• Title/Summary/Keyword: Randomized controlled trials

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NEW ANTIDEPRESSANTS IN CHILD AND ADOLESCENT PSYCHIATRY (소아청소년정신과영역의 새로운 항우울제)

  • Lee, Soo-Jung
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.14 no.1
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    • pp.12-25
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    • 2003
  • Objectives:As increasing number of new antidepressants have been being introduced in clinical practice, pharmacological understanding has been broadened. These changes mandate new information and theories to be incorporated into the treatment process of children with depressive disorders. In light of newly coming knowledge, this review intended to recapitulate the characteristics of new antidepressants and to consider the pivotal issues to develope guidelines for the treatment of depression in childhood and adolescence. Methods:Searching the Pub-Med online database for the articles with the key words of 'new', 'antidepressants' and 'children' ninety-seven headings of review articles were obtained. The author selected the articles of pertinent subjects in terms of either treatment guideline or psychopharmacology of new antidepressants. When required, articles about the clinical effectiveness of individual antidepressants were separatedly searched. In addition, the safety information of new antidepressants was acquired by browsing the official sites of the United States Food and Drugs Administration and Department of Health and Human Services. Results:1) For the clinical course, treatment phase, and treatment outcome, the reviews or treatment guidelines adopted the information from adult treatment guidelines. 2) Systematic and critical reviews unambiguously concluded that selective serotonin reuptake inhibitors(SSRIs) excelled tricyclic antidepressants( TCAs) for both efficacy and side effect profiles, and were recommend for the first-line choice for the treatment of children with depressive disorders. 3) New antidepressants generally lacked treatment experiences and randomized controlled clinical trials. 4) SSRIs and other new antidepressants, when used together, might result in pharmacokinetic and/or pharmacodynamic drug-to-drug interaction. 5) The difference of the clinical effectiveness of antidepressants between children and adults should be addressed from developmental aspects, which required further evidence. Conclusion:Treatment guidelines for the pharmacological treatment of childhood and adolescence depression could be constructed on the basis of clinical trial findings and practical experiences. Treatment guidelines are to best serve as the frame of reference for a clinician to make reasonable decisions for a particular therapeutic situation. In order to fulfill this role, guidelines should be updated as soon as new research data become available.

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Aquatic exercise for the treatment of knee osteoarthritis: a systematic review & meta analysis (무릎 골관절염 환자를 대상으로 한 수중 운동과 지상운동 비교: 체계적 문헌고찰 및 메타분석)

  • Kim, Young-il;Choi, Hyo-Shin;Han, Jung-haw;Kim, Juyoung;Kim, Gaeun
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.16 no.9
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    • pp.6099-6111
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    • 2015
  • This study was a systematic review and meta-analysis comparing the effects of aquatic exercise and land-based exercise in the treatment of knee osteoarthritis. 7 studies (n=449) met selection and exclusion criteria out of 287 potential studies obtained from the literature search via Ovid-Medline, Cochrane Library CENTRAL, CINAHL, RISS and KISS. The overall risk of bias of selected studies using SIGN (Scottish Intercollegiate Guidelines Network) checklist for randomized controlled trials (RCT) was regarded as low. As a result of meta analysis, Standardized Mean Difference (SMD) for pain was -0.26(95% CI -0.49, -0.03, p=0.03, $I^2=14%$), which implies that aquatic exercise groups had significant less pain than land-based exercise groups. On the other hand, there was no significant difference between aquatic exercise groups and land based exercise groups for flexion Range of Motion (ROM) (-0.12, 95% CI -0.51, 0.27, p=0.53, $I^2=0%$), extension ROM (-0.04, 95% CI -0.55, 0.48, p=0.89, $I^2=43%$), physical function (-0.12, 95% CI -0.44, 0.19, p=0.44, $I^2=0%$), Quality of Life (QOL) (-0.15, 95% CI -0.54, 0.24, p=0.46, $I^2=0%$). This study has some limitations due to few RCTs comparing aquatic exercise groups and land-based exercise groups in the treatment of knee osteoarthritis. Therefore, further RCTs should be conducted along with long-term outcomes.

