Pub Date : 2024-01-10DOI: 10.5124/jkma.2024.67.1.26
Kyung-Wook Jo
Background: In South Korea, bacteria in the Mycobacterium abscessus complex (MABC), a group of rapidly growing mycobacteria, are second to those in the Mycobacterium avium complex as a cause of non-tuberculous mycobacterial pulmonary disease. The MABC includes several subspecies, including M. abscessus subsp. abscessus (M. abscessus) and M. abscessus subsp. massiliense (M. massiliense), the former of which is difficult to treat owing to its antibiotic resistance.Current Concepts: M. abscessus encodes a functional erythromycin ribosomal methylase gene, erm(41), that causes inducible macrolide resistance. Contrastingly, M. massiliense lacks a functional erm(41) gene owing to a partial deletion. Accordingly, culture conversion rates using currently recommended macrolide-based antibiotic treatments are considerably higher among patients with M. massiliense infection than in those infected with M. abscessus. Phase therapy (intensive and continuous) is recommended for MABC pulmonary disease and, depending on the subspecies and antimicrobial susceptibility test results, should include an initial treatment of ≥3 to 4 injectable and oral antibiotics, followed by inhaled or intravenous amikacin and ≥1 to 2 oral antibiotics. Recommended injectable antibiotics include amikacin, imipenem or cefoxitin, and tigecycline, and oral antibiotics include macrolides (azithromycin or clarithromycin), clofazimine, linezolid, and rifabutin. For some patients, surgery should be considered as an adjunctive treatment option.Discussion and Conclusion: Given that M. abscessus expresses the inducible resistance gene erm(41) associated with macrolide resistance, the identification of MABC subspecies is important for disease management. However, despite the combined application of several injectable/oral antibiotics, the treatment outcomes for M. abscessus pulmonary disease remain unsatisfactory.
{"title":"Treatment of Mycobacterium abscessus complex pulmonary disease","authors":"Kyung-Wook Jo","doi":"10.5124/jkma.2024.67.1.26","DOIUrl":"https://doi.org/10.5124/jkma.2024.67.1.26","url":null,"abstract":"Background: In South Korea, bacteria in the Mycobacterium abscessus complex (MABC), a group of rapidly growing mycobacteria, are second to those in the Mycobacterium avium complex as a cause of non-tuberculous mycobacterial pulmonary disease. The MABC includes several subspecies, including M. abscessus subsp. abscessus (M. abscessus) and M. abscessus subsp. massiliense (M. massiliense), the former of which is difficult to treat owing to its antibiotic resistance.Current Concepts: M. abscessus encodes a functional erythromycin ribosomal methylase gene, erm(41), that causes inducible macrolide resistance. Contrastingly, M. massiliense lacks a functional erm(41) gene owing to a partial deletion. Accordingly, culture conversion rates using currently recommended macrolide-based antibiotic treatments are considerably higher among patients with M. massiliense infection than in those infected with M. abscessus. Phase therapy (intensive and continuous) is recommended for MABC pulmonary disease and, depending on the subspecies and antimicrobial susceptibility test results, should include an initial treatment of ≥3 to 4 injectable and oral antibiotics, followed by inhaled or intravenous amikacin and ≥1 to 2 oral antibiotics. Recommended injectable antibiotics include amikacin, imipenem or cefoxitin, and tigecycline, and oral antibiotics include macrolides (azithromycin or clarithromycin), clofazimine, linezolid, and rifabutin. For some patients, surgery should be considered as an adjunctive treatment option.Discussion and Conclusion: Given that M. abscessus expresses the inducible resistance gene erm(41) associated with macrolide resistance, the identification of MABC subspecies is important for disease management. However, despite the combined application of several injectable/oral antibiotics, the treatment outcomes for M. abscessus pulmonary disease remain unsatisfactory.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"4 12","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139440333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-10DOI: 10.5124/jkma.2023.66.12.712
Hyun-Min Seo, Joung Soo Kim
Background: The contagious skin infestation scabies, is caused by the mite Sarcoptes scabiei var. hominis. These microscopic organisms navigate under the skin surface to lay eggs, creating burrows that cause notable discomfort and itching and enable the maturation and subsequent proliferation of the mites. Spread to other hosts can occur through direct, often prolonged, skin-to-skin contact or indirectly through shared items such as clothing, bedding, or towels.Current Concepts: Management of a scabies outbreak encompasses several pivotal steps: accurate diagnosis, comprehensive treatment with topical scabicides to kill the mites, rigorous environmental control (including washing all possibly infested materials in hot water), meticulous contact tracing of all close contacts, administration of symptomatic relief through antihistamines and corticosteroids, and meticulous follow-up to verify successful treatment outcomes.Discussion and Conclusion: The prevention of further infestation and recurrent outbreaks is crucial, necessitating a holistic, integrative public health management approach. This approach involves consistent communication and public education about preventive measures and prompt treatment strategies to curtail widespread infestation, thereby safeguarding community health.
