Chemotherapy-induced Peripheral Neuropathy in Patients with Breast Cancer: Associated Factors and Impact on Health-Related Quality of Life

Purpose@#This study aimed to identify factors associated with the occurrence of chemotherapy-induced peripheral neuropathy (CIPN) and to study its impact on health-related quality of life (HRQoL) in patients with breast cancer. @*Methods@#In total, 137 women with breast cancer who had undergone more than one cycle of chemotherapy were recruited for this descriptive study from the outpatient department of a university hospital in Incheon, Korea. Data were collected using a self-reported questionnaire, which included the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CIPN20 and EORTC QLQ-C30. @*Results@#The mean CIPN score between patients was 13.57 on the sensory scale, 15.87 on the motor scale, and 25.06 on the autonomic scale. Of the studied socio-demographic, disease and treatment, and health behavior-related factors, only the chemotherapy regimen was significantly associated with CIPN (t = 2.50, p= .013). Taxane-based chemotherapy was significantly related to higher CIPN scores. Regression analyses revealed that CIPN was a factor that was significantly influential on HRQoL, adjusting for socio-demographic and clinical factors. @*Conclusion@#This study suggests that oncology nurses need to be aware of the increased risk of CIPN in patients with breast cancer undergoing taxane-based chemotherapy. In addition, interventions for alleviating CIPN may be required to improve HRQoL among these patients.

Development and Clinical Validity of a Mild Vascular Cognitive Impairment Assessment Tool for Korean Stroke Patients

PURPOSE: The present study was conducted to develop a mild vascular cognitive impairment (MVCI) assessment tool for patients with stroke and to examine its validity, reliability, and clinical adequacy. METHODS: Items of this tool were developed based on previously verified cognitive assessment tools. Face, content, and criterion (concurrent) validities, optimal cut-off score for differentiation of MVCI and normal cognitive function, clinical adequacy, internal consistency, and inter-rater reliability of the assessment tool were determined in 60 stroke patients at a university hospital located in Incheon, South Korea. RESULTS: The devised MVCI assessment tool contains 20 items which were designed to assess seven cognitive domains: orientation, memory, language, attention, reasoning/abstraction, visuospatial perception, and executive function/problem solving. Content, face, and construct validities were well supported. Clinical adequacy testing revealed that the overall probability of correctly discriminating MVCI using the MVCI assessment tool for stroke was 90.0%, which was statistically significant. Furthermore, a score of 23 was found to be the optimal cut-off score for MVCI. Internal consistency and inter-rater reliability were also well supported. CONCLUSIONS: The findings of this study indicate that the developed MVCI assessment tool for stroke could serve as a clinically useful tool for detecting MVCI and for properly assessing degree of cognitive impairment in stroke patients.

An Integrative Model of Workplace Self-protective Behavior for Korean Nurses

PURPOSE: This study was conducted to develop and test a hypothetical stage model of workplace self-protective behaviors with respect to blood transmitted infections and musculoskeletal injuries for Korean nurses. METHODS: A nonexperimental, cross-sectional study designwas adopted. The study participants were 320 nurses at two Korean university hospitals. Perceived sensitivity, severity, barriers, benefits, self-efficacy, social support, and safety climate were assessed. RESULTS: Overall, fit indicators showed a good fit for the hypothetical model of self-protective behaviors against blood transmitted infections and musculoskeletal injuries. The significant factors of self-protective behaviors against blood transmitted infections were perceived barriers and social support. The significant factors of self-protective behaviors against musculoskeletal injuries were perceived benefits, barriers, and self-efficacy. CONCLUSION: Our findings suggest that the significant psychosocial constructs of stages of self-protective behavior are dependent on health problem type. Accordingly, we advise that characteristics of behavior and types of disease and health problem should be given priority when developing intervention programs for particular self-protective health behaviors.

