Clinical practice guidelines (CPGs) have been developed by the members of the Korean Academy of Medical Science (KAMS) under the limited financial support of the Ministry of Health & Welfare and partnership organizations including the 11 Clinical Research Centers of the National Evidence-based Healthcare Collaborating Agency (NECA) in Korea. The Korean Medical Guideline Information Center (KoMGi), a database of evidence-based CPGs, opened on January, 2008, and it is a very useful nationwide dissemination tool of CPGs for health professionals. The following is a summary of emerging tasks related to CPGs in Korea. First, a strategy for efficient partnership between the private sector and government should be formulated and executed. Second, budget preparation and planning of financial support is needed for developing and disseminating evidence-based CPGs. Third, development of Korean-specific methodology is needed and technical support should be provided. Fourth, an educational training program should be developed for core confidence of guideline development groups. Fifth, to share current information and accelerate the dissemination of CPGs, the functions of Guideline Information Center should be reorganized and utilized. To develop highly applicable evidence-based CPGs, multidisciplinary communication and active participation among professional societies is desired.
Budgets ; Delivery of Health Care ; Evidence-Based Medicine ; Financial Support ; Health Occupations ; Information Centers ; Interdisciplinary Communication ; Korea ; Private Sector

OBJECTIVES: To examine predictors of successful control for selfishness, dishonesty, resentment, and fear(SDRF) among Korean Alcoholics Anonymous(AA) members. METHODS: This study was a cross-sectional study. The study group included members from 18 different AA groups which were enrolled in the Korean AA Association in 1998. 207 out of 300 self administered questionnaires were completed by AA members (response rate 69.0%). Alcoholics who attended AA meetings were divided into two groups according to their self reported level of success in SDRF control; one with very successful experience after AA participation and the other with little or no success. In this study, the general characteristics, AA activities, relapse experience, and degree of effort exerted for SDRF control were compared between two groups. In order to study predictors of successful SDRF control after joining AA, 4 logistic regression analyses were performed for each of the 4 SDRF indices. RESULTS: The proportion of those reporting a very successful experience was 19.9% for selfishness, 20.7% for dishonesty, 25.5% for resentment, and 24.7% for fear. After control for the effect of general characteristics, the practice of the 12th step(taking alcoholics to an AA meeting after conveying messages) was found to be a significant predictor for the successful control of both selfishness(OR=6.04) and the dishonesty(OR=7.77). And individuals making every effort for SDRF control showed more successful control of selfishness(OR=4.10), dishonesty(OR=4.01), and fear(OR=34.89). CONCLUSIONS: Bivariate and multivariate analyses demonstrated that especially practicing the 12th step and making every effort themselves, may help alcoholics to control SDRF successfully after joining AA.
Alcoholics Anonymous* ; Alcoholics* ; Cross-Sectional Studies ; Humans ; Logistic Models ; Multivariate Analysis ; Questionnaires ; Recurrence ; Self Report

This study introduces the Clinical practice guidelines (CPGs) appraisal system by the Korean Academy of Medical Sciences (KAMS). Quality management policies for CPGs vary among different countries, which have their own cultures and health care systems. However, supporting developers in guideline development and appraisals using standardized tools are common practices. KAMS, an organization representing the various medical societies of Korea, has been striving to establish a quality management system for CPGs, and has established a CPGs quality management system that reflects the characteristics of the Korean healthcare environment and the needs of its users. KAMS created a foundation for the development of CPGs, set up an independent appraisal organization, enacted regulations related to the appraisals, and trained appraisers. These efforts could enhance the ability of each individual medical society to develop CPGs, to increase the quality of the CPGs, and to ultimately improve the quality of the information available to decision-makers.
Guideline Adherence/*standards ; *Models, Organizational ; Practice Guidelines as Topic/*standards ; Quality Assurance, Health Care/*standards ; Republic of Korea

Korea has a relatively short history in the development and use of clinical practice guidelines (CPGs). Additionally, it has been difficult to employ the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument due to the lack of consensus and the presence of differences in Korean medical settings and in the Korean socio-cultural environment. An AGREE II scoring guide was therefore developed to reduce differences among evaluators using the same tool. In consideration of the importance of using a quantitative measure of satisfaction with the elements described in the AGREE II manual, a final draft was developed through a Delphi consensus process. Ninety-two draft scoring guides for anchor points 1, 3, 5, and 7 (full score) in 23 items were developed. Consensus was defined as agreement among at least 70% of the raters. Agreement on 88 draft scoring guidelines was reached in the first Delphi round, and agreement for the remaining four was achieved in the second round. The development of an AGREE II scoring guide in this study is expected to contribute to improving the CPG environment.
Consensus ; Humans ; Peer Review ; *Practice Guidelines as Topic ; Republic of Korea

