Effects of a Finger Guard while Opening the Glass Ampoule by Nursing Students

PURPOSE: The purpose of this study was to identify the effects of a finger guard developed to prevent sharp injuries in nursing students.METHODS: This study was an equivalent control group posttest design. Seventy nursing students were randomly allocated to either the experimental group (n=35) or the control group (n=35). The finger guard was used whileopening the glass ampoule in the experimental group. The outcome variables such as sharp injuries, anxiety and user satisfaction were measured.RESULTS: Sharp injuries were 0 in the experimental group and 2 in the control group (p=.160). Anxiety in the experimental group was significantly lower than the control group (p < .001). User satisfaction was 4.33 score in the range from 1 to 5, the highest item was the weight (4.63), followed by effectiveness (4.51).CONCLUSION: Using a protective device while opening the glass ampoule was observed to be effective in reducing anxiety among the nursing students, and exhibited protection of skin.

Effects of Neck and Back Touch on Ultrasonic Vocalization and the Rat Grimace Scale in Rats Receiving Intramuscular Injections

PURPOSE: To determine the effects of neck and back touch on Ultrasonic Vocalization (UV) and the Rat Grimace Scale (RGS) in rats touched by the human hand as an intervention for reducing pain and anxiety associated with intramuscular injections. METHODS: This study was a randomized, controlled, pre-test/post-test design study. Twenty male Sprague-Dawley rats were assigned to either the experimental or control groups (n=10 rats/group). The experimental group was touched in a manner similar to massaging the rat's neck and back twice a day for one week. The two groups received two intramuscular injections. The 22kHz and 50kHz UV and the RGS scores were measured before and after each intramuscular injection. RESULTS: The 22kHz UV and RGS score were significantly higher in the control group than in the experimental group when the first intramuscular injection was administered; whereas, no difference between the experimental and the control groups were observed when the second intramuscular injection was administered. There was no statistical difference in the 50kHz UV between the two groups when the first and second injections were administered. CONCLUSION: This study found that touching was an effective intervention method to reduce negative emotions and pain in rats receiving their first intramuscular injection.

Vav3, a GEF for RhoA, Plays a Critical Role under High Glucose Conditions

BACKGROUND: The role of small GTPase molecules is poorly understood under high glucose conditions. METHODS: We analyzed the expression pattern of Vav3 in skeletal muscle C2C12 cells under high glucose culture condition with reverse transcription-polymerase chain reaction and Western blot analysis. We also measured glucose uptake using isotope-labelled glucose. RESULTS: We showed that expression of Vav3 (a guanine nucleotide exchange factor for RhoA) increased. mRNA and protein levels in skeletal muscle C2C12 cells under high glucose conditions. The AMP-activated protein kinase (AMPK) activator AMPK agonist 5-aminoimidazole-4-carboxy-amide-1-d-ribofuranoside (AICAR) suppressed high glucose-induced Vav3 induction. In addition, exposure of cells to high glucose concentration increased the phosphorylation of PAK-1, a molecule downstream of RhoA. The phosphorylation of paxillin, a downstream molecule of PAK-1, was also increased by exposure to high glucose. Phosphorylation of these molecules was not observed in the presence of AICAR, indicating that AMPK is involved in the RhoA signal pathway under high glucose conditions. Knock down of Vav3 enhances metformin-mediated glucose uptake. Inhibition of AMPK blocked the increases of Vav3 knock down-induced glucose uptake. Metformin-mediated Glut4 translocation was also increased by Vav3 knock-down, suggesting that Vav3 is involved in metformin-mediated glucose uptake. CONCLUSION: These results demonstrate that Vav3 is involved in the process of metformin-mediated glucose regulation.

The Effects of Simulation-Based Training, Underwent Before or After the Clinical Practice for the Nursing Students / 한국간호교육학회지

PURPOSE: This study was conducted to compare the effects of simulation-based training on knowledge, self-efficacy and clinical performance, underwent before or after the clinical practice for the nursing students. METHOD: A comparison group design was established with pre-clinical practice group (n=34) and post-clinical practice group (n=34). Both groups participated in simulation-based training before or after the clinical practice at the recovery room. Chi-square test, t-test and paired t-test were performed to analyze the data. RESULTS: Both groups showed significantly higher post-test scores in knowledge and self-efficacy than pre-test scores (p<.001). The group with simulation training performed before their clinical practice (pre-clinical practice group) showed significantly higher self-efficacy (p=.044) than the group with simulation training done after their clinical practice (post-clinical practice group). However, there was no significant difference in the knowledge (p=.922) and clinical performance (p=.887). CONCLUSION: These findings of the study suggest that simulation based training in pre-clinical practice is effective to enhance the self-efficacy and to improve knowledge and clinical performance of the nursing students.

