• 제목/요약/키워드: critical evidence

검색결과 632건 처리시간 0.028초

Antipsychotics for patients with pain

  • Shin, Sang Wook;Lee, Jin Seong;Abdi, Salahadin;Lee, Su Jung;Kim, Kyung Hoon
    • The Korean Journal of Pain
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    • 제32권1호
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    • pp.3-11
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    • 2019
  • Going back to basics prior to mentioning the use of antipsychotics in patients with pain, the International Association for the Study of Pain (IASP) definition of pain can be summarized as an unpleasant experience, composed of sensory experience caused by actual tissue damage and/or emotional experience caused by potential tissue damage. Less used than antidepressants, antipsychotics have also been used for treating this unpleasant experience as adjuvant analgesics without sufficient evidence from research. Because recently developed atypical antipsychotics reduce the adverse reactions of extrapyramidal symptoms, such as acute dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia caused by typical antipsychotics, they are expected to be used more frequently in various painful conditions, while increasing the risk of metabolic syndromes (weight gain, diabetes, and dyslipidemia). Various antipsychotics have different neurotransmitter receptor affinities for dopamine (D), 5-hydroxytryptamine (5-HT), adrenergic (${\alpha}$), histamine (H), and muscarinic (M) receptors. Atypical antipsychotics antagonize transient, weak $D_2$ receptor bindings with strong binding to the $5-HT_{2A}$ receptor, while typical antipsychotics block long-lasting, tight $D_2$ receptor binding. On the contrary, antidepressants in the field of pain management also block the reuptake of similar receptors, mainly on the 5-HT and, next, on the norepinephrine, but rarely on the D receptors. Antipsychotics have been used for treating positive symptoms, such as delusion, hallucination, disorganized thought and behavior, perception disturbance, and inappropriate emotion, rather than the negative, cognitive, and affective symptoms of psychosis. Therefore, an antipsychotic may be prescribed in pain patients with positive symptoms of psychosis during or after controlling all sensory components.

국내 학술지에 게재된 증례 연구 분석을 통한 산후풍의 한의학적 치료에 대한 고찰 (A Review on Sanhupung Treatment in Korean Medicine by Analyzing Case Studies Published in Korean Journal)

  • 황수인;이희윤;윤영진;박장경
    • 대한한방부인과학회지
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    • 제34권4호
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    • pp.131-150
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    • 2021
  • Objectives: The purpose of this study is to analyze the domestic study trends on Korean medicine treatment of Sanhupung. Methods: Case studies applying Korean medicine treatment on Sanhupung were searched through 5 domestic journal databases. General characteristics, interventions, outcomes, and results of the selected studies were analyzed. Also, the quality of the case studies was reviewed based on the CAse REport (CARE) guideline and Joanna Briggs Institute (JBI) critical appraisal checklist. Results: 11 studies (16 cases) were found to be analyzed according to their general characteristics, symptoms, interventions, treatment period, outcome, and results. The most common complaint of Sanhupung patients was pain, and the most applied intervention for Sanhupung was herbal medicine and acupuncture. The duration of treatment ranged from 9 days to 4 months. All case studies reported that the Korean medicine treatment was effective in treating Sanhupung. According to the quality assessment, 'Timeline of case', 'Diagnostic challenges', 'Intervention adherence and tolerability', 'Adverse and unanticipated events', and 'Informed consent' were showed low reporting rates. Conclusions: Further clinical studies are needed to establish the evidence for Korean medicine treatment for Sanhupung.

New Obligations of Health Insurance Review and Assessment Service: Taking Full-fledged Action Against the COVID-19 Pandemic

  • Yoo, Seung Mi;Chung, Seol Hee;Jang, Won Mo;Kim, Kyoung Chang;Lee, Jin Yong;Kim, Sun Min
    • Journal of Preventive Medicine and Public Health
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    • 제54권1호
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    • pp.17-21
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    • 2021
  • In 2020, the coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to global health systems. The Korea has taken full-fledged actions against this novel infectious disease, swiftly implementing a testing-tracing-treatment strategy. New obligations have therefore been given to the Health Insurance Review and Assessment Service (HIRA) to devote the utmost effort towards tackling this global health crisis. Thanks to the universal national health insurance and state-of-the-art information communications technology (ICT) of the Korea, HIRA has conducted far-reaching countermeasures to detect and treat cases early, prevent the spread of COVID-19, respond quickly to surging demand for the healthcare services, and translate evidence into policy. Three main factors have enabled HIRA to undertake pandemic control preemptively and systematically: nationwide data aggregated from all healthcare providers and patients, pre-existing ICT network systems, and real-time data exchanges. HIRA has maximized the use of data and pre-existing network systems to conduct rapid and responsive measures in a centralized way, both of which have been the most critical tactics and strategies used by the Korean healthcare system. In the face of new obligations, our promise is to strive for a more responsive and resilient health system during this prolonged crisis.

