The heart rate characteristics (HRC) analysis is a technique for predicting and monitoring neonatal infectious diseases in infants with a risk for infectious disease, such as sepsis, using the HRC index based on the electrocardiogram (ECG) data transmitted from a HeRO® device connected to an ECG monitor.

The assessments were performed via a systematic review. Searching five databases (KoreaMed, Ovid-MEDLINE, Ovid-EMBASE, and Cochrane) yielded 284 related studies. Two reviewers independently assessed the quality of these studies, using the Scottish Intercollegiate Guidelines Network checklist and the assessment results were described based on the results of the quality appraisal and level of evidence.

The safety and effectiveness of the technique were assessed based on eight non-Korean studies (one randomized controlled trial (RCT), five cohort studies, one case-control study, one case series). The four studies that reported area under the curve (AUC) values, the timing of the analysis and AUC values (0.67– 0.75) were inconsistent among the studies. The elevation of the HRC index prior to the diagnosis of an infectious disease was not observed for meningitis or for multiple infectious diseases. In addition, although the group with additional monitoring using the technique had a significantly lower mortality rate, whether the HRC index had a direct impact on the infection prevention activities and the possibility of bias arising from the researchers’ precautionary treatment based on the clinical symptoms and other test results as well as the actual time of disease onset are unknown.

Therefore, the committee presented the following recommendations based on the available evidence and expert opinion. HRC analysis is a safe technique for predicting and monitoring neonatal infectious diseases in infants with a risk for infectious disease, such as sepsis, using the HRC index based on the ECG data transmitted from a HeRO® device connected to an ECG monitor; however, further research is needed to determine its effectiveness (Level of evidence C, Technology category II-a).

Accurate prognostication is important for patients and their families to prepare for the end of life. Objective Prognostic Score (OPS) is an easy-to-use tool that does not require the clinicians’ prediction of survival (CPS), whereas Palliative Prognostic Score (PaP) needs CPS. Thus, inexperienced clinicians may hesitate to use PaP. We aimed to evaluate the accuracy of OPS compared with PaP in inpatients in palliative care units (PCUs) in three East Asian countries.

This study was a secondary analysis of a cross-cultural, multicenter cohort study. We enrolled inpatients with far-advanced cancer in PCUs in Japan, Korea, and Taiwan from 2017 to 2018. We calculated the area under the receiver operating characteristics (AUROC) curve to compare the accuracy of OPS and PaP.

A total of 1,628 inpatients in 33 PCUs in Japan and Korea were analyzed. OPS and PaP were calculated in 71.7% of the Japanese patients and 80.0% of the Korean patients. In Taiwan, PaP was calculated for 81.6% of the patients. The AUROC for 3-week survival was 0.74 for OPS in Japan, 0.68 for OPS in Korea, 0.80 for PaP in Japan, and 0.73 for PaP in Korea. The AUROC for 30-day survival was 0.70 for OPS in Japan, 0.71 for OPS in Korea, 0.79 for PaP in Japan, and 0.74 for PaP in Korea.

Both OPS and PaP showed good performance in Japan and Korea. Compared with PaP, OPS could be more useful for inexperienced physicians who hesitate to estimate CPS.

It is estimated that over 90 percent of hospitalized patients will receive some form of vascular access device (VAD) for their treatment. Currently, patients requiring medium-term catheterization often have peripherally inserted central catheters (PICCs) placed, which are expensive, time consuming and usually for long-term catheterization. Midline catheters (MCs) are VADs placed in deep peripheral veins, with a dwell time of up to 29 days. The study aimed to evaluate if using MCs over PICCs has any clinical and economic benefits.

A cost-calculator was developed in Microsoft Excel 2013 to demonstrate the clinical and economic differences of using MCs over PICCs in an inpatient setting in Korea. A literature review was conducted and included eighteen studies that showed MCs have positive clinical, patient, economic, and institutional outcomes. The model captured clinical outcomes such as usage duration, complications, and costs. The time horizon was one year, and various model inputs were derived from the literature review.

