• The Journal of Korean Medicine
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• v.41 no.2
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• pp.137-149
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• 2020

Background: Opioids are a class of drugs found in the opium poppy, and used primarily as a pain reliever. About 130 people die every day from opioid abuse in the U.S., and the number of deaths was 6 times higher than it was 20 years ago. Objectives: To derive the implications on Korean Medicine(KM), this study aimed to investigate the current state of opioids abuse in the U.S. and analyze cases to solve opioids abuse using acupuncture. Methods: Literature on opioids abuse in the U.S. were searched through the websites of government, agency, and research institute. Results: There were several cases using acupuncture on opioids abuse. First, the Act on the use of acupuncture was enacted. Second, the clinical practice guidelines by the American College of Physicians recommended using acupuncture. Third, a large clinical study was conducted on whether acupuncture could replace opioids. Fourth, Vermont and Washington State conducted pilot projects on insurance coverage of acupuncture. Conclusions: As opioids issues are also valid in Korea, KM can serve a critical role in pain management to pursue expanded insurance coverage. In order to do so, building the discourses of KM in opioid issues is critical by defining its medical advantage, conducting large-scale clinical researches and implementing pilot projects to tackle social problems.

• YAKHAK HOEJI
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• v.56 no.2
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• pp.126-135
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• 2012

Purpose: To develop therapeutic duplication criteria for the drugs used for respiratory diseases. Method: Therapeutic duplication was defined as "more than 2 drug ingredient-usage in which each has the same therapeutic effect and combination therapy does not confer additional therapeutic benefit". Respiratory system drugs approved in Korea were examined for the study. The WHO's Anatomical Therapeutic Chemical Classification System was used for grouping of the corresponding drug ingredients. The principles and recommendations on combination usage or multiple drug regimens were reviewed by using the clinical practice guidelines, textbooks, product labelings, and clinical articles. Clinical expert group consultation was performed and expert opinions were incorporated into the final criteria. Results: Nine hundred sixty two drug products with Korean Food and Drug Administration classification codes of 141, 149, 222, and 229 were evaluated, of which 87 active ingredients were composed. The drug ingredients were classified into 12 groups (antihistamines, oral nasal decongestants, leukotriene receptor antagonists, inhaled anticholinergics, inhaled corticosteroids, oral ${\beta}2$-agonists, long-acting ${\beta}2$-agonists, short-acting ${\beta}2$-agonists, xanthines, antiallergics, mucolytics and cough suppressants). The use of more than 2 drug ingredients including the same group was therapeutic duplication, and thus combination should be recommended not to be used. Conclusion: Twelve drug groups were identified as therapeutic duplication criteria. Combination therapy within each group should not be used otherwise therapeutic benefits outweigh potential risks.

• Korean Journal of Clinical Pharmacy
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• v.26 no.3
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• pp.220-229
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• 2016

Background: The treatment goal for patients with chronic hepatitis B infection is to prevent progression of the disease to cirrhosis and hepatocellular carcinoma. Current therapies include standard and pegylated interferon-alfa and nucleoside/nucleotide analogues: lamivudine, adefovir, entecavir, telbivudine, clevudine, and tenofovir. This study aims to analyze changes in the prescribing patterns of chronic hepatitis B (CHB) medications in South Korea between 2013 and 2014. Methods: A cross-sectional study was conducted using National Patients Sample data compiled by the Health Insurance Review and Assessment Service from 2013 and 2014. Patients with CHB were identified with Korean Standard Classification of Diseases code-6 (B18.0 and B18.1) and those who were maintaining active prescriptions with CHB medications covering the index date (December $1^{st}$, each year) were included. The utilization of antiviral therapy was investigated during 2013 and 2014. Results: A total of 4,204 and 4,552 patients in 2013 and 2014 respectively, were included in the analysis. The proportion of male patients was two of third and the patients 41-60 years old accounted for 60% of all analyzed patients. The most utilized drug was entecavir (55.1% in 2013 and 44.8% in 2014) and the second most utilized drug was tenofovir in both years (18.8% in 2013 and 29.0% in 2014). The percentage of combination therapy was 13.6% and 13.1% in 2013 and 2014, respectively. The proportion of tenofovir prescriptions was increased in 2014 compared with 2013. Conclusion: With the development of new drugs and the changes in clinical practice guidelines, the prescription pattern of the antiviral agents for patients with CHB has changed. The rate of utilization of tenofovir has increased.

