• Journal of Korean Academy of Nursing
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• v.8 no.1
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• pp.163-180
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• 1978

Much of a person's energy is spent in the effort of becoming a productive member of to-day's complex society. This activity may cause tension, and chronic unrelieved tension is an influential factor in blood pressure elevation. The problem of this study was to identify manifest needs and self-actualization of patients with essential hypertension, and to analyse and compare their manifest needs and selt-actualization with the selected general characteristics of We, sex, religion, occupation and level of education with a control group of patients with normal blood pressure readings. The purpose was to contribute to the planning of nursing interventions toward reducing the impact of complex psycho-somatic factors on the anxiety of patients with essential hypertension. The instruments used included selected items from the Edwards (1959) Personal Preference Schedule (EPPS) as adapted by Hwang (1965) and from the Personal Orientation Inventory (POI) (Shostrom 1964, 1974) adapted by Kim and Lee (1977) to measure manifest needs and self-actualization. The convenience sample was chosen from 149 persons who presented themselves for general physical examinations at Ewha University Medical Centre and 41 patients diagnosed with essential hypertension at three general hospitals in Seoul during June 1 and August 31, 1977. Forty-nine persons from the Ewha group with blood-pressure readings exceeding 150/90 were added to the experimental group. Data were analysed by the S.P.S.S. computer programme using t-test and tests for statistical significance. Statistically significant findings were as follows: A. Blood Pressure and Manifest Needs. 1. with the exception of Autonomy, patients with hypertension had significantly high scores on all variables Abasement, Achievement, Affiliation, Aggression, Dominance, Emotionality, Exhibitionism and Sex. 2. When mean scores of normal persons were compared by age groups, normal persons had higher scores in the following order on Abasement (50's, 40's, 20's, 30's), Achievement (50's, 30's, 40's, 20's), Affiliation (50's, 40's, 30's, 20's), Dominance (50's, 40's, 40's, 20's) and Exhibitionism (30's, 50's, 40's, 20's). In each case, there was a significant difference between the first and last age group scores. 3. When the mean scores of normal persons were compared by sex, normal men had higher scores than women on Achievement, Affiliation, Aggression, Dominance, Exhibitionism and Sex. Male patients had higher scores than female patients on Achievement, Dominance, Exhibitionism and Sex, but female patients scored higher in Emotionality. 4. Normal persons had higher scores related to religion in the following order on Achievement (Buddhism, no religion, Christianity). Hyper tensive patients had higher scores on. Exhibitionism (no religion, Christianity, Buddhism). 5. Normal persons had higher scores related to occupation in the following order on Achievement and Exhibitionism (unemployed, office workers, teachless, businessmen), Emotionality (office workers, unemployed, businessmen, teacher) and Sex (office workers, unemployed, teachers, businessmen). Hypertensive patients had higher scores on Achievement and Aggression (teachers, businessmen, office worker, unemployed), Dominance and Exhibitionism (businessmen, teacher, of ace workers, unemployed) and Sex (teachers, office worker, businessmen, unemployed). 6. Normal persons had higher scores related to level of edification in the following order on Abasement, Emotionality and Autonomy (secondary school graduation, university). Hypertensive patients had higher scores on Abasement (no education, primary, university, secondary), Achievement (no education, secondary, university, primary) , Dominance (university, no education, secondary, primary), Exhibitionism (university, secondary, no education, primary), and Sex (university, secondary, primary, no education). B. Blood Pressure and Self_Actualization 1, Patients with hypertension had significantly lower scores on all variables. 2. Normal persons had higher scores related to age groups in the following order on Existentiality (20's, 30's, 40's, 50's). Hypertensive patients showed no significantly different scores. 3. Normal women had higher scores than men on Time Competence. Normal men had higher scores on Feeling Reactivity. Male patients had higher scores than women on Self-Actualizing Value and Self-Regard. 4. Normal persons ha 1 higher scores related to religion on spontaneity (Buddhism, no religion, Christianity). Hypertensive patients had higher scores on Time Competence and Nature of Man (Buddhism, Christianity, no religion). 5. Normal persons had higher scores related to occupation in the following order on Existentiality (teachers, office workers, businessmen, unemployed) and Self-Regard (unemployed, office workers, teachers, businessmen). Hypertensive patients showed no significantly different scores. 6. Normal persons had higher scores related to level of education in the following order on Existentiality and Self-Acceptance (university, secondary). Hypertensive patients had higher scores on inner-Director (university, secondary, no education, primary) and Existentiality (university, secondary, primary, no education). Recommendations for nursing interventions with hypertensive patients with emotional problems or low self-actualization were made. 1. The nurse should encourage the patient through her interactions with other members of the medical team to accept counselling and health education. 2. Through her therapeutic interpersonal relationships with the patient, the nurse should help him discover the causes of his emotional tension. 3. Through her health teaching with the family, the nurse should encourage them to participate with the medical team in the patient's therapeutic plan and in providing him with the minimum possible emotional support. 4. Through frequent counselling with the obsessive-thinking and inflexible patient, the nurse should reevaluate the patient's behaviour and her interventions. 5. Seriously ill patients should be given needed reeducation by members of the professional medical team.

