The Effect of a Movie-Based Nursing Intervention Program on Rehabilitation Motivation and Depression in Stroke Patients

PURPOSE: The aim of this study was to develop and measure the effect of a movie-based-nursing intervention program designed to enhance motivation for rehabilitation and reduce depression levels in stroke patients. METHODS: The study used a quasi-experimental, nonequivalent control group and a pretest-posttest design. The 60 research subjects were assigned to the experimental (n=30) or control group (n=30). The movie-based nursing intervention program was provided for the experimental group during 60-minute sessions held once per week for 10 weeks. The program consisted of patient education to strengthen motivation for rehabilitation and reduce depression, watching movies to identify role models, and group discussion to facilitate therapeutic interaction. RESULTS: After 10 weeks of participation in the movie-based nursing intervention program, the experimental group's rehabilitation motivation score was significantly higher, F=1161.54 (within groups df=49, between groups df=1), p<.001, relative to that observed in the control group. In addition, the experimental group's depression score was significantly lower relative to that observed in the control group, F=258.97 (within groups df=49, between groups df=1), p<.001. CONCLUSION: The movie-based nursing intervention program could be used for stroke patients experiencing psychological difficulties including reduced motivation for rehabilitation and increased depression during the rehabilitation process.

A Meta-Analysis of the Correlates of Resilience in Korean Nurses / 임상간호연구

PURPOSE: Nurses' resilience plays an important role in overcoming the challenges that nurses often encounter at clinic, and many factors have been examined which influence on nurses' resilience levels. Through this study, those factors were systematically searched and quantitatively synthesized. METHODS: In order to find relevant studies, both English and Korean academic databases were searched, and, finally, a total of 33 articles were identified and included in this analysis. RESULTS: The effect size on the protective variables was large and that of the risk variables was medium. In the protective variable group, the job variable group showed a larger effect size compared to the organizational variable group. Among the protective variables, compassion satisfaction showed the highest contribution on enhancing the resilience level of nurses. In the risk variable group, the personal variable group showed the highest effect size, which was followed by the organizational and job variables. Among the risk variables, the personal stress response showed the highest contribution to decreasing the level of resilience of nurses. CONCLUSION: This study provides a meaningful data for future studies in terms of developing evidence-based interventions to enhance the levels of resilience among Korean nurses.

Decision Making about Mode of Delivery Among Pregnant Women with Previous Cesarean Delivery / 대한산부인과학회잡지

OBJECTIVE: To estimate the rates at which women with a previous cesarean delivery were offered and consented to trial of labor (TOL) and to investigate the factors affecting the decision making about mode of delivery METHODS: For 12 months duration, pregnant women with one previous cesarean were enrolled prospectively in this study. Eligibility to TOL was defined as pregnancy after 36 weeks of gestation without medical or obstetric indication of cesarean section. Patients were received counseling and consented to the process of TOL. The social and obstetric factors were collected through interview and the medical records were analyzed. RESULTS: Among the initial 185 patients with one previous cesarean, 106 were considered eligible to TOL. Seventy-two patients out of the 106 delivered with elective repeat cesarean while 34 patients tried TOL; 24 were delivered with vaginal birth after cesarean (VBAC), while 10 were received emergency cesarean section. The indications of cesarean section were cephalopelvic disproportion (CPD, 7 cases) and fetal distress (FD, 1 case). Two received emergency cesarean without definite obstetric indication. The rate of high education, college greaduate or more was higher in the group of TOL than in those of elective cesarean (50% vs 68%, p=0.04). The rates of patients with indication of previous cesarean, CPD, FD, or abnormal placentation were more frequent among the patient with TOL (23% vs 48%, p=0.007). CONCLUSION: These result provides clinical information about the decision making about mode of delivery among the patients eligible to TOL with one previous cesarean. More clinical studies about TOL and VBAC are required in the different setting of hospital or institute.

