• 제목/요약/키워드: Evidence based medicine

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

  • 도영경;이진용;김용익;권영훈;이상일;김창엽
    • 보건행정학회지
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    • 제14권3호
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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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    • 제14권2호
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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.

Whole Brain Radiotherapy Combined with Stereotactic Radiotherapy Versus Stereotactic Radiotherapy Alone for Brain Metastases: a Meta-analysis

  • Duan, Lei;Zeng, Rong;Yang, Ke-Hu;Tian, Jin-Hui;Wu, Xiao-Lu;Dai, Qiang;Niu, Xiao-Dong;Ma, Di-Wa
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권2호
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    • pp.911-915
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    • 2014
  • Aim: This study was to evaluate the effect of whole brain radiation (WBRT) combined with stereotactic radiotherapy (SRS) versus stereotactic radiotherapy alone for patients with brain metastases using a meta-analysis. Materials and Methods: We searched PubMed, EMBASE, Cochrane Library from their inception up to October 2013. Randomized controlled trials involving whole brain radiation combined with stereotactic radiotherapy versus stereotactic radiotherapy alone for brain metastases were included. Statistical analyses were performed using RevMan5.2 software. Results: Four randomized controlled trials including 903 patients were included. The meta-analysis showed statistically significant lowering of the local recurrence rate (OR=0.29, 95%CI: 0.17~0.49), new brain metastasis rate (OR=0.45, 95%CI: 0.28~0.71) and symptomatic late neurologic radiation toxicity rate (OR=3.92, 95%CI: 1.37~11.20) in the combined group. No statistically significant difference existed in the 1-year survival rate (OR=0.78, 95%CI: 0.60~1.03). Conclusions: The results indicate that whole brain radiotherapy combined with stereotactic radiotherapy has advantages in local recurrence and new brain metastasis rates, but stereotactic radiotherapy alone is associated with better neurological function. However, as the samples included were not large, more high-quality, large-sample size studies are necessary for confirmation.

최근 RA와 관련된 임상 및 실험 논문의 경향 (The direction of the study regarding the treatment of Rheumatoid Arthritis)

  • 김영태;이재동;이윤호
    • Journal of Acupuncture Research
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    • 제19권5호
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    • pp.189-198
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    • 2002
  • Objective : To research the trend of the study related to rheumatoid arthritis(RA) and to establish the hereafter direction of the study on RA. Methods : We have selected 12 medical report about RA in Arthritis & Rheumatism and Journal of Rheumatology recently, reviewed them, and investigated their methods. Results & Conclusions : The pattern of study was as follows: physical & serologic research in 2 articles, immunologic research in 7 articles, and genetic research in 3 articles. There is now evidence of the benefit of treatment early in the disease course and evidence of the impact of treatment on outcomes. New classes of therapeutic agents have also been introduced. Wherever possible, these revised guidelines are evidence-based. By the above results, it would be needed further research on RA mechanism related immunologic and genetic process.

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2017 과민성장증후군의 임상진료지침 개정안 소개 (Review of the Clinical Practice Guidelines for Irritable Bowel Syndrome in Korea, 2017 Revised Edition)

  • 정혜경
    • 대한소화기학회지
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    • 제72권5호
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    • pp.252-257
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    • 2018
  • This guidance is an updated version of the irritable bowel syndrome (IBS) guidelines based on evidence-based medicine. IBS is a common chronic gastrointestinal syndrome that occurs in approximately 10% of the population and causes chronic abdominal pain as well as bowel habit changes, such as stool frequency or consistency. The final diagnosis of IBS is based on the exclusion of organic diseases that would explain the symptoms and the absence of endoscopic abnormalities. IBS can reduce the quality of life and cause a major disease burden, such as repeated examinations and continuous drug use, by mistaking organic diseases including malignancy. The major changes are as follows: 1) when to perform a colonoscopy under the impression of IBS; 2) effect of a low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet; 3) impact of probiotics in IBS; and 4) role of antibiotics in IBS. The Korean Society of Neurogastroenterology and Motility recently updated these guidelines to support physicians for qualified medical services and reduce the socioeconomic burden of IBS.

보완대체의학의 암치료 연구 현황 - MEDLINE을 중심으로 - (Current Research for Complementary and Alternative Medicine for Cancer - Based on the Data of MEDLINE -)

  • 권창현;유화승;이연월;조종관
    • 대한암한의학회지
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    • 제10권1호
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    • pp.57-74
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    • 2005
  • Objectives : Many cancer patients use therapies promoted as literal alternative and complementary medicine to conventional medical care. So the health provider has to guide it by appropriate clinical guideline. The purpose is to indicate the international research tool of korean medical oncology for related investigators and help to make the clinical guideline for korean oncology. Method : We reviewed complementary and alternative therapies for cancer and cancer-related symptoms by searching MEDLINE, and using the name and synonyms of the therapy. Publications on complementary medicine were identified by searching the Cochrane Library. Results and Conclusion : Most complementary and alternative medicine used by cancer patients have demonstrable, important benefits, including decreased symptoms and better quality of life. We have to standardize the scientific research protocol for korean oncology and build evidence based medicine in the future.

