• 한국방사선학회논문지
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• 제8권2호
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• pp.75-79
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• 2014

흉부 CT와 같이 조직 대조도 차이가 큰 부위의 CT 검사도 환자의 팔의 위치에 따른 아티팩트 발생과 화질저하, 과다피폭 등을 방지하기 위하여 환자의 손을 머리 위로 올리고 검사를 시행하고 있다. 흉부 CT와 같이 조직 대조도 차이가 큰 부위의 검사에서 환자 팔의 위치에 따라 화질저하, 과다피폭 등이 발생한다. 2012년 서울의 K 대학병원 흉부 CT 검사는 1,642건이었다. 이중 118건이 팔을 올리지 않고 흉부 CT검사를 시행하였다. 정상적으로 팔을 올리고 검사한 그룹은 총 DLP 값의 평균이 275 $mGy{\cdot}cm$로 나타났으며 팔을 올리지 않고 검사한 그룹의 총 DLP값 평균은 312.46 $mGy{\cdot}cm$로 나타났다. 동일 환자의 경우 후향적 조사에서 적극적으로 팔을 올리고 검사한 경우 총 DLP 값이 267.5 $mGy{\cdot}cm$로 조사되었고 팔을 올리지 않고 검사한 경우 총 DLP 값이 307.5 $mGy{\cdot}cm$로 나타났다. 흉부 CT 검사에서 검사자가 적극적으로 팔을 올리지 않고 검사하면 인체의 가장 두꺼운 부위인 어깨부위를 통과한 X-ray 광자의 부족으로 인해 선형 아티팩트가 발생하였다. 흉부 CT 검사시 적극적으로 팔을 올려서 검사하는 노력으로 적은 피폭선량과 양질의 의료영상을 환자에게 제공할 수 있는 선량 최적화의 방법이 될 것이다.

• Journal of Oral Medicine and Pain
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• 제18권2호
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• pp.121-130
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• 1993

Mandibular rest position is very essential position because in that position, masticatory muscularture can be reciprocally coordinative and unstrained. So obtaining a good ability to establish and maintain rest position in non-functioning state is mandatory for treatment of patient with craniomandibular disorders. In general, many types of mandibulr movement exercise start from rest position and use the sense of muscle relearning, that is, muscle smoothness and relaxation, throughout the exercise period. In this study, 44 normal subjects for control group and 37 patients with craniomandibular disorders for experimental group participated and they were classified into 3 subgroups, respectively. One method to guide mandibular rest position was used for one subgroup, so theree methods were used for this study, 1)self-guided rest position without any education, 2) guided by Rocabado's tongue rest position, 3) guided through swallowing after Dawson's centric relation. To record electromyographic activity, Bioelectric processor EM2 (Myotronics, U.S.A.) was used. The numbers of sessions from start to stable resting electromyographic level and muscle activities in stable state were recorded and two recordings which were first and second, 3 days after first recording, were done, The data were processed with SPSS/PC+package. The obtained results were as follows : 1. Mean number of sessions in second recording were fewer than those in first recording in both groups. In comparison among 3 subgroups, mean number of sessions of subgroup guided through Dawson's method were fewer than those of other groups though it is not statistically significant. 2. There was a difference of mean number of sessions between control and experimental group in first recording, but in second recording there was no difference in any cases. 3. Mean value of muscle activity were generally not different without regard to group and method if once come to stable resting position level. Mean value of muscle activity of guided subgroups showed a tendency of decreasing in second recording than in first recording. However, in self-guided subgroup there was a inconsistent pattern. 4. The amounts of change in session number from first to second recording in control group were fewer than those in experimental group.

• 보건행정학회지
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• 제15권4호
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• pp.110-135
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• 2005

The objectives of this study were (1) to describe doctors' perception and attitudes toward patient safety culture and medical error reporting in their working unit and hospitals, (2) to examine whether these perception and attitudes differ by doctors' characteristics, such as sex, position, and specialties, and (3) to understand the relationship between overall perception of patient safety in their working unit and each sub domain of patient safety culture. A survey was conducted with 135 doctors working in a university hospital in Korea. After descriptive analyses and chi-square tests of subgroup differences, a multivariate-regression of overall perception of patient safety in their unit with sub-domains of patient safety culture was conducted. Overall, a significant proportion of doctors expressed negative perception of their working units' patient safety culture, many reporting potentials for patient safety problems to occur in their unit. They also negatively viewed their hospital leadership's commitment on patient safety. Regarding the patient safety in their working unit, doctors were most worried about staffing level and observance of safety procedures. Most doctors did not know how and which medical error to report. They also perceived that medical errors would work against them personally and penalize them. About 22 percent of respondents believed that even seriously harmful medical errors were not reported.

