How Do Oncology Nurses Cope With the Psychological Burden of Caring for Dying Patients?

BACKGROUND: Cancer is a leading cause of death worldwide, and most patients with cancer in South Korea die in hospitals. Oncology nurses experience physical, emotional, and occupational challenges associated with the psychological burden of caring for dying patients. OBJECTIVE: This study explored the coping strategies used by oncology nurses to deal with the psychological burden of patient deaths. METHODS: In this descriptive qualitative study, 10 oncology nurses who had recently experienced a patient's death were recruited via snowball sampling. All were female, with a mean age of 32.9 years (range, 27-44 years), and their mean working duration was 9.9 (range, 3-23) years. Participants were interviewed individually face-to-face 3 times, with each interview lasting 1 to 1.5 hours. RESULTS: Oncology nurses coped with the psychological burden of a patient's death in the following 4 ways: ( a ) avoiding patient deaths to the extent possible, ( b ) reflecting upon the meaning of life and death, ( c ) suppressing their emotional distress over the patient's death, and ( d ) becoming kinder and more caring toward people around them. CONCLUSIONS: The findings suggest that oncology nurses struggle to cope with the psychological burden of patient deaths. Oncology nurses are affected both negatively and positively by experiencing death as they provide end-of-life care. IMPLICATIONS FOR PRACTICE: Oncology nurses need education or counseling to reduce the psychological burden of caring for dying patients with cancer. Hospital administrators need to continuously identify ways to reduce the psychological burden of oncology nurses providing end-of-life care.

Factors Related to Patients' Self-care and Self-care Confidence in Korean Patients With Heart Failure and Their Caregivers: A Cross-sectional, Correlational Study.

BACKGROUND: The relationships of patient factors and caregiver contribution to patients' self-care to different types of self-care have been rarely examined in Korean patients with heart failure. OBJECTIVE: The aim of this study was to examine patient (ie, age, depressive symptoms, and self-care confidence) and caregiver (ie, caregiver contribution to self-care maintenance and self-care management, and caregiver confidence in contributing to self-care) factors related to different types of self-care (ie, self-care maintenance, symptom perception, and self-care management) and self-care confidence in Korean patients with heart failure. METHODS: In this cross-sectional, correlational study, data from 41 pairs of patients (mean age, 68.0 years) and caregivers (mean age, 54.1 years) were collected and analyzed using multiple regression. RESULTS: Higher levels of self-care confidence in patients were related to higher levels of self-care maintenance in patients. Higher levels of self-care confidence in patients were related to higher levels of symptom perception. Higher levels of self-care confidence in patients and caregiver contribution to self-care maintenance were related to higher levels of self-care management. Less severe depressive symptoms in patients and higher levels of caregiver confidence in contributing to self-care were related to higher levels of self-care confidence. CONCLUSION: Different patient and caregiver factors were related to different types of self-care and self-care confidence in Korean patients, but patients' self-care confidence was related to all types of self-care. Clinicians and researchers need to develop and deliver effective interventions to both patients and their caregivers to improve patients' self-care confidence and, in turn, self-care, considering different factors associated with each type of self-care.

Chemical composition, antioxidant, anti-elastase, and anti-inflammatory activities of Illicium anisatum essential oil.

The essential oil of air-dried Illicium anisatum (Illiciaceae), obtained by hydrodistillation was analyzed by gas chromatography-mass spectrometry (GC-MS). Fifty-two components were identified in the essential oil and the main component was eucalyptol (21.8 %). The antioxidant and anti-elastase activities of the essential oil were also investigated; the essential oil exhibited moderate DPPH scavenging and anti-elastase activities. To clarify the mechanism of the anti-inflammatory activities of I. anisatum essential oil (IAE), we evaluated whether it could modulate the production of nitric oxide (NO) and prostaglandin E2 (PGE2) by activated macrophages. The results indicate that IAE is an effective inhibitor of LPS-induced NO and PGE2 production in RAW 264.7 cells. These inhibitory activities were accompanied by dose-dependent decreases in the expression of iNOS and COX-2 proteins and iNOS and COX-2 mRNA. In order to determine whether IAE can be safely applied to human skin, the cytotoxic effects of IAE were determined by colorimetric MTT assays in human dermal fibroblast and keratinocyte HaCaT cells. IAE exhibited low cytotoxicity at 100 microg mL-1. Based on these results, we suggest that IAE may be considered an anti-aging and anti-inflammatory candidate for cosmetic materials, but additional in vitro and in vivo tests have to be performed to prove its safety and efficacy.