• Journal of agricultural medicine and community health
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• v.28 no.1
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• pp.15-27
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• 2003

Objectives: This study was conducted to compare the medical care patterns of hypertensive patients between rural and urban areas. Methods: We selected one rural county(Region A where there were 19 public health centers; one health center, 8 health sub-centers and 10 community health posts) and two urban districts(Region B and C where there was no health sub-center and community health post) in Daegu city. Region B had similar socioeconomic characteristics with rural county A while region C had different characteristics. The medical insurance records of 14,422 incident patients (2,501 in region A, 4,873 in region B and 7,048 in region C) with diagnostic code of hypertension from September 1998 to August 1999 were reviewed. Incident patient was defined as a patient who had no record of medical fee claim for hypertension to the national health insurance corporation in past 6 months and visited a medical facility for hypertension for the first time. The data for annual visit days, annual prescription days and annual total medical expenses were abstracted. The medical care pattern was categorized by the number of annual visit days and prescription days. The most proper care group was defined as the patient who visited 6-15 days with 240 prescription days or more in a year. Results: The type of medical facilities for the most visit was clinics, 373.% and it was followed by general hospitals, 28.2%; public health centers, 24.7%; and hospitals, 9.8% in region A(p<0.05). In region B, it was clinics, 63.1% and followed by general hospitals, 27.6%; health center, 5.2%; and hospitals, 4.1%(p<0.05). In region C, it was clinics, 53.8% and followed by general hospitals, 35.0%; health center, 6.3%; and hospitals, 4.9%(p<0.05). Annual mean total medical expenses per patient was highest in region C(won195,993) and followed by region A(won191,683) and region B(won178,713). The proportion of the most proper care group was 7.7% in region A, 5.2% in region B and 6.7% in region C(p<0.05). According to the type of medical facilities for the first visit, the proportion of the most proper care group was highest(14.7%) in the patients of public health centers, and it was followed by general hospitals, 8.8%; clinics, 3.6%; and hospitals, 2.0% in region A(p<0.05). In region B, it was highest in general hospitals, 9.7% and followed by hospitals, 4.0%; health center, 3.6%; and clinics, 3.4%(p<0.05). In region C, it was highest in general hospitals, 10.1% and followed by clinics, 5.2%; hospitals, 4.1%; and health center, 3.1%(p<0.05). Conclusions: The proportion of proper care for hypertension was higher in rural area and it was attributed to the care of health center, sub-centers and community health posts which appeared to follow patients better than hospitals and clinics.

• Journal of agricultural medicine and community health
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• v.28 no.1
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• pp.67-77
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• 2003

Objectives: This study is designed to suggest the health service goals necessary for providing the more efficient services relevant to the requests of the community, through the evaluation on the operating status of the unified health subcenters. Methods: We visited total 5 unified health subcenters comprising 3 ones located in Gyeongsangbuk-do and 2 ones located in Gyeongsangnam-do from December 2000 to January 2001, and interviewed about the pre- and post-unified status related to manpower, facilities, equipment, medical service and health service quality, and the problems and improvement plans of the unified management. Results: According to the evaluation on the manpower before and after the unification of the health subcenters, the total employees increased by 2.8 persons on average from 6.8 to 9.6 persons in the investigated subjects. The numbers of doctors, dentists and nurses were almost the same as before. There were no clinical pathologic technician and radiological technician before but they were appointed to duty in 3 unified health subcenters later. The unification of the health subcenters has produced slight increases in the frequency of the medical service and dental treatment and considerable increases in that of the physical therapy and laboratory tests. In relating to the changes of the health service, the cases of visiting health care and ambulatory medical service, and the total number of health education participants were greatly increased after the unification. The number of cases undergoing the vaccination and cervical cancer screening was similar to that of the pre-unification while the patient number of the registration to hypertension or diabetes showed a tendency to increase a little. Since the unification of the health subcenters, the frequency of laboratory tests has been increased, but the quality of health service has not been improved yet. Nevertheless, the unification seems to be positive according to the result of the great improvement in visiting health care, ambulatory medical service and health education service. The problems of the unification of the health subcenters were indicated in indefiniteness of the service details between the workers; excessively large building hard to be effectively managed; insufficient medical instruments, inappropriation of working expenses, lack of professional training for the health education, etc. Conclusions: For further active functions of the unified health subcenters, the minimal allocation basis to appoint doctors, nurses and administrative workers to do the duty should be differentiated from the basis for a health subcenter, and the fundamental instruments needs to be expanded to improve the quality of the medical service and visiting health care service. Moreover, the unified health subcenter needs to have definite service details between the workers, and should improve the working efficiency through the development of service-related guidelines.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.152-156
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• 2005