{"title":"Principles for effective management of scabies outbreaks","authors":"Hyun-Min Seo, Joung Soo Kim","doi":"10.5124/jkma.2023.66.12.712","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.12.712","url":null,"abstract":"Background: The contagious skin infestation scabies, is caused by the mite Sarcoptes scabiei var. hominis. These microscopic organisms navigate under the skin surface to lay eggs, creating burrows that cause notable discomfort and itching and enable the maturation and subsequent proliferation of the mites. Spread to other hosts can occur through direct, often prolonged, skin-to-skin contact or indirectly through shared items such as clothing, bedding, or towels.Current Concepts: Management of a scabies outbreak encompasses several pivotal steps: accurate diagnosis, comprehensive treatment with topical scabicides to kill the mites, rigorous environmental control (including washing all possibly infested materials in hot water), meticulous contact tracing of all close contacts, administration of symptomatic relief through antihistamines and corticosteroids, and meticulous follow-up to verify successful treatment outcomes.Discussion and Conclusion: The prevention of further infestation and recurrent outbreaks is crucial, necessitating a holistic, integrative public health management approach. This approach involves consistent communication and public education about preventive measures and prompt treatment strategies to curtail widespread infestation, thereby safeguarding community health.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"61 14","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138982448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-10DOI: 10.5124/jkma.2023.66.12.735
Eol Lee, SuIll Oh
Background: The Medical Service Act was implemented to protect the public’s health, but has come to excessively restrict the fundamental rights of medical professionals. Therefore, it is necessary to systematically organize the level of physicians’ obligations and the sanction provisions present under the Medical Law.Current Concepts: The Medical Law consists of 120 articles, 6 of which address physicians’ rights. However, the law also provides 72 reasons for physicians’ obligations and penalties, 40 reasons for the suspension of qualifications, 20 reasons for administrative fines, 30 reasons for corrective orders, and 17 reasons for the revocation of permission for establishment. Thus, the Medical Law provides medical professionals with approximately 150 reasons for obligations and sanctions.Discussion and Conclusion: We would like to suggest some measures to improve the excessive regulation of physicians under the Medical Law. First, statistics on the status of penalties and administrative dispositions must be accumulated and disclosed; second, obligations, penalties, and administrative dispositions must be stipulated in one consolidated article; third, penalties should be avoided for simple violations of duty; fourth, reasons for administrative dispositions–such as enforcement ordinances of the Medical Law–must be elevated to the Medical Law itself; fifth, the authority for administrative dispositions against medical institutions must be unified under the Minister of Health and Welfare, the subject of duties and responsibilities must be clarified as the ‘establisher of a medical institution,’ rather than a ‘medical institution,’ and the adequate time required for when two types of administrative dispositions are made must be unified; and sixth, detailed information on the administrative disposition procedures must be newly established in the Medical Law.
