Establishment and Operation of Wartime Health Care System in North Korea during the Korean War and Support from the Korean Society in Yanbian.

North Korea's health care system during the Korean War has a significant meaning in North Korean medical history and is also an appropriate research topic for understanding North Korea's wartime system. However, previous studies on North Korean medical history has been focused on before and after the war. This study traces the formation and operation of North Korea's wartime health system to fill the gap in the literature, aiming to identify that the support of the North Korean community in China's Yanbian community was key to North Korea's wartime health system. North Korea reorganized its health care system, centered on the military, such as establishing field hospitals concurrently with the outbreak of the war. However, as time went on, the North Korean health care project began to put an emphasis on protecting the lives and health of the civilians behind the frontline. In addition to the primary need to prevent infectious diseases, the hygiene and prevention project functioned as a means to control and mobilize the public by emphasizing broad public participation. Although North Korea tried to meet the demand for a large medical personnel through short-term training, medical personnel were always in short supply during the war. During the war, it was the Korean society in Yanbian that replenished medical personnel in North Korea and provided a space for a relatively stable hospital operation. Numerous Koreans in Yanbian participated in the Korean War as nurses, paramedic staff, transfusion donors, and army surgeons for North Korea. Such large-scale participation of medical personnel in Yanbian was based on the long-established medical exchanges between Yanbian and North Korea. Koreans in Yanbian also accommodated North Korean wounded, refugees, and war orphans and provided various medical assistance to them. During the war, Yanbian was a "secure rear" capable of performing medical actions that could not be done in North Korea. This study has confirmed that North Korea's current participation in public health projects, which is a characteristic of its health care sector, has its origins in the Korean War. Moreover, it demonstrates that North Korea's medical history needs to be viewed from an East Asian perspective, including the Korean society in Yanbian, rather than a national-only perspective. The application of this view to the analysis of North Korean's health care system in other historical periods would facilitate richer discussions.

A One-Bag Rapid Desensitization Protocol for Paclitaxel Hypersensitivity: A Noninferior Alternative to a Multi-Bag Rapid Desensitization Protocol.

BACKGROUND: Desensitization is used to safely continue treatment with a culprit drug in patients with drug hypersensitivity. Currently, a multi-bag protocol is widely used for rapid desensitization, but performing the desensitization procedure is labor intensive as pharmacists and nurses need to prepare and administer diluted solutions. However, it has not been investigated whether dilution is essential for successful desensitization. OBJECTIVE: To investigate the efficacy and safety of a nondilution, 1-bag protocol in comparison with a conventional multi-bag protocol for desensitization of patients with paclitaxel hypersensitivity. METHODS: Patients who underwent paclitaxel desensitization between 2011 and 2018 were analyzed in this retrospective cohort study. The completion rate, time to completion, and occurrence and severity of breakthrough reaction (BTR) between a 1-bag protocol and a multi-bag protocol were compared. RESULTS: A total of 211 desensitization procedures were performed, of which 207 procedures (98.1%) were completed successfully. The administration time was significantly shorter in the 1-bag protocol group compared with the conventional multi-bag protocol group (266.0 ± 149.3 minutes vs 484.2 ± 178.6 minutes, P < .05) without differences in the completion rate (97.6% vs 98.9%, P = .645), the incidence of BTR (16.1% vs 27.6%, P = .778), and the proportion of severe BTR (2.6% vs 5.7%, P = .134). CONCLUSIONS: A nondilution, 1-bag protocol is noninferior to a multi-bag rapid desensitization protocol and can be a safe and effective option for paclitaxel desensitization.

The Socialist Camp's North Korean Medical Support and Exchange (1945-1958): Between Learning from the Soviet Union and Independent Course.

