• Title/Summary/Keyword: Clinical Practice Guidelines

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Consensus on definition and quality standard of clinical practice guideline using RAND method (RAND 방법으로 합의한 임상진료지침의 정의와 질 평가 기준)

  • Ji, Seon-Mi;Kim, Soo-Young;Sheen, Seung-Soo;Heo, Dae-Seog;Kim, Nam-Soon
    • Health Policy and Management
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    • v.20 no.2
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    • pp.1-16
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    • 2010
  • Background : Clinical practice guidelines are an increasingly familiar part of clinical practice. Moreover, rigorously developed evidence based guidelines has been widely used. However, in Korea, some of published documents as clinical practice guidelines have shown considerable disparity in structure, contents and quality. This is mainly because there is no consensus on the definition and quality standard of clinical practice guidelines. The purpose of this study was to draw consensus on the definition and the quality standard about clinical practice guidelines. Method : We developed a questionnaire about the definition of clinical practice guidelines with inclusion criteria(23 items) and the quality standard(30 items). We selected 9 experts who had prior experience in developing and implementing guidelines. Rating methods for appropriateness of items were adopted from the RAND method. Consensus was drawn in three rounds. Results : Of the 47 items agreed, 40 items were determined to be appropriate. Clinical practice guidelines were defined as "scientifically and systematically developed statements to assist practitioners and patients on making decisions about appropriate health care for specific clinical circumstances." Narrative reviews, systematic reviews or health technology assessment without recommendations, translation of foreign guidelines, guidelines for patients only and training manuals were not considered as clinical practice guidelines. For the quality standard of clinical practice guidelines, 27 items were deemed necessary. Conclusions : The consensus on the definition with inclusion criteria and the quality standard of clinical practice guidelines carries an important meaning as the first attempt to draw a general agreement in our society. The unique achievement of the consensus reflects the current status of clinical practice guidelines that there has been a high tendency to adapt foreign guidelines. We hope efforts of this kind will continue to bring improvement in clinical practice guidelines.

Medico Legal Aspects of Clinical Practice Guideline (표준 치료 지침서(Clinical Practice Guideline)의 의료법학적 의의)

  • Bae, Hyun-A
    • The Korean Society of Law and Medicine
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    • v.9 no.2
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    • pp.181-207
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    • 2008
  • With recent emphasis on evidence based medicine, clinical practice guidelines are seen as a potential mechanism by which unify various managerial and professional approaches to improving the quality of care. The development process of guidelines has been the subject of much research. and it is need translating the medical evidence of research into a clinical practice guidelines. the gathered evidence needs to be interpreted into a clinical, public health, policy, or payment context. The term 'clinical practice guidelines' can evoke a diverse range of responses from healthcare personnel. Clinical practice guidelines are increasingly used in patient management but some clinicians are not familiar with their origin or appropriate applications. Understanding the limitations as well as benefits of CPG could enable clinicians to have clearer view of the place of guidelines in every practice. In the context of increasing complaints and litigation in healthcare, the legal implications of clinical practice guidelines are of increasing importance. Clinical practice guidelines could, in theory, influence the manner in which the courts establish negligence by suggesting the doctor breached the duty of care by failing to provide the required standard of medical care. In several studies, the CPGs were relevent to and played a pivotal role in the proof of negligence. Much depends on the quality of guidelines and the tools developed and the authoritativeness of a guideline. Recently, there are several opinions the court also should review the validity and reliability of expert testimony including medical evidence. and widespread use of guidelines in malpractice lawsuit could lead the physicians to greater compliance with guidelines in the long term. In conclusion, Health care reformers, physicians as well as guidelines developers should understand that guidelines have both medical and legal aspects as a double-edges sword. so clinicians, legal representatives and decision-makers should not defer unduly to guidelines.

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Clinical Characteristics and Current Managements for Patients with Chronic Subdural Hematoma : A Retrospective Multicenter Pilot Study in the Republic of Korea

  • 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
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    • v.65 no.2
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    • pp.255-268
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    • 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.

Barriers on Development of Clinical Practice Guidelines for Cardiopulmonary Resuscitation (임상진료지침 개발과정의 장애요인 - 심폐소생술을 중심으로 -)

  • Park, Seong-Hi
    • Quality Improvement in Health Care
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    • v.7 no.1
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    • pp.46-58
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    • 2000
  • 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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A Preliminary Study for the Development of Clinical Practice Guidelines of Korean Medicine for Bladder Cancer (방광암(膀胱癌)의 한의학적 진료지침 개발을 위한 기초 연구)

  • Park, Tae-yeol;Yoo, Hwa-seong;Lee, Sang-hun
    • The Journal of Internal Korean Medicine
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    • v.37 no.6
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    • pp.911-928
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    • 2016
  • 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.

