• Title/Summary/Keyword: Clinical guideline

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Effect of Cognitive Behavioral Therapy (CBT) for Perinatal Depression: A Systematic Review and Meta-Analysis (산전우울 임부를 위한 인지행동치료 프로그램의 효과: 체계적 문헌고찰 및 메타분석)

  • Shin, Hyeon-Hee;Shin, Yeong-Hee;Kim, Ga-Eun
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.11
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    • pp.271-284
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    • 2016
  • This study was carried out to evaluate the efficacy of CBT for perinatal depression through systematic literature review and meta-analysis. The following databases were used to search the literature: CINAHL, PubMed, EMBASE, Koreamed, Library of Korean Congress, KISS, and Korean Academic Publication Database. Keywords included 'perinatal depression,' 'pregnant women,' and 'cognitive behavioral therapy,' and the evaluated articles were published up to May 2016. Using the R program, the effect size of perinatal depression and anxiety were calculated by random-effects model. The heterogeneity of the effect size was analyzed by data moderator analysis using the meta-ANOVA. Furthermore, the funnel plot, Egger's regression test, fail-safe N, trim-and-fill test, and publication bias analysis were conducted and used to verify the results. Out of the 180 selected articles, 16 clinical trial studies were meta-analyzed. Each articles were evaluated for the risk of bias by the checklist of SIGN; the overall risk of bias was low. The effect size of CBT for perinatal depression was Hedges' g=-0.55 (95% CI: -0.76~-0.33), which was a moderate level, while for anxiety reduction, Hedges' g=-0.20 (95% CI: -0.48~-0.08) and it was not statistically significant. Heterogeneity or risk of publication bias were low. This meta-analytic study found that CBT is moderately effective in reducing perinatal depression in pregnant women.

Advances in Radiation Oncology in New Millennium in Korea (21세기 방사선종양학의 전망:최근의 진보와 한국에서의 발전)

  • Huh, Seung-Jae;Park, Chan-Il
    • Radiation Oncology Journal
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    • v.18 no.3
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    • pp.167-176
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    • 2000
  • The objective of recent radiation therapy is to improve the quality of treatment and the after treatment quality of life. In Korea, sharing the same objective, significant advancement was made due to the gradual increase of patient number and rapid increase of treatment facilities. The advancement includes generalization of three-dimensional conformal radiotherapy (3D-CRT), application of linac-based stereotactic radiosurgery (SRS), and furthermore, the introduction of intensity modulated radiation therapy (IMRT). Authors in this paper prospectively review the followings: the advancement of radiation oncology in Korea, the recent status of four-dimensional radiation therapy, IMRT, the concept of the treatment with biological conformity, the trend of combined chemoradiotherapy, the importance of internet and radiation oncology information management system as influenced by the revolution of information technology, and finally the global trend of telemedicine in radiation oncology. Additionally, we suggest the methods to improve radiotherapy treatment, which include improvement of quality assurance (QA) measures by developing Koreanized QA protocol and system, regional study about clinical protocol development for phase three clinical trial, suggestion of unified treatment protocol and guideline by academic or research societies, domestic generation of treatment equipment's or system, establishment of nationwide data base of radiation-oncology-related information, and finally patterns-of-care study about major cancers.

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The preliminary study for three-dimensional alveolar bone morphologic characteristics for alveolar bone restoration