This study evaluated the methodological quality of CPGs using the Korean AGREE II scoring guide and a web-based appraisal system and was conducted by qualified appraisers. A total of 27 Korean CPGs were assessed under 6 domains and 23 items on the AGREE II instrument using the Korean scoring guide. The domain scores of the 27 guidelines were as following: the mean domain score was 82.7% (median 84.7%, ranging from 55.6% to 97.2%) for domain 1 (scope and purpose); 53.4% (median 56.9%, ranging from 11.1% to 95.8%) for domain 2 (stakeholder involvement); 63.0% (median 71.4%, ranging from 13.5% to 90.6%) for domain 3 (rigor of development); 88.9% (median 91.7%, ranging from 58.3% to 100.0%) for domain 4 (clarity of presentation); 30.1% (median 27.1%, ranging from 3.1% to 67.7%) for domain 5 (applicability); and 50.2% (median 58.3%, ranging from 0.0% to 93.8%) for domain 6 (editorial independence). Three domains including scope and purpose, rigor of development, and clarity of presentation were rated at more than 60% of the scaled domain score. Three domains including stakeholder involvement, applicability, and editorial independence were rated at less than 60% of the scaled domain score. Finally, of the 27 guidelines, 18 (66.7%) were rated at more than 60% of the scaled domain score for rigor of development and were categorized as high-quality guidelines.
Humans ; Internet ; *Practice Guidelines as Topic ; *Program Evaluation ; Quality Assurance, Health Care ; Republic of Korea

Tools for assessing methodological quality or risk of bias in randomized controlled trials (RCTs) and non-randomized studies (NRS) were reviewed. The van Tulder scale and Cochrane's assessment of risk of bias are the two most useful methodological quality evaluation tools for RCTs. Cochrane's tool includes sequence generation, allocation of sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other potential sources of bias. The Cochrane Collaboration Group recommends the Downs and Black instrument and the Newcastle-Ottawa Scale for evaluating the quality of NRS. In conclusion, this study offers useful information to physicians about tools for assessing the quality of evidence in clinical guidelines. Further research is needed to provide an essential core for evidence-based decision making regarding levels and/or grades of recommendations.
Bias (Epidemiology) ; Cooperative Behavior ; Decision Making

BACKGROUND: This study aimed to assess the effectiveness of exercise intervention in reducing body weight and glycosylated hemoglobin (HbA1c) level in patients with type 2 diabetes mellitus (T2DM) in Korea. METHODS: Cochrane, PubMed, Embase, KoreaMed, KMbase, NDSL, KCI, RISS, and DBpia databases were used to search randomized controlled trials and controlled clinical trials that compared exercise with non-exercise intervention among patients with non-insulin-treated T2DM in Korea. The effectiveness of exercise intervention was estimated by the mean difference in body weight changes and HbA1c level. Weighted mean difference (WMD) with its corresponding 95% confidence interval (CI) was used as the effect size. The pooled mean differences of outcomes were calculated using a random-effects model. RESULTS: We identified 7,692 studies through literature search and selected 23 articles (723 participants). Compared with the control group, exercise intervention (17 studies) was associated with a significant decline in HbA1c level (WMD, −0.58%; 95% CI, −0.89 to −0.27; I 2=73%). Although no significant effectiveness on body weight was observed, eight aerobic training studies showed a significant reduction in body weight (WMD, −2.25 kg; 95% CI, −4.36 to −0.13; I 2=17%) in the subgroup analysis. CONCLUSION: Exercise significantly improves glycemic control; however, it does not significantly reduce body weight. Aerobic training can be beneficial for patients with non-insulin-treated T2DM in Korea.
Body Weight Changes ; Body Weight ; Diabetes Mellitus, Type 2 ; Exercise Therapy ; Hemoglobin A, Glycosylated ; Humans ; Korea

