• 의학교육논단
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• 제20권1호
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• pp.1-5
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• 2018

A traditional clerkship consists of a series of short rotations in specialty disciplines and is usually based in tertiary, urban teaching hospitals. Shortened inpatient stays and the shift toward ambulatory management have had a negative impact on student learning. There have been growing concerns that the traditional specialty-based clerkship in fragmented and highly specialized clinical environments may not be the optimal choice for basic clinical education. As a result, a new model of clinical clerkship called longitudinal integrated clerkships (LICs) has emerged. There is increased interest in LICs due to the growing evidence of positive outcomes for students, patients, and supervising clinicians. Emphasizing continuity as one of the main organizing principles of an LIC, this article reviews the introduction of LICs into medical education, the key concepts and educational theories which underpin LICs, and the typology of LICs. The author also offers some personal suggestions for contemplation before clerkship programs in Korea adopt LICs.

• 대한구강악안면임플란트학회지
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• 제19권3호
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• pp.146-152
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• 2015

Mini-dental implants for overdenture applications are increasingly popular due to their ease in placement with simplified, less traumatic surgical protocols in limited-width alveolar ridges. However, the clinical decisions including implant number, position, and loading protocol must be based on a thorough evaluation and evidence-based diagnosis. Herein, we reported a case treated with the current method of mandibular mini-implant supported overdenture.

• The Korean journal of internal medicine
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• 제39권2호
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• pp.205-214
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• 2024

Hypertension remains a global health concern because of suboptimal blood pressure control despite advancements in antihypertensive treatments. Chronotherapy, defined as evening or bedtime administration of medication based on biological rhythms, is emerging as a potential strategy to improve blood pressure control and treatment outcomes. Clinical trials have investigated the potential effects of nighttime administration of antihypertensive medication in the improvement of 24 hours blood pressure control and reduction of cardiovascular risk. Implementing chronotherapy in clinical practice could have significant implications in enhancing blood pressure control and improving clinical outcomes in patients with hypertension, particularly those with resistant hypertension. However, recent trials have reported contradictory results, causing confusion in real-world practice. Herein we review, analyze, and critique the current evidence and propose suggestions regarding the clinical application and future directions of chronotherapy.

• 혜화의학회지
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• 제15권1호
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• pp.41-45
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• 2006

Aims: This overview summarizes the existing evidence on acupuncture for cancer-related pain. Methods: Literature searches were conducted in 7 databases. All clinical studies of acupuncture, electroacupuncture, ear acupuncture and transcutaneous electrical nerve stimulation (TENS) in cancer patients with the main outcome measure of pain were included. Results: Of the 8 studies included, one high quality randomized clinical trial (RCT) of ear acupuncture showed statistically significant pain relief in comparison with placebo ear acupuncture. All the other studies were either non-blinded (n = 2) or uncontrolled clinical trials (n = 5). Most investigations suffered from methodological flaws such as inadequate study design, poor reporting of results, small sample size and overestimation of the results. Conclusions: The current evidence does not support the use of acupuncture as an adjunctive analgesic method for cancer patients. Only one high quality RCT showed promising results thus warranting further investigation into this under-researched area.

• Journal of Korean Neurosurgical Society
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• 제39권5호
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• pp.347-354
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• 2006

Objective : We evaluate the role of multislice computerized tomographic angiography[MCTA] in the diagnosis of intracranial vasospasm following subarachnoid hemorrhage[SAH] in patients suspected of having vasospasm on clinical ground. Methods : Between October 2003 and June 2005, patients with ruptured cerebral aneurysms of the anterior circulation clipped within 3 days of the onset were included. We performed follow-up MCTAs in patients who were suspected to have vasospasm on transcranial doppler sonography[TCD] findings and clinical grounds. Based on the clinical presentation of symptomatic vasospasm, we investigated the correlation between clinical, TCD, and MCTA signs of vasospasm and evaluated the role of MCTA in vasospasm. Results : One hundred one patients met the inclusion criteria and symptomatic vasospasm developed in 25 patients [24.8%]. We performed follow-up MCTAs in 28 patients. MCTA revealed spasm in the vessels of 26 patients. The sensitivity of MCTA was 100%. Among the 26 patients with MCTA evidence of vasospasm, 3 patients had TCD signs of vasospasm after symptomatic vasospasm presentation. Another 3 patients with symptomatic vasospasm had no TCD signs of vasospasm in daily serial recordings. Six other patients without symptomatic vasospasm showed MCTA evidence of vasospasm [false positive result] but these patients had also positive TCD signs of vasospasm. Volume rendering[VR] images tended to show significantly more exaggerated vasospasm than maximum intensity projection[MIP] images. The mean cerebral blood flow velocity of both proximal segment of the middle cerebral artery [M1] was significantly correlated with each reduced M1 diameter on MCTA [P<005]. Conclusion : MCTA could be a useful tool for evaluation and planning management of critically ill patients suspected of having vasospasm; however, more randomized controlled trials are necessary to assess these points definitively.

