보장성 강화를 위한 의료기술평가의 역할

박종연(Chong Yon Park) 한국보건의료연구원 2017 근거와 가치 Vol.3 No.2

의료정보정책 및 디지털헬스의 국제동향 - Global Digital Health Partnership Summit, 18.02.19~20, 호주 캔버라 -

최솔지(Solji Choi),차선미(Sunmi Cha),박종연(Chong Yon Park) 한국보건의료연구원 2018 근거와 가치 Vol.4 No.1

Abstract: This report is to review recent international trends in the field of health information policy and digital health through the Global Digital Health Partnership (GDHP) Summit held at Canberra, the capital of Australia, last February 18~20. International participants from thirteen countries, Hong Kong SAR, and the World Health Organization (WHO) have kicked off a new global network to support best use of digital technology in modern healthcare. This event seems an opportunity for deep, transformational engagement by governments, digital health agencies, and the WHO so they can learn, share policy and other evidence that supports them to deliver better digital health services. The Summit suggested to supports governments and health system reformers to improve the health and wellbeing of their citizens through best use of evidence-based digital technologies as the vision of GDHP. And, for the outcomes in future digital health, the five identified topics, Interoperability, Cyber security, Policy environments, Engaging consumers and clinicians, and Evidence and evaluation, have been discussed in small group sessions.

임상연구에 관하여

문기태(Ki tae Moon) 한국보건의료연구원 2016 근거와 가치 Vol.2 No.2

This paper reviews current trends in clinical research. Clinical research can be defined as the study of humans or groups of humans. In the field of clinical research, Korea ranks 7th in the world. To improve healthcare policy and clinical strategy for diagnosis and treatment, scientific evidence based on clinical research is needed. To increase the transparency of clinical research, all clinical research should be registered before starting. To register clinical research, the World Health Organization (WHO) established International Clinical Trials Registry Platform (ICTRP), and the Korea Centers for Disease Control and Prevention established Clinical Research Information Service (CRIS). CRIS is approved by the WHO as a primary registry and meets the criteria of ICTRP. The United Kingdom and the United States established National Institute for Health Research and Patient- Centered Outcomes Research Institute respectively to fund clinical research publicly. The United States ‘ClinicalTrials. gov’ is the most well-known web clinical research registry service. Industry led research has therefore, governments of advanced countries have increased public research funds.

근거기반 임상진료지침 개발 협력 연구

최솔지(Sol Ji Choi),정승은(Seung Eun Jung),정우경(Woo Kyoung Jeong),최미영(Mi young Choi),백정환(Jung Hwan Baek) 한국보건의료연구원 2016 근거와 가치 Vol.2 No.3

Objectives: This study aims to establish collaboration system for trustworthy clinical practice guideline. Evidence- based Korean Clinical Imaging development was led by the Korean Society of Radiology (KSR) and the National Evidence-based Healthcare Collaborating Agency (NECA). Methods: Collaboration framework is consisted of internal collaboration and external collaboration. Guideline development committee and working groups co-worked as internal collaboration. As extra collaboration, expected end-users were involved in consensus group who are clinical experts related to guidelines. Protocol for guideline development and education was performed. Consensus group consulted during developing process and contributed to panel survey. Results: Collaborating works for trustworthy clinical practice guideline, a protocol was developed to reflect the process of developing diagnostic guidelines in Korea, which differs from traditional interventional treatment. Conclusion: Collaboration framework was effective for developing evidence-based clinical imaging guideline. Moreover, this framework will be continued and revised respond to the needs for trustworthy guidelines.

천식 환자의 원격의료 중재의 체계적 문헌고찰 개관

김지민(),정유진(),박동아() 한국보건의료연구원 2018 근거와 가치 Vol.4 No.1

Objectives: The aim of the overview was to synthesize the current evidence of published systematic reviews (SRs) addressing telehealth intervention for asthma patients. Methods: We searched MEDLINE, EMBASE, and Cochrane database of systematic review (CDSR), other reviews (DARE), technology assessments (HTA), Economic evaluations (EED) up to March 2016. By two authors independently, SRs were selected based on predefined inclusion criteria. Only English or Korean articles published after 2010 were selected. The outcomes of interest were clinical outcome (i.e., asthma symptoms, quality of life, health utilization, etc), associated costs and factors influencing the adoption of telehealth. Narrative analysis for the selected articles was conducted. Results: We included 8 SRs to examine the effect of telehealth in patients with asthma. There were no clinical variables such as asthma control, quality of life, use of medical services, pulmonary function, side effect and compliance reported consistent improvement in telehealth group compared with usual care. As a result of analyzing number of clinic visit, the increasing tendency appeared in telehealth group compared with control group, the medical cost was less expensive. Taken together with the number of clinic visit and medical cost, there was no difference between groups. In the economic aspect, we reviewed the medical cost per visit and cost-effectiveness of the telehealth. Upon examination of medical cost per visit, the medical cost of telehealth was lower, and annual medical cost appeared also to be less. Cost-effectiveness was different according to target population (adults, children). Conclusion: The use of telehealth for asthma was unlikely to result in statistically significant improvements in health outcomes. To clarify the effectiveness of telehealth for asthma, further researches are needed with the well-defined intervention and outcome variables.

