The purpose of this study was to lay out child-friendly planning guidelines for environments in a bid to create residential environments geared toward backing up children's life. Earlier studies were reviewed to make a literature analysis to find out existing planning guidelines for environments, and small-group workshop was held to formulate down-to-earth planning guidelines. And a survey was conducted on the parents of selected children to assess the importance of the selected planning guidelines. The findings of the study were as follows: First, residential environments were categorized into housing spaces and outdoor playing spaces, and 25 and 28 planning guidelines for each field were prepared respectively. When a survey was implemented, all the 53 planning guidelines were rated as important or very important. Second, the guidelines for safety were considered very important, and the importance of the planning guidelines varied with children's age. The findings of the study suggest that the development of more reinforced criteria for children's safety is required to create child-friendly residential environments.
Objectives: This study presents Korean medicine clinical practice guidelines for bladder cancer, of which the 5-year survival rate has still been about 75% since the 1990s despite the rapid development of medical science. Methods: A consensus was reached by an expert committee composed of professors and researchers who specialize in Korean medicine on the basis of a literature review that included other countries' clinical guidelines and a textbook. Results: Traditional Chinese medicine clinical practice guidelines were published for the first time in 2014. In Korea, the medical system is different from China in that Korea has completely dualized Korean and Western medicine and a low availability of proprietary herbal medicines. Therefore, these Korean medicine clinical practice guidelines for treating bladder cancer based on the previously published guidelines of Chinese medicine will help first-line Korean medicine doctors. Conclusions: Further studies related to Korean medicine are necessary to develop more advanced Korean medicine clinical practice guidelines for treating bladder cancer.
Background: As prevention of coronavirus disease 2019 (COVID-19) transmission in healthcare settings has become a critical component in its effective management, COVID-19 specific infection prevention and control (IPC) guidelines were developed and implemented by numerous countries. Although largely based on the current evidence-base, guidelines show much heterogeneity, as they are influenced by respective health system capacities, epidemiological risk, and socioeconomic status. This study aims to analyze the variations and concurrences of these guidelines to draw policy implications for COVID-19 response and future guidelines development. Methods: The contents of the COVID-19 IPC guidelines were analyzed using the categories and codes developed based on "World Health Organization guidelines on core components." Data analysis involved reviewing, appraising and synthesizing data from guidelines, which were then arranged into categories and codes. Selection of countries was based on the country income level, availability of COVID-19 specific IPC guideline developed at a national or district level. Results: The guidelines particularly agreed on IPC measures regarding application of standard precautions and providing information to patients and visitors, monitoring and audit of IPC activities and staff illnesses, and management of built environment/equipments. The guidelines showed considerable differences in certain components, such as workplace safety measures and criteria for discontinuation of precautions. Several guidelines also contained unique features which enabled a more systematic response to COVID-19. Conclusion: The guidelines generally complied with the current evidence-based COVID-19 management but also revealed variances stemming from differences in local health system capacity. Several unique features should be considered for benchmark in future guidelines development.
Oh, Hyuk-Jin;Seo, Youngbeom;Choo, Yoon-Hee;Kim, Young Il;Kim, Kyung Hwan;Kwon, Sae Min;Lee, Min Ho;Chong, Kyuha
Journal of Korean Neurosurgical Society
/
v.65
no.2
/
pp.255-268
/
2022
Objective : Chronic subdural hematoma (CSDH) is a common disease in neurosurgical departments, but optimal perioperative management guidelines have not yet been established. We aimed to assess the current clinical management and outcomes for CSDH patients and identify prognostic factors for CSDH recurrence. Methods : We enrolled a total of 293 consecutive patients with CSDH who underwent burr hole craniostomy at seven institutions in 2018. Clinical and surgery-related characteristics and surgical outcomes were analyzed. The cohort included 208 men and 85 women. Results : The median patient age was 75 years. Antithrombotic agents were prescribed to 105 patients. History of head trauma was identified in 59% of patients. Two hundred twenty-seven of 293 patients (77.5%) had unilateral hematoma and 46.1% had a homogenous hematoma type. About 70% of patients underwent surgery under general anesthesia, and 74.7% underwent a single burr hole craniostomy surgery. Recurrence requiring surgery was observed in 17 of 293 patients (5.8%), with a median of 32 days to recurrence. The postoperative complication rate was 4.1%. In multivariate analysis, factors associated with CSDH recurrence were separated hematoma type (odds ratio, 3.906; p=0.017) and patient who underwent surgery under general anesthesia had less recurrence (odds ratio, 0.277; p=0.017). Conclusion : This is the first retrospective multicenter generalized cohort pilot study in the Republic of Korea as a first step towards the development of Korean clinical practice guidelines for CSDH. The type of hematoma and anesthesia was associated with CSDH recurrence. Although the detailed surgical method differs depending on the institution, the surgical treatment of CSDH was effective. Further studies may establish appropriate management guidelines to minimize CSDH recurrence.
