• Title/Summary/Keyword: 치료방법에 대한 이해

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Pain, Acupuncture and Brain Imaging (통증, 침술 및 뇌영상)

  • Kwak, Yong-Ho;Won, Ran;Lee, Hye-Jung;Lee, Bae-Hwan
    • Science of Emotion and Sensibility
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    • v.13 no.3
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    • pp.551-558
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    • 2010
  • Pain is very complex and multi-level experience that should be objective or subjective. Acupuncture is a traditional method to heal the pain and have been based on meridian theory. There have been many clinical evidences showing the pain-relieving effect of acupuncture but science-based understanding of it was poor. Furthermore in daily life, we feel huge gap between the source of pain and pain control by acupuncture stimulation. However, the underlying connection between pain control and acupuncture stimulation has been reported in many recent reports. In this paper, we briefly introduce the brain imaging techniques (functional magnetic resonance images, positron emission tomography, electroencephalograph, and magnetoencephalography) and review researches in pain and acupuncture. Through this, the brain areas that activated by pain and acupuncture will be verified, and compared each other regarding their specificity and similarity. In addition, detailed understanding of brain function which is related to pain and acupuncture analgesia through brain imaging techniques will be discussed.

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Treatment of Early Laryngeal Cancer - Indication and Technique of Conservative Partial Laryngectomy - (초기 후두암의 치료 - 보존적 후두절제술의 적용범위와 방법 -)

  • 서장수;송시연
    • Korean Journal of Bronchoesophagology
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    • v.3 no.1
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    • pp.27-36
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    • 1997
  • 초기후두암에 있어서 보존적 술식의 장점은 후두 전적출술시와 같은 국소치료효과를 얻을 수 있으면서도 후두의 생리적 기능을 최대한 보존하는데 있다. 성공적인 후두부분절제술을 위해서는 후두내에서 종양의 발생위치 및 그 확산에 대한 연부조직들의 해부학적 역할에 대한 이해가 필요하다. 과거에는 초기후두암환자에서 정상적인 목소리를 보존할 수 있다는 이점 때문에 방사선 치료가 일차적 치료요법으로 많이 시행되어 왔다. Wang 과 Wong은 성대 막양부에 국한된 병변에서 방사선치료에 대한 5년간 조절율(5-year control rate)이 92%, 전연합부를 침범한 경우가 81%, 그리고 후방으로 전파된 경우 76%로 감소된다고 보고하였다. Olofsson 등은 전연합부를 침범한 57례의 환자에서 방사선 치료를 시행하여 85.7%의 5년 생존율을 얻었으나, 57례중 15례에서 재발하여 구제수술(salvage surgery)을 시행하였고, Jesse 등$^{13)}$ 은 전연합부를 침범한 91례의 T1, T2 성문암을 방사선 치료를 시행하여 8.8%의 실패율을 보였으나 22례의 환자에서 재발하여 후에 salvage surgery를 시행하였다. 그러나 Ogura 등은 피열 연골을 침범한 79례의 환자에서 보존적 수술을 시행한 결과 6례의 환자에서 재발하여 90%의 3-years control rate를 얻을 수 있었다고 보고하였다. 이처럼 병변이 전연합부, 피열연골 혹은 후방성문하부로의 침범이 있는 경우는 방사선 치료 효과가 떨어지고, 따라서 방사선 치료에 실패할 가능성이 보다 높기 때문에 비록 방사선 치료 후 실패한 경우에서 구제 수술을 시행할 수는 있지만 후두기능을 보존하려는 궁극적인 목표를 생각할 때 보존적 수술을 우선적으로 시행하는 것이 바람직하다고 할 수 있다. Biller 등은 방사선 요법에서 실패한 성문부 종양에서는 대부분 전적출술을 시행하지만 일부는 보존적 수술을 시행할 수 있다고 보고하였다. 이들은 반대측 성문부에 종양의 침범이 없어야 하고, 전연 합으로의 파급은 있어도 가능하며 성대돌기를 제외한 피열연골이 정상이어야 하고, 종양의 성문하부로의 파급이 5mm 이내라야 하며, 연골에 침범이 없어야 하고, 성대고정이 없어야 하며, 재발 병소가 방사선요법 전의 원발병소와 상관관계가 있어야 하며, 원발병소가 후두부분적출술에 합당할 경우 보존적 술식을 시행할 수 있다고 하였다. 최근에는 다양한 후두 재건술의 발달로 보다 진행된 후두암에 대한 보존적 후두절제술들이 소개되고 있다. 단측 T3,T4 후두암 혹은 경성문암, 이상와에 위치한 암의 경우 음성만을 재건하는 후두근적출술 (near total laryngectomy)을 시행하기도 한다. 본원 이비인후과에서 1986년부터 초기성문암 51례 중 24례(47.1%)와 초기성문상암 17례 중 12례 (70.6%)에 대하여 보존적 술식을 시행하였다. 초기 성문암의 보존적 술식을 시행한 24례중, 2례(8.3%)에서 경부재발, 1례(4.2%)에서 경부재발과 동반된 폐의 원격전이가 있었으나 원발부위의 재발은 관찰되지 않았고, 술후 합병증으로 1례(4.2%)에서 후두협착, 3례(12.5%)에서 수술부위의 육아종형성, 그리고 1례(4.2%)에서 기관지염이 발생하였으나 오연으로 인한 폐렴은 발생하지 않았다. 초기성문 상암의 보존적 술식을 시행한 12례 중 1례(8.3%)에서 원발병소의 재발, 2례(16.7%)에서 경부재발이 있었으며, 술후 합병증으로 3례(16.7%)에서 오연으로 인한 폐렴의 발생이 있었지만 다른 합병증은 발생하지 않았다. 초기성문암 24례 중 재발이 나타난 3례의 환자를 제외한 21례(97.5%)와 초기성문상암 12례 중 재발이 나타난 3례의 환자를 제외한 9례 (75%)에서는 현재까지 재발소견을 보이지 않고 있다. 이러한 결과는 다른 보고자들과 유사한 결과를 보이고 있지만 아직까지 증례가 많지 않기 때문에 생존율을 얻기에는 미흡한 점이 있으며, 향후 지속적인 추적관찰이 필요할 것으로 사료된다.

