Safety Climate and Organizational Communication Satisfaction Among Korean Perianesthesia Care Unit Nurses.

PURPOSE: This study investigated organizational communication satisfaction and safety climate among perianesthesia care unit (PACU) nurses and factors affecting safety climate. DESIGN: A cross-sectional study of 103 registered nurses currently working in PACUs in Korea. METHODS: Organizational communication satisfaction was measured using the Communication Satisfaction Questionnaire, and safety climate was assessed using the Safety Attitudes Questionnaire-Korean version 2. Additional questions covered the demographics of the respondents and the characteristics of the hospital where they worked. FINDINGS: Factors affecting teamwork climate included communication climate and horizontal informal communication. Safety climate was affected by media quality and organizational integration; job satisfaction by working in secondary hospitals, communication climate, and media quality; perception of management by working in public hospitals, media quality, and personal feedback; and working conditions by working in public hospitals, media quality, and personal feedback. CONCLUSIONS: The results show that Korean PACU nurses experience poorer safety climate compared with other countries. One suggestion is to enhance nurses' satisfaction using organizational communication (eg, by developing effective communication media that satisfy users) and to promote communication at an organizational level so that individual health care professionals are aware of their organizations' vision and policies.

Development of a Population Pharmacokinetics-Based in vitro-in vivo Correlation Model for Drugs with Site-Dependent Absorption: the Acyclovir Case Study.

Acyclovir is a Biopharmaceutics Classification System (BCS) class III antiviral agent which is only absorbed in the upper part of the gastrointestinal tract. This study aimed to establish a new in vitro-in vivo correlation (IVIVC) platform based on population pharmacokinetic modeling for drugs with site-dependent absorption using acyclovir as a model drug. Three types of sustained-release (SR; 500 mg) acyclovir tablets were prepared by the wet granulation method. The in vitro dissolution profiles of the acyclovir SR tablets and the immediate-release (IR; 200 mg) were determined by the paddle method and their in vivo pharmacokinetics were evaluated in Beagle dogs. A population pharmacokinetic model was developed using S-ADAPT. By separating the dissolution and absorption processes, the population pharmacokinetic model adequately described all the in vivo pharmacokinetic data and estimated the in vivo dissolution profiles. The changes of absorption rate over time after oral administration were also successfully estimated. The parameter estimates of the in vitro and in vivo drug releases were correlated by linear regression. Finally, the in vivo pharmacokinetic profiles were well predicted by the developed IVIVC model from the in vitro dissolution data with the prediction errors within 8.26% and 10.06% for the maximum plasma concentration (Cmax) and area under the plasma concentration-time curve (AUC), respectively. The present approach provides a better understanding of the in vivo absorption for drugs that have limited absorption window and may be useful for their new formulation design and development.

Synergistic Meropenem-Tobramycin Combination Dosage Regimens against Clinical Hypermutable Pseudomonas aeruginosa at Simulated Epithelial Lining Fluid Concentrations in a Dynamic Biofilm Model.

Exacerbations of chronic Pseudomonas aeruginosa infections are a major treatment challenge in cystic fibrosis due to biofilm formation and hypermutation. We aimed to evaluate different dosage regimens of meropenem and tobramycin as monotherapies and in combination against hypermutable carbapenem-resistant P. aeruginosa A hypermutable P. aeruginosa isolate (meropenem and tobramycin MICs, 8 mg/liter) was investigated in the dynamic CDC biofilm reactor over 120 h. Regimens were meropenem as the standard (2 g every 8 h, 30% epithelial lining fluid [ELF] penetration) and as a continuous infusion (CI; 6 g/day, 30% and 60% ELF penetration) and tobramycin at 10 mg/kg of body weight every 24 h (50% ELF penetration). The time courses of totally susceptible and less-susceptible bacteria and MICs were determined, and antibiotic concentrations were quantified by liquid chromatography-tandem mass spectrometry. All monotherapies failed, with the substantial regrowth of planktonic (>6 log10 CFU/ml) and biofilm (≥6 log10 CFU/cm2) bacteria occurring. Except for the meropenem CI (60% ELF penetration), all monotherapies amplified less-susceptible planktonic and biofilm bacteria by 120 h. The meropenem standard regimen with tobramycin caused initial killing followed by considerable regrowth with resistance (meropenem MIC, 64 mg/liter; tobramycin MIC, 32 mg/liter) for planktonic and biofilm bacteria. The combination containing the meropenem CI at both levels of ELF penetration synergistically suppressed the regrowth of total planktonic bacteria and the resistance of planktonic and biofilm bacteria. The combination with the meropenem CI at 60% ELF penetration, in addition, synergistically suppressed the regrowth of total biofilm bacteria. Standard regimens of meropenem and tobramycin were ineffective against planktonic and biofilm bacteria. The combination with meropenem CI exhibited enhanced bacterial killing and resistance suppression of carbapenem-resistant hypermutable P. aeruginosa.

