• Clinical and Experimental Pediatrics
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• v.45 no.3
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• pp.302-310
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• 2002

Purpose : X-linked agammaglobulinemia(XLA) is an immunodeficiency caused by abnormalities in Bruton's tyrosine kinase(Btk), and is characterized by a deficiency of peripheral blood B cells. We studied cytoplasmic expression of Btk protein and analyzed the Btk gene in peripheral blood mononuclear cells(PBMC) from three XLA families in Korea. Methods : Heparinized venous blood samples were collected from four XLA patients and additional family members in three unrelated XLA families. Mononuclear cells were separated from their blood and the intracellular Btk protein was characterized by a flow cytometry. The mutation analysis was performed using direct sequencing. Results : Cytoplasmic expression of Btk protein in monocytes was not detected in the patients with XLA. We observed a novel deletion and two point mutations within introns(intron 1 and intron 18) resulting in alternative splicings. In XLA family 2, a 980 bp deletion(from intron 9+191 T to intron 10-215 C) including exon 10 was found in patient P2. He was the only sporadic case in this study, because his mother and brother showed a normal Btk expression by flow cytometry. Conclusion : These identified genetic alterations support the molecular heterogeneity of Btk gene in XLA disease. Additionally, by means of flow cytometric analysis, we diagnosed three hypogammaglobulinemia patients as XLA. Advancements in diagnostic methods has facilitated a prompt and definite diagnosis of this disease.

• Journal of Hospice and Palliative Care
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• v.10 no.3
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• pp.137-144
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• 2007

Purpose: The purpose of this study is to identify and assess the needs of the cancer patients and their families and provide basic data to meet with their needs. Methods: This is a descriptive study using questionnaire method. Questionnaire were collected by mail from 76 discharged patients from a hospice ward from May until the end of October, 2004, and data were analyzed by SPSS 10.0. Results: Admitted patients had needs of pain control (85.5%), non-pain symptoms (63.2%) such as vomiting, dyspnea, ascites, etc, and emotional and spiritual problem solving (28.9%, 14.5%). Interests of patients were health care of himself/herself (65.8%), concern for their spouses left alone (32.9%), and future of their children (15.8%). In families' needs of care of 5 areas, "information on patient's status and treatment/nursing care" was shown most high score ($3.48{\pm}0.62$). In detailed questions, they request most 'to inform the prognosis of patients' and the next is 'to inform the reasons that nursing care was required'. The next highest score was to 'inform family roles' ($3.39{\pm}0.64$), and next was spiritual support ($3.11{\pm}0.79$), and emotional support ($3.08{\pm}0.72$). Expectations of family on the treatment were comfortable dying (73.4%) scored the highest. Patients' families were satisfied with volunteer service most in service area (97.4%). The next was pain control (89.5%) and nursing service (77.6%). Conclusion: Health care staff should identify the actual needs of families caring cancer patients and they should operate realistic programme which can give continuous and assistance by reflecting individual needs and characteristics. With these srategies, the quality of life of patients and families can be improved. And then the intervention programme should be developed to measure subjective nursing care needs of terminally ill cancer patients and their families.

• Journal of Korean Academy of Nursing
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• v.20 no.3
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• pp.430-458
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• 1990

