Development and Evaluation of a Blended Self-Management Program for Metabolic Syndrome in Patients With Rheumatic Diseases

Rheumatic diseases are known to be associated with the development of metabolic syndrome, which increases mortality rates due to cardiovascular complications. Although a variety of self-management programs for rheumatic diseases have been developed, few have concentrated on metabolic syndrome. This study aimed to develop and verify a blended (a mixture of telephone and online interventions) metabolic syndrome self-management program. The program was developed in four stages: analysis to identify program contents, website design, website development, and validity testing. A quasi-experimental nonequivalent control group, pretest-posttest design was adopted to verify the program effectiveness in 54 patients with rheumatic disease. The program was initially implemented via telephone for 4 weeks and then self-administered via a web-based platform for 20 weeks. Indices of metabolic syndrome and self-management and quality of life scores were measured as outcome variables. Data were collected three times: before intervention, after 4 weeks of telephone interventions, and after 20 weeks of online self-interventions. The devised program had a significant overall effect on metabolic syndrome indices, metabolic syndrome-related self-management behaviors, and quality of life. Detailed analysis showed the program effectively reduced body mass index, waist circumference, systolic blood pressure, and blood glucose levels and improved metabolic syndrome self-management behaviors. Based on our findings, it can be expected that the use of this program may retard or prevent the progression of metabolic syndrome by improving some metabolic syndrome indices and metabolic syndrome-related self-management behaviors, which are key components of care in rheumatic disease patients with metabolic syndrome. This web-based program appears to be beneficial in public health care settings because it is cost-effective, readily available, and may provide long-term support.

Temporal Changes in Metabolic Syndrome Indices and Factors of Metabolic Syndrome Development in Patients With Rheumatic Disease: A Prospective Cohort Study

Patients with rheumatic disease have a high prevalence of metabolic syndrome. The purpose of this study was to investigate temporal changes in metabolic syndrome indices and to identify factors influencing metabolic syndrome development. A prospective cohort study design was adopted. The study participants were 68 outpatients with a rheumatic disease at an outpatient clinic of a university hospital. Data on demographics, health-related characteristics, steroid use, serum C-reactive protein levels, and metabolic syndrome indices were collected between December 2017 and March 2021. Temporal changes in body mass indices, serum triglyceride, and cholesterol levels were significant. Body mass indices, diastolic blood pressure, serum triglyceride, high-density lipoprotein, and fasting blood glucose levels at time of diagnosis were found to influence metabolic syndrome development. Temporal changes in serum triglyceride, cholesterol, and fasting blood glucose levels were significantly influenced by inflammatory status. The findings demonstrate the importance of controlling inflammatory activities in the context of inhibiting the progression of metabolic syndrome and rheumatic diseases.

Paroxysmal Sympathetic Hyperactivity After Acquired Brain Injury: An Integrative Literature Review

BACKGROUND

Paroxysmal sympathetic hyperactivity may occur in patients with acute brain injury and is associated with physical disability, poor clinical outcomes, prolonged hospitalization, and higher health care costs.

OBJECTIVE

To comprehensively review current literature and provide information about paroxysmal sympathetic hyperactivity for nurses.

METHODS

An integrative literature review was conducted according to Whittemore and Knafl's method. The search was conducted from October 2020 through January 2021. The main targets of the literature search were definition, incidence rate, causes, clinical characteristics, pathophysiology, diagnosis, and treatment of paroxysmal sympathetic hyperactivity in pediatric and adult patients. The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

The most characteristic clinical features of paroxysmal sympathetic hyperactivity are hypertension, tachycardia, tachypnea, hyperthermia, diaphoresis, and abnormal motor posturing. Reported incidence rates of paroxysmal sympathetic hyperactivity in patients with brain injury range from 8% to 33%. Various diagnostic criteria have been proposed; most are based on clinical symptoms. Ruling out other causes of the signs and symptoms of paroxysmal sympathetic hyperactivity is important because the signs and symptoms are nonspecific. The major goals of paroxysmal sympathetic hyperactivity management are avoidance of stimuli that may trigger a paroxysmal episode, inhibition of sympathetic overactivity, and prevention of damage to other organs.

CONCLUSIONS

Critical care nurses should be aware of the signs and symptoms of paroxysmal sympathetic hyperactivity in patients with acute brain injury. Early identification is important to ensure timely treatment for patients with paroxysmal sympathetic hyperactivity.

Factors That Influence Sleep Disturbance and the Mediating Effects of Depression on Sleep Disturbance in Patients With Rheumatoid Arthritis

Little is known about the nature of relationships between sleep disturbance and influencing factors in rheumatoid arthritis. The purpose of this study was to identify factors that influence sleep disturbance and to evaluate mediating effects of depression on sleep disturbance. A nonexperimental, descriptive, correlational study design was adopted. One hundred patients with rheumatoid arthritis were recruited. Inflammatory status and levels of pain, fatigue, functional disability, depression, and sleep disturbance were measured. The factors that directly influenced sleep disturbance were gender, rheumatoid arthritis duration, serum C-reactive protein level, fatigue, and depression. Depression was found to have mediating effects on the relationships between sleep disturbance and arthritis symptoms. Pain, fatigue, and depression were found to have significant direct or indirect impacts on sleep disturbance. Our findings may improve understanding of sleep disturbance and aid the development of effective nursing management strategies for patients with rheumatoid arthritis suffering from sleep disturbance.

