• Title/Summary/Keyword: Evidence-based practical medicine

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Antidepressant Prescription Patterns in Bipolar Disorder: a Nationwide, Register-based Study in Korea

  • Yoon, Woon;Shon, Seung-Hyun;Hong, Youjin;Joo, Yeon Ho;Lee, Jung Sun
    • Journal of Korean Medical Science
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    • v.33 no.46
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    • pp.290.1-290.11
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    • 2018
  • Background: The role of antidepressants (ADs) in bipolar disorder is long-standing controversial issue in psychiatry. Many clinicians have used ADs as a treatment for bipolar depression, and the selection of therapeutic agents is very diverse and inconsistent. This study aimed to examine recent AD prescription patterns for patients with bipolar disorder in Korea, using the nationwide, population-based data. Methods: This study utilized the Korean nationwide, whole population-based registry data of the year 2010, 2011, and 2013. All prescription data of the ADs, antipsychotics, and mood stabilizers of the sampled patients diagnosed with bipolar disorder (n = 2,022 [in 2010]; 2,038 [in 2011]; 2,626 [in 2013]) were analyzed for each year. Results: Annual prescription rate of ADs was 27.3%-33.6% in bipolar disorder, which was gradually increasing over the 3-year period. The combination pattern of ADs and antipsychotic drugs tended to increase over 3 years. The proportion of females and the prevalence of comorbid anxiety disorder were significantly higher in AD user group in all three years. Among individual ADs, escitalopram was prescribed most frequently, and fluoxetine and bupropion were prescribed to the next many patients. The mean duration of bipolar depressive episodes was 135.90-152.53 days, of which ADs were prescribed for 115.60-121.98 days. Conclusion: Our results show prescription rate of ADs in bipolar disorder was maintained at substantial level and increased in recent 3 years. More empirical data and evidence are needed to establish practical treatment consensuses.

A Survey on Korean Medicine Doctors' Recognition and Treatment Method for Developing Clinical Practice Guideline of Nausea and Vomiting of Pregnancy (임신오조 한의표준임상진료지침 개발을 위한 한의사의 인식과 치료 실태에 관한 조사)

  • Heung-Sook Lee;Hyo-Jeong Jung;Su-Ji Choi;Dong-Il Kim
    • The Journal of Korean Obstetrics and Gynecology
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    • v.36 no.2
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    • pp.36-54
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    • 2023
  • Objectives: This study was aimed to develop a Korean Medicine (KM) clinical practice guideline (CPG) of Nausea and Vomiting of Pregnancy (NVP). Methods: We conducted a questionnaire survey targeting KM doctors belonging to the Association of Korean Medicine by e-mail. We received 1,023 responds, and analyzed the answers. Results: 1. 83.0% of respondents knew the concepts and contents of CPG, and 98.1% had practical use plan. 2. 82.1% of respondents used pattern identification diagnosis for NVP patients, and the most commonly diagnosed pattern was spleen-stomach weakness (脾胃虛弱) with 41.3%. 3. The most frequently used treatment for NVP patients was KM combined treatment (46.7%). Herbal medicine+acupuncture (46.8%) was most used among KM combined treatments, and herbal medicine (37.1%) was most used among KM single treatments. 4. Among the contents of CPG for NVP, the fields of interest were selected in the order of KM treatment, KM-Western medicine cooperative treatment, KM diagnosis, prevention and regimen management. In the 'diagnosis part', the use of the symptom evaluation scale questionnaire was 41.8%, higher than the KM pattern diagnosis (34.4%). In the 'treatment part', herbal medicine accounted for 33.8%, higher than that of acupuncture (including electro-acupuncture) at 23.7%. 5. As for the expected development effects, opinions on evidence-based, safety, clinical use, and standardization were the most common. Conclusions: We figured out KM doctors' recognition of KM clinical practice guideline, clinical diagnosis, treatment on NVP to make the contents of the CPG reflecting the clinical situation.

