Introduction: The importance of clinical skills training in traditional Korean medicine education is increasingly emphasized. Since the clinical skills tests are high-stakes tests that determine success in national licensing exams, it is essential to develop reliable multifaceted analysis methods for clinical skills tests in actual education settings. In this study, we applied the multifaceted validity evaluation methods to the evaluation results of the cardiopulmonary resuscitation module to confirm the applicability and effectiveness of the methods. Methods: In this study, we used internal consistency, factor analysis, generalizability theory G-study and D-study, ANOVA, Kendall's tau, descriptive statistics, and other statistical methods to analyze the multidimensional validity of a cardiopulmonary resuscitation test in clinical education settings over the past three years. Results: The factor analysis and internal consistency analysis showed that the evaluation rubric had an unstable structure and low concordance. The G-study showed that the error of the clinical skills assessment was large due to the evaluator and unexpected errors. The D-study showed that the variance error of the evaluator should be significantly reduced to validate the evaluation. The ANOVA and Kendall's tau confirmed that evaluator heterogeneity was a problem. Discussion and Conclusion: Clinical skills tests should be continuously evaluated and managed for validity in two steps of pre-production and actual implementation. This study has presented specific methods for analyzing the validity of clinical skills training and testing in actual education settings. This study would contribute to the foundation for competency-based evidence-based education in practical clinical training.

Objectives: Underpinned by the context of a Korean traditional medicine cohort study on healthy aging, this research primarily aims to guide the selection of Clinical Outcome Assessments (COAs) for elderly healthy aging patient registry research, offering insights into the selection process; and secondly, to streamline the resource-intensive process of obtaining permissions for validated COAs, benefiting future traditional Korean medicine clinical researchers. Methods : In this study, we identified outcomes through a review of previous studies, followed by a process involving expert consultations to select the final outcomes. Subsequently, for the selected outcomes that were Clinical Outcome Assessments (COAs) developed tools, we searched in commercial databases to confirm the availability of Korean versions and the necessity of obtaining permissions. Finally, we obtained permissions for their utilization and, when needed, acquired the original instrument questionnaire through payment. Results: Through a literature review of existing observational studies, a total of 57 outcomes were selected, with 19 of them identified as COA instruments. Upon verifying usage permissions for these 19 instruments, it was found that 17 required author-specific permissions, and among these, 2 needed a purchase as they were commercially available. Conclusion: This study provides a detailed overview of outcome selection and permission acquisition for elderly patient registry research. It underscores the importance of Clinical Outcome Assessment (COA) tools and the rigorous approval process, aiming to enhance research reliability. Continuous verification of COA information is essential, and future research should explore Core Outcome Set (COS) development through consensus-building approaches like Delphi studies.

Objectives: This study is purposed to investigate the effect and safety of laser therapy for stroke patients by systematic review and meta-analysis of the randomized controlled trials (RCTs). Methods: RCTs on the treatment of laser therapy for stroke patients were selected among the literature published from January 2000 to June 2022 in twelve domestic and foreign databases. The quality of the literature was evaluated using the Cochrane's Risk of Bias tool and RevMan 5.4 was used for the synthesis of results. Results: Total 2,598 patients with stroke were finally selected from 18 RCTs. Meta-analysis showed that laser therapy was effective in significantly improving activities of daily living (MBI), motor function (effective rate), upper motor function (FMA-UE), shoulder pain related factors (CGRP, ET-1, BK). Overall, the risk of bias was uncertain or low in the quality assessment of the literature. Conclusions: Although it is unclear that laser therapy is more effective than sham laser, laser therapy might be more effective in improving symptoms than conventional rehabilitation alone. Furthermore, no serious adverse events were founded in laser therapy studies. However, the quality of the selected literature was generally low. Therefore, further studies with high methodological quality on laser therapy for stroke patients would be required in the future.

Objectives: The purpose of this study is to evaluate weight change and analyze adverse events in post-menopausal obese women with Gamitaeeumjowee-tang for weight loss. Methods: A retrospective chart review was conducted for medical records of 115 post-menopausal obese women (body mass index, BMI≥25 kg/m²) who were administered with Gamitaeeumjowee-tang for 12 weeks for the purpose of weight loss. Weight, skeletal muscle ratio and BMI changes were compared before and after the program. Adverse events were evaluated by causality, severity and system-organ classes. Results: A total of 115 patients were included in this study. The average total weight loss in post-menopausal women was 5.72±2.04kg(p<0.001) and the average weight loss rate was 8.06±2.70%(p<0.001). After the 12-week program, the body fat rate was significantly decreased(3.76±2.20%)(p<0.001) and the skeletal muscle ratio was significantly increased(2.07±1.24%)(p<0.001). There were no significant differences in weight loss, skeletal muscle ratio change and body fat rate change depending on the number of hospital visits. Insomnia was frequently reported throughout the period, and no serious adverse events were reported. Conclusions: This study showed the potential that weight management treatment with Gamitaeeumjowee-tang could be a good way to lose weight of post-menopausal obese women without serious adverse events. Continuous well designed clinical studies are needed.

