Postoperative Pain Management Status led by Nurse of Acute Pain Service / 임상간호연구

Purpose@#This study was conducted to demonstrate objective stability of postoperative pain management status managed by nurse-based, anesthesiologist-supervised Acute Pain Service (APS). @*Methods@#A retrospective descriptive review was conducted with 5,748 patients who had used intravenous Patient Controlled Analgesia (PCA) from January to December 2017. Data were analyzed using descriptive statics, Frequency analysis, ANOVA, Cross tabulation with X2 test, and Correlation coefficient. @*Results@#As the APS nurse's education date increased, the period of using PCA was statistically significantly longer, and the period of stopping PCA while using it became shorter (p<.001). Statistically significant, the most painful operations were extremities, spine, upper abdomen, and thorax, while the least painful surgery was lower abdomen (p<.001). Lower abdominal surgery used the highest amount of PCA (p<.001), and extremities and spinal surgery, the lowest amount of PCA and frequently stop using it (p<.001). The most common side effects were nausea and vomiting after surgery, with an incidence of 16.0% within 24 hours and 9.8% within 48 hours. The overall error caused by PCA was 1.5%, with 84.3% being caused by human errors. @*Conclusion@#With the pain management effect of APS nurses, patients used PCA more effectively. There were also fewer side effects and error rates compared to prior studies.Therefore, it is suggested that this system is safe and effective for pain management.

Postoperative Pain Management Status led by Nurse of Acute Pain Service / 임상간호연구

Purpose@#This study was conducted to demonstrate objective stability of postoperative pain management status managed by nurse-based, anesthesiologist-supervised Acute Pain Service (APS). @*Methods@#A retrospective descriptive review was conducted with 5,748 patients who had used intravenous Patient Controlled Analgesia (PCA) from January to December 2017. Data were analyzed using descriptive statics, Frequency analysis, ANOVA, Cross tabulation with X2 test, and Correlation coefficient. @*Results@#As the APS nurse's education date increased, the period of using PCA was statistically significantly longer, and the period of stopping PCA while using it became shorter (p<.001). Statistically significant, the most painful operations were extremities, spine, upper abdomen, and thorax, while the least painful surgery was lower abdomen (p<.001). Lower abdominal surgery used the highest amount of PCA (p<.001), and extremities and spinal surgery, the lowest amount of PCA and frequently stop using it (p<.001). The most common side effects were nausea and vomiting after surgery, with an incidence of 16.0% within 24 hours and 9.8% within 48 hours. The overall error caused by PCA was 1.5%, with 84.3% being caused by human errors. @*Conclusion@#With the pain management effect of APS nurses, patients used PCA more effectively. There were also fewer side effects and error rates compared to prior studies.Therefore, it is suggested that this system is safe and effective for pain management.

Use of Oral Nutritional Supplements for Patients with Diabetes / 임상당뇨병

Dietary counseling and oral nutritional supplements (ONS) should be considered to increase the nutritional intake of people malnourished or at risk of malnutrition. These supplements are typically ready-made liquids and contain a balanced mix of energy, protein, and micronutrients. The diabetes-specific ONS are specifically designed for patients with hyperglycemia or diabetes mellitus in order to provide better glycemic control such as postprandial glucose and HbA1c compared to the standard ONS. These supplements are lower in carbohydrates and higher in fat than standard supplements and are rich in monounsaturated fats. Using diabetes-specific ONS in malnourished diabetic patients can allow increasing energy intake while maintaining glucose control and improving nutritional status and also providing economic benefits. However, inadequate intake of ONS that do not fit the patient's condition can be a problem. Therefore, when using ONS for patients with diabetes, it is necessary to clinically evaluate the nutritional status of the patient and to provide individualized education and management accordingly.

An Intravenous leiomyoma with cardiac involvement in a patient with uterine leiomyoma / 대한내과학회지

A case of intravenous leiomyomatosis (IVL) invading the vena cava and extending to the right atrium, a rare benign smooth-muscle tumor, is described. Despite their histological benignity, these lesions have a tendency to metastasize and are closely related to the condition called "benign metastasizing leiomyoma" and "intracaval mass and cardiac extension". A 50-year old woman was admitted to the hospital with dyspnea beginning 6 months ago and previous history of hysterectomy due to uterine myoma. Echocardiography revealed severe tricuspid valve insufficiency and a mobile elongated mass which occupied the inferior vena cava and was extending into the right ventricular cavity. Pelvic ultrasonography and pelvic MRI identified suspicious metastasis to both ovaries and peritoneum. She underwent resection of the cardiac tumor, concomitant tricuspid annuloplasty with a closure of the foramen ovale and both salphyngo-oophorectomy with vaginal stump mass biopsy. All of them could be histologically identified as IVL.

