• 제목/요약/키워드: Child with cancer

검색결과 238건 처리시간 0.02초

Prognostic factors in children with extracranial germ cell tumors treated with cisplatin-based chemotherapy

  • Kim, Jinsup;Lee, Na Hee;Lee, Soo Hyun;Yoo, Keon Hee;Sung, Ki Woong;Koo, Hong Hoe;Seo, Jeong-Meen;Lee, Suk-Koo
    • Clinical and Experimental Pediatrics
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    • 제58권10호
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    • pp.386-391
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    • 2015
  • Purpose: To evaluate the outcomes and prognostic factors in children with extracranial germ cell tumors (GCTs) treated at a single institution. Methods: Sixty-six children diagnosed with extracranial GCTs between 1996 and 2012 were included in the study. Primary treatment was surgical excision, followed by six cycles of cisplatin-based chemotherapy. The survival rates were compared according to the International Germ Cell Cancer Cooperative Group classification used for GCTs in adults to validate the classification guidelines for GCTs in children. Results: The median patient age was 4.4 years. In 34 patients (51.5%), the primary tumor site was the gonad. Extragonadal GCTs were detected in 32 patients. The 5-year overall survival and event-free survival (EFS) were $92.0%{\pm}3.5%$ and $90.4%{\pm}3.7%$, respectively. In univariate analysis, tumor histology, metastasis, and elevated alpha-fetoprotein were not prognostic factors in children with extracranial GCTs. However, EFS was poorer in patients with mediastinal disease (n=12, $66.7%{\pm}13.6%$) than in those with nonmediastinal disease (n=54, $96.0%{\pm}2.8%$) (P=0.001). The 5-year EFS was lower in patients older than 10 years, (n=21, $80.0%{\pm}8.9%$) compared with those younger than 10 years (n=45, $95.2%{\pm}3.3%$) (P=0.04). Multivariate analysis identified the mediastinal tumor site as the only independent prognostic factor. Conclusion: The prognosis of children with extracranial GCTs was favorable. However, nongerminomatous mediastinal tumors were associated with poor survival in children. Further research is needed to improve the prognosis of children with malignant mediastinal GCTs.

High degree of supervision improves adherence to inhaled corticosteroids in children with asthma

  • Park, Geun Mi;Han, Hye Won;Kim, Hee Se;Kim, Jae Youn;Lee, Eun;Cho, Hyun-Ju;Yang, Song-I;Jung, Young-Ho;Hong, Soo-Jong;Kim, Hyung Young;Seo, Ju-Hee;Yu, Jinho
    • Clinical and Experimental Pediatrics
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    • 제58권12호
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    • pp.472-477
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    • 2015
  • Purpose: Adherence to treatment with inhaled corticosteroids (ICS) is a critical determinant of asthma control. The objective of this study was to assess factors that determine adherence to ICS therapy in children with asthma. Methods: Fifty-eight children with asthma, aged 5 to 16 years, used ICS with or without a spacer for 3 months. Adherence rates as measured from questionnaires and canisters, asthma symptom scores, and inhalation technique scores were assessed every 30 days. The degree of supervision by caregivers was assessed at day 30. Results: Adherence rates measured using canisters were lower at day 60 than at day 30 (P=0.044) and did not change thereafter ($74.4%{\pm}17.4%$ at day 30, $66.5%{\pm}18.4%$ at day 60, and $67.4%{\pm}22.2%$ at day 90). Adherence rates at days 60 and 90 and during the total study period were significantly different when measured by using questionnaires versus canisters (P<0.001, P=0.022, and P =0.001, respectively). In the comparison of adherence rates repeatedly measured at days 30, 60, and 90 and adherence rates during the total study period among the 3 groups, adherence rates in the high-degree supervision group were significantly higher than those in the low-degree supervision group ($82.0{\pm}16.0$ vs. $66.1{\pm}14.5$, $75.4{\pm}14.4$ vs. $56.2{\pm}18.4$, $75.0{\pm}18.3$ vs. $55.0{\pm}19.7$ [P=0.027]; $77.9{\pm}12.2$ vs. $59.1{\pm}11.4$ [P=0.021]) after adjustment for sex and age. Conclusion: The level of caregiver supervision is an important factor affecting adherence to ICS therapy in children with asthma. Therefore, a high degree of supervision may be required to increase adherence to ICS therapy in children with asthma.