  • Cho, Hyun-Jae;Jeon, Jae-Yun;Ahn, Sung-Jin;Lee, Sung-Won;Chung, Joo-Ryun;Park, Chang-Joo;Hwang, Kyung-Gyun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.41
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    • pp.33.1-33.7
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    • 2019
  • Background: The concept of the ideal morphology for the alveolar bone form is an important element to reconstruct or restore the in maximizing esthetic profile and functional alveolar bone restoration. The purpose of this preliminary study is to evaluate the normal alveolar bone structure to provide the standard reference and guide template for use in diagnosing for implant placement, determining the correct amount of bone augmentation in actual clinical practice and producing prostheses based on three-dimensional imaging assessment of alveolar bone. Methods: This study was included 11 men and 11 women (average age, 22.6 and 24.5 years, respectively) selected from among 127 patients. The horizontal widths of alveolar bone of maxilla and mandible were measured at the crestal, mid-root, and root apex level on MDCT (multi-detector computed tomography) images reconstructed by medical imaging software. In addition, tooth dimensions of the central incisors, canines, second premolars, and first molars of maxilla and mandible, including the horizontal width of the interdental alveolar bone crest, were also measured and statistically analyzed. Results: The horizontal alveolar bone width of the palatal side of maxilla showed a distinct increment from the alveolar bone crest to the apical region in both anterior and posterior areas. The average widths of the maxillary alveolar ridge were as follows: central incisor, 7.43 mm; canine, 8.91 mm; second premolar, 9.57 mm; and first molar, 12.38 mm. The average widths of the mandibular alveolar ridge were as follows: central incisor, 6.21 mm; canine, 8.55 mm; second premolar, 8.45 mm; and first molar, 10.02 mm. In the buccal side, the alveolar bone width was not increased from the crest to the apical region. The horizontal alveolar bone width of an apical and mandibular border region was thinner than at the mid-root level. Conclusions: The results of the preliminary study are useful as a clinical guideline when determining dental implant diameter and position. And also, these measurements can also be useful during the production of prefabricated membranes and customized alveolar bone scaffolds.

Single Dose Toxicity Test of 'Mahwangyounpae-tang' Extract in Male ICR Mouse (마황윤폐탕(麻黃潤肺湯) 추출물의 수컷 ICR 마우스에서 경구 단회투여 독성 평가)

  • Jung, Woo-Sik;Cho, Dong-Hee;Seo, Yeong-Ho;Park, Mee-Yeon;Choi, Hae-Yun;Kim, Jong-Dae;Jeon, Kwi-Ok
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.20 no.2
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    • pp.442-448
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    • 2006
  • To obtain the 50% lethal dose (LD50), approximated lethal dose (ALD) and approximated target organs of 'Mahwangyounpae-tang' for further study like repeat dose toxicity, genotoxicity and reproductive toxicity, single dose toxicity was tested in male ICR mouse according to KFDA Guideline 1999-61 [KFDA, 1999] at a dosage level of 2,000, 1,000, 500, 250 and $125\;mg/kg/10m{\ell}$. In this study, mortalities, clinical signs, body weight changes and body weight gains, gross findings and weight of principal organs were detected during and/or after 14 days of single dosing. After 2 or 3 days of dosing, 1 or 2 animals in 2,000 and 1,000 mg/kg-dosing groups were died. Excitation and leaping response were observed as test article-treatment related clinical signs. These abnormal signs were restricted to 2,000 and 1,000 mg/kg-dosing groups and they were recovered to normal within 4 days after dosing in case of survivors. A significant decrease of body weight were observed in some periods of observation in 2,000 and 1,000 mg/kg-dosing group from 1 days after dosing compared to those of vehicle control group. A significant decrease of body weight gains were observed in observation periods in 2,000 and 1,000 mg/kg-dosing group compared to those of vehicle control group. Hypertrophy of heart and decoloration of kidney were observed as test article-treatment related gross findings. These abnormal findings were restricted to 2,000 and 1,000 mg/kg-dosing groups. A significant increase of absolute and relative heart and kidney weight were demonstrated in 2,000 mg/kg-dosing groups. LD50 in this study was detected as 2,242.42 mg/kg. ALD in this study was detected as 1,000 mg/kg and the target organ was considered as the heart and kidney.