Background: Occlusive complications after arterial revascularization are difficult to treat and have high recurrence rate. This study was performed to establish an effective treatment modality and to evaluate the factors affecting the occlusive complications by analysis of clinical data. Material and Method: During the period of 5 years. 33 patients (55 reoperations) were studied at the Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital following 173 arterial revascularization surgeries. The clinical characteristics, operating methods, the time intervals of reoperation, used graft, and the results of treatment were evaluated retrospectively. Result: All the patients were men except one and the mean age was 63.5 years old. The mean time internal from first operation to reoperation was 11.9 months. The cause of arterial occlusive diseases were 28 atherosclerosis and 5 Burger's diseases, Associated diseases were Hypertension $(57.6\%)$, Diabetes mellitus $(33.3\%)$, heart failure $(18.2\%)$, and so on. The mean rate of reoperation was 1.67 times and the most common type of first operation was femoro-popliteal bypass grafting $(57.6\%)$. The graft that used revascularization surgery were 25 cases of PTFE and 6 case were Dacron. There was no statistical difference between two groups. The kinds of reoperations were thrombectomy in 20 cases, angioplasty 18 cases, re-bypass surgery in 13 cases, and lumbar sympathectomy in 4 cases. The results of reoperation were 15 cases of functional recovery, 7 cases of limb salvage, 5 cases of above-knee amputation. 3 cases of below-knee amputation and 3 deaths. Conclusion: The main cause of occlusive complications are occlusion of inflow or outflow artery. Treatments were different according to the first operation methods and graft used. The most frequent time of reoperation was within one year after the first operation. We believe that graft surveillance especially during the first year is very important factor in observing the patient. We can look forward to improving limb salvage rate to perform additional treatment such as radiological interventions and lumbar sympathectomy.

• Childhood Kidney Diseases
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• v.9 no.1
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• pp.38-45
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• 2005

Purpose : The purpose of this study was to analyze the therapeutic effect of plasmapheresis in various pediatric diseases. Methods : Therapeutic plasmapheresis was performed by COBE Spectra centrifugation. Nine cases were included in this study. The number an[;. method of plasmapheresis, together with the progress and prognosis of each case were retrospectively reviewed. Results : The patients' ages ranged from 26 mont]Is to 16 years of age, and the mean age was 9.9 years. There were S males and 4 females. The underlying diseases requiring plasmapheresis included 2 cases of hemolytic uremic svndrome(HUS), 1 case of lupus nephritis, 2 cases of rapidly Progressive glomerulonephritis(RPGN), 1 case of focal segmental glomorulosclerosis(FSGS), 1 case of systemic vasculitis after pulmonary hemorrhage, 1 case of acute renal failure associated with pulmonary hemoIThage, and 1 case of acute rejection after renal transplantation. The average number of plasmapheresis performed was 6.2 times with a range of 3 to 13 times. The patients with HUS, lupus nephritis, ANCA positive systemic vasculitis induced by pulmonary hemorrhage and ARF-associated pulmonary hemorrhage showed a good response to therapeutic plasmapheresis, but the patients with RPGN, refractory FSGS, and acute rejection after renal transplantation were not responsive to treatment. The most common side effect was hypocalcemia which was rarely symptomatic. Vital signs were not compromised. Conclusion : Although it is presumptuous to generalize the therapeutic effects of plasma pheresis in different diseases due to the small number of study subjects, this study shows that plasmapheresis may be an effective therapeutic modality in various pediatrics diseases and should be considered as a therapeutic option.

• Childhood Kidney Diseases
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• v.7 no.2
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• pp.157-165
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• 2003