Objectives: The objective of this study was to review clinical studies conducted over the last ten years that investigated weight or fat loss interventions that can preserve muscle or fat-free mass in Sarcopenic obesity Methods: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Research Information Sharing Service (RISS) and Korea Studies Information Service (KISS) were searched for Randomized clinical trials that had investigated all-type of interventions on the management of sarcopenic obesity from October 2013 to September 2023. Results: A total of 14 studies met all the inclusion criteria. Interventions that increase muscle mass while reducing body fat at the same time included resistance training (including using elastic bands) and whole-body electromyostimulation(WB-EMS) in exercise intervention and Hypocaloric high-protein diet in nutritional intervention, exercise and nutritional combined intervention, and combination intervention of electrical acupuncture and amino acid supplementation. Among them, the most positive method of changing the body composition in sarcopenic obesity was the electric acupuncture and amino acid supplements. Conclusion: Varying diagnostic criteria and management interventions for sarcopenic obesity in the included studies made it hard to maintain homogeneity across the studies. Well-defined criteria for diagnostic sarcopenic obesity should be considered. In addition, since all of the interventions examined did not show sufficient clinical effectiveness, follow-up studies are needed to confirm effective interventions for sarcopenic obesity patients in the future.

Objectives: Following the global COVID-19 pandemic, with the escalation of remote medical care formalization in Korea, there is a pressing need for objective data in the Korean medicine field to respond to remote treatment medical care policies. This study aims to investigate the perceptions and acceptance of remote treatments among Korean Medicine Doctors (KMDs). Methods: After expert reviews and pilot testing, the 31-question survey covered participant characteristics, experiences, forms, intentions, and perceptions related to Remote Treatments. The survey was electronically distributed to members of the Association of Korean Medicine, and 662 clinical KMDs provided valid responses. Results: Among respondents, 76.1% engaged in remote treatments, utilizing various platforms. Those with experience in Remote Treatments showed a significantly higher willingness to continue participating during the institutionalization process (p<0.001). 49.7% of respondents stated that traditional Korean medicine is competitive in remote treatments, with the main reasons being the ability for regular management after herbal medication(26.1%) and increased patient satisfaction due to sufficient counseling compared to Western medicine(25.2%). Respondents preferred Remote Treatment conditions with a treatment time of less than 10 minutes(47.6%) and equivalent fees to in-person visits(45.6%). Regarding suitable intervention tools during Remote Treatment, respondents favored non-covered herbal prescriptions(39.0%), covered herbal granules(24.6%), and non-covered herbal granules(23.0%). Conclusion: This study investigated the perceptions and acceptance of KMDs regarding remote treatments. These findings provide valuable insights for policymakers aiming to establish effective policies for Remote Treatments suitable for the Korean medicine healthcare environment.

Objectives: Network pharmacology is an analysis method that explores drug-centered efficacy and mechanism by constructing a compound-target-disease network based on system biology, and is attracting attention as a methodology for studying herbal medicine that has the characteristics for multi-compound therapeutics. Thus, we investigated the potential functions and pathways of Myrrha on Allergic Rhinitis (AR) via network pharmacology analysis and molecular docking. Methods: Using public databases and PubChem database, compounds of Myrrha and their target genes were collected. The putative target genes of Myrrha and known target genes of AR were compared and found the correlation. Then, the network was constructed using STRING database, and functional enrichment analysis was conducted based on the Gene Ontology (GO) Biological process and Kyoto Encyclopedia of Genes and Genomes (KEGG) Pathways. Binding-Docking stimulation was performed using CB-Dock. Results: The result showed that total 3 compounds and 55 related genes were gathered from Myrrha. 33 genes were interacted with AR gene set, suggesting that the effects of Myrrha are closely related to AR. Target genes of Myrrha are considerably associated with various pathways including 'Fc epsilon RI signaling pathway' and 'JAK-STAT signaling pathway'. As a result of blinding docking, AKT1, which is involved in both mechanisms, had high binding energies for abietic acid and dehydroabietic acid, which are components of Myrrha. Conclusion: Through a network pharmacological method, Myrrha was predicted to have high relevance with AR by regulating AKT1. This study could be used as a basis for studying therapeutic effects of Myrrha on AR.

