HyunSoo Oh

Effects of a sexual rehabilitation intervention program on stroke patients and their spouses

The present study was conducted to examine whether a sexual rehabilitation intervention program, which was developed during the present study and designed for stroke patients and their spouses, was effective in terms of sexual knowledge and satisfaction and frequency of sexual activity at 1 month after intervention. The study subjects were conveniently selected from stroke patients admitted to the neurology department at a university hospital located in Incheon, South Korea. A total of 46 subjects (12 couples for the experimental group and 11 couples for the control group) were included. Sexual knowledge, sexual satisfaction, frequency of sexual activity, level of cognitive function, and performance with respect to daily living activities were measured. The results obtained demonstrated that the devised sexual rehabilitation intervention program significantly increased sexual satisfaction and frequency of sexual activity, but that it did not promote sexual knowledge. The present study has meaning because the intervention program could be used as a practical guideline for post-stroke sexual rehabilitation. In addition, the findings of this study provide evidence regarding the usefulness of sexual education and counseling on the sexual health of post-stroke patients and their spouses.

Patterns and Clinical Correlates of Pain Among Brain Injury Patients in Critical Care Assessed with the Critical Care Pain Observation Tool

This study was conducted to assess the patterns and clinical correlates of acute pain in brain injury patients during the critical care period using the Critical Care Pain Observation Tool (CPOT). Data were collected from 31 brain-injury patients admitted to an intensive care unit (ICU) at a university hospital located in Incheon, Republic of Korea. Glasgow Coma Scale and CPOT scores were assessed on days 1, 3, 6, 9, and 14 after ICU admission. Results showed that temporal changes in pain intensity displayed a consistent pattern in critical care patients with a brain injury during the first 14 days of ICU admission. Mean pain score was highest on day 1, decreased rapidly to reach a minimum on day 3 or 6, and then increased on day 9. In most patients, pain reduced slightly on day 14. Mean CPOT scores were significantly higher in the nonsurgery group than in the surgery group. There was also a nonsignificant trend of higher pain intensity scores among patients with moderate brain injury compared with those with severe injury. CPOT scores immediately after endotracheal suctioning were significantly higher than before endotracheal suctioning, but CPOT scores 20 minutes after suctioning were similar to those before suctioning. The present study may be meaningful in terms of presenting valid clinical information regarding the patterns and characteristics of acute pain in brain injury patients who are often unable to self-report on the presence and intensity of pain.

The identification of multiple symptom clusters and their effects on functional performance in cancer patients

AIMS AND OBJECTIVES To identify cancer-related symptom clusters, to explore their inter-relationships and to examine the effects of single symptoms and the synergistic effects of symptom clusters on functional performance using path analysis by structural equation modelling in patients with various types of cancer. BACKGROUND Recent studies suggest that cancer patients frequently experience three or more concurrent related symptoms and that this clustering of symptoms is likely to have negative synergistic impacts on outcomes, because of the complicated dynamics of clusters. DESIGN A cross-sectional design. METHODS One hundred and ten patients with various types of cancer were recruited as in- and out-patients at a University Hospital in Incheon, South Korea. Data collection was performed using a questionnaire and by direct interview. Pain, insomnia, fatigue, depression and functional performance were measured. RESULTS The developed model was composed of antecedents, symptom clusters and outcomes. Of the symptoms often encountered as clusters in cancer patients, insomnia, depression and fatigue were found to have significant single (direct) effects on functional performance. Seven symptom clusters were identified between pain and functional performance, three between insomnia and functional performance and one between depression and functional performance. These single symptoms and symptom clusters were found to have significant synergistic effects on functional performance and to explain 24% of functional performance variance. CONCLUSIONS Multiple cancer-related symptom clusters may occur and the dynamics within symptom clusters is complicated. Our findings provide sound evidence regarding the importance of assessing and managing clusters of symptoms simultaneously rather than focusing on single symptoms. RELEVANCE TO CLINICAL PRACTICE A comprehensive understanding of symptom clusters in cancer patients would help establish valid diagnostic symptom cluster entities and aid the development of subjective/objective phenotypic criteria for symptom cluster based diagnoses and of nursing care protocols for managing symptom clusters.