{"title":"Problems and improvements in the Medical Law’s excessive regulation of physicians in Korea","authors":"Eol Lee, SuIll Oh","doi":"10.5124/jkma.2023.66.12.735","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.12.735","url":null,"abstract":"Background: The Medical Service Act was implemented to protect the public’s health, but has come to excessively restrict the fundamental rights of medical professionals. Therefore, it is necessary to systematically organize the level of physicians’ obligations and the sanction provisions present under the Medical Law.Current Concepts: The Medical Law consists of 120 articles, 6 of which address physicians’ rights. However, the law also provides 72 reasons for physicians’ obligations and penalties, 40 reasons for the suspension of qualifications, 20 reasons for administrative fines, 30 reasons for corrective orders, and 17 reasons for the revocation of permission for establishment. Thus, the Medical Law provides medical professionals with approximately 150 reasons for obligations and sanctions.Discussion and Conclusion: We would like to suggest some measures to improve the excessive regulation of physicians under the Medical Law. First, statistics on the status of penalties and administrative dispositions must be accumulated and disclosed; second, obligations, penalties, and administrative dispositions must be stipulated in one consolidated article; third, penalties should be avoided for simple violations of duty; fourth, reasons for administrative dispositions–such as enforcement ordinances of the Medical Law–must be elevated to the Medical Law itself; fifth, the authority for administrative dispositions against medical institutions must be unified under the Minister of Health and Welfare, the subject of duties and responsibilities must be clarified as the ‘establisher of a medical institution,’ rather than a ‘medical institution,’ and the adequate time required for when two types of administrative dispositions are made must be unified; and sixth, detailed information on the administrative disposition procedures must be newly established in the Medical Law.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"1087 ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138982684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-10DOI: 10.5124/jkma.2023.66.12.728
J. Lim, Sun Mi Lim, Kye-Hyun Kim
Background: On September 25, 2023, the law requiring the mandatory installation and operation of closed circuit television (CCTV) in the operating room went into effect. In this study, doctors’ perceptions of the law were re-examined on September 23, 2023 (just prior to the law’s enforcement), following a survey conducted on July 21, 2021 (before the re-examination of the bill). This study aimed to confirm doctors’ perceptions of the infringement of fundamental rights of this law, the collapse of essential medical services due to the avoidance of surgery, and other concerns and priority solutions ahead of the law’s enforcement.Methods: The survey was conducted from 8 to 18 September, 2023, by the Korean Medical Association Doctor Survey; a total of 1,267 doctors responded to the survey.Results: Out of 1,267 respondents, 1,156 (91.2%) said “yes,” and 111 (8.8%) said “no” to issue concerning constitutional violations of fundamental rights–such as the freedom of medical personnel to practice their profession–and moral rights. A total of 1,149 (90.7%) respondents agreed with the concern regarding the collapse of essential medical care due to the avoidance of surgeons.Conclusion: Sufficient guidance should be provided, along with guidelines that provide explicit standards for the installation and operation of the CCTV systems, along with safety management measures. Medical disputes and the heavy legal responsibility of medical personnel are the main reasons as to why essential medical care collapses, given the avoidance of surgery. Medical disputes should be avoided in order to prevent essential medical care collapse, as the video is used as evidence for criminal sanctions.
