• Title/Summary/Keyword: Clinical unmet need

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Unmet Need and Inappropriate Use in Emergency Ambulance Service (응급 환자 이송서비스의 적절성: 미충족 의료와 부적절한 이용)

  • Kang, Kyunghee
    • Health Policy and Management
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    • v.24 no.4
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    • pp.357-366
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    • 2014
  • Background: The objective of this study was to evaluate the efficiency of an emergency ambulance system and to investigate socio-economic and clinical characteristics associated with emergency ambulance service. Methods: Based on 2011 Korea health panel, unmet need and inappropriate use of emergency ambulance service were measured by Gibson in 1977. Furthermore, the factors associated with unmet need and inappropriate use of emergency ambulance service were identified by Fisher's exact tests and multiple logistic regression models. Results: Unmet need, defined as the proportion of emergency patients who clinically need ambulance transportation but do not receive it, was found to be 59.8%. Inappropriate use, defined as the proportion of emergency patient receiving ambulance care who did not clinically need it, was found to be 37.2%. There were statistically significant differences between appropriate and inappropriate groups in overall variables of socio-economic and clinical characteristics. Specifically, gender, age, relationship to household, and reasons of visiting emergency department (accident/disease) were statistically significant factors associated with appropriate use of emergency ambulance service. Conclusion: Unmet ambulance need is a useful measure for patients needs assessment, and inappropriate ambulance use is a valid criteria in judging the efficiency of emergency ambulance system. To improve and understand emergency ambulance system, unmet need and inappropriate use of emergency ambulance service should be more concerned.

Selecting the Priority Research Topics Addressing Unmet Post-immunization Safety Needs: A Model for Generating Research Proposal and Designing a Questionnaire for the Clinical Experts (설문조사를 통한 전문가 대상 예방접종 후 이상반응 관련 우선순위 연구주제 선정 기준모델 제시)

  • Kim, Hyun Jeong;Lee, Hyesung;Kim, Ju Hwan;Yoon, Dongwon;Noh, Yunha;Shin, Ju-Young
    • Korean Journal of Clinical Pharmacy
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    • v.29 no.3
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    • pp.173-185
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    • 2019
  • Objective: To gather inputs from clinical experts on selecting and prioritizing research topics, to address unmet vaccine safety needs. Methods: A questionnaire containing 15 vaccine safety assessment research proposals was sent to 28 vaccine experts chosen from various domestic medical association boards, and the rationale for each of the proposals was provided by presenting the following information: 1) a brief summary of the clinical safety studies on the vaccine, conducted by the Clinical Immunization Safety Assessment (CISA) project group, supervised by the United States Center for Disease Control (U.S. CDC), and 2) a summary of recently published studies that address vaccine safety issues. The experts were instructed to select and rank 5 topics in the order of preference, and the preference score for each proposed topic was calculated by assigning points on a scale of 1 to 5. Results: All 28 experts responded to the questionnaire, and the following topics were selected according to their calculated preference scores: 1) Human papillomavirus vaccine safety profile in the Korean female adolescents; 2) A signal detection of adverse events following Influenza vaccination: comparison between the US and South Korea; 3) Incidence of anaphylaxis following National Immunization Program vaccines between 2008 and 2017; 4) Safety of quadrivalent influenza vaccines compared to trivalent influenza vaccines; and 5) Pneumococcal vaccine safety profile in the general population. Conclusion: Five research topics addressing vaccine safety were selected, for which well-constructed research protocols need to be promptly developed to address current unmet vaccine safety needs in South Korea.

Clinical development of photodynamic agents and therapeutic applications

  • Baskaran, Rengarajan;Lee, Junghan;Yang, Su-Geun
    • Biomaterials Research
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    • v.22 no.4
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    • pp.303-310
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    • 2018
  • Background: Photodynamic therapy (PDT) is photo-treatment of malignant or benign diseases using photosensitizing agents, light, and oxygen which generates cytotoxic reactive oxygens and induces tumour regressions. Several photodynamic treatments have been extensively studied and the photosensitizers (PS) are key to their biological efficacy, while laser and oxygen allow to appropriate and flexible delivery for treatment of diseases. Introduction: In presence of oxygen and the specific light triggering, PS is activated from its ground state into an excited singlet state, generates reactive oxygen species (ROS) and induces apoptosis of cancer tissues. Those PS can be divided by its specific efficiency of ROS generation, absorption wavelength and chemical structure. Main body: Up to dates, several PS were approved for clinical applications or under clinical trials. $Photofrin^{(R)}$ is the first clinically approved photosensitizer for the treatment of cancer. The second generation of PS, Porfimer sodium ($Photofrin^{(R)}$), Temoporfin ($Foscan^{(R)}$), Motexafin lutetium, Palladium bacteriopheophorbide, $Purlytin^{(R)}$, Verteporfin ($Visudyne{(R)}$), Talaporfin ($Laserphyrin^{(R)}$) are clinically approved or under-clinical trials. Now, third generation of PS, which can dramatically improve cancer-targeting efficiency by chemical modification, nano-delivery system or antibody conjugation, are extensively studied for clinical development. Conclusion: Here, we discuss up-to-date information on FDA-approved photodynamic agents, the clinical benefits of these agents. However, PDT is still dearth for the treatment of diseases in specifically deep tissue cancer. Next generation PS will be addressed in the future for PDT. We also provide clinical unmet need for the design of new photosensitizers.

