• Title/Summary/Keyword: Evidence-based medicine

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An Overview and Implication of Apology Law and Disclosure Law in U.S.A. (미국의 사과법 및 디스클로져법의 의의와 그 시사점)

  • Lee, Won;Park, Ji Yong;Jang, Seung-Gyeong
    • The Korean Society of Law and Medicine
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    • v.19 no.1
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    • pp.81-111
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    • 2018
  • Recently in Korea, public interest about patient safety has increased because patient safety incidents occurred continuously. In addition, as the way of coping with medical personnel and medical institutions after occurrence of patient safety incident became controversial, the necessity of introducing apology law and disclosure law was raised. We analyzed the contents of apology law and disclosure law in U.S.A and critically examined the legislative movements in Korea. First, the Apology law requires that a medical personnel provide apology, consolation, sympathy to the patient for discomfort, pain, damage or death, and that the expression of apology shall be inadmissible as evidence of an admission of liability in civil action or administrative proceeding. The Apology law is divided into 'full apology law' and 'partial apology law' depending on whether mistake, error, fault, liability, and legal liability shall be inadmissible. Meanwhile, Disclosure law enforces or voluntarily enforces the law to communicate with the patient regarding the disclosure of the incident, the cause of incident, the compensation plan, and the measures to prevent the recurrence in the adverse incident that serious harm to the patient. In Korea, the concern about patient safety incidents has been amplified, and as the importance of communication between the medical personnel and patient has been recognized, the revision bill for the "Patient Safety Act", which adopted the U.S.A apology or disclosure law, was submitted to the National Assembly. The purpose of this study was to critically review the contents of the revised legislation based on the analysis of the apology law and disclosure law in U.S.A. and to provide implications for future legislative direction.

Roles of MicroRNA-21 and MicroRNA-29a in Regulating Cell Adhesion Related Genes in Bone Metastasis Secondary to Prostate Cancer

  • Mohamad, Maisarah;Wahab, Norhazlina Abdul;Yunus, Rosna;Murad, Nor AzianAbdul;Zainuddin, Zulkifli Md;Sundaram, Murali;Mokhtar, Norfilza Mohd
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.7
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    • pp.3437-3445
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    • 2016
  • Background: There is an increasing concern in the role of microRNA (miRNA) in the pathogenesis of bone metastasis (BM) secondary to prostate cancer (CaP). In this exploratory study, we hypothesized that the expression of vinculin (VCL) and chemokine X3C ligand 1 (CX3CL1) might be down-regulated in clinical samples, most likely due to the post-transcriptional modification by microRNAs. Targeted genes would be up-regulated upon transfection of the bone metastatic prostate cancer cell line, PC3, with specific microRNA inhibitors. Materials and Methods: MicroRNA software predicted that miR-21 targets VCL while miR-29a targets CX3CL1. Twenty benign prostatic hyperplasia (BPH) and 16 high grade CaP formalin-fixed paraffin embedded (FFPE) specimens were analysed. From the bone scan results, high grade CaP samples were further classified into CaP with no BM and CaP with BM. Transient transfection with respective microRNA inhibitors was done in both RWPE-1 (normal) and PC3 cell lines. QPCR was performed in all FFPE samples and transfected cell lines to measure VCL and CX3CL1 levels. Results: QPCR confirmed that VCL messenger RNA (mRNA) was significantly down-regulated while CX3CL1 was up-regulated in all FFPE specimens. Transient transfection with microRNA inhibitors in PC3 cells followed by qPCR of the targeted genes showed that VCL mRNA was significantly upregulated while CX3CL1 mRNA was significantly down-regulated compared to the RWPE-1 case. Conclusions: The down-regulation of VCL in FFPE specimens is most likely regulated by miR-21 based on the in vitro evidence but the exact mechanism of how miR-21 can regulate VCL is unclear. Up-regulated in CaP, CX3CL1 was found not regulated by miR-29a. More microRNA screening is required to understand the regulation of this chemokine in CaP with bone metastasis. Understanding miRNA-mRNA interactions may provide additional knowledge for individualized study of cancers.

