• Journal of Gastric Cancer
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• v.23 no.4
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• pp.535-548
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• 2023

Purpose: This study evaluated real-world compliance with surgical treatment according to Korea's gastric cancer treatment guidelines. Materials and Methods: The 2018 Korean Gastric Cancer Treatment Guidelines were evaluated using the 2019 national survey data for surgically treated gastric cancer based on postoperative pathological results in Korea. In addition, the changes in surgical treatments in 2019 were compared with those in the 2014 national survey data implemented before the publication of the guidelines in 2018. The compliance rate was evaluated according to the algorithm recommended in the 2018 Korean guidelines. Results: The overall compliance rates in 2019 were 83% for gastric resection extent, 87% for lymph node dissection, 100% for surgical approach, and 83% for adjuvant chemotherapy, similar to 2014. Among patients with pathologic stages IB, II, and III disease who underwent total gastrectomy, the incidence of splenectomy was 8.08%, a practice not recommended by the guidelines. The survey findings revealed that 48.66% of the patients who underwent gastrectomy had pathological stage IV disease, which was not recommended by the 2019 guidelines. Compared to that in 2014, the rate of gastrectomy in stage IV patients was 54.53% in 2014. Compliance rates were similar across all regions of Korea, except for gastrectomy in patients with stage IV disease. Conclusions: Real-world compliance with gastric cancer treatment guidelines was relatively high in Korea.

• Korean Journal of Ecology and Environment
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• v.36 no.3 s.104
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• pp.356-368
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• 2003

Water quality of effluent from wastewater treatment plants (WWTPS) was reviewed to examine the feasibility of agricultural reuse using USEPA and WHO guidelines. It might meet the guidelines for BOD and SS, however, the most critical microbiological concentration was too high and further treatment is required. The pilot study of three treatments were performed to reduce microbiological concentrations. The UV irradiation was proved to be very effective in disinfection of secondary level effluent, and about 30 mW ${\cdot}$ s/$cm^2$ of dose was suggested to meet the even most stringent USEPA guidelines. Slow sand filter demonstrated effective removal of bacteria, and effluent concentration of total coliform (TC), fecal coliform (FC), and E. coli. dropped from about 10,000/100 mL to 300, 200, and 150 MPN/100 mL, respectively, showing over 95% removal. These level of bacterial concentration sufficiently meet the WHO guidelines ($10^3\;{\sim}\;10^5$ FC/100 mL), and could meet the more stringent USEPA guidelines (200 FC/100 mL) if properly applied. Slow sand filter also provided about 50% removal of SS, turbidity, and BOD in addition to bacterial removal. The removal efficiency of pond system was relatively poor, but still showed over 85% removal and effluent concentration of TC, FC, and E. coli was all below 10,000/100 mL. The pond system alone could meet the WHO guidelines, but hardly meet the USEPA guidelines and further treatment might be necessary. Overall, three methods evaluated in the study treat the effluent to meet the WHO microbiological guidelines for agricultural reuse. The UV disinfection and slow sand filter might also could the USEPA guidelines, while the pond system can hardly meet the USEPA guidelines if applied alone. The WHO and USEPA guidelines were made based on data from upland field agricultural system and may not be directly applicable to the paddy field agricultural system. Therefore, national standards for agricultural reuse of reclaimed water should be made considering domestic agricultural systems as well as international guidelines. Also, further investigation is recommended to develop optimum and feasible treatment measures for agricultural reuse of effluent from WWTPs.

• The Korean Society of Law and Medicine
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• v.23 no.2
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• pp.39-65
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• 2022

There are two aspects of clinical practice guidelines that act as non-legal control before medical practice and as legal control standards after medical practice. The essential purpose of clinical practice guidelines is the former, but the latter action cannot be excluded. The clinical practice guidelines are a means of linking law and medical care. The negative perception of clinical practice guidelines that medical professionals' autonomy can be violated by the enactment of clinical practice guidelines is an excessive negative evaluation of clinical practice guidelines. Rather, judicial judgment based on clinical practice guidelines plays a role in respecting the autonomy of medical professionals. In other words, the clinical practice guidelines suppress legal regulations on medical care as much as possible and are based on doctors' professional ethics and self-discipline, and patient awareness and cooperation. In order to establish an ideal relationship of cooperation between doctors and patients, 'medical ethics' must be incorporated as a legal means. Clinical practice guidelines are the most appropriate means for incorporating such medical ethics into legal procedures. The lawyer solves the case with a legal syllogism that establishes a norm and applies facts to it to conclude. For the resolution of medical disputes, Clinical practice guidelines are used to establish norms that doctors should perform for specific diseases, and conclusions are drawn by applying the established norms to specific medical practices. When it is not easy to apply the established norms to specific medical practices, medical judgments by experts, such as emotions, expert testimony, and explanations by expert members, are used. As such, the Law respects the autonomy of medical care even in the establishment of norms and the application of norms. In particular, Clinical practice guidelines prepared independently by the medical community are referred to in establishing norms, which are the prerequisites for legal syllogism. This shows that doctors participate in the formation of precedents and contribute to the formation of norms. The use of clinical practice guidelines in trials is respect and consideration for the autonomy of medical care. Although there may be an aspect in which the autonomy of individual doctors is limited by clinical practice guidelines, it should be considered that the autonomy of doctors as a group is respected. In this way, the clinical practice guidelines play a role in protecting the autonomy of the "medical" group from the logic of the "law."

