• 지역사회간호학회지
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• 제15권1호
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• pp.56-66
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• 2004

Objectives: The purpose of this study was to verify a change for family nursing phenomena and satisfaction of clients of vulnerable families in an urban community. Methods: The study subjects were 711 families, randomly selected, who had chronic diseases(arthritis diabetes, stroke, hypertension, mental disease, cancer, dementia) with basic social welfare services from the nation and had disabled persons in an urban community, South Korea. The instruments used were the family nursing phenomena in Korea by ICNP and client satisfaction. Client satisfaction consisted of client satisfaction on home visiting nurses(4 Likert scales) and home visiting services(3 Likert scales). Results: The average visiting number is 3.82. The service number of education and counseling is 3.16, patient and symptom management 3.08, assessment and diagnosis 3.08, test 2.02, medication service 1.71회, dressing 1.01, referral to social welfare institute 1.00회, referral to medical service institute 0.21. In both, pre home visiting and post home visiting, the highest rated phenomenon was the 'lack of social support system' and following that 'deficit of financial management skill and support'. 'lack of family interaction in community', and 'social isolation' 'unhealthy life style' and 'inadequate care management of sick member', in that order. The percentages of phenomena besides 'deficit of financial management skill and support' decreased. The satisfaction level of clients towards the nurses was 3.27 points on a scale of 4, and the nursing services was 2.70 points on a scale of 3. Conclusion: Home visiting nursing services should continue to provide comprehensive healthcare services and support for vulnerable families, in urban communities.

• PNF and Movement
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• 제16권3호
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• pp.485-493
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• 2018

Purpose: This study provides a treatment for central nervous system development in patients with chronic stroke by investigating changes in the upper limb function over time. The correlations among the activities, participation, and environmental factors of the international classification of functioning (ICF), disability and health are also examined. Methods: The subjects of this study are 18 patients with chronic stroke who were hospitalized and treated at 00 hospital in the Chungcheongbuk-do province. Their upper extremity functions are evaluated using the manual function test (MFT). The activities, participation, and environmental factors are evaluated using the ICF generic form. The correlations between the total scores of the affected and unaffected sides and the ICF items are analyzed using the Pearson correlation analysis. The significance level is p<0.05. Results: When the correlations between the activities and participation areas of ICF and the total score of the affected side of MFT were examined, significant correlations (p<0.05) were found in the following items: changing basic body position (D410), lifting and carrying objects (D430), moving around using equipment (D465), using transportation (D470), washing oneself (D510), caring for body parts (D520), and dressing (D540). When the correlations between the activities and participation areas of ICF and the total score of the unaffected side of MFT were examined, significant correlations (p<0.05) were found among writing (D170), speaking (D330), eating (D550), and drinking (D560). In addition, when the correlation between the environment area of ICF and the total score of the unaffected side of the MFT were examined, significant correlations (p<0.05) were found between products and technology for personal use in daily living (E115) and immediate family (E310). Conclusion: The MFT of patients with chronic stroke is closely correlated with the activities, participation, and environmental factors of ICF. This result suggests that ICF can be used as a useful tool to comprehensively evaluate the abilities of the patient, including the upper extremity function.

• 정신신체의학
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• 제6권1호
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• pp.79-84
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• 1998

저자들은 뇌졸중후 우울증보다 매우 드물게 발생하는 뇌졸중후 양극성장애 증례를 경험하여 보고하였다. 좌반구 기저핵 뇌경색이후 뇌졸중후 우울증을 앓아오던 환자에서 조증 에피소드가 발병하여 원인을 규명하는 과정에서 자기공명영상을 시행한 결과, 이차성 양극 성장애와 연관되는 것으로 보고되어온 우반구 기저핵의 새로운 뇌경색이 밝혀졌다. 한 환자에서 좌반구 뇌졸중이후 우울증, 우반구 뇌졸중이후 양극성장애의 발생이 시간적 연관성을 보였으며, 한편 뇌졸중후 우울증과 이차성 양극성장애 각각이 병변 위치와 특이한 연관성을 보여주고 있다. 문헌 고찰에 의하면, 이차성 조증이 주로 피질의 병변과 연관성을 보이는 반면, 양극성 장애는 피질하 병변에서 호발하는 것으로 보고되어왔으며, 이차성 조종의 위험인자로는 정신장애의 가족력과 경한 피질하 위축이 제시되었다. 이 증례에서도 우반구 피질하 병변과 경한 피질하 위축이 관찰되었다. 뇌졸중 병변위치와 기분장애의 상관성 및 위험인자에 대한 연구는, 일차성 기분장애의 신경생물학적 연구에 기여할 수 있을 것이며, 임상에서도 뇌졸중 환자의 정신증상 치료에서 조중 유발의 위험성을 인식하는데 도움이 될수 있을 것이다.

