• 한국콘텐츠학회논문지
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• 제17권9호
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• pp.39-49
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• 2017

본 연구는 질적 연구를 통하여 의료급여환자들의 의료이용 경험을 이해함으로써 의료급여환자와 건강보험환자 간 의료이용량의 통계적 차이현상의 원인과 과정을 파악하기 위해 수행되었다. 주요 분석결과는 다음과 같다. 첫째, 의료급여환자의 과잉의료는 대체로 존재하지 않으며, 복합적 질병을 가지고 있어서 발생하는 것이다. 그러나 물리치료와 한방 침에 있어서 일부 과잉이용이 발생하고 있는 것으로 판단된다. 둘째, 의료급여환자들은 의료비를 마련하기 위하여 생계급여에서 일부를 활용하거나 주변 가족이나 이웃의 도움을 받고 있었다. 그러나 과도한 의료비 부담으로 비급여 의료서비스와 대형병원 의료이용은 실제 의료필요만큼 이용하지 못하고 있었다. 또한 일부 환자는 아파도 우선 참고 견디고 있었다. 한편, 일부 의료기관에서는 의료급여환자에 대한 차별적 진료행위를 여전히 하고 있었다. 셋째, 공무원과 의료기관 모두는 의료급여환자에게 의료비 지원정책에 대한 미흡한 정보 제공 등 충분한 도움을 주지 못하고 있었다. 넷째, 정부가 수행하고 있는 의료급여정책인 선택병의원제도, 의료급여사례관리제도, 진료연장승인제도 모두는 불필요한 의료이용을 감소시키는데 기여하고 있는 것으로 판단된다. 그러나 의료급여환자들에게 필요한 의료이용을 제한하는 문제를 초래할 수 있어 이에 대한 대책마련이 요구되었다. 이상의 연구결과를 살펴보면 건강보험환자와 의료급여환자의 의료이용량의 차이를 통계적으로 검증한 선행연구와는 달리 의료급여환자들은 의도적인 과잉이용을 하지 않고 있으며, 오히려 필요한 의료서비스 이용에 제한을 받는다고 생각하고 있었으므로, 이에 대한 대책마련이 요구된다.

• Archives of Plastic Surgery
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• 제34권1호
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• pp.93-98
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• 2007

Purpose: Many options are available for the incision and pocket selection in breast augmentation. Each method has its advantages and disadvantages. To leave an invisible operation scar and to achieve easier pocket dissection by the central location of the incision on the breast, we made a transareolar-perinipple incision. To overcome the disadvantages of the transareolar incision, originally advocated by Pitanguy in 1973, we modified the direction of incision line and dissection plane. Methods: To avoid the injury of 4th intercostal nerve responsible for nipple sensation, we made perinipple incision on the medial side of the nipple instead of trans-nipple incision and made the transareolar incision as 11-5 o'clock on the left side and 1-7 o'clock on the right side instead of 3-9 o'clock on both sides. To avoid the possible infection and breast feeding problem caused by the injury to the lactiferous duct, and the possible implant hernia caused by the incisions lying on a same plane of pocket dissection, we made a subcutaneous dissection just above the breast tissue medially down to the bottom of breast tissue and made a subglandular or subfascial pocket, which may avoid the injury of lactiferous duct and create different planes for skin incision and pocket dissection. Other advantages of the transareolar-perinipple incision include easier pocket dissection, less chance of hematoma, and as a result less postoperative pain because of the central location of the approach which allow finger dissection and meticulous bleeding control with direct vision, without any specialized instrument such as an endoscope or long mammary dissectors. As for pocket selection, we made dual pockets. We prefer subglandular or subfascial pocket. Also, we made a subpectoral pocket in the upper 1/4 of the pocket to add more volume on the upper part of the augmented breast, which can make aesthetically more desirable breasts in thin Asian women with small breasts. Possible disadvantages of our method are subclinical infection and scar widening, which could be overcome by meticulous operation techniques, antibiotic therapy, and intradermal tattooing. Results: From September, 2003 to August, 2005, 12 patients underwent breast augmentation using round smooth surface saline implants by our method. During the mean follow-up period of 13 months, there were no complications such as infection, hematoma, capsular contracture, and sensory change of nipple, and results were satisfactory. Conclusion: We suggest breast augmentation via transareolar-perinipple incision and dual pockets(subpectoral-subglandular or subfascial) as a valuable method in thin oriental women with small breasts.