Pain Reduction Effects of Lidocaine Gel for Urethral Catheterization : A Systematic Review and Meta-Analysis (요도 카테터 삽입술에서 리도카인 윤활제의 통증 감소 효과 : 체계적 문헌고찰과 메타분석)

  • Hong, Hyun-Jung;Kim, Ga-Eun;Lee, Ha-Nee;Lee, A-Reum
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.6
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    • pp.438-448
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    • 2017
  • This study was a systematic review and meta-analysis that evaluated the results of research on the pain reduction effects of lidocaine gel for urethral catheterization in adults. A literature search was conducted using seven electronic databases, gray literature and other resources based on the guidelines of Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). A Risk of Bias (RoB) tool was applied to assess the quality of selected studies. Data were analyzed using the RevMan 5.3.-program. Sixteen randomized controlled trials involving 1904 adults were included. RoB was not observed in the funnel plot. Overall, lidocaine gel was effective for pain reduction during urethral catheterization (Standard Mean Difference[SMD] -0.96;95% CI: -1.43, -0.49). To explore the cause of heterogeneity (I2=95%, p<.001), subgroup analysis was conducted according to three catheter types (urinary catheter, flexible cystoscopy, and rigid cystoscopy) and the SMDs were -0.88 (95% CI:-1.51, -0.26), -0.31 (95% CI:-0.63, 0.01), and -1.93 (95% CI:-2.88, -0.97), respectively. A significant pain reduction effect was observed regardless of gender in urinary catheterization. However, in rigid cystoscopy, a significant pain reduction effect was observed only in male subjects. Pain reduction effects were observed when 10~11ml lidocaine gel was used during rigid cystoscopy and when lubrication was used during urinary catheterization, irrespective of application time. These findings suggest that lidocaine gel is a useful anesthetic lubricant for urinary catheterization and rigid cystoscopy in male adults.

Associations of serum 25(OH)D levels with depression and depressed condition in Korean adults: results from KNHANES 2008-2010 (한국 성인의 혈청 25(OH)D 수준과 우울증 및 우울증상 경험과의 연관성: 국민건강영양조사 2008-2010 분석 결과)

  • Koo, Sle;Park, Kyong
    • Journal of Nutrition and Health
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    • v.47 no.2
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    • pp.113-123
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    • 2014
  • Purpose: Vitamin D has been known to play an important role in the central nervous system and brain functions in the human body, and cumulative evidence has shown that vitamin D deficiency might be linked with various mental health conditions. Epidemiologic studies have shown that vitamin D deficiency may be associated with higher risk of depression in the US and European populations. However, limited information is available regarding the association between vitamin D status and depression in the Korean population. The objective of this study was to examine the associations between vitamin D levels and prevalence of depression. Methods: We conducted a cross-sectional analysis using nationally representative data from the 2008-2010 Korean National Health and Nutrition Examination Survey from which serum 25-hydroxyvitamin D concentrations were available. A total of 18,735 adults who had available demographic, dietary, and lifestyle information were included in our analysis. We defined "depression" with a diagnosis by a physician. "Depressed condition" was defined as having feelings of sadness or depression without diagnosis by a physician. Results: The prevalence of depression was 1.63% and 5.43% in Korean men and women, respectively; 12.5% of men and 26.1% of women were defined as the group having depressed conditions. In multivariate logistic regression models, no significant associations were observed between vitamin D status and prevalence of depression or depressed conditions in Korean men and women. Conclusion: We found no association between vitamin D insufficiency and depression/depressed conditions in Korean adults. Future large prospective studies and randomized controlled trials are needed to confirm this relationship.

Effectiveness of Internet-based Interventions on HbA1c Levels in Adult Patients with Diabetes: A Meta-Analysis of Randomized Controlled Trials (인터넷 기반 중재프로그램을 통한 성인 당뇨 환자의 HbA1c 중재효과: 메타분석)

  • Jung, Chang Suk;Noh, Hyun Jung;Gu, Min Jeong;Kim, Yi Young;Lee, Soon Young
    • Journal of health informatics and statistics
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    • v.43 no.4
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    • pp.307-317
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    • 2018
  • Objectives: This study aimed to verify the effectiveness of Internet-based intervention programs for adults with diabetes by conducting a meta-analysis of studies conducted since 2000. Methods: We conducted a systematic review of research papers published in domestic and overseas journals from January 2000 to December 2015, and selected 9 papers that met the analysis criteria. Data analysis was performed using the open source statistical software R 3.5.0, to analyze the effectiveness of Internet-based interventions on experimental and control groups. Results: The analysis showed that intervention programs for controlling HbA1c levels in adult patients with diabetes most commonly comprised 7 sessions on Internet-based management (77.8%), and the most common frequency of application of intervention programs was 4 session in 6 months (33.4%). The present meta-analysis revealed statistically significant effects of Internet-based intervention activities (SMD = 0.92, 95% CI 0.45-1.40). The analysis of the effect size according to the intervention period showed that the 3-month, 6-month, and 12-month interventions reported in eight studies (89%) had a high effect on the Internet-based intervention group. Conclusions: The results of this study confirm the effectiveness of Internet-based intervention programs for adult patients with diabetes. The need for research on the utilization of Internet-based intervention programs for the steady management of diabetes, a chronic disease; for the development of specific guidelines for intervention activities; and for establishing appropriate protocols are acknowledged.

