목적 : 작업치료사들이 신경인지장애 환자를 중재할 때 사용하는 용어를 국제적으로 공인된 ICF를 이용하여 중재 용어집을 개발하고, 그 타당도를 검증하여 다학제적인 영역에서 이해 가능한 공용어를 사용하고자 하는데 목적이 있다. 연구방법 : 임상경력 5년 이상의 작업치료사 및 교수 30명을 전문가 그룹으로 선정하여 중재 행위와 기록 용어에 대해 조사하도록 하였다. 문헌고찰 및 조사한 용어를 국제 기능, 장애 및 건강에 대한 분류 체계와 작업치료 실행체계를 참고하여 분류하였고, 중재 예시를 국제의료행위 분류의 3개의 축(대상, 방법, 행위)을 기반으로 제시하였다. 이후 주요신경인지장애 환자를 중재하는 48개의 기관을 대상으로 타당도와 중요도 설문조사를 실시하였다. 결과 : 중재 용어집은 신체기능, 활동 및 참여와 환경요인 영역으로 분류하였다. 신체기능은 정신기능, 감각기능, 음성기능, 심장 및 호흡기능, 연하 기능, 신경근 골격계 및 움직임 관련 기능으로 분류하였고, 활동 및 참여 영역은 학습과 지식의 적용, 과제와 일반적 요건, 의사 소통하기, 이동(mobility), 자기관리, 가정생활, 대인상호작용, 주요생활영역, 지역사회생활로 분류하였다. 환경요인은 제품과 기술, 자연환경 및 인공환경 변화, 지원과 관계, 태도, 시스템 및 정책으로 분류하였다. 중재용어에 대한 타당도 검증결 과 신체기능 .77, 활동 및 참여 .81, 환경요인에서 .64로 전체 내용타당도 지수는 .73으로 나타났고 중요도에서도 평균 3.89 ± .74 점으로 나타났다. 직군간의 타당도와 중요도의 유의한 차이는 없었으나. 치매관련센터군, 교수 및 행정가군에서 신경인지장애 중재에서의 환경요인에 대한 인식이 저하되어 있음을 알 수 있었다. 결론 : ‘신경인지장애 환자를 위한 작업치료 중재 용어집’은 다양한 치매 관련 기관에서 가이드로 적절하게 사용할 수 있을 것이다. 향후 도출된 본 용어집을 활용하여 신체기능, 활동 및 참여, 환경요인을 통합하는 작업치료 문서화가 가능해지고, 시대적 변화에 따라 개정되는 노력이 지속적으로 필요할 것이다.

목적 : 본 연구는 뇌졸중 환자의 상지기능과 일상생활동작 향상을 위해 적용된 과제 지향적 접근 연구들을 체계적 고찰과 메타분석으로 연구결과들을 비교 분석하였다. 이 결과들을 통해 앞으로의 과제 지향적 접근의 방향을 제시하고자 하였다. 연구방법 : 분석 자료는 2000년 1월부터 2018년 8월까지 MEDLINE, CINAHL, Pubmed 데이터베이스를 사용하여 선정기준에 적합한 17편의 무작위 실험 연구를 수집하였다. 선정된 연구들은 질적 평가(Pedro score)와 Patient, Intervention, Comparison, Outcome(PICO)를 사용하여 체계적으로 정리하였다. 그 후 각 연구들의 중재 형식을 참고하여 평균, 표준편차, 표본수를 사용하여 메타분석을 실시하였다. 결과 : 선정된 17편의 연구는 Pedro score 5점 이상의 연구로 다양한 과제 지향적 접근을 통하여 상지기 능과 일상생활동작을 증진시키고자 하였다. 과제 지향적 접근의 중재 형식은 횟수 강도 등을 통제하는 반복강화형, 기계적 장치나 보조기 등을 사용하는 조합형, 환자별 특성 및 목표 등을 참고한 환자맞춤형 의 3가지로 분류하였다. 과제 지향적 접근이 상지기능에 미치는 영향은 큰 효과크기를 보였으며, 중재 형식에 따른 분석에서는 환자맞춤형은 큰 효과크기, 조합형과 반복강화형은 중간 효과크기를 보였다. 과제 지향적 접근의 일상생활활동에 대한 영향은 중간 효과크기를 나타내었다. 결론 : 환자의 기능 향상을 위한 과제 지향적 접근은 일관되고 정형화된 과제 보다 다양한 자극과 환자 중심의 목표, 환경, 피드백을 활용하여 과제의 다양성을 강화할수록 보다 높은 치료적 효과를 기대할 수 있다.

