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.

Citations

• RoBANS 2: A Revised Risk of Bias Assessment Tool for Nonrandomized Studies of Interventions
  Hyun-Ju Seo, Soo Young Kim, Yoon Jae Lee, Ji-Eun Park
  Korean Journal of Family Medicine.2023; 44(5): 249.     CrossRef
• Association between Conflicts of Interest Disclosure and Quality of Clinical Practice Guidelines in Japan: A Meta-Epidemiological Study
  Norio Yamamoto, Akihiko Ozaki, Shunsuke Taito, Takashi Ariie, Hidehiro Someko, Hiroaki Saito, Tetsuya Tanimoto, Yuki Kataoka
  Journal of Personalized Medicine.2023; 13(12): 1722.     CrossRef

Background
A usual source of care (USC) is related to longitudinal and personalized services, which are attributes of primary care. Patient-centered communication, an important element of patient-centered care, helps physicians understand health problems from a patient’s point of view. We analyzed the association between USC and patient-centered communication.
Methods
Data from the Korea Health Panel 2018 were used in the analysis. Patient-centered communication scores were obtained by combining the four communication-related questionnaire items. Usual source of care types were categorized based on responses to two questionnaire items: no USC, a place without a regular doctor and with a regular doctor. Multiple logistic regression analysis was used to adjust for confounders.
Results
Good communication rate was higher for those with a regular doctor (71.8%) than for those with no USC (61.8%) or a place only (61.5%). Those with a regular doctor had better communication (odds ratio, 1.49 for individuals with poor/moderate health, and 2.08 for those with good health) than those without a USC after adjusting for confounders. In terms of communication, no difference was observed between individuals with no USC and those with a place only.
Conclusion
Having a regular doctor promotes communication between patients and doctors. Good communication may be a mediator between having a regular doctor and related beneficial outcomes. Better communication by having a regular doctor, along with several other benefits identified in previous studies suggests the need for a health policy that encourages individuals to have regular doctors.

Citations

• Types of Usual Source of Care and Medication Adherence in Patients with Diabetes Mellitus
  Yoon-Eui Choi, Nak-Jin Sung
  Korean Journal of Family Practice.2025; 15(1): 47.     CrossRef
• Correlation between Usual Source of Care and Medication Adherence in Patients with Hypertension
  Han-Kil Kang, Nak-Jin Sung
  Korean Journal of Family Medicine.2024; 45(2): 82.     CrossRef
• Determinants of Patient-Centered Communication, Its Impact On Quality of Services, Overall Health Status And Trust In The Healthcare System In The United States
  Cuma Çakmak, İsmail Biçer
  Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi.2024; 11(4): 630.     CrossRef

Background
The use of euglycemic diabetic ketoacidosis (EDKA) related to sodium-glucose cotransporter 2 inhibitors (SGLT2i) use in people with diabetes has been increasingly reported. The causes are multifactorial, and dietary changes in SGLT2i users were observed to trigger EDKA. A ketogenic diet or very low-carbohydrate diet (VLCD) enhances body ketosis by breaking down fats into energy sources, causing EDKA. This study aimed to understand the patient specific risk factors and clinical characteristics of this cohort.
Methods
Several databases were carefully analyzed to understand the patients’ symptoms, clinical profile, laboratory results, and safety of dietary changes in SGLT2i’s. Thirteen case reports identifying 14 patients on a ketogenic diet and SGLT2i’s diagnosed with EDKA were reviewed.
Results
Of the 14 patients, 12 (85%) presented with type-2 diabetes mellitus (DM) and 2 (15%) presented with type-1 DM. The duration of treatment with SGLT2i before the onset of EDKA varies from 1 to 365 days. The duration of consuming a ketogenic diet or VLCD before EDKA onset varies from 1 to 90 days, with over 90% of patients hospitalized <4 weeks after starting the diet. At presentation, average blood glucose was 167.50±41.80 mg/dL, pH 7.10±0.10, HCO₃ 8.1±3.0 mmol/L, potassium 4.2±1.1 mEq/L, anion-gap 23.6±3.5 mmol/L, and the average hemoglobin A1c was 10%±2.4%. The length of hospital stay ranged from 1 to 15 days. None of the patients were reinitiated on SGLT2i’s, and 50% (2/4) of the patients reported were on the ketogenic diet or VLCD upon patient questioning.
Conclusion
Despite the popularity of the ketogenic diet and VLCD for weight loss, their use in diabetics taking SGLT2i’s is associated with EDKA. Physicians should educate patients with diabetes taking SGLT2i’s about the risk of EDKA. In addition, patients should be encouraged to include their physicians in any decision related to significant changes in diet or exercise routines. Further research is needed to address if SGLT2i’s should be permanently discontinued in patients with diabetes on SGLT2i and whether the ketogenic diet developed EDKA.