Exploring synergistic effect among essential oils in antibacterial action (항균작용에 대한 에센셜 오일들 간의 상승작용 탐색)

  • Kim, Ka-Eun;Park, Soon Kwon;Cho, Il-Young
    • Journal of Digital Convergence
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    • v.14 no.8
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    • pp.547-553
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    • 2016
  • This study was conducted to look at the antimicrobial synergistic effect of blended oil into the target skin flora. The essential oils used in antimicrobial test were 100% eucalyptus (EU), lemon (LE), lavender (LA) and four blended oils, EU+LE, LE+LA, EU+LA, and, EU+LE+LA in ratio of 1:1 and 1:1:1 respectively. As a result, LE showed the highest, LA showed the lowest antimicrobial activity among single oil group. In blended oil group, antimicrobial activity of the EU + LA showed significantly increasing effect than the sum of the antimicrobial activity of the single oil. However, the antimicrobial effects of the blend of three oils did not show any synergistic effect. This result showed that the interaction between the chemical components constituting the oil than the number of blended oil seems more significant on the synergistic effect. Therefore, blending essential oil based on scientific evidence becomes more necessary in the future.

Increased whole grain, fruits and vegetable intake reduced oxidative stress in high school students (전곡류 및 채소, 과일 섭취의 증가가 청소년의 체내 항산화능 개선에 미치는 영향)

  • Kim, So Hyeon;Cho, Sang Woon;Hwang, Seong Su;Ahn, Mijung;Lee, Dukhee;Kang, Seung Wan;Park, Yoo Kyoung
    • Journal of Nutrition and Health
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    • v.45 no.5
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    • pp.452-461
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    • 2012
  • There is increasing evidence that dietary factors in plant-based diets are important for the prevention of chronic disease. Especially, phytonutrients in fruits and vegetables have been recognized as major contributors for the decreased level of oxidative stress. In this study, the effect of switching the dietary habit to high consumption of fruits and vegetables were evaluated on the parameters of serum antioxidant status in healthy high school students. Forty one students participated in a randomized controlled trial and were assigned to the control group (n = 18) or the intervention group (n = 23). The intervention group was provided for 8 weeks with the main food source being whole grain and vegetables. Anthropometric measurements, blood parameters and dietary intakes were measured, and compared before and after study. After 8 weeks, weight and BMI were significantly decreased in the intervention group (p = 0.000). The serum diacron reactive oxygen metabolites (d-ROMs) test resulted in a significantly decreased level only in the intervention group (p < 0.05) after 8 weeks, but serum biological antioxidant potential (BAP) was increased significantly in both groups (p < 0.001). Intake of energy, total fat, cholesterol and sodium in the intervention group were significantly decreased after 8 weeks (p < 0.05). Also, the intervention group had significantly increased vitamin and phytonutrient intakes of all-trans-${\beta}$-carotene, ${\alpha}$-carotene, ${\alpha}$-tocopherol, ascorbic acid, and total phenols (p < 0.05). Overall, the results of this study suggest that whole grain, fruits, and vegetables supplementation showed improvement of the adolescent health.

Supplement of High Protein-Enriched Diet Modulates the Diversity of Gut Microbiota in WT or PD-1H-Depleted Mice

