Korean Medicine Clinical Practice Research Articles

Exploring Korean Medicine professions' perspectives on the applicability of ChatGPT in facial palsy practice: A web-based survey

IntroductionSince November 2022, when Chat generative pre-trained transformer (ChatGPT) was released, studies have been conducted to explore its potential use in various text-based areas. In the field of Korean Medicine (KM), studies evaluating the feasibility of ChatGPT are mainly focused on the educational domain. This study aimed to 1) identify the current level of ChatGPT-generated responses in answering questions from patients and KM practitioners, specifically exemplified by facial palsy and 2) explore the potential applicability of ChatGPT in KM practice through a perception survey of experts. MethodsThis study evaluates the applicability of ChatGPT concerning facial palsy through a survey of board-certified acupuncturists. The survey comprises two parts: assessing response quality for patients and for KM doctors in clinical practice. Ethical approval was obtained, and a 36-item questionnaire was administered online to 33 participants. Responses were analyzed for quality, relevance, and applicability using a combination of Likert scales and a standardized assessment tool. ResultsAmong 33 eligible participants, 30 board-certified acupuncturists agreed to participate (response rate: 90.9%). Survey results showed that the applicability of ChatGPT was lower for specialized KM practitioner inquiries than for general patient inquiries. Although the responses were considered useful to the readers (part 1: 96.7%, part 2: 63.3%) and understandable (part 1: 66.7%, part 2: 60%), the proportion of positive evaluations was relatively low in the domains assessing reliability and sufficiency. ConclusionsThough ChatGPT is generally viewed positively for its potential utility, its direct application in KM clinical practice treating facial palsy at its current level seems challenging. To improve reliability, the information generated by ChatGPT should be critically reviewed by qualified expert medical personnel. To enhance sufficiency, further training of the artificial intelligence model with additional KM information is required.

Resident Perceptions of Competency-Based Korean Medicine Education: A Qualitative, Content Analysis Study Conducted using Focus Group Interviews

Objectives: The new educational system emphasizes acquisition of clinical competency by the time of graduation from Korean medicine colleges that allow Korean medicine doctors to immediately perform clinical tasks. This study investigated awareness of competency-based education in Korean medicine hospital residents who must simultaneously undergo training and assist medical students in clinical practice.Methods: This was a qualitative research that was conducted using focus group interviews (FGIs) to investigate the awareness of demands for improvement in competency-based Korean medicine education in Korean medicine hospital. To apply the principles and procedures of FGIs, a semi-structured questionnaire was developed. Data analysis was conducted using the five steps of framework analysis.Results: According to contents analysis, first competency-based education that reflects actual clinical practice tasks is needed. Second, sufficient basic skill mastery education must be reinforced. Third, an intermediate curriculum that mediates clinical practice and basic education is needed. Fourth, the Objective Structured Clinical Examination and Clinical Performance Examination must be expanded to prepare for the Korean medicine doctor practical test.Conclusions: Korean medicine residents reported the gap between clinical practice and use of knowledge and skills acquired in the curriculum while acting as direct observers and educations of clinical clerkship in hospitals. Based on this exploratory study it is necessary to conduct research on the educational competency of Korean medicine residents who play an important role as educational leaders in Korean medicine clinical practice training.

Research Trends of Pharmacopuncture: a bibliometric analysis using VOSviewer (2007-2023).

Pharmacopuncture is considered a unique new type of acupuncture in Korean medicine (KM). This study was performed to investigate the research trends regarding pharmacopuncture through a bibliometric analysis using VOSviewer. The Web of Science Core Collection was searched for this study. The search terms were pharmacopuncture and pharmaco-puncture. The search was conducted on May 23, 2023, and 185 studies retrieved up to this date were included. Software VOSviewer version 1.6.19 was used to perform the bibliometric analysis. After data clearing, keyword co-occurrence and cooperation pattern analyses were performed. The number of studies on pharmacopuncture have gradually increased since the mid-2000s, with the most published in 2020 (46 studies). The quality of the studies has also steadily increased, and recently, several randomized controlled trials of pharmacopuncture have been conducted. Moreover, this treatment has been investigated in the context of KM clinical practice guideline development in Korea. The scope of pharmacopuncture studies to date seems to be limited to musculoskeletal pain and bee venom pharmacopuncture. The researchers from Jaseng Medical Foundation have been the core researchers in the field of pharmacopuncture in Korea. They collaborated with researchers from universities or government-funded research institutes. However, small-scale research teams from KM clinics and university researchers were also identified as independent clusters. Pharmacopuncture research has grown both quantitatively and qualitatively, but the scope needs to be further expanded. There is also a gap between the use of pharmacopuncture by KM doctors in clinical settings and pharmacopuncture research. Based on these findings, some suggestions for future studies in this field are discussed. Furthermore, these findings may be used as data to expand and globalize pharmacopuncture research in the future.

