Seasonal vitamin D levels and lupus low disease activity state in systemic lupus erythematosus.

BACKGROUND: Seasonal variation and sunlight exposure can impact serum vitamin D levels, potentially influencing lupus symptoms. We investigated seasonal vitamin D levels and their correlation with clinical manifestations and disease activity in systemic lupus erythematosus (SLE). METHODS: Serum 25(OH) vitamin D3 (25(OH)D3) levels were categorised as deficient (25(OH)D3 < 10 ng/mL), insufficient (10-30 ng/mL) and sufficiency (>30 ng/mL) in participants analysed in winter (n = 407) and summer (n = 377). Logistic regression analysis was performed to assess the impact of vitamin D levels on achieving a lupus low disease activity state (LLDAS), stratified by season. RESULTS: The mean serum 25(OH)D3 levels differed significantly between the winter and summer measurement groups (22.4 vs. 24.2 ng/mL; p = .018). The prevalences of vitamin D deficiency, insufficiency and sufficiency in the winter group were 12.8%, 66.6% and 20.6%, respectively, compared with 4.5%, 67.9% and 27.6% in the summer group. Achieving LLDAS was highest in the vitamin D sufficiency group (winter: 56.6%, summer: 55%) and lowest in the vitamin D deficiency group (winter: 15.4%, summer: 13.6%), with significant differences (all p < .001). Multivariate analysis identified SLE disease activity index ≤4, normal anti-double-stranded DNA and vitamin D sufficiency as significant factors for achieving LLDAS in both seasons. CONCLUSIONS: Sufficient vitamin D levels are important for achieving LLDAS in patients with SLE during winter and summer. Therefore, physicians should pay attention to the adequacy of vitamin D levels and consider recommending vitamin D supplementation for patients with vitamin D insufficiency.

Ambient Stable All Inorganic CsCu2I3 Artificial Synapses for Neurocomputing.

In resistive switching memories or artificial synaptic devices, halide perovskites have attracted attention for their unusual features such as rapid ion migration, adjustable composition, and facile synthesis. Herein, the environmentally friendly and highly air stable CsCu2I3 perovskite films are used as the active layer in the Au/CsCu2I3/ITO/glass artificial synapses. The device shows variable synaptic plasticities such as long-term and short-term synaptic plasticity, paired-pulse facilitation, and spike-timing-dependent plasticity by combining potentiation and depression along the formation of conductive filaments. The performances of the devices are maintained for 160 days under ambient conditions. Additionally, the accuracy evaluation of the CsCu2I3-based artificial synapses performs exceptionally well with the MNIST and Fashion MNIST data sets, demonstrating high learning accuracy in deep neural networks. Using the novel B-site engineered halide perovskite material with extreme air stability, this study paves the way for artificial synaptic devices for next-generation in-memory hardware.

Visible Light Driven Ultrasensitive and Selective NO2 Detection in Tin Oxide Nanoparticles with Sulfur Doping Assisted by l-Cysteine.

In the pandemic era, the development of high-performance indoor air quality monitoring sensors has become more critical than ever. NO2 is one of the most toxic gases in daily life, which induces severe respiratory diseases. Thus, the real-time monitoring of low concentrations of NO2 is highly required. Herein, a visible light-driven ultrasensitive and selective chemoresistive NO2 sensor is presented based on sulfur-doped SnO2 nanoparticles. Sulfur-doped SnO2 nanoparticles are synthesized by incorporating l-cysteine as a sulfur doping agent, which also increases the surface area. The cationic and anionic doping of sulfur induces the formation of intermediate states in the band gap, highly contributing to the substantial enhancement of gas sensing performance under visible light illumination. Extraordinary gas sensing performances such as the gas response of 418 to 5 ppm of NO2 and a detection limit of 0.9 ppt are achieved under blue light illumination. Even under red light illumination, sulfur-doped SnO2 nanoparticles exhibit stable gas sensing. The endurance to humidity and long-term stability of the sensor are outstanding, which amplify the capability as an indoor air quality monitoring sensor. Overall, this study suggests an innovative strategy for developing the next generation of electronic noses.

Does low income effects 5-year mortality of hepatocellular carcinoma patients?

