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Infection patterns of trematode parasites among Joseon people.

Ho Chul KI ; Dong Hoon SHIN ; Min SEO ; Jong Yil CHAI

Journal of the Korean Medical Association.2014;57(10):866-875. doi:10.5124/jkma.2014.57.10.866

While paleoparasitologists in Korea reported scientific evidences for the infection patterns of various parasite species among the pre-modern Joseon people, historical study is also needed for understanding the socio-cultural aspects of parasitic infections of the past. In this study on the historical documents, we revealed the socio-cultural environment of Joseon society by which people were easily infected by trematode parasites. The historical records showed that Joseon people enjoyed raw fish cuisines, that might have caused Clonorchis sinensis and Metagonimus yokogawai infection, much more frequently than originally expected. It is also proven that Joseon people ate raw crab and crayfish, the intermediate host of Paragonimus westermani, as the seasonal delicacy or miracle cure drug for incurable diseases. We also found many Joseon records on raw-oyster dishes, possibly having caused Gymnophalloides seoi infection among the people. By this study, we could get the historical clues on how Joseon people could have been infected by various trematode parasites.
Astacoidea ; Clonorchis sinensis ; Heterophyidae ; Korea ; Paragonimus westermani ; Parasites* ; Seasons

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The ideal management of blood cholesterol: a review of the updated 2013 ACC/AHA cholesterol guideline for reducing cardiovascular risk.

Hyo In CHOI ; Ki Hoon HAN

Journal of the Korean Medical Association.2014;57(10):857-865. doi:10.5124/jkma.2014.57.10.857

Atherosclerotic cardiovascular disease (ASCVD) is the most important public health problem worldwide in terms of the size of expenditures in most healthcare budgets. In November 2013, the American College of Cardiology and American Heart Association (ACC/AHA) released a clinical practice guideline on the treatment of blood cholesterol to reduce ASCVD risk in adults. Based on the design and results of the randomized clinical trials and meta-analyses published through July 2013, four groups of individuals were identified for whom an extensive body of randomized clinical tria evidence demonstrated a clear reduction in ASCVD events from statin therapy with a good margin of safety. Together with ASCVD, in severe hypercholesterolemic (low-density lipoprotein cholesterol > or =190 mg/dL) or diabetic subjects, the guideline recommends the use of statins if the newly-developed Pooled Cohort Equations estimate a 10-year ASCVD risk of equal to or higher than 7.5%. The guideline recommendations represent a new paradigm for treating cholesterol focused on using the appropriate intensity of statin therapy for those most likely to benefit, while the guideline has eliminated low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol targets. Non-statin therapies were discouraged due to the lack of evidence for their production of acceptable ASCVD risk reduction benefits. This radical shift away from the set of previous guidelines has created controversy and confusion. This article reviews the 2013 ACC/AHA guideline for the treatment of blood cholesterol to reduce ASCVD risk in adults and the optimal strategies for using this guideline in clinical practice.
Adult ; American Heart Association ; Budgets ; Cardiology ; Cardiovascular Diseases ; Cholesterol* ; Cohort Studies ; Delivery of Health Care ; Health Expenditures ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Lipoproteins ; Public Health ; Risk Reduction Behavior

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Communicating bad news in medical practice.

Young Mee LEE

Journal of the Korean Medical Association.2014;57(10):847-856. doi:10.5124/jkma.2014.57.10.847

Breaking bad news to patients is one of the most difficult communication tasks to clinicians. The quality of delivery of bad news seems to be directly related to patients' anxiety and distress, strong emotions, their adjustments to bad situation, coping and satisfaction with care and clinical outcomes. Evidence has supported that health care professions' communication skills to deliver bad news can be improved by communication skills education and training. In this review, the author described the definition of bad news, patients' preferences and views on communication of bad news, some protocols or guidelines to breaking bad news, and educational effect of bad news communication skills training. In addition, the author suggested some practical tips and dialogue examples in Korean, which can be applied into clinical settings.
Anxiety ; Delivery of Health Care ; Education ; Health Communication ; Humans ; Physician-Patient Relations ; Truth Disclosure

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Treatment of drug resistant bacteria: new bugs, old drugs, and new therapeutic approaches.