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미세먼지(霧霾)가 발생하는 질병과 중의학, 한의학의 관리가능성 - 예방과 치료를 중심으로- (The Possibility of Managing Diseases Caused by Particulate Matter(PM10) with Chinese and Korean Medicines - Emphasis on Medical Prevention and Treatment -)

  • 고원준;안정훈;이선동
    • 대한예방한의학회지
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    • 제22권1호
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    • pp.69-80
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    • 2018
  • Objectives : This paper examines the effects of Particulate Matter on human bodies and the possibility of treating them with Chinese or Korean medicines. Methods : This paper categorizes the diseases caused by Particulate Matter, as well as the causes, pathology, prevention methods, and effectiveness of treatments by Chinese and Korean medicines. Based on these results, it analyzes whether such diseases can be managed by Chinese and Korean medicine. Results : Particulate Matter is known to affect respiratory organs, skin, circulatory system, nervous system, gestational diabetes, and other parts of the human body. While studies show evidence that treatments by Chinese and Korean medicines can reduce symptoms of some diseases and improve bodily functions that are damaged by Particulate Matter, there is no statistically significant evidence that they can provide fundamental treatments nor treat irreversible damages. Conclusion : Currently, there is no definite evidence that Chinese and Korean medicine can treat symptoms and diseases caused by Particulate Matter. Therefore, some Korean medicine doctors' arguments that Korean medicine is effective in treating such diseases are problematic, and thus, there is a need for much research in this field.

선진국의 일차의료부문의 통합의료 - 일차보건의료체계에서의 한의학에 주는 함의 - (Use of Integrative Medicine among primary care patients in Western counties - Its implication for traditional Korean medicine in primary care system -)

  • 한동운
    • 대한예방한의학회지
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    • 제16권1호
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    • pp.1-13
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    • 2012
  • The objective of this study is to discuss the role of integrative medicine (IM) in contemporary health care settings, and how and which factors affect and facilitate the success of IM in terms of the integration of complementary and alternative medicine (CAM) and conventional medicine in primary health care (PHC). IM is meant to provide the best possible health care, for both patient and physician. The way of IM use in the developed countries presents various ways that IM can be provided, and it appears that strategies have been successfully developed to facilitate integration. Although few of the barriers to the integration of CAM and conventional medicine have been resolved, concerns over the legitimacy of CAM in health care (e.g., safety, biomedical evidence, and efficacy) are being overcome by the use of evidence-based practice in IM delivery. There are dominant models of IM that have been developed. The model types signify different levels of equity between CAM and conventional medicine in regard to the power, autonomy, and control held by each. However, the factors common to all IM models, whether describing CAM as supplementary or complementary to conventional medicine, is the concept of a health care model that aspires to be client-centred and holistic, with focus on health rather than disease as well as mutual respect among peer practitioners. Finally, this study concluded that the growth and viability of traditional Korean medicine(TKM) depend on evidence-based practices and identifying the successful influences on the integration of TKM and conventional medicine for recognition of its inherent value in PHC. Some recommendations for the integration of TKM and conventional medicine were suggested.

한의 중풍 진료 현황 파악 및 활성화 방안 모색을 위한 전자우편 설문조사 (E-mail survey on the current status of clinical practice and activation measures for Korean medicine in stroke care)

  • 김미경;한창호
    • 대한한의학회지
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    • 제38권3호
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    • pp.143-159
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    • 2017
  • Objectives: The aim of this study was to investigate the current status of and seek for measures to activate Korean medicine in stroke care. Methods: This is an e-mail survey targeting the members of Korean medical doctors registered at the association of Korean medicine. The project team of the society of stroke on Korean medicine for the development of clinical practice guideline for stroke has devised the items for the questionnaire. The survey was conducted for 15 days in November 2016. Results: The percentage of the respondents who have treated patients with stroke for the past month was 11.2% in the acute phase, 20.5% in the convalescent phase, and 32.4% in the chronic phase. Approximately 80% of the respondents answered they had a decrease in the number of patients compared to 10 years ago, regardless of the stroke phase. Most of the respondents were using Western medicine together with traditional Korean medicine for physical examination. Acupuncture and herbal medicine were the main therapeutic interventions. The two measures chosen by the most respondents to activate the Korean medicine usage for stroke care were the expansion of the insurance coverage (34.9%) and the generation of evidence on the effectiveness of traditional Korean medicine (25.1%) Conclusion: It is necessary to actively show the role of the Korean medicine through the establishment of the evidence on the effectiveness of Korean medicine and the promotion based on the evidence. In addition, optimal treatment methods should be derived based on the traditional knowledge and modern scientific research and the methods should be educated to every Korean medical clinics and hospitals so that they can be implemented in clinical practice. At the same time, the government should provide policy support to ensure that the optimal treatment can be timely and appropriately implemented.