Effects of Gout Web based Self-management Program on Knowledge Related to Disease, Medication Adherence, and Self-management

PURPOSE: This study was conducted to examine the changing patterns of knowledge related to disease, medication adherence, and self-management and to determine if outcomes were more favorable in the experimental group than in the comparison group through 6 months after providing a web-based self-management intervention. METHODS: A non-equivalent control group quasi-experimental design was used and 65 patients with gout, 34 in experimental group and 31 in comparison group, were selected from the rheumatic clinics of two university hospitals. Data were collected four times, at baseline, at 1 month, 3 months, and 6 months after the intervention. RESULTS: According to the study results, the changing patterns of knowledge and self-management were more positive in the experimental group than in the control group, whereas difference in the changing pattern of medication adherence between two groups was not significant. CONCLUSION: The results indicate that the web-based self-management program has significant effect on improving knowledge and self-management for middle aged male patients with gout. However, in order to enhance medication adherence, the web-based intervention might not be sufficient and other strategies need to be added.

Demographic and Health-related Risk Factors for the Recurrence of Primary Spontaneous Pneumothorax

PURPOSE: This study was conducted to examine the relationships between the recurrence of pneumothorax with demographic and health-related risk factors. METHODS: Demographic factors (age and gender) and health-related risk factors (Body Mass Index, smoking, exercise, stress, fatigue, and morbidity from colds) were measured from 60 patients admitted to two acute care institutions due to pneumothorax. RESULTS: The study results showed significant differences in factors such as height and minutes of performing exercise per week, between the first occurrence and recurrence groups. However, other risk factors did not show significant differences between the two groups. CONCLUSION: Prevention of recurrences is important for the treatment and management of pneumothorax. More studies are required to accumulate empirical evidence for health-related risk factors and pneumothorax recurrence, as the relationship between all factors and recurrence were not obtained by the study results.

Meta-analysis on the Risk Factors for Fracture in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: This study was conducted by using a meta-analysis to calculate the mean effect sizes of the risk factors for fracture of patients with rheumatoid arthritis (RA) and to perform tests for the significance of the calculated mean effect sizes. METHODS: Eleven studies that directly examined the relationships between fracture and risk factors were selected from 179 related studies identified from PubMed, MEDLINE, COCHRAN and CINHAL with the key words being 'rheumatoid arthritis', 'fracture' and 'risk factors'. RESULTS: The mean effect size of age on fracture was significant. The mean effect sizes of steroid use and the duration of RA on fracture were also significant. However, all of these effect sizes (age, the use of steroid and the duration of disease) were small (bar D=0.15, 0.16 and 0.12, respectively). The mean effect size of the BMD at the lumbar spine was significant and the effect of the BMD at the L-spine was of medium size (bar D=0.47). The mean effect sizes of the other risk factors such as disability, disease activity, the BMD at the femur neck, BMI and a smoking habit were not significant. CONCLUSION: From the study results, it was noted that the efforts to prevent fracture of RA patients should focus on patients with an older age, the patients who used steroid, the patients with a longer duration of RA and the patients who present with low BMD at the lumbar spine.

Criterion-Related Validity of the Critical Patients' Severity Classification System Developed by the Hospital Nurses' Association / 성인간호학회지

PURPOSE: This study was conducted to test criterion-related validity of the Critical Patients' Severity Classification System (CPSCS) developed by the Hospital Nurses' Association by examining relationships with brain injury severity measured by Glasgow Coma Scale (GCS), recovery state measured by Glasgow Outcome Scale (GOS), and days of stay in ICU of brain injury patients. METHODS: Prospective correlational research design was adopted by including 194 brain injury patients admitted to ICU of one university hospital. RESULTS: The score of CPSCS appeared to significantly discriminate the severity of brain injury. Among nursing activities in CPSCS, Respiratory therapy, IV Infusion and Medication, Monitoring, Activities of Daily Living (ADL), Treatment and Procedure were significant to discriminate the severity of brain injury. Respiratory therapy, Vital Signs, and Monitoring appeared to significantly discriminate the recovery states of 1- and 3-months. Nursing activities significantly contributed to predict the days of ICU stay were Respiratory therapy, ADL, and Teaching and Emotional Support. CONCLUSION: CPSCS developed by the Hospital Nurses Association appeared to be valid to discriminate or predict brain injury severity, recovery states, and days of stay in ICU for brain injury patients.