Young Hwa CHOI

Journal of the Korean Medical Association.2014;57(10):837-844. doi:10.5124/jkma.2014.57.10.837

Rapidly increasing antimicrobial resistance and lack of effective antibiotics are dilemma in the treatment of infectious diseases. Clinicians are now considering the use of old antibiotics such as colistin, fosfomycin because of limitation of therapeutic options. The unique pharmacokinetic and pharmacodynamics properties of these antibiotics have led the new therapeutic approaches, such as the combination of agents and newer dosing regimens. Colistin has become the last drug of the treatment of multidrug resistant gram-negative bacteria and the loading dose and high dose maintenance has been suggested. Tigecycline is licensed for the treatment of complicated skin and intra-abdominal infections and has broad activity against gram-positive and gram-negative pathogens but cautious use in the treatment of bloodstream infection and pneumonia is recommended. Oral and intravenous fosfomycin may be effective treatment options in the case of resistant gram-negative infections but clinical studies are limited.
Anti-Bacterial Agents ; Bacteria* ; Colistin ; Communicable Diseases ; Fosfomycin ; Gram-Negative Bacteria ; Intraabdominal Infections ; Pneumonia ; Skin

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Medications or food before anesthesia to note taking.

Wonjung HWANG

Journal of the Korean Medical Association.2014;57(10):832-836. doi:10.5124/jkma.2014.57.10.832

Decisions about stopping or continuing medications perioperatively should be based on withdrawal potential, the potential for disease progression if therapy is interrupted, and the potential for drug interactions with anesthesia. In general, most medications are tolerated well through surgery and do not interfere with anesthetic administration. Therefore, most drugs should be continued through the morning of surgery. However, some medications are known to influence surgical risk or surgical decisions (e.g., antiplatelet agents, anticoagulants, some hormonal therapies, and herbal remedies), so it is important to obtain a complete medication list from the patient and to advise adjusting doses or discontinuing certain potentially complicating medications in advance of surgery. This article reviews general recommendations for perioperative management of a number of common medication classes.
Anesthesia* ; Anticoagulants ; Disease Progression ; Drug Interactions ; Humans ; Medication Therapy Management ; Perioperative Care ; Platelet Aggregation Inhibitors ; Preanesthetic Medication

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Preoperative management of chronic disease.

Hyo Jo HAN

Journal of the Korean Medical Association.2014;57(10):826-831. doi:10.5124/jkma.2014.57.10.826

With the innovation and improvements in medical science, longer life expectancy has been achieved and growing population is being diagnosed and treated as chronic diseases such as diabetes, chronic pulmonary obstructive disease or hypertension. These chronic diseases often affect multiple organs of cardiovascular and neuroendocrine system and blunt regulatory function which is crucial for the defense response against external and internal harmful stresses. The risk of perioperative complications including cardiovascular events is also higher in poorly controlled diabetes or hypertension. Therefore it is very important to evaluate and manage these problems preoperatively. This paper reviews preoperative management of common chronic diseases such as diabetes, hypertension, and chronic pulmonary obstructive disease.
Chronic Disease* ; Diabetes Mellitus ; Hypertension ; Life Expectancy ; Neurosecretory Systems ; Preoperative Care

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Recent knowledge of preoperative evaluation and preanesthetic management in infants.

