Purpose: The purpose was to examine the self-efficacy, coping, and compliance in patients with kidney transplantation. Methods: Participants consisted of 300 outpatients who underwent kidney transplantation and regularly visited hospital for health check-up. A tool developed by Ahn (2000) was used for measuring self-efficacy. A modified version of the Jalowiec Coping Scale (Jalowiec, 1987) by Hwang (2004) was used for measuring coping, and a tool developed by Ryu, Kim, and Kang (2003) was used for compliance. Data were analyzed using SPSS program version 21.0 ANOVA, Pearson's correlation coefficient, and Scheff$\acute{e}$'s test for post-hoc test. Results: Coping shows significant differences according to marital status and education. Coping was used more often among patients with ABO incompatible transplantation than those with ABO compatible. Differences in compliance were significant according to donor type, ABO incompatible, period after transplantation, and admission after the transplantation. The management of life style, stress, nutrition, and exercise in self-efficacy and compliance had lower scores than the others. Conclusion: There are significant correlations between self-efficacy, coping, and compliance in patients with kidney transplant which might be helpful for health care professionals in taking care of these population.
Kim, Hwa-Soon;Cho, Ok-Min;Cho, Hyo-Im;Kim, Ju-Yeun
Journal of Korean Academy of Nursing
/
v.42
no.3
/
pp.396-404
/
2012
Purpose: The purpose of this study was to identify the features, risk scores and risk factors for deep vein thrombosis in critically ill patients who developed deep vein thrombosis in their lower extremities. Methods: The participants in this prospective descriptive study were 175 adult patients who did not receive any prophylactic medication or mechanical therapy during their admission in the intensive care unit. Results: The mean age was 62.24 (${\pm}17.28$) years. Men made up 54.9% of the participating patients. There were significant differences in age, body mass index, and leg swelling between patients who developed deep vein thrombosis and those who did not have deep vein thrombosis. The mean risk score was 6.71(${\pm}2.94$) and they had on average 4.01(${\pm}1.35$) risk factors. In the multiple logistic regression, body mass index (odds ratio=1.14) and leg swelling (odds ratio=6.05) were significant predictors of deep vein thrombosis. Conclusion: Most critically ill patients are in the potentially high risk group for deep vein thrombosis. However, patients who are elderly, obese or have leg edema should be closely assessed and more than one type of active prophylactic intervention should be provided.
From Oct. 1983 to Dec. 1991, 135 cases of atrial septal defect which were operated at the department of Thoracic and Cardiovascualr Surgery, Chonnam National University Hospital, were analysed retrospectively. They were 23.7% of all congenital heart diseases operated in the same period. Among the 135 cases, 62 cases were male and 73 cases were female. Their ages were ranged from 2 to 54 years and the mean was 18 years old. Main symptoms at admission were exertional dyspnea[70.37%], frequent URI[49.12%] and palpitation[32.59%], but 12 cases[8.88%] were asymptomatic. Electrocardiographic findings wer regular sinus rhythm in 96.99%, RVH in 64.66%, incomplete RBBB in 27.06%, complete RBBB in 42.10%, and first degree AV block in 9.02% All 135 cases were operated under the direct vision with cardiopulmonary bypass. Anatomically, most frequent type was fossa ovalis defect with complete septal rim[78.52%]. 117 of 135 ASD patients were repaired with pathch closure[86.66%] and 14 patients were repaired with direct closure[10.37%] and 4 patients in mutiple ASD were repaired with patch and direct closure[2.96%]. Postoperative complications were occured in 21 cases[15.56%], and they were wound infection, pleural effusion, postoperative bleeding, urinary tract infection, and heart failure mainly. One case died due to epidural hematoma and operative mortality was 0.74%.
Twenty eight patients with atrial septal defect operated on from May, 1983, to July, 1986 at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, were analyzed retrospectively. Among the 28 patients of atrial septal defect, 8 were male and 20 were female. Their ages ranged from 4.6 years to 52.5 years old with the mean of 15.3 years. The main clinical symptoms on admission were exertional dyspnea [82%], frequent respiratory infection [75%], palpitation [54%] and easy fatigability [25%]. Electrocardiographic findings were as follows: Regular sinus rhythm [100%], RVH [54%], RBBB [25%] and first degree of A-V block [4%]. Hemodynamic studies were performed in all cases and mean pulmonary systolic arterial pressure was 34.1*11.8mmHg. and mean Qp/Qs was 2.6*0.9. All 28 patients were operated under direct vision using extracorporeal circulation. 23 cases were secundum type defect and a single hole was found in 22 cases. The associated cardiovascular anomalies were found in 11 patients: ventricular septal defect in 3, patent ductus arteriosus in 1, partial anomalous pulmonary venous drainage in 2, mitral regurgitation in 2, tricuspid regurgitation in 1, anomalous left atrial septation in 1 and valvular pulmonary stenosis in 1. The defect closed directly in 22 cases and with patches in 6 cases. Postoperative complications were wound infection, arrhythmia bleeding, intracardiac patch detachment, pneumothorax and urethral injury. But there was no operative mortality.
To assess the status of safety accidents, authors reviewed and analysed the records of safety accidents of a welding material manufacturing factory at Pohang city from January 1989 to December 1993. The results are; 1. The total incidence of safety accidents was 295 spells for five years. 2. Average age of workers with accident was 35.7 years. Average duration of employment was 6.2 years and the duration of employment increased as the year increased. 3. There was no statistical significance on season, month, weekday and time by year in the incidence of safety accidents. The most frequent part of body injured was upper extremities and the most frequent type of injury was abrasion. 4. Mean admission rate of safety accidents was 12.6% and the ratio of treated spells as occupational injury was 7.8%. 5. The most frequent cause of injury was worker's mistake and the most frequent action for the prevention of further accidents was safety education. 6. The incidence rate of safety accidents on 1993 was 116.2 spells per 1,000 persons. Above results suggest that to prevent safety accidents, safety education should be done continuously, the environmental and human factors were controlled and more exact reporting system of safety accidents was needed.