  • Xie, Yajun;Zhao, Ping;Han, Zhigang;Li, Wei;Shi, Dan;Xu, Lei;Yi, Qiying
    • Journal of Microbiology and Biotechnology
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    • v.31 no.2
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    • pp.207-216
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    • 2021
  • Supplement of high-protein food plays an important role in improving the symptoms of malnutrition and the immune capacity of the body, but the association of high-protein diet and gut microbiota remained unaddressed. Here, we systematically analyzed the internal organs and gut microbiota in C57(WT) or PD-1H-depleted (KO) mice (T cells were activated) fed with pupae or feed for six weeks. We observed that the body weight gain in the mice fed with pupae increased less significantly than that of the feed group, while the villi and small intestine lengths in the pupa group were reduced compared with that of mice given feed. However, the average body weight of the KO mice increased compared with that of the WT mice fed with pupae or feed. Pupae increased the concentration of blood glucose in WT, but not in KO mice. Moreover, in the feed group, there was no difference in the weight of the internal organs between the WT and KO mice, but in the pupae-fed group, liver weight was decreased and spleen weight was increased compared with that of KO mice. The amounts/plural/amounts of Melainabacteria, Chloroflexi, and Armatimonadetes were specifically upregulated by pupae, and this upregulation was weakened or eliminated by PD-1H depletion. Some bacteria with high abundance in the feed-fed KO mice, such as Deferribacteres, Melainabacteria, Acidobacteria, Bacteroidetes, Spirochaetes and Verrucomicrobia, were decreased in pupae-fed KO mice, and Proteobacteria and Deinococcus were specifically enriched in pupae-fed KO mice. Bacteroidetes, Firmicutes and Akkermansia were associated with weight loss in the pupae-fed group while Lachnospiraceae and Anaerobiospirillum were related glucose metabolism and energy consumption. Based on high-throughput sequencing, we discovered that some gut bacteria specifically regulated the metabolism of a high-protein diet, and PD-1H deficiency improved life quality and sustained blood glucose. Moreover, PD-1H responses to high-protein diet through modulating the type and quantity of gut bacteria. These findings provide evidence about the association among gut microbiota, T cell activation (for PD-1H depletion) and high-protein diet metabolism, have important theoretical significance for nutrition and health research.

Insights into the genetic diversity of indigenous goats and their conservation priorities

  • Liu, Gang;Zhao, Qianjun;Lu, Jian;Sun, Feizhou;Han, Xu;Zhao, Junjin;Feng, Haiyong;Wang, Kejun;Liu, Chousheng
    • Asian-Australasian Journal of Animal Sciences
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    • v.32 no.10
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    • pp.1501-1510
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    • 2019
  • Objective: An experiment was conducted to evaluate genetic diversity of 26 Chinese indigenous goats by 30 microsatellite markers, and then to define conservation priorities to set up the protection programs according to the weight given to within- and between-breed genetic diversity. Methods: Twenty-six representative populations of Chinese indigenous goats, 1,351 total, were sampled from different geographic regions of China. Within-breed genetic diversity and marker polymorphism were estimated calculating the mean number of alleles, observed heterozygosities, expected heterozygosities, fixation index, effective number of alleles and allelic richness. Conservation priorities were analyzed by statistical methods. Results: A relatively high level of genetic diversity was found in twenty-four population; the exceptions were in the Daiyun and Fuqing goat populations. Within-breed kinship coefficient matrices identified seven highly inbred breeds which should be of concern. Of these, six breeds receive a negative contribution to heterozygosity when the method was based on proportional contribution to heterozygosity. Based on Weitzman or Piyasatian and Kinghorn methods, the breeds distant from others i.e. Inner Mongolia Cashmere goat, Chengdu Brown goat and Leizhou goat obtain a high ranking. Evidence from Caballero and Toro and Fabuel et al method prioritized Jining Gray goat, Liaoning Cashmere goat, and Inner Mongolia Cashmere goat, which agree with results from Kinship-based methods. Conclusion: Conservation priorities were determined according to multiple methods. Our results suggest Inner Mongolia Cashmere goat (most methods), Jining Gray goat and Liaoning Cashmere goat (high contribution to heterozygosity and total diversity) should be prioritized based on most methods. Furthermore, Daiyun goat and Shannan White goat also should be prioritized based on consideration of effective population size. However, if one breed can continually survive under changing conditions, the straightforward approach would be to increase its utilization and attraction for production via mining breed germplasm characteristics.

The current child and adolescent health screening system: an assessment and proposal for an early and periodic check-up program (현행 영유아 및 소아청소년 건강검진제도의 평가 및 대안)

