• 대한상한금궤의학회지
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• 제6권1호
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• pp.1-25
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• 2014

Objective : The purpose of this study is exploring value of Shanghanlun six diagnostic system as Narrative Medicine by analyzing cases. Methods : In the article, we examined the theory of narrative medicine and current studies. And then key elements of narrative medicine was defined. On the basis of these, two medical cases were analyzed by reordering in accordance with time sequences and causality for confirming narrative factors. Results : The narrative approach to analyzing cases shows us that different diseases could be the result of same pathological patterns based on Shanghanlun. This tells us following four aspects. [1] Shanghanlun is the causes-oriented records and the text includes narrative factors. [2] Shanghanlun six diagnostic system is a process of constructing plot of medical case history through the clinical interpretation of contextual meaning of patient's life. [3] In the process of diagnosis, Schemata and script are engaged in assuming and confirming six patterns diseases. [4] The subjective factors of an individual can be applied universally through the provision of Shanghanlun. Conclusions : Narrative factors of Shanghanlun six diagnostic system suggest the possibility and value of Shanghan Medicine as Narrative Medicine in terms of Medical Humanities, essence of medical diagnosis and therapeutic action.

• 대한한의학원전학회지
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• 제35권4호
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• pp.11-23
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• 2022

Objectives : Recently in the field of medical education, the study of narrative has been gaining much attention. This study examines the Huangdineijing in terms of narrative studies. Methods : The chapter Shanggutianzhenlun, which is narratively sound in its composition, and the chapter Siqidiaoshendalun, whose narrative structure is simple but composed in a way that is difficult to understand were studied. Results : The narrative structure of Shanggutianzhenlun is interrogatory with a main character, making it appropriate for narrative study. However, the Siqidiaoshendalun arranges its content rather simply. Conclusions : The Shanggutianzhenlun needs to be converted into appropriate narrative terminology, while the Siqidiaoshendalun needs narrative supplementation using methods such as visual thinking and mind mapping.

• 대중서사연구
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• 제26권3호
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• pp.291-323
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• 2020

본 논문은 먼저 펠레그리노의 <의철학의 재탄생>에서 강조하는 현대적 의료 윤리의 가치 변화를 고찰하였다. 펠레그리노는 의료인의 윤리에 대한 인문학적 성찰을 강조해온 철학자이다. 그는 현대 사회의 변화에 따라 의료 윤리도 재정립되어야 한다고 주장한다. 이 논문은 펠레그리노의 주장을 바탕으로, 문학과 대중서사텍스트 속에서 문제적 상황을 주목하였다. 실제로 우리를 위해 의료 윤리가 무엇을 답변해야 하는지를 살펴보려 한 것이다. 의료인들은 철학적 딜레마를 겪거나 현실과 윤리 사이의 갈등을 겪어 왔다. 펠레그리노는 의료인은 질병과의 싸움에 앞서, 환자와의 상호작용을 통해 환자의 고통에 공감하고 그 요구에 응답해야 한다고 주장한다. 이것은 매우 당위적인 선언처럼 보이지만, 문학 작품과 대중서사텍스트 속의 의료인들은 이러한 윤리적 딜레마에 자주 노출된다. 이청준의 소설을 통해 의료인이 환자를 어떻게 '좋음'의 상태로 이끌어야하는 지를 성찰할 수 있으며, 메디컬 드라마들을 통해 대중들이 의료인에게 요구하는 윤리적 행위가 무엇인지를 포착할 수 있다. 코로나19로 전세계가 고통을 받고 있는 지금, 의료인들 또한 큰 고난에 처해 있지만, 동시에 대중의 존경을 받고 윤리적 존재로서의 가치를 높이고 있기도 하다. 의료가 일상의 서사가 된 지금, 우리에게 의료 윤리는 삶을 유지하기 위한 필요조건이 되고 있다. 본 논문을 통해, 의료 윤리의 중요성을 다시 인식하고, 의료 서사 속에서 구체화된 윤리적 문제를 성찰적으로 검토하는 의미를 얻을 수 있을 것이다.