For an annual catheter utilization of MCs over PICCs, the total cost-saving was USD 3,764,994. Total treatment costs for MCs were USD 7,230,825 and for PICCs were USD 8,987,922. The total treatment costs included device cost, complication cost and labor cost related to using both MCs and PICCs. For MCs versus PICCs, device costs were USD 6,554,317 versus USD 6,563,356, complication costs were USD 106,749 versus USD 982,417, and labor costs were USD 569,759 versus USD 1,442,149.

In both the base and sensitivity analyses, results showed that MCs can be an impressive cost-saving option among patients with unnecessary PICC use in Korea. Among patients who require medium-term catheterization and use PICCs even when not targeted for central line insertion, MCs are a more cost-effective option, and MCs will benefit these patients with lesser complication rates. MCs are a suitable alternative with clinical and economic benefits that could lead to lower burden on patients and healthcare systems.

Failure at the proximal neck for endovascular aortic repair (EVAR) in abdominal aortic aneurysm (AAA) is more common in the presence of unfavorable proximal neck anatomy. In patients with hostile neck, EndoAnchors provide proximal fixation and reduces potential type I endoleak or endograft migration. However, the population size for AAA patients with hostile anatomic neck among Korean is unknown and cost-analysis with regard to EndoAnchors has not been established.

To figure out the population size of AAA patients with hostile neck anatomy, retrospective medical chart review was conducted from four major medical centers. Hostile proximal aortic neck was defined as any or all of neck length 28 mm, infrarenal neck angulation >60°, ≥50 percent of circumferential thrombus, ≥50 percent of calcified neck, and conical neck. Cost-analysis on EndoAnchor use for treatment purpose was conducted based on Korean National Health Insurance Claims dataset (HIRA-NIS 2015).

Two-hundred and ten patients’ anatomic data treated with EVAR were included; 130 (61.9 percent) patients met the criteria for a hostile aortic neck and 32 (15.2 percent) patients had multiple hostile anatomy parameters. Endograft migration was reported in four (1.9 percent) patients and intra or post-op type I endoleak was reported in 21 (10.0 percent) patients. Based on 1-year claims data, 1,607 patients were treated with EVAR in 2015 and the annual average medical costs for open repair were USD 16,151. Given the patients with type I endoleak or endograft migration needs open repair if not treated with EndoAnchors, the estimated annual costs for patients treated with EndoAnchor were USD 2,234,321 and those for patients without EndoAnchor were USD 2,595,508, therefore USD 361,187 can be saved annually.

The population size with hostile aortic neck in Korea was comparable with those in western countries. Economically, EndoAnchor is a cost-saving treatment for type I endoleak and migration after EVAR from Korean payer.

Despite evidence linking regular nut consumption with reduced chronic disease risk, population-level intakes remain low. Research suggests nut-promoting advice from doctors facilitates regular nut consumption. However, there is no information on current nut recommendation practices of health professionals. The aim of the present study was to examine the advice provided by health professionals regarding nut consumption.

In this cross-sectional study, participants were invited to complete a survey including questions about their nut recommendation practices.

New Zealand (NZ).

The NZ Electoral Roll was used to identify dietitians, general practitioners and practice nurses.

In total 318 dietitians, 292 general practitioners and 149 practice nurses responded. Dietitians were more likely (82·7 %) to recommend patients increase consumption of nuts than general practitioners (55·5 %) and practice nurses (63·1 %; both P<0·001). The most popular nuts recommended were almonds, Brazil nuts and walnuts, with most health professionals recommending raw nuts. The most common recommendation for frequency of consumption by dietitians and practice nurses was to eat nuts every day, while general practitioners most frequently recommended 2–4 times weekly, although not statistically significantly different between professions. Dietitians recommended a significantly greater amount of nuts (median 30 g/d) than both general practitioners and practice nurses (20 g/d; both P<0·001).

Dietitians were most likely to recommend consumption of nuts in accordance with current guidelines, but there are opportunities to improve the adoption of nut consumption recommendations for all professions. This may be a viable strategy for increasing population-level nut intakes to reduce chronic disease.