Objectives: Cold extremities have been suggested to correlate with sleep disturbances. This study aims to explore the relationship between thermal sensations in body, encompassing both cold and heat sensations, with sleep quality and insomnia. Methods: Self-administered questionnaires were utilized to assess thermal sensations in body, sleep quality and symptoms of insomnia in middle-aged women. A multiple logistic regression analysis was performed to ascertain the association between thermal sensations in body and both sleep quality and insomnia symptoms. Results: Among 899 participants, 255 (28.4%) were categorized in the cold sensation group, 95 (10.6%) in the heat sensation group, 70 (7.8%) in the group with both cold and heat sensations, and 479 (53.3%) in the no-sensation group. Pittsburgh Sleep Quality Index and Insomnia Severity Index were notably higher in the group experiencing both sensations when compared to the no-sensation group. After adjustments for covariates, the odds ratios for poor sleep quality, moderate/severe insomnia, and long sleep latency were significantly elevated in the group with both sensations when compared to the no-sensation group. The odds ratios for poor sleep quality in the cold sensation group and for moderate/severe insomnia and low sleep efficiency in the heat sensation group were significantly higher when compared to the no-sensation group. Conclusions: The risk for sleep disturbances varied depending on the presence of thermal sensations in body, with the greatest risk observed for low sleep quality and insomnia in individuals experiencing both cold and heat sensations.

Objectives: The aim of the study was to investigate the potential of Yangdorak diagnosis application against gallstone scanned by Ultrasound diagnosis. Method: For this aim, among 97 patients who had visited Julip Korean Medicine Clinic from July 2016 to June 2023, 30 patients with no gallstone as a control group and 67 patients with gallstone and diagnosed by ultrasonography, were subjected to Yangdorak diagnosis. Then, the changes in Gallbladder Meridian (GB) value as F5 AVE(average of left and right GB value) by Yangdorak were comparatively analyzed between gallstone and non-gallstone groups and statistical significance was evaluated by Tukey's multiple comparison test using Prism software. Results: After all subjects were evaluated by the Yangdorak and ultrasonography to assess the potential of the Yangdorak diagnosis for gallstone, it was noteworthy that the Yangdorak values relevant to F5 AVE of female gallstone group(N=36) were significantly (p<0.001) decreased compared to the control group (N=30), while there was no significance in male gallstone group(N=31). Also, it was recognized significant difference between male and female groups. Conclusion: Based on these results, if the Yangdorak value can be estimated from a decrease with clinical symptom in female patient, it is recommended to follow up the ultrasonography test for diagnosing the gallstone.

Objectives: This study aimed to investigate the levels of brain iron deposition in Parkinson's disease (PD) patients using Quantitative Susceptibility Mapping (QSM) and to determine whether distinctions compared to the general population exist. Furthermore, we examined potential variations in iron deposition among different PD subtypes. Methods: Structural brain imaging was conducted on 75 participants at Gangdong Kyung Hee University Hospital between August 2017 and May 2020. PD patients were categorized into Tremor Dominant (TD) and Postural Instability and Gait Difficulty (PIGD) subtypes. Voxel-based morphometry and QSM were employed to compare voxel-wise magnetic susceptibility across the entire brain between Normal Controls (NC) and PD groups. Subsequently, QSM values were compared between TD and PIGD groups. Results: QSM values were compared among 46 PD patients and 23 normal controls, as well as between TD (n=22) and PIGD (n=24) groups. Voxel-based QSM analysis revealed no significant differences between groups. Similarly, ROI-based QSM analysis showed no significant distinctions. Conclusions: No significant variations were observed between the PD patient group, NC group, or PD subtypes. This study systematically compared QSM values across a broad range of brain regions potentially linked to PD pathology. Additionally, the subdivision of the PD group into TD and PIGD subtypes for QSM-based iron deposition analysis represents a meaningful and innovative approach.

Objectives: This study was aimed to review the global status of adverse event (AE) reports and the characteristics of the reported AEs of plants managed as herbal medicines (HMs) with toxic precautions in Korea. Methods: This is a cross-sectional quantitative study that analyzed information available through VigiAccess, a website that provides summarized statistical information from the WHO's global AE database to the public. VigiAccess was searched in 8 Jan, 2024. Information on the total number of reports, number of reports by year and continent, and the age and gender of patients were obtained, and the types of frequently reported AEs were also reviewed. Results: Data on the status of report submissions were obtained for a total of 9 HMs including Aconitum ciliare, Aconitum carmichaeli, Arisaema japonicum, Pinellia ternata, Euphorbiae Lathyridis, Croton tiglium, Strychni Ignatii, Strychnons nux-vomica, and Linum usitatissimum. The number of reports per HM was from 1 to 137. The most commonly reported type of AEs were gastrointestinal disorders in most of the HMs, followed by neurological disorders. Serious adverse events were reported only in Strychni Ignatii, Strychnons nux-vomica, and Linum usitatissimum, including one case of death. Conclusions: This study shows the status of reported AEs of botanicals considered as HMs with toxic precautions in Korea based on real world data. However, when interpreting the findings of this study, readers should consider the significant limitations of this study mainly because of the characteristics of the data source.