The Prediction of Pre-eclampsia/Fetal Growth Restriction based on Notch of Uterine Artery Doppler Velocimetry / 대한산부인과학회잡지

OBJECTIVES: The objective of this study is to evaluate the predictability of pre-eclampsia and fetal growth restriction(FGR) using the notch of uterine artery Doppler velocimetry after the second trimester of pregnancy, and to evaluate the hemodynamic changes preceeding the onset of symptoms of pre-eclampsia, therefore determining the significance of the notch in uterine artery Doppler velocimetry. MATERIALS AND METHODS: Between March 1996 and April 1999, in Severance Hospital, 99 pregnant women who showed notches in uterine artery Doppler velocimetry at the 24th to 32nd gestational weeks were studied. Those already manifested by pre-eclampsia and FGR were excluded. The study population were divided into two groups, women in their 24-26th gestational weeks and in their 27-32nd gestational weeks, and the prevalence of pre-eclampsia and FGR were evaluated in each group. Also, the prevalence of the mentioned diseases according to the bilaterality of the notch, and the duration to the onset of the symptoms of pre-eclampsia were compared. RESULTS: Among 42 patients who showed the notch in the 24-26th gestational weeks, 14 developed pre-eclampsia/FGR(33.3%), and among 57 in the 27-32nd gestational weeks, 17 developed the mentioned diseases(31.5%). No significant difference in prevalence rate was observed. In those who showed bilateral notches, 11 out of 24 cases developed pre-eclampsia/FGR(45.8%). In those with unilateral notch, 20 out of 75 cases had the disease(26.7%). The difference in the two groups were statistically significant(p<0.05). Among 42 patients who showed the notch in the 24-26th gestational weeks, 7 developed pre-eclampsia(16.7%), and among 57 in the 27-32nd gestational weeks, 17 developed pre-eclampsia(15.7%). No significant statistic difference was observed. The duration to the onset of symtoms of pre-eclampsia were 5.3 and 5.5 weeks each group. CONCLUSIONS: The notch means early marker of hemodynamic changes preceeding the onset of symptoms of pre-eclampsia. Therefore, patients who show the notch of uterine artery Doppler velocimetry in the second half of pregnancy should be considered as high risk patients for either pre-eclampsia or FGR, and especially those with bilateral notches require close observation and follow-up.

Clinical Analysis of Midtrimester Amniocentesis / 대한산부인과학회잡지

OBJECTIVES: Amniocentesis is the most commonly used invasive method for prenatal diagnosis of genetic disorders. But this invasive study may induce preterm labor, endanger both the mother and the fetus, cause infection and abortion. This study was performed to clarify the safety and confidency of amniocentesis. MATERIAL AND METHODS: 1,500 amniocentesis cases were performed from 1987 to 1996 at Severance hospital for prenatal diagnosis of genetic disorders. Of 1,500 cases, 499 cases whose pregnancy outcomes were proven were finally analized. We compared incidence of complications such as spontaneous abortion, vaginal spotting, premature rupture of membranes, preterm labor or chorioamnionitis according to placental location, frequency of needle insertion and amniotic fluid color. RESULTS: 1) Indications for amniocentesis were (1) advanced maternal age - 47.3%, (2) positive maternal serum triple test - 13.8%, (3) fetal chromosomal anomaly suspected in ultrasonography - 10.0%. 2) 6.6% of the amniocentesis samples had color changes due to bleedng or meconium passing. 3) 18.8% of the cases were performed at 16th gestational weeks followed by 20th, 18th and 17th weeks. 4) 2.2% had complications such as spontaneous abortion, vaginal bleeding, premature rupture of membranes, preterm labor and chorioamnionitis in 4 weeks after amniocentesis. 5) No correlation was found between the placental location, frequency of needle insertion(below 3 times) and complication rate. The spontaneous abortion rate in the group with amniotic fluid discolorization was 6.1% whose only 0.4% had spontaneous abortion to the group with clear amniotic fluid. 6) Median value of amniotic fluid alphafetoprotein(alphaFP) of pregnant women in midtrimester were 15,769.4ng/ml at 15 weeks, 13,160.3ng/ml at 16 weeks, 11,539.3ng/ml at 17 weeks, 9,569.8 mg/ml at 18 weeks, 8,423.4mg/ml at 19 weeks, 6,527.1ng/ml at 20 weeks, 5,979.3ng/ml at 21 weeks, 4,363.2ng/ml at 22 weeks, 3,555.2ng/ml at 23weeks, respectively. In midtrimester amniotic fluid alphaFP declined gradually as gestational weeks increase. CONCLUSIONS: Fetal loss rate of midtrimester amniocentesis was 0.8%, proving that it outstanding in the aspects of safty and confidency. Since the fetal loss rate significantly increases in case with amniotic fluid discoloration, it is needless to mention the importance of close follow-up.