Clinical and Radiological Findings of Discogenic Low Back Pain Confirmed by Automated Pressure-Controlled Discography

OBJECTIVE: Few studies on the clinical spectrum of automated pressure-controlled discography (APCD)-defined positive discs have been reported to date. Thus, the present study was undertaken to analyze clinical parameters critical for diagnosis of discogenic pain and to correlate imaging findings with intradiscal pressures and pain responses in patients with APCD-positive discs. METHODS: Twenty-three patients who showed APCD-positive discs were selected for analysis. CT discogram findings and the degrees of nuclear degeneration seen on MRI were analyzed in comparison to changes of intradiscal pressure that provoked pain responses; and clinical pain patterns and dynamic factors were evaluated in relation to pain provocation. RESULTS: Low back pain (LBP), usually centralized, with diffuse leg pain was the most frequently reported pattern of pain in these patients. Overall, LBP was most commonly induced by sitting posture, however, standing was highly correlated with L5/S1 disc lesions (p < 0.01). MRI abnormalities were statistically correlated with grading of CT discogram results (p < 0.05); with most pain response observed in CT discogram Grades 3 and 4. Pain-provoking pressure was not statistically correlated with MRI grading. However, it was higher in Grade 3 than Grade 4. CONCLUSION: APCD-positive discs were demonstrated in patients reporting centralized low back pain with diffuse leg pain, aggravated by sitting and standing. MRI was helpful to assess the degree of nuclear degeneration, yet it could not guarantee exact localization of the painful discs. APCD was considered to be more useful than conventional discography for diagnosis of discogenic pain.

A Case of Impetigo Herpetiformis Treated with Isotretinoin / 대한피부과학회지

Impetigo herpetiformis is a rare and severe pustular disorder which primarily occurs in pregnancy. Etretinate and acitretin are effective in impetigo herpetiformis with systemic steroid. A major concern with the use of systemic retinoids is their high teratogenic potential. Isotretinoin is another retinoid but its teratogenic potential lasts only for two months. Hence, isotretinoin may be used to treat women of childbearing years with impetigo herpetiformis. We report a case of impetigo herpetiformis in a 26-year-old woman whose condition was improved with isotretinoin.

Clinical Relevance of Pain Patterns in Osteoporotic Vertebral Compression Fractures

Few studies have been conducted to explain the pain patterns resulting from osteoporotic vertebral compression fractures (OVCF). We analyzed pain patterns to elucidate the pain mechanism and to provide initial guide for the management of OVCFs. Sixty-four patients underwent percutaneous vertebroplasty (N=55) or kyphoplasty (N=9). Three pain patterns were formulized to classify pains due to OVCFs: midline paravertebral (Type A), diffuse paravertebral (Type B), and remote lumbosacral pains (Type C). The degree of compression was measured using scale of deformity index, kyphosis rate, and kyphosis angle. Numerical rating scores were serially measured to determine the postoperative outcomes. As vertebral body height (VBH) decreased, paravertebral pain became more enlarged and extended anteriorly (p<0.05). Type A and B patterns significantly showed the reverse relationship with deformity index (p<0.05), yet Type C pattern was not affected by deformity index. Postoperative pain severity was significantly improved (p<0.05), and patients with a limited pain distribution showed a more favorable outcome (p<0.05). The improvement was closely related with the restoration of VBH, but not with kyphosis rate or angle. Thus, pain pattern study is useful not only as a guide in decision making for the management of patients with OVCF, but also in predicting the treatment outcome.

Selection of Target Age for School Education of Cardiopulmonary Resuscitation Using Video Self-instruction Program

PURPOSE: The effectiveness of teaching cardiopulmonary resuscitation (CPR) in schools is known to be higher among older students. However, several easier programs have been successful even for primary school children. The purpose of this study is to determine the optimal target age for teaching CPR in schools. METHODS: Six classes from the fifth to the tenth grade were randomly selected. A video-based self-instructional program was presented by health teachers in each school using the Korean version of CPR Anytime(TM) during normal school hours. Questionnaires were given after training to determine their degree of confidence in performing CPR, their willingness to perform CPR on a family, a friend, and a stranger, and at what age the children wanted to learn CPR. Skill tests were administered for several volunteer students. One week after the training, the students were asked to what extent they had shared their knowledge of CPR technique with other people. RESULTS: Two hundred one students were given the CPR instruction. The confidence in performing CPR was lowest among seventh grade children. The willingness expressed by the students to perform CPR on a family member, a friend, and a stranger were 99.5%, 95.7% and 58.8%, respectively, with boys in the tenth grade most willing to perform CPR on a stranger. The students responded that it is most suitable to learn CPR at grade 6.4+/-2.4. The highest average skill score of 9.5/11 was for sixth grade. The average distribution rate was 1.23, and again this was highest in sixth grade at 3.72. CONCLUSION: This study suggests that the optimal target school age for CPR education using video-based self instruction may be at approximately the sixth grade.

