• 의료법학
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• 제22권2호
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• pp.3-48
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• 2021

2020년에 선고된 주요 판결들 중에는, 독감 및 코로나 백신 접종 부작용으로 시의성이 있는 아나필락시스와 관련하여 의료진의 과실을 인정한 사례와 부정한 사례가 있었고, 기존에도 판례를 통해 인정된 적은 있지만 드문 사례로서 수인한도를 넘어설 만큼 불성실하게 진료를 한 경우 그러한 과실을 별도의 불법행위로 인정하여 위자료 지급을 인정한 판결이 선고되었다. 또한, 손해배상 범위 산정과 관련하여, 맥브라이드를 기준으로 노동능력상실률을 산정해온 관행을 깨고 항소심에서 대한의학회 장애평가기준에 따라 장해율을 산정한 판결이 있었으며, 전화 진료를 비롯한 원격의료는 의료법상 허용되지 않는다는 대법원의 입장을 명확히 하였다는 점에서 의미 있는 판결이 있었다. 설명의무에 관하여는 확립된 법리 위에 개별 사건에서 설명의무 이행 여부를 판단하는 구체적 기준에 관한 세부적인 내용이 더해지는 과정으로 보이며, 진료기록 기재와 관련하여서는 사후기재의 의심이 강하게 들더라도 증명방해에 해당하지 않는다고 판단하였다. 그 외에도, 사실관계가 동일함에도 심급에 따라 과실 및 인과관계 판단이 달라진 판결들에서 원심판결과 대상판결의 차이점을 비교하였으며, 최근 의사의 업무상과실치사상에 대하여 실형이 선고되는 사례가 늘고 있는 상황에서 1심에서 실형을 선고하면서 구체적으로 그 이유에 관하여 설명한 판결을 다루었다.

• 말소리와 음성과학
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• 제16권2호
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• pp.99-109
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• 2024

동시조음은 제한된 시간과 공간 안에서 연속적인 조음기관의 움직임으로 인해 주위의 분절음과 다양한 중첩을 통해 서로 영향을 주고받는 것이다. 본 연구는 파열음, 파찰음과 모음(ᅡ, ᅵ, ᅮ)으로 구성된 CVC 음절과 VCV 음절에서 읽기장애아동과 일반아동의 동시조음 특성 차이를 규명하였다. 연구대상자는 초등학교 2-6학년 읽기장애아동 13명과 일반아동 13명이었다. 읽기과제 음성 자료를 이용해 자음이 끝나고 모음이 시작되는 지점과 모음 안정 구간의 중간 지점에서 제 2 포먼트를 측정하였다. 측정된 제 2 포먼트를 이용해 회귀분석을 실시해 집단별 조음위치, 발성유형에 따라 로커스방정식(LE) 기울기를 구하여 삼원분산분석(3-way ANOVA)을 실시하였다. CVC 음절에서 읽기장애아동은 일반아동에 비해 작은 LE 기울기 값을 보였다. 조음위치에서는 연구개음이나 양순음이 치조음이나 경구개음과 비교해 더 가파른 LE 기울기를 보였다. VCV 음절에서는 집단, 발성유형에서 유의미한 차이를 보이지 않았으며 조음위치에서 보인 유의미한 차이도 CVC 음절 결과와 다른 양상을 보였다. 본 연구는 읽기장애아동이 음절구조에 따라 다른 양상의 동시조음 기울기를 보인다는 것과 읽기장애 아동의 높은 휴지 비율은 VCV 구조에서 동시조음에 더 큰 영향을 미친다는 것을 확인하였다.