Causal relationships among factors associated with cancer-related fatigue

PURPOSE This study was conducted to develop and verify a comprehensive model, which illustrates the dynamic causal relationships between fatigue and its associated factors in cancer patients. METHOD The subjects were 110 in- or out-patients with various types of cancer being treated at a University Hospital, Incheon, South Korea. The comprehensive model consists of physical distress, sleep-related, physiologic, psychological distress, physical performance, and exercise factors. RESULTS Psychological distress had a significant direct effect on physical distress, and 81% of the variance in physical distress was explained by psychological distress. While psychological distress showed to have a significant total effect (the sum of direct effects of psychological distress and indirect effects through its relationship with physical distress) on fatigue, it was not found to have a significant direct effect on fatigue. Only exercise had a significant direct effect on fatigue and 70% of fatigue variance was explained by exercise alone. All remaining factors were not found to have significant direct effects on fatigue. CONCLUSIONS The hypothetical model was well suited to explain cancer-related fatigue. Our result indicates that psychological distress should be relieved in combination with a strategy to reduce physical distress in order to obtain better outcomes with respect to cancer-related fatigue. Only exercise had a significant direct effect on fatigue. In terms of the nursing implications, the proposed model can help oncology nurses better understand cancer-related fatigue and assess presence of correctable correlates. This model can be a future framework when developing intervention strategies for cancer-related fatigue.

A Comprehensive Review of Central Post-Stroke Pain

Although central post-stroke pain is widely recognized as a severe chronic neuropathic pain condition, its consolidated definition, clinical characteristics, and diagnostic criteria have not been defined due to its clinically diverse features. The present study was undertaken to comprehensively review current literature and provide a more complete picture of central post-stroke pain with respect to its definition, prevalence, pathophysiology, clinical characteristics, and diagnostic problems, and to describe the range of therapies currently available. In particular, nursing care perspectives are addressed. It is hoped that this review will help nurses become knowledgeable about central post-stroke pain and provide valuable information for the drafting of effective nursing care plans that improve outcomes and quality of life for patients with central post-stroke pain.

Comparisons of Acute Physiological Parameters Influencing Outcome in Patients with Traumatic Brain Injury and Hemorrhagic Stroke

BACKGROUND Although several factors are known to influence prognosis after acute brain injury, physiologic derangements were found to be associated with, or contributing to, increased mortality and disability in these patients. AIMS This study was conducted to identify acute physiological parameters that significantly predict outcome and compare the identified parameters in patients with traumatic brain injury (TBI) and hemorrhagic stroke. METHODS Participants were 190 adult patients with TBI or hemorrhagic stroke who were admitted within 24 hours of injury. Details concerning potential physiological predictors were collected, that is, blood pressure (BP), heart rate, respiratory rate, body temperature, hematocrit, partial pressure of oxygen and carbon dioxide in arterial blood, serum osmolality, pH, total cholesterol, and glucose levels on admission. Mortality and functional and cognitive ability 6 months after injury were measured as outcome variables. RESULTS Most physiological parameters, with the exceptions of blood glucose, total cholesterol, and osmolality, were significant prognostic predictors in TBI and hemorrhagic stroke. However, the physiological parameters and their predictabilities differed in patients with TBI and hemorrhagic stroke, which indicated that physiological predictors depend on chosen outcome and brain injury type. CONCLUSIONS AND IMPLICATIONS In critical care units, the most important aims of nursing care are decreasing mortality and disability rates. In order to achieve such goals, acute physiological parameters such as BP, respiratory rate, heart rate, PaO2, PaCO2, and temperature should be monitored and managed, with the aim of reducing the risk of secondary brain injury.

Development of a web-based gout self-management program.

OBJECTIVE: This study was conducted to develop a web-based gout self-management program that can be applicable to each gout stage and to evaluate the validity of the developed program. METHODS: A web-based gout self-management program was developed and evaluated in 5 stages: analysis (needs assessment on 60 gout patients and content analysis through a systematic review of literature and websites), design, development, implementation, and evaluation. RESULTS AND CONCLUSION: The gout-related information section was structured with overview, causes, risk factors, symptoms, diagnosis, progress, treatments, and complications. The self-management section consisted of diet/nutrition, weight control, alcohol management, exercise, and pain and stress management. The program included bulletin board and expert section to promote bidirectional interactions between program users and providers. Self-assessment tool of gout stages and self-management checklist were provided. Program contents and ease of site navigation (http://goutin.kr) were found to be appropriate and satisfactory to both patient and expert groups.

