Korean Journal of Family Medicine

Recent Advance in Clinical Practice Guideline Development Methodology: Soo Young Kim; Korean J Fam Med 2022;43(6):347-352. Published online November 20, 2022; DOI: https://doi.org/10.4082/kjfm.22.0178

Abstract
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Clinical practice guidelines (CPG) can be defined as systematically developed recommendations and related content obtained by reviewing scientific evidence, which help healthcare providers make decisions. CPG is one of the most powerful tools that helps clinicians make evidence-based decisions in practice. Methodologies in areas essential for CPG development, such as for systematic review, risk of bias (ROB) assessment, adaptation, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations, are rapidly developing. Therefore, they must be well-understood and applied to evidence-based CPG development. In this regard, it is necessary to learn about the updates and changed in the methodologies for CPG development. This manuscript covers the following CPG development methodologies: (1) main principles of CPG, (2) managing conflict of interest, (3) considering patient value and preference, (4) determination of key questions, (5) ROB assessment, (6) adaptation, (7) rapid guideline development, (8) living guideline development, and (9) GIN-McMaster Guideline Development Checklist.

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Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions: Yogarabindranath Swarna Nantha; Korean J Fam Med 2017;38(6):315-321. Published online November 14, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.6.315

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A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.

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Methodology of Korean Lifetime Health Maintenance Program.: Soo Young Kim, Young Sik Kim, Min Seon Park, Sung Sunwoo, Jung Jin Cho; Korean J Fam Med 2009;30(10):769-776. Published online October 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.10.769

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Korean Lifetime Health Maintenance Program (KLHMP) represents one of several efforts to take a more evidence-based approach to the development of recommendations on a wide range of preventive services. This paper summarizes the methods of the third KLHMP developed by Korean Academy of Family Medicine. The review process of KLHMP was mainly based on trans contextual guideline adaptation of United States preventive service Task force (USPSTF) recommendation. The method of review process was done according to categories of recommendation (adotion of USPSTF's recommendation, adatation of USPSTF's recommendation, development of new recommendation). If the recommendation done by USPSTF is up to date and acceptable in Korean context, it was translated and adopted. If the USPSTF recommendation was not up to date, nor applicable, the recommendation was drawn by adaptation process. If the condition has not been reviewed by USPSTF, the recommendation was drawn by de novo development process, forming key question, literature search (primary researchs, systematic reviews, guidelines), literature evaluation, evidence systhesis, considering of applicability and acceptability of evidence.

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Knowledge and Attitude of Family Medicine Residents Towards Evidence-based Medicine.: Sung Ook Jo, Yang Hyun Jo, Eal Whan Park, Eun Young Choi, Jae Hun Kim, Yoo Seock Cheong; J Korean Acad Fam Med 2006;27(12):975-981. Published online December 10, 2006

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Background
: As medical informations are expanded, searching for useful information has become ever more important. Presently, teaching EBM (evidence-based medicine) is emphasiged. The purpose of this study was to survey family medicine residents' knowledge and utilization of EBM. Also, we investigated whether teaching EBM increased the knowledge and use of EBM in family medicine residents.

Methods : In July 2005, we sent a questionnaire to family medicine residents in Korea and received 260 answers. The questionnaire concerned education, attitude, utilization and knowledge of EBM. We analyzed the relationship of the level of knowledge and utilization of EBM in practice by using chi-square test.

Results : The family medicine residents who hed experienced learning EBM was 61%. Almost half of them were educated during their family medicine training programs (42.2%). Among the total, 33.6% of the respondents had an experience to attend EBM journal club. As for the knowledge of EBM, 59.8% of respondents knew the concept of what is EBM, 36.5% understood PICO question structure, and 28.5% knew how to calculate the NNT value. In the residents who had experienced EBM learning, the level of knowledge (P＜0.001), the frequency of utilization (P＜0.001), and the intention to use EBM in their practice were higher than in those who had not yet experienced EBM learning.

Conclusion : Although family medicine residents usually learn EBM in medical school and resident training program, education and utilization of EBM were not organized enough. As can be seen in this study, it is necessary to make an effective education program in medical schools and resident training programs to increase the knowledge and utilization of EBM education.

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Evidence Based Evaluation of Health Information in the Television News.: Ye Won Hwang, Jung Soo Byun, Kyung Woo Lee, In Hong Hwang, Soo Young Kim; J Korean Acad Fam Med 2006;27(7):523-528. Published online July 10, 2006

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Background
: A rapid growth of socioeconomic status in Korea has triggered health information resolution of unprecedented magnitude among the general population. Despite its obvious benefits, the increase in the amount of information could also result in many potentially harmful effects on both consumers and professionals who do not use it appropriately.

