Ischaemic stroke in a patient with non-valvular atrial fibrillation (NVAF) despite non-vitamin K oral anticoagulant (NOAC) therapy.

Primary stroke prevention in non-valvular atrial fibrillation (NVAF) is primarily with non-vitamin K oral anticoagulant (NOAC) therapy. However, 20-36% of ischaemic strokes seem to occur in patients with atrial fibrillation while already on anticoagulation. We present a case of an ischaemic stroke in an elderly female in her 70s with medical history significant for hypertension and NVAF. She had a CHA2DS2-VASc score of 3 and was on apixaban for thromboprophylaxis. She presented with neurological deficits consistent with a left middle cerebral artery stroke, confirmed via head imaging; the most likely stroke aetiology was determined to be cardioembolic in the setting of NVAF. She was treated with continuation of her apixaban at the same dosage She displayed improved function, although with residual expressive aphasia at her 2-month neurology follow-up. Cardioembolic ischaemic stroke in NVAF despite current NOAC therapy does not have current management guidelines.

Effects of Nonpharmacological Interventions on Sleep Quality and Insomnia in Perimenopausal and Postmenopausal Women: A Meta-Analysis.

This study aimed to analyze the effects of nonpharmacological interventions on perimenopausal and postmenopausal women with sleep problems. Eight databases (MEDLINE/PubMed, Cochrane Library, EMBASE, CINAHL, and four Korean databases) were searched, from their inception through to 30 November 2021, for randomized controlled trials (RCTs) evaluating the effects of nonpharmacological interventions versus control conditions on sleep quality and insomnia in perimenopausal and postmenopausal women. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and the severity of insomnia was assessed using the Insomnia Severity Index (ISI). In the meta-analysis, corrected standardized mean differences (SMDs; Hedges' g) and 95% confidence intervals (CIs) were calculated as effect measures by applying the random effects model and inverse variant method. Fifteen trials met our inclusion criteria. Nonpharmacological interventions were found to have positive effects on sleep quality, measured with the PSQI (SMD = -1.32; 95% CI = -1.78 to -0.86; p < 0.001), and on the severity of insomnia, measured using the ISI (SMD = -1.11; 95% CI = -1.82 to -0.41; p = 0.002), compared with the control groups. Among perimenopausal and postmenopausal women with sleep problems, nonpharmacological interventions improved sleep quality and reduced the severity of insomnia.

A menopausal transition model based on transition theory.

PURPOSE: The purpose of this study was to construct a hypothetical model based on Meleis and colleagues' Transition Theory and a literature review to explain women's menopausal transition, constructing a modified model considering previous studies and model fit and testing the effects between variables. METHODS: With a correlational survey design, middle-aged Korean women aged 40 to 64 years who had experienced menopausal symptoms were recruited and filled out a self-administered study questionnaire. Measures included menopausal symptoms, resilience, social support, menopause management, menopause adaptation, and quality of life. The data were analyzed using SPSS 24.0 and AMOS 24.0. RESULTS: The model fit indices were considered acceptable: χ2 /degree of freedom=2.93, standardized root mean residual=.07, comparative fit index=.90, and parsimonious normed fit index=.73. All eight direct-effect paths-from menopausal symptoms to support and adaptation, from support to adaptation and resilience, from resilience to adaptation and management, from management to quality of life, and from adaptation to quality of life-were significant. The explanatory power of the menopause transition model was 63.6%. CONCLUSION: Women who experience menopausal symptoms may be able to maintain and improve their quality of life if menopause management and menopause adaptation are successful through resilience and social support. Future research is needed to confirm whether strengthening facilitation as a nursing intervention strategy may promote healthy response patterns.

Corrigendum: Factors influencing prenatal and postpartum depression in Korea: a prospective cohort study.

[This corrects the article on p. 326 in vol. 27.].

Depression and stress in Korean parents: A cohort study.