Despite considerable evidence supporting the health benefits of regular nut consumption, nut intakes remain lower than recommended among many populations. Understanding how the general population perceives nuts could inform strategies to promote regular nut consumption and increase intakes among the general public.

Cross-sectional study. Participants were invited to complete a questionnaire which included information on nut consumption and knowledge and perceptions of nuts.

The study was set in New Zealand (NZ).

Participants (n 1600), aged 18 years or over, were randomly selected from the NZ electoral roll.

A total of 710 participants completed the questionnaire (response rate 44 %). More than half of the respondents believed that nuts are healthy, filling, high in protein and high in fat. The most common reason cited by consumers for eating nuts was taste (86 % for nuts, 85 % for nut butters), while dental issues was the most frequent reason for avoidance. About 40 % of respondents were not aware of the effects of nut consumption on lowering blood cholesterol and CVD risk.

Despite overall basic knowledge of the nutritional value of nuts, a substantial proportion of the general population was unaware of the cardioprotective effects of nuts. The present study identified common motivations for eating and avoiding nuts, as well as perceptions of nuts which could affect intake. These should guide the content and direction of public health messages to increase regular nut consumption. The public’s knowledge gaps should also be addressed.

Polycyclic aromatic hydrocarbons (PAH) are common dietary exposures that cross the human placenta and are classified as a probable human carcinogen. The aim of the present study was to investigate the potential impact of exposure to PAH-containing meat consumed during pregnancy on birth outcomes.

Prospective birth cohort study. Only non-smoking women with singleton pregnancies, who were free from chronic disease such as diabetes and hypertension, were included in the study. Maternal consumption of PAH-rich meat was estimated through FFQ. Multiple linear regression was used to assess factors related to higher intake and the association between dietary PAH and birth outcomes.

Republic of Korea, 2006–2011.

Pregnant women (n 778) at 12–28 weeks of gestation enrolled in the Mothers and Children’s Environmental Health (MOCEH) study.

The multivariable regression model showed a significant reduction in birth weight associated with higher consumption level of foods rich in PAH, such as grilled or roasted meat, during pregnancy (β=−17·48 g, P<0·05 for every 1 point higher in meat score). Further adjusting for biomarkers of airborne PAH did not alter this association. There was no evidence that higher consumption level of PAH-rich meat shortens the duration of gestation (P=0·561). Regression models performed for birth length and head circumference produced negative effects that were not statistically significant.

Consumption of higher levels of barbecued, fried, roasted and smoked meats during pregnancy was associated with reduced birth weight. Dietary risk of PAH exposure in Korean women is of concern.

Agreement between echocardiography and right heart catheterisation-derived right ventricular systolic pressure is modest in the adult heart failure population, but is unknown in the paediatric cardiomyopathy population.

All patients at a single centre from 2001 to 2012 with a diagnosis of cardiomyopathy who underwent echocardiography and catheterisation within 30 days were included in this study. The correlation between tricuspid regurgitation gradient and catheterisation-derived right ventricular systolic pressure and mean pulmonary artery pressure was determined. Agreement between echocardiography and catheterisation-derived right ventricular systolic pressure was assessed using Bland–Altman plots. Analysis was repeated for patients who underwent both procedures within 7 days. Haemodynamic data from those with poor agreement and good agreement between echocardiography and catheterisation were compared.

A total of 37 patients who underwent 48 catheterisation procedures were included in our study. The median age was 11.8 (0.1–20.6 years) with 22 males (58% total). There was a modest correlation (r=0.65) between echocardiography and catheterisation-derived right ventricular systolic pressure, but agreement was poor. Agreement between tricuspid regurgitation gradient and right ventricular systolic pressure showed wide 95% limits of agreement. There was a modest correlation between the tricuspid regurgitation gradient and mean pulmonary artery pressure (r=0.6). Shorter time interval between the two studies did not improve agreement. Those with poor agreement between echocardiography and catheterisation had higher right heart pressures, but this difference became insignificant after accounting for right atrial pressure.

Transthoracic echocardiography estimation of right ventricular systolic pressure shows modest correlation with right heart pressures, but has limited agreement and may underestimate the degree of pulmonary hypertension in paediatric cardiomyopathy patients.