Purpose : $Henoch-Sch\"{o}nlein$ purpura(HSP) is a systemic vasculitis that involves multiple organs, especially the kidney, which is the most important organ in determining the prognosis of the disease. The morbidity of HSP nephritis in adults is low and there have been little research done on its clinical course so far. Therefore, we have compared the clinical course of HSP nephritis in children and adults in Korea. Methods : We retrospectively analyzed 81 cases of HSP nephritis in children younger than 15 years of age, and 25 cases of adults older than 15 years of age who were admitted to Yonsei University Medical College Severance Hospital from Jan. 1986 to May 2003. Results : The male to female ratio was 1.5 : 1 in children and 1.3 : 1 in adults. The incidence of HSP nephritis for both age groups was found to be increased during the autumn and winter. Infection was the predisposing factor in 39 cases(48.1%) of children, 16 cases(64.0%) of adults, and drugs were the predisposing factor in 8 cases(9.9%) of children and 4 cases (16.0%) of adults. All patients initially presented with microscopic hematuria. Thirteen cases (16.0%) of children and 7 cases(28.0%) of adults initially showed proteinuria of nephrotic range. Thirty four cases(42.0%) of children and 4 cases(16.0%) of adults showed normal urinalysis after treatment. Asymptomatic urinary abnormalities were found in 41 cases(50.6%) of children and 18 cases(72.0%) of adults. Complications such as nephrotic syndrome and hypertension were found in 3 cases(3.7%) of children and 2 cases(8.0%) of adults. Three children(3.7%) and 1(4.0%) adult required dialysis or renal transplantation. Follow-up renal biopsies were performed on 21 children, of whom 10 cases(47.6%) did not show any histologic change, 9 cases(42.9%) showed low grade changes, and 2 cases(9.5%) showed high grade changes. Prognosis was gloomy when proteinuria of nephrotic range and high grade of abnormal histology were present at diagnosis, and there was no significant difference between the two groups(P<0.05) Conclusion : This study showed that there was no difference in terms of the clinical features and courses between the children and adults with HSP nephritis. Proteinuria of nephrotic range and the severity of abnormal histologic changes at diagnosis were found to be associated with a bad prognosis, therefore we recommend that patients with these features require long term follow-up and management.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.359-365
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• 2006

Background: Arterial grafts have been used to achieve better long-term results for coronary revascularization. Bilateral internal thoracic artery (ITA) grafts have a better results, but it may be not used in some situations such as diabetes and chronic obstructive pulmonary disease (COPD). We evaluated the clinical and angiographic results of composite left internal thoracic artery-radial artery (LITA-RA) Y graft. Material and Method: Between April 2002 and September 2004, 119 patients were enrolled in composite Y graft for coronary bypass surgery. The mean age was $62.6{\pm}8.8$ years old and female was 34.5%. Preoperative cardiac risk factors were as follows: hypertension 43.7%, diabetes 33.6%, smoker 41.2%, and hyperlipidemia 22.7%, There were emergency operation (14), cardiogenic shock (6), left ventricle ejection fraction (LVEF) less than 40% (17), and 17 cases of left main disease. Coronary angiography was done in 35 patients before the hospital discharge. Result: The number of distal anastomoses was $3.1{\pm}0.91$ and three patients (2.52%) died during hospital stay. The off-pump coronary artery bypass (OPCAB) was applied to 79 patients (66.4%). The LITA was anastomosed to left anterior descending system except three cases which was to lateral wall. The radial Y grafts were anastomosed to diagonal branches (4), ramus intermedius (21), obtuse marginal branches (109), posterolateral branches (12), and posterior descending coronary artery (8). Postoperative coronary angiography in 35 patients showed excellent patency rates (LITA 100%, and RA 88.5%; 3 RA grafts which anastomosed to coronary arteries <70% stenosed showed string sign with competitive flow). Conclusion: The LITA-RA Y composite graft provided good early clinical and angiographic results in multivessel coronary revascularization. But it should be cautiously used in selected patients.

• Childhood Kidney Diseases
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• v.3 no.1
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• pp.64-71
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• 1999

Purpose : The protective effects of dietary protein on the progression of renal failure were studied in subtotally nephrectomized rats. Methods : Treatment groups were as follows; 5/6 nephrectomy and a normal protein ($18.5\%$) diet (NP); 5/6 nephrectomy and a low protein ($6\%$) diet (LP): 5/6 nephrectomy, a normal protein diet and converting enzyme inhibitor, enalapril (NPE): 5/6 nephrectomy, a low protein diet and enalapril (LPE). Both diets were isocaloric and had the same phosphorus content. Proteinuria, remnant kidney weight, mesangial matrix expansion score and glomerular volume were assessed at 4, 12 and 16 weeks after renal ablation. Results : LP and NP developed progressive hypertension. Eight weeks after surgery, LPE and NPE controlled hypertension. LP, LPE, and NPE had significantly less proteinuria than NP at 16 weeks (P<0.05). Kidney weight in LP were markedly less enlarged than NP (P<0.05). There was no difference in kidney weight between LPE and NPE. At 12 and 16 weeks the mesangial matrix expansion score was significantly less in LP, LPE, and NPE compared to NP (P<0.05). At 12 and 16 weeks mean glomerular volume was significantly less in LP compared to NP (P<0.05). At 12 and 16 weeks mean glomerular volume in LPE was significantly less compared to NPE. Conclusion : Dietary protein restriction afforded considerable protection from renal injury in the rat remnant kidney model. During the enalapril treatment, there was no additional protective effect of dietary protein restriction against the development of renal lesions.