• 임상간호연구
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• 제27권2호
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• pp.187-198
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• 2021

Purpose: This study aimed to develop an evidence-based nursing practice guideline for preventing postoperative pulmonary complications (PPCs). Methods: The guideline adaptation process was conducted through the 24 steps based on the guideline adaptation manual of Korean Hospital Nurses Association. Results: The newly developed guideline to prevent PPCs consisted of four domains and 30 recommendations. The number of recommendations in each domain was 7 for assessment of PPCs, 17 for nursing interventions to prevent PPCs after general anesthesia, 4 for education (intended for patients and medical staff), and 2 for monitoring and recording. Conclusion: The developed guidelines will contribute in standardization of nursing practice and PPCs prevention and management. We recommend the dissemination and utilization of these guidelines nationwide to improve the quality of postoperative pulmonary complication prevention.

• 임상간호연구
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• 제22권3호
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• pp.285-293
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• 2016

Purpose: The purpose of this study was aimed to develop evidence-based nursing practice guideline for preventing intermittent urinary catheterization (IUC) related complications using guideline remake process. Methods: Guideline remake process was conducted according to guideline adaptation manual developed by Gu et al (2012) which consisted of three main phases and 9 modules including a total of 24 steps. Results: Newly developed IUC guideline consists of introduction, overview of intermittent catheterization, summary of recommendations, recommendations, references, and appendices. There were 50 recommendations in 5 sections including assessment, equipments, catheterization, complications management, and education/consult. Three recommendations (6%) were graded A, and five (10%) and 41 recommendations(82%) were B and C, respectively. Conclusion: The IUC remade-guideline was developed based on evidence-based nursing and therefore, this guideline is recommended to be disseminated and utilized by nurses nationwide to improve the quality of care for IUC and to decrease the IUC related complications.

• 임상간호연구
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• 제21권2호
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• pp.196-206
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• 2015

Purpose: This study was done to use a guideline adaptation process to develop a Korean evidence-based diabetic foot care clinical practice guideline for diabetic foot prevention and management. Methods: The guideline adaptation process was conducted according to the guideline adaptation manual developed by the National Evidence-Based Healthcare Collaborating Agency. The process consists of three main phases, with 9 modules including a total of 23 steps. Results: The newly developed diabetic foot care clinical practice guideline consisted of an introduction, description of diabetic foot, summary of recommendations, recommendations, references, appendices, and glossary. There were 165 recommendations in 4 sections (risk assessment for diabetic foot ulcers, prevention of diabetic foot ulcers, wound assessment of diabetic foot ulcers, and management of the diabetic foot). In grading by recommendations, for A there were 30 (18.2%), B, 8 (4.8%), C, 30 (18.2%) D, 97 (58.8%). Conclusion: This guideline can be used as educational material for healthcare workers and diabetic patients. It can also be utilized as a practice guideline for healthcare workers in the hospital and community setting.

• 한국의료질향상학회지
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• 제4권1호
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• pp.82-103
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• 1997

Background : With increased concerns about variation among physician's practice pattern and their impact on the quality of care, clinical practice guidelines have been developed by many different organizations, with differing aims and incentives. From the same point of view, there is growing interest in the development of clinical practice guidelines in Korea, but with only a few examples. As a result, there is not much exploration on the incentive and barrier to develop guidelines as well as description on the development process. The purposes of this study are to describe the process of the four different clinical practice guidelines in a hospital setting, and to identify incentives and barriers in the development of guidelines. Methods : For this research, a clinical practice guideline development committee and four clinical practice guideline development teams were organized in a university hospital which has more than 1,200 bead. Twenty eight doctors, three nurses, and one technician participated as members of development teams for eight months. Four to six meetings were held, and three to seven departments in the hospital were involved. Results : The topics which developed into clinical practice guidelines were cardiopulmonary resuscitation(CPR), blood transfusion, anticoagulation, and angiography. The main goals set by teams were education(CPR, angiography), risk management(blood transfusion), and to enhance quality of care(anticoagulation). Among four teams, only in the team for anticoagulation guideline medical record review and pilot-testing were performed. Also literature review was not carried out systematically. However, all the guidelines were developed by multidisciplinary be used as standard protocols in the practice. Conclusion : Experience and skill in developing process has to be improved to have a more valid and useful practice guideline. In particular, literature review and problem identification by examining medical record should be emphasized. Also further studies on the clinical outcomes of the guidelines application and changes in physicians' behaviors would be required.

