• 동의신경정신과학회지
• /
• 제33권4호
• /
• pp.377-388
• /
• 2022

Objectives: For diagnosis and evaluation, evaluation tools are needed. Various tools can be used to diagnose and evaluate mental disorders. Among them, psychological tests are widely used. For Korean Standard Classification of Diseases (KCD) diagnosis, psychological tests are also required. Currently developed critical pathway (CP) presented tools for diagnosis and evaluation of mental disorders. The CP suggests the use of tools based on the Clinical Practice Guideline (CPG). Therefore, CPG-based tools should be able to be used in the clinical scene of Korean Medicine for diagnosing and evaluating mental disorders according to CP. Methods: Tools suggested by CPs are summarized. The degree of utilization of tools in CPGs is also summarized. A review was conducted by Korean Medicine neuropsychiatrist experts on tools and user's usage plan. Results: As a result, developed CPs suggested using 19 tools for anxiety disorder, 13 tools for insomnia), 12 tools for Hwabyeong, and 9 tools for dementia. In CPG, 48, 34, 44, and 44 tools were used for anxiety disorder, insomnia, Hwabyeong, and dementia, respectively. Among tools presented in CP, HAM-A, HAM-D, CGI, SAS, and TESS for anxiety disorder, CPG, ISI, and PSQI for insomnia disorder, CPG, STAI, and STAXI for Hwabyeong were frequently used in CPG. For dementia CPG, MoCA, MMSE, HDS, ADL, and ADAS-cog were frequently used. Among them, MoCA, ADL, and ADAS-cog were suggested tools in CP. Conclusions: As a result of analyzing tools suggested and used in the developed CPs and CPGs, it was verified that various tools were used in each study. Most of them were symptom and behavioral evaluation scales. Therefore, symptoms and behavior evaluation scales used more frequently should be able to be used in the clinical scene of Korean Medicine.

• Clinical Endoscopy
• /
• 제55권2호
• /
• pp.167-182
• /
• 2022

Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriate sedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneous breathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of the medical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Cardiopulmonary complications are usually temporary. Most patients recover without sequelae. However, they may progress to serious complications, such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications by meticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinical practice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using an adaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expert consensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policy makers with information on how to perform endoscopic sedation with minimal risk.

• 대한한의학회지
• /
• 제43권3호
• /
• pp.122-138
• /
• 2022

Objectives: This study was conducted to develop a Korean Medicine(KM) Clinical Practice Guidelines(CPG) of female infertility. We conducted this questionnaire survey to reflect the experiences of Korean Medicine doctors(KMD) and clinical field in Korea. Method: We sent a questionnaire survey to KMD belonging to the Association of Korean Medicine by e-mail. We received 665 responds, and analyzed the answers. Results: 51.2% of respondents knew the previously developed CPG of female infertility, and 18.3% actually used. 83.3% agreed about the necessity of CPG of female infertility, and 80.3% had practical use plan. 90.2% of respondents treated less than 5 infertility woman for a month. 22.7% of respondents treated 50% of patients with collaborative treatment of KM and Western medical treatments. The main age group of patients was '35~40 years'(54.7%), and the most common cause was unexplained infertility(61.7%). The most common pattern identification of female infertility patients was Kidney deficiency(55.4%). KMD used 'a combination of decoction of herbal medicine, acupuncture and moxibustion treatment' the most(43%), and 'a decoction of herbal medicine treatment alone' was next(35%). 84.2% conducted lifestyle modification education about diet, stress, exercise etc. Conclusion: We figured out Korean Medicine doctors' recognition about CPG of female infertility, preference of treatments, and also characteristics of patients visiting Korean Medical clinics to make a practical CPG reflecting clinical situation.

