• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권2호
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• pp.110-115
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• 2008

목 적: 장중첩증의 일차적인 치료로 사용되는 비수술적 관장 정복은 장천공, 쇼크 그리고 복막염 등과 같은 심각한 합병증과 불필요한 스트레스 및 과도한 방사선 노출의 위험이 있다. 본 연구에서는 무리한 비수술적 정복의 시도를 피하기 위하여 장중첩증 환자의 임상 양상 및 검사 소견 중 비수술적 정복 실패를 예측할 수 있는 인자를 파악하고자 하였다. 방 법: 고려대학교 의료원 안산병원에서 1998년 3월에서 2006년 7월까지 장중첩증으로 진단되어 치료받았던 환자 314명 중 비수술적 정복이 시도되었던 300명을 대상으로 하였다. 비수술적 정복의 성공 군과 실패군으로 나누어 성별, 연령, 임상증상 및 이학적 소견 그리고 증상의 시작에서 비수술적 정복술을 시도하기까지의 시간과 비수술적 정복 실패와의 연관성을 분석하였다. 결 과: 비수술적 정복 실패 군의 경우 성공 군에 비해 연령이 어렸고(12.3${\pm}$17.2개월 vs 18.0${\pm}$15.8개월, p=0.03), 정복 시도까지의 시간 경과가 길었으며(33.6${\pm}$29.0시간 vs 21.5${\pm}$20.3시간, p<0.01), 구토, 기면은 많았음(p<0.01)에 비해 복통이나 보챔은 적었다(p<0.01). 이러한 인자들의 다중회귀분석에서 비수술적 정복 실패와 연관된 인자는 6개월 미만 연령(odds ratio: 2.5, 95% confidence interval: 1.2~5.2, p=0.01), 24시간 경과(odds ratio: 2.1, 95% confidence interval: 1.2~4.2, p=0.03), 혈변(odds ratio: 4.8, 95% confidence interval: 1.9~12.2, p<0.01), 기면(odds ratio: 3.4, 95% confidence interval: 1.1~10.4, p=0.04), 복통 또는 보챔(odds ratio: 0.2, 95% confidence interval: 0.1~0.4, p<0.01)이었다. 결 론: 장중첩증에서 6개월 미만 어린 연령, 혈변이나 기면의 소견, 증상 시작 24시간이 경과된 경우 비수술적 정복 실패의 가능성이 많으므로 이러한 사항을 충분히 고려하여 시행 여부를 결정하는 것이 좋겠다.

• 대한간호학회지
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• 제20권2호
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• pp.227-248
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• 1990

The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptible to our society. Thus, the study was designed to demonstrate the effectiveness of home heath care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study ; 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and excise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self - care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However. there was no significant difference between the experimental and control groups in the level of compliane, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care knowledge or self -care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more dear- cut picture of the effectiveness of home care.

• 대한임상독성학회지
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• 제3권2호
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• pp.79-85
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• 2005

Purpose: With the recent boom in 'eating healthy', many adults are interested in dieting to prevent future diseases. However only well trained experts can distinguish between what are edible vegetables and herbs from their poisonous look-alikes. In cases where a patient unknowingly ingests a poisonous herb, is caught off guard by the poisonous side effects that occur because of their lack of knowledge of what they have ingested. This paper will focus on the need to educate the public about the risks involved with ingesting wild vegetables and herbs and study the emergency diagnosis and treatment of poisoned patients that enter the emergency room. Method: This study was done in the spring of 2004 (from March to May) in the Kangwon Young-Seo districts of Korea. 15 subjects used in this study, entered the emergency room showing signs of toxic symptoms. Data was collected by examining subject's records. Additional data was collected by collaborating with physicians in the hospital that diagnosed and treated the subjects. Identifying the poisonous vegetable or herb is the first step to proper diagnosis and treatment. Subjects admitted to the emergency room, underwent a battery of tests: laboratory examination, ECG, radiological exam and etc. Results: The demographics of the study encompassed subjects with the average age of $50{\pm}19$ years old. There were 10 men and 5 women. Common symptoms of this study included; gastrointestinal symptoms such as nausea, vomiting, epigastric pain and so on. In the case of Caltha palustris ingestion, additional symptoms were present; bradycardia and hypotension which lasted for a long time. While cases that ingested Scopolia parviflora had little effect on vital signs but manic episodes lasted for about three days. Veratrum patulum ingestion showed signs of bradycardia and hypotension but contrary to Caltha palustris recovery was shorten by treating with dopamine. However, dizziness, headache and paresthesia of the extremities continued for a long time. Finally Sium ninsi ingestion showed visual disturbance, paresthesia of the extremities, dizziness as their initial symptoms. Conclusion: The risks involved with ingesting wild plants without the proper knowledge can lead to serious side effects and steps need to be taken to educate the public. In addition, all emergency physicians need to have a working knowledge of the symptoms and signs associated with ingesting toxic wild plants and need to treat accordingly.