Changes in Renal Function by Nebulized Colistimethate Treatment (Colistimethate 분무요법 시행 환자에서 투여 전후 신기능의 변화)

  • Ahn, Hye Jin;Jung, Yoo Jin;Kim, Jae Song;Kim, Soo Hyun;Son, Eun Sun
    • Korean Journal of Clinical Pharmacy
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    • v.27 no.2
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    • pp.92-98
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    • 2017
  • Background: Nebulized colistimethate is increasingly used, because there are problems such as renal dysfunction and low distribution within the lungs when colistimethate is administered intravenously. This study was designed to compare and analyze the changes in renal function by of nebulized colistimethate treatment for its safe administration. Methods: This study retrospectively reviewed the electronic medical records of adult patients above 19 years old, receiving only the nebulized colistimethate at least 4 days in Yonsei university health system from Nov 2014 to Aug 2015. Acute kidney injury (AKI) was determined by using the RIFLE criteria (Risk, Injury, Failure, Loss and End-stage renal disease) according to serum creatinine (SCr) levels before and after use of nebulized colistimethate. Results: 48 patients were included our study and their SCr increased significantly after nebulized colistimethate treatment ($SCr_0$ vs. $SCr_1$; $0.85{\pm}0.80$ vs. $1.00{\pm}0.82mg/dL$, n=48, p<0.001), but the changes were in normal range according to the standards at Yonsei university health $system^a$. Among 48 patients, 38 patients were in the non-AKI group (79.2%), and 10 patients developed AKI (20.8%). Within the AKI group, 2 patients were in the Injury group (20%) and the other 8 in the Risk group (80%). Conclusion: There was no significant difference in age, dosage and duration of treatment between AKI group and non-AKI group (p>0.05). The study has a significance in that it reviewed the safety of nebulized colistimethate only treatment to national patients, analyzing its nephrotoxicity. It has confirmed that nebulized colistimethate is a safer method than intravenous injection, and requires to establish a guideline for the use of nebulized colistimethate in further studies with broader patient groups. $^a$ : SCr Male 0.68-1.19 mg/dL, Female 0.49-0.91 mg/dL.

Metastatic Colorectal Cancer Treatment and Survival: the Experience of Major Public Hospitals in South Australia Over Three Decades

  • Roder, David;Karapetis, Christos S;Wattchow, David;Moore, James;Singhal, Nimit;Joshi, Rohit;Keefe, Dorothy;Fusco, Kellie;Buranyi-Trevarton, Dianne;Sharplin, Greg;Price, Timothy J
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.14
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    • pp.5923-5931
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    • 2015
  • Background: Registry data from four major public hospitals indicate trends over three decades from 1980 to 2010 in treatment and survival from colorectal cancer with distant metastases at diagnosis (TNM stage IV). Materials and Methods: Kaplan-Meier product-limit estimates and Cox proportional hazards models for investigating disease-specific survival and multiple logistic regression analyses for indicating first-round treatment trends. Results: Two-year survivals increased from 10% for 1980-84 to 35% for 2005-10 diagnoses. Corresponding increases in five-year survivals were from 3% to 16%. Time-to-event risk of colorectal cancer death approximately halved (hazards ratio: 0.48 (0.40, 0.59) after adjusting for demographic factors, tumour differentiation, and primary sub-site. Survivals were not found to differ by place of residence, suggesting reasonable equity in service provision. About 74% of cases were treated surgically and this proportion increased over time. Proportions having systemic therapy and/or radiotherapy increased from 12% in 1980-84 to 61% for 2005-10. Radiotherapy was more common for rectal than colonic cases (39% vs 7% in 2005-10). Of the cases diagnosed in 2005-10 when less than 70 years of age, the percentage having radiotherapy and/or systemic therapy was 79% for colorectal, 74% for colon and 86% for rectum (&RS)) cancers. Corresponding proportions having: systemic therapies were 75%, 71% and 81% respectively; radiotherapy were 24%, 10% and 46% respectively; and surgery were 75%, 78% and 71% respectively. Based on survey data on uptake of offered therapies, it is likely that of these younger cases, 85% would have been offered systemic treatment and among rectum (&RS) cases, about 63% would have been offered radiotherapy. Conclusions: Pronounced increases in survivals from metastatic colorectal cancer have occurred, in keeping with improved systemic therapies and surgical interventions. Use of radiotherapy and/or systemic therapy has increased markedly and patterns of change accord with clinical guideline recommendations.