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Non-Pharmacological Interventions for Behavioral and Psychological Symptoms of Neurocognitive Disorder (신경인지장애의 정신행동증상에 대한 비약물학적 개입)

  • Hyun Kim;Kang Joon Lee
    • Korean Journal of Psychosomatic Medicine
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    • v.31 no.1
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    • pp.1-9
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    • 2023
  • Patients with neurocognitive disorder show behavioral psychological symptoms such as agitation, aggression, depression, and wandering, as well as cognitive decline, which puts a considerable burden on patients and their families. For the treatment of behavioral psychological symptoms, patient-centered, non-pharmacological treatment should be used as a first line approach. This paper describes non-pharmacological interventions to manage and treat behavioral psychological symptoms in patients with neurocognitive disorder. In order to control behavioral psychological symptoms such as agitation, depression, apathy, insomnia, and wandering, it is important to identify and evaluate factors such as environmental changes and drugs, and then solve such problems. Non-pharmacological interventions include reassurance, encourage, distraction, and environmental change. It is necessary to understand behavior from a patient's point of view and to approach the patient's needs and abilities appropriately. Reminiscence therapy, music therapy, aroma therapy, multisensory stimulation therapy, exercise therapy, light therapy, massage therapy, cognitive intervention therapy, and pet therapy are used as non-pharmacological interventions, and these approaches are known to improve symptoms such as depression, apathy, agitation, aggression, anxiety, wandering, and insomnia. However, the quality of the evidence base for non-pharmacological approaches is generally lower than for pharmacological treatments. Therefore, more extensive and accurate effectiveness verification studies are needed in the future.