BACKGROUND: In Korea, the universal health system offers coverage to all members of society. Despite this, it is unclear whether risk of death from hepatocellular carcinoma (HCC) varies depending on income. We evaluated the impact of low income on HCC mortality. METHODS: The Korean National Health Insurance sampling cohort was used to identify new HCC cases (n = 7325) diagnosed between 2004 and 2008, and the Korean Community Health Survey data were used to investigate community-level effects. The main outcome was 5-year all-cause mortality risk, and Cox proportional hazard models were applied to investigate the individual- and community-level factors associated with the survival probability of HCC patients. RESULTS: From 2004 to 2008, there were 4658 new HCC cases among males and 2667 new cases among females. The 5-year survival proportion of males was 68%, and the incidence per person-year was 0.768; the female survival proportion was 78%, and the incidence per person-year was 0.819. Lower income was associated with higher hazard ratio (HR), and HCC patients with hepatitis B (HBV), alcoholic liver cirrhosis, and other types of liver cirrhosis had higher HRs than those without these conditions. Subgroup analyses showed that middle-aged men were most vulnerable to the effects of low income on 5-year mortality, and community-level characteristics were associated with survival of HCC patients. CONCLUSION: Having a low income significantly affected the overall 5-year mortality of Korean adults who were newly diagnosed with HCC from 2004 to 2008. Middle-aged men were the most vulnerable. We believe our findings will be useful to healthcare policymakers in Korea as well as to healthcare leaders in countries with NHI programs who need to make important decisions about allocation of limited healthcare resources according to a consensually accepted and rational framework.

Are serum cholesterol levels associated with cognitive impairment and depression in elderly individuals without dementia?: A retrospective cohort study in South Korea.

OBJECTIVES: As aging progresses, older adults experience several health changes, including changes in cholesterol levels, which increases their risk for other diseases. Older adults are particularly vulnerable to cognitive impairment and depression, which may be due to several factors. The aim of this study was to evaluate the association between serum cholesterol level and cognitive impairment and depression in older adults. METHODS: This study used senior cohort data from the National Health Insurance Service of South Korea. A total of 128 371 participants contributed repeated measures to this dataset. Cognitive impairment was measured via a self-reported questionnaire and depression was measured using claim data. Generalized estimating equations were used to identify associations between serum cholesterol level and cognitive impairment and depression, including subgroup analyses by sex. RESULTS: There was no significant association between low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), or triglycerides (TG) with cognitive impairment. Low high-density lipoprotein cholesterol (HDL-C) was significantly associated with a higher risk of cognitive impairment, whereas high HDL-C was associated with lower cognitive impairment. Higher LDL-C was significantly associated with lower depression. Higher TC also was significantly associated with depression. CONCLUSION: HDL-C is associated with depressive symptoms, and may be a key factor in predicting psychiatric symptoms or cognitive decline. Our study suggest that routine health screenings may aid in the early detection of high-risk individuals.

Association between early treatment hospitals, serum cholesterol level and cardiovascular disease risk in dyslipidemia patients.

BACKGROUND: Studies have shown the importance of managing chronic diseases, such as cardiovascular disease (CVD), at the primary treatment level. Here, we aimed to evaluate the association between medical treatment institutions and health outcomes in patients with dyslipidemia, a major risk of CVD, to provide evidence for increasing chronic disease management at the primary care level in Korea. METHODS: We used National Health Insurance Sampling cohort data, of which 37 506 patients were newly diagnosed with dyslipidemia during 2009-14. CVD risk and changes in serum cholesterol level after dyslipidemia diagnosis were outcome variable examined. A generalized estimating equation model was used to identify associations between initial medical institution, CVD risk and changes in serum cholesterol levels. The Cox proportional-hazard ratio was used to assess the association between initial medical institutions and detailed CVD risk. Subgroup analyses were conducted to assess CVD risk following treatment with prescription medication. RESULTS: Our analyses demonstrate that CVD risk was lower at primary care-level community health centers and clinics compared to tertiary hospitals, with a statistically significant difference observed in clinics. Ischemic heart disease was lower at community health centers and clinics. However, all medical institution types were associated with significantly lower serum cholesterol levels compared to the baseline. CONCLUSIONS: Management of patients with dyslipidemia at primary care institutions was associated with reduced CVD risk and decreased serum cholesterol levels. Therefore, policymakers should strengthen the quality of healthcare at primary care institutions and educate patients that these institutions are appropriate for managing chronic disease.