Ethanol Ablation of the Thyroid Nodules: 2018 Consensus Statement by the Korean Society of Thyroid Radiology

  • Soo Yeon Hahn;Jung Hee Shin;Dong Gyu Na;Eun Joo Ha;Hye Shin Ahn;Hyun Kyung Lim;Jeong Hyun Lee;Jeong Seon Park;Ji-hoon Kim;Jin Yong Sung;Joon Hyung Lee;Jung Hwan Baek;Jung Hyun Yoon;Jung Suk Sim;Kwang Hwi Lee;Seon Mi Baek;So Lyung Jung;Yeo Koon Kim;Yoon Jung Choi
    • Korean Journal of Radiology
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    • v.20 no.4
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    • pp.609-620
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    • 2019
  • Minimally invasive treatment of symptomatic thyroid nodules is now commonplace. Ethanol ablation (EA) of thyroid cystic nodules has been performed since the 1990s, but there is no global consensus or guideline. Although various limitations of EA have been described, recommendations for practical application are necessary. Therefore, the Task Force Committee of the Korean Society of Thyroid Radiology initiated the present consensus statement and here we provide recommendations for the role of EA in the management of symptomatic thyroid nodules. These recommendations are based on evidence to date from the literature and expert opinion.

An Experimental Study on the Effect of Maltol against Oxygen Toxicity (산소중독에 대한 MALTOL의 보호효과에 관한 실험적 연구)

  • Hwang, Sung-Joo;Cho, Soo-Hon;Yon, Dork-Ro
    • Journal of Preventive Medicine and Public Health
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    • v.26 no.4 s.44
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    • pp.551-564
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    • 1993
  • Since the widespread application of hyperbaric oxygenation in clinical medicine, the problems of oxygen toxicity have been attracting a deep interest from the researchers on hyperbaric medicine as a practical issue. Among extensive research trials, the study on the protective agents oxygen toxicity occupied one of the most challenging field. As the mechanisms of oxygen toxicity, the role of the oxygen free radicals produced by peroxidation process are strongly accepted by the leading researchers on oxygen toxicity, the probable protective effects of antioxidant against oxygen toxicity are sustaining a sufficient rational. Maltol ($2-methyl-3-hydroxy-{\gamma}-pyrone$) which is known to be a component of Korean red ginseng has been reporting to have an antioxidant action. But, further study is needed to provide definite evidence for this compound to be an antioxidant, since the action was based on the results which were obtained under in vitro experiment. In this study, the author attempted to evaluate the effect of maltol as protective agent against oxygen toxicity through the observation of death rate, convulsion rate, time to convulsion and microscopic pathological changes in some organs of experimental rats exposed to various conditions. The findings observed are as follows : 1) The death rate, convulsion rate, time to convulsion, lung/weight ratio and microscopic pathological finding of lung were identified as reliable objective and quantitative indices for oxygen toxicity. 2) Maltol showed excellent protective effect against pulmonary oxygen toxicity as an antioxidant.

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Current Status of Herb-Drug Interaction Information and Information Database in Korea (국내 한약-양약 상호작용 연구논문 분석을 통한 상호작용 정보 현황파악 및 제공방안에 대한 연구)

  • Park, Soo-Jin;Kwon, Young-Kyu;Shin, Jae-Gook
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.24 no.4
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    • pp.543-552
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    • 2010
  • The objectives of this study are to examine the current status and problems of herb-drug interaction (HDI) information and information database in Korea and suggest the better way to establish useful HDI database. We collected HDI studies that published in Korea and analyzed according to objective, methods, selection criteria of herbs, number of study, correlation between study subject and frequently used herbal medicine (HM). Then we selected representative HM database on the internet made by Korea Food and Drug Administration (KFDA) among the several databases and analyzed its contents related to HDI. Several HDI studies were carried out from laboratory based research to clinical trials and HM databases have been developed for providing information about different aspects of traditional Korean medicine. But the information of HDI and information database are still far from practical applications because there are no coherence to select study subjects and methods among researchers. So, it is necessary to build up HDI database led by the government for providing systematic HDI information. HDI information database is expected to be able to provide useful evidence for health professionals in prescription and consultation to reduce the chance of adverse effects and improve the quality of medical care.