The Impact of COVID-19 on Lifestyle, Health, and the Quality of Life in Community Treatment Center Residents: A Study Using a Mixed Study Method (COVID-19 가 생활치료센터 입소자들의 라이프스타일, 건강, 삶의 질에 미치는 영향: 혼합연구방법을 활용한 연구)

  • Jung, Jae-Hyu;Park, Kang-Hyun;Park, Ji-Hyuk
    • Therapeutic Science for Rehabilitation
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    • v.10 no.1
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    • pp.77-93
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    • 2021
  • Objective : The purpose of this study was to investigate the lifestyle changes in patients with COVID-19 and their effects on health and the quality of life. Methods : A mixed study method was used for 15 confirmed cases admitted to residential treatment centers in September 2020. The YLP was used to evaluate the lifestyle patterns, and the Korean version of WHOQOL-BREF, MSBS-8, ISI-K, and PHQ-9 were used to analyze health and quality of life before and after COVID-19. The results obtained through in-depth interviews were analyzed using Colaizzi's thematic analysis. Results : YLP (p<.01), WHOQOL-BREF (p<.01), MSBS-8 (p<.01), and ISI-K (p=.05) showed statistically significant differences between the assessment outcomes before and after COVID-19. In addition, 179 meaningful statements, 14 sub-themes, 11 themes, and 3 categories were elicited. The final 3 categories are the emotions of the confirmed cases, the experiences in residential treatment centers and the needs from the perspective of the confirmed cases. Conclusion : There are negative effects on lifestyle, health, and quality of life on confirmed cases. In response, the confirmed cases requested several activities and counseling. Therefore, it is necessary to develop a program to improve the lifestyle, quality of life, and health of asymptomatic cases and cases with mild symptoms.

장개빈(張介賓)의 의학윤리(醫學倫理) 사상(思想)에 대한 고찰(考察);관어장개빈의학윤리사상적연구(關於張介賓醫學倫理思想的硏究)

  • Kim, Yong-Jin
    • Journal of Korean Medical classics
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    • v.19 no.4
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    • pp.126-135
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    • 2006
  • 목전(目前), 수착여의학상관적현대과학기술적급속발전(隨着與醫學相關的現代科學技術的急速發展), 의료계대의학윤리적요구월래월고(醫療界對醫學倫理的要求越來越高), 의학윤리사상재동양주요원요의생적윤리이발전기래(醫學倫理思想在東洋主要園繞醫生的倫理而發展起來). 우기도료명대(尤其到了明代), 장개빈근거(張介賓根據) "소문(素門) 방성쇠론(方盛衰論)"중(中)"부실인정(不失人情)"문장(文章), 제출료인환자여감호인이급의자지간각유기구체정황(提出了因患者與監護人以及醫者之間各有其具體情況), 소이필수분별가이타선료해(所以必須分別加以妥善了解), 즉주요원요의생윤리사상언급환자혹감호인적구체정황(卽主要園繞醫生倫理思想言及患者或監護人的具體情況). 종관기내용가지(綜觀其內容可知), 재환자방면(在患者方面), 장개빈인위의생응사선응예지환자적각종정황(張介賓認爲醫生應事先應預知患者的各種情況), 여약환자심리존유측시의생능력적상법(如若患者心里存有測試醫生能力的想法), 나마치료효과취불회호. 재감호인방면(在監護人方面), 장개빈인위유어개인적친분혹이해관계(張介賓認爲由於個人的親分或利害關係), 왕왕회사환자화의생면임군경(往往會使患者和醫生面臨窘境), 저일점응가이주의(這一點應加以注意). 재의생방면(在醫生方面), 장개빈인위의생응숙지자신적의학능력(張介賓認爲醫生應熟知自身的醫學能力), 불능기편환자(不能欺編患者), 야불능설비방기타의생적화(也不能設誹謗其他醫生的話). 령외, 장개빈종기보편성의학윤리사상(張介賓從其普遍性醫學倫理思想), 인위의사응구비총명적자질(認爲醫師應具備聰明的資質), 필수유일과열애생명적심(必須有一顆熱愛生命的心), 이차환인위의생응다독의경(而且還認爲醫生應多讀醫經), 다배양사(多拜良師), 정확지장악약물급진단치료질병적방법(正確地掌握藥物及診斷治療疾病的方法).

