Decision and Practice of End-of-Life Care in Lung Disease Patients with Physicians Orders for Life Sustaining Treatment / 한국호스피스완화의료학회지

Purpose@#The purpose of this study was to analyze end-of-life care practices in lung disease patients with physician orders for life-sustaining treatment (POLSTs). @*Methods@#We retrospectively analyzed data from medical records regarding the end-of-life care practices of POLST decisions for patients with lung disease hospitalized at a tertiary hospital in Seoul, South Korea. Data were collected from January 1 to June 30, 2021. @*Results@#Of 300 total patients, 198 had lung cancer (66.0%) and 102 had non-malignant lung diseases (34.0%). A POLST was written for 187 patients (62.3%), and an advance directive was written for 20 patients (6.7%). Subsequent treatments were hemodialysis in 13 patients (4.3%), surgery in 3 patients (1.0%), and cardiopulmonary cerebral resuscitation in 1 patient (0.3%). Among cancer patients, chemotherapy was performed in 11 patients (3.7%), targeted therapy in 11 patients (3.7%), immunotherapy in 6 patients (2.0%), and radiation therapy in 13 patients (4.3%). Depending on the type of lung disease, types of treatment differed, including hemodialysis, ventilators, bilevel positive airway pressure, high-flow nasal cannulas, nebulizers, enteral nutrition, central line, inotropic agents, and opioids. onclusion: Although the goals of hospice care are the same whether a patient has lung cancer or a nonmalignant lung disease, because the characteristics of the respective diseases differ, end-oflife care practices and hospice approaches must be considered differently.

Evaluation of factors related to Anaesthesia-induced Lens opacity in experimental mice / 한국실험동물학회지

To investigate conditions that cause temporal lens opacity, we tested chemical and physical factors, such as anaesthesia dose, ocular surface dryness, and infrared (IR) light exposure in anaesthetised C57BL/6 N mice. Mice were anaesthetised with a low (80%; tiletamine/zolazepam 32 mg/kg and xylazine 8 mg/kg, intraperitoneal injection) or high (120%; 48 mg/kg and 12 mg/kg) dose of anaesthetic and examined every 5 min from 10 to 30 min after anaesthesia was induced. Lens opacity levels were assessed and graded (1–6) using the standard classification system. Regardless of the anaesthetic dose, lens opacity grade was 1–2 in moisturised eyes with application of 0.5% carboxymethylcellulose, and 5–6 in dry ocular surface conditions. Lens opacity in mice with high-dose anaesthetic in the dry ocular surface condition was not different from that of mice with low-dose anaesthetic. Lens opacity grade 1–2 was noted in eyes in the wet ocular surface condition, regardless of IR light exposure. During IR light exposure in eyes in the dry ocular surface condition, lens opacity (grade 6) in mice with high-dose anaesthetic was not different from that (grade 6) in mice with low-dose anaesthetic. We demonstrated that ocular surface dryness might be a relevant factor for the formation and progression of lens opacity in anesthetized C57BL/6 N mice. Anaesthesia dose and IR light exposure did not strongly influence lens opacity formation. Furthermore, eyes with corneal dryness-induced lens opacity recovered to normal status without additional intervention.

Evaluation of factors related to Anaesthesia-induced Lens opacity in experimental mice / 한국실험동물학회지

To investigate conditions that cause temporal lens opacity, we tested chemical and physical factors, such as anaesthesia dose, ocular surface dryness, and infrared (IR) light exposure in anaesthetised C57BL/6 N mice. Mice were anaesthetised with a low (80%; tiletamine/zolazepam 32 mg/kg and xylazine 8 mg/kg, intraperitoneal injection) or high (120%; 48 mg/kg and 12 mg/kg) dose of anaesthetic and examined every 5 min from 10 to 30 min after anaesthesia was induced. Lens opacity levels were assessed and graded (1–6) using the standard classification system. Regardless of the anaesthetic dose, lens opacity grade was 1–2 in moisturised eyes with application of 0.5% carboxymethylcellulose, and 5–6 in dry ocular surface conditions. Lens opacity in mice with high-dose anaesthetic in the dry ocular surface condition was not different from that of mice with low-dose anaesthetic. Lens opacity grade 1–2 was noted in eyes in the wet ocular surface condition, regardless of IR light exposure. During IR light exposure in eyes in the dry ocular surface condition, lens opacity (grade 6) in mice with high-dose anaesthetic was not different from that (grade 6) in mice with low-dose anaesthetic. We demonstrated that ocular surface dryness might be a relevant factor for the formation and progression of lens opacity in anesthetized C57BL/6 N mice. Anaesthesia dose and IR light exposure did not strongly influence lens opacity formation. Furthermore, eyes with corneal dryness-induced lens opacity recovered to normal status without additional intervention.

Influence of Professional Self-concept, Job Overload and Perceived Organizational Support on Job Involvement in Clinical Nurses / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify the influence of professional self-concept, job overload, and perceived organizational support on job involvement in clinical nurses. METHODS: The participants in this study were 232 nurses who were working in five general hospitals in city D. Data was collected using self-reported questionnaires from August 16 to September 15, 2016. The data was analyzed using the IBM SPSS 19.0 program. RESULTS: Job involvement of clinical nurses was influenced by professional self-concept, perceived organizational support, turnover intention, age, and monthly income. These variables explained 47.6% of job involvement of clinical nurses, and professional self-concept was the most significant factor in job involvement. CONCLUSION: The findings indicate that the job involvement of clinical nurses is influenced by professional self-concept and perceived organizational support. Consequently, it is necessary to increase professional self-concept and perceived organizational support for nurses' job involvement.

