Factors Influencing Preventive Behaviors for COVID-19 in Undergraduate Nursing Students:A Cross-Sectional Descriptive Study

Purpose@#This study aimed to determine how undergraduate nursing students’ knowledge and health beliefs affected their COVID-19-related infection-prevention behaviors. @*Methods@#This study used a descriptive survey. A total of 188 undergraduate nursing students from two universities in South Korea participated in this study. The data were collected from June 2020 to August 2020. Factors influencing infection-prevention behaviors were identified using multiple regression analysis. @*Results@#The participants’ mean knowledge level regarding COVID-19 was 84.05 ± 11.78 out of 100. The average health belief score was 2.80 ± 0.32 points out of 5. COVID-19-related preventive health behaviors were correlated with experiences of searching for COVID-19 information (r = .22, p < .01), perceived severity (r = .24, p < .01), perceived benefits (r = .29, p < .01), cues to action (r = .30, p < .01), knowledge (r = .27, p < .01), and perceived barriers (r = - .19, p < .05). Factors that significantly affected COVID-19-related preventive health behaviors were the participants’ years of study, experiences regarding COVID-19 prevention education, perceived severity, perceived barriers, and cues to action. @*Conclusion@#COVID-19-related preventive health behaviors are promoted by increasing awareness about the disease and promoting COVID-19 education in nursing curriculums.

Remimazolam: pharmacological characteristics and clinical applications in anesthesiology

A novel ultra-short-acting benzodiazepine (BDZ), remimazolam (CNS 7056), has been designed by ‘soft drug’ development to achieve a better sedative profile than that of the current drugs. Notably, the esterase linkage in remimazolam permits rapid hydrolysis to inactivate metabolites by non-specific tissue esterase and induces a unique and favorable pharmacological profile, including rapid onset and offset of sedation and a predictable duration of action. Similar to other BDZs, its sedative effects can be reversed using flumazenil, a BDZ antagonist. The pharmacokinetics and pharmacodynamics of remimazolam are characterized by relatively high clearance, small steady-state volume of distribution, short elimination half-life, short context-sensitive half-life, and fast onset and recovery, indicating rapid elimination, minimal tissue accumulation, and good control. In addition, remimazolam possesses a superior safety profile, including low liability for cardiorespiratory depression and injection pain, making it a preferred hypnotic agent in various clinical settings. Early clinical investigations suggest that remimazolam is well tolerated and effective for procedural sedation and for induction and maintenance of general anesthesia. To date, however, the clinical use of remimazolam has been confined to a few volunteer studies and a limited number of clinical investigations. Therefore, further studies regarding its recovery issues or postoperative complications, characteristics of electroencephalogram changes, and cost-benefit analyses are required to facilitate its widespread use.

Collaborative Disaster Governance Recognized by Nurses during a Pandemic

Purpose@#We aimed to identify collaborative disaster governance through the demand and supply analysis of resources recognized by nurses during the COVID-19 pandemic. @*Methods@#We used a descriptive study design with an online survey technique for data collection. The survey questions were developed based on focus group interviews with nurses responding to COVID-19 and expert validity testing. A 42-question online survey focusing on disaster governance was sent to nurses working in COVID-19 designated hospitals, public health offices, and schools. A total of 630 nurses participated in the survey. Demand and supply analysis was used to identify the specific components of disaster governance during a pandemic situation and analyze priority areas in disaster governance, as reported by nurses. @*Results@#Demand and supply analysis showed that supplies procurement, cooperation, education, and environment factors clustered in the high demand and supply quadrant while labor condition, advocacy, emotional support, and workload adjustment factors clustered in the high demand but low supply quadrant, indicating a strong need in those areas of disaster governance among nurses. The nurses practicing at the public health offices and schools showed major components of disaster governance plotted in the second quadrant, indicating weak collaborative disaster governance. @*Conclusion@#These findings show that there is an unbalanced distribution among nurses, resulting in major challenges in collaborative disaster governance during COVID-19. In the future and current pandemic, collaborative disaster governance, through improved distribution, will be useful for helping nurses to access more required resources and achieve effective pandemic response.

