Feasibility Evaluation of Korean Advance Directives (K-AD) / 한국간호교육학회지

PURPOSE: This study evaluates the feasibility of Korean Advance Directives (K-AD) developed earlier. METHODS: From January 1 to February 28, 2013, data were collected from 330 adults through a self-reported questionnaire established by the authors based on literature review and expert consultation. The feasibility of K-AD was multi-dimensionally evaluated through four criteria: cognitive, psychological, document making and socially expecting aspects. Data were analyzed using t tests, one-way ANOVA, and Scheffe post hoc tests via the SAS 9.1.3 program. RESULTS: The feasibility of K-AD differed significantly by gender (p=.003), educational level (p<.001), religion (p=.002), and self-reported health status (p=.039). Differences in the level of easiness with K-AD by gender (p=.008) and education (p=.047) were significant. Perceived simplicity of AD differed significantly by religion (p=.005), and the necessity of AD differed significantly by gender (p=.025) and religion (p=.005). CONCLUSION: K-AD are sufficiently feasible to be tentatively utilized in practice. This is the first study to explore the feasibility of K-AD on the basis of multiple aspects. However, further studies involving diverse populations and methodologies to validate the usefulness of K-AD are warranted.

Development of a Korean Version of an Advance Directive Model via Cognitive Interview / 한국호스피스완화의료학회지

PURPOSE: The purpose of the study was to develop a feasible form of a Korean version of advance directives (K-AD). METHODS: Sixteen adults participated in this study: 10 aged 20~50 years and nine aged 65 years or older. Using a draft version of the K-AD, cognitive interview was conducted on the participants to establish a culturally acceptable form of advance directives whose directions can be understood and responded accordingly by the general population. RESULTS: Cognitive interviews revealed areas of concerns for the draft version of K-AD: lack of instructions or clarity for technical and medical terms, context complexity and inadequate response categories. The draft version was revised by rewording, offering examples and rearranging the context. Editorial style was added with appropriate uses of bold fonts, bullet-points and underlines to facilitate interviewees' cognitive responses. CONCLUSION: Study results feasibility of the revised version of the K-AD. Further study should be performed with a larger number of participants to develop a K-AD with an acceptable level of reliability and validity.

Prerequisite for Korean Advance Directives: From the View of Healthcare Providers

PURPOSE: The purpose of this study was to explore the main prerequisite for Korean Advance Directives [KAD] to ensure their better use. METHODS: Data were collected from two focus group interviews and individual email responses. Study participants were 5 doctors and 6 nurses. All interview data were transcribed and analyzed using qualitative content analysis. RESULTS: Three main themes emerged; establishing a philosophy of KAD, protocol to practice KAD, and the KAD document itself. A philosophy is needed to ensure individual needs, consensus to practice AD and identify principle agents. The core of protocol was found to be as follows; 1) process, 2) premise, 3) procedure, 4) contextual preparation, 5) timing, 6) feasibility. Component and feasibility need to be established for the document itself. CONCLUSION: For a positive acceptance of KAD in Korean society, a culture sensitive, reality based, and user friendly AD needs to be developed.

Relationships of Basal Level of Serum 17-Hydroxyprogesterone with that of Serum Androstenedione and Their Stimulated Responses to a Low Dose of ACTH in Young Adult Patients with Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

A single measurement of serum 17alpha-hydroxyprogesterone (17OHP) level can be unreliable because of its marked diurnal variation. We investigated the relationship of serum level of 17OHP with that of androstenedione (AD), which shows a smaller diurnal variation. And we tested whether the responses of these two hormones to low-dose ACTH stimulation are correlated in patients with 21-hydroxylase deficiency. Baseline serum 17OHP and AD levels were measured in 87 patients and a low-dose ACTH stimulation test was performed in 41 patients. The basal 17OHP level correlated positively with the basal AD level independently of sex, type of 21-hydroxylase deficiency, and the time of day of blood sampling (n = 87, R2 = 0.75, P < 0.001). The area under the curve of 17OHP and AD correlated positively with their respective basal levels. The fold-change increase in 17OHP after ACTH injection correlated negatively with the basal 17OHP level, but that of AD did not correlate with the basal AD level. The random serum 17OHP level, used in the clinic, is a reliable guide and a low-dose ACTH stimulation test provides no extra benefit for assessing the treatment adequacy in patients with 21-hydroxylase deficiency.

