• Quality Improvement in Health Care
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• v.7 no.1
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• pp.60-70
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• 2000

Background : The aim of this study was to examine the effectiveness of the critical pathway to diabetic patients who were admitted in the hospital. Methods : For establishment of critical pathway for diabetic patients, we organized the multidisciplinary care team. During 5 months, 31 diabetic inpatients were applied the critical pathway and the results were compared with 11 diabetic inpatients who were treated with conventional way. We assessed the patients satisfaction, knowledge on the disease, compliance of medical regimen, length of stay(LOS) and hospital cost. We used the computer program SAS for statistical analysis. Data were summarized with mean, and analyzed using t-test repeated measures ANOVA and Wilcoxon rank sum test. Results : Length of stay(LOS) was remarkably shortened in critical pathway group compared with the conventional treatment group($7.6{\pm}1.23$ vs $12.0{\pm}4.73$, p<0.000). Although LOS was significantly shortened in critical pathway group, patients satisfaction was much higher than conventional treatment group. There were no significant difference of knowledge on the disease, compliance of medical regimen and blood glucose level between two groups at discharge. Hospital cost of each patients also significantly decreased in critical pathway group(890,000 won vs 1,280,000 won, p<0.05). Conclusion : These results showed that establishment of critical pathway for diabetic inpatients with team approach is the one of the way to improve the quality of diabetic patients management and to enhance the efficiency of hospital management.

• Journal of Sasang Constitutional Medicine
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• v.26 no.1
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• pp.55-63
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• 2014

Objectives This research was performed to establish the clinical practice guideline(CPG) for Lesser Yin Symptomatology of Soeumin disease. Methods Dongeui suse bowon(sinchuk edition), textbook for Sasang constitutional medicine, Clinical guidebook for Sasang constitutional medicine, and standardization reports on Sasang constitutional medicine and papers concerning symptomatology of Soeumin Disease, especially Lesser Yin Symptomatology was collected and classified. Additionally experts' conference was held to make agreement on the conflicting issues on a regular basis. Results & Conclusions There was no concerning paper on Lesser Yin Symptomatology. Experts' agreement was needed to establish the CPG. Lesser Yin pattern can be classified into 2 groups; Lesser Yin severe pattern and Lesser Yin critical pattern. There are Lesser Yin pattern accompanied abdominal pain and bowel irritability pattern and Lesser Yin pattern accompanied green tinged watery diarrhea pattern in Lesser Yin severe pattern. There are Visceral syncope pattern and Exuberant yin repelling yang pattern in Lesser Yin critical pattern. Lesser Yin symptomatology has several symptoms like abdominal pain and diarrhea, thirst, oral discomfort, chest discomfort, whole body pain, articular pain and coldness of hands and feet. Additionally there are abdominal pain and diarrhea in Lesser Yin symptomatology accompanied abdominal pain and bowel irritability pattern, there is green tinged watery diarrhea in Lesser Yin pattern accompanied green tinged watery diarrhea pattern and if this symptoms exacerbate, delirious speech and constipation can occur. There are restlessness and coldness on hands and feet in Visceral syncope pattern and severe restlessness and coldness on hands and feet and symptom which the patient cannot drink water in Exuberant yin repelling yang.

• Journal of Sasang Constitutional Medicine
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• v.26 no.1
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• pp.1-10
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• 2014

Objectives This study was aimed to develop the clinical practice guideline for Soeumin symptomatology. This was the first clinical practice guideline, which focuses on symptomatology, not disease. Methods Donguisusebowon and many articles were reviewed and examined for developing clinical practice guidelines. Among the previous guidelines, we assessed the guidelines by Appraisal of Guidelines for Research and Evaluation (AGREE II). After AGREE II assessment, we chose and revised the clinical practice guideline. Results & Conclusions By researching and discussing the Soeumin symptomatology, we make the principle of the clinical practice guideline, including classification, definition, algorithm, and treatment assessing tool.

