• Title/Summary/Keyword: Evidence-based medicine

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Korean Clinical Imaging Guidelines for the Appropriate Use of Chest MRI (한국형 흉부 MRI 영상 진단 정당성 권고안)

  • Jiyoung Song;Bo Da Nam;Soon Ho Yoon;Jin Young Yoo;Yeon Joo Jeong;Chang Dong Yeo;Seong Yong Lim;Sung Yong Lee;Hyun Koo Kim;Byoung Hyuck Kim;Kwang Nam Jin;Hwan Seok Yong
    • Journal of the Korean Society of Radiology
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    • v.82 no.3
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    • pp.562-574
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    • 2021
  • MRI has the advantages of having excellent soft-tissue contrast and providing functional information without any harmful ionizing radiation. Although previous technical limitations restricted the use of chest MRI, recent technological advances and expansion of insurance coverage are increasing the demand for chest MRI. Recognizing the need for guidelines on appropriate use of chest MRI in Korean clinical settings, the Korean Society of Radiology has composed a development committee, working committee, and advisory committee to develop Korean chest MRI justification guidelines. Five key questions were selected and recommendations have been made with the evidence-based clinical imaging guideline adaptation methodology. Recommendations are as follows. Chest MRI can be considered in the following circumstances: for patients with incidentally found anterior mediastinal masses to exclude non-neoplastic conditions, for pneumoconiosis patients with lung masses to differentiate progressive massive fibrosis from lung cancer, and when invasion of the chest wall, vertebrae, diaphragm, or major vessels by malignant pleural mesothelioma or non-small cell lung cancer is suspected. Chest MRI without contrast enhancement or with minimal dose low-risk contrast media can be considered for pregnant women with suspected pulmonary embolism. Lastly, chest MRI is recommended for patients with pancoast tumors planned for radical surgery.

Current Status of Symptom and Pain Control in Cancer Patients Treated with Chemotherapy (화학요법을 받는 암환자의 증상 및 통증조절 현황)

  • Chung, Young;Na, Duck-Mi;Kim, Jin-Sun;Yang, Kyung-Mi
    • Journal of Hospice and Palliative Care
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    • v.6 no.2
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    • pp.144-151
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    • 2003
  • Purpose : The purpose of this study was to identify the current status of symptom and pain control in cancer patients treated with chemotherapy. Methods : The study population consisted of 66 cancer patients treated with chemotherapy and the data was collected by chart audit and using questionnaire from 19 clinicians in an university hospital during the period of August 7 to 24, 2001. The degree of symptom, analgesics type, dose, administration route, and pain control method of cancer patients treated with chemotherapy was investigated. The collected data were analyzed by frequency, percent, mean, and SD using SPSS $PC^+$ program. Results : The number of cancer patients treated with chemotherapy was 66, male 35 (53.0%), female was 31 (47.0%). The largest of age group was $61{\sim}69$(34.8%) years old. Most frequent cancer site was stomach 19 case (28.8%), cole-rectal 17 case (25.8%), urinary 11 case (16.7%) in the respective order. The most common stage of cancer was stage 3, 14 case (29.2%). The most frequent duration of diagnosis was under 3 month, 25 (37.9%). The frequent symptom of cancer patients treated with chemotherapy was marasmus ($2.4193{\pm}1.2220$), pain ($1.9333{\pm}1.2194$), sleep disorders ($1.7142{\pm}1.0384$), personality change ($1.5806{\pm}0.8971$) in the respective order. 3) The analgesics used for pai control were narcotic analgesics 66.2% and nonnarcotic analgesics 33.8%. Pain control method were regular basis+as needed 47.4%, as needed 31.6%, regular basis 21.0% in order. Administration route were oral 50.7%, injection 41.8%, patch 7.5% in order. Conclusion : The most frequent symptom of cancer patients treated with chemotherapy were marasmus and pain. The frequent analgesics was narcotic analgesics but 21% of the clinician regularly prescribed analgesics for pain control. Thus this prescription was insufficient for pain control. Administration route that were used more oral or injection than patch. Based on this evidence, it seemed that more active practice and education about evaluation and pain control of cancer patients treated with chemotherapy are needed.