Citations

• A Single Arm Pilot Observational Study to Evaluate the Safety and Feasibility of a Pre‐Operative Very Low Calorie Diet in Severely Obese Patients With Endometrial Cancer
  Chloe Ayres, Hanna Burbidge, Jayna Garratt, Ganendra Raj Mohan, Yee Leung, Stephanie Jeffares, Sanela Bilic, Paul A. Cohen
  Cancer Reports.2025;[Epub]     CrossRef
• From Sweet to Sour: SGLT-2-Inhibitor-Induced Euglycemic Diabetic Ketoacidosis
  Andrijana Koceva, Nika Aleksandra Kravos Tramšek
  Journal of Personalized Medicine.2024; 14(7): 665.     CrossRef

Background
This study aimed to assess the benefits of associating rehabilitation with therapeutic patient education (TPE) to decrease fear-avoidance belief and pain and improve function in adults with chronic low back pain (CLBP).
Methods
This randomized controlled study included 100 patients with CLBP according to the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The patients were divided into two teams: group A that participated in the TPE in association with rehabilitation and group B that received rehabilitation only. Pain and functional amelioration were assessed initially (T0) and at the end of the program (T1) using a visual analog scale at rest, work, and activity, and the Echelle d’Incapacité Fonctionnelle pour l’Évaluation des Lombalgies scale. Psychological and apprehension and avoidance assessments were also conducted, including the evaluation of depression, anxiety, fear-avoidance belief, and kinesiophobia using the Hospital Anxiety and Depression Scale, Fear-Avoidance Beliefs Questionnaire, and Tampa scale of kinesiophobia scale.
Results
The evaluation of progression initially (T0) and then at the end of the program (T1) revealed a significant reduction in pain at rest (P=0.00) and while working (P=0.00) and doing physical activity (P=0.03); a decrease in anxiety (P=0.03), fear-avoidance belief (P=0.03), and kinesiophobia (P=0.02); and an improvement in function (P=0.00) for patients in group A without amelioration of depression (P=0.15). Concerning group B, we identified a significant regression in pain at rest (P=0.001) and while working (P=0.03) and doing physical activity (P=0.00); depression (P=0.01); fear-avoidance beliefs (P=0.00); and kinesiophobia (P=0.002). Comparison between the groups revealed that associating TPE with rehabilitation resulted in a more significant improvement in function (P=0.00), anxiety (P=0.00), fear-avoidance belief (P=0.00), and kinesiophobia (P=0.00).
Conclusion
Associating TPE with rehabilitation improved function and reduced fear, false beliefs, and kinesiophobia of movement in patients with CLBP.

Citations

• Reassurance use and reassurance-related outcomes for low back pain in primary care: A scoping review
  Annie Young, Simon D. French, Adrian C. Traeger, Mark Hancock, Ben Darlow, Leticia Corrêa, Hazel J. Jenkins
  The Journal of Pain.2025; 29: 104753.     CrossRef
• Integration of Conventional and Virtual Reality Approaches in Augmented Reality for Theory-Based Psychoeducational Intervention Design for Chronic Low Back Pain: Scoping Review
  Robin Conen, Steffen Mueller, Ana Nanette Tibubos
  Interactive Journal of Medical Research.2025; 14: e59611.     CrossRef
• Pain Education and Virtual Reality Improves Pain, Pain-related Fear of Movement, and Trunk Kinematics in Individuals With Persistent Low Back Pain
  Peter Window, Michelle McGrath, Daniel S. Harvie, Esther Smits, Venerina Johnston, Megan Murdoch, Trevor Russell
  The Clinical Journal of Pain.2024; 40(8): 478.     CrossRef
• Ambulante Wirbelsäulenrehabilitation der Phase 3: Krankheitsinformation und Patientenschulung
  Michael Quittan, Günther F. Wiesinger
  Schmerz Nachrichten.2023; 23(3): 161.     CrossRef
• Comparative effectiveness of non-pharmacological interventions in reducing psychological symptoms among patients with chronic low back pain
  Lu-Ping Zhou, Ren-Jie Zhang, Jin Shang, Liang Kang, Zhi-Gang Zhang, Bo Zhang, Jia-Qi Wang, Chong-Yu Jia, Chen-Hao Zhao, Huang-Qing Zhang, Xian-Liang Zhang, Cai-Liang Shen
  International Journal of Surgery.2023;[Epub]     CrossRef