Influence of Age, Gender, and Severity on Recovery of Patients with Brain Injury

PURPOSE: This study was conducted to investigate the individual and cross influences of age, gender, and severity on recovery of patients with brain injury. METHODS: For the purpose of the study, traumatic or spontaneous brain injury patients admitted to the intensive care unit (ICU) were conveniently selected. The data regarding outcomes were collected 3 months after admission. RESULTS: Individual influences of the study variables on patients' recovery were significant, except for gender. But while the individual influence of gender on recovery was not significant, cross influence of gender and age was significant, but only for the sub-dimension of 'arousalbility and awareness'. The study results also showed that 3-way cross influence of gender, age, and severity was only significant on the sub-dimension of 'arousalbility and awareness'. CONCLUSION: The sub-dimension of recovery cross influenced by the demographic factors of gender and age, and severity was 'arousalbility and awareness'. This might indicate that the study variables that cross influencing recovery had more influence on consciousness compared to physical function and psycho-social adaptation.

A Exploratory Study on the Personality Type, Problematic Drinking Pattern, and Stress Coping Style of the Nasal Bone Fracture Patients Due to Violence / 성인간호학회지

PURPOSE: This study was conducted to identify the personality type, problematic drinking pattern, and stress coping style of the nasal bone fracture patients by comparing those with general fracture patients. METHODS: 50 nasal bone fracture patients due to violence and 50 general fracture patients due to simple trauma, such as fall and traffic accident were conveniently selected. RESULTS: The study results showed that nasal bone fracture patients due to violence significantly presented higher level of A type personality and more problematic drinking pattern than general fracture patients due to simple trauma. Stress coping style, however, did not show significant difference between two groups. CONCLUSION: In order to prepare prevention strategies for basal bone fracture in the future, health education alter problematic drinking habit to sound drinking pattern may be offered and provided nursing interventions tailored to A type personality.

Changing Pattern and Comparison of Nutritional States before and after Nasogastric Tube Feeding for the Severe Brain Injury Patients in Critical Period / 성인간호학회지

PURPOSE: The purpose of the study were to examine the nutritional status of severe brain injury adult patients in critical period, and to compare the nutritional states before and after tube feeding. METHODS: Data from 19 patients admitted to the SICU in a university hospital due to severe brain injury were analyzed. Nutritional states were measured by anthropometric and blood biochemical indicators. RESULTS: MAC and MAMC were significantly decreased only at 7 days after admission compared with those on the day of admission. TSF was significantly decreased from 7 days to 14 days after admission. Fat rate was significantly decreased from 3 days to 14 days after admission. Hb was significantly decreased only at 3 days after admission. Albumin was significantly decreased from 3 days to 14 days after admission. However, lymphocyte was significantly increased at 14 days after admission. TSF and Albumin became significantly worse even after initiating tube feeding. CONCLUSIONS: Nutritional status of severe brain injury patients in SICU became worse after admission whichever indicators were adopted to evaluate nutritional status, anthropometric or blood biochemical indicators, and became worse even after initiating tube feeding.