Development of a gastroretentive delivery system for acyclovir by 3D printing technology and its in vivo pharmacokinetic evaluation in Beagle dogs.

Gastroretentive (GR) systems are designed to prolong gastric residence time to allow sustained absorption and improve the oral bioavailability of drugs with a narrow absorption window in the upper part of the gastrointestinal tract. The present study aimed to develop a GR system for acyclovir using 3D printing technology and evaluate its in vivo pharmacokinetics after oral administration in Beagle dogs. The system consisted of a gastro-floating device, which can float in the gastric fluid, prepared by a fused deposition modeling 3D printer and conventional acyclovir sustained-release (SR) tablet. The acyclovir SR tablet was inserted to the floating device to allow sustained release of the drug in the stomach. The buoyancy and sustained-release property of the developed GR system were determined using an in vitro dissolution test, in vivo pharmacokinetic study, and abdominal X-ray imaging in Beagle dogs. The in vivo dissolution profiles of the GR system were also predicted based on the in vivo pharmacokinetic data using a population pharmacokinetic (POP-PK) model. In the dissolution test, the sustained-release characteristic of the GR system was identified with a time corresponding to 80% dissolution (T80) of 2.52 h. Following oral administration of the GR system, the time to reach the maximum concentration (Tmax) of acyclovir was significantly prolonged, whereas the maximum concentration (Cmax) decreased and the area under the curve increased compared with those obtained after the administration of immediate-release and SR tablets, indicating prolonged absorption. By X-ray imaging, we showed that the developed GR system stayed in the stomach for more than 12 h. The POP-PK model successfully described the observed plasma concentration-time data and predicted the in vivo biphasic dissolution profiles of the GR system, which was significantly different from the in vitro dissolution. The developed GR system could be applied to various drugs and had great prospects in the design and development of novel controlled-release formulations.

Simultaneous analysis of acetylcarnitine, proline, hydroxyproline, citrulline, and arginine as potential plasma biomarkers to evaluate NSAIDs-induced gastric injury by liquid chromatography-tandem mass spectrometry.

Although major adverse effects associated with nonsteroidal anti-inflammatory drugs (NSAIDs) are gastric injury, assessment of NSAIDs-induced gastrointestinal adverse effects is mostly dependent on endoscopy due to the lack of plasma biomarkers. Several amino acids associated with collagenase activity and gastric mucosal mass have been suggested as plasma biomarker candidates for gastric injury. Therefore, this study aimed to develop a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the plasma biomarker candidates, i.e., acetylcarnitine, proline, hydroxyproline, citrulline, and arginine and evaluate their potential as a biomarker for NSAIDs-induced gastric injury. The method utilized simple protein precipitation with methanol and D4-citrulline as an internal standard (IS). The assay resulted in the lower limit of quantification (LLOQ) of 0.1 µg/mL for acetylcarnitine and 1 µg/mL for proline, hydroxyproline, citrulline, and arginine in the surrogate blank plasma. The intra- and inter-day accuracy ranged 82.5-111.2% for acetylcarnitine, 95.4-103.3% for proline, 98.9-106.4% for hydroxyproline, 99.5-103.5% for citrulline, and 87.4-105.3% for arginine. The precision was within 6.17%, 3.63%, 6.20%, 6.31%, and 6.17% for acetylcarnitine, proline, hydroxyproline, citrulline, and arginine, respectively. The developed assay was successfully applied to monitor the changes of the plasma levels of the five amino acids in rats and Beagle dogs following repeated oral administrations of aceclofenac. In rats, plasma concentrations of proline, hydroxyproline, and citrulline were significantly reduced after 4 days of aceclofenac administration compared to the control group. In dogs, plasma concentrations of proline and citrulline were significantly decreased after 7 days of aceclofenac administration compared to those obtained after the first aceclofenac administration. These data indicate that plasma levels of proline, hydroxyproline, and citrulline may be used as quantitative biomarkers of NSAIDs-induced gastric damage. The present assay could also be utilized to monitor the changes of these amino acids as potential indicators for various physiological and pathophysiological conditions.

Regional Absorption of Fimasartan in the Gastrointestinal Tract by an Improved in situ Absorption Method in Rats.

