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Purpose@#This study aimed to investigate the relationship between' perceived ethical climate, workplace bullying, and turnover intention among hospital nurses. @*Methods@#This study was conducted with 190 full-time nurses working in hospitals in Korea as participants. Data were collected from online communities using Google Docs from July 22 to July 25, 2022. @*Results@#Average values were as follows: ethical climate was 3.79±0.60, workplace bullying was 2.31±0.77, and turnover intention was 3.79±0.60. While turnover intention had no correlation with ethical climate, it had a positive relationship with workplace bullying. Workplace bullying was influenced by verbal aggression (β=.48, p=.001), inappropriate task assignment (β=.26, p=.006), monthly salary (β=.18, p=.001), and working department (β=-.13, p=.012). These four variables may explain 60.0% of hospital nurses' turnover intention. @*Conclusion@#To prevent turnover of hospital nurses, nursing managers should establish nursing career development programs to ensure adequate retention of experienced nurses. The need to provide nurses with communication skills training to prevent verbal attacks and bullying in the workplace has been identified.
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Objectives@#This study aims to understand the perceptions regarding preventive dental services among dental professionals. @*Methods@#In-depth interviews were conducted with three groups of dental professionals―dentists, dental hygienists, and dental hygienists that specialized in preventive service―who were selected using a convenience sampling method. @*Results@#First, there was limited awareness among dentists regarding the need for preventive care, because of the treatment-oriented philosophy and scarcity of preventive care success models. Second, dental hygienists commented that there was a lack of the person in charge and systematic process for preventive services. It would not help when they decided to change working place even though they had high anxiety working for preventive care. However, both these professionals agreed that preventive treatment is important as the core of care and that it was important to develop various improvement methods to promote preventive services. @*Conclusions@#To activate preventive services in dental clinics, it is essential to improve the operating system and encourage dental professionals to realize the importance of preventive services.
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Phosphoinositide 3-kinase (PI3K) is considered as a promising therapeutic target for rheumatoid arthritis (RA) because of its involvement in inflammatory processes. However, limited studies have reported the involvement of PI3KC2γ in RA, and the underlying mechanism remains largely unknown. Therefore, we investigated the role of PI3KC2γ as a novel therapeutic target for RA and the effect of its selective inhibitor, PBT-6. In this study, we observed that PI3KC2γ was markedly increased in the synovial fluid and tissue as well as the PBMCs of patients with RA. PBT-6, a novel PI3KC2γ inhibitor, decreased the cell growth of TNF-mediated synovial fibroblasts and LPS-mediated macrophages. Furthermore, PBT-6 inhibited the PI3KC2γ expression and PI3K/AKT signaling pathway in both synovial fibroblasts and macrophages. In addition, PBT-6 suppressed macrophage migration via CCL2 and osteoclastogenesis. In CIA mice, it significantly inhibited the progression and development of RA by decreasing arthritis scores and paw swelling. Three-dimensional micro-computed tomography confirmed that PBT-6 enhanced the joint structures in CIA mice. Taken together, our findings suggest that PI3KC2γ is a therapeutic target for RA, and PBT-6 could be developed as a novel PI3KC2γ inhibitor to target inflammatory diseases including RA.
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G protein-coupled receptors (GPCRs) are membrane receptors whose agonist-induced dynamic conformational changes trigger heterotrimeric G protein activation, followed by GRK-mediated phosphorylation and arrestin-mediated desensitization. Cytosolic regions of GPCRs have been studied extensively because they are direct contact sites with G proteins, GRKs, and arrestins. Among various cytosolic regions, the role of helix 8 is least understood, although a few studies have suggested that it is involved in G protein activation, receptor localization, and/or internalization. In the present study, we investigated the role of helix 8 in dopamine receptor signaling focusing on dopamine D1 receptor (D1R) and dopamine D2 receptor (D2R). D1R couples exclusively to Gs, whereas D2R couples exclusively to Gi. Bioinformatic analysis implied that the sequences of helix 8 may affect GPCR-G protein coupling selectivity; therefore, we evaluated if swapping helix 8 between D1R and D2R changed G protein selectivity. Our results suggest that helix 8 is not involved in D1R-Gs or D2R-Gi coupling selectivity. Instead, we observed that D1R with D2R helix 8 or D1R with an increased number of hydrophobic residues in helix 8 relative to wild-type showed diminished β-arrestin-mediated desensitization, resulting in increased Gs signaling.
