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Changes in the Adjunct professor system of medical offices in the Joseon Dynasty (조선시대 의료관청의 겸교수 제도의 변화)

  • PARK Hun-pyeong
    • The Journal of Korean Medical History
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    • v.36 no.1
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    • pp.1-9
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    • 2023
  • To be an adjunct professor(gyeomgyosu) literally means to act as an instructor while also holding a different position. Adjunct professors were initially introduced under Confucianism. Gradually, technical offices also appointed adjunct professors using Confucian-educated bureaucrats for the purpose of educating lower-level technical officials and cadets. This paper examines the history of the civil service system related to adjunct professors through the Code of Laws, and examines those who have been appointed to the public office described in various documents. This paper argues that changes in the medical office's adjunct professor system reflect changes in the national medical talent training policy. The main basis of specific recognizing medical personnel is to decouple the appointment of Confucian scholars from that of full-time doctors. The replacement of the role of medical educators from Confucian scholars to full-time doctors was largely accomplished during the reign of King Jungjong(中宗) and was completed during the period of King Injo(仁祖). The time when Euiyakdongcham was created and the Office of Euiyakdongcham was established coincided with the period when the adjunct professor was disrupted in the medical office. However, this change in the adjunct professor system of medical authorities is in contrast to interpretation, which is a representative technical field. In the case of interpretation, Moonshin's sayeogwon position as adjunct professor was maintained even in the late Joseon Dynasty, and apart from this, there was a hanhagmunsin in Seungmunwon. Interpreter families had institutional arrangements that prevented them from making interpretation their own monopoly. Therefore, families of medical bureaucrats had more room for institutional growth than those of bureaucratic interpreters. Of course, these institutional devices did not prevent the growth of interpreting bureaucratic families in the late Joseon Dynasty. However, the situation in which medicine was accepted only as a kind of knowledge, not as an object of full-time work for sadaebue, would have been an opportunity to rise for those in technical jobs who were full-time medicine. As medicine became more differentiated and developed in the late Joseon Dynasty, medical knowledge and the knowledge about the medical profession became more important. The politicians could not avoid the use of a philosophically oriented system in which a confucian-educated bureaucrat equipped with only Confucian knowledge might replace a full-time doctor. Thus, the contradiction between the reality and the ideal of ignoring or denying reality was reproduced like other Confucian-centered societies. These contradictions have implications for us living in the modern age. Establishing the relationship between philosophy (or belief) and technology should not end with the superiority of one side or the other.

[Secondary publication] Sudden Aortic Rupture in Ehlers-Danlos Syndrome Type IV (엘러스-단로스 제4형 증후군 환자에서 발생한 대동맥 파열)

  • Baek, Taehwa;Kim, Minjung;Ki, Chang-Seok;Park, Seong Hwan;Lee, Heon;Kim, Kyung Ryoul;Choi, Byung-Ha
    • The Korean Journal of Legal Medicine
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    • v.40 no.2
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    • pp.61-64
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    • 2016
  • Ehlers-Danlos syndrome type IV (EDS IV) is a hereditary disorder of the connective tissue, characterized by easy bruising, thin skin with visible veins, and spontaneous rupture of the large arteries, uterus, or bowel. EDS IV is caused by mutations of the gene for type III procollagen (COL3A1), resulting in insufficient collagen production or a defect in the structure of collagen. EDS IV can have fatal complications such as the rupture of great vessels or organs, which can cause hemorrhaging and sudden unexpected death. Here, we report a case of a 43-year-old female who collapsed after a struggle with a neighbor. In this patient, the bifurcation of the bilateral common iliac artery ruptured, with no evidence of trauma, inflammation, or atherosclerosis. Genetic analysis of COL3A1 showed the presence of a c.2771G>A (p.Gly924Arg) mutation, which may be associated with EDS IV. The forensic pathologist should consider the possibility that the spontaneous visceral or arterial rupture was caused by EDS IV. Genetic analysis is not currently a routine procedure during autopsy. However, in this case, we suggest that the patient possibly had an underlying EDS IV condition, and we recommended family members of the deceased to seek genetic analysis and counseling.

