{"title":"Therapeutic approach to atopic dermatitis in children","authors":"H. Jee, M. Han","doi":"10.5124/jkma.2022.65.10.675","DOIUrl":"https://doi.org/10.5124/jkma.2022.65.10.675","url":null,"abstract":"Background: Atopic dermatitis, a chronic inflammatory skin disease can significantly reduce patients’ quality of life. It is commonly observed in infants or young children but can also occur in adults. Patients with atopic dermatitis are at risk of developing food allergies, allergic rhinitis, and asthma.Current Concepts: Treatment of atopic dermatitis should commence with moisturization of epidermal skin and avoidance of environmental factors that may trigger exacerbation of atopic dermatitis. Topical corticosteroid application remains the gold standard for medical management of atopic dermatitis; however, topical corticosteroids are often avoided owing to concerns regarding the adverse effects of these drugs. Recently, several systemic immunosuppressants and biological agents have been introduced for the treatment of atopic dermatitis. These medications are associated with fewer adverse effects than those observed with previous treatments and have therefore shown positive results for successful management of atopic dermatitis.Discussion and Conclusion: It is expected that new drugs tailored to the disease level of each patient will revolutionize the treatment of atopic dermatitis more effectively in future.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"48 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83411179","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}
{"title":"Epidemiology, risk factors, and prevention of colorectal cancer","authors":"K. Jung, H. Kim, Hungdai Kim","doi":"10.5124/jkma.2022.65.9.549","DOIUrl":"https://doi.org/10.5124/jkma.2022.65.9.549","url":null,"abstract":"Background: Colorectal cancer remains the fourth most common malignancy in Korea, and has been ranked as the third leading cause of cancer deaths in 2020. This study aims to describe the epidemiologic status of colorectal cancer in Korea, and provide basic data for effective primary and secondary prevention methods by summarizing risk factors and screening tools.Current Concepts: Although colorectal cancer incidence and mortality have decreased in recent years in Korea, it still poses a significant public health burden. From the early 1990s until the mid-2000s, the 5-year relative survival of patients with colorectal cancer in Korea continuously increased. This can be attributed to the successful introduction of the government-led screening program; development of improved surgical techniques, anticancer drugs, and adjuvant treatment; and advances medical resources and infrastructure along with economic growth. However, since the late 2000s, the improvement in survival has stagnated. The coronavirus disease 2019 outbreak has reduced hospital visits and screenings, which is assumed to cause delays in diagnosis, leading to a worse prognosis in the patients. To overcome these obstacles, it is essential to explore modifiable environmental risk factors and appropriate screening test methods in Korea.Discussion and Conclusion: Primary prevention through risk factor modification and secondary prevention using suitable screening programs can reduce the incidence and mortality rates of colorectal cancer.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83708913","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}
{"title":"Survey study on the emotional labor of physicians in Korea","authors":"Jin Suk Kim","doi":"10.5124/jkma.2022.65.9.616","DOIUrl":"https://doi.org/10.5124/jkma.2022.65.9.616","url":null,"abstract":"Background: Currently, research on emotional labor is increasing. The purpose of this study was to measure the level of emotional labor of Korean physicians and analyze its differences according to the physicians’ individual and group characteristics.Methods: The 2020 Korean Physician Survey was conducted from November 19, 2020, to January 10, 2021, through an online questionnaire. Participants were selected from the member database of the Korean Medical Association by stratified quota sampling. The target population was 57,714, out of which 6,507 participants answered the questionnaire. Out of the 6,507 participants, 5,563 were included for the analysis as they were clinically experienced in patient care.Results: It was found that Korean physicians engaged significantly in emotional labor (average score=70.03). Further, the level of emotional labor was high in women and physicians <40 years of age, as well as in fellow clinicians, physicians in clinic, physicians in private medical institutions, and psychiatrists.Conclusion: Education, legal protection, mandatory holidays, and counseling programs might be necessary to manage the emotional labor of physicians.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75861753","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}