Development and Validity Testing of a Morning Stiffness Assessment Scale for Patients with Rheumatoid Arthritis

Morning stiffness is known to exert a significant impact on functional ability, quality of life, and employment status. There is an increasing need for a valid, reliable tool to comprehensively assess morning stiffness. The purpose of this study was to develop and verify a Morning Stiffness Assessment Scale. Items were developed on the basis of a framework of the conceptual attributes of morning stiffness. Validity and reliability tests were conducted on the devised scale. Eighty-five patients with rheumatoid arthritis were included to verify the devised scale. A 10-item Morning Stiffness Assessment Scale was developed. Its content and construct validities were well supported. The scale was found to have good reliability. The devised scale is simple and brief, but it provides a more comprehensive means of evaluation for morning stiffness. We believe this scale offers a clinically useful means of properly assessing morning stiffness and has potential utility for evaluating the effects of morning stiffness treatments.

Factors associated with dexamethasone-induced hiccups in cancer patients undergoing chemotherapy: A case control study

PURPOSE

The purpose of this study was to identify demographic, health- and cancer-related, and physiological factors associated with dexamethasone-induced intractable hiccups in cancer patients.

METHOD

This study adopted a retrospective case control design. The study subjects were 168 cancer patients admitted to a university hospital for chemotherapy between October 2011 and December 2016: 58 patients who experienced intractable hiccups while on dexamethasone (cases) and 110 matched patients who received dexamethasone but did not experience hiccups (controls). Data were collected from most recent medical records and included demographic, health- and cancer-related, and physiological factors.

RESULTS

Our findings demonstrated that the development of dexamethasone-induced hiccups was significantly associated with a male gender, a young age, overweight/obesity, the use of alkylating anticancer agents (particularly as the first anticancer drug), high levels of hemoglobin, serum creatinine, uric acid, and albumin, and an elevated body temperature.

CONCLUSIONS

Oncology nurses should be aware of influencing factors of dexamethasone-induced hiccups in cancer patients receiving chemotherapy. Our findings may provide evidence to design oncology nursing strategies that help maximize the benefits of chemotherapy in cancer patients.

Identification of symptom clusters and their synergistic effects on quality of life in rheumatoid arthritis patients

AIMS

To examine the presence of symptom clusters and synergistic effects of symptom clusters on quality of life in rheumatoid arthritis patients.

BACKGROUND

Rheumatoid arthritis patients frequently experience multiple concurrent symptoms of pain, fatigue, and depression.

DESIGN

A nonexperimental, cross-sectional correlation design.

METHODS

The study participants were 179 rheumatoid arthritis patients. Data were collected between August and December 2016. A hypothetical model was developed based on the Theory of Unpleasant Symptoms Model: physiological antecedents included disease activity and obesity; symptoms of pain, fatigue, and depression were hypothesized as being clustered, and quality of life was taken as the outcome variable.

RESULTS

Disease activity had significant direct effects on pain, fatigue, and depression and indirect effects on fatigue and depression, whereas obesity had a significant direct effect on fatigue alone. Three symptom clusters, namely, pain fatigue, fatigue depression, and pain-fatigue depression were identified and found to have significant synergistic effects on quality of life.

CONCLUSIONS

Our findings support the importance of managing clusters of symptoms simultaneously, that is, collective symptom management. Inter-cluster dynamics between symptoms should be considered when nurses develop symptom management strategies or self-management programs to improve the quality of life of rheumatoid arthritis patients.

Correlates of cognitive impairment in patients with chronic kidney failure on haemodialysis: Systematic review and meta-analysis

AIM

To review and identify correlates of cognitive impairment in patients with chronic kidney failure (CKF) on haemodialysis.

BACKGROUND

The literature is consistent with regard to the high prevalence of cognitive impairment among patients with CKF on haemodialysis and its dependence on multidimensional risk factors.

DESIGN

Systematic review and meta-analysis based on Cochrane Handbook and PRISMA.

DATA SOURCES

Electronic searches of the MEDLINE, EMBASE, Cochrane Library databases and major Korean databases were used. Only original research that assessed correlates of cognitive impairment in patients with CKF on haemodialysis and published between 2004-2016 in English or Korean were included.

REVIEW METHODS

Studies were selected according to the PICOS: Population (chronic kidney failure patients with cognitive impairment on haemodialysis); Intervention (not applicable); Comparison (healthy controls or patients with chronic kidney failure on haemodialysis without cognitive impairment); Outcome (cognitive impairment); and Study design (primarily nonexperimental correlational studies and studies with experimental, quasi-experimental, or pre-post cohort designs). Q-test and I² index were used to examine study homogeneity.

RESULTS

A total of 39 studies were finally included. Age, gender, stroke history, difficulties in activities of daily life, haemoglobin levels, pain, sleep difficulties, and depression were found to be significant correlates of cognitive impairment.