• 한방비만학회지
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• 제7권2호
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• pp.27-37
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• 2007

Background Clinical practice guidelines (CPG) are systematically developed statements to assist practitioners and patients on healthcare decisions. They provide recommendations for the average patient, which should take into account individual clinical judgment and the patient's values and expectations. Ephedra has sympathomimetic effect and has been used for weight loss worldwide. However, its safety is controversial especially in autonomic and cardiovascular systems. Therefore, the need of appropriate CPG for ephedra prescription in obesity was advocated in Korean Traditional Medicine. Methods The committee comprised of specialists of obesity, oriental herbology, oriental cardiology, constitutional medicine. The committee collected all relevant references about adverse effect and safety of ephedra in the forms of meta-analysis, systematic review, randomized controlled trial, case-control study and observational study from international and domestic databases and paper journals. 11 English- and 5 Korean-language references were gathered and categorized by PICO (Patient, Intervention, Comparison, Outcome) method. We could not complete strength of recommendation which should be clarified according to the evidence grade estimation. Result The first version of CPG for ephedra prescription in obesity was issued by Korean Oriental Association for Study of Obesity. It includes topics of introduction, pharmacokinetics, side effects and adverse events, constitutional aspect and recommendations for dose, indication and contraindication. Conclusion There should be periodic upgrade of this CPG from now on. Although there are some drawbacks in this version of CPG, it has significance as the first CPG in Korean Traditional Medicine.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.757-766
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• 2020

Objective : Spinal epidural abscess (SEA) is a severe and life-threatening disease. Although commonly performed, the effect of timing in surgical treatment on patient outcome is still unclear. With this study, we aim to provide evidence for early surgical treatment in patients with SEA. Methods : Patients treated for SEA in the authors' department between 2007 and 2016 were included for analysis and retrospectively analyzed for basic clinical parameters and outcome. Pre- and postoperative neurological status were assessed using the American Spinal Injury Association Impairment Scale (AIS). The self-reported quality of life (QOL) based on the Short-Form Health Survey 36 (SF-36) was assessed prospectively. Surgery was defined as "early", when performed within 12 hours after admission and "late" when performed thereafter. Conservative therapy was preferred and recommend in patients without neurological deficits and in patients denying surgical intervention. Results : One hundred and twenty-three patients were included in this study. Forty-nine patients (39.8%) underwent early, 47 patients (38.2%) delayed surgery and 27 (21.9%) conservative therapy. No significant differences were observed regarding mean age, sex, diabetes, prior history of spinal infection, and bony destruction. Patients undergoing early surgery revealed a significant better clinical outcome before discharge than patients undergoing late surgery (p=0.001) and conservative therapy. QOL based on SF-36 were significantly better in the early surgery cohort in two of four physical items (physical functioning and bodily pain) and in one of four psychological items (role limitation) after a mean follow-up period of 58 months. Readmission to the hospital and failure of conservative therapy were observed more often in patients undergoing conservative therapy. Conclusion : Our data on both clinical outcome and QOL provide evidence for early surgery within 12 hours after admission in patients with SEA.

• 대한후두음성언어의학회지
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• 제22권2호
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• pp.126-132
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• 2011

Background and Objectives : Vocal fold paresis is a clinical condition and considered as a continuum of neurologic dysfunction encompassing partial denervation and variable degrees and patterns of reinnervation. Its incidence, clinical presentation, significance are incompletely understood and still debated. This study describes the clinical, electromyographic findings in patients who presented with complaints of dysphonia and whose laryngoscopic finding revealed vocal fold paresis. Materials and Method : 47 patients (male : 25, female : 22) who referred to Ewha Womans University Medical Center Voice clinic for evaluation of vocal complaints were enrolled in this study. All patients had undergone a through history and physical examination including strobovideoscopic and laryngoscopic examination. Patients with in the history and/or laryngoscopic examination suggestive of vocal fold paresis were evaluated by laryngeal electromyography (LEMG). Results : Of these patients, 23 (48.9%) were found to have evidence of neuropathy on LEMG. There was no significant difference in voice symptoms and laryngoscopic findings between two groups of patients with evidence of neuropathy and who show normal findings on LEMG. Conclusion : LEMG can clinically help to guide the evaluation and management of vocal fold paresis. Due to some limitations of LEMG, laryngoscopic findings and clinical correlations should also be considered when diagnosing the vocal fold paresis.

• 척추신경추나의학회지
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• 제12권1호
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• pp.1-12
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• 2017

Objective : The purpose of this study is to review the randomized clinical trials of Chuna manual therapy for cervicogenic headache and provide a evidence for the efficacy of Chuna manual therapy. Methods : We searched randomized clinical trials that performed Chuna manual therapy for cervical headache up to Feb. 2017 in 6 databases. Randomized clinical trials were selected according to the inclusion criteria and the data were extracted and analyzed. The risk of bias was assessed using the Cochrane Risk of Bias Criteria. Results : 16 RCTs met the inclusion criteria. The meta-analysis of 13 RCTs showed favorable results for the use of chuna manual therapy compared to drug, physical treatment. Conclusions : In 16 RCTs, we found that Chuna manual therapy was effective in cervicogenic headache. However, all RCTs are exposed to a number of bias risks. Therefore, well designed clinical trial would be needed to raise the evidence level of Chuna manual therapy.

• 한방재활의학과학회지
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• 제26권3호
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• pp.67-77
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• 2016

Objectives To evaluate the evidence supporting the effectiveness of Bee Venom therapy for traumatic injury. Methods We conducted search across 3 electronic databases (Pubmed, CAJ and Oasis) to find clinical trials that used Bee Venom therapy as treatment for traumatic injury. The methodological quality of RCTs (Randomized controlled clinical trials) were assessed using the Cochrane Risk of Bias (RoB) tool, while NRCTs (Non-Randomized controlled clinical trials) were assessed using the Cochrane Risk of Bias Assessment tool for Non-randomized Study (RoBANS) tool. Results Among 87 articles that were searched, 10 RCTs and 19 NRCTs were finally selected. Among 19 selected studies, all studies showed that Bee Venom therapy has significant effect on traumatic injury. Conclusions Our systematic review found encouraging but limited evidence of Bee Venom therapy for traumatic injury. We recommend clinical trials which compare the effectiveness of Bee Venom therapy with other pharmacopuncture therapies to clarify the effectiveness of Bee Venom therapy from other pharmacopuncture therapies.