• CELLMED
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• v.6 no.3
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• pp.15.1-15.4
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• 2016

Evidence based practice (EBP) is a system of applying the most current and valid high quality evidence to support clinical decision making in a healthcare setting. In the twenty five years since its inception, EBP has become the accepted benchmark for excellence in healthcare. Although the system emerged within the biomedical sciences, in the years since EBP has become normative across all healthcare modalities from dentistry, allied health to complementary and alternative medicine (CAM). Practicing evidence based medicine within any modality potentially offers the patient the best available care based on high quality evidence. Yet it is the nature of the evidence that provokes some questions about the suitability of EBP across all modalities of healthcare. The meta analysis of randomized controlled trial (RCT) stands at the pinnacle of the hierarchy of evidence in EBP. This forms a challenge to CAM due to the difficulty in reducing the elementals of a holistic naturopathic assessment of a patient into an answerable question to be tested within a RCT. On one level this makes EBP paradigmatically incompatible with CAM, yet on another level it presents the opportunity to redefine the parameters of what is considered high level evidence. EBP has become a tool, and at times a weapon wielded by governments and health insurance companies to direct healthcare funding and policy. The implications of the nature of accepted evidence are becoming far reaching. The pursuit of the best available healthcare for each individual is the focus of EBP. However, the injudicious use of this system to direct health policy is fraught with biomedical bias and dominance. This issue raises the challenge to CAM to present high level evidence according to the rules of evidence, or face the annihilation of centuries of empirical knowledge.

• Health Policy and Management
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• v.32 no.4
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• pp.356-367
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• 2022

Background: The emergence of new infectious diseases threatens public health, increasing socioeconomic damage, and national risks. This study aimed to develop an evidence-based risk assessment tool to quickly respond to new infectious diseases. Methods: The risk elements were extracted by reviewing the risk assessment methods of the World Health Organization, United States, Europe, United Kingdom, and Germany, and the validity and priority of elements were determined through expert meetings and Delphi surveys. Then, the scale and level for each risk element were defined and a final score calculation method according to the risk evaluation result was derived. The developed risk assessment tool was verified using data at the time of domestic transmission of an emerging infectious disease. Results: In case of spread of actual infectious diseases, priority is determined based on the criticality of the elements in each area of transmissibility and severity, from which the weighted score of the risk assessment is derived. Then, the risk score for each element was calculated by multiplying the average value of the risk evaluation by its weight and the evaluation risk assessment score for the two areas was calculated. At last, the final score is plotted in a matrix where the x-axis indicates the transmissibility and the y-axis the severity and plotted on the coordinate plane for time series use. Conclusion: With respect to transmissibility and severity, this risk assessment method to respond to new and re-emerging infectious diseases enables rapid and evidence-based evaluation by quantitatively and qualitatively assessing various risk elements.

• The Journal of Korean Medicine
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• v.40 no.3
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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.

• The Journal of the Korean dental association
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• v.52 no.8
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• pp.472-477
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• 2014

The new paradigm of dentistry require the detection of caries in their earlier stages. To achieve this, a high technology detection device and systematic and organized caries management system are needed. Caries management by risk assessment (CAMBRA) model is representative caries management system that satisfied new paradigm. Dental caries prevention and treatment according to CAMBRA model is patient-centered, risk-based, evidence-based practice. Therefore, individual caries management such as CAMBRA should be performed through accurate assessment of caries disease indicators and comprehensive assessment of caries risk factors and protective factors. Based on the CAMBRA better effectiveness of comprehensive dental caries management including non-surgical treatment will be accomplished.

• Nuclear Engineering and Technology
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• v.49 no.1
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• pp.113-123
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• 2017

In human reliability analysis, dependence assessment is an important issue in risky large complex systems, such as operation of a nuclear power plant. Many existing methods depend on an expert's judgment, which contributes to the subjectivity and restrictions of results. Recently, a computational method, based on the Dempster-Shafer evidence theory and analytic hierarchy process, has been proposed to handle the dependence in human reliability analysis. The model can deal with uncertainty in an analyst's judgment and reduce the subjectivity in the evaluation process. However, the computation is heavy and complicated to some degree. The most important issue is that the existing method is in a positive aspect, which may cause an underestimation of the risk. In this study, a new evidential analytic hierarchy process dependence assessment methodology, based on the improvement of existing methods, has been proposed, which is expected to be easier and more effective.

• Korean Journal of Clinical Pharmacy
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• v.21 no.3
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• pp.193-207
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• 2011

Purpose: The purpose of this study is to assess appropriateness of current standard for insurance coverage by Health Insurance Review & Assessment Service (HIRA) on chemotherapy used in the treatment of advanced non-small cell lung cancer (NSCLC), by reviewing a variety of clinical evidences, and thereby, if needed, to propose an updated evidence-based recommendations. Methods: We collected data from HIRA regarding on the insurance standard which includes the scope and conditions for coverage on systemic chemotherapy of NSCLC. We performed a search for clinical databases and examined the most current clinical evidence from clinical literature including various clinical practice guidelines. Based on the collected data the appropriateness of HIRA standard for insurance coverage of chemotherapy of NSCLC was assessed. Results: Collected data demonstrated that HIRA standard did not reflect the most current clinical practice and evidence. Some were inappropriately listed in HIRA formulary and accepted as a chemotherapy being covered by insurance, despite the lack of evidences of clinical efficacy or superiority over other chemotherapeutic agents or regimens. In addition, there seems to be a need for a modification on the standard for insurance coverage of certain newer chemotherapeutic agents based on the current accumulated data showing their clinical efficacy and benefits in the selected group of NSCLC patients. Therefore, we concluded that current HIRA standard for insurance coverage on chemotherapy of NSCLC needs to be revised and we proposed an updated recommendation based on these latest clinical evidences. Conclusion: The standard for insurance coverage of chemotherapy should be continually examined its appropriateness based on the most recent clinical evidences in a timely manner so as to provide the most effective and safe therapy to cancer patients.