• 생물정신의학
• /
• 제19권4호
• /
• pp.153-158
• /
• 2012

Understanding of a clinical trial is essential in developing clinical guideline and adopting evidence based practice. In designing and executing clinical trials, following ethical requirements should be considered : social value, scientific validity, fair subject selection, informed consent, favorable risk-benefit ratio, institutional review board, and respect for human subjects. According to the stage of drug development, purpose of trials, accumulated scientific data, clinical trials for drug development are classified as phase 1, 2, 3, and 4. Phases of clinical trials can be overlapped and the judgment of entering into the next phase should be considered highly strategically. In reading, evaluating and interpreting clinical trial reports, various skills and challenges exist. Patient sample composition, trial duration, selection of endpoints, responders and non-responders, placebo effect, patient recruitment, and extrapolation to the real world are the examples of those challenges. Treatment success will come from the well balanced approach of evidence based decision making and consideration of specific single case.

• 대한한방부인과학회지
• /
• 제33권1호
• /
• pp.116-127
• /
• 2020

Objectives: The purpose of this study is to analyze csatisfaction with clinica1 training in the department of Korean Medicine Obstetrics and Gynecology and the related factors. Methods: All the students on the graduating class of school of Korean Medicine, Dong-Shin University must be trained for 1 year in the department of Korean Medicine Obstetrics and Gynecology according to clinical training guideline including Objective Structured Clinical Examination (OSCE). After completing clinical training, we distributed questionaries to them about a reflex of the object of study, usefulness, difficulty, satisfaction and preference. And then, we analyzed the related factors including descriptive statistics, frequency analysis and correlation analysis by SPSS 12.0. Results: In general, a reflex of the aim of study (7.31±1.59), satisfaction with contents (7.44±1.58), and difficulty (6.13±1.34) were evaluated restectively. There is no statistically significant difference with sex. There is a statistically significant positive correlation between a reflex of the aim of study and satisfaction with contents. The primary preferences of clinical practice were Clinic Training, Ward Training, PBL (Problem Based Learning), OSCE. In OSCE, a reflex of the aim of study (7.04±1.83) and usefulness (7.02±1.97) were highly evaluated. There is no statistically significant difference with sex. The primary preferences for clinical OSCE practice were breast examination, genital examination, ultrasound scan, and pap smear. Facilities and equipment (6.84±2.01), contents of clinical training (7.29±1.83), the handout (7.20±1.98) and time scheduling (7.29±1.90) were evaluated respectively in general composition of clinical training. Conclusions: Clinical training program in the department of Korean Medicine Obstetrics and Gynecology can be highly estimated from the viewpoint of satisfaction with clinical training and the related factors.

• 한방재활의학과학회지
• /
• 제32권4호
• /
• pp.73-82
• /
• 2022

Objectives The purpose of this study is to develop a case study protocol to complete final version of Korean medicine clinical pathway (CP) by applying Korean medicine CP based on carpal tunnel syndrome Korean medicine clinical practice guidelines developed by clinical experts to clinical field. Methods After applying previously developed CP, 10-point Likert scale questionnaires on satisfaction of CP, appropriateness and improvement on out patient department (OPD) treatments are carried out in the 2^nd week of OPD treatment. An open-ended questionnaire is also carried out to ask if there is any requirement to be added or improved among CP interventions. Results Final version of CP is going to be completed based on the questionnaire, excluding articles of which average or median value is less than 5 from 10-point Likert scale. Conclusions This evidence-based case study protocol is expected to contribute development of carpal tunnel syndrome clinical pathway.

• Journal of Hospice and Palliative Care
• /
• 제23권3호
• /
• pp.103-113
• /
• 2020

A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients' physical and mental symptoms, psychological support, appropriate decision-making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.

• 임상간호연구
• /
• 제17권2호
• /
• pp.176-191
• /
• 2011

Purpose: This methodological study translated, adapted, and validated the evidence based guideline of RNAO (Registered Nurses Association of Ontario) in Canada, for acute stroke care to domestic circumstances. Methods: Quality of the RNAO guideline was evaluated using AGREE tool. Then the guideline was translated into Korean and a preliminary guideline was established After checking content validation by an expert group, the Korean version of the guideline was applied to clinical settings to see its applicability. Results: The RNAO guideline in Korea was deemed appropriate. The Korean version of the guideline was drawn up with 56 items in 3 areas in stroke system related nursing, nursing of acute stroke inpatients, and stroke nursing assessment. A questionnaire survey was performed on appropriateness, enforceability, and applicability of those recommendations. A total of 54 recommendations were finalized after deleting 2 items below CVI 0.7 and correcting 3 items by taking professional advices. After trial application of the guideline to 40 stroke patients hospitalized at a ward of a hospital in Seoul, its performance was improved but was not statistically significant. Conclusion: This guideline is expected to contribute to improving nursing quality by offering it as a guide to evidence based practices for acute stroke care in Korea.

