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Background: The applicability of Korean medicine (KM) treatments for post-acute COVID-19 syndrome were investigated.Methods: A cross-sectional, web-based survey of Korean medical doctors (KMDs) was conducted in June 2022. The 25-item questionnaire comprised of five parts: basic characteristics, prescribed post-COVID-19 KM treatments, treatment effect in patients with post-acute COVID-19 syndrome, patient satisfaction, and awareness and utilization of the relevant KM Clinical Practice Guideline by the KMDs.Results: In total, 1,063 completed questionnaires were collected, and 822 were analyzed. The most common symptoms in patients with post-acute COVID-19 syndrome treated by KMDs was weakness and fatigue (84.3%). Herbal decoctions (39.2%) and herbal powder (not covered by medical insurance; 25.8%) were primarily used. Among the KMDs, 95% (n = 781) responded that KM treatments, particularly herbal decoctions (82.6%) and herbal powder (not covered by medical insurance; 46.8%), were effective. Overall, 92.6% (n = 761) of KMD participants answered that the patients were satisfied with KM treatments, mostly due to symptomatic improvement (60.8%). The primary reason for dissatisfaction was the burden of cost for patients (78.4%). The main reasons for low uptake of KM services by patients with post-acute COVID-19 syndrome were lack of publicity and administrative issues such as no health insurance coverage.Conclusion: KM is highly applicable for post-acute COVID-19 syndrome. Health policies supporting the use of KM for post-acute COVID-19 syndrome are recommended.

Background: The objective of this study was to identify the clinical features of patients who recovered from COVID-19, and to determine their unmet medical needs and quality of life.Methods: A cross-sectional national survey was conducted in Korea in June 2022, targeting patients with at least four weeks of symptoms of COVID-19. The questionnaire survey had 37 items across: basic characteristics, acute COVID-19 and post-acute COVID-19 syndrome (long COVID) symptoms, access to medical facilities for long COVID, unmet medical needs, long COVID support system, and quality of life.Results: Among 1,430 responses, 745 (52.1%) respondents had experienced long COVID. The most common symptoms were ear, nose, and throat complications (n = 461, 61.9%), followed by weakness and fatigue (n = 393, 52.8%). Amongst the 745 respondents who experienced long COVID, 337 (45.2%) had visited a medical institution, of which, 84.9% had visited a clinic or hospital for treatment. Korean medicine clinics and hospitals had the highest satisfaction rates (43.4%). There were 242 respondents (32.5%) who reported unmet medical needs for their long COVID. Symptom severity and duration of COVID-19 were risk factors for unmet medical needs. Quality of life was low in those patients with long COVID and unmet medical needs, and decreased further with increased severity and longer duration of symptoms.Conclusion: Studies on the effects of Korean medicine treatment of long COVID, and establishing a system providing sufficient treatment for patients with long COVID are needed. These findings could be used by clinicians, researchers, and COVID-19-related policymakers.

We investigated the effectiveness of integrative Korean medicine treatment in patients with pre-existing scoliosis who received inpatient care for traffic-accident-induced acute LBP. We selected 674 patients diagnosed with scoliosis between 1 January 2015, and 30 June 2021, using lumbar spine (L-spine) imaging, across four Korean medicine hospitals in Korea for a retrospective chart review and sent them a questionnaire-based follow-up survey. The primary outcome was a numeric rating scale (NRS) score of LBP. The secondary outcomes were the Oswestry Disability Index (ODI), 5-level EuroQol 5-dimension (EQ-5D-5L), and patient global impression of change (PGIC) scores. In total, 101 patients responded to the follow-up survey. NRS scores decreased from 4.86 (4.71–5.02) to 3.53 (3.17–3.90) from admission to discharge, subsequently decreasing to 3.01 (2.64–3.38) (p < 0.001) at the last follow-up. Similarly, ODI scores decreased from 35.96 (33.08–38.85) to 22.73 (20.23–25.24) and 14.21 (11.74–16.67) (p < 0.001), respectively. Approximately 87.1% of patients were satisfied with their inpatient care. There were no significant differences in the degree of improvement according to the severity of scoliosis. Integrative Korean medicine treatment can improve pain, lumbar dysfunction, and quality of life in patients with traffic-accident-induced acute low back pain and pre-existing mild scoliosis.