Yongsuk KIM

Journal of the Korean Medical Association.2014;57(10):819-825. doi:10.5124/jkma.2014.57.10.819

Preoperative assessment and optimization of a patient's condition are important components of anesthesia practice. Improvements in evaluation and management can potentially reduce adverse events, improve patient and caregiver satisfaction, and reduce costs. Although routine preoperative laboratory tests are ordered in many institutions, history taking and physical examination provide more information about patients than laboratory tests do. Therefore, history taking and physical examination should be used to direct test ordering, and a test should be ordered only if the results will impact the decision to proceed with the planned procedure or alter the care plans. Preoperative laboratory tests without specific indications lack clinical usefulness and may actually lead to patient injury because of unnecessary interventions, delay of surgery, anxiety, and even inappropriate therapies. After sufficient discussion between anesthesiologists and surgeons in each institution, diagnostic testing guidelines for the preoperative evaluation should be developed to improve patient care, standardize clinical practice, improve efficiency, and reduce costs. For preoperative management for infants, preoperative evaluation is similar to that for the adult, but reducing anxiety of patients and their parents is especially important. Although many nonpharmacologic methods are used to reduce anxiety, the pharmacologic methods are more effective than nonparmacologic methods. The administration of sedative premedication to infants who are about to undergo anesthesia and surgery can result in beneficial effects during the preoperative and postoperative periods by decreasing anxiety, increasing cooperation during anesthesia induction, and reducing negative postoperative behavioral responses.
Adult ; Anesthesia ; Anxiety ; Caregivers ; Diagnostic Tests, Routine ; Humans ; Infant* ; Parents ; Patient Care ; Physical Examination ; Postoperative Period ; Preanesthetic Medication ; Premedication ; Preoperative Care

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Preanesthetic management for patients to have surgical procedures.

Jaemin LEE

Journal of the Korean Medical Association.2014;57(10):816-818. doi:10.5124/jkma.2014.57.10.816

No abstract available.
Humans

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Strategy for noncommunicable disease control and prevention.

Yoon Hyung PARK

Journal of the Korean Medical Association.2014;57(10):808-814. doi:10.5124/jkma.2014.57.10.808

The prevalence of non-communicable disease (NCD) has been continuously increasing due to population ageing and changes in consumption and lifestyle patterns. This global trend is also apparent in the Republic of Korea, reflected in increasing mortality and personal costs for the treatment and management of NCD. Cancers, cerebrovascular diseases, and hypertensive diseases have been the major causes of death in South Korea since 1983. Numerous studies have suggested the need for a sustained comprehensive treatment tailored for individual patients and have recommend the development of a systematic program to manage NCD patients to provide such care. The Korean government has been implementing national NCD management programs since 2000. In 2005, the management of major NCD including hypertension, diabetes, heart disease, and stroke was included as a major target in the New Health Plan 2010. In 2006, the government established the National Cerebro-Vascular Disease Prevention and Control Policy, and a registry program for the group at high-risk for cardio-vascular disease (hypertension and diabetes) was implemented in 19 cities and counties from 2007, with gradual expansion over time. Recently, in line with the discussions on the reorientation of the health care delivery system movement, the government is to introduce a "clinic-centered NCD management policy" in 2012, which will strengthen the role of primary care clinics as sources of outpatient care for NCD, and will encourage patients to designate a primary care clinic of their choice for their continued care. The WHO global action plan guiding national-level NCD policies requires an NCD prevention and control model at the community level, presenting strategic goals and detailed options for the introduction and application of the approach to communities. It necessary to develop an NCD prevention and control model, consisting of a strategy of community intervention, education for NCD patients, and the enactment of an NCD law that adequately meets the needs of community members.
Ambulatory Care ; Cause of Death ; Delivery of Health Care ; Education ; Health Promotion ; Heart Diseases ; Humans ; Hypertension ; Jurisprudence ; Korea ; Life Style ; Mortality ; Prevalence ; Primary Health Care ; Republic of Korea ; Risk Factors ; Stroke

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Principles of Judicous use of Antimicrobial Agents for Upper Respiratory Tract Infections in Children.

Sung Hee OH

Journal of the Korean Medical Association.1999;42(1):61-74. doi:10.5124/jkma.1999.42.1.61

No abstract available.
Anti-Infective Agents* ; Bronchitis ; Child* ; Common Cold ; Humans ; Otitis Media ; Pharyngitis ; Respiratory Tract Infections* ; Sinusitis

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