  • Eun, Baik-Lin;Moon, Jin Soo;Eun, So-Hee;Lee, Hea Kyoung;Shin, Son Moon;Seong, In Kyung;Chung, Hee Jung
    • Clinical and Experimental Pediatrics
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    • v.53 no.3
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    • pp.300-306
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    • 2010
  • Purpose : Recent changes in the population structure of Korea, such as rapid decline in birth rate and exponential increase in old-aged people, prompted us to prepare a new health improvement program in children and adolescents. Methods : We reviewed current health screenings applied for children and adolescents in Korea and other developed countries. We collected and reviewed population-based data focused on mortality and morbidity, and other health-related statistical data. We generated problem lists in current systems and developed new principles. Results : Current health screening programs for children and adolescents were usually based on laboratory tests, such as blood tests, urinalysis, and radiologic tests. Almost all of these programs lacked evidence based on population data or controlled studies. In most developed countries, laboratory tests are used only very selectively, and they usually focus on primary prevention of diseases and health improvement using anticipatory guidance. In Korea, statistics on mortality and morbidity reveal that diseases related to lifestyle, such as obesity and metabolic syndrome, are increasing in all generations. Conclusion : We recommend a periodic health screening program with anticipatory guidance, which is focused on growth and developmental surveillance in infants and children. We no longer recommend old programs that are based on laboratory and radiologic examinations. School health screening programs should also be changed to meet current health issues, such as developing a healthier lifestyle to minimize risk behaviors—or example, good mental health, balanced nutrition, and more exercise.

Victims of Bullying among Korean Adolescents: Prevalence and Association with Psychopathology Evaluated Using the Adolescent Mental Health and Problem Behavior Screening Questionnaire-II Standardization Study Data (청소년정서행동발달검사 표준화연구 자료를 활용한 학교폭력 피해 전국유병률 및 관련요인 조사)

  • Bhang, Soo-Young;Yoo, Han-Ik K.;Kim, Ji-Hoon;Kim, Bong-Seog;Lee, Young-Sik;Ahn, Dong-Hyun;Suh, Dong-Su;Cho, Soo-Churl;Hwang, Jun-Won;Bahn, Geon-Ho
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.23 no.1
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    • pp.23-30
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    • 2012
  • Objectives : This study was conducted to investigate the prevalence of victims of bullying and the demographic characteristics of victims, and their related psychopathology, in a Korean nationwide sample of youths in middle and high school over a one month period. Methods : During the autumn of 2009, students in the 7th to 12th grades at 23 secondary schools participated in a nationwide, cross-sectional study. The study subjects completed the Adolescent Mental Health and Problem Behavior Screening Questionnaire-II (AMPQ-II) and Symptom Checklist-90-Revision (SCL-90-R). Based on the data acquired, descriptive statistics, correlation coefficients and multiple logistic regression analysis were performed. Results : Among the 3364 participants, 2272 (67.54%) completed the questionnaire. The prevalence of victimization was 28.9%. Male gender was positively associated with victimization, and grade level was negatively related to victimization. The AMPQ-II bullying score (Factor 4) was significantly (p<.001) and positively correlated to the AMPQ-II student total score (r= 0.50), Worry and thought (Factor 1 ; r=0.38), Mood and suicide (Factor 2 ; r=0.31), Academic and Internet-related problems (Factor 3 ; r=0.24), Rule violations (Factor 5 ; r=0.23), and AMPQ-II teacher total score (r=0.11). Somatization (r=0.23), Obsessive-compulsive behavior (r=0.24), Interpersonal sensitivity (r=0.30), Depression (r=0.33), Anxiety (r=0.26), Hostility (r=0.30), Phobic anxiety (r=0.22), Paranoid ideation (r=0.36), and Psychoticism (r=0.31) results from the SCL-90-R were also found to be positively related to the AMPQ-II bullying score, and remained significant after adjusting for age and gender. A total of 26% of the victims reported suicidal ideations as compared to 9% of non-victims over the month prior to the evaluation ($x^2$=119.595, df=1, p<.001). The multiple logistic regression analysis indicated that the AMPQ-II bullying score significantly increased the risk of suicidal ideation [Exp(b)=1.55, df=1, p<.001] after adjusting for age and gender. Conclusion : School bullying was highly prevalent among Korean middle and high school students. This study provided strong evidence that suicidal ideation and psychopathology were serious problems among the victims of bullying.