The present prospective observational study aimed to analyze the outcomes of inpatients who received integrative Korean medicine treatment in order to provide evidence on its effects on lumbar spinal stenosis (LSS). Patients with LSS who received inpatient treatment at four Korean medicine hospitals from January 2015 to December 2018 were followed up. Outcomes measured included the numeric rating scale (NRS) scores for back and leg pain, and Oswestry Disability Index (ODI). Changes in outcomes at admission, discharge, and follow-up, as well as associated predictors that could account for the improvement in outcomes were analyzed. The NRS score for back pain, NRS score for leg pain, and ODI decreased by 2.20 points (95% confidence interval (CI), &minus, 2.41 to &minus, 1.99), 2.28 points (95% CI, &minus, 2.59 to &minus, 1.96), and 17.31 points (95% CI, &minus, 19.6 to &minus, 15.02), respectively, at long-term follow-up compared with at admission. Patients with LSS who received inpatient integrative Korean medicine treatment exhibited an improvement in pain and functional disability. Further studies are required to determine the effects of integrative Korean medicine treatment.

This study is a qualitative study based on 1:1 semi-structured interviews designed to explore the treatment selection process and factors that influence the treatment decisions of patients with spinal pain undergoing surgery or Korean medicine treatment.Patients admitted to a Korean hospital for treatment after either undergoing or receiving a recommendation for spinal surgery, aged 19-74 years, able to communicate in Korean, and who provided informed consent were invited to participate in the study. Of the 15 participants selected, 9 underwent spinal surgery, while 6 had spinal surgery recommended but did not choose to have it.Three main themes emerged from the interviews: positive factors for Korean medicine; positive factors for surgery; difficulties in decision-making. Recommendations by and cases of people around them had the greatest influence on patients who chose Korean medicine treatment (their own situation). Patients who chose surgery tended to be influenced by their physicians, whose opinions had the greatest influence on their choice.Treatment decisions are influenced by: recommendation by or cases of personal acquaintances; fear of surgery; trust in physician; physician's competence; experience of pain; lack of information; patient's situation. The factors that influence the choice of Korean medicine treatment and surgery clearly differ. The findings would be useful for clinicians and patients who must decide between various treatments modality recommendations.Einleitung: Wir berichten hier über eine qualitative Studie auf der Grundlage semistrukturierter Einzelinterviews, in denen es darum ging, den Prozess und die Einflussfaktoren der Entscheidungsfindung von Patienten zu erforschen, die sich wegen Wirbelsäulenschmerzen einer Behandlung mittels Operation oder Koreanischer Medizin unterziehen. Methoden: Zur Studienteilnahme eingeladen wurden Patienten im Alter von 19–74 Jahren, die entweder nach einer Wirbelsäulenchirurgie oder mit der Empfehlung für eine solche in ein koreanisches Krankenhaus aufgenommen wurden, Koreanisch sprachen und ihre Einwilligung nach Aufklärung erteilten. Von den 15 ausgewählten Teilnehmern unterzogen sich 9 einer Wirbelsäulenoperation; den anderen 6 Patienten war eine solche Operation empfohlen worden, doch sie entschieden sich dagegen. Ergebnisse: Aus den Interviews stachen drei zentrale Aspekte heraus: positive Faktoren für Koreanische Medizin, positive Faktoren für Chirurgie, Schwierigkeiten bei der Entscheidung. Empfehlungen und Fälle aus dem persönlichen Umfeld hatten den größten Einfluss auf Patienten, die sich für die Koreanische Medizin entschieden (ihre eigene Situation). Patienten, die sich für die Chirurgie entschieden, waren tendenziell durch ihre Ärzte beeinflusst; deren Meinung hatte den größten Einfluss auf ihre Entscheidung. Schlussfolgerungen: Die Entscheidung für eine Behandlung wird beeinflusst durch: Empfehlungen und Fälle von Bekannten; Furcht vor einer Operation; Vertrauen in den Arzt; die Kompetenz des Arztes; Schmerzerfahrungen; Mangel an Information; die Situation des Patienten. Die Faktoren, die die Entscheidung für die Koreanische Medizin und für die Chirurgie beeinflussen, unterscheiden sich deutlich. Die Ergebnisse wären nützlich für Kliniker und Patienten, die vor der Entscheidung zwischen verschiedenen empfohlenen Behandlungsmodalitäten stehen.