Cryptomeria japonica essential oil inhibits the growth of drug-resistant skin pathogens and LPS-induced nitric oxide and pro-inflammatory cytokine production.

In this study, the chemical composition of Cryptomeria japonica essential oil (CJE) was analyzed and its biological activities were tested. CJE was obtained by steam distillation from leaves collected from Jeju Island and analyzed by gas chromatography (GC)-flame ionization detection (FID) and GC-MS. Kaurene (17.20%), elemol (10.88%), gamma-eudesmol (9.41%), and sabinene (8.86%) were the major components in CJE. The antibacterial and anti-inflammatory activities of CJE against drug-susceptible and -resistant skin pathogens have been not reported previously. Thus, we determined the anti-bacterial activities of CJE using the disk diffusion method and minimum inhibitory concentration (MIC) values. CJE showed excellent antibacterial activities against Propionibacterium acnes and Staphylococcus epidermidis, which are acne-causing bacteria. The MIC of CJE against drug-susceptible and -resistant P. acens and S. epidermidis ranged from 0.16 to 10.0 microl/ml. In addition, the effects of CJE on nitric oxide (NO), prostaglandin E2 (PGE2), tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6 production in lipopolysaccharide (LPS)-activated RAW 264.7 macrophages were also examined. Pro-inflammatory cytokine and mediator tests indicated that CJE has excellent dose-dependent inhibitory activities. Therefore, based on these results, we propose that CJE is an attractive acne-mitigating candidate for skin health.

Abies koreana essential oil inhibits drug-resistant skin pathogen growth and LPS-induced inflammatory effects of murine macrophage.

Since acne vulgaris is the combined result of a bacterial infection and the inflammatory response to that infection, we examined whether Abies koreana essential oil (AKE) possessed anti-inflammatory and antibacterial activities against skin pathogens. In this study, AKE showed excellent antibacterial activities against drug-susceptible and -resistant Propionibacterium acnes and Staphylococcus epidermidis, which are acne-causing bacteria. In addition, AKE reduced the LPS-induced secretion of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-6, NO and PGE(2) in RAW 264.7 cells, indicating that it has anti-inflammatory effects. Therefore, we suggest that AKE may be an attractive candidate for promoting skin health.

Biological activities of Korean Citrus obovoides and Citrus natsudaidai essential oils against acne-inducing bacteria.

This study was designed to analyze the chemical composition of Citrus obovoides (Geumgamja) and Citrus natsudaidai (Cheonyahagyul) oils and to test their biological activities. These citrus essential oils were obtained by steam distillation of fruits collected from Jeju Island, Korea, and were analyzed using gas chromatograph (GC)-flame ionization detectors (FID) and GC-MS. Limonene and gamma-terpinene were the major components of the two citrus species. To evaluate in vitro anti-acne activity, they were tested against Propionibacterium acnes and Staphylococcus epidermidis, which are involved in acne. The Geumgamja and Cheonyahagyul oils exhibited antibacterial activity against both P. acnes and S. epidermidis. Their effects on DPPH radical scavenging, superoxide anion radical scavenging, and nitric oxide radical were also assessed. Cheonyahagyul and Geumgamja exhibited only superoxide anion radical-scavenging activity. To assess their potential usefulness in future cosmetic product applications, the cytotoxic effects of the two oils were determined by colorimetric MTT assays using two animal cell lines: normal human fibroblasts and HaCaT cells. They exhibited low cytotoxicity at 0.1 microl/ml in both cell lines. In addition, they reduced P. acnes-induced secretion of interleukin-8 (IL-8) and tumor necrosis factor alpha (TNF-alpha) in THP-1 cells, an indication of anti-inflammatory effects. Therefore, based on these results, we suggest that Geumgamja and Cheonyahagyul essential oils are attractive acne-mitigating candidates for topical application.

Chemical composition and anti-inflammatory effects of essential oil from Farfugium japonicum flower.

