This study examined burdens of primary family carcgivcrs of paticnto with cerebrovascular accidents (CVA) along with related factors. In addition, their needs for support group intervention were assessed to develop a support group to reduce the burdens of caregiving. Eighty-one primary family caregivers of patients with CVAs at a general hospital in Seoul participated in this study . The patients with CVAs aged from 26 to 83 years with mean age of 63 years. About 90% of the patients had some paralysis and 56.6% suffered speech problems. Fifty-eight percent of the primary family caregivers were spouses of the patients and 80.2% were women. Primary family caregivers' burdens were assessed by the Burden Scale originally devel oped by Zarit (1980) and Novak & Geust(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 financiaI burden. The results were as follows : 1. The average of burden score was 91.7, indicating moderate to severe level of burden. The time-dependent burden was scored highest followed by physical, developmental, social, financial, and emotional burdens. 2. of the characteristics of patients, age, gender, and severity of the disease were found to be associated with the level of burden. Of the characteristics of primary family caregivers, age and educational level were significantly related to the level of burden. Time of care since the CVA and the quality of relationship between a patient and a caregiver prior to the stroke were significant situational factors affecting the level of burden. 3. The need for support group intervention for the caregivero was very high (95.1%). The earcgivcrs of patients who had a CVA for the first time showed higher levels of need compared to those of patients who had a CVA more than once. The caregivers indicated a support group held once a month near home or hospital would be welcomed. In addition, they replied that a group composed of 9 to 10 caregivers and guided by health care professionals (e.g., physicians and nurses) would be most desirable. More than 85% of the earegivers identified the areas that they wanted intervention in as follows : knowledge, skills, and resources to care for a patient with a CVA. the counsel of health care professionals, share of their experiences with those who have similar situations, stress management skills, and methods to overcome emotional isolation due to the great responsibility for a patient. Given the results, support group is expected to be an effective way to reduce the burdens of primary family caregivers of patients with CVAs. As a follow up It is necessary to examine the effect of support group intervention on the patient's recovery and rehabilitation.
Caregivers* ; Delivery of Health Care ; Female ; Hospitals, General ; Humans ; Korea ; Paralysis ; Rehabilitation ; Self-Help Groups* ; Seoul ; Spouses ; Stroke*

OBJECTIVES: The vocal changes after a thyroidectomy are temporary and nonsevere, therefore, obtaining accurate analytical results on the pathological vocal characteristics following such a procedure is difficult. For a more objective acoustic analysis, this study used the cepstral analysis method to examine changes in the patients' voices during the perioperative period regarding sustained vowel phonation. METHODS: The sustained phonation of the five vowels (i.e., /a/, /e/, /i/, /o/, and /u/) by 35 patients with thyroidectomy were recorded by using a Multi-Speech program. Of the 35 patients, 10 were men and 25 were women, with an average age of 51.5 years. Voice data were collected a total of 3 times (preoperatively, 5-7 days after the operation, and 6 weeks after the operation) and were edited according to each fragment (on-set, mid, and off-set) for cepstral analysis. RESULTS: The cepstral analysis on the patients' voices revealed no significant differences between the examination periods of all vowel phonations. However, analysis of the on-set fragment of the vowel /i/ revealed pathological characteristics in which the cepstral measurements of the voice were significantly lower after the operation than before the operation, with the cepstral measurements of the voice increasing further 6 weeks following surgery. CONCLUSION: The results of the acoustic analysis on the on-set fragment of the vowel /i/ will be important data for characterizing the vocal changes during the perioperative period. This study contributes to future research on the mechanisms underlying changes in the voice of patients with a history of thyroid or neck surgery.
Acoustics ; Female ; Humans ; Male ; Methods ; Neck ; Perioperative Period ; Phonation ; Thyroid Gland ; Thyroidectomy* ; Voice*

PURPOSE: The purpose of this study was to identify the main factors influencing family functioning of caregivers in families with stroke. METHOD: A Convenient sample of 173 primary family caregivers who take care of a stroke patient at an Oriental medicine hospital in Jeonbuk. Interviews were done with a standardized questionnaire including family functioning by nurses. RESULTS: In Pearson's correlation analysis, the influencing factors related to family functioning were ADL(p=.017), level of paralysis(p=.019) as stressors, Quality of relation(p=.000) as situational variables, and family caregivers' burden(p=.000). Stepwise multiple regression analysis showed 29.9% of the variance family functioning was significantly accounted for by the quality of relationship between stroke patient and caregiver(26.8%), and caregiver burden(3.1%). CONCLUSIONS: Findings indicate that families of stroke patients need family-focused nursing intervention as supported care to improve the relationship between patient and primary caregiver and relieve caregiver burden by culturally tailoring to Korean.
Caregivers* ; Humans ; Jeollabuk-do ; Medicine, East Asian Traditional ; Nursing ; Stroke* ; Surveys and Questionnaires

