An Intervention Study of Self-feeding for the Elderly in Nursing Homes

PURPOSE: This study aims to investigate the effects of an intervention of self-feeding for elderly residents who were eating with assistance or eating by himself/herself with spilling food. METHODS: The Participants were 11 elderly people and 6 formal caregivers from 7 nursing homes in Korea. The intervention was to use the spoon and chopstick sets designed for compensating the weakened eating function. Both quantitative and qualitative data were collected through observation, structured questions, and in-depth interviews. RESULTS: The mealtime was significantly increased by 3.2 minutes (p=.011) after the intervention. Three themes were extracted for the meaning of self-feeding expressed by the elders; fighting alone for self-feeding, pride of participating in the study, and burden for self-feeding and research participation. Caregivers expressed the meaning of the elder's self-feeding such as the regret of missed chances, facilitating rehabilitation, the increase of the eating pleasure and quality of care, and ambivalence. CONCLUSION: Self-feeding has become an opportunity to recognize life values for the elders in nursing homes; for the caregivers, to reconsider caring of the elderly. Posture and eating utensils were also important to improve self-feeding skills.

Vitamin D deficiency is associated with increased risk of bacterial infections after kidney transplantation

BACKGROUND/AIMS: There may be an association between vitamin D levels and allograft outcomes in kidney transplant recipients (KTRs). However, few studies have been conducted to determine the association between vitamin D levels and post-transplant infections. This study investigated the impact of vitamin D deficiency on the risk of infection after kidney transplantation. METHODS: We measured 25-hydroxyvitamin D (25(OH)D) levels prior to kidney transplantation. Vitamin D deficiency was defined as a serum 25(OH)D level < 20 ng/mL. We examined the incidence of various post-transplant infections during follow-up period. We used Cox proportional hazards regression analysis to determine factors associated with increased risk of post-transplant infections during the follow-up period. RESULTS: A total of 164 KTRs were followed up for a mean of 24.8 ± 10.7 months. Among them, 135 patients (82.3%) had vitamin D deficiency. Patients with vitamin D deficiency had a significantly higher incidence of urinary tract infection (p = 0.027) and any bacterial infection (p = 0.010) compared to those without vitamin D deficiency. Vitamin D deficiency was not significantly associated with incidence of viral or fungal infections. Cox proportional hazards regression analysis revealed that vitamin D deficiency (hazard ratio, 11.07; 95% confidence interval, 1.46 to 84.03; p = 0.020) was independent risk factor for post-transplant bacterial infections. CONCLUSIONS: Pre-transplant vitamin D deficiency was a significant risk factor for bacterial infections after kidney transplantation. Further studies are needed on possible benefits of vitamin D supplementation for preventing post-transplant bacterial infection.

Vitamin D deficiency is associated with increased risk of bacterial infections after kidney transplantation

BACKGROUND/AIMS: There may be an association between vitamin D levels and allograft outcomes in kidney transplant recipients (KTRs). However, few studies have been conducted to determine the association between vitamin D levels and post-transplant infections. This study investigated the impact of vitamin D deficiency on the risk of infection after kidney transplantation. METHODS: We measured 25-hydroxyvitamin D (25(OH)D) levels prior to kidney transplantation. Vitamin D deficiency was defined as a serum 25(OH)D level < 20 ng/mL. We examined the incidence of various post-transplant infections during follow-up period. We used Cox proportional hazards regression analysis to determine factors associated with increased risk of post-transplant infections during the follow-up period. RESULTS: A total of 164 KTRs were followed up for a mean of 24.8 ± 10.7 months. Among them, 135 patients (82.3%) had vitamin D deficiency. Patients with vitamin D deficiency had a significantly higher incidence of urinary tract infection (p = 0.027) and any bacterial infection (p = 0.010) compared to those without vitamin D deficiency. Vitamin D deficiency was not significantly associated with incidence of viral or fungal infections. Cox proportional hazards regression analysis revealed that vitamin D deficiency (hazard ratio, 11.07; 95% confidence interval, 1.46 to 84.03; p = 0.020) was independent risk factor for post-transplant bacterial infections. CONCLUSIONS: Pre-transplant vitamin D deficiency was a significant risk factor for bacterial infections after kidney transplantation. Further studies are needed on possible benefits of vitamin D supplementation for preventing post-transplant bacterial infection.