{"title":"Diagnosis and treatment of women with recurrent urinary tract infection","authors":"Seung-Ju Lee","doi":"10.5124/jkma.2022.65.9.594","DOIUrl":"https://doi.org/10.5124/jkma.2022.65.9.594","url":null,"abstract":"Background: Uncomplicated urinary tract infection (cystitis) is the most common bacterial infection among women visiting primary care clinics, and approximately 50% experience recurrence. Recurrent cystitis represents a substantial burden on the patients’ quality of life, healthcare costs, and antibiotics overuse.Current Concepts: Symptoms remain the cornerstone of cystitis diagnosis, and urine culture is necessary if recurrent cystitis is suspected. Antibiotics (typically nitrofurantoin and fosfomycin) are the first-line treatment. Based on the resistance data, cephalosporins and amoxicillin-clavulanate are the second-line treatment recommendations. Fluoroquinolones are not the first-line options because of safety concerns and rising resistance rates. In considering patients with recurrent cystitis, it is important to assess the patient’s risk factors. Postmenopausal women may present differently and require different diagnostic and treatment approaches from that of younger women. Non-antimicrobial approaches to prevent recurrent cystitis are preferred due to tolerability, safety, antimicrobial resistance concerns, and patient choice. Oral immunostimulant is effective for any age, and vaginal estrogen therapy is additionally recommended in postmenopausal women. Self-start and post-coital antibiotic therapy and non-antimicrobial prophylaxis may be combined. Low-dose continuous antibiotic therapy may be considered for women in whom other regimens fail.Discussion and Conclusion: To improve the quality of life and medical care of women, closing the gap between the physicians’ perceptions and patients’ needs is necessary. Furthermore, various preventive therapies for recurrent cystitis should be fully utilized.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"8 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90190117","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}
{"title":"Direction of diagnosis and treatment improvement in colorectal cancer","authors":"I. Park","doi":"10.5124/jkma.2022.65.9.540","DOIUrl":"https://doi.org/10.5124/jkma.2022.65.9.540","url":null,"abstract":"Background: Cancer is a major public health problem and the leading cause of death in Korea since 2000. Colorectal cancer is the third leading cause of cancer-related death. Therefore, early detection through screening, surgical techniques improvement, anticancer drugs, adjuvant treatment, and medical resources advancement is important to reduce colorectal cancer-related mortality.Current Concepts: In Korea, the 5-year relative survival rate of patients with colorectal cancer is approximately mid-70%, which is superior to other developed countries, such as the United States, United Kingdom, and Japan, with 60% to 68% because of the well performed screening program and technical improvement. Efforts are underway to conduct active endoscopic treatment for early colorectal cancer and identify cases requiring surgery. Minimally invasive surgery has evolved beyond conventional applications into disease-specific methods, and the robotic system has an important role for evolvement. Performing metastatic colorectal cancer efforts is necessary to improve the survival rate through active surgical treatment and gene therapy.Discussion and Conclusion: Eventually, the role of the patient’s genetic information in diagnosing and treating colorectal cancer is expected to increase. In some cases, diagnosing colorectal cancer using a non-invasive method is already realized. Active surgical treatment based on personal characteristics contributes in improving the treatment outcomes for difficult-to-treat metastatic colorectal cancer. After the period of overall colorectal cancer treatment results improvement, we will undertake the precision treatment era.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"51 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91110424","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}
{"title":"An upstanding life of Sang-Kyu Ryu, as a surgeon and an independent activist","authors":"H. Seo","doi":"10.5124/jkma.2022.65.9.624","DOIUrl":"https://doi.org/10.5124/jkma.2022.65.9.624","url":null,"abstract":"","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"64 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88922491","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}
{"title":"Principles of the use of inhaler devices in asthma treatment","authors":"Sung-Yoon Kang, T. Min","doi":"10.5124/jkma.2022.65.9.606","DOIUrl":"https://doi.org/10.5124/jkma.2022.65.9.606","url":null,"abstract":"Background: Inhaler therapy is the most critical route of administering drugs in the management of asthma due to its rapid onset of action, better pulmonary efficacy, and reduced risk of side effects, compared with other routes of administration.Current Concepts: Although many physicians and patients believe they know how to use inhaler devices, most do not know the correct techniques. To achieve better and more effective treatment results, the inhalation device should be appropriate for the characteristics and wishes of each patient. Available inhaler devices include pressurized metered dose inhalers, dry powder inhalers, soft mist inhalers, and nebulizers. To improve disease outcomes and treatment adherence, a personalized stepwise approach, based on each patient’s conscious inhalation, inspiratory flow, and hand-lung coordination, is recommended in the selection of the most appropriate device.Discussion and Conclusion: Common problems with inhaler usage include failure to exhale completely before inhaling, insufficient inhalation efforts, and inadequate breath-hold after inhalation. Therefore, continuing education and support are warranted to ensure optimal outcomes and enable patients to improve inhaler usage techniques. Health care providers should also know the devices and develop systems in order to provide comprehensive support to patients in clinical practice.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"21 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78058589","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}