Pregnancy Outcomes in Women with Unexplained Elevation of Maternal Serum Human Chorionic Gonadotropin Levels at Midtrimester / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to determine the association between unexplained elevation of maternal serum human chorionic gonadotropin (hCG) in the second trimester and adverse pregnancy outcomes. MATERIAL AND METHODS: Between February 1995 and July 1999, we evaluated 1566 pregnant women who have underwent second trimester triple marker screening tests (alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin) and delivered at Severance Hospital, Yonsei Medical Center. Multiple pregnancies, abnormal fetal karyotypes, fetal anomalies, and abortions were excluded from the study. One hundred twenty-one women with hCG levels greater than 2.0 multiples of the median (MoM) were included in the study group while 1389 women with hCG levels less than 2.0 MoM served as the control group. Pregnancy outcomes were obtained from the delivery and neonatal records in our institution. Adverse pregnancy outcomes between the two groups were compared using chi-square test and Fisher's exact test. RESULTS: Women with unexplained elevation of human chorionic gonadotropin levels were associated with statistically significant increased risks for preeclampsia, preterm delivery, and low birth weight (p<0.05). However, there were no significant differences between the study and control groups with respect to preterm premature rupture of membranes, abnormal fetal heart rate tracing, abruptio placentae, intrauterine fetal death, and neonatal death. CONCLUSION: An unexplained elevation in human chorionic gonadotropin level in the second trimester may increase the risk for preeclampsia, preterm delivery, and low birth weight but not for other adverse pregnancy outcomes such as preterm premature rupture of membranes, abnormal fetal heart rate tracing, intrauterine fetal death, or neonatal death.

Reference Ranges of Doppler Indices in the Fetal Middle Cerebral Artery according to Gestational Age / 대한산부인과학회잡지

OBJECTIVES: To investigate the "brain sparing effect", a paradoxical increase in fetal cerebral perfusion in pregnant women with uteroplacental insufficiency through fetal middle cerebral artery(MCA) waveform analysis, and to construct new reference ranges for fetal MCA Doppler flow velocity resistance indices in nomal preganacies to be used in the assessment of fetal well-being. MATERIALS AND METHODS: The subjects were selected from pregnant women receiving antenatal care at Severance Hospital between March 1996 and December 1999. Fetal MCA reference resistance index range according to gestational age were obtained through routine Doppler velocimetry for 4621 normal pregnant women between 24-42 gestational weeks. Those manifesting multiple pregnancy, Diabetes Mellitus, drug abuse, chronic hypertension, fetal congenital anomaly, fetal growth restriction(FGR) with discrepencies of more than 7days and pregnancies complicated by pregnancy induced hypertension (PIH) were excluded. Additionally, the fetal MCA hemodynamic changes were compared for 140 pregnant women with FGR or PIH. The normal ranges for fetal MCA Doppler resistance indices were expressed as mean+/-SD, and a comparative analysis between the PIH or FGR group and the normal control group was performed. Statistical analysis was done using the SPSS 8.0 program, t-test and the Pearson correlation. RESULT: The fetal MCA doppler flow resistance indices for normal pregnancies were 0.77+/-0.006 at 24 weeks and 0.79+/-0.006 at 28 weeks, demonstrating a statistically significant increase(p<0.05). At 40 weeks the index was 0.71+/-0.009 showing a significant decrease after 28weeks(p<0.05). There was a tendency for the resistance index to be lower in the PIH/FGR group compared to the normal controls. CONCLUSION: Constructing a normal reference resistance index range for fetal MCA flow is of high clinical value with regards to predicting fetal well being and understanding the hemodynamics of fetal cerebral perfusion.