• Journal of Korean Neurosurgical Society
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• 제67권1호
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• pp.73-83
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• 2024

Objective : The Act on Life-Sustaining Treatment (LST) decisions for end-of-life patients has been effective since February 2018. An increasing number of patients and their families want to withhold or withdraw from LST when medical futility is expected. This study aimed to investigate the status of the Act on LST decisions for patients with acute cerebrovascular disease at a single hospital. Methods : Between January 2017 and December 2021, 227 patients with acute cerebrovascular diseases, including hemorrhagic stroke (n=184) and ischemic stroke (n=43), died at the hospital. The study period was divided into the periods before and after the Act. Results : The duration of hospitalization decreased after the Act was implemented compared to before (15.9±16.1 vs. 11.2±18.6 days, p=0.127). The rate of obtaining consent for the LST plan tended to increase after the Act (139/183 [76.0%] vs. 27/44 [61.4%], p=0.077). Notably, none of the patients made an LST decision independently. Ventilator withdrawal was more frequently performed after the Act than before (52/183 [28.4%] vs. 0/44 [0%], p<0.001). Conversely, the rate of organ donation decreased after the Act was implemented (5/183 [2.7%] vs. 6/44 [13.6%], p=0.008). Refusal to undergo surgery was more common after the Act was implemented than before (87/149 [58.4%] vs. 15/41 [36.6%], p=0.021) among the 190 patients who required surgery. Conclusion : After the Act on LST decisions was implemented, the rate of LST withdrawal increased in patients with acute cerebrovascular disease. However, the decision to withdraw LST was made by the patient's family rather than the patient themselves. After the execution of the Act, we also observed an increased rate of refusal to undergo surgery and a decreased rate of organ donation. The Act on LST decisions may reduce unnecessary treatments that prolong end-of-life processes without a curative effect. However, the widespread application of this law may also reduce beneficial treatments and contribute to a decline in organ donation.

• 가정∙방문간호학회지
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• 제9권2호
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• pp.114-128
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• 2002

In order to provide information for the establishment and maintenance of a rehabilitation day care center for stroke patients. this study is to assess needs for the rehabilitation day care center of the stroke patients and to identify the factors influencing the needs for the center. The data were collected face-to-face interview with 223 stroke patients. using a structured questionnaire. from September 24. 2001 to November 20. 2001. Major findings are as follows. 1. Most of the participants($94.6\%$) needed rehabilitation day care center for stroke patients. $95.5\%$ of participants were willing to use the rehabilitation day care center. 2. Also the score of the needs for the center's health services was $2.84\pm60$ out of 4.00. In regards to the sub-contents. while the physical exercise therapy showed the highest mark($3.54\pm71$) in the needs. the following marks showed physical therapy($3.48\pm79$), training for the memory. thinking and judgment($3.30\pm93$). training for ADL($3.09\pm99$). health education program($3.04\pm93$). In the meantime. the expected effects from the use of the center are $2.89\pm61$ out of 4 and its sub-contents showed that the center would promote their physical and mental well-being($3.30\pm74$) and the center would be more effective than in home care($3.12\pm70$). 3. Meanwhile. the desired frequency of use in the future and distance had significant interrelation with their families living together(p<.05). In addition those who paid to use it differentiated significantly according to their ages and the types of insurance they had(p<.05). 4. The needs in degrees of speech disorder therapy and hobbies & amusements. the patients with other disease had significantly higher degrees than those patients without it (p<.05). Also in regard to the need degrees for physical therapy. healthy education programs and individual counseling including their families. the degrees of the patients with speech disorders were significantly lower than those of the patients without the disorder (p<.05). On the other hand. the patients with speech disorders were significantly higher than those patients without it in the need degree of the speech disorder therapy (p=.000). And the needs in degree concerning about speech disorder therapy. physical exercise therapy. training for ADL. medicinal substances therapy and family education were negatively correlated with the ADL (r=-.236$\sim$.305, (p<.005). 5. Finally. the expected effect of using the rehabilitation day care center showed significant differences statistically according to whether or not they had other disease (p<.05). In conclusion. the study showed the stroke patients were willing to use the center and had a high requirements for it and they especially had relatively high need degrees for the physical exercise therapy. physical therapy. training for memory. thinking and judgment. and healthy education program. And significant factors for the use of the center were their ages. types of insurance. family cohabitation. complications and speech disorders. ADL and so forth. Accordingly. the rehabilitation day care center needs to be established for the stroke patients and the center should develop rehabilitation care programs. which are individual and special programs customized for each patient's characteristics and health conditions.

