• 보건행정학회지
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• 제20권2호
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• pp.1-16
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• 2010

Background : Clinical practice guidelines are an increasingly familiar part of clinical practice. Moreover, rigorously developed evidence based guidelines has been widely used. However, in Korea, some of published documents as clinical practice guidelines have shown considerable disparity in structure, contents and quality. This is mainly because there is no consensus on the definition and quality standard of clinical practice guidelines. The purpose of this study was to draw consensus on the definition and the quality standard about clinical practice guidelines. Method : We developed a questionnaire about the definition of clinical practice guidelines with inclusion criteria(23 items) and the quality standard(30 items). We selected 9 experts who had prior experience in developing and implementing guidelines. Rating methods for appropriateness of items were adopted from the RAND method. Consensus was drawn in three rounds. Results : Of the 47 items agreed, 40 items were determined to be appropriate. Clinical practice guidelines were defined as "scientifically and systematically developed statements to assist practitioners and patients on making decisions about appropriate health care for specific clinical circumstances." Narrative reviews, systematic reviews or health technology assessment without recommendations, translation of foreign guidelines, guidelines for patients only and training manuals were not considered as clinical practice guidelines. For the quality standard of clinical practice guidelines, 27 items were deemed necessary. Conclusions : The consensus on the definition with inclusion criteria and the quality standard of clinical practice guidelines carries an important meaning as the first attempt to draw a general agreement in our society. The unique achievement of the consensus reflects the current status of clinical practice guidelines that there has been a high tendency to adapt foreign guidelines. We hope efforts of this kind will continue to bring improvement in clinical practice guidelines.

• Clinics in Shoulder and Elbow
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• 제15권1호
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• pp.43-51
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• 2012

목적: 쇄골 골절의 치료에 관한 광범위한 자료 검토를 통해 현 시점에서의 적절한 쇄골 골절 치료방법을 찾고자 한다. 대상 및 방법: 성인에서 발생한 쇄골 골절과 관련된 전반적인 내용, 즉 쇄골 골절의 역학, 분류, 수술 적응증, 최근 도입된 치료 방법의 현황 및 결과를 문헌 고찰을 통해 정리하였다. 또한, 쇄골 중간 부위 골절의 수술 적응증의 확대와, 새로운 치료법의 하나로 주목받고 있는 anatomically precontoured plate의 도입을 비롯한 최신 지견에 대해 살펴보았다. 결과 및 결론: 지금까지 쇄골 골절은 비수술적 방법으로 대부분 치료되어 왔다. 하지만 최근 들어 기존에 추산되었던 것 보다 많은 수의 불유합, 부정유합 발생이 보고되면서 수술적 치료의 적응증이 점점 확대되는 추세이다. 하지만 아직까지는 쇄골 골절에 대한 이상적인 치료 방침이 확립되지 않았음을 고려할 때, 환자 개개인의 임상 정보와 선호도를 세심히 고려한 맞춤형 치료가 이루어져야 하겠다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8741-8747
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• 2014

Purpose: We aimed to investigate the associations between polymorphisms of interleukin-1A (IL-1A), IL-1B, and IL-1 receptor antagonist (IL-1RN) and prostate cancer (PCa) risk. Materials and Methods: A comprehensive search for articles of MEDLINE and EMBASE databases and bibliographies of retrieved articles published up to August 3, 2014 was performed. Methodological quality assessment of the trials was based on a standard quality scoring system. The meta-analysis was performed using STATA 12.0. Results: We included 9 studies (1 study for IL-1A, 5 studies for IL-1B, and 3 studies for IL-1RN), and significant association was found between polymorphisms of IL-1B-511 (rs16944) as well as IL-1B-31 (rs1143627) and PCa risk. IL-1B-511 (rs16944) polymorphism was significantly associated with PCa risk in homozygote and recessive models, as well as allele contrast (TT vs CC: OR, 0.74; 95%CI, 0.58-0.94; P=0.012; TT vs TC+CC; OR, 0.79; 95%CI, 0.63-0.98; P=0.033; T vs C: OR, 0.86; 95%CI, 0.77-0.96; P=0.008). The association between IL-1B-31 (rs1143627) polymorphism and PCa risk was weakly significant under a heterozygote model (OR, 1.35; 95%CI, 1.00-1.80; P=0.047). Conclusions: Sequence variants in IL-1B-511 (rs16944) and IL-1B-31 (rs1143627) are significantly associated with PCa risk, which provides additional novel evidence that proinflammatory cytokines and inflammation play an important role in the etiology of PCa.