• Quality Improvement in Health Care
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• v.4 no.1
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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.

• Nutrition Research and Practice
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• v.14 no.6
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• pp.621-636
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• 2020

BACKGROUND/OBJECTIVES: The Seoul Metabolic Syndrome Management (SMESY) program is a 1-yr lifestyle modification program targeting metabolic syndrome (MetS) in Seoul residents. This study investigated the associations between adherence to dietary guidelines and MetS among the SMESY program participants. SUBJECTS/METHODS: Data of 54,385 participants aged 20-64 yrs who completed the SMESY program in 2015, had information on adherence to dietary guidelines, and were not medicated for diabetes, hypertension, or dyslipidemia were analyzed. Participants underwent MetS screening and completed a lifestyle questionnaire including adherence to 10 dietary guidelines before and after participation. Participants were classified according to the number of MetS risk factors at baseline (MetS group, ≥ 3; risk group, 1-2; healthy group, none). Adherence to dietary guidelines was determined from the number of "yes" responses regarding the fulfillment of each guideline on ≥ 5 days/week. Multiple logistic regression was used to evaluate associations between newly diagnosed MetS and changes in adherence to dietary guidelines. RESULTS: In the MetS group, MetS prevalence decreased after the SMESY program (men, -41.9%p; women, -48.7%p), and all risk factors were significantly improved (P < 0.0001). All groups exhibited improved adherence to all dietary guidelines after participation (P < 0.0001). In the MetS group with positively changed adherence scores, the MetS prevalence decreased by -44.1%p for men and -49.5%p for women, whereas the prevalence in those with negative changes decreased by -38.1%p for men and -48.6%p for women. In the risk group, those with positively changed adherence scores had significantly decreased odds ratios (ORs) for newly diagnosed MetS compared with those with negative changes (OR, 0.70; 95% confidence interval [CI], 0.61-0.80 for men; OR, 0.88; 95% CI, 0.79-0.99 for women). CONCLUSIONS: The SMESY program may effectively reduce the risk of MetS among adults with risk factors by improving adherence to dietary guidelines.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.31 no.2
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• pp.40-59
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• 2018

Objectives : We report on the contents and reviews of the guidelines for clinical trials of herbal medicine for psoriasis. Methods : After reviewing the existing reports, the guidelines were drafted by the writing committee on guidelines for Korean medicine clinical trial center in Kyung Hee university Korean medicine hospital. Since then, the guidelines have been consulted by the experts in diseases, clinical trials and pharmaceuticals. In addition, the guidelines have been certified by the Korean medicine clinical trial center association and Korean Medicine Ophthalmology & Otolaryngology & Dermatology Society. Results : The guidelines for clinical trials are divided into 8 categories: (1) general contents, (2) evaluation standards of effectiveness, (3) outcome valuables, (4) selection of study participants, (5) designs of clinical trials, (6) safety evaluations, (7) combination therapies in psoriasis treatment and (8) Korean medical considerations. Conclusions : There are 3 major contents for discussion: (1) obscurity of Korean medical considerations to differentiate from existing guidelines, (2) the absence of Korean version of PASI and DLQI, which are validity parameters and (3) realistic institutional problem using the herbal medicine.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.6
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• pp.113-120
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• 2016

The purpose of this study is to identify the knowledge of and adherence to the infection control guidelines for indwelling urinary catheters, central venous catheters and ventilators among intensive care nurses. The subjects were 175 intensive care nurses working in 2 upper general hospitals and 3 general hospitals. Data were collected from July 1 to July 31, 2013. The collected data were analyzed by descriptive statistics, t-test and ANOVA using SPSS 18.0 for Windows. The mean scores of the knowledge of the infection control guidelines on indwelling urinary catheters, central venous catheters and ventilators were 0.87, 0.82 and 0.82 points, respectively. The average scores for the adherence to the infection control guidelines for indwelling urinary catheters, central venous catheters and ventilators were 4.18, 4.04 and 4.07 points, respectively. Statistically significant correlations were found between the knowledge of and adherence to the infection control guidelines for indwelling urinary catheters (r=.72, p<.00), central venous catheters (r=.54, p<.001) and ventilators (r=.30, p<.001). The knowledge of and adherence to the infection control guidelines for indwelling urinary catheters differed significantly according to gender, educational status, total career, number of patients, type of hospital, and attendance of seminar. The knowledge of and adherence to the infection control guidelines for central venous catheters differed significantly according to educational status, total career, number of patients, type of hospital, and attendance of seminar. The knowledge level of the infection control guidelines for the ventilator differed significantly according to the total career. The results of this study indicate that education and training programs for improving the knowledge of adherence to the infection control guidelines should be developed.