Transcatheter arterial chemoembolization and radiation therapy for treatment-na$\ddot{i}$ve patients with locally advanced hepatocellular carcinoma

  • Kim, Sang Won;Oh, Dongryul;Park, Hee Chul;Lim, Do Hoon;Shin, Sung Wook;Cho, Sung Ki;Gwak, Geum-Youn;Choi, Moon Seok;Paik, Yong Han;Paik, Seung Woon
    • Radiation Oncology Journal
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    • 제32권1호
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    • pp.14-22
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    • 2014
  • Purpose: To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) followed by radiotherapy (RT) in treatment-na$\ddot{i}$ve patients with locally advanced hepatocellular carcinoma (HCC). Materials and Methods: Eligibility criteria were as follows: newly diagnosed with HCC, the Barcelona Clinic Liver Cancer stage C, Child-Pugh class A or B, and no prior treatment for HCC. Patients with extrahepatic spread were excluded. A total of 59 patients were retrospectively enrolled. All patients were treated with TACE followed by RT. The time interval between TACE and RT was 2 weeks as per protocol. A median RT dose was 47.25 $Gy_{10}$ as the biologically effective dose using the ${\alpha}/{\beta}$ = 10 (range, 39 to 65.25 $Gy_{10}$). Results: At 1 month, complete response was obtained in 3 patients (5%), partial response in 27 patients (46%), stable disease in 13 patients (22%), and progressive disease in 16 patients (27%). The actuarial one- and two-year OS rates were 60.1% and 47.2%, respectively. The median OS was 17 months (95% confidence interval, 5.6 to 28.4 months). The median time to progression was 4 months (range, 1 to 35 months). Grade 3 or greater liver enzyme elevation occurred in only two patients (3%) after RT. Grade 3 gastroduodenal toxicity developed in two patients (3%). Conclusion: The combination treatment of TACE followed by RT with two-week interval was safe and it showed favorable outcomes in treatment-na$\ddot{i}$ve patients with locally advanced HCC. A prospective randomized trial is needed to validate these results.

소아완화의료에 대한 호스피스 완화의료 전문기관 종사자의 인식 (Palliative Care Practitioners' Perception toward Pediatric Palliative Care in the Republic of Korea)

  • 문이지;신희영;김민선;송인규;김초희;유주연;박혜윤
    • Journal of Hospice and Palliative Care
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    • 제22권1호
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    • pp.39-47
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    • 2019
  • 목적: 본 연구는 소아완화의료 대상 환자와 가족을 돌보는 전문기관 종사자의 환자진료 및 시스템 연계에 대한 인식을 알아보기 위해 수행된 서술적 조사 연구이다. 방법: 자료 수집은 호스피스 완화의료 전문기관(이하 전문기관)에 근로하는 전문가를 대상으로 2017년 9월부터 10월까지 진행되어 총 61건의 자료를 수거하였다. 결과: 소아완화의료를 입원형, 자문형, 가정형 중 한가지 형태로라도 제공하고 있는 기관은 11기관(18.0%)이었으며, 지역별 분포는 서울, 경기, 인천, 경상 지역에 집중되어 있어 기타 지역에서는 활용 가능한 자원이 전무한 상황이다. 개입 시 장애요인은 '훈련된 전문인력을 확보하는 것의 어려움'이며, 비암성 소아청소년 환자의 경우 '예후 및 경과 예측의 어려움 47.5% (n=28)' 으로 확인되었다. 소아완화의료 구성형태는 '성인과 다른 소아청소년의 특성, 소아청소년 전문인력 필요, 관리 및 제도보완 필요'를 이유로 응답자 중 73.8% (n=45)이 별도의 소아완화의료팀 구성이 필요하다는 의사를 밝혔다. 개입시점은 '완치가능성이 적은 소아암 진단 시'부터 진행해야 하는 것이 33.7% (n=33)로 가장 높았으나 의뢰시점은 '사망시점을 예상하기 어려우나 지속적 악화상태인 경우'가 38.2% (n=39)로 가장 높아, 전문기관으로 의뢰 전 기존 치료 병원에서 개입을 진행되는 것을 선호하였다. 응답기관 중 14.8% (n=9)만이 추후 소아완화의료 제공에 참여할 의사가 있다고 밝혔다. 결론: 2018년 두 곳으로 시작한 소아청소년 완화의료 시범사업기관에 더해 지역별로 배치되어 있는 전문기관에서 소아완화의료를 제공할 수 있도록 하여 자원의 접근성을 높일 필요가 있다. 별도 소아완화의료 구성의 필요성을 인정함에도 소아완화의료를 제공하는 것에 대한 부담감으로 실제적 서비스를 제공하는 데 어려움이 있기에 우선적으로 소아완화의료 전문가를 양성하고 교육 개발 및 의뢰 시점에 대한 논의 등을 통하여 소아완화의료 확산에 대한 현실적 논의를 진행해야 할 것이다.