Elimination of Lancet-Related Needlestick Injuries Using a Safety-Engineered Lancet: Experience in a Hospital

  • An, Hye-sun;Ko, Suhui;Bang, Ji Hwan;Park, Sang-Won
    • Infection and chemotherapy
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    • v.50 no.4
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    • pp.319-327
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    • 2018
  • Background: Lancet-related needlestick injuries (NSIs) occur steadily in clinical practices. Safety-engineered devices (SEDs) can systematically reduce NSIs. However, the use of SEDs is not active and no study to guide the implementation of SEDs was known in South Korea. The lancet-related NSIs may be eliminated to zero incidence using a SED lancet with effective sharp injury protection and reuse prevention features. Materials and Methods: We implemented a SED lancet by replacing a conventional prick lancet in a tertiary hospital in a sequential approach. A spot test of the new SED was conducted for 1 month to check the acceptability in practice and a questionnaire survey was obtained from the healthcare workers (HCWs). A pilot implementation of the SED lancet in 2 wards was made for 1 year. Based on these preliminary interventions, a hospital-wide full implementation of the SED lancet was launched. The incidence of NSIs and cost expenditure before and after the intervention were compared. Results: There were 29 cases of conventional prick lancet-related NSIs for 3 years before the full implementation of SED lancet. The proportion of prick lancet-related NSIs among yearly all kinds of NSIs during two years before the pilot study was average 11.7% (22/188). Pre-interventional baseline incidence of all kinds of NSIs was 7.01 per 100 HCW-years. After the full implementation of SED lancet, the lancet-related NSIs became zero in the 2nd year (P = 0.001). The average direct cost of 18,393 US dollars (USD) per year from device and post-exposure medical care before the intervention rose to 20,701 USD in the 2nd year of the intervention. The incremental cost-effectiveness ratio was 210 USD per injury avoided. Conclusion: The implementation of a SED lancet could eliminate the lancet-related NSIs to zero incidence. The cost increase incurred by the use of SED lancet was tolerable.

The Characteristics and Spatial Configuration for a Nurse's Office in an Elementary School in a Rural Area -Focused on Cheongwon Gun Area- (농촌지역 초등학교 보건실의 공간구성 및 특성 -청원군 지역을 중심으로-)

  • Lee, Jae-Hyung;Jung, Jin-Ju
    • Journal of the Korean Institute of Rural Architecture
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    • v.12 no.1
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    • pp.9-16
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    • 2010
  • As the importance of health and school health grows, the purposes of this research are to investigate the differences between the characteristics and the utilization of the nurse's office of an elementary school in an urban area and the nurse's office of an elementary school in a rural area, and to provide the data for the planning of construction of a nurse's office convenient for students to use after grasping the regional characteristics. The methods of this research include the interview and the survey conducted to the heath teachers after visiting 20 nurse's offices in 13 eups and myeons, and examined and analyzed the differences between the characteristics and the utilization of the nurse's office of elementary schools in an urban area and the nurse's office of an elementary school. The nurse's offices of the elementary schools in Cheongwon, a rural area, are worse in access to health care institutions and in the connection to the placement than those of the elementary schools in urban areas, so most of eups and myeons were not allowed for easy access to medical service. Depending on the bad personal surroundings of each elementary student, mental stress and the lack of heal care of each student should be taken care of along with the educating of the parents and the children. Also because of the difficulties in access to the health care institutions, it is suggested that a lot of support and interest should be provided for the nurse's offices and that a lot of changes with functions should occur to the nurse's offices so that the nurse's office of an elementary school can play the role as a local health care institution. Besides, the health teachers also should be able to provide more professional medical services by taking in-service training courses.

Development and Maintenance of Cohort Data at Chonnam National University Medical School (전남대학교 의과대학 코호트 구축과 운영 사례)

  • Eun-Kyung Chung;Eui-Ryoung Han
    • Korean Medical Education Review
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    • v.25 no.2
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    • pp.126-131
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    • 2023
  • The aim of this study was to systematically collect data for evaluating short- and long-term outcomes using Kirkpatrick's four-level evaluation model, Chonnam National Medical School has established plans for developing and managing a database of student and graduate cohorts. The Education Evaluation Committee, with assistance from the Medical Education Office, manages the development and maintenance of cohort data. Data collection began in the 2022 academic year with first- through fourth-year medical students and graduates of the year 2022. The collected data include sociodemographic characteristics, admission information, psychological test results, academic performance data, extracurricular activity data, scholarship records, national medical licensing exam results, and post-graduation career paths. The Education Evaluation Committee and the Medical Education Office analyze the annually updated student and graduate cohort data and report the results to the dean and relevant committees. These results are used for admissions processes, curriculum improvement, and the development of educational programs. Applicants interested in using the student and graduate cohort data to evaluate the curriculum or conduct academic research must undergo review by the Educational Evaluation Committee before being granted access to the data. It is expected that the collected data from student and graduate cohorts will provide a sound and scientific basis for evaluating short- and long-term achievements based on student, school, and other characteristics, thereby supporting medical education policies, innovation, and implementation.