The aim of the present study was to assess the regional absorption of fimasartan by an improved in situ absorption method in comparison with the conventional in situ single-pass perfusion method in rats. After each gastrointestinal segment of interest was identified, fimasartan was injected into the starting point of each segment and the unabsorbed fimasartan was discharged from the end point of the segment. Blood samples were collected from the jugular vein to evaluate the systemic absorption of the drug. The relative fraction absorbed (Fabs,relative) values in the specific gastrointestinal region calculated based on the area under the curve (AUC) values obtained after the injection of fimasartan into the gastrointestinal segment were 8.2% ± 3.2%, 23.0% ± 12.1%, 49.7% ± 11.5%, and 19.1% ± 11.9% for the stomach, duodenum, small intestine, and large intestine, respectively, which were comparable with those determined by the conventional in situ single-pass perfusion. By applying the fraction of the dose available at each gastrointestinal segment following the oral administration, the actual fraction absorbed (F'abs) values at each gastrointestinal segment were estimated at 10.9% for the stomach, 27.1% for the duodenum, 40.7% for the small intestine, and 5.4% for the large intestine, which added up to the gastrointestinal bioavailability (FX·FG) of 84.1%. The present method holds great promise to assess the regional absorption of a drug and aid to design new drug formulations.

Pharmacokinetics and Anti-Gastric Ulceration Activity of Oral Administration of Aceclofenac and Esomeprazole in Rats.

This study examined the effects of esomeprazole on aceclofenac pharmacokinetics and gastrointestinal complications in rats. Aceclofenac alone, or in combination with esomeprazole, was orally administered to male Sprague-Dawley rats. Plasma concentrations of aceclofenac, its major metabolite diclofenac, and esomeprazole were simultaneously determined by a novel liquid chromatography-tandem mass spectrometry method. Gastrointestinal damage was determined by measuring ulcer area and ulcer lesion index of the stomach. Oral administration of aceclofenac induced significant gastric ulceration, which was inhibited by esomeprazole administration. Following concurrent administration of aceclofenac and esomeprazole, overall pharmacokinetic profiles of aceclofenac and metabolic conversion to diclofenac were unaffected by esomeprazole. Aceclofenac metabolism and pharmacokinetics were not subject to significant food effects, whereas bioavailability of esomeprazole decreased in fed compared to fasting conditions. In contrast, the pharmacokinetics of aceclofenac and esomeprazole were significantly altered by different dosing vehicles. These results suggest that co-administration of esomeprazole with aceclofenac may reduce aceclofenac-induced gastrointestinal complications without significant pharmacokinetic interactions. The optimal combination and clinical significance of the benefits of the combination of aceclofenac and esomeprazole need to be further evaluated.

Experience of complementary and alternative medicine in patients with amyotrophic lateral sclerosis and their families: A qualitative study.

The purpose of this study was to explore the life experience related to complementary and alternative medicine (CAM) use among patients with amyotrophic lateral sclerosis (ALS). Data were collected though semi-structured interviews of nine patients with ALS and seven family members, who have used CAM. Audio recordings of the interviews were transcribed verbatim and checked for accuracy. The Giorgi's method of phenomenology was used for data analysis. Five constituents forming the units of meaning were: facing the limits of conventional medicine; getting to know CAM; recognizing the ineffectiveness of CAM; using CAM for symptomatic treatment; and seeking new CAM endlessly for complete cure. The study results provide an in-depth understanding of experience with CAM among patients with ALS and their family members. Healthcare providers must give accurate information about the efficacy of CAM as well as its safety and possible adverse effects and should offer patient-centred treatment through active communication throughout the process of diagnosis and treatment.

The sexuality experience of older widows in Korea.

Sexuality plays an important role in elders' lives. However, few studies exist concerning the essential meaning crucial for the overall understanding of sexuality in later life. In this study we explored the experience of what sexuality implied and meant to older widows using the descriptive phenomenological approach. Purposive sampling yielded 10 elderly women who were in sexual relationships. We collected data through in-depth interviews with participants and conducted a thematic analysis. The findings were classified into eight themes: trying to find another side of herself, starting a romantic relationship, invigorating life, displaying femininity, being concerned about the perceptions of others, enjoying sexual freedom, feeling the limit of sexual intimacy, and facing up to reality. The sexual lives of older widows entailed a process of recovering their femininity, self-achievement, and self-esteem, which helped them to live independent lives by developing more active and flexible attitudes.

The Association between Pain and Depression, Anxiety, and Cognitive Function among Advanced Cancer Patients in the Hospice Ward.

