Immunoglobulin G4 (IgG4) 관련 경화성 담관염과 원발성 담즙성 담관염의 중복은 매우 드문 임상 양상으로, 이로 인한 비대상성 간경변증으로의 진행은 극히 예외적인 것으로 알려져 있다. 본 증례는 두 질환이 병존하며 스테로이드 포함한 치료 에도 불구하고 반복적인 담관염과 담도 협착, 지속적인 IgG4 상승이 관찰되었고, 결국 간섬유화와 복수를 동반한 비대상성 간경변증으로 진행한 사례이다. 기존 문헌에서도 IgG4 관련 질환과 원발성 담즙성 담관염의 중복 또는 다른 장기 침범 사례가 보고된 바 있으나 ursodeoxycholic acid와 면역 치료 병합에 반응하였고 일부에서만 불완전한 치료 반응과 진행성 경과를 보였다. 이러한 중복 사례에서는 간경변 진행 가능성을 신중히 고려해야 하며, 재발성 IgG4 관련 경화성 담관염의 경우 rituximab이 치료 대안이 될 수 있으나, 중복 질환에서의 유효성은 아직 확립되지 않아 최종적으로 간이식까지 고려해야함을 증례로서 보고하는 바이다.

Purpose: This study aimed to measure the level of patient advocacy (the core attribute), nursing professionalism and ethical climate perceived by hospital nurses in Korea, and to identify factors influencing patient advocacy (the core attribute). Method: This study was conducted on 234 full-time nurses who had been working for more than 1 year at a general hospital located in a provincial city in Korea. Data were collected from November 15 to 30, 2024, using questionnaires. The collected data were analyzed using IBM SPSS/WIN 27.0. Results: Among patient advocacy, ‘safeguarding patients’ autonomy’ was explained by 30.0% by professional self-concept, patients, and professional identity in nursing, ‘acting on behalf of patients’ was explained by 34.0% by professional self-concept, role of nursing practice, patients, originality of nursing, and professional identity in nursing, and ‘championing social justice’ was explained by 36.0% by professional self-concept, patients, and managers. Conclusion: In order to improve patient advocacy of hospital nurses, it could be concluded that improving professional self-concept among the sub-factors of nursing professionalism and improving patients among the sub-factors of ethical climate are very effective. Therefore, nursing managers need to make managerial efforts to improve nurses’ professional self-concept and awareness of patients.

담관 협착 및 확장은 그 원인을 정확히 알기 어려운 경우가 많다. 호산구성 담관염은 담관 협착 및 확장을 일으킬 수 있는 양성 질환으로, 발생빈도는 드문 것으로 알려져 있다. 조직병리학, 방사선 사진, 내시경 및 혈액학적 소견을 종합하여 진단할 수 있으며, 스테로이드 투여를 통해 호전을 기대할 수 있다. 드물지만 담관 협착 및 확장의 감별진단 시 고려해야 하는 질환으로, 이 증례를 통해 호산구성 담관염을 알아보고자 한다.

Background: Multiple fractures, particularly femoral fractures, are increasingly prevalent and associated with high mortality rates and significant functional impairments. This highlights the urgent need for effective rehabilitation strategies, such as robot-assisted training, to enhance recovery and improve quality of life. Objectives: This study aimed to evaluate the clinical effectiveness of robotassisted rehabilitation for multiple femoral fractures. Design: Single-subject design. Methods: A 15-day A-B-A' single-subject design was employed. A man in his 30s with multiple fractures underwent standard rehabilitation during the baseline (A) and regression baseline (A') phases, with robotic therapy introduced during the intervention phase (B). Daily assessments of mobility and balance were analyzed using the two-standard deviation method. Results: Robotic therapy led to significant improvements: the TUG test time decreased from 16.21±0.64 seconds (A) to 10.63±0.46 seconds (B) and 9.64±0.35 seconds (A'). The 10 MWT time improved from 6.31±0.64 seconds (A) to 5.41±0.17 seconds (B) and 5.01±0.12 seconds (A'). LOS increased from 364.01±35.83 cm² (A) to 484.67±29.97 cm² (B) and 518.03±18.82 cm² (A'). Plantar pressure imbalance (59.2% right, 40.8% left in A) was corrected to nearly equal distribution in B (49.4%/50.6%) and A' (50.8%/49.2%). Conclusion: Robotic rehabilitation therapy improves balance and weightbearing capacity in patients with multiple fractures, suggesting its effectiveness as an early intervention following bone union.