한국의 갑상선암 과잉진단, 과잉치료 논란과 그 시사점

홍영준(Young Jun Hong) 한국보건의료연구원 2016 근거와 가치 Vol.2 No.3

The dramatic increase in the incidence of thyroid cancer over recent decades in South Korea is attracting the world’s attention. It also raises strong suspicion of overdiagnosis, because thyroid-cancer-related mortality rates have not changed substantially. Therefore, overdiagnosis and issues related to overtreatment of thyroid cancer in Korea have caused bitter controversy among medical experts. This article takes a quick look at the recent history of these disputes and considers the implications of overdiagnosis and overtreatment of thyroid cancer in Korea, along with appropriate solutions.

지카바이러스 감염에 의한 신경계 증후와 공중보건 위기

박만성(Man Seong Park) 한국보건의료연구원 2016 근거와 가치 Vol.2 No.2

In the wake of a surge of cases of microcephaly and Guillain-Barre syndrome in Brazil, association of which with Zika virus infection has now been confirmed, the World Health Organization declared ‘Public Health Emergency of International Concern’. Once an obscure mosquito-borne virus due to mildness of the disease caused by the virus, Zika has become a virus that humanity must overcome with an all-out effort. In this article, we briefly review current knowledge of the virus, the vector, the epidemiological situation and the response strategy. In the context of general understanding of the virus and public health crisis, we highlight three papers that have been seminal in terms of confirming the apparent association of Zika virus infection and the neurological manifestations such as microcephaly and Guillain-Barre syndrome, and bringing attention to a possibility of a different way of the Zika infection-mediated neurological manifestation such as acute myelitis.

우리나라 치매관리 현황과 치매국가책임제

곽경필(Kyung Phil Kwak) 한국보건의료연구원 2018 근거와 가치 Vol.4 No.1

복잡계로서의 뇌와 치매

서국희(Guk-Hee Suh) 한국보건의료연구원 2018 근거와 가치 Vol.4 No.1

Introduction: Brain is a Complex System with neurons as nodes and synapses as links. The nodes of brain network can be identified as hubs which get highly focusing connectivity from other nodes anatomically and functionally. Dementia can be assumed that the brain cannot maintain normal functions as usual due to destruction or death of hub neurons in view of complex system theory. Main Text: Dementia is a condition of chronic brain failure. Organ failure means the failure of an essential system in the body irrespective of any causes leading to the organ dysfunction so that normal homeostasis cannot be maintained. Symptoms or a syndrome is greatly different from a disease. Dementia is a group of symptoms or a syndrome, not a disease. National health program to detect early dementia can greatly waste social and personal resources due to two reasons. Firstly, in case of correct detection of early dementia, problem can arise from absence of ways to cure or delay progression of dementia. National health programs to prevent and treat hypertension, diabetes mellitus, hyperlipidemia, heart disease, smoking and so on have been successfully implemented, which may be also greatly helpful to prevent occurrence of dementia. The key message of England’s national campaign is “What is good for your heart is good for your head” as a strong prevention slogan. Individuals who have been informed that they have dementia may feel very uncomfortable and desperate to find ways to prevent or treat their own dementia. There is no ways with proven efficacy and safety for the treatment of dementia in terms of cure or delay of progression. However they will try to make great efforts in vain. It is a tragedy. Secondly, in case of wrong diagnosis of early dementia which is much more likely to happen, individuals may feel anxious and panic after hearing that they might have early dementia and visit dementia experts with expectation that they do not have early dementia. Unfortunately even though they are informed that they do not have dementia from dementia experts, they cannot feel sure and continue to feel uncomfortable and anxious which will lead them to other dementia experts. Conclusion: We need to know that we cannot defeat dementia by campaigns and political will to fight against dementia. Rather we need to be truly humane enough to take good care of high dependent people with dementia to die with human dignity, not to leave them outside of society.

패혈증 의심환자에서 프로칼시토닌 검사의 효과

조송희(Song hee Cho),서재경(Jae Kyung Suh),고민정(Min jeong Ko),이상민(Sang min Lee),장보형(Bo hyung Jang),장은진(Eun Jin Jang) 한국보건의료연구원 2016 근거와 가치 Vol.2 No.2

Objectives: This study was to assess clinical effectiveness on determining discontinuation of antibiotics based on procalcitonin levels in sepsis suspected patients. Methods: Existing systematic review search was performed based on the pre-established strategy in various databases including EMBASE, Ovid-Medline, and KoreaMed. Prkno et al. (2013) was selected considering comprehensiveness of literature search, research scope, as well as the Assessment of Multiple Systematic Reviews (AMSTAR) score. Using the search strategy of the selected study, additional systematic search was conducted to identify randomized clinical trials (RCT) that compare the effectiveness of procalcitonin-based antibiotics therapy with standard care. In order to evaluate the quality of studies, the risk of bias assessment tool was used. All database search and quality assessment were conducted by two reviewers independently. Metaanalysis was performed using a random-effect model. Results: A total of 8 RCTs were included. Duration of antibiotic therapy was significantly reduced in procalcitonin-guided therapy group, compared to standard treatment group (mean difference, -2.43; 95% confidence interval, -3.46, -1.40), while 28-day mortality, hospital mortality, and length of stay did not show any significant difference. Conclusion: Procalcitonin-guided therapy shortened duration of antibiotic treatment compared to standard care without any harmful effect on other clinical outcomes such as mortality or length of hospital stay.