Recovery State of Hemorrhagic Stroke Patients: Exploratory Comparison of Recovery State between Spontaneous Intracerebral Hemorrhage(s-ICH) and Spontaneous Subarachnoid Hemorrhage(s-SAH) / 성인간호학회지

PURPOSE: This study was conducted to compare the recovery state of 6 month between s-ICH and s-SAH patients. The patients' recovery state was measured with 2 dimensions: functional and cognitive. METHODS: Non-experimental prospective design was adopted by including 108 hemorrhagic stroke patients(s-ICH: 52 vs s-SAH: 56) admitted to Intensive Care Unit of one university hospital. RESULTS: The study results showed that overall functional recovery state of s-SAH patients was better than that of s-ICH patients, and s-SAH patients also showed better recovery states in all of the sub-dimensions of functional recovery, such as feeding, grooming, and toileting, than those of s-ICH in 6 month. On the contrary, the study results showed that overall cognitive recovery states of 6 month between two groups were not significantly different. However, according to the results comparing the sub-dimensions of cognitive recovery, s-SAH patients' recovery states on attention, communication and memory were significantly better than those of s-ICH patients, while recovery states on problem solving, safety behavior, and social behavior between 2 groups were not significantly different. CONCLUSION: From the study results, it was noted that s-SAH patients showed better recovery states in cognitive dimension as well as in functional dimension compared with s-ICH patients.

The Prognostic Values of Acute Physiological Parameters in Hemorrhagic Stroke Patients: Differences Between Patients with High and Low Glasgow Coma Scale Scores on Admission / 성인간호학회지

PURPOSE: This study was to identify the significant acute physiological predictors of mortality and of functional and cognitive recovery in hemorrhagic stroke patients. METHODS: The subjects were 108 hemorrhagic stroke patients admitted to Neurological Intensive Care Unit of a university hospital. RESULTS: The significant physiological predictors of mortality and of functional and cognitive recovery were quite different upon admission Glasgow Coma Scale scores: respiratory rate, hematocrit, serum pH, osmolality, and PaCO2 were the predictors in the subjects with a high Glasgow Coma Scale scores while blood pressure, PaO2, respiratory rate, and hematocrit in the subjects with a low Glasgow coma scale scores. CONCLUSION: The physiological derangements induced by acute stroke are undoubtedly influence clinical outcome. More study is required to determine their diverse impacts on clinical outcomes.

Comprehensive Predictors of Fatigue for Cancer Patients / 간호학회지

PURPOSE: This study was conducted to identify comprehensive predictors of fatigue in cancer patients. METHODS: One hundred ten cancer patients visiting in-patient or out-patient clinics of a university hospital located in Incheon participated in this study. RESULTS: The hematologic indicators (WBC and Hemoglobin) were significant for explaining fatigue. The psychological factors of fatigue were statistically significant. Both anxiety and depression, included as psychological factors, were significant in explaining fatigue in cancer patients. The influence of physical factors on fatigue was also statistically significant. Among the variables included as physical factors, pain, nausea/vomiting/anorexia, and sleep disturbance were significant whereas, dyspnea was not significant. The influence of the daily activity factor on fatigue was statistically significant. Among the variables included as daily activity factors, regular exercise or not and the usual activity level were significant in explaining fatigue of cancer patients, while the level of rest was not statistically significant. CONCLUSIONS: From the study results fatigue of cancer patients appeared to be influenced by multidimensional factors, such as physiological, physical, psychological, and activity related factors.

Comparisons of the Prognostic Predictors of Traumatic Brain Injury According to Admission Glasgow Coma Scale Scores-Based on 1- and 6-month Assessments / 간호학회지

PURPOSE: The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. METHODS: The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. RESULTS: The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. CONCLUSIONS: The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation METHODS: This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.

Development of an Integrative Cognitive Rehabilitation Program for Brain Injured Patients in the Post-acute Stage / 간호학회지

PURPOSE: This study was conducted to develop a comprehensive cognitive rehabilitation program that can be easily applied to brain injured patients by family members or nurses in community or hospital settings. METHODS: A Systemic literature review design was used. Thirty-three related studies were reviewed. RESULT: Based on the results of the literature review, the training tasks for attention were designated to enhancing 4 hierarchical areas, i.e., focused, selective, alternating, and divided attention. On the other hand, the memory rehabilitation tasks mainly consisted of mnemonic skills, such as the association method which helps patients memorize given information by linking together common attributes, the visual imagery method, and self-instruction method. The problem solving rehabilitation program included a task of games or plays which stimulated the patients' curiosity and interest. The training tasks for problem solving were to encourage the process of deriving reasonable solutions for a problematic situation resembling real problems that the patients were faced with in their everyday life. CONCLUSION: It is expected that the cognitive rehabilitation program developed from this study could help patients having difficulty in their every day life, due to a reduced cognitive ability resulting from brain injury, to effectively adapt to every day life.