The Effect of the Prevention Program of Needle-Stick Injury on Needle-Stick Knowledge, Compliance and Incidence / 병원감염관리

BACKGROUND: The purpose of this study was to develop and apply a prevention program for needle-stick injuries among health care workers who have a high occupational risk of such injuries, and to analyze the effect of the program on the subjects' knowledge regarding such injuries and compliance with protocols, as well as the incidence of needle-stick injuries among subjects. METHODS: The subjects of this study were nurses (RNs) and nurse's aides (NAs) working at a university hospital in Daegu. The data were collected by conducting surveys and determining the incidence of needle-stick injuries during a 1-year period before the application of the program. The program consisted of preventive education on needle-stick injury, the use of standardized boxes to measure blood sugar test, and the use of intravenous catheters with safety needles. Six months after the intervention, surveys were conducted to analyze the incidence of needle-stick injuries. The data on knowledge and compliance related to needle-stick injuries before and after program application were analyzed using the paired t-test, and data on the incidence of injuries were analyzed using the chi-square test. RESULTS: The scores on knowledge (RN, P<0.001; NA, P=0.007) and compliance (RN, P<0.001; NA, P=0.038) were significantly higher after the intervention than before. However, the number of reports on the incidence of needle-stick injuries before and after the intervention were not significantly different (RN, P=0.691; NA, P=0.079). CONCLUSION: The prevention program for needle-stick injuries was effective in improving the knowledge and compliance related to needle-stick injuries among RNs and NAs, but the number of reports on the incidence of injuries showed no difference. Therefore, the prevention program must be reevaluated and further developed after continuously monitoring and analyzing it in a hospital setting in order to decrease the incidence of needle-stick injuries.

Randomized, Multicenter, Phase III Trial of Heptaplatin 1-hour Infusion and 5-Fluorouracil Combination Chemotherapy Comparing with Cisplatin and 5-Fluorouracil Combination Chemotherapy in Patients with Advanced Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Heptaplatin (Sunpla) is a cisplatin derivative. A phase IIb trial using heptaplatin resulted in a 34% response rate with mild nephrotoxicity. We conducted a randomized phase III trial of heptaplatin plus 5-FU compared with cisplatin plus 5-FU in patients with advanced gastric cancer. MATERIALS AND METHODS: One hundred seventy-four patients (heptaplatin, n=88; cisplatin, n=86) from 13 centers were enrolled. The eligibility criteria were as follows: patients with pathologically-proven adenocarcinoma, chemonaive patients, or patients who had received only single adjuvant chemotherapy, and who had a measurable or evaluable lesion. On day 1, heptaplatin (400 mg/m2) or cisplatin (60 mg/m2) was given over 1 hour with 5-FU (1 gm/m2) on days 1~5 every 4 weeks. RESULTS: At the time of survival analysis, the median overall survival was 7.3 months in the 5-FU + heptaplatin (FH) arm and 7.9 months in the 5-FU + cisplatin (FP) arm (p=0.24). Of the FH patients, 34.2% (complete response [CR], 1.3%; partial response [PR], 32.9%) experienced a confirmed objective response compared with 35.9% (CR 0%, PR 35.9%) of FP patients (p=0.78). The median-time-to-progression was 2.5 months in the FH arm and 2.3 months in the FP arm. The incidence of neutropenia was higher with FP (28%) than with FH (16%; p=0.06); grade 3~4 nausea and vomiting were more frequent in the FP than in the FH arm (p=0.01 and p=0.05, respectively). The incidence of increased proteinuria and creatininemia was higher with FH than with FP; however, there was no statistical difference. There were no treatment-related deaths. CONCLUSION: Heptaplatin showed similar effects to cisplatin when combined with 5-FU in advanced gastric cancer patients with tolerable toxicities.

Discrepant Views of Korean Medical Oncologists and Cancer Patients on Complementary and Alternative Medicine / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was designed to evaluate the communication gap between Korean medical oncologists and cancer patients on complementary and alternative medicine (CAM). MATERIALS AND METHODS: Cross sectional studies utilized the responses of 59 medical oncologists and 211 patients. To understand the communication gap, perceived reasons and nondisclosure of CAM use, reactions of physicians to disclosure, and expectations for CAM were analyzed. Data were compared with use of the chi- squared test. RESULTS: Both medical oncologists and patients were in accord that CAM use would privde the patients with a feeling of hope. The medical oncologists believed more often than patients to attribute CAM use for control over medical care decisions, for the treatment of an incurable disease or as a nontoxic approach (p<0.05). Regarding reasons for nondisclosure, medical oncologists were morelikely to think that physicians would not understand the use of CAM, discontinue treatment or disapprove of the use of CAM (p<0.0001). Patients attributed nondisclosure mainly to the lack of questioning about CAM. Medical oncologists were more likely to warn of the risks with CAM use and less likely to encourage the use of CAM than perceived by patients (p=0.01). Patients expected that CAM could cure disease, extend survival, relieve symptoms and improve the immune system or quality of life more often than medical oncologists (p<0.05). CONCLUSION: Given the discrepant views of medical oncologists and patients on the use of CAM, medical oncologists should be aware of the discrepancies and attempt to resolve any differences.

