Comparison of upper and lower body forced air blanket to prevent perioperative hypothermia in patients who underwent spinal surgery in prone position: a randomized controlled trial / 대한마취과학회지

Background@#We compared upper- and lower-body forced-air blankets in terms of their ability to prevent perioperative hypothermia, defined as a reduction in body temperature to < 36.0°C, during the perioperative period in patients undergoing spine surgery in the prone position. @*Methods@#In total, 120 patients scheduled for elective spine surgery under general anesthesia were divided into an upper-warming group (n = 60) and a lower-warming group (n = 60). After inducing anesthesia and preparing the patient for surgery, including prone positioning, the upper and lower bodies of the patients in the upper- and lower-warming groups, respectively, were warmed using a forced-air warmer with specified upper and lower blankets. Body temperature was measured using a tympanic membrane thermometer during the pre- and post-operative periods and using a nasopharyngeal temperature probe during the intraoperative period. Patients were evaluated in terms of shivering, thermal comfort, and satisfaction in the post-anesthesia care unit (PACU). @*Results@#The incidence of intraoperative and postoperative hypothermia was lower in the upper-warming group than in the lower-warming group ([55.2% vs. 75.9%, P = 0.019] and [21.4% vs. 49.1%, P = 0.002]). Perioperative body temperature was higher in the upper-warming group (P < 0.001). However, intraoperative blood loss, postoperative thermal comfort scale and shivering scores, patient satisfaction, and PACU duration were similar in the two groups. @*Conclusions@#The upper-body blanket was more effective than the lower-body blanket for preventing perioperative hypothermia in patients who underwent spine surgery in the prone position.

Diagnostic Availability of Ocular Response Analyzer in Korean Patients with Normal Tension Glaucoma

PURPOSE: To compare the parameters measured with the ocular response analyzer (ORA; Reichert Inc., Depew, NY, USA) between normal control subjects and patients with normal tension glaucoma (NTG) and to investigate clinical usefulness of ORA. METHODS: Intraocular pressure (IOP) and central corneal thickness (CCT) were measured using the Goldmann applanation tonometer (GAT) in 100 eyes of 100 normal subjects and 100 eyes of 100 NTG patients. Four types of ORA parameters, corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated IOP (IOPg), and corneal-compensated IOP (IOPcc) were also measured. RESULTS: The mean CH values were 11.2 mm Hg and 10.3 mm Hg and the mean CRF values were 10.8 mm Hg and 9.9 mm Hg in the normal subjects group and the NTG group, respectively. Mean CH and CRF were significantly lower in NTG patients (p < 0.001) and the IOPcc were higher than normal subjects (p = 0.004). IOPg was in agreement with the GAT IOP (ICC = 0.811) and IOPcc was not correlated with CCT. The cut-off value of 'IOPcc - IOPg' as the diagnostic standard parameter was -0.05 mm Hg (sensitivity; 76%, specificity; 55%). CONCLUSIONS: IOPg measurements were similar to GAT IOP, and other ORA parameters (CH, CRF, IOPcc) were significantly different between normal subjects and NTG patients. Consequently, the difference of IOPcc and IOPg could be a useful parameter in NTG diagnosis.

Concept Analysis on the Organizational Commitment: Focused on the Nursing Organizations / 한국간호교육학회지

PURPOSE: The purpose of this study was to explore the clear concept of organizational commitment for effective nursing personnel management. METHOD: This study was conducted using Walker & Avant's conceptual analysis framework(2005). RESULTS: Organizational commitment was identified with six attributes: acknowledgment, acceptance, trust, sacrifice, attachment, regulation. Antecedents of organizational commitment were personal characteristics, perceived organizational support, empowerment, fair compensation, job satisfaction, job autonomy, organizational culture, and leadership. Consequences of organizational commitment were turnover intention, job performance and organizational citizenship behavior. CONCLUSION: Organization commitment is a core concept for understanding the management of nursing personnel. Appropriate instruments to operationalize the concept of organizational commitment including six attributes need to be developed.

Treatment Outcome of Phacotrabeculectomy and Trabeculectomy in Patients with Cataracts and Glaucoma

PURPOSE: To compare the treatment outcome and complications of phacotrabeculectomy and trabeculectomy in patients with glaucoma and cataracts. METHODS: The authors of the present study retrospectively reviewed the records of 56 eyes that underwent phacotrabeculectomy and trabeculectomy with mitomycin-C between March 2006 and December 2009 in patients with glaucoma and cataracts. The change of intraocular pressure (IOP) and number of glaucoma medications up to 24 months postoperatively were compared and the treatment failure rate as well as postoperative complications analyzed. RESULTS: IOP and number of glaucoma medications at 24 months after surgery were similar in the 2 groups. Additionally, both groups showed a significant decrease in IOP and number of glaucoma medications after surgery. The cumulative failure rates, frequency and distribution of postoperative complications were also similar in both groups and conjunctival bleb leak was the most common complication. CONCLUSIONS: Both phacotrabeculectomy and trabeculectomy showed long-term IOP reduction and a similar failure rate and complications. Therefore, both can be considered as a primary surgical treatment in patients with glaucoma and cataracts. In patients who need strict IOP control, trabeculectomy can be preferentially considered. If patients have visually significant cataracts or greater visual needs, phacotrabeculectomy can be considered.

