Eunjung Lim

I Will If You Will Similarity in Married Partners’ Readiness to Change Health Risk Behaviors

Married men and women (N = 1,899 couples) reported readiness to eat a healthier diet, lose weight, and get more exercise (stage of change) and indicated whether they were confident to make these changes (self-efficacy). Husbands’ and wives’ reports of readiness to change each health behavior were positively associated. Furthermore, women who indicated readiness to eat a healthier diet and get more exercise (contemplation or preparation stages) were less likely to endorse confidence to change when their husbands were in a lower stage than they were relative to those whose husbands shared the same stage of change. Similarly, men who indicated readiness to lose weight were less likely to endorse being confident in their ability to lose weight when their wives were in a lower stage than they were relative to those who shared the same stage. Consideration of interpersonal factors in the behavior change process may enhance behavioral interventions that include married partners together rather than either individual alone.

Does Preoperative Risk for Delirium Moderate the Effects of Postoperative Pain and Opiate Use on Postoperative Delirium

OBJECTIVES To investigate whether preoperative risk for delirium moderates the effect of postoperative pain and opioids on the development of postoperative delirium. DESIGN Prospective cohort study. SETTING University medical center. PARTICIPANTS Patients 65 years of age or older scheduled for major noncardiac surgery. MEASUREMENTS A structured interview was conducted preoperatively and postoperatively to determine the presence of delirium, defined using the Confusion Assessment Method. We first developed a prediction model to determine which patients were at high versus low risk for the development of delirium based on preoperative patient data. We then computed a logistic regression model to determine whether preoperative risk for delirium moderates the effect of postoperative pain and opioids on incident delirium. RESULTS Of 581 patients, 40% developed delirium on days 1 or 2 after surgery. Independent preoperative predictors of postoperative delirium included lower cognitive status, a history of central nervous system disease, high surgical risk, and major spine and joint arthroplasty surgery. Compared with the patients at low preoperative risk for developing delirium, the relative risk for postoperative delirium for those in the high preoperative risk group was 2.38 (95% confidence interval: 1.67-3.40). A significant three-way interaction indicates that preoperative risk for delirium significantly moderated the effect of postoperative pain and opioid use on the development of delirium. Among patients at high preoperative risk for development of delirium who also had high postoperative pain and received high opioid doses, the incidence of delirium was 72%, compared with 20% among patients with low preoperative risk, low postoperative pain, and those who received low opioid doses. CONCLUSIONS High levels of postoperative pain and using high opioid doses increased risk for postoperative delirium for all patients. The highest incidence of delirium was among patients who had high preoperative risk for delirium and also had high postoperative pain and used high opioid doses.

Whey Protein Supplementation Does Not Affect Exercise Training-Induced Changes in Body Composition and Indices of Metabolic Syndrome in Middle-Aged Overweight and Obese Adults

Little is known about the effects of different quantities of whey protein on exercise training-induced changes in body composition and indices of metabolic syndrome in middle-aged overweight and obese adults. Therefore, we examined the effects of consuming 0.8-MJ supplements with 0 (n = 126), 10 (n = 112), 20 (n = 44), or 30 (n = 45) g whey protein twice daily in conjunction with resistance (2 d/wk) and aerobic (1 d/wk) exercise training in a double-blind, randomized, placebo-controlled, community-based 9-mo study in men (n = 117) and women (n = 210); (age: 48 ± 7.9 y; BMI: 30.0 ± 2.8 kg/m(2)). Whey protein supplementation did not influence any of the following outcomes, some of which were affected by training. Among all participants, strength increased by 15 ± 12% (P < 0.001) and maximal oxygen uptake capacity (VO(2)max) increased by 9 ± 15% (P < 0.001). Body weight was unchanged (0.1 ± 3.7 kg, P = 0.80), lean body mass increased by 1.9 ± 2.8% (0.95 ± 1.3 kg, P < 0.001), and fat mass decreased by 2.6 ± 9.4% (-0.86 ± 3.1 kg, P = 0.001). Oral-glucose-tolerance testing showed that plasma glucose AUC was unchanged (-18.0 ± 170 mmol/L·  3 h, P = 0.16), insulin AUC decreased by 2.6 ± 32% (-7.5 ± 29 nmol/L·  3 h, P = 0.01), and HOMA-IR (0.2 ± 2.0, P = 0.81) and the insulin sensitivity index (0.3 ± 3.0, P = 0.63) were unchanged. Plasma concentrations of TG; total, LDL, and HDL cholesterol; C-reactive protein; plasminogen activator inhibitor-1; blood pressure; and waist circumference were unchanged. Whey protein supplementation did not affect exercise training-induced responses in body composition and indices of metabolic syndrome in middle-aged overweight and obese adults who maintained body weight.