• 한국호스피스완화의료학회:학술대회논문집
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• 한국호스피스완화의료학회 2004년도 정기총회 및 하계학술대회
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• pp.100-102
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• 2004

Under the current medical system, a terminal patient and his/her family who are neglected inevitably face various aspects of crises including not only physical, but also psychological, social, economic, spiritual and legal problems. Nurses often look after many terminal patents with these types of complicated problems. Therefore, educating the nurses who will take care of such patents would greatly reduce stress so the patents end could their lives in peace and without losing their dignity. This research is a quasi experimental study of nonequivalent control group. A pretest-posttest design where a basic education program is developed for nurses, who frequently treat terminal patents, to understand the importance of the role of hospice and to apply their understandings to treat terminal lancer patents. A sample of the nurses were taken from those who were working in general wards at two general hospitals in Seoul during October, 2003${\sim}$December 2003. The study was composed of 46 experimental group and 43 control group. A basic hospice education program was developed by taking emphasized and overlapping parts from advanced practice hospice nurses education course, short-term education course, an extensive literature survey and by consulting three professionals as well. With the group of 5 professors with vast experiences in oncolgy, 5 nursing administrator, 3 nursing practitioner, the tentative first version of the program was developed and reviewed. Afterwards, by utilizing person to person interviews with 2 head nurses experienced with terminal patients, 1 nurse in charge of hospice, 1 nurse on the contents of the program, and a person to person rating on the educating medium by a nurse were performed. The final version of a basic education program was developed after the second revision. The hospice basic education program consists of introduction to hospice, hospice and commucation, management of pain for terminal cancer patients, physical management for terminal cancer patients, socio-psycological caring of terminal cancer patients and management of death and separation. Total education time was four hours organized into 50 minutes of instruction and 10 minutes of break. $Powerpoint^{(R)}$ software was used as the education medium. As research tools, "Knowledge on Hospice" was developed by the author after receiving a review from one expert. "Attitude of Hospice Nursing" was revised Kim(2001)'s attitude measuring tool which was based on Wang(1998), Kwon(1989), Park and Sung(1991)'s tool. "Liability on nursing terminal patients" was used as developed by Zarits(1980) and Mongomory(1985) translated by Lee(1985). For collecting data, preliminary investigation prior to 1 week of the hospice basic education program and post-investigations after 1 week and 4 weeks of the education were carried out for the nurses at a general ward who understood and agreed on the purpose of the program. Collected data were analyzed throughout t-test, $x^2-test$, Manova test and Bonferroni correction in $SAS^{(R)}$ program. The summary of the investigation is as follows: Hypothesis 1: "Educated experimental group would possess more knowledge on hospice compared to the un-educated control group" was supported after 1 (F=12.14, p=.00) and 4 (F=5.3, p=.02) weeks of education. Hypothesis 2: "Educated experimental group would take a positive attitude toward hospice nursing compared to the un-educated control group" was supported after 1(F=3.92, p=.05) and 4(F=5.05, p=.02) weeks of education. Hypothesis 3: "Educated experimental poop would feel less liability compared to the un-educated control group in nursing terminal cancer patients' was rejected. In this study, it was found that knowledge on hospice was significantly important. By applying hospice basic education programs to nurses, the education program helped nurses to take a positive attitude toward terminal patients. It was, however, seen that the education program had no effect on alleviating liability in nursing terminal patients. Therefore, it is expected that this educational program would help hospices and nurses at general wards to understand the concept and the role of hospice so that terminal patents, now neglected under current medical system, would be able to end their lives in peace.

