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

No abstract available.
*Authorship ; *Editorial Policies ; Guideline Adherence/standards ; Korea ; Ownership/*standards ; Peer Review, Research/*standards ; Periodicals as Topic/*standards ; Writing/*standards

OBJECTIVE: To perform a systematic review of compliance with standardized terminology and reporting criteria for radiofrequency (RF) tumor ablation, proposed by the International Working Group on Image-Guided Tumor Ablation in 2003, in the published reports. MATERIALS AND METHODS: Literature search in the PubMed database was performed using index keywords, PubMed limit system, and eligibility criteria. The entire content of each article was reviewed to assess the terminology used for procedure terms, imaging findings, therapeutic efficacy, follow-up, and complications. Accuracy of the terminology and the use of alternative terms instead of standard terminology were analyzed. In addition, disparities in accuracy of terminology in articles according to the medical specialty and the type of radiology journal were evaluated. RESULTS: Among the articles (n = 308) included in this study, the accuracy of the terms 'procedure or session', 'treatment', 'index tumor', 'ablation zone', 'technical success', 'primary technique effectiveness rate', 'secondary technique effectiveness rate', 'local tumor progression', 'major complication', and 'minor complication' was 97% (298/307), 97% (291/300), 8% (25/307), 65% (103/159), 55% (52/94), 33% (42/129), 94% (17/18), 45% (88/195), 99% (79/80), and 100% (77/77), respectively. The overall accuracy of each term showed a tendency to improve over the years. The most commonly used alternative terms for 'technical success' and 'local tumor progression' were 'complete ablation' and 'local (tumor) recurrence', respectively. The accuracy of terminology in articles published in radiology journals was significantly greater than that of terminology in articles published in non-radiology journals, especially in Radiology and The Journal of Vascular and Interventional Radiology. CONCLUSION: The proposal for standardization of terminology and reporting criteria for RF tumor ablation has been gaining support according to the recently published scientific reports, especially in the field of radiology. However, more work is still needed for the complete standardization of terminology.
*Catheter Ablation ; Female ; *Guideline Adherence ; Humans ; Neoplasms/*surgery ; *Terminology as Topic ; Writing/*standards

Acupuncture ; standards ; Acupuncture Therapy ; standards ; China ; Complementary Therapies ; standards ; Guideline Adherence ; Herpes Zoster ; diagnosis ; therapy ; Humans ; Male ; Practice Guidelines as Topic ; standards ; Risk Assessment ; Severity of Illness Index

Against the large number of assessment indices to the adequacy peritoneal dialysis and incompatibility of some indices, an intelligent assessment approach to the peritoneal dialysis adequacy based on MART2 (modified from ART2) network is proposed. After non-dimension and weighting preconditioning, the assessment indices were put to MART2 and sorted into many clusters. The center-of-gravity of each cluster was identified as adequacy or inadequacy according to the assessment criteria of dialysis adequacy, and the adequacy of each cluster could be determined by the adequacy of corresponding center-of-gravity when the network threshold was high. Finally, the peritoneal dialysis adequacy of each patient could be judged according to the adequacy of cluster to which the patients' indices belong. Experimental results demounstrate its effectiveness.
Creatinine ; metabolism ; Guideline Adherence ; Humans ; Kidney Failure, Chronic ; metabolism ; therapy ; Peritoneal Dialysis ; instrumentation ; standards ; Quality Assurance, Health Care ; Urea ; metabolism

INTRODUCTIONAntimicrobial stewardship programmes (ASP) can reduce antibiotic use but patient safety concerns exist. We evaluated the safety of prospective carbapenem review and feedback and its impact on carbapenem use and patient outcomes.

MATERIALS AND METHODSAfter 3 months implementation of our ASP, we compared patients with and without acceptance of ASP recommendations on the use of carbapenems. Primary outcome was 30-day mortality. Secondary outcomes included duration of carbapenem use, length of hospitalisation, clinical response, microbiological clearance, 30-day readmission and mortality at discharge.

