• Title/Summary/Keyword: Evidence based medicine

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Hypoxia-inducible Factor 1 Alpha (HIF-1α) as a Prognostic Indicator in Patients with Gastric Tumors: A Meta-analysis

  • Zhang, Zhi-Gang;Zhang, Qiu-Ning;Wang, Xiao-Hu;Tian, Jin-Hui
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.7
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    • pp.4195-4198
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    • 2013
  • Background and Objective: Though researched for years, the prognostic role of hypoxia-inducible factor 1 alpha (HIF-$1{\alpha}$) in gastric cancer is still controversial. We thus undertook a systematic review to assess the relationship. Method: A systematically literature search of Pubmed, Embase, Web of Science, China Biological Medicine Disc and Cochrane Library was undertaken in February 2013, and the reference lists of articles were retrieved. Results: 12 trials (1,555 participants) were included to assess the association between HIF-$1{\alpha}$ expression and survival. Summary hazard ratios (HRs) were calculated. HIF-$1{\alpha}$ expression was significantly correlated with poor overall survival of gastric cancer patients (HR=1.34, 95%CI: 1.13-1.58; P=0.0009), but not with poor disease free survival of gastric cancer patients (HR=1.67, 95%CI: 0.99-2.82; P=0.06). Conclusion: HIF-$1{\alpha}$ was associated with poor OS, but not DFS, especially for Asian patients. But studies evaluating relationships of HIF-$1{\alpha}$ with OS and DFS in non-Asian gastric cancer patients appear needed.

Korean Clinical Practice Guideline for the Treatment of Depressive Disorder(II) (한국형 우울증 임상진료지침 개발(II))

  • Kang, Rhee-Hun;Kim, Soo-Young;Lee, Min-Soo
    • Korean Journal of Biological Psychiatry
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    • v.13 no.4
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    • pp.219-225
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    • 2006
  • Depression has been causing huge direct and indirect losses to people's health because of its high prevalence, various clinical patterns, drug reaction and diverse courses different among individuals, but its treatment has not been systematic but dependent on individual clinicians' experience and knowledge. To correct this problem, it has been highly necessary to develop clinical guidelines defined as "systematically developed statements to assist practitioners' and patients' decisions about appropriate healthcare for specific clinical circumstances." Currently, countries throughout the world are making efforts to establish evidence-based guidelines among different levels of guidelines and to evaluate and test them. Although such efforts have been unsatisfactory in Korea because of several constraints including lack of high-quality RCT, the Korean Depression Clinical Practice Guideline has started to develop evidence-based guidelines, which are established through strictly designed processes. Thus, the present study purposed to review methods adopted in the development processes and to present the processes of developing the evidence-based guidelines clearly and transparently.

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Role of Ābzan (Sitz Bath) in Gynaecological Disorders: A Comprehensive Review with Scientific Evidence

  • Ahmed, Rummana Kauser Shabbir;Shameem, Ismath
    • CELLMED
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    • v.12 no.1
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    • pp.5.1-5.8
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    • 2022
  • Ābzan(sitz bath or hydration therapy) is one of the important and widely practised methods of regimenal therapy used for local evacuation or diversion of morbid humours described for various diseases in Unani system of medicine. Itis a type of bath in which hips and buttocks are immersed in water, either plain or medicated for therapeutic effects. Thus, it serves as an important and effective external mode of treatment. It has been successfully practised by Greeko-Arab physicians in the management of almost all types of gynaecological disorders like genital prolapse, leucorrhoea, pruritus vulvae, menstrual disorders, infertility, pelvic inflammatory diseases etc, but its efficacy has been proved in very few gynaecological diseases only. Hence, there is a need for systemic review to investigate the effectiveness of sitz bath in gynaecological disorders to generate scientific based evidence for the clinician as well as for common public. Based on the available literature, this review article suggests that the sitz bath has a scientific evidence-based effect in treating gynaecological diseases.

Traditional Korean Medicine Practitioners' Awareness and Attitudes toward Evidence Based Medicine (한의사의 근거중심의학에 대한 인식 및 태도 - 침구요법을 중심으로)

  • Baek, Seung-Min;Lee, Sang-Hun;Kim, Jung-Eun;Liu, Yan;Park, Hyo-Ju;Kim, Bo-Young;Choi, Sun-Mi
    • Korean Journal of Acupuncture
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    • v.28 no.3
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    • pp.99-111
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    • 2011
  • Objectives : The aim of this study is to estimate traditional Korean medicine (TKM) practitioners' awareness and attitudes about acupuncture clinical study toward evidence based medicine (EBM). Methods : We conducted two surveys before and after the workshop. First survey, about the awareness and attitudes toward EBM was carried out with questionnaire. Second survey, about their changes in the attitudes toward EBM after the workshop was carried out with on-line questionnaire. Results : 70.0 % of respondents shows interest in the trends of clinical research. In contrast, 26.0 % of respondents used to search papers by themselves. 30.3 % of respondents reported that they apply the result of researches to their practice. 41.0 % of respondents thought that case study is needed for their practice, whereas 29.5 % responded that randomized controlled trial is most important. In the second survey, the attitudes toward EBM were changes positive. fair number of respondents usually get information from data regardless of EBM for their practice, but 23.5 % of respondents refer to the journals. Conclusions : The awareness and needs for education on the attendees toward EBM is quite high, and the effect of education is possibly influential. We expect the improvement on the refresher and the extension of education course for practitioners, and undergraduate curriculum.