No abstract available.
Humans*

The purpose of this study was to determine the effects of self-help management program which strengthens self-efficacy for post stroke elders who attend day care center in Chongju. One group pretest-posttest design was used, and the subjects were 7 post stroke elders with hemiparesis. The self-help management program consisted of 5 sessions and each session included group education on stroke. ROM exercise. recreation and self-care strategies. Those strategies for encouraging and reinforcing self-efficacy provided verbal persuasion. performance accomplishment and vicarious experience. All subjects were questioned before and after the program about ADLs, IADLs. self-efficacy. self-care behavior and depression. The analysis of data revealed that the program was effective to increase the IADLs. self-efficacy and self-care behavior. However. there was no significant difference between pre and post ADLs and depression. The results indicated that this program may be adopted to improve the physical and psychological function of post stroke elderly patients in community settings.
Activities of Daily Living ; Aged* ; Day Care, Medical ; Depression ; Education ; Humans ; Paresis ; Persuasive Communication ; Recreation ; Self Care ; Stroke*

Purpose: Surgeons can treat debilitating conditions of uncontrollable complex anorectal fistulas with sepsis, even after repeated fistula surgeries, for curative intention. Adipose-derived stem cells have shown good outcomes for refractory Crohn fistula. Unfortunately, cell therapy has some limitations, including high costs. We have therefore attempted immediate cell-assisted lipotransfer (CAL) in treating refractory complex anal fistulas and observed its outcomes. Methods: In a retrospective study, CAL, using a mixture of freshly extracted autologous stromal vascular fraction (SVF) and fat tissues, was used to treat 22 patients of refractory complex anal fistula from March 2018 to May 2021. Preoperative and postoperative assessments were performed with direct visual inspection, digital palpation, and endoanal ultrasonography. A fistula was considered completely healed if (1) the patient had no symptoms of discharge or inflammation; (2) there were no visible secondary openings of fistula tract inside and outside of the anorectal unit and even in the perineum; and (3) there was no primary opening in the anus. The endpoint of complete remission was wound healing without signs of inflammation 3 months after CAL treatment. Results: In a total of 22 patients who received CAL treatment, 19 patients showed complete remission, 1 patient showed partial improvement, and 2 patients showed no improvement. One of the 2 patients without improvement at primary endpoint showed complete remission 9 months after CAL. There were no significant adverse effects of the procedure. Conclusion We found that the immediately-collected CAL procedure for refractory complex anal fistula showed good outcomes without adverse side effects. It can be strongly recommended as an alternative surgical option for the treatment of complex anal fistula that is uncontrollable even after repeated surgical procedures. However, considering the unpredictable characteristics of SVF, long-term follow-up is necessary.

OBJECTIVE: To investigate whether motor evoked potential (MEP) amplitude ratio measurements are sufficiently objective to assess functional activities of the extremities. We also delineated the distribution between the presence or absence of MEPs and the Medical Research Council (MRC) scale for muscle strength of the extremities. METHODS: We enrolled 183 patients with first-ever unilateral hemiplegia after stroke. The MEP parameters were amplitude ratio (amplitude of affected side/amplitude of unaffected side) recorded at the first dorsal interosseous (FDI) and tibialis anterior (TA) muscles. We performed frequency analyses using the MRC scale for muscle strength and the presence or absence of evoked MEPs. Change on the MRC scale, hand function tests (HFTs), and the Modified Barthel Index (MBI) subscore were compared between the evoked MEP and absent MEP groups using the independent t-test. Receiver operating characteristic curves were used to determine the optimal cutoff scores for the MEP amplitude ratio using the HFT results and MBI subscores. Correlations between the MEP amplitude ratio and the MRC scale, HFTs, and MBI subscore were analyzed. RESULTS: About 10% of patients with MRC scale grades 0-2 showed evoked MEPs at the FDI muscle, and 4% of patients with MRC scale grades 3-5 did not show MEPs. About 18% of patients with MRC scale grades 0-2 showed evoked MEPs at the TA muscle, and 4% of patients with MRC scale grades 3-5 did not show MEPs. MEP amplitude increased with increasing MRC scale grade. The evoked MEP group had more significant changes on the MRC scale, HFT, and the climbing stair score on the MBI than those in the group without MEPs. Larger MEP amplitude ratios were observed in patients who had more difficulty with the HFTs and ambulation. The MEP amplitude ratio was significantly correlated with the MRC scale, HFT, and MBI subscore. CONCLUSION: We conclude that the MEP amplitude ratio may be useful to predict functional status of the extremities in patients who suffered stroke.
Activities of Daily Living ; Evoked Potentials, Motor* ; Extremities* ; Hand ; Hemiplegia ; Humans ; Motor Skills ; Muscle Strength ; Muscles ; ROC Curve ; Stroke* ; Walking