A Web-based Survey for Assessment of Korean Medical Treatment Clinical Practice Patterns for Neck Pain and Cervical Intervertebral Disc Displacement (경항통 및 경추 추간판 탈출증의 한의진료 임상현황조사를 위한 웹기반 설문조사)

  • Suh, Chang Yong;Lee, Yoon Jae;Kim, Me-riong;Bae, Young Hyeon;Kim, Ho Sun;Kim, No Hyeon;Yang, Kyu Jin;Lee, Gi Bum;Ha, In Hyuk
    • Journal of Acupuncture Research
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    • v.33 no.4
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    • pp.65-72
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    • 2016
  • Objectives : While neck pain is highly prevalent in Korea, studies examining its Korean medical treatment are currently lacking. The aim of this study was to assess current Korean medical treatment practice patterns for neck pain. Methods : A preliminary questionnaire was developed to investigate current practice patterns of neck pain and cervical intervertebral disc displacement (IDD) treatment, and underwent further revision through external review. The final questionnaire was distributed as a web-based survey to 18,289 potential respondents by email. Results : The response rate was 3.34 %. Most participants replied that they received multiple Korean medicine interventions for neck pain treatment consisting of such methods as acupuncture, wet cupping, interferential current therapy and electroacupuncture. A total of 378 respondents acknowledged that diagnostic testing was needed for neck pain treatment. The most commonly used Korean Standard Classification of Diseases (KCD) principal diagnosis code for neck pain was M542, and for cervical IDD was M501. Conclusion : This survey study helps determine current practice patterns of neck pain, and recognizes the need for use of diagnostic devices in neck pain treatment. These results are further anticipated to provide basic data for clinical practice guidelines (CPGs) and future studies using Korean National Health Insurance and Health Insurance Review & Assessment Service data.

A Web-based Survey for Assessment of Korean Medical Treatment Clinical Practice Patterns for Temporomandibular Disorders (턱관절 질환의 한의진료 임상현황조사를 위한 웹기반 설문조사)

  • Kim, Chang-Eun;Do, Ho-Jeong;Song, Hyun-Seop;Shin, Jae-Kwon;Lee, Won-Jun;Kim, Jong-Ho;Lee, Keun-Jae;Yoon, Young-Suk;Kim, No-Hyeon;Suh, Chang-Yong;Lee, Yoon-Jae;Kim, Mi-Riong;Cho, Jae-Heung;Kwon, Mi-Jung;Ha, In-Hyuk
    • Journal of Korean Medicine Rehabilitation
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    • v.28 no.1
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    • pp.73-84
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    • 2018
  • Objectives While Temporomandibular disorders (TMD) is highly prevalent in Korea, studies examining its Korean medical treatment are currently lacking. The aim of this study was to assess current Korean medical treatment practice patterns for TMD. Methods A preliminary questionnaire was developed to investigate current practice patterns of TMD treatment and underwent further revision through external review. The final questionnaire was distributed as a web-based survey to 18,289 potential respondents by email. Results The response rate was 2.23%. Most participants replied that they received multiple Korean medicine interventions for TMD treatment consisting of such methods as acupuncture, chuna manipulation, electroacupuncture. The percentage of treatment services among uncovered services, which need to be covered by national health insurance was high in the order of pharmacopuncture, chuna manipulation, and herbal medicine. The most commonly used diagnostic examination tools for TMD was Physical examination and next was Imaging diagnosis. The frequency of TMD treatment was the highest at 2~3 times per week (76%) and the period was from 4 to 12 weeks (63%). Conclusions This survey study helps determine current practice patterns of TMD, and recognizes the need for use of diagnostic devices in TMD treatment. These results are further anticipated to provide basic data for clinical practice guide lines (CPGs).