CONCLUSIONS

Nurses should be aware that the risk of cognitive impairment in patients with CKF on haemodialysis can be significantly higher for elders, women and in patients with a stroke, greater difficulties in activities of daily living, lower haemoglobin concentrations, higher pain levels, sleep difficulties, or depression.

Comparisons of the stages and psychosocial factors of smoking cessation and coping strategies for smoking cessation in college student smokers: Conventional cigarette smokers compared to dual smokers of conventional and e-cigarettes

AIM

This study was conducted to compare conventional cigarette and dual smokers (users of both conventional and e-cigarettes) with respect to the stages of smoking cessation behavior change and psychosocial factors and coping strategies for smoking cessation among college students.

METHODS

Using convenience and snowball sampling methods, 300 college student smokers were recruited. The data were collected from July to December, 2016. The data included the general characteristics of the participants, information related to smoking and smoking cessation, the stages of smoking cessation behaviors, self-efficacy in, and barriers to, smoking cessation, and adoption of coping strategies for smoking cessation.

RESULTS

The prevalence of e-cigarette use in the cohort was 19.3%. Nicotine dependence in the dual smoker group was significantly higher than that in the conventional cigarette smoker group. No significant intergroup differences were observed for the stage of smoking cessation behavior and self-efficacy in, and perceived barriers to, smoking cessation. However, the dual smokers had a significantly higher prevalence of quit attempts and were more likely to adopt smoking cessation coping strategies.

CONCLUSIONS

The findings indicated that the dual smokers had higher levels of nicotine dependence, but were more likely to attempt to quit smoking and adopt smoking cessation coping strategies. This implies that dual smokers might find it more difficult to quit smoking related to higher nicotine dependence, despite having a higher motivation for smoking cessation. These characteristics should be considered when developing smoking cessation strategies for e-cigarette smokers. In addition, different approaches to smoking cessation education should be used for e-cigarette and conventional cigarette smokers.

A 2-year prospective follow-up study of temporal changes associated with post-stroke cognitive impairment

AIMS

To explore temporal patterns of change in cognitive impairments during the 2 years following stroke and to identify factors that affect these temporal changes.

BACKGROUND

Despite the prognostic importance, temporal changes in post-stroke cognitive impairment have not been systematically investigated.

DESIGN

A non-experimental, prospective, longitudinal descriptive study design.

METHODS

Fifty-two stroke patients were enrolled. Data were collected from April 2015 to September 2017. Cognitive function was evaluated at 5 different times (immediately, and at 3, 6, 12, and 24 months post-stroke).

RESULTS

Significant changes in cognitive function following stroke exhibited an "s-shaped" curve, and the most rapid changes were observed between 3 and 6 months after stroke. The incidence of post-stroke cognitive impairment ranged from 23.1% to 42.3% and was highest at 3 months and lowest at 6 months. Gender, educational level, pre-stroke cognitive and functional abilities, haematoma, and brain surgery were associated with incidence of post-stroke cognitive impairment.

CONCLUSIONS

The ongoing changes exhibited by patterns of cognitive impairment provide evidence that consistent efforts are required to achieve positive changes in post-stroke cognitive function. Our findings may be helpful to develop nursing care strategies aimed at improving cognitive ability and consequently the quality of life of stroke patients.

Temporal Patterns and Influential Factors of Blood Glucose Levels During the First 10-Day Critical Period After Brain Injury

This study was conducted to document temporal patterns of blood glucose level changes during the first 10-day critical period and to identify factors that influence stress-induced hyperglycemia development in brain injury patients. The medical records of 190 brain injury patients were retrospectively reviewed. Blood glucose levels in the poor recovery group were significantly higher than in the good recovery group, particularly during the first 72 hr (158-172 mg/dl). The poor recovery group showed persistent, fluctuating hyperglycemia, whereas the good recovery group exhibited hyperglycemic peaks during the first 3 days that subsequently reduced linearly to normal. Gender, preexisting hypertension, disease severity at admission, total calorie intake, and steroid use were found to influence stress-induced hyperglycemia development significantly. In conclusion, close monitoring and adjustment are required to maintain safe blood glucose levels and the development of protocols for safe glycemic management is essential to improve critical care in brain injury patients.

A diaper-embedded disposable nitrite sensor with integrated on-board urine-activated battery for UTI screening

This paper reports a low-cost solution to the early detection of urinary nitrite, a common surrogate for urinary tract infection (UTI). We present a facile method to fabricate a disposable and flexible colorimetric [1] nitrite sensor and its urine-activated power source [2] on a hydrophobic (wax) paper through laser-assisted patterning and lamination. Such device, integrated with interface circuitry and a Bluetooth low energy (BLE) module can be embedded onto a diaper, and transmit semi-quantitative UTI monitoring information in a point-of-care and autonomous fashion. The proposed nitrite sensing platform achieves a sensitivity of 1.35 ms/(mg/L) and a detection limit of 4 mg/L.

A tailored relocation stress intervention programme for family caregivers of patients transferred from a surgical intensive care unit to a general ward

AIMS AND OBJECTIVES

To develop and examine a relocation stress intervention programme tailored for the family caregivers of patients scheduled for transfer from a surgical intensive care unit to a general ward.