• 대한한방소아과학회지
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• 제31권1호
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• pp.43-51
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• 2017

Objectives Hataedock method is a Korean medical therapy which removes fetal toxin by orally administering herbal decoction to neonates. This study was to observe skin damage and anti-inflammatory effect via regulating IL-4 activity in NC/Nga mice which were induced atopic dermatitis (AD)-like skin lesion by Dermatophagoides (D.) farinae after applying Douchi Hataedock method. Methods NC/Nga mice with 3 weeks of gestational age were used. Each 10 mice were allocated to the control group (Ctrl), the AD-induced group (AE), and the group which induced AD after administering Douchi extract (GT). After 4 weeks from administering Douchi extract to the mice, the primary AD was induced by applying D. farinae extract 6 times per week for 3 weeks and then the secondary AD was induced by the same method after 1 week from the primary AD induction. To identify the skin damage and anti-inflammatory effect, we observed LxR, IL-4, Fc ${\varepsilon}$ receptor, substance P, and $NF-{\kappa}B$. Results The GT group showed alleviation of skin injury and decrease in capillary angiogenesis. Stratum corneum damage, epithelial cell hyperplasia, lymphocyte infiltration, and capillary distribution relatively decreased in the GT group. LxR-positive reaction in the GT group were increased by 53% than that of the AE group. IL-4 production, $Fc{\varepsilon}$ receptor activity, and substance P-positive reaction in the GT group were decreased by 82%, 42%, and 82% respectively compare to those of the AE group. $NF-{\kappa}B$-positive reaction in the GT group were decreased by 15% compare to that of the AE group. Conclusions Hataedock method with Douchi extract alleviated AD via reducing inflammatory cytokines secreted at the early stage of AD. Thus, Douchi Hataedock method has a beneficial effect for the prevention and treatment of AD.

• 대한한방부인과학회지
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• 제32권4호
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• pp.132-143
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• 2019

Objectives: The purpose of this study is to provide basic information on Korean medical research and treatment through analysis of breast cancer patients, who visited ${\bigcirc}{\bigcirc}$ university Korean medicine hospital. Methods: To analyze characteristics of breast cancer patients who visited korean medicine hospital, we searched medical records from January 1, 2016 to May 13, 2019, and 86 breast cancer patients were analyzed. Results: 1. The general characteristics of the subjects are as follows. The average age was $47.65{\pm}9.62years$ and 40's was the most (46.51%). The average height was $159.78{\pm}4.91cm$ and the average weight was $57.29{\pm}9.34kg$. The average body mass index (BMI) of the patients was $22.40{\pm}3.50kg/m^2$. 2. The stage distribution record indicated stage０ (9.72%), stageI (31.94%), stageII (34.72%), stageIII (20.83%) and stageIV (2.78%). 14 patients with unknown stage were excluded. 3. Before coming to the korean medicine hospital, of the 86 patients, 72 (83.72%) patients received surgical therapy, 55 (63.95%) patients received chemotherapy and 44 (51.16%) patients received radiotherapy. 11 (12.79%) patients chose oriental medicine as their primary treatment option. 4. The mean duration from diagnosis to hospital visit was $13.87{\pm}15.53months$. Among the total 86 patients, 46 (53.49%) patients visited for symptom relief during the follow-up period. 5. The most common symptom was general weakness in 29 (33.72%) patients, followed by hot flash, myalgia, insomnia, digestion disorder, numbness, edema, arthralgia, operation site pain, cold sensation and mastalgia. 6. Among 86 patients, 55 (63.95%) patients received acupuncture and moxibustion together. The most prescribed herbal medicine to subjects was Sibjeondaebo-tang-gamibang and Cheonhye-dan (25%). Conclusions: These results could be helpful to provide basic data on the Korean medical approach of breast cancer patients.

• 대한한방내과학회지
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• 제42권5호
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• pp.833-845
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• 2021

Parkinson's syndrome is a degenerative brain disease that presents characteristic motor symptoms of tremor, rigidity, and gait disturbance. In addition to these motor symptoms, Parkinson's syndrome also presents non-motor symptoms (NMSs) such as sleep disturbance and cognitive decline. NMSs reduce patient's quality of life and psychosocial functioning and cause economic burden on the patient, so appropriate evaluation and treatment are required. Lewy body dementia is one of the several diseases belonging to Parkinson's syndrome. Its symptoms such as cognitive function, memory impairment, and hallucinations occur with Parkinsonism. Although drug therapy is being used with drug treatment to treat non-motor symptoms, it has limitations such as side effects, which stimulated interest in other complementary treatment methods such as oriental medicine treatment, dance, and yoga. The patient in this case complained of tremor in the right upper extremity, muscle hypertension and pain, and persistent vision, memory, and cognitive decline. The patient was diagnosed with probable Lewy body dementia. The patient was hospitalized for 4 months and received acupuncture and herbal medicines. After treatment, the patient's NMS scale scores decreased from 90 to 63, and the Unified Parkinson's Disease Rating Scale scores (summed I, II, and III) decreased from 17 points to 8 points. The Beck Depression Inventory score decreased from 22 points to 13 points. In addition, the patient's subjective evaluation revealed improvement. In this case, a patient diagnosed with probable Lewy body dementia who did not respond to the standard treatment and did not want to take medications showed improvement in not only motor symptoms but also NMSs after integrative Korean medicine treatment.

