The purpose of this study was to identify the needs which were perceived by patients who were received spinal anesthesia for surgery. The subjects consisted of 50 adult patients who were admitted to 2 university hospitals and 2 general hospitals in Pusan city and 1 general hospital in Koje City for surgery under spinal anesthesia. Thirty eight percent of subjects received information about anesthesia before the operation. The instrument for this study was developed by the researcher based on literature and a pretest. Data were collected from December 10, 1999 to February 10, 2000 and were analyzed by content analysis. The results were that there were 533 meaningful statements in the needs of spinal anesthesia patients. The needs of spinal anesthesia patients had 51 items (preoperation (6), induction of nesthesia(5), intraoperation (27), postoperation(13)) and 6 categories (information, emotional welfare, physical welfare, post anesthetic management, control of physical environment, humane treatment). From the results, it can be concluded that: 1. In the pre-operation period, we have to explain anesthesia procedures, adequate position of anesthesia, duration before anesthesia wears off and sensation of paralysis. We have to supply emotional support to relieve anxiety because of anesthesia. 2. In induction of anesthesia, we have to support patient's position for anesthesia, and relieve anxiety so that patients participate in induction of anesthesia well. 3. In intra-operative period, we have to check the level of anesthesia, and keep up a comfortable position for operation and care for physical discomfort such as thirst, nausea, vomiting, dyspnea and to maintain body temperature of the patient. Since the patient is conscious, we have to communicate with the patient to relieve anxiety, maintain privacy, inform the patient of the process of the operation and encourage the surgeon to explain the outcome of the operation. The operating team needs the careful about what they say and to place the instrument well. We have to ventilate the room air and reduce noise. 4. In the post-operative period, we have to explain the purpose and duration of bed rest, complications of anesthesia and care for physical discomfort such as pain, dysuria, headache, backache. Also we have to maintain body temperature of the patient and maintain privacy.
Adult ; Anesthesia ; Anesthesia, Spinal* ; Anxiety ; Back Pain ; Bed Rest ; Body Temperature ; Busan ; Dyspnea ; Dysuria ; Gyeongsangnam-do ; Headache ; Hospitals, General ; Hospitals, University ; Humans ; Nausea ; Noise ; Paralysis ; Privacy ; Sensation ; Thirst ; Vomiting

PURPOSE: Endoscopic variceal sclerotherapy(EVS) has been considered the mainstay therapy for bleeding esophageal varices in adults. However, recent data have shown that endoscopic variceal ligation is just as efficacious and has fewer complications than EVS. Although there are many reports concerning EVL in adults, only a few studies have been done of children. METHODS: We performed EVL in 9 children under 6 years of age(mear age, 2.5 year) with esophageal varices. Outcome was assessed with respect to survival, rebleeding, and complications. RESULTS: The causes of portal hypertension were 3 cases of congenital hepatic fibrosis, 3 cases of biliary atresia, 2 cases of portal vein thrornbosis, and one case of portal vein fibromuscular dysplasia. The age at diagnosis ranged from 10 months to 6 years. The patients underwent a mean of 2.6+/- 0.7 sessions of EVL(ranging from two to four). The numbers of bands per person were 5.6+/-1.8, and the numbers of bands per session were 2.2+/-1.0 Two complications of esophageal rebleeding were noted, and none of the cases experienced symptoms of esophageal stenosis, nor gastroesophageal reflux. CONCLUSION: EVL is safe and effective in controlling variceal hemorrhage in children with portal hypertension, regardless of etiology. The cornplication rate is low and EVL is an acceptable and perhaps preferable altemative to EVS in children with esophageal varices. But regular periodic examination for recurrence of varices after eradication should be required.
Adult ; Biliary Atresia ; Child* ; Diagnosis ; Esophageal and Gastric Varices* ; Esophageal Stenosis ; Fibromuscular Dysplasia ; Fibrosis ; Gastroesophageal Reflux ; Hemorrhage ; Humans ; Hypertension, Portal ; Ligation* ; Portal Vein ; Recurrence ; Varicose Veins