Remission Predictors of Graves' Disease in Children / 대한소아내분비학회지

PURPOSE: Antithyroid drug treatment is usually recommended as the initial treatment for children with Graves' disease. However, achieving remission with medical therapy usually requires many years of treatment, the risk for adverse reactions is relatively high and relapse is common after discontinuation of medication. There is therefore a debate about how Graves' disease should be treated in children. The aim of this study was to identify predictors of remission during 2 years from quitting of antithyroid drug. METHODS: We retrospectively studied children who had been treated for Graves' disease with antithyroid medication. We compared the children who achieved remission after two years with those who had persistent disease, to determine the variables associated with remission. RESULTS: 41 patients were enrolled, of whom five (12.2%) achieved remission and the rest (87.8%) could not achieve remission until the last visit. There were no significant differences in T3, free T4, antimicrosomal antibody (AMA), or thyroid stimulating hormone (TSH)-binding inhibitory immunoglobulin (TBII) between the two groups at presentation. However, the remission group had a significantly higher titer of TSH (P = 0.04) and a significantly lower titer of antithyroglobulin antibody (ATA) (P = 0.01) than the non-remission group at presentation. The non-remission group had higher ATA concentrations 3 months after treatment with antithyroid medication than the remission group did (P = 0.02). CONCLUSION: TSH and ATA concentrations at presentation can be used to stratify patients according to the likelihood of remission during 2 years from quitting of antithyroid drug.

Serum creatinine, blood urea nitrogen change in low birth weight infants during their first days of life / 대한주산의학회잡지

OBJECTIVE: To study the changes in serum creatinine and correlation between gestational age or birth weight and serum creatinine in low birth weight infants in the immediate postnatal period. METHODS: Medical records of all premature infants, who were admitted to the neonatal intensive care unit of Hallym University Hospital between January 2003 and December 2007, were reviewed. 162 infants met our inclusion criteria. Medical records were reviewed for : birth weight, gestational age, length, gender, APGAR scores, use of medications, blood urea nitrogen (BUN) and serum creatinine (Scr) during the first days of life. Premature infants were separated into three groups according to their birth weight: 500 to 999 g; 1,000 to 1,499 g; and 1,500 to 2,000 g. RESULTS: Scr was found to decrease postnatally, however there was a delay in the decrease of Scr in the subgroup of infants<1,000 g BW, Scr was also found to decrease with increasing birth weight at 1 week after birth (Pearson test, p=0.01). Serum BUN was found to decrease with increasing birth weight at 1 week after birth (Pearson test, p=0.00). CONCLUSION: In low birth weight infants Scr decrease during the first days of life. However, in infants smaller than 1,000 g birth weight there is a delay in the decrease of their Scr that extends beyond the first days of life. Our findings indicate progression of renal function is directly correlated to birth weight.

Two cases of central nervous system complications caused by Mycoplasma pneumoniae infection / 소아과

Mycoplasma pneumoniae (M. pneumoniae) infection causes a wide variety of clinical manifestations in children and young adults, the main one being pneumonia. M. pneumoniae is transmitted from person to person by infected respiratory droplets. Symptoms caused by M. pneumoniae infection can be divided into those involving the respiratory tract, and those caused by extrapulmonary disease. M. pneumoniae infections may cause central nervous system (CNS) complications-with encephalitis being the most frequent-and stroke being a rare complication. The pathogenesis of the CNS disease is unclear; possibilities include direct infection and an immune-mediated reaction. We present two cases of CNS complications subsequent to infection with M. pneumoniae; both cases had convincing evidence of preceding M. pneumoniae respiratory disease with no evidence of viable M. pneumoniae in the cerebrospinal fluid. We report cases of encephalitis and stroke following a recent M. pneumoniae infection.