AIM: This study identified the level of depression and stress in couples experiencing pregnancy and childbirth. BACKGROUND: Married couples who experience pregnancy and delivery, deal with psychological changes during the parenthood transition. If they do not adapt well, they experience negative emotions that negatively affect them and their child. Therefore, the incidence and changing patterns of depression among couples need to be explored. METHODS: Using a prospective cohort study design, the researchers collected the couples' depression and stress levels 6 times. This study included 219 prenatal pregnant women, 181 spouses during pregnancy in the prenatal period, 178 postpartum mothers, and 125 spouses after childbirth. The levels of depression and stress were investigated using the Edinburgh Postnatal Depression Scale and Perceived Stress Scale. RESULTS: The incidence rate of prenatal depression was 10.5- 21.5% in pregnant women and 10.5-12.7% in their spouses. After childbirth, the incidence rate of depression was 21.3- 32.0% in postpartum women and 6.4-10.4% in their spouses. The levels of depression and stress varied from the prenatal to the postpartum period, showing different patterns between women and their spouses. Significantly, the emotional patterns in the couples were different as far as parity was concerned. CONCLUSIONS: The levels of depression and stress in couples continuously changed during the prenatal and postpartum periods and the patterns differed as well. Even couples who experience a healthy pregnancy and childbirth experience negative emotional changes. Therefore, timely nursing management will alleviate stress and depression not first-time by first-time parents.

Factors influencing prenatal and postpartum depression in Korea: a prospective cohort study.

Purpose: This study explored the prevalence of prenatal and postpartum depression in Korea and its influencing factors from 20 weeks of pregnancy to 12 weeks postpartum. Methods: Using a prospective cohort study design, data on women's depression and its influencing factors were collected at 20, 28, and 36 weeks of pregnancy and at 2, 6, and 12 weeks postpartum. The participants were 219 women and 181 spouses during pregnancy; and 183 mothers and 130 spouses after childbirth. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale and influencing factors were measured by the Postpartum Depression Predictors Inventory-Revised, parity, and spousal depression. Results: The prevalence of maternal depression was 10.5% to 21.5% before birth, and it was 22.4% to 32.8% postpartum. The prevalence slightly decreased during the prenatal period but peaked at 2 weeks postpartum. Antenatal depression was influenced by low socioeconomic status, lower self-esteem, having experienced prenatal depression, having experienced prenatal anxiety, a previous history of depression, lower social support, lower marital satisfaction, and higher life stress. The factors influencing postpartum depression were lower self-esteem, having experienced prenatal depression, having experienced prenatal anxiety, lower social support, lower marital satisfaction, and higher life stress, as well as infant temperament and maternal blues. Parity and spousal depression had no impacts. Conclusion: The prevalence and influencing factors of maternal depression changed over time. Nurses need to screen women accordingly during the perinatal period and should provide education or counseling to prevent depression and promote adjustment to parenthood.

Development and application of a couple-centered antenatal education program in Korea.

Purpose: This study was conducted to develop a couple-centered antenatal education program and to test the program's feasibility. Methods: With a preliminary-experimental study design, 33 pregnant couples who were expecting their first child participated in this study. The program consisted of four sessions (1 hour/session/week) of education and counseling. Data were collected before and after the intervention from September 2018 to April 2019 at a women's hospital in Daejeon, Korea, with demographic data forms, the Edinburgh Postnatal Depression Scale, Perceived Stress Scale, Maternal-Fetal Attachment Scale, Korean Newborn Care Confidence Scale, Wijma Delivery Expectancy/Experience Questionnaire, and Dyadic Adjustment Scale-10. Results: The pregnant women and their husbands were on average 32.30±3.10 and 33.21±6.25 years old, respectively. The mean marriage duration was 2.34±1.63 years, the gestational age was 31.30±2.66 weeks, and 78.8% of the couples had a planned pregnancy. After the program, both the pregnant women and their husbands showed significant improvements in attachment to the fetus and confidence in providing infant care. Prenatal depression, prenatal stress, and fear of childbirth in pregnant women significantly decreased after completing the program. However, the dyadic adjustment score did not change significantly either in the pregnant women or their husbands. Conclusion: A couple-centered antenatal education program seems to be effective for couples adjusting to parenthood, but further studies should explore ways to have a positive impact on couples' relationships.

Effects of psychoeducation on the mental health and relationships of pregnant couples: A systemic review and meta-analysis.