임신성 당뇨병을 가진 임산부를 위한 간호중재 프로그램의 효과: 무작위 대조군 실험연구의 체계적 문헌고찰 (Effects of nursing intervention programs for women with gestational diabetes: a systematic review of randomized controlled trials)

  • 김주희;정재원
    • 여성건강간호학회지
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    • 제27권1호
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    • pp.14-26
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    • 2021
  • Purpose: This study aimed to identify the effects of nursing intervention programs for women with gestational diabetes mellitus (GDM) through a critical review of recent studies. Methods: Studies related to effects of nursing intervention programs for women with GDM published in English or Korean between 2000 and 2019 were extracted from 10 electronic databases. The quality of the studies was evaluated and double-checked for accuracy by two reviewers using the Revised Cochrane Risk-of-Bias tool for randomized controlled trials. Results: Twenty studies were selected, of which 19 had a low risk of bias and one had a high risk of bias. Interventions fell into six main groups: (1) integrated interventions, (2) self-monitoring of blood glucose levels, (3) dietary interventions, (4) exercise, (5) psychotherapy, and (6) complementary therapy. This review found that nursing interventions for GDM were of many types, and integrated interventions were the most common. However, low-carbohydrate diets and blood glucose monitoring interventions did not show statistically significant results. Evidence shows that various nursing intervention programs applied to GDM improved diverse aspects of maternal, fetal, and neonatal health, including both physical and psychological aspects. Conclusion: The composition and delivery of integrated interventions continue to evolve, and these interventions affect physical and psychological indicators. Although interventions affecting physical health indicators (e.g., blood glucose levels, diet, and exercise) are important, many studies have shown that programs including psycho-emotional nursing interventions related to anxiety, depression, stress, self- efficacy, and self-management are also highly useful.

Multivariable Integrated Evaluation of GloSea5 Ocean Hindcasting

  • Lee, Hyomee;Moon, Byung-Kwon;Kim, Han-Kyoung;Wie, Jieun;Park, Hyo Jin;Chang, Pil-Hun;Lee, Johan;Kim, Yoonjae
    • 한국지구과학회지
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    • 제42권6호
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    • pp.605-622
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    • 2021
  • Seasonal forecasting has numerous socioeconomic benefits because it can be used for disaster mitigation. Therefore, it is necessary to diagnose and improve the seasonal forecast model. Moreover, the model performance is partly related to the ocean model. This study evaluated the hindcast performance in the upper ocean of the Global Seasonal Forecasting System version 5-Global Couple Configuration 2 (GloSea5-GC2) using a multivariable integrated evaluation method. The normalized potential temperature, salinity, zonal and meridional currents, and sea surface height anomalies were evaluated. Model performance was affected by the target month and was found to be better in the Pacific than in the Atlantic. An increase in lead time led to a decrease in overall model performance, along with decreases in interannual variability, pattern similarity, and root mean square vector deviation. Improving the performance for ocean currents is a more critical than enhancing the performance for other evaluated variables. The tropical Pacific showed the best accuracy in the surface layer, but a spring predictability barrier was present. At the depth of 301 m, the north Pacific and tropical Atlantic exhibited the best and worst accuracies, respectively. These findings provide fundamental evidence for the ocean forecasting performance of GloSea5.

Antidepressant-like effect of ginsenoside Rb1 on potentiating synaptic plasticity via the miR-134-mediated BDNF signaling pathway in a mouse model of chronic stress-induced depression

  • Wang, Guoli;An, Tianyue;Lei, Cong;Zhu, Xiaofeng;Yang, Li;Zhang, Lianxue;Zhang, Ronghua
    • Journal of Ginseng Research
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    • 제46권3호
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    • pp.376-386
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    • 2022
  • Background: Brain-derived neurotrophic factor (BDNF)-tropomyosin-related kinase B (TrkB) plays a critical role in the pathogenesis of depression by modulating synaptic structural remodeling and functional transmission. Previously, we have demonstrated that the ginsenoside Rb1 (Rb1) presents a novel antidepressant-like effect via BDNF-TrkB signaling in the hippocampus of chronic unpredictable mild stress (CUMS)-exposed mice. However, the underlying mechanism through which Rb1 counteracts stress-induced aberrant hippocampal synaptic plasticity via BDNF-TrkB signaling remains elusive. Methods: We focused on hippocampal microRNAs (miRNAs) that could directly bind to BDNF and are regulated by Rb1 to explore the possible synaptic plasticity-dependent mechanism of Rb1, which affords protection against CUMS-induced depression-like effects. Results: Herein, we observed that brain-specific miRNA-134 (miR-134) could directly bind to BDNF 30 UTR and was markedly downregulated by Rb1 in the hippocampus of CUMS-exposed mice. Furthermore, the hippocampus-targeted miR-134 overexpression substantially blocked the antidepressant-like effects of Rb1 during behavioral tests, attenuating the effects on neuronal nuclei-immunoreactive neurons, the density of dendritic spines, synaptic ultrastructure, long-term potentiation, and expression of synapse-associated proteins and BDNF-TrkB signaling proteins in the hippocampus of CUMS-exposed mice. Conclusion: These data provide strong evidence that Rb1 rescued CUMS-induced depression-like effects by modulating hippocampal synaptic plasticity via the miR-134-mediated BDNF signaling pathway.