Comparison of Obstetric Pain, Anxiety, and Cervical Dilatation between Epidural Analgesia and No Analgesia group during Labor Stage I

PURPOSE: This research was done to compare obstetric pain, anxiety and cervical dilatation between an epidural analgesia group and a control group. METHODS: Participants were assigned to the experimental or control group depending on their decisions for pain relief. Subjective / objective obstetric pain, anxiety level and cervical dilatation were measured and ANOVA was used for comparison of groups and paired t-test to make pre-post comparisons. RESULTS: Homogeneity of pain, anxiety and cervical dilatation were assessed at the latent phase. Cervical dilatation was larger in the control group than the experimental group, at both the active and the transitional phase (F=22.9, p<.001; F=39.9, p<.001 respectively). The degree of pain and anxiety were not significantly different between the groups. Within the experimental group, subjective / objective pain and anxiety level were significantly lower postanalgesia compared to pre-analgesia in the active phase. All variables, except for sweating in the objective pain measurement, changed significantly at the transient phase. CONCLUSION: The results of this evidence-based research indicate that epidural analgesia while effective in relieving pain and anxiety may have an adverse effect on the cervix during labor stage I. Epidural analgesia should be used carefully during cervical dilatation in labor stage I.

The Neurophysiologic Response of Anterior Horn Cell Activity to Paraspinal Electrical Stimulation

OBJECTIVE: This study was proposed to evaluate the electrophysiologic changes in central motor conduction and in silent period (SP) after paraspinal transcutaneous electrical stimulation near caudal area of the spinal cord. METHOD: Conditioning stimulation was applied to T12 paraspinal area for 20 minutes using interferential current therapy (80~100 Hz) in 11 healthy subjects. The amplitude and latency of central motor conduction and duration of SP were measured in motor evoked potential (MEPs) by using magnetic stimulator, before and after the conditioning stimulation. These variables were recorded in both tibialis anterior muscle, innervated from stimulated spinal area, and both abductor pollicis brevis, innervated from cervical cord not directly stimulated by electrical stimulation. RESULTS: After conditioning stimulation, the amplitudes of central motor conduction decreased (p<0.01), and the latencies did not change in both cervical and lumbar muscles in transcranial and spinal MEP studies, and the duration of SP was decreased in same manner (p<0.01). CONCLUSION: These results mean that the excitability of anterior horn cells decreases and the supraspinal inhibitory mechanism of the central motor conduction is suppressed by a certain conditioned electrical cutaneous stimulation in entire spinal cord.

Electrophysiologic Responses to the Electrical Stimulation: A Peripheral Nerve Conditioning Near the Spinal Cord

It has been reported that the electrical stimulation of nerves can cause the changes of anterior horn cell excitability and conduction velocity of the nerves in vivo and vitro studies. The purpose of this study is to evaluate the electrophysiologic changes of the peripheral nerves near the spinal cord by the electrical stimulation. Subjects were 20 healthy volunteers, with the age of 21 to 27 years. The conditioning current was an interferential current of 10 Hz and 100 Hz with the maximal tolerable intensity (18~20 mA). Conditioning stimulation was applied to the paraspinal area between T9 and T12 for 15 minutes. Before and after the conditioning stimulation, we measured the peripheral nerve conduction, H-reflex, F-wave, and somatosensory evoked potential (SEP) of the tibial nerve. The results after the conditioning revealed that the tibial motor and sensory conductions were unchanged but the latency of the H-reflex was significantly prolonged with a significant reduction of H amplitude and H/M ratio (p0.05). There was no statistical difference between the changes by a high or low frequency stimulation. These results suggest that a certain conditioned electrical stimulation of peripheral nerves near the spinal cord may cause the decrement of anterior horn cell excitability, and the inhibition of the alpha motor nerve and sensory nerve conductions near the spinal cord.

Electrophysiologic Changes of Tibial Nerve by Low Frequency Stimulation in Peripheral Polyneuropathic Patients

The changes of anterior horn cell excitability and conduction of the nervous system by the electrical stimulation of nerve have been reported in both vivo and vitro studies. Purpose of this study is to observe the neurophysiologic changes of nerves by 10 Hz electrical stimulation on polyneuropathic peripheral nerves. Subjects were 18 diabetic polyneuropathic patients diagnosed by the conduction studies. Electrophysiologic studies were performed in both right and left tibial nerves before and after conditioning of the right tibial nerve. Electrophysiologic studies included five tests which were the sural sensory and tibial motor conduction(abductor hallucis), F response(abductor hallucis), H reflex(gastrosoleus) and somatosensory evoked potential(ankle, SEP). Ten Hz rectangular electrical current was used for the conditioning stimulation. It was applied to the popliteal tibial nerve with the tolerable maximal intensity(10-24 mA) for 5 minutes. Following changes were statistically significant in statistics after the conditioning. Prolongation of F latency (p<0.05), increases of F chronodispersion, duration and area(p<0.05), prolongation of H latency(p<0.05), increase of H amplitude(p<0.05), decrease of P1 latency of SEP(p<0.01) and increase of P1N1 amplitude of SEP(p<0.01) were seen in both conditioned and unconditioned legs. Increase of F wave conduction time(FWCT) and decrease of F wave conduction velocity (FWCV) were seen in conditioned leg(p<0.05). Above findings suggest that certain electrical stimulation of polyneuropathic nerve may cause increase of the anterior horn cell excitability, fascilitation of the SEP conduction and slowness of alpha motor conduction to and from the spinal cord.