Lead-Free Dual-Phase Halide Perovskites for Preconditioned Conducting-Bridge Memory.

Organometallic and all-inorganic halide perovskites (HPs) have recently emerged as promising candidate materials for resistive switching (RS) nonvolatile memory due to their current-voltage hysteresis caused by fast ion migration. Lead-free and all-inorganic HPs have been researched for non-toxic and environmentally friendly RS memory devices. However, only HP-based devices with electrochemically active top electrode (TE) exhibit ultra-low operating voltages and high on/off ratio RS properties. The active TE easily reacts to halide ions in HP films, and the devices have a low device durability. Herein, RS memory devices based on an air-stable lead-free all-inorganic dual-phase HP (AgBi2 I7 -Cs3 Bi2 I9 ) are successfully fabricated with inert metal electrodes. The devices with Au TE show filamentary RS behavior by conducting-bridge involving Ag cations in HPs with ultra-low operating voltages (<0.15 V), high on/off ratio (>107 ), multilevel data storage, and long retention times (>5 × 104 s). The use of a closed-loop pulse switching method improves reversible RS properties up to 103 cycles with high on/off ratio above 106 . With an extremely small bending radius of 1 mm, the devices are operable with reasonable RS characteristics. This work provides a promising material strategy for lead-free all-inorganic HP-based nonvolatile memory devices for practical applications.

The association of under-weight and obesity with mortality after hip arthroplasty.

Background: although many studies have demonstrated the association between body mass index (BMI) and many diseases, there is little evidence of postoperative mortality after hip arthroplasty. The aim of this study was to evaluate the association between BMI and mortality after hip arthroplasty in the older population. Methods: a total of 3,627 older patients who underwent hip arthroplasty from 2010 to 2013 were included. We used Cox regression analysis to evaluate the association between BMI and mortality after hip arthroplasty. The hazard ratios (HRs) was calculated from 30 days, 31-365 days, and from the first day of surgery to the day of death during the study. Results: under-weight (BMI under 18.5 kg/m2) is significantly associated with increased mortality (HR:1.423; 95% Confidence Interval (CI): 1.023-1.981) after hip arthroplasty compared to the normal range. However, in the short-term mortality within 30 days after surgery, both under-weight (HR: 2.368; 95%CI: 1.130-4.960) and obesity (25-29.9 kg/m2, HR: 2.023; 95%CI: 1.008-4.059) are associated with increased mortality. Conclusion: our study suggested that under-weight is associated with increased risk of mortality after hip arthroplasty. Further, in a short-term outcome, obesity appear to be associated with increased mortality after hip arthroplasty within 30 days.

Effects of a mandatory DRG payment system in South Korea: Analysis of multi-year nationwide hospital claims data.

BACKGROUND: In 2002, a voluntary diagnosis-related groups (DRGs) payment system was introduced in South Korea for seven disease groups, and participation in the DRGs was mandated for all hospitals beginning in 2013. The primary aim of this study was to compare results reflective of patient care between voluntary participation hospitals (VPHs) and mandatory participation hospitals (MPHs) governed by either the DRGs or fee-for-service (FFS) payment system. METHODS: We collected DRGs and FFS inpatient records (n=3,038,006) from the Health Insurance Review and Assessment for the period of July 2011 to July 2014 and compared length-of-stay, total medical costs, shifting services to an outpatient setting, and readmission rates according to payment system, time of DRGs implementation, and hospital type. We analyzed the effects of mandatory introduction in DRGs payment system on results for patient care and used generalized estimating equations with difference-in-difference methodology. RESULTS: Most notably, patients at MPHs had significantly shorter LOS and lower readmission rates than VPH patients after mandatory introduction of the DRGs. Shifting services to an outpatient setting was similar between the groups. CONCLUSIONS: Our findings suggest that the DRGs payment policy in Korea has decreased LOS and readmission rates. These findings support the continued implementation and enlargement of the DRGs payment system for other diseases in South Korea, given its potential for curbing unnecessary resource usage encouraged by FFS. If the Korean government deliberates on expansion of the DRGs to include other diseases with higher rates of complications, policymakers need to monitor deterioration of health care quality caused by fixed pricing.