Clinical Application of Digital Therapeutics for Insomnia (불면증 디지털 치료제의 임상 적용)

  • Cho, Chul-Hyun
    • Sleep Medicine and Psychophysiology
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    • v.28 no.1
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    • pp.6-12
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    • 2021
  • Insomnia is one of the most common sleep disorders experienced by modern people, and treatment is often not adequate due to various limitations. Digital therapeutics for insomnia are expected to play a revolutionary role in supplementing and satisfying unmet needs in real-world clinical treatment. Digital therapeutics for insomnia were developed based on cognitive-behavioral therapy for insomnia, which is the first standard treatment for insomnia. The effectiveness of digital therapeutics for insomnia developed by several companies has been proven through well-designed clinical research. Various approaches have been used for practical application of digital therapeutics for insomnia. Thus far, meaningful results have been drawn, but there are areas that need to be improved upon based on real-world evidence. Sleep researchers need to validate the safe and effective application of digital therapeutics for the treatment of insomnia.

The Effect of Stress and Depression on Unmet Medical Needs (스트레스와 우울증이 미충족 의료수요에 미치는 영향)

  • Park, Eun Hee;Park, Eun-Cheol;Oh, Daniel H.;Cho, Eun
    • Korean Journal of Clinical Pharmacy
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    • v.27 no.1
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    • pp.44-54
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    • 2017
  • Background: Mental health issues such as stress and depression have been regarded as major social problems in Korea. We investigated the relationship between stress and depression with unmet medical needs (UMN). Methods: Using the nationwide database of 2010 Korea National Health and Nutritional Examination Survey (K-NHANES), subjects aged 19 years or above were selected (n=6,055). In the K-NHANES questionnaire, subjects were asked about their UMN experience, severity of stress, and perceived depression lasting at least 2 weeks over the past year. The effects of stress and depression on UMN were analyzed in 4 models established by adding predisposing, enabling and need factors in a step-wise fashion. The risks for UMN were also assessed according to the causes of UMN. Results: Individuals who felt stress 'very often' (odds ratio (OR) 3.28, 95% CI=2.23-4.86) and 'often' (OR 2.53, 95% CI=1.93-3.31) and who experienced depression (OR 1.68, 95% CI=1.35-2.10) reported significantly elevated UMN rates, and these effects were substantial especially for the individuals who had UMN due to economic constraint. Females, lower education level, lower income, unemployed status, and negative perceptions about health status were found to be additional risk factors for UMN. Conclusion: Our results confirmed the risks of stress and depression on UMN. It is strongly advisable to create initiatives to improve mental health, particularly stress and depression, and to fulfill individuals' medical utilization needs.

Designing Clinical Studies and Keeping Research Ethics (임상연구의 설계 및 연구윤리)

  • Chang, Jae Seung;Lee, Sunny;Ha, Tae Hyon;Yoon, In-Young;Ha, Kyooseob
    • Korean Journal of Biological Psychiatry
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    • v.19 no.4
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    • pp.172-178
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    • 2012
  • Data from clinical studies are needed for psychiatrists to make quick and scientific decisions based on the best available evidence in clinical settings. Various methods of clinical studies are useful for clinicians to have reliable answers to unmet clinical needs. Although randomized controlled trials may provide high-quality information about major issues, well-designed, naturalistic and observational studies often give us unbiased explanation for real-world phenomena. Adequate selection of clinical variables and appropriate number of participants are key factors of well-designed clinical studies. Statistical methods can add an extra dimension to initial design of clinical studies. Given ethical issues in clinical studies on psychiatric disorders, special regards should be paid to participants' ability to provide informed consents. New strategies of clinical studies need to be developed to meet clinical needs and protect the rights and welfare of study participants.

Current Unmet Needs and Clues to the Solution in the Management of Tricuspid Regurgitation

  • Byung Joo Sun;Jae-Hyeong Park
    • Korean Circulation Journal
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    • v.52 no.6
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    • pp.414-428
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    • 2022
  • Although tricuspid regurgitation (TR) is a general medical issue with growing prevalence and socioeconomic burden, most clinicians have not paid much attention to TR in the past. Several problems of TR have been pointed out in clinical practice, which include: ambiguous clinical manifestations and the difficulty in initial detection, limitations in generally used diagnostic tools, the absence of objective criterion for therapeutic intervention, high operative morbidity and mortality, and lack of long-term clinical data after the intervention for TR. Therefore, patients with TR usually visit clinicians at a much-advanced state, and this delay gives a major dilemma in clinical decision-making in a routine clinical practice. To improve the clinical outcome of TR, we need more knowledge about TR for solving the current problems and making strategies for better clinical practice. With this background, we have discussed in the present article about the pathophysiology of TR and the problems frequently experienced by clinical physicians in the diagnosis and treatment of TR. Furthermore, we have discussed the future strategy to improve the treatment of TR.