{"title":"Doctors’ perception on the infringement of basic rights and the collapse of essential medical services following CCTV installation in the operating rooms","authors":"J. Lim, Sun Mi Lim, Kye-Hyun Kim","doi":"10.5124/jkma.2023.66.12.728","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.12.728","url":null,"abstract":"Background: On September 25, 2023, the law requiring the mandatory installation and operation of closed circuit television (CCTV) in the operating room went into effect. In this study, doctors’ perceptions of the law were re-examined on September 23, 2023 (just prior to the law’s enforcement), following a survey conducted on July 21, 2021 (before the re-examination of the bill). This study aimed to confirm doctors’ perceptions of the infringement of fundamental rights of this law, the collapse of essential medical services due to the avoidance of surgery, and other concerns and priority solutions ahead of the law’s enforcement.Methods: The survey was conducted from 8 to 18 September, 2023, by the Korean Medical Association Doctor Survey; a total of 1,267 doctors responded to the survey.Results: Out of 1,267 respondents, 1,156 (91.2%) said “yes,” and 111 (8.8%) said “no” to issue concerning constitutional violations of fundamental rights–such as the freedom of medical personnel to practice their profession–and moral rights. A total of 1,149 (90.7%) respondents agreed with the concern regarding the collapse of essential medical care due to the avoidance of surgeons.Conclusion: Sufficient guidance should be provided, along with guidelines that provide explicit standards for the installation and operation of the CCTV systems, along with safety management measures. Medical disputes and the heavy legal responsibility of medical personnel are the main reasons as to why essential medical care collapses, given the avoidance of surgery. Medical disputes should be avoided in order to prevent essential medical care collapse, as the video is used as evidence for criminal sanctions.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"860 ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138982783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-10DOI: 10.5124/jkma.2023.66.12.701
H. Jung
Background: Scabies infestation is known to be more common in hot and humid climates, areas with low medical accessibility, and households with many family members living together. Recently, the number of collective residence facilities for chronic patients and elderly people has increased in developed countries. Furthermore, mass infections are occurring in these facilities.Current Concepts: The cause of scabies infestation is Sarcoptes scabiei var. hominis. It takes about 9 to 15 days for an egg to hatch and grow into an adult mite. Adult mites have an oval body and four pairs of legs. Female mites lay eggs and live for 4 to 6 weeks. In order to spread, mites from an existing host must transfer to a new host. Therefore, external environments such as temperature and humidity are advantageous for the survival of mites, and the closer the distance to other hosts, the higher the infestation rates. In general, scabies infestation induces T helper (Th) 1 cell-mediated reaction, which can prevent the proliferation of mites to some extent. However, in crusted scabies infestations, Th2 cell-mediated response is mainly induced. This response does not suppress the proliferation of the mites and makes them more contagious.Discussion and Conclusion: It is necessary to keep in mind and accurately know the characteristics of scabies when diagnosing skin diseases. The Korean Society of Dermatology has selected eradication of the scabies infestation as a key project and is actively providing support to group residential facilities such as nursing hospitals.
背景：众所周知，疥疮多发于气候炎热潮湿、医疗条件较差的地区以及家庭成员较多的家庭。最近，发达国家为慢性病患者和老年人提供的集体居住设施数量有所增加。此外，在这些机构中也出现了大规模感染：疥疮的病原体是疥螨变种（Sarcoptes scabiei var. hominis）。疥螨卵从孵化到长成成螨大约需要 9 到 15 天。成螨长有椭圆形的身体和四对腿。雌螨产卵，寿命为 4 到 6 周。为了传播，现有宿主的螨虫必须转移到新的宿主身上。因此，温度和湿度等外部环境对螨虫的生存有利，与其他宿主的距离越近，感染率就越高。一般来说，疥虫感染会诱发 T 辅助细胞（Th）1 介导的反应，这在一定程度上可以阻止螨虫的增殖。然而，在结痂性疥疮感染中，主要诱发 Th2 细胞介导的反应。讨论与结论：在诊断皮肤病时，有必要牢记并准确了解疥疮的特征。韩国皮肤病学会已将根除疥疮作为重点项目，并积极为护理医院等集体居住设施提供支持。
{"title":"Epidemiology and pathogenesis of scabies","authors":"H. Jung","doi":"10.5124/jkma.2023.66.12.701","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.12.701","url":null,"abstract":"Background: Scabies infestation is known to be more common in hot and humid climates, areas with low medical accessibility, and households with many family members living together. Recently, the number of collective residence facilities for chronic patients and elderly people has increased in developed countries. Furthermore, mass infections are occurring in these facilities.Current Concepts: The cause of scabies infestation is Sarcoptes scabiei var. hominis. It takes about 9 to 15 days for an egg to hatch and grow into an adult mite. Adult mites have an oval body and four pairs of legs. Female mites lay eggs and live for 