• 대한한방부인과학회지
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• 제25권3호
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• pp.117-131
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• 2012

Objectives: This study was designed to observe the effect of chuna manupulation in alleviating the symptoms of postpartum patients with low back pain and pelvic girdle pain. Methods: Targeted by outpatient 30 postpartum patients, A group was patients who were treated with acupuncture, traditional Korean medicine, physical therapy, B group was patients who were treated with acupuncture, traditional Korean medicine, physical therapy, and chuna manupulation. After 2-months, the progress of symptoms was evaluated by visual analogue scale(VAS) and Oswestry Disability Index(ODI) and Pain drawing. Results: 1. Group A and B were analyzed for general characteristics, with an average age of both groups, average weeks at admission after delivery, parity and method of delivery, weight gain and BMI during pregnancy were no significant differences in. 2. VNRS improvement in the rate of group A was $2.84{\pm}4.73$, VNRS improvement in the rate of group B was $4.85{\pm}1.49$. Between the two groups was statistically significant. 3. ODI improvement rate in group A was $10.14{\pm}4,39$, ODI improvement rate in Group B was $15.16{\pm}3.41$. Between the two groups was statistically significant. 4. Patients who received acupuncture, traditional Korean medicine, physical therapy, and chuna manupulation. in group B compared pubis, thighs, buttocks showing more effective in pain relief than group A, who received only acupuncture, traditional Korean medicine, physical therapy. Conclusions: In case of postpartum patients with low back pain and pelvic girdle pain, it is more effective to treat with Integrated traditional Korean therapy and chuna manupulation than to treat with only integrated traditional Korean therapy.

• Journal of Oral Medicine and Pain
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• 제30권4호
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• pp.427-432
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• 2005

본 연구는 구강안면통증 환자의 음성적 특징과 청각 환경에 따른 음성적 변화를 살펴보기 위한 것이다. 구강안면통증 환자 29명과 정상인 31명을 대상으로 그들의 일반 음성과 청각 조건(소음, 음악)에서의 음성 파라미터들을 비교 분석하여 다음과 같은 결론을 얻을 수 있었다. 1. 구강안면통증 환자는 정상인의 음성과 비교해 낮은 F0(Hz) 값과 높은 jitter(%), shimmer(%)값을 가져 정상인에 비해 낮고 불안정한 음성 특징(feature)을 나타내었다. 2. 구강안면통증 환자의 음성은 소음 환경과 비교해 음악 환경에서 낮은 F0(Hz)값과 shimmer(%)값을 가져 보다 이완되고 안정된 음성 특징을 나타내었다. 3. 정상인의 음성은 소음 환경에서 높은 F0(Hz)값을 가졌으나 음악, 소음 환경에 따른 특징적인 차이를 나타내지 않았다. 이상의 결과를 통해 구강안면통증 환자는 정상인의 음성과 비교해 특징적인 차이를 보였으며 외부적인 청각 환경에도 다른 반응 양상을 나타내었다. 따라서 구강안면통증 환자들의 기능적 장애를 보다 효율적으로 치료하기 위해서는 음악과 같은 긍정적인 정서 환경이 제공되어야 할 것으로 사료된다.

• Journal of Acupuncture Research
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• 제28권1호
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• pp.65-75
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• 2011

Objectives : The purpose of this study was to evaluate the clinical effect of indirect moxibustion treatment for HIVD patients. Methods : From March 2010 to December 2010, 32 HIVD patients who admitted to Semyung oriental medical hospital were divided into two groups. Group I was treated by indirect moxibustion and general acupuncture, group II by general acupuncture. We evaluated the treatment effect of each group with the visual analog scale(VAS) and Oswestry disability index(ODI) by dividing three period(from admission day to third day after admission, from third day to sixth day after admission and from sixth day to ninth day after admission). Results : 1. Group I was more effective than group II in VAS score reducing rate at sixth day after admission and ninth day after admission but there was no statistical significance between two groups at third day after admission 2. Group I was more effective than group II in VAS improvement rate from third day to sixth day after admission but there was no statistical significance between two groups from admission day to third day after admission and sixth day to ninth day after admission. 3. Group I was more effective than group II in ODI score reducing rate at sixth day after admission and ninth day after admission but there was no statistical significance between two groups at third day after admission. 4. In ODI improvement rate group I was higher than group II, but there was no statistical significance. Conclusions : Through this research, Indirect moxibustion treatment is considered to be effective reducing pain for HIVD(Herniated intervertebral disc) patients.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.691-700
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• 2017

Objective : The authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes. Methods : A total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs : subsidence, C2-C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain. Results : In the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups : however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425) ; fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31). Conclusion : Our clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.