• Journal of muscle and joint health
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• v.24 no.3
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• pp.227-237
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• 2017

Purpose: The purpose of this study is to analyze the suitability and applicability of the recommendations for the exercise intervention program in fall prevention guidelines for the elderly. Methods: We searched systematically RISS, KISS, National Assembly Library, KoreaMed, and KM base for Korean guidelines and used OVID-MEDLINE, EMBASE, Cochrane library, Trip database, GIN, NGC, WHO, and CDC for international guidelines including fall prevention exercises for the elderly until August 2016. Results: A total of 11 guidelines were selected as the result of the literature search. After evaluating the quality of guidelines, 9 guidelines were used to analyze the recommendations. A total of 19 recommendations were derived from 9 guidelines. Of 19 recommendations, 12 recommendations were considered to be appropriate and applicable. As a result, we recommend for the elderly to do a single type of balance exercise, strength exercise, aerobic exercise or multiple forms of exercise for 20~30 minutes per a day, 2~3 days or more than 3 days per a week, and consistently for more than 10 weeks. Conclusion: To prevent falls in the elderly, it is important for the elderly to perform a regular balance, strength, or aerobic exercise for 20~30 minutes per a day, 2~3 days per a week.

• Journal of the Ergonomics Society of Korea
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• v.35 no.6
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• pp.595-609
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• 2016

Objective: The purpose of this study was to develop and validate the guidelines for Medic Work Table (MWT) based on the anthropometric data of medical technologists. Background: Users' anthropometric data such as sitting height, sitting elbow height, knee height, and so on are significant factors for designing comfortable and useful furniture. Thus, many guidelines for different types of desks and chairs based on the users' anthropometric data have been suggested to many researchers. However, few researches have been conducted to provide design guidelines for MWT for blood collecting task. Medical technologists often use their upper extremities to perform blood collecting task with high repetitions. These repeated motions could be a critical factor in the prevalence rate of Work-related Musculoskeletal Disorders (WMSDs). Therefore, a study on ergonomic design of MWT would be essential in preventing the WMSDs and improving the quality of the working environment of medical technologists. Method: This study suggested design guidelines for ergonomic MWT by focusing on the heights of the upper side and underside, depths of the inside and outside, and width of MWT through anthropometric studies and literature reviews. Afterwards, a new MWT was made using the suggested design guidelines for this study. Five healthy medical technologists participated to evaluate the original MWT and new MWT. All participants took part in the range of motion (ROM) test, electromyography (EMG) muscle activity test, and usability test to validate the suggested guidelines in this study. EMG signals of related muscles (Flexor Carpi Ulnaris, Extensor Carpi Ulnaris, Deltoid Anterior, and Biceps Branchii) were recorded through the surface electromyography system from both the original MWT and the new MWT. The ROM test of the shoulder and elbow flexion was also assessed using motion sensors. Results: The newly designed MWT showed decreased ROMs of the shoulder and elbow up to 22% and 18% compared to the original MWT. The muscle activities in the new MWT also showed a decrease of 13% in Anterior Deltoid, 6% in Biceps Brachii, 5% in Flexor Carpi Ulnaris, and 8% in Extensor Carpi Ulnaris muscle groups, compared to the original MWT. In the usability test, the satisfaction score of the new MWT was also 56.1% higher than that of the original MWT. Conclusion: This study suggested guidelines for designing MWT and validating the guidelines through qualitative and quantitative analyses. The results of motion analysis, muscle activity, and usability tests demonstrated that the newly designed MWT may lead to less physical stress, less awkward posture, and better physical user interface. Application: The recommended guidelines of the MWT would be helpful information for designing an ergonomic MWT that reduces physical loads and improves the performance of many medical technologists.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.19 no.1
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• pp.16-24
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• 2009

This research aims to measure and analyze the dimensions of typical office chairs and desks sold in domestic market, and to suggest the modifications of national guidelines considering Korean peoples' body characteristics. The scope of this study was limited to the desktop type of computer jobs, excluding laptop environment. The dimensions of 24 different office chairs and 7 tables were measured, and their dimensions were analyzed against the Ministry of Labor (MOL) Notification and Korean Standards (KS). At the same time, the data from the Size Korea was also considered. As a result, the KS guidelines were overall fulfilled by the measured products, while the MOL Notification was not. It was found that the guidelines on the chair height, seat pan depth, lumber support height, and armrest height need to be modified. Some inconsistencies between the MOL Notification and KS were also found. It is suggested that the required dimensions specified by both guidelines should be unified.