목적 : 본 연구는 여가 참여, 여가 탐색 및 방해요인에 대한 다면적 측정이 가능한 노인여가참여 평가도구가 뇌졸중 환자의 여가 평가도구로써 유용하게 사용될 수 있는지 알아보기 위해 신뢰도와 타당도를 검증한 연구이다. 연구방법 : 신뢰도 검증을 위해 뇌졸중 환자 64명이 참여하였으며, 노인여가참여 평가도구를 시행하여 내적 일치도를 분석하였다. 공인 타당도는 단축형 노팅햄 여가 설문지(The shortened version of the Nottingham Leisure Questionnaire)와의 상관관계를 분석하였다. 판별 타당도 검증을 위해 건강한 대 학생 55명이 참여하였고, 두 군간 노인여가참여 평가도구의 평가 결과를 비교하였다. 결과 : 내적 일치도는 전체 문항에 대한 크론바흐 알파 값은 .749로 높은 신뢰도를 나타냈고, 공인 타당도 결과는 단축형 노팅햄 여가 설문지 총점과 노인여가참여 평가도구의 여가 참여 문항 점수 간 상관계수가 .851로 높은 상관관계를 나타냈다(p < .01). 판별 타당도 결과는 두 그룹 간 여가 활동 수, 여가 탐 색의 활동 수, 방해요인에서 통계적으로 유의한 차이가 있는 것으로 나타났다(p < .01) 결론 : 노인여가참여 평가도구는 뇌졸중 환자를 대상으로 평가가 가능하다는 것을 신뢰도 및 타당도 검증을 통해 확인하였다. 여가 참여에 대한 다면적 측정이 이루어지는 노인여가참여 평가도구를 통해 뇌졸중 환자의 여가 중재 계획 및 실행에 유용하게 적용할 수 있기를 기대한다.

Background: To evaluate whether extracorporeal shock wave therapy (ESWT) in the pain point is a more effective treatment than the trigger point for myofascial pain syndrome (MPS) of the upper trapezius. Objects: The purpose of this study was to compare the most effective areas when applying extracorporeal shock wave therapy. Methods: A total of 30 patients with MPS were randomly assigned to the trigger point in the ESWT (n = 15) and pain point ESWT (n = 15) groups. Interventions in both groups were performed in one session, i.e., 2,000 shocks with 1.5 bar intensity. Pain and function were assessed using the visual analog scale (VAS) and cervical range of motion (ROM) and based on mechanical muscle properties. Statistical analysis was performed using the repeated measures two-way analysis of variance to determine the significance probability between pre- and post-test. Results: Changes in mechanical muscle properties were not statistically significant between the two groups. However, VAS and cervical ROM showed statistically significant differences at pre- and post-intervention, regardless of the group (p < 0.05). Conclusion: Although no significant difference was observed in the intervention effect, applying an extracorporeal shock wave to the pain point rather than the pain trigger point should be considered in order to save time in effectively and accurately identifying the pain trigger point and site.

Background: Compared with normal people, stroke patients have decreased voluntary craniocervical motion, which affects their balance. Objects: This study was conducted in order to examine the effects of active craniocervical movement training using a cognitive game on stroke patient’s cervical movement control ability, balance, and functional mobility. Methods: The subject of this study were 29chronic stroke patients who were randomly allocated to either an experimental, cognitive game group (n = 15), or control group (n = 14), to which only neuro-developmental treatment (NDT) was applied. The intervention was conducted 5 times per week, 30 minutes per each time, for a total of 4 weeks. Active angle reproduction test, static stability test, limits of stability test, and Time up and Go (TUG) test, respectively, were carried out in order to evaluate cervical movement control ability, static balance, dynamic balance, and functional mobility. Paired t-test was used in order to compare differences between prior to after the intervention, along with an independent-test in order to compare prior to and after-intervention differences between the two groups. Results: After the craniocervical training with a body-driven cognitive game, the experimental group showed significant differences in flexion, extension, and lateral flexion on the affected side, and rotation on the affected side in the active angle reproduction test. The experimental group indicated significant differences in sway length both with eyes-open and with eyesclosed in the static stability test and in limits of stability test and TUG test. The control group to which NDT was applied had significant differences in flexion in the active angle reproduction test and in limits of stability test and TUG test. Conclusion: The above results mean that craniocervical training using a body-driven cognitive game positively influences stroke patient’s cervical movement control ability and as a result their balance and functional mobility.

