• 제목/요약/키워드: Narrative medicine

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의학과 신학의 융합 교육과정 개발, 의료선교의 역사적 사례, 연구개발 성과에 관한 연구 (The Design of Convergence Curriculum, the Historical Case of Medical Mission and the Research Initiative Outcome of Medicine and Theology)

  • 손문
    • 기독교교육논총
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    • 제65권
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    • pp.133-161
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    • 2021
  • 이 연구는 코로나-19 펜데믹의 상황 속에서 우리 사회의 취약성에 주목한다. 중증호흡기증후군 코로나바이러스 2019는 사스-코비드-2 바이러스의 심각성을 파생하고 그것의 의학적 치료 속에서 새로운 회복 탄력성의 희망을 제공한다. 이에 더하여, 기독교 여성실천신학의 생태적 관계 속에서 사회와 환경의 지속가능한 회복 가능성을 제공한다. 연구자는 코로나-19 시대의 침체와 우울감을 절망과 통합의 기독교교육적 내러티브 속에서 해석학적 대안으로 제안한다. 특히 의학과 신학의 융합교육 과정 개발은 노인세대를 위한 의료선교와 코로나-19 시대의 새로운 교육적 모형으로 제네바대학교가 제공하는 역사적 사례로서 칼빈의 MOOC 강좌를 사례를 통해 제공된다. 이와 같은 의학과 신학의 융합 교육과 연구의 개발 성과는 코로나-19의 심각성을 극복하며 신앙공동체의 새로운 회복과 복지를 위한 기독교교육의 도덕적 함의를 제공함으로 의미 있는 공헌을 하게 된다.

보완대체의학에 대한 대학생의 인식 및 적용요인에 관한 연구 (Recognition and Application Factors of College Students on Complementary and Alternative Medicine)

  • 정미라;조승아;백대진
    • 한국융합학회논문지
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    • 제8권12호
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    • pp.417-423
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    • 2017
  • 본 연구의 목적은 대학생들을 대상으로 보완대체의학에 대한 인식 및 적용요인, 적용실태, 성별에 따른 만족도, 유용성에 관한 연구로 추후 보완대체의학의 활용방안을 마련하고자 시도되었다. 본 연구는 충남에 소재한 H대학교 대학생들을 대상으로 한 서술적 조사 연구이다. 본 연구 결과 인식, 적용요인 및 실태로는 보완대체의학을 현대의학의 보조 수단으로 인식한 응답이 150명(50.3%), 적용요인으로 정신적 심리적 안정감이 61명(20.3%), 적용질환으로는 근골격계 질환자가 101명(33.7%)으로 가장 높게 나타났으며, 성별에 따른 보완대체의학에 대한 만족도에서는 여성이 남성보다 높게 나타났다. 보완대체의학의 유용성 적용 시 장점은 2.60이었으며, 개선점과 특징은 2.32, 일반적 인식은 2.80을 보여 유용성에 대한 지식수준이 낮은 것으로 나타났다. 본 연구결과 사회의 기반이 되는 대학생들의 질병예방과 건강유지를 위하여 보완대체의학의 올바른 인식 보급이 필요하다. 또한 보완대체의학의 인식과 적용요인, 성별에 따른 만족도를 분석한 결과 향후 보완대체의학 프로그램 개발을 위한 정보로 제시할 수 있을 것이다.

Strategies for Managing Dementia Patients through Improving Oral Health and Occlusal Rehabilitation: A Review and Meta-analysis