4 to 6 weeks. In order to spread, mites from an existing host must transfer to a new host. Therefore, external environments such as temperature and humidity are advantageous for the survival of mites, and the closer the distance to other hosts, the higher the infestation rates. In general, scabies infestation induces T helper (Th) 1 cell-mediated reaction, which can prevent the proliferation of mites to some extent. However, in crusted scabies infestations, Th2 cell-mediated response is mainly induced. This response does not suppress the proliferation of the mites and makes them more contagious.Discussion and Conclusion: It is necessary to keep in mind and accurately know the characteristics of scabies when diagnosing skin diseases. The Korean Society of Dermatology has selected eradication of the scabies infestation as a key project and is actively providing support to group residential facilities such as nursing hospitals.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"746 ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138982728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-10DOI: 10.5124/jkma.2023.66.12.741
Yohan Shin, Kye-Hyun Kim, Sung Je Moon, Joohyun Kang
Background: Korea has the most rapidly aging population in the world. Medical costs for the elderly are quickly increasing, which raises concerns about the sustainability of health insurance finances. Accordingly, the need to allocate limited medical resources efficiently has increased, with improving the fee schedule seen as an effective way to achieve this. Japan has experienced a super-aging society for at least 20 years prior to Korea and has been successful in improving its fee schedule. Korea’s fee schedule, however, needs to overcome the challenge of being relatively limited in type and simplicity.Current Concepts: The new patient consultation fee in Japan is the same regardless of the type of medical institution and is approximately 40% higher than found in Korea. In the case of established patient consultations, the fee for medical institutions with fewer than 200 beds are substantially higher than for large medical institutions, thereby suppressing re-examination at large hospitals. Japan’s additional points consist of 71 types of items, which is more diverse than Korea’s 28 types, and the additional points for children under six years of age, holidays, and late nights are set significantly higher than that found in Korea.Discussion and Conclusion: Japan designed its fee schedule to structurally reduce the consumption of medical resources and to effectively compensate for the behavior of medical providers. This policy is a standard which Korea’s fee schedule should aim for. In the future, it will be necessary to prepare measures to respond to the super-aging environment through detailed research concerning Japan’s fee schedule.
{"title":"The current status and implications of the medical insurance fee schedule in Japan","authors":"Yohan Shin, Kye-Hyun Kim, Sung Je Moon, Joohyun Kang","doi":"10.5124/jkma.2023.66.12.741","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.12.741","url":null,"abstract":"Background: Korea has the most rapidly aging population in the world. Medical costs for the elderly are quickly increasing, which raises concerns about the sustainability of health insurance finances. Accordingly, the need to allocate limited medical resources efficiently has increased, with improving the fee schedule seen as an effective way to achieve this. Japan has experienced a super-aging society for at least 20 years prior to Korea and has been successful in improving its fee schedule. Korea’s fee schedule, however, needs to overcome the challenge of being relatively limited in type and simplicity.Current Concepts: The new patient consultation fee in Japan is the same regardless of the type of medical institution and is approximately 40% higher than found in Korea. In the case of established patient consultations, the fee for medical institutions with fewer than 200 beds are substantially higher than for large medical institutions, thereby suppressing re-examination at large hospitals. Japan’s additional points consist of 71 types of items, which is more diverse than Korea’s 28 types, and the additional points for children under six years of age, holidays, and late nights are set significantly higher than that found in Korea.Discussion and Conclusion: Japan designed its fee schedule to structurally reduce the consumption of medical resources and to effectively compensate for the behavior of medical providers. This policy is a standard which Korea’s fee schedule should aim for. In the future, it will be necessary to prepare measures to respond to the super-aging environment through detailed research concerning Japan’s fee schedule.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"1032 ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138982763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-10DOI: 10.5124/jkma.2023.66.12.705
D. Yu, Young Bok Lee