Care is a central concept of nursing. Nursing would not exist without caring. Care and quality of life are closely related. Human behavior is a manifestation of culture. We can say that caring and nursing care are expression of culture. The nurse must understand the relationship of culture with care for ensure quality nursing care. But knowledge of cultural factors in nursing is not well developed. Time and in - depth study are needed to find meaningful relationships between culture and care. Nurses recognized the importance of culturally appropriate nursing There are two care systems in culturally based nursing. The folk care system and the professional nursing care system. The folk care system existed long before the professional nursing care system was introduced into this culture. If the discrepancy between these two care systems is great, the client may receive inappropriate nursing care. Culture and subcaltures are diverse and dynamic in nature. Nurses need to know the caring behaviors, patterns, and their meaning in their own culture. In Korea we have taken some first step to study cultural nursing phenomena. It is not our intent necessarily to return to the past and develop a nationalistic of nursing, but to identify the core of traditional caring and relate that to professional nursing care. Our Assumptions are as follows : 1) Care is essential for human growth, well being and survial. 2) 7here are diverse and universal forma, expressions, patterns, and processes of human care that exist transcul - turally. 3) The behaviors and functions of caring differ according to the social structure of each culture. 4) Cultures have folk and professional care values, beliefs, and practices. To promote the quality of nursing care we must understand the folk care value, beliefs, and practices. We undertook this study to understand caring in our traditional culture. The Goals of this study were as follows : 1) To identify patterns in caring behavior, 2) To identify the structural components of caring, and 3) To understand the meaning and some principles of caring. We faised several questions in this study. Who is the care-giver? Who is the care-receipient? Was the woman the major care -giver at any time? What are the patterns in caring behavior? What art the priciples underlying the caring process? We used an interdisciplinary team approach, composed of representatives from nursing and anthropology, to contribute in -depth understanding of caring through a socicaltural perspeetive. A Field study was conducted in Ro-Bong, a small agricultural kinship village. The subjects were nine women and one man aged be or more years of age. Data were collected from january 15 to 21, 1990 through opem-ended in-depth interviews and observations. The interview focused on caring behaviors sorrounding birth, aging, death and child rearing. We analysed these data for meaning, pattern and priciples of caring. In this report we describe caring behaviors surrounding childbirth. The care-givers were primarily mothers- in -low, other women in the family older than the mother - to- be, older neighbor woman, husbands, and mothers of the mother-to- be. The care receivers were the mother-to-be the baby, and the immediate family as a component of kinship. Emerging caring behavior included praying, helping proscribing, giving moral advice(Deug - Dam), showing concern, instructing, protecting, making preparations, showing consideration, touching, trusting, encouraging, giving emotional comfort, being with, worrying about, being patient, preventing problems, showing by an example, looking after bringing up, taking care of postnatal health, streng thening the health condition, entering into another's feelings(empathizing), and sharing food, joy and sorrow The emerging caring component were affection, touching, nurtuing, teaching, praying, comforting, encouraging, sharing. empathizing, self - discipline, protecting, preparing, helping and compassion. Emerging principles of. caring were solidarity, heir- archzeal relationships, sex - role distinction. Caring during birth expresses the valve of life and reflects the valued traditional beliefs that human birth is given by god and a unique unifying family event reaching back to include the ancestors and foreward to later generations. In addition, We found positive and rational foundations for traditionl caring behaviors surrounding birth, these should not be stigmatized as inational or superstitious. The nurse appropriately adopts the rational and positive nature of traditional caring behaviors to promote the quality of nursing care.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.695-698
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• 2010

Purpose: Supernumerary nipple or polythelia is one of the developmental anomalies occurring at the embryonic stage and this anomaly usually arises from the milk line. While this atypical feature is determined during early developmental stage, it may not come out obviously or become troublesome until puberty or lactation. Moreover, sometimes it is confused with a pigmented nevus. Methods: Case 1, a 18-year-old woman with intramammary supernumerary breast consisted of another nipple with middle sized areola on the right lower breast was admitted for a $2.8{\times}3.1\;cm$-sized mass on the right breast which was starting appeared 1 year earlier. The preliminary cytological examination of the material obtained by needle aspiration biopsy from the mass was revealed by fibroadenoma with no malignant change. The patient had the surgical excision of the mass and accessory breast. Case 2, a 16 year-old woman admitted for intra-areolar polythelia of the left breast, even she doesn't have any family history of polythelia. Since she wanted surgical correction of her atypical nipple for aesthetic and psychological reasons, we reconstructed the areola using transposition flaps in an S-plasty design. Results: Case 1, the excised supernumerary nipple showed following histological features. In the superficial layer, an acanthotic and hyperpigmented epithelium with elongated rete ridges was found. In the dermis, there were follicles with hairs surrounded by hypertrophic sebaceous glands. In the deepest portion, abundant secretory glomerules and excretory ducts of apocrine gland type were observed. Case 2, follow-up visits 3 months after the procedure showed a satisfactory result with good shape and projection of the nipple. Conclusion: We report two cases of aberrant mammary tissue who underwent surgical correction, including complete breast (with nipple, areola, and glandular tissue) and intra-areolar polythelia according to the Kajava's classification, and the results were satisfactory.

