[A study on differences of opinion on health care care programs among physicians, nurses, non-medical personnel and patients]

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 try out 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, reveals 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.(ABSTRACT TRUNCATED AT 400 WORDS)

Oxidative damage to DNA during aging: 8-hydroxy-2'-deoxyguanosine in rat organ DNA and urine

Oxidative damage to DNA is shown to be extensive and could be a major cause of the physiological changes associated with aging and the degenerative diseases related to aging such as cancer. The oxidized nucleoside, 8-hydroxy-2'-deoxyguanosine (oh8dG), one of the approximately 20 known oxidative DNA damage products, has been measured in DNA isolated from various organs of Fischer 344 rats of different ages. oh8dG was present in the DNA isolated from all the organs studied: liver, brain, kidney, intestine, and testes. Steady-state levels of oh8dG ranged from 8 to 73 residues per 10(6) deoxyguanosine residues or 0.2-2.0 x 10(5) residues per cell. Levels of oh8dG in DNA increased with age in liver, kidney, and intestine but remained unchanged in brain and testes. The urinary excretion of oh8dG, which presumably reflects its repair from DNA by nuclease activity, decreased with age from 481 to 165 pmol per kg of body weight per day for urine obtained from 2-month- and 25-month-old rats, respectively. 8-Hydroxyguanine, the proposed repair product of a glycosylase activity, was also assayed in the urine. We estimate approximately 9 x 10(4) oxidative hits to DNA per cell per day in the rat. The results suggest that the age-dependent accumulation of oh8dG residues observed in DNA from liver, kidney, and intestine is principally due to the slow loss of DNA nuclease activity; however, an increase in the rate of oxidative DNA damage cannot be ruled out.

[An exploratory study of role adaptation of newly employed nurses]

The purpose of this study was to investigate factors influencing role adaptation in newly employed nurses and the consistency between role expectations before employment and after one year of employment. The results of this study may contribute to strategy development towards positive role adaptation in newly employed nurses. The data used in this study were collected from 111 nurses, the sample was drawn from all newly employed professional nurses working at Y Medical Center in 1987. The data were collected longitudinally in the 2nd-3rd weeks, the 3rd month and the 12th month after employment. The results of this study were as follows: 1. The degree of change the importance of factors influencing role adaptation and the length of time after employment were investigated. The result showed that the degree of change was the greatest within the first 3 months after employment. Important factors related to role adaptation were working conditions, the environment of the assigned ward and the work load. These factors always displayed high scores without any great change over time. New employees put more importance on practical factors which were obtained through experience in their jobs rather than on ideal factors which they had considered more important while in school. 2. Consistency between role expectation before employment and after 12 month of employment was investigated. The highest consistency item was the expectation about the variety of patients, and the highest inconsistency was the expectation about their own welfare. An average score of 69.07 points was achieved from a maximum of 125 points for the 25 items, showing that expectations for role development before employment were not fully satisfied. In conclusion the administrator should assess the initial expectation at the time of employment of new nurses and she/he should make clear to the new nurses that these expectations may not be realistic. In this way the administrator can provide more satisfactory conditions towards the expectations of the new nurses and help them towards positive role adaptation and reduction of role conflict. Newly employed nurses have high and unrealistic expectations about socialization to the profession from their nursing educational program. It is suggested that a transitional training program should be planned and carried out for newly employed nurses.

Effects of thiobarbiturates on smooth muscle reactivity in isolated aortas from spontaneously hypertensive rats

The direct effects of thiobarbiturates on helical strips of aortas from spontaneously hypertensive (SH) rats were compared with those from Wistar-Kyoto (WKY) rats. At 5-6 wk of age, the arterial pressure of SH and WKY rats did not differ, and the effects of thiobarbiturates on aortic strips from SH and WKY rats were similar. By contrast, at the age of 10-12 or 20-21 wk arterial pressure was higher in SH than in WKY rats, and responses to thiobarbiturates differed in aortic strips from SH and WKY rats: contractile responses were greater in WKY than in SH rats, and relaxing effects were greater in SH than in WKY rats. Responses to sodium nitroprusside did not differ in the aortas of SH and WKY rats, but the effects of nifedipine were greater in strips from SH rats than from WKY rats at the age of 10-12 wk. Ca2(+)-induced contractions of strips exposed to Ca2(+)-free media and depolarized by high K+ were inhibited by treatment with thiamylal; the inhibition was greater in SH than in WKY rats. The increase in smooth-muscle relaxation induced by thiobarbiturates in strips from SH rats may be due to increased sensitivity to the Ca2(+)-channel blocking action of thiobarbiturates.