BACKGROUND

Family relocation stress syndrome has been reported to be similar to that exhibited by patients, and investigators have emphasised that nurses should make special efforts to relieve family relocation stress to maximise positive contributions to the well-being of patients by family caregivers.

DESIGN

A nonequivalent control group, nonsynchronised pretest-post-test design was adopted.

METHODS

The study subjects were 60 family caregivers of patients with neurosurgical or general surgical conditions in the surgical intensive care unit of a university hospital located in Incheon, South Korea. Relocation stress and family burden were evaluated at three times, that is before intervention, immediately after transfer and four to five days after transfer.

RESULTS

This relocation stress intervention programme was developed for the family caregivers based on disease characteristics and relocation-related needs. In the experimental group, relocation stress levels significantly and continuously decreased after intervention, whereas in the control group, a slight nonsignificant trend was observed. Family burden levels in the control group increased significantly after transfer, whereas burden levels in the experimental group increased only marginally and nonsignificantly. No significant between-group differences in relocation stress or family burden levels were observed after intervention.

CONCLUSIONS

Relocation stress levels of family caregivers were significantly decreased after intervention in the experimental group, which indicates that the devised family relocation stress intervention programme effectively alleviated family relocation stress.

RELEVANCE TO CLINICAL PRACTICE

The devised intervention programme, which was tailored to disease characteristics and relocation-related needs, may enhance the practicality and efficacy of relocation stress management and make meaningful contribution to the relief of family relocation stress, promote patient recovery and enhance the well-being of patients and family caregivers.

Temporal changes in physiological parameters of systemic inflammatory response syndrome during the three days prior to a diagnosis of sepsis: a case-control study

AIMS AND OBJECTIVES

This study was conducted to determine temporal patterns of early changes in physiological parameters of systemic inflammatory response syndrome over three days prior to a diagnosis of sepsis.

BACKGROUND

Early detection and timely management of systemic inflammatory response syndrome are often not implemented due to a failure to recognise or diagnose systemic inflammatory response syndrome.

DESIGN

A retrospective case-control study design was adopted.

METHODS

All 81 study subjects in an intensive care unit were included: 33 case subjects who received a definitive diagnosis of sepsis and 48 control patients who were not diagnosed with systemic inflammatory response syndrome or sepsis. Vital signs (temperatures, heart rates, blood pressures and respiratory rates) and white blood cell count, urine output, serum creatinine concentration, platelet count and serum glucose level data were collected for one, two and three days prior to sepsis diagnosis.

RESULTS

Homogeneity test revealed greater proportions of the aged and subjects with diabetes mellitus, hypertension and wound in the case group. Analysis also showed significant intergroup differences in systemic inflammatory response syndrome criteria score, heart rates, platelet counts and blood glucose levels, but no intergroup differences in body temperatures, blood pressures, respiratory rates, urine outputs or serum creatinine levels. A larger proportion of case subjects were fitted with a central venous or Foley catheter.

CONCLUSIONS

The presence of a wound, hypertension or diabetes mellitus, and the use of an invasive medical device may increase the risk of systemic inflammatory response syndrome. Of the physiological parameters examined, heart rate, platelet counts, and blood glucose levels might serve as significant early signs of systemic inflammatory response syndrome.

RELEVANCE TO CLINICAL PRACTICE

Caution should be observed whenever diabetic or hypertension patients develop sudden and persistent hyperglycaemia or tachycardia, and nurses should also be aware of the potential for systemic inflammatory response syndrome in patients with a central venous or indwelling urinary catheter.

Temporal patterns of change in vital signs and Cardiac Arrest Risk Triage scores over the 48 hours preceding fatal in-hospital cardiac arrest

AIM

To determine temporal patterns of vital sign and Cardiac Arrest Risk Triage score changes over the 48-hour period preceding cardiac arrest in an ICU setting.

BACKGROUND

Vital sign instability usually occurs prior to cardiac arrest. However, few studies have been conducted on the temporal patterns of individual vital signs preceding cardiac arrest.

DESIGN

A retrospective case-control study.

METHODS

The study subjects were 140 ICU patients (1 June 2011-31 December 2012): 46 died of cardiac arrest (case group), 45 died of other illnesses (control I group) and 49 were discharged after recovering (control II group).

RESULTS

Initial detectable changes in blood pressure appeared 18-20 hours and became dramatic at 5-10 hours before cardiac arrest. Noticeable changes in heart rates began at 4 hours and became more prominent at 2 hours pre-arrest. No apparent patterns in respiratory rate changes were observed. Body temperatures usually indicated a hypothermic state pre-arrest. Cardiac Arrest Risk Triage scores were 16-18 at 48 hours pre-arrest and then continuously increased to 20. Only mean values of systolic blood pressures were significantly different between the three study groups. Mean diastolic blood pressures, heart rates, respiratory rates and Cardiac Arrest Risk Triage scores differed between the case and control II groups and between the control I and II groups.

CONCLUSION

The study demonstrates vital sign instability preceded cardiac arrest and that the temporal patterns of changes in individual vital signs and Cardiac Arrest Risk Triage scores differed between groups. The findings of this study may aid the development of management strategies for cardiac arrest.

