We investigated the actual status of antipsychotics maintenance therapy(AMT) for schizophrenic patients through a mail survey sent to psychiatrists practicing in Seoul and Kyonggj province who had no less than two years of psychiatric expertise and who were below fifty years of age. Out of 453 questionnaires sent, 215 completed questionnaires were returned (response rate 47%). The majority of respondents considered pharmacotherapy as the most important longterm treatment strategy for schizophrenia. Haloperidol was selected by the majority as their first choice neuroleptics. The proposed mean daily maintenance dosage was 383+/-229(75-1250)mg in chlorpromazine equivalent. The mean duration of AMT was 1.8+/-1.0(0.25-7.5)years after the first episode and 3.6+/-1.8(0.5-10)years after multi-episodes. Psychotherapy was regarded as more important by the resident psychiatrists group than by the certified psychiatrists. There were preferential differences for a particular treatment strategy, dosage and duration of AMT among the different clinics. A great number of respondents(93%) regarded long-term continuous maintenance as their major AMT policy, Only a few respondents(4.3%) were satisfied with the established guidelines for AMT in treatment of schizophrenia. The results show considerable variations in psychiatrists opinions on AMT which was influenced by grades of expertise of the clinician and the working environment of the clinic or the hospital. To decrease these variabilities and make clinically useful guidelines, it will be necessary' to do further pharmacoepidemiological studies as well as other types of related clinical research.
Antipsychotic Agents* ; Chlorpromazine ; Surveys and Questionnaires ; Drug Therapy ; Haloperidol ; Humans ; Postal Service ; Psychiatry ; Psychotherapy ; Schizophrenia ; Seoul*

PURPOSE: To determine the relative accuracy of barium enema findings of Hirschsprung's disease (HD) and to calculate a level of probability for three signs combined. MATERIAL AND METHODS: Barium enema findings in 45 patients who had undergone rectal biopsy to prove or exclude the diagnosis of HD were retrospectively analyzed by evaluating the presence of a transition zone, irregular contractions and delayed evacuation of barium. Seventeen were neonates (group 1) and the other 28 were infants and children (group 2). The sensitivity, specificity, and positive and negative predictive values of the findings were compared. RESULTS: In visualization of a transition zone, sensitivity, specificity and positive predictive value were 76.5%, 72.7% and 89.7%, respectively. Sensitivity for irregular contractions and delayed evacuation of barium was 76.5% and 91.7%, respectively, whereas for specificity, the corresponding values were 63.6% and 40%. Sensitivities for radiologic signs were higher in group 1 than in group 2, but, the specificities were lower. If two or three findings were positive, the level of probability was 85 - 100%. If two findings were negative, however, the corresponding value was 30%. CONCLUSION: We conclude that the most reliable HD finding is the presence of a transition zone. Irregular contractions and the delayed evacuation of barium are not specific. Two or three positive findings may suggest a higher probability of HD than any single positive finding alone.
Barium* ; Biopsy ; Child ; Diagnosis* ; Enema* ; Hirschsprung Disease* ; Humans ; Infant ; Infant, Newborn ; Retrospective Studies ; Sensitivity and Specificity

Pylephlebitis, a septic thrombophlebitis of the portal vein or one of its tributaries, is a life-threatening complication of intra-abdominal infection. The causes of pylephlebitis include acute diverticulitis, appendicitis, acute cholecystitis, necrotizing pancreatitis, inflammatory bowel disease, and bowel perforation. Although pylephlebitis is an unusual complication of diverticulitis, its morbidity and mortality remain high. Therefore, early diagnosis and initiation of adequate antibiotic therapy is important for improving the long-term prognosis of patients suffering from this rare disease. We report a case of pylephlebitis with Streptococcus viridans and Bacteroides fragilis bacteremia secondary to diverticulitis with a review of the literature.
Appendicitis ; Bacteremia ; Bacteroides ; Bacteroides fragilis ; Cholecystitis, Acute ; Diverticulitis ; Early Diagnosis ; Humans ; Inflammatory Bowel Diseases ; Intraabdominal Infections ; Pancreatitis ; Portal Vein ; Prognosis ; Rare Diseases ; Streptococcus ; Stress, Psychological ; Thrombophlebitis ; Viridans Streptococci

Background: In Korea, during the early phase of the coronavirus disease 2019 (COVID-19) pandemic, we responded to the uncertainty of treatments under various conditions, consistently playing catch up with the speed of evidence updates. Therefore, there was high demand for national-level evidence-based clinical practice guidelines for clinicians in a timely manner. We developed evidence-based and updated living recommendations for clinicians through a transparent development process and multidisciplinary expert collaboration. Methods: The National Evidence-based Healthcare Collaborating Agency (NECA) and the Korean Academy of Medical Sciences (KAMS) collaborated to develop trustworthy Korean living guidelines. The NECA-supported methodological sections and 8 professional medical societies of the KAMS worked with clinical experts, and 31 clinicians were involved annually. We developed a total of 35 clinical questions, including medications, respiratory/critical care, pediatric care, emergency care, diagnostic tests, and radiological examinations. Results: An evidence-based search for treatments began in March 2021 and monthly updates were performed. It was expanded to other areas, and the search interval was organized by a steering committee owing to priority changes. Evidence synthesis and recommendation review was performed by researchers, and living recommendations were updated within 3–4 months. Conclusion We provided timely recommendations on living schemes and disseminated them to the public, policymakers and various stakeholders using webpages and social media.Although the output was successful, there were some limitations. The rigor of development issues, urgent timelines for public dissemination, education for new developers, and spread of several new COVID-19 variants have worked as barriers. Therefore, we must prepare systematic processes and funding for future pandemics.