Factors Affecting Fall-Prevention Behavior of Long-Term Care Nurses / 한국직업건강간호학회지

Purpose@#The purpose of this study was to identify factors influencing fall-prevention behaviors of nurses working in long-term care hospitals. @*Methods@#Participants included 147 nurses working in 10 long-term care hospitals in B city. Data were collected from September 20-October 12, 2016. SPSS/WIN 21.0 was used for analysis with t-test, ANOVA, Scheffé ́ test, Pearson correlation coefficients, and multiple regression. @*Results@#It was found that attitude toward fall (r=.29, p<.001) and patient safety culture (r=.25, p=.002) had a significant positive correlation with fall-prevention behaviors of nurses working in long-term care hospitals. The factors influencing fall-prevention behaviors in participants were clinical career and patient safety culture (β=.21, p=.012), contributing to 19% of the total variance in fall- prevention behaviors. @*Conclusion@#The findings showed that systematic delivery of differentiated fall prevention education is preferred to nurse's clinical career as a private factor to improve fall-prevention behaviors of nurses in long term care hospital. Particularly, it is imperative to conduct periodical and practical fall-prevention education for nurses to prevent career discontinuity. An independent report system and open communication system as well as a scheme that can disseminate patient safety culture in individual departments to implement patient direct nursing are required to encourage patient safety culture in organizations.

Effect of intravenous induction agents on emergence delirium after sevoflurane anesthesia in pre-school aged children undergoing adenotonsillectomy

BACKGROUND: In pre-school aged children, the occurrence of emergence delirium (ED) is increased after sevoflurane anesthesia. The purpose of this study was to evaluate if intravenous inducting agents such as propofol, ketamine or thiopental sodium affected the development of ED. METHODS: A total of 62 children between 3 and 6 years of age scheduled for elective tonsillectomy and adenoidectomy were divided into 3 groups in a double-blinded manner. Anesthesia was induced using one of the three drugs intravenously: 5 mg/kg of sodium thiopental, 1 mg/kg of ketamine or 2 mg/kg of propofol. Anesthesia was then maintained with sevoflurane. The development of ED was assessed in the post-anesthetic care unit. RESULTS: The propofol and ketamine group showed a significantly lower pediatric anesthesia emergence agitation (PAEA) score and a lower incidence of ED compared with the thiopental group. CONCLUSIONS: Propofol and ketamine decreased the development of emergence delirium when used as an induction agent.

The influence of age and gender on remifentanil EC(50) for preventing rocuronium induced withdrawal movements / 대한마취과학회지

BACKGROUND: Rocuronium-induced withdrawal movements can be harmful to patients during the induction period. Remifentanil has been reported to reduce these movements effectively. In this study, we determined the EC(50) of remifentanil for the prevention of rocuronium induced withdrawal movements in male, female, old and child group. METHODS: We included patients scheduled for general anesthesia and assigned them into 4 groups depending on their age and gender: male group (20-60 yr), female group (20-60 yr), old group (>65 yr) and child group (6-12 yr). Remifentanil was administered by target controlled infusion. Propofol 2 mg/kg was then administered after equilibration between the effect and plasma concentration of remifentanil was reached. After loss of consciousness, rocuronium 0.6 mg/kg was administered. Patient's response to the rocuronium was graded using a 4 point scale in a blinded manner. The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was determined using Dixon's up-and -down method. RESULTS: The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was 1.8 +/- 0.5 ng/ml [95% confidence interval 1.3-2.2] in the male group, 2.3 +/- 1.0 ng/ml [1.3-3.2] in the female group, 0.5 +/- 0.4 ng/ml [0.2-0.8] in the old group and 2.8 +/- 0.8 ng/ml [2.1-3.5] in the child group. CONCLUSIONS: The EC(50) of remifentanil for preventing rocuronium induced withdrawal movements was lowest in the elderly and higher in children than male adult patients. No difference in the EC(50) of remifentanil was seen between male and female adult patients.

The influence of ABCB1 and OPRM1 genetic polymorphism on fentanyl requirements for postoperative pain control / 대한마취과학회지

BACKGROUND: Fentanyl, which is a potent synthetic micron-opioid receptor agonist, is one of the most widely used opioids in anesthesia and pain control. However, the pharmacodynamics of fentanyl show wide inter-individual variability. Therefore, this study was conducted to evaluate the influence of the blood-brain barrier transporter protein, p-glycoprotein, and micron-opioid receptor genetic polymorphism on fentanyl pharmacodynamics. METHODS: Seventy-nine patients who underwent posterior lumbar interbody fusion (PLIF) were included in this study. Postoperatively, the patients received fentanyl via an intravenous patient controlled analgesia device. The cumulative fentanyl doses and other pharmacodynamic data were then recorded at 2 h, 6 h, 12 h, 24 h and 48 h after the operation. In addition, genomic DNA was isolated from the patient's peripheral leukocytes and then evaluated for the presence of OPRM1 A118G and ABCB1 C3435T genetic polymorphism using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The results of this study indicated that ABCB1 C3435T genetic polymorphism may be related to the cumulative fentanyl requirement for postoperative pain control. However, these findings were not statistically significant (P = 0.09). In addition, no relationship was observed between OPRM1 A118G and the cumulative postoperative fentanyl requirement. However, the cumulative postoperative fentanyl requirement was lower in the TTAA group (ABCB1 3435 TT, OPRM1 118 AA) than in the CCGG group (ABCB13435 CC, OPRM1 118 GG). CONCLUSIONS: The ABCB1 C3435T polymorphism may affect fentanyl pharmacodynamics. However, further studies are required to confirm the relationship between p-glycoprotein and fentanyl.