• 종양간호연구
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• 제11권3호
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• pp.247-253
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• 2011

Purpose: The purpose of the study was to evaluate the accuracy of two different fluid intake measurement methods (fluid only vs. all dietary intake) in measuring fluid balance compared to body weight change among patients with cancers. Methods: A total of 60 cancer patients in an urban cancer center in South Korea participated in the study. Adult patients who were over 18 years old; having 24-hour I&O order; and taking either normal regular diet or soft blend diet were included. Demographic information and disease related information were also gathered. The data were analyzed using SPSS 18.0 program. Results: Measuring 'fluid only' for oral intake was a more accurate measure than measuring 'all dietary intake' (p=.026 vs. p=.094). Both methods had positive correlations with the amount of weight change (r=.329, p=.010; r=.303, p=.019). Measuring body weight was a more accurate and efficient way of evaluating the fluid balance than 24 hour cumulative I&O. Conclusion: Developing clinical manual for selecting proper patients who needs fluid balance monitoring is imperative. Administering weight check and/or 24 hour cumulative I&O should be considered thoroughly based on solid nursing evidence in future.

• Journal of Korean Neurosurgical Society
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• 제60권2호
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• pp.195-204
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• 2017

Objective : This 2009-2011 nation-wide study of adult Koreans was aimed to provide characteristics, medical utilization states, and survival rates for newly diagnosed patients with primary nonmalignant and malignant spine tumors. Methods : Data for patients with primary spine tumors were selected from the Korean Health Insurance Review and Assessment Service database. The data included their age, sex, health insurance type, co-morbidities, medical cost, and hospital stay duration. Hospital stay duration and medical costs per person occurring in one calendar year were used. In addition, survival rates of patients with primary malignant spine tumors were evaluated. Results : The incidence rate of a primary spine tumor increased with age, and the year of diagnosis ($p{\leq}0.0001$). Average annual medical costs ranged from 1627 USD (pelvis & sacrum & coccyx tumors) to 6601 USD (spinal cord tumor) for primary nonmalignant spine tumor and from 12137 USD (spinal meningomas) to 20825 USD (pelvis & sacrum & coccyx tumors) for a primary malignant spine tumor. Overall survival rates for those with a primary malignant spine tumor were 87.0%, 75.3%, and 70.6% at 3, 12, and 24 months, respectively. The Cox regression model results showed that male sex, medicare insurance were significantly positive factors affecting survival after a diagnosis of primary malignant spine tumor. Conclusion : Our study provides a detailed view of the characteristics, medical utilization states, and survival rates of patients newly diagnosed with primary spine tumors in Korea.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.673-680
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• 2020

The demineralized bone matrix (DBM) as the bone graft material to increase the fusion rate was widely used in spinal fusion. The current study aimed to compare the fusion rate of DBM to the fusion rate of autograft in lumbar spine fusion via meta-analysis of published literature. After systematic search, comparative studies were selected according to eligibility criteria. Checklist (risk of bias assessment tool for non-randomized study) was used to evaluate the risk of bias of the included nonrandomized controlled studies. The corresponding 95% confidence interval (95% CI) were calculated. We also used subgroup analysis to analyze the fusion rate of posterolateral lumbar fusion and lumbar interbody fusion. Eight studies were finally included in this meta-analysis. These eight studies included 581 patients. Among them, 337 patients underwent spinal fusion surgery using DBM (DBM group) and 204 patients underwent spinal fusion surgery with mainly autologous bone and without using DBM (control group). There was no significant differences of fusion rate between the two groups in posterolateral fusion analysis (risk ratio [RR], 1.03; 95% CI, 0.90-1.17; p=0.66) and interbody fusion analysis (RR, 1.13; 95% CI, 0.91-1.39; p=0.27). Based on the available evidence, the use of DBM with autograft in posterolateral lumbar spine fusion and lumbar interbody fusion showed a slightly higher fusion rate than that of autograft alone; however, there was no statistically different between two groups.

• Journal of Acupuncture Research
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• 제34권2호
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• pp.113-125
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• 2017

Objectives : Cervical herniated intervertebral disc (HIVD) are common diseases. They can be managed with acupuncture, but the evidence for effectiveness is uncertain. This review analyzed the acupuncture studies of domestic neck pain and cervical HIVD; the purpose of this study was to provide basic data useful for future research. Methods : We investigated acupuncture treatments for neck pain and cervical HIVD by searching 5 Korean Internet databases. The keywords used were "neck pain", "HIVD-cervical spine", and "nuchal pain". A total of 53 research papers (17 case reports, 16 clinical data analyses, 11 randomized controlled trials, and 9 non-randomized controlled trials) were found and analyzed according to the publication year, type of study, treatment, use of filiform needles, and type of pharmacopuncture used acupoint. The effectiveness of acupuncture treatment was determined. Results : 1. Filiform needles have been primarily used in domestic research and were used in at least half of published pharmacopuncture studies. 2. In 51 papers using filiform needles, many studies used only local acupoints; few studies used only distant acupoints. 3. All studies using pharmacopuncture were performed using local acupoints. In particular, the studies based on A-shi point, trigger point, and radiologic lesion sites were useful for multiple purposes. Conclusion : In this study, we analyzed the acupuncture contents of the domestic neck pain and HIVD-cervical spine clinical studies. This study considers the assessment of the quality and efficacy of each study, which is likely to require research that reflects the future.

