• Journal of Yeungnam Medical Science
• /
• 제38권2호
• /
• pp.118-126
• /
• 2021

Background: This study is an analysis of evaluator factors affecting physician-patient interaction (PPI) scores in clinical performance examination (CPX). The purpose of this study was to investigate possible ways to increase the reliability of the CPX evaluation. Methods: The six-item Yeungnam University Scale (YUS), four-item analytic global rating scale (AGRS), and one-item holistic rating scale (HRS) were used to evaluate student performance in PPI. A total of 72 fourth-year students from Yeungnam University College of Medicine in Korea participated in the evaluation with 32 faculty and 16 standardized patient (SP) raters. The study then examined the differences in scores between types of scale, raters (SP vs. faculty), faculty specialty, evaluation experience, and level of fatigue as time passes. Results: There were significant differences between faculty and SP scores in all three scales and a significant correlation among raters' scores. Scores given by raters on items related to their specialty were lower than those given by raters on items out of their specialty. On the YUS and AGRS, there were significant differences based on the faculty's evaluation experience; scores by raters who had three to ten previous evaluation experiences were lower than others' scores. There were also significant differences among SP raters on all scales. The correlation between the YUS and AGRS/HRS declined significantly according to the length of evaluation time. Conclusion: In CPX, PPI score reliability was found to be significantly affected by the evaluator factors as well as the type of scale.

• Journal of Oriental Neuropsychiatry
• /
• 제32권2호
• /
• pp.129-140
• /
• 2021

Psychotherapy in Korean Medicine is characterized not only by management of mental issues, but also a holistic perspective of the mind and body, which includes physical treatment. In this case report, we describe the efficacy of Korean psychotherapy for couples with physical symptoms of heartache, emotional tension and marital relationships by addressing the challenges at the Mind and Body levels. For the physical treatment of the couple, the wife was treated with a Bunshimgi-Eum and the husband was administered a Cheonwangbosimdan, combined with a psychiatric interview based on Korean Medicine. It involves listening to the couple's story, YiJungBeongi therapy, understanding and learning about vases and defense mechanisms, self-understanding and understanding of the husband through self-understanding and expansion, and husband's understanding of the wife's position, self-interpretation and acceptance. Based on counseling, the couple's personal characteristics and expansion for self-growth, the progress and results of the couple's challenges and relationship improvement in a relatively short period of time are presented. In response, we hope that the evidence based on Korean Psychotherapy supporting the counseling for couples will continue to accumulate. We would like to report and share a few opinions.

• Journal of Hospice and Palliative Care
• /
• 제27권1호
• /
• pp.1-10
• /
• 2024

This article underscores the importance of integrating comprehensive palliative care for noncancer patients who are undergoing hemodialysis, with an emphasis on the aging populations in Asian nations such as Taiwan, Japan, the Republic of Korea, and China. As the global demographic landscape shifts towards an aging society and healthcare continues to advance, a marked increase has been observed in patients undergoing hemodialysis who require palliative care. This necessitates an immediate paradigm shift to incorporate this care, addressing the intricate physical, psychosocial, and spiritual challenges faced by these individuals and their families. Numerous challenges impede the provision of effective palliative care, including difficulties in prognosis, delayed referrals, cultural misconceptions, lack of clinician confidence, and insufficient collaboration among healthcare professionals. The article proposes potential solutions, such as targeted training for clinicians, the use of telemedicine to facilitate shared decision-making, and the introduction of time-limited trials for dialysis to overcome these obstacles. The integration of palliative care into routine renal treatment and the promotion of transparent communication among healthcare professionals represent key strategies to enhance the quality of life and end-of-life care for people on hemodialysis. By embracing innovative strategies and fostering collaboration, healthcare providers can deliver more patient-centered, holistic care that meets the complex needs of seriously ill patients within an aging population undergoing hemodialysis.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
• /
• 제28권1호
• /
• pp.4-13
• /
• 2017

The seeds of addiction are typically sown years prior to the onset of addictive substance use or engagement in addictive behaviors, due to the priming of the reward pathway (RewP) by alterations in the mechanism of stress-signaling from the hypothalamic-pituitary-adrenal axis (HPA) and related pathways. Excessive stress from a single-event and/or cumulative life experiences during childhood, such as those documented in the Adverse Childhood Experiences Study, is translated into neurobiological toxicity that alters the set-point of the HPA axis and limbic system homeostasis [suggested new term: regulation pathway (RegP)]. The resultant alteration of the RegP not only increases the risk for psychiatric and physical illness, but also that for early onset and chronic addictions by dysregulating the RewP. This paper reviews the interface of these symbiotic pathways that result in the phenotypic pathology of emotional dysregulation, cognitive impairment, and compulsive behaviors, as well as morbidity and shorter life expectancy when dysregulated by chronic stress.