A Comprehensive Review of Central Post-Stroke Pain

Although central post-stroke pain is widely recognized as a severe chronic neuropathic pain condition, its consolidated definition, clinical characteristics, and diagnostic criteria have not been defined due to its clinically diverse features. The present study was undertaken to comprehensively review current literature and provide a more complete picture of central post-stroke pain with respect to its definition, prevalence, pathophysiology, clinical characteristics, and diagnostic problems, and to describe the range of therapies currently available. In particular, nursing care perspectives are addressed. It is hoped that this review will help nurses become knowledgeable about central post-stroke pain and provide valuable information for the drafting of effective nursing care plans that improve outcomes and quality of life for patients with central post-stroke pain.

Clinical validity of a relocation stress scale for the families of patients transferred from intensive care units

AIMS AND OBJECTIVES

This study was conducted to develop a family relocation stress scale by modifying the Son's Relocation Stress Syndrome Scale, to examine its clinical validity and reliability and to confirm its suitability for measuring family relocation stress.

BACKGROUND

The transfer of ICU patients to general wards is a significant anxiety-producing event for family members. However, no relocation stress scale has been developed specifically for families.

DESIGN

A nonexperimental, correlation design was adopted.

METHODS

The study subjects were 95 family members of 95 ICU patients at a university hospital located in Incheon, South Korea. Face and construct validities of the devised family relocation stress scale were examined. Construct validity was examined using factor analysis and by using a nomological validity test. Reliability was also examined.

RESULTS

Face and content validity of the scale were verified by confirming that its items adequately measured family relocation stress. Factor analysis yielded four components, and the total variance explained by these four components was 63·0%, which is acceptable. Nomological validity was well supported by significant relationships between relocation stress and degree of preparation for relocation, patient self-care ability, family burden and satisfaction with the relocation process. The devised scale was also found to have good reliability.

CONCLUSIONS

The family relocation stress scale devised in this study was found to have good validity and reliability, and thus, is believed to offer a means of assessing family relocation stress.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study provide a reliable and valid assessment tool when nurses prepare families for patient transfer from an ICU to a ward setting, and may also provide useful information to those developing an intervention programme for family relocation stress management.

Spectrum of the cavity-QED microlaser: strong coupling effects in the frequency pulling at off resonance

We report the first experimental observation of the cavity-QED microlaser spectrum, specifically the unconventional frequency pulling brought by a strong atom-cavity coupling at off resonance. The pulling is enhanced quadratically by the atom-cavity coupling to result in a sensitive response to the number of pumping atoms (2.1 kHz per atom maximally). Periodic variation of the pulling due to the coherent Rabi oscillation is also observed as the number of pumping atoms is increased across multiple thresholds.

The identification of multiple symptom clusters and their effects on functional performance in cancer patients

AIMS AND OBJECTIVES

To identify cancer-related symptom clusters, to explore their inter-relationships and to examine the effects of single symptoms and the synergistic effects of symptom clusters on functional performance using path analysis by structural equation modelling in patients with various types of cancer.

BACKGROUND

Recent studies suggest that cancer patients frequently experience three or more concurrent related symptoms and that this clustering of symptoms is likely to have negative synergistic impacts on outcomes, because of the complicated dynamics of clusters.

DESIGN

A cross-sectional design.

METHODS

One hundred and ten patients with various types of cancer were recruited as in- and out-patients at a University Hospital in Incheon, South Korea. Data collection was performed using a questionnaire and by direct interview. Pain, insomnia, fatigue, depression and functional performance were measured.

RESULTS

The developed model was composed of antecedents, symptom clusters and outcomes. Of the symptoms often encountered as clusters in cancer patients, insomnia, depression and fatigue were found to have significant single (direct) effects on functional performance. Seven symptom clusters were identified between pain and functional performance, three between insomnia and functional performance and one between depression and functional performance. These single symptoms and symptom clusters were found to have significant synergistic effects on functional performance and to explain 24% of functional performance variance.

CONCLUSIONS

Multiple cancer-related symptom clusters may occur and the dynamics within symptom clusters is complicated. Our findings provide sound evidence regarding the importance of assessing and managing clusters of symptoms simultaneously rather than focusing on single symptoms.

RELEVANCE TO CLINICAL PRACTICE

A comprehensive understanding of symptom clusters in cancer patients would help establish valid diagnostic symptom cluster entities and aid the development of subjective/objective phenotypic criteria for symptom cluster based diagnoses and of nursing care protocols for managing symptom clusters.

Prescribed nondegenerate high-order modes in an axial-asymmetric high-finesse Fabry-Perot microcavity

We report an axial-asymmetric high-Q Fabry-Perot cavity supporting nondegenerate Hermite-Gaussian modes of the same mode order. Axial asymmetry of mirror surface was introduced by mechanically grinding off one side of a cylindrical mirror substrate without degrading the original mirror quality. The bases of the resulting Hermite-Gaussian modes were aligned with respect to the direction of grinding, making it possible to prescribe the mirror principal axes.