Low Social Support and Risk for Depression in People With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

  • Azmiardi, Akhmad;Murti, Bhisma;Febrinasari, Ratih Puspita;Tamtomo, Didik Gunawan
    • Journal of Preventive Medicine and Public Health
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    • 제55권1호
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    • pp.37-48
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    • 2022
  • Objectives: Depression is a frequent complication of type 2 diabetes mellitus. This study aimed to investigate the relationship between low social support and risk for depression in people with type 2 diabetes through a meta-analysis. Methods: PubMed, ProQuest, SpringerLink, ScienceDirect, Scopus, the Cochrane Library, Embase, and Google Scholar were searched for English-language articles published up to 2021. Pooled adjusted odds ratios (aORs) were calculated using a random-effect model with 95% confidence intervals (CIs). Heterogeneity was evaluated by using the Cochrane Q test and I2 statistics. The risk of publication bias was estimated using a funnel plot, the Egger test, and the Begg test. The Joanna Briggs Institute Critical Appraisal Tools were used to assess the quality of evidence and the risk of bias. Results: Eleven studies were included in this meta-analysis, containing a total of 3151 people with type 2 diabetes mellitus. The pooled analysis showed that people with type 2 diabetes mellitus who had low social support had twice as high a risk of depression as those with high social support (aOR, 2.02; 95% CI, 1.51 to 2.70; p<0.001). A random-effect model was used because the heterogeneity was high (I2 = 87%). Conclusions: Low social support was found to increase the risk of depression among people with type 2 diabetes mellitus. Further investigation into factors that may moderate this relationship is required.

Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

  • Escandon, Joseph M.;Mohammad, Arbab;Mathews, Saumya;Bustos, Valeria P.;Santamaria, Eric;Ciudad, Pedro;Chen, Hung-Chi;Langstein, Howard N.;Manrique, Oscar J.
    • Archives of Plastic Surgery
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    • 제49권5호
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    • pp.617-632
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    • 2022
  • Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure. A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed. Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1-13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1-43%), 7% (95% CI < 1-34%) for dermal graft interposition, < 1% (95% CI < 1-37%) for radial forearm free flap, < 1% (95% CI < 1-52%) for ligation of the fistula, 17% (95% CI < 1-64%) for interposition of a deltopectoral flap, 9% (95% CI < 1-28%) for primary closure, and 2% (95% CI < 1-20%) for interposition of a sternocleidomastoid muscle flap. Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.

협력적 실행연구를 통한 초임 유아교사의 유아관찰 평가의 실천과 반성 (Child Observation Assessment Practice and Reflections of a First-year Early Childhood Teacher Through Collaborative Action Research)

  • 양정은
    • 한국엔터테인먼트산업학회논문지
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    • 제14권5호
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    • pp.159-170
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    • 2020
  • 유아를 평가하는 과정에서 교사의 역할이 매우 중요함에도 불구하고, 교직 입문 과정에서 초임 유아교사들은 충분한 배경지식이나 실제적 지도능력을 갖추지 못하고 있어 상당한 어려움을 겪고 있다. 본 연구에서는 협력적 실행연구를 통하여 한 초임 유아교사가 '유아관찰평가'에 대한 신념과 실제를 반성적으로 바라보고 실천적으로 개선해나갈 수 있도록 지원하고자 한다. 실행연구의 순환과정을 통해 참여교사는 유아관찰평가에 대한 자신의 신념과 접근방식을 반성적으로 들여다봄으로 스스로를 성장시키는 계기가 될 것이다. 본 연구결과를 바탕으로 초임 유아교사의 교직 입문을 지원할 수 있는 하나의 방안으로 협력적 실행 연구의 적용을 제안하고자 한다.

초등 예비교사의 수학 교수·학습에 대한 신념 측정을 위한 도구 개발 (Development of an Instrument Measuring Elementary Pre-service Teachers' Beliefs on Teaching and Learning Mathematics)

  • 황지현;김진호;권나영
    • 한국수학교육학회지시리즈C:초등수학교육
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    • 제25권1호
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    • pp.43-55
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    • 2022
  • 수학을 지도하고 배우는 방법에 관하여 교사 교육 프로그램을 통해서 교사들의 신념이 변화하는지 조사하는 것은 중요하다. 이런 의미에서 이 연구는 초등 예비교사들의 신념 변화를 알기 위해 이를 측정하는 도구를 개발하는데 목적이 있다. 수학교육 전문가들과 함께 검사 문항들을 생성하고 검토한 후, 연구자들은 이 도구의 구조 타당도를 평가하기 위해 수학과 교재연구 및 지도법 강좌를 수강한 166명의 예비교사들로부터 설문자료를 수집하였다. 검사도구 개발을 위해 평행 분석과 탐색적 요인분석을 차례로 적용하여 타당도와 신뢰도를 검토하였다. 연구 결과로 개발된 도구는 초등 예비교사의 교사 중심, 학습자 중심 교육 신념을 측정하는데 이용할 수 있다. 그리고 개발 도구를 적용해서 얻는 점수를 적절히 해석하는 방법을 제안한다.