http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
S-445 Outcomes Analysis of Surgical and Medical Treatments for Patients with Primary Aldosteronism
( Ye Seul Yang ),( Kyeong Seon Park ),( Jung Hee Kim ),( A Ram Hong ),( Dong-hwa Lee ),( Min Kyong Moon ),( Sung Hee Choi ),( Chan Soo Shin ),( Sang Wan Kim ),( Seong Yeon Kim ) 대한내과학회 2016 대한내과학회 추계학술발표논문집 Vol.2016 No.1
Objective:?Patients with aldosterone-producing adenomas are treated using surgery, and patients with idiopathic hyperaldosteronism receive medical treatment using mineralocorticoid receptor antagonists (MRA). However, the outcomes of surgical and medical treatment for primary aldosteronism (PA) remain unclear. Therefore, we compared the outcomes of surgical and medical treatment for PA and aimed to identify a specific subgroup that can benefit from medical treatment.?Design:?Retrospective observational study.?Methods:?We identified 269 patients with PA (unilateral excess: 221 cases; bilateral excess: 48 cases) from 2000-2015 at the Seoul National University Hospital and two other tertiary centers. The main outcomes were the amelioration of hypertension and hypokalemia.?Results:?Treatment improved hypertension in the surgical treatment group (78.2%) and the medical treatment group (55.6%) (P?<0.001). At the last follow-up, hypokalemia was normalized in the surgical treatment group (97.1%) and the medical treatment group (93.7%;?P?= 0.046). Among patients with unilateral aldosterone excess, surgery provided advantages in resolving hypertension and normalizing hypokalemia without worsening renal function. Among patients who were >60 years old, surgical and medical treatment provided similar amelioration of hypokalemia and hypertension (71.4% vs. 56.5%,?P?= 0.243; 88.6% vs. 100%, p=0.244; respectively). The surgical treatment group exhibited lower postoperative eGFR and higher serum potassium levels, compared to the medical treatment group.?Conclusions:?Surgical treatment provided better hypertension and hypokalemia outcomes among patients with PA, compared to medical treatment. However, MRAs may be appropriate for elderly patients with impaired renal function.
Cost-Effectiveness Analysis of Home-Based Hospice-Palliative Care for Terminal Cancer Patients
Ye-seul Kim,한은아,이재우,강희택 한국호스피스완화의료학회 2022 한국호스피스.완화의료학회지 Vol.25 No.2
Purpose: We compared cost-effectiveness parameters between inpatient and homebased hospice-palliative care services for terminal cancer patients in Korea. Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospicepalliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice- palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion: Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.
Kim Ye-Seul,Choi Jae-Woong,Song Sang Hoon,Hwang Ho Young,Sohn Suk Ho,Kim Ji Seong,Kang Yoonjin,Gu Ja-Yoon,Kim Kyung-Hwan,Kim Hyun Kyung 대한진단검사의학회 2023 Annals of Laboratory Medicine Vol.43 No.4
Background: Point-of-care testing (POCT) coagulometers are increasingly used for monitoring warfarin therapy. However, in high international normalized ratio (INR) ranges, significant discrepancy in the INR between POCT and conventional laboratory tests occurs. We compared the INR of POCT (CoaguChek XS Plus; Roche Diagnostics, Mannheim, Germany) with that of a conventional laboratory test (ACL TOP 750; Instrumentation Laboratory SpA, Milan, Italy) and explored possible reasons for discrepancy. Methods: Paired POCT and conventional laboratory test INRs were analyzed in 400 samples from 126 patients undergoing warfarin therapy after cardiac surgery. Coagulation factor and thrombin generation tests were compared using the Mann–Whitney U test. Correlations between coagulation factors and INRs were determined using Pearson correlation coefficients. Results: The mean difference in the INR between the tests increased at high INR ranges. Endogenous thrombin potential levels were decreased at INR <2.0 for CoaguChek XS Plus and 2.0< INR <3.0 for ACL TOP 750 compared with those at INR <2.0 for both tests, indicating a better performance of ACL TOP 750 in assessing thrombin changes. The correlation coefficients of coagulation factors were stronger for ACL TOP 750 INR than for CoaguChek XS Plus INR. Vitamin K-dependent coagulation factors were found to contribute to the INR discrepancy. Conclusions: Decreases in vitamin K-dependent coagulation and anticoagulation factors can explain the significant discrepancy between the two tests in high INR ranges. Since conventional laboratory test INR values are more reliable than POCT INR values, a confirmatory conventional laboratory test is required for high INR ranges.