Factors Influencing the Intention of Hand Hygiene Compliance among Nursing Caregivers in Long Term Care Facilities: Based on the Planned Behavior Theory / 재활간호학회지

Purpose@#The purpose of this study was to investigate factors influencing the intention of hand hygiene implementation based on the theory of planned behavior among caregivers in long-term care facilities (LTCF). @*Methods@#A descriptive cross-sectional survey was conducted with 231 caregivers who are employed in LTCF. Data were collected from April, in 2020 until April, in 2021. @*Results@#Nursing caregivers working at LTCF tend to have a high level of interest in and awareness of the importance of hand hygiene. Levels of behavioral beliefs, normative beliefs, attitude toward behavior, and subjective norms were relatively high, but control beliefs and perceived control levels were relatively low. For variables that affect intention of hand hygiene, behavioral beliefs (β=0.23, p<.001) and normative beliefs (β=0.18, p=.003) significantly affected hand hygiene compliance intentions in belief factors, while subjective norm (β=0.23, p<.001) and attitude toward behavior (β=0.11, p=.047) significantly affected hand hygiene compliance intentions in key factors. with a total explanatory power of 28.2% (F=23.53, p<.001). @*Conclusion@#As in the result, hand hygiene compliance rate can be enhanced by multilateral hand hygiene promotion programs and education that can increase levels of behavior beliefs, normative beliefs, subjective norms, and attitude toward behavior, which are significant variables in the nursing caregivers’ hand hygiene compliance intentions.

Nursing Care Workers’ Experience of Care Giving Infected Patients in Long-term Care Hospital / 재활간호학회지

Purpose@#The purpose of this study is to explore nursing care worker's experience of care services for infected patients in long-term care hospital. @*Methods@#For this study, the researcher used the convenience sampling method to recruit 9 nursing care workers in long-term care hospitals. Data were collected through in-depth interview with them. The data collected were analyzed using the thematic analysis method. @*Results@#24 codes were extracted, and through the process of organizing the meanings, 8 sub-themes and 4 themes were deduced. The themes deduced were ‘Diversely coexisting psychological responses’, ‘Caring for an infected patient at a given position’, ‘Obstacles to implementation of principled infection control guidelines’, ‘Needs for customized education of caregiver for infected patients’. @*Conclusion@#This study would be deemed significant in that it has provided for some basic data to the education of the nursing care workers and the development of an intervention program.

Development and Application of an Infection Control Education Program in Long-Term Care Hospitals / 재활간호학회지

Purpose@#The purpose of this study was to develop an infection control education program (ICEP) for infection control practitioners (ICPs) in long-term care hospitals (LTCH) and to test the effectiveness of the program. @*Methods@#The ICEP was developed based on the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model. Focus group interviews, Borich needs assessment, and location of focus models were used to assess educational needs. To test the effectiveness of the developed ICEP program, one-group pretest-posttest design was used. Participants were 269 ICPs working at LTCH. Knowledge, skills, awareness, self-efficacy, and teaching efficacy on infection control were measured before and after the program using questionnaires. A paired t-test was performed to analyze the data. @*Results@#Compared to pre-test, there was a significant improvement in knowledge (47.07±10.22 vs, 76.99±0.88, p<.001) and skills (32.11±12.48 vs. 62.11±14.08, p<.001). Awareness of infection control, self-efficacy, and teaching efficacy were also significantly improved. @*Conclusion@#We developed an ICEP for ICPs working at LTCH. Based on the results of this study, the ICEP is effective in improving infection control knowledge, skills, self-efficacy, and teaching efficacy for the ICPs. It is suggestive to provide an ICEP to improve hospital infection control activities.

