Purpose: This study sought to investigate the effects of robot-assisted gait training on balance in total hip arthroplasty (THA) patients after bilateral avascular necrosis (AVN). Methods: This case study in two patients utilized an ‘A-B-A’ single-subject experimental design that included five days of pre-intervention, followed by five days of intervention, and five days of post-intervention. The intervention involved the use of a standing inclined robot (R-bot) for 15 minutes. The outcome measures were evaluated using the Functional Reaching Test (FRT), Time Up to Go (TUG), and the Modified One Leg Standing Test (OLST). Results: Patient 1 showed improvement based on data gathered from baseline A to intervention period B, with results as follows: FRT improved from 27.7 cm to 41.28 cm, OLST LT from 14.03 seconds to 67.37 seconds, OLST RT from 2.94 seconds to 35.97 seconds, and TUG from 12.96 seconds to 7.82 seconds. Patient 2 also showed improvement from baseline A to intervention period B, with results as follows: FRT improved from 17.18 cm to 24.3 cm, OLST LT from 11.53 seconds to 52.01 seconds, OLST RT from 12.99 seconds to 62.19 seconds, and TUG from 27.31 seconds to 12.99 seconds. Conclusion Based on the results of this study, robotic rehabilitation during the early stages after surgery is effective for promoting balance in patients who have undergone THA due to bilateral AVN.

BACKGROUND AND PURPOSE: Thrombolysis is underused in acute ischemic stroke, mainly due to the reluctance of physicians to treat thrombolysis patients. However, a computerized clinical decision support system can help physicians to develop individualized stroke treatments. METHODS: A consecutive series of 958 patients, hospitalized within 12 hours of ischemic stroke onset from a representative clinical center in Korea, was used to establish a prognostic model. Multivariable logistic regression was used to develop the model for global and safety outcomes. An external validation of developed model was performed using 954 patients data obtained from 5 university hospitals or regional stroke centers. RESULTS: Final global outcome predictors were age; previous modified Rankin scale score; initial National Institutes of Health Stroke Scale (NIHSS) score; previous stroke; diabetes; prior use of antiplatelet treatment, antihypertensive drugs, and statins; lacunae; thrombolysis; onset to treatment time; and systolic blood pressure. Final safety outcome predictors were age, initial NIHSS score, thrombolysis, onset to treatment time, systolic blood pressure, and glucose level. The discriminative ability of the prognostic model showed a C-statistic of 0.89 and 0.84 for the global and safety outcomes, respectively. Internal and external validation showed similar C-statistic results. After updating the model, calibration slopes were corrected from 0.68 to 1.0 and from 0.96 to 1.0 for the global and safety outcome models, respectively. CONCLUSIONS: A novel computerized outcome prediction model for thrombolysis after ischemic stroke was developed using large amounts of clinical information. After external validation and updating, the model's performance was deemed clinically satisfactory.
Antihypertensive Agents ; Blood Pressure ; Calibration ; Glucose ; Hospitals, University ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Korea ; Logistic Models ; National Institutes of Health (U.S.) ; Stroke*

PURPOSE: The purpose of this study was to examine differences in the perceived importance and frequency of nurse role behaviors for medical and surgical nurses and to examine the relationship between perceived importance and frequency of nurse role behaviors in the two groups. METHOD: A descriptive design was used with convenience sampling of 351 medical and surgical nurses in the 40 hospitals with over 500 beds. Data were collected using a structured questionnaire. RESULTS: 1) The total score for perceived importance of nurse role behaviors was 4.09+/-.53 for medical nurses and 4.13+/-.53 for surgical nurses. 2) The total score for frequency was 3.15+/-.54 for medical nurses and 3.24+/-.56 for surgical nurses. 3) The perceived importance of nurse role behaviors was higher than the frequency, but the difference between two groups was not significant. 4) The perceived importance of nurse role behaviors was highly correlated with frequency (r=.579, p=.000) for the two groups. CONCLUSION: Medical and surgical nurses perceived the importance nurse role behavior but the frequency of the behavior is lower. Therefore, further research is needed to develop strategies to increase the frequency of nurse role behaviors.
Nurse's Role* ; Surveys and Questionnaires

