Adherence to GOLD guideline treatment recommendations in Korean pulmonologist

김태옥,김민석,박하영,신홍준,박철규,오인재,김유일,김영철,임성철 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.0

Introduction: Low adherence to treatment guideline increased morbidity and mortality. The aim of this study was assessed the adherence rate of pharmacological treatment to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline published in 2011 and 2017. Methods: We retrospectively reviewed the data of 1818 patients with COPD in the Korean COPD Subgroup Study cohort (KOCCOS) collected from January 2012 to January 2018. We analyzed the data categorized two groups based on the date registered in cohort. Results: Among the 1818 patients with COPD, 1411 were enrolled the cohort before 2017 and 407 were enrolled after 2017. Among 1411 patients enrolled the cohort before 2017, 858 (61.5%) received guideline-concordant treatment and among 407 patients enrolled the cohort after 2017, 407 (49.6%) received guideline-concordant treatment. Adherence to GOLD guidelines was reduced in GOLD group A and B patients enrolled before 2017 (48.8% vs. 22.4%) and after 2017 (52.8% vs. 21.9%). The drug containing inhaled corticosteroid (ICS) was the lowest adherence. Among patients enrolled after 2017, 54.1% of patients with Group B and less than 50% of FEV1 received guideline-concordant treatment according to the GOLD guideline 2011. Conclusions: Low adherence to GOLD Guideline was most common in GOLD Group A and B. And the most common drugs were ICS-containing drugs.

Guideline adherence to chemotherapy administration safety standards: a survey on nurses in a single institute

김기동,이희숙,김윤하,김법종,김문홍,최석철,유상영 대한부인종양학회 2011 Journal of Gynecologic Oncology Vol.22 No.1

Objective: Little is known about the guideline adherence of nurses to chemotherapy administration guidelines. We determined the guideline adherence of nurses to the Chemotherapy Administration Safety Standards and the relationship between demographic characteristics and guideline adherence. Methods: Survey sheets containing two questions on demographic characteristics and 16 questions on the guideline adherence of nurses regarding chemotherapy administration were distributed to all in-patient departments in our hospital in which chemotherapy was performed. All clinical nurses in the department were recommended to respond. Results: Of 202 nurses, 123 responses were collected (61% response rate). The guideline adherence rate was >70% for 15 of 16 questions, but 55% of respondents indicated that there was no competency monitoring for nurses. Nurses with >7 years of clinical nursing experience felt more competent in performing cardiopulmonary resuscitation (CPR) than nurses with <7 years of clinical nursing experience (p=0.032). Conclusion: The guideline adherence rate of nurses with respect to chemotherapy administration was high, with the exception of the absence of a competency monitoring for nurses. A significant number of nurses with <7 years of clinical nursing experience felt incompetent in performing CPR.

Inverse association of improved adherence to dietary guidelines with metabolic syndrome: the Seoul Metabolic Syndrome Management program

Dongwoo Ham,YoungYun Cho,Mi-Suk Park,Yun-Sug Park,Sun-Young Kim,Hye-Min Seol,Yoo Mi Park,Sunok Woo,Hyojee Joung,Do-Sun Lim 한국영양학회 2020 Nutrition Research and Practice Vol.14 No.6

BACKGROUND/OBJECTIVES: The Seoul Metabolic Syndrome Management (SMESY) program is a 1-yr lifestyle modification program targeting metabolic syndrome (MetS) in Seoul residents. This study investigated the associations between adherence to dietary guidelines and MetS among the SMESY program participants. SUBJECTS/METHODS: Data of 54,385 participants aged 20-64 yrs who completed the SMESY program in 2015, had information on adherence to dietary guidelines, and were not medicated for diabetes, hypertension, or dyslipidemia were analyzed. Participants underwent MetS screening and completed a lifestyle questionnaire including adherence to 10 dietary guidelines before and after participation. Participants were classified according to the number of MetS risk factors at baseline (MetS group, ≥ 3; risk group, 1-2; healthy group, none). Adherence to dietary guidelines was determined from the number of “yes” responses regarding the fulfillment of each guideline on ≥ 5 days/week. Multiple logistic regression was used to evaluate associations between newly diagnosed MetS and changes in adherence to dietary guidelines. RESULTS: In the MetS group, MetS prevalence decreased after the SMESY program (men, -41.9%p; women, -48.7%p), and all risk factors were significantly improved (P < 0.0001). All groups exhibited improved adherence to all dietary guidelines after participation (P < 0.0001). In the MetS group with positively changed adherence scores, the MetS prevalence decreased by -44.1%p for men and -49.5%p for women, whereas the prevalence in those with negative changes decreased by -38.1%p for men and -48.6%p for women. In the risk group, those with positively changed adherence scores had significantly decreased odds ratios (ORs) for newly diagnosed MetS compared with those with negative changes (OR, 0.70; 95% confidence interval [CI], 0.61-0.80 for men; OR, 0.88; 95% CI, 0.79-0.99 for women). CONCLUSIONS: The SMESY program may effectively reduce the risk of MetS among adults with risk factors by improving adherence to dietary guidelines.