• Journal of Korean Neurosurgical Society
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• 제62권4호
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• pp.422-431
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• 2019

Objective : In an aging society, the number of patients with symptomatic degenerative spondylolisthesis (DS) is increasing and there is an emerging need for fusion surgery. However, few studies have compared transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) for the treatment of patients with DS. The purpose of this study was to investigate the clinical and radiological outcomes between TLIF and LLIF in DS. Methods : We enrolled patients with symptomatic DS at L4-5 who underwent TLIF with open pedicle screw fixation (TLIF group, n=41) or minimally invasive LLIF with percutaneous pedicle screw fixation (LLIF group, n=39) and were followed-up for more than one year. Clinical (visual analog scale and Oswestry disability index) and radiological outcomes (spondylolisthesis rate, segmental sagittal angle [SSA], mean disc height [MDH], intervertebral foramen height [FH], cage subsidence, and fusion rate) were assessed. And we assessed the changes in radiological parameters between the postoperative and the last follow-up periods. Results : Preoperative radiological parameters were not significantly different between the two groups. LLIF was significantly superior to TLIF in immediate postoperative radiological results, including reduction of spondylolisthesis rate (3.8% and 7.2%), increase in MDH (13.9 mm and 10.3 mm) and FH (21.9 mm and 19.4 mm), and correction of SSA ($18.9^{\circ}$ and $15.6^{\circ}$) (p<0.01), and the changes were more stable from the postoperative period to the last follow-up (p<0.01). Cage subsidence was observed significantly less in LLIF (n=6) than TLIF (n=21). Fusion rate was not different between the two groups. The clinical outcomes did not differ significantly at any time point between the two groups. Complications were not statistically significant. However, TLIF showed chronic mechanical problems with screw loosening in four patients and LLIF showed temporary symptoms associated with the surgical approach, such as psoas and ileus muscle symptoms in three and two cases, respectively. Conclusion : LLIF was more effective than TLIF for spondylolisthesis reduction, likely due to the higher profile cage and ligamentotactic effect. In addition, LLIF showed mechanical stability of the reduction level by using a cage with a larger footprint. Therefore, LLIF should be considered a surgical option before TLIF for patients with unstable DS.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.84-95
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• 2022

Objective : To investigate the clinical efficacy and safety of the controlled distraction-compression technique using an expandable titanium cage (ETC) in posttraumatic kyphosis (PTK). Methods : We retrospectively studied and collected data on 20 patients with PTK. From January 2014 to December 2017, the controlled distraction-compression technique using ETC was consecutively performed in 20 patients with PTK of the thoracolumbar zone (range, 36-82 years). Among them, nine were males and 11 were females and the mean age was 61.5 years. The patients were followed regularly at 1, 3, 6, and 12 months, and the last follow-up was more than 2 years after surgery. Results : The mean follow-up period was 27.3±7.3 months (range, 14-48). The average operation time was 286.8±33.1 minutes (range, 225-365). The preoperative regional kyphotic angle (RKA) ranged from 35.6° to 70.6° with an average of 47.5°±8.1°. The immediate postoperative mean RKA was 5.9°±3.8° (86.2% correction rate, p=0.000), and at the last follow-up more than 2 years later, the mean RKA was 9.2°±4.9° (80.2% correction rate, p=0.000). The preoperative mean thoracolumbar kyphosis was 49.1°±9.2° and was corrected to an average of 8.8°±5.3° immediately after surgery (p=0.000). At the last follow-up, a correction of 11.9°±6.3° was obtained (p=0.000). The preoperative mean back visual analog scale (VAS) score was 7.9±0.8 and at the last follow-up, the VAS score was improved to a mean of 2.3±1.0 with a 70.9% correction rate (p=0.000). The preoperative mean Oswestry disability index (ODI) score was 32.3±6.9 (64.6%) and the last follow-up ODI score was improved to a mean of 6.85±2.9 (3.7%) with a 78.8% correction rate (p=0.000). The overall complication was 15%, with two of distal junctional fractures and one of proximal junctional kyphosis and screw loosening. However, there were no complications directly related to the operation. Conclusion : Posterior vertebral column resection through the controlled distraction-compression technique using ETC showed safe and good results in terms of complications, and clinical and radiologic outcomes in PTK. However, to further evaluate the efficacy of this surgical procedure, more patients need long-term follow-up and there is a need to apply it to other diseases.