Background
Given that the role of serum testosterone on incident cardiovascular disease has been uncertain, it is necessary to find out the relationship between serum testosterone and carotid atherosclerosis.
Methods
The study participants included 1,302 Korean adults (873 men and 429 postmenopausal women) who participated in the Healthy Twin Study and were not receiving androgen deprivation therapy. The participants were classified into three groups: men aged <40 and ≥40 years and postmenopausal women. Total testosterone (TT) and sex hormone-binding globulin (SHBG) concentrations were measured using electrochemiluminescence immunoassays, and free testosterone (cFT) levels were calculated using Vermeulen’s method. Carotid intima-media thickness (IMT) was measured at three levels using a high-resolution B-mode ultrasound equipped with a 7-MHz linear transducer. The associations between sex hormone concentrations and carotid IMT were evaluated using a mixed linear regression analysis.
Results
After adjusting for cardiovascular risk factors, TT was found to be inversely associated with common carotid IMT in men aged ≥40 years, with a 4.5% decrease in common carotid IMT for every one-standard deviation increase in TT concentration (P=0.0063). In contrast, TT was not significantly associated with carotid IMT in all segments in men aged <40 years and postmenopausal women. Additionally, SHBG and cFT were not associated with carotid IMT in any segment.
Conclusion
The significant association between TT level and common carotid IMT in men aged ≥40 years suggests that decreased testosterone levels are involved in the development of atherosclerosis in men.

Citations

• Refined metabolite profiling in the collateral circulation of chronic total occlusion of coronary arteries: Insights from a metabolomics investigation
  Hu Sigan, Li Min, Cheng Zengwei, Gao Shiyi, Kang Pinfang, Gao Dasheng
  Atherosclerosis Plus.2024; 55: 63.     CrossRef

Background
This study examined the relationship between alcohol consumption and total testosterone deficiency based on facial flushing among Korean men.
Methods
A total of 314 men were included in this study and divided into non-drinkers (n=78) and drinkers (n=236). Drinkers were also divided into flushers (n=96) and non-flushers (n=140). Flushers and non-flushers were separated into two groups based on the amount of alcohol consumed: moderate drinkers (≤8 standard drinks per week) and heavy drinkers (>8 standard drinks per week). Total testosterone <3.5 ng/mL was defined as testosterone deficiency.
Results
The risk of testosterone deficiency was significantly higher in heavy drinkers who flushed than in nondrinkers (odds ratio, 4.37; 95% confidence interval, 1.20–15.88; P=0.025). However, no significant difference was observed in the risk of testosterone deficiency in non-flushers, regardless of the amount of alcohol consumed.
Conclusion
This study suggests that the risk of testosterone deficiency increases in heavy drinkers (>8 drinks per week) who flush compared to that in non-drinkers.

Citations

• The chronic alcohol consumption influences the gonadal axis in men: Results from a meta‐analysis
  Daniele Santi, Angelo Cignarelli, Matteo Baldi, Andrea Sansone, Giorgia Spaggiari, Manuela Simoni, Giovanni Corona
  Andrology.2024; 12(4): 768.     CrossRef
• The relationship between physical performance and alcohol consumption levels in Russian adults
  Nikita A. Mitkin, German E. Kirilkin, Tatiana N. Unguryanu, Sofia Malyutina, Sarah Cook, Alexander V. Kudryavtsev
  Scientific Reports.2024;[Epub]     CrossRef
• Positive association between serum bilirubin within the physiological range and serum testosterone levels
  Cunbao Ling, Yadong Liu, Meiling Yao, Libing Tian
  BMC Endocrine Disorders.2024;[Epub]     CrossRef
• Understanding the Role of Alcohol in Metabolic Dysfunction and Male Infertility
  Valentina Annamaria Genchi, Angelo Cignarelli, Andrea Sansone, Dimitri Yannas, Leonardo Dalla Valentina, Daniele Renda Livraghi, Giorgia Spaggiari, Daniele Santi
  Metabolites.2024; 14(11): 626.     CrossRef
• The role of anti-aging approaches in managing hypogonadism in sedentary older males
  Khaled A. Abdel-Sater
  Frontiers in Aging.2024;[Epub]     CrossRef
• Association between Alcohol Consumption and Body Composition in Russian Adults and Patients Treated for Alcohol-Related Disorders: The Know Your Heart Cross-Sectional Study
  Nikita A. Mitkin, Tatiana N. Unguryanu, Sofia Malyutina, Alexander V. Kudryavtsev
  International Journal of Environmental Research and Public Health.2023; 20(4): 2905.     CrossRef
• Current Status of Korean Alcohol Drinking in Accordance with the Korean Alcohol Guidelines for Moderate Drinking Based on Facial Flushing
  Sami Lee, Jihan Kim, Jong Sung Kim
  Korean Journal of Family Medicine.2023; 44(3): 129.     CrossRef
• Alcohol and Testosterone Deficiency in People Who Experience Facial Flushes
  Jungun Lee
  Korean Journal of Family Medicine.2022; 43(6): 345.     CrossRef