Asthma predictive index as a useful diagnostic tool in preschool children: a cross-sectional study in Korea

  • Lee, Dong Hyeon;Kwon, Ji-Won;Kim, Hyung Young;Seo, Ju-Hee;Kim, Hyo-Bin;Lee, So-Yeon;Jang, Gwang-Cheon;Song, Dae-Jin;Kim, Woo Kyung;Jung, Young-Ho;Hong, Soo-Jong;Shim, Jung Yeon
    • Clinical and Experimental Pediatrics
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    • 제63권3호
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    • pp.104-109
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    • 2020
  • Background: It is challenging to diagnose asthma in preschool children. The asthma predictive index (API) has been used to predict asthma and decide whether to initiate treatment in preschool children. Purpose: This study aimed to investigate the association between questionnaire-based current asthma with API, pulmonary function, airway hyperreactivity (AHR), fractional expiratory nitric oxide (FeNO), and atopic sensitization in preschool children. Methods: We performed a population-based cross-sectional study in 916 preschool children aged 4-6 years. We defined current asthma as the presence of both physician-diagnosed asthma and at least one wheezing episode within the previous 12 months using a modified International Study of Asthma and Allergies in Childhood questionnaire. Clinical and laboratory parameters were compared between groups according to the presence of current asthma. Results: The prevalence of current asthma was 3.9% in the study population. Children with current asthma showed a higher rate of positive bronchodilator response and loose and stringent API scores than children without current asthma. The stringent API was associated with current asthma with 72.2% sensitivity and 82.0% specificity. The diagnostic accuracy of the stringent API for current asthma was 0.771. However, no intergroup differences in spirometry results, methacholine provocation test results, FeNO level, or atopic sensitization rate were observed. Conclusion: The questionnaire-based diagnosis of current asthma is associated with API, but not with spirometry, AHR, FeNO, or atopic sensitization in preschool children.

Identification of Hepatitis B (HBV) and C (HCV) Virus Infection among Doctors and Nurses in Tertiary Hospitals in Mongolia