• 한국안광학회지
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• 제3권1호
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• pp.249-258
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• 1998

소프트 콘택트렌즈의 착용자에 대한 실태와 문제점에 대한 결과는 다음과 같다. 1. 최초의 콘택트렌즈 착용자의 가장 많은 연령층은 19세이며, 가장 먼저 착용한 연령은 15세이고, 가장 늦게 착용한 연령은 26세이다. 2. 처음 콘택트렌즈의 착용할 때의 시력검사 장소는 대게 안경원이다. 3. 현재 사용하고 있는 콘택트렌즈의 구입처는 대부분 안경원이다. 4. 현재 사용하고 있는 렌즈는 거의 소프트 렌즈이다. 5. 현재 사용하고 있는 렌즈의 생산국은 국내생산이 가장 많고, 모르는 것, 그리고 외국생산품 있다. 6. 콘택트렌즈 착용 후 시력을 알고 있는 사람은 거의 적으며, 특히 양안 시력을 알고 있는 사람은 특히 드물다. 7. 현재 사용하고 있는 소프트 콘택트렌즈의 색깔에 대해서는 10대에서는 무색이 가장 많고, 20대에서는 유색이, 그리고 30대에서는 거의 모르고 있다. 8. 소프트 콘택트렌즈의 장점에 대해서는 10대와 20대에서는 한 개정도, 30대에서는 전혀 모르는 것이 가장 많았다. 9. 소프트 콘택트 렌즈의 단점에 대해서는 10대와 30대에서는 한 개이나, 20대에서는 2개 정도 알고 있는 것이 가장 많았다. 10. 소프트 콘택트렌즈의 착용에 대한 부작용에 대해서는 10대에서는 한가지, 20대와 30대에서는 전혀 모르는 것이 가장 많았다. 11. 소프트 콘택트렌즈의 착용자에 대한 주요 자각증상에 대해서는 모두 7가지가 있으나, 전혀 자각증상이 없는 것이 가장 많고, 다음은 잘모르는 것, 그리고 자각증상이 있는 것에서는 통증이 가장 많았다. 12. 현재 착용하고 있는 소프트 콘택트렌즈의 부작용이 있는 렌즈의 현미경적 표면 조사에서는 렌즈의 파손, 렌즈의 중첩, 이물질의 침착 등이 주로 나타났다. 이상의 연구에서 현재 착용하고 있는 렌즈는 대게 소프트 렌즈이며, 구입처는 안경원이며, 소프트 렌즈에 대한 피검자의 지식과 시력에 대한 지식은 아주 적은 편이다. 따라서 현실적으로 볼 때에 안경사의 소프트렌즈에 대한 관리 및 취급을 할 수 있도록 법적 또는 교육적 지원이 있어야 한다고 생각된다.

• 지역사회간호학회지
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• 제7권2호
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• pp.183-202
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• 1996

This study was designed out to develop a home health care service for nurses working in community care services. This study investigates actual conditions at welfare institutions related to health needs the demands of clients, and the state of home health care services we hope that this study will improve upon the current service system. In Korea home health care services are still developing and only new becoming a part of the health care supply system. The data was collected by recording the client home nursing assessments modified to the situation of UTMB home health agency. In this study 107 clients were selected for home care who needed care for physical and mental deficits. The study lasted from March to November of 1995 at one of the welfare service institutions in Chunchon city. The results show that those who most frequently needed care services were over 50 years old with a health deficit of 80.3%, followed by sex as women who needed care at 59.8%. 50.5% of the clients had very little education. 99.1% of the clients live with their family, and a medical diagnostic analysis reveals that 73.9% of the 5 year period of illnesses were the following : 38.8% - muscular -skeleton system disorder, 24.4% - hypertension and stroke, 25.7% sole disease of arthritis. For behavioral conditions 43.3% of the patients were without care services, 56.6% of the patients were taking treatment that 73.5% of those were taking medication. The most main complaint of patients were 22.4% of pain in the extremities, next were 16.8% of a limitation of body activities, 15.0% was lumbo-sacralgia. According to the investigator who was a senior student nurse, the following suggestions were made: 32.7% for curative medical services, 29.9% for physical exercise, 19.6% for emotional support. Consultation nursing services consisted of 67.2% for physical therapy, 11.2% for the maintaining healing, 9.4% for counseling. The patients at home, required assistance most frequently for muscular-skeleton problems under the category of physical systems (33.3%). But, on the other hand, 49.5% of the patients required care givers at home, 28.2% had a knowledge deficit, 21.0% had malnutrition, 18.4% had bad impaired communication. The character of health problems were devided into chronic disease(67.0%), accidents(I3.1%), and general disease(15.9%). 86% of the disabled client had an impairment of the physical system. Eating (86.9%) , Toileting(77.6%), and personal care showed much the same of ADL condition, the level and range of achievement of mobility, the most frequently self performed was 81.3% only in a room size area, and 40.2% were completely dependent when going out. Although there were a large number of home care services in th community at these welfare institutions, many clients needed a variety of curative services. As policy changes have gathered momentum, responsibility for the development of a more suitable program was demanded by the clients from the community.