Qualitative Assessment and Development of Level of Evidence and Strength of Recommendation Models in the Field of Physical Therapy in Korea (국내 물리치료분야에 대한 질적 평가와 근거 수준 및 권고 등급 모형 개발 방안)

  • Sung-Hyoun Cho;Jeong-Woo Lee
    • Journal of The Korean Society of Integrative Medicine
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    • v.11 no.2
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    • pp.231-242
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    • 2023
  • Purpose : This study aimed to identify ways to improve the quality of physical therapy research and ultimately review the current situation to improve evidence-based decision-making in physical therapy. Methods : For better evidence-based decision-making in physical therapy, researchers should review the quality assessment of articles in more detail and report their findings for valid and appropriate level of evidence and strength of recommendations. The level of evidence affects how well the findings are derived from well-designed literature. The evaluation of the evidence focuses primarily on the study design and the degree of bias that may compromise the validity of the findings. The final recommendation is based on a combination of the study design and literature quality. To uncover gems of information in each paper, a risk of bias assessment should be performed after the literature has been initially selected. Results : Researchers should consider the complexity of the intervention, appropriate grouping, and calculation of effect sizes for the intervention. Researchers conducting systematic reviews should provide a detailed description of the quality assessment performed and present a detailed analysis of their interpretation of the results. The results of systematic reviews and meta-analyses should be interpreted with caution and include a risk of bias assessment. Guidelines for the level of evidence and strength of recommendations should be developed and utilized more broadly to improve reporting practices in physical therapy. Conclusion : Researchers should be knowledgeable about the strengths and limitations of each study design and methodology. In the future, researchers will also need to improve their ability to critically evaluate their findings, given the potential for their results to influence clinical practice.

Self Care in Depression (우울증의 자기 관리 방법)

  • Lee, Sun-Hea;Park, Yong Chon
    • Korean Journal of Biological Psychiatry
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    • v.14 no.1
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    • pp.5-13
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    • 2007
  • Objectives : Depression disturbs the individual life from the loss of productivity to suicide. Furthermore the whole society is also influenced by depression in social and economic areas. Many scientific treatment methods are known to be effective in depression. But in reality more than half of patients with depression prefer self help treatment rather than medically based treatment. For the patients with mild depression and primary physicians, it is reasonable to provide the evidence based self care including self help or alternative treatment. This study is supported by the Korean Health 21 R&D Project for the Depression Center to establish the Korean treatment guideline for depression. Methods : The members of Depression Center including the authors attended the workshops where the methods of evidence based medicine such as literature search, quality evaluation of the articles, making the level of evidence were educated. The professional librarians helped the authors for get the searched articles. Among the total of 354 abstracts of systemic review and 300 abstracts of random controlled trials, 3 systemic reviews and 2 random controlled trials were the main structure of evaluation. Result : Among the 37 self care methods known to be effective for depression, 11 kinds of methods were worth of evaluation. The first step for the self care of mild depression is to use St. John's wort, exercise, bibliotherapy, and light therapy in depression during winter season. Acupuncture, negative ion therapy, massage, relaxation technique are known to be efective with evidence. Music therapy, hypnotherapy, and aromatherapy are known to be effective but until now the evidences is insufficient and further evaluations are needed. Conclusion : Among 11 listed self-care methods, several methods need more evidence especially in Korean situation. Exercise is the most recommendable evidence based self care method in Korea nowadays. St. John's wort is effective with evidence, but it is not the OTC drug in Korea, so it is not recommendable now. For the bibliotherapy, there is no book such as "Feeling Good" in Korea. Only the introductory book about depression is available. Publishing the self help book based upon cognitive behavioral approach or psychodynamic approach is needed. Light therapy is practiced in a few clinics, but not self-help style. Exposure to the sunlight is recommended in the level of commen sense. These self care methods are for the mild patient. Moderate to severe patients with depression should seek the professional treatment.