  • Batbold, D.;Baigalmaa, Dovdon;Ganbaatar, B.;Chimedsuren, O.
    • Perspectives in Nursing Science
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    • 제7권1호
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    • pp.50-54
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    • 2010
  • The studies of M. Colombo (1989) and W. Lange (1992) showed that 30~40% of people became chronic after suffering from hepatitis B virus (HBV) and C virus (HCV) infection, and about 50% of the chronic cases transformed into primary liver cancer. There have been few studies done in Mongolia on hepatitis infection among health professionals, particularly in nurses. In a study done by Chimedsuren (8), the study showed that 19.4% of people with identified surface hepatitis B antigen (HBsAg) and antibodies to hepatitis C virus and 8% of people with the identified nucleotide of RNA for the hepatitis C virus (polymerase chain reaction) had an acute form of hepatitis C. Studies on the hepatitis virus genome damaging effect on liver cells showed that genotype 8 (A, B, C, D, E, F, G, TTV) had the most damaging effect on liver cells (Hahn and Faeka, 2007). Several studies have shown a relationship between hepatitis B virus infection and a lack of compliance regarding safety regulations and rules by medical personnel. Results of a study from the Maternal and Child Health Research Center showed that tests done to detect hepatitis B virus antigen and antibodies to C virus did not reveal anything. Both antigen and antibodies in 69% cases did not show, and separately, B virus and antibodies to hepatitis C virus were identified in 13% and 9%, respectively. Results of the tests taken from health personnel in Shastin Central Hospital showed that in 76% of the cases, the B virus antigen with C virus antibodies was not identified. In 8% of the cases, the B virus antigen was present on its own. The combination of B the virus antigen and C virus antibodies were present in 8% of nurses and doctors, respectively. 82% of the cases had negative results for the detection of a combination of B virus antigen and C virus antibodies taken from health personnel from the State Central Clinical Hospital whereas the B virus antigen and C virus antibodies by themselves were present in 7% and 14% of the cases, respectively. Combined cases of the B virus antigen and C virus antibodies were identified in 4% of the personnel. Results of the tests taken from the health personnel in the Hospital of the Ministry of Justice and Internal Affairs showed that in 79% of the cases, the B virus antigen with C virus antibodies were not identified. Separately, the B virus and antibodies to hepatitis C virus were identified in 8% and 13% of the cases, respectively.

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Prognostically Significant Fusion Oncogenes in Pakistani Patients with Adult Acute Lymphoblastic Leukemia and their Association with Disease Biology and Outcome

  • Sabir, Noreen;Iqbal, Zafar;Aleem, Aamer;Awan, Tashfeen;Naeem, Tahir;Asad, Sultan;Tahir, Ammara H;Absar, Muhammad;Hasanato, Rana MW;Basit, Sulman;Chishti, Muhammad Azhar;Ul-Haque, Muhammad Faiyaz;Khalid, Ahmad Muktar;Sabar, Muhammad Farooq;Rasool, Mahmood;Karim, Sajjad;Khan, Mahwish;Samreen, Baila;Akram, Afia M;Siddiqi, Muhammad Hassan;Shahzadi, Saba;Shahbaz, Sana;Ali, Agha Shabbir
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권7호
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    • pp.3349-3355
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    • 2012
  • Background and objectives: Chromosomal abnormalities play an important role in genesis of acute lymphoblastic leukemia (ALL) and have prognostic implications. Five major risk stratifying fusion genes in ALL are BCR-ABL, MLL-AF4, ETV6-RUNX11, E2A-PBX1 and SIL-TAL1. This work aimed to detect common chromosomal translocations and associated fusion oncogenes in adult ALL patients and study their relationship with clinical features and treatment outcome. Methods: We studied fusion oncogenes in 104 adult ALL patients using RT-PCR and interphase-FISH at diagnosis and their association with clinical characteristics and treatment outcome. Results: Five most common fusion genes i.e. BCR-ABL (t 9; 22), TCF3-PBX1 (t 1; 19), ETV6-RUNX1 (t 12; 21), MLL-AF4 (t 4; 11) and SIL-TAL1 (Del 1p32) were found in 82/104 (79%) patients. TCF3-PBX1 fusion gene was associated with lymphadenopathy, SIL-TAL1 positive patients had frequent organomegaly and usually presented with a platelets count of less than $50{\times}10^9/l$. Survival of patients with fusion gene ETV6-RUNX1 was better when compared to patients harboring other genes. MLL-AF4 and BCR-ABL positivity characterized a subset of adult ALL patients with aggressive clinical behaviour and a poor outcome. Conclusions: This is the first study from Pakistan which investigated the frequency of5 fusion oncogenes in adult ALL patients, and their association with clinical features, treatment response and outcome. Frequencies of some of the oncogenes were different from those reported elsewhere and they appear to be associated with distinct clinical characteristics and treatment outcome. This information will help in the prognostic stratification and risk adapted management of adult ALL patients.