Forensic Body Fluid Identification by Analysis of Multiple RNA Markers Using NanoString Technology

  • Park, Jong-Lyul;Park, Seong-Min;Kim, Jeong-Hwan;Lee, Han-Chul;Lee, Seung-Hwan;Woo, Kwang-Man;Kim, Seon-Young
    • Genomics & Informatics
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    • v.11 no.4
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    • pp.277-281
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    • 2013
  • RNA analysis has become a reliable method of body fluid identification for forensic use. Previously, we developed a combination of four multiplex quantitative PCR (qRT-PCR) probes to discriminate four different body fluids (blood, semen, saliva, and vaginal secretion). While those makers successfully identified most body fluid samples, there were some cases of false positive and negative identification. To improve the accuracy of the identification further, we tried to use multiple markers per body fluid and adopted the NanoString nCounter system instead of a multiplex qRT-PCR system. After measuring tens of RNA markers, we evaluated the accuracy of each marker for body fluid identification. For body fluids, such as blood and semen, each body fluid-specific marker was accurate enough for perfect identification. However, for saliva and vaginal secretion, no single marker was perfect. Thus, we designed a logistic regression model with multiple markers for saliva and vaginal secretion and achieved almost perfect identification. In conclusion, the NanoString nCounter is an efficient platform for measuring multiple RNA markers per body fluid and will be useful for forensic RNA analysis.

Critical Pathway for Spinal Stenosis Patients (척추관 협착증 환자 진료 프로세스 개발)

  • Lee, Hwan Mo;Kim, Ho Jung;Kim, Keung Nyun;Ahn, Poong Gi;Chun, Jahae;Shin, Hyun-Ju;Kim, Yang Soo;Shin, Hye Sun;Kim, In Sook;Chung, Hye Kyung;Kim, Young Ah;Chae, Hyung Ki;Park, In Young
    • Quality Improvement in Health Care
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    • v.15 no.2
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    • pp.83-86
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    • 2009
  • 연구배경: 수술적 치료가 필요한 척추관 협착증 환자들은 주로 60세 이상의 고령환자로 장기간의 입원 시 기회 감염의 증대와 불필요한 의료비의 증대를 가져오게 되며, 수술 후 환자들의 재원일수의 증가는 병원의 병상가동률을 감소시키고, 전공의에게는 불필요한 업무를 증가시킨다. 연구목적: 비용 효과면에서 최적화된 진료 지침의 개발은 불필요한 의료비의 감소 및 Hospital Induced Complication을 줄여 환자 만족도를 증진시킬 수 있으며, 각 환자에 대한 전공의 업무를 줄일 수 있다. 의료기관: 서울특별시에 소재한 2,075병상의 종합전문요양기관 연구방법: 정형외과 및 신경외과의 척추관 협착증 환자의 처방을 비교하여 최적의 표준진료지침을 개발하고 최종적으로 CP Master Program(EMR 프로그램)에 입력하여 환자에게 적용하였다. 연구결과: CP 적용 전, 후 비교를 통해 재원일수는 3.8일이 감소하였으며, 이에 따라 병상 가동률 및 진료수익이 증가했으리라고 예상되며 현재 비교 검토 중이다. 또한, CP 개발 및 CP Master Program의 사용을 통한 전공의 업무 감소에 대해 검토하고 있다.

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The Application of Paewinsky et al.'s Age Estimation Method to Periapical Radiographs (치근단 방사선 사진에서 Paewinsky 연령추정법 적용에 대한 연구)

  • Roh, Byung-Yoon;Seo, Jeong-Uk;Kim, Chang-Gyum;Choi, Chang-Un;Lee, Won-Joon;Lee, Sang-Seob
    • The Korean Journal of Legal Medicine
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    • v.42 no.4
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    • pp.141-145
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    • 2018
  • There have been many radiographic studies on age estimation that evaluate reduction in size of dental pulp cavity with secondary dentin formation. The Paewinsky method reported high accuracy in estimating ages by measuring the width of the pulp cavity in panoramic radiographs. The aim of this study was to evaluate the application of the Paewinsky method to digital periapical radiographs. This study was conducted on 103 cases that reported to the Section of Human Identification of the National Forensic Service. The age was calculated by applying the Paewinsky method that measures the root and pulp canal width at three points in a tooth. The estimation results were compared with those calculated by the Johanson method. When the Paewinsky models were applied to digital periapical radiographs, the errors were significantly greater as compared to the original study. The errors of the maxillary second premolar and mandibular lateral incisor were greater than those of the maxillary central incisor, lateral incisor, mandibular canine, and first premolar. Furthermore, errors of the age estimation models in level C were greater than those in levels A and B. This study could be a reference for the application of the Paewinsky method to digital periapical radiographs.