Clinical Practice Patterns for Benign Prostatic Hyperplasia: An Online Survey

Objectives: This study investigated Korean medicine doctors’ perspectives on clinical practice patterns in the process of developing Korean medicine clinical practice guidelines for benign prostatic hyperplasia.Methods: A questionnaire was developed for Korean medicine doctors. A total of 323 oriental medicine doctors participated in the survey, which was live for a total of 9 days from September 22, 2022, to September 30, 2022.Results: Regarding awareness of treatments for benign prostatic hyperplasia, 63.8% of respondents showed high awareness of Korean medical treatments. However, items such as diagnostic criteria (17.7%), evaluation methods (17.0%), and Western medical treatments (22.9%) showed low recognition rates. In clinical practice, 76.2% of respondents were found to treat five or fewer patients with benign prostatic hyperplasia per month, and the average treatment period was 1 to 3 months for most at 41.2%. Korean medicine doctors diagnosed benign prostatic hyperplasia based on clinical features. The main interventions used were acupuncture, herbal medicine (prescription medicine), and moxibustion. This study has several limitations because of the low response rate for this survey; therefore, the participants are not representative of all Korean medicine doctors. In addition, because the study was conducted broadly on various topics related to benign prostatic hyperplasia, sufficient quality management was not carried out. Further studies that include a larger sample size and more in-depth studies on benign prostatic hyperplasia are needed.Conclusions: It is necessary to develop appropriate and reasonable Korean medicine clinical practice guidelines for benign prostatic hyperplasia.

Korean Medicine Clinical Practice Guideline Update for Temporomandibular Disorders: An Evidence-Based Approach.

Many updated clinical research results have been published since the Korean Medicine Clinical Practice Guidelines (KMCPGs) for temporomandibular disorders (TMDs) were published in 2018. Therefore, it is necessary to update the existing clinical practice guidelines (CPGs). This study presents updated recommendations for TMD treatment based on current research data published up to February 2020. The draft version of the level of evidence and grade of recommendation was determined through an assessment of the risk of bias and a meta-analysis of selected literature based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The final guidelines were derived using the Delphi method. Eighteen recommendations were derived for eight items of Korean medicine treatment for TMDs. Compared with previous Korean medicine CPGs for TMDs, the grades of seven recommendations, including acupuncture, pharmacopuncture, and Chuna manual therapy, were increased. The grades of the two recommendations have been changed. Six new recommendations were added to fully reflect clinical reality. Acupuncture, pharmacopuncture, and Chuna manual therapy are recommended for TMD patients in clinical practice. Concurrent conventional conservative therapy with Korean medicine or a combination of Korean medicines should be considered in clinical practice in patients with temporomandibular disorders.

A Survey on Korean Medicine Doctors’ Recognition for Developing Korean Medicine Clinical Practice Guidelines for Gastric Cancer

Objective: The purpose of this study was to provide data for the development of Korean medicine (KM) clinical practice guidelines (CPG) for gastric cancer (GC) by identifying the awareness and knowledge needs of KM doctors (KMD) through an online survey.Methods: A survey questionnaire was produced by referring to the previous recognition survey studies for clinical KMDs. The survey questionnaire was composed of questions regarding the current status of clinical care for GC, the knowledge level of clinicians about GC, and other details that clinicians use during practice. The survey was conducted from September 20 to October 22, 2021. An online survey was conducted with 195 KMDs from the Society of Korean Medicine and the Korean Association of Traditional Oncology of KM.Results: A total of 195 respondents participated in the online survey regarding the current status of GC treatment. Of this number, 10.3% of the respondents specialize in GC, but even if they do not currently specialize in GC, they are more likely to treat patients with GC in the future. In terms of the specifics of KM treatment, there was a demand for information on comprehensive KM treatment methods, such as herbal medicine, acupuncture, moxibustion, cupping, and chuna, as well as on analyzing the effectiveness of combined treatment with chemotherapy and radiation.Conclusion: In this study, we were able to understand the clinical KMDs’ perception of GC, knowledge level, and requirements in the CPG. The results of this study will provide the basic data for the development of CPG for GC.

