OBJECTIVES: In order to explore effects of board-game therapy for cognitive rehabilitation in patients with schizophrenia, we investigated the change of executive cognitive function over a 2-month period of board-game therapy in patients with schizophrenia. METHODS: Two groups of chronic schizophrenic inpatients were participated in this study. One group(n=21) were treated with board-game therapy for 2 months and the other control group(n=19) were not treated. For the evaluation of the executive cognitive function, a Wisconsin Card Sorting Test(WCST) was administered before and after the introduction of the board-game therapy. PANSS score change was also evaluated. RESULT: At the beginning of this study, there was no significant difference in performance of cognitive function tests, demographical data or clinical severity between both patient groups. After 2 months of treatment with the board-game therapy, the board-game therapy group showed significant improvements of executive cognitive function without any significant change of their schizophrenic symptoms. On the contrary, there was no change in control group. CONCLUSION: This study showed that a board-game therapy is effective for the enhancement of executive cognitive function in patients with chronic schizophrenia. A board-game therapy could be introduced with ease into psychiatric fields, such as inpatients' or outpatients' clinic wards and day hospital. Our result indicates that the board-game therapy is a promising tool for the enhancement of cognitive function, especially executive cognitive function and helpful for cognitive rehabilitation for schizophrenic patients.
Humans ; Inpatients ; Rehabilitation* ; Schizophrenia* ; Wisconsin

Traumatic injury to the lower legs has been increasing in Korea and often leads to skin and soft tissue loss, exposing blood vessels, nerves, tendons or bones. Salvaging these legs often requires free flaps. Over the past two decades, the use of free tissue transfer has produced an increasing salvage rate for severely injured lower leg. Between April. 1988 to July, 1997, 47 cases of lower soft tissue defects were reconstructed with free flaps, and retrospective analysis was performed to determine more about the factors associated with free flap failure or immediate vascular complications. We evaluated wound status before operation, operation time after injury, vascular status of recipient site, use of vein graft, use of reverse flow, salvage protocol in compromised anastomosis, survival rate and complications. There were 9 cases of venous thrombosis and 2 cases of arterial insufficiency while 7 out of 9 cases of venous thrombosis were reexplorated. However, 2 cases of partial flap necrosis and 1 case of total necrosis. Two cases of arterial insufficiency were necrotized, so the overall free flap failure rate was 9.6%. The results were analyzed to determine the factors promoting either failure or vascular complication, Many factors which are often blamed for failure (trauma cause, preoperative general condition, preoperative infection status, intraoperative ischemic time) were not significant in this study, but prolonged time after injury correlated with free flap failure, We concluded the adequate debridement and infection control, adequate selection of recipient vessel, accurate vascular anastomosis and most of all, early free flap transfer after injury, will improve the success rate.
Blood Vessels ; Debridement ; Free Tissue Flaps* ; Infection Control ; Korea ; Leg* ; Necrosis ; Retrospective Studies ; Skin ; Survival Rate ; Tendons ; Transplants ; Vascular System Injuries ; Veins ; Venous Thrombosis ; Wounds and Injuries

BACKGROUND: The purpose of this study was to determine the optimal dose of remifentanil for minimizing hemodynamic changes during intubation and reducing propofol-induced pain in elderly patients. METHODS: In a randomized prospective study, 60 patients (ASA I-II, elder than 65 years) were enrolled to determine which of two target remifentanil blood concentrations (3 ng/ml, 5 ng/ml) was required to blunt hemodynamic changes during intubation and to reduce propofol-induced pain. After the target effect site concentration of remifentanil had been reached, the target controlled infusion of propofol was started and propofol-induced pain was recorded. Blood pressure and heart rate were recorded at baseline, just before intubation and 1, 3, 5 min after intubation. RESULTS: There were no significant differences in the hemodynamic parameters between two groups, but not in arterial pressure at just before intubation and 1 minute after intubation. However, the group R5 (5 ng/ml) showed significantly less intense pain induced by propofol than in the group R3 (3 ng/ml). CONCLUSIONS: The results suggest that the group R5 provide more relief in propofol induced pain than the group R3, but showed great possibility of hypotension and bradycardia in both groups, which means it should be used with cautions in the elderly patients.
Aged ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Intubation ; Piperidines ; Propofol ; Prospective Studies

