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후천성 뇌손상 환자의 집행기능 장애에 대한 메타인지중재 효과 : 체계적 문헌연구
정철훈,권재성 대한작업치료학회 2023 대한작업치료학회지 Vol.31 No.2
Objective: This study aimed to examine the latest evidence for the role of metacognitive intervention in improving executive dysfunction in patients with acquired brain injury(ABI). To this end, we conducted a systematic review of Korean and international randomized controlled trials (RCTs), extracted intervention details, and analyzed the results. Methods: This study used PubMed, EMBASE, CINAHL, KCI, KISS, and RISS to search for Korean and international literature published from January 2015 to November 2022. Seven studies were selected for the final analysis according to the PRISMA checklist, and the results were presented using the PICOS method. The PEDro scale was used to evaluate the quality of the selected studies. Results: Of the 611 retrieved studies, seven were selected (n = 347), which were all “good” in quality. In assessments of executive function, activities of daily living and participation, the interventions that showed significant differences between groups after the intervention were Cognitive Orientation to daily Occupational Performance and Error-Based Learning Conclusion: This study is clinically significant as we have improved the level of evidence power for metacognitive intervention in patients with ABI by selecting only well-designed RCTs. In summary, this study provides evidence to support the use of metacognitive intervention to treat executive dysfunction in patients with ABI. 목적:본 연구의 목적은 후천성 뇌손상 환자의 집행기능 장애에 대한 메타인지중재 효과를 연구한 무작위임상대조군연구를 대상으로 체계적 문헌연구를 실시하여 중재 내용을 추출하고 결과를 분석하여 최신의 근거를 알아보기 위함이다. 연구방법:본 연구는 검색 엔진으로 PubMed, Excerpta Medica Database(EMBASE), Cumulated Index in Nursing and Allied Health Literature(CINAHL), 한국학술지인용색인(Korea Citation Index; KCI), 한국학술정보(Korean Studies Information Service System; KISS), 한국교육학술정보원(Research Information Sharing Service; RISS)를 사용하여 2015년 1월부터 2022년 11월까지 출판된 국내ㆍ외 문헌을 검색하였다. PRISMA checklist에 따라 문헌을 선택하여 최종적으로 7편의 문헌을 분석하였고, PICOS 방식을 사용하여 결과를 제시하였다. 최종 선정된 문헌은 PEDro scale을 사용하여 연구의 질적 수준을 평가하였다. 결과:검색된 611편의 문헌 중 7편(n = 347)이 최종적으로 선정되었고, 연구의 질적 수준은 7편 모두 ‘좋음’ 이었다. 집행기능과 일상생활활동 및 참여 평가에서 중재 이후 그룹간 유의미한 차이가 있었던 중재는 Cognitive Orientation to daily Occupational Performance, Error-Based Learning이었다. 결론:본 연구는 후천적 뇌손상 환자를 대상으로 한 메타인지중재 연구들 중, 잘 설계된 무작위임상대조군연구를 선정하고 분석하여 중재에 대한 체계적 문헌연구의 근거수준을 높였다는 점에서 임상적인 의미가 있다. 그러므로 후천성 뇌손상 환자의 집행기능 장애를 다루기 위한 메타인지중재를 제공하는 과정에서 기초자료로 활용될 수 있을 것이다.
두개조기유합증, 안와격리증, 안구돌출증 환자의 동시 교정 치험례
정철훈,은석찬,서동국,조우성,박세혁 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.2
The simultaneous correction of the hypertelorism and exophthalmos combined with craniosynostosis is very rarely performed operative procedures in the world. The craniosynostosis is the congenital anomaly that designates premature fusion of one or more sutures in either cranial vault or cranial base. Hypertelorism is not a distinct clinical syndrome in itself, but is a physical finding secondary to facial and cranial maldevelopment and it is defined as a increase in the distance between the medial orbital walls. Exophthalmos can occur following the decrease in the size of the orbit in patients with developmental skeletal disorders such as craniofacial synostosis.The authors experienced 9-year-old male patient, who has complex cranio-facial abnormality. The craniosynostosis was oxycephaly type and primary fronto- orbital advancement surgery had been performed in other hospital. The abnormal cranial vault combined with hypertelorism and exophthalmos due to maldeveloped both orbital walls. Surgical correction was obtained by various cranio-fronto-orbital remodeling technique such as calvarial bone craniotomy, fronto-orbital advancement, paramedian resection, medial canthopexy, Tessier- Wolfe three wall orbital expansions. We achieved a quite satisfactory result both functionally and aesthetically in a complex cranio-facial deformity patient by combination and modification of previously developed various cranio- facial plasty technique and hereby report the case with brief discussion and review of literature.