Torsion of the pregnant uterus

A 31-year-old woman, with a history of previous cesarean section and right oophorectomy, was admitted for a repeat cesarean section. After the commencement of surgery uterine torsion was diagnosed because of the anterior position of the remaining left ovary and tube, the absence of normal uterovesical peritoneum, and extremely engorged vessels in the lower uterine surface. Posterior classical hysterotomy was performed and a healthy female baby was delivered. Following delivery of the baby and suturing the incision site of the uterus, the contracted uterus was detorted and put back in the pelvic cavity. Extreme uterine torsion of 180 degrees at term is a rare obstetric event. This paper presents a case of uterine torsion at full term pregnancy in which the delivery and repositioning of the uterus was successful.

A Case of Sertoli-Leydig Cell Tumor / 대한산부인과학회잡지

The Sertoli-Leydig cell tumor is a rare sex cord stromal tumor of the ovary, accounting for less than 0.5% of all primary ovarian neoplasm. This tumor is the most common type of all virilizing ovarian tumors. However, only one-third of patients develop virilization. Recently, we experienced a case of intermediately differentiated Sertoli-Leydig cell tumor with amenorrhea and so we present it with brief review of literature.

Prenatal Genetic Diagnosis in 2,000 Amniocenteses / 대한산부인과학회잡지

OBJECTIVE: To systematic analyze the change of indications, age distribution of the patients and chromosomal results according to patient's age and indications in midtrimester genetic amniocentesis METHODS: This study reviewed 2,000 genetic amniocentesis cases from 1984 to 1997 which were done at Severance Hospital, after prenatal genetic counseling for the mothers who have high risk for carrying chromosomally abnormal babies. We analized the change of the indication, age distribution and chromosomal results according to maternal age and indications of amniocentesis RESULTS: 1. The incidence of amniocentesis had been in gradual increase since the 1980's, and from the mid 1990's it showed an abrupt increment. 2. Of the 2,000 amniocentesis cases, 31.8% was maternal age 35 to 39 which was most common age group and followed by age 30 to 34 was 28.4% and age 25 to 29 was 27.4. 3. The indications for amniocentesis were advanced maternal age(39.6%), abnormal maternal serum markers(27.8%) and abnormal ultrasonographic findings which implies chromosomal abnormality(6.4%). Recently maternal serum markers and ultrasonography play an important role as an indicator for the amniocentesis. 4. From the 2000cases, 1,950 cases showed normal diploidy and 50 cases abnormal karyotype which consisted 2.5%. In autosomal disorders ll Down syndrome, 7 Edward syndrome, 1 Patau syndrome, 15 Translocation, 3 Mosaicism were diagnosed. In sex chromosomal disorders 3 Klinefelter syndmme, 2 Turner syndrome and other 8 chromosomal abnormalities were diagnosed. No statistic significance was found among different age groups. Those who had abnormal ultrasonographic findings implying chromosomal abnormality were found to have correlation with chromosomal abnormality than other indications CONCLUSION: Midtrimester genetic amniocentesis is an important diagnostic tool in prenatal diagnosis, of which the annual incidence has been recently increased abruptly. Not only maternal age, but the maternal serum markers and ultrasonograms should be considered in prenatal counseling, The genetic amniocentesis should be well informed to the general population.

Effect of Oral Nutritional Support During Radiation Therapy in Patients with Thoracic and Gead/Neck Cancer / 대한암학회지

PURPOSE: This study was designed to evaluate the role of oral nutritional support and nutritional counseling by dietician during radiation therapy. MATERIALS AND METHODS: This study included total 58 patients with head/neck, lung, or esophageal cancers who received radiation therapy with radical purpose between February and December, 1996. They were randomized either into nutrient supplement group (Group I) or control group (Group II). In Group I, the dietician advised patients to take high density nutrient supplement (NuCare, 250 kcal/can, Miwon co., LTD) based on dieticians initial evaluation for oral intake from initiation to completion of radiation therapy. In Group II, patients received nutritional support other than high density nutrient supplement only when patients lose weight more than 2 Kg during radiation treatment. All patients were evaluated for nutritional status and diet pattern and received nutritional counseling before radiation therapy and then weekly during treatment. RESULTS: Total 45 patients (22 patients in group I, 23 patients in group II) were available. In group I, all patients received average 3 cans (2~4 cans) a day. The calory from nutrient supplement was 43.9% of their daily energy intake (25.9~68.7%). About 72.7% of patients in Group I could keep up with their oral intake over 80% of daily requirement energy comparing to only 12.3% for patients in Group II(p0.05). CONCLUSION: There was less significant weight loss in patients who started oral nutritional supplement based on the daily requirement energy early in radiation therapy. We think it is better to recommend nutritional supplement before weight loss started because radiation induced side effects such as esophagitis and oral mucositis prohibited patients to continue to take nutrient supplement.