Subject(s)
Arrestin , Arrestins , Computational Biology , Cytosol , Dopamine , Family Characteristics , GTP-Binding Proteins , Membranes , Phosphorylation , Receptors, Dopamine D1 , Receptors, Dopamine D2 , Receptors, DopamineABSTRACT
PURPOSE: This study aimed to explore and understand nursing students' nunchi experiences in clinical practice. METHODS: Participants were nursing students in the third and fourth years who had clinical experience. A total of 20 nursing students were divided into three focus groups based on their grade levels and gender. Data were collected from December 2017 to March 2018 through focus group interviews and were analyzed via Colaizzi's phenomenological methodology. RESULTS: The study results consisted of 5 theme clusters, 11 themes, and 24 subthemes. These clusters were: confusion about ambiguous behavioral standards, effort in following social norms, concern about getting hurt, physical and psychological exhaustion, and forming social attitudes. CONCLUSION: These results show that nunchi has positive and negative effects on the clinical practice of nursing students. We need to improve the causes of nunchi, which can have a negative impact on clinical practice.
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Humans , Focus Groups , Nursing , Social Norms , Students, NursingABSTRACT
PURPOSE: Objectives of this study were to identify and describe cultural meaning for nursing students in the class in fundamental nursing practice. METHODS: Data were collected from November 2016 to May 2017 included focus group interviews and participants observation. The key informants in this study included 23 nursing students divided into 3 focus groups who had taken the course in fundamental nursing practice in university U and university S in Kyungpook, and university D in Jeonnam. Interviews continued until no new information could be identified from transcripts. Data were analyzed using the taxonomic analysis method developed by Spradley. RESULTS: Based on the data acquired from the interviews, cultural domains in the class “fundamental nursing practice” were classified as ‘community oriented activities’, ‘learning and playing space’, ‘relationship of difference and discrimination’, ‘time for present and future’. CONCLUSION: The culture in the class “fundamental nursing practice” could be summarized as ‘non-standardized learning with team dynamics’. Also nursing students learned about a small society whose members are becoming nurses. Results indicate that it is critical for professors to understand students' values, beliefs and their attitude in order to aid in adjustment to class.
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Humans , Anthropology, Cultural , Focus Groups , Learning , Methods , Nursing , Students, Nursing , UniversitiesABSTRACT
PURPOSE: We report a case of unilateral, focal, pigmented paravenous retinochoroidal atrophy (PPRCA). CASE SUMMARY: A 46-year-old female visited our clinic in complaint of a vague problem with her right eye identified during a general medical examination. The visual acuity (without correction) of both eyes was 1.0. Slit-lamp examination of both eyes revealed no specific signs. Fundus examination of the right eye revealed focal, bony-spicule-shaped retinochoroidal atrophy with pigmentation along the course of the superior retinal vein. A fundus autofluorescence examination revealed principally hypofluorescence with some hyperfluorescence at the margin of the atrophic retinochoroidal lesion. Optical coherence tomography revealed mixed clumping and atrophy of the retinal pigment epithelium (RPE) layer and thinning of the choriocapillaris layer. Fluorescence angiography revealed a window defect and blockage at the site of the lesion (the fluorescent material did not enter the lesion). The site of the window defect was in correlation with the atrophic RPE region. The site of the blockage at lesion also matched with the site of the regional pigment clumping. No definite leakage was observed. CONCLUSIONS: To the best of our knowledge, this is the first case of unilateral focal PPRCA reported from Korea.