• 동의신경정신과학회지
• /
• 제34권1호
• /
• pp.1-12
• /
• 2023

Objectives: To standardize treatment, improve quality of medical service, and reduce medical costs of patients with depression by developing a clinical pathway (CP) of Korean medicine. Methods: CP was developed based on clinical practice guideline (CPG) for depression. To consider the degree of economic burden and satisfaction, the current status of management for patients with depression was examined. After CP was primarily developed, contents of the CP were supplemented by referring to previously developed CPs. Results: Based on CPG, current status survey and previous CP, four types of CP (Korean medicine clinics, Korean medicine hospitals, Western-Korean medicine collaborative hospitals, public medical center) were developed and shown in the algorithm version. However, in the case of Korean medicine hospitals and Western-Korean medicine collaborative hospitals, CPs were detailed according to different clinical scenes of outpatients and inpatients. This study also shows six different time task matrix version. Conclusions: CP for depression is expected to not only reduce financial burden of patients and health insurance, but also increase the quality of treatment and satisfaction.

• 의료법학
• /
• 제23권2호
• /
• pp.39-65
• /
• 2022

진료가이드라인은 의료행위 전의 비법적 통제로서 작용하는 측면과 의료행위 후의 법적인 통제기준으로 작용하는 두 가지 측면이 있다. 진료가이드라인의 본질적 목적은 전자이지만, 후자의 작용을 배제할 수 없다. 진료가이드라인은 법과 의료를 연결하는 수단이다. 진료가이드라인의 제정에 의해 의료전문가의 자율성이 침해될 수 있다는 진료가이드라인에 대한 부정적 인식은 진료가이드라인에 대한 지나친 부정적 평가이다. 오히려 진료가이드라인에 의한 사법판단은 의료전문가의 자율성을 존중하는 역할을 한다. 즉 진료가이드라인은 의료에 대한 법적 규제를 최대한 억제하고, 의사의 직업윤리 및 자기규율과 환자의 자각 및 협력을 바탕으로 하는 것이다. 의사와 환자의 협력이라는 이상적인 관계를 정립하기 위해서는 「의료윤리」를 법적 수단으로 편입해야 한다. 이러한 의료윤리의 법적 절차에의 편입작업에 가장 적절한 수단이 의료가이드라인이다. 법률가는 규범을 정립하고, 그것에 사실을 적용하여 결론을 내리는 법적 삼단논법으로 사안을 해결한다. 의료분쟁의 해결은, 의사가 특정 질환에 어떠한 의료행위를 해야 하는가라는 규범을 정립할 때에 진료가이드라인을 사용하며, 정립된 규범을 구체적인 진료행위에 적용하여 결론을 도출한다. 정립된 규범을 구체적인 진료행위에 적용하는 것이 쉽지 않은 때에는 감정이나 전문가 증언, 전문위원의 설명과 같은 전문가의 의학적 판단을 이용한다. 이처럼 사법(司法)은 규범의 정립이나 규범의 적용에도 의료의 자율성을 존중하고 있다. 특히 법적 삼단논법의 대전제인 규범의 정립에는 의료계가 자주적으로 작성한 진료가이드라인을 참고하고 있다. 이는 의료인이 판례의 형성에 참가하여 규범형성에 기여하는 모습이다. 진료가이드라인이 재판에 이용되는 것은 의료의 자율성에 대한 존중과 배려이다. 진료가이드라인에 의해 개개의 의사의 자율성이 제약되는 측면은 있을 수 있지만, 집단으로서의 의사의 자율성은 존중된다고 보아야 한다. 이처럼 진료가이드라인은 「법」의 논리에서 보면, 「의료」 집단의 자율성을 보호하는 역할을 한다.