The Hematologic Response to Anti-apoptotic Cytokine Therapy: Results of Pentoxifylline, Ciprofloxacin, and Dexamethasone Treatment for Patients with Myelodysplastic Syndrome

TNF-alpha mediated apoptosis of the hematopoietic cells has been thought to contribute to the ineffective hematopoiesis observed in myelodysplastic syndrome (MDS). The combination of pentoxifylline (P) and ciprofloxacin (C) has been shown to reduce the serum levels of TNF-alpha, and an earlier trial of P and C with dexamethasone (D) provided good palliation for patients with MDS. The purpose of this study is to assess the hematologic response to PCD therapy for patients suffering with MDS. 21 of 25 patients who completed at least of 12 weeks of treatment were evaluable for the treatment efficacy. At baseline, the patient's median age was 60 yr (range: 18-75 yr). The diagnoses according to WHO classification included: RA (n=5), RCMD (n=10), RARS (n=1), RCMD/RS (n=1), RAEB (3), and CMML (n=1). 11 patients (52%) had at least single lineage response. 3 patients (11%) showed improvement of triple lineage cytopenia. There were no differences in the response rates between the FAB subtypes. The median time to response was 4 weeks (range: 2-12 weeks), and it is interesting that 9 of 11 patients who had a response remained without relapse for a median of 177 days (range: 78-634 days). These preliminary results indicate that anti-cytokine therapy with PCD is an effective and well tolerated palliative treatment for patients with MDS.

Thyroid Dysfunction in Premature Infants

PURPOSE: Severe neonatal hypothyroxinemia is associated with leukomalacia, intraventicular hemorrhage and long-term neurodevelopmental disability. We designed this study to evaluate the incidence of thyroid dysfunctions and the effects of low T4 level on neonatal morbidity to establish the basis for the thyroid hormone supplementation. METHODS: Thyroid function tests, measured by radioimmunoassay and filter paper screening, were obtained from the preterm infants with birth weights less than 2000 g. The first measurement was done during 2nd week of life followed by the measurement at 2 weeks later and repeated until normalized. RESULTS: 17/32 (53.1%) infants had thyroid dysfunction: Four infants had hypothyroidism, twelve infants had hypothyroxinemia and one infant had hyperthyrotropinemia. The frequency of thyroid dysfunction showed inverse relationship to the birth weight. All infants with birth weights less than 1, 000 g, 11 infants (70.6%) with birth weights between 1, 000 and 1, 499 g and two infants (18.2%) with birth weights more than 1500 g had thyroid dysfunction. Nine infants with thyroid dysfunction were not detected by filter paper screening test. Infants with hypothyroxinemia had more RDS, longer mechanical ventilation days and hospital stay compared to the infants with normal T4 level. CONCLUSION: Thyroid dysfunction is frequently observed in premature infants and it can be associated with increased neonatal morbidity. Serial follow up of thyroid function test is recommened among premature infants.

A Comparison of Rectal, Axillary, and Skin-to-Mattress Temperatures in Neonates

PURPOSE: This study was conducted to evaluate the comparability and accuracy of body temperatures measured at three different sites: rectum, axilla and between skin and mattress in the newborn infants. METHODS: 168 term and preterm infants admitted to NICU at Kyungpook University Hospital were enrolled in the study. Glass and digital thermometers were used for the simultaneous measurement of rectal, axilla and skin-to-mattress temperatures. RESULTS: Among three different body temperatures measured by glass thermometer, the rectal temperatures recorded the highest in the bassinet, while no differences were found in the incubator. Rectal temperature by glass thermometer agreed most closely with axillary temperature by digital thermometer. The digital thermometers took significantly less time to measure temperatures from rectum and axilla than glass thermometer. Phototherapy did not influence body temperature measured in the incubator. CONCLUSION: In the bassinet, axilla temperature measured by a digital thermometer was as reliable as rectal temperature measured by a glass thermometer. Skin-to-mattress temperature provides an accurate, safe and easily accessible alternative site while infants are in the incubator.

The Intake, Preference, and Utilization of Kimchi in Female High School Students / 대한지역사회영양학회지

The purpose of this study was to investigate the intake, preference, and utilization of kimchi in female high school students. A questionnaire was used as the instrument of investigation. The subjects were 371 female high school students in Chonbuk province. More than 80% of the subjects had eaten 8 kinds of kimchies Korean cabbage kimchi, cubed radish kimchi, radish leaves kimchi, green onion kimchi, salted cucumber, watery radish kimchi, radish root & leaves kimchi, and Korean wild radish kimchi. The subjects living in urban areas ate more stalk of sweet potato kimchi and leaf mustard kimchi, however the subjects living in rural areas ate more sedum kimchi. The subjects in large families ate more leaf mustard kimchi and sedum kimchi. The preferred kinds of kimchi were radish kimchi, Korean cabbage kimchi, cubed radish kimchi, and cucumber radish kimchi. Seventy-four point four percent of the subjects liked kimchi, whereas 1.6% of them disliked it. The reason eating kimchi was 'custom'(59.0%), 'taste'(30.7%), 'nutrition'(4.3%), 'traditional flod'(2.7%), and 'parents advice'(2.7%). 38.4% of the subjects in urban area ate kimchi for taste whereas 25.0% of them in rural area did. They prefefrred 'well fermented', 'hot', and 'very pungent' kimchi. The preferred dishes made with kimchi were stir-fried rice with kimchi, kimchi stew, pan-fried kimchi, and rice with bean sprouts & kimchi.