Subject(s)
Female , Humans , Middle Aged , Atrophy , Fluorescein Angiography , Korea , Pigmentation , Retinal Pigment Epithelium , Retinal Vein , Tomography, Optical Coherence , Visual AcuityABSTRACT
PURPOSE: To compare the outer retinal thickness in normal fellow eyes of patients with unilateral age-related macular degeneration (AMD) and normal control eyes. METHODS: We retrospectively reviewed the medical records of 60 patients with unilateral exudative AMD including polypoidal choroidal vasculopathy and 60 normal controls. Spectralis optical coherence tomography was performed in the normal fellow eyes of patients with unilateral AMD and in the normal group. The thicknesses between the retinal pigment epithelium (RPE) line and the cone outer segment tips (COST) line, between the COST line and the photoreceptor inner segment/outer segment (IS/OS) line, and between the IS/OS line and the external limiting membrane (ELM) line were measured at the fovea in both groups. RESULTS: The thickness between the RPE and COST lines was 32.4 ± 3.0 µm in normal fellow eyes of patients with unilateral AMD and 35.3 ± 3.5 µm in the normal group (p < 0.001). Total retinal thickness, thicknesses between the COST and the IS/OS lines and the IS/OS and the ELM lines in fellow eyes were not significantly different from those of normal eyes (p = 0.126, 0.615, 0.874). There was no significant difference in total retinal thickness or each outer retinal thickness measured in normal fellow eyes between patients with neovascular AMD and polypoidal choroidal vasculopathy. CONCLUSIONS: The thickness between the RPE and the COST lines was thinner in the fellow eyes of patients with unilateral AMD than in the normal eyes. We suggest that less thickness between the RPE and COST lines might indicate a greater risk of AMD.
Subject(s)
Humans , Choroid , Macular Degeneration , Medical Records , Membranes , Retinal Pigment Epithelium , Retinaldehyde , Retrospective Studies , Tomography, Optical CoherenceABSTRACT
PURPOSE: The objective was to evaluate the effect of co-implantation of a preloaded capsular tension ring (CTR) and aberration-free monofocal intraocular lens (IOL) on clinical outcomes and visual quality after cataract surgery. MATERIALS AND METHODS: Patients who underwent cataract surgery were randomized into two groups that were implanted with a CTR and IOL (group 1, 26 eyes) or an IOL only (group 2, 26 eyes). At 1 and 3 months after surgery, visual acuity, refractive errors, refractive prediction errors, ocular aberrations, and modulation transfer function (MTF) were analyzed. At 3 months postoperatively, anterior chamber depth (ACD) and contrast sensitivity were evaluated. RESULTS: Group 1 showed greater hyperopic shift, which caused the refractive prediction error at 3 months after surgery to be significantly different between the two groups (p=0.049). Differences in ACD between the preoperative and postoperative periods tended to be greater in group 1 than in group 2. At 3 months postoperatively, internal MTF values at 20, 25, and 30 cycles per degree were significantly better in group 1 than in group 2 (p=0.034, 0.017, and 0.017, respectively). Contrast sensitivity showed comparable results at almost all spatial frequencies between the groups. CONCLUSION: Regarding visual acuity and quality, both groups showed comparable results. Co-implantation of a CTR and aberration-free monofocal IOL was associated with hyperopic refractive outcomes. Surgeons should consider the position of the IOL when planning co-implantation of a CTR and IOL.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Cataract/physiopathology , Cataract Extraction , Contrast Sensitivity , Lens Implantation, Intraocular/instrumentation , Postoperative Period , Prospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To evaluate the prognostic factors that contribute to favorable surgical outcomes of single-stage adjustable strabismus surgery in thyroid eye disease. METHODS: Retrospective review of clinical case notes were done of all patients who had surgical treatment for strabismus related to thyroid eye disease under the care of a single hospital between January 2005 and December 2012 (n = 30). Factors that possibly influenced the outcome were statistically analyzed for significance. "Successful" surgical outcome was defined as patients whose residual deviation was within 8 prism diopters and free from diplopia in the primary position on postoperative 1 year. RESULTS: Mean preoperative vertical deviation was 17.5 prism diopters (PD) and horizontal deviation was 20.3 PD. Mean follow-up time was 12.4 months. Twenty-four patients (80.0%) had successful surgical results. Four patients (13.3%) needed further surgery due to recurrence of previous strabismus and two patients (6.7%) needed prism glasses due to remaining strabismus. Previous history of proptosis (p = 0.02), optic neuropathy (p = 0.01), intravenous (IV) steroid pulse therapy (p = 0.02), number of times of IV steroid pulse therapy (p = 0.01), and orbital decompression surgery (p = 0.03) were different between success and failure groups. CONCLUSIONS: Single-stage adjustable strabismus surgery under topical anesthesia showed a success rate of 80% for strabismus patients with thyroid eye disease. Patients who previously had proptosis, optic neuropathy, IV steroid pulse therapy, and orbital decompression surgery significantly showed unsuccessful results after strabismus surgery.