• 대한한의학회지
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• 제40권3호
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• pp.59-75
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• 2019

Objectives: The purpose of this study is to examine the current status of Korean medicine health technology assessment and explore realistic plans to activate it. Methods: We investigated all the applications for new health technology assessment related to Korean medicine from 2007 to 2016. The several expert meetings were held to draw out the barriers and improvement strategies of the new health technology assessment of Korean medicine field. Results: There were 31 cases in total except for duplications or reapplies falling into 3 main types. First, 19 of them were to try to enter a medical market and be covered by National Health Insurance. Eight cases were to apply western medicine technology as new health technology in Korean medicine area. The rest was 4 cases, which were totally not appropriate for the purpose of new health technology assessment system. According to the expert opinion, the obstacles of activation in new health technology assessment of Korean medicine were application of unstandardized technology, lack of understanding and experience, lack of clinical trial supporting system for Korean medicine, lack of committee members within the nHTA(new Health Technology Assessment) review board, ambiguous definition of medical practice and sharp conflict between western medicine and Korean medicine. Conclusions: Several suggestions were derived. First of all, to activate Korean medicine in the nHTA system, the existing system should be used sufficiently, and multifaceted efforts are needed to upgrade the system, if necessary. Also, self-help efforts, Korean medicine clinical trial supporting system and increasing R&D investment, establishing extra-committee for Korean medicine in nHTA could be needed. Finally, long-term strategy for improving collaboration between Korean medicine and western medicine should be considered.

• 척추신경추나의학회지
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• 제15권1호
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• pp.135-145
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• 2020

Objectives : This study reports the clinical case of a patient diagnosed with ossification of the posterior longitudinal ligament treated with Korean Medicine focusing on Chuna therapy. Methods : The patient was treated by a doctor from July 18th, 2019 to November 28th, 2019. The patient was diagnosed with ossification of the posterior longitudinal ligament based on magnetic resonance imaging results and was recommended to undergo surgery at another hospital. The primary complaint of the patient was left neck pain, left arm sensation, right leg sensation, and right leg loss of strength. The doctor treated the patient with Chuna therapy, acupuncture, cupping, herbal medicine, and pharmacopuncture. The effect of treatment was evaluated using visual analogue scale, neck disability index, pain rating score and Japanese Orthopedic Association score. Spurling, compression, and distraction tests were utilized. Results : Visual analogue scale decreased from 10 at the arm and 10 at the leg to 1 and 2, respectively. Neck disability index decreased from 25 to 11, pain rating score decreased from 66 to 1, and Japanese Orthopedic Association score recovered from 12 to 17 points. In addition, positive spurling test, compression test, and distraction test all improved to negative. Conclusions : Korean medicine treatment can be effective for ossification of the posterior longitudinal ligament patients, even when surgery is recommended. Further clinical studies, such as case series and case-control studies, are required to verify these findings.