This study aimed to investigate the long-term effects of and satisfaction with integrative Korean medicine treatment and motion style acupuncture treatment (MSAT) in patients with lumbar disc herniation (LDH). We retrospectively analyzed medical charts and prospectively surveyed adult patients aged between 19 and 64 years treated for lumbar disc herniation for at least 6 days at three Korean hospitals from 1 January 2015 to 31 December 2020. The primary outcome was the Numeric Rating Scale (NRS) for back pain. Secondary outcome measures included the NRS for radiating leg pain, the Oswestry Disability Index (ODI), and the European Quality of Life-5 Dimension-5 Level (EQ-5D-5L) questionnaire. The NRS scores for low back pain decreased from 5.40 ± 1.58 to 2.92 ± 2.09, NRS for radiating leg pain from 5.57 ± 1.56 to 1.78 ± 2.36, and ODI from 46.39 ± 16.72 to 16.47 ± 15.61 at baseline and survey, respectively. The EQ-5D-5L increased from 0.57 ± 0.19 to 0.82 ± 0.14. In conclusion, Korean medicine and MSAT could be effective treatment methods for patients with LDH. The results of this study can be used as helpful information for clinicians who treat patients with LDH in real clinical settings.

Background This cross-sectional, retrospective, observational study analyzed the demographics of patients with peripheral facial palsy in South Korea and their use of healthcare services. Methods The 2016 Korean Health Insurance Review and Assessment National Patient Sample dataset was used; a total of 4790 patients, diagnosed with facial palsy, who had used healthcare services at least once between January 2016 and December 2016 were included, and data on the use of medical services, hospitalizations, sociodemographic factors, treatments, and medications were analyzed. Results Overall, 326 patients per 100,000 individuals used healthcare services at least once because of peripheral facial palsy in 2016, with higher numbers for women and those aged 50–59 years. The percentage of patients who used Korean traditional medicine (KM), Western medicine (WM), and both KM and WM was 54.4, 23.3, and 22.3%, respectively. Users of both WM and KM had higher per capita medical costs, more visits, and longer treatment durations. Physiotherapy was the most frequent WM treatment (44.4%), and “examinations” was the costliest (24.7%) category. “Procedures” was both the most frequent and costliest KM category (99.9 and 57.3%, respectively). “Continuous intravenous injections” (8.6%) and “superficial heat therapy” (8.3%) were the most frequent WM treatments, while acupuncture accounted for 98% of all KM treatments. Conclusions This study analyzed the demographic characteristics and medical service use of patients with peripheral facial palsy in detail. These results can be used as basic information to improve clinical and policy strategies for the management and treatment of peripheral facial palsy.

Objective In this study, we aimed to analyze cost trends for the outpatient treatment of lumbar intervertebral disc herniation (LDH). Methods We used cross-sectional data obtained from the Korea Health Panel Survey from 2011 to 2015. We compared outpatient medical expenses for conservative treatment of LDH using traditional Korean medicine (TKM) or Western medicine (WM). Results This analysis revealed that the total medical expenses for outpatient treatment of LDH using WM treatment methods increased by 30% from 2011 to 2015, and self-payment expenses increased by 50%. The total medical expenses for outpatient treatment of LDH using TKM methods increased by 8%, and self-payment expenses decreased by 33%. The National Health Insurance Service (NHIS) expenditure for WM increased by 7%, and non-covered costs increased by 83%. The NHIS expenditure for TKM increased by 41%, and non-covered costs decreased by 66%. Conclusions The total medical expenses for WM treatments are increasing in Korea, especially for non-covered treatments. The non-covered costs for TKM treatments are decreasing, suggesting a change in medical cost trends according to whether Korea’s actual medical expense insurance scheme is applied.