Background: Lower back pain/injuries are common in caregivers, and physical stresses at the lower back during patient care are considered a primary cause. An instrumented hospital bed my help reduce the physical loads during patient repositioning. Objects: We estimated the physical stresses at the lower back during patient repositioning to assess biomechanical benefits of the instrumented hospital bed. Methods: Fourteen individuals repositioned a patient lying on an instrumented hospital bed. Trials were acquired for three types of repositioning (boosting superiorly, pulling laterally, and rolling from supine to side-lying). Trials were also acquired with two bed heights (10 and 30 cm below the anterior superior iliac spine), and with and without the bed tilting feature. During trials, kinematics of an upper body and hand pulling forces were recorded to determine the compressive and shear forces using static equilibrium equations. Repeated measures ANOVA was used to test if the peak compressive and shear forces were associated with repositioning type (3 levels), bed height (2 levels), and bed feature (2 levels). Results: The peak compressive force ranged from 836 N to 3,954 N, and was associated with type (F = 14.661, p < 0.0005) and height (F = 10.044, p = 0.007), but not with bed feature (F = 0.003, p = 0.955). The peak shear force ranged from 66 to 473 N, and was associated with type (F = 8.021, p < 0.005), height (F = 6.548, p = 0.024), and bed feature (F = 22.978, p < 0.0005). Conclusion: The peak compressive force at the lower back during patient repositioning, draws one’s attention as it is, in some trials, close to or greater than the National Institute for Occupational Safety and Health safety criterion (3,400 N). Furthermore, the physical stress decreases by adjusting bed height, but not by using tilting feature of an instrumented bed.

본 연구는 코로나 19를 비롯하여 앞으로 발생할 수 있는 신종감염병에 적극적으로 대처할 수 있도록 요양보호사의 코로나 19 환자안전관리 활동 영향요인을 파악하여 감염병 안전관리 활동 촉진 방안을 모색하기 위한 근거자료로 활용하기 위해 진행한 서술적 조사연구이다. 대상자는 요양보호사 302명으로 자 료수집은 2022년 8월 1일부터 31일까지였으며, 수집된 자료는 SPSS 29.0 프로그램을 이용하여 t-test, ANOVA, Scheffe’s test, Person’s correlation coefficients, Multiple linear regression 방법으로 분석하였 다. 환자안전관리 활동은 코로나 19 인지도(r=.420, p<.001), 감염 예방행위(r=.585 p<.001)와 양의 상관관계 를 보였고, 환자안전관리 활동 영향요인으로 코로나 19 인지도(β=.331, p<.001)와 감염 예방행위(β=.529, p<.001)로 나타났고, 설명력은 44.3%였다. 본 연구결과를 바탕으로 요양보호사의 환자안전관리 활동을 촉 진시키기 위해서는 코로나 19 인지도와 감염 예방행위를 고려한 환자안전관리 활동 교육프로그램을 개발하여 적용할 것을 제언한다.

Purpose: This study aimed to identify the need for simulation education to strengthen patient safety competencies in nursing practice field experience and explore and analyze improvements in simulation education. Methods: Data were collected through focus group interviews with 31 participants from four groups of fourth-year nursing students and one group of new nurses from August 7, 2023 to February 11, 2024. Interview data were systematically reviewed by qualitative content analysis. Results: Five major themes were identified; (1) awareness of patient safety competencies among nursing students and new nurses, (2) awareness of patient safety education among nursing students and new nurses, (3) simulation education topics for strengthening patient safety competencies, (4) interfering factors of simulation education for strengthening patient safety competencies, and (5) facilitating factors of simulation education to strengthen patient safety competencies. Accordingly, 15 categories were derived, and the current status of simulation education for patient safety, educational needs, and improvements were reported. Conclusion: This study attempted to reflect on the needs of learners before developing a simulation education program and derive educational content to strengthen patient safety competencies.

This study analyzes the discourse of Korean internet users regarding patient clothing and identifies the changes to structure and content of clothing resulting from infectious disease outbreaks. The analysis draws on texts from Korean blogs, internet cafes, and news articles from 2011 to 2021 related to patient clothing. Using Ucinet 5 and NodeXL 1.0.1 programs, network density, centrality, and cluster analyses were conducted using the Wakita–Tsurumi algorithm. Additionally, Latent Dirichlet Allocation (LDA) topic modeling was applied using Python 3.7 to further explore thematic patterns within the discourse. Throughout the period of study, it was found that users consistently discussed the specific purpose and functionality of patient clothing. Following the outbreak of COVID-19, the distribution and influence of keywords related to the functional aspects of patient clothing, such as “hygiene and safety,” significantly increased. An increased focus was placed on elements such as functionality, activity, autonomy, hygiene, and safety during the pandemic as public health concerns grew. It can be seen that patients increasingly share their experiences online and hospitalization rates surge during health crises; this study provides valuable insights into how the design of patient clothing can be improved through various informatics techniques. It underscores the evolving perception of patient clothing as essential medical equipment during health emergencies. In addition, it offers practical guidance for enhancing designs that better reflect shifting societal concerns, particularly regarding health, safety, and patient comfort.