• 한방재활의학과학회지
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• 제31권4호
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• pp.129-143
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• 2021

Objectives This study was aimed to evaluate clinical practice guidelines (CPGs) of traffic injuries, which has already been developed at domestic or outside of country, and to explore the Korean medical treatments included in the CPGs. Methods Twelve electronic databases (PubMed, Cochrane library, China National Knowledge Infrastructure [CNKI {Chinese Academic Journals, CAJ}], Research Information Sharing Service [RISS], Oriental Medicine Advanced Searching Integrated System [OASIS], KoreaMed, Korean Medical Guideline Information [KoMGI), National Guideline Clearinghouse [AHRQ], Core Outcome Measures in Effectiveness Trials Initiative Website [COMET], Turning Research into Practice [TRIP], The National Institute for Health and Care Excellence [NICE], and Medical Research Information Center [MedRIC]) up to July 2021 were searched. Only systematically developed CPGs for traffic injuries were selected and appraised. The appraisal was conducted by using Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. Results Six CPGs were included and evaluated. All CPGs were appraised as highly recommended because they exceeded 60% in more than 4 among 6 domains of AGREE II, including domain of 'rigor of development', and 30% in the rest. Recommendations related to Korean medicine treatments such as on manual therapy related to Chuna were given in 6 CPGs, 4 for acupuncture, 1 for Qigong and 1 for Taping. Conclusions The 6 CPGs were developed up to now through a systematic development methodology and there were many recommendations for Korean medical treatments related to manual (Chuna) treatment, acupuncture and Qigong. However, the evidence for the side effects and risk factors of Korean medical treatments was scantly reflected in CPGs. Therefore, it is considered that balanced CPG with benefits and risks should be developed, covering Korean medical diagnosis, treatment and prognosis.

• 대한한방내과학회지
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• 제40권1호
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• pp.13-37
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• 2019

Objectives: The purpose of this study was to assess the effects of Korean medicine for non-alcoholic fatty liver disease (NAFLD). We analyzed the result of randomized controlled trials (RCTs) that applied Korean medicine to NAFLD patients through meta analysis and systematic review. Methods: The key question was to the effects of Korean medicine for NAFLD patients according to the PICO-SD (participants, intervention, comparison, outcome, study design) and we included only RCTs. We searched 10 databases including NDSL, KMBASE, KISS, KISTI, KoreaMed, Koreantk, OASIS, Cochrane, Pubmed, EMBASE without a language restriction. We assessed risk of bias by Cochrane group's Risk of Bias tool. Results: The finally selected 12 RCTs were analyzed. Total number of participants was 1189 (male 719, female 470) as 684 and 505 in the oriental medicine group (i.e. herbal drugs, acupuncture, acupoint embedding therapy) and control group (conventional drugs, placebo), respectively. The meta analysis results of examining 7 RCTs comparing the therapeutic efficacy of herbal medicine with that of Western medicine showed statistically significant (p<0.05) differences in the efficacy evaluation, liver function test results, blood lipids, and TNF-${\alpha}$. Furthermore, the meta analysis results of investigating 3 RCTs comparing the therapeutic efficacy of herbal medicine with that of a placebo showed statistically significant (p<0.05) differences in the liver function test results, blood lipids, and waist circumference. Conclusions: The research showed that Korean medicine for NAFLD can be effective treatment. But more studies are required to enhance the level of evidence and we should report on safety.

