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Current Status of Clinical Practice Guidelines in Korea
Choi Miyoung,김수영,Lee You Kyung,Executive Committee for Clinical Practice Guidelines, The Korean Academy of Medical Sciences 대한의학회 2021 Journal of Korean medical science Vol.36 No.6
Background: The development process of clinical practice guidelines (CPGs) must adhere to development standards and must be supported and steered by a representative and consistent governing body. We aimed to investigate the current status of the most recent CPGs published in Korea through surveys of medical professional societies and literature searches. Methods: We collected CPGs developed in Korea in the past 5 years through several electronic database searches (MEDLINE, Embase, and KoreaMed), hand searches, and surveys of medical society memberships from the Korean Academy Medical Societies. Three authors selected Korean CPGs according to our inclusion/exclusion criteria and extracted data from selected CPGs about general characteristics, characteristics of CPGs for setup, evidence evaluation, and the finalization phase. Results: Out of 2,337 articles searched from various sources and 66 documents collected by survey, 129 guidelines (122 by database searching and 7 by survey) were selected. During the recent 5 years, the yearly numbers of CPGs developed were around 25. A single organization was the most frequent CPG development body (42, 32.6%). The most common development methodologies described in the CPGs included were de novo (53, 41.1%) followed by adaptation (48, 37.2%) and hybrid (4, 3.1%). Systematic literature searching was performed in most of the guidelines (79.8%). The evidence level was reported in 104 guidelines (80.6%). There were 77 guidelines (59.7%) that reported an update plan. Fifty guidelines were published in Korean (41.0%), and 46 guidelines were published in English only (37.7%). Conclusion: Among CPGs developed in Korea in the last 5 years, the proportion adhering to CPG development standards has increased, but there is still room for improvement.
오태정,문주영,Kyu Yeon Hur,Seung Hyun Ko,Hyun Jung Kim,Taehee Kim,Dong Won Lee,Min Kyong Moon,The Committee of Clinical Practice Guideline,Korean Diabetes Association and Committee of the Cooperative Studie 대한신장학회 2020 Kidney Research and Clinical Practice Vol.39 No.3
Diabetes is a leading cause of end-stage renal disease. Therefore, prevention of renal dysfunction is an important treatment goal in the management of diabetes. The data of landmark cardiovascular outcome trials of sodiumglucose cotransporter-2 (SGLT2) inhibitors showed profound reno-protective effects. The Korean Diabetes Association and the Korean Society of Nephrology reviewed clinical trials and performed a meta-analysis to assess the effects of SGLT2 inhibitors on the preservation of estimated glomerular filtration rate (eGFR). We limited the data of SGLT2 inhibitors which can be prescribed in Korea. Both eGFR value and its change from the baseline were significantly more preserved in the SGLT2-inhibitor treatment group compared to the control group after 156 weeks. However, some known adverse events were increased in SGLT2 inhibitor treatment, such as genital infection, diabetic ketoacidosis, and volume depletion. We recommend long-term use of SGLT2 inhibitors in patients with type 2 diabetes mellitus (T2DM) for attenuation of renal function decline. However, we cannot generalize our recommendations due to the lack of long-term clinical trials testing the reno-protective effects of every SGLT2 inhibitor in a broad range of patients with T2DM. This recommendation can be revised and updated after the publication of several large-scale renal outcome trials.