• Archives of Craniofacial Surgery
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• v.14 no.2
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• pp.89-95
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• 2013

Background: If patients have a better understanding about their problem and treatment, compliance and satisfaction with treatment will increase. For this purpose, simple repeated explanations regarding a patients' problem and treatment are essential. Critical pathway (CP) has a very wide range in medicine with the exception of the plastic surgery field. The authors developed a CP for facial bone fractures and implemented it clinically. The aim of this study was to evaluate the effectiveness of the CP on the degree of recognition of the problem along with patient satisfaction with the treatment process. Methods: From May 2011 to October 2011, a total of 82 patients suffering from facial bone fractures were studied. The CP for facial bone fractures was developed by plastic surgeons, residents and nurses. Subsequently, the authors investigated the degree of recognition of the disease and patient satisfaction with the treatment through the use of a questionnaire. The authors compared the score of the questionnaires before and after implementation of the clinical pathway. Results: The degree of the recognition of the problem changed from 3.1 to 4.2 (p<0.001). Further, the degree of satisfaction with the treatment process changed from 3.6 to 4.3 (p<0.05). Overall, there was a two point increase in improvement. Conclusion: Implementation of the CP for facial bone fractures was effective in improving the degree of recognition and satisfaction. The authors expect that hereafter, the CP for facial bone fractures will be implemented actively in the plastic surgery field.

• The Journal of Korean Obstetrics and Gynecology
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• v.23 no.4
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• pp.80-94
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• 2010

Purpose: This survey was done in order to determine Korean medical doctors (K.M.D)' expertise on clinical practice guideline for infertility and the degree of concordance with the guideline. Methods: The questionnaires were distributed via e-mail to all members of Korean Medical Doctors Society and Korean Gynecology Society from August $30^{th}$ to September $1^{st}$ in 2010. Two hundred sixty nine of completed questionnaires were analyzed through two groups, members of the Gynecology Society and nonmembers of the Gynecology Society. Results: According to the analysis of the outcome of the survey done by 99 members of the Korean Gynecology Society and 170 non-members, two-thirds of the participants had prior information of the clinical practice guideline. 63.6 percent of the participants feel strong necessity of the development of Korean medical infertility clinical practice guideline. Seventy percent of the participants are willing to participate in developing or reviewing a clinical guideline. On the question in active utilization and concordance to the guideline once the Korean medical infertility guideline is developed, 44% answered they would while 34.6% said they would utilize the guideline after some modifications. On the prospect of the impact of the development and application of Korean medical clinical practice guideline for infertility, majority of the participants marked positively that the standardization of clinical practice for infertility will lead to the nation's participation with the Nation's Support Work and that the development will somewhat contribute to the standardization of the clinical practice. Conclusions: The survey confirmed high demand of the clinical practice guidelines for infertility and the degree of concordance for infertility amongst Korean Medical doctors.

• The Journal of Korean Medicine
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• v.37 no.1
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• pp.1-9
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• 2016

Objectives: Objectives : This study is aimed to develop a Clinical Practice Guideline (CPG) on acupuncture treatment for the patients with Post-stroke Urinary Retention; PSUR. Methods: Experts committee, consisting of stroke or methodology specialists, searched Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and 19 Korean medicine journals. The search terms were selected to screen the randomized controlled trials (RCTs) or systematic reviews for the effectiveness of acupuncture on PSUR compared with placebo or conventional group. Levels of evidence and grades of recommendations were appraised based on Recommendations for Development of Clinical Practice Guideline in Korean Medicine. Results & Conclusions: 4 RCT were included to build the CPG. There was a strong evidence to support the effectiveness of acupuncture treatment for PSUR. The moderate evidence was presented that over 3 times a week of the acupuncture should be performed over 4 weeks on the acupoints, such as SP6, CV3, CV6, CV4, SP9, BL28, BL23, BL22, KI3 or BL67, for 15-30 minutes. 20-140Hz frequency and 10-20 minutes of treatment is suggested if electro-acupuncture treatment is performed with. It was also suggested that the procedure should begin at the acute stage just after the vital signs of the patients are stabilized. Finally, there was a moderate evidence to support safety of acupuncture treatment for PSUR.

• Pediatric Infection and Vaccine
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• v.18 no.1
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• pp.1-14
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• 2011

Tuberculosis is a disease with high morbidity and mortality in children worldwide. Despite the decrease in the incidence of tuberculosis in Korea, more than 30,000 new patients are diagnosed each year. Active tuberculosis is less frequent in children compared to adults but the risk of miliary tuberculosis and CNS tuberculosis is much higher. The diagnosis of tuberculosis in children and adolescents is difficult due to the nonspecific symptoms upon presentation. Diagnostic work up is based on the confirmation of tuberculosis infection by tuberculin skin test, abnormal radiologic findings, and contact with an adult with active tuberculosis. Anti-tuberculosis medications are prescribed according to the drug susceptibility of the index patient. Latent tuberculosis infection plays an important role in adult tuberculosis by reactivation. Thus, it is critical to accurately diagnose latent tuberculosis in children to prevent reactivation in adulthood. Korean guidelines for diagnosis and treatment of tuberculosis in children and adolescents provide evidence based recommendations in the optimal diagnosis and treatment for active and latent tuberculosis in children and adolescents based on the current Korean situation.