RESULTSOf 226 recommendations for 183 patients, 59.3% was accepted. De-escalation, switching to oral antibiotics and antibiotic cessation comprised 72% of recommendations. Patients with acceptance of ASP recommendations had lower 30-day mortality and higher end-of-therapy clinical response despite shorter carbapenem duration (P <0.05). Predictors of 30-day mortality were Pitt bacteraemia score (adjusted odds ratio [aOR] 1.39, 95% confidence interval [CI], 1.11 to 1.74; P = 0.004) and non-acceptance of ASP recommendations (aOR 2.84, 95% CI, 1.21 to 6.64; P = 0.016).

CONCLUSIONOur prospective carbapenem review and feedback mainly comprising of reducing carbapenem use is safe.

Carbapenems ; therapeutic use ; Drug Utilization ; standards ; Feedback ; Guideline Adherence ; statistics & numerical data ; Humans ; Patient Safety ; Pharmaceutical Services ; Treatment Outcome

OBJECTIVETo retrospectively evaluate the HER2 status of 1 501 invasive breast cancer (IBC) by immunohistochemistry (IHC) and fluorescent in situ hybridizaion (FISH), and to compare and analyze the changes and their effects, using the 2007 and 2013 American Society of Clinical Oncology/College of American Pathologist(ASCO/CAP) HER2 testing guidelines.

METHODSTissue handling and HER2 testing were performed according the 2007 ASCO/CAP guideline recommendations. The HER2 status of all newly diagnosed IBC were routinely assessed by IHC, and reflex FISH assay was done on all the IHC equivocal (IHC 2+) cases. The HER2 status of 1 501 cases of IBC was re-evaluated according to these two criteria.

RESULTSUsing the 2007 and 2013 ASCO/CAP criteria, the overall positive, equivocal and negative rates of HER2 over-expression and/or amplification in the 1 501 IBCs were 23.05% and 23.52%, 11.59% and 12.52%, and 65.36% and 63.96%, respectively. The positive and equivocal rates increased by 0.47% and 0.93% respectively, but the negative rate decreased by 1.40% when using the new criteria. For HER2 IHC staining using the 2007 and 2013 guidelines, the positive, equivocal and negative rates were 17.99% and 18.13% (+0.13%), 32.51% and 32.91% (+0.40%) and 49.50% and 48, 97% (-0.53%), respectively. FISH for HER2 amplification was done in 348 of the 1 501 IBCs, and using the 2007 and 2013 guidelines, the positive, equivocal and negative rates were 27.59% and 29.02% (+1.43%), 1.15% and 3.74% (+2.59%) and 71.26% and 67.24% (-4.02%), respectively.

CONCLUSIONSThe application of 2013 ASCO/CAP guideline could lead to an increase in positive and equivocal rates, and a decrease in negative rate. The influence could be more prominent for the evaluation of FISH result, and would raise the positive and equivocal rates since a mean HER2 copy number is used in the new criteria. Our re-estimation of IHC result was concordant with the prediction of the guideline.

Breast Neoplasms ; chemistry ; Female ; Guideline Adherence ; Humans ; Immunohistochemistry ; Medical Oncology ; Receptor, ErbB-2 ; analysis ; Retrospective Studies ; Societies, Medical ; standards