• Archives of Plastic Surgery
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• v.41 no.5
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• pp.500-504
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• 2014

Background Skin cancer is the most prevalent cancer by organ type and referral accuracy is vital for diagnosis and management. The British Association of Dermatologists (BAD) and literature highlight the importance of accurate skin lesion examination, diagnosis and educationally-relevant studies. Methods We undertook a review of the relevant literature, a national audit of skin lesion description standards and a study of speciality training influences on these descriptions. Questionnaires (n=200), with pictures of a circular and an oval lesion, were distributed to UK dermatology/plastic surgery consultants and speciality trainees (ST), general practitioners (GP), and medical students (MS). The following variables were analysed against a pre-defined 95% inclusion accuracy standard: site, shape, size, skin/colour, and presence of associated scars. Results There were 250 lesion descriptions provided by 125 consultants, STs, GPs, and MSs. Inclusion accuracy was greatest for consultants over STs (80% vs. 68%; P<0.001), GPs (57%) and MSs (46%) (P<0.0001), for STs over GPs (P<0.010) and MSs (P<0.0001) and for GPs over MSs (P<0.010), all falling below audit standard. Size description accuracy sub-analysis according to circular/oval dimensions was as follows: consultants (94%), GPs (80%), STs (73%), MSs (37%), with the most common error implying a quadrilateral shape (66%). Addressing BAD guidelines and published requirements for more empirical performance data to improve teaching methods, we performed a national audit and studied skin lesion descriptions. To improve diagnostic and referral accuracy for patients, healthcare professionals must strive towards accuracy (a circle is not a square). Conclusions We provide supportive evidence that increased speciality training improves this process and propose that greater focus is placed on such training early on during medical training, and maintained throughout clinical practice.

• Journal of Physiology & Pathology in Korean Medicine
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• v.31 no.4
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• pp.201-212
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• 2017

This study draws pattern differentiations of headache disorders on the ground of modern clinical applications and Korean medical literature. Categorization and symptoms of headache disorders are based on International Classification of Headache Disorders 3rd edition(beta version). And clinical papers are searched in China Academic Journals(CAJ) of China National Knowledge Infrastructure(CNKI). In the aspect of eight principle pattern identification, primary headache occurs due to lots of yang qi and has more inner pattern rather than exterior pattern, heat pattern rather than cold pattern, excess pattern rather than deficiency pattern. And primary headache is related with liver in the aspect of visceral pattern identification and blood stasis, wind and phlegm are relevant mechanisms. Migraine without aura is associated with ascendant hyperactivity of liver yang, phlegm turbidity, sunken spleen qi, wind-heat, blood deficiency or yin deficiency. Migraine with aura is mainly related with wind and it's major mechanisms are ascendant hyperactivity of liver yang, liver fire, yin deficiency of liver and kidney, blood deficiency or liver depression and qi stagnation. High repetition rate of tension-type headache can be identified as heat pattern or excess pattern. And trigeminal autonomic cephalalgias can also be accepted as heat pattern or excess pattern when the occurrence frequency is high and is relevant to combined pattern with excess pattern of external contraction and deficiency pattern of internal damage based on facial symptoms by external contraction and nervous and anxious status by liver deficiency. This study can be expected to be Korean medical basis of clinical practice guidelines on headache by proposing pattern identifications corresponding to the western classifications of headache disorders.

• Korean Journal of Clinical Pharmacy
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• v.31 no.1
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• pp.61-78
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• 2021

Background and Objective: The use of potentially inappropriate medications (PIMs) increases the risk of negative health outcomes, including drug-related admissions. Tools for structured medication review have been developed to ensure optimal medication use and safety. Here, we aimed to evaluate medication use review (MUR) tools for community-dwelling older patients. Methods: We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). We searched PubMed, Embase, and the Cochrane Library from 1991 to 2020, excluding tools that are specifically applied to hospitalized patients or nursing home residents. We identified the most common inappropriate medications, drug-disease interactions, drug-drug interactions and prescribing omissions presented among tools. Results: From among 9,788 identified reports screened, 60 met our inclusion criteria; finally, 27 were eligible for data analysis considering originality and up-to-dateness. Most tools presented explicit criteria (93%), and only one was specific to community-dwelling elderly. The most common PIM was tricyclic antidepressants. Use of diltiazem and verapamil in patients with heart failure and the combination of nonsteroidal anti-inflammatory analgesics and warfarin were the most frequent disease-specific PIM and drug-interaction, respectively. Conclusions: Although several medication review tools have been developed for older adults, specific guidelines for community-dwelling populations remain limited. Furthermore, the list of PIMs differed among available tools. In future, specific but integrating MUR tools need to be developed for clinical practice considering this population.