Background: Scabies is a highly contagious skin disease caused by scabies mite infestation, resulting in intense itching. In 2023, the Korean Dermatological Association is actively implementing the “Eradication of Scabies, National Health Project” as a key initiative. Under this project, educational programs for sanatoriums and other group residential facilities, as well as nationwide public awareness campaigns, are being conducted. An expert committee of dermatologists has developed standardized clinical guidelines for the diagnosis and treatment of scabies.Current Concepts: The clinical presentation of scabies varies depending on the age and health status of the patient, the number of scabies mites, and the mode of transmission. Characteristic skin symptoms include intense itching that worsens at night and the presence of burrows and red, inflamed papules on typical areas such as finger webs, inner wrists, scrotum, and around the umbilicus. In older adults or immunocompromised infants, scabies may involve the scalp, face, palms, and soles. Atypical skin findings such as excessive hyperkeratosis, nodules, and other unusual manifestations may also occur.Discussion and Conclusion: Using the scabies diagnostic and treatment algorithm, healthcare professionals in Korean clinical settings can make rapid medical decisions when examining patients with scabies. This algorithm provides a systematic and straightforward approach to diagnosing and treating scabies effectively and improves patient care and management in real time.
{"title":"Guideline for the diagnosis and treatment of scabies","authors":"D. Yu, Young Bok Lee","doi":"10.5124/jkma.2023.66.12.705","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.12.705","url":null,"abstract":"Background: Scabies is a highly contagious skin disease caused by scabies mite infestation, resulting in intense itching. In 2023, the Korean Dermatological Association is actively implementing the “Eradication of Scabies, National Health Project” as a key initiative. Under this project, educational programs for sanatoriums and other group residential facilities, as well as nationwide public awareness campaigns, are being conducted. An expert committee of dermatologists has developed standardized clinical guidelines for the diagnosis and treatment of scabies.Current Concepts: The clinical presentation of scabies varies depending on the age and health status of the patient, the number of scabies mites, and the mode of transmission. Characteristic skin symptoms include intense itching that worsens at night and the presence of burrows and red, inflamed papules on typical areas such as finger webs, inner wrists, scrotum, and around the umbilicus. In older adults or immunocompromised infants, scabies may involve the scalp, face, palms, and soles. Atypical skin findings such as excessive hyperkeratosis, nodules, and other unusual manifestations may also occur.Discussion and Conclusion: Using the scabies diagnostic and treatment algorithm, healthcare professionals in Korean clinical settings can make rapid medical decisions when examining patients with scabies. This algorithm provides a systematic and straightforward approach to diagnosing and treating scabies effectively and improves patient care and management in real time.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"25 ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138982173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-10DOI: 10.5124/jkma.2023.66.12.696
Hyojin Kim, Yang Won Lee
Background: Scabies is an ectoparasitic dermatosis caused by Sarcoptes scabiei var. hominis. Subpopulations experiencing increased direct skin-to-skin contact are at high risk of infestation.Current Concepts: The prevalence of scabies in Korea has fluctuated, depending on the overall socioeconomic status and hygienic environment; according to these characteristics, the scabies prevalence can be differentiated into periods. In the 1960s and 1970s, scabies was poorly controlled overall. Outbreaks were regional, and the incidence in dermatologic outpatient clinics was as high as approximately 10%. Scabies was more common in men and younger people (in their 20s or younger) then. In the 2010s, institutional outbreak became more prevalent, and older generations (60s or older) became highly vulnerable to scabies, as supported by the incidence per 100,000 population being extremely high in those 80 years or older in 2011. The number of scabies cases in 2021 in Korea was 29,693, and the age-standard incidence rate was 43.4 per 100,000 population. This may have resulted from the rapidly increased number of long-term care hospitals and nursing homes in the 2000s and from various other factors affecting the difficulty of diagnosing scabies.Discussion and Conclusion: Well-organized coordination between dermatology and facilities as well as more opportunities to educate relevant personnel to increase their understanding of scabies are essential to cope with changing challenges imposed by scabies.