Objectives: This study was conducted to develop a standard acupotomy consent form that takes into account the unique characteristics of Korean Medicine. The study was motivated by the increasing importance of patient autonomy and the growing number of legal disputes related to medical malpractice in the clinical field of Korean Medicine. Methods: The analysis phase of the study involved a survey of the current status of acupotomy consent forms in Korean Medicine hospitals nationwide. The items of each form were analyzed based on the contents of the Medical law and the standard contract for medical procedures of the Fair Trade Commission (FTC). In the development and evaluation phase, the items and contents of the acupotomy consent form were evaluated using a 5-point Likert scale and content validity was assessed through two rounds of Delphi surveys. In the improvement phase, the contents of the consent form were revised based on the results of a survey of inpatient and outpatient patients in the Department of Acupuncture and Moxibustion at Pusan National University Korean Medicine Hospital, and real-time online meeting. The final version of the standard acupotomy consent form was completed after undergoing proofreading and corrections by a linguistics expert. Results: Only 30% of Korean Medicine hospitals have implemented acupotomy consent forms. The items of the consent forms did not fully include the items presented in the Medical act and the standard contract for medical procedures of the FTC. To address this issue, two rounds of Delphi surveys and a real-time discussion were conducted with a panel of 12 experts on 27 preliminary items of consent forms. The items and contents that met the criteria for content validity ratio, convergence, and consensus were derived. Based on the derived items and content, a standard acupotomy consent form was developed. Conclusions: The standard consent form for acupotomy is anticipated to ensure patient autonomy and enhance transparency and liability in acupotomy. Furthermore, it is expected to serve as evidence in case of medical disputes related to acupotomy and contribute as a reference document for the development of standard consents forms for various procedures of Korean Medicine. However, the limitations of the study include that the survey of consent forms was limited to only training hospitals of Korean Medicine, and the standard consent form is only applicable to adults in Korea. Future studies are needed to address these limitations.

Objectives: In the context of competency-based education emphasized in Korean Medicine, this study aimed to develop a pilot version of a CPX (Clinical Performance Examination) Practicing Chatbot utilizing large language models with prompt engineering. Methods: A standardized patient scenario was acquired from the National Institute of Korean Medicine and transformed into text format. Prompt engineering was then conducted using role prompting and few-shot prompting techniques. The GPT-4 API was employed, and a web application was created using the gradio package. An internal evaluation criterion was established for the quantitative assessment of the chatbot's performance. Results: The chatbot was implemented and evaluated based on the internal evaluation criterion. It demonstrated relatively high correctness and compliance. However, there is a need for improvement in confidentiality and naturalness. Conclusions: This study successfully piloted the CPX Practicing Chatbot, revealing the potential for developing educational models using AI technology in the field of Korean Medicine. Additionally, it identified limitations and provided insights for future developmental directions.

Objectives: This study aims to report a case of chronic nummular dermatitis improved by Hwangryunagyo-tang. Methods: The patient in this study was a 15-year-old female, who visited our hospital with symptoms such as redness, erythema, papule, excoriation, scale, exudation, crusting, lichenification, and pruritus of the extremities and trunk. Considering that the skin lesions were coin-shaped and persisted for more than 6 months, the patient's symptoms were diagnosed as chronic nummular eczema. Based on the patient's symptoms and overall condition, Hwangryunagyo-tang was prescribed. Results: Approximately 4 months after administration of Hwangryunagyo-tang, the exudate disappeared, and overall skin symptoms improved, from objective score 33.7 to 6.6, leaving only slight scale, dryness, and pigmentation. As the pruritus of the skin lesion decreased from numeric rating scale 8 to 1, the patient's sleeping condition also improved from numeric rating scale 9 to 0. Conclusion: This study is significant in that the symptoms of chronic nummular dermatitis were effectively improved after administration of Hwangryunagyo-tang.