National Health Insurance Data Analysis for the Second-Wave Development of Korean Medicine Clinical Practice Guidelines in South Korea

National Health Insurance Data Analysis for the Second-Wave Development of Korean Medicine Clinical Practice Guidelines in South Korea

Recent applications of Kampo treatment for neurological diseases

AbstractBackgroundAlthough various new drugs have been developed for neurological diseases, many diseases have no effective treatment or only inadequate efficacy. Here we introduce some examples of effective Kampo treatment.Key Findings(1) Parasomnia in the elderly is preceded by the onset of diffuse Lewy body disease, with symptoms such as nightmares and loud screaming in the middle of the night. Keishikaryukotsuboreito (KSTRB), indicated in the classics for treating parasomnia, was effective in alleviating the symptoms. KSTRB is also used for enuresis that persists into adulthood. (2) Chronic subdural hematomas (CSDHs), treated by hematoma removal with burr‐hole surgery, recur at a rate of up to 20%. Goreisan (GRS) reduces hematoma volume and prevents postoperative CSDH recurrence. Homogeneous CSDH was most responsive to GRS in preventing recurrence. (3) Migraine frequently interferes with daily life. Keishibukuryogan (KBG), which alleviates blood stasis, was effective for patients with both menstruation‐associated migraine and scintillating scotomas. (4) Many traditional herbal medicines are listed in the Korean Medicine Clinical Practice Guideline for Stroke in Korea. Chunghyuldan, a related formula of Orengedokuto (OGT), is mainly used to prevent stroke.ConclusionKampo medicine is being applied in new and effective ways to treat various neurological diseases. Hopefully, more clinicians will recognize the usefulness of such Kampo medicines and utilize them in their daily practice.

Current Status of Korean Medicine Treatment for Post-acute COVID-19 Syndrome: A Survey of Korean Medicine Doctors

Background: The applicability of Korean medicine (KM) treatments for post-acute COVID-19 syndrome were investigated.Methods: A cross-sectional, web-based survey of Korean medical doctors (KMDs) was conducted in June 2022. The 25-item questionnaire comprised of five parts: basic characteristics, prescribed post-COVID-19 KM treatments, treatment effect in patients with post-acute COVID-19 syndrome, patient satisfaction, and awareness and utilization of the relevant KM Clinical Practice Guideline by the KMDs.Results: In total, 1,063 completed questionnaires were collected, and 822 were analyzed. The most common symptoms in patients with post-acute COVID-19 syndrome treated by KMDs was weakness and fatigue (84.3%). Herbal decoctions (39.2%) and herbal powder (not covered by medical insurance; 25.8%) were primarily used. Among the KMDs, 95% (n = 781) responded that KM treatments, particularly herbal decoctions (82.6%) and herbal powder (not covered by medical insurance; 46.8%), were effective. Overall, 92.6% (n = 761) of KMD participants answered that the patients were satisfied with KM treatments, mostly due to symptomatic improvement (60.8%). The primary reason for dissatisfaction was the burden of cost for patients (78.4%). The main reasons for low uptake of KM services by patients with post-acute COVID-19 syndrome were lack of publicity and administrative issues such as no health insurance coverage.Conclusion: KM is highly applicable for post-acute COVID-19 syndrome. Health policies supporting the use of KM for post-acute COVID-19 syndrome are recommended.