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Informational Needs of Postoperative Gastric Cancer Patients (위암 수술 후 환자의 정보 요구)

  • Kim, Ae-Ran;Choi, Min-Gew;Noh, Jae-Hyung;Sohn, Tae-Sung;Bae, Jae-Moon;Kim, Sung
    • Journal of Gastric Cancer
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    • v.9 no.3
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    • pp.117-127
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    • 2009
  • Purpose: Adequate health-related information provided by health professionals may help cancer patients overcome their uncertain situation and manage their healthcare. To provide information effectively, there is a need to understand the content of the patients' essential information. The purpose of this study was to identify recent informational needs of postoperative gastric cancer patients. Materials and Methods: Data were collected from 190 postoperative gastric cancer patients who attended the Stomach Cancer Patients' Day ceremony (18 November 2008) held by the Stomach Cancer Center of Samsung Medical Center with the use of a questionnaire which measured informational needs. A questionnaire with 37 items was comprised of domains of diagnostic tests, cancer therapy, prognosis, follow-up, sexual activity, stomach cancer-related information, and 7 single items. Results: The priorities of informational needs were the domains of prognosis, ways of healthcare during treatment (a single item), follow-up, stomach cancer-related information, cancer therapy, and diagnostic tests (in descending order). Items related to prognosis, diet, and management of their healthcare ranked in the top 10 informational need scores. As age decreased, the degree of informational needs about diagnostic tests, cancer therapy, sexual activity, and stomach cancer-related information increased. Conclusion: We suggest that prognosis-related information based on the accumulated institutional therapeutic outcomes and objective prognosis data should be incorporated in the current education program. Health professionals should provide comprehensible information content to cancer patients and caregivers and encourage patients to participate in their therapy with a more positive attitude.

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The evaluation of methodological quality of meta-analysis studies in speech language pathology using AMSTAR (AMSTAR에 기반한 국내 언어치료 분야 메타분석 논문의 방법론적 질평가)

  • Han, Minju;Byeon, Haewon
    • Journal of the Korea Convergence Society
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    • v.11 no.2
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    • pp.161-165
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    • 2020
  • Although research using meta-analysis is increasing in the field of rehabilitation science, not all meta-analytical papers are of the same quality. In particular, although meta-analysis is a research method with the highest level of evidence, it may be possible to derive distorted conclusions or alternatives by simply integrating representative values without considering heterogeneity among individual studies. This study analyzed the current status of meta-analysis papers on the subject of language arbitration published in Korea from January 2010 to June 2019, and used A Measurement Tool to Assess the Methodological Quality of Systematic Review (AMSTAR). As a result of evaluating the methodological quality of the final five papers, the average of 7.4 points out of 11 points was found above average. In order to raise the qualitative level of Meta-analysis in speech-language pathology in the future, it is necessary to include verification of publication bias and specification of conflicts of interest.