A Clinical Study of Child Abuse / 소아과

PURPOSE: To promote awareness and efforts by pediatricians to identity and prevent child abuse by investigation of characteristics of victim and types of injury caused by abuse. METHODS: A retrospective study was performed with 20 patients who had been diagnosed or suspected as child abuse at Hallym University Hospital from January 1999 to December 2005. The medical records, radiologic documents, and social worker's notes were reviewed to investigate age, sex, visiting time, form of abuse, perpetrator, risk factor, and type of injury. RESULTS: The mean age of the subjects was 2.8 years. Fourteen patients were between 0-1 years old, 2 patients between 1-6 years old, 3 patients between 7-12 years old, and 1 case over 13 years old. The ratio of male to female was 1:1. The majority of these patients (70%) visited via emergency department. Eight five percent of these patients reported with physical abuse, 5% psychological abuse, 5% sexual abuse, and 5% neglect respectively. The suspected perpetrator was the biological father in six cases, the biological mother in three cases, the stepmother in two cases, caregiver in one case, relatives in one case and "unknown" in six cases. Bruise and hematoma (80%) were the most common physical findings. Skull fractures were diagnosed in six cases, long bone fractures in two cases, hemoperitoneum in two cases, subdural hemorrhage in 10 cases, epidural hemorrhages in two cases, subarachnoidal hemorrhages in two cases, and retinal hemorrhages in five cases respectively. Seventeen cases required hospitalization and surgical operations performed were in nine cases. Four patients died and three patients had sequalae such as developmental delay and quadriplegia. CONCLUSION: Child abuse results in high mortality and morbidity in victims. Therefore early recognition and prevention is very important. Pediatricians should always suspect the possibilities of abuse in cases of fracture, intracranial hemorrhage, abdominal injury, or even any injury to the body. We recommend that the clinical investigation of suspicious children should include a full multidisciplinary social assessment, a skeletal survey and CT or MRI.

Serum Nickel Level after Implantation of Amplatzer(R) Occluder

PURPOSE: Transcatheter closure of patent foramen ovale (PFO), atrial septal defect (ASD) and patent ductus arteriosus (PDA) is a new and less traumatic technique than open heart surgery. One of the more popular occluding devices is the Amplatzer(R) septal occluder which is made of nitinol. The present study was undertaken to evaluate the safety and release of nickel after implantation of Amplatzer(R) occluder in patients with PFO, ASD and PDA. METHODS: Random blood samples were obtained from 25 patients with Amplatzer(R) PFO, ASD, PDA occluder during 4-year and 7-month post closure period. The nickel content in the specimens was determined using atomic absorption spectrometer. RESULTS: All patients showed satisfactory clinical improvements and there was no echocardiographic evidence of complications. During the post closure, concentrations of nickel in serum were within normal range with values 0.2 ug/dL. CONCLUSION: Nickel seems to be released from Amplatzer(R) occluder. The dissolusion of nickel from Amplatzer(R) occluder is minimal and systemic rise in serum levels of nickel are within normal range. However, further studies are needed to evaluate biological effects in patients with nickel hypersensitivity.

A Study on the Related Factors of the Wellbeing of Family Caregivers in Elderly with Stroke / 간호학회지

PURPOSE: The purpose of this study was to identify the factors related to the wellbeing of the family caregivers of the elderly with a stroke. METHODS: The subjects of this study were 199 elderly treated in four oriental hospitals in Korea, and their primary family caregivers. The data was collected by interviewsand a self reported questionnaire, during the period from October, 2003 to April, 2004. RESULTS: The results of this study were as follows. The mean score of wellbeing of family caregivers was 60.6412.63. The factors related to wellbeing of family caregivers were sex, age, education, depression, illness severity, ADL, paralysis, and speech disability in elderly characteristics. Among family caregivers characteristics, education, relation, and burden were significantly related. In situational variables, family income and the previous relationship between the elderly and family caregivers were related to wellbeing. Stepwise multiple regression analysis revealed that the most powerful predictor of wellbeing was the burden of family caregivers. A combination of the depression of elderly and age of family caregivers accounted for 50.3% of the variance of wellbeing. CONCLUSIONS: On developing the nursing intervention for improving wellbeing of family caregivers, many factors should be considered, especially caregiver burden, and elderly depression.