Background/Aims: There are inconsistencies in the effects of low to moderate dose alcohol consumption on the development of hypertension in adult men. We hypothesized that a region-specific effect might participate in this heterogeneity. Methods: We conducted a systematic review and meta-analysis to evaluate the effect of alcohol dose on hypertension incidence using contemporary data through December 2017. Subjects were categorized according to their level of alcohol consumption as non-drinkers (reference) and low- (0.01 to 20.0 g/day), moderate- (20.1 to 40.0 g/day), moderate- to high- (40.1 to 60.0 g/day), and high-dose (> 60.0 g/day) drinkers. We defined hypertension as a blood pressure ≥ 140/90 mmHg and/or the use of anti- hypertensive drugs. Results: In total, 11 articles (seven Asian and four Western) were selected for our analysis. Among Asian men, a significantly elevated risk was observed even in the low alcohol dose group in comparison with the group with no alcohol consumption, and the risk increased in a dose-dependent manner (pooled relative risks [95% confidence intervals (CI)]: 1.25 [1.13 to 1.38], 1.48 [1.27 to 1.72], 1.75 [1.43 to 2.15], and 1.78 [1.51 to 2.09]). Among Western men, a similar dose-response relationship was noted in general (p for subgroup difference > 0.1), but a significantly elevated risk was evident only in the high-dose group (pooled relative risks [95% CI]: 1.22 [0.85 to 1.74], 1.57 [0.90 to 2.75], 1.47 [0.44 to 4.91], and 1.49 [1.02 to 2.18]). Conclusions Even low doses of alcohol can lead to the development of hypertension, particularly in Asian men. Our findings could serve as additional evidence for developing an appropriate preventive strategy in each region.

Since the Korean College of Helicobacter and Upper Gastrointestinal Research has first developed the guideline for the diagnosis and treatment of Helicobacter pylori infection in 1998, the revised guideline was proposed in 2009 by the same group. Although the revised guideline was made by comprehensive review of previous articles and consensus of authoritative expert opinions, the evidence-based developmental process was not applied in the revision of the guideline. This new guideline has been revised especially in terms of changes in the indication and treatment of H. pylori infection in Korea, and developed by the adaptation process as evidence-based method; 6 guidelines were retrieved by systematic review and the Appraisal of Guidelines for Research and Evaluation (AGREE) II process, 21 statements were made with grading system and revised by modified Delphi method. After revision, 11 statements for the indication of test and treatment, 4 statements for the diagnosis and 4 statements for the treatment have been developed, respectively. The revised guideline has been reviewed by external experts before the official endorsement, and will be disseminated for usual clinical practice in Korea. Also, the scheduled update and revision of the guideline will be made periodically.
Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Aspirin/therapeutic use ; Bismuth/therapeutic use ; Breath Tests ; Clarithromycin/therapeutic use ; Gastroesophageal Reflux/etiology ; Gastroscopy ; Helicobacter Infections/complications/*diagnosis/drug therapy ; *Helicobacter pylori ; Humans ; Lymphoma, B-Cell, Marginal Zone/complications ; Metaplasia/complications ; Metronidazole/therapeutic use ; Peptic Ulcer/complications/drug therapy ; Proton Pump Inhibitors/therapeutic use ; Republic of Korea ; Stomach Neoplasms/complications/surgery ; Tetracycline/therapeutic use

When clinicians or healthcare professionals are to make decisions, they can judge the quality of evidence and reliability of recommendations by 'Level of evidence' and 'Grade of recommendation'. Because of this, the step of grading evidence and recommendations is very important in developing clinical practice guidelines. The objective of this study was to identify the various grading systems and criteria of the clinical practice guidelines. We reviewed 101 guidelines from the National Guideline Clearinghouse Database and chose 66 sets of guidelines to analyze in terms of the grading systems for level of evidence and strength of recommendation. The grading systems for 'Level of evidence' were classified into 4 types by criteria such as study design, study quality, consistency, limitations, strength of evidence, and validity. Type II was the most common evidence grading system applied by 12 organizations (37.5%) and 30 sets of guidelines (45.5%). The grading systems for 'Grade of recommendation' were classified into 4 types by criteria such as level/quality of evidence, strength of recommendations, study quality, consistency, applicability, balance between benefit and harm, and effectiveness/usefulness. Type I was the most common recommendation grading system applied by 9 organizations (33.4%) and 23 sets of guidelines (40.4%). A formal grading system based on consistent and clear approaches is needed because the process of grading work can be subjective when clinical practice guideline users are making decisions. It is necessary for clinical practice guideline developers to have a common criterion so that they can judge the grade of evidence and recommendations objectively in the development of clinical practice guidelines.
Delivery of Health Care ; Methods* ; Practice Guidelines as Topic