Subject(s)
Humans , Anesthesia , Decompression , Diplopia , Exophthalmos , Eye Diseases , Eyeglasses , Follow-Up Studies , Glass , Optic Nerve Diseases , Orbit , Recurrence , Retrospective Studies , Strabismus , Thyroid GlandABSTRACT
PURPOSE: The purpose of this study was to determine the relationship among the factors of nursing professionalism, critical thinking disposition and self-leadership in nursing students. METHODS: The participants were 715 nursing students in tertiary education. Data was collected from March 10 to 14, 2014 using self-report questionnaires and analyzed through descriptive statistics, t-test, ANOVA and Pearson correlation coefficient with SPSS/win 17.0. RESULTS: The mean scores for nursing professionalism (3.48+/-.50), critical thinking disposition (3.14+/-.27), self-leadership (3.44+/-.40) were above average. There was a positive correlation between nursing professionalism and self-leadership (r=.452, p<.01) and between critical thinking disposition and self-leadership (r=.405, p<.001). CONCLUSION: The result of this study indicates that developing nursing professionalism and critical thinking disposition in nursing students is significant for improving their self-leadership. Therefore the findings suggest meaningful basic data for nursing education.
Subject(s)
Humans , Education , Education, Nursing , Nursing , Surveys and Questionnaires , Students, Nursing , ThinkingABSTRACT
PURPOSE: To report a case of massive spontaneous suprachoroidal hemorrhage in a middle-aged female with heavy alcohol consumption. CASE SUMMARY: A 48-year-old female with a history of heavy alcohol consumption developed a massive spontaneous suprachoroidal hemorrhage in the right eye. Fundus examination and B-scan ultrasonography of the right eye revealed a hemorrhagic choroidal detachment with kissing choroidal sign. On systemic evaluation, she was diagnosed with alcohol-induced hepatitis, diabetes, and diabetic nephropathy. We performed trans-scleral drainage of the suprachoroidal hemorrhage, trans pars plana vitrectomy and silicone oil injection in her right eye. CONCLUSIONS: To our knowledge, this is the first case report of massive spontaneous suprachoroidal hemorrhage in a patient with heavy alcohol intake.