Methods : This study was performed to evaluate health information in the television news from June 2003 through January 2004. We evaluated the quality and the accuracy of health information provided in the night news. We reviewed the health information for quality using the evidence-based medicine tools which evaluate the accuracy required to understand the text.

Results : A total of 85 types of information were identified. Among them, 34 (40.0%) contained inaccurate or misleading statement based on evidence-based medicine. These included confusing surrogate outcome with an end outcome (15.3%), extrapolating nonhuman results to human (8.2%), exaggerating results in conclusion (12.9%), incorrect words (7.1%), indefinite study methods (2.4%) In broadcasting stations A, B and C, the rate of error were 55.6%, 38.2% and 42.4%, respectively. The rate of error were higher in information of Korean source compared to those of international sources (65.8% and 27.3%).

Conclusion : Many inaccurate medical information exist in the television news.

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Quantity and Quality Assessment of Randomized Controlled Trials Published in Five Korean Medical Journals, from 1980 to 2000.: Suk Won Kim, Youn Seon Choi, Hyung Sik Ahn, Hoi Young Lee, Duck Sun Ahn, Young Mee Lee; J Korean Acad Fam Med 2004;25(2):118-125. Published online February 10, 2004

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Background
: As evidence-based medicine is getting popular recently, the importance
of randomized controlled trial as a research methodology is also getting highlighted. This study
was conducted in order to identify the status quo of randomized controlled trial research in
major domestic journals and to provide baseline data for constructing Korean clinical trial
database such CCTR (Cochrane Clinical Trial Registry).

Methods : Five journals issued by
domestic publication industry were selected, out of which 127,560 original articles, equal to
253 volumes, were investigated. The author extracted the articles, which performed pro
spective clinical trial, targeting human beings. The selected papers were analyzed with experts
to single out randomized controlled trial among them. Furthermore, the quality of the
re-selected ones were assessed according to Jadad Quaility Assessment Scale.

Results : After
analysis, it turned out that the number of papers adopting prospective clinical trial were 406
volumes (3.2%) of 12,760 and that they increased from 157 in 1980s to 224 in 1990s.
However, the percentage of prospective clinical trial monographs, introduced during 1980s and
1990s, remained 2.0 to 4.0. The number of randomized controlled trial-based papers were 115,
accounting for 0.9% of total articles. The number of RCT increased to approximately two fold
from 1980s to 1990s. Quality analysis showed that among a total of 115 RCT papers, those of
scoring 1 and 3 were 16 (13.9%), 82 articles obtained score 2 (72.2%). There was no papers,
which won the marks of 4 and 5.

Conclusion : It was found that domestic randomized
controlled trial research was weak both in number and quality. Therefore, it is necessary to
activate clinical medicine study with good quality to upgrade the amount and quality of
monographs.

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Assessing the degree of evidence based therapeutic intervention in a university based family medicine outpatient clinic.: Chang Li Tang, Dung Hyun Moon, Myoung Ho Hong, Kyung Hwan Cho, Youn Seon Choi, Do Kyung Yoon, Jeong A Kim, Young Mee Lee, June Young Lee; J Korean Acad Fam Med 2002;23(1):40-59. Published online January 1, 2002

Abstract
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Background
: Despite the development of medical knowledge and technology, it has long been pointed out that the treatment guidelines are not sufficiently based on evidence. It has not been yet studied how evidence based medicine if implemented when physicians make their therapeutic decision. The purpose of this study was to determine the degree of evidence based interventions in a university based family medicine outpatient clinic.

Methods : The degree of evidence based practice was evaluated using Ellis and Gills' method developed by the Evidence-Based Medicine Center in Oxford. The patients' records of an outpatient clinic of a university hospital were reviewed on the primary diagnosis - intervention. The evidence based guidelines were defined as traditional textbooks and the results of randomized controlled trials found on databases such as Medicine, Clinical evidence, Best evidence, and Cochrane. In case where there were no guidelines, consultation with the specialists was done. The degree of the evidence based therapeutic interventions was assessed by three levels.

Results : There were 179 primary diagnosis - intervention pairs, among them, 125 pairs (69.8%) of interventions were based on randomized controlled trial evidence and 19 pairs (10.6%) based on convincing non-experimental evidence. No evidence was found for 35 pairs (19.6%). As a result, 80.4% of the total 144 pairs were regarded as evidence-based medicine.

Conclusion : The result showed that considerable portion of the total cases were evaluated as based on clinical evidence, which is similar to the conclusions of the previous studies in other countries. We hope that future similar studies will be conducted in other institutions as well as in other specialities.