The Factors related to Mothers' Intention to Vaccinate against Hepatitis A: Applying the Theory of Planned Behavior

PURPOSE: This study was conducted using the theory of planned behavior to analyze factors influencing mothers' intention to vaccinate their children against hepatitis A (HA). METHODS: This descriptive study used a questionnaire. The participants were 100 mothers with children under 19 years. The collected data were analyzed by the t-test, analysis of variance, and the Mann-Whitney U test. The Pearson's correlation was used to test the correlations among variables. Stepwise multiple regression was used to identify factors related to HA vaccination intention. RESULTS: The attitude of mothers with children under 19 to HA vaccination were quite positive (6.2 of 7), and their perceived behavioral control (5.73 of 7), subjective norm (5.54 of 7), and vaccination intention (5.96 of 7) were relatively high. Attitude toward HA vaccination was the strongest influencing factor, followed by subjective norm. The explanatory power of attitude and subjective norm for HA vaccination was 84%. CONCLUSION: HA vaccination is very important for preventing HA. Mothers' positive attitudes toward HA vaccination were an important factor influencing their children's HA vaccination. Providing education on the benefits of HA vaccination and the vaccination schedule may foster positive attitude toward vaccination.

Comparative Analysis of Phase Lag Entropy and Bispectral Index as Anesthetic Depth Indicators in Patients Undergoing Thyroid Surgery with Nerve Integrity Monitoring

BACKGROUND: Most depth of anesthesia (DOA) monitors rely on the temporal characteristics of a single-channel electroencephalogram (EEG) and cannot provide spatial or connectivity information. Phase lag entropy (PLE) reflects DOA by calculating diverse connectivity from temporal patterns of phase relationships. The aim of this study was to compare the performance of PLE and bispectral index (BIS) monitors for assessing DOA during anesthesia induction, nerve integrity monitoring (NIM), and anesthesia emergence. METHODS: Thirty-five patients undergoing elective thyroid surgery with recurrent laryngeal nerve NIM received propofol and remifentanil via target-controlled infusion. After applying PLE and BIS monitors, propofol infusion was initiated at a calculated effect site concentration (Ce) of 2 µg/mL and then increased in 1-µg/mL Ce increments. After propofol Ce reached 5 μg/mL, a remifentanil infusion was begun, and anesthesia induction was considered complete. During NIM, PLE and BIS values were compared at a specific time points from platysma muscle exposure to subcutaneous tissue closure. PLE and BIS values were recorded continuously from preanesthetic state to full recovery of orientation; bias and limits of agreement between monitors were calculated. RESULTS: PLE and BIS values decreased progressively with increasing propofol Ce during anesthetic induction and increased by stages during emergence. The prediction probabilities of PLE and BIS for detecting propofol Ce changes were 0.750 and 0.756, respectively, during induction and 0.749 and 0.746, respectively, during emergence. No aberrant PLE or BIS values occurred during NIM. Correlation coefficients for BIS and PLE were 0.98 and 0.92 during induction and emergence, respectively. PLE values were significantly higher than BIS values at full recovery of orientation. Estimated bias between monitors was −4.16 ± 8.7, and 95% limits of agreement were −21.21 to 12.89. CONCLUSION: PLE is a reasonable alternative to BIS for evaluating consciousness and DOA during general anesthesia and during NIM. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003490

Association between Serum-Ferritin Levels and Sleep Duration, Stress, Depression, and Suicidal Ideation in Older Koreans: Fifth Korea National Health and Nutrition Examination Survey 2010–2012 / 가정의학회지

BACKGROUND: Serum-ferritin levels may be associated with psychiatric symptoms among the elderly; however, this association has not been extensively studied. The aim of this study was to evaluate the association between serum-ferritin levels and mental health issues in older Koreans. METHODS: This cross-sectional study included large-scale national data from the Korea National Health and Nutrition Examination Survey 2010–2012. In total, 1,802 older Koreans (≥65 years old) were included. The assessed psychiatric symptoms included short sleep duration, stress, depressed mood, and suicidal ideation. Any association between serum-ferritin levels and mental health issues according to sex was examined using logistic regression analysis. RESULTS: The prevalence of short sleep duration, stress, depressed mood, and suicidal ideation was 50.9%, 21.7%, 18.2%, and 22.5%, respectively. In men, suicidal ideation decreased with increased serum-ferritin levels after multivariate adjustment for sociodemographic and lifestyle factors and comorbidities. The odds ratios (OR) and 95% confidence interval (CI) of suicidal ideation by quartiles of serum-ferritin level were 1 (reference), 1.132 (95% CI, 0.569–2.252), 0.453 (95% CI, 0.217–0.945), and 0.608 (95% CI, 0.295–1.253), respectively, (P for trend=0.039). In women, no trend was observed. However, compared to the lowest quartile, short sleep duration (<7 h) and stress perception were significantly decreased in the third quartile, with odds ratios of 0.601 (95% CI, 0.461–0.888), and 0.606 (95% CI, 0.386–0.952), respectively. CONCLUSION: Moderate serum-ferritin levels were associated with decreased risk for suicide ideation in men, and were associated with decreased short sleep duration and stress perception in women.