Domestic squalor has been associated with alcohol misuse but little work has explored this. Executive dysfunction is commonly observed in squalor and is also associated with alcohol misuse. Hoarding can accompany squalor, but it is unclear whether hoarding is also linked with alcohol misuse. This study compared neuropsychology and hoarding status of individuals living in squalor with and without a history of alcohol misuse.

A subgroup analysis was conducted on a series of 69 neuropsychological reports of people living in squalor. Data on cognitive profiles, basic demographics, alcohol use, and hoarding were extracted and analyzed.

Alcohol misuse was reported in 25 of the 69 participants (36%). Alcohol misusers were significantly younger (mean age 66.2 years, SD = 10.7) than non-misusers (mean age 75.6 years, SD = 10.3) (p < 0.00) and significantly more likely to be male (p = 0.01). No significant differences between the two subgroups were found for estimated premorbid intellectual functioning, Mini Mental State Examination (MMSE) scores, or individual neuropsychological domains. Alcohol misusers were more likely to be living in squalor without hoarding than squalor with hoarding (p = 0.01).

Alcohol misusers living in squalor were less likely to hoard than non-misusers. This finding suggests that alcohol misuse may be a risk factor for squalor via failure to maintain one's environment rather than through intentional accumulation of objects. The similar cognitive profile among those with and without a history of alcohol misuse could represent a common pattern of executive dysfunction that predisposes individuals to squalor regardless of underlying alcohol misuse diagnosis.

This study examined changes in health-related quality of life (HRQoL) and quality of care (QoC) as perceived by terminally ill cancer patients and a stratified set of HRQoL or QoC factors that are most likely to influence survival at the end of life (EoL).

We administered questionnaires to 619 consecutive patients immediately after they were diagnosed with terminal cancer by physicians at 11 university hospitals and at the National Cancer Center in Korea. Subjects were followed up over 161.2 person-years until their deaths. We measured HRQoL using the core 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and QoC using the Quality Care Questionnaire–End of Life (QCQ–EoL). We evaluated changes in HRQoL and QoC issues during the first three months after enrollment, performing sensitivity analysis by using data generated via four methods (complete case analysis, available case analysis, the last observation carried forward, and multiple imputation).

Emotional and cognitive functioning decreased significantly over time, while dyspnea, constipation, and pain increased significantly. Dignity-conserving care, care by healthcare professionals, family relationships, and QCQ–EoL total score decreased significantly. Global QoL, appetite loss, and Eastern Cooperative Oncology Group Performance Status (ECOG–PS) scores were significantly associated with survival.

Future standardization of palliative care should be focused on assessment of these deteriorated types of quality. Accurate estimates of the length of life remaining for terminally ill cancer patients by such EoL-enhancing factors as global QoL, appetite loss, and ECOG–PS are needed to help patients experience a dignified and comfortable death.

The incidence of restless legs syndrome (RLS) is presumed to be higher among people with schizophrenia who take antipsychotic medication, most of which blocks the dopamine D2 receptor. The purpose of this study was to determine whether the G-protein β3 subunit (GNB3) C825T polymorphism is associated with antipsychotic-induced RLS in schizophrenia.

We examined 178 Korean patients with schizophrenia. All of the subjects were evaluated using the diagnostic criteria of the International Restless Legs Syndrome Study Group and the International Restless Legs Scale. Genotyping was performed for the C825T polymorphism in the GNB3 gene.

The genotype distribution did not differ significantly between antipsychotic-induced RLS patients and patients who had no-RLS symptoms (χ2 = 4.30, p = 0.116). The genotypes of the C825T single-nucleotide polymorphism (SNP) were classified into two groups: C+ (CC and CT genotypes) and C– (TT genotype). The presence of the C allele (C+) was associated with an increased likelihood of RLS (χ2 = 4.14, p = 0.042; odds ratio = 2.56, 95% confidence interval = 1.02–6.47).

These results suggest that the GNB3 C825T SNP is associated with RLS in schizophrenia. However, confirming this association requires future larger scale studies in which the effects of medication are strictly controlled.