• Clinical and Experimental Otorhinolaryngology
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• 제11권4호
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• pp.250-258
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• 2018

Objectives. To compare narrative skills between fourth and fifth grades of Persian-speaking students with hearing impairments and typical hearing students of the same grade and also to evaluate the effects of group, sex, hearing age, and educational grade of the students on their spoken/written narrative performance. Methods. The subjects were 174 students aged 10-13 years, 54 of whom wore cochlear implants, 60 suffered from moderate to severe hearing losses and wore hearing aids, with the remaining 60 students being typical hearing in terms of the sense of hearing. The micro- and macrostructure components of spoken and written narrative were elicited from a pictorial story (The Playful Little Elephant) and then scored by raters. Results. Compared to the typical hearing, the students with hearing impairments had significantly lower scores in all of the microstructure components of narratives. However, the findings showed no significant difference among different groups in macrostructure components of narratives. It was also revealed that the students had equal performance in spoken and written narrative. Finally, factor analysis manifested that group, sex, hearing age, and educational level of children might alter the outcome measures in various interactions. Conclusion. Although cochlear implantation was more effective than hearing aid on spoken and written narrative skills, the Persian-speaking students with hearing impairments were seen to need additional trainings on microstructure components of spoken/written narrative.

• 의학교육논단
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• 제22권3호
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• pp.153-162
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• 2020

The aim of modern medicine is to prolong life by fighting death. Doctors have traditionally believed that this was an ethical good deed. The negative connotation surrounding death has led to the avoidance of terminally ill patients. But in a modern society where death is medicalized, doctors have to see dying patients every day and are in a state of guilt from implementing meaningless life-sustaining treatments. Therefore, medical schools should allow medical students to embrace a new perspective through death education. Yonsei University Medical College has implemented death education since 2017 as an optional class for first and second year medical students. Students watch videos related to death once a week for 6 weeks and submit their reflections by e-mail. The professor reads the students' reflections and gives them weekly feedback. Through this coursework, students realize that death is not a medical event, but rather a part of life and completion. The ultimate purpose of death education is to transform blind life-absolutist identity into narrative identity.

• Restorative Dentistry and Endodontics
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• 제45권2호
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• pp.21.1-21.12
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• 2020

The aim of this article was to review age-dependent clinical recommendations for appropriate root canal instrumentation techniques. A comprehensive narrative review of canal morphology, the structural characteristics of dentin, and endodontic outcomes at different ages was undertaken instead of a systematic review. An electronic literature search was carried out, including the Medline (Ovid), PubMed, and Web of Science databases. The searches used controlled vocabulary and free-text terms, as follows: 'age-related root canal treatment,' 'age-related instrumentation,' 'age-related chemo-mechanical preparation,' 'age-related endodontic clinical recommendations,' 'root canal instrumentation at different ages,' 'geriatric root canal treatment,' and 'pediatric root canal treatment.' Due to the lack of literature with practical age-based clinical recommendations for an appropriate root canal instrumentation technique, a narrative review was conducted to suggest a clinical algorithm for choosing the most appropriate instrumentation technique during root canal treatment. Based on the evidence found through the narrative review, an age-related clinical algorithm for choosing appropriate instrumentation during root canal treatment was proposed. Age affects the morphology of the root canal system and the structural characteristics of dentin. The clinician's awareness of root canal morphology and dentin characteristics can influence the choice of instruments for root canal treatment.

• 의학교육논단
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• 제21권2호
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• pp.92-99
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• 2019

The aim of this study was to use narrative inquiry to explore the experiences of medical students who faced expulsion, military service, and readmission, and their journeys of identity formation. Three medical students were recruited via snowball sampling, and each participant was interviewed twice. According to the sequence of experiences, their stories were summarized as follows: the process of being expelled, the military service experience and readmission process, and the present. Before all three students were expelled, they lived dissolute lives free of concern from the entrance examination and failed to cope well with dropping out. They felt that military experience had helped them develop interpersonal skills in the clinical setting and the strength to withstand a difficult crisis. Two students were motivated to become doctors after military service, but the other was not. They had reflected deeply over their unique experiences. The scars imprinted from their experiences became a means of stimulation, and they ultimately acquired the resilience and ability to accommodate for and counteract their weaknesses. This appears to have been an important influence on their identity formation. The narrations of their rare experiences can help medical educators more fully understand and support medical students through difficulties, specifically with regard to academic failure or expulsion. These findings may prompt medical professors to think about the kind of guidance or motivation that could help students before expulsion, rather than assuming that they are simply lacking academic ability.