{"title":"Surgical treatment for metastatic colorectal cancer","authors":"E. Park, S. Baik","doi":"10.5124/jkma.2022.65.9.568","DOIUrl":"https://doi.org/10.5124/jkma.2022.65.9.568","url":null,"abstract":"Background: Stage IV colorectal cancer (CRC) exhibits heterogeneous characteristics in tumor extent and biology. The overall survival of patients with metastatic CRC has improved with the development of multimodal treatments and new chemotherapeutic drugs.Current Concepts: Resection of metastatic CRC is performed for liver, lung, or peritoneal metastases. Conversion surgeries to resect oligometastatic lesions have been developed with tumor regression using chemotherapeutic agents. Two-stage hepatectomy has extended the surgical indications for patients with metastatic CRC. Synchronous liver and primary tumor resection can be considered in patients with adequate conditions. Local ablation with radiotherapy can be used to treat lung metastasis. Meanwhile, for treating patients with CRC with peritoneal metastasis, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy can be considered. Surgical treatments should be performed in patients with symptomatic primary tumors with unresectable metastasis. However, in recent studies, primary tumor resection in patients with asymptomatic CRC with synchronous, unresectable metastases did not show overall survival benefits.Discussion and Conclusion: The treatment of metastatic CRC is challenging because of the variable tumor extent and heterogenous characteristics. Tailored surgical treatments and multidisciplinary approaches may improve the survival and quality of life of patients with metastatic CRC.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"354 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82610286","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}
G. Son, S. B. Park, Tae Un Kim, B. Park, I. Lee, Joo-Young Na, D. Shin, Sang-Bo Oh, Sung Hwan Cho, H. S. Kim, Hyung-Wook Kim
{"title":"Multidisciplinary treatment strategy for early colon cancer","authors":"G. Son, S. B. Park, Tae Un Kim, B. Park, I. Lee, Joo-Young Na, D. Shin, Sang-Bo Oh, Sung Hwan Cho, H. S. Kim, Hyung-Wook Kim","doi":"10.5124/jkma.2022.65.9.558","DOIUrl":"https://doi.org/10.5124/jkma.2022.65.9.558","url":null,"abstract":"Background: Treatment for early colon cancer has progressed rapidly with endoscopic resection and minimally invasive surgery. Selection of patients without risk of lymph node metastasis is necessary before deciding on endoscopic resection for early colon cancer treatment. We aimed to review the optimal multidisciplinary treatment strategies for early colon cancer, including endoscopy and surgery.Current Concepts: Pathological risk factors include histologic grade of cancer cell differentiation, lymphovascular invasion, perineural invasion, tumor budding, and deep submucosal invasion. These risk factors for predicting lymph node metastasis are crucial for determining the treatment strategy of endoscopic excision and radical resection for early colon cancer. Prediction of the depth of invasion in early colon cancer using endoscopic optical assessments is vital to determine the appropriate treatment method for endoscopic or surgical resection. Furthermore, optical assessment of pit and vascular patterns is useful for estimating the depth of submucosal invasion using magnifying chromoendoscopy and narrow-band imaging endoscopy. Performing an endoscopic and pathologic evaluation of the risk factors for lymph node metastasis is imperative when selecting endoscopic or surgical resection. Endoscopic treatments include cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. In addition, appropriate surgical treatment should be recommended for patients with early colon cancer with a high risk of lymph node metastasis.Discussion and Conclusion: A multidisciplinary approach should be recommended to establish an optimized treatment strategy, minimize the risk of complications, and obtain excellent oncologic outcomes via patienttailored treatment in patients with early colon cancer.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"40 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82314850","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}
{"title":"Multidrug-resistant bacteria: a national challenge requiring urgent addressal","authors":"N. Kim","doi":"10.5124/jkma.2022.65.8.462","DOIUrl":"https://doi.org/10.5124/jkma.2022.65.8.462","url":null,"abstract":"Background: Multidrug-resistant bacterial infections are a worldwide threat owing to their increased prevalence, and poor prognosis due to inadequate antibacterial drugs.Current Concepts: Until 2019, several new antibacterial agents, targeting gram-positive bacteria—including telavancin, oritavancin, dalbavancin, ceftaroline, lefamulin, and delafloxacin—had been approved for use in the United States and Europe. Newer antibiotics targeting gram-negative bacteria include ceftazidime-avibactam, imipenem-cilastatin-relebactam, meropenem-vaborbactam, cefiderocol, eravacycline, and plazomicin. The guidance on the treatment of multidrug-resistant bacteria by the Infectious Diseases Society of America, published in February 2022, recommend the use of new antibacterial agents recently approved. However these drugs have not yet been introduced in Korea, thus impeding their prescription by physicians. Multidrug-resistant bacterial infections demonstrably contribute to a high mortality rate and socioeconomic burden.Discussion and Conclusion: Considering the societal impact of antibiotic resistance, the government should monitor and encourage antimicrobial stewardship to reduce the prevalence of multidrug-resistant bacteria, and hasten the introduction of new antibacterial agents for treating multidrug-resistant bacterial infections in Korea.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"39 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77427829","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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