The Effect of Horticultural Program on Cognitive Function, Activities of Daily Living(ADL) and Hand Grip Strength of Institutionalized Dementia Patients / 성인간호학회지

PURPOSE: The purpose of this study was to examine the effect of use of a horticultural program on the cognitive function, activities of daily living, and hand grip strength of institutionalized dementia patients. METHOD: Twenty three study participants completed a five week protocol comprised of one week of baseline and four weeks of treatment. The study design was a one group repeated measurement study. For the first and fifth week of the study period, data was collected with 3 instruments: Korean Version of Hasegawa Dementia Scale (HDS-K), Katz's ADL index, hand grip strength. Data analysis was conducted by SPSS version 10.0. RESULTS: Total HDS-K score(p=.000), Activities of daily living(p=.013) and hand grip strength(p=.001) was significantly improved after treatment compared to the baseline. CONCLUSION: The horticultural program was effective for improving cognitive function, ADL and hand grip strength of the dementia patients. Repeated studies utilizing a control group are needed, using various durations, plants and processes, to confirm these results and to standardize the horticultural program protocol.

The Effect of Horticultural Program on Cognitive Function, Activities of Daily Living(ADL) and Hand Grip Strength of Institutionalized Dementia Patients / 성인간호학회지

PURPOSE: The purpose of this study was to examine the effect of use of a horticultural program on the cognitive function, activities of daily living, and hand grip strength of institutionalized dementia patients. METHOD: Twenty three study participants completed a five week protocol comprised of one week of baseline and four weeks of treatment. The study design was a one group repeated measurement study. For the first and fifth week of the study period, data was collected with 3 instruments: Korean Version of Hasegawa Dementia Scale (HDS-K), Katz's ADL index, hand grip strength. Data analysis was conducted by SPSS version 10.0. RESULTS: Total HDS-K score(p=.000), Activities of daily living(p=.013) and hand grip strength(p=.001) was significantly improved after treatment compared to the baseline. CONCLUSION: The horticultural program was effective for improving cognitive function, ADL and hand grip strength of the dementia patients. Repeated studies utilizing a control group are needed, using various durations, plants and processes, to confirm these results and to standardize the horticultural program protocol.

The Effect of Senior Simulation on Nurses' Attitude Toward the Elderly / 간호학회지

PURPOSE: This study was performed to explore the effect of senior simulation on nurses' attitudes toward the elderly. METHOD: Twenty-seven nurses working in various settings such as acute hospitals, community health centers, geriatric hospitals, and clinics were recruited. Among them, 25 subjects completed the whole experimental protocol. Aging Semantic Differential Scaling was utilized to evaluate attitudes toward the elderly and 'Suit for Experiencing Being Aged' from the Sakamoto Model was provided for the experiment. Before and after the experiment subjects filled out questionnaires. RESULT: Attitude score before experiment was 4.36, which indicates neutral attitude. Objective attitude scores were not different significantly after experiment. However subjective statements indicated attitude changes in a positive way. CONCLUSION: Senior simulation can affect nurses' attitude toward elderly in subjective way. That is, nurses became more empathetic and understanding to elderly's physical limitations and felt more initiative nursing approach were needed in caring elderly.

A Study on Attitude Patterns of Elderly toward Dying / 성인간호학회지

PURPOSE: This study was performed to identify and understand the nature of attitude patterns regarding dying process exhibited in the elderly persons who lived in the community setting. METHOD: Q methodology was applied. Ten elderly were selected from the senior centers and requested to answer open ended questions by using written questionnaires. Additionally, 12 other elderly from different senior centers were interviewed in depth, and their statements were recorded via voice pen by researchers to derive Q-population. From the 120 Q-population, 33 Q-sample were selected. 22 P-sample were rated by 1 to 9 point scale respectively for Q-sorting. For Q-type analysis, pc QUNAL was used. RESULT: Three types of attitude patterns were identified, which were valuing dignity, seeking provision of nature, and avoiding of dying process. CONCLUSION: The significance of this study is as follows : Discovery of 3 attitude patterns of elderly toward dying, better understanding about elderly's perspectives for favorable dying, and informations for possible development of nursing strategies for elderly who is facing death.