Do cost containment policies save money and influence physicians' prescribing behavior? Lessons from South Korea's drug policy for diabetes medication.

OBJECTIVE: We evaluate the effects of drug price reduction policy on pharmaceutical expenditure and prescription patterns in diabetes medication. DESIGN: An interrupted time series study design using generalized estimating equations. SETTING: This study used National Health Insurance claim data from 2010 to 2013. PARTICIPANTS: A total of 68 127 diabetes patients and 12 465 hospitals. INTERVENTION(S): The drug price reduction policy. MAIN OUTCOME MEASURES: The primary outcome is pharmaceutical expenditure and prescription rate. To evaluate changes in prescription rate, we measured prescription rates such a brand-name drug and drug price reduction rate. RESULTS: Although the drug price reduction policy associated with decreased pharmaceutical expenditure (-13.22%, P < 0.0001), the trend (-0.01%, P = 0.9201) did not change significantly compared with the pre-intervention period. In addition, the trends in the monthly prescription rate of brand-name drugs decreased (-0.14%, P = 0.0091), while the immediate change was an increase (5.72%, P < 0.0001). Regardless of the drug reduction rate, the prescription rate after the introduction of the drug price reduction policy decreased compared with the pre-intervention period, and this decline was significant for reduction rates of 0% (-2.74%, P < 0.0001) and 10% (-0.13%, P = 0.0018). CONCLUSIONS: Our results provide evidence of the effects of the drug price reduction policy on pharmaceutical expenditure and prescription patterns. This policy did not affect the prescribing behavior of healthcare providers and did not increase the use of drugs not subject to this policy. Although this study did not observe changes in the cost of pharmaceuticals after the introduction of the drug price reduction policy, further research is needed on the long-term changes in such costs.

Changes in prescription pattern, pharmaceutical expenditure and quality of care after introduction of reimbursement restriction in diabetes in Korea.

Background: To ensure effective prescription practices and reduce diabetes-related pharmaceutical expenditures, Korea adopted a clinical practice guideline for the reimbursement system. Health care providers cannot receive reimbursement from National Health Insurance(NHI) unless it is for an appropriate prescription under the predefined clinical condition. The aim of this study was to evaluate prescription patterns in oral hypoglycemic agents, costs and effects on patient care since the introduction of the diabetes reimbursement restriction. Methods: We used claim data from 2008 to 2013, which included 26 315 diabetes patients and 9907 hospitals. An interrupted time series study design using generalized estimating equations was used to evaluate changes in patterns of single and combination therapy, brand name drug prescriptions, cost and hospital admission following the reimbursement restriction. Results: Following reimbursement restriction initiation, we found a statistically significant decrease in the average prescription rate of brand name drugs (-6.2%), whereas single therapy prescription increased (9.9%). There was also a reduction in trend change in the monthly prescription rate for combination therapy (-1.7%) and brand name drugs (-0.8%). For single therapy, the trend change in prescription rate increased after the intervention (0.8%). A reduction of trend change in pharmaceutical costs (-0.3%) was observed. However, we did not find a significant change in hospital admission for diabetes. Conclusions: Reimbursement restriction affects both pharmaceutical costs and physicians' decisions to prescribe oral hypoglycemic agents. We did not observe a significant reduction in quality of care following the intervention. Collectively, these findings indicate that reimbursement restriction has improved effective drug utilization and decreased health expenditures.

Spontaneous spinal epidural hematoma of the thoracic spine after herbal medicine: a case report.

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is an uncommon disease, but it can lead to acute cord compression with disabling consequences. Identifiable reasons for spontaneous hemorrhage are vascular malformations and bleeding disorders. However, SSEH after taking herbal medicines has not been described yet. CASE PRESENTATION: A 60-year-old female experienced sudden back pain combined with numbness and weakness in the lower limbs for several hours with no trauma, drug use, family history or any disease history. Her deep tendon reflexes were normoactive, and Babinski was negative. An emergent MRI showed a spinal epidural hematoma extending from T3 to T5. She was taken to surgery after immediate clinical and laboratory evaluations had been completed. Emergency decompression with laminectomy was performed and the patient recovered immediately after the surgery. Additional history taken from the patient at outpatient clinic after discharge revealed that she had been continuously taking herbal medicine containing black garlic for 8 weeks. CONCLUSION: To our knowledge, no report has been previously issued on SSEH after taking herbal medicines. Although contradictory evidence is present on bleeding risks with herbal uses, we believe that it's reasonable to ascertain if patients with SSEP are taking herbal medication before or during spinal surgery.