Evaluation of Adherence to Guideline for Heart Failure with Reduced Ejection Fraction in Heart Failure with Preserved Ejection Fraction and with or without Atrial Fibrillation

Ahn Min-Soo,Yoo Byung-Su,Son Jung-Woo,Park Young Jun,Lee Hae-Young,Jeon Eun-Seok,Kang Seok-Min,Choi Dong-Ju,Kim Kye Hun,Cho Myeong-Chan,Kim Seong Yoon,Kang Dae Ryong,Go Tae-Hwa 대한의학회 2021 Journal of Korean medical science Vol.36 No.40

Background: This study evaluated the relationship between guideline adherence for heart failure (HF) with reduced ejection fraction (HFrEF) at discharge and relevant clinical outcomes in patients with acute HF with preserved ejection fraction (HFpEF) with or without atrial fibrillation (AF). Methods: We analyzed Korean Acute Heart Failure Registry data for 707 patients with HFpEF with documented AF and 687 without AF. Guideline adherence was defined as good or poor according to the prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and mineralocorticoid receptor antagonists. Anticoagulation adherence was also incorporated for the AF group. Results: Among patients with normal sinus rhythm, those with poor guideline adherence had a reduced prevalence of comorbidities and favorable clinical characteristics when compared with those with good guideline adherence. Using inverse probability of treatment weighting (IPTW) to address the bias of nonrandom treatment assignment, good adherence was associated with a poor 60-day composite endpoint in the multivariable Cox model (weighted hazard ratio [wHR], 1.74; 95% confidence interval [CI], 1.01–3.00; P = 0.045). For patients with AF, baseline clinical characteristics were similar according to the degree of adherence. The IPTW-adjusted analysis indicated that good adherence was significantly associated with the 60-day composite endpoint (wHR, 0.47; 95% CI, 0.27–0.79; P = 0.005). In the analysis excluding warfarin, good adherence was associated with 60-day rehospitalization (wHR, 0.60; 95% CI, 0.37–0.98; P = 0.040), 1-year re-hospitalization (wHR, 0.67; 95% CI, 0.48–0.93; P = 0.018), and the composite endpoint (wHR, 0.77; 95% CI, 0.59–0.99; P = 0.041). Conclusion: Our findings indicate that good adherence to guidelines for HFrEF is associated with a better 60-day composite endpoint in patients with HFpEF with AF.

중환자실 간호사의 기관내 흡인 임상지침 수행 현황

양은정 ( Yang Eunjung ),신현숙 ( Shin Hyunsook ) 경희대학교 동서간호학연구소 2017 동서간호학연구지 Vol.23 No.1

Purpose: This study aimed to evaluate the adherence to the clinical guideline for endotracheal suction in nurses working at intensive care units (ICU) and to identify the characteristics of nurses with good adherence. Methods: This study was a descriptive study to evaluate the pattern of adherence and its related factors to endotracheal suction. One hundred fifty five nurses working at ICU participated in this study. We used a questionnaire developed based on American Association for Respiratory Care (AARC) guidelines and other associated factors from previous studies. Results: Around half of the participants reported that their adherence to the clinical guideline was poor. Items deviated from the recommended guideline were reasons for initiating a suctioning, applied suction pressure ranged from 20 to 200mmHg, and applied catheter size from 6 to 17 french. Other factors deviated were the depth of inserted catheter, and inappropriate use of normal saline instillation. The most significant factor was related to hospital; the misused or misled clinical protocol. Conclusions: The adherence to the clinical guidelines of the endotracheal suction in ICU nurses was not appropriate, which might contribute to the patient health outcomes. More enhanced continuing education as well as hospital regulation is warranted.

A survey of attitudes to clinical practice guidelines in general and adherence of the Korea practical guidelines for management of gallbladder polyp

Jooyeon Jeong,Jae Keun Kim,Joon Seong Park,Dong Sup Yoon 한국간담췌외과학회 2014 한국간담췌외과학회지 Vol.18 No.2

Backgrounds/Aims: While clinical practice guidelines are effective tools for improving the quality of patient care and provide specific recommendations for daily practice, the usage of them have been often suboptimal. Therefore, evaluation of physician attitude to guidelines is an important initial step in improving guideline adherence levels. The aim of this study was to survey the attitude on general guidelines and adherence with the Korea Practical Guidelines for gallbladder (GB) polyp two year after their publication and distribution among Korean private clinicians. Methods: To evaluate the survey, questionnaires were sent with a stamp on an addressed envelope to 3,256 private clinicians who were registered at the Seoul Medical Association in April, 2010. From the 3,256 questionnaires, 376 clinicians (11.5%) responded to the survey. Results: A total of 91.0% responders agreed to the statement that general guidelines were useful tools for improving patient care and quality of care. One hundred one responders (26.9%) stated that they were aware of the Korea GB polyp guidelines while 73 physicians (72.3%) founded the guideline had changed their practice and user-friendly. Most of physicians (73.4%) agreed to practical procedures recommended by guidelines. Conclusions: Korean primary physicians were generally positive to the practical guidelines, as propagation of the guideline among primary physicians may improve adherence to guideline and patients care for GB polyps.