• The Korean journal of internal medicine
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• v.39 no.1
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• pp.160-171
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• 2024

Background/Aims: The effectiveness of remdesivir treatment in reducing mortality and the requirement for mechanical ventilation (MV) remains uncertain, as randomized controlled trials (RCTs) have produced conflicting results. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and other data resources to find RCTs published prior to April 10, 2023. The selection of studies, assessment of risk of bias, and meta-analysis were conducted according to PRISMA guidelines. The primary outcomes were all-cause mortality and the need to initiate MV. Results: A total of 5,068 articles were screened, from eight RCTs comprising 11,945 patients. The meta-analysis found that, compared to standard care or placebo, remdesivir treatment provided no significant all-cause mortality benefit (pooled risk ratio [RR], 0.93; 95% confidence interval [CI], 0.85-1.02; 8 studies; high certainty evidence), while subgroup analyses revealed a trend towards reduced mortality among patients requiring oxygen but not MV (pooled RR, 0.88; 95% CI, 0.77-1.00; 6 studies; I² = 4%). The need to initiate MV (pooled RR, 0.74; 95% CI, 0.59-0.94; 7 studies; moderate certainty evidence) in remdesivir-treated patients was also reduced compared to controls. Remdesivir significantly increased clinical improvement and discharge and significantly reduced serious adverse events. Conclusions: In this systematic review and meta-analysis of RCTs, it was found that remdesivir treatment did not show a substantial decrease in the risk of mortality. However, it was linked to a reduction in the necessity for additional ventilator support, suggesting remdesivir could be beneficial for COVID-19 patients, particularly those who are not on MV.

• Journal of dental hygiene science
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• v.11 no.3
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• pp.135-154
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• 2011

Dental hygiene was originated from dentistry and dental hygiene knowledge was a component of dental knowledge body. Since the late 1980s dental hygiene theory was began to develop. Nursing theories such as metaparadigm, nursing process and human need theory affected theory development as dental hygiene process. Dental hygiene process provides a framework for high quality dental hygiene care. Dental hygiene process include five phases; assessment, dental hygiene diagnosis, dental hygiene planning, implementation, evaluation. Dental hygiene process of care is recognized as standard for dental hygiene education and clinical dental hygiene practice. Dental hygiene practice has moved from auxiliary model to professional model. Critical thinking skill and disposition are necessary to provide evidence-based dental hygiene care using dental hygiene process as clinical process and critical thinking process. Critical thinking, problem solving and evidence-based practice must be integrated into dental hygiene process for quality dental hygiene care.

• Clinical Psychopharmacology and Neuroscience
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• v.16 no.4
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• pp.361-375
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• 2018

We aimed to compare the efficacy and safety of long-acting injectable (LAI) and oral second-generation antipsychotics (SGAs) in treating schizophrenia by performing a systematic review and meta-analysis. MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library, as well as five Korean databases, were systemically searched to identify studies published from 2000 to 16 April 2015, which compared the efficacy and safety of LAI and oral SGAs. Using data from randomized controlled trials (RCTs), meta-analyses were conducted. In addition, the GRADE (the Grading of Recommendations, Assessment, Development and Evaluation) approach was applied to explicitly assess the quality of the evidence. A total of 30 studies including 17 RCTs and 13 observational studies were selected. The group treated with LAI SGAs was characterized by significantly lower relapse rates, longer times to relapse and fewer hospital days, but also by a higher occurrence of extrapyramidal syndrome and prolactin-related symptoms than that in the group treated with oral SGAs. Our findings demonstrate that there is moderate to high level of evidence suggesting that in the treatment of schizophrenia, LAI SGAs have higher efficacy and are associated with higher rates of extrapyramidal syndrome and prolactin-related symptoms. Additionally, the use of LAI SGAs should be combined with appropriate measures to reduce dopamine $D_2$ antagonism-related symptoms.

• Asian-Australasian Journal of Animal Sciences
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• v.31 no.9
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• pp.1525-1534
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• 2018

Objective: The aim of this study was to examine the use of outcome-based observations within Assured Dairy Farm scheme (ADF), Soil Association Organic Standards (SA), and cross compliance (CC) farm assessment reports. Methods: A total of 449 ADF reports, 37 SA reports and 26 CC reports were analyzed and their objective comments categorized as either resource-based or outcome-based. Results: A mean of 61.0% of ADF questions were responded to with comments, in comparison to 25.0% of SA and, 21.0% of CC report questions. The SA and CC reports had significantly more outcome-based comments than the ADF (p<0.001). The assessors' tendency of choosing resource-based approach was revealed in the questionnaire results. Conclusion: Generally, the comments were comprehensive and contained professional judgements. Large numbers of comments provided in the ADF reports were mostly compliant and resource-based evidence, which serves as proof of assessment rather than aiding the certifying process. The inclusion of specific welfare outcome measures in the SA inspection likely increased the use of outcome-based comments in the reports, irrespective of whether the farm achieved compliance with a given standards. The CC scheme, on the other hand, focused on providing outcome-based evidence to justify noncompliant decisions.