Spontaneous muscle infarction in diabetic patients is a rare condition that usually occurs in those with advanced diabetic complications. Increased clinical awareness is important for early recognition, particularly in a diabetic patient presenting with a painful thigh or leg swelling. However, the disorder has received little attention in the rehabilitation medicine literature. Magnetic resonance imaging is the diagnostic choice of study, and in the appropriate clinical setting, may obviate the need for a muscle biopsy. We reported three patients with diabetic muscle infarction, review additional reported cases, and discussed the principles of diagnosis and management.
Biopsy ; Diabetes Complications ; Diabetes Mellitus ; Diagnosis ; Humans ; Infarction* ; Leg ; Magnetic Resonance Imaging ; Rehabilitation ; Thigh

OBJECTIVE: To document the anti-spastic effect and dose-response relationship of gabapentin (GBP) quantitatively using muscle stretch reflex in spinal cord injured rabbits. METHOD: Spinal cords of 25 rabbits were contused by 20 gx20 cm weight drop in the 11th thoracic spine. After 2 weeks, muscle stretch reflex was measured. Triceps surae was dissected and stretched for 5 mm at the rate of 2 mm/sec and the length-tension curve were obtained. The slope in the length-tension curve was defined as stiffness index (SI). After baseline measurement, group I (n=6) received 50 mg/kg GBP IM injection and group II (n=8) received 100 mg/kg GBP IM injection, but control group (n=5) did not. Muscle stretch reflex was measured again after 30 minutes and 60 minutes, and then after sciatic nerve section. Active tension was calculated by subtracting passive tension from total tension. Proportion of SI was calculated by dividing follow-up SI with baseline SI. RESULTS: The proportion of SI of active tension reduced significantly at 30 minutes and 60 minutes compared to baseline (p<0.001, p<0.001). The proportion of SI of active tension in both group I and group II reduced significantly than control group (p=0.041, p<0.001). The proportion of SI of active tension in group II reduced than group I, but it was not statistically significant (p=0.166). CONCLUSION: The GBP reduced significantly muscle stretch reflex in spinal cord injured rabbits and showed dose-response tendency.
Follow-Up Studies ; Muscle Spasticity ; Rabbits ; Reflex, Stretch* ; Sciatic Nerve ; Spinal Cord Injuries ; Spinal Cord* ; Spine

For producing large numbers of professional nurses who could manage 21th century's human health, it is necessary to review the direction of registered nursed' national examination which evaluates the nursing education and is granted a licence. For adapting to social expectation of the nurse, we have to nurture the nurses' problem solving capability in clinical setting. Seven divisions of Korean Academy of Nursing suggested clinical competency according to their categories. This paper was presented in the workshop for setting up direction of registered nurses' national examination. We expect that this paper would be more refine and confirm through reviewing subdivisions' learning objectives and discussing clinical minimum level of competence contents with clinical leaders.
Education ; Education, Nursing ; Financing, Organized ; Humans ; Learning ; Mental Competency ; Nursing* ; Problem Solving ; Women's Health*

BACKGROUND AND OBJECTIVES: Inappropriately high left ventricular mass (iLVM) is known to be related to cardiovascular prognosis. A non-dipper pattern has a greater mean left ventricular (LV) mass than the dipper pattern in hypertensive patients. However, the appropriateness of LV mass in dipper or non-dipper patterns has not been adequately investigated. The aim of this study was to define the relationship between nocturnal dipping and the appropriateness of LV mass. SUBJECTS AND METHODS: Using the ambulatory blood pressure monitoring (ABPM) database, the data of 361 patients who underwent ABPM and echocardiography was analyzed retrospectively. Appropriateness of LV mass was calculated as observed/predicted ratio of LV mass (OPR) using a Korean-specified equation. Nocturnal dipping was expressed as percent fall in systolic blood pressure (BP) during the night compared to the day. RESULTS: Daytime, nighttime and 24 hours BP in hypertensive patients was 140.4+/-14.8 mmHg, 143.7+/-15.2 mmHg and 129.4+/-20.0 mmHg, respectively. OPR was 106.3+/-19.9% and nocturnal dipping was 10.2+/-10.9 mmHg. In a multiple linear regression model, 24 hours systolic BP (beta=0.097, p=0.043) and nocturnal dipping (beta=-0.098, p=0.046) were independent determinants of OPR as well as age (beta=0.130, p=0.025) and body mass index (BMI) (beta=0.363, p<0.001). Odds ratio of the non-dipper pattern was 2.134 for iLVM (p=0.021) and 3.694 for obesity (p<0.001; BMI >25 kg/m2). CONCLUSION: The non-dipper pattern is independently associated with iLVM in hypertensive patients as well as obesity.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Body Mass Index ; Echocardiography ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Linear Models ; Obesity ; Odds Ratio ; Prognosis ; Retrospective Studies