Results of Application of Video-Assisted Thoracoscopic Surgery for the Treatment of Empyema Thoracis (흉강경을 이용한 농흉 치료의 결과)

  • Choi, Gi Hoon;Choi, Goang Min;Kim, Hyoung Soo;Cho, Seong Joon;Ryu, Se Min;Ahn, Hee Cheol;Seo, Jeong Yeol
    • Tuberculosis and Respiratory Diseases
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    • v.61 no.5
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    • pp.463-472
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    • 2006
  • Background: Since video-assisted thoracoscopic surgery (VATS) was introduced as a new treatment modality for empyema thoracis, numerous reports have suggested that VATS is a more effective treatment method than the traditional methods that mainly use antibiotics and drainage apparatus. However, no confirmative evidence of the superiority of VATS over the traditional method has been provided yet. Methods: We attempted to evaluate the efficacy of VATS for the treatment of empyema thoracis by reviewing past medical records and simple chest films. First, we divided the patients into two groups based on the treatment method: group A of 15 patients who were treated with the traditional method between January 2001 and December 2003, and group B of 9 patients who were treated with VATS between December 2003 and August 2006. The final outcomes used in this study were the number of days of hospital stay, chest tube duration, leukocytosis duration, febrile duration, and intravenous antibiotics usage duration. In addition, radiological improvements were compared. Results: The mean age(${\pm}$standard deviation) of 11 men and 4 women in group A was $58.2{\pm}15.7$ years, and of 9 men and 2 women in group B was $51.6{\pm}9.5$ years. Group B had a significantly shorter hospital stay ($16.6{\pm}7.4$ vs. $33.7{\pm}22.6$ days; p=0.014), shorter chest tube duration ($10.5{\pm}5.7$ vs. $19.5{\pm}14.4$ days; p=0.039), shorter leukocytosis duration ($6.7{\pm}6.5$ vs. $18.8{\pm}13.2$ days; p=0.008), shorter febrile duration ($0.8{\pm}1.8$ vs. $9.4{\pm}9.2$ days; p=0.004), and shorter duration of intravenous antibiotics usage ($14.9{\pm}6.4$ vs. $25.4{\pm}13.9$ days; p=0.018). However, radiological improvements did not show any statistical differences. Conclusion: Early application of VATS for empyema thoracis treatment reduced hospital stay, thoracostomy tube duration, leukocytosis duration, febrile duration, and antibiotics usage duration in comparison with the traditional methods. The early performing of VATS might be an effective treatment modality for empyema thoracis.

Sopungsungi-won (SP) Prevents the Onset of Hyperglycemia and Hyperlipidemia in Zucker Diabetic Fatty Rats

  • Kim, Youn-Young;Kang, Hyo-Joo;Ko, Sung-Kwon;Chung, Sung-Hyun
    • Archives of Pharmacal Research
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    • v.25 no.6
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    • pp.923-931
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    • 2002
  • Sopungsungi-won (SP) is a known for\mula for senile constipation and diabetes mellitus, based on traditional Korean medicine. The preventive effect of SP on the development of overt diabetes in Zucker diabetic fatty (ZDF) rats was evaluated. When administered orally through a diet for 8 weeks, diabetic conditions such as hyperglycemia, polydipsia and hypertriglyceridemia were all ameliorated in SP-treated rats. In parallel with the onset and progression of hyperglycemia in the ZDF control rats; there was a marked decline in plasma insulin concentrations from 26.1 $\mu$U/ml, at age 7 weeks, to 14.8 $\mu$U/ml at age 15 weeks. In the SP-treated rats, however, the plasma insulin concentrations did not decline, and SP at a dose of 5 g/kg significantly increased the insulin levels to 31.9 $\mu$U/ml. Early normalization of plasma insulin and a retained ability to subsequently increase plasma insulin were indicative of a pancreatic $\beta$ cell protective action by the SP for\mula. In addition, expressions of an insulin-responsive gene and corresponding protein, glucose transporter 4 (GLUT4), in skeletal \muscle, were also determined in SP- and rosiglitazone-treated ZDF rats. mRNA and protein levels of GLUT4 in SP-treated rats were upregulated in a dose dependent manner. Furthermore, when ZDF rats were treated with 2 g/kg of the SP for\mula, the activity of glucose-6-phosphatase was decreased by 49%, whereas the activity of glucokinase was increased by 196%, compared to the ZDF control rats. Taken together, these data provide evidence that the SP for\mula markedly lowered the plasma glucose levels, probably through an effect not only on improvement of insulin action, but through a combined sti\mulation of glycolysis and an inhibition of gluconeogenesis in the liver, and also suggest the validity of SP's clinical use in the treatment of type 2 diabetes mellitus following further toxicological investigation.