Effects of Job Embeddedness, Nursing Work Environment, and Nursing Professionalism on Turnover Intention in Nurses Working at Rehabilitation Hospitals / 재활간호학회지

PURPOSE@#This study was conducted to identify the effects of job embeddedness, nursing work environment, and nursing professionalism on turnover intention in nurses working at rehabilitation hospitals.@*METHODS@#This descriptive study employed a cross-sectional research design. Questionnaires were collected from May to June, 2019. Participants were 200 nurses from three rehabilitation hospitals in Seoul and Gyunggi province. Data were analyzed using independent t-test, ANOVA, Pearson correlation, stepwise multiple regression.@*RESULTS@#Mean scores for turnover intention, nursing work environment, nursing professionalism. and job embeddedness were 3.21±0.65, 2.90±0.43, 3.06±0.24, and 3.11±0.40, respectively. Turnover intention was negatively correlated with job embeddedness, nursing practice environment, and nursing professionalism. Nursing work environment was the most important predictor in turnover intention, followed by job embeddedness.@*CONCLUSION@#The findings in this study indicated that we need to investigate the level of job embededness, nursing work environment, and nursing professionalism in nurses working at rehabilitation hospitals. Hospital managers should develop and apply appropriate policies and strategies to reduce nurses' turnover intention, improve nursing work environment and enhance the level of job embededness.

Inhibition of endoplasmic reticulum stress in high-fat-diet-induced obese C57BL/6 mice: Efficacy of a novel extract from mulberry (Morus alba) leaves fermented with Cordyceps militaris / 한국실험동물학회지

A few clues about correlation between endoplasmic reticulum (ER) stress and mulberry (Morus alba) leaves were investigated in only the experimental autoimmune myocarditis and streptozotocin-induced diabetes. To investigate whether a novel extract of mulberry leaves fermented with Cordyceps militaris (EMfC) could suppress ER in fatty liver, alterations in the key parameters for ER stress response were measured in high fat diet (HFD)-induced obese C57L/6 mice treated with EMfC for 12 weeks. The area of adipocytes in the liver section were significantly decreased in the HFD+EMfC treated group as compared to the HFD+Vehicle treated group, while their level was higher in HFD+Vehicle treated group than No treated group. The level of the eukaryotic initiation factor 2 alpha (eIF2α) and inositol-requiring enzyme 1 beta (IRE1α) phosphorylation and CCAAT-enhancer-binding protein homologous protein (CHOP) expression were remarkably enhanced in the HFD+Vehicle treated group. However, their levels were restored in the HFD+EMfC treated group, although some differences were detected in the decrease rate. Similar recovery was observed on the ER stress-induced apoptosis. The level of Caspase-3, Bcl-2 and Bax were decreased in the HFD+EMfC and HFD+orlistat (OT) treated group compared to the HFD+Vehicle treated group. The results of the present study therefore provide first evidence that EMfC with the anti-obesity effects can be suppressed ER stress and ER stress-induced apoptosis in the hepatic steatosis of HFD-induced obesity model.