Middle East Consensus Statement on the Prevention, Diagnosis, and Management of Cow's Milk Protein Allergy

  • Vandenplas, Yvan;Abuabat, Ahmed;Al-Hammadi, Suleiman;Aly, Gamal Samy;Miqdady, Mohamad S.;Shaaban, Sanaa Youssef;Torbey, Paul-Henri
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.17 no.2
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    • pp.61-73
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    • 2014
  • Presented are guidelines for the prevention, diagnosis, and treatment of cow's milk protein allergy (CMPA) which is the most common food allergy in infants. It manifests through a variety of symptoms that place a burden on both the infant and their caregivers. The guidelines were formulated by evaluation of existing evidence-based guidelines, literature evidence and expert clinical experience. The guidelines set out practical recommendations and include algorithms for the prevention and treatment of CMPA. For infants at risk of allergy, appropriate prevention diets are suggested. Breastfeeding is the best method for prevention; however, a partially hydrolyzed formula should be used in infants unable to be breastfed. In infants with suspected CMPA, guidelines are presented for the appropriate diagnostic workup and subsequent appropriate elimination diet for treatment. Exclusive breastfeeding and maternal dietary allergen avoidance are the best treatment. In infants not exclusively breastfed, an extensively hydrolyzed formula should be used with amino acid formula recommended if the symptoms are life-threatening or do not resolve after extensively hydrolyzed formula. Adherence to these guidelines should assist healthcare practitioners in optimizing their approach to the management of CMPA and decrease the burden on infants and their caregivers.

Tailored Sun Safety Messages for Outdoor Workers

  • Sajjad S. Fazel;Shelby Fenton;Nicole Braun;Lindsay Forsman-Phillips;D. Linn Holness;Sunil Kalia;Victoria H. Arrandale;Thomas Tenkate;Cheryl E. Peters
    • Safety and Health at Work
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    • v.14 no.1
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    • pp.43-49
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    • 2023
  • Background: Messaging surrounding skin cancer prevention has previously focused on the general public and emphasized how or when activities should be undertaken to reduce solar ultraviolet radiation (UVR) exposure. Generic messages may not be applicable to all settings, and should be tailored to protect unique and/or highly susceptible subpopulations, such as outdoor workers. The primary objective of this study was to develop a set of tailored, practical, harm-reducing sun safety messages that will better support outdoor workers and their employers in reducing the risk of solar UVR exposure and UVR-related occupational illnesses. Methods: We adapted a core set of sun safety messages previously developed for the general population to be more applicable and actionable by outdoor workers and their employers. This study used an integrated knowledge translation approach and a modified Delphi method (which uses a survey-based consensus process) to tailor the established set of sun safety messages for use for outdoor worker populations. Results: The tailored messages were created with a consideration for what is feasible for outdoor workers, and provide users with key facts, recommendations, and tips related to preventing skin cancer, eye damage, and heat stress, specifically when working outdoors. Conclusion: The resulting tailored messages are a set of evidence-based, expert- approved, and stakeholder-workshopped messages that can be used in a variety of work settings as part of an exposure control plan for employers with outdoor workers.