A Survey on Korean Medicine Doctors’ Recognition and Treatment for Developing Korean Medicine Clinical Practice Guideline of Female Infertility

Objectives: This study was conducted to develop a Korean Medicine(KM) Clinical Practice Guidelines(CPG) of female infertility. We conducted this questionnaire survey to reflect the experiences of Korean Medicine doctors(KMD) and clinical field in Korea.Method: We sent a questionnaire survey to KMD belonging to the Association of Korean Medicine by e-mail. We received 665 responds, and analyzed the answers.Results: 51.2% of respondents knew the previously developed CPG of female infertility, and 18.3% actually used. 83.3% agreed about the necessity of CPG of female infertility, and 80.3% had practical use plan. 90.2% of respondents treated less than 5 infertility woman for a month. 22.7% of respondents treated 50% of patients with collaborative treatment of KM and Western medical treatments. The main age group of patients was ‘35~40 years’(54.7%), and the most common cause was unexplained infertility(61.7%). The most common pattern identification of female infertility patients was Kidney deficiency(55.4%). KMD used 'a combination of decoction of herbal medicine, acupuncture and moxibustion treatment' the most(43%), and 'a decoction of herbal medicine treatment alone' was next(35%). 84.2% conducted lifestyle modification education about diet, stress, exercise etc.Conclusion: We figured out Korean Medicine doctors' recognition about CPG of female infertility, preference of treatments, and also characteristics of patients visiting Korean Medical clinics to make a practical CPG reflecting clinical situation.

Adaptation and Dissemination of Korean Medicine Clinical Practice Guidelines for Traffic Injuries.

In South Korea, car insurance that includes medical coverage of traditional Korean medicine (TKM) has increased exponentially. Clinical practice guidelines (CPG) for traffic injuries were established in 2016. We aimed to revise and update de novo CPG and distribute the adapted CPG to TKM practitioners and patients. Clinical key questions from previous CPG were identified and updated regarding the grade of recommendation and level of evidence using additional evidence from the literature obtained through a systematic search and the use of the Grading of Recommendations Assessment, Development, and Evaluation methodology. The dissemination and implementation of the updated CPG were conducted at the CPG Center of Korean Medicine. Ultimately, 25 recommendations based on 13 clinical key questions were developed: 2 for diagnosis, 22 for TKM treatments, and 1 for prognosis. After recognition by professional societies and certification by the CPG Center of Korean Medicine, leaflets, card news, and infographics for TKM doctors in South Korea were produced and distributed. These are the only TKM CPG for patients who have experienced traffic injuries. They are expected to contribute to standardized and evidence-based treatment using TKM and similar interventions. Moreover, disseminating the adapted CPG will promote treatment reliability and strengthen insurance coverage.

Disease-based evidence map for the second-wave development of evidence-based Korean medicine clinical practice guidelines in Korea

Disease-based evidence map for the second-wave development of evidence-based Korean medicine clinical practice guidelines in Korea

A study on the current state of Korean medicine treatment in infertile women: an observational multi-center study protocol

Objectives: The purpose of this study is to investigate the characteristics of female infertility patients who come to Korean medicine clinics and analyze the trends of Korean medicine treatment methods and the effects of female infertility by registry data.Methods: We are recruiting study participants from Korean medicine hospitals and clinics. If female infertility patients come, we will ask them to register for this study. After enrollment, we will collect demographic information, treatment methods, pregnancy results, adverse events, and treatment costs.Result: First, we will analyze the characteristics of patients, the status of the use of Korean medicine treatment interventions, the cost status of Korean medicine infertility treatment, and the delivery characteristics of pregnant women after Korean medicine treatment. Second, we will analyze the effectiveness of Korean medicine treatment. The primary outcome is clinical pregnancy rate, and secondary outcomes are 12-week pregnancy maintenance rate, degree of dysmenorrhea and premenstrual syndrome, stress level, and health-related quality of life score.Discussion: This study is the first observational multi-center study in Korea for female infertility. By establishing the registry, we are creating a resource that contains patient-reported outcome measures for female infertility. The registry is expected to provide valuable data for developing Korean medicine Clinical practice guidelines for female infertility.

Korean Medicine Clinical Practice Guidelines for Lumbar Herniated Intervertebral Disc in Adults: Based on Grading of Recommendations Assessment, Development and Evaluation (GRADE).

A significant number of individuals suffer from low back pain throughout their lifetime, and the medical costs related to low back pain and disc herniation are gradually increasing in Korea. Korean medicine interventions have been used for the treatment of lumbar intervertebral disc herniation. Therefore, we aimed to update the existing Korean medicine clinical practice guidelines for lumbar intervertebral disc herniation. A review of the existing guidelines for clinical treatment and analysis of questionnaires targeting Korean medicine doctors were performed. Subsequently, key questions on the treatment method of Korean medicine used for disc herniation in actual clinical trials were derived, and drafts of recommendations were formed after literature searches using the Grading of Recommendations, Assessment, Development and Evaluation. An expert consensus was reached on the draft through the Delphi method and final recommendations were made through review by the development project team and the monitoring committee. Fifteen recommendations for seven interventions for lumbar disc herniation were derived, along with the grade of recommendation and the level of evidence. The existing Korean medicine clinical practice guidelines for lumbar intervertebral disc herniation have been updated. Continuous updates will be needed through additional research in the future.