• Archives of Reconstructive Microsurgery
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• 제25권2호
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• pp.43-48
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• 2016

Purpose: Perforator flap-using ischial sore reconstruction is performed in a prone position. But after the surgery, recurrence frequently occurs in a sitting position. In this sense, we introduce modified flap insetting method which closely resembles patient's sitting position to lessen the flap tension surgically. Materials and Methods: Authors tried to check a skin tension difference between prone position and sitting position in normal people group and to find out the importance of performing flap insetting in hip flexion position. Healthy volunteers were collected (n=20) and designed the same length of 4 divided sections around the ischium. Lengths of each section were measured when hip joint was flexed to 90 degree and when both hip and knee joints were flexed to 90 degree and the statistical evaluation was performed. Twenty cases with ischial sore underwent reconstructive surgery using perforator flap under hip flexion position and followed-up for any recurrences. Results: There was a meaningful difference between the joint flexed skin length and that of the neutral position. Flap showed sufficient thickness over 12 months. Conclusion: It seems that recurrence could be reduced when the reconstructed flap could sufficiently cover in a sitting position regarding its significant length difference in normal people group.

• Journal of Chest Surgery
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• 제50권6호
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• pp.467-470
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• 2017

Extensive mitral annulus calcifications are considered a contraindication for valve surgery. We describe the case of a 76-year-old female with severe mitral and aortic stenosis associated with extensive calcifications of the heart. The patient underwent an open mitroaortic valve replacement using transcatheter aortic valve implantation with an Edwards SAPIEN XT valve (Edwards Lifesciences Corp., Irvine, CA, USA) in the mitral position. The aortic valve was replaced using a stentless valve prosthesis (LivaNova S OLO; LivaNova PLC, London, UK). Postoperative echocardiography showed that the prosthetic valve was in the correct position and there were no paravalvular leaks. A bailout open transcatheter valve implantation can be considered a safe and effective option in selected cases with an extensively calcified mitral valve.

• Clinical and Experimental Pediatrics
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• 제59권1호
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• pp.30-34
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• 2016

Purpose: Although Bednar's aphthae are common and regress spontaneously, these lesions may lead to feeding intolerance and are often misdiagnosed, rendering examinations useless. This study sheds new light on the clinical features of Bednar's aphthae. Methods: Sixteen neonates and infants were newly diagnosed with Bednar's aphthae via routine health check-ups in an outpatient clinic. Medical records were retrospectively reviewed, and the following parameters were analyzed; sex, gestational age, birth weight, mode of delivery, and perinatal problems. A physical examination was carried out during the next outpatient visit to examine the healing process and check for the existence of scars or complications. Results: Initial presentation included changes in feeding habits (n=10), longer feeding time, reduced intake, and increased irritability. In 6 patients, Bednar's aphthae were discovered incidentally, without prior symptoms. Feeding posture and method of feeding are important causes of Bednar's aphthae. Eleven patients were fed in a horizontal position, whereas 5 patients were fed in a semiseated position. Fifteen patients were bottle-fed, whereas 1 patient was exclusively breastfed. After correcting the feeding position, the ulcerative lesions disappeared within 1 month of diagnosis. During the follow-up period, lesions did not recur in any of the patients. Conclusion: This study suggests that Bednar's aphthae are caused by mechanical pressure. A diagnosis of Bednar's aphthae should be considered when lesions are found on the palate of infants and when symptoms seem to be feeding related. Proper education of parents can both treat Bednar's aphthae and easily prevent its recurrence.

• 대한방사선기술학회지:방사선기술과학
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• 제34권4호
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• pp.263-269
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• 2011

척추촬영법은 의료기관별로 상이하고 각종 대학 및 국가시험을 위한 교재 등에 상이하게 기술되어 혼선을 빚고 있는 실정이다. 이에 동일한 환자의 선자세와 누운자세에서 촬영한 영상을 바탕으로 각 자세에서 척추측만각과 척추전만각의 차이를 비교함으로써 임상 및 관련기관, 참고서적에 가장 적절한 촬영 자세를 정립하여 제시하고자 하였다. 2009년 3월부터 2011년 9월까지 척추질환 환자 중 수술적 치료를 받지 않은 85명을 대상으로 Cobb's method를 이용하여 척추전만각(lordortic angle) 및 척추측만각(scoliotic angle)을 측정하였다. 각각의 측정자료는 t-test(SPSS 18)를 이용하여 유의성을 분석하였으며, 임상의 실태 파악을 위해 서울소재 10곳의 대학병원을 대상으로 척추촬영의 자세와 시행근거를 설문으로 조사하였다. 척추측만각의 측정 결과, 선자세가 바로누운자세보다 평균 20.98% 증가하였으며, 통계적으로 매우 유의한 차이를 보였다(p<.01). 척추전만각은 지지대잡은자세가 측와위자세보다 29.3% 증가하였으며, 통계적으로 매우 유의하였다(p<.01). 의료기관의 실태 결과, 누운자세촬영이 70.0%로 선자세촬영의 30.0%보다 월등하게 나타났다. 결론적으로 선자세촬영은 누운자세촬영보다 척추측만각 및 척추전만각이 증가하여 임상적 진단과 치료에서 중력이 가해진 선자세 촬영의 중요성과 일치하였으므로 임상의 검사자는 그 차이를 인식하여 필히 정확한 선자세에서 촬영이 요구된다.