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Test Execution Variation in Peritoneal Lavage Cytology Could Be Related to Poor Diagnostic Accuracy and Stage Migration in Patients with Gastric Cancer

  • Ki, Young-Jun;Ji, Sun-Hee;Min, Jae Seok;Jin, Sung-Ho;Park, Sunhoo;Yu, Hang-Jong;Bang, Ho-Yoon;Lee, Jong-Inn
    • Journal of Gastric Cancer
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    • v.13 no.4
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    • pp.214-225
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    • 2013
  • Purpose: Peritoneal lavage cytology is part of the routine staging workup for patients with advanced gastric cancer. However, no quality assurance study has been conducted to show variations or biases in peritoneal lavage cytology results. The aim of this study was to demonstrate a test execution variation in peritoneal lavage cytology between investigating surgeons. Materials and Methods: A prospective cohort study was designed for determination of the positive rate of peritoneal lavage cytology using a liquid-based preparation method in patients with potentially curable advanced gastric cancer (cT2~4/N0~2/M0). One hundred thirty patients were enrolled and underwent laparotomy, peritoneal lavage cytology, and standard gastrectomy, which were performed by 3 investigating surgeons. Data were analyzed using the chi-square test and a logistic regression model. Results: The overall positive peritoneal cytology rate was 10.0%. Subgroup positive rates were 5.3% in pT1 cancer, 2.0% in pT2/3 cancer, 11.1% in pT4a cancer, and 71.4% in pT4b cancer. In univariate analysis, positive peritoneal cytology showed significant correlation with pT stage, lymphatic invasion, vascular invasion, ascites, and the investigating surgeon. We found the positive rate to be 2.1% for surgeon A, 10.2% for surgeon B, and 20.6% for surgeon C (P=0.024). Multivariate analysis identified pT stage, ascites, and the investigating surgeon to be significant risk factors for positive peritoneal cytology. Conclusions: The peritoneal lavage cytology results were significantly affected by the investigating surgeon, providing strong evidence of test execution variation that could be related to poor diagnostic accuracy and stage migration in patients with advanced gastric cancer.

A Study on the substance of Eum-Fire(陰火) in Li Dong-yuan(李東垣)'s Eum-Fire theory (이동원(李東垣)이 논한 음화(陰火)의 실질(實質)에 대한 연구)

  • Eun, Seok-Min
    • Journal of Korean Medical classics
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    • v.25 no.4
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    • pp.5-22
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    • 2012
  • Objective : The concept of Eum-Fire(陰火), which was brought up by Li Dong-yuan(李東垣), is such a very ambiguous thing that many medical scholars had tried to understand its real meaning. Trying to understand the real concept of Eum-Fire, this study goes on based on the view that the concept of Eum-Fire in the medical books of Li Dong-yuan was used as being the same thing with the concept of Xim-Fire(心火) and Premier-Fire (相火), and the substance of this kind of fire is the fire in Ximpo(心包) and Myungmun (命門) which works in the system of Ximgye(心系). To verify this view is the main objective of this study. Method : Inquiring into Li Dong-yuan's medical books, this study investigated examples of the uses of the terms of Eum-Fire, Xim-Fire and Premier-Fire, and analyzed the relation between the meanings of these terms. And as a collateral evidence to the main view of this study, this study notes Wang An-dao(王安道)'s reference about Eum-Fire and inquires into the concept of Premier-Fire that was formed by Liu He-jian(劉河間), who had been referred to in Wang An-dao's argument about Eum-Fire. And this study also presents the Chen Shi-duo(陳士鐸)'s view about Eum-Fire that is expected to show a more concrete concept of Eum-Fire than now and seems to deserve to be compared with that of Li Dong-yuan. Result and Conclusion : It could be understood that the concept of Eum-Fire in Li Dong-yuan's books was used as a thing that owns the same substance as a kind of fire with Xim-Fire and Premier-Fire. In this viewpoint it could also be understood that Li Dong-yuan had attached the concepts like Xim-Fire and Eum-Fire to the concept of Premier-Fire, so terms like these could be understood as such concepts that represented the diverse figures of Premier-Fire. And this study also found that the substance of Xim-Fire as a kind of Premier-Fire means the fire of Ximpo and Myungmun that works in the system of Ximgye, which seems to be formerly introduced as a frame of Premier-Fire by Liu He-jian. This study also found the indirect basis of this viewpoint in the books of Chen Shi-duo, and could get a conclusion that Chen Shi-duo's view about Eum-Fire can be regarded as a thing that could show us more concrete matter of Eum-Fire than now.

The Study of MHC class I Restricted CD8+ T Cell Mediated Immune Responses against Mycobacterium tuberculosis Infection: Evidence of M. tuberculosis S pecific CD8+ T Cells in TB Patients and PPD+ Healthy Individuals (MHC class I 분자들에 의해 제시되는 Epitope을 인지하는 CD8+ T 림프구의 결핵균 감염에 대한 면역반응의 연구: 결핵 환자와 PPD+ 건강개체에 존재하는 결핵균 항원에 특정한 CD8+ T세포)