This study focused on the socialist camp's North Korean medical support and its effects on North Korean medical field from liberation to 1958. Except for the Soviet assistance from liberation to the Korean War, existing studies mainly have paid attention to the 'autonomous' growth of the North Korean medical field. The studies on the medical support of the Eastern European countries during the Korean War have only focused on one-sided support and neglected the interactions with the North Korean medical field. Failing in utilizing the materials produced in North Korea has led to the omission of detailed circumstances of providing support. Since the review of China's support and the North Korea-China medical exchanges has been concentrated in the period after the mid-1950s, the impacts of China's medical support on North Korea during the Korean War period and the post-war recovery period have not been taken into account. In terms of these limitations, this study examined the medical activities by the Socialist camp of the Eastern European countries in North Korea after the Korean War. The medical aid teams from Hungary, Romania, Bulgaria, Czechoslovakia, Poland, and East Germany that came to North Korea in the wake of the Korean War continued to stay in North Korea after the war to build hospitals and train medical personnel. In the hospitals operated by these countries, cooperative medical care with North Korean medical personnel and medical technology education were conducted. Moreover, medical teams from each country in North Korea held seminars and conferences and exchanged knowledge with the North Korean medical field staffs. These activities by the Socialist countries in North Korea provided the North Korean medical personnel with the opportunity to directly experience the medical technology of each country. China's support was crucial to North Korea's 'rediscovery' of Korean medicine in the mid-1950s. After the Korean War, North Korea began to apply the Chinese-Western medicine integration policy, which was performed in China at that time, to the North Korean health care field through China's medical support and exchanges. In other words, China's emphasis on Chinese medicine and the integration of the Chinese-Western medicine were presented as one of the directions for medical development of North Korea in the 1950s, and the experiences of China in this process convinced North Korea that Korean medicine policy was appropriate. The decision-makers of the North Korean medical policies, who returned to North Korea after studying abroad in China at that time, actively introduced the experiences from China and constantly sought to learn about them. This study identified that a variety of external stimuli had complex impacts on the North Korean medical field in the gap between 'Soviet learning' in the late 1940s and the 'autonomous' medical development since the 1960s. The North Korean medical field was formed not by the unilateral or dominant influences of a single nation but by the stimulation from many nations and the various interactions in the process.

The Establishment and operation of Longjing Medical College - The History of Longjing Medical College as Frontier History: Focusing on its 'Disconnection' and 'Continuity'.

Longjing Medial College, established in Longjing, Yanbian, China on September 12, 1945, existed for about 1 year and 6 months until it was renamed as the Medical Department of Dongbei Junzheng Daxue Jilin Fenxiao in April 1947. However, there are only few records and studies on Longjing Medical College in Yanbian as well as in Korea. In order to fill the gap, this study attempted to restore the history of Longjing Medical College built in Yanbian, China immediately after the liberation. In particular, it analyzed how and why the Longjing Medical College was founded and operated, and which relations the college had with the post-war medical educational institutions, focusing on the 'disconnection' and 'continuity' in the historical sense. Since the establishment of Manchukuo, the Japanese colonial government had made it a major "frontier" and actively promoted the mass migration of Japanese and Koreans. For them, the government also set up three Exploitation Medical Schools in 1940. As a part of these three institutions, Longjing Exploitation Medical School educated more than 150 students by 1945, of which about one third was Korean. After the liberation, the Longjing Educational Alliance decided to pursue the return-movement of the Longjing Exploitation Medical School and took over the institution. On September 12, 1945, Longjing Medical College opened at the school site of Longjing Exploitation Medical School. Longjing Medical College was founded by people who had 'the perspective of Korean nationality' in an atmosphere where the 'ethnicity' of the Koreans exercised considerable power. Nevertheless, in 1946, when the Chinese Civil War began and the Yanbian region became an important base of the Chinese Communist Party, the Party began to expand and strengthen their influences in the region. Accordingly, the operation rights of Longjing Medical College were transferred to the Yanbian Administrative offices of Supervision and Government of Jirinsheng which were the administrative institution by the Chinese Communist Party in turns. In the end, Longjing Medical College was reorganized into the Medical Department of Dongbei Junzheng Daxue Jilin Fenxiao (1947. 3) and the first branch of the Chinese Medical College (1948. 1), a medical education institution focused on nurturing the medical personnel required for the Chinese Civil War. In January 1949, the first branch moved to Harbin, merged with the second branch there, and was transformed into Harbin Medical College. Afterwards, the Yanbian Koreans played a major role to establish Yanbian Medical College in a basis of the teachers and buildings left by the moving-out of the first branch(1948. 10. 1). Now, Yanbian Medical College is the official body of Yanbian University Medical Center. Longjing Medical College, which has such a complicated history, is partially 'disconnected' from the Yanbian medical educational institutions in the post-war era in terms of its possession, operation objective, and academic system. However, many of the early members of the Longjing Medical College were not only teachers and students of the Longjing Exploitation Medical School, but also a few of them continued to teach at the Medical Department of Dongbei Junzheng Daxue Jilin Fenxiao, the first branch of the Chinese Medical College, and Yanbian Medical College. Particularly, several members actively participated in the establishment of each school or in the position of the top leader of the school. Also, all the medical education institutions referred to above used the building and facilities of Longjing Exploitation Medical School until the period of Yanbian Medical College. As such, the history of Longjing Medical College as frontier history, gives us a difficult, but significant question on the meanings of 'disconnection' and 'continuity' in history and their implications.