• 대한의료기공학회지
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• 제22권1호
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• pp.1-27
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• 2023

Objective : This paper provides a narrative review of the research literature on the neurophysiological and neurochemical mechanisms of local vibration while studying the treatment principles and mechanisms of Whidam's vibrator Sugi therapy. Methods : Searches related to vibration therapy research were conducted in PUBMED using "Vibration", "Whole Body Vibration", "Localized Vibration", and "Focal Vibration". The Conditions were limited to review and systematic review. Results : Roberto Casale's paper was selected as an inquiry task and reviewed critically and narratively by referring to other papers. The stimulation process of local vibration (LV) was broadly classified into receptor transmission (pain reception phase), ascending sensory pathway to the spinal cord (segmental phase), and action of the cortex and subcortical structures (systemic control phase) according to the pain pathway. In addition, the role of C-tactile mechanoreceptors, changes in neurotransmitters and neurohormones, LV stimulation below perception threshold (lower threshold), pain control and kinesiologic illusions were specially addressed. In addition, the expression and function of Piezo Channels were added to supplement the human pain and tactile sensing mechanism. Conclusions : LV exerts pain control mechanisms through different interactions that can interfere with pain transmission and pain perception. Since LV provides sufficient neurophysiological reasons for clinical application, it is necessary to expand the use of Whidam's vibrator Sugi therapy to a wider range of clinical applications.

• 성인간호학회지
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• 제24권4호
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• pp.358-369
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• 2012

Purpose: This study was performed to compare the costs of nursing interventions implemented for the obstetrical and gynecological patients using Korean Reimbursement System and ABC codes system developed in the US for costing out interventions performed by health care professional. Methods: First, the narrative data on nursing interventions were extracted from electronic medical record system of a tertiary university and mapped with Nursing Intervention Classification (NIC) by two researchers until 100% consent was reached. Narrative nursing interventions mapped with NIC were then remapped with ABC codes system using the electronic program developed in the research. The mapping data were analyzed with real numbers, frequency, percentage, mean, and standard deviation. Results: More nursing interventions were mapped with ABC codes than Korean reimbursement system. Total of 97 different types of narrative interventions could be mapped with NIC, 43 NIC interventions could be reimbursed by ABC code but only 16 NIC interventions were reimbursed by Korea Reimbursement System. Conclusion: Korean medical insurance fee system needs amendment to include more comprehensively interventions performed by nurses which are very important to patient outcomes. Further study is needed to develop strategies to costing out nursing interventions.

• 국제교류와 융합교육
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• 제1권1호
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• pp.1-12
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• 2021

본 연구는 외국인 환자의 국제진료에 대한 내러티브를 통한 의료인문학 교육과정의 적용 가능성에 대한 연구이다. 내러티브를 분석한 결과 첫째, 한국의 의료시스템과 수준은 세계적인 수준이며, 환자 진료를 위한 지식과 술기가 충분하다는 것을 알 수 있었고, 둘째, 한국의 의사상에서 강조하는 환자 진료에 대한 역량이 충분하다는 것을 알 수 있었다. 셋째, 한국의 의사상의 사회적 책무성 측면에서 봉사활동의 중요성을 알고 이러한 봉사활동을 의과대학 교육부터 체득화되고, 또한 다양한 문화권의 의료 현장 경험을 통하여 봉사활동은 의사로서 평생 할 수 있는 일로 이어지는 것이 중요함을 알 수 있다. 전문직업성 영역에서는 의사로서 프로페셔널리즘을 발현할 수 있었고, 모든 과정에서 의료진들은 환자의 아픔을 이해하고, 공감하여 환자에게도 진심이 전달되었음을 알 수 있었다, 전문직업성은 최근 더욱 강조되고 있는 영역으로 의과대학 교육뿐만 아니라, 의사들에게도 전문직업성에 대한 교육적 기회를 제공하는 것이 필요하다. 이러한 국제진료 경험은 의과대학 의료인문학 교육과정에 적용 가능하며, 6년 교육과정 전체에 조화와 통합된 의료인 문학 교육과정이 운영될 수 있다.