  • Yeon-Hee Lee;Sung-Woo Lee;Hak Young Rhee;Min Kyu Sim;Su-Jin Jeong;Chang Won Won
    • Journal of Korean Dental Science
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    • 제16권2호
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    • pp.128-148
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    • 2023
  • Dementia is an umbrella term that describes the loss of thinking, memory, attention, logical reasoning, and other mental abilities to the extent that it interferes with the activities of daily living. More than 50 million individuals worldwide live with dementia, which is expected to increase to 131 million by 2050. Recent research has shown that poor oral health increases the risk of dementia, while oral health declines with cognitive decline. In this narrative review, the literature was based on the "hypothesis" that dementia and oral health have a close relationship, and appropriate oral health and occlusal rehabilitation treatment can improve the quality of life of patients with dementia and prevent progression. We conducted a literature search in PubMed and Google Scholar databases, using the search terms "dementia," "major neurocognitive disorder," "dentition," "occlusion," "tooth loss," "dental prosthesis," "dental implant," and "occlusal rehabilitation" in the title field over the past 30 years. A total of 131 studies that scientifically addressed dementia, oral health, and/or oral rehabilitation were included. In a meta-analysis, the random effect model demonstrated significant tooth loss increasing the dementia risk 3.64-fold (pooled odds ratio=3.64, 95% confidence interval [2.50~5.32], P-value=0.0348). Tooth loss can be an important indicator of cognitive function decline. As the number of missing teeth increases, the risk of dementia increases. Loss of teeth can lead to a decrease in the ascending information to the brain and reduced masticatory ability, cerebral blood flow, and psychological atrophy. Oral microbiome dysbiosis and migration of key bacterial species to the brain can also cause dementia. Additionally, inflammation in the oral cavity affects the inflammatory response of the brain and the complete body. Conversely, proper oral hygiene management, the placement of dental implants or prostheses to replace lost teeth, and the restoration of masticatory function can inhibit symptom progression in patients with dementia. Therefore, improving oral health can prevent dementia progression and improve the quality of life of patients.

$\ll$대한침구학회지$\gg$ 개선에 대한 전략적 방향 (Strategic Directions for the Improvement of Journal of Korean Acupuncture and Moxibustion Society)

  • 송호섭
    • Journal of Acupuncture Research
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    • 제27권4호
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    • pp.147-178
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    • 2010
  • Objectives : This study was to propose the improved instruction for authors and research ethic regulations by the comparative analysis of those of the domestic journals, for the purpose of enhancing the citation rate of Journal of Korean Acupuncture and Moxibustion Society. Methods : Narrative review method was used for comparatively analyzing instruction for authors of 34 domestic journals, especially focused on how to write a reference. Thereafter, in order to elucidate the drawbacks of current instruction for authors and research ethic regulations of the acupuncture and moxibustion society, the well prepared instructions and research ethic regulations was selected from them, which were compared with the present instructions for authors and research ethic regulations of the acupuncture and moxibustion society. Results : As a result of the comparative analysis of instruction for authors in the 34 domestic journals, style for references was based largely on that of National Library of Medicine and vancouver at the same time. The number of reference was limited according to types of writings. for example, the original article and case report was frequently limited to 40 and 20 references respectively. Authors were mostly listed up to six. If there are more, the first three or six authors were listed with 'et al'. it was generally recommended that using abstracts as references should be avoided and References to papers accepted but not yet published should be designated as 'in press' or 'forthcoming', and that the names of journals should be set in italics and abbreviated according to the List of Journals Indexed for Medline (formerly Index Medicus) published by the National Library of Medicine or koreanmed or WHO-IST, etc. In addition, citation of electrical literature, English writing of reference and obligational citation of more than two articles in the journals were encouraged. In consequence of comparison between well prepared instructions and research ethic regulations of the selected journals and those of current instructions for authors and research ethic regulations of the acupuncture and moxibustion society, the followings were needed to be added or revised. 1. Requirements for case reports were not mentioned. 2. Reporting Guidelines for Specific Study Designs were not included. 3. Previous Orthography of herbal prescription should be revised. 4. Orthography of authors and guidelines for writing article constituents such as title, abstract, introduction, method, statistics, results, discussions were not presented. 5. How to write a reference was so simplified. 6. Definition of Research Ethical Misconduct was omitted and establishment, management and members of committee for research ehtics were not mentioned, 7. Information, reception and investigative procedures of Research Ethical Misconduct was not specified. Conclusions : For the development of Journal of Korean Acupuncture and Moxibustion Society, apporopriate revision of the instruction for author and research ethic regulations should be made based upon the above findings. English writing of reference were believed to be one of the alternatives enhancing citation rate.

