• Anxiety and mood
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• v.20 no.2
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• pp.72-81
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• 2024

Objective : This study aimed to establish expert consensus on treatment strategies for generalized anxiety disorder (GAD) when treatment response is insufficient and when comorbid conditions are present as part of developing the 2024 Korean guidelines for the treatment of GAD. Methods : The executive committee developed a questionnaire based on existing international and Korean treatment guidelines and academic literature. Sixty-five experts participated in a survey. Responses were analyzed using chi-squared test and 95% confidence intervals to determine the level of consensus. Treatment strategies were categorized into first-line, second-line, and third-line choices. Results : For patients with an insufficient treatment response, combining pharmacotherapy and psychotherapy was the most preferred first-line strategy. Experts recommended switching to or augmenting with a different class of antidepressants, adding benzodiazepines or azapirones, and augmenting with atypical antipsychotics as first-line pharmacotherapy adjustments. Suitable psychotherapies included cognitive behavioral therapy (CBT), mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), and applied relaxation. For patients with comorbid conditions such as depression, other anxiety disorders, or alcohol and substance use disorders, a combination of pharmacotherapy and psychotherapy was also the most preferred first-line treatment. In these cases, the use of antidepressants alone or in combination with benzodiazepines, azapirones, or atypical antipsychotics was recommended. Conclusion : This expert consensus reflects current clinical practices and experiences in Korea, providing valuable insights for clinicians treating GAD patients who have insufficient treatment responses or comorbidities. Findings of this study emphasize the importance of a multimodal treatment approach, including both pharmacotherapy and psychotherapy. They also offer specific recommendations for adjusting treatment strategies in these complex cases.

• Journal of Veterinary Clinics
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• v.41 no.5
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• pp.295-300
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• 2024

The immune-mediated destruction of erythroid precursors within the bone marrow can result in inefficient erythropoiesis, classified as precursor-targeted immune-mediated anemia (PIMA). Herein, we describe the case of a 1-year-old Scottish Fold cat who presented with a pale mucous membrane with a history of prior diagnosis with immune-mediated hemolytic anemia (IMHA), characterized by normocytic normochromic moderate anemia. The cat was administered six months of immunosuppressive therapy, including prednisolone, cyclosporine, or mycophenolate mofetil, but exhibited insufficient reticulocytosis. Bone marrow examination subsequently revealed a decreased myeloid to erythroid ratio of 0.35:1, and PIMA was diagnosed. Treatment modification with chlorambucil was implemented, and the cat remained well-managed without IMHA recurrence for 15 months. This case highlights the importance of careful evaluation methods, such as reviewing medication history and performing bone marrow examinations, in IMHA patients with an insufficient response to immunosuppressive therapy. These results further suggest the occasional need for medication adjustments during treatment.

• Korean Journal of Clinical Pharmacy
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• v.25 no.1
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• pp.9-17
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• 2015

Background: Biologic disease-modifying antirheumatic drugs (bDMARDs) extend the treatment choices for rheumatoid arthritis patients with insufficient response or intolerance to conventional DMARDs (cDMARDs). These agents have considerable efficacy compared with conventional DMARDs, but only a few head-to-head comparisons among these agents have been performed. The objective of this systematic review and network meta-analysis (NMA) was to compare the relative efficacy of Certolizumab with conventional DMARD to licensed bDMARD with cDMARD therapy for patients who failed to prior cDMARD treatment under the condition of the reimbursement coverage criteria in Korea. Methods: A systematic review was conducted using MEDLINE and Cochrane library. Key endpoints were the American College of Rheumatology (ACR) responses of 20/50/70 at six months. Bayesian outcomes were calculated as median of treatment effect, probability of the best, Odds Ratio (OR) and probability that OR was greater than one. Results: Compared with other bDMARDs, Certolizumab were associated with higher or comparable ACR response rates; in ACR20, the OR (probability of OR>1) was 2.08 (92.6%) for Adalimumab, 1.86 (85.7%) for Etanercept, 1.89 (79.5%) for Golimumab, 2.36 (92.1%) for Infliximab, 1.79 (87.0%) for Abatacept, 1.74 (80.8%) for Rituximab and 1.82 (86.8%) for Tocilizaumab. In ACR50 and ACR70, the ORs did not present significant differences. Conclusion: Certolizaumab with cDMARD was more effective or comparable than other bDMARDs in patients who failed prior cDMARD treatment.