BACKGROUND: Pain is the most common but severe physical symptom among cancer patients. This study aimed to identify correlation between pain and psychological symptoms for terminal cancer patients. METHODS: The total sample consisted of 69 subjects who were recruited through two hospice wards, limited to patients who were mentally alert and had no psychiatric diseases. The subjects were divided into two groups according to the numerical rating scale: the pain-free group, 0 to 3 points; and the pain group, 4 to 10 points. We used the Beck depression inventory (BDI), Beck anxiety inventory (BAI), mini-mental status examination-Korea (MMSE-K), and short form 36 health survey (SF-36). Logistic regression analysis was performed to verify the correlation between pain and other psychosocial disorders. RESULTS: The mean scores of BDI in the pain-free and pain groups were 25.7 and 31.5; mean BAI scores were 23.4 and 34.7; mean MMSE-K scores were 25.7 and 21.8, respectively. There were no significant differences between the two groups in SF-36 score except scores of body pain. The results of logistic regression analysis adjusted for age, sex, marital status, types of cancer, history of chemotherapy, or radiotherapy showed significant correlation between pain and depression (BDI ≥ 24; odds ratio [OR], 4.199; 95% confidence interval [CI], 1.171 to 15.060), and pain and cognitive impairment (MMSE < 24; OR, 5.495; 95% CI, 1.449 to 20.843); but not between pain and anxiety (BAI ≥ 22; OR, 3.011; 95% CI, 0.907 to 9.997). CONCLUSION: Pain significantly affects depression and cognitive impairment among advanced cancer patients in the hospice ward. Accordingly, more aggressive treatment of pain is required to reduce not only physical suffering but also physiological distress.

The unusual origin of the sternocleidomastoid artery from the lingual artery.

The sternocleidomastoid (SCM) artery supplying blood to the SCM muscle has different origins according to its anatomical segment. The authors performed cadaveric neck dissection to review the surgical anatomy of neurovascular structures surrounding the carotid artery in the neck. During the dissection, an unusual finding was cited in which the SCM artery supplying the middle part of the SCM muscle originated from the lingual artery (LA); it was also noted that it crossed over the hypoglossal nerve (HN). There have been extremely rare reports citing the SCM artery originated from the LA. Though the elevation of the HN over the internal carotid artery was relatively high, the vascular loop crossing over the HN was very close to the carotid bifurcation. Special anatomical consideration is required to avoid the injury of the HN during carotid artery surgery.

Factors affecting clinical outcomes in treating patients with grade 1 degenerative spondylolisthesis using interspinous soft stabilization with a tension band system: a minimum 5-year follow-up.

STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To explore the factors influencing the clinical outcomes and motion-preserving stabilization after interspinous soft stabilization (ISS) with a tension band system for grade 1 degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA: Despite increasing recognition of the benefits of dynamic stabilization systems for treating lumbar degenerative disorders, the factors affecting the clinical and radiological outcomes of these systems have rarely been identified. METHODS: Sixty-five patients (mean age, 60.3 years) who underwent ISS with a tension band system between 2002 and 2004 were analyzed. The mean follow-up period was 72.5 months. The patients were divided according to the postsurgical clinical improvements into the optimal (n = 44) and suboptimal groups (n = 21), and the radiological intergroup differences were analyzed. Multiple linear regression analysis was performed to determine the impact of the radiological factors on the clinical outcomes. RESULTS: Significant intergroup differences were observed on the follow-up clinical examination. Radiologically, total lumbar lordosis (TLL) and segmental lumbar lordosis (SLL) were significantly improved only in the optimal group, resulting in significant intergroup differences in TLL (P = 0.023), SLL (P = 0.001), and the L1 tilt (P = 0.002). All these measures were closely associated with postoperative segmental lumbar lordosis, which also was the most influential radiological variable for the clinical parameters. CONCLUSION: In the patients with grade 1 DS, the back pain relief and functional improvement following ISS were affected by the improvements in the sagittal spinal alignment through the achievement of segmental lumbar lordosis. ISS can be an alternative treatment to fusion surgery for grade 1 DS in patients who do not require fixation or reduction.

Spinopelvic alignment after interspinous soft stabilization with a tension band system in grade 1 degenerative lumbar spondylolisthesis.