목적: 본 연구의 목적은 뇌손상 환자의 자기인식 정도를 측정하기 위해 Prigatano 등(1986)이 개발한 Patient Competency Rating Scale (PCRS)를 한국어로 번안한 Korean version of the Patient Competency Rating Scale (K-PCRS)의 타당도 및 신뢰도를 연구하기 위함이다. 연구방법: PCRS 원 문항에 대해 번역 및 역번역 과정, 사전 이해도 검증, 문항 적합성 검증을 거쳐 K-PCRS의 예비문항을 구성하였고, 실험군 뇌손상 환자 62명, 보호자 60명, 치료사 62명을 대상으로 수집한 자료에 대해 신뢰도를 분석하였다. 또한 구성타당도 검증을 위해 탐색적, 확인적 요인분석 및 K-PCRS와 우울증과의 상관성을 확인하였으며, 대조군 참여자 60명과 참여자 가족 60명을 비교하여 K-PCRS의 변별타당도를 확인하였다. 결과: 탐색적 요인분석 결과, 5개 요인이 추출되었으나 마지막 요인에서 0.40이상의 요인 부하량이 확인되지 않아, 원척도에서 제시한 4요인을 고정하여 분석하였고 확인적 요인분석 결과 적정수준의 적합도를 보여 K-PCRS의 4요인 모형이 지지되었다. 또한 K-PCRS와 K-BDI의 상관성 분석결과 K-PCRS의 환자-보호자의 불일치 점수와 K-BDI와의 상관계수는 0.2, 환자-치료사의 불일치 점수와 Korean-Beck Depression Inventory (K-BDI)와의 상관계수는 0.4로 모두 음의 상관성을 보였다. 대조군과의 비교를 통한 변별타당도 분석결과 실험군과 대조군의 K-PCRS 총점은 유의한 차이가 있었으며(p < 0.05) 실험군의 환자-보호자 불일치 평균과 대조군의 참가자-가족의 불일치 평균에서도 유의한 차이가 있었다(p < 0.05). 신뢰도 분석 결과 환자용, 보호자용, 임상가용 K-PCRS의 Cronbach α계수는 환자용 0.947이었고, 보호자용 0.946, 임상가용 0.958로 높은 상관계수를 보였다. 결론: 본 연구에서 K-PCRS의 타당도 및 신뢰도를 확인하였으며, 향후 뇌손상 환자의 자기인식 정도를 객관적으로 평가하기 위해 K-PCRS가 활용될 수 있기를 기대한다.

Stroke is one of the most common disabilities experienced by the elderly in the community. However, stroke progresses to a chronic level, patients are discharged from medical institutions and eventually no longer receive therapeutic interventions at home. In this systematic review, we compared home-based rehabilitation (HBR) with comparison for patients with stroke. Literature published in Cumulative Index for Nursing and Allied Health Literature (CINAHL), Embase, Physiotherapy Evidence Database (PEDro), PubMed, and Google Scholar were reviewed. A total of 1,158 studies were initially retrieved. After reading the full texts, 11 articles were included in the systematic review. Quality assessment of the included studies was conducted using Risk of Bias (RoB) 2.0, and Egger’s regression test was used to evaluate publication bias. Data analysis was performed using the R studio software (R Studio). According to the quality assessment using RoB 2.0, three studies were evaluated as low risk, two as of some concern, and three as high risk. The overall effect size was moderate (0.309). The value of the balance function was a small effect size (0.201), while the value of the gait function was a moderate effect size (0.353). The values were small and moderate effect (0.154, 0.411) for the chronic and subacute conditions, respectively. According to the Egger’s regression test, no publication bias was observed. The findings of this study indicate that HBR resulted in the greatest improvement in gait function in patients with subacute stroke compared to those with chronic stroke. Therefore, the application of this intervention to patients with stroke in the community is recommended.

악성 간문부 담관 폐쇄(malignant hilar biliary obstruction, MHBO) 치료를 위해 시행되는 내시경 담관배액술은 후속 치료, 생존율 및 환자 삶의 질 향상에 필수적이다. 그러나 간문부 담관의 복잡한 해부학적 특징으로 인해 시술의 난이도가 높고 시술 관련 우발증의 위험이 있다. 본 고에서는 완전 피막형 자가팽창성 금속 스텐트(fully covered self-expandable metal stent, fcSEMS)를 이용한 나란한 양측 삽입 담관배액술을 시행 후 근위부 담관내 이탈(proximal stent migration)이 발생한 증례를 보고한다. 현재까지 MHBO에 대해서는 어떤 종류의 스텐트를 어떠한 방법으로 시술할지에 대하여 충분한 근거가 정립되어 있지는 않다. 그렇지만 본 증례와 같이 fcSEMS를 사용할 경우 스텐트 이탈 위험성이 ucSEMS보다 높다는 것은 인지하고 있어야 하겠으며, 환자 진료 시 이러한 사항을 고려하여 적절한 대비가 필요하겠다. 향후 이러한 스텐트 이탈을 줄일 수 있는 다양한 예방법이 고안된다면 많은 도움이 될 것으로 기대 된다.