Background
The association between a history of pregnancy and liver fibrosis remains unclear. Herein, we investigated the association between reproductive factors, including a history of pregnancy and liver fibrosis, in postmenopausal Korean women.
Methods
This study used nationally representative, population-based data collected from the Korea National Health and Nutrition Examination Survey 2008–2017. Of 14,624 women with natural menopause, 11,085 with no previous history of any type of cancer, hepatitis, or chronic heavy alcohol consumption were enrolled. We investigated the reproductive factors, including a history of pregnancy, total reproductive years, age at menarche and menopause, and oral contraceptive use. Liver fibrosis was defined as a Fibrosis-4 index score ≥2.67 kg/m².
Results
Of the study participants, 372 (3.3%) had advanced liver fibrosis. Multivariable logistic regression analysis showed that women with a history of more than one pregnancy were associated with a lower risk of liver fibrosis compared to women who had never been pregnant, after adjusting for potential confounders (adjusted odds ratio, 0.30; 95% confidence interval, 0.15–0.59). The risk of liver fibrosis did not increase significantly with an increasing number of pregnancies (P for trend=0.135). Other reproductive factors, including total reproductive years, age at menopause and menarche, and oral contraceptive use, were not significantly associated with liver fibrosis.
Conclusion
Postmenopausal women who had experienced one or more pregnancies had a reduced risk of liver fibrosis. Our findings reveal a potential protective role of pregnancy against liver fibrosis.

Background
This study aimed to evaluate the association between the duration of workplace noise exposure and glucose metabolism status in a nationally representative Korean sample.
Methods
This cross-sectional study included 3,534 participants aged ≥40 years without tinnitus or hearing loss from the Korea National Health and Nutrition Examination Survey (2018). The primary exposure was noise in the workplace and its duration. We divided the noise exposure group into four groups according to the duration of noise exposure (<3 years, 3–10 years, 10–20 years, and ≥20 years). The primary outcomes were fasting blood sugar (FBS), hemoglobin A1c (HbA1c), and pre-diabetes and diabetes diagnosed using FBS. Logistic and linear regression analyses were used to test the association between noise exposure and glycemic status.
Results
After adjustment, HbA1c levels were significantly higher in the noise exposure than in the non-noise exposure group. HbA1c levels were significantly higher in those exposed to occupational noise for more than 20 years than in others. In the subgroup analysis among those who had been exposed to noise for >20 years, the non-aerobic physical activity group had significantly higher HbA1c levels than the physical activity group. Furthermore, among those who had been exposed to noise for >20 years, the without hearing protection group had significantly higher HbA1c levels than those using hearing protection.
Conclusion
The association between noise exposure and the prevalence of diabetes is unclear. However, our study clearly suggests that there is a relationship between elevated HbA1c levels and workplace noise exposure and that a long period of workplace noise exposure, no physical activity, and not wearing a hearing protection device could increase the risk of diabetes.

Citations

• Noise - an insidious stressor affecting xenobiotic metabolism?
  Rosemary Waring, Stephen Mitchell
  Xenobiotica.2025; 55(1): 1.     CrossRef
• Dysregulations of metabolites and gut microbes and their associations in rats with noise induced hearing loss
  Ningning Li, Xiuzhi Zhang, Yanan Cui, Hui Wu, Yue Yu, Shanfa Yu
  Frontiers in Microbiology.2023;[Epub]     CrossRef