• Journal of Ginseng Research
• /
• 제43권1호
• /
• pp.27-37
• /
• 2019

Background: The structural conversions in ginsenosides induced by steaming or heating or acidic condition could improve red ginseng bioactivities significantly. In this paper, the chemical transformations of red American ginseng from fresh Panax quinquefolium L. under steaming were investigated, and the possible mechanisms were discussed. Methods: A method with reversed-phase high-performance liquid chromatography coupled with linear ion trap mass spectrometry ($HPLC-MS^n$)-equipped electrospray ionization ion source was developed for structural analysis and quantitation of ginsenosides in dried and red American ginseng. Results: In total, 59 ginsenosides of protopanaxadiol, protopanaxatriol, oleanane, and ocotillol types were identified in American ginseng before and after steaming process by matching the molecular weight and/or comparing $MS^n$ fragmentation with that of standards and/or known published compounds, and some of them were determined to be disappeared or newly generated under different steaming time and temperature. The specific fragments of each aglycone-type ginsenosides were determined as well as aglycone hydrated and dehydrated ones. The mechanisms were deduced as hydrolysis, hydration, dehydration, and isomerization of neutral and acidic ginsenosides. Furthermore, the relative peak areas of detected compounds were calculated based on peak areas ratio. Conclusion: The multicomponent assessment of American ginseng was conducted by $HPLC-MS^n$. The result is expected to provide possibility for holistic evaluation of the processing procedures of red American ginseng and a scientific basis for the usage of American ginseng in prescription.

• Korean Medical Education Review
• /
• 제25권3호
• /
• pp.212-228
• /
• 2023

Systems thinking, a linking domain of health systems science (HSS), is an approach that investigates specific problems from a holistic perspective. It supports improving patients' health, fulfilling their health needs, and anticipating issues that threaten patient safety within the healthcare system. It also helps solve problems through critical thinking and ref lection. This study aimed to develop an curriculum on systems thinking, explore the effectiveness of the course, and investigate the applicability of HSS education at individual universities. In this study, the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model was utilized to design, develop, implement, and evaluate an elective course on systems thinking. In the design process, learning outcomes and goals were developed, and educational content, teaching-learning methods, and student evaluation methods were linked. In the development process, class materials and evaluation materials were prepared. In the implementation process, the course was implemented, and the evaluation process analyzed the results of learning performance and curriculum assessments. The evaluation found the following results. First, the students in the study realized the importance of systems thinking and experienced the need for systems thinking through non-medical and medical situations. Second, the students were very satisfied with the learning activities in the course (mean=4.84), and the results of the self-competence evaluation, conducted before and after the course, also showed a significant improvement. This study confirmed the effectiveness of the elective course, and its results can serve as a reference for developing an HSS curriculum.

• Safety and Health at Work
• /
• 제3권1호
• /
• pp.43-49
• /
• 2012

In recent years, various international organizations have raised awareness regarding psychosocial risks and work-related stress. European stakeholders have also taken action on these issues by producing important documents, such as position papers and government regulations, which are reviewed in this article. In particular, 4 European models that have been developed for the assessment and management of work-related stress are considered here. Although important advances have been made in the understanding of work-related stress, there are still gaps in the translation of this knowledge into effective practice at the enterprise level. There are additional problems regarding the methodology in the evaluation of work-related stress. The European models described in this article are based on holistic, global and participatory approaches, where the active role of and involvement of workers are always emphasized. The limitations of these models are in the lack of clarity on preventive intervention and, for two of them, the lack of instrument standardization for risk evaluation. The comparison among the European models to approach work-related stress, although with limitations and socio-cultural differences, offers the possibility for the development of a social dialogue that is important in defining the correct and practical methodology for work stress evaluation and prevention.