This study analyzed factors influencing clinical symptoms and treatment of patients with traffic accident injuries. It used a retrospective chart review and questionnaire survey obtained from 560 patients (266 men and 294 women). It also conducted follow-up observations of progress after car insurance settlements and investigated the usefulness of and patient satisfaction with integrative Korean medicine treatment for traffic accident injuries. Retrospective data of patients admitted for traffic accident injury were obtained. A questionnaire survey was conducted to collect data regarding the degree of traffic accident damage, severity of pain at settlement, any treatment after settlement and duration and cost of such treatment, and patient satisfaction with car insurance services and Korean medicine treatment for traffic accident injury. The results showed no significant association between pain and the degree of damage to the car at the time of traffic accident (P = 0.662), although the degree of damage to the car was more significantly associated with time to reach a car insurance settlement than severity of pain in the patient (P = 0.003). There was no significant association between the degree of damage to the car in a traffic accident and pain after a traffic accident. Greater severity of pain at the time of the car insurance settlement was associated with greater cost and longer time spent in treatment after the car insurance settlement.

In this single-center, parallel, randomized controlled trial, we aim to examine the effects and safety of motion style acupuncture treatment (MSAT, a combination of acupuncture and Doin therapy) on pain reduction and functional improvement in patients with whiplash-associated disorders (WADs). Ninety-seven patients with cervical pain admitted to the Bucheon Jaseng Hospital of Korean Medicine, South Korea, due to acute whiplash injury were treated with integrative Korean medicine (IKM) with (MSAT group, 48 patients) or without (control group, 49 patients) an additional 3-day MSAT during hospitalization (5&ndash, 14 days) and followed-up for 90 days. The mean numeric rating scale (NRS) scores of the MSAT and control groups at baseline were 5.67 (95% confidence interval (CI), 5.33, 6.01) and 5.44 (95% CI, 5.06, 5.82), respectively, and on day 5, 3.55 (95% CI, 3.04, 4.06) and 4.59 (95% CI, 4.10&ndash, 5.07), respectively. The NRS change difference between the groups was &minus, 1.07 (95% CI, &minus, 1.76, &minus, 0.37). The rate of recovery of neck pain (NRS score change &ge, 2 points) was significantly faster in the MSAT than in the control group (log-rank test p = 0.0055). IKM treatment combined with MSAT may be effective in reducing the pain and improving the range of motion in patients with WADs.

This study considers a free licensing strategy with passive ownership and investigates the interaction with ex-post privatization policy in a mixed oligopoly where free licensing can be announced before the government selects its optimal degree of privatization. We examine and compare foreign and public licensors and explore the relationships between the foreign share of passive ownership in domestic firms and the incentive of free licensing strategies. We show that free licensing strategies always yield more privatization and higher welfare. By contrast, free licensing between the foreign and public licensors depends on the share of passive ownership and technology gap. We further consider open technology and fee licensing strategies and provide contrasting findings on the optimal degree of privatization and welfare consequences.

We coated inorganic layer containing oxygen, aluminium, phosphorus, and negligible sodium (APO) on stainless steel (STS) by using slot-die coating method and studied its application prospects as a substrate for flexible devices. The APO layer was compositionally uniform in overall area with an amorphous crystal structure. Surface morphology characterization of STS exhibited an improved flatness after the APO layer coating process. The optical property characterization of the APO film carried out by measuring optical reflectance spectrum and refractive index. We also investigated the electrical-transport mechanism in the APO layer. These experimental observations imply the possibility of potential application of APO-STS as a substrate for flexible devices.