Prediction of Patient Discharge Status Based on Indicators on Admission / 한국호스피스완화의료학회지

PURPOSE: To provide effective palliative care, it is important to predict not only patients' life expectancy but their discharge status at a time of inpatient admission to a hospice care facility. This study was aimed to identify meaningful life expectancy indicators that can be used to predict patients' discharge status on admission to the facility. METHODS: Among 568 patients who were admitted to the hospice ward of P hospital from April 1, 2016 through December 31, 2017, 377 terminal cancer patients were selected. This retrospective cohort study was performed by using performance status, symptoms and signs, socioeconomic status, laboratory findings on admission. RESULTS: Alive discharge was associated with a good performance status that was measured with the Karnofsky and Eastern Cooperative Oncology Group (ECOG) scales and the Global health and Mental status. Less anorexia, dyspnea, dysphagia and fatigue were also associated with symptoms and signs. Associated laboratory findings were close to normal Complete Blood Cell (CBC) count, Liver Function Test (LFT) and Blood Urea Nitrogen (BUN). CONCLUSION: Our findings suggest that Karnofsky Performance Status (KPS), ECOG, Global health, Mental status, anorexia, dyspnea, dysphagia, fatigue, CBC, LFT, BUN are meaningful indicators when predicting discharge status for inpatients. Further investigation is warranted.

Relations of Sleep Quality, Lifestyle, and Successful Aging in the Elderly Attending a Senior Welfare Center / 재활간호학회지

PURPOSE: The purpose of this study was to investigate the relationship of sleep quality, lifestyle and successful aging in the elderly. METHODS: The subjects of this study were 125 elderly people, aged 65 years and older, who attended a senior welfare center in Cheongju city, Korea. They completed a structured self-reported questionnaire comprising measures of quality of sleep, lifestyle, and successful aging. Data were analyzed using t-test, ANOVA, Scheffé's test, Pearson's correlation coefficient, and hierarchical linear multiple regression analysis with SPSS/WIN 20.0. RESULTS: Lifestyle showed a positive correlation with the quality of sleep, and successful aging showed a significant positive correlation with quality of sleep and lifestyle. Pin money (β=.32), quality of sleep (β=.20) and lifestyle (β=.55) were strong influential factors in successful aging. Hierarchical multiple regression analysis showed the determinant variables account for 35.9% of the variation in successful aging (F=35.11, p < .001). CONCLUSION: Successful aging depends on controllable factors such as the willingness to change the lifestyle of choosing one's life and how one copes with applying appropriate sleep hygiene. These results suggest that improvement of the quality of sleep and lifestyle will be helpful to the successful aging process.

Administration of Alpha(s1)-Casein Hydrolysate Increases Sleep and Modulates GABA(A) Receptor Subunit Expression

Sleep is the most basic and essential physiological requirement for mental health, and sleep disorders pose potential risks of metabolic and neurodegenerative diseases. Tryptic hydrolysate of α(S1)-casein (α(S1)-CH) has been shown to possess stress relieving and sleep promoting effects. However, the differential effects of α(S1)-CH on electroencephalographic wave patterns and its effects on the protein levels of γ-aminobutyric acid A (GABA(A)) receptor subtypes in hypothalamic neurons are not well understood. We found α(S1)-CH (120, 240 mg/kg) increased sleep duration in mice and reduced sleep-wake cycle numbers in rats. While α(S1)-CH (300 mg/kg) increased total sleeping time in rats, it significantly decreased wakefulness. In addition, electroencephalographic theta (θ) power densities were increased whereas alpha (α) power densities were decreased by α(S1)-CH (300 mg/kg) during sleep-wake cycles. Furthermore, protein expressions of GABA(A) receptor β1 subtypes were elevated in rat hypothalamus by α(S1)-CH. These results suggest α(S1)-CH, through GABA(A) receptor modulation, might be useful for treating sleep disorders.

Lipolytic effect of novel extracts from mulberry (Morus alba) leaves fermented with Cordyceps militaris in the primary adipocytes derived from SD rats / 한국실험동물학회지