Development of Leadership Behaviors in Undergraduate Nursing Students: A Service-Learning Approach

AIM The purpose of this study was to determine leadership behaviors developed by nursing students and peers before and after a service‐learning experience. BACKGROUND Nurses have been called to fill growing needs in the health care setting, rendering care to vulnerable and diverse populations in a wide range of organizations. Leadership behaviors are therefore essential. METHOD Baccalaureate students (N = 65) completed the Student Leadership Practices Inventory‐Self at the beginning and end of the semester. The students also rated peers using the Leadership Practices Inventory‐Observer and answered six questions about service‐learning. RESULTS Repeated measures of analysis of variance for pre‐ and posttests revealed that leadership behaviors improved (p < .0001). A significant correlation was found (p = .02) between the overall posttest scores for both instruments. CONCLUSION Integrating service‐learning into a leadership course is an effective approach to the development of leadership behaviors.

Effect of food form on postprandial plasma amino acid concentrations in older adults

To assess the effect of food form (FF) on postprandial (PP) plasma amino acid (AA) concentrations, ten older adults (five men and five women, age 72 (sem 2) years, BMI 26.0 (sem 0.9) kg/m2) consumed, on separate days, energy and macronutrient-matched test meal replacement products (MRP) (approximately 25 % of the subjects daily energy need; approximately 54 % carbohydrate, 21 % protein, 25 % fat) in beverage and solid form. Blood samples were taken during fasting and throughout the 4 h PP period; plasma AA concentrations were assessed using HPLC. Consumption of each MRP led to an increase in total AA, branched-chain AA (BCAA), essential AA (EAA), non-essential AA (NEAA) and leucine concentrations (4 h area under the curve, AUC) (time effect; P < 0.05). The beverage MRP resulted in a greater initial (i.e. 30 min) and sustained (4 h AUC) increase in total AA, BCAA, EAA, NEAA and leucine concentrations compared with the solid MRP (each effect of FF; P < 0.05). Although there was no effect of FF on PP insulin response, glucose concentration was greater 1 and 2 h after the solid MRP was consumed (FF × time interaction; P < 0.05). For all PP time points combined, total AA concentration was positively associated with plasma insulin (r 0.25) and glucose (r 0.24) concentrations for the solid MRP but not for the beverage MRP. In conclusion, older adults can achieve higher plasma AA concentrations when a protein-containing MRP is ingested in beverage form. The implications of the higher AA availability on anabolic processes warrant investigation.

Does using a femoral nerve block for total knee replacement decrease postoperative delirium

BackgroundThe effect of peripheral nerve blocks on postoperative delirium in older patients has not been studied. Peripheral nerve blocks may reduce the incidence of postoperative opioid use and its side effects such as delirium via opioid-sparing effect.MethodsA prospective cohort study was conducted in patients who underwent total knee replacement. Baseline cognitive function was assessed using the Telephone Interview for Cognitive Status. Postoperative delirium was measured using the Confusion Assessment Method postoperatively. Incidence of postoperative delirium was compared in two postoperative management groups: femoral nerve block ± patient-controlled analgesia and patient-controlled analgesia only. In addition, pain levels (using numeric rating scales) and opioid use were compared in two groups.Results85 patients were studied. The overall incidence of postoperative delirium either on postoperative day one or day two was 48.1%. Incidence of postoperative delirium in the femoral nerve block group was lower than patient controlled analgesia only group (25% vs. 61%, P = 0.002). However, there was no significant difference between the groups with respect to postoperative pain level or the amount of intravenous opioid use.ConclusionsFemoral nerve block reduces the incidence of postoperative delirium. These results suggest that a larger randomized control trial is necessary to confirm these preliminary findings.

Rates and predictors of depression in adoptive mothers: moving toward theory.

There are approximately 1.8 million adopted children living in the United States. Adoptive parents may experience depressive symptoms and put their children at risk for negative outcomes. The results of this study describe the rates of depression in 300 adoptive mothers and associations with hypothesized explanatory variables, which predict approximately half of the variance in maternal depressive symptoms: expectations of themselves as mothers, the child, and family and friends; feeling of rest; past and present psychiatric difficulties (self-esteem, history of depression); and interpersonal variables (bonding, marital satisfaction, perceived support). These findings are useful in planning effective interventions to mitigate depressive symptoms.