Bioactive compounds in food for age-associated cognitive decline: A systematic review (인지기능 개선을 위한 식품유래 생리활성소재에 대한 체계적 문헌고찰)

  • Kang, Eun Young;Cui, Fengjiao;Kim, Hyun Kyung;Go, Gwang-woong
    • Korean Journal of Food Science and Technology
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    • v.53 no.3
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    • pp.278-289
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    • 2021
  • The rapid aging of society has led to a surge in cognitive dysfunction in the elderly. As there is limited evidence for the development of dementia in medicine, a shift in focus on prevention strategies using bioactive compounds in food is required. This systematic review evaluated the effects of various bioactive compounds on age-associated cognitive decline. The literature was searched for terms related to bioactive compounds in cognitive decline and article selection was limited to clinical randomized controlled trials for a single bioactive compound. We identified 21 studies that evaluated the strength of the evidence. ω-3 fatty acids and vitamin B presented a strong evidence level, whereas vitamin D and E, anserine/carnosine, and chromium were defined as having moderate levels of evidence. ω-3 fatty acids relieved cognitive decline and reduced amyloid β-related protein accumulation. Vitamin B decreased homocysteine levels, which is accompanied by alleviation of cognitive function. In conclusion, ω-3 and vitamin B have the potential to improve age-associated cognitive decline.

Clinical Applications and Efficacy of Korean Ginseng (고려인삼의 주요 효능과 그 임상적 응용)

  • Nam, Ki-Yeul
    • Journal of Ginseng Research
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    • v.26 no.3
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    • pp.111-131
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    • 2002
  • Korean ginseng (Panax ginseng C.A. Meyer) received a great deal of attention from the Orient and West as a tonic agent, health food and/or alternative herbal therapeutic agent. However, controversy with respect to scientific evidence on pharmacological effects especially, evaluation of clinical efficacy and the methodological approach still remains to be solved. Author reviewed those articles published since 1980 when pharmacodynamic studies on ginseng have intensively started. Special concern was paid on metabolic disorders including diabetes mellitus, circulatory disorders, malignant tumor, sexual dysfunction, and physical and mental performance to give clear information to those who are interested in pharmacological study of ginseng and to promote its clinical use. With respect to chronic diseases such as diabetes mellitus, atherosclerosis, high blood pressure, malignant disorders, and sexual disorders, it seems that ginseng plays preventive and restorative role rather than therapeutics. Particularly, ginseng plays a significant role in ameliorating subjective symptoms and preventing quality of life from deteriorating by long term exposure of chemical therapeutic agents. Also it seems that the potency of ginseng is mild, therefore it could be more effective when used concomitantly with conventional therapy. Clinical studies on the tonic effect of ginseng on work performance demonstrated that physical and mental dysfunction induced by various stresses are improved by increasing adaptability of physical condition. However, the results obtained from clinical studies cannot be mentioned in the indication, which are variable upon the scientist who performed those studies. In this respect, standardized ginseng product and providing planning of the systematic clinical research in double-blind randomized controlled trials are needed to assess the real efficacy for proposing ginseng indication. Pharmacological mode of action of ginseng has not yet been fully elucidated. Pharmacodynamic and pharmacokinetic researches reveal that the role of ginseng not seem to be confined to a given single organ. It has been known that ginseng plays a beneficial role in such general organs as central nervous, endocrine, metabolic, immune systems, which means ginseng improves general physical and mental conditons. Such multivalent effect of ginseng can be attributed to the main active component of ginseng,ginsenosides or non-saponin compounds which are also recently suggested to be another active ingredients. As is generally the similar case with other herbal medicines, effects of ginseng cannot be attributed as a given single compound or group of components. Diversified ingredients play synergistic or antagonistic role each other and act in harmonized manner. A few cases of adverse effect in clinical uses are reported, however, it is not observed when standardized ginseng products are used and recommended dose was administered. Unfavorable interaction with other drugs has also been suggested, which the information on the products and administered dosage are not available. However, efficacy, safety, interaction or contraindication with other medicines has to be more intensively investigated in order to promote clinical application of ginseng. For example, daily recommended doses per day are not agreement as 1-2g in the West and 3-6 g in the Orient. Duration of administration also seems variable according to the purpose. Two to three months are generally recommended to feel the benefit but time- and dose-dependent effects of ginseng still need to be solved from now on. Furthermore, the effect of ginsenosides transformed by the intestinal microflora, and differential effect associated with ginsenosides content and its composition also should be clinically evaluated in the future. In conclusion, the more wide-spread use of ginseng as a herbal medicine or nutraceutical supplement warrants the more rigorous investigations to assess its effacy and safety. In addition, a careful quality control of ginseng preparations should be done to ensure an acceptable standardization of commercial products.