Mulberry (Morus alba) leaves are known to have therapeutic effects on lipid metabolism including lipogenesis, lipolysis and hyperlipidemia. However, novel compounds with strong lipolytic ability among 27 extracts of the mulberry leaves fermented with Cordyceps militaris (EMfCs) have not yet been identified. Therefore, the cAMP concentration and cell viability were measured in the primary adipocytes of SD (Sprague Dawley) rats and 3T3-L1 cells after treatment of 27 EMfCs. Briefly, mulberry leaves powders amended with three different concentrations (0, 25 and 50%) of silkworm pupae (SWP) powder were fermented with 10% C. militaris (v/w) during three different periods (3, 4 and 6 weeks). A total of 27 extracts were obtained from the fermented mulberry leaves powders using three different solvents (dH2O, 50% EtOH and 95% EtOH). Among the 27 EMfCs treated groups, a significant increase in the concentration of cAMP was detected in primary adipocytes treated with 10 extracts when compared with the Vehicle treated group. However, their cAMP concentration did not agree completely with the non-toxicity, although most extracts showed non-toxicity. Furthermore, the concentration of cAMP and level of free glycerol gradually increased in a dose dependent manner (100, 200 and 400 µg/mL) of 4M3-95 contained cordycepin without any significant toxicity. Overall, the results of this study provide strong evidence that 4M3-95 extract derived from EMfCs can stimulate the lipolysis of primary adipocytes at an appropriate concentration and therefore have the potential for use as lipolytic agents to treat obesity.

Effects of Adamantyl Derivatives on Pharmacokinetic Behavior of Paclitaxel in Rats

Paclitaxel (PTX) is one of the most frequently used anticancer agent for treating refractory ovarian cancer, metastatic breast cancer and non-small cell lung cancer. However, its oral administration is impeded by very low bioavailability (<5%) due to the P-glycopprotein (P-gp) efflux pump effect. This study investigated in vitro and in vivo P-gp inhibitory effects of adamantyl derivatives AC-603 and AC-786 in rats. Two adamantyl derivatives tested in this study increased the cytotoxicity of daunomycin (DNM) in P-gp overexpressed cell line by inhibiting P-gp efflux function. Pharmacokinetics of PTX with orally co-administered P-gp inhibitors were assessed in rats to improve PTX absorption. The pharmacokinetic parameters of PTX were determined in rats after intravenous (2 mg/kg) or oral (25 mg/kg) administration in the presence or absence of verapamil (a positive control), AC-603 or AC-786 (0.5 mg/kg or 5 mg/kg). Compared to control group (PTX alone), experimental groups (PTX with AC-603 or AC-786) significantly increased the area under the plasma concentration-time curve of PTX following oral administration by 1.7–2.2 fold. The volume of distribution and total clearance of PTX were decreased, while other parameters were not significantly changed. In conclusion, co-administration of AC-603 or AC-786 enhanced the relative bioavailability of orally administered PTX as compared to control.

Perioperative management of tracheal injury following endotracheal intubation in a neonate: A case report

Tracheal injury in neonates is a rare but serious complication of endotracheal intubation. The morbidity and mortality are associated with early recognition and adequate management. Herein, we reported a case of perioperative management of neonatal tracheal injury following multiple attempts at endotracheal intubation caused by unanticipated difficulty.

D-Xylose as a sugar complement regulates blood glucose levels by suppressing phosphoenolpyruvate carboxylase (PEPCK) in streptozotocin-nicotinamide-induced diabetic rats and by enhancing glucose uptake in vitro

BACKGROUND/OBJECTIVES: Type 2 diabetes (T2D) is more frequently diagnosed and is characterized by hyperglycemia and insulin resistance. D-Xylose, a sucrase inhibitor, may be useful as a functional sugar complement to inhibit increases in blood glucose levels. The objective of this study was to investigate the anti-diabetic effects of D-xylose both in vitro and stretpozotocin (STZ)-nicotinamide (NA)-induced models in vivo. MATERIALS/METHODS: Wistar rats were divided into the following groups: (i) normal control; (ii) diabetic control; (iii) diabetic rats supplemented with a diet where 5% of the total sucrose content in the diet was replaced with D-xylose; and (iv) diabetic rats supplemented with a diet where 10% of the total sucrose content in the diet was replaced with D-xylose. These groups were maintained for two weeks. The effects of D-xylose on blood glucose levels were examined using oral glucose tolerance test, insulin secretion assays, histology of liver and pancreas tissues, and analysis of phosphoenolpyruvate carboxylase (PEPCK) expression in liver tissues of a STZ-NA-induced experimental rat model. Levels of glucose uptake and insulin secretion by differentiated C2C12 muscle cells and INS-1 pancreatic beta-cells were analyzed. RESULTS: In vivo, D-xylose supplementation significantly reduced fasting serum glucose levels (P < 0.05), it slightly reduced the area under the glucose curve, and increased insulin levels compared to the diabetic controls. D-Xylose supplementation enhanced the regeneration of pancreas tissue and improved the arrangement of hepatocytes compared to the diabetic controls. Lower levels of PEPCK were detected in the liver tissues of D-xylose-supplemented rats (P < 0.05). In vitro, both 2-NBDG uptake by C2C12 cells and insulin secretion by INS-1 cells were increased with D-xylose supplementation in a dose-dependent manner compared to treatment with glucose alone. CONCLUSIONS: In this study, D-xylose exerted anti-diabetic effects in vivo by regulating blood glucose levels via regeneration of damaged pancreas and liver tissues and regulation of PEPCK, a key rate-limiting enzyme in the process of gluconeogenesis. In vitro, D-xylose induced the uptake of glucose by muscle cells and the secretion of insulin cells by beta-cells. These mechanistic insights will facilitate the development of highly effective strategy for T2D.