Do Reduced Copayments Affect Mortality after Surgery due to Stroke? An Interrupted Time Series Analysis of a National Cohort Sampled in 2003-2012.

BACKGROUND: The South Korean government introduced a policy in 2 phases, in September 2005 and in January 2010, for reducing copayments for patients with critical diseases, including stroke, to prevent excessive medical expenditures and to ease economic barriers. Previous studies of the effect of this policy were focused primarily on cancer. Therefore, we investigated the relationship between this policy and 1-year mortality after surgery among patients with stroke. METHODS: We used data from the Korean National Health Insurance sampling cohort (n = 2173 in 2003-2012) and performed an interrupted time series analysis. RESULTS: Approximately 26% of the patients died within 1 year after surgery. The time trends after reducing copayments from 10% to 5% (phase 2) were inversely associated with risk of 1-year mortality (relative risk = .855, 95% confidence interval: .749-.975; P = .0196). In addition, this inverse association was greater in patients with low incomes, of older ages, and with higher Charlson comorbidity indices. CONCLUSIONS: The introduction of a policy for reducing copayments to ease excessive cost burdens for patients with stroke was positively associated with a reduced risk of 1-year mortality after surgical treatment due to stroke. On the basis of our results, health policy makers should make an effort to identify vulnerable populations and to overcome economic barriers for providing effective alternatives to ensure patients receive optimal health care.

Psychiatric outcomes after hysterectomy in women with uterine myoma: a population-based retrospective cohort study.

Controversy regarding psychological or psychiatric outcomes following hysterectomy still exists. The purpose of this study was to investigate the risk of postoperative psychiatric disorders in women with hysterectomy compared to that in women with uterus-conserving surgery for myomas by using population-based data from South Korea. This study was designed as a retrospective cohort study. We analyzed the National Health Insurance Service National Sample Cohort data including all administrative medical claims from 2002 to 2013. The study population, consisting of 9581 women, was defined as those diagnosed with uterine myoma who underwent medical procedures. The association between psychiatric and mood disorders and hysterectomy was assessed using Cox proportional hazard regression. During the study period, 1381 (14.4%) women experienced psychiatric disorders and 374 (3.9%) experienced mood disorders. The hazard ratio (HR) for psychiatric disorder was higher in women after hysterectomy than in women after uterus-conserving procedures (adjusted HR = 1.44; 95% CI = 1.27-1.64, p < 0.0001). In addition, the HR for mood disorders in women after hysterectomy was significantly higher than in women after uterus-conserving procedures (adjusted HR = 1.62; 95% CI = 1.26-2.08, p = 0.0002). Our study suggests that hysterectomy increased the risk of psychiatric disorders compared to uterus-conserving procedures in women with uterine myoma. Considering these findings, more focus on psychological responses in women following hysterectomy is needed, and appropriate psychosocial support or provisioning of information before or after procedures could reduce psychological distress.

Do hospital characteristics influence Cesarean delivery? Analysis of National Health Insurance claim data.

Background: The rates of Cesarean delivery in South Korea are high among the Organization for Economic Cooperation and Development countries. We analyzed the relationship between hospital characteristics, in particular hospital volume and market competition and Cesarean delivery. Methods: We used data from National Health Insurance claims (n = 53 591) at 51 hospitals to analyze the relationship between hospital characteristics and Cesarean delivery between 2010 and 2013. We performed logistic regression analysis using generalized estimating equations models that included both inpatient and hospital variables to examine factors associated with Cesarean delivery. Results: Among 53 591 hospitalization cases, 14 425 (26.9%) patients underwent Cesarean delivery. Hospital volumes for deliveries were inversely associated with Cesarean delivery (per increases 100 deliveries = OR 0.896, 95% CI 0.887-0.905). Market competition had inverse relationship with Cesarean delivery (per increase in 10 Hirschmann-Herfindal index points; OR 0.982, 95% CI 0.979-0.985). Conclusions: Our findings suggest that hospital characteristics affect Cesarean delivery. These situations might be caused by maintaining profit with regard to survival or competition, and protecting themselves against unexpected delivery risks. Therefore, based on our findings, health policy makers must make an effort to implement effective strategies for the optimal management of excessive Cesarean rates in South Korea.