• 한국항해항만학회지
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• 제40권3호
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• pp.89-95
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• 2016

S-Mode는 항해설비에 있어 표준화된 디스플레이, 기능 및 공통인터페이스를 사용자에게 제공하여 항해기능 사용의 친숙화를 도모함으로써 항해안전성 향상을 위한 기능이다. 2008년 국제해사기구에서 국제선장협회는 S-Mode 도입의 필요성을 제기하였고, 2015년 6월 해사안전위원회에서 승인된 e-Navigation 전략이행계획에 주요과제로서 S-Mode 가이드라인 개발을 2019년까지 완료할 것을 목표로 하고 있다. 본 연구는 S-Mode 가이드라인 개발에 대한 사용자의 기대와 요구사항을 조사하기 위해서 핵심 항해설비인 전자해도시스템의 주 사용자인 항해사를 대상으로 S-Mode의 필요성과 표준화의 범위, 개발에 고려하여야 할 우선순위 요소에 대한 설문조사를 실시하고 그 내용을 분석하였다. 연구의 결과는 e-Navigation 이행 시 선박 항해설비 전반에 적용될 S-Mode 개념 및 기능에 대한 개념을 구체화하고, 개발에 고려할 세부요소들을 제시함으로써 구체적인 표준화 항목을 도출하는 것에 기여할 수 있을 것으로 기대된다.

• 한국조경학회지
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• 제34권6호
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• pp.22-38
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• 2007

Since 1990, urban areas have been expanded rapidly due to the concentration of the population and several development projects including large scale apartment complexes and residential developments. Due to these development projects, the quality and functions of ecosystems have been continuously degraded, regardless of public agencies' efforts introducing development index, guideline, and amendment of law for sustaining the quality of ecosystems. Substantial guideline and content cannot expect the sustainable maintenance of nation's natural resources. Recent improve this situation, ecological planning was introduced, but research data of environments and objective systems were not enough showing the limits. The purposes of this study were to reduce the urban sprawl caused by residential development plans for environment-friendly residential developments, to establish applicable ecological planning, and to suggest the land use plans that reduce adverse effects of developments to nature ecosystem.

• 한국의료질향상학회지
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• 제7권1호
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• pp.46-58
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• 2000

Background : Despite favorable effects of guidelines on patient care, guidelines often fail to achieve their objectives. Poorly implemented medical practice guidelines can produce only weak effects on the process of health care delivery. Therefore, we performed this study to investigate barriers related development of clinical practice guidelines. Methods : Cardiopulmonary resuscitation was selected as a target problem. Self questionnaires about management of cardiopulmonary resuscitation were developed by a researcher with advisory 8 experts. The questionnaires were designed as a unstructured methods. The data were collected from March 1 to May 31, 1999. A total 50 death case admitted inpatient to Inha University Hospital were subjected to evaluate the development and application of clinical practice guidelines for cardiopulmonary resuscitation. The data were examined by frequency, t-test with SPSS. Result : The article reviewed several common barriers that might limit successful implementation of guidelines in clinical practice, as illustrated by evaluating recommendations for cardiopulmonary resuscitation clinical practice guidelines. Some major problems with guidelines were characterized as follows (1) ethical problem : euthanasia, (2) occurrence on various emergency event and setting, (3) non-medical problems (4) unreliable of medical record etc. Conclusion : Careful analysis of guideline attributes, anticipated effect on medical care, and organizational factors revealed several barriers to successful guideline implementation that should be addressed in the design of future guideline-based interventions.

• Korean Chemical Engineering Research
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• 제55권2호
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• pp.195-200
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• 2017

사고 대응 가이드라인은 사고 발생 시 그 영향을 줄이기 위한 수단으로 중요한 역할을 한다. 유용한 사고 대응 가이드라인의 개발을 위하여 개발 절차에 공학적 방법론의 적용이 필요하다. 본 논문에서는 기존에 존재하는 사고 대응 가이드라인 작성 방법론에 Bow-Tie 기법, 사고 전개 모델, 위험 대응 의사결정 등 위험 관리 기법을 적용하였다. 이러한 방법으로 일반화된 사고 대응 가이드라인 작성 절차를 제안하였으며, 직접적으로 활용할 수 있도록 Sheet를 개발하고, 특정 Case를 적용하여 Sample Guide를 작성하였다.