Factors Associated With Recovery From Early Postoperative Delirium

Delirium occurs in 14% to 56% of postoperative, hospitalized elderly persons, making it one of the most common postoperative complications for the older patient. The aim of this study was to determine factors associated with recovery of delirium from postoperative day one (POD 1) to postoperative day two (POD 2). The hypothesis was that those with less pain are more likely to recover from delirium by POD 2. Patients aged 65 or older who were scheduled for noncardiac surgery, spoke English, and developed delirium on POD 1 as detected by the Confusion Assessment Method (CAM) were included (n = 176). Postoperative delirium on POD 2 was also measured with the CAM. Postoperative pain was assessed on PODs 1 and 2 using the Numeric Rating Scale (NRS). One hundred seventy-six patients developed delirium on POD 1, with 66 (38%) recovering from delirium by POD 2. The mean age of those patients who recovered from delirium was 72.5 ± 5.7 (n = 66), whereas the mean age of those patients who did not recover from delirium was 75.9 ± 6.5 (n = 110). Multivariate logistic regression revealed that patients less than age 75 were more likely to recover from delirium (OR = 2.31; 95% CI = 1.18-4.53; P = .015), as were patients who had pain scores of less than 5 on POD 2 (OR = 2.59; 95% CI = 1.26-5.35; P = .0098). Patients with lower pain levels (NRS ≤4) were also more likely to recover from delirium on POD 2. The type of postoperative pain therapy (the use or nonuse of patient-controlled analgesia) was not related to delirium recovery. The results suggest that aggressive pain management in the first 48 hours postoperatively may be important in promoting recovery from postoperative delirium.

Age and sex affect protein metabolism at protein intakes that span the range of adequacy: comparison of leucine kinetics and nitrogen balance data.

Research suggests that changes in leucine oxidation (leuox) with feeding may reflect adult protein requirements. We evaluated this possibility by assessing the effects of age, sex, and different protein intakes on whole-body leucine kinetics and nitrogen balance. Thirty-four young (n=18, 22-46 years) and old (n=16, 63-81 years) men and women completed three 18-day trials with protein intakes of 0.50, 0.75 and 1.00 g protein·kg body weight(-1)·d(-1). Fasting and fed-state leucine kinetics were quantified on day 12 of each trial using a primed, constant infusion of L-[1-13C]leucine. Protein requirement was estimated using classical nitrogen balance measurements and calculations. Leucine kinetics parameters were influenced by age and sex across all protein intakes. With feeding, leuox increased more in old vs. young adults. Independent of age, fasting and fed-state leuox were lower, and net leucine balance (fasting+fed-state) was higher in women vs. men. Among all subjects and protein intakes, nitrogen balance was correlated with fed-state leuox (r=0.39), fed-state leucine balance (r=0.60), net leucine balance (r=0.49) and the change in leuox from the fasting to fed state (r=0.49) (P<.05 for all results). At the highest protein intake, the change in leuox with feeding was inversely correlated with protein requirement (r=-0.39). These findings indicate that leucine kinetics, especially leuox, reflect nitrogen balance-based estimates of the need for dietary protein and generally support the view that protein requirement is comparable between young and old adults.

A survey of education and confidence level among graduating anesthesia residents with regard to selected peripheral nerve blocks.

BackgroundAs peripheral nerve blockade has increased significantly over the past decade, resident education and exposure to peripheral nerve blocks has also increased. This survey assessed the levels of exposure and confidence that graduating residents have with performing selected peripheral nerve blocks.MethodsAll program directors of ACGME-accredited anesthesiology programs in the USA were asked to distribute an online survey to their graduating residents. Information was gathered on the number and types of nerve blocks performed, technique(s) utilized, perceived comfort level in performing nerve blocks, perceived quality of regional anesthesia teaching during residency, and suggested areas for improvement.ResultsOne hundred and seven residents completed the survey. The majority completed more than 60 nerve blocks. Femoral and interscalene blocks were performed most frequently, with 59% and 41% of residents performing more than 20 of each procedure, respectively. The least-performed block was the lumber plexus block, with just 9% performing 20 or more blocks. Most residents reported feeling “very” to “somewhat” comfortable performing the surveyed blocks, with the exception of the lumber plexus block, where 64% were “not comfortable.” Overall, 78% of residents were “mostly” to “very satisfied” with the quality of education received during residency.ConclusionsMost of the respondents fulfilled the ACGME requirement and expressed satisfaction with the peripheral nerve block education received during residency. However, the ACGME requirement for 40 nerve blocks may not be adequate for some residents to feel comfortable in performing a full range of blocks upon graduation. Many residents felt that curriculums incorporating simulator training and didactic lectures would be the most helpful method of improving the quality of their education pertaining to peripheral nerve blocks.