OBJECTIVE: Adiponectin is an adipocyte-derived hormone with profound insulin sensitizing, anti-inflammatory, and antiatherogenic effects. Apart from its obvious potential as a mediator of adult metabolic syndrome, in pregnancy, adiponectin could have a significant role in regulating energy homeostasis. However, correlations between umbilical cord and maternal serum adiponectin levels and neonatal birthweights are far from understood. The purpose of the present study was to clarify correlations between umbilical cord and maternal serum adiponectin levels and neonatal birthweights. METHODS: The study included 30 healthy mothers who had given birth to healthy neonates. Adiponectin levels in maternal serum and umbilical cord serum were determined by ELISA and analysed. RESULTS: The ranges of adiponectin levels for umbilical cord and maternal serum were 7.12-24.93 microgram/mL and 1.76-8.20 microgram/mL, respectively. Umbilical cord adiponectin levels (14.82+/-3.66 microgram/mL) were significantly higher than maternal serum levels (4.73+/-1.87)(p<0.001). Umbilical cord adiponectin levels were correlated positively with neonatal birthweights (r=0.459, p=0.011). No significant differences in adiponectin levels were found between female and male neonates. In addition, there was no correlation between umbilical cord adiponectin levels and maternal serum adiponectin levels, maternal body mass index, umbilical leptin, or insulin levels. CONCLUSION: The levels of adiponectin were higher in umbilical cord than in maternal serum. The adiponectin levels in umbilical cord were found to correlate positively with neonatal birthweights. Therefore, adiponectin may be involved in fetal energy metabolism in pregnancy.
Adiponectin* ; Adult ; Body Mass Index ; Energy Metabolism ; Enzyme-Linked Immunosorbent Assay ; Female ; Homeostasis ; Humans ; Infant, Newborn ; Insulin ; Leptin ; Male ; Mothers ; Parturition ; Pregnancy ; Umbilical Cord

PURPOSE: The purpose of this study was to analyze changes in the work patterns of nurses working in tertiary hospitals in Seoul, Korea. METHOD: Structured self-administered questionnaires were sent to the nursing department of each hospital, and distributed to nurses. The questionnaires were designed to identity changes in work patterns, frequency of contact inside & between departments, and interpersonal relationship inside & between departments. And also variables for analysis included the followings; acknowledgement of convenience, information applicability, willingness to participate in, and job satisfaction after implementation of a Hospital Information System. A total of 249 nurses from 13 hospitals replied. RESULTS: Changes in direct nursing time showed the most improvement and the frequency of contact was decreased while interpersonal relationships among coworkers was improved. As most nurses expressed a positive opinion of the HIS including its convenience, and information applicability, their willingness to participate in it and job satisfaction, it can be concluded that the implementation of the HIS has resulted in positive influences in the work patterns of clinical nurses.
Hospital Information Systems ; Information Systems* ; Job Satisfaction ; Korea ; Nursing ; Surveys and Questionnaires ; Seoul* ; Tertiary Care Centers*

OBJECTIVE: To develop an experimental model that is useful to evaluate the effect of antispastic medication administered intrathecally and to titrate the intrathecal baclofen effect quantitatively by using muscle stretch reflex. METHOD: Ten rabbits were laminectomized posteriorly and intrathecal catheter was inserted. Then the spinal cords were contused by 12.5 gx20 cm weight drop around 12th thoracic vertebra. After 8~12 days, muscle stretch reflex was measured before intrathecal baclofen injection (ITBI) and after ITBI 30 minutes, 60 minutes, and 120 minutes. Rabbits' triceps surae were dissected and stretched 5 mm at the rate of 2 mm/sec using a step motor. The change of muscle tension was graphed into the time (length)-tension curve. The slope in the time (length)-tension curve was defined as stiffness index (SI). RESULTS: The measurement of muscle stretch reflex was available in 5 of 10 spinal cord injured rabbits. The proportion of SI reduced significantly at 60 minutes and 120 minutes compared to baseline (p=0.005, p<0.001). CONCLUSION: Our data proved the antispastic effect of ITBI quantitatively by using muscle stretch reflex. We concluded that the quantitative measurement method of the antispastic effect of ITBI will be useful in evaluating antispastic effect by intrathecal administration of the other antispastic medications.
Baclofen* ; Catheters ; Models, Theoretical ; Muscle Tonus ; Rabbits ; Reflex, Stretch* ; Spinal Cord Injuries ; Spinal Cord* ; Spine