Objectives: The purpose of this case study was to report the effect of Chuna therapy include Space Spinal Conduction Exercise and Manipulation Treatment for Functional dyspepsia patients. Methods: A 32-years-old male patients with functional dyspepsia visited the clinic ten times from March 17th 2023 to April 22th 2023. To assess the treatment outcomes, we used the Standard tool for pattern identification of Functional dyspepsia and Nepean Dyspepsia Index-Korean version (NDI-K) symptom score. Result: After treatment, Standard tool for pattern identification of Functional dyspepsia and Nepean Dyspepsia Index-Korean version (NDI-K) score decreased. Conclusion: Chuna therapy include Space Spinal Conduction Exercise and Manipulation Treatment was effective in the treatment of patient with Functional dyspepsia.

Objectives: We would like to report improvement in symptoms after performing Korean Medicine treatment including Gamiboik-tang administration to patient with presbystasis that lasts for more than a decade. Methods: An 83-year-old male patient diagnosed with presbystasis was administered Gamiboik-tang for 4 weeks and acupuncture was performed. The degree of improvement is evaluated based on the body balance test and the patient's subjective symptom change. Results: Both the body balance test and the patient's subjective symptoms improved after administration of Gamiboik-tang and Korean Medicine treatment Conclusions: Korean Medicine treatment, including Gamiboik-tang administration and acupuncture treatment, is thought to be effective for presbystasis.

Objectives: The purpose of this study is to report a case of Korean medicine treatment accompaning myofascial trigger-point accupuncture for severe & persistent lower urinary tract symptoms after radical prostatectomy. Materials and Methods: A prostate cancer patient with severe & persistent lower urinary tract symptoms after radical prostatectomy conducted 26 months ago, was treated with Korean medicine accompaning myofascial trigger-point accupuncture. The International Prostate Symptom Score(IPSS), the IPSS Quality of Life(IPSS-QoL) and the Overactive Bladder Symptom Score(OABSS) questionaires were administered to evaluate the effect of treatment for lower urinary tract symptoms. Results: After 5 month treatment with Korean medicine accompaning myofascial trigger-point accupuncture, IPSS, IPSS-QoL and OABSS progressed from 28 to 8, from 5 to 2 and from 12 to 4 respectively. Conclusion: This case study suggests that Korean medicine accompaning myofascial trigger-point accupuncture may contribute to treat severe & persistent lower urinary tract symptoms after radical prostatectomy.

Objectives: The purpose of this study was to report the short-term blood pressure-lowering effects observed in a patient with malignant hypertension through slow breathing maneuver with heart rate variability(HRV) biofeedback. Methods: Biofeedback sessions, totaling 13, each lasting 10 minutes, were administered. Blood pressure was measured pre and post-treatment, as well as thrice daily at 10 am, 4 pm, and 8 pm. Systolic blood pressure(SBP), diastolic blood pressure(DBP), and pulse rate were recorded for comparative analysis. Results: Before biofeedback, the average SBP, DBP, and pulse rate were 227.2±18.3, 135.2±11.0, and 104.4±5.3, respectively. Immediately post-biofeedback, these values changed to 213.7±15.2, 126.9±8.5, and 99.2±3.6. However, sustained long-term blood pressure reduction was not observed. Conclusions: The findings suggest that biofeedback therapy induces a short-term reduction in blood pressure in cases of malignant hypertension, potentially associated with autonomic nervous system regulation. Integrating biofeedback with other Korean medicine treatments, such as acupuncture or moxibustion, may offer a comprehensive approach for managing malignant hypertension.

Objectives: Korea has a unique history of being both a recipient and a donor of Official Development Assistance (ODA), and the international community expects Korea to contribute to the development of developing countries by utilizing this experience. Traditional Korean medicine (TKM) seeks to contribute to global health, however the concept of ODA has been unclear and there has been no clear strategy and sustainable initiatives. Methods: This study examines the concept of ODA and its application in global health, including business objectives, scale, evaluation principles, and development strategies. Additionally, we reviewed the current status of Traditional Korean medicine globalization projects and conducted a SWOT analysis of the internal and external environment of the TKM sector. Based on these findings, we redefined the concept of ODA for TKM and proposed suggestions for its development. Results: The current study identified key ideas for TKM ODA. It should prioritize the improvement of primary healthcare in recipient countries, aligning with the international evaluation criteria of the SDGs. Secondly, TKM's 70 years of experience can be leveraged to enhance both the competence and economic benefits of recipient countries' medical systems. Based on these concepts, a TKM ODA development model was proposed, comprising two core visions, three development strategies and goals, and six core values. Conclusion: This study systematically examined the TKM in global health and suggested sustainable development strategies for TKM ODA. Through its expansion, TKM could contribute to the advancement of global traditional medicine and its overall engagement in healthcare.