Two Cases of Surgical Intervention in Persistent Localized Choriocarcinoma / 대한산부인과학회잡지

Gestational trophoblastic tumors including choriocarcinoma bave become one of the most curable human malignancies with an overall cure rate exceeding 90%. Although systemic chemotherapy is the initial treatment for chorio- carcinoma, some patients with chemotherapy-resistant choriocarcinorna can be treated by integration of cbemotherapy, surgery and radio- therapy. We report two cases of persistent localized choriocarcinoma which was treated by surgical intervention.

Amniotic Fluid Index According to Fetal Presentation / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effect of fetal presentation to the measurement of amniotic fluid index(AFI) in singleton pregnancy after 20 weeks of gestation. MATERIALS AND METHODS: Review of the medical and ultrasonographic records from 1992 to 1996 including AFI value and pregnancy outcomes was performed retrospectively. The inclusion criteria were (1) singleton pregnancy delivered after 37 weeks of gestation, (2) birth weight between 10th and 90th percentile, (3) no fetal anomaly, (4) 5 minute Apgar score>or=7, (5) no maternal medical disease such as hypetensive disorders or diabetes, (6) and intact amniotic membranes at the time of ultrasonography. The results of 7,362 tests from 5,607 pregnancies were reviewed and analyzed. RESULTS: In normal pregnancies after 20 weeks of gestation, the AFI value showed the peak during 25~30 week and decreased thereafter. The range of AFI during preterm pregnancy(30~36 weeks, N=2,836) were between 9.4 and 21.8 cm(5th to 95th percentile, mean value of 15.2+/-4.1cm). The range of AFI at term(37~40 weeks, N=1,245) were 7.7 and 21.9 cm(5th to 95th percentile, mean value of 14.2+/-4.5cm), which showed significant difference (p=0.000) from that of preterm. The range of AFI after 41 weeks(N=75) were within 4.3 and 26.7cm(5th to 95th percentile, mean value of 13.8+/-6.3cm), which showed gradual decrease. The AFI among the gravidas with breech presentation showed similar values between 20~36 weeks. At term pregnancies(after 37 weeks, N=84) with breech presentation, the AFI(range 5.2cm~22.3cm, mean value 13.5+/-4.8cm) was smaller than those with cephalic presentation, but statistically insignificant(p=0.103). The commonly used criteria for oligohydramnios, AFI 5.0cm, equated to 1st percentile in cephalic presentation and 5th percentile in breech pregnancies, respectively. CONCLUSION: In this study AFI throughout pregnancies after 20 week of gestation showed difference of distribution of AFI according to gestational age and fetal presentation in term pregnancy. Further studies would be required to establish the cutoff value of oligohydramnios in cephalic and breech presentation at term pregnancy to establish different criteria according to fetal presentation.

A Case of Peritoneal Tuberculosis with Elevated Serum CA 125 Level / 대한산부인과학회잡지

Peritoneal tuberculosis is a disease rarely seen nowadays. Its symptoms are easy fatigue, abdominal distension, intermittent abdominal pain and ascites. Its onset is insidious, which si-mulates symptoms of peritonitis or carcinomatosis. Peritoneal tuberculosis should be considered in the differential diagnosis when a Patient's symptoms and signs are ascites, ovarian tumor, vague abdominal pain and abdominal distension with high serum level of CA 125, an antigenic determinant of epithelial ovarian cancers. We have recently experienced a case of peritoneal tuberculosis with markedly elevated serum level of CA 125 in 54 year-old woman and report our case with a brief review of the literature.