PURPOSE: This study was conducted to describe qualitatively the entities of nurse's experiences in general hospitals and to suggest basic data guiding research on developing Standards of clinical nursing practice in Korea. METHOD: Fourteen nurses working at general hospitals with over 300 beds in Seoul were interviewed in-depth until saturation using tape-recorders and transcription. RESULT: The central theme of clinical nursing practice experienced by subjects was "being with clients" that means accepting client's personal character, solving client's needs and providing client-centered nursing. A also "being with clients" was felt to be the responsibility of nurses which was learned from their nursing schools. The nursing strategies performed in order to be with patients were proving skillful nursing techniques, accepting, educating, emotional support, advocating, and self-reflecting, the subjects experienced somewhat problematic affects such as difficulties in interpersonal relationship, work overload, negative image of nursing, deficit of self-confidence for nursing actions, poor working conditions, and unfair treatment. Nurses at the hospital practiced with pride when they felt that they were accepted by clients. CONCLUSION: Further research is needed to analysis problems in clinical practice and the comparison of nurses' experiences of clinical practice, with nurses' experiences in various settings.
Hospitals, General ; Humans ; Korea ; Nursing ; Schools, Nursing ; Seoul

Combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) has been traditionally advocated for patients in whom symptomatic disease has been elicited in both vascular territories. This rationale has related to the concern for an increased myocardial infarction rate following CEA with untreated coronary artery disease and conversely, the potential for stroke in patients receiving CABG with untreated carotid stenosis. Although significant cardiac and cerebral complication rates have been identified in these combined cases, justification for the procedure has stemmed from combined rates obtained which were lower than those encountered for either procedure performed in isolation. There has been a trend toward performance of combined CEA/CABG in patients with asymptomatic carotid stenosis. Release of the Asymptomatic Carotid Atherosclerosis Study (ACAS) in 1995 appears to have played a significant role in changing trend. Interpreting the ACAS data finding is problematic for the combined procedure. Yet controversy continues concerning the most appropriate management for patients with severe coronary artery disease who also have asymptomatic carotid stenosis. Recently we have successfully managed two cases of coronary artery disease and asymptomatic carotid stenosis patients by combined CEA and CABG without any surgical complication. We report these 2 cases and briefly review the literature.
Carotid Artery Diseases ; Carotid Stenosis ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Endarterectomy, Carotid* ; Humans ; Myocardial Infarction ; Stroke ; Transplants

As a nursing practice involves nurses'actions in a specific context of health care, this study has focused on exploring the espoused theories in nursing practice within the action science perspectives. Espoused theories are the belief, principles, and rationale expressed by the practitioner as guiding her/his actions in a situation of practice. The data were analysed qualitatively and 25 elements of espoused theories of nursing action were identified and clustered into 6 categories. The 25 elements of espoused theories are as follows: The clinical nurse worked in wholistic and individual nursing, focussed on the patient's needed, comfort and supportive nursing (5 theories of nursing goal); excellent skills, knowledge based, assessment and data collection, explaining, educating or a scientific basis(6 theories of nursing intervention): advocacy, value oriented, treatment, accountability and commitment(4 theories of nursing ethics); human respect, partnership, trust(3 theories of patient-nurse relationship) : knowledgable, accumulated clinical experiences and personally lived experiences, positive perspectives(4 theories of nurse), role of intervention, rewarding, peer relationship(3 theories of situations). The above mentioned espoused theories are similar to that of nursing textbooks which students learned through basic nursing education and almost the same as the Acts ofa Nurse in Korean. However, we are doubtful whether nurses actually do as they think. Therefore, it is recommended to review the theories-in-use in order to find any discrepancies between the espoused theories and the reality of nursing actions.
Data Collection ; Delivery of Health Care ; Education, Nursing ; Humans ; Nursing* ; Reward ; Social Responsibility

