group.
Conclusions: The incidence of high-risk ulcer stigma during SLE was low, and delayed bleeding occurred in, both, high-risk and low-risk groups of SLE. SLEs performed after colorectal ESD may not be effective in preventing delayed bleeding, and further prospective studies are needed to evaluate the efficacy of SLE in post-colorectal ESD.

KCI등재SCISCOUPUS

7Risk stratification of patients with gastric lesions indefinite for dysplasia

저자 : Young Sin Cho , Il-kwun Chung , Yunho Jung , Su Jung Han , Jae Kook Yang , Tae Hoon Lee , Sang-heum Park , Sun-joo Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1074-1082 (9 pages)

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Background/Aims: There are no definite guidelines for the management of gastric lesions diagnosed as indefinite for dysplasia (IND) by endoscopic forceps biopsy (EFB). Therefore, this study aimed to evaluate the clinical outcomes of gastric IND and predictive factors for gastric neoplasm.
Methods: This study included 457 patients with a first diagnosis of gastric IND by EFB between January 2005 and December 2013. Patient characteristics and endoscopic and pathological data were reviewed and compared.
Results: Of the 457 gastric IND patients, 128 (28%) were diagnosed with invasive carcinoma, 21 (4.6%) with high-grade dysplasia, 31 (6.8%) with low-grade dysplasia, and 277 (60.6%) as negative for dysplasia. Of lesions observed, 180 (39.4%) showed upgraded histology. Multivariate analysis revealed that surface erythema (odds ratio [OR], 2.804; 95% confidence interval [CI], 1.741 to 4.516), spontaneous bleeding (OR, 2.618; 95% CI, 1.298 to 5.279), lesion size ≥ 1 cm (OR, 5.762; 95% CI, 3.459 to 9.597), and depressed morphology (OR, 2.183; 95% CI, 1.155 to 4.124) were significant risk factors for high-grade dysplasia or adenocarcinoma. The ORs associated with 2 and ≥ 3 risk factors were 7.131 and 34.86, respectively.
Conclusions: Precautions should be taken in the management of gastric IND patients, especially when risk factors, including surface erythema, spontaneous bleeding, lesion size ≥ 1 cm, and depressed morphology are present. Considering the combined effect of the presence of multiple risk factors on the incidence of high-grade dysplasia or adenocarcinoma, endoscopic resection should be recommended if a gastric IND patient has at two or more of these factors.

KCI등재SCISCOUPUS

8Risk of colorectal cancer in patients with positive results of fecal immunochemical test performed within 5 years since the last colonoscopy

저자 : Yoon Suk Jung , Jinhee Lee , Chang Mo Moon

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1083-1091 (9 pages)

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Background/Aims: Annual fecal immunochemical tests (FITs) are often repeated within the recommended colonoscopy surveillance intervals. However, it remains unclear whether interval FITs are useful. To answer this question, we assessed the risk of colorectal cancer (CRC) according to the interval from the last colonoscopy to an FIT.
Methods: Using the Korean National Cancer Screening Program database, we collected data on patients who underwent FITs in 2011. Patients with positive FIT results were classified into three groups according to their previous colonoscopy interval: 0.5 to 5 years (group 1), 5 to 10 years (group 2), and ≥ 10 years or no colonoscopy (group 3). CRC incidence was defined as CRC diagnosed within 1 year after an FIT.
Results: Among 177,660 patients with positive FIT results, the incidence of CRC in groups 1, 2, and 3 was 0.72% (n = 214/29,575), 1.28% (n = 116/9,083), and 3.88% (n = 5,387/139,002), respectively. The age- and sex-adjusted risk for CRC was higher in groups 2 (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.43 to 2.25) and 3 (OR, 5.56; 95% CI, 4.85 to 6.38) than in group 1. Among patients who did and did not undergo a polypectomy during the previous colonoscopy, those in group 2 had a higher rate of CRC than those in group 1 (without polypectomy: 1.15% vs. 0.63%; OR, 1.79; 95% CI, 1.37 to 2.34) (with polypectomy: 2.37% vs. 0.93 %; OR, 2.30; 95% CI, 1.44 to 3.69).
Conclusion: In patients with positive FIT results who had undergone a colonoscopy within the past 5 years, the risk of CRC is very low, regardless of whether a polypectomy was performed, suggesting that interval FITs are not useful.