Influence of the Head Posture on Central Venous Catheter Position during Right Subclavian Catheterization / 대한마취과학회지

BACKGROUND: Confirmation of central venous catheter position with chest X-ray is recommended, but frequently omitted in clinical practice. It was suggested that the head posture during right subclavian catheterization affects the incidence of catheter malposition in infants. We evaluated the influence of the head posture on catheter position during right subclavian catheterization in adults. METHODS: Two-hundred and seventy four patients scheduled for thoracic or neuro-surgery requiring central venous catheterization were enrolled. Patients were divided into 3 groups depending on the head posture during catheter insertion: the neutral group (n = 109), the turn away group (n = 72), and the turn toward group (n = 93). The catheter position was confirmed with postoperative chest X-ray. RESULTS: Central venous catheterization was failed in 5 patients. There were no differences in the incidence of catheter malposition and the complications among the 3 groups. CONCLUSIONS: The head posture during right subclavian catheterization did not affect catheter malposition and immediate complication rates.

Comparison of 0.15% Ropivacaine/Fentanyl and 0.1% Levobupivacaine/Fentanyl Infused for Postoperative Epidural Analgesia / 대한마취과학회지

BACKGROUND: In this study we compared the analgesic effects and the incidences of motor weakness and other side effects of postoperative continuous epidural infusion of 0.15% ropivacaine/fentanyl or 0.1% levobupivacaine/fentanyl. METHODS: Sixty seven patients scheduled for elective knee arthroplasty or revision surgery under combined spinal-epidural anesthesia were randomized to receive either 0.15% ropivacaine with 2microgram/ml fentanyl (the ropivacaine group) or 0.1% levobupivacaine with 2microgram/ml fentanyl (the levobupivacaine group) for postoperative epidural analgesia using a PCA pump at a rate of 5 ml/h during the 48 hour period following surgery. Verbal numerical rating scale (VNRS) scores on rest and movement, Bromage scores, additional analgesic requirements and side effects were assessed. RESULTS: In the ropivacaine group, rest VNRS scores were lower than in the levobupivacaine group on the second postoperative day, and movement VNRS scores were also lower in the ropivacaine group during the first and second postoperative days. Bromage scores, additional analgesic requirements and side effects were similar in the two groups. CONCLUSIONS: Both 0.15% ropivacaine with 2microgram/ml fentanyl and 0.1% levobupivacaine with 2microgram/ml fentanyl provided effective postoperative epidural analgesia, but ropivacaine group members were able to exercise more effectively.

The homotrimeric structure of HtrA2 is indispensable for executing its serine protease activity

Serine protease activity of high temperature requrement 2 (HtrA2) is essential for promoting cell death, as well as for protecting against cellular stresses. An X-ray crystallographic study described the formation of a pyramid shaped homotrimer that is a proteolytically competent form of HtrA2; however, little is known about effects of the trimeric structure of HtrA2 on the natural substrates. In this study, we generated the HtrA2 protein that has a single point mutation at the homotrimerization motif to assess relationship between structure and the proteolytic activity of HtrA2 on its substrates. Using gel filtration, a native gel electrophoresis system, and a co-precipitation assay, we confirm that phenylalanine 149 in HtrA2 is a crucial determinant for the formation of the HtrA2 homotrimeric structure. Moreover, we described that the HtrA2 monomeric form abolished not only autoproteolytic activity, but also the proteolytic activity against XIAP (X-linked inhibitor of apoptosis protein) known as the HtrA2 substrate. Taken together, the results indicate that the homotrimeric structure of HtrA2 is required for executing its serine protease activity.

Prostaglandin A2 Induces Caspase-independent Apoptosis in Hepatocellular Carcinoma Cells / 대한간학회지

BACKGROUND/AIMS: Prostaglandin (PG) A2 has been reported to inhibit the growth of hepatocellular carcinoma cells via activation of apoptosis, although the molecular mechanisms involved have not been clarified, yet. To investigate the mechanism of the PGA2-induced apoptosis, we analyzed the activation of caspases during the apoptosis of hepatoma cell lines. METHODS: Induction of apoptosis by PGA2 in hepatoma cell lines, Hep 3B and Hep G2, was assessed by DAPI staining of nuclei and agarose gel electrophoresis of genomic DNA. The involvement of caspases was analyzed by immunoblot analysis of poly ADP-ribose polymerase (PARP) and by checking the effect of caspase inhibitors on PGA2-induced apoptosis. RESULTS: PGA2 inhibited the growth of Hep 3B and Hep G2 cells, accompanying nuclear condensation and fragmentation, and genomic DNA laddering, which are the hallmarks of apoptosis. The PARP was not cleaved during the apoptosis of Hep 3B and Hep G2 cells and caspase inhibitors such as z-VAD-Fmk and z-DEVD-Fmk exerted no effect on the PGA2-induced apoptosis. CONCLUSIONS: These results suggest that PGA2 induces apoptosis in Hep 3B and Hep G2 cells via caspase-independent pathway.