텍스트 네트워크 분석을 이용한 조산 경험 이야기의 시각화 (Visualization of unstructured personal narratives of perterm birth using text network analysis)

  • 김증임
    • 여성건강간호학회지
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    • 제26권3호
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    • pp.205-212
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    • 2020
  • Purpose: This study aimed to identify the components of preterm birth (PTB) through women's personal narratives and to visualize clinical symptom expressions (CSEs). Methods: The participants were 11 women who gave birth before 37 weeks of gestational age. Personal narratives were collected by interactive unstructured storytelling via individual interviews, from August 8 to December 4, 2019 after receiving approval of the Institutional Review Board. The textual data were converted to PDF and analyzed using the MAXQDA program (VERBI Software). Results: The participants' mean age was 34.6 (±2.98) years, and five participants had a spontaneous vaginal birth. The following nine components of PTB were identified: obstetric condition, emotional condition, physical condition, medical condition, hospital environment, life-related stress, pregnancy-related stress, spousal support, and informational support. The top three codes were preterm labor, personal characteristics, and premature rupture of membrane, and the codes found for more than half of the participants were short cervix, fear of PTB, concern about fetal well-being, sleep difficulty, insufficient spousal and informational support, and physical difficulties. The top six CSEs were stress, hydramnios, false labor, concern about fetal wellbeing, true labor pain, and uterine contraction. "Stress" was ranked first in terms of frequency and "uterine contraction" had individual attributes. Conclusion: The text network analysis of narratives from women who gave birth preterm yielded nine PTB components and six CSEs. These nine components should be included for developing a reliable and valid scale for PTB risk and stress. The CSEs can be applied for assessing preterm labor, as well as considered as strategies for students in women's health nursing practicum.

RAND 방법으로 합의한 임상진료지침의 정의와 질 평가 기준 (Consensus on definition and quality standard of clinical practice guideline using RAND method)

  • 지선미;김수영;신승수;허대석;김남순
    • 보건행정학회지
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    • 제20권2호
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    • pp.1-16
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    • 2010
  • Background : Clinical practice guidelines are an increasingly familiar part of clinical practice. Moreover, rigorously developed evidence based guidelines has been widely used. However, in Korea, some of published documents as clinical practice guidelines have shown considerable disparity in structure, contents and quality. This is mainly because there is no consensus on the definition and quality standard of clinical practice guidelines. The purpose of this study was to draw consensus on the definition and the quality standard about clinical practice guidelines. Method : We developed a questionnaire about the definition of clinical practice guidelines with inclusion criteria(23 items) and the quality standard(30 items). We selected 9 experts who had prior experience in developing and implementing guidelines. Rating methods for appropriateness of items were adopted from the RAND method. Consensus was drawn in three rounds. Results : Of the 47 items agreed, 40 items were determined to be appropriate. Clinical practice guidelines were defined as "scientifically and systematically developed statements to assist practitioners and patients on making decisions about appropriate health care for specific clinical circumstances." Narrative reviews, systematic reviews or health technology assessment without recommendations, translation of foreign guidelines, guidelines for patients only and training manuals were not considered as clinical practice guidelines. For the quality standard of clinical practice guidelines, 27 items were deemed necessary. Conclusions : The consensus on the definition with inclusion criteria and the quality standard of clinical practice guidelines carries an important meaning as the first attempt to draw a general agreement in our society. The unique achievement of the consensus reflects the current status of clinical practice guidelines that there has been a high tendency to adapt foreign guidelines. We hope efforts of this kind will continue to bring improvement in clinical practice guidelines.

The Role of Yoga Intervention in the Treatment of Allergic Rhinitis: A Narrative Review and Proposed Model