Pancreatic cancer has a poor prognosis with a five-year survival rate of less than 10%. Moreover, chemotherapy is mostly rendered ineffective owing to chemotherapy resistance and cytotoxicity. Therefore, the development of effective therapeutic strategies and novel drugs against pancreatic cancer is an urgent need. Cucurbitacin D (CuD), a plant steroid derived from Trichosanthes kirilowii, is an anticancer agent effective against various cancer cell lines. However, the anticancer activity and molecular mechanism of CuD in pancreatic cancer remain unknown. Therefore, we aimed to investigate the anticancer activity and molecular mechanism of CuD in the human pancreatic cancer cell line, Capan-1. CuD induced cell cycle arrest at the G2/M phase, apoptosis, and reactive oxygen species generation in Capan-1 cell line. In addition, CuD induced the activation of the p38 MAPK signaling pathway that regulates apoptosis, which was also inhibited by N-acetyl-L-cysteine and the p38 inhibitor SB203580. These data suggest that CuD induces cell cycle arrest and apoptosis via the ROS/p38 pathway in Capan-1 pancreatic cancer cell line; hence, CuD is a promising candidate that should be explored further for its effectiveness as an anticancer agent against pancreatic cancer.

ObjectiveThis study aimed to promote an understanding of spontaneous pneumothorax by analysing the prevalence rate and medical service use by patients with spontaneous pneumothorax according to sociodemographic characteristics.DesignA 12-year nationwide study.SettingData obtained from the Korean National Health Insurance Service Sharing Service.ParticipantsA total of 4658 participants who used medical services due to spontaneous pneumothorax between 2002 and 2013 in Korea.Outcome measuresFor those diagnosed with spontaneous pneumothorax, use of medical services, hospitalisation data, sociodemographics, comorbidity, treatment administered and medication prescribed were recorded.ResultsThe annual prevalence of spontaneous pneumothorax ranged from 39 to 66 per 100 000 individuals, while the prevalence of hospitalisation due to spontaneous pneumothorax ranged from 18 to 36 per 100 000 individuals. The prevalence rate of spontaneous pneumothorax in Korea has increased since 2002. The male to female ratio was approximately 4–10:1, with a higher prevalence rate in men. By age, the 15–34 years old group, and particularly those aged 15–19 years old, showed the highest prevalence rate; the rate then declined before increasing again for those aged 65 years or older. In total, 47%–57% of patients with spontaneous pneumothorax underwent hospitalisation. The average number of rehospitalisations due to pneumothorax was 1.56 per person, and more than 70% of recurrences occurred within 1 year. Chronic obstructive pulmonary disease was the most common comorbidity. The average treatment period was 11 days as an outpatient and 14 days in-hospital. The average medical costs were $94.50 for outpatients and $2523 for hospital admissions. The most common treatment for spontaneous pneumothorax was oxygen inhalation and thoracostomy, and the most commonly prescribed medications were analgesics, antitussives and antibiotics.ConclusionsWe here detailed the epidemiology and treatments for spontaneous pneumothorax in Korea. This information can contribute to the understanding of spontaneous pneumothorax.

Background There is a controversy about the effect of having a usual source of care on medical expenses. Although many studies have shown lower medical expenses in a group with a usual source of care, some have shown higher medical expenses in such a group. This study aimed to empirically demonstrate the effect of having a usual source of care on medical expenses. Methods The participants included those aged 20 years and older who responded to the questionnaire about “having a usual source of care” from the Korean Health Panel Data of 2012, 2013, and 2016 (6,120; 6,593; and 7,598 respectively). Those who responded with “I do not get sick easily” or “I rarely visit medical institutions” as the reasons for not having a usual source of care were excluded. The panel regression with random effects model was performed to analyze the effect of having a usual source of care on medical expenses. Results The group having a usual source of care spent 20% less on inpatient expenses and 25% less on clinic expenses than the group without a usual source of care. Particularly, the group having a clinic-level usual source of care spent 12% less on total medical expenses, 9% less on outpatient expenses, 35% less on inpatient expenses, and 74% less on hospital expenses, but 29% more on clinic expenses than the group without a usual source of care. Conclusion This study confirmed that medical expenses decreased in the group with a usual source of care, especially a clinic-level usual source of care (USC), than in the group without a usual source of care. Encouraging people to have a clinic-level USC can control excessive medical expenses and induce desirable medical care utilization., Graphical Abstract

