• 대한치과보철학회지
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• 제53권4호
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• pp.377-391
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• 2015

상하악 치열궁의 부조화는 3차원적인 교합의 문제를 일으키며 불안정한 교합접촉에 의해 교합평면의 붕괴와 다수의 치아 상실 및 저작기능의 감소가 발생할 수 있다. 치아 상실로 인한 구치부의 지지 상실과 상하악 치열궁의 부조화로 인한 불안정한 교합접촉 및 부적절한 전방유도를 갖는 경우, 교정치료를 동반한 보철치료를 통해 안정적인 교합접촉과 전방유도를 회복하고, 조화로운 교합관계로의 개선이 필요하다. 본 증례보고는 앞서 언급된 문제들이 복합적으로 나타난 환자를 치과보철과와 치과교정과의 협진을 통해 양호한 구강회복 결과를 얻었기에 이를 보고하고자 한다.

• Clinical and Experimental Pediatrics
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• 제55권8호
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• pp.272-279
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• 2012

Purpose: The aim of this study was to develop an appropriate nursing information guideline according to corrected age, after investigating parents' concerns about the growth, development, and diseases of their premature infants after discharge from the neonatal intensive care unit (NICU). Methods: The parents of premature infants (birth weight, <2,500 g; gestational age, <37 weeks) who went to a neonatal follow-up clinic after NICU discharge at Seoul St. Mary's Hospital from January 2005 to December 2009, were asked with regard to their concerns about their infants through a questionnaire survey. The results of physical examinations, including body measurements and neurodevelopmental status at 4, 8, 12, and 18 months of corrected age, were retrospectively reviewed in 390 infants. Results: The most common parental concerns were developmental delay, poor growth, and feeding and nutritional problems. Parental concerns about developmental delay, growth failure in improvement in body weight and length, and overweightness were high in specificity but very low in sensitivity. After NICU discharge, 30% of premature infants experienced infectious diseases before 18 months of corrected age, the most common of which was respiratory tract infection. Conclusion: For guiding of premature infants in outpatient day clinics after NICU discharge, it is necessary to identify the parents' highest concerns, to educate them about the possibilities of growth and neurodevelopmental disabilities in their infants and to provide them with handouts containing guidelines on the management of infectious diseases, especially respiratory infections.

• Journal of Hospice and Palliative Care
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• 제23권3호
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• pp.126-138
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• 2020

Purpose: In Korea, since the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life was implemented in February 2018, advance directives (ADs) have become legally effective and should be documented after sufficient explanation by a registered counselor. However, little is known regarding the adequacy of current AD counseling. This qualitative study aimed to explore the barriers to AD counseling based on counselors' experiences. Methods: We conducted focus group interviews using purposive sampling. Seven counselors working at hospitals, community health institutions, and non-profit organizations participated in this study. They were asked about the challenges and problems they encountered during AD counseling. Results: Three themes emerged from this study; 1) issues regarding consistency in AD counseling, 2) issues regarding AD counselors' competency and work environment, and 3) issues regarding the adequacy of the service system. The interviewees stated that the lack of a manual for standardized service made AD counseling inconsistent. The limited competency and poor work environment of counselors were pointed out as major barriers. The interviewees also stated that a proper service system considering individual circumstances is absent. Conclusion: The goals of AD counseling should be clarified and guidance should be implemented for providing standardized services. Further efforts to enhance the competency of AD counselors and to improve their working conditions are needed. Establishing an integrated framework for an adequate service system is also essential to overcome systematic barriers to AD counseling.

• 한국융합학회논문지
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• 제9권10호
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• pp.121-129
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• 2018

본 연구는 방사선학과 학생들의 전공 선택 만족도에 영향을 주는 요인을 파악하고 평가하였다. 방사선학과 학생 151명을 대상으로 설문 조사하여 t-test, 다중회귀분석을 실시하였다. 학과 선택 중 선호성과 현재 요인이 유의한 차이가 있었다. 임상실습에서는 실습환경, 실습지도, 실습시간과 평가, 실습 후 만족도, 취업과의 연계성이 유의한 차이가 있었다. 학과 교육 과정 요인에서는 교육 과정 구성, 교수 학습 및 평가, 지원 시설, 학제 만족, 교육 과정 만족이 유의한 차이가 있었다. 결과적으로, 학생들의 전공 선택 만족을 높이기 위한 시스템 개발과 교육의 질 향상을 위한 노력이 필요하다.