Patterns and clinical correlates of pain among brain injury patients in critical care assessed with the critical care pain observation tool

This study was conducted to assess the patterns and clinical correlates of acute pain in brain injury patients during the critical care period using the Critical Care Pain Observation Tool (CPOT). Data were collected from 31 brain-injury patients admitted to an intensive care unit (ICU) at a university hospital located in Incheon, Republic of Korea. Glasgow Coma Scale and CPOT scores were assessed on days 1, 3, 6, 9, and 14 after ICU admission. Results showed that temporal changes in pain intensity displayed a consistent pattern in critical care patients with a brain injury during the first 14 days of ICU admission. Mean pain score was highest on day 1, decreased rapidly to reach a minimum on day 3 or 6, and then increased on day 9. In most patients, pain reduced slightly on day 14. Mean CPOT scores were significantly higher in the nonsurgery group than in the surgery group. There was also a nonsignificant trend of higher pain intensity scores among patients with moderate brain injury compared with those with severe injury. CPOT scores immediately after endotracheal suctioning were significantly higher than before endotracheal suctioning, but CPOT scores 20 minutes after suctioning were similar to those before suctioning. The present study may be meaningful in terms of presenting valid clinical information regarding the patterns and characteristics of acute pain in brain injury patients who are often unable to self-report on the presence and intensity of pain.

Susceptibility and factors of pertussis vaccination adherence in Korean health care workers

OBJECTIVE

To examine pertussis susceptibility and identify factors that might influence commitment to pertussis vaccination plan among Korean health care workers.

METHODS

The susceptibilities were examined using Bordetella pertussis IgG ELISA. The individual and related behaviors and cognition and affect factors were measured.

RESULTS

Approximately 20% of subjects were susceptible to pertussis. Only perceived sensitivity and social support system were found to have significant direct effects on commitment to vaccination plan.

CONCLUSIONS

Vaccination with pertussis among health care workers is certainly needed in Korea. In practice, when developing educational programs, perceived sensitivity and support systems need to be specifically considered.

Longitudinal-transverse separations of deep-inelastic structure functions at low Q2 for hydrogen and deuterium

We report on a study of the longitudinal to transverse cross section ratio, R=sigmaL/sigmaT, at low values of x and Q2, as determined from inclusive inelastic electron-hydrogen and electron-deuterium scattering data from Jefferson Laboratory Hall C spanning the four-momentum transfer range 0.06<Q2<2.8 GeV2. Even at the lowest values of Q2, R remains nearly constant and does not disappear with decreasing Q2, as might be expected. We find a nearly identical behavior for hydrogen and deuterium.

Meta-analysis of the effects of respiratory rehabilitation programmes on exercise capacity in accordance with programme characteristics

AIMS AND OBJECTIVES

This study was performed to investigate the effects of respiratory rehabilitation programmes on exercise capacity in terms of the programme type, the protocol used and other programme characteristics.

BACKGROUND

As the suitable rehabilitation programmes have not been specified, diverse programmes are provided in clinics.

DESIGN

Meta-analysis of the primary study results.

METHODS

A computerized search through MEDLINE and CINHAL in addition to tracking down references cited in bibliographies of primarily searched studies were performed to obtain sample studies. Finally 19 research reports were examined.

RESULTS

The results of meta-regression showed that the combined effect size of the programmes on exercise capacity was unaffected by forced expiratory volume (in one second), age, the duration and frequency of the programme, or study quality. In addition, the results of meta-anova indicated that the combined effect size was not affected by (i) whether a programme was hospital based or not, (ii) whether a programme was lower-extremity or combined low- and upper-extremity exercise training, (iii) measurement time, and (iv) exercise intensity.

CONCLUSIONS

The effects of programmes on exercise capacity were not differed in terms of the places where rehabilitation programmes were applied, programme content, measurement time, exercise target sites of body, and the duration and frequency of the programme.

RELEVANCE TO CLINICAL PRACTICE

The results of the present study can provide objective data when constructed or applied on a respiratory rehabilitation programme in clinics.

Alterations in fluid, electrolytes and other serum chemistry values and their relations with enteral tube feeding in acute brain infarction patients

AIMS AND OBJECTIVES

This study was performed to examine whether fluid and electrolyte levels are significantly altered after enteral tube feeding in acute brain infarction patients.

BACKGROUND

Results on the water and electrolyte complications associated with enteral tube feeding are inconsistent and this is partly because of uncontrolled disease-related variables.

DESIGN

Non-experimental design (retrospective study).

METHODS

This study was conducted by retrospectively reviewing the medical records of 85 tube-fed patients.

RESULTS

Mean values of major serum electrolytes (sodium, potassium and chloride) were not significantly altered by tube feeding. However, differences between fluid input and output were significantly increased after tube feeding. The incidence of dehydration reduced overall, while over-hydration increased.

CONCLUSION

The enteral tube feeding of iso-osmolar formulae appeared to be tolerated by most subjects in the present study in terms of electrolyte balance. However, fluid imbalance and over-hydration incidences were significantly increased after tube feeding.

RELEVANCE TO CLINICAL PRACTICE

Due to significant alterations in fluid balance after tube feeding, close attention to the recording of fluid balance, such as intake/output measurements, body weights and simple bedside assessments is needed to detect fluid imbalances and other serious complications at an early stage in enteral tube-feeding patients.