Kim, Dae-Ki;Jwa, Cheol-Su;Kim, Gang-Hyeon;Kang, Jae-Kyu
Journal of Korean Neurosurgical Society
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v.42
no.3
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pp.191-194
/
2007
Objective : Homeless patients probably have epidemiologic features that are different from those of general population. However, there have been no published articles about clinical characteristics of neurosurgical homeless patients. The authors tried to assess the clinical characteristics and treatment outcome of homeless neurosurgical patients. Methods : We retrospectively reviewed the medical records and radiological films of 76 homeless patients and 72 non-homeless patients following head trauma who were admitted to our neurosurgical department between June 2001 and June 2005. We compared two groups of the patients with the demographics, the clinical and laboratory characteristics. Also, 3D-day mortality was determined according to Glasgow Coma Scale (GCS) score. Results : Age of homeless patients was younger than that of non-homeless patients. Homeless patients had previous craniotomy evidences in skull x-rays more frequently (10.5% vs. 1.4%). Acute subdural hematoma was the most common type of head injury in the two groups. Moderate and severe head injury, based on GCS score on admission was more frequent in homeless patients (64% vs. 39%). Fifty percent of homeless patients underwent operation for traumatic head injury. However, 3D-day mortality according to GCS score was not significantly higher in homeless patients. Conclusion : Most homeless neurological patients were relatively young men. Also, moderate or severe brain injuries were observed more frequently. However, mortality rate of homeless patients in neurosurgical field is not significantly higher in the present study.
Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.
Objective : The purpose of this study was to investigate the reliable factors influencing the surgical outcome of the patients with traumatic acute subdural hematoma (ASDH) and to improve the functional outcome of these patients. Methods : A total of 256 consecutive patients who underwent surgical intervention for traumatic ASDH between March 1998 and March 2008 were reviewed. We evaluated the influence of perioperative variables on functional recovery and mortality using multivariate logistic regression analysis. Results : Functional recovery was achieved in 42.2% of patients and the overall mortality was 39.8%. Age (OR=4.91, p=0.002), mechanism of injury (OR=3.66, p=0.003), pupillary abnormality (OR=3.73, p=0.003), GCS score on admission (OR=5.64, p=0.000), and intraoperative acute brain swelling (ABS) (OR=3.71, p=0.009) were independent predictors for functional recovery. And preoperative pupillary abnormality (OR=2.60, p=0.023), GCS score (OR=4.66, p=0.000), and intraoperative ABS (OR=4.16, p=0.001) were independent predictors for mortality. Midline shift, thickness and volume of hematoma, type of surgery, and time to surgery showed no independent association with functional recovery, although these variables were correlated with functional recovery in univariate analyses. Conclusion : Functional recovery was more likely to be achieved in patients who were under 40 years of age, victims of motor vehicle collision and having preoperative reactive pupils, higher GCS score and the absence of ABS during surgery. These results would be helpful for neurosurgeon to improve outcomes from traumatic acute subdural hematomas.
A 15 years Old girl was admitted with chief complaints of intermittent claudication of lower extremity, dizziness, and headache for 5 years. On admission, malignant hypertension was noted in the upper part of body [190-150/120-110] but femoral & dorsalis pedis pulse could not palpate. Once she had experienced C. V. A. due to hypertension of upper part, about years ago. On auscultation, systolic murmur was audible along the left sternal border. E.C.G. Showed left ventricular hypertrophy pattern, and others within normal limit. Retrograde aortography demonstrated diffuse narrowing of entire thoracic aorta with underdeveloped lower abdominal aorta [below the renal artery] & both common lilac artery, and rich collaterals, but normally visualized greater arteries in the aortic arch. On left posterolasteral thoracotomy, entire descending thoracic aorta revealed marked narrowing with mild perivascular adhesion, but no mediastinal pleura adhesion. These findings suggest as congenital type of atypical coarctation in the entire thoracic aorta with mild secondary change. But histopathology was showed the findings of chronic non-specific aortitis, later. Dacron by pass graft was performed with end to side anastomosis between graft and aortic wall. After operation, all her preoperative symptoms & signs were disappeared, and discharged with good general condition.
A 51 year-old male was admitted with the chief complaints of swallowing difficulty and pain on neck and upper chest for 2 months prior to admission: He was taken biopsy under esophagoscopy, and the result was squamous cell carcinoma. Preoperatively we studied the esophagogram and chest CT. On these, we found the main appreciable mass at midesophagus easily. But, we missed the upper cervical unexpected mass. So we performed the esophagectomy and lymph node dissection from upper clavicle level to the esophagogastric junction by thoracic approach as wide as possible, and cervical esophagostomy and feeding gastrostomy also. At that evening we reviewed the studied films in detail, and we found another mass lesion at C4-C6 level of cervical esophagus. We performed the 2nd operation e.g. cervical esophagectomy on next morning without hesitation. Between these two masses, there was almostly normally looking skip area grossly. The squamous cell carcinoma of the esophagus could be multicentric in character and may have skip area. But, we heard little reports until now. The two masses could be different in origin or be same probably by submucosal spreading. Anyway, it was an alarming case to the surgeon not to neglect the another possible lesions in squamous cell type. Postoperative course was uneventful, he took G-tube feeding with no problems on 7th postoperative day. Now he took the postoperative irradiation at out patient department.
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