• 한국의상디자인학회지
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• 제21권4호
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• pp.55-67
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• 2019

This study analyzed the fabric and product size of the burn patient's custom compression garment and measured the pressure applied by the garment to assess whether proper pressure is being delivered for treatment. The test clothes were presented to the market by body size and commissioned with the same design. The subjects selected four people close to the average body size of men in their 20s determined by 7th Size Korea. The experiment was conducted by wearing a compression suit, performing activities and measuring changes in the pressure of the garment according to changes in posture. The fabric used for the compressive clothing was not ruptured even at 216 kPa, the elasticity recovery rate was measured between 80.5 and 94.5%. The product dimensions of the experimental clothing varied by up to 8cm from brand to brand, requiring the standardization of compression clothing. The experiment showed that four types of compression suit varied in pressure, and the pressure range, excluding the gastric arm (17.9mmHg), was between 2.5-14.1mmHg, which failed to meet the level of pressurization for treatment purposes. The clothing pressure in the chest area dropped when performing movements rather than standing still. This was interpreted to be a result of reduced the adhesion of the compression suit during operation. The peak pressure (31.68mmHg) and the lowest pressure (2.2mmHg) was noted in the scapula, indicating that no pressure was being transmitted on the vertebrae. The pressure of the garment on the right shoulder blade was elevated in a supine position. Because much time is spent laying down, it is necessary for the pattern design to accommodate for the increased clothing pressure on the shoulder blades. Standardization of the level of pressurization for burn patient's custom-made pressure suits for each stage of treatment is urgently required.

• 의료법학
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• 제17권2호
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• pp.145-173
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• 2016

우리나라에서 전통적으로 환자의 자기결정권 내지 자율권은, 의사의 보고성 설명의무에 대응하는 알 권리 그리고 의사의 기여적 설명의무에 대응하는 수진 동의권 및 수진 거절권, 양자를 '중심'으로 해서 논의되어 왔다. 환자의 자율적 결정의 내용으로서 형성 피력되는, 자기 신체 및 의료 상황에 대해 알고 싶지 않은 희망과 그로 인한 이익에 관한 지위- 도덕적 법적 지위 - 는 환자로부터의 알 권리와 동의권의 포기 또는 (의사가 부담하는) 설명의무의 면제라는 소극적 지위 차원에서 인식되었다. 그리고 설명 동의 원칙 도그마의 적용에 의한 역기능 문제는 설명 동의 원칙의 적용 배제 및 그에 따른 의사의 책임 부인이라는 역시 소극적 접근법에 의해 '주로' 인식되었다. 즉 환자의 그러한 알고 싶지 않다는 '무지(無知)의 희망'을 실현시켜 줄 법적 수단이 환자의 '모를 권리' 및 의사의 '부작위 배려의무'라는 '적극적 지위'로 이해되고 인정되지 않았던 것이다. 이러한 당사자의 적극적 지위 설정이 전제되지 않으면 실제상 및 이론상 문제가 제기된다. 환자가 동의권을 포기한다고 선언하거나 의사의 설명의무를 면제한다고 표명했음에도 불구하고, 의사가 굳이 환자를 상대로 설명 내지 보고를 행하여 환자에게 큰 손해가 발생한 경우에, 의사의 그 행위를 규범적으로 어떻게 평가할 것인가가 문제인 것이다. 한편 의사가 설명의 역기능을 우려하여 설명을 행하지 않았고, 그 행태에 대해 적절한 것이란 평가가 가능한 경우에, 그 재량적 불설명의 적법성을 인정할 직접적 근거가 무엇인지를 밝히는 것 또한 문제이다. 이러한 문제를 해결하기 위해 근본적으로 환자에게 '모를 권리'라는 지위를, 의사에게 '배려의무'라는 지위를 인정할 필요가 있다. 요컨대 이 권리와 의무 개념은 환자의 자율성 관념의 충실화와 설명역기능 현상의 적정한 방지라는 법규범적 요구를 충족시키는 데에 매우 유용한 도구로서 수용할 수 있다.

• 대한전기학회:학술대회논문집
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• 대한전기학회 2005년도 심포지엄 논문집 정보 및 제어부문
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• pp.51-53
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• 2005

Considerable noise is sometimes associated with degeneration of the hee joint surface. Such noise may indicate roughness or softening of the cartilage surfaces, and may be a useful index for early disease. In this study, we have evaluated arthritic pathology using the acoustical analysis of knee joint sounds. During sitting and standing periods, subjects' active knee flexion and extension were monitored. Fundamental frequency, mean amplitude of pitch, jitter and shimmer were analyzed according to the position and the joint angle. The result showed that the fundamental frequency of the 2nd patient group and standing position was higher than the others, and that the pitch of sounds changed unstably. These results suggest that an analysis of knee joint sound might assist non-invasive diagnosis of an articular pathology.