• The Korean Journal of Pain
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• 제24권1호
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• pp.36-43
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• 2011

Background: Nucleoplasty is a minimally invasive spinal surgery using a $Coblation^{(R)}$ technique that creates small voids within the disc. The purpose of this study was to evaluate the efficacy of cervical nucleoplasty in patients with cervical disc disorder. Methods: Between March 2008 and December 2009, 22 patients with cervical disc disorders were treated with cervical nucleoplasty after failed conservative treatment. All procedures were performed under local anesthesia, and fluoroscopic guidance and voids were created in the disc with the $Perc^{TM}$ DC Spine $Wand^{TM}$. Clinical outcomes were evaluated by the Modified Macnab criteria and VAS score at preprocedure, postprocedure 1 month, and 6 months. Results: Six patients had one, eight patients had two and eight patients had three discs treated; a total of 46 procedures was performed. Mean VAS reduced from 9.3 at preprocedure to 3.7 at postprocedure 1 month and to 3.4 at postprocedure 6 months. There was no significant complication related to the procedure within the first month. Outcomes were good or excellent in 17/22 (77.3%) cases. Postprocedure magnetic resonance imaging was acquired in two patients after two months showing morphologic evidence of volume reduction of protruded disc material in one patient but not in the other. Conclusions: Percutaneous decompression with a nucleoplasty using a $Coblation^{(R)}$ technique in the treatment of cervical disc disorder is a safe, minimally-invasive and less uncomfortable procedure, with an excellent short-term clinical outcome.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권4호
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• pp.345-355
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• 2021

Background: This study aimed to evaluate the efficacy of external vibrating devices and counterstimulation on a child's dental anxiety, apprehension, and pain perception during local anesthetic administration. Methods: This was a prospective, randomized, parallel-arm, single-blinded interventional, clinical trial. One hundred children aged 4-11 years, requiring pulp therapy or extraction under local anesthesia (LA), were recruited and allocated equally into two groups (1:1) based on the interventions used: Group BD (n = 50) received vibration using a Buzzy^® device {MMJ Labs, Atlanta, GE, USA} as a behavior guidance technique; Group CS (n = 50) received counterstimulation for the same technique. Anxiety levels [Venham's Clinical Anxiety Rating Scale (VCARS), Venham Picture Test (VPT), Pulse oximeter {Gibson, Fingertip Pulse Oximeter}, Beijing, China)] were assessed before, during, and after LA administration, while pain perception [Wong-Baker Faces Pain Rating Scale (WBFPS), Visual Analogue Scale (VAS)] was evaluated immediately after injection. Statistical analysis was performed using the Student's t-test to assess the mean difference between the two groups and the repeated measures ANOVA for testing the mean difference in the pulse rates. Statistical significance was set at P < 0.05. Results: Significant differences in mean pulse rate values were observed in both groups. In contrast, the children in the BD group had higher diminution (P < 0.05), whereas the mean VCARS and VPT scores were conspicuous (P < 0.05). Based on the mean WBFPS and VAS scores, delayed pain perception after LA injection was more prominent in the BD group than in the CS group. Conclusion: External vibration using a Buzzy^® device is comparatively better than counterstimulation in alleviating needle-associated anxiety in children requiring extraction and pulpectomy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제50권2호
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• pp.70-79
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• 2024

Objectives: The surgical guide is a static computer-assisted device used for implant surgery planning and guidance. By taking an impression and referring to the patients' three-dimensional computed tomography scan of the desired implant site, a surgical guide can be created. During surgery, the surgical guide aids in achieving the designed implant placement position and direction. We examined and evaluated the long-term clinical outcomes of implant surgery using surgical guides. Materials and Methods: This study investigated a total of 15 patients with 32 implants that were placed using surgical guides from 2009 to 2011 with a mean follow-up period extended beyond 10 years. Patient demographics and implant survival rates were recorded. We analyzed marginal bone loss (MBL) by assessing the radiographs acquired at installation, three months after installation, and one month, one, two, and five years after prosthesis delivery. Results: The mean patient age was 57.33 years at implant placement. Of the 32 implants, five implants were placed in the anterior region and 27 implants were in the posterior region. Six implants failed and three of them were replaced, resulting in an 81.25% survival rate. The mean follow-up period was 10 years and nine months. Mean MBL compared to post-installation was significantly higher than at three months after installation, and one month, one, two, and five years after prosthesis delivery. Mean MBL at three months after installation, and one month, one year, and two years were significantly higher compared to the previous visit (P<0.05). However, MBL at five years after prosthesis delivery did not differ significantly compared to at two years. Conclusion: In this study, implant rehabilitation assisted by surgical guides exhibited favorable survival rates. With the limitation of the sample amount in this study, further research and more samples are required to evaluate the long-term clinical effectiveness of surgical guides.

• 한국임상약학회지
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• 제25권4호
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• pp.238-245
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• 2015