BACKGROUND: Urography(IVU) is considered the best first investigation in patient with suspected urinary calculi, but recently ultrasonography(USG), combined with a plain film of the abdomen, has been suggested as an alternative. METHODS: We undertaken study to see if this approch can be used in emergency patients and outpatients by radiologists with different amounts of ultrasound experence. Some 192 patients with suspected urinary colic presenting to Koo Hospital Emergency Department and Youngnam Universith Hospital outward Department(IM, URO, FM) over 12-month period were studied. They had a plain abdominal film(KUB) and USG examination of the kidney, ureter, bladder following hydration and subsequently underwent IVU. Of these, 22 patients passed a stone before their IVU. The data analysis was performed on the remaining 170 patients. Urography was used as the gold standard. RESULTS: Some 170 patients subsequently underwent IVU at a mean interval of 1.8 days after the ultrasound examination. In 91 of 170 patients the IVU was positive. In 97 of 170 patients the combination of JUB plus USG was positive, leaving three false negative KUB plus USG. Thus the sensitivity of KUB plus USG was 97%, specificity was 89%, positive predictive value was 91%, and negative predictive value was 96%. CONCLUSIONS: Our findings in this study suggest that in the hydrated patient the combination of KUB plus US is a very sensitive and relative specific screening test. Because of the high negative predictive value of KUB plus US, urography is not likely to be helpful when KUB plus US are negative. Urography is indicated only if KUB plus US findings are equivocal or if intervention is necessa.ry.
Abdomen ; Colic ; Emergencies ; Emergency Service, Hospital ; Humans ; Kidney ; Mass Screening ; Outpatients ; Sensitivity and Specificity ; Statistics as Topic ; Ultrasonography* ; Ureter ; Urinary Bladder ; Urinary Calculi* ; Urography*

Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.
Fetus ; Humans ; Incidence ; Infertility ; Ovulation Induction ; Parturition ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Twin ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted ; Triplets ; Twins

PURPOSE: This study was done to explore the levels of depression experienced by adolescents, and to compare health behavior between depressed and non-depressed adolescents. METHOD: Participants were chosen by a stratified random sampling of adolescents in the second grade of a high school in P city. Levels of depression and health behavior of the students were measured using questionnaires. Data collection was done in May, 2002. Data were analyzed with descriptive statistics and logistic regression using the SPSS WIN 10.0 Program. RESULTS: The prevalence of depression (CES-D) among the students was 53.5%. In multiple logistic regression analysis, sex (OR 1.80, 95% CI 1.35-2.41), school performance, mid (OR 1.68, 95% CI 1.48-1.97) and low (OR 1.42, 95% CI 1.29-1.61), drinking (OR 1.47, 95% CI 1.09-1.98), and not eating breakfast (OR 1.74, 95% CI 1.56-1.97) were significantly higher in students in the depressed group than those in the non-depressed group. CONCLUSIONS: Based on the findings, we concluded that many adolescent experience depression and depression in adolescents is significantly related to behaviors of smoking, alcohol, no exercise, and not eating breakfast. However this study did not address causality among these variables. There, further research, such as a longitudinal study, is needed to identify causality among the variables.
Adolescent* ; Breakfast ; Data Collection ; Depression* ; Drinking ; Eating ; Health Behavior* ; Humans ; Logistic Models ; Prevalence ; Smoke ; Smoking ; Child Health ; Surveys and Questionnaires

PURPOSE: A structural equation model was analyzed to explore the determinants of health-promoting behaviors in patients living at home in Korea who had post stroke hemiplegia. METHOD: Demographic characteristics, activities of daily living, religiosity, family support, self-efficacy, acceptance of disability, perceived barriers to health-promoting activities, depression, and health-promoting behavioral data was collected from 239 patients using self-report questionnaires. RESULT: Variables that have a direct effect on health-promoting behaviors were self-efficacy and family support. Depression, acceptance of disability, perceived barriers, activities of daily living and religiosity also influenced health-promoting behaviors in an indirect way. CONCLUSION: It is imperative to explore strategies for patients with post stroke hemiplegia to identify and maximize their resources, develop their self-efficacy, improve their emotional state, and enhance their physical activity and spiritual growth, which would maximize health-promoting behaviors.
Adult ; Aged ; Aged, 80 and over ; Attitude to Health ; Female ; *Health Behavior ; *Health Promotion ; Hemiplegia/etiology/*nursing/rehabilitation ; *Home Nursing ; Humans ; Male ; Middle Aged ; Models, Theoretical ; Questionnaires ; Self Efficacy ; Stroke/complications/*nursing/psychology