Nurses' Usage of Clinical Practice Guideline and Demand of Evidence Based Clinical Practice Guideline (간호사의 임상실무지침서 사용현황과 근거중심 임상실무지침서 요구도 조사)

  • Ha, Mi Suk;Park, Myong Hwa
    • Korean Journal of Adult Nursing
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    • v.18 no.4
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    • pp.582-592
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    • 2006
  • Purpose: The purpose of this study was to offer the baseline data for developing a systematic and high quality of clinical practice guideline by exploring how nurses utilize clinical guidelines and what they need for. Method: This study has been done with 242 nurses of a university hospital in Daegu using a self-administered questionnaire. The instrument used in this study was developed by researchers based on the results of the previous studies. Data analysis was done with SPSS 11.0 Program. Results: Nurses felt that clinical guidelines were not sufficiently disseminated to update their clinical knowledge education. Nurses showed the strong demand for developing clinical practice guidelines with the newest and systematic evidence. However, a relatively low number of nurses knew evidence-based nursing and evidence-based clinical guidelines. Conclusion: It is necessary to develop an educational program for evidence-based nursing and an evidence-based nursing clinical practice guideline for nurses and to explore the strategies for development and dissemination of evidence-based clinical practice guidelines to solve the urgent and frequent clinical problems.

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A Preliminary Study for Development of Clinical Practice Guidelines of Korean Medicine in Colorectal Cancer (결장직장암 치료에 대한 한의 임상 가이드라인 개발을 위한 기초연구)

  • Kim, Junyoung;Yoo, Hwaseung;Cho, Junghyo
    • Journal of Haehwa Medicine
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    • v.24 no.2
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    • pp.65-83
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    • 2016
  • Objectives : The purpose of this study is to present the clinical practice guidelines for colorectal cancer through the analysis of existing clinical practice guidelines and randomised clinical trials (RCTs) in Western and Chinese medicine. Methods : The data related to Western and Oriental medical treatment of colorectal cancer were collected using various search engines such as Google Scholar, KIOM OASIS, PUBMED and Jisan library of Daejeon university. Results & Discussion : Colorectal cancer is the third most common cancer in Korea. In recent studies, applying combined oriental and western medicine can improve the survival, quality of life, immune function, and suppress of tumor growth in colorectal cancer. However there isn't still an objective and systemic clinical guideline for colorectal cancer, so we have difficulty in clinical application. This study will be a preliminary study to establish clinical practice guidelines of Korean Medicine for colorectal cancer. Conclusions : Further objective and systemic clinical studies related to Korean Medicine are needed to develop more advanced clinical practice guidelines of colorectal cancer.

A Preliminary Study for Development of Clinical Practice Guidelines of Korean Medicine in Breast Cancer (유방암 치료에 대한 한의 임상 가이드라인 개발을 위한 기초연구)

  • Lee, Kang-Wook;Yoo, Hwa-Seung;Lee, Jin-Sun;Lee, Nam-Hun
    • The Journal of Korean Obstetrics and Gynecology
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    • v.29 no.2
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    • pp.47-66
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    • 2016
  • Objectives : The purpose of this study was to present the clinical practice guidelines for breast cancer through the analysis of existing clinical practice guidelines in Western and Chinese medicine. Methods : The literature search was performed regarding conventional and integrative medical treatment of breast cancer using Google Scholar, KIOM OASIS, PUBMED and Jisan library of Daejeon university. Results : Breast cancer is the fifth most common cancer in Korea. Recent studies revealed that combining conventional and integrative medical treatment can reduce the sequela of surgical operation and improve survival rate. However there isn’t still a systemic clinical guideline for breast cancer in korean medicine. This study will be a preliminary study to establish clinical practice guidelines of Korean Medicine for breast cancer.Conclusions : Further objective and systemic clinical studies related to Korean Medicine are needed to develope more advanced clinical practice guidelines of breast cancer.

A Study on the Cooperation between Medical Care and Law - Focusing on the discussion of the role of clinical practice guideline in Japan - (의료와 사법(司法)의 협력 -일본에서의 진료가이드라인의 역할에 대한 논의를 중심으로-)

  • Song, young-min
    • 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."

Developmental procedures for the clinical practice guidelines for conscious sedation in dentistry for the Korean Academy of Dental Sciences

  • An, So-Youn;Seo, Kwang-Suk;Kim, Seungoh;Kim, Jongbin;Lee, Deok-Won;Hwang, Kyung-Gyun;Kim, Hyun Jeong
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.16 no.4
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    • pp.253-261
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    • 2016
  • Background: Evidence-based clinical practice guidelines (CPGs) are defined as "statements that are scientifically reviewed about evidence and systematically developed to assist in the doctors' and patients' decision making in certain clinical situations." This recommendation aims to promote good clinical practice for the provision of safe and effective practices of conscious sedation in dentistry. Method: The development of this clinical practice guideline was conducted by performing a systematic search of the literature for evidence-based CPGs. Existing guidelines, relevant systematic reviews, policy documents, legislation, or other recommendations were reviewed and appraised. To supplement this information, key questions were formulated by the Guideline Development Group and used as the basis for designing systematic literature search strategies to identify literature that may address these questions. Guideline documents were evaluated through a review of domestic and international databases for the development of a renewing of existing conscious sedation guidelines for dentistry. Clinical practice guidelines were critically appraised for their methodologies using Appraisal of guidelines for research and evaluation (AGREE) II. Results: A total of 12 existing CPGs were included and 13 recommendations were made in a range of general, adult, and pediatric areas. Conclusion: The clinical practice guidelines for conscious sedation will be reviewed in 5 years' time for further updates to reflect significant changes in the field.