No abstract available.
Diagnosis-Related Groups* ; Korea*

No abstract available.
Evidence-Based Medicine*

While overtreatment in medical services has for a long time been a topic of interest among the medical community, the concept of overdiagnosis has recently attracted interest because of the increasing scientific evidence supporting it; there are numerous academic papers investigating ‘overdiagnosis’ which have been published. Overdiagnosis is the phenomenon of a disease being diagnosed that will never progress to the point of causing symptoms or death. In certain individuals, even despite the detection of cancer cells, the person will die of other disease before the cancer can progress. It is known that overdiagnosis occurs in various diseases, such as high blood pressure, diabetes, and various psychiatric disorders. In cancer, there exist slow growing cancers in which symptoms and death often occur late and thus the patient will ultimately die of another cause before they are affected by the cancer. Through this, there is a potential of overdiagnosis due to early cancer screening. Overdiagnosed patients are harmed by the diagnosis and treatment which in no way benefit them. The general public as well as health care professionals should be informed of the balance between the benefits and harms. This article will analyze the problems related to overdiagnosis with a focus on early screening in cancer.
Breast Neoplasms ; Delivery of Health Care* ; Diagnosis ; Early Detection of Cancer* ; Humans ; Hypertension ; Mass Screening ; Medical Overuse* ; Prostatic Neoplasms ; Thyroid Neoplasms

BACKGROUND: The major serious risk of blood transfusion is post-transfusion hepatitis. Currently HBsAg, anti-HCV and serum alanine aminotransferase (ALT) assays are screened for potential blood donors to prevent transfusion associated hepatitis in Korea. But the effectiveness of serum ALT as a surrogate marker for the screening of non-A, non-B hepatitis is controversial. The present study was designed to evaluate the prevalence of hepatitis markers in Korean blood donors and the usefulness of ALT as a surrogate marker. METHODS: The prevalence rates of anti-HCV and HBsAg were analyzed by age, sex and ALT cut-off level in 405,931 blood donors. The current anti-HCV EIA (LG HCD 3.0 ) comparing to anti-HCV confirmatory immunoblot assay (LG HCD confirm ) and ALT test were evaluated. RESULTS: The positive rate of HBsAg was 3.32% and higher in male across all age group (p<0.01). The rate increased as age increases up to thirties and decreased thereafter. The positive rate of anti-HCV was 0.24% in EIA, and higher in female across all age group except for teenage group (p<0.01). The rate increased as age increases up to fifties (p<0.01). Results of immunoblot assay showed 64% disaccordance with that of EIA and the rate of disaccord was high in female and young age group. The rate of mixed infection of hepatitis B and C was 0.003%. ALT level was within normal range in 95.2% of donors, and the prevalences of HBsAg and anti-HCV were higher as ALT increased above normal level (p<0.01). The sensitivity of ALT in identifying hepatitis C was 34.5% at 45 IU/L, and 22.8% at 65 IU/L. The most accurate cut-off level of ALT for hepatitis C was 23 IU/L in Receiver-Operating Characteristic (ROC) plot and the sensitivity and specificity were 65.5% and 79.9% at that level. CONCLUSION: In contrast to HBsAg, the prevalence rate of anti-HCV showed different pattern in that it was higher in female and continuously increased up to fifties. Confirmatory assay for hepatitis C should be done for the high false positivity of current anti-HCV EIA. The sensitivity and positive predictive value of ALT was so poor that ALT was not found to be useful as a surrogate marker for hepatitis C, but the discontinuance of ALT testing of blood donors needs to be evaluated by further studies.
Alanine Transaminase ; Biomarkers* ; Blood Donors ; Blood Transfusion ; Coinfection ; Female ; Hepatitis B ; Hepatitis B Surface Antigens ; Hepatitis C ; Hepatitis* ; Humans ; Korea ; Male ; Mass Screening ; Prevalence* ; Reference Values ; Sensitivity and Specificity ; Tissue Donors* ; Volunteers*

No abstract available.
Delivery of Health Care

No abstract available.
Angiotensin II* ; Angiotensins* ; Animals ; Hemorrhage* ; Rats*