[A study on the nurse's response for the clinical application of nursing diagnosis]

Although the usefulness and importance of clinical application of nursing diagnosis are well recognized by the academic circle, it is not yet generally practiced. In order to provide data for establishing a policy for clinical nursing diagnosis; a study was made at a seminar, sponsored by the Department of nursing, Severance Hospital, with participation of 190 nurses from 33 hospitals. The objective of the study was to find out: 1) if the nurses agree with the academic community in recognizing the benefits and problems of clinical application of nursing diagnosis; 2) how the nurses evaluate their ability to carry out nursing diagnosis; and 3) if educational programs would help enhance ability of nursing diagnosis among nurses. The summary of findings by the study is as follows: 1. While all nurses responded positively on the question of benefits improving science and quality of nursing, thus elevating credibility and position of nurses, some expressed concern on the practicality of the system in setting up nursing objectiveness, confirming the nursing problems and utilizing patient information. For the 20 questions and the scale of 1-5, the lowest average score was 3.223 and the highest 4.066. 2. The study attempted to find out the opinion of the nurses on the problems that would make difficult to adopt the nursing diagnosis in clinics. The result of the study indicates the nurses believe the major problems are the fact that the subject of nursing diagnosis are not well defined and that the form sheets do not match with the ones that are currently being used. However, comparing it with the result of the previous study on the same question (inadequate manpower and insufficient time allocated for the job were two major problems pointed out then). It can be said that the opinion of the nurses studied this time was much more positive and it suggests that they believe the system can be adopted without increasing manpower and only by giving additional training and by adjusting the format of nursing record sheets. It suggests that the future for adopting a clinical nursing diagnosis is very bright. 3. As the most urgent problem to be solved for adopting clinical nursing diagnosis, 38. 5% responded that it was "education of nurses", and 34.2% responded that it was "staffing adequate number of nurses". 4. For the 10 questions asked for self-evaluation of ability to adopt the system, with the scale of 1-5, average score was lower than 3.(ABSTRACT TRUNCATED AT 400 WORDS)

In vivo oxidative DNA damage: measurement of 8-hydroxy-2'-deoxyguanosine in DNA and urine by high-performance liquid chromatography with electrochemical detection

HPLC with electrochemical detection is a highly sensitive and selective method for detecting the oxidatively modified DNA residue oh8dG. By this method, the detection of oh8dG from DNA and urine offers a powerful approach for assessing in vivo oxidative damage. Application of this technique to the detection of oh8dG from DNA permits the quantitation of the steady-state levels of this oxidatively modified deoxynucleoside and overcomes the detection problems associated with the extremely low levels present in DNA. In addition, the selectivity gained by this detection method eliminates the problem of separating the signal for oh8dG from normal deoxynucleosides. The quantitation of oh8dG in urine complements the measurement of oh8dG in DNA by estimating cumulative oxidative DNA damage in the body. In addition, the urinary assay provides a noninvasive means of measuring this type of damage in laboratory animals and human populations. Thus, an individual animal or human subject may be monitored over time, possibly under various prooxidant conditions, using oh8dG as a sensitive marker for oxidative DNA damage. This analytical approach may allow one to estimate the exposure of an individual to prooxidant conditions associated with lifestyle, genetic predisposition, degenerative diseases, and environmental toxins.