The effects of patient education on patient safety: can we change patient perceptions and attitudes?: Lessons from the Armed Forces Capital Hospital in Korea.

OBJECTIVE: Strategies to promote patient involvement in medical error prevention have been implemented, but little is known about the effects of education on changes in perceptions and attitudes about patients' own safety. DESIGN: We administered a survey to military personnel admitted to the Armed Forces Capital Hospital. Responses were classified according to perception and attitude. SETTING: Single military hospital in Korea. PARTICIPANTS: A total of 483 completed surveys were included in our study; 252 of the respondents received safety education at admission. METHODS: We provided educational program material to one-half of the patients at admission (intervention group). The other one-half of patients received no safety education (non-intervention group). We then performed two rounds of a self-administered survey, based on whether the patient received patient safety education. Cronbach's alpha was calculated to determine scale score reliability. Regression analysis was used to evaluate associations between education and change in scores. RESULTS: Scores for perception and attitude were greater in the intervention group. The results of the regression analysis revealed that compared with the non-intervention respondents, the respondents who received education had higher perception (estimate: 7.809, P < 0.0001) and attitude scores (estimate: 5.539, P < 0.0001). CONCLUSION: Our study results suggested that patient education was associated with higher scores in both perception and attitudes about safety. To improve patient engagement in this area, efficient methods that encourage patient empowerment should be developed. Specialized health care providers who provide patient level education are needed to achieve a satisfactory patient safety climate.

How did market competition affect outpatient utilization under the diagnosis-related group-based payment system?

OBJECTIVE: Although competition is known to affect quality of care, less is known about the effects of competition on outpatient health service utilization under the diagnosis-related group payment system. This study aimed to evaluate these effects and assess differences before and after hospitalization in South Korea. DESIGN: Population-based retrospective observational study. SETTING: We used two data set including outpatient data and hospitalization data from National Health Claim data from 2011 to 2014. PARTICIPANTS: Participants who were admitted to the hospital for hemorrhoidectomy were included. A total of 804 884 hospitalizations were included in our analysis. MAIN OUTCOME MEASURE(S): The outcome variables included the costs associated with outpatient examinations and the number of outpatient visits within 30 days before and after hospitalization. RESULTS: High-competition areas were associated with lower pre-surgery examination costs (rate ratio [RR]: 0.88, 95% confidence interval [CI]: 0.88-0.89) and fewer outpatient visits before hospitalization (RR: 0.98, 95% CI: 0.98-0.99) as well as after hospitalization compared with moderate-competition areas. CONCLUSION: Our study reveals that outpatient health service utilization is affected by the degree of market competition. Future evaluations of hospital performance should consider external factors such as market structure and hospital location.

Percutaneous Subtrochanteric Osteotomy for Painful Dislocated Hips in Patients With Cerebral Palsy.