A Case of Keratoconjunctivitis Caused by Chlamydophila Psittaci

PURPOSE: Only a few cases of keratoconjunctivitis caused by Chlamydophila psittaci have been reported worldwide, and no case reported in Korea. We report an atypical case of keratoconjunctivitis caused by Chlamydophila psittaci. CASE SUMMARY: A 34-year-old male patient who had raised a parrot at home presented with three weeks of conjunctival injection and a week of ocular pain in his left eye. There were papillae on the left upper and lower tarsal conjunctiva and punctuate epithelial erosion of the entire cornea. He also complained of dizziness, fever, and dyspnea. Upon chest X-ray, consolidation on the right middle lobe was apparent. The Chlamydophila IgM antibody test was positive, and the pneumonia improved quickly. Nevertheless, signs of keratoconjunctivitis persisted despite 3-week treatment with oral doxycycline. As a result, the patient received an additional 10-day treatment with oral azithromycin. Four weeks after the first visit, symptoms were improving gradually, and, after six weeks, no signs of keratoconjunctivitis remained except minimal erosion. CONCLUSIONS: When patients show keratoconjunctivitis after contact with a bird, prolonged ketatoconjunctivitis by Chlamydophila psittaci should be considered.

Development of Nursing Key Performance Indicators for an Intensive Care Unit by using a Balanced Scorecard

PURPOSE: The purpose of this study was to develop visions of nursing service, nursing strategies and key performance indicators (KPIs) for an intensive care unit (ICU) based on a Balanced Scorecard (BSC). METHODS: This study was undertaken by using methodological research. The development process consisted of four phases; the first phase was to develop the vision of nursing in ICUs. The second phase was to develop strategies according to 4 perspectives of a BSC. The third phase was to develop KPIs according to the 4 perspectives of BSC and the final phase was to combine the nursing visions, strategies and KPIs of ICUs. RESULTS: Two main visions of nursing service for ICUs were established. These were 'realization of harmonized professional nursing with human respect' and 'recovery of health through specialized nursing' respectively. In order to reach the aim of developing nursing visions, thirteen practical strategies and nineteen KPIs were developed by four perspectives of the BSC. CONCLUSION: The results will be used as objective fundamental data to attain business outcomes for the achievement of nursing visions and strategies of ICUs.

Effect of Nitrous Oxide on Bispectral Index during Sevoflurane Anesthesia / 대한마취과학회지

BACKGROUND: Nitrous oxide is generally avoided in order to prevent either hypoxia or graft dislodgment during tympanoplasty. The aim of this study was to investigate the effect of nitrous oxide on the bispectral index during sevoflurane anesthesia at the anesthetic dose. METHODS: The bispectral index was continually measured during nitrous oxide-oxygen-sevoflurane anesthesia, discontinuation of nitrous oxide and the reintroduction of nitrous oxide. RESULTS: The bispectral index of nitrous oxide-oxygen-sevoflurane anesthesia increased after discontinuing the nitrous oxide and decreased after its reintroduction. CONCLUSIONS: Nitrous oxide decreased the bispectral index of nitrous oxide-oxygen-sevoflurane anesthesia compared with oxygen-sevoflurane anesthesia at the anesthetic dose.

Effect of Nicardipine on Induction, Maintenance and Recovery during Gynecologic Laparoscopic Surgery / 대한마취과학회지

BACKGROUND: Pneumoperitoneum for a gynecologic laparoscopic surgery induces hemodynamic changes. We evaluated the effects of nicardipine on induction, maintenance, and recovery. METHODS: Thirty patients scheduled for gynecologic laparoscopic surgery were randomly allocated to two groups: control group (placebo group, n = 15), group N (nicardipine group, 10 microgram/kg followed by 0.5-2.0 microgram/kg/min). The systolic arterial pressure, mean arterial pressure, and heart rate were measured at preinduction, induction, intubation and 5, 10, 15, 20 min after insufflation. Loss of consciousness, induction dose, effective site concentration, propofol maintenance dose (the maintenance dose of propofol from intubation to end of anesthesia, PMD) were also measured. Propofol was titrated to maintain a bispectal index value of 40-60. RESULTS: There was a significant difference in PMD between two groups. The PMD of group N was significantaly less than group C. Nicardipine adminstration attenuated increase in the blood pressure, but did not affect on heart rates during CO2 insufflation. CONCLUSIONS: Co-administration of nicardipine was effective in attenuating the hemodynamic changes after pneumoperitoneum during gynecologic laparoscopic surgery, without changes of induction and recovery.