Subject(s)
Female , Humans , Middle Aged , Alcohol Drinking , Choroid , Diabetic Nephropathies , Drainage , Hemorrhage , Hepatitis , Silicone Oils , Ultrasonography , VitrectomyABSTRACT
PURPOSE: To compare the astigmatic power of toric intraocular lenses (IOLs) obtained from the AcrySof, TECNIS, and iTrace toric calculator in patients with preoperative with-the-rule (WTR) or against-the-rule (ATR) corneal astigmatism. MATERIALS AND METHODS: Fifty eyes with cataract and corneal astigmatism greater than 0.75 diopters were enrolled in each group (WTR and ATR). Keratometric values were measured using autokeratometry, an IOLMaster, and an iTrace, which incorporated corneal topography and ray-tracing aberrometry. Based on measured keratometric values, the astigmatic power of each toric IOL was calculated using three toric calculators. RESULTS: Bland-Altman plots showed good agreement between six pairwise corneal astigmatism values in both groups. The TECNIS calculator tended to suggest a higher astigmatic power of the toric IOL than the AcrySof calculator. With the higher astigmatism and keratometric values from the IOLMaster, in both groups, calculations from the AcrySof and TECNIS calculators resulted in higher calculated astigmatic powers than those from same calculators with autokeratometry-measured values, demonstrating good agreement. With the higher calculated astigmatic power values, the values from the iTrace toric calculator using keratometric values obtained from iTrace ray tracing wavefront aberrometry or iTrace simulated keratometry showed fair to moderate agreement with those from the other calculator-keratometry pairs in both groups. CONCLUSION: To achieve the best refractive outcome after toric IOL implantation, understanding the differences in keratometric values between instruments and in calculated astigmatic power among toric calculator programs is necessary. Moreover, systemic analysis of each toric calculator in conjunction with postoperative data is required.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Aberrometry , Astigmatism/physiopathology , Cataract , Cornea/surgery , Corneal Topography , Eye , Lens Implantation, Intraocular , Lenses, Intraocular , Phacoemulsification/methods , Postoperative Period , Refraction, Ocular/physiology , Visual Acuity/physiologyABSTRACT
PURPOSE: To compare the efficacy of selective laser trabeculoplasty (SLT) in phakic and pseudophakic eyes in primary open-angle glaucoma. METHODS: Charts of 55 phakic eyes and 24 pseudophakic eyes that underwent 360-degree SLT were retrospectively reviewed. Intraocular pressure (IOP) was measured before SLT and 1 week, 1, 3, 6, 9, 12, 18 and 24 months after SLT. Treatment success was defined as IOP reduction > or = 20% without additional medications, laser or glaucoma surgery. Mean IOP change, mean percentage of IOP reduction and success rates of phakic and pseudophakic eyes were compared. RESULTS: Mean percentage of IOP reduction after SLT at 1 week and 1, 3, 6, 9, 12, 18, and 24 months were 18.8%, 23.9%, 24.6%, 23.3%, 24.0%, 22.1%, 20.8%, and 17.9%, respectively, in the phakic group and 15.7%, 22.3%, 23.7%, 25.3%, 25.6%, 25.2%, 21.9%, and 19.3%, respectively, in the pseudophakic group. Success rates were 57.6 +/- 11.9% in the phakic group and 61.3 +/- 10.4% in the pseudophakic group. No statistically significant differences in IOP change, percentage of IOP reduction, and success rates were observed between the groups at each time point after SLT (p > 0.05). CONCLUSIONS: Application of 360-degree SLT appears an efficient treatment option for the management of phakic and pseudophakic open-angle glaucoma. Evaluating the success of SLT 1 month postoperatively may be premature.
Subject(s)
Cataract , Glaucoma , Glaucoma, Open-Angle , Intraocular Pressure , Retrospective Studies , TrabeculectomyABSTRACT
PURPOSE: To report a case of central serous chorioretinopathy development after glaucoma filtering surgery and spontaneous resolution in a patient with a history of central serous chorioretinopathy in the contralateral eye. CASE SUMMARY: A 46-year-old male with a history of chronic uveitis in both eyes presented with uncontrolled intraocular pressure (IOP) in his left eye. Initial IOP was 34 mm Hg in his left eye. On preoperative evaluation, central serous chorioretinopathy, which was diagnosed in another clinic 1 month prior, was observed in his right eye. Slightly pale optic disc and retinal nerve fiber layer defects were noted in the left eye. However, macular abnormalities were not observed in the left eye. Trabeculectomy and peripheral iridectomy using mitomycin C were performed in the left eye. The patient was prescribed triamcinolone 8 mg daily for 4 days to reduce the post-surgical inflammation. On postoperative day 4, IOP in the left eye was 7 mm Hg and newly developed central serous chorioretinopathy was noted. On follow-up, IOP was maintained at 7-10 mm Hg and central serous chorioretinopathy disappeared 7 months postoperatively. CONCLUSIONS: When clinicians consider performing an ophthalmological procedure in a patient with a history of central serous chorioretinopathy in the contralateral eye, careful observation of central serous chorioretinopathy development is recommended.