• 대한예방한의학회지
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• 제19권3호
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• pp.29-43
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• 2015

Objective : The purpose of this study was to identify characteristics of patients' self-perceived health in traditional Korean medical facilities. Method : This research was conducted based on the survey on patients whom have visited traditional Korean medical facilities in 2011 by the Ministry of Health and Welfares and Korean Institute for Health and Social Affairs. Using a sample of 3,931 (1,180 male and 2,751 female) outpatients' self-perceived health based on the data from usage and consumption of Korean Medicine. 'Healthy', 'Fair', and 'Poor Health' were used to measure patients' self-perceived health status. The data was analyzed by frequency, t-test, cross correlation analysis and multiple logistics regression analysis using the SPSS program package. Results : Sex(P<0.001), age(P<0.001), marital status(P<0.001), education(P<0.001), employment status(P<0.001), occupation(P<0.001), health insurance(P<0.001) and income level(P<0.0001) showed statistical significance. Main Treatment Facilities(P<0.001), experience of taking Korean medicine(P=0.032), experience of receiving acupuncture treatment(P<0.001), number of visits(P<0.001), medical expense (P=0.005), and subjective health status after the treatments showed statistical significance for Korean herbal medicine(P=0.038), acupuncture (P=0.001), cupping therapy(P=0.006), oriental physiotherapy(P=0.003), and treatment satisfaction(P<0.001). For subjective health status based on suffering disorders in the past three months, the response of poor health was higher in the group suffering recent illnesses. Statistical significance was seen in hypertension (P=0.002), arthritis(P<0.001), lumbar pain(P<0.001), diabetes mellitus(P=0.001), stroke(P<0.001), hwa-byung (P=0.001), gastric disorders(P=0.021), common cold(P<0.001), ankle sprain(P<0.001), muscular injury(P<0.001), lumbar sprain(p=0.009) and fracture(P=0.03). Also the number of diseases during the past three months showed statistical significance(P<0.001). Statistical significance was also seen in Level of knowledge(P<0.001), route of information(P<0.001), reliability of Korean medicine(P=0.003), insurance coverage(P=0.005), medical costs(P<0.001), and future willingness to use Korean medicine(P<0.001). As a result of the multiple logistics regression analysis, risks of subjective poor health statistically increased in female population, elderlies, medicaid beneficiaries, less educated, higher medical expense, and more disorders during the past three months. Conclusion : Patients' self-perceived health status has significant differences with each variables such as sex, age, marital status, education, health insurance, medical expense, number of diseases.

• 한국보건간호학회:학술대회논문집
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• 한국보건간호학회 2002년도 제27회 보건종합학술대회
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• pp.224-227
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• 2002