Age differences in fluid balance and serum Na+ and K+ levels after nasogastric tube feeding in stroke patients: elderly vs nonelderly

BACKGROUND

Enteral nutrition support has been commonly used to improve nutrition status in acute stroke patients. The purpose of this study was to examine whether significant alterations in fluid and serum Na+ and K+ levels due to nasogastric tube feeding depended on patient age.

METHODS

This study was conducted by retrospective review of the medical records of tube-fed patients with acute brain infarction who had been hospitalized in a university hospital.

RESULTS

Rates of overhydration were high before tube feeding in both elderly and nonelderly stroke patients. This overhydration rate became more prevalent after iso-osmolal tube feeding in the elderly but decreased somewhat in the nonelderly subjects, and this difference in fluid balance after tube feeding between the elderly and nonelderly was statistically significant. Contrary to fluid balance, serum Na+ and K+ concentrations were no different in the elderly and nonelderly patients after tube feeding.

CONCLUSIONS

Although the results showed that overhydration state was prominent after tube feeding in the elderly, it appeared that there was a very mild clinical impact because the osmolality and serum sodium were not changed in this group. However, more attention to the maintenance of fluid balance in the elderly tube-fed stroke patients is needed because elderly patients have great difficulty in maintaining a normal fluid balance.

Effects of Nasogastric Tube Feeding on Serum Sodium, Potassium, and Glucose Levels

PURPOSE

To examine whether significant alterations in serum sodium, potassium, and glucose levels occurred after nasogastric tube feeding with iso-osmolar formula in acute brain infarction patients.

DESIGN AND METHODS

Serum sodium, potassium, and glucose levels were analyzed by a retrospective medical record review of 85 nasogastric tube-fed patients.

FINDINGS

The mean values of serum sodium and potassium levels on the day before, and 1st, 2nd, and 3rd days of nasogastric feeding were within the normal range. Alterations in the incidence rates of high, normal, and low level of serum sodium and potassium after tube feeding were not statistically significant. The mean blood glucose levels on the day before, and 1st, 2nd, and 3rd days of tube feeding were above normal, and the increase after tube feading was not statistically significant.

CONCLUSIONS

Enteral tube feeding using iso-osmolar formula did not significantly alter serum sodium and potassium balance. However, most participants were hyperglycemic before and after tube feeding, indicating that hyperglycemia can be induced in the acute stages of brain infarction regardless of tube feeding.

A meta-analysis of the effects of various interventions in preventing endotracheal suction-induced hypoxemia

The purpose of this study was to clarify the effects of interventions that were applied to prevent endotracheal suction-induced hypoxia by meta-analysis. To obtain a sample for this meta-analysis, a computerized search was performed through MEDLINE in addition to tracking down additional references cited in bibliographies of past reports. Finally thirty research reports were examined. In terms of the application time of oxygenation, insufflation and preoxygenation were the most prevalently used in the studies. Regarding the methods of oxygenation, the most prevalent technique for oxygenation was hyperoxygenation in combination with hyperinflation. Hyperoxygenation and hyperinflation were most frequently induced by FiO2 of 1 and a 150% tidal volume of three to six breaths, respectively. Suctioning was commonly sustained for <15 seconds using pressures of -80 to -120 mmHg and with size 14 French catheters. Insufflation was less effective than the other methods examined in the present study. From this study, it can be concluded that the interventions that were applied to prevent endotracheal suction-induced hypoxia, regardless of their application times or methods, reduced suction-induced hypoxia significantly.

Measurements of GnE/GnM from the 2H(e-->,en-->)1H Reaction to Q2=1.45 (GeV/c)2

We report new measurements of the ratio of the electric form factor to the magnetic form factor of the neutron, G(n)(E)/G(n)(M), obtained via recoil polarimetry from the quasielastic 2H(e-->,e(')n-->)1H reaction at Q2 values of 0.45, 1.13, and 1.45 (GeV/c)(2) with relative statistical uncertainties of 7.6% and 8.4% at the two higher Q2 points, which points have never been achieved in polarization measurements.

Decreasing pain and depression in a health promotion program for people with rheumatoid arthritis

PURPOSE

To examine whether a comprehensive health promotion program for rheumatoid arthritis (CHPPRA) could alleviate patients' pain, depression, and functional disability.

DESIGN

A quasi-experimental design, nonequivalent control group pretest-posttest design and a preexperimental design, one-group pretest-posttest design were used. The study was conducted in Korea.

METHODS

Outcome variables (pain, depression, and functional disability) and objectives (the practice of pain-management behaviors, regular exercise, and psychosocial coping strategies) were measured in 36 Korean outpatients diagnosed with rheumatoid arthritis (RA). ANOVA/MANOVA and the Wilcoxon signed rank test were used to analyze data.

FINDINGS

Participants in CHPPRA had reduced pain and depression, but did not show improvements in functional disability. In the intervention group, pain management and psychosocial coping skills were significantly improved, but exercise was not significantly altered after participating in CHPPRA.

CONCLUSIONS

Although this study was limited in design, the results can be reference data for designing, using, and evaluating programs for people with RA.