Trend Review of Traditional Chinese Medicine Studies on Pharmacopuncture Treatment for Post-Stroke Depression (뇌졸중 후 우울증의 약침치료에 대한 중의학 임상논문 연구동향)

  • Lee, Yeogyeong;Khang, Hyunjin;Song, Geumju;Oh, Jiyeon;Kim, Sangbeom;Kim, Jongmin;Park, Sejin
    • Journal of Oriental Neuropsychiatry
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    • v.32 no.3
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    • pp.235-245
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    • 2021
  • Objectives: To provide clinical evidence of pharmacopuncture treatment for post-stroke depression by reviewing randomized controlled trials on Traditional Chinese medicine pharmacopuncture for post-stroke depression. Methods: Randomized controlled trials on pharmacopuncture treatment for post-stroke depression were searched from the China National Knowledge Infrastructure (CNKI). Literature searches of English and Chinese databases were performed. Selected literature was assessed with the Jadad scale. Results: Twelve papers were selected from 20 studies. The following results were obtained: 1) Pharmacopuncture was used for post-stroke depression; 2) Dengzhan-Xixin was the most used injection medicine for post-stroke depression; 3) BaiHui (GV20) was the most used in pharmacopuncture treatment; 4) Based on the Hamilton Depression Rating Scale (HAMD), it was confirmed that all studies using pharmacopunture had significant efficacy. Conclusions: For the treatment of post-stroke depression, Dengzhans-Xixin was commonly used as an injectable medication. Additional research studies on pharmacopuncture including its practical use are needed.

Self-evaluated knowledge of pharmacy customers in South-Estonia about the use and safety of herbal products

  • Volmer, Daisy;Lilja, John;Hamilton, David
    • CELLMED
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    • v.1 no.1
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    • pp.8.1-8.4
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    • 2011
  • Medicinal plants and their products are popular in Estonia. There are two approaches to use of herbal products: first, that based on traditions and practical experience and, second, that supported by scientific evidence. It is important to marry these two approaches. One place where traditions and new knowledge could meet is the pharmacy. In this study we evaluated knowledge about the use and safety of herbal products of pharmacy customers in South-Estonia. A convenience sample of pharmacy customers in south Estonia (n = 196) participated in the study. Of the survey participants, 76% were frequent or occasional users of herbal products and considered these products safe (75%) and effective (73%). Herbal products were mostly (91%) consumed for prophylaxis or treatment of minor illnesses. Main information sources about herbal products were pharmacists (75%) and package information leaflets (65%). Mode of action (95%), administration (81%) and indication (77%) were the information details more frequently sought from the pharmacy about herbal products. Of the survey participants, 22% described some problems connected with the use of herbal products. Herbal products are popular in Estonia and pharmacists have an important role in counselling on these products. Despite knowledgeable use of herbal products and infrequent experience of side effects with these products, safety issues should be more stressed in the providing of information details to pharmacy customers.

Benefits and risks of therapeutic alternatives for macrolide resistant Mycoplasma pneumoniae pneumonia in children

  • Yang, Hyeon-Jong
    • Clinical and Experimental Pediatrics
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    • v.62 no.6
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    • pp.199-205
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    • 2019
  • Although Mycoplasma pneumoniae pneumonia (MPP) has been generally susceptible to macrolides, the emergence of macrolide-resistant MPP (MRMP) has made its treatment challenging. MRMP rapidly spread after the 2000s, especially in East Asia. MRMP is more common in children and adolescents than in adults, which is likely related to the frequent use of macrolides for treating M. pneumoniae infections in children. MRMP is unlikely to be related to clinical, laboratory, or radiological severity, although it likely prolongs the persistence of symptoms and the length of hospital stay. Thereby, it causes an increased burden of the disease and poor quality of life for the patient as well as a societal socioeconomic burden. To date, the only alternative treatments for MRMP are secondary antimicrobials such as tetracyclines (TCs) or fluoroquinolones (FQs) or systemic corticosteroids; however, the former are contraindicated in children because of concerns about potential adverse events (i.e., tooth discoloration or tendinopathy). A few guidelines recommended TCs or FQs as the second-line drug of choice for treating MRMP. However, there have been no evidence-based guidelines. Furthermore, safety issues have not yet been resolved. Therefore, this article aimed to review the benefits and risks of therapeutic alternatives for treating MRMP in children and review the recommendations of international or regional guidelines and specific considerations for their practical application.