• The Korean Society of Law and Medicine
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• v.17 no.2
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• pp.257-279
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• 2016

Recently, the Well-dying Act was legislated in Korea, and it will come into effect in August 4, 2017. This Act allows to withdraw the life sustaining treatment from impending death patients and also provide the hospice and palliative treatment to terminal patients. In the Supreme Court's case so called "Madam Kim", medical condition of Madam Kim was a persistent vegetative status owing to brain damage and her family members wanted to remove the artificial ventilation. In 2009, the Supreme Court allowed to withdraw the artificial ventilation under the specific conditions. We applied this new Well-dying Act to the Madam Kim's case hypothetically in order to know this Act can reasonably solve the problem of life sustaining treatment for dying or terminal patients. For the impending patients, the Well-dying Act has the problem not to withdraw the futile treatment due to the advance directives of patients. Vice versa, the terminal patients have no chance to withdraw the life sustaining treatment due to the this Act impose the duty to provide the hospice and palliative treatment despite of advance directives. We need to ruke out the persistent vegetative patients from the terminal patients caused by the cancer, acquired immune deficiency syndrome, chronic obstructive lung disease and chronic liver cirrhosis, In addition, we have to discuss the effect of the advance directives of terminal patients in view of self determination right.

• Journal of Korean Public Health Nursing
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• v.4 no.1
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• pp.5-16
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• 1990

'What is nursing' this question could always be arised and such a question could bring forth the new possibility to definete the nursing concept more clearly. At the middle of 19th Centry, Mrs. Nightingale defined the concept of nursing as follows; 'Nursing is a kind of treatment act to aid the patient so that the health of patients may be recovered naturally, as keeping the most comfortable circumstances.' But after then, the role and function of nurses about purpose and method of nursing has continuously been studied, as the social circumstance has been changed. The fact that care provider and client have the same concept about nursing is very important at the first step of assessment. But at the present time, the care provider and client have not same concept yet, so the difference of unrsing concept between care provider and client is analyzed in this study. This study would be belived to be helpful for the advance of nursing in the future. In this study, 20 questionare from nursing objectives developed by Abdellah(basic care needs, sustenal care needs, remedial care needs and restorative care needs) are used for adult. The data of this study by the 6 point rating scale are analyzed by SAS as follows; 1. Respondent's view is that nursing is necessary in case of group(school or company) rather than private and in case of abnormal conditions rather than normal conditions. 2. Every questionares of nursing objectives are divided into 4 points of view such as basic care needs, sustenal care needs, remedial care needs and restorative care needs are examined. The evaluation by 6 point rating scale revealed that $5.08\pm0.65$ point in basic care needs $4.93\pm0.68$ point in sustenal care needs $4.91\pm0.80$ point in remedial care needs and $4.61\pm0.91$ point in restorative care needs. While basic care needs and substenal care needs that need more physical care show high points, remedial care needs and restorative care needs that need more psychological, social and spiritual care show low points. 3. It was checked whether there is any significant difference between above 4 point of views in nursing objectives and qeneral characteristics or not. As a result, there is significant difference between 4 point of view and ages, educational level, marriage, composition of children. And also there is significant difference between religion and basic care needs, remedial care needs and restorative care needs. But there is no significant difference between any point of view and sex, occupation, experience of admission and experience of family admission. As this study is based on the data gethered from a restricted area, the result can not represent the opinion of all the clients. Therefore the same kind of study should be carried out on many areas repeatedly and also it should be tried to extract objective concept. And also periodical study is needed to observe the changing process of nursing concept.