BACKGROUND: The present study was performed to elicit what effect nalbuphine would have on isoflurane MAC (minimum alveolar concentration) in the patients undergoing lower abdominal surgery. METHODS: Sixty-two women were randomly allocated to one of five study groups to receive an intravenous injection of no nalbuphine (group I), 0.25 mg/kg (group II), 0.5 mg/kg (group III), 1.0 mg/kg (group IV), 1.5 mg/kg (group V). Anesthesia and tracheal intubation were induced with propofol 2 mg/kg, succinylcholine 1 mg/kg. Patients were inhaled at a preset end-tidal concentration of isoflurane, which was maintained for 20 min. Response to skin incision, movement or no movement, was determined 30 minutes after nalbuphine injection. The isoflurane concentration of the next patient in the same group moved up or down in steps of 0.1~0.3%, according to the previous patient's response. MAC was determined using the "up-down" method and logistic regression. RESULTS: The MAC's of isoflurane were 1.09 vol% end-tidal in the control group, 0.89 vol% in group II, 0.65 vol% in group III, 0.55 vol% in group IV, and 0.51 vol% in group V. CONCLUSIONS: It would be suggested that nalbuphine dose-dependently reduce the isoflurane MAC, and have ceiling effect on the reduction of isoflurane MAC.
Anesthesia ; Female ; Humans ; Injections, Intravenous ; Intubation ; Isoflurane* ; Logistic Models ; Nalbuphine* ; Propofol ; Skin ; Succinylcholine

PURPOSE: The aim of this study was to compare the factors of health-related quality of life in older adults according to the type of residency. METHODS: A cross-sectional comparative study was conducted. The subjects were 114 institutionalized older adults and 99 community dwelling older adults. Data were collected through face-to-face interviews by nurses using structured questionnaires composed of SF-36 (ver.2) and CGA-SF. RESULTS: The institutionalized older adults had more health problems and experienced lower quality of life compared to community dwelling older adults. Factors influencing health-related quality of life for institutionalized older adults were social support, educational level, and ADL, which explained about 25.7% of the total variance, while thoseof community dwelling older adults were IADL, experiencing fall, and weight loss, which had explanatory power of 31.8%. CONCLUSION: These results indicate that differentiated nursing strategies according to the type of residency are required to promote health-related quality of life for older adults.
Activities of Daily Living ; Adult ; Aged ; Humans ; Internship and Residency ; Quality of Life ; Residence Characteristics ; Weight Loss ; Surveys and Questionnaires

STATEMENT OF PROBLEM: Ceramic and composite resin have been used to fulfill the demand for esthetic prosthesis. However, ceramic is easy to break and wears off the opposite natural teeth. Conventional composite resin also has low abrasive resistance and color stability. Ceramic Optimized Polymer (ceromer) was developed in mid-1990s to overcome the shortfalls of ceramic and composite resin. Ceromer has similar abrasiveness with the natural tooth and has relatively high strength. Color stability affects esthetics and long-term prognosis of the prosthesis. PURPOSE: The purpose of this study was to compare color stability of ceromers(2 types : Artglass., Targis.) with ceramics(Vintage.-polishing, Vintage.-glazing). MATERIAL AND METHOD: The color difference(E*) was measured by spectrophotometer with different immersion time. Twenty disks, 3mm in thickness and 10mm in diameter, were fabricated for each specimen in shade A2(Vita Lumin shade guide). Specimens(5 samples in each group) were immersed in the food colorants(Red no.3, Yellow no.4, Blue no.1, Distilled water) for 24 hours, 48 hours and 72 hours respectively. L*, a* and b* value were measured with spectrophotometer (CM 503i : Minolta Co., Japan) and mean E* value was calculated for statistical analysis. RESULTS: The results of this study were obtained as follows. 1. The E* values of all test samples increased with the time of immersion. 2. The E* values of all materials increased in order of Distilled Water, Yellow no.4, Blue no.1 and Red no.3. There was significant difference between Red no.3 and the other food colorants(p<0.05). 3. The E* values increased in order of Vintage-glazing, Vintage-polishing, Artglass and Targis. There was significant difference between Vintage.-glazing and the other materials (p<0.05). CONCLUSION: By means of the above results, immersion time was found to be a critical factor for color stability of ceromer. For the long-term color stability of prosthesis it is recommended patients having ceromer prosthesis(Artglass., Targis.) to reduce the habitual intake of Red no.3 colorants con taining foods.
Ceramics ; Esthetics ; Food Coloring Agents* ; Humans ; Immersion ; Polymers ; Prognosis ; Prostheses and Implants ; Tooth ; Water