• Korean Journal of Health Education and Promotion
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• v.14 no.1
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• pp.1-9
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• 1997

The health education in hospitals has many problems including lack of the division specialized in health education, lack of implementation system of health education, insufficient professional health education and insufficient health education materials. Despite these restraints, hospitals should reinforce health education program as a part of active response centered on disease prevention and health promotion targeting healthy people who have potential health risk before the onset of disease, rather than passive approach emphasizing the treatment. Accordingly, health education team should be organized in a hospital, in which health educators can provide the following education services. First of all, hospitals themselves should provide active community services in collaboration with community organizations. In addition, multi-disciplinary approach in cooperation with schools, work places should be reinforced to establish the comprehensive health education system. The establishment of medical service referral system with other medical institutions and the linkage system for medical information exchange are also needed. The utilization of education materials obtained through these system should be open to community residents as well as patients. Finally, medical staff working in hospitals should try to provide the high-quality health education that is as high as the level of medical services. The high-quality health education is possible when its level is based on one required by community residents and the county rather than the international or arbitrary standard.

• THE JOURNAL OF KOREAN ORIENTAL ONCOLOGY
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• v.4 no.1
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• pp.71-87
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• 1998

Even though appropriate immune response is necessary for the survival of the individual, excessive or insufficient immune Response might cause autoimmune or allergic disease. So the immune response must be controlled to the degree that is beneficial for the well being of the individual. This study was undertaken to know the effects of Gunleetang Gagambang on the immune system of the mouse. Gunleetang Gagambang has been used for cure of tumor as a traditional medicine without any experimental evidence to support the rational basis for its clinical use. This study was carried out to evaluate the possible therapeutic or antitumoral effects of Gunleetang Gagambang extract against tumor, and to carry out some mechanisms responsible for its effect. Some kinds of tumor were induced by the typical application of 3-methylcholanthrene(MCA) or by the implantation(s.c) of malignant tumor cells such as leukemia cells(3LL cells) or sarcoma cells(S180 cells). Treatment of the Gunleetang Gagambang on water-extract(dailly 1mg/mouse, i. p.) was continued for 7 days prior to tumor induction and after that the treatment was lasted for 20 days. Against squamous cell carcinoma induced by MCA, Gunleetang Gagambang decreased not only the frequency of tumor production but also the number and the weight of tumors per tumor bearing mice(TBM). Gunleetang Gagambang on also significantly suppressed the development of 3LL cell and S180 cell-implanted tumors in occurrence-frequency and their size. and some developed tumors were regressed by the continuous treatment of Gunleetang Gagambang extract into TBM. In vitro, treatment of Gunleetang Gagambang extract had no effect on the growth of some kinds of cell line such as FsaII, A431 strain but significantly inhibited the proliferation of 3LL, S180 cells and augmented the DNA synthesis of mitogen-activated lymphocytes. Gunleetang Gagambang also stimulated the migrative ability of leukocyte, the MIF and IL-2 production of T lymphocytes, but not IL 6 production of B cells. Gunleetang Gagambang administration to mice enhanced NK cells activities. These results demonstrated that Gunleetang Gagambang extract exhibited a significant prophylactic benefits against tumors and its antitumor activity was manifested depending on the type of tumor cells. And these results also suggested that effect of Gunleetang Gagambang might be chiefly due to nonspecitie enhancement of NK cell activities and cell-mediated immune responses.

• The Korean Journal of Pain
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• v.12 no.2
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• pp.250-252
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• 1999

A 77-year-old male patient was admitted to the hospital with acute appendicitis and underwent emergency appendectomy under inhalation anesthesia without any complications. After the operation, the patient was placed on epidural analgesia with the mixture of fentanyl-bupivacaine and scopolamine patch for nausea and vomiting. The patient experienced central anticholinergic syndrome (CAS) with hallucination, confusion, somnolence, dysarthria and delirium at 20 hours after patch placement and recovered from all symptoms of CAS in 24 hours after the removal of the patch. The CAS occurs when central cholinergic sites are occupied by specific drugs and also as a result of an insufficient release of acetylcholine. The diagnosis of CAS is often determined by a process of exclusion and not actually made until a positive therapeutic response to physostigmine, a centrally active anticholiesterase agent, has taken place. Treatment of CAS includes prompt removal of the patch, cleansing of the area, and physostigmine administration. The scopolamine patch should be used with extreme caution in elderly patient.