BACKGROUND: Previous studies suggest that psychoeducational interventions for pregnant and postpartum couples can improve perinatal mental health outcomes and promote couples' relationships. However, most studies conducted to date have focused only on maternal depression, with few studies addressing the needs of fathers, or the effects of paternal participation on the mental health/relationship of both partners. OBJECTIVES: This study aimed to systematically examine the effects of perinatal couples' psychoeducation on parental mental health and their relationship. DESIGN: A systematic review and meta-analysis were conducted. DATA SOURCES: Six electronic databases were searched, including Embase, MEDLINE, Web of Science, the Cochrane Library, CINAHL, and PubMed. REVIEW METHODS: The authors independently extracted data from journals written in English or Korean, published between January 2000 and August 2017. Randomized controlled trials (RCTs) that reported psycho-emotional symptoms and couples' relationship outcomes were screened. Of the 11 studies that systematically reviewed couples' mental health and relationship problems, seven RCTs, with data available to pool for quantitative analysis, were reviewed. The total number of participants from all studies was 7119, and the number of participant couples ranged from 15 to 869. RESULTS: Psychoeducational interventions had a small effect size in promoting maternal mental health (SMD = -0.307; 95% CI: -0.47 to -0.14). However, there was evidence of heterogeneity for the overall outcome, with I2 of 16% and p = .27. Paternal mental health also improved, but with a small effect size (SMD = -0.296; 95% CI: -0.53 to -0.05). The pooled results of four studies showed that interventions had very small effect sizes for improving maternal perception of the couple's relationship (SMD = 0.125; 95% CI: -0.05 to 0.30). There was evidence of heterogeneity for the overall outcome, with I2 of 7% and p = .36. Psychoeducational interventions with fathers showed a medium effect size for improving paternal perception of the couple's relationship (SMD = 0.348; 95% CI: 0.16 to 0.52); heterogeneity was I2 of 0% and p = .68. CONCLUSION: This study was meaningful as it revealed evidence from published trials regarding the effectiveness of psychoeducational programs that target both pregnant women and their partners. Results indicate that psychoeducational interventions can reduce maternal postpartum depression and ameliorate paternal negative affect, as well as provide overall improvement in the couples' relationship satisfaction. However, further studies on physiological indicators and/or clinical symptoms of postpartum depression are needed to better understand the practical significance of psychoeducational intervention.

[Adaptation in pregnant women: a descriptive phenomenological study using Giorgi's approach]. / ìž„ì‹ ì—¬ì„±ì˜ ì ì‘ì— 관한 Giorgi의 ê¸°ìˆ ì  현상학 연구.

Purpose: This descriptive phenomenological study aimed to explore the lived experience and meaning of pregnant women's adaptation. Methods: Ten pregnant women from an ongoing Pregnant Couples' Cohort Study agreed to participate in this study. The data were collected through telephone in-depth interviews regarding what they experienced and felt about pregnancy adaptation. The qualitative data were analyzed using Giorgi's method of descriptive phenomenology. Results: Five core situation components were extracted from the raw data, along with 12 themes and 33 focal meanings. The five core situations were 1) first recognizing the pregnancy, 2) pregnancy-related changes, 3) the upcoming birth, 4) the postpartum period, and 5) parenting. The 12 themes were as follows: "anxiety, pressure, and embarrassment due to pregnancy," "efforts to adapt to physical changes," "efforts to adapt to the psychological difficulties of pregnancy," "efforts to adapt to the financial burden and role changes caused by pregnancy," "connecting with the fetus," "adapting to a new marital relationship centering on the baby," "the frustration of childbirth," "fear of childbirth," "postpartum care, need help with lactation planning," "parenting beyond what I imagined" "dad's willingness to participate in parenting," and "career disconnect and consideration of workplace needs." Conclusion: We identified that pregnant women experience adaptation in physical, psychological, relational, and social aspects. The thematic clusters identified be used to develop nursing interventions to promote women's adaptation to pregnancy.

Pregnant Women's Antenatal Depression and Influencing Factors.

PURPOSE: The objective of this study was to investigate the prevalence of antenatal depression in pregnant women and its influencing factors. METHODS: With a cross-sectional survey design, a total of 396 pregnant women were recruited from a local obstetrics and gynecology clinic. Measurements included antenatal depression, perceived stress, predictors of depression during pregnancy, and demographic and obstetric characteristics. RESULTS: Mean antenatal depression score was 8.20 (standard deviation=4.95) out of 30, falling into its normal range. However, the prevalence of antenatal depression was 35.9% when cut-point of 9/10 was used. The prevalence of antenatal depression among women in the first trimester was 31.4%. It was slightly increased to 34.9% in the second trimester but significantly increased to 40.5% in the third trimester. In multiple logistic regression analysis, experiencing prenatal anxiety (odds ratio [OR], 4.16), having no job (OR, 2.90), lower self-esteem (OR, 1.62), and higher perceived stress (OR, 1.32) were significant factors influencing antenatal depression. CONCLUSION: Negative feeling such as feeling anxious, lower self-esteem, and higher perceived stress during pregnancy are key factors affecting antenatal depression. Thus, antenatal nursing intervention focusing on pregnant women's feeling upon their job status is necessary to improve their antenatal psychological well-being.