The purpose of this study was to examine the relationship between the regular selling price and nutrient contents of foods used for special medical purposes in Korea. This study investigated the regular selling price and nutritional composition of 114 enteral nutrition (EN) foods on the manufacturer’s internet homepage. The average price of the total products was 1,156.0 won/100 mL. The price of foods used for calorie and nutrient supplementation (CNS) was significantly higher compared to that of the other EN food types (p<0.01). With respect to the nutritional content per 100 mL of the product, EN foods for CNS had significantly higher contents of energy, protein, 5 minerals, and 7 vitamins than the other EN food types. On comparing the nutritional contents of foods according to the price, the balanced nutrition foods showed significantly higher contents of energy, carbohydrate, protein, 3 minerals, and 7 vitamins in high-priced products than in low-priced foods. Summarizing these results, foods for CNS were approximately twice as expensive as the other EN foods, and the energy, protein, mineral, and vitamin contents were also high. Balanced nutrition foods had higher nutrient contents in high-priced products, which showed the relationship between the product price and nutrient content.

Background: It is reported that the proprioceptive sensation of patients with neck pain is reduced, and neck sensory-motor control training using visual feedback is reported to be effective. Objects: The purpose of this study is to investigate how sensorimotor control training for the cervical spine affects pain, function, and psychosocial status in patients with chronic cervical pain. Methods: The subjects consisted of 36 adults (male: 15, female: 21) who had experienced cervical spine pain for more than 6 weeks. An exercise program composed of cervical stabilization exercise (10 minutes), electrotherapy (10 minutes), manual therapy (10 minutes), and cervical sensorimotor control training (10 minutes) was implemented for both the experimental and the control groups. The cervical range of motion (CROM) and head repositioning accuracy were assessed using a CROM device. In the experimental group, the subjects wore a laser device on the head to provide visual feedback while following pictures in front of their eyes; whereas, in the control group, the subjects had the same training of following pictures without the laser device. Results: There were no statistically significant differences between the two groups in pain, dysfunction, range of motion, or psychosocial status; however, post-test results showed significant decreases after 2 weeks and 4 weeks compared to baseline (p < 0.01), and after 4 weeks compared to after 2 weeks (p < 0.01). The cervical joint position sense differed significantly between the two groups (p < 0.05). Conclusion: In this study, visual feedback enhanced proprioception in the cervical spine, resulting in improved cervical joint position sense. On the other hand, there were no significant effects on pain, dysfunction, range of motion, or psychosocial status.

Autophagy is a cell survival mechanism that works for the survival of cells under various physiological and pathological conditions. ATG5 is a key protein in the process of autophagy propagation and is involved in tumor development and progression. Chemotherapeutic agents targeting ATG5 enhance the host's immune response in various human cancers and intensify the effectiveness of chemotherapy. However, the physiological role of ATG5 protein in oral squamous cell carcinoma (OSCC) has not been fully recognized. The purpose of this study was to examine the correlation between clinico-pathological factors of OSCC patients and ATG5 immunoexpression through immunohistochemistry (IHC) in the tissues of OSCC patients treated at our hospital, and to analyze the regarding influences and their mechanisms. The authors analyzed 20 OSCC patients from National University Dental Hospital, at Pusan National University from January 2002 to December 2007, which were eligible for the study. Data were obtained by reviewing the medical records of the OSCC patients, and ATG5 immunoexpression was obtained using IHC staining in the tissue samples of the OSCC patients. In the tissue sample of OSCC patients, the immunoexpression of ATG5 elevated, in comparison to the normal oral mucosa, and there was a significant correlation with Drinking, Pathological Stage. In regards to Cox regression analysis, Clinical stage, Tumor size, Histopathologic grade, Cervical nodal metastasis, Loco-regional recurrence, and ATG5 expression have statistically significant correlations. These results imply that the changes in the expression of ATG5 proteins in OSCC can be a prominent factor in the OSCC progression and the prognosis of OSCC patients.