• 가정∙방문간호학회지
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• 제12권1권
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• pp.41-69
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• 2005

Purpose: This study was performed to evaluate the outcomes of the home care nursing program conducted jointly by thirty two catholic churches and C hospital in Seoul. Method: The subjects included 173 patients who registered for the program during a 4 month-period from November 1, 2004 to February 28, 2005 and received home care services for more than 4 times and 32 professional nurses participating in the program. Using the concept of medical outcome study (MOS), the structure, process, outcome elements were analyzed. Result: 1) A Catholic homecare nursing center and nurses of the C hospital played a central role in providing nursing care, and each church operated its own vehicle from its own office. Home care nurse's job satisfaction was 2.8 out of total score of 4. The major illness was cerebrovascular disease including stroke followed by skeletomuscular disease including degenerative arthritis cancer, and diabetes. Among reasons for accessing the home care nursing program, hypertension management was most prevalent. More than half of the registration was done through catholic churches. Most people who referred the patient to the program was through the church. Most patients received home care nursing 1-2 times a week for 30 to 60 minutes in average and the most frequent type of service provided was basic nursing. 3) The most frequent reason for terminating home care services was death. The change in PPS(Palliative Performance Scale) level from the time of registration and after 4 visits was the same in 45%, decreased in 30%, and improved in 25%. Patient satisfaction was very high, showing 3.4 out of total score of 4. Conclusion: These results proved that the home care nursing program was highly appreciated by subjects and nurses were providing professional care. Thus the two parties involved in the program were actively supporting the program to fulfill their mission. However, several areas needed to be improved such as relating with local community, relating with family doctor, and issue of improving the working conditions for home care nurses.

• 대한간호학회지
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• 제28권2호
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• pp.479-489
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• 1998

This work was done for 9 patients having experience of a herb medical treatment after being diagnosed as CVA during a year from January, 1996 to December, 1996 by using an ethnographic research method. The summarized results of this research are following. Ⅰ. THE EXPERIENCE OF THE ILLNESS First, the falling-ill phase is the time that they have the first stroke of paralysis and the decision pattern of medical institution' comes out. The emotional experience in the period is something like 'flustration', 'anxiety', 'despair', and 'expectation'. Second, the active-treatment phase is the time that the patients as well as their family or care giver not only show the positive attitude and actively participate in the illness treatment but also show a lot of interest in medical institutions and activities of health recovery. There is a primary factor of the continuation of treatment as an experience of treatment and being crushed and sensitivity as an experience of the illness. Third, the rehabilitation phase is the time that the patients or their family become tired and insensitive to the treatment and recuperation, and then reduce the treatment activity. There is a primary influence factor of the discontinuance of treatment as an experience of treatment and physical experience and emotional experience as an experience of the illness. The physical experience is divided into 'personal-hygiene care', and 'the sphere of activity' The emotional experiences are 'blaming someone', 'contempt' and 'despair' as a negative experience and 'hope' as a positive experience. Ⅱ. COPING STRATEGY There are a physical coping, an emotional and mental coping, a social coping, and a spiritual coping as a coping strategy used for the patients to overcome their illness and adjust themselves to their altered life. First, the physical coping comes out as 8 categories, 'using an auxiliary tool', 'doing exercise', 'protecting', 'improving their diet', 'taking care of something', 'using subsidiary medicines', 'trying a folk remedy', and 'having interest in their health'. Second, for the emotional and mental coping, there are 'accepting' and 'trying' as a positive coping and a failure of control as a negative coping. Third, the social coping is appeared as 'being supported'. Fourth, the spiritual coping is recognized as' recourse to God' and 'preparation of death'. After all, the elderly CVA patients in an agricultural area choose the act of treatment based on the traditional belief and the relationship with a caretaker. A personal health can be maintained by taking care of themselves and controling their mind, and the overcome of the illness is decided on the basis of traditional concepts and cultural principles in which the patients as well as the family, neigbors and take carers should work out together and cooperate with each other in order to achieve that.

• 대한한의학회지
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• 제27권4호
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• pp.215-224
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• 2006

Objectives : In order to apply useful data to clinical practice, we undertook this study and tried to find factors related with sequelae of facial palsy in relation with patients' age and gender distribution, past history with the disease, condition before onset, duration of recovery time, existence of remaining sequelae, types of the sequelae, and duration for sequelae to disappear. Methods : We evaluated patients' condition (fatigue, stress, chills, cold and so on), past history (diabetes mellitus, hypertension, stroke, herpes zoster, cancer and so on), duration of recovery time, types of the sequelae, age and sequelae distribution as to when the treatments were started as we examined 473 patients who were diagnosed with facial palsy, and visited the Out-patient Department of Acupuncture and Moxibustion of Bundang Oriental Medicine Hospital of Dongguk University through 2003 and 2004. Results : The sequelae of facial palsy were not significantly relevant to the signs found before facial palsy occurred(fatigue, stress, chills, and cold), or to patients' past history (hypertension, diabetes mellitus, facial palsy, herpes zoster). The duration of recovery time was within 30 days for 45.3% of the patients examined in this study, and within 90 days for 72.6%. Evaluating the existence of sequelae in relation to age, we found more in the group comprised of patients aged 50 and over than under 50. We found more sequelae in the group which is consisted of patients who had not been treated until 6 days after than within 5 days from the onset. Conclusion: Attention to sequelae will be needed for patients aged 50 and over and who were not treated until 6 days after the onset, as they had more sequelae.