  • Chauhan, Ripudaman Singh;Rajesh, S.K
    • 셀메드
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    • 제10권3호
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    • pp.25.1-25.7
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    • 2020
  • Allergic Rhinitis (AR) is an IgE (immunoglobin-E) mediated inflammatory condition of upper respiratory tract; main clinical features involve runny nose, sneezing, nasal obstruction, itching and watery eyes. AR is a global problem and has large variations in incidences, currently affects up to 20% - 40% of the population worldwide. It may not be a life-threatening disease per se but indisposition from the condition can be severe and has the potential to adversely affect the daily functioning of life. Classical yoga literature indicates that, components of yoga have been used to treat numerous inflammatory conditions including upper respiratory tract. A few yoga intervention studies reported improvement in lung capacity, Nasal air flow and symptoms of allergic rhinitis. This review examined various anti-inflammatory pathways mediated through Yoga that include downregulation of pro-inflammatory cytokines and upregulation of anti-inflammatory cytokines. The hypothalaminic-pitutary-adrenal (HPA) axis and vagal efferent stimulation has been reported to mediate anti-inflammatory effect. A significant reduction is also reported in other inflammatory biomarkers like- TNF-alpha, nuclear factor kappa B (NF-κB), plasma CRP and Cortisol level. Neti, a yogic nasal cleansing technique, reported beneficial effect on AR by direct physical cleansing of thick mucus, allergens, and inflammatory mediator from nasal mucosa resulting in improved ciliary beat frequency. We do not find any study showing effect of yoga on neurogenic inflammation. In summary, Integrated Yoga Therapy may have beneficial effect in reducing symptoms and improving quality of life for patients with allergic rhinitis. Yoga may reduce inflammation through mediating neuro-endocrino-immunological network. Future studies are needed to explore the mechanism how yoga might modulate immune inflammation cascade and neurogenic inflammation at the cellular level in relevance to allergic rhinitis; the effects of kriyas (yogic cleansing techniques) also need to be evaluated in early and late phase of AR. So the proposed model could guide future research.

Adverse effects following dental local anesthesia: a literature review

  • Ho, Jean-Pierre T.F.;van Riet, Tom C.T.;Afrian, Youssef;Chin Jen Sem, Kevin T.H.;Spijker, Rene;de Lange, Jan;Lindeboom, Jerome A.
    • Journal of Dental Anesthesia and Pain Medicine
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    • 제21권6호
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    • pp.507-525
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    • 2021
  • Local anesthesia is indispensable in dentistry. Worldwide, millions of local anesthetic injections are administered annually, and are generally considered safe invasive procedures. However, adverse effects are possible, of which dentists should be aware of. This scoping review aimed to provide an extensive overview of the reported literature on the adverse effects of dental local anesthesia. The types of papers, what is reported, and how they are reported were reviewed. Additionally, the incidence and duration of adverse effects and factors influencing their occurrence were also reviewed. An electronic search for relevant articles was performed in PubMed and Embase databases from inception to January 2, 2020. The titles and abstracts were independently screened by two reviewers. The analysis was narrative, and no meta-analysis was performed. This study included 78 articles. Ocular and neurological adverse effects, allergies, hematomas, needle breakage, tissue necrosis, blanching, jaw ankylosis, osteomyelitis, and isolated atrial fibrillation have been described. Multiple adverse effects of dental local anesthesia have been reported in the literature. The results were heterogeneous, and detailed descriptions of the related procedures were lacking. Vital information concerning adverse effects, such as the dosage or type of anesthetic solution, or the type of needle used, was frequently missing. Therefore, high-quality research on this topic is needed. Finally, the adverse effects that are rarely encountered in real-world general practice are overrepresented in the literature.

A narrative review on the application of doubly labeled water method for estimating energy requirement for Koreans