담관암의 유일한 치료 방법은 수술로, 수술 가능성 평가가 진단 과정에 있어 매우 중요하다. 처음 진단 당시에는 원격 전이가 확인되지 않아 수술적 치료를 계획하던 중 다발성의 폐결절이 새롭게 확인되었던 원위부 총담관암 증례를 문헌고찰과 함께 보고한다. 원발 부위의 원위부 총담관암의 크기 변화는 없어 폐 전이 외의 감별진단이 필요하다고 판단하였다. 최근 COVID-19 감염력이 있던 증례로 수술 생검 결과상 최종적으로 폐 크립토코코스증으로 진단되었다.

흉골 자기공명영상 검사 시 호흡 등 환자 움직임에 의한 인공물 발생을 최소화하는 것은 어렵다. 하지만 자기공명영 상 검사는 타 영상 검사와 비교해 흉골 병변을 발견하는 데 있어 진단적 가치가 높은 장점이 있다. 따라서 본 연구에 서는 환자의 검사 자세 및 딥러닝 기법을 통해 최적의 검사 방법을 도출하고자 한다. 자세 별 영상 변화를 확인하기 위해 바로 누운 자세, 엎드린 자세, 유방 코일을 사용한 엎드린 자세로 진행하였으며, 고식적 기법의 영상과 Deep Resolve Boost(DRB) 기법을 적용한 영상을 비교 관찰하였다. 모든 대상에게 같은 조건으로 각 영상을 2회씩 획득 한 후 전반적인 영상 품질을 기준으로 정성적으로 평가하였고, DRB의 적용 여부에 따른 신호 대 잡음비의 변화 정도를 정량적으로 평가하여 개선 정도를 산출하였다. 정성적 평가에서 DRB 적용 여부와 무관하게 엎드린 자세, 유방 코일을 사용한 엎드린 자세, 바로 누운 자세 순으로 높은 점수를 얻었으며, DRB를 적용한 영상이 고식적 기법 의 영상보다 높은 점수를 얻었다. 또한 정량적 평가를 통해 유방 코일을 사용한 엎드린 자세, 엎드린 자세, 바로 누운 자세 순으로 높은 개선 정도를 확인하였다. 본 연구를 통해 흉골 검사 시 DRB 기법을 적용하는 것은 영상의 질을 높이는 방법임을 확인하였다. DRB를 적용하지 못하는 환경에서는 될 수 있으면 엎드린 자세를 적용하는 것을 권고하며, DRB를 적용할 수 있는 환경에서는 환자 측 인자를 고려하여 엎드린 자세와 유방 코일을 사용한 엎드린 자세를 모두 적용할 수 있다.

Purpose: This study aimed to develop a program using the Room of Errors (ROE) technique to enhance the patient nursing student’s safety competencies and determine the effectiveness of simulation-based education. Methods: We conducted a methodological study using the ADDIE model for program development (Molenda, 2003). During the ROE activities, students identified errors that threatened patient safety. The program's effectiveness was evaluated in the implementation phase by measuring students' confidence in patient safety using a one-group pretest-posttest design. Results: Participants' satisfaction with the ROE program was 4.90 ± 0.36 on a 5-point Likert scale. The pre- and post-ROE program patient safety confidence scores (H-PEPSS) were statistically significant, increasing from 3.62 ± 0.54 to 4.19 ± 0.60. Participants' subjective evaluations were generally positive, indicating increased insight, confidence, and vigilance in error prevention. Conclusion: Based on this study’s significant findings, it would be beneficial to encourage students and healthcare providers to utilize ROE programs to enhance patient safety competencies.

Purpose: To review systematically the qualitative research related to the patient-safety competence of nurses based on nurses’ nursing experiences, synthesizing the results understanding. Method: The well-known Thomas and Harden meta-synthesis method was applied. Five databases were searched for relevant literature: CINAHL , RISS , DBpia, KISS, NDSL. Results: Six qualitative studies were selected for review. Three themes were synthesized: patient-safety incidents and patient-safety competency of nurses in emergency situations; processes to advance patient-safety competency in nursing; advancing patient-safety competency in nursing. Eight subthemes were identified. Conclusion: This study improved the understanding of nurses’ experiences in terms of patient-safetycompetenc. Based on systematic review and meta-synthesis of basic patient-care data, study results suggest a direction for the development of patient-safety competencies in nursing and provide evidence for further research.