Five Most Common Prognostically Important Fusion Oncogenes are Detected in the Majority of Pakistani Pediatric Acute Lymphoblastic Leukemia Patients and are Strongly Associated with Disease Biology and Treatment Outcome

  • Awan, Tashfeen;Iqbal, Zafar;Aleem, Aamer;Sabir, Noreen;Absar, Muhammad;Rasool, Mahmood;Tahir, Ammara H.;Basit, Sulman;Khalid, Ahmad Mukhtar;Sabar, Muhammad Farooq;Asad, Sultan;Ali, Agha Shabbir;Mahmood, Amer;Akram, Muhammad;Saeed, Tariq;Saleem, Arsalan;Mohsin, Danish;Shah, Ijaz Hussain;Khalid, Muhammad;Asif, Muhammad;Haq, Riazul;Iqbal, Mudassar;Akhtar, Tanveer
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권11호
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    • pp.5469-5475
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    • 2012
  • Background and Objectives: Acute lymphoblastic leukemia (ALL) is a complex genetic disease involving many fusion oncogenes (FO) having prognostic significance. The frequency of various FO can vary in different ethnic groups, with important implications for prognosis, drug selection and treatment outcome. Method: We studied fusion oncogenes in 101 pediatric ALL patients using interphase FISH and RT-PCR, and their associations with clinical features and treatment outcome. Results: Five most common fusion genes i.e. BCR-ABL t (22; 9), TCF3-PBX1 (t 1; 19), ETV6-RUNX1 (t 12; 21), MLL-AF4 (t 4; 11) and SIL-TAL1 (del 1p32) were found in 89/101 (88.1%) patients. Frequency of BCR-ABL was 44.5% (45/101). BCR-ABL positive patients had a significantly lower survival ($43.7{\pm}4.24$ weeks) and higher white cell count as compared to others, except patients with MLL-AF4. The highest relapse-free survival was documented with ETV6-RUNX1 (14.2 months) followed closely by those cases in which no gene was detected (13.100). RFS with BCR-ABL, MLL-AF4, TCF3-PBX1 and SIL-TAL1 was less than 10 months (8.0, 3.6, 5.5 and 8.1 months, respectively). Conclusions: This is the first study from Pakistan correlating molecular markers with disease biology and treatment outcome in pediatric ALL. It revealed the highest reported frequency of BCR-ABL FO in pediatric ALL, associated with poor overall survival. Our data indicate an immediate need for incorporation of tyrosine kinase inhibitors in the treatment of BCR-ABL+ pediatric ALL in this population and the development of facilities for stem cell transplantation.

면역저하 소아에서 발생한 다제내성 녹농균 균혈증을 ceftolozane-tazobactam으로 성공적으로 치료한 증례보고 (Treatment of Multidrug-resistant Pseudomonas aeruginosa Bacteremia in a Immunocompromised Child With Ceftolozane-tazobactam)

  • 유혜선;신아름;김두리;최재영;주희영;조중범;강철인;김예진
    • Pediatric Infection and Vaccine
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    • 제30권1호
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    • pp.47-54
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    • 2023
  • 최근 광범위 항생제 사용의 증가로 인한 다제내성 그람 음성균의 출현이 전 세계적으로 문제가 되고 있다. 특히 다제내성 녹농균(multidrug-resistant Pseudomonas aeruginosa) 감염의 치료는 어려우며 중환자의 사망률을 증가시키는 원인이 된다. 세프톨로잔-타조박탐(ceftolozane-tazobactam, ZerbaxaTM)은 5세대 세팔로스포린과 베타락탐 분해효소저해제로 다제내성 녹농균에 의한 복잡성 요로감염과 복잡성 복강내 감염의 치료에 효과가 있는 것으로 입증되었다. 본지에서 저자들은 소아청소년 혈액암 환자에서 발생한 다제내성 녹농균에 의한 균혈증을 세프톨로잔-타조박탐을 사용하여 성공적으로 치료한 국내 첫 번째 사례를 보고하고자 한다.

가정간호 기록지 분석 - 원주기독병원 가정간호 보건활동을 중심으로 - (An Analysis of Referrals, Nursing Diagnosis, and Nursing Interventions in Home Care - Wonju Christian Hospital Community Health Nursing Service -)

  • 서미혜;허혜경
    • 가정간호학회지
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    • 제3권
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    • pp.53-66
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    • 1996
  • Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

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