  • Kim, Oh Yoen;Park, Jonghoon;Kim, Eun-Kyung
    • Nutrition Research and Practice
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    • 제16권sup1호
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    • pp.11-20
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    • 2022
  • Research articles were reviewed to validate the estimated energy requirements (EERs) equations developed by the Institute of Medicine of the National Academies (IOM). These equations are based on total energy expenditure (TEE) measured by the doubly labeled water (DLW) method. We subsequently aimed to provide the basis for the suitability to apply the IOM equations as EER equations for Koreans, and develop relevant equations for EER in the Dietary Reference Intake for Koreans (KDRI). Additionally, besides the EER(IOM) equations, other equations were examined for EER estimation. Research papers demonstrating the validation of the EER(IOM) equations based on TEE(DLW) were searched through PubMed (up to September 2019). Of the 637 potentially relevant articles identified, duplicates and unsuitable titles and abstracts were excluded. Furthermore, papers with irrelevant subject and inappropriate study design were also excluded. Finally, 11 papers were included in the review. Among the reviewed papers, 8 papers validated the application of the EER(IOM) equations for EER based on TEE(DLW). These included 3 studies for children (USA 1, Korea 2), 1 for adolescents (Portugal), 2 for adults (Korean), and 2 for the elderly (Korea, USA). EER(IOM) equations were found to be generally acceptable for determining EER by using the DLW method, except for Korean boys at 9-11 yrs (overestimated) and female athletes at 19-24 yrs (underestimated). Additionally, 5 papers include the validation of other EER equations, beside EER(IOM) for EER based on TEE(DLW). In Japanese dietary reference intake and recommended dietary allowance, EER equations are acceptable for determining EER based on TEE(DLW). The EER(IOM) equations is generally acceptable for determining EER using the DLW method in Koreans as well as several populations, although certain defined groups were found to be unfit for the estimation. Additionally, the concept of healthy body mass index of Koreans and physical activity levels need to be considered, thereby providing the basis for developing relevant equations of EER in KDRI.

정신병적 우울증의 치료 전략 (Treatment Strategies for Psychotic Depression)

  • 이소영;정한용
    • 생물정신의학
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    • 제13권4호
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    • pp.234-243
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    • 2006
  • 정신병적 우울증의 심한 정도와 나쁜 예후, 그리고 현재까지의 연구 실적을 고려했을 때, 임상의사들은 정신병적 증상을 동반한 우울증과 정신병적 증상을 동반하지 않는 우울증을 구분하여 치료계획을 수립하는 것이 바람직하다. 저자들은 체계적인 검색을 통해 광범위하게 조사를 하였으나, 정신병적 우울증 환자의 약물치료에 대한 근거는 아직 부족한 것으로 생각한다. 소수의 연구 결과들이지만 현재까지 발표된 근거에 의하면, 항우울제와 항정신병약물의 병합치료와 전기충격요법이 그 효과에 대한 근거 수준이 가장 높아서 정신병적 우울증 환자를 위한 일차적 치료법으로 생각된다. 그러나 최근에 항우울제 단독치료가 항우울제와 항정신병약물의 병합치료에 비해 효과 면에서 떨어지지 않는다는 분석 결과가 발표되면서 항우울제-항정신병약물 병합치료법과 항우울제를 사용하다가 필요시에 항정신병약물을 추가하는 방법 둘 다 권고된 바 있다. 이는 기존 치료 권고 사항과 대조가 되기 때문에, 향후 이러한 관점에서 기존의 치료 전략들이 어떻게 영향을 받을지 주목된다. 그러나 적어도 정신병적 우울증 환자에게 항정신병약물을 단독으로 사용하는 것은 항우울제와 병합하였을 때 보다 덜 효과적이므로 항정신병약물 단독으로 시작하는 것은 바람직하지 않다는 데에는 연구자들 간에 의견이 일치하고 있다. 항우울제 중에서는 삼환계 항우울제에 대한 근거 수준이 가장 높고 선택적 세로토닌 재흡수 차단제의 경우 현재는 근거가 부족하나 앞으로 유망할 것으로 보인다. 항우울제와 항정신병약물 병합 치료에 반응이 없거나 부작용으로 인해 투여할 수가 없을 경우에는 항우울제의 종류를 바꾸거나 lithium을 강화하는 방법을 고려할 수 있다. 실제 임상에서는 환자 개개인의 위험과 이득을 고려하여 약물을 선택하는 것이 중요하다. 또한 선택된 약물을 충분한 양, 그리고 충분한 기간 동안 시도했는지도 중요하다. 이와 함께 부작용의 출현에 대해 잘 모니터링을 해야 하고, 특히 우울증 자체가 악화되는 것과 구분해야 한다. 결론적으로, 임상의사들은 정신병적 증상을 동반하는 우울증 환자의 치료 전략을 현재까지 수행된 연구 근거의 양과 수준을 감안하여 받아들여야 하고, 아직까지 명백한 결론을 이끌어내기에는 부족하기 때문에 향후 이에 대한 많은 체계적 연구들이 필요할 것이다.

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