• 한국산학기술학회논문지
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• 제22권4호
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• pp.504-512
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• 2021

TCDD로 유발할 수 있는 남성 난임 원인 중 가장 큰 비율을 차지하는 것은 정자형성 장애와 정자의 질적 저하가 있다. 이를 해결하기 위해 GYB의 한의학적 처방을 이용하여 TCDD-유도 생식독성을 유발한 랫드에서 내분비기능 및 생식독성 관련 지표에 미치는 영향을 조사하고자 본 연구를 시행하였다. 수컷 SD 랫드를 5개의 그룹으로 7마리씩 나누어 실험하였다. 정상 대조군은 vehicle 및 saline을 투여하였으며, TCDD 단독투여그룹은 TCDD(2 ㎍/kg, weeks) 및 생리식염수를 복강 내 투여하였으며, 시험 군은 6주 동안 GYB (75, 150, 300 mg/kg)를 3가지 농도로 나누어 경구로 투여하였다. TCDD를 투여한 모든 군에서 체중 감소가 나타났으며, 호르몬 변화에서 GYB 300 mg/kg 투여군에서 free testosterone의 유의한(p<0.01) 감소가 나타났다. 또한 GYB 투여군의 고환조직에서 생식세포 일부 파괴, 정세관 위축 그리고 정자 수의 감소가 농도 의존적으로 개선되는 것이 관찰되었다. 또한 Johnsen's score, serotoli cell index(SCI)에서도 농도 의존적으로 개선되었다(p<0.05). 이러한 발견은 향후 남성 난임의 해결방안으로 의학적 시술이 아닌 약물요법을 효과적으로 사용할 수 있을 것으로 기대할 수 있다.

• Korean Journal of Acupuncture
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• 제40권3호
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• pp.79-89
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• 2023

Objectives : The purpose of this study is to investigate various application methods of focused ultrasound and apply them to clinical use in Korean medicine. Methods : Search was performed using the search engines of electronic databases, including PubMed, ScienceDirect, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ScienceON, Oriental Medicine Advanced Searching Integrated System (OASIS), China National Knowledge Infrastructure (CNKI), Wanfang Data, Japan Science Technology Information Aggregator, Electronic (J-STAGE) and Citation Information by NII (CiNii), from inception to July 2023 without language limitation. Inclusion criteria were clinical studies including randomized controlled trials (RCTs), and animal experimental studies related with focused ultrasound treatments for acupoints or meridian sinews. Results : Total 17 papers, 7 for RCT, 6 for in vivo animal studies, and other experimental studies, were finally selected. Indications used in studies were shoulder pain, back pain, chronic back pain, and degenerative knee arthritis. In experimental studies, studies on animal models of hypoxic ischemic brain damage and hyperlipidemia were also conducted. As for the acupoints, LR3, LI4, and ST36 were used in clinical studies and, in animal experimental studies, GV20, KI1, and ST36 were used. As for the dose, 4 studies below 3 W/cm² and 3 studies in the range of 0.625 to 5 W/cm² in clinical studies, and all studies did not exceed 5 W/cm². In animal experimental studies, 0.5 W/cm², 2 W/cm², 7.5 WW/cm², 15 W/cm², 10~20 W/cm² were used. In all three studies describing the penetration depth during irradiation, it was less than 1 cm. Conclusions : We suggest that focused ultrasound is an appropriate treatment tool for stimulating the acupoints to transfer heat energy. Future studies with rigorous and well-designed RCTs for various diseases will be required to ascertain the focused ultrasound stimulate acupoints or meridian sinews.

• Korean Journal of Acupuncture
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• 제40권4호
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• pp.141-148
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• 2023

Objectives : The purpose of this study is to investigate on the application of the yttrium aluminum garnet (YAG) lasers for acupoints irradiation. Methods : We conducted a systematic search for peer-reviewed studies published from inception to November 2023, in the following electronic databases: PubMed, Scopus, and Web of Science in English, Science ON, Oriental Medicine Advanced Searching Integrated System (OASIS) and Research Information Sharing Service (RISS) in Korean, and China National Knowledge Infrastructure (CNKI) and Wanfang in Chinese, and Japan Science Technology Information Aggregator, Electronic (J-STAGE) and Citation Information by NII (CiNii) in Japanese. Inclusion criteria were original articles including clinical and experimental studies related with YAG lasers for acupoints including Ashi or meridian sinews. Results : Among the 8 selected studies, there were 7 studies on human subjects and 1 study on animals, 7 studies on Nd:YAG (1,064 nm) laser, and 1 study on Er:YAG (2,940 nm) laser. A total of 16 acupoints were used, 15 of which were in the face and 1 of which was located in the foot. In addition, there were two studies using Ashi. 4 studies looked at the effect of pain relief, 2 studies looked at safety, 1 study looked at changes in blood flow, and 1 study looked at the effect of skin care. There were no reported adverse events, and the YAG laser was confirmed to be safe and effective in pain relief, beautifying the skin, and increasing blood flow. Conclusions : We suggest that high intensity YAG lasers can be applied to laser acupuncture or laser moxibustion. YAG lasers are considered to be worth using for various clinical indications of Korean medicine because of photobiomodulation effects, analgesic action, and deep penetration depth. Further scientific research and clinical evidences should be warranted.