[Use of a noninvasive parameter of early diastolic ventricle function for the detection of graft rejection following heart transplantation]

Since changes in left ventricular early diastolic time intervals can be expected as one of the first detectable functional alterations indicating acute rejection in cardiac transplant patients, time-constant Te, a parameter derived from digitized M-mode echocardiogram, was proved as a marker of acute rejection. Echo results of 30 transplant patients (5-63 yrs) were correlated with myocardial biopsy results (48 rejection negative, 16 rejection positive) of the same day. In transplant patients the M-mode echo parameter Te is prolonged even in phases without rejection (79.0 +/- 12.5 ms vs 64.0 +/- 7.9 ms of healthy controls; p less than 0.0001). Te of transplant patients during rejection were significantly longer than Te of patients without rejection (97.8 +/- 17.9 ms vs 79.0 +/- 12.5 ms; p less than 0.0001). Individual courses demonstrate that rejection is associated with further prolongation of Te and that Te returns to individual basic value in response to treatment. So, Te may prove as a useful noninvasive marker of acute cardiac rejection.

Detection of DNA adducts by high-performance liquid chromatography with electrochemical detection

A method for the detection of rare adducts in DNA has been developed by combining the resolution of high-performance liquid chromatography with the specificity and sensitivity of electrochemical detection. Many adducts are electrochemically active, while the normal bases, except for guanine, are not. Enzymatic hydrolysis of DNA is used to obtain the deoxynucleosides for analysis, or where appropriate, acid hydrolysis or thermal depurination of DNA is used to free the adduct base for analysis. Various types of DNA damage have been induced by in vitro exposure of DNA to acrolein, dimethyl sulfate, sodium nitrite, ascorbate/Cu2+ and gamma-irradiation. Several adducts are detected at a level of one adduct in 10(5)-10(6) normal bases in micrograms of DNA. The method is also useful for measuring O6-methylguanine (O6MeGua) in DNA from rats treated with N-nitrosodimethylamine and 8-hydroxydeoxyguanosine (oh8dG), and O6-MeGua in DNA from bacteria treated with hydrogen peroxide and dimethyl sulfate. oh8dG, which appears to be the most suitable marker for measuring the steady-state level of oxidative DNA damage, can be measured at fmol levels in DNA from normal rat tissues. The method is applicable to the analysis of DNA base damage caused by major endogenous processes relevant to aging, such as deamination, methylation and oxidation. The analysis of DNA adducts with this simple assay also may be potentially useful for studies on carcinogenesis and as a tool in studies on the epidemiology of cancer.

[The effect of crisis intervention by the visiting nurse with cancer patients]

This study was undertaken at Yonsei University Medical Center to identify the crisis responses and nursing problems of patients who had been diagnosed with cancer, and changing patterns of grieving over time periods, and to analyse the effectiveness of follow up care through home visiting nursing. This study was carried out in three stages. The 1st study data were collected from a total of 205 patients who had been diagnosed with cancer from Sept. 1 to Dec. 31, 1987 using a cross-sectional method. The 2nd study data were collected three times from 30 patients with cancer at 4 weeks intervals from March 1 to June 31, 1988 using a longitudinal method. The 3rd study data were collected from two different groups from March 1 to June 31, 1988. One was an experimental group who was visited by nurses and the other one was a control group not visited by nurses. The subjects of the 3rd study consisted of 60 patients with cancer and a Quasi-experimental research design was used. The results were as follows: 1. The patients did not experience one stage at a time among the five stages of grieving, denial, anger, bargaining, depression and acceptance, as identified by Kübler Ross. They experienced a combination of stages, especially of the bargaining and the depression stages. This stages did not change with the passing of time. 2. The patients expressed more physical and socioeconomical problems than emotional problems. And they used more problem coping methods than emotional coping methods. 3. Follow up care through home visiting nursing positively influenced the patient's quality of life, especially their physical well-being and symptom control. The patients responded positively to the home visiting nursing, stating that it was helpful to them. It was concluded that the development of a home visiting nursing program is needed for the effective home care of patients with cancer.