Background Neck pain is a common complaint in the general population. Despite the consistent ongoing pain and the resulting economic burden on affected individuals, there have only been a few studies investigating the treatment of acute neck pain. This study aims to evaluate the effectiveness, safety, and cost-effectiveness of the motion style acupuncture treatment (MSAT) and acupuncture treatment for acute neck pain. Methods This 2-armed, parallel, multi-centered randomized controlled trial will be conducted at 4 community-based hospitals in Korea. A total of 128 subjects will be randomly assigned, at a 1:1 ratio, to the MSAT and the acupuncture treatment groups. Treatment will be administered 2 to 3 times a week for 2 weeks. The primary outcome will be the visual analog scale of neck pain on movement. The secondary outcomes will be the numeric rating scale of the neck, neck disability index, Northwick Park questionnaire, patient global impression of change, range of motion of the neck, 5-level EuroQol-5 dimension, 12-item Short-Form Health Survey, and EuroQol visual analogue scale. This protocol has been registered at the Clinicaltrials.gov (NCT04539184). Discussion To our knowledge, this study is the first well-designed multi-centered randomized controlled trial to evaluate the effectiveness, safety, and cost-effectiveness of MSAT on acute neck pain. The results of this study will be useful for clinicians in primary medical institutions that frequently treat acute neck pain patients and for policymakers working with national health insurance.

Additional file 3: Table S1. Medical Service Use of TMD Patients.

Rheological properties of native potato starch (NPS) and pregelatinized potato starch (PPS) were investigated under steady and dynamic shear conditions at 20°C and 60°C. The consistency index, apparent viscosity, and yield stress values of PPS were much lower than those of NPS. The flow behavior of PPS is more temperaturedependent. Dynamic moduli (G′ and G″) and complex viscosity of PPS were much lower than those of NPS, while tan δ values of PPS were in the range of 2.30–3.50 (tan δ>1), indicating that PPS is more viscous than elastic. Rheological properties of NPS are strongly influenced by pregelatinization.

The effects of nonionic surfactants having different hydrophilicity and membranes having different hydrophobicity and molecular weight cut-off on the performance of micellar-enhanced ultrafiltration (MEUF) process were examined. A homologous series of polyethyleneglycol (PEG) alkylether having different numbers of methylene groups and ethylene oxide groups was used for nonionic surfactants. Polysulfone membranes and cellulose acetate membranes having different molecular cut-off were used for hydrophobic membranes and hydrophilic membranes, respectively. The concentration of surfactant added to pure water was fixed at the value of 100 times of critical micelle concentration (CMC). The flux through polysulfone membranes decreased remarkably due to adsorption mainly caused by hydrophobic interactions between surfactant and membrane material. The decline of solution flux for cellulose acetate membranes was not as serious as that for polysulfone membranes because of hydrophilic properties of cellulose acetate membranes. The surfactant rejections for the cellulose acetate membranes increased with decreasing membrane pore size and with increasing the hydrophobicity of surfactant. On the other hand the surfactant rejections for polysulfone membranes showed totally different rejection trends with those for cellulose acetate membranes. The surfactant rejections for the polysulfone membranes depend on the strength of hydrophobic interactions between surfactant and membrane material and molecular weight of surfactants.

Background: During the end-of-life stage, patients suffer from multiple symptoms or impairments of altered body systems. This study examined nurses’ knowledge of end-of-life care and also the relationship between the nurses’ knowledge and their characteristics. Methods: This was a descriptive, correlational study using a convenience sample of 368 Korean registered nurses working in cancer units, general wards, and intensive care units of a university health system. Twenty questions of the Palliative Care Quiz for Nursing (PCQN) were used to examine nurses’ knowledge of end-of-life care. Results: The mean score on the PCQN was 8.95 of a possible 20. Participants who had the end-of-life care education ( M = 9.57, SD = 2.19) tended to score higher than those without this education ( M = 8.47, SD = 2.34), and the difference was statistically significant. Conclusion: Comprehensive continuing education programs on end-of-life care should be provided to fill the gap in knowledge and skill of staff nurses.