A Survey on the Clinical Practice Patterns of Irritable Bowel Syndrome in Korean Medicine

Objective: This study investigated the perception, diagnosis, and treatment of irritable bowel syndrome (IBS) in the general population, in patients, and in Korean medicine doctors (KMDs) in order to provide basic information for the development of Korean medicine clinical practice guidelines for IBS.Methods: A questionnaire was developed in two versions, one for the general population/patients and one for KMDs. The questions were about the general perception, diagnosis, and treatment of IBS. Both online and offline surveys were conducted using these questionnaires.Results: In total, 213 general population/patients and 435 KMDs responded to the survey. The results of the analysis were as follows. Most of the KMDs diagnosed IBS based on clinical aspects. Acupuncture was the most common treatment, followed by prescription herbal medicine, moxibustion, and manufactured herbal medicine. 34.3% of KMDs used clinical practice guidelines for IBS patient treatment. 57.8% of patients were diagnosed with IBS by doctors at primary medical institutions, and 53.1% were diagnosed with colonoscopy. More than half of the IBS patients who have been treated with Korean medicine said they experienced improvement of symptoms and prevention of recurrence, but more than 70% of the respondents said future safety and effectiveness studies of Korean medicine were needed.Conclusions: In spite of the positive perception of IBS treatment with Korean medicine, actual utilization was relatively low. The development and promotion of, as well as education about, appropriate and reasonable Korean medicine practice guidelines for IBS is necessary.

Comparative Efficacy of Jaungo, A Traditional Herbal Ointment, and the Water-in-Oil Type Non-Steroidal Moisturizer for Radiation-Induced Dermatitis in Patients With Breast Cancer: A Study Protocol for a Prospective, Randomized, Single-Blinded, Pilot Study.

Background: Radiation-induced dermatitis (RID) is a common complication of radiation therapy (RT). Although it has a high prevalence and can even trigger the premature end of conventional cancer therapies, there is no standard management. This study aims to evaluate whether topical use of Jaungo (Shiunko), a traditional herbal ointment mainly composed of Lithospermi radix and Angelica sinensis, could reduce RID compared to the water-in-oil type non-steroidal moisturizer in patients with breast cancer.Methods: This is a prospective, single-blinded, randomized controlled pilot trial that investigates the effect of topical application of Jaungo for the prevention of RID in postoperative breast cancer patients scheduled for RT, in comparison with the non-steroidal moisturizer, with a random distribution of 50 patients across the two groups. RT will be administered for 5–7 weeks with a biological equivalent dose (BED10) of 60 Gy or more, and the interventions will be applied 3 times a day during RT duration. Participants will be assessed a total of nine times, including eight visits during the period of RT and one visit at a 2-week follow-up period after the end of treatment. The incidence and severity of RID, quality of life, skin reaction symptoms, and maximum pain related to RID will be measured. The incidence rate of grade 2 or higher RID using the Radiation Therapy Oncology Group (RTOG) in the two groups will be statistically compared as the primary outcome. The types and frequencies of adverse events will be also collected and evaluated. All assessments will be performed by independent radiology oncologists.Discussion: This trial is currently ongoing and is recruiting. This study will determine the preventive efficacy of Jaungo in RID with postoperative breast cancer patients and provide evidence in traditional Korean medicine clinical practice.