• Quality Improvement in Health Care
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• v.4 no.2
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• pp.230-240
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• 1997

Background : Hypercholesterolemia is a major independent risk factor of coronary heart disease. Practice guidelines for management of hypercholesterolemia had been made in several developed countries. This study was undertaken to assess the effect of practice guideline reminders and flow-sheets to improve the quality of management of hypercholesterolemia. Methods: Practice guideline reminders and flow-sheets based on National Cholesterol Education Program Adult Treatment Panel II guidelines, were placed on the office desks of outpatient department of family medicine at the Asan Medical Center. Before this intervention, we educated the doctors to use these reminders and flow-sheets. The charts of all patients who had cholesterol levels greater than or equal to 240 mg/dl during 4 months before and after introduction of reminders and flow-sheets, were reviewed retrospectively. We compared the performances of physicians about management of hypercholesterolemia between pre-intervention period and post-intervention period. Results: The detection rate of hypercholesterolemia in post-intervention period was increased to 83.2% compared by 71.5% in pre-intervention period. Risk factor analysis for coronary heart disease increased significantly from 16.9% to 68.7%. Adequacy of management was 19.2% in pre-intervention period and 78.0% in post-intervention period. It showed statistically significant improvement in management of hypercholesterolemia. Conclusion : This study suggested that practice guideline reminders and flow-sheets were the effective methods in improving the quality in management of hypercholesterolemia.

• The Journal of Pediatrics of Korean Medicine
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• v.34 no.2
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• pp.75-85
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• 2020

Objectives Although clinical practice guidelines (CPGs) are becoming crucial in medical decision-making worldwide, there are very few development guidelines for children. Therefore, this preliminary study aimed to assess the status of worldwide except east asia-CPGs recommending complementary and alternative medicine interventions (CAM-i) in children worldwide except east asia in order to help developing Korean medicine CPGs (KMCPGs) for children. Methods To identify the current status of CPGs including CAM-i that have been developed so far, the author searched the related databases, and selected CPGs for children. The data related to the status of evidence-based CPGs, the materials related to the characteristics of CAM-i, and the details of recommendations for CAM-i were selected from the obtained findings. Results A total of 106 CPGs were identified based on the searches, of which 11 were finally selected as pediatric CPGs. These pediatric CPGs have been developed since 2007 to target various diseases. The countries developing these CPGs include the United Kingdom, Scotland, Australia, and the United States, with the U.K. having the largest share. The majority of CPGs used MEDLINE, Embase, and Cochrane library as databases. The most frequently recommended topic was acupuncture, followed by herbal medicine. Many CPGs suggested that more research was needed. Conclusions Through this study, the author was able to identify the characteristics of the developed pediatric CPGs that include CAM-i. More preceding studies are needed for the development of pediatric KMCPGs. It is hoped that this report can be used as the foundation for future development of pediatric KMCPGs.

• Quality Improvement in Health Care
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• v.10 no.2
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• pp.154-163
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• 2003

Purpose: The aim of this study is to develop and apply the critical pathway to the nasal bone fracture patients and to elucidate its effect. Methods: Critical pathway (CP) sheet and questionnaire were developed by a team approach. Critical pathway were applied to 30 nasal bone fracture patients (CP group) from June 2001 to November 2001. Length of hospitalization, cost for hospitalization and bed turnover rate of CP group were compared to those of the 30 patients who had same disease entities and treated by conventional regimen (control group). Results: Length of hospitalization in the CP group (4.20 day) were significantly shorter than that of control group (6.21 day). Mean cost for hospitalization of the CP group (492,106 won) were significantly lower than that of control group (678,376 won). Bed turnover rate in CP group (2.5) were higher than that of control group. The patients satisfaction for the medical personnel, explanation regarding operation procedure, therapeutic operation fee, and length of hospitalization were all affirmative. Conclusion: Critical pathway that we developed for nasal bone fracture definitely improved the quality of treatment and lowered cost of medical service. Furthermore, other critical pathways should be developed for another facial trauma patients.