• Journal of Oral Medicine and Pain
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• 제37권3호
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• pp.135-139
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• 2012

유전성출혈모세혈관확장증은 피부 및 점막에 있는 말단 혈관이 비정상적으로 확장된 모세혈관 확장증과 내부 장기, 특히 폐, 뇌, 간 부위의 동정맥기형 발생을 특징으로 하는 상염색체 우성 유전질환이다. 이 질병을 가진 환자들은 종종 오랜 시간 동안 진단이 되지 않은 채로 지내다가 생명을 위협할 수 있는 심각한 출혈, 뇌졸중, 뇌농양과 같은 합병증이 발생하기도 한다. 따라서 이 질환의 조기 진단 및 적절한 선별검사가 매우 중요하다. 유전성출혈모세혈관확장증의 조기 진단을 통해 증상 없이 존재하다 합병증을 유발할 수 있는 폐, 간, 뇌 부위의 동정맥기형에 대한 선별 검사를 시행함으로써 이 질병에 이환된 환자와 가족에 대한 예방적 관리가 가능하다. 피부 및 점막에 발생하는 모세혈관확장증은 특징적인 소견을 보이며 치과의사에 의해 쉽게 발견되므로 치과의사는 유전성출혈모세혈관확장증에 대해 잘 알고 조기 진단에 기여할 필요가 있다. 최근 이 질환으로 진단된 증례가 있어 문헌 고찰과 함께 보고하고자 한다.

• The Journal of Korean Physical Therapy
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• 제11권1호
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• pp.23-43
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• 1999

A study on severity of cerebro-vascular accident patients in Korea was conduced in order to determine the risk factors affecting the severity of stroke patients. This study was performed by interviewing a total of 477 hospitalized and ambulatory patient of CVA in Seoul, Taejon, and Taegu and Pusan areas from April 1, 1998 through June 30, 1998. The results are as follows; 1. Two hundred and sixty seven $(56\%)$ at Four hundred and seventy seven subjects were manes, md two hundred and ten $(44\%)$ were females. $28.3\%$ of the subjects' ages were 50's and $27.3\%$ were 60's and $18.5\%$ were 70's. $22.6\%$ of the subjects' occupations were home makers, $17.8\%$ were farming. $66.4\%$ of the subjects spent their childhood in urban areas and $33.1\%$in rural areas. $41.7\%$ of the subjects became violin of CVA in Spring, $35.0\%$ in Winter. 2. On physical and mental conditions of the subjects at the occurrence of CVA, $28.7\%$ of the subjects were engaged in physical activities. $22.6\%$ were in a rest stale $19.5\%$ were in sleeping and $18.9\%$ were mentally shocked. $79.4\%$ of the male subjects and $14.8\%$ of female subjects smoked cigarettes. $82\%$ of male subjects drank coffee. $81.1\%$ of the subjects did not exercise regularly. $45.9\%$ of the subjects had the systolic blood pressures in the range of 160 to 199 mmHg and $5.6\%$ of the subjects had hypertension before the occurrence of stroke and $11.7\%$ had diabetes. 3. Of the types of strokes, cerebral hemorrhage was the highest $(49.1\%)$. cerebral infarction was the second $(41.1\%)$. Severe strokes were found in cerebral hemorrhage cases $(52.0\%)$ and cerebral infarction cases $(40.1\%).\;50.9\%$. of the male subjects were moderate cases, $50.9\%$ were severe cases. In females, moderate cases were $72.4\%$, severe cases $15.2\%$. $37.5\%$ of the subjects who had preceding diseases were severe cases, and $15.6\%$ of the subjects without preceding diseases were severe cases. $50.7\%$ of the subjects whose family members had strokes had severe strokes. $34\%$ of the subjects sleeping less than 6 hours a day, $42.4\%$ of the subjects with irregular eating habits, $33.3\%$ of the subjects who liked meat, and $42.3\%$ of the subjects who liked salty foods had severe strokes. $35.9\%$ of the subjects with hot temper, $27.6\%$ of the subjects with moderate temper and $14.5\%$ of subjects with mild temper were severe cases. 4. The correlation coefficient between obesity and blood pressure was 0.094.