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Using Ultrasonography in Korean Medicine to Observe Organs and Diseases, and Evidence of its Use (한의학에서 초음파 진단기기를 활용한 장부 및 질병 관찰과 그 활용 근거)

  • Baik, Tai-Hyeun
    • The Journal of Korean Medicine
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    • v.35 no.3
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    • pp.70-92
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    • 2014
  • Objectives: Due to advance of science and IT technology, high tech imaging equipment like ultrasonography, CT, MRI and PET scan is constantly being developed and progressed; use of these techniques is needed for Korean medicine. Methods: Historical study was undertaken on the evidence of using ultrasonography. Normal organs and various sorts of diseases were also observed by ultrasonography. Results: Korean medicine judges disease of internal organs and condition of health by symptoms of functional disease and organic disease based on anatomical theory. Ultrasonography based on anatomical theory is non-invasive and free from radiation exposure and can be performed directly from clinical practice in real-time. Ultrasonography can be a big help for securing the stability of the internal organs in inserting needles in the thorax and abdomen as well as diagnosing functional and organic diseases based on anatomical theory. Conclusion: We look forward to a great development of scientification and objectification of Korean medicine by using and researching imaging equipment based on anatomical theory as well as ultrasonography.

Application of Health Care Big data and Necessity of Traditional Korean Medicine Data Registry (보건의료 빅데이터를 활용한 연구방법 및 한의학 레지스트리의 필요성)

  • Han, Kyungsun;Ha, In-Hyuk;Lee, Jun-Hwan
    • Journal of Korean Medicine for Obesity Research
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    • v.17 no.1
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    • pp.46-53
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    • 2017
  • Health care big data is thought to be a promising field of interest for disease prediction, providing the basis of medical treatment and comparing effectiveness of different treatments. Korean government has begun an effort on releasing public health big data to improve the quality and safety of medical care and to provide information to health care professionals. By studying population based big data, interesting outcomes are expected in many aspects. To initiate research using health care big data, it is crucial to understand the characteristics of the data. In this review, we analyzed cases from inside and outside the country using clinical data registry. Based on successful cases, we suggest research method for evidence-based Korean medicine. This will provide better understanding about health care big data and necessity of Korean medicine data registry network.

Establishing research priorities of FDG PET in oncology indications using Delphi technique (델파이법을 활용한 종양분야 FDG PET의 경제성 평가 연구 우선순위 선정)

  • Do Young Kyung;Lee Jin Yong;Kim Young-Ik;Kwon Young Hoon;Lee Sang-Il;Kim Chang-Yup
    • Health Policy and Management
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    • v.14 no.3
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    • pp.45-65
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    • 2004
  • The rapid increase in PET devices and its utilization in Korea necessitates relevant health insurance policies based on scientific evidence, including economic evaluation of PET in clinical conditions. However, there is very little amount of evidence regarding PET, and the first step would be to establish research priorities to give a momentum for research and assure efficient use of research capacities. To this end, we conducted a two-round Delphi study, which produced stable consensus on about top 10 oncology indications for research, which included lymphoma staging, colorectal cancer recurrence/restaging, lung cancer staging, and other conditions. The results were largely consistent with current U.S. Medicare reimbursement indications and are expected to lead to relevant researches and evidence-based health policies on PET reimbursement and regulation.

Clinical Practice Guidelines for Gastric Cancer in Korea: An Evidence-Based Approach

  • Lee, Jun Haeng;Kim, Jae G.;Jung, Hye-Kyung;Kim, Jung Hoon;Jeong, Woo Kyoung;Jeon, Tae Joo;Kim, Joon Mee;Kim, Young Il;Ryu, Keun Won;Kong, Seong-Ho;Kim, Hyoung-Il;Jung, Hwoon-Yong;Kim, Yong Sik;Zang, Dae Young;Cho, Jae Yong;Park, Joon Oh;Lim, Do Hoon;Jung, Eun Sun;Ahn, Hyeong Sik;Kim, Hyun Jung
    • Journal of Gastric Cancer
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    • v.14 no.2
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    • pp.87-104
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    • 2014
  • Although gastric cancer is quite common in Korea, the treatment outcome is relatively favorable compared to those in western countries. However, there are currently no Korean multidisciplinary guidelines for gastric cancer. Experts from related societies developed guidelines de novo to meet Korean circumstances and requirements, including 23 recommendation statements for diagnosis (n=9) and treatment (n=14) based on relevant key questions. The quality of the evidence was rated according to the GRADE evidence evaluation framework: the evidence levels were based on a systematic review of the literature, and the recommendation grades were classified as either strong or weak. The applicability of the guidelines was considered to meet patients' view and preferences in the context of Korea. The topics of the guidelines cover diagnostic modalities (endoscopy, endoscopic ultrasound, and radiologic diagnosis), treatment modalities (surgery, therapeutic endoscopy, chemotherapy, and radiotherapy), and pathologic evaluation. An external review of the guidelines was conducted during the finalization phase.