Functional and Cognitive Recovery of Patients With Traumatic Brain Injury Prediction Tree Model Versus General Model

raumatic brain injury (TBI) is a leading cause of death and disability. As a result of TBI, 1.5 million persons die every year and nearly 2% of the world population has a long-term or lifelong need for help in performing activities of daily living. A patient’s condition during the first few weeks after a TBI is extremely unstable and life-threatening. During such critical periods, accurate neurological assessment is essential for predicting recovery. Many researchers have evaluated various clinical variables as prognostic indicators. For critical care nurses, data from neurological assessments are particularly important, both for evaluating the severity of TBIs and for planning the short-term management and early rehabilitation of patients with TBI. The care team and the families of patients with TBI are concerned about the prognosis for death/survival and degrees of disability and about possible complications during critical Functional and Cognitive Recovery of Patients With Traumatic Brain Injury Prediction Tree Model Versus General Model Cover Article

Implementation of a clinical pathway in primary spontaneous pneumothorax patients treated by wedge resection surgery.

Purpose: This study was conducted to develop a clinical pathway for primary spontaneous pneumothorax (PSP) patients treated by wedge resection surgery. The authors also aimed to evaluate the effects of the implementation of the PSP clinical pathway on (1) complication occurrence rates, (2) self-efficacy with respect to PSP recurrence prevention, (3) patient-perceived quality of life, and (4) patient treatment satisfaction. Design: This study was conducted using a quasi-experimental, nonequivalent study design. Sample: The study subjects were 60 PSP patients admitted to the thoracic surgery departments at 2 university hospitals located in Seoul, South Korea. Methods: A retrospective medical record review was conducted to develop a PSP clinical pathway, and the developed clinical pathway was then applied to the treatment group (n = 30). Complication occurrence rates, self-efficacy with respect to PSP recurrence prevention, perceived quality of life, and patient treatment satisfaction were measured. Findings: The developed PSP clinical pathway is comprehensive and includes self-care and recurrence prevention education in addition to common protocols, such as medication and diagnostic tests. The pathway significantly improved self-efficacy with respect to preventing PSP recurrence, health-related quality of life, and patient treatment satisfaction, but did not reduce complication rates. Implications: The present study offers a new comprehensive clinical pathway for PSP patients who have undergone wedge resection surgery. This study may be useful in the clinical nursing field by providing guiding standards for PSP-related education with respect to diet, exercise, self-supervision, complication, stress control, and recurrence prevention.

Temporal patterns of change in vital signs and Cardiac Arrest Risk Triage scores over the 48 hours preceding fatal in‐hospital cardiac arrest

AIM To determine temporal patterns of vital sign and Cardiac Arrest Risk Triage score changes over the 48-hour period preceding cardiac arrest in an ICU setting. BACKGROUND Vital sign instability usually occurs prior to cardiac arrest. However, few studies have been conducted on the temporal patterns of individual vital signs preceding cardiac arrest. DESIGN A retrospective case-control study. METHODS The study subjects were 140 ICU patients (1 June 2011-31 December 2012): 46 died of cardiac arrest (case group), 45 died of other illnesses (control I group) and 49 were discharged after recovering (control II group). RESULTS Initial detectable changes in blood pressure appeared 18-20 hours and became dramatic at 5-10 hours before cardiac arrest. Noticeable changes in heart rates began at 4 hours and became more prominent at 2 hours pre-arrest. No apparent patterns in respiratory rate changes were observed. Body temperatures usually indicated a hypothermic state pre-arrest. Cardiac Arrest Risk Triage scores were 16-18 at 48 hours pre-arrest and then continuously increased to 20. Only mean values of systolic blood pressures were significantly different between the three study groups. Mean diastolic blood pressures, heart rates, respiratory rates and Cardiac Arrest Risk Triage scores differed between the case and control II groups and between the control I and II groups. CONCLUSION The study demonstrates vital sign instability preceded cardiac arrest and that the temporal patterns of changes in individual vital signs and Cardiac Arrest Risk Triage scores differed between groups. The findings of this study may aid the development of management strategies for cardiac arrest.