  • Cho, Jang-Eun;Lee, Kyung Wha;Park, Seung Kyu;Cheon, Seon-Hee;Cho, Sang-Nae;Cho, Sungae
    • IMMUNE NETWORK
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    • v.3 no.3
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    • pp.235-241
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    • 2003
  • Background: The protective immunity against tuberculosis (TB) involves both CD4+ T cells and CD8+ T cells. In our previous study, we defined four Mycobacterium tuberculosis derived peptide epitopes specific for HLA-$A^*0201$ restricted CD8+ T cells ($ThyA_{30-38}$, $RpoB_{127-135}$, $85B_{15-23}$, $PstA1_{75-83}$). In this study, we investigated the immune responses induced by these peptide specific CD8+ T cells in latently and chronically infected people with TB. Methods: We characterized these peptide specific CD8+ T cell population present in PBMC of both TB patients and PPD+healthy people using IFN-${\gamma}$elispot assay, intracellular staining and HLA-A2 dimer staining. Results: The frequency of peptide specific CD8+ T cell was in the range of 1 to 25 in $1.7{\times}10^5$ PBMC based on ex vivo IFN-${\gamma}$ elispot assay, demonstrating that these peptide specific CD8+ T cell responses are induced in both TB patients and PPD+ people. Short term cell lines (STCL) specific for these peptides proliferated in vitro and secreted IFN-${\gamma}$ upon antigenic stimulation in PPD+ donors. Lastly, HLA-$A^*0201$ dimer assays indicated that $PstA1_{75-83}$ specific CD8+ T cell population in PPD+ healthy donors is heterogeneous since approximately 25~33% of $PstA1_{75-83}$ specific CD8+ T cell population in PPD+ healthy donors produced IFN-${\gamma}$ upon peptide stimulation. Conclusion: Our results suggest that MHC class I restricted CD8+ T cell mediated immune responses to M. tuberculosis infection are induced in both TB patients and PPD + people; however, the CD8+ T cell population is functionally heterogeneous.

A Systematic Review and Meta-analysis of Sensory Integration Intervention Studies in Children with Cerebral Palsy (뇌성마비 아동의 감각통합 중재 연구에 대한 체계적 고찰과 메타분석)

  • Kim, Eun-Joo;Choi, Yoo-Im
    • Journal of Digital Convergence
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    • v.11 no.4
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    • pp.383-389
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    • 2013
  • The purpose of this study was to investigate evidence-based practice (EBP) for sensory integration (SI) intervention in children with cerebral palsy (CP) through a systematic review and meta analysis. The screening strategy was performed to select studies for analysis after that, a meta-analysis was implemented for calculating the effect size (ES) in group studies. Twenty-four studies were included for a systematic review and included seven case reports, three single-subject designs, and fourteen group experimental design studies(three randomized controlled trials, three two groups nonrandomized studies, and six one group nonrandomized studies). The ES of the experimental group studies was moderate size of 0.272. The results of the ES according to the dependent variables, the ES was the largest in the fine motor development. The effect size of the published papers was greater than the unpublished paper's and two groups nonrandomized studies' size effect was the largest in the design. The ES of the infants was larger than the children. The ES for a period of 8 weeks, the number of five times a week, and time in 90 minutes showed the biggest in SI program. Although the ES of SI intervention in children with CP showed moderate effect, accumulation of research well be needed.

The Equality of Keywords of Journal of KAPD with Medical Subject Headings (대한소아치과학회지의 주요어와 의학주제표목의 일치도)

  • Kim, Eunhee;Kim, Ahhyeon;Shim, Younsoo;Ahn, Eunsuk;Jeon, Eunyoung;An, Soyoun
    • Journal of the korean academy of Pediatric Dentistry
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    • v.43 no.2
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    • pp.123-128
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    • 2016
  • The purpose of this study is to analyze the equality between keywords used in the Journal of the Korean Academy of Pediatric Dentistry and medical subject headings (MeSH). A total of 4,353 English keywords in 1,165 papers from 1998 to 2014 were eligible for this study. We classified them according to equality to MeSH. We assayed patterns of errors in using MeSH, and reviewed frequently used non-MeSH terms. 24.9% of total keywords were completely coincident with MeSH terms, 75.1% were not MeSH terms. The results show that the accordance rate of keywords with MeSH terms in the Journal of the Korean Pediatric Dentistry is at a low level. Therefore, there is a need for authors to understand MeSH more specifically and accurately. Use of proper keywords aligned with the international standards such as MeSH is important to be properly cited. Authors should pay attention and be educated on the correct use of MeSH as keywords.