PURPOSE: The study was performed to identify the process of change, decisional balance and self-efficacy corresponding to the stage of smoking cessation behavior based on Transtheoretical Model in industrial workers. METHOD: A convenience sample of 146 industrial workers except for the never smokers, were recruited at a H industry in Ulsan. Data were collected from February 1 to 28, 2002. The research instruments were Stages of Change of Smoking Cessation Measure(DiClemente et al, 1991), Process of change(Prochaska, 1988), Smoking Abstinence Self Efficacy (SASE: DiClemente et al, 1985) and Decisional balance(SDB; Kim, 1999). RESULT: The results of this study were as follows; 1. The subjects were distributed in each stage of smoking cessation change: There were 64 subjects (43.0%) in the precontemplation stage, 35 subjects(23.5%) in the contemplation stage, 28 subjects(18.8%) in the preparation stage, 14 subjects(10.1%) in the action stage and 7 subjects(4.7%) in the maintenance stage. 2. Analysis of variance showed that experiental process(F=2.808, p=.042), behavioral process (F=4.567, p=.004) self-efficacy(F=9.809, p=.000), pros(F=11.107, p=.000), cons(F=6.686, p=.000), pros- cons(F=3.446, p=.018) were significantly associated with the stages of smoking cessation change. 3. Through discriminant analysis, it was found that 'PROS' was the most influential variable in discriminating the four stages of change. CONCLUSION: This study can provide the basis of staged matching smoking cessation program using TTM for more effective and useful intervention.
Self Efficacy* ; Smoke* ; Smoking Cessation* ; Smoking* ; Ulsan

PURPOSE: This study is to identify the types of role awareness of home health care specialists working at medical institutions, to understand their role awareness correctly by grasping the quality of each type, and to provide useful help in the education of home health care specialists. METHOD: Q-methodology is used to objectify role awareness of medical institution specialists who may recognize situations differently according to their individual experience and comprehension based on the view of behavior. Q-classification was carried out on 30 home health care specialists working at medical institutions using 30 selected questions. Collected data were examined through factor analysis using QUANL PC program. RESULTS: Three different types of role awareness of home health care specialists working at medical institutions were identified. Type I is "educational-function-centered", Type II "patient-centered" and Type III "professional-service-centered". CONCLUSION: Regardless of these types, home health care specialists commonly had a high pride as a specialist and a sense of mission regarding themselves as important persons responsible for patients' health.
Comprehension ; Delivery of Health Care* ; Education ; Hand Strength ; Humans ; Missions and Missionaries ; Specialization*

OBJECTIVE: The purpose of this study was to find out the effect of job stress, and the coping strategy of hospital workers on job satisfaction. METHODS: 468 self-administered questionnaires, were obtained from 120 doctors, 194 nurses, 45pharmacists and 109 administrators at a university hospital located in Seoul. The sociodemographic characteristics, personality types, degree of social support, job stresses, coping strategies, and job satisfaction were all assessed from the questionnaires. RESULTS: The analysis of job stress, according to occupation, showed that the most important job-related stress-inducing factors were: for doctors, role overload, and poor advancement opportunity; for nurses, role overload, and career development and wages; for pharmacists, role overload and lack of recognition from other health professionals; and for administrators, career development and wages, and organizational inefficiency. Job satisfaction had a significant positive correlation with control strategy, and a negative correlation with role ambiguity, career development and wages, personal relationship, role overload, and symptom management strategy. Job satisfaction was significantly influenced by control strategy, occupation, role ambiguity, person with an 'A' type personality and gender, from a multiple regression analysis. CONCLUSION: The results of this study suggested that to increase the job satisfaction for hospital workers, they need to be encouraged to use control strategies; create a supportive hospital atmospheres for social supports; re-evaluation, structuring and a new job design are all required to reduce role ambiguity.
Administrative Personnel ; Atmosphere ; Health Occupations ; Humans ; Job Satisfaction* ; Occupations ; Pharmacists ; Questionnaires ; Salaries and Fringe Benefits ; Seoul

Adenosquamous carcinoma of stomach is a mixed glandular-epidermoid tumor where both components are neoplastic. Its incidence is extremely rare. The five theories on the origin of squamous components are 1) island of ectopic squamous epithelium in the gastric mucosa, 2) squamous metaplasia of gastric epithelium, 3) squamous differentiation in a preexisting adenocarcinoma, 4) endothelial cell differentiated toward squamous elements, and 5) totipotential undifferentiated cells of the gastric mucosa. We experienced three cases of adenosquamous carcinoma. Case 1 was a 71-year-old female patient; an ulcerative lesion was present in the pylorus, measuring 5 cm in diameter. Case 2 was a 57-year-old male patient; an ulcerative lesion is present in the pylorus, measuring 6 cm in diameter. Case 3 was a 58-year-old female patient; an ulcerative lesion was present in the body and fundus, measuring 10 cm in diameter. Microscopic examination revealed a mixed malignant squamous and adenomatous component.
Adenocarcinoma ; Aged ; Carcinoma, Adenosquamous* ; Endothelial Cells ; Epithelium ; Female ; Gastric Mucosa ; Humans ; Incidence ; Male ; Metaplasia ; Middle Aged ; Pylorus ; Stomach* ; Ulcer