STUDY DESIGN: Retrospective clinical study. OBJECTIVE: The purpose of this study was to examine the changes in spinopelvic alignment after interspinous soft stabilization (ISS) with a tension band system and to identify the lumbosacral parameters related to those changes and to determine their impact on the clinical outcomes compared with posterior lumbar interbody fusion (PLIF) in patients with low-grade degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA: The sacropelvic morphometric changes after fusion surgery have received much research attention. However, few reports have addressed the issue after use of dynamic or soft stabilization systems. METHODS: From April 2001 to November 2003, 45 patients presenting with grade 1 DS with stenosis underwent either ISS with a tension band system (ISS group) or PLIF with pedicle screw fixation (PLIF group). The mean follow-up period was 76.8 months. Three pelvic parameters, the sacral slope (SS), pelvic tilt (PT), and pelvic incidence, were investigated to address the sacropelvic morphometric change. Clinical outcomes were assessed using the visual analog scale score, the Oswestry Disability Index, and the patient's satisfaction index. RESULTS: Both groups showed significant improvements in all of the clinical outcomes, with no significant differences between groups. In the ISS group, the SS increased and PT decreased, whereas in the PLIF group, the SS decreased and PT increased, resulting in pelvic anteversion and retroversion, respectively, with significant intergroup differences in SS and PT (SS: P = 0.047; PT: P = 0.01). The positive association of lumbar lordosis with SS (r = 0.448) and its negative association with PT (r = -0.674) in the respective groups indicate the influence of changes in lumbar lordosis on pelvic positional changes. Significant correlations between follow-up segmental lumbar lordosis and the visual analog scale score for leg pain (r = -0.685) and Oswestry Disability Index score (r = -0.425) were found in the ISS group alone. CONCLUSION: Segmental lordotic change after ISS with a tension band system was the possible decisive factor in the development of pelvic anteversion while maintaining sagittal lumbar balance; lack of lumbar lordosis led to compensatory pelvic retroversion in the PLIF group. Considering the comparable clinical results with PLIF surgery and the achievement of physiologic sagittal spinopelvic balance, the ISS procedure can be a feasible alternative to fusion surgery in patients with grade 1 DS with stenosis.

Pure epidural cavernous hemangioma of the cervical spine that presented with an acute sensory deficit caused by hemorrhage.

Pure epidural cavernous hemangioma of the spine without vertebral involvement is rare. Due to the slow growth of this lesion, the most common symptoms are chronic pain, myelopathy, and radiculopathy. In our case, the patient complained of an acute onset sensory deficit of the C4 dermatome. An MRI revealed an epidural mass with an acute hematoma. Here, we report a case of a pure epidural cavernous hemangioma that presented with acute neurologic symptoms caused by intralesional hemorrhage and an acute epidural hematoma, which were demonstrated on the patient's MRI.

Comparative radiologic evaluation of percutaneous endoscopic lumbar discectomy and open microdiscectomy: a matched cohort analysis.

BACKGROUND: Only a few studies comparing percutaneous endoscopic discectomy and open discectomy have been reported in the literature. The purpose of this study was to compare the radiographic changes in patients treated with percutaneous endoscopic lumbar discectomy (PELD) with those of patients treated with open lumbar microdiscectomy (OLM). METHODS: A total of 30 patients who underwent PELD with a minimum three years of follow-up were randomly selected. To compare with the PELD group, 30 patients who underwent OLM during the same period were also randomly selected according to sex, age, and disc level. The clinical outcomes were evaluated by the Macnab criteria. Statistical analysis was performed using independent sample t-test, paired sample t-test, chi-square test, Fisher's exact test, and analysis of variance (ANOVA). RESULTS: The successful clinical outcomes were 96.7% in the PELD group and 93.3% in the OLM group. Among the various radiological parameters, changes of disc height (1.41 +/- 1.19 mm in the PELD group and 2.29 +/- 2.12 mm in the OLM group, p=0.024) and foraminal height (1.26 +/- 0.91 mm in the PELD group and 1.85 +/- 0.92 mm in the OLM group, p=0.017) were significantly different between the two groups. CONCLUSIONS: Although the clinical outcomes were similarly satisfactory in both groups, PELD is a less invasive procedure than open microdiscectomy in s elected cases.

Renal cement embolism during percutaneous vertebroplasty.

Percutaneous vertebroplasty (PVP) is an effective treatment for lesions of the vertebral body that involves a percutaneous injection of polymethylmethacrylate (PMMA). Although PVP is considered to be minimally invasive, complications can occur during the procedure. We encountered a renal embolism of PMMA in a 57-year-old man that occurred during PVP. This rare case of PMMA leakage occurred outside of the anterior cortical fracture site of the L1 vertebral body, and multiple tubular bone cements migrated to the course of the renal vessels via the valveless collateral venous network surrounding the L1 body. Although the authors could not explain the exact cause of the renal cement embolism, we believe that physicians should be aware of the fracture pattern, anatomy of the vertebral venous system, and careful fluoroscopic monitoring to minimize the risks during the PVP.