Comparison of volume-controlled and pressure-controlled ventilation in the Trendelenburg position for gynecological laparoscopic surgery

BACKGROUND: Minimal invasive gynecologic surgery usually requires pneumoperitoneum and Trendelenburg positioning, which results in adverse effects on respiratory and hemodynamic parameters. The aim of this study was to investigate the effects of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) introduced sequentially in patients who underwent gynecological laparoscopy on respiratory mechanics, cardiovascular responses, and gas exchange. METHODS: Forty patients who were scheduled for gynecologic laparoscopic surgery were enrolled. Baseline ventilation of their lungs was performed with VCV with a tidal volume (TV) of 8 ml/kg ideal body weight (IBW). Forty minutes after pneumoperitoneum and Trendelenburg positioning, the ventilation mode was changed to PCV, and airway pressure was set to provide a TV of 8 ml/kg IBW without exceeding 35 cmH2O. Respiratory mechanics and hemodynamic and gas exchange parameters were recorded at 10 minutes after induction, 30 minutes after CO2 pneumoperitoneum and Trendelenburg positioning, 30 minutes after PCV, and 30 minutes after desufflation and supine position. RESULTS: After pneumoperitoneum and Trendelenburg positioning, there were significant increases in systolic blood pressure, diastolic blood pressure, central venous pressure, peak airway pressure (PAP), mean airway pressure (Pmean), whereas lung compliance and PaO2 significantly decreased. The decrease in PAP and increases of Pmean, lung compliance and PaO2 were observed during PCV compared with VCV (P < 0.05). There were no differences in hemodynamic parameters between VCV and PCV. CONCLUSIONS: Our results demonstrated that PCV may be an effective method of ventilation during gynecologic laparoscopy in terms of improved oxygenation and minimizing adverse respiratory mechanics.

Clinical Experiences as Related to Standard Precautions Compliance among Nursing Students: A Focus Group Interview Based on the Theory of Planned Behavior

PURPOSE: During clinical placements, nursing students who come into close contact with patients and provide nursing interventions may be exposed to harmful pathogens. However, little is known about nursing students' experiences with standard precautions (SP) in clinical settings. METHODS: We conducted interviews with six focus groups of nursing students (n = 38) from two universities in South Korea. The focus group interviews each took 90e120 minutes and included 6e7 participants from two different universities. The meetings used semi-structured interview protocols. Qualitative content analysis was employed. RESULTS: Four themes and 9 subthemes were identified: (a) attitudes (knowledge deficit, sensitivity), (b) subjective norms (negative role models, classroom and in-field gaps, blind spots), (c) perceived behavioral control (psychological barriers, physical barriers, lack of information), and (d) intention (changes in compliance awareness). CONCLUSIONS: These focus groups revealed that many nursing students worked in vulnerable environments and risked pathogen exposure. Nursing students expressed the importance of SP but reported witnessing many instances of failure to comply with established measures. Several barriers were explored as reasons of SP noncompliance. By removing the barriers presented in this study, nursing students would be able to perform their duties in a safe clinical environment.