{"title":"Current status of scabies in Korea","authors":"Hyojin Kim, Yang Won Lee","doi":"10.5124/jkma.2023.66.12.696","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.12.696","url":null,"abstract":"Background: Scabies is an ectoparasitic dermatosis caused by Sarcoptes scabiei var. hominis. Subpopulations experiencing increased direct skin-to-skin contact are at high risk of infestation.Current Concepts: The prevalence of scabies in Korea has fluctuated, depending on the overall socioeconomic status and hygienic environment; according to these characteristics, the scabies prevalence can be differentiated into periods. In the 1960s and 1970s, scabies was poorly controlled overall. Outbreaks were regional, and the incidence in dermatologic outpatient clinics was as high as approximately 10%. Scabies was more common in men and younger people (in their 20s or younger) then. In the 2010s, institutional outbreak became more prevalent, and older generations (60s or older) became highly vulnerable to scabies, as supported by the incidence per 100,000 population being extremely high in those 80 years or older in 2011. The number of scabies cases in 2021 in Korea was 29,693, and the age-standard incidence rate was 43.4 per 100,000 population. This may have resulted from the rapidly increased number of long-term care hospitals and nursing homes in the 2000s and from various other factors affecting the difficulty of diagnosing scabies.Discussion and Conclusion: Well-organized coordination between dermatology and facilities as well as more opportunities to educate relevant personnel to increase their understanding of scabies are essential to cope with changing challenges imposed by scabies.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"133 ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138982224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-10DOI: 10.5124/jkma.2023.66.12.716
H. Ryu
Background: Recent advances in molecular biology and genomics have revolutionized the understanding of the intricate molecular underpinnings of cancer. Next-generation sequencing analysis now allows identification of specific actionable genetic alterations. This breakthrough has paved the way for precision medicine in oncology, redefining the conventional clinical trial landscape and enabling personalized approaches to cancer treatment.Current Concepts: The shift toward precision medicine involves a fundamental departure from the traditional Phases 1–4 clinical trial protocols. Instead of using uniform treatment pathways, personalized therapies are designed based on the genetic profiles of individual patients. Tumor-agnostic clinical trials are becoming as a prominent concept, encompassing innovative adaptive designs that adapt treatments to specific genetic variations. Master protocols such as umbrella studies, basket trials, platform studies, and master observational trials exemplify this transformation.Discussion and Conclusion: International precision medicine research is characterized by exemplar studies such as the NCI-MATCH study in the United States, the Drug Rediscovery Protocol study in the Netherlands, and the Targeted Agent and Profiling Utilization Registry study in the United States. Korean oncology research also contributed to the international effort in precision medicine through initiatives like K-MASTER and the Korean Precision Medicine Networking Group, which is making commendable contributions to the global precision medicine movements.
