Earticle

이 연구는 복합부위통증증후군(Complex Regional Pain Syndrome; CRPS) 환자의 인지적 융합이 일상생활 기능에 영향을 미치는 심리적 과정을 이해하기 위해, 일지연구를 통해 인지적 융합- 경험회피-일상생활 기능의 매개모형을 검증하고자 했다. CRPS 환우회에 등록된 성인 환자 24 명을 대상으로, 14일에 걸쳐 매일 하루 일과를 마친 뒤 Google form을 통해 인지적 융합, 경 험회피, 일상생활 기능(활동회피, 활동방해, 집중곤란)으로 구성된 일지의 응답을 받았다. 다 수준 매개모형분석 결과, 경험회피가 인지적 융합과 CRPS 환자의 일상생활 기능과의 관계에 서 부분 매개하는 것으로 나타났다. 이러한 결과는 인지적 융합이 CRPS 환자의 기능에 직접 적으로 영향을 미칠 뿐만 아니라, 경험회피를 매개로 하여 간접적으로 CRPS 환자의 일상생활 기능에 영향을 미친다는 것을 의미한다. 이 연구는 수용전념치료의 이론적 근거와 일치하는 결과로, CRPS 환자의 일상생활 기능 증진에 있어 통증과 관련된 생각, 감정, 신체적 감각 등 여러 경험에 대한 수용을 촉진하는 것이 효율적일 수 있음을 시사한다.

The purpose of this study was to investigate the mediating effect of experiential avoidance on the association between cognitive fusion and daily functioning (i.e., avoidance, disability and concentration) in patients with complex regional pain syndrome (CRPS). Twenty-four patients registered with the CRPS Association in Korea, participated in this study. They completed an online end-of-day diary over 14 consecutive days assessing cognitive fusion, experiential avoidance and daily levels of avoidance, disability, and concentration. A multi-level mediation model analysis showed that experiential avoidance partially mediated the association between cognitive fusion and daily functioning (i.e., avoidance, disability, concentration) in patients with CRPS. These results indicate that cognitive fusion not only directly affects daily functioning of patients with CRPS, but also indirectly affects daily functioning through experiential avoidance. This study, in line with the theoretical basis of acceptance and commitment therapy, suggests that it may be effective to promote acceptance of various pain-related experiences, such as pain-related thoughts, emotions, and physical sensations.

1. 결론 본 연구는 암환자 가족의 가족기능을 조사하여 가족 중심의 암환자 간호계획을 수립하는데 기초자료를 제공하고자 시도하였다. 대상자는 서울시 소재 4개 대학부속 종합병원에서 암으로 진단받고 입원 중인 환자가족 95명과 서울시 소재 1개 대학부속 종합병원에 근무하는 직원 가족 중 암환자가 없는 정상가족 95명을 대상으로 하였다. 본 연구에 사용된 도구는 문제해결, 의사소통, 역할, 정서적 반응, 정서적 참여, 행동조절, 일반적 기능의 7개 하부영역으로 구성된 53문항의 가족기능 측정도구를 사용하였다. 자료처리는 SAS PC 프로그램으로 descriptive statistics, χ2-test, t-test, ANOVA를 적용하여 통계처리 하였다. 본 연구 결과를 통하여 얻은 결론은 다음과 같다. 1) 암환자 가족의 가족기능은 하부영역별 평균점수가 일반적 기능 3.29, 문제해결 3.24, 정서적 참여 3.20, 의사소통 3.12, 정서적 반응 2.93, 행동조절 2.57, 역할 1.93의 순이었다. 2) 암환자가족과 정상가족의 가족기능 정도는 통계적으로 유의한 차이가 없었다. 3) 암환자가족의 가족 특성, 질병특성, 암의 단계에 따른 가족기능정도에는 통계적으로 유의한 차이는 없었으나 가족기능의 7개 하부영역별 비교시 유의한 차이를 보이는 영역이 일부있었다. 가족형태 비교시 핵가족이 대가족 보다 역할영역에서 유의하게 높은 가족기능을 보였고, 가정경제정도에 따른 비교시 가정경제 정도가 보통인 가족, 여유있는 가족, 가난한 가족의 순으로 행동조절기능 영역에서 유의한 차이를 보였다. 또한 입원횟수에 따른 비교시 행동조절 영역에서 입원횟수가 1회일 때 가장 높고 차츰 낮아지다가 4회 입원시부터 다시 증가되면서 유의한 차이를 보였고, 정서적 참여기능에서도 입원횟수가 1회일 때 가장 높고 차츰 낮아지다가 4회 입원시부터 다시 증가되면서 유의한 차이를 보였다. 암의 진행 단계에 따른 가족기능 점수는 암의 적응단계, 초기단계, 말기단계 순으로 나타났으나 통계적으로 유의한 차이는 없었다. 2. 제언 본 연구에서 사용한 가족기능 측정도구가 한국에서는 처음 사용된 도구인 만큼 폭 넓은 대상자에게 도구의 신뢰도와 타당도를 검증할 것을 제언한다. 암의 진행과정에 따라 변화되는 가족기능을 확인할 수 있는 종단적 연구를 제언한다.