In this study, the chemical composition and anti-inflammatory activities of hydrodistilled essential oil from Farfugium japonicum were investigated for the first time. The chemical constituents of the essential oil were further analyzed by GC-MS and included 1-undecene (22.43%), 1-nonene (19.83%), beta-caryophyllene (12.26%), alpha-copaene (3.70%), gamma-curcumene (2.86%), germacrene D (2.69%), and 1-decene (2.08%). The effects of the essential oil on nitric oxide (NO) and prostaglandin E2 (PGE(2)) production in lipopolysaccharide (LPS)-activated RAW 264.7 macrophages were also examined. The results indicate that the F. japonicum essential oil is an effective inhibitor of LPS-induced NO and PGE(2) production in RAW 264.7 cells. These inhibitory effects of the F. japonicum essential oil were accompanied by dose-dependent decreases in the iNOS and COX-2 mRNA expression. In order to determine whether F. japonicum essential oil can safely be applied to human skin, the cytotoxic effects of F. japonicum essential oil were determined by colorimetric MTT assays in human dermal fibroblast and keratinocyte HaCaT cells. F. japonicum essential oil exhibited low cytotoxicity at 100 mug/mL. Based on these results, we suggest that F. japonicum essential oil may be considered a potential anti-inflammatory candidate for topical application.

Antibacterial and anti-inflammatory effects of Jeju medicinal plants against acne-inducing bacteria.

Propionibacterium acnes and Staphylococcus epidermidis are pus-forming bacteria that trigger inflammation in acne. The present study was conducted to evaluate the antimicrobial activities of Jeju medicinal plants against these etiologic agents of acne vulgaris. Ethanol extracts of Jeju plants were tested for antimicrobial activities by disc diffusion and broth dilution methods. The results from the disc diffusion assays revealed that four medicinal plants, Mollugo pentaphylla, Angelica anomala, Matteuccia orientalis, and Orixa japonica inhibited the growth of both pathogens. Among these, A. anomala had strong inhibitory effects. Its MIC values were 15.6 microg/ml and 125 microg/ml against P. acnes and S. epidermidis, respectively. The cytotoxic effects of the four extracts were determined by colorimetric MTT assays using two animal cell lines: human dermal fibroblasts and HaCaT cells. Although the M. orientalis root extract had moderate cytotoxicity in HaCaT cells at 200 microg/ml, most extracts exhibited low cytotoxicity at 200 microg/ml in both cell lines. In addition, the extracts reduced the P. acnes-induced secretion of interleukin-8 and tumor necrosis factor-alpha (TNF-alpha) in THP-1 cells, an indication of their anti-inflammatory effects. Based on these results, we suggest that M. pentaphylla, A. anomala, M. orientalis, and O. japonica are attractive acne-mitigating candidates for topical application.

Chemical composition and biological activities of essential oils extracted from Korean endemic citrus species.

The aim of this study was to analyze the chemical composition of 14 kinds of citrus oils and to test their biological activities. Citrus essential oils were obtained by steam distillation from immature fruits collected from Jeju Island and were analyzed using gas chromatograph (GC)- flame ionization detectors (FID) and GC-MS. Limonene (55.4% to 91.7%), myrcene (2.1% to 32.1%), alpha-pinene (0.6% to 1.6%) and linalool (0.4% to 6.9%) were the major components in most citrus species. To evaluate in vitro antibacterial activity, all essential oils were tested against Propionibacterium acnes and Staphylococcus epidermidis. Nine out of fourteen citrus oils exhibited antibacterial activity against P. acnes, but not against S. epidermidis. The effects of the citrus oils on DPPH radical scavenging, superoxide radical anion scavenging, nitric oxide radical, and cytotoxicity were also assessed. Three essential citrus oils, Joadeung, Dongjunggyul, and Bujiwha, exhibited potent inhibitory effects on nitric oxide production. Two essential oils, Dongjunggyul and Joadeung, showed potent free radical scavenging activities in the DPPH assay. For future applications in cosmetic products, we also performed MTT assays in a human dermal fibroblast cell line. The majority of the essential oils showed no cytotoxicity. The results indicate that citrus essential oils can be useful natural agents for cosmetic application.

Identification of essential amino acid residues in valine dehydrogenase from Streptomyces albus.

Cys-29 and Cys-251 of Streptomyces albus valine dehydrogenase (ValDH) were highly conserved in the corresponding region of NAD(P)(+)-dependent amino acid dehydroganase sequences. To ascertain the functional role of these cysteine residues in S. albus ValDH, site-directed mutagenesis was performed to change each of the two residues to serine. Kinetic analyses of the enzymes mutated at Cys-29 and Cys-251 revealed that these residues are involved in catalysis. We also constructed mutant ValDH by substituting valine for leucine at 305 by site-directed mutagenesis. This residue was chosen, because it has been proposed to be important for substrate discrimination by phenylalanine dehydrogenase (PheDH) and leucine dehydrogenase (LeuDH). Kinetic analysis of the V305L mutant enzyme revealed that it is involved in the substrate binding site. However it displayed less activity than the wild type enzyme toward all aliphatic and aromatic amino acids tested.