According to the development of medical technology, new medical treatments have been dramatically increased as an inevitable consequence, however, it is not easy for medical workers to learn the knowledge that is necessary for new medical treatments and their additions in the medical services. Therefore, it could not be helped increasing the guidelines for applying new medical treatments, and then, the problem would come out whether to attribute the medical negligence to the doctors who did not follow the guidelines when the patient became worse because of his non-compliance. Nevertheless, there is no document to review the problem mentioned above and also no definite precedents. Thus, the civil lawful character and obligation of guidelines on the lawsuit against the medical default have been examined in this studies. The medical negligence is defined as usual doctors violate the care obligation which is demanded for them to follow when they treat patients under the proper medical standard in those days. It is resonable to assume that the matter of guidelines is to decide the level of the care obligation, that means the care which is required of the rational doctors under same circumstances, and in general, the experts' testimonies should be needed in this case. In addition, the issue comes out whether the guidelines can be the standard of the judgement of the medical negligence. Finally, I suppose, the evaluation of the issue depends on who makes the guidelines, what materials are based on, and also depends on whether there is another guidelines in the same disease, what the purpose of guidelines is to save the medical costs or to realize the appropriate medical services, in addition, it depends on how often renew the guidelines, and how wide is the usage of guidelines.
In 2009, American Journal of Health-System Pharmacy (AJHP) recommended that targeting vancomycin trough concentrations of 10 mg/L or more because of therapeutic failure and potential risk of developing vancomycin resistance. Therefore, new dosage guidelines that could achieve to these higher target were needed. The aims of this study were to develop dosage guidelines targeting new vancomycin trough concentration and to evaluate the performance of these new guidelines. All data analysis were performed using NONMEM(R). Population pharmacokinetic model was first developed from vancomycin dosage and concentration data collected retrospectively during routine therapeutic drug monitoring in 441 patients, then new vancomycin dosage guidelines were developed by using the model to predict vancomycin trough and peak concentrations in a simulated dataset. The estimates, such as, vancomycin concentration trough level, time to achieve target level, mean error were performed to evaluate and compare difference between conventional dosage and new dosage guidelines. The proposed dosage guidelines were predicted to achieve 43.5% of vancomycin trough level within 10~20 mg/L, which is significantly higher than current guidelines (26.3%). Time to achieve target trough level was 19.4 hours in new guidelines comparing to 93.1 hours in the conventional dosage. Thus, new vancomycin dosage guidelines have been developed to achieve new target trough concentrations earlier and more consistently than conventional guidelines.
Objective: Atrial fibrillation (AF) guidelines have been published in the USA and Europe. Recently, the USA and Europe have updated their guidelines, respectively. These new AF guidelines help in addressing key management issues in clinical situations. This study, therefore, systematically compared guidelines for rate and rhythm control pharmacotherapy of patients with AF between the USA (American College of Cardiology and American Heart Association, ACC/AHA) and Europe (European Society of Cardiology, ESC). Methods: This study investigated and compared American guidelines (2014) and European guidelines (2010 and 2012). Results: Generally, there are four meaningful differences between ACC/AHA and ESC guidelines. Important differences are treatment classification system, level of recommendation, drug list, and dosage. In addition, ACC/AHA described pharmacokinetic drug interactions for antiarrhythmic drugs. ESC emphasized ECG and atrioventricular nodal slowing as feature of antiarrhythmic drugs. Conclusion: This research addresses important use of anti-arrhythmic drugs and movement to accept recent recommendations in Korea. For the successful application of the guidelines, a role of pharmacists is crucial in clinical situation.