Effects of Lactated Ringer's Solution on Acid-Base and Serum Electrolyte Levels during Liver Surgery in Cirrhosis Patients / 대한마취과학회지

BACKGROUND: Changes in acid-base balance and serum electrolytes by infusion of lactated Ringer's solution in liver cirrhosis patienst during liver surgery are poorly characterized. In this study, we evaluated the effects of infusing large amount of lactated Ringer's solution on acid-base and serum electrolytes during liver surgery in cirrhosis patients. METHODS: Thirty-two patients were divided into two groups. Group I (n = 21) was made up of patients who had received liver lobectomy without cirrhrosis. Group II (n = 11) was made up of patients who had received liver lobectomy with cirrhosis above a moderate level. Arterial blood gas and serum electrolyte levels were checked 4 times during the study in each patient: just after the operation start, after infusing 3,000 ml and 6,000 ml of lactated Ringer's solution during operation, and 30 minutes after arrival at the postanesthesia care unit. RESULTS: pH and base excess decreased according to the amount of lactated Ringer's solution used in both groups and these results were significant. Serum electrolyte levels were not changed and only Ca2+ levels were significantly different in the two groups. The cause of changing of Ca2+ levels found out by intravenous infusion of Ca2+ solution. CONCLUSIONS: In liver surgery patients with or without liver cirrhosis decreased pH and base excess in serum by increased amount of used lactated Ringers solution during liver surgery but in serum electrolytes and others acid-base parameters, CVP, changes on there were not any statistical significant. When a large amount of LR solution is used in liver surgery, we recommend regular arterial blood gas analyses for acid-base balance and an infusing speed of 20 ml/kg/h.

Impact of Group Cognitive Behavioral Therapy on Quality of Life in Patients with Panic Disorder / 신경정신의학

OBJECTIVES: We examined the impact of 12-session group cognitive behavioral trerapy(GCBT) on quality of life in patients with panic disorder, and also investigated correlation with the change of some clinical characteristics. METHODS: Patients(N=108) who met DSM-IV criteria for panic disorder with or without agoraphobia were treated by 12-session GCBT. We assessed the quality of life using SF-36 and some clinical characteristics including symptom profiles. We measured anxiety and depression levels using the Spielberger State-Trait Anxiety Inventory(STAI) and the Beck Depression Inventory(BDI), and also measured some cognitive behavioral indexes typically found in panic patients using the Anxiety Sensitivity Index(ASI), the Agoraphobic Cognition Questionnaire(ACQ), the Panic Belief Questionnaire(PBQ), and the Body Sensation Questionnaire(BSQ). RESULTS: GCBT-treated patients showed significant improvement in quality of life in all subscales of SF-36(general health, t=-5.23; , physical functioning, t=-5.89; , role physical, t=-3.67; , body pain, t=-6.36; , vitality t=-8.29; , social functioning, t=-6.56; , role emotion, t=-3.62; , mental health, t=-6.81). Multiple regression analysis showed that the change of anxiety sensitivity was the best predictor of the improvement of SF-36(mental health, R2=.19, p<0.001;, vitality, R2=.14, p<0.001; , social functioning, R2=.15, p<0.001). Otherwise the change of panic belief(general health, R2=.11, p< 0.01; , body pain, R2=15, p<0.001), BDI(role emotion, R2=.08, p<0.05) could explain the improvement of one of subscales of SF-36. CONCLUSION: Our results suggested that 12-session GCBT could significantly improve quality of life in patients with panic disorder. Especially, the reduction of anxiety sensitivity, panic belief and depression with the correction of cognitive distortion and sensitivity might play an important role in improving quality of life in panic patients.

Association of Alcohol Dependence with the Dopamine Transporter Gene Polymorphism / 신경정신의학

OBJECTIVES: Alcoholism is known to be a heritable disease. It has been hypothesized that dopamineergic systems play an important heritable role in human behavor related to alcohol dependence, such as alcohol seeking. Therefore, genes involved in this pathway, including dopamine transporter(DAT1) which is responsible for taking released dopamine back up into presynaptic terminals and terminating dopaminergic activity, are potential candidate that may affect susceptibility to alcoholism. Analysis of a 40-base pair(bp)repeat(VNTR)in the 3'untranslated region of the DAT1 gene revealed variable number of the repeat ranging from 3 to 11 copies. Therefore, in the present study, we examined the association between alcoholism and VNTR polymorphism of DAT1. METHODS: Genomic DNA analysis with polymerase chain reaction(PCR)was used to identify the presence of a VNTR polymorphism. It was carried out within a group of 94 alcoholic patients and 113 normal controls. RESULTS: 1)There were no significant differences in allelic or genotype frequencies between the group of alcoholic patients and controls. 2)There were no significant differences in the first drinking age, onset age and latency of alcoholism according to DAT1 genotypes. 3)There was a significant difference in allelic frequencies between alcoholics with family history and those without family history. CONCLUSIONS: These results suggested that VNTR polymorphism of DAT1 is unlikely to be a factor in the genetic etiology of alcoholism, but might be related to familial transmission of alcoholism.