• Clinical and Experimental Pediatrics
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• 제50권7호
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• pp.601-605
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• 2007

The cure rate of acute lymphoblastic leukemia (ALL) in children dramatically improved over past 5 decades from zero to about 80%. The main cause of improvement is owing to the development of chemotherapy by multicenter clinical trial of large study groups with the understanding of leukemia biology. Recently, pediatric ALL protocols were applied to the treatment of adolescent and even adult ALL patients. For nearly 30 years, clinical factors have been used to risk-stratify therapy for children with ALL, so that the most intensive therapies are reserved for those patients at the highest risk of relapse. The risk groups of ALL are divided as standard- (low- plus intermediate-), high- and very high-risk group according to the prognostic factors, and treatment results improved by this risk based treatment. The factors used to risk-stratify therapy include age, gender, presenting leukocyte count, immunophenotype, cytogenetic aberrations including ploidy and translocations, and initial response after 1 to 2 weeks of therapy. But treatment efficacy is the most important determinant and can abolish the clinical significance of most, if at all, prognostic factors. Today, in the era of intensive, multiagent regimens, there is increasing evidence that we have reached the limits of prognostic significance of currently applied clinical risk factors in childhood ALL. As the cure rate of ALL is about 80%, introducing new prognostic factors such as new molecular prognostic markers, new methods of assessment about minimal residual disease, and pharmacogenetic study, with the development of stem cell transplantation and molecular targeted therapy are needed to cure residual 20% of childhood ALL patients without short and long term complications.

• 대한통합의학회지
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• 제8권2호
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• pp.11-20
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• 2020

Purpose : The purpose of this study was to research the effects of dual-hemisphere transcranial direct current stimulation (dual tDCS) and modified constraint-induced movement therapy (mCIMT) to improve upper extremity motor function after stroke. Methods : The study period was from August 2019 to November 2019, and included 24 patients who met the selection criteria. Participants were divided into 2 groups: dual tDCS and mCIMT, and sham dual tDCS and mCIMT group. Dual tDCS and mCIMT group performed mCIMT immediately after applying dual tDCS for 20 minutes, and sham dual tDCS and mCIMT group performed mCIMT immediately after applying sham tDCS for 20 minutes without turning on the power source. Total interventions were conducted 5 times per week for 4 weeks, and mCIMT was conducted for 30 minutes per session for both experimental and control groups. Fugl-Meyer assessment (FMA) and Motor Activity Log scale (MAL) were analyzed before and after 4 weeks of intervention. Results : Both experimental and control groups showed significant changes in FMA, Amount of Use (AOU), and Quality of Movement (QOM) of MAL. When the differences between groups was compared using ANCOVA, the experimental group showed a greater improvement in FMA and AOU of MAL than the control group. Conclusion : In order to enhance the effect of improving upper limb function of stroke patients, dual tDCS could be applied to provide more effective treatment in the clinical setting. Further studies will be needed in larger groups of stroke patients, including long-term follow-up, and multi-group comparisons through the establishment of anodal tDCS and mCIMT, cathodal tDCS, and mCIMT groups to clarify the effects of dual tDCS. In addition, research is needed to establish a protocol for tDCS, and this evidence-based intervention protocol is expected to be used in the clinical setting as an interventional method for various purposes.

• 한국산업보건학회지
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• 제27권4호
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• pp.324-332
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• 2017

Objectives: Much scientific evidence indicate a positive association between moldy environments and respiratory illnesses and/or symptoms. However, few comprehensive assessments of mold have been performed for such settings. Spore counts or microscopic enumeration only may not be sufficient for evaluating fungal exposure. Recently, Mold Specific QPCR technology developed by the US EPA (Environmental Relative Moldiness Index, ERMI) has been widely used worldwide and great performance for assessing fungal exposure has been shown. Methods: We aimed to develop a Korean version of ERMI suitable for the distribution of fungal flora in Korea. Thirty dwellings in the Seoul and Incheon area were selected for sampling, and each was classified as 'Flooded, 'Water-damaged' or 'Non-water-damaged'. Results: Dust on the floor and airborne sampling were collected using an MAS100 and a 'Dustream' collector. Samples were analyzed by quantitative polymerase chain reaction(QPCR) for the 36 molds belonging to ERMI. Student t-test and ANOVA tests were carried out using SAS software. The median ERMI values of flooded, water damaged, and non-water damaged dwellings were 8.24(range: -5.6 to 27.9), 5.47(-25. 4 to 32.7), and -15.30(-24.6 to 14.8), respectively. Significant differences were observed between flooded and non-water damaged dwellings (P=0.001) and between water-damaged and non-water damaged dwellings (P=0.032). Conclusion: Our findings indicate that ERMI values attributed to dust samples in Korea could be applicable for the identification of flooded or water damaged buildings. However, much data is needed for continuously developing the Korean version of ERMI values.