• The Journal of Korean Medicine
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• v.41 no.3
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• pp.247-259
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• 2020

Objectives: This review aims to investigate clinical studies related to bee venom pharmacopuncture for cancer patients and to analyze the research trend for further study. Methods: We searched for clinical studies using bee venom pharmacopuncture therapy on patients with cancer through the electronic databases including Pubmed, Cochrane library, OASIS, KISS, NDSL, and KMBASE. There was no restriction on language and publication date, and after selection/exclusion process, the study design, target disease, intervention details including acupoints, treatment frequency and period, outcomes, study results and adverse events were extracted. Results: Thirteen clinical studies were finally selected. There were a randomized controlled trial RCT about the effect of sweet bee venom pharmacopuncture on cancer-related pain, and three case series about chemotherapy-induced peripheral neuropathy. In case reports, there were nine studies about oligodendroglioma, plexiform neurofibroma, breast cancer, prostate cancer, lung cancer, urachal adenocarcinoma, malignant melanoma, and atypical squamous cells of undetermined significance. The bee venom therapy affected the improvement of outcomes such as symptoms, quality of life, tumor response, and lab findings. Conclusions: The present study found that bee venom therapy is applicable to the treatment of cancer patients, and showed some effect on various symptoms. However, due to insufficient number and quality of studies, well designed and high-quality clinical trials are necessary to confirm the effectiveness and safety of bee venom pharmacopuncture therapy in patients with cancer.

• Child Health Nursing Research
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• v.27 no.1
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• pp.75-85
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• 2021

Purpose: The symptoms and impairments caused by cerebral palsy usually require long-term treatment, resulting in a substantial burden on the family of affected children. This study explored the experiences of fathers with prematurely-born children with cerebral palsy, with a focus on how such experiences influenced their families. Methods: A qualitative case study method was used. Nine subjects were recruited from April 2018 to June 2019 at one hospital, and each was interviewed three times by a neonatal nurse. Results: Five core experiences of fathers were identified: "regret for an insufficient initial response", "confronting my child born as a premature baby", "the position of being a dad who can't do anything", "the process of treatment like a tunnel with no exit", and "a father's getting meaning in life through children". These stories covered an individual's timeline and family interactions. Conclusion: Our findings suggest that fathers of prematurely-born children tend to suppress their emotions; therefore, a novel intervention program to encourage fathers' emotional expression and to support healthier interactions with their families is needed. Moreover, our findings could contribute basic information for the construction of a community-based support system to aid families, including prematurely-born children and other persons with impairments.

• The Journal of Pediatrics of Korean Medicine
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• v.8 no.1
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• pp.39-58
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• 1994

Even though appropriate immune response is necessary for the survival of the individual, excessive or insufficient immune response might cause autoimmune or allergic disease respectively. So the immune response must be controlled to the degree that is beneficial for the well being of the individual. This study was undertaken to know the effects of Junsibaekchulsan(JB) on the immune system od the mouse. For the evalulation of the cell-mediated immunity(CMI), delayed-type hypersensitivity against dinitrofluorobenzene(DNFB) were measured, and humoral immunity, hemagglutinin and hemolysin titers against SRBCs(sheep red blood cells) were measured, and rosette formation of spleen cells with SRBCs were measured. For the evaluation of innate immunity, phagocytic activity of macrophages, natural killer cell activity, and reactive nitrogen and oxygen intermediates were measured. The results are as follows: 1. The administration of JB depressed the antibody formation (hemagglutinin and hemolysin) against SRBCs. 2. The administration of JB did not affect the delayed-type hypersensitivity against DNFB. 3. The administration of JB did not affect the cytotoxic activity of natural killer cells. 4. The administration of JB increased the phagocytic activity of macrophages. 5. The administration of JB increased the rosette formating cells of the spleen cells. 6. The exposure of JB induced the secretion of reactive nitrogen intermediates but administration of JB deperssed the production of reactive oxygen intermediates. Administration of JB selectively depressed the humoral immune response without affecting CMI and innate immunity. These results of JB on the immune system might be useful for the treatment of such.

• Journal of Preventive Medicine and Public Health
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• v.53 no.5
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• pp.307-310
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• 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed unprecedented pressure on healthcare systems, even in advanced economies. While the number of cases of SARS-CoV-2 in Africa compared to other continents has so far been low, there are concerns about under-reporting, inadequate diagnostic tools, and insufficient treatment facilities. Moreover, proactiveness on the part of African governments has been under scrutiny. For instance, issues have emerged regarding the responsiveness of African countries in closing international borders to limit trans-continental transmission of the virus. Overdependence on imported products and outsourced services could have contributed to African governments' hesitation to shut down international air and seaports. In this era of emerging and re-emerging pathogens, we recommend that African nations should consider self-sufficiency in the health sector as an urgent priority, as this will not be the last outbreak to occur. In addition to the Regional Disease Surveillance Systems Enhancement fund (US$600 million) provided by the World Bank for strengthening health systems and disease surveillance, each country should further establish an epidemic emergency fund for epidemic preparedness and response. We also recommend that epidemic surveillance units should create a secure database of previous and ongoing pandemics in terms of aetiology, spread, and treatment, as well as financial management records. Strategic collection and analysis of data should also be a central focus of these units to facilitate studies of disease trends and to estimate the scale of requirements in preparation and response to any future pandemic or epidemic.