ENVIRONMENTAL AUDITING: Economic Values of Recreational Power Boating Resources in Pennsylvania

/ The travel cost method was used to estimate the economic value of seven major power boating resources in Pennsylvania. A significant relationship between number of visitor trips and cost per visitor trip existed for five of the seven water bodies. The annual total value for those five resources was $396 million, which was 2.5 times greater than the total out-of-pocket expenditures of approximately $157 million visitors spent to visit them. Research results can help resource managers plan and craft programs and policies that are founded on economic values of the natural resources involved.

[Local injection of dexamethasone acetate suspension into the nasal mucosa in cases of olfactory disturbance]

Local injections of suspended steroid solution into the nasal mucosa were performed for 102 patients with olfactory disturbances. Dexamethasone acetate suspension in a concentration of 4 mg/0.5 ml was injected into the mucosa of the nasal septum on each side every 2 weeks for a total of 8 times. Mecobalamin and ATP were also administrated in a daily dose of 750 micrograms and 300 mg, respectively. Of the 102 olfactory disturbance patients, 32 patients had chronic sinusitis, 24 patients had common cold, 14 patients had allergic rhinitis, 9 patients had head trauma and the remaining 23 patients the reason for the disturbance was unknown. Using a visual analogue scale, improvements were found in 63.7%. We assessed the effect of this therapy on the threshold of olfactory sensation and perception using a T & T olfactogram. The overall mean values of olfactory sensation and perception were significantly improved; from 4.75 +/- 1.44 (SD) to 3.01 +/- 2.13 (SD) and from 5.30 +/- 0.88 (SD) to 4.19 +/- 1.60 (SD), respectively. All but the cases of head trauma showed significant improvement. Overall, 44 (43.1%) of the 102 patients were defined as having had a positive olfactory response to this treatment (an improvement in the average perception olfactory score of > = 1.0). In cases of chronic sinusitis, 15 (46.9%) of the 32 patients were positive. 12 (50.0%) of the common cold 24 patients, 7 (50.0%) of the 14 allergic rhinitis patients, 2 (22.2%) of the 9 head trauma patients and 11 (47.8%) of the 23 unknown etiology patients were positive for this treatment. Patients with severe olfactory dysfunction and anosmia showed a lower response than the patients who were mildly to moderately affected. Patients showing no response in the Alinamin intravenous test showed also lower improvement rates than those showing a normal response. Interestingly, 8 (27.6%) of 29 patients with a normal appearance of the olfactory clefts and no response for the Alinamin test responded positively to this treatment. This meant that the olfactory disturbance might be due to the existence of edema surrounding the olfactory nerve, not of the olfactory cleft. The improvement rate of patients treated within one year from the onset of these olfactory disturbance was better than the rate of those over one year. The present new therapeutic modality is very useful as a treatment which showed only be performed by otolaryngologists.

Chemohormonal therapy for malignant melanomas of the nasal and paranasal mucosa

We present three cases of primary malignant melanoma of the nasal or paranasal mucosa that were successfully treated by chemohormonal therapy using tamoxifen (TAM), an anti-estrogen agent. All of the patients showed good responses. TAM is widely known to be an anti-estrogen chemotherapeutic agent in the treatment of breast cancer and is thought to exert its anti-neoplastic effect in breast cancer tissues by competing with estrogen for estrogen receptors. The mechanism of the effect of TAM in malignant melanoma is not yet known. Although its anti-neoplastic mechanism requires further exploration, we believe that chemohormonal therapy may become important in multidisciplinary treatment of malignant melanoma of the nasal and paranasal mucosa.

[Chemohormonal therapy for malignant melanomas]

The management of malignant melanoma of the head and neck is controversial in view of the poor prognosis. Although radical surgery has been proposed as the best therapy for mucosal malignant melanoma, it has seldom been performed because of the extent of tumors and anatomical difficulties. In spite of testing various methods such as chemotherapy, radiotherapy and immunotherapy, that have been suggested for treatment of this malignant disease, there are still no well established effective therapies. We attempted chemohormonal therapy including TAM (Tamoxifen), an anti-estrogen agent, in six patients with primary malignant melanoma from 1993 to 1996. Three patients had a complete response, two had a partial response, and one showed no change. The toxicity in this protocol was found to be low. Generally, the patients showed good responses to chemohormonal therapy. TAM has been previously best known as a therapeutic agent for mammary cancer. Its anti-cancer effect is thought to be due to the anti-estrogen activity revealed by binding to the estrogen receptor competitively with estrogen in the tumor tissue. However, the mechanism of the action of TAM against malignant melanoma has not been clarified yet. Although its anti-cancer mechanism should be further explored, it is suggested that this chemohormonal therapy could occupy a very important position in the multidisciplinary therapy of malignant melanoma of the head and neck.

Submandibular hemangioma as the initial manifestation of Kasabach-Merritt syndrome

Kasabach-Merritt syndrome (thrombocytopenia, consumption coagulopathy and occasional hemolysis) is an infrequent but often fatal complication of rapidly growing hemangiomas in infants. We describe a 1-month-old infant with a huge hemangioma involving the left submandibular region associated with a severe consumptive coagulopathy, who was successfully treated with transfusion of blood products, prednisone and radiation therapy. It is stressed that pediatric otorhinolaryngologists should always be aware of the lethal status of this condition in infants.