Purpose: The aims of the study were to explore caregiving burden and quality of life (QOL) and to identify factors affecting QOL of family members of terminal cancer patients from hospice palliative care center. Methods: Survey was performed using structured questionnaires measuring caregiving burden and QOL. To collect data, family members from 6 hospice palliative care facilities were recruited from July to September 2018. During that period, survey questionnaires were distributed and collected and total 140 study respondents participated in the survey. Collected data were analyzed using SPSS WIN 23.0 and descriptive statistics, t-test, ANOVA, correlation coefficient, stepwise multiple regression analysis were performed as appropriate. Results: Caregiving burden and QOL score were 2.83 and 3.23 out of 5 point respectively. Factors affecting QOL were emotional burden (β = -0.35, p <.001), perceived health status (β = 0.23, p <.001), family support (β = 0.23, p <.001), age (β = -0.19, p <.003), economic burden (β = -0.16, p <.020), education (β=0.13 p<.033). Conclusion: Study results suggest that the lower caregiving burden, the higher QOL level of family members of terminal cancer patients. Since QOL of family members was affected by various factors, efforts to promote QOL through alleviating caregiving burden are required.

본 연구는 간호대학생을 대상으로 임종간호 관찰경험 여부에 따른 웰다잉에 대한 인식, 사전연 명의료의향서 지식 및 태도와의 차이를 파악하기 위해 시도되었다. 연구대상은 경기도, 충청도, 전라도 소재의 4년제 간호학과 대학생 321명을 대상으로 구조화된 설문지를 이용하여 자료수집을 하였다. 수집된 자료는 SPSS 25.0 program을 이용하여 기술통계, t-test, ANOVA, Scheffe' test, Pearson's correlation coefficient로 분석하였다. 연구결과 임상실습 중 임종간호 관찰경험이 있는 간호대학생이 관찰경험이 없는 학생보다 사전연명의료의향서에 대한 태도가 긍정적으로 나타났고 유의한 차이를 보였다(t=3.011, p<.003). 임종간호 관찰경험이 있는 간호대학생의 웰다잉에 대한 인식(r=.194, p=.008)과 사전연명의료의 향서 지식(r=.201, p=.006)은 사전연명의료의향서 태도와 정적 상관관계가 나타난 반면, 임종간호 관찰경험이 없는 간호대학생은 사전연명의료의향서 태도와 웰다잉에 대한 인식(r=.189, p=.029)에서만 정적 상관 관계를 보였다. 따라서 간호대학생의 좋은 죽음과 사전연명의료의향서에 대한 올바른 인식과 긍정적인 태도를 함양시키기 위한 체계적인 교육이 이루질 수 있도록 표준화된 교육프로그램 개발이 필요하다.

목적 : 60세 이상 녹내장 환자의 시력, 입체시, 대비감도, 시야 결과를 분석하고자 하였다. 방법 : 본 연구에 참여 의사를 밝힌 고령자 중 정상안압녹내장에 해당하는 환자 총 18명(남5, 여13, 평균 나이 는 70.00±5.12세)을 대상으로 하였다. ETDRS(Early Treatment Diabetic Retinopathy Study)를 사용하여 측 정하였고, 입체시 검사는 티트무스 검사를 시행하였다. 대비감도 검사는 명소시 조건하에서 각각 3, 6, 12, 18 cpd (cycle per degree)의 주파수에 대해 검사하였다. 시야 평균지수는 정적시야계를 이용하여 측정하였고, 각각의 측 정값들의 상관성은 SPSS 21.0를 사용하여 분석하였고, 유의수준은 0.050 이하로 하였다. 결과 : 정상안압녹내장 환자군에서 좋은 눈의 평균지수 값은 –1.39±1.31 dB, 나쁜 눈의 평균지수 값은 – 3.59±2.34 dB 이였고, 티트무스 검사를 이용한 입체시 검사 결과 248.89±235.25초를 보였다. 고대비 시력은 0.11±0.11 LogMAR, 저대비 시력은 0.42±0.08 LogMAR를 보였다. Better MD는 입체시, 우안 저대비시력, 좌 안 대비감도 3 cpd와 의미 있는 음의 상관관계를 보였다(p<0.050). 결론 : 60세 이상 녹내장 환자에서 발생할 수 있는 시력, 입체시, 대비감도, 시야변화의 상관성을 확인할 수 있 었으며 정기적인 시기능 평가가 필요할 것으로 보인다.