How can the perceptions of Korean medicine doctors aid clinical practice guidelines for patients with degenerative lumbar spinal stenosis?: a cross-sectional survey

IntroductionThis study aimed to investigate the perception of Korean medicine (KM) doctors regarding the treatment of degenerative lumbar spinal stenosis (LSS) and explore their opinions on the core clinical questions (CQs) of KM clinical practice guidelines (CPGs) for patients with degenerative LSS. MethodsAn online cross-sectional survey distributed via e-mail was conducted in December 2016. The study population included registered KM doctors (KMDs) in South Korea. The e-mail contained 13 questionnaire items regarding the doctors’ demographic characteristics and perceptions of the core CQs that should be addressed in CPGs for patients with degenerative LSS. Descriptive analyses were performed to summarize the data. ResultsA total of 680 KMDs responded to the survey. Kidney qi deficiency was the most commonly used diagnostic name for degenerative LSS. Acupuncture ranked first in the treatment used for degenerative LSS and in the treatment desired to be included in the development of CPG recommendations. Ojeok-san (积散, 積散, Wuji-san, Goshaku-san) was the number one herbal medicine, and 5% bee venom pharmacopuncture was the number one pharmacopuncture technique used for degenerative LSS. Drug therapy was the most selected control treatment considered appropriate to assess treatment effectiveness and safety. Pain relief was the most chosen indicator among the indicators considered reasonable to assess therapeutic effectiveness. ConclusionResults of this study are expected to inform the development of key CQs of the KM standard CPG for degenerative LSS. The involvement of KMDs in the CPG development process can help develop useful and available CPGs.

A study on the effectiveness of pharmacopuncture for chronic neck pain

Neck pain is a common musculoskeletal disorder that impacts individuals' daily life, and might sometimes lead to disability and increased medical costs. Pharmacopuncture combines acupuncture with herbal medicine, in which herbal extracts are administered on the acupoints. We designed a pragmatic randomized controlled trial (RCT) to compare the effectiveness of pharmacopuncture and physical therapy as a treatment for chronic neck pain. This study is a 2-armed, parallel, multi-center RCT. The participants will be randomly assigned to pharmacopuncture or physical therapy group to receive their respective 8-session treatments for 4 weeks. The primary outcome is the visual analogue scale of neck pain. Secondary outcomes is the Northwick Park questionnaire, visual analogue scale of radiating arm pain, numeric rating scale of the neck and arm bothersomeness, neck disability index, patient global impression of change, short form-12 health survey version 2, and 5-level EuroQol-5 dimension. This is a protocol for a pragmatic RCT that would attempt to present evidence conducive to clinical decision or policy-making by investigating the effectiveness of pharmacopuncture therapy, a widely used approach in Korean medicine clinical practice, in comparison to the standard therapy.

Strategies to revise the Korean Medicine Clinical Practice Guideline for lumbar herniated intervertebral disc—A web based approach

IntroductionLumbar herniated intervertebral disc (LHIVD) is a common musculoskeletal disorder and in Korea, affected patients often consult traditional Korean Medicine (TKM) practitioners. The ‘Korean Medicine Clinical Practice Guideline (KM-CPG) for LHIVD’ was developed in 2015 to help the evidence-based decision-making of clinical practitioners and patients. The aim of this study was to investigate opinions of TKM doctors on the KM-CPG for LHIVD and whether it had been implemented in order to use this information to establish a strategy for revision. MethodsA questionnaire was developed consisting of 17 items which included: demographic characteristics; awareness, utilization status, and directions to improve of the KM-CPG for LHIVD; and clinical treatment status. The questionnaire was sent via e-mail to 18,334 TKM doctors. ResultsA total of 373 respondents answered the questionnaire, of whom 95.4 % were clinical practitioners. 258 respondents (69.2 %) did not recognize the KM-CPG for LHIVD, and reported they had been unaware of the guideline due to lack of publicity (n = 236, 63.3 %) and this was the most frequent response regarding why this had been an obstacle to its use. Of the 115 participants who knew the guideline existed, 40.9 % gave a negative answer about its actual utilization in clinical practice. The main recommendations for improvement of the KM-CPG by respondents were to: include recommendations on diagnosis and prognosis, identify excluded interventions, and refine or upgrade recommendations through evidence-based research. ConclusionIn order to develop KM-CPG for LHIVD with high utilization, it is necessary to conduct clinical research for producing the evidence that could supplement previous recommendations, as well as raising awareness through a dissemination strategy.

A Survey on Patient's Experience on Health Care Utilization and Perception of Health Care System for Developing of a Korean Medicine Clinical Practice Guideline for Traffic Injuries

A Survey on Patient's Experience on Health Care Utilization and Perception of Health Care System for Developing of a Korean Medicine Clinical Practice Guideline for Traffic Injuries