• The Korean Nurse
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• v.37 no.2
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• pp.53-62
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• 1998

ursing as a profession is characterized by its holistic, mind-body-spirit approach to the patient. Also, nurses have historically been the leaders in health education and promotion. Parish nursing has a great potential for providing primary preventive health care. services as well as assisting people to access the health care system. While working in the community, parish nurses see the church as the new arena for delivering health care services. The parish nurse program was introduced by Granger Westberg in 1984. The concept of parish nursing is based on several beliefs; health is multidimensional and affects all aspects of an individual-physical, psychological, social, and spiritaul being. Parish nursing is one model in which churches can cooperatively work with health care institutions to address the needs of their parishioners. The role of the parish nurse is emphasized in four basic area: a) health education, b) health counseling, c) referal services, and d) facilitation and organization of support groups within the congregation. The parish nurse programs work chiefly in congregation or commuity where a certain language of faith is ready at hand. This means that the parish nurse works in an ecology of meanings and care which encourages the drawing on the message of God's grace, the practices and habits it encourages. The parish nurse may be involved in the church's health ministries and may work on either paid or volunteer basis; however, one of the most important qualification of the parish nurse is to have the nursing knowledge and skills to practice within the standards of Nursing Practice Act. The completion of standards of practice for professional nurses practicing as parish nurses had been identified as a priority by the HMA Executive Board (1996, HMA). In conclusion, parish nursing promotes health and healing by empowering the faith community, family, or individual to incorporate health and healing practices. There are several preconditions that should proceed to establish the foundation for successful development of the parish nursing program in Korea. First, reciprocal relationship with home health nursing should be considered. Second, correct terms and concepts of parish nursing should be studied and understood. Third, systematic study and investigation should be followed for further development of parish nursing. Fourth, strengths and weaknesses of different models should be studied to develop proper model of parish nursing for Korean situation. Finally, consensus of standardized education program and corporation with various religious communities as well as health institutions should be established. When these preconditions are met, the role of parish nursing as a new program for the promotion of holistic health will be established.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.22 no.2
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• pp.539-547
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• 2021

This study was conducted to identify the effects of knowledge of Advance Directives (AD) and the patient's perception of a peaceful death on their attitude toward the withdrawal of life-sustaining treatment and to provide basic data for the development of a nursing intervention program for activating self-determination in the withdrawal of life-sustaining support of patients. The subjects were 167 adult cancer patients who received outpatient or inpatient treatment, from September 15, 2019, to March 30, 2020. The data was analyzed by mean, standard deviation, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression by using SPSS 21.0. From the results, it was observed that the knowledge of AD was 8.87±2.46 out of 12, perception of a peaceful death was 2.87±0.42 out of 4, and attitude toward withdrawal of life-sustaining treatment was 3.46±0.49 out of 5. There was a positive correlation between knowledge of AD, perception of a peaceful death, and their attitude toward withdrawal of life-sustaining treatment. The influencing variables were the knowledge of AD, perception of a peaceful death, discussion with family on withdrawal of life-sustaining treatment, and explanation power was 16.0% (F=10.355, p<.001). Therefore, it is necessary to develop a program that would improve the perception of a peaceful death, increase the knowledge of AD to improve the patients' attitude toward the withdrawal of life-sustaining treatment. An intervention to assist a discussion between the patients and their families in advance would also be useful.