Interventions promoting exclusive breastfeeding up to six months after birth: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The World Health Organization (WHO) recommends that mothers practice exclusive breastfeeding (EBF) of their infants for 6 months. Various breastfeeding support interventions have been developed to encourage mothers to maintain breastfeeding practices. Research aim: This study aims to review how effectively breastfeeding support interventions enable mothers to practice EBF for 6 months and to suggest the best intervention strategies. METHODS: Six databases were searched, including MEDLINE, EMBASE, Cochrane, CINAHL, PsycINFO, and KoreaMed. The authors independently extracted data from journals written in English or Korean and published between January 2000 and August 2017. Randomized controlled trials (RCTs) reporting EBF until 6 months were screened. RESULTS: A total of 27 RCTs were reviewed, and 36,051 mothers were included. The effectiveness of breastfeeding support interventions to promote EBF for 6 months was significant (odds ratio [OR] = 2.77; 95% confidence interval [CI]: 1.81-3.76). A further subgroup analysis of intervention effects shows that a baby friendly hospital initiative (BFHI) intervention (OR = 5.21; 95% CI: 2.15-12.61), a combined intervention (OR = 3.56; 95% CI: 1.74-7.26), a professional provider led intervention (OR = 2.76; 95% CI: 1.76-4.33), having a protocol available for the provider training program (OR = 2.87; 95% CI: 1.89-4.37) and implementation during both the prenatal and postnatal periods (OR = 3.32; 95% CI: 1.83-6.03) increased the rate of EBF for 6 months. CONCLUSION: We suggest considering a multicomponent intervention as the primary strategy and implementing BFHI interventions within hospitals. Evidence indicates that intervention effectiveness increases when a protocol is available for provider training, when interventions are conducted from the pre- to postnatal period, when the hospital and community are connected, and when healthcare professionals are involved.

Stereotactic EEG-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy.

OBJECTIVE: To determine the outcomes of combined stereo-electroencephalography-guided and MRI-guided stereotactic laser interstitial thermal therapy (LITT) in the treatment of patients with drug-resistant mesial temporal lobe epilepsy (mTLE). METHODS: We prospectively assessed the surgical and neuropsychological outcomes in 21 patients with medically refractory mTLE who underwent LITT at the University of Chicago Medical Center. We further compared the surgical outcomes in patients with and without mesial temporal sclerosis (MTS). RESULTS: Of the 21 patients, 19 (90%) underwent Invasive EEG study and 11 (52%) achieved freedom from disabling seizures with a mean duration of postoperative follow-up of 24±11 months after LITT. Eight (73%) of 11 patients with MTS achieved freedom from disabling seizures, whereas 3 (30 %) of 10 patients without MTS achieved freedom from disabling seizures. Patients with MTS were significantly more likely to become seizure-free, as compared with those without MTS (P=0.002). There was no significant difference in total ablation volume and the percentage of the ablated amygdalohippocampal complex between seizure-free and non-seizure-free patients. Presurgical and postsurgical neuropsychological assessments were obtained in 10 of 21 patients. While there was no group decline in any neuropsychological assessment, a significant postoperative decline in verbal memory and confrontational naming was observed in individual patients. CONCLUSIONS: MRI-guided LITT is a safe and effective alternative to selective amygdalohippocampectomy and anterior temporal lobectomy for mTLE with MTS. Nevertheless, its efficacy in those without MTS seems modest. Large multicentre and prospective studies are warranted to further determine the efficacy and safety of LITT.

Depth of Pleural Effusion in Thoracentesis: Comparison of Lateral, Posterolateral and Posterior Approaches in the Supine Position.

BACKGROUND: In patients who have difficulty sitting, thoracentesis is attempted in a supine position via lateral approach. Recently, a new table has been designed for supine thoracentesis. This table has gaps that allow access to the posterolateral and posterior hemithorax. OBJECTIVES: To compare important safety-related parameters between lateral, posterolateral, and posterior approaches in supine thoracentesis. MATERIALS AND METHODS: First, two cadavers were placed supine on a table featuring gaps allowing access to the posterolateral and posterior hemithorax. Water was administered with sonographic measurement of the depth of pleural effusion (DPE) at the mid-axillary and posterior axillary line. Second, CT images were analyzed in 25 consecutive patients (32 free-shifting, moderate-to-large effusions; mean, 668 (146 - 2020 mL). DPE, craniocaudal distance that effusion can be visualized (CCD), and presence of passive atelectasis at each of the lateral, posterolateral, and posterior routes was assessed. RESULTS: In each cadaver, DPE in the posterolateral route was greater than that in the lateral route (P = 0.002, P < 0.001). The amount of pleural fluid enough to spread DPE to higher than 1 cm at the posterior axillary line was less than half the amount at the mid-axillary line (500 mL vs. 1,100 mL; 800 mL vs. 1700 mL). CT showed that the DPEs and CCDs of posterolateral and posterior routes were greater than those of the lateral route (P < 0.001). In thirteen effusions (40.6%), DPE was greater than 1 cm in both posterolateral and posterior routes but less than 1 cm in the lateral route. Frequencies of passive atelectasis in posterolateral and posterior routes (81.3% and 90.6%) were higher (P < 0.001) than that in the lateral route (28.1%). CONCLUSION: Safety-related parameters of posterolateral and posterior approaches in supine thoracentesis are far better than that of the conventional lateral approach.