• 한국응용과학기술학회지
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• 제35권2호
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• pp.433-444
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• 2018

본 연구는 국민건강보험공단의 장애와 건강통계 자료를 분석하여 장애인 건강검진 수검률을 살펴보고 건강검진에 따른 문제점과 향후 개선방안을 제시하고 건강검진 문진조사 결과를 바탕으로 장애인의 건강관리 형태 등을 소고하고자 한다. 연구대상은 장애인복지법 제2조에 따른 신체적, 정신적 장애로 오랫동안 일상생활이나 사회생활에서 제약을 받고, 2015. 12. 31. 기준 등록한 장애인2,479,080명 중 건강검진과 건강형태 조사에 참여한 장애인으로 한정하여 정책적 의견을 제시하였다. 결론으로 장애인 건강검진은 첫째, 장애인에 적합한 건강검진 서비스를 준비하기 위해서는 장애인 당사자들의 의견이 필요할 것이다. 둘째, 장애유형 및 중증도별 건강검진 항목 개발이 필요할 것으로 생각된다. 셋째, 장애인건강검진 의료장비 및 편의시설에 대하여 고민해 보아야 할 것이다. 넷째, 서비스 제공자에 대한 인력 확보와 교육이 필요할 것으로 생각된다. 다섯째, 장애인의 이동권을 확보할 수 있도록 하여야 할 것이다. 장애인의 건강형태는 첫째, 장애인 건강증진을 위한 각 영역별 전문가 협의체를 구성하여야 할 것이다. 둘째 장애인 건강증진 프로그램과 이를 운영하는 시설 현황분석이 필요할 것으로 생각된다. 셋째, 장애인건강권 및 의료접근성 보장에 관한 법률에 나와 있는 중앙장애인 보건의료센터에서 장애유형 및 중증도별 표준화된 건강증진 프로그램 개발이 필요할 것으로 생각된다. 지금까지 장애인 건강검진과 건강형태에 대한 내용을 살펴보고 이에 따른 정책적 의견을 제시하였다. 따라서 향후 연구로 본 연구에서 제시하고 있는 과제를 바탕으로 세부적인 연구들이 추진되길 바라며 장애인의 건강과 관련된 프로그램의 인과관계가 지속적으로 밝혀져야 할 것이다.

• 디지털융복합연구
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• 제11권5호
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• pp.405-410
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• 2013

2008년 장애인 차별금지 및 권리구제 등에 관한 법률의 시행으로 웹 접근성이 법적으로 의무화한 결과, 중앙행정기관이나 지방자치단체 등 공공부문을 대상으로 웹 접근성 준수 수준에 대해 실태 조사한 결과 매년 향상되고 있는 것으로 조사되었다. 하지만 이러한 법적 제도 장치는 장애인에 대한 편의성 증진에 초점이 맞춰져 있어, 모든 사용자를 만족하게 한다는 유니버설 디자인 개념에는 맞지 않는다. 이에 본 연구는 유니버설 디자인 개념을 도입한 웹 접근성 지침(UD-WCAG)을 통해 국내 17개 시도 교육청 홈페이지의 웹 접근성 실태를 조사하였다. 실태조사는 한국정보문화진흥원의 자가진단 도구를 통한 검증, 유니버설 디자인 개념을 도입한 웹 접근성 지침(UD-WCAG)을 통한 검증, 스크린리더를 사용한 검증 등 총 3단계로 진행되었으며, 자가진단 도구를 통한 검증에 비해 UD-WCAG을 통한 조사결과가 전반적으로 준수율이 낮은 것으로 조사되었다.