Review on Advance Directives / 간호학회지

Rapid progress in modern medical technology has made it possible to sustain life and/or delay death using 'heroic' treatments. The availability of life-sustaining treatment brings several issues in end-of-life care such as 'dying with dignity' and an radical increase in health care costs. The use of Advance Directives(AD) have been widely heralded by health care providers, gerontologists, and advocacy groups as means of protecting patients' right to accept or refuse life-sustaining treatment in end-of-life care. The use of AD can not only improve patients' autonomy and quality of life but also bring efficiency in distributing health care resources. The proportion of older persons in Korean population has been increasing. Those 65 years of age or over were about 7 percent of the population. Death and dying is not limited to older persons, but it is more prevalent among them. In conjunction with an aging population and the increasing prevalence of death, the issues of death and dying will become crucial in near future in terms of 'dying with dignity', 'autonomy', and 'self-control'. This paper attempts to explode and establish the concept of advance directives (AD) based on literature review. Data sources are computer searches with the MEDLINE database. Due to the lack of prior study on AD for a Korean cases, studies abroad are reviewed. This paper suggests the need for future study on the possibility of the use of AD in Korea.

The trend and Issues of the Gerontological Nursing Study in Korea / 간호학회지

Issues related to the elderly have been recognized in Korea and nursing scholars have tried to study there issues. It is hard to say which the direction we, are going or have to go, since there has been little systemic effort to establish gerontological nursing field yet. Therefore, it is necessary to find out the trend and the guidelines of gerontolotical nursing studies for the future. Dissertation and published articles related to the elderly in the nursing field from 1991 to the February of 1997 were are reviewed. Total 127 studies were analysed in terms of concept, design/methodology, and results, and the nature and issues of the geronotologic nursing studies in Korea were explored. The results are as follows: 1. There was no clear chronological definition of the elderly. 2. The most popular research design was an exploratory/descriptive study. 3. The major concepts studies were physical and mental health. 4. Among those studies using instrument which were developed and modified and /or translated by researchers, the reliability and validity were rarely reported. 5. Theory based studies were rare. We suggest the following issues for future studies : 1. The chronological and other criteria related to the definition of elderly is needed. 2. Physiopsychosocial characteristics of Korean elderly and their managements in terms of intervention studies need to be conducted more synthetically. 3. Social issues from the change of types and function of family such as single elderly family need to be studied. 4. Participation in and collaborate with other disciplines are needed. 5 Development and test of instruments to measure phenomena or concepts is needed. 6. Macroscopic approach such as policy also needed. 7. Theory based studies are needed.

Development and Validation of Korea Sleep Scale A / 간호학회지

The purpose of study was to develop and validate Korean Sleep Scale A which can be easily administrated by nurse for a wide range of adult subjects. Dimensions of adult concept were derived by literature review. Previously developed sleep scales were also analyzed in order to develop scales items. The Korean sleep scale A was structured as a 15 item, 4 point like type scale. The Scale was tested an 298 female and male adult subjects after pilottest and content validation. The results showed reliability by internal consistency of Cronbach's alpha=75 Construct validity was tested by factor analysis and known group technique. Factor analysis showed 4 factor-sleep pattern, sleep evaluation, sleep result, and cause of sleep disturbance. Theses four factors explained 55.9% of total variance. Correlations between factors ranged from .15-.32. There was correlation among Korean Sleep Scale A score, Verran and Snyder-Halpern(VSH) Sleep Scale scale, and sleep satisfaction scale score, r= .71(p=.00), r=.51(p=.03), respectively. These study results partially support reliability, construct validity, and criterion related validity of Korean Sleep Scale A. Further validation study is required with other subjects and other settings.