Alcoholism affects not only the individuals who depend on it, but also their families. Children who have an alcohol dependent parent have various problems and need help, but little attention has been given to them. Many references report only negative characteristics of these children. In order to help the children of alcohol dependent parents, health professionals need more information. A wholistic understanding and analysis of these children is needed as a basis for the development of suitable programs of help them. A phenomenological methodology was used to identify the experience of children whose fathers were addicted to alcohol. The findings portray the essence of the lived experience of children of alcohol dependent fathers. Nine adolescents participated in in-depth inverviews and observation with the researcher, done between October and December 2001. The data were recorded on audio tape and transcribed. Sampling was continued until the data were theorectically saturated. The Colaizzi's method was used for data analysis. The results of this study are as follows. Three themes and twenty six meanings were identified. The first theme is Living Alone: living abusively as partner to an alcohol dependent father, living dangerously like an explosive fury, living as an object that ha no self, living with rejection of fatherly being, living with felt responsibility but having no power to help mother who suffers patiently with pain and abuse, living along with no shoulder to lean on, and living with the prejudice of sex discrimination. The second theme is Paradoxical Coping in Life. The meanings are obsessive behavior as a way to control father's behavior, always on the defensive due to anxiety and tension, being afraid of life alone due to paranoid thoughts, contradictory expectation about father's drinking behavior due to life with chronic tension, stress becoming familiar and life being boring and tendious without stimulation, life that is fake and filled with misinterpretations about reality, affection sought from others due to loneliness, compensatory life within peer group, negative expectation about the future due to negative experiences, controling others to protect ego, denial of real emotion to protect self from hurt, life of regretting self, and strong need for approval from others. The third theme is sustaining life. The meanings are ambivalence between revenge on father and pity, struggle for desirable self against fear of gather-like image, understanding father through self reflection, hope to find fatherly being through father's recovery, being able to stand through emotional control and cognitive restructuring, nurturing the seed of hope for the future while in a situation of desperation. The contribution of this study is to give a wholistic understanding of the empirical reality of children of alcohol dependent parents and to develop substantive theory in nursing knowledge. In nursing practice, the results of this study can provide a foundation for the development of programs for children of alcohol dependent parents.

• Tuberculosis and Respiratory Diseases
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• 제66권6호
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• pp.471-476
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• 2009

과민성 폐장염은 감수성 있는 사람이 특정 유발물질에 노출됨으로써 폐실질과 말초 기관지에 육아종성 염증을 일으키는 면역질환이다. 과민성 폐장염은 동물성 및 식물성 항원, 저분자 화학 물질, 세균 및 곰팡이 등의 미생물 흡인에 의해 유발 될 수 있으나 본 증례처럼 주사제에 의한 사례는 매우 드물다. 저자들은 특별한 노출력 없는 건강한 여성에서 태반 추출물 주사 후 발생한 과민성 폐장염의 첫 사례를 경험하여 보고하는 바이다.

• 대한예방한의학회지
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• 제8권2호
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• pp.99-113
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• 2004

Problems and current situation of public health globally and domestically were analyzed in this study and based on these findings, ways to improve from western medicine and Oriental medicine can be deduced as follows: 1. Current problems of public health in Korea and the world 1) Increase of diseases resulted from daily habits and infectious diseases, many are at the brink of being ill. Quality of life from extended life span and unbalanced health care must be solved. 2) Natural and societal factors including host factors, public health service, and other external and internal factors play an important role in deciding healthy and being ill. 3) Some of the limits and problems of modem medicine include insufficient academic knowledge and incomplete theory, as well as misled approach to the treatment. Human itself isn't perfect organism and other realistic problems hinder one's well-being. 4) Regardless of western medicine or Oriental medicine, patients were approached as someone with diseases and disorders, and wholistic approach was disregarded. Lack of clinical training, absence of clear educational philosophy and goal are some of the reasons why the education isn't under concrete system 2. Important factors for the medical education and proper direction for the education of Oriental medicine 1) Important factors for medical education - Education should not be limited on the human health and illness, but also cover qualities such as well-being, social welfare, service, and happiness. Every aspects of human life must be considered and attended for more productive outcome. - Basic understanding of humanity must be included in the educational curriculum - Foundation of human diseases and pain are associated with inner life and surrounding causes including family, society, nature, race, culture, religion, politics, and etc., thus the education must be approached to recognize aforementioned criteria. 2) Proper direction for the education of Oriental medicine - Values of Oriental medicine for medical principles and importance of lifehood must be educated. - Educational goal, limits, and levels must be established for the school of Oriental medicine - Respect for life must be the top priorities of educational direction which should lead to solution based education for the human health. Latest medical theory and technology should be accommodated as well as prevention, treatment, and balancing of basic courses and clinical training for optimal education.