This study was designed to assess the level of family function between cancer patient's families and normal families, and to seek better quality family-Mcentered nursing care. The subjects for this study were 95 cancer patient’s families who were selected from the 4 university hospitals and 95 normal families who were selected from 1 university hospital. The instrument used for this study was McMaster Family Assessment Device (FAD) developed by Epstein, Baldwin and Bishop (1983). The scale consisted of 53 items covering 7 areas: ‘problem solving’, ‘communication’, ‘roles’, ‘affective responsiveness’, ‘affective involvement’, ‘behavior control’, and ‘general functioning’. As for data analyses, descriptive statistics, χ2-test, t-test, ANOVA were adopted using SAS program. The result of this study was as follows: There there was no significant difference between cancer patient’s family function and normal family function. Also there was no significant difference on cancer patient’s family function with regard to family characteristics, disease’s characteristics, and clinical

Background and Purpose：Many Physical therapist are inclined to communicate less effectively each other because they hardly use the standard terminology. The purposes of this case report are (1) to apply ICF- based documentation in evaluation (2) to submit the strategy of intervention process to improve the ability of walking short distance of the client who has post-stroke. Description：The client was 44-years-old man with hemiplegia who was in 1 month post- stroke problems were diagnosed while applying the ICF core set. The goals agreed with client were independently walking short distance, stairs and obstacles. To come up with the intervention strategy, hypothesis was set and 4 weeks ofintervention was carried out after proposing the short goal and detailed purpose. Outcome：The client's performance in walking short distance and confidence were increased after impairment focused intervention, that are improved in walking velocity, endurance, supporting ability in lower limbs, rhythmical movement in upper limbs and the coordination of both limbs. Activities focused intervention also enhanced the ability in climbing steps and walking around obstacles. Conclusion：The decided hypothesis and goal that are to solve the problems the client faced were remarkably meaningful.

연구목적은 동작관찰훈련이 뇌졸중 환자의 인지기능 향상에 영향을 미치는가를 알아보고자 하였다. 연구방법으로는 2018년 4월 23일부터 5월 18일까지 경인지역 병원에 입원 중인 재활환자 7명을 대상으로MMSE-K와 LICA를 사용하여 평가를 진행하였고, 동작관찰프로그램으로는 상지 ROM 댄스, 풀 오버형 옷정리, 운동화 끈 묶기, 수건 개기, 양말 개기, 종이접기, 넥타이 매는 법 총 7가지 과제를 적용하였다. 통계프로그램으로는 SPSS version 20을 사용하였으며기술통계, Wilcoxon signed ranks을 사용하여 값을 구하였다. 동작관찰훈련을 적용한 결과 MMSE-K 점수는 3.29±1.38의 변화량을 보여 p값 0.001로 유의한값을 보였고, LICA 점수는 기억력에서 12.16±6.73으로 가장 유의한 값이 나왔다. 결론은 동작관찰훈련이뇌졸중 환자의 인지기능 영역 중 기억력에서 가장많은 영향을 미쳤으며, 다른 영역에서도 점수 향상은있었으나 통계적으로 유의하지는 않았다. 앞으로 동작관찰훈련이 많이 사용되어 추후에는 뇌손상 부위별로 어느 영역에서 효과가 있는지에 대한 후속 연구가 이루어지길 바란다.

