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한 대학병원 전공의들의 죽음에 대한 시각이 환자진료에 미치는 영향
문성혁,박상학,김학렬,김상훈 대한신경정신의학회 2003 신경정신의학 Vol.42 No.5
Objectives:This study aimed to investigate the effect of intern and resident’s perspective of death on the attitude to Patients care. Methods:Participants were recruited from interns and residents working in Chosun University Hospital. The questionnaires on perspective of death and attitudes to patient care include i) the perspectives of death and degree of fear of death ii) the attitude of telling truth to dying patients iii) the attitude to the disease frequently associates with the thought of “living with it is worse than dying”, and iv) the avoidant or acceptable attitude when they are treating patients with low chance of recovery thus facing death. Results:Eighty-eight interns and residents participated in this survey. The most frequent reply on the perspective of death was “death is a part, and a process of life” (48.9%). This group also choose more those types of diseases in which they think “living is worse than dying if oneself get it” (p=0.014). This group also showed more avoidant inclination in treating patients with low chance of recovery and facing death compared with other groups (p=0.068). Paradoxically those people who answered that they have no fear to death showed significantly more avoidant behavior against the care of dying patients (p=0.050). Conclusion:This study showed that interns’ and resident’s perspectives of death affect their pattern of patients care, particularly with avoidant patterns against patients. This study suggests the importance of the medical education on thanatology that including the ethical and moral aspects of death
한 눈 중등도 일차하사근기능항진 환자에서 하사근후전술 후 발생한 반대편 눈의 하사근기능항진
문성혁,곽동엽,김명미.Sung Hyuk Moon. MD. Dong Yub Kwak. MD. Myung Mi Kim. MD. PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.12
Purpose: To investigate the incidence rate of inferior oblique muscle overaction (IOOA) in the contralateral eye and the effect of inferior oblique (IO) muscle recession of the contralateral eye in the patients who received IO muscle recession for unilateral moderate (+2 or +3) primary IOOA. <br /> Methods: Medical records of 88 patients with unilateral primary IOOA who underwent unilateral IO muscle recession were retrospectively reviewed and observed during a follow-up period of more than 1 year. Graded recession of the IO muscle was performed according to the degree of IOOA. If postoperative IOOA was below +1, the surgery was considered successful. If IOOA in the contralateral eye was more than +2 after surgery, the IOOA was considered to have occurred.<br /> Results: In cases where IOOA was +2 and +3 before the surgery, the success rate was 98.2% and 100%, respectively, showing an overall success rate of 98.8%. The incidence of contralateral IOOA after recession of the unilateral IO muscle was 24.1% in the +2 group and 16.6% in the +3 group with an overall incidence rate of 21.6% and when the IO muscle recession of the contralateral eye was performed, the success rate was 100%. <br /> Conclusions: The incidence of contralateral IOOA was 21.6% after the unilateral IO muscle recession in moderate unilateral primary IOOA. A satisfactory outcome was obtained through an additional IO muscle recession in the contralateral eye. <br /> J Korean Ophthalmol Soc 2013;54(12):1888-1892
한 눈 선천상사근마비 환자에서 단계적 하사근후전술의 결과
문성혁,김명미,Sung Hyuk Moon,MD,Myung Mi Kim,MD,PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.12
Purpose: To examine changes in vertical deviation and improvement in head tilt after graded inferior oblique (IO) recession surgery in patients with congenital unilateral superior oblique palsy (SOP). Frequency of inferior oblique overaction (IOOA) or bilateral SOP in the contralateral eye after surgery was also investigated. <br /> Methods: We retrospectively reviewed medical records of 65 patients who had undergone graded IO recession surgery in unilateral congenital SOP with at least 1 year of postoperative follow-up. Postoperative vertical deviation was classified as excellent (under 3 prism diopters, PD), good (4-7 PD) or poor (over 8 PD). The occurrence of IOOA was considered if more than 2 IOOAs were observed in the contralateral eye after surgery. <br /> Results: Forty-five of the 65 patients (69%) obtained excellent results and 67.3% had improvement in head tilt after surgery. IOOA in the contralateral eye was not observed in any patients before surgery. Postoperative IOOA in the contralateral eye occurred in 9 patients (13.8%) and a diagnosis of masked bilateral SOP was made in 1 patient (1.5%). <br /> Conclusions: The graded IO recession procedures are considered to be an effective surgical method for the treatment of unilateral congenital SOP. However, IOOA or masked bilateral SOP occurring in the contralateral eye was observed in 15.3% of the patients undergoing surgery. <br /> J Korean Ophthalmol Soc 2013;54(12):1882-1887