2차 스크리닝
5) 권고안 도출방법 및 초안의 작성
●
최종 선정된 17개 만성콩팥병 임상진료지침을 대상으로 소분류(혹은 임상질문)별 관련 권고 및 사용 근거를 발췌하기 위하여 근거자료 추출용 권고안 매트릭스(Recommendation Matrix)를 작성하였음(표 16).
●
권고 초안에 대한 도출 과정은 표 17과 같음.
●
14개 소분류(혹은 임상질문)에 대하여 총 38개 권고를 도출하여 제시함.
●
권고 요약본 초안을 개발함에 있어서 권고 이외에 진료 시 고려할 점, 권고 관련 편익 및 위해, 진료의뢰가
필요한 상황을 집필하여 별도의 글 상자에 제시함.
96
소분류: 환자교육 권고 (Recommendations)
기존 근거수준/ 권고등급
Supporting Evidence - 사용된 근거별 개수 표기 - ABCDGuid -linA-1A-2B-1B-2CD G2 (대한신장학회 2009)
환자에게 신기능에 영향을 줄 수 있는 약물의 목록을 알려줄 것을 제안한다. - NSAID 계열의 진통소염제, 콩팥 배설의 항생제, 조영제 검사C (Weak evidence)0000001 G4 (KDIGO 2013) Additional dietary advice : We recommend that individuals with CKD receive expert dietary advice and information in the context of an education program, tailored to severity of CKD and the need to intervene on salt, phosphate, potassium, and protein intake where indicated. (1B)
B/1 (Best practice)0000001 G5 (NICE 2014)
Offer people with CKD education and information tailored to the severity and cause of CKD, the associated complications and the risk of progression.-0000001 Offerpeople withCKDhigh-qualityinformation oreducation programmes as appropriate to the severity of their condition to allowtime forthemtofullyunderstand and make informed choices about their treatment.
-0000001 Healthcare professionals providing information and education programmes should ensure they have specialist knowledge about CKD and the necessary skills to facilitate learning.-0000001 G6 (USA VA/DoD 2019)
When providing patient education, there is insufficient evidence to recommend for or against a particular health education program, mode, or modality to prevent chronic kidney disease progression. (Neither for nor against)
-1300001 G7 (KHA-CARI 2013)
We suggest early, comprehensive and structured CKD education about management of hypertension, diabetes, obesity and smoking and other risk factors as this may delay CKD progression (2C).C/Grade 20000001
표 16. 소분류(혹은 임상질문)별 만성콩팥병 권고안 매트릭스 작성 예시
hat the provision of CKD education is conducted by oviders who are involved in the screening process (2D).D/Grade 20000001 서 ‘Supporting Evidence’의 표기 eta-analysis , CTs with control trials (no control) CTs, Observational study (Cohort, Case-control) -sectional, Case report t opinion, Consensus lines Reference list for supporting evidence [Types of evidence] 회 CKD 대책위원회·신장학연구재단. 만성콩팥병 진료지침. 2009. P. S95. [CPG] O. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. 2013. p. 80. [CPG] Chronic kidney disease (partial update): Early identification and management of chronic kidney disease in adults in y and secondary care (Clinical Guideline 182, Methods, evidence and recommendations). 2014. p. 217. [CPG] epartment of Veterans Affairs, Department of Defense. VA/DoD clinical practice guideline for the management of c kidney disease. 2019. p. 40. [CPG] imbudzi E, Lo C, Misso ML, et al. Effectiveness of self-management support interventions for people with comorbid es and chronic kidney disease: A systematic review and meta-analysis. Syst Rev. Jun 13 2018;7(1):84. [SR & meta] oboshi H, Oka M. Effectiveness of an educational intervention (the Encourage Autonomous Self-Enrichment Program) ients with chronic kidney disease: A randomized controlled trial. Int J Nurs Stud. Feb 2017;67:51-58. [RCT] arahimi H, Zolfaghari M, Abolhassani F, Rahimi Foroushani A, Mohammadi A, Rajaee F. E-learning model in chronic disease management: A controlled clinical trial. Iran J Kidney Dis. Jul 2017;11(4):280-285. [CTs with control] amagata K, Makino H, Iseki K, et al. Effect of behavior modification on outcome in early- to moderate-stage chronic disease: A cluster-randomized trial. PLoS One. 2016;11(3):e0151422. [RCT] Health Australia-Caring for Australasians with Renal Impairment. KHA-CARI guideline: Early chronic kidney disease: ion, prevention and management. 2013. p. 345. [CPG]
98