Effectiveness of a Behavioral Intervention Program for Urinary Incontinence in a Community Setting / 간호학회지

PURPOSE: The purposes of this study were to examine the effectiveness of a behavioral intervention program combining pelvic floor muscle exercise with bladder training for urinary incontinence and also to conduct follow-up assessment after self-training. METHODS: This study was conducted using a non-equivalent control group, pretest-posttest design. The subjects were 60 middle-aged women (control group, n=30; intervention group, n=30) who experienced an episode of urinary incontinence at least once a week. The program was run over a 4 week period (once a week) and composed of urinary incontinence education, pelvic floor muscle exercise, and bladder training. RESULTS: Overall, there was a significant difference in urinary incontinence symptoms and psycho-social wellbeing related to urinary incontinence between the treatment and control group. Of the variables, weekly leakage frequencies, leakage amounts on each occasion, leakage index, frequencies of nocturia, and quality of life were significantly different between the groups. Follow-up assessment (9th week) indicated that overall incontinence symptoms and psycho-social well-being were significantly different between the posttest and follow-up assessments. Most variables of incontinence symptoms and psycho-social well-being were significantly improved at follow-up assessment versus posttest. CONCLUSIONS: The program was overall effective in terms of relieving symptoms and improving psycho-social well-being related to urinary incontinence, and this effect continued after a 4-weeks self-training period. In the respect that this is a community-based application study, the results can be meaningful and applicable.

The Circadian Rhythms of Blood Pressure and Heart Rate in the Hypertensive Subjects: Dippers and Non-Dippers

The purpose of this study was to compare the circadian blood pressure and heart rate rhythm of dippers and non-dippers. Biochemical and clinical characteristics of dippers and non-dippers were also compared to determine whether non-dippers have an increased prevalence of hypertension- related conditions. The subjects were 123 out-patients with essential hypertension who had undergone ambulatory blood pressure monitoring at the University Hospital in Inchon, South Korea, from January 1, 1997 to December 31, 1998. Daytime values were determined between 6:00 AM and 8:00 PM and the nighttime values were determined between 8:00 PM and 6:00 AM. Non-dippers were defined as those who showed a reduction in systolic blood pressure, diastolic blood pressure or heart rate less than 10% and they accounted for 25%, 32% and 31% of the subjects, respectively. The timings of the circadian systolic and diastolic blood pressure and heart rate in dippers were very consistent: showing the lowest values during the night, rising in the early morning and reaching a plateau in the late morning. Non-dippers' circadian rhythms of systolic and diastolic blood pressures fluctuated less than those of dippers, and the 24-hours heart rate rhythms of the dipper and non- dipper groups were completely reversed. None of the biochemical characteristics tested in the present study showed a significant difference between dippers and non-dippers whether dipper was classified by systolic or diastolic blood pressure or heart rate. Similarly, hypertension-related symptoms and complications were not associated with the dipper/non-dipper description, whether classified by sBP, dBP, or HR.