최종한,조윤정,김현진,고승현,전숙,강지현,김경곤,김은미,김현정,송기호,남가은,김광일,Committee of Clinical Practice Guidelines,Committee of Clinical Practice Guidelines,Committee of Food and Nutrition,Policy Committee,Policy Development C 대한비만학회 2022 Journal of obesity & metabolic syndrome Vol.31 No.2
Carbohydrate-restricted diets and intermittent fasting (IF) have been rapidly gaining interest among the general population and patients with cardiometabolic disease, such as overweight or obesity, diabetes, and hypertension. However, there are limited expert recommendations for these dietary regimens. This study aimed to evaluate the level of scientific evidence on the benefits and harms of carbohydrate-restricted diets and IF to make responsible recommendations. A meta-analysis and systematic literature review of 66 articles on 50 randomized controlled trials (RCTs) of carbohydrate-restricted diets and 10 articles on eight RCTs of IF was performed. Based on the analysis, the following recommendations are suggested. In adults with overweight or obesity, a moderately-low carbohydrate or low carbohydrate diet (mLCD) can be considered as a dietary regimen for weight reduction. In adults with type 2 diabetes mellitus, mLCD can be considered as a dietary regimen for improving glycemic control and reducing body weight. In contrast, a very-low carbohydrate diet (VLCD) and IF are recommended against in patients with diabetes. Furthermore, no recommendations are suggested for VLCD and IF in adults with overweight or obesity, and carbohydrate-restricted diets and IF in patients with hypertension. Here, we describe the results of our analysis and the evidence for these recommendations.
COVID-19 Vaccination for Endocrine Patients: A Position Statement from the Korean Endocrine Society
구철룡,정경연,안창호,문준성,이주희,김은희,권혜미,김희경,서성환,홍상모,하정훈,노은,김진화,김미경,Committee of Clinical Practice Guideline of the Korean Endocrine Society 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.4
Since the first outbreak of coronavirus disease 2019 (COVID-19), ongoing efforts have been made to discover an efficacious vaccineagainst COVID-19 to combat the pandemic. In most countries, both mRNA and DNA vaccines have been administered, and theirside effects have also been reported. The clinical course of COVID-19 and the effects of vaccination against COVID-19 are both influenced by patients’ health status and involve a systemic physiological response. In view of the systemic function of endocrine hormones, endocrine disorders themselves and the therapeutics used to treat them can influence the outcomes of vaccination for COVID-19. However, there are very limited data to support the development of clinical guidelines for patients with specific medicalbackgrounds based on large clinical trials. In the current severe circumstances of the COVID-19 pandemic, position statements madeby clinical specialists are essential to provide appropriate recommendations based on both medical evidence and clinical experiences. As endocrinologists, we would like to present the medical background of COVID-19 vaccination, as well as precautions to prevent the side effects of COVID-19 vaccination in patients with specific endocrine disorders, including adrenal insufficiency, diabetesmellitus, osteoporosis, autoimmune thyroid disease, hypogonadism, and pituitary disorders.
허규연,김미경,고승현,한미연,이동원,권혁상,Committee of Clinical Practice Guidelines,Korean Diabetes Association and Committee of the Cooperative Studies,Korean Society of Nephrology 대한당뇨병학회 2020 Diabetes and Metabolism Journal Vol.44 No.1
The safety of metformin use for patients with type 2 diabetes mellitus (T2DM) and advanced kidney disease is controversial, and more recent guidelines have suggested that metformin be used cautiously in this group until more definitive evidence concerning its safety is available. The Korean Diabetes Association and the Korean Society of Nephrology have agreed on consensus statements concerning metformin use for patients with T2DM and renal dysfunction, particularly when these patients undergo imaging studies using iodinated contrast media (ICM). Metformin can be used safely when the estimated glomerular filtration rate (eGFR) is ≥45 mL/min/1.73 m2. If the eGFR is between 30 and 44 mL/min/1.73 m2, metformin treatment should not be started. If metformin is already in use, a daily dose of ≤1,000 mg is recommended. Metformin is contraindicated when the eGFR is <30 mL/ min/1.73 m2. Renal function should be evaluated prior to any ICM-related procedures. During procedures involving intravenous administration of ICM, metformin should be discontinued starting the day of the procedures and up to 48 hours post-procedures if the eGFR is <60 mL/min/1.73 m2.