As the competition of city design from various municipals recently, color guidelines are continuously established. But the contents of color guidelines are differing from one municipal to the other, It has doubts on its effectiveness. Thus, the objective of this researchis to investigate municipals' color guidelines in order to apprehend the characteristics and differences among each other. In order to do this, the research will collect color guidelines of 5 different cities and 2 different districts. Then, by organizing tables for different characteristics of contents, the research will attempt to identify the difference between municipals. The conclusion of such research is as follows. First, basic contents of color guidelines are composed with planning, proposing and managing stages. Furthermore its objective, target subject, detailed guidelines and exemplary cases were common. Second, the contents of color guidelines of municipals were vastly differing from each other in respect to the size of the cities or the objectives of its application. Third, color guideline contents of the city of Seoul, Sejong city, and Chung-ra district are composed rather reliably while that of the city of Inchun, and Sung-buk district were lacking considerably in terms of up-to-date survey of environment, color proposal, and managing policy in comparison to other municipals. In conclusion, there is a strong necessity for standardization of establishment or form of the color guidelines. Furthermore, measures for proper adjustment in respect to the size of a municipal or its purpose should be arranged adequately.
The purpose of this study was to assess the quality of the case reports in the Journal of Acupuncture Research (JAR). All case reports were retrieved from November 2017 to June 2020. There were 19 case reports included in this assessment based on the case report (CARE) guidelines and case report and standards for reporting interventions in clinical trials of acupuncture (STRICTA) guidelines. The overall quality of reporting was relatively high (83.08% on Case Report guidelines and 77.78% on Standards for Reporting Interventions in Clinical Trials of Acupuncture guidelines), but several crucial items remained substantially underreported, such as identifying as a case report (keywords), patient information and perspective, clinical findings, diagnostic assessment, and intervention information. In 18 out of 19 included case reports of acupuncture-related interventions, several items remained considerably underreported such as acupuncture regimen variation, depth of needle insertion, response sought, and experience of acupuncturists. In the classification by disease, condition, or syndrome, 13 out of 19 included case reports were for musculoskeletal disorders (68.4%), which is the main clinical medical field of Korean medicine services. The results of this study may help develop more appropriate reporting guidelines for case reports published in JAR.
Background : Despite favorable effects of guidelines on patient care, guidelines often fail to achieve their objectives. Poorly implemented medical practice guidelines can produce only weak effects on the process of health care delivery. Therefore, we performed this study to investigate barriers related development of clinical practice guidelines. Methods : Cardiopulmonary resuscitation was selected as a target problem. Self questionnaires about management of cardiopulmonary resuscitation were developed by a researcher with advisory 8 experts. The questionnaires were designed as a unstructured methods. The data were collected from March 1 to May 31, 1999. A total 50 death case admitted inpatient to Inha University Hospital were subjected to evaluate the development and application of clinical practice guidelines for cardiopulmonary resuscitation. The data were examined by frequency, t-test with SPSS. Result : The article reviewed several common barriers that might limit successful implementation of guidelines in clinical practice, as illustrated by evaluating recommendations for cardiopulmonary resuscitation clinical practice guidelines. Some major problems with guidelines were characterized as follows (1) ethical problem : euthanasia, (2) occurrence on various emergency event and setting, (3) non-medical problems (4) unreliable of medical record etc. Conclusion : Careful analysis of guideline attributes, anticipated effect on medical care, and organizational factors revealed several barriers to successful guideline implementation that should be addressed in the design of future guideline-based interventions.
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