Purpose: The purpose of this study was to describe nurses' experiences on patient safety incidents in special departments. Methods: Data were collected from June 1 to July 31, 2019 through in-depth interviews with 8 nurses who worked in tertiary hospitals. Data were analyzed using Braun & Clarke's thematic analysis method. Results: Four themes and fourteen sub-themes emerged. Four themes are as follows: ‘Incidents occurred by missing confirmation in the operating room’, ‘Unexpected incidents in ICU’, ‘Incidents related to difficult intravenous cannulation in pediatric patients’, ‘Nurses are near to patient safety’. Conclusion: The findings provided valuable information on the hospital nurses' experiences on patient safety incidents in special departments, which may have serious consequences and have not been easily addressed. Programs to sustain patient safety and nursing systems to guard against these incidents should be developed.

The objective of this study was to investigate the effects of dietary vitamin B intake on biomarkers related to lipid metabolism, inflammation and blood glucose control, that are important in the development of type 2 diabetes and its complications. Seventy-six adults (42 males, 34 females) were recruited from a group of diabetes patients who had visited the medical center for treatment. Data on anthropometric characteristics and dietary intake of thiamine, riboflavin, niacin, vitamin B6 and folate were collected using 24-hour diet recall and the CAN Pro 4.0 program. Also, data on clinical indices such as serum lipids, blood pressure, high-sensitivity C-reactive protein (hs-CRP), hemoglobin A1c (HbA1c) and homeostasis model assessment 2-insulin resistance (HOMA2-IR) were collected and analyzed for correlation with dietary vitamin B intake. Results from the dietary intake survey showed that riboflavin and folate intake (in males) and folate intake (in females) were below the Dietary Reference Intake for Koreans. Statistical analysis revealed a negative correlation between hs-CRP and dietary intake of B vitamins. Riboflavin intake was inversely associated with systolic blood pressure after adjustments for age, BMI, smoking, alcohol consumption, exercise, ingestion of diabetes mellitus medication and energy intake (p<0.05). Our results suggest that dietary vitamin B may influence inflammation and consequently may help in better management of type 2 diabetes.

Mucormycosis is an aggressive opportunistic fungal infection that can be found in the oral cavity. The fungus usually affects the immunocompromised patients and tends to invade and block blood vessels, resulting in significant tissue necrosis and invasive mucormycosis. However, a non-invasive form of mucormycosis is mostly asymptomatic and found accidentally in the immunocompetent normal hosts, manifested by localized overgrowth of the fungus. Here, we report a rare case of asymptomatic non-invasive mucormycosis of the mandible that was incidentally diagnosed in wide resection specimen of liver transplant patient who had previously underwent surgery of excision and simultaneous alloplastic bone graft due to mandibular ameloblastoma. Histopathological examination of the specimen revealed that there was neither vasculitis nor tissue necrosis, but numerous fungal hyphae were located only within the alloplastic graft materials in decalcified tissue sections. Awareness of the possibility of life-threatening mucormycosis in immunocompromised patients should be emphasized because it can be inactive or reactivated depending on the immune state of patients.

목적 : 본 연구는 뇌졸중 환자의 인지기능 및 사회인지 기능과 사회참여의 관계를 분석하고 뇌졸중 환자의 사회인지에 대한 중재의 필요성을 제시하고자 한다. 연구방법 : 본 연구는 대전광역시 유성구에 위치한 W병원에서 진료 중인 뇌졸중 환자 104명을 대상으로 인지검사인 K-MMSE(Korea-Mini Mental State Examination)를 사용하여 인지기능을 평가하였고, 사회생활기술 척도(Social Skill Scale; SSS), 대인관계기능 척도(Independent Living Skill Survey-Interpersonal Relationship; ILSS-IR)로 사회인지 기능을 평가하였다. 또한 사회참여는 한국형 사회참여척도(Korean Version of the Reintegration to Normal Living Index; K-RNLI)를 사용하였다. 평가 결과를 바탕으로 피어슨 상관관계수를 사용하여 사회참여와 대상자의 일반적 특성, 인지기능 및 사회인지와의 관련성을 분석하였다. 결과 : 일반적 특성에 따른 사회참여는 성별과 마비측에서 유의한 상관관계를 보였다. 인지와 사회참여는 상관관계를 보이지 않았으나 사회인지 기능인 사회생활기술(p<.01), 대인관계기능(p<.01)에서는 사회참여와 유의한 상관관계를 보였다. 결론 : 사회참여는 뇌졸중 환자들의 중요한 치료 목표이며, 이를 위해 인지기능 및 사회인지 기능과 관련된 새로운 평가와 중재 개발이 필요할 것이다.