오태정,문주영,허규연,고승현,김현정,김태희,이동원,문민경,The Committee of Clinical Practice Guideline,Korean Diabetes Association and Committee of the Cooperative Studies,Korean Society of Nephrology 대한당뇨병학회 2020 Diabetes and Metabolism Journal Vol.44 No.4
Diabetes is a leading cause of end-stage renal disease. Therefore, prevention of renal dysfunction is an important treatment goal in the management of diabetes. The data of landmark cardiovascular outcome trials of sodium-glucose cotransporter-2 (SGLT2) inhibitor showed profound reno-protective effects. The Korean Diabetes Association and the Korean Society of Nephrology reviewed clinical trials and performed meta-analysis to assess the effects of SGLT2 inhibitors on the preservation of estimated glomerular filtration rate (eGFR). We limited the data of SGLT2 inhibitors which can be prescribed in Korea. Both eGFR value and its change from the baseline were significantly more preserved in the SGLT2 inhibitor treatment group compared to the control group after 156 weeks. However, some known adverse events were increased in SGLT2 inhibitor treatment, such as genital infection, diabetic ketoacidosis, and volume depletion. We recommend the long-term use SGLT2 inhibitor in patients with type 2 diabetes mellitus (T2DM) for attenuation of renal function decline. However, we cannot generalize our recommendation due to lack of long-term clinical trials testing reno-protective effects of every SGLT2 inhibitor in a broad range of patients with T2DM. This recommendation can be revised and updated after publication of several large-scale renal outcome trials.
Current Long-Term Pharmacotherapies for the Management of Obesity
김보연,강선미,강지현,김경곤,김범택,김승준,김양현,김정환,김재현,남가은,박지연,손장원,신혜정,오태정,이혁,전언주,정소정,홍용희,김종화,Committee of Clinical Practice Guidelines,Korean Society for the Study of Obesity (KSSO) 대한비만학회 2020 The Korean journal of obesity Vol.29 No.2
Obesity is a serious and growing worldwide health challenge associated with type 2 diabetes mellitus, cardiovascular disease, osteoarthritis, some cancers, sleep apnea, asthma, and nonalcoholic fatty liver. The Korean Society for the Study of Obesity recommends that pharmacotherapy should be considered when intensive lifestyle modifications fail to achieve a weight reduction in obese patients with a body mass index ≥25 kg/m2. Long-term medications for obesity have traditionally fallen into two major categories: centrally acting anorexiant medications and peripherally acting medications, such as orlistat. In this paper, we provide an overview of the anti-obesity medications currently available for the long-term and individualized treatment of obesity.
Song, Jin Ho,Jeong, Jae Uk,Lee, Jong Hoon,Kim, Sung Hwan,Cho, Hyeon Min,Um, Jun Won,Jang, Hong Seok,Korean Clinical Practice Guideline for Colon and Rectal Cancer Committee The Korean Society for Radiation Oncology 2017 Radiation Oncology Journal Vol.35 No.3
Purpose: Whether preoperative chemoradiotherapy (CRT) is better than postoperative CRT in oncologic outcome and toxicity is contentious in prospective randomized clinical trials. We systematically analyze and compare the treatment result, toxicity, and sphincter preservation rate between preoperative CRT and postoperative CRT in stage II-III rectal cancer. Materials and Methods: We searched Medline, Embase, and Cochrane Library from 1990 to 2014 for relevant trials. Only phase III randomized studies performing CRT and curative surgery were selected and the data were extracted. Meta-analysis was used to pool oncologic outcome and toxicity data across studies. Results: Three randomized phase III trials were finally identified. The meta-analysis results showed significantly lower 5-year locoregional recurrence rate in the preoperative-CRT group than in the postoperative-CRT group (hazard ratio, 0.59; 95% confidence interval, 0.41-0.84; p = 0.004). The 5-year distant recurrence rate (p = 0.55), relapse-free survival (p = 0.14), and overall survival (p = 0.22) showed no significant difference between two groups. Acute toxicity was significantly lower in the preoperative-CRT group than in the postoperative-CRT group (p < 0.001). However, there was no significant difference between two groups in perioperative and chronic complications (p = 0.53). The sphincter-saving rate was not significantly different between two groups (p = 0.24). The conversion rate from abdominoperineal resection to low anterior resection in low rectal cancer was significantly higher in the preoperative-CRT group than in the postoperative-CRT group (p < 0.001). Conclusions: As compared to postoperative CRT, preoperative CRT improves only locoregional control, not distant control and survival, with similar chronic toxicity and sphincter preservation rate in rectal cancer patients.