The study assessed the self-reported frequency and quality of use of the Paediatric Standard Treatment Book by staff in urban clinics and rural health centres. 61 of the 88 nursing officers and 44 of the 89 community health workers in 9 urban and 4 rural health settings completed written questionnaires on their use of the Standard Treatment Book. The survey participants were also assessed on the management of three case scenarios of common clinical conditions. Whilst 69% of the participants reported daily use of the book, only 51% indicated that they always followed the guidelines. Performance in the case scenarios was poor. Although 87% made a correct diagnosis in the most straightforward case, only 38% indicated complete treatment and only 36% indicated complete and correct advice. In two more complex scenarios less than 30% of the participants made correct diagnoses and less than 10% indicated complete treatment and advice. 75% of the study group wanted inservice training on the use of the book; the majority of these said that doctors should give this training. 79% thought that the book could be improved. Many of the participants felt that more topics and more flow charts should be included. Whilst nursing officers and community health workers regard the Standard Treatment Book (STB) as important, many do not make optimal use of it. Knowledge of appropriate advice to give parents regarding their child's illness was particularly poor. Given the low scores of health workers on case scenarios involving children with more than one presenting problem, the use of the STB appears to be essential for management of most severely ill children presenting to health facilities in Papua New Guinea. Doctors, especially paediatricians, have an important role to play in stressing the importance of the book, in teaching health workers to use it correctly and in emphasizing an integrated approach to the management of sick children. The study incorporated an assessment of health facility infrastructure and equipment. All facilities needed maintenance work, and more than half had significant deficiencies in equipment and drug availability. Medical staff supervision and support of primary health staff is important and should include increasing and improving the use of the Standard Treatment Book. Such support should also aim to improve the working environment and health facility resources. This would substantially improve the service provided.
Child ; Child Health Services - standards ; Clinical Protocols ; Community Health Services ; Community Health Workers Delivery of Health Care / standards* Guideline Adherence - statistics & ; numerical data ; Papua New Guinea

Nephrectomy is the cornerstone therapy for renal cell carcinoma (RCC) and continued refinement of the procedure through research may enhance patient outcomes. A national nephrectomy registry may provide the key information needed to assess the procedure at a national level. The aim of this study was to review nephrectomy data available at a population-based level in Australia and to benchmark these data against data from the rest of the world as an examination of the national nephrectomy registry model. A PubMed search identified records pertaining to RCC nephrectomy in Australia. A similar search identified records relating to established nephrectomy registries internationally and other surgical registries of clinical importance. These records were reviewed to address the stated aims of this article. Population-based data within Australia for nephrectomy were lacking. Key issues identified were the difficulty in benchmarking outcomes and no ongoing monitoring of trends. The care centralization debate, which questions whether small-volume centers provide comparable outcomes to high-volume centers, is ongoing. Patterns of adherence and the effectiveness of existing protocols are uncertain. A review of established international registries demonstrated that the registry model can effectively address issues comparable to those identified in the Australian literature. A national nephrectomy registry could address deficiencies identified in a given nation's nephrectomy field. The model is supported by evidence from international examples and will provide the population-based data needed for studies. Scope exists for possible integration with other registries to develop a more encompassing urological or surgical registry. Need remains for further exploration of the feasibility and practicalities of initiating such a registry including a minimum data set, outcome indicators, and auditing of data.
Australia ; Benchmarking ; Carcinoma, Renal Cell/*surgery ; Guideline Adherence ; Humans ; Kidney Neoplasms/*surgery ; Models, Theoretical ; Nephrectomy/*standards/*statistics & numerical data ; Practice Guidelines as Topic ; *Registries ; Treatment Outcome

Esophageal carcinoma is one of the most common malignant tumors, especially in China which is the high incidence area. As a result of mild symptoms of early-stage esophageal cancer, the majority of patients cannot be diagnosed until they develop to advanced cancer, and the treatment outcome of surgery or chemoradiotherapy is still unsatisfactory at present. The guidelines of esophageal cancer issued by National Comprehensive Cancer Network (NCCN) are regarded as important reference tools by clinical oncologists, and provide uniform criteria for the diagnosis and treatment of esophageal carcinoma. However, the guidelines are not always suitable for Chinese patients because the data come from European and American population which have significant ethnical difference from Chinese. We retrospectively analyzed the changes of treatment strategy of esophageal cancer in NCCN guidelines and the advance of treatment for esophageal carcinoma in China, aiming to provide our oncologists with new research ideas. We also hope to set up clinical cancer cooperation organizations, and release our own cancer guidelines to serve Chinese patients and oncologists.
Chemoradiotherapy ; China ; Esophageal Neoplasms ; diagnosis ; diagnostic imaging ; therapy ; Guideline Adherence ; Humans ; Multimodal Imaging ; Positron-Emission Tomography ; Practice Guidelines as Topic ; standards ; Tomography, X-Ray Computed ; United States