The Compound Relationship of Smoking and Alcohol Consumption with Obesity

The purpose of this study was to examine 1) whether the relationship between smoking and obesity was linear or non-linear (specifically U-shaped), and 2) if this relationship was proved to U-shaped, whether it was due to the in teraction of the effects of smoking and alcohol consumption on obesity. The present study was performed using cross sectional data taken from the medical records of 400 male patients. Data was analyzed using linear and curvilinear estimation, Fisher's exact test, and two-way ANCOVA. The relationship between smoking intensity and BMI was able to be explained significantly by a quadratic model, rather than by linear model. As has been shown in other studies, this relationship was parabolic (or U-shaped), though it was not particularly remarkable. This U-shaped relationship appeared to be due to the interaction of the effects of smoking intensity and alcohol consumption on BMI. On the other hand, the relationship between smoking intensity and the percentage of body fat was able to be explained significantly by a linear as well as a quadratic model. Additionally, the interaction effect between smoking intensity and alcohol consumption did not influence the percentage of body fat significantly. In conclusion, there is no doubt that smoking and obesity are both serious health hazards. Based on the results of this and other studies, it can be confirmed that heavy smoking has a positive relationship with obesity. Therefore, the health benefits of smoking cessation, as well as the correction of unhealthy habits such as alcohol consumption should be clearly emphasized.

Acute Effect of Ethanol on Firing Patterns of Purkinje Cells in the Rat Cerebellar Slice Preparation

This study examined the acute effects of ethanol (EtOH) on the firing patterns of Purkinje cells (PCs) using an intracellular recording in slice preparation of rat cerebellum. The experiments were performed in sagittal cerebellar slices (400 microm) of adult Sprague-Dawley rats (80-100g). Ethanol was applied by a bath superfusion with a known concentration expressed as the percentage of solution by volume (v/v) at 0.1, 0.5, 1, 2, and 4%. The result of the Chi-square test illustrated that the firing patterns were altered significantly after EtOH (p=0.007). However, the firing patterns that were altered by EtOH application were not affected by EtOH concentration (p= 0.1296). Among the 54 PCs tested, 30 PCs did not display any spontaneous firing activity and 24 PCs displayed spontaneous spike activity, either spiking in the simple manner (n=14) or cyclicly oscillating (n=10). In the presence of EtOH, 31 PCs were quiet, 22 PCs exhibited simple spiking activity and 1 PC continued to oscillate. Most PCs that displayed spontaneous activity before EtOH application progressively slowed their spike activity after EtOH superfusion. Especially, it was evident that 9 out of 10 oscillating PCs stopped their regular cyclic activity. In addition, 9 out of 14 PCs that displayed simple spike activity ceased to fire after EtOH application. Eleven out of 30 quiet PCs began to fire irregularly after EtOH application and this phenomenon usually occurred with membrane depolarization. EtOH induced spontaneous activity in 36.7% (11/30) of the quiescent PCs. In conclusion, there was differential EtOH sensitivity in the vitro slice preparation. EtOH depressed the endogenously generated spontaneous activity, especially the oscillatory firing activity. In contrast, the silent PCs were excited after EtOH application. Since this differential sensitivity persists in the presence of tetrodotoxin (TTX), it is suggested that this differential sensitivity is peculiar to the PCs.

Preliminary Analysis for Predicting Changes in Pain and Depression after Implementing the Rheumatoid Health Promotion Program / 간호학회지

This study was performed to evaluate the effect of 7-week comprehensive health promotion program for RA patients (CHPPRA) on changes in pain and depression. In addition, it was also examined that this effect was generated by changes in patients' health promoting strategies (positive self-image, positive thinking, problem solving, communication, pain management, stress management, exercise, and knowledge about RA) learned through CHPPRA. Twenty-eight out-patients of RA clinic in a university hospital participated for this study. The results are as followers. Changes in exercise, self-concept, positive thinking, problem solving, depression, and pain management were significant predictors to explain relieving pain level. Since all of these variables had positive standardized beta weights (betas), it can be interpreted that increasing level of these health promoting strategies may induce pain improvement. Changes in positive thinking, communication skill, exercise, self-concept, pain management, and knowledge about the disease were significant predictors to explain positive change in depression. Since all of the significant variables except the change in knowledge about the disease had positive standardized beta weights (betas), it can be interpreted that increasing level of these health promoting strategies may induce improving depression level. However, our results showed that the higher level of the knowledge about the disease was, the worse depression was.