OBJECT: To support the application of the Bethesda classification to the histologic diagnosis of cervical squamous lesions. METHODS: We evaluated the cervical biopsies and human papilloma virus (HPV) DNA status of 100 clinic patients. The 100 biopsy specimens were analyzed using criteria of the Bethesda system for low-grade squamous intraepithelial lesion(LSIL) and high-grade squamous intraepithelial lesions(HSIL) in association with analysis of HPV DNA virus type by PCR. RESULTS: By PCR amplified from paraffin embedded tissues, the 40 of 90 cases of classified as HSIL were HPV 16 or 18 positive and 1/10 cases of classified as LSIL was HPV 16 positive. CONCLUSION: This study supports the usefullness of certain histologic criteria of the Bethesda system for distinguishing squamous intraepithelial lesions into two grades.
Biopsy ; Cervix Uteri ; Classification ; Diagnosis* ; DNA ; DNA Viruses ; Female ; Human papillomavirus 16* ; Humans ; Papilloma ; Paraffin ; Polymerase Chain Reaction

Leiomyoma is one of the rarest solid tumor of the ovary. Approximately 50 cases have been published to date. However, most reported leiomyoma of the ovaries were small and rarely induced serious symptoms. We report a case of ovarian leiomyoma in 57-year-old woman which has been experienced in our haspital with brief review of literature.
Female ; Humans ; Leiomyoma* ; Middle Aged ; Ovary*

The transdermal administration of narcotics is one of the alternative ways of providing adequate pain relief for the patients with chronic cancer pain. A Phase 4 trial was conducted to evaluate the efficacy and safety of Fentanyl-TTS in adult patients with cancer-related pain in Korea. METHODS: Patients with histologically confirmed malignancy, who have pain related to the cancer and/or therapy, pain necessitating the use of opoid analgesics, age of 18 yr or older, ability to communicate effectively with study personnel, and signed on informed consent were included. The patients were titrated with a short-acting narcotic to control their cancer pain before they are converted to a fentanyl-transdermal therapeutic system(TTS). Short acting parenteral morphine and MS contin were used as rescue medications. All patients were evaluated initially and were followed up with a pain visual analogue scale(VAS), quality of life(QOL)-VAS. Patients were asked to keep the daily record for 21 days about pain VAS, QOL-VAS, amount of rescue morphine used, and side effects. RESULTS: Twenth two patients were enrolled from January 1996 to October 1997. The dose of fentanyl-TTS required, ranged between 25 and 75 ug/hr (25 microgram/hr in 13, 50 microgram/hr in 4, and 75 microgram/hr in 2). The mean dose of morphine required before the use of the fentanyl-TTS was 135.3 mg (20-285 mg/day), but it was decreased after the use of the fentanyl-TTS. Pain VAS and QOL-VAS were in adquate level during the fentanyl- TTS treatment. Patients favored continuous use of fentanyl after the study was finished. Side effect of fentanyl-TTS was minimal. CONCLUSION: Transdermal fentanyl seems to be a convenient and effective analgesic for the control of cancer related pain in Korean. A controlled trial comparing fentanyl-TTS to morphine needs to be followed.
Administration, Cutaneous ; Adult* ; Analgesics ; Fentanyl ; Humans ; Informed Consent ; Korea ; Morphine ; Narcotics

Carcinosarcoma of the esophagus is regarded as a rare malignant neoplasm composed of both carcinomatous and sarcomatous elements. Esophageal carcinosarcoma classified into 3 subgroups, pseudosarcoma, so called carcinosarcoma, and true carcinosarcoma. we report a case of large polypoid tumor consist of squamous cell carcinoma, undifferentiatred small cell and spindle cell proliferation. The patient was 47 year-old man who had suffered from dysphasia and substernal chest pain for 2 months. A protruded tumor in size of 8x4x3.5 cm with stalk was found in midesophagus at the level of 28 cm from the incisor. The tumor was round with smooth surface stained with Lugol solution. There were multiple erosions at the stalk of the tumor, Partial esophagectomy and esophagogastrostomy was done, Undifferentiated small cell was confirmed by immunoreactivity to neuron specific enolase and electron microscopic findings.
Aphasia ; Carcinoma, Squamous Cell ; Carcinosarcoma* ; Cell Proliferation ; Cellular Structures* ; Chest Pain ; Esophageal Neoplasms ; Esophagectomy ; Esophagus* ; Humans ; Incisor ; Middle Aged ; Phosphopyruvate Hydratase