In recent years, the number of systematic review and meta-analysis literatures has markedly increased. Systematic reviews can give important information about clinical decision making when studies show different or even contradictory results. By utilizing systematic reviews, clinicians can get unbiased summaries of the estimates, which are a reliable source of clinical information. Contrary to the narrative review, the systematic review conducts a comprehensive research of relevant studies on a defined clinical question, and critically appraises the risk of bias in included studies. The systematic review usually includes meta-analysis which summarizes the quantitative estimates by using statistical methods. Most meta-analyses aggregate data from primary studies, but individual data are also commonly used. Explaining heterogeneity among included studies and subsequent subgroup analysis are often required. Systematic review and meta-analysis depend on the quality of included studies, and subsequently cannot overcome the limitations of primary studies. Also, meta-analysis is prone to publication biases and methodological flaws. Despite these limitations, systematic review has definitive strengths. Maximizing these strengths require reliable second-hand data and a comprehensive analysis.
Bias (Epidemiology) ; Decision Making ; Evidence-Based Medicine ; Population Characteristics ; Publication Bias ; Review Literature as Topic

The aim of this study was to evaluate the appropriateness of some kinds of surgery and admission, such as cesarean section (C/S), cholecystectomy, and pediatric pneumonia. For appropriateness evaluation, we ourselves developed some criteria, which were included in the category of explicit and linear criteria, with the assistance of specialists of relevant clinical field. The evaluation of appropriateness was performed by two family physicians. The major findings were as follows: 1. For ceserean section, 77.6% of deliveries were determined to be 'appropriate', but the level of appropriateness was not significantly different among hospitals between hospital groups by size. The most frequent indication of C/S was repeated operation, followed by cephalopelvic disproportion(CPD). The labor trials for vaginal delivery among repeated C/S and CPD cases were performed in 24.5% of pertinent deliveries. 2. About 73.8% of cholecystectomy cases was appropriate to one of the surgical indications, without significant differences among hospitals. Of surgical indications, 'sufficiently frequent and intense symptom recurrence' was the most frequent, and 'confirmed acute cholecystitis' was the second. 3. Of children admitted due to pneumonia, only 57.4% of cases satisfied admission criteria, and the level of appropriateness of admission was different among hospitals. The common reasons for admission were 'failure to initial treatment', 'suspected bacterial pnermonia', 'young infant', etc. We could find that there were differences of quality among hospitals in some procedures, especially in the pediatric pneumonia and labor trial before C/S, which suggested that the implementation of quality assurance activities would be necessary in this country. In this study, we used some simple and primitive research tools and the numbers of subjects and tracer procedures were limited. So advanced studies with plentiful subjects and more representative diseases or procedures should be tried.
Cesarean Section* ; Child ; Cholecystectomy* ; Female ; Humans ; Physicians, Family ; Pneumonia* ; Pregnancy ; Specialization ; Trial of Labor ; Utilization Review

Systematic review had become one of the important research area in medicine. Systematic review can be demonstrating benefit or harm of an intervention when results of individual studies are inconclusive. While narrative reviews can often include an element of selection bias, systematic reviews typically involve a comprehensive plan and search strategy with the goal of reducing bias by identifying, appraising, and synthesizing all relevant studies on a particular topic and investigation of heterogeneity among included studies. Systematic reviews typically include a meta-analysis component which involves using statistical techniques to synthesize the data from several studies into a single quantitative estimate or summary effect size. Systematic review overcomes the limitation of small sample sizes by pooling results from a number of individual studies to generate a single best estimate. Although systematic reviews are published in academic forums, the Cochrane Collaboration is a widely recognized international and not-for-profit organization that promotes, supports, and disseminates systematic reviews and meta-analyses on the efficacy of interventions in the health care field. Systematic review has become a popular and powerful tool. If rigorously conducted, it is essential for evidence-based decision making in clinical practice as well as on the health policy level.
Bias (Epidemiology) ; Cooperative Behavior ; Decision Making ; Delivery of Health Care ; Evidence-Based Medicine ; Health Policy ; Meta-Analysis as Topic ; Population Characteristics ; Publication Bias ; Sample Size ; Selection Bias