This study aims to identify whether the action-observation training impacts on the improvement of stroke patient’s cognitive functioning. When it comes to the research methods, Korean version of Mini-Mental State Examination (MMSE-K) and Literacy Independent Cognitive Assessment (LICA) conducted to assess samples between 23 April and 18 May 2018. Samples are seven patients who are hospitalized in Kyung-In region. In the meantime, seven tasks such as the range of joint motion (ROM) dance, arrangement of pullover clothes, lacing-ups of a pair, folding up a facecloth and socks, the origami and tying a necktie implemented as the action-observation programme. In order to analyse collected data, descriptive statistics analysis, paired t-test and the Wilcoxon signed-rank test were carried out via SPSS version 20 (a statistics programme). The change in value from MMSE-K showed its statistical significant as 3.29 (±1.38, p<.001) as well as value from LICA in recollective powers was 12.16 (±6.73), therefore, the statistic is said to be statistically significant. In conclusion, action-observation training most influenced recollective powers amongst stroke patient’s cognitive functioning areas. Even though development of cognitive functioning discovered in other areas, its values were possibly statistically insignificant. Hence, future research ought to demonstrate which areas action-observation training is effective according to brain lesion site.

This study examined burdens of primary family caregivers, and family functioning of patients with cancer. In addition, the relationship between two concepts was assessed to develop nursing intervention to reduce the burdens of caregiving, and to improve family functioning. Ninety-two primary family caregivers of patients with cancer at a general hospital in Seoul participated in this study. The patients with cancer aged from 19 to 84 years with a mean age of 51 years, and sixty-one percent were male. About 30 percent of the patients suffered liver and billiary tract cancer. Fifty-six percent of the primary family caregivers were spouses of the patients and 70.7 percent were women. Primary family caregivers' burdens were assessed by the Burden Scale originally developed by Zarit (1980) and Novak & Guest(1989) and modified by Jang (1995) for use in Korea. The instrument consists of six subscales: time-dependent burden, developmental burden, physical burden, emotional burden, social burden, and financial burden. Family functioning was assessed by the Family APGAR developed by Smilkstein(1978). The results were as follows: 1. The average burden score was 86.1, indicating a moderate level of burden. The time-dependent burden scored highest followed by developmental, physical, social, financial, and emotional burdens. The mean score of family APGAR was 9.71; among subjects 82.6% were included in dysfunctional families. 2. Of the characteristics of patients, age, gender, number of admissions, and job were found to be associated with the level of burden. There was no significant difference between patient characteristics and family functioning. Of the characteristics of primary family caregivers, caregiver's perception of patient prognosis was significantly related to the level of burden, and family functioning. Caregiver's sex and age were also related to family functioning. The quality of relationship between a patient and a caregiver was significant situational factors affecting the level of burden, and family functioning. In addition, the income of family, and help from other family members were related to the level of burden. Given the results, it is essential to develop nursing intervention to reduce burden and to improve family functioning, such as support groups.

A 35-year-old male with type-2 diabetes mellitus and a history of insulin and metformin (2,000 mg/day) use presented to the emergency department (ED) with generalized weakness. Abdominal computed tomography (CT) performed 3 months prior to presentation showed a severely atrophic right kidney and a few tiny stones in the left kidney, with a serum level of creatinine of 1.14 mg/dL. At the ED, the patient’s blood pressure was 153/89 mmHg. Workup revealed acute kidney injury (creatinine, 11.97 mg/dL), high-anion-gap metabolic acidosis (pH, 6.93), and a blood lactic acid level > 15 mmol/L. Based on the medication history, the patient was diagnosed with metformin-associated lactic acidosis. CT showed a left distal ureteral stone, measuring 6 mm in size, which resulted in hydroureteronephrosis. The patient was initially treated with continuous renal replacement therapy. Subsequently, left percutaneous nephrostomy was performed, which led to the return of the creatinine level to baseline, with complete resolution of lactic acidosis.

Objectives：Early detection and treatment of breast cancer has a high correlation with survival. Nevertheless, onethird of the patients who are newly diagnosed with breast cancer do not visit hospital within three months of recognizing their symptoms. This study was performed to determine the influence of marital relationship functioning on the time it takes patients with symptomatic breast cancer to present to hospital. Methods：Two hundred and sixteen post-operative breast cancer patients who were referred to the Stress Clinic at the Breast Cancer Center at Kyungpook National University Hospital were included. We divided the patients into two groups: early presentation(within three months), and delayed presentation(after three months) once a diagnosis of breast cancer is determined. Marital relationship functioning was evaluated with the Global Assessment of Relational Functioning(GARF) tool. Results：Fifty seven patients fell into the delayed presentation group(i.e. they presented to the Stress Clinic after three months). It was determined that advanced stage cancer was more prevalent in the delayed presentation group (p=0.035). Patient delay was associated with a higher level of dysfunctional marital relationship functioning(OR= 3.861, 95% CI=1.003-12.553). Conclusion：Dysfunctional marital relationship functioning was found to be an important factor associated with delayed presentation for the treatment of breast cancer.