Evaluation on Toxicity of Habitual dose of Extract of Rheum Palmatum through Single Blinded Pilot Study (단일맹검시험을 통한 대황(大黃) 상용량(常用量)의 독성작용 평가)

  • Kwon, Hyork;Chi, Gyoo-Yong;Eom, Hyun-Sup
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.24 no.3
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    • pp.390-400
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    • 2010
  • This study is aimed to test physiological and hematological actions of Rheum palmatum through clinical pilot study optimized for usual oriental medicine prescription. Thirty-one cases were finally collected and the sample extract 100 $m{\ell}$ of Rheum palmatum (ERP) was administered two times in a day during 3 days and checked with blood CBC test, urinalysis, liver function test, abdominal X-ray as well as general diagnostic process of oriental medicine; pattern identification, assessment of shapes and constitution. The total toxic effective rate of ERP was 9.68% in 3 cases of the whole in case of consistent uneasy state in the subjective symptomatic assessment and aggravation of blood and urine examination. The relevant diagnostic factors were so-eum constitution and essence type subject, carapaces species, lung type in the aspect of Jisan shape theory. On the other hand, the positive effective rate of ERP was 29.03% manifesting improvement of vital signs or present illness and no abnormal changes of blood chemistry and urinalysis and simple abdomen radiology. The relevant diagnostic factors were tae-eum constitution, energy type subject, aves species, heart and liver type in Jisan's shape theory. And the other cases were manifesting no specific change through the administration of ERP. The ratio of the numbers of decrease and increase was 44:5 in the tenderness and hardness of abdominal palpation. But if the pattern identification doesn't comply with the aim of rhubarb application despite of constipation and abdominal pain, the tendeness and biochemical report was shown in abnormal change. The mean number of diarrhea by ERP was $16.77{\pm}6.95$ during 3 days after administration, and the frequent areas of abdominal pain were lower>middle>upper in order, and it meant the target site of ERP too. Besides, the toxic reaction against ERP was expressed highly in case of decrease in blood cell count and hemoglobin, hematocrit having blood deficiency syndrome. Likewise, the toxicity of ERP was influenced by pattern identification manifesting present disease condition and diagnostic factors of four constitutions, Jisan's shape theory collaterally. In conclusion, evaluation of herbal toxicity in order for using as a clinical guideline, various diagnostic pattern information and shape features like the above should be studied together with other pharmacologic toxicology test for the future.

Comparison of high molecular coating type dentine hypersensitivity desensitizers (고분자 기반 코팅형 상아질 지각 과민 처치제의 효과에 대한 비교 연구)

  • Roh, Young-Hoon;Lee, Joo-Yeon;Park, Hyun-Jung;Choi, Cha-Nam;Park, Yoon-Jeong;Koo, Ki-Tae;Kim, Tae-Il;Seol, Yang-Jo;Lee, Yong-Moo;Ku, Young;Rhyu, In-Chul;Chung, Chong-Pyoung
    • The Journal of the Korean dental association
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    • v.46 no.11
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    • pp.683-688
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    • 2008
  • Purpose : The aim of this study was to evaluate the clinical efficacy of two commercially available desensitizing agents over 3 weeks on patients with dentin hypersensitivity. Materials and Methods : An oxalate-based solution, Sensblok (NIBEC Inc. Seoul, Korea) & Superseal (Pheonix Inc. Michigan, USA), and a distilled water placebo were compared in a clinical setting. Seven volunteers exhibiting three or more teeth that were sensitive to tactile & air were enrolled in the study (35 teeth total). A visual analog scale (VAS) was used for recording each patient s level of sensitivity to tactile & air stimuli. A Florida probe was rubbed across the exposed dentin three times with a constant pressure 20 grams to measure the tactile stimulus. The air stimulus was generated by dental unit air syringe for 1-second blast from 1/2 inch distance. The desensitizing agents were applied according manufacture s guideline. VAS scores were recorded at baseline, 1 minute after treatment, at 1 week, 2weeks, 3weeks. VAS score were analyzed using a repeated measures ANOVA ( =0.05). Results : The Sensblok, Superseal, and distilled water placebo all decreased dentin sensitivity. A statistically significant difference existed between Sensblok and placebo when tactile stimulus was applied (P<0.05), but no significant difference was found among other desensitizing agents and tactile and air stimuli.

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