BACKGROUND: Treatment of a painful, chronically dislocated hip in nonambulatory children with cerebral palsy (CP) is challenging and controversial. Although many surgical options have been described, there is limited information, including patient-centered outcomes, following treatment. The purpose of our study was to evaluate the effect of a percutaneous subtrochanteric valgus osteotomy (SVO) using external fixation (EF) on hip abduction, radiographic parameters, and quality of life (QOL) measures in such patients. METHODS: Fifteen nonambulatory patients (8 male, 7 female) with CP with 19 chronically dislocated hips underwent SVO using EF and adductor tenotomy at an average age of 14.3 years (range, 10.7 to 26.8 y). Changes in hip abduction and radiographic angular correction following surgery were assessed. Caregivers completed 2 surveys detailing differences in the patient's QOL measures, including severity and duration of pain and ease of nursing care, and the modified Child Health Index of Life with Disabilities (CPCHILD). RESULTS: Caregivers of 11 patients completed both surveys at an average follow-up of 50 months (range, 17 to 119 mo) after fixator removal. There was improvement in pain, sitting tolerance, ease of transfers, and perineal care in the majority (9/11) of patients. The modified CPCHILD (possible score, 10 to 50) improved from 27.2 to 16.23 (P=0.05). Hip abduction improved from -7 degrees (range, -32 to 5 degrees) to 24 degrees (range, 0 to 40 degrees) (P<0.0001). The average valgus osteotomy correction was 48.2 degrees (range, 2.2 to 93.2 degrees). The pelvic femoral shaft angle improved from -15.2 degrees (range, -47.7 to 7.4 degrees) to 15.4 degrees (-44.3 to 44.6 degrees). There was some correlation of both, change in hip abduction (R=0.55) and osteotomy angle (R=0.60), with improvement in QOL measures. There were 3 major complications (20%) in 15 patients. CONCLUSIONS: On the basis of preliminary results, percutaneous SVO stabilized with EF improves QOL in the majority of nonambulatory CP patients despite untoward events and is a viable alternative to open osteotomy with internal fixation. More robust comparative studies are needed to further assess the optimal salvage technique in this patient population. LEVEL OF EVIDENCE: Level IV.

Is Parathyroid Hormone A Viable Solution For Nonunion? A Systematic Review And Pooled Analysis.

We conducted a systematic review and pooled analysis of published studies to evaluate the clinical results of parathyroid hormone (PTH) in the treatment of nonunion and delayed union and assess whether there are any adverse effects of PTH. Four electronic databases (PubMed, Web of Science, EMBASE, and Cochrane library) were searched from 1950 to 2016. A total of 24 patients from 13 published studies were identified. The mean age of the patients was 57 years (range, 19-91 years). Mean duration of nonunion after initial treatment (surgical or conservative) was 8.4 months (range, 3-36 months). PTH was given to the patients for 1.5 months to 10 months (mean, 5.3 months) for various types of fractures. The union rates after using PTH was 96%. Mean time to union after PTH therapy was 7.3 months (range, 3-15 months). No patients reported any side effects during the entire period of PTH treatment. Our study has helped to further elucidate the outcomes of PTH therapy in the treatment of nonunion. We believe that PTH is a viable option that is a promising, safe, and effective anabolic treatment for delayed union and nonunion.

Readmission rates of South Korean psychiatric inpatients by inpatient volumes per psychiatrist.

BACKGROUND: Readmission rates of psychiatric inpatients are higher in South Korea than other Organization for Economic Co-operation and Development (OECD) countries. In addition, the solution for readmission control is deficient based on the characteristics of the South Korean National Health Insurance (NHI) system. Therefore, it is necessary to identify ways to reduce psychiatric inpatient readmissions. This study investigated the relationship between inpatient volume per psychiatrist and the readmission rate of psychiatric inpatients in South Korea. METHOD: We used NHI claim data (N = 37,796) from 53 hospitals to analyze readmission within 30 days for five diagnosis (organic mental disorders, mental and behavioral disorders due to psychoactive substance use, schizophrenia, mood disorders, neurotic disorders, and stress-related and somatoform disorders) between 2010 and 2013. We performed χ2 and analysis of variance tests to investigate associations between patient and hospital-level variables and readmission within 30 days. Finally, generalized estimating equation (GEE) models were analyzed to examine possible associations with readmission. RESULTS: Readmissions within 30 days accounted for 1,598 (4.5 %) claims. Multilevel analysis demonstrated that inpatient volume per psychiatrist were inversely related with readmission within 30 days (low odds ratio [OR]: 0.38, 95 % confidence interval [CI]: 0.28-0.51; mid-low OR: 0.48, 95 % CI: 0.36-0.63; mid-high OR: 0.55, 95 % CI: 0.44-0.69; Q4 = ref). The subgroup analysis by diagnosis revealed that both "schizophrenia, schizotypal, and delusional disorders" and "mood disorders" had inverse relationships with readmission risk for all volume groups. CONCLUSIONS: We observed an inverse association between inpatient volume per psychiatrist and the 30-day readmission rate of psychiatric inpatients, suggesting that it could be a useful quality indicator in mental health care.