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조갑출 ( Kap Chul Cho ) 연세대학교 간호정책연구소 2006 간호학탐구 Vol.15 No.1
Backgrounds: As the hospital structure becomes more complicated and bureaucratic, concerns for management of the institution have taken priority over patient care itself. Humanistic nursing scholars are leading a movement of humanistic caring and nurse-as-advocate. Since 1990, descriptive studies about the concept of client advocacy have been published in the health science journals. However, there are not enough bases to apply the concept of client advocacy in nursing practice. Purposes: The purpose of this study, literature review, is to inquire possibility of the development to the prescriptive theory from the client advocacy model and the application to the nursing practice with the client advocacy model. Results: A definition and the conceptual structure of client advocacy was described in this paper. The attributes consisted of four categories : nurse-client relationship, motives for advocacy, advocacy behaviors, and responses to the advocacy behaviors. In order to apply the client advocacy model to the nursing practice, following procedures are established : 1. Identify and assess the advocacy needed client Although client advocacy is one of the most common nursing activities under all of the nursing situations, the nurse should apply client advocacy for the vulnerable population. 2. Determine the behavior of client advocacy Decision of the proper advocacy behavior should be made with respecting the client`s self-determination. Additionally, determination of the pathway of client advocacy should be done by analyzing client`s situation. 3. Perform the client advocacy activities Since the purpose of the client advocacy is enhancing client`s rights and benefit, the nurse needs to find the advocacy strategy which could bring the maximum benefit to the client. 4. Pursue positive outcome of the client advocacy In order to apply the client advocacy to the nursing practice, the client`s rights and health benefit should be the outcome of the advocacy activity. Also, the outcome of the client advocacy should be measurable. Suggestions: On the basis of the results of this study, suggestions for further research were described as follows : 1) It is necessary to develop an instrument to measure nurse`s advocacy activities on the basis of attributes and indicators. 2) It is necessary to have a study which proves the positive outcomes of the client advocacy by measuring and comparing the client`s satisfaction, hospital days, complication, and recovery.
조홍근,김범수,허갑범,이현철,김경래,정윤석,송영구 대한내과학회 1995 대한내과학회지 Vol.48 No.4
The syndrome of resistance to thyroid hormone are disorders in which the body's tissue are resistant to the effects of thyroid hormone. They are characterized by reduced clinical and biochemical manifestations of thyroid hormone action relative to the circulating hormone levels. In practice, such patients are identified because they have increased serum thyroxine (T₃) and triiodothyronine (T₄) and normal thyrotropin (TSH) levels in the absence of intercurrent acute illness, drugs, or alterations of thyroid hormone binding to serum proteins. Since the publication of the index cases in 1967 by Refetoff et al., about 200 cases have been reported. Mutations which result in single amino acid substitutions in the T₃ binding region of the β receptor molecule is suggested for causal mechanism. We experienced a case of 26 year old female with generalized resistance to thyroid hormone. She had increased serum concentration of free thyroxine (fT₄ 5.42 ng/dl) and triiodothyronine (T₃$gt;800ng/dl). Serum TSH level were increased (TSH: 2.08 μIU/ml). The serum α-subunit/TSH molar ratio was less than 1.0 and Magnetic Resonance Imaging showed no evidence of pituitary mass. These features are characteristics of the syndrome of generalized resistance to thyroid hormone. So we present this case of syndrome of generalized resistance to thyroid hormone with a literature review.
여러 질환에서의 Antinuclear Antibody(ANA) Test 에 관한 연구
조준구,김현숙,홍천수,조철호,권오현,김현만,이수곤,허갑범,전상일 대한내과학회 1987 대한내과학회지 Vol.32 No.2
Antinuclear antibodies are autoantibodies that are usually detected by indirect immunofluorescence and are directed against components of human and other mammalian cell nuclei. Between January 1982 and December 1984, we retrospectively reviewed the records of 238 patients with a positive ANA test. The following results were obtained from this review. 1) Among 238 ANA positive specimens, 98 (41.2%) were connective tissue disorders, 43 (18.0%) immune disorders and 97 (40.8%) other disorders. 2) Among 238 ANA positive specimens, 135 (57%) were low, 26 (11%) intermediate and 77 (32%) high titers. Sixty three of 98 (64.2%) sera from patients with connective tissue disorders and 44 of 53 (83%) sera from patients with SLE had ANA titers of 1:80 or more. Thirty two of 42 (74.4%) sera from patients with immune disorders and 68 of 97 (70.1%) sera from patients with other disorders had ANA titers of 1: 20. 3) Among 238 ANA positive specimens, immunofluorescent patterns showed that 105 (44%) were homogeneous, 102 (43%) speckled, 13 (5.5%) mixed, 12 (5%) peripheral and 6(2.5%) nucleolar pattern. 4) In 53 SLE patients, 41 (77%) were high titers in ANA test and homogeneous and speckled patterns were 26 (55.5%) and 20 (37.7%) respectively. Thirty of 37 (81%) SLE patients had positive anti-DNA test and 16cases (43%) were high titers. 5) Nineteen patients (13.6%) of 140 nonrheumatic disorders showed high ANA titers. Among nine patients with idipathic thrombocytopenic purpura, three patients showed high ANA titers (1:160 1). In conclusion ANA test was useful to diagnose various rheumatic disease. Some nonrheumatic patients also revealed positive ANA test. ANA titers were high in rheumatic disorders, but some non-rheumatic patients with high ANA titers should be followed to look for evolving rheumatic disorders.