• The Korean Nurse
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• v.29 no.2
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• pp.48-65
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• 1990

The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is : First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to tryout the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9,1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups - nurses, non-medical personnel and patients -gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, re-veals that the physicians were least positive for the- effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients( who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer. The patients wanted "education on how to take care patients at home", "making arrangement to be admitted into hospital when need arises", "IV injection", "checking blood pressure", and "administering medications." On the other hand, nurses believed that they can offer all 16 types of services except "Controlling pain of patients", 4. For the question of "what types of patients are suitable for Home Health Care Program; " the physicians, the nurses and non-medical personnel all gave high score on the cases of "patients of chronic disease", "patients of old age", "terminal cases", and the "patients who require long-term stay in hospital". 5. On the question of who should control Home Health Care Program, only physicians proposed that it should be done through hospitals, while remaining three groups recommended that it should be done through public institutions such as public health center. 6. On the question of home health care fee, the respondents in all four groups believed that the most desireable way is to charge a fixed amount of visiting fee plus treatment service fee and cost of material. 7. In the case when the Home Health Care Program is to be operated through hospitals, it is recommended that a new section be created in the out-patient department for an exclusive handling of the services, instead of assigning it to an existing section. 8. For the qualification of the nurses for-home visiting, the majority of respondents recommended that they should be "registered nurses who have had clinical experiences and who have attended training courses for home health care". 9. On the question of if the program should be implemented; 74.0% of physicians, 87.5% of non-medical personnel, and 93.0% of nurses surveyed expressed positive support. 10. Among the respondents, 74.5% of -physicians, 81.3% of non-medical personnel and 90.9% of nurses said that they would refer patients' to home health care. 11. To the question addressed to patients if they would take advantage of home health care; 82.7% said they would if the fee is applicable to the Health Insurance, and 86.9% said they would follow advises of physicians in case they were decided for early discharge from hospitals. 12. While 93.5% of nurses surveyed had heard about the Home Health Care Program, only 38.6% of physicians surveyed, 50.9% of non-medical personnel, and 35.7% of patients surveyed had heard about the program. In view of above findings, the following measures are deemed prerequisite for an effective implementation of Home Health Care Program. 1. The fee for home health care to be included in the public health insurance. 2. Clearly define the types and scope of services to be offered in the Home Health Care Program. 3. Develop special programs for training nurses who will be assigned to the Home Health Care Program. 4. Train those nurses by consigning them at hospitals and educational institutions. 5. Government conducts publicity campaign toward the public and the hospitals so that the hospitals support the program and patients take advantage of them. 6. Systematic and effective publicity and educational programs for home heath care must be developed and exercises for the people of medical professions in hospitals as well as patients and their families. 7. Establish and operate pilot projects for home health care, to evaluate and refine their programs.

• Journal of Hospice and Palliative Care
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• v.13 no.4
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• pp.216-224
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• 2010

Purpose: The purpose of this study was to evaluate a community-based cancer patient management program (CBPCMP) which was collaborated between a hospice center and public health centers. Methods: The CBPCMP proceeded on four steps; 1) Signing agreements with three public health centers, 2) Enrolling the domiciliary terminal cancer patients, 3) Providing home hospice service, and 4) Inquiring patient's level of satisfaction. From February 1 to December 31 in 2009, 43 terminal cancer patients were referred and provided with home hospice service. The hospice team made a total of 605 visits. Medical records for each visit and data from satisfaction surveys were analyzed. Results: 76.7% of patients were older than 60 years, and 90.7% of the patients were alert. The level of functional status for 76.7% of patients rated as lower than ECOG grade 1. 62.8% of the patients or their caregivers signed hospice service agreements. On the initial evaluation, the most frequent reasons for referral were general weakness (86.0%), followed by anorexia (72.1%). Nurses visited the patients' most frequently (371 visits), followed by volunteers (216 visits). Nurses provided emotional support and health promotion counseling on 95.1% and 22.9% of visits, respectively. The mean satisfaction score rated by patients and their family was 4.45 out of 5. Conclusion: This study tested CBPCMP in collaboration with hospice centers and public health centers. CBPCMP showed a possibility to improve the quality of end of life care. To insure the quality care, however, the guidelines for home hospice service should be developed.