Subject(s)
Humans , Male , Middle Aged , Central Serous Chorioretinopathy , Filtering Surgery , Follow-Up Studies , Glaucoma , Inflammation , Intraocular Pressure , Iridectomy , Mitomycin , Nerve Fibers , Retinaldehyde , Trabeculectomy , Triamcinolone , UveitisABSTRACT
BACKGROUND AND OBJECTIVES: As a prognostic factor, the association of Hashimoto's thyroiditis (HT) with papillary thyroid carcinoma (PTC) is still controversial. The aim of this study is to compare clinicopathologic parameters between PTC alone and PTC with HT patients. SUBJECTS AND METHOD: We reviewed the medical record retrospectively. 205 patients underwent thyroid surgery from January 2006 to December 2008. Among the 205 patients, 120 patients were included in this study. We compared various clinicopathologic parameters such as gender, tumor size, multifocality, lymphovascular invasion, extrathyroidal extension, central lymph node metastasis, and lateral lymph node metastasis between PTC alone and PTC with HT patients. RESULTS: 18.3% of PTC patients were associated with HT. There were no significant differences in clinocopatholgic parameters such as gender, tumor size, multifocality, lymphovascular invasion, extrathyroidal extension, central lymph node metastasis or lateral lymph node metastasis. Tumor recurrences were found in 6 out of 98 cases of PTC alone and in 3 out of 22 cases of PTC with HT. There was no significance between two groups (p=0.363). CONCLUSION: Results indicate that HT may not be associated with clinicopathologic factors in PTC.
Subject(s)
Humans , Lymph Nodes , Medical Records , Neoplasm Metastasis , Prognosis , Recurrence , Retrospective Studies , Thyroid Gland , Thyroid Neoplasms , ThyroiditisABSTRACT
PURPOSE: To evaluate the clinical manifestations of double elevator palsy and describe the surgery outcomes in patients. METHODS: We performed a retrospective chart review of all patients who were treated surgically for double elevator palsy between 1999 and 2012 at Yonsei University, Severance Hospital in Seoul, Korea. RESULTS: Overall, 15 subjects (7 males and 8 females) with a mean age of 14.6 years (range, 3-40 years) underwent their first surgery during the study period. All patients received inferior rectus recession as a primary procedure. Nine patients (60.0%) underwent a secondary procedure which included 4 cases of horizontal muscle transposition, 2 cases of correction of exotropia, and 3 cases of correction of hypotropia and exotropia simultaneously. The mean preoperative hypotropia was decreased from 29.9 +/- 8.4 prism diopter (PD) to 4.7 +/- 5.3 PD postoperatively. Mean follow-up period was 40.9 +/- 48.2 months. Seven patients (46.7%) underwent eyelid surgery for true ptosis. At last follow-up, a majority of patients showed mild or no amblyopia. CONCLUSIONS: Primary inferior rectus recession and additive secondary horizontal muscle transposition surgery was effective in treatment of double elevator palsy. The clinical manifestations and surgical outcomes of monocular elevation deficiency in the present study can help in the treatment of Korean patients.