Usefulness of Pain Distribution Pattern Assessment in Decision-Making for the Patients with Lumbar Zygapophyseal and Sacroiliac Joint Arthropathy

There are currently no initial guides for the diagnosis of somatic referred pain of lumbar zygapophyseal joint (LZJ) or sacroiliac joint (SIJ). We developed a classification system of LZJ and SIJ pain, the "pain distribution pattern template (PDPT)" depending on the pain distribution patterns from a pool of 200 patients whose spinal pain source was confirmed. We prospectively applied the PDPT to determine its contribution to clinical decision-making for 419 patients whose pain was presumed to arise from the LZJs (259 patients) or SIJs (160 patients). Forty-nine percent (128/259) of LZJ and 46% (74/160) of SIJ arthopathies diagnosed by PDPT were confirmed by nerve blocks. Diagnostic reliabilities were significantly higher in Type A and C patterns in LZJ and Type C in SIJ arthropathies, 64%, 80%, and 68.4%, respectively. For both LZJ and SIJ arthropathies, favorable outcome after radiofrequency (RF) neurotomies was similar to the rate of positive responses to diagnostic blocks in Type A to Type D, whereas the outcome was unpredictable in those with undetermined type (Type E). Considering the paucity of currently available diagnostic methods for LZJ and SIJ arthropathies, PDPT is useful in clinical decision- making as well as in predicting the treatment outcome.

A Case of Kerion Celsi Caused by Trichophyton mentagrophytes / 대한의진균학회지

Kerion celsi is an inflammatory type of tinea capitis. It is a deep, boggy swelling and is painful. Patchy hair loss and broken hairs, inflammation and scaling are characteristic. We report a case of kerion celsi caused by Trichophyton(T.) mentagrophytes in 4 year-old boy. He presented with 6 cm x 7 cm and 2cm x 2cm sized erythematous boggy masses with multiple pustules and crusts on the vertex. Cultures from a scalp lesion of the patient on Sabouraud dextrose agar media showed T. mentagrophytes. Treatment was done systemically with itraconazole and prednisolone for 14 weeks.

Diagnostic Relevance of Pressure-Controlled Discography

Discogenic pain is a leading cause of chronic low back pain. The authors investigated the efficacy of pressure-controlled discography to determine its role in clinical decision-making for the management of patients with discogenic pain. Pressure-controlled discography was performed in 21 patients (51 discs) with pain-provocation, followed by post-discography computerized tomography scans. Pain response was classified as positive response and negative response, and measured with visual analog scale scores. Discographic findings were graded by the modified Dallas discogram scale. Elastance, pain provocation on intradiscal pressure, pressure and volume of initial pain response, and pain response intensity were statistically analyzed. Elastance showed significant differences between Grade 0 and Grade 4 and 5. Decreased elastance with positive pain response group was a good indicator to imply that disc degeneration presumably is a pain generator. Results of pain response were well correlated with intradiscal pressure but not with the amount of injected volume. Among 31 discs of Grade 4 and 5, 74% showed negative pain response and 26% showed positive response. It was concluded that pressure-controlled discography was useful to diagnose discogenic pain and excellent guide in decision-making for spinal operations.

Comparison of Skin Responses for Irritation Produced by Benzalkonium Chloride and Sodium Lauryl Sulfate / 대한피부과학회지

BACKGROUND: With the development of bioengineering techniques for noninvasive characterization of skin pathophysiology, the induction of irritant dermatitis by surfactants has been extensively studied. OBJECTIVE: We performed this study to compare the skin responses in terms of transepidermal water loss (TEWL) and erythema induced by benzalkonium chloride (BAC), a well-known non-corrosive irritant, in comparison with sodium lauryl sulfate (SLS), a representative corrosive irritant. METHOD: We applied 0.1, 0.2, 0.5, 1, and 2% solutions of BAC and SLS on volar forearm skin for 24 hours using a large Finn chamber with filter paper disc on 19 normal healthy subjects. TEWL and erythema index (E-index) were measured prior to testing, then at 30 minutes, one day, two days, three days, one week, and two weeks after the removal of the patches. RESULTS: TEWL values of BAC and SLS patch areas increased with concentration. However, BAC induced a significantly lower TEWL increase than SLS did at the corresponding concentrations. TEWL induced by BAC was highest at 30 minutes after the removal of the patch, whereas TEWL induced by SLS was highest at one day. TEWL values had recovered with the passage of time to baseline values at 2 weeks after removal of the patch at lower concentrations (0.1, 0.2, 0.5%) of SLS, but still showed significantly high TEWL values at 1% and 2% concentration SLS patch areas. TEWL values of BAC in 0.1, 0.2, 0.5 and 1% concentrations had recovered to the baseline values at 2 weeks after the removal of the patch, but not in 2% concentration BAC patch areas. E-indices of BAC and SLS increased with concentration in a similar reaction pattern. E-index induced by BAC was highest at 30 minutes after the removal of the patch, and E-index induced by SLS was highest at 30 minutes or 1 day after the removal of the patch. E-index of each concentration, except 2%, had recovered with the passage of time to baseline values on both BAC and SLS patch areas at 2 weeks, but E-indices of both 2% BAC and SLS did not recover at 2 weeks. CONCLUSION: Benzalkonium chloride showed much less damage to the skin barrier function compared to the corresponding concentration of SLS, whilst they showed a similar degree of erythema. Skin barrier function affected by the corrosive irritant SLS would need a more prolonged recovery time than skin barrier disruption by non-corrosive irritant BAC.