{"title":"Latest trends in cancer clinical trials using genomics","authors":"H. Ryu","doi":"10.5124/jkma.2023.66.12.716","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.12.716","url":null,"abstract":"Background: Recent advances in molecular biology and genomics have revolutionized the understanding of the intricate molecular underpinnings of cancer. Next-generation sequencing analysis now allows identification of specific actionable genetic alterations. This breakthrough has paved the way for precision medicine in oncology, redefining the conventional clinical trial landscape and enabling personalized approaches to cancer treatment.Current Concepts: The shift toward precision medicine involves a fundamental departure from the traditional Phases 1–4 clinical trial protocols. Instead of using uniform treatment pathways, personalized therapies are designed based on the genetic profiles of individual patients. Tumor-agnostic clinical trials are becoming as a prominent concept, encompassing innovative adaptive designs that adapt treatments to specific genetic variations. Master protocols such as umbrella studies, basket trials, platform studies, and master observational trials exemplify this transformation.Discussion and Conclusion: International precision medicine research is characterized by exemplar studies such as the NCI-MATCH study in the United States, the Drug Rediscovery Protocol study in the Netherlands, and the Targeted Agent and Profiling Utilization Registry study in the United States. Korean oncology research also contributed to the international effort in precision medicine through initiatives like K-MASTER and the Korean Precision Medicine Networking Group, which is making commendable contributions to the global precision medicine movements.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"129 ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138982908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-10DOI: 10.5124/jkma.2023.66.11.658
Donghwan Kim, Eunsun Kim
Background: The integration of medical devices with artificial intelligence (AI) software is rapidly advancing as technology progresses. AI machine learning can be used in commercial medical services to generate practical data; there is evidence that it can be integrated into newly developed devices. However, such devices must undergo approval, regulation, and supervision. The Food and Drug Administration approves regulations for numerous machine-learning medical devices and shares open lists with the public. In this article, we examine recent medical AI devices in different fields, including the diagnosis of colorectal polyps.Current Concepts: Currently, in the field of gastroenterology, there has been a significant amount of research aimed at enhancing adenoma detection rates using tools powered by AI, such as the EndoScreener and GI Genius. Various such devices have also been developed for other fields; examples include the 23andMe Personal Genome Service for DNA detection, Spectral MD’s DeepView platform for wound imaging in surgery, Gili Pro BioSensor for monitoring vital signs, DreaMed Advisor Pro for diabetes, Minuteful for urinary analysis, BrainScope TBI for cerebral diagnosis, Compumedics Sleep Monitoring System for sleep disorders, Idx-DR v2.3 for ophthalmology, and EarliPoint system for pediatrics.Discussion and Conclusion: By the time this article is published, it is likely that even more AI medical devices will have been approved and commercialized. The development of such devices should be strongly encouraged. Additionally, we anticipate greater involvement from practitioners in the development and validation of diverse medical AI devices in Korea.
{"title":"AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps","authors":"Donghwan Kim, Eunsun Kim","doi":"10.5124/jkma.2023.66.11.658","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.11.658","url":null,"abstract":"Background: The integration of medical devices with artificial intelligence (AI) software is rapidly advancing as technology progresses. AI machine learning can be used in commercial medical services to generate practical data; there is evidence that it can be integrated into newly developed devices. However, such devices must undergo approval, regulation, and supervision. The Food and Drug Administration approves regulations for numerous machine-learning medical devices and shares open lists with the public. In this article, we examine recent medical AI devices in different fields, including the diagnosis of colorectal polyps.Current Concepts: Currently, in the field of gastroenterology, there has been a significant amount of research aimed at enhancing adenoma detection rates using tools powered by AI, such as the EndoScreener and GI Genius. Various such devices have also been developed for other fields; examples include the 23andMe Personal Genome Service for DNA detection, Spectral MD’s DeepView platform for wound imaging in surgery, Gili Pro BioSensor for monitoring vital signs, DreaMed Advisor Pro for diabetes, Minuteful for urinary analysis, BrainScope TBI for cerebral diagnosis, Compumedics Sleep Monitoring System for sleep disorders, Idx-DR v2.3 for ophthalmology, and EarliPoint system for pediatrics.Discussion and Conclusion: By the time this article is published, it is likely that even more AI medical devices will have been approved and commercialized. The development of such devices should be strongly encouraged. Additionally, we anticipate greater involvement from practitioners in the development and validation of diverse medical AI devices in Korea.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":" 93","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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