의료종사자, 환자, 일반인의 코로나19 사회적 거리두기 행동 지침에 대한 인식과 수행 비교

허연정(Heo Yeon Jeong),남소희(Nam So Hee),정재심(Jeong Jae Sim),김연희(Kim Yeon Hee) 한국기초간호학회 2021 Journal of korean biological nursing science Vol.23 No.1

Purpose: To identify the differences in perception of and adherence to the COVID-19 social distancing behavior guidelines among health care workers, patients, and the general public and to use them to prevent the spread of COVID-19. Methods: From October 16 2020 to November 30, 2020, a survey was conducted among 85 health care workers, 85 patients, and 82 general public regarding the perception of and adherence to the COVID-19 social distancing behavior guidelines. Results: Patients scored significantly higher than the general public in the adherence to the COVID-19 social distancing behavior guideline, and there was no difference between health care workers and general public, and patients and health care workers. In the multivariate analysis, the factors that influence the adherence of the COVID-19 social distancing behavior guide were found in women and the perception of the COVID-19 social distancing behavior guideline. Conclusion: In order to promote the implementation of the COVID-19 social distancing behavior guideline, it is necessary to increase the perception of the COVID-19 social distancing behavior guideline and provide additional education in men. It is necessary to investigate the reason behind why men have low adherence to the COVID-19 social distancing behavior guideline.

Large Variation in Clinical Practice amongst Pediatricians in Treating Children with Recurrent Abdominal Pain

Michael W. van Kalleveen,Elise J. Noordhuis,Carole Lasham,Frans B. Plötz 대한소아소화기영양학회 2019 Pediatric gastroenterology, hepatology & nutrition Vol.22 No.3

Purpose: To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags. Methods: The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and interobserver variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up. Results: A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35–0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower interobserver variability than in the retrospective study. Adherence to the guideline was 66.8%. Conclusion: We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.

Large Variation in Clinical Practice amongst Pediatricians in Treating Children with Recurrent Abdominal Pain

van Kalleveen, Michael W.,Noordhuis, Elise J.,Lasham, Carole,Plotz, Frans B. The Korean Society of Pediatric Gastroenterology 2019 Pediatric gastroenterology, hepatology & nutrition Vol.22 No.3

Purpose: To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags. Methods: The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and inter-observer variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up. Results: A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35-0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower inter-observer variability than in the retrospective study. Adherence to the guideline was 66.8%. Conclusion: We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.

Adherence to Surveillance Guidelines after the Removal of Colorectal Polyps: A Multinational, Multicenter, Prospective Survey

( Chang Kyo Oh ),( Satimai Aniwan ),( Panida Piyachaturawat ),( Zhiqin Wong ),( Thida Soe ),( Bayasgalan Luvsandagva ),( Quang Trung Tran ),( Achmad Fauzi ),( Jeong-sik Byeon ),( Young-seok Cho ) 대한간학회 2021 Gut and Liver Vol.15 No.6

Background/Aims: As the number of colonoscopies and polypectomies performed continues to increase in many Asian countries, there is a great demand for surveillance colonoscopy. The aim of this study was to investigate the adherence to postpolypectomy surveillance guidelines among physicians in Asia. Methods: A survey study was performed in seven Asian countries. An email invitation with a link to the survey was sent to participants who were asked to complete the questionnaire consisting of eight clinical scenarios. Results: Of the 137 doctors invited, 123 (89.8%) provided valid responses. Approximately 50% of the participants adhered to the guidelines regardless of the risk of adenoma, except in the case of tubulovillous adenoma ≥10 mm combined with high-grade dysplasia, in which 35% of the participants adhered to the guidelines. The participants were stratified according to the number of colonoscopies performed: ≥20 colonoscopies per month (high volume group) and <20 colonoscopies per month (low volume group). Higher adherence to the postpolypectomy surveillance guidelines was evident in the high volume group (60%) than in the low volume group (25%). The reasons for nonadherence included concern of missed polyps (59%), the low cost of colonoscopy (26%), concern of incomplete resection (25%), and concern of medical liability (15%). Conclusions: A discrepancy between clinical practice and surveillance guidelines among physicians in Asia was found. Physicians in the low volume group frequently did not adhere to the guidelines, suggesting a need for continuing education and appropriate control. Concerns regarding the quality of colonoscopy and complete polypectomy were the main reasons for nonadherence. (Gut Liver 2021;15:878-886)