• Korea Journal of Hospital Management
• /
• 제25권1호
• /
• pp.32-45
• /
• 2020

Purpose: The purpose of this research is to develop two medical tourism system models which explain medical tourism phenomenon with a systemic approach. Methodology/Approach: This research was conducted using a qualitative data analysis which mainly refer previous references in relation to medical tourism in the areas of tourism and medicine. Leiper's tourism system model was utilized as a conceptual framework. In-depth interviews with experts in the area were attempted in order to pretest the models. Findings: This research suggests a medical tourism system framework and a medical service provision framework. The first model presents medical tourism components and their relationships within a framework presented in a diagram. The second model shows the relationships among medical services required by medical tourists, the service providers, and service human resources along with movements of medical tourists. Practical Implications: The first model presents a spatial composition of medical tourism components and their relationships, whereas the second model shows the linkage among medical services, the service providers, and relevant service human resources along with time sequential steps of medical tourists. These two models are complementary and may be used as useful tools to observe medical tourism phenomenon with a systemic and holistic approach. These two models may enable stake holders avoid unnecessary confusions and conflicts that result in duplication of government policies and a waste of budget and human resources.

• Journal of Korean Academy of Nursing
• /
• 제31권1호
• /
• pp.7-19
• /
• 2001

In our country, patients with diabetes mellitus are searching for complementary treatments to recover from illness, while they received treatments from the doctor. However, have been evaluated or investigated systematically. This study was carried out to explore application of complementary treatments for patients with DM. For this survey, questionnaires were developed by researchers and the data was collected from July to October of 1999. Among the 223 subjects, there is one general hospital, one oriental hospital, 15 area C.H.P, ahd 2 area health centers. The results were as follows: 1. The total number of cases was 223 and the average age was 62.85 years old and average duration of DM was 8.1 years. The number of patients who had experience with alternative therapies was 145 (65%). The number of those who have not undergone treatments was 78 (35%). 2. The 43.5% of experienced CAM were advised family and relatives. Only 30.3% approved the effect of CAM and 52.5% said that If another a new CAM is introduced, they will try it. 4. Ninety three kinds of complementary treatments were used. Among the used items, 63.7% was various types of plants, 21.6% was animal material and 14.7% was the mixed group. As a single item, Bombyx Mori (Silkworm) was the most frequently used (10.5%) followed by the bean, mushroom, Morus bombycis (mulberry), Ginseng, Commelina Communis (Dalgaebi), Chinese medicine, root of Rosa rugosa (Haedangwha). 5. Among the used items, Trichosanthes kirilowii Max. Eucommia ulmoides Oliver, Commelina Communis, Aralia elata, pine needle, mulberry fruit, root of Rosa rugosa. Ginseng, Lycii Fructus, Dioscorea radix, Polygonatum odoratum, Cassia tora L, Bombyx Mori, loach, Crucian carp were based upon the pharmacological function of effect for control of diabetes mellitus symptom. 6. In the analysis of the relationships between the general characters of the patients with new complementary alternative medicine try and hospital treatment; 1) The shorter group suffered from DM (p=.038), poor Self-MBG (p=.037) and wanted to try new complementary alternative medicine. 2) The group of DM education experience were carried out hospital treatment well (p=.045). In conclusion, further study will be required for the patients experience using alternative therapies as the D-M in terms of holistic view of patients.

• CELLMED
• /
• 제6권3호
• /
• pp.15.1-15.4
• /
• 2016

Evidence based practice (EBP) is a system of applying the most current and valid high quality evidence to support clinical decision making in a healthcare setting. In the twenty five years since its inception, EBP has become the accepted benchmark for excellence in healthcare. Although the system emerged within the biomedical sciences, in the years since EBP has become normative across all healthcare modalities from dentistry, allied health to complementary and alternative medicine (CAM). Practicing evidence based medicine within any modality potentially offers the patient the best available care based on high quality evidence. Yet it is the nature of the evidence that provokes some questions about the suitability of EBP across all modalities of healthcare. The meta analysis of randomized controlled trial (RCT) stands at the pinnacle of the hierarchy of evidence in EBP. This forms a challenge to CAM due to the difficulty in reducing the elementals of a holistic naturopathic assessment of a patient into an answerable question to be tested within a RCT. On one level this makes EBP paradigmatically incompatible with CAM, yet on another level it presents the opportunity to redefine the parameters of what is considered high level evidence. EBP has become a tool, and at times a weapon wielded by governments and health insurance companies to direct healthcare funding and policy. The implications of the nature of accepted evidence are becoming far reaching. The pursuit of the best available healthcare for each individual is the focus of EBP. However, the injudicious use of this system to direct health policy is fraught with biomedical bias and dominance. This issue raises the challenge to CAM to present high level evidence according to the rules of evidence, or face the annihilation of centuries of empirical knowledge.