Background: Pharmacy schools newly adopted a 6-year program strengthening clinical knowledge since 2011 in Korea. The clinical training under the guidance of preceptors at hospital sites is a requisite for pharmacy students during the last year of undergraduate course. It has been rarely studied on the hospital pharmacists' perspective regarding being a preceptor or teaching pharmacy students. Objectives: This study aimed to examine the hospital pharmacists' intention toward student training and to identify the relevant factors among the individual pharmacists' characteristics and working environment within the theoretical frame of the Theory of Planned Behavior (TPB). Method: A mail-survey was conducted for pharmacists working in tertiary hospitals in Seoul and Incheon. The survey questionnaire consisting of 131 questions with a 5-likert scale was developed for investigating pharmacists' attitude, subjective norm, perceived behavioral control and the intention to teach pharmacy students as well as other demographic variables. To estimate the construct validity of components, factor analysis was conducted and Cronbach's alpha was calculated to estimate the reliability of the observed variables. Statistical analyses of one-way variance analysis and multiple regression analysis were performed using SPSS 18.0. Results: The survey response rate was 53% (116/210) and the three constructs of attitude (r = .519), subjective norm (r = .233) and perceived control (r = .392) have appropriate correlations with the intention, proving the appropriateness of using the TPB model. Pharmacists working in inpatient (mean = 3.45) and outpatient clinics (mean = 3.34) generally showed positive intention for teaching. The attitude (${\beta}=.432$, p < 0.01) and perceived control (${\beta}=.270$, p < .01) constructs were significant predictors of the intention. Both age (r = 0.246, p = 0.017) and length of career (r = 0.310, p = 0.002) were positively related with the perceived control. Conclusion: Hospital pharmacists showed generally positive intention to provide student training in spite of the concern on their limited perceived behavioral control. Future research to find the actual barriers pharmacists faced in educating students need to be conducted.

• Journal of Hospice and Palliative Care
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• 제14권3호
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• pp.144-151
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• 2011

목적: 본 연구는 간호대학생의 임상실습 경험유무에 따른 죽음에 대한 태도, 자아존중감 및 삶의 만족도의 차이를 파악하기 위한 서술적 조사연구이다. 방법: 양산시에 위치한 2개 대학에 재학 중인 간호대학생 1,030명으로 대상으로 하였다. 자료수집은 2010년 10월 1일~10월 30일까지 강의시간 이외의 시간에 연구의 목적과 방법을 설명하고 설문에 대한 응답은 익명으로 처리됨을 알려 준 뒤 연구에 참여하기로 자발적으로 동의한 대상자에게 서면동의서와 설문지를 배부하고 개별적으로 설문내용을 작성하도록 한 후 현지에서 직접 회수하였고, 수집된 자료는 PASW statistics data editor 통계 프로그램을 이용하여 실수, 백분율, 평균, 표준편차, 카이제곱 검정, t 검정, 분산분석, Scheffe 검정과 Pearson correlation coefficients로 분석하였다. 결과: 죽음에 대한 태도 점수는 임상실습 경험이 있는 간호대학생의 경우 2.85점, 실습경험이 없는 간호대학생의 경우 2.79점으로 중간수준이었으며, 임상실습 경험이 있는 간호대학생이 임상실습 경험이 없는 간호대학생에 비해 죽음에 대해 보다 긍정적인 태도를 가지고 있었고 자아존중감과 삶의 만족도가 높았다. 임상실습 경험이 있는 간호대학생의 죽음에 대한 태도는 자신이 지각하는 경제수준과 본인이 지각하는 자신의 건강상태에 따라 죽음에 대한 태도의 차이가 있었으며, 자아존중감과 만족도와 낮은 상관관계가 있었다. 결론: 간호제공자의 죽음에 대한 태도는 임종간호의 가장 중요한 요소로 간호의 질을 결정함을 감안할 때 미래의 간호사가 될 간호대학생의 죽음에 대한 태도를 보다 긍정적으로 변화시킬 필요가 있다. 특히 임상실습 경험이 없는 간호대학생이 죽음에 대해 보다 부정적인 태도를 가지고 있었고 자아존중감과 삶의 만족도가 낮았으므로 이들에게 보다 적극적인 관심이 필요할 것이다. 한편 임상실습 경험 유무에 따른 간호대학생의 죽음에 대한 태도, 자아존중감 및 삶의 만족도에 대한 선행연구가 부족하여 논의하는데 제한이 있으므로 반복연구가 필요할 것을 제언한다.

• 의료법학
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• 제24권4호
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• pp.37-63
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• 2023

의료소송에서 의사의 환자에 대한 '설명'이 문제되는 경우는 다양하다. 진단의 초기부터 시작하여 수술 등의 치료과정, 치료를 위해 입원이 필요한 경우, 입원 중과 퇴원 시, 그리고 퇴원 후에 이르기까지 의학적인 설명과 지도가 의사에게 요구된다. 나아가 의료행위로 인하여 발생하게 될 경제적 비용에 대하여도 의사 혹은 의료기관의 고지가 요청되기도 한다. 우리나라 사법부는 이와 같은 의사의 설명에 대하여 진료의 단계 및 의료법 등 관계법령을 고려하여 의료행위에 대한 동의를 구하기 위한 설명과 환자의 요양방법 지도와 관련된 진료상 설명을 구분하여 법리를 전개해 오고 있다. 또한 헌법재판소는 경제적 비용에 관한 설명과 연계된 비급여 비용 고지 제도에 관하여 최근 판단하기도 하였다. 그런데 의사의 설명이 불충분하였다는 것만을 이유로 의사에게 책임을 추궁을 하는 것은 임상현실의 실제 상황과 부합하지 않는 측면이 존재하고, 오히려 의권의 위축을 초래하는 반사적인 불이익이 있을 수 있다. 따라서 의사의 설명은 환자의 자기결정권 보장과 의권 보호라는 양측면에서 살펴보아야 할 필요가 있다.