Clinical and economic evaluation of pharmacists' contribution to patient care on a multi-disciplinary liver transplant team.

OBJECTIVES: We aimed to describe and to evaluate the clinical and economic implications of pharmacists' interventions as members of the liver transplant team for hospitalized liver recipients. METHODS: Retrospective descriptive and cost-benefit analysis of documented pharmacist interventions for hospitalized patients from January 2010 to June 2012 was conducted. The type of drug-related problems (DRPs) was categorized. The clinical significance of pharmacist interventions was rated using five scales by two professionals. The cost avoidance was estimated based on the probability that an adverse drug event (ADE) would have occurred without intervention using previously reported additional costs for ADE treatment. RESULTS: A total of 1,880 interventions were documented for 420 liver transplant recipients. The most common DRP was "need additional drug therapy" (42.6%), followed by "dosage problems" (23.5%). The most common drug class addressed by intervention was antimicrobials (51.4%). Most interventions were rated as more than clinically "significant". Analysis showed that pharmacist activities related to potential ADE prevention had a clear cost-benefit with a net cost-benefit € 94,009 and a cost-benefit ratio of 3.8. CONCLUSION: This study demonstrated the positive impact of clinical pharmacists on the care of hospitalized liver transplant patients in terms of both clinical and economic outcomes.

Safety of reduced dose of mycophenolate mofetil combined with tacrolimus in living-donor liver transplantation.

BACKGROUND/AIMS: The dose of mycophenolate mofetil (MMF) has been reduced in Asia due to side effects associated with the conventional fixed dose of 2-3 g/day. We aimed to determine the pharmacokinetics of a reduced dose of MMF and to validate its feasibility in combination with tacrolimus in living-donor liver transplantation (LDLT). METHODS: Two sequential studies were performed in adult LDLT between October 2009 and 2011. First, we performed a prospective pharmacokinetic study in 15 recipients. We measured the area under the curve from 0 to 12 hours (AUC(0-12)) for mycophenolic acid at postoperative days 7 and 14, and we performed a protocol biopsy before discharge. Second, among 215 recipients, we reviewed 74 patients who were initially administered a reduced dose of MMF (1.0 g/day) with tacrolimus (trough, 8-12 ng/mL during the first month, and 5-8 ng/mL thereafter), with a 1-year follow-up. We performed protocol biopsies at 2 weeks and 1 year post-LDLT. RESULTS: In the first part of study, AUC(0-12) was less than 30 mgh/L in 93.3% of cases. In the second, validating study, 41.9% of the recipients needed dose reduction or cessation due to side effects within the first year after LDLT. At 12 months post-LDLT, 17.6% of the recipients were administered a lower dose of MMF (0.5 g/day), and 16.2% needed permanent cessation due to side effects. The 1- and 12-month rejection-free survival rates were 98.6% and 97.3%, respectively. CONCLUSIONS: A reduced dose of MMF was associated with low blood levels compared to the existing recommended therapeutic range. However, reducing the dose of MMF combined with a low level of tacrolimus was feasible clinically, with an excellent short-term outcome in LDLT.