7-Methylguanine adducts in DNA are normally present at high levels and increase on aging: analysis by HPLC with electrochemical detection

The 7-methylguanine adduct in the DNA of rat liver is determined as an indicator of exposure to exogenous and endogenous methylating agents. A method for the analysis of 7-methylguanine adducts has been developed by combining the selectivity of separation of reversed-phase HPLC with the specificity and high sensitivity of electrochemical detection. The sensitivity of the method is about 10,000-fold that of optical methods and is sufficient to determine the endogenous background of DNA methylation. DNA from the liver of normal young rats (6 months old) contains 7-methylguanine at a level of 1 residue per 31,000 bases in mitochondrial DNA and 1 residue per 105,000 bases in nuclear DNA. These levels increase about 2.5-fold in old rats (24 months old). We attribute this strikingly high level of adducts to endogenous methylation, which could contribute to aging and cancer.

Normal oxidative damage to mitochondrial and nuclear DNA is extensive

Oxidative damage to DNA can be caused by excited oxygen species, which are produced by radiation or are by-products of aerobic metabolism. The oxidized base, 8-hydroxydeoxyguanosine (oh8dG), 1 of approximately 20 known radiation damage products, has been assayed in the DNA of rat liver. oh8dG is present at a level of 1 per 130,000 bases in nuclear DNA and 1 per 8000 bases in mtDNA. Mitochondria treated with various prooxidants have an increased level of oh8dG. The high level of oh8dG in mtDNA may be caused by the immense oxygen metabolism, relatively inefficient DNA repair, and the absence of histones in mitochondria. It may be responsible for the observed high mutation rate of mtDNA.

Left ventricular relaxation and filling pattern in diabetic heart muscle disease: an echocardiographic study

In order to study left ventricular function digitized M-mode-echocardiograms were analyzed. 34 patients with insulin-dependent diabetes mellitus (mean age 37.8 years, mean diabetes history 21.5 years) were compared with 35 healthy individuals (mean age 40.9 years). Only patients with negative exercise-ECG, normal 2-D-echocardiogram and normal systemic arterial blood pressure were enclosed. In diabetics the time-constant Te of free wall endocardial retraction was significantly prolonged (76.8 +/- 21.2 ms versus 64.0 +/- 7.9 ms in normals, p less than 0.005), the dimension change during early diastole (dD DS-ERF) was significantly reduced (54.5 +/- 13.1% versus 69.8 +/- 9% in normals, p less than 0.001) and the dimension change during atrial contraction phase (dD ACP) was significantly enlarged (23.4 +/- 14.4% versus 14.3 +/- 6.4% in normals, p less than 0.001). These data suggest that impaired left ventricular diastolic function can be found in patients with long standing insulin-dependent diabetes mellitus.

Reaction of S-nitrosoglutathione with sulfhydryl groups in protein

The covalent modification of sulfhydryl groups by S-nitrosoglutathione has been examined using model compounds. S-Nitrosoglutathione and thiol compounds causing extremely fast transnitrosation reaction and subsequent production of mixed disulfide. Yeast alcohol dehydrogenase is rapidly inactivated by S-nitrosoglutathione. The reversibility and Ellman test demonstrate that the inactivation is the result of covalent modification of sulfhydryl groups in this enzyme.

Isolation of Aeromonas salmonicida from masu salmon in the Republic of Korea

The isolation and identification of the Gram-negative fish pathogen, Aeromonas salmonicida salmonicida, from masu salmon (Oncorhynchus masou) at the Yang Yang Salmon Hatchery in the Republic of Korea is described. The bacterium possessed certain characteristics in common with isolates from fish in Japan. It is an important cause of mortality among cultured salmonids in the Republic of Korea. This is the first report of this fish pathogen from the Asian mainland.

Inactivation of angiotensin converting enzyme by sodium nitroprusside

Angiotensin I converting enzyme is rapidly inactivated by sodium nitroprusside and that inactivation is suppressed in the presence of chloride ion and by the presence of L-alanyl-L-proline or glycyl-L-tryptophan, which are both competitive inhibitors of its catalytic activity. The inactivation by sodium nitroprusside appears to result from the modification of an unusually reactive lysine residue in or near the active site.