Comparative Efficacy and Safety of Cefepime alone Versus Ceftazidime Plus Tobramycin in Cancer Patients with Febrile Neutropenia / 감염과화학요법

BACKGROUND: Broad-spectrum antibiotic therapy has been recommended as an empirical regimen in cancer patients with febrile neutropenia. Cefepime is a fourth generation cephalosporin with good activity against both gram-positive cocci and gram-negative bacilli. MATERIALS AND METHODS: To compare the efficacy and safety of cefepime alone with ceftazidime plus tobramycin as empirical regimen for adult cancer patients with febrile neutropenia, a randomized, open label, comparative trial was performed. If the patient showed clinical improvent 72 hours, antibiotic could be changed to oral ciprofloxacin. Clinical and microbiological responses were determined at 72 hours and at the end of therapy. To investigate the antimicrobial resistance of viridans streptococci, swab cultures were obtained from throat in all enrolled patients and antimicrobial susceptibility tests were performed by using microdilution method according to the NCCLS. RESULTS: A total of 89 patients were enrolled. Forty-eight patients received cefepime alone (CA), and 41 patients received ceftazidime plus tobramycin (CT). Demographic and baseline clinical characteristics were similar in both groups (P>0.05). The initial clinical success rate at day 2-4 in group CA (91.7%) was similar with that in CT group (85.4%) (P=0.31). At the end of therapy, the final clinical success rate in CA group (91.7%) was similar to that in CT group (100%) (P=0.15). In 18 patients, with microbiologically defined infections, the eradication rate was 100% in both groups. Adverse events including liver dysfunction (21.3%) and renal dysfunction (2.2%), were similar in both groups (P=0.87). Viridans streptococci were isolated from the throat cultures in 25 cases, and all of these strains were susceptible to penicillin (MIC(90)0.12 microgram/mL), cefepime (1 microgram/mL), and vancomycin (0.12 microgram/mL). CONCLUSION: Efficacy and safety of cefepime monotherapy was comparable to the combination of ceftazidime and tobramycin. It could be used as an alternative empirical regimen for treating cancer patients with febrile neutropenia.

Comparative Efficacy and Safety of Cefepime alone Versus Ceftazidime Plus Tobramycin in Cancer Patients with Febrile Neutropenia / 감염과화학요법

BACKGROUND: Broad-spectrum antibiotic therapy has been recommended as an empirical regimen in cancer patients with febrile neutropenia. Cefepime is a fourth generation cephalosporin with good activity against both gram-positive cocci and gram-negative bacilli. MATERIALS AND METHODS: To compare the efficacy and safety of cefepime alone with ceftazidime plus tobramycin as empirical regimen for adult cancer patients with febrile neutropenia, a randomized, open label, comparative trial was performed. If the patient showed clinical improvent 72 hours, antibiotic could be changed to oral ciprofloxacin. Clinical and microbiological responses were determined at 72 hours and at the end of therapy. To investigate the antimicrobial resistance of viridans streptococci, swab cultures were obtained from throat in all enrolled patients and antimicrobial susceptibility tests were performed by using microdilution method according to the NCCLS. RESULTS: A total of 89 patients were enrolled. Forty-eight patients received cefepime alone (CA), and 41 patients received ceftazidime plus tobramycin (CT). Demographic and baseline clinical characteristics were similar in both groups (P>0.05). The initial clinical success rate at day 2-4 in group CA (91.7%) was similar with that in CT group (85.4%) (P=0.31). At the end of therapy, the final clinical success rate in CA group (91.7%) was similar to that in CT group (100%) (P=0.15). In 18 patients, with microbiologically defined infections, the eradication rate was 100% in both groups. Adverse events including liver dysfunction (21.3%) and renal dysfunction (2.2%), were similar in both groups (P=0.87). Viridans streptococci were isolated from the throat cultures in 25 cases, and all of these strains were susceptible to penicillin (MIC(90)0.12 microgram/mL), cefepime (1 microgram/mL), and vancomycin (0.12 microgram/mL). CONCLUSION: Efficacy and safety of cefepime monotherapy was comparable to the combination of ceftazidime and tobramycin. It could be used as an alternative empirical regimen for treating cancer patients with febrile neutropenia.

Transition metal induces apoptosis in MC3T3E1 osteoblast: Evidence of free radical release

Transition metal ions including Se2+, Cd2+, Hg2+ or Mn2+ have been thought to disturb the bone metabolism directly. However, the mechanism for the bone lesion is unknown. In this study, we demonstrated that MC3T3E1 osteoblasts, exposed to various transition metal ions; selenium, cadmium, mercury or manganese, generated massive amounts of reactive oxygen species (ROS). The released ROS were completely quenched by free radical scavengers-N-acetyl cysteine (NAC), reduced glutathione (GSH), or superoxide dismutase (SOD). First, we have observed that selenium (10 micrometer), cadmium (100 micrometer), mercury (100 micrometer) or manganese (1 mM) treatment induced apoptotic phenomena like DNA fragmentation, chromatin condensation and caspase-3-like cysteine protease activation in MC3T3E1 osteoblasts. Concomitant treatment of antioxidant; N-acetyl-L-cysteine (NAC), reduced-form glutathione (GSH), or superoxide dismutase (SOD), prevented apoptosis induced by each of the transition metal ions. Catalase or dimethylsulfoxide (DMSO) has less potent inhibitory effect on the apoptosis, compared with NAC, GSH or SOD. In line with the results, nitroblue tetrazolium (NBT) stain shows that each of the transition metals is a potent source of free radicals in MC3T3E1 osteoblast. Our data show that oxidative damage is associated with the induction of apoptosis in MC3T3E1 osteoblasts following Se2+, Cd2+, Hg2+ or Mn2+ treatment.