Predictors of Complementary and Alternative Medicine Use by Breast Cancer Patients in Bandung, Indonesia

  • Azhar, Yohana;Achmad, Dimyati;Lukman, Kiki;Hilmanto, Dany;Aryandono, Teguh
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.4
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    • pp.2115-2118
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    • 2016
  • Background: The study aimed to assess complementary and alternative medicine (CAM) use and their associated factors with breast cancer patients in Bandung, Indonesia. Materials and Methods: In total, 330 breast cancer patients were administered questionnaires on their CAM use and CAM predictive factors including socio-demographic parameters, clinical data and quality of life, trust in physicians, trust in hospitals, satisfaction and informational needs. Data were analyzed using univariate analysis and multivariate log regreesion analysis. Results: Overall 33.3% of patients reported use of CAM. Lower income, lower education, presence of metastasis, prolonged diagnosis, less trust in physician were found to be highly associated with CAM use. Conclusions: CAM use by breast cancer patients can be interpreted as an attempt to explore all possible options, an expression of an active coping style, or expression of unmet needs in the cancer care continuum. Physicians need to openly discuss the use of CAM with their patients and identify whether they have other unmet supportive needs.

MARS-PD: Meridian Activation Remedy System for Parkinson's Disease

  • Miso S. Park;Chan-young Kim;In-woo Choi;In-cheol Chae;Wangjung Hur;SangSoo Park;Horyong Yoo
    • The Journal of Internal Korean Medicine
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    • v.44 no.1
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    • pp.1-11
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    • 2023
  • Objective: There are currently no disease-modifying medications or definite long-term sustainable interventions for patients with Parkinson's disease (PD), indicating an unmet treatment need. Our goal was to create a long-term sustainable intervention for PD patients that can be used in Korean medicine clinics. Methods: The Meridian Activation Remedy System (MARS) was created to stimulate a patient's 12 meridians and sinew channels using a combination of acupoint stimulation and exercise. The acupoints and motions used in MARS were selected through literature studies and expert advice. The methodologies were refined using observational and case studies. With slow and fast movements, the MARS intervention was intended to activate both slow- and fast-twitch muscle fibers. Intradermal acupuncture and motion that shift the center of gravity were employed to enhance the patient's balance and proprioception. In addition, the intervention included alternating movement exercises to address the complex cognitive decline commonly occurring in PD patients. Results: The following acupoints were chosen for the MARS intervention: bilateral Hegu (LI4), Houxi (SI3), Waiguan (TE5), Neiguan (PC6), Zhongchong (PC9), Yuji (LU10), Zusanli (ST36), Yanglingquan (GB34), Taichong (LR3), Kunlun (BL60), and Taixi (KI3). We also developed actions that can stimulate the body's 12 meridians. Conclusion: We developed the MARS intervention, which combines acupuncture and exercise, to address the unmet therapeutic needs of PD patients. We hope that with additional research, the MARS intervention can be set as an effective therapeutic program for PD patients.

Comparison of Factors Influencing Health-Related Quality of Life between Young-Aged and Old-Aged Patients with Cancer: Analysis of the 2015 Korea Health (노인 암환자의 건강관련 삶의 질 영향요인: 2015년 한국의료패널 자료 분석)

  • Kim, Shinmi;Lee, Insook
    • Journal of Home Health Care Nursing
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    • v.27 no.2
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    • pp.156-168
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    • 2020
  • Purpose: This study aimed to examine factors influencing health-related quality of life (HRQOL) and compare them between young-aged and old-aged patients with cancer. Methods: Data of 291 patients (young-aged: 168, old-aged: 123) were obtained from the 10th wave of the 2015 Korea Health Panel Survey. The HRQOL was measured using the Korean version of Euro-QoL-5D. Independent t-test, analysis of variance, and multiple regression analysis were performed to identify factors influencing HRQOL. Results: The average HRQOL score was 0.87±0.10 and 0.82±0.15 among young-aged and old-aged, respectively. The factors differed partially between the two groups. For young-aged, the influencing factors were activity restriction, subjectively perceived health status, and smoking. For old-aged, the influencing factors were activity restriction, subjective health status, and unmet healthcare needs. Conclusion: Strategies to improve the HRQOL of elderly adults need to be developed considering the age group. Additionally, studies that include clinical factors such as symptoms are required to prepare need-based practical approaches for better quality of life of such patients.