• The Korea Journal of Herbology
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• v.39 no.2
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• pp.19-25
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• 2024

Objectives : Jeopgoltang (JGT) is a new Korean herbal medicine formulation that is used to treat bone fractures. Although JGT is frequently used in clinical practice, there is a lack of scientific evidence on its safety. This study aimed to evaluate the preclinical toxicity of JGT using a single oral dose toxicity test in Sprague-Dawley (SD) rats. Methods : Five male and female rats per group were orally administered 1,250, 2,500, or 5,000 mg/kg of JGT after fasting for 12 h. Mortality and changes in clinical signs, body weight, and necropsy findings were monitored for 14 days according to the guidelines of the Korean Ministry of Food and Drug Safety and Organisation for Economic Co-operation and Development (OECD). Results : No significant clinical signs or mortality were observed after a single administration of up to 5,000 mg/kg. In addition, no significant necropsy findings related to JGT administration were observed. Conclusions: In conclusion, these results suggest that approximate Lethal Dose (ALD) of JGT on SD rats is over 5,000 mg/kg.

• Journal of Pharmacopuncture
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• v.11 no.3
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• pp.17-31
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• 2008

Objective: To review the theoretic basis of the Sa-Ahm 5 Element acupuncture devised about 360 years ago, papers and books were researched. Methods: Total of 59 books and papers ranging from ancient Huang Di nei jing to modern Bio Medical Acupuncture for Pain Management were researched to study the basic theory of it in relation to the 5 Shu points, Results: Gao-mu in Chinese Ming dynasty, for the 1st time, had used 5 Shu points based on creation cycle as tonification and sedation treatment respectively and named it as 'tonification and sedation treatment of self meridian' but since then, this method, without special reasons, has been rarely used until Sa-Ahm's new doctrine that include the concept of destruction cycle was asserted. Conclusions: Sa-Ahm 5 Element acupuncture is a method which uses 5 Shu points from the viewpoints of simultaneous tonification and sedation methods which are based on promotion and control cycles. Though it is nowadays mostly-used method in accordance with practitioner's points, it needs to be set guidelines by which to effectively practice Sa-Ahm acupuncture.

• The Journal of Korean Physical Therapy
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• v.25 no.2
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• pp.71-75
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• 2013

Purpose: Although use of a tilt table is recommended in clinical practice, there are no published guidelines regarding pressure and inclination for tilt table use. The aim of the current study was to assess the changes of pressure on sacrum and buttock according to different inclination of the tilt table in healthy subjects. Methods: Thirty two healthy subjects participated in this study. Subjects were positioned supine on the tilt table and safety straps were secured across the chest, pelvic, and knee with sufficient tension to prevent the subjects from falling. Pressure and peak pressure of sacrum and buttock were measured using pressure mapping system with the tilt table standing at $0^{\circ}$, $15^{\circ}$, $30^{\circ}$, $45^{\circ}$, $60^{\circ}$, $75^{\circ}$, and $85^{\circ}$ inclination. Results: A significant decrease in the pressure of sacrum and buttock was achieved by increasing tilt table inclination (p<0.05): $0^{\circ}{\sim}15^{\circ}$ (8.16%), $15^{\circ}{\sim}30^{\circ}$ (8.02%), $30^{\circ}{\sim}45^{\circ}$ (11.61%), $45^{\circ}{\sim}60^{\circ}$ (16.18%), $60^{\circ}{\sim}75^{\circ}$ (16%), and $75^{\circ}{\sim}85^{\circ}$ (11.48%). A significant decrease in the peak pressure was achieved by increasing tilt table inclination (p<0.05): $30^{\circ}{\sim}45^{\circ}$ (9.91%), $45^{\circ}{\sim}60^{\circ}$ (19.24%), $60^{\circ}{\sim}75^{\circ}$ (19.93%), and $75^{\circ}{\sim}85^{\circ}$ (11.48%). No significant peak pressure change was observed in $0^{\circ}{\sim}15^{\circ}$, $15^{\circ}{\sim}30^{\circ}$ tilt table inclination (p>0.05). Conclusion: The results of this study showed that the pressure of sacrum and buttock were decreased according to increasing tilt table inclination in healthy subjects. Guidelines are needed in order to optimize patient safety and overall outcome for tilt table standing.

• Tuberculosis and Respiratory Diseases
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• v.79 no.4
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• pp.214-233
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• 2016

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.