Congestive heart failure due to mitochondrial cardiomyopathy in Kearns-Sayre syndrome

Despite extensive analysis of the ultrastructural changes in skeletal muscle fibers in chronic progressive external ophthalmoplegia (CPEO), similar changes in the heart muscle fibers of patients with cardiac involvement in CPEO, called Kearns-Sayre syndrome, have not been described in detail. We report the clinical long-term course in a patient with Kearns-Sayre syndrome in whom mitochondrial cardiomyopathy was suspected in vivo and was confirmed at autopsy as the underlying cause of severe dilative cardiomyopathy. Enlarged, abnormally structured, excessively augmented mitochondria and loss of myofibrils could be shown both in skeletal and heart muscle cells.

Fatal mitochondrial cardiomyopathy in Kearns-Sayre syndrome

The clinical and postmortem findings in a 26 year old man with Kearns-Sayre syndrome are described. In the last years of his life he suffered from cardiac arrhythmias and a congestive cardiomyopathy, dying of cardiac pump failure. The heart was enlarged, especially the left ventricle which was fibrotic and excessively dilated. Histological and fine structural investigation revealed an excessive loss of myofibrils and an increase of enlarged mitochondria with lamellar and atypically tubular cristae in widespread heart muscle cells. Mitochondrial anomalies were also observed in some cells of the conductive system. This patient thus suffered not only from a mitochondrial myopathy with ragged red fibers but also from a fatal mitochondrial cardiomyopathy. The anomalies observed in the mitochondria of the conductive system cells suggest that the well-known conductive abnormalities in patients with Kearns-Sayre syndrome might be at least partly caused by disturbed function of these mitochondria.

Glycosaminoglycans: structure and interaction

In the last few years, there has been considerable progress in the studies on glycosaminoglycans, a group of acidic polysaccharides present in the intercellular matrix of connective tissue. X-ray diffraction studies have indicated that these polymers can exist in the condensed phase in some helical form. Chiroptical and hydrodynamic measurements have provided significant information regarding the molecular conformation in solution and other physicochemical properties of the polymers. Studies related to the interaction properties of glycosaminoglycans with polypeptides, metal ions, and other molecules are numerous. This review covers mainly the results and their interpretations of both published and as yet unpublished material of the 1970s, but certain previous data are also included. A present-day concept regarding the structure and interaction properties of these molecules on the basis of various physicochemical measurements is presented. The biosynthesis and metabolism of glycosaminoglycans, and the structure of proteoglycans and glycoproteins, are not discussed.

Optical characteristics of carboxyl group in relation to the circular dichroic properties and dissociation constants of glycosaminoglycans

Circular dichroism studies of glycosaminoglycans including chemically transformed heparins at various pH values reveal that carboxyl chromophore plays an important role in the dichroic behavior of the polymers. With decreasing pH, iduronic acid-containing glycosaminoglycans show increased negative ellipticity near 220 nm whereas the polymers containing glucuronic acid display enhanced negative dichroism near 230 nm and decreased negative dichroism around 210 nm. The pH-dependent optical properties have been utilized to determine the pKa values of uronic acid moieties. The acid strengths of the iduronic acid-containing glycosaminoglycans are inherently smaller than those of corresponding glucuronic acid-containing polymers. Glycosaminoglycans in which the amino sugars are linked with iduronic acid display a very weak n leads to pi* amide transition, or none. The rotational strength at 210 nm of these polymers is largely due to iduronic acid moieties. The CD variations above 200 nm with change in pH do not indicate any major conformational transition of the molecules but the difference between dermatan sulfate and heparin can be attributed to difference either in iduronic acid conformation or in intersaccharide linkages.

Conformational transition of hyaluronic acid: carboxylic group participation and thermal effect

The chiroptical, viscosity and titration studies of hyaluronic acid in mixed organic/water solvent show a reversible conformational transition of the molecule depending upon pH, solvent composition, temperature, and molecular weight. Neither methylhyaluronate nor chondroitin undergoes conformational transition of this type. These results indicate that hydrogen bonding between the protonated carboxylic group and carbonyl oxygen of the acetamido group is directly involved in the conformational change. Results with chondroitin provide further support for the 4-fold helical structure that we have proposed for hyaluronic acid in mixed organic/water solvent. The thermal stability of the conformation has been studied under various pH values and solvent compositions.