Subject(s)
Humans , Male , Amblyopia , Elevators and Escalators , Exotropia , Eyelids , Follow-Up Studies , Korea , Paralysis , Retrospective Studies , SeoulABSTRACT
This study was undertaken to identify genetic polymorphisms that are associated with the risk of an elevated fasting glucose (FG) level using genome-wide analyses. We explored a quantitative trait locus (QTL) for FG level in a genome-wide study from a Korean twin-family cohort (the Healthy Twin Study) using a combined linkage and family-based association analysis approach. We investigated 1,754 individuals, which included 432 families and 219 pairs of monozygotic twins. Regions of chromosomes 2q23.3-2q31.1, 15q26.1-15q26.3, 16p12.1, and 20p13-20p12.2, were found to show evidence of linkage with FG level, and several markers in these regions were found to be significantly associated with FG level using family-based or general association tests. In particular, a single-nucleotide polymorphism (rs6138953) on the PTPRA gene in the 20p13 region (combined P = 1.8 x 10(-6)) was found to be associated with FG level, and the PRKCB1 gene (in 16p12.1) to be possibly associated with FG level. In conclusion, multiple regions of chromosomes 2q23.3-2q31.1, 15q26.1-15q26.3, 16p12.1, and 20p13-20p12.2 are associated with FG level in our Korean twin-family cohort. The combined approach of genome-wide linkage and family-based association analysis is useful to identify novel or known genetic regions concerning FG level in a family cohort study.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Asian People/genetics , Blood Glucose/genetics , Chromosomes, Human, Pair 15/genetics , Chromosomes, Human, Pair 16/genetics , Chromosomes, Human, Pair 2/genetics , Chromosomes, Human, Pair 20/genetics , Cohort Studies , Family , Genetic Linkage , Genome-Wide Association Study , Genotype , Polymorphism, Single Nucleotide , Protein Kinase C/genetics , Quantitative Trait Loci , Receptor-Like Protein Tyrosine Phosphatases, Class 4/genetics , Republic of Korea , Twins, Monozygotic/geneticsABSTRACT
PURPOSE: In this study an examination was done of the effects of the American Society of PeriAnesthesia Nurses (ASPAN) Evidence-Based Clinical Practice Guidelines on body temperature, shivering, thermal discomfort, and time to achieve normothermia in patients undergoing total knee replacement arthroplasty (TKRA) under spinal anesthesia. METHODS: This study was an experimental study with a randomized controlled trial design. Participants (n=60) were patients who underwent TKRA between December 2011 and March 2012. Experimental group (n=30) received active and passive warming measures as described in the ASPAN's guidelines. Control group (n=30) received traditional care. Body temperature, shivering, thermal discomfort, time to achieve normothermia were measured in both groups at 30 minute intervals. RESULTS: Experimental group had slightly higher body temperature compared to control group (p=.002). Thermal discomfort was higher in the experimental group before surgery but higher in the control group after surgery (p=.034). It decreased after surgery (p=.041) in both groups. Time to achieve normothermia was shorter in the experimental group (p=.010). CONCLUSION: ASPAN's guidelines provide guidance on measuring patient body temperature at regular intervals and on individualized and differentiated hypothermia management which can be very useful in nursing care, particularly in protecting patient safety and improving quality of nursing.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Anesthesia, General , Arthroplasty, Replacement, Knee , Body Temperature , Evidence-Based Nursing , Hypothermia/prevention & control , Intraoperative Care , Practice Guidelines as Topic , Rewarming , ShiveringABSTRACT
Background: Little is known regarding the functional outcome and quality of life of neuro-ICU survivors. In Korea, the neuro-ICU concept was introduced relatively late and data about long term outcome and predictors concerning functional outcome is scarce. The main objective of this study was to analyze functional outcome and mortality, and to determine prognostic predictors for the outcome in patients admitted to Korean neuro-ICUs. Methods: Consecutive adult (≥ 15-years-of-age) patients admitted to a neuro-ICU due to various causes including ischemic or hemorrhagic stroke, and other neurological or neurosurgical problems such as traumatic brain injury, seizure, or drug intoxication during an 18-month period from July 2008 through December 2009 were included. Demographic and clinical variables were compared between groups stratifi ed based on 6-month modifi ed Rankin scale score. Results: Of 555 patients, there were signifi cant differences in age (P=0.013), sex (P=0.02), hospital stay (P<0.01), neuro-ICU stay (P<0.01), admission diagnosis (P=0.001), intubation (P<0.01), mechanical ventilation (P<0.01), tracheostomy (P<0.01), comorbid conditions such as atrial fi brillation (P<0.01), cardiac complication (P<0.01) and pulmonary complication (P<0.01), a high Therapeutic Intervention Scoring System (TISS-28) score (P<0.01), and a high Acute Physiology and chronic health evaluation (APACHE) II score (P<0.01) between favorable and unfavorable outcome groups. The overall mortality rate was 15.0% (n=83). In multivariable logistic regression analysis, age, sex, high TISS-28, high APACHE II score, intubation, and cardiac complication were independent predictors of unfavorable outcome. Conclusion: The identifi ed predictors for functional outcomes in Korean neuro-ICU patients will be an important aid in diagnosing and treating neuro-ICU patients.