Shortening length of hospital stay and elevating parental confidence in infant care by prematurity discharge training method improvement (미숙아의 퇴원교육방법 개선을 통한 재원일수 단축 및 보호자의 양육자신감 향상)

  • Cho, Mi Ra;Kim, Jin Wha;Park, Kyung Ju;Lee, Hye Sim;Jang, Se HuiI;Cho, Hui Jeong
    • Quality Improvement in Health Care
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    • v.14 no.2
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    • pp.117-123
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    • 2008
  • 문제: 장기 입원 치료를 받은 미숙아의 퇴원교육을 퇴원당일 짧은 시간에 시행함으로써 간호사는 제한된 인력으로 교육시간을 길게 할애하지 못하고, 표준화된 지침의 부재로 인해 퇴원교육을 누락하는 경우가 있으며 보호자는 교육내용을 충분히 이해할 시간이 부족하여 퇴원에 대한 필요 이상의 두려움을 가지고 있었다. 목적: 미숙아에 대한 퇴원교육을 표준화된 지침에 따라 단계적이고 체계적인 방법으로 개선함으로써 불필요한 퇴원지연을 예방하여 재원일수 단축시키고 보호자의 양육 자신감을 향상시킨다. 의료기관: 부산광역시에 소재한 대학병원의 신생아실 질 향상 활동: 미숙아의 퇴원을 지연시키는 원인을 분석하고 개선된 미숙아 퇴원교육 방법을 적용한 후 미숙아 재원일수와 보호자의 양육자신감을 측정하였다. 개선효과: 개선 활동 후 미숙아의 재원일수가 11.33일에서 8.28일로 3.05일 단축되었고 보호자 양육자신감 점수는 68점에서 76.25점으로 8.25점 향상되었다. 교훈: 퇴원을 앞둔 미숙아들이 좀 더 개방적으로 가족과 함께 지내면서 퇴원준비를 할 수 있는 여건과 미숙아의 성장과 발달에 대한 보호자들의 이해를 돕기 위한 인터넷강좌나 공개 강좌 등이 필요하다. 보호자들의 양육 자신감 향상과 정보교환을 위해 자조조직을 활성화하고 보다 질 높은 서비스를 위해서는 현실적으로 간호사의 인원 충원이 필요하다.

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Secondary Dental Pain and Facial Pain Due to Pansinusitis : A Case Report (범부비동염에 의한 이차성 치통과 안면통: 증례보고)

  • Kim, Nam-Koo;Auh, Q-Schick;Chun, Yang-Hyun;Hong, Jung-Pyo
    • Journal of Oral Medicine and Pain
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    • v.32 no.3
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    • pp.329-336
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    • 2007
  • Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues or periodontal structures1). These odontogenic pains are managed well and predictably by dental therapies. One of the most frequent encounters and most confusing phenomena with which the dental diagnostician must deal is the problem of referred pain. The most important step toward proper management of a toothache is to consider that the pain may not be of dental origin. And Patients with orofacial pain, especially those in chronic pain, present a diagnostic and management challenge for the practitioners. There are many structures in the head and neck that can produce heterotopic pains felt in the teeth and other structures. Once referred pain is suspected, the true source of the pain must be located in order to render effective therapy. With increased interest in temporomandibular disorders and orofacial pain, many studies of accurate diagnosis and differential diagnosis about orofacial pain have been established. The purpose of this paper is to present a case for pansinusitis which produced pain referral in teeth and mimicked the symptoms of migraine.

Comprehensive Understanding of the Double-sidedness of Sexual Fantasy: focused on disability, crime and treatment (성적 공상의 양면성에 대한 통합적 이해 - 장애, 범죄, 치료 관련 요인을 중심으로)

  • Sin, Na-Ra;Song, Wonyoung
    • Journal of Digital Convergence
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    • v.14 no.1
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    • pp.339-351
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    • 2016
  • Comprehensive Understanding of the Double-sidedness of Sexual Fantasy: focused on disability, crime and treatment. This study was to understand the double-sidedness of sexual fantasy. First, definition of normal sexual fantasy and abnormal sexual fantasy in former researches is discussed. Secondly, sexual fantasy's role as a risk factor in the context of obsessional discomfort or sexual crime. Thirdly, guideline and principle when using sexual fantasy as a tool of treatment. Fourthly, measuring and evaluating tools of sexual fantasy were reviewed and necessity of developing new scale was proposed. In addition, summary and ideas for further research were suggested.