Mineral Imbalance: Bone Decalcification and Soft Tissue Calcification (무기질 불균형: 골 탈석회화와 연조직 석회화)

  • Jeong, Dae-Won;Lim, Hyun-Sook;Kang, Young-Hee
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.38 no.12
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    • pp.1815-1819
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    • 2009
  • Based on the soft and rigid extents, tissues are mainly divided into two groups in mammals, soft tissues including heart, lung, kidney and brain, and hard tissues including tendon, cartilage, teeth and bone. Among various tissues, bone, a dynamic rigid organ, is continuously remodeled by the opposing functional activity between bone formation by osteoblasts and bone destruction by osteoclasts. Bone protects the soft tissues and provides mineral reservoirs, which can supply the mineral needs of other soft tissues to normally maintain cellular function. While calcification in bone is an important action to fundamentally support the body and protect the soft tissues, calcification in soft tissues, including the heart, aorta, kidney, lung and spleen, results in severe organ damages, eventually causing sudden death. A growing body of evidence indicates that the osteoporotic patient who are aging, post-menopausal, diabetes and chronic kidney disease simultaneously represent a high clinical incidence of soft tissue calcification, illustrating a link between soft tissue calcification and bone decalcification (osteoporosis). This study will review what is currently known about the connection between bone decalcification and soft tissue calcification.

Using morphometrics to unravel species relationships and delimitations in Sorbus pohuashanensis in the Korean peninsula (한반도내 당마가목의 실체와 근연종과의 관계-전형질분석을 중심으로)

  • Park, Soo-Kyung;Gil, Hee-Young;Kim, Hui;Chang, Chin-Sung
    • Korean Journal of Plant Taxonomy
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    • v.43 no.4
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    • pp.300-311
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    • 2013
  • Subalpine species, Sorbus pohuashanensis in the Korean peninsula, which is assumed to be evolved from hybridization between S. commixta and an unknown species based on the flavonoids data. Morphometric analysis was conducted on the basis of 19 leaf and flower (or fruit) characters. A total of 721 samples in 13 populations of Sorbus pohuashanensis and S. commixta from Korea and additional specimens of S. commixta, S. pohuashanensis, and S. wilsoniana from Japan and China were examined to reveal the hybridization patterns and morphological differences. We found a preliminary evidence where Korean mountain rowan is more related to a Chinese inland taxon, S. wilsoniana, rather than Northeastern Chinese S. pohuashanensis in terms of flavonoids. The current morphological structure of the Korean mountaion rowan, however, which is more similar to S. commixta, was neither associated with that of S. wilsoniana nor that of S. pohuashanensis. This indicates that this morphological variation represents an intermediate of S. commixta and S. wilsoniana via a more ancient hybridization event in terms of qualitative characters, such as stipules, buds, and carpels. These morphometric differences together with other distinguishing characteristics suggest that the Korean mountain rowan should be considered as a conspecific species of S. commixta, although this demonstration of hybridization with the current phenetic species concept contradicts longstanding historical species concept.

Chinese Patients with Gastric Cancer Need Targeted Adjuvant Chemotherapy Schemes

  • Shi, Wen-Tao;Wei, Lei;Xiang, Jin;Su, Ke;Ding, Qiong;Tang, Meng-Jie;Li, Ji-Qiang;Guo, Yi;Wang, Pu;Zhang, Jing-Wei
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.10
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    • pp.5263-5272
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    • 2012
  • Background: Gastric cancer (GC) is one of the most common cancers in China. Adjuvant chemotherapy (AC) is a routine auxiliary treatment for GC recommended by the guidelines issued in 2011 by the Ministry of Health of the People's Republic of China, but the relevant credible consequences in China have been insufficient because of China's late start and ethical concerns. Methods: A series of databases, including Cochrane Library, MEDLINE, EMBASE, the Chinese database of the National Knowledge Infrastructure and the VIP database, were searched by 2 reviewers independently for studies investigating AC for GC through March 2012. The retrieved literature was screened according to the eligibility criteria. Results: A total of 35 randomized control trials (RCTs) were subjected to the final analysis, including 4,043 patients in treatment group and 3,884 in the control group, as well as 4 clinical-control trials (CCTs), which accessed the final analysis with 238 and 252 patients, respectively. AC reduced the risk of death as a protective treatment with statistical significance (HR=0.91, 95%CI: [0.85, 0.97], P=0.002), and it seemed more effective for Asian than non-Asian patients. The effects of AC were not influenced by the starting time (P>0.05). D2 lymphadenectomy-based chemotherapy was effective (HR=0.89, 95%CI: [0.80, 0.99], P=0.04). Oral S-1 40 mg/m2 after D2 lymphadenectomy might be a better choice for Asians with advanced GC and might result in a greater reduction of adverse events than in non-Asian patients. GRADE quality assessment determined that the strength of the evidence from foreign studies from Europe, the United States and Asian countries other than China was high, while it was moderate for Chinese studies. Conclusion: AC was effective or even curative in Chinese patients in general, although it is still necessary to optimize a targeted AC scheme for Chinese patients with GC.