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9Impact of liver cirrhosis on the clinical outcomes of patients with COVID-19: a nationwide cohort study of Korea

저자 : Dongsub Jeon , Minkook Son , Jonggi Choi

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1092-1104 (13 pages)

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Background/Aims: The impact of liver cirrhosis (LC) on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) remains elusive. This study evaluated the association between LC and the development of severe complications from COVID-19.
Methods: We used the National Health Insurance claims data of Korea. We included 234,427 patients older than 19 years who tested for severe acute respiratory syndrome coronavirus 2. Patients with LC who were infected with COVID-19 (n = 67, LC+ COVID+) were matched with those with cirrhosis only (n = 332, LC+ COVID-) and those with COVID-19 only (n = 333, LC- COVID+) using a propensity score in a 1:5 ratio. The primary outcome was the development of severe complications.
Results: Of the matched patients, the mean age was 60 years and 59.7% were male. Severe complications occurred in 18, 54, and 60 patients in the LC+ COVID+, LC+ COVID-, and LC- COVID+ groups, respectively. After adjusting for comorbidities, there was no significant difference in the risk of developing severe complications from COVID-19 between the LC+ COVID+ and LC- COVID+ groups but significant difference exists between the LC+ COVID+ and LC+ COVID-. Older age, hypertension, cancer, chronic obstructive pulmonary disease, and a higher Charlson comorbidity index were associated with a higher risk of severe complications in patients with cirrhosis and COVID-19.
Conclusions: Our study suggests that LC was not independently associated with the development of severe complications, including mortality, in patients with COVID-19. Our results need to be evaluated through a large, prospective study.

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10Clinical features and predictors of masked uncon-trolled hypertension from the Korean Ambulatory Blood Pressure Monitoring Registry

저자 : Hyun-jin Kim , Jeong-hun Shin , Yonggu Lee , Ju Han Kim , Sun Ho Hwang , Woo Shik Kim , Sungha Park , Sang Jae Rhee , Eun Mi Lee , Sang Hyun Ihm , Wook Bum Pyun , Jinho Shin

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 36권 5호 발행 연도 : 2021 페이지 : pp. 1102-1119 (18 pages)

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Background/Aims: The clinical characteristics of patients with masked uncontrolled hypertension (MUCH) have been poorly defined, and few studies have investigated the clinical predictors of MUCH. We investigated the demographic, clinical, and blood pressure (BP) characteristics of patients with MUCH and pro-posed a prediction model for MUCH in patients with hypertension.
Methods: We analyzed 1,986 subjects who were enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) Registry and taking antihypertensive drugs, and classified them into the controlled hypertension (n = 465) and MUCH (n = 389) groups. MUCH was defined as the presence of a 24-hour ambulatory mean systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg in patients treated with antihypertensive drugs, having normal office BP.
Results: Patients in the MUCH group had significantly worse metabolic profiles and higher office BP, and took significantly fewer antihypertensive drugs com-pared to those in the controlled hypertension group. Multivariate logistic regression analyses identified high office systolic BP and diastolic BP, prior stroke, dyslipidemia, left ventricular hypertrophy (LVH, ≥ 116 g/㎡ for men, and ≥ 96 g/㎡ for women), high heart rate (≥ 75 beats/min), and single antihypertensive drug use as independent predictors of MUCH. A prediction model using these predictors showed a high diagnostic accuracy (C-index of 0.839) and goodness-of-fit for the presence of MUCH.
Conclusions: MUCH is associated with a high-normal increase in office BP and underuse of antihypertensive drugs, as well as dyslipidemia, prior stroke, and LVH, which could underscore achieving optimal BP control. The proposed model accurately predicts MUCH in patients with controlled office BP.

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