In vitro and in vivo evaluation of porous TiNi-based alloy as a scaffold for cell tissue engineering.

This study aims to look into the applicability of a porous TiNi-based shape memory alloy (SMA) scaffold as an incubator for bone marrow mesenchymal cells, hepatocytes, and pancreatic islet cells. The porous TiNi-based SMA used was fabricated using a self-propagating high-temperature synthesis (SHS) technique, in which scaffold blocks measuring 4 × 4 × 10 mm were prepared. In vitro tests were done using mesenchymal stem cells (MSC) isolated from mature bone marrow of CBA/j inbred mice, and cultured in 3 different culture media - Control medium, Osteogenic medium, and Chondrogenic medium. Hepatocytes and islet cells were isolated from the livers and pancreatic glands of Wistar rats respectively, seeded on porous TiNi-based SMA scaffolds, and cultured. The scaffolds were then implanted into the abdominal cavity of Wistar rats and later harvested, at days 7, 14, 21, and 28, post-implantation. SEM imaging was performed with pre-implanted scaffolds at day 0 and harvested scaffolds at days 7, 14, 21, and 28, post-implantation. Based on weight increase percentages, the in vitro study revealed that the osteogenic group showed a 2-fold increase, and the chondrogenic group showed a 1.33-fold increase, compared to the control group. The in vivo study, on the other hand, showed that from day 7 post-implantation, the cellular in-growth gradually invaded the inner porous structure from the periphery towards the center, and at day-28 post-implantation, all pores were closed and completely filled with cells and the extracellular matrix. The results show that porous TiNi-based SMA is a unique biocompatible incubator for cell cultures and can be successfully used for tissue bioengineering and artificial organs.

Impact of Menopausal Status, Metabolic Syndrome and its Risk Factors on Impaired Quality of Life above Middle-aged Women.

PURPOSE: This study explored influencing factors on quality of life (QoL) above middle-aged women in relation to demographic factors, health-related factors, menopausal status, metabolic syndrome (MS) and its risk factors. METHODS: This study was secondary data analysis from the Sixth Korea National Health and Nutrition Examination Survey 2013~2015 that utilized a complex, multi-stage probability sample design. Study sample of 2,310 was inclusive of (28.8%) of women who were over 40. To evaluate the factors that would influence an impaired quality of life, χ² test, GLM, and logistic regression analysis were done. RESULTS: Level of quality of life was lower in women with late post-menopause(over 10 years since menopause) than women with pre-menopause. Factors influencing impaired QoL were as follows: graduated middle school and elementary school or less (OR=2.43, 4.42, respectively, p<.05), no job (OR=1.92, p<.001), stress (OR=1.92, p=.001), depression (OR=1.93, p=.001), insufficient sleep (OR=1.64, p=.003), late post-menopause (OR=2.61, p=.044) and over 85cm of waist circumference (OR=1.76, p=.01). CONCLUSION: These results suggest that late post-menopause may be an independent factor influencing an impaired QoL. To promote post-menopausal womens' health, a nursing strategy is required to teach women how to manage levels of stress, depression, insufficient sleep, and abdominal obesity through health education, nutritional counselling, and physical activity program.

Novel supine thoracentesis bed enabling thoracentesis via the posterior axillary line.

PURPOSE: This study describes on supine thoracentesis bed (STB), which helps thoracentesis of supine patient by enabling unlimited access to the posterolateral surface of a hemithorax. MATERIALS AND METHODS: Records of 15 patients who had received US-guided supine thoracentesis on STB were reviewed. We investigated the lateral or posterolateral approaches selected by the operators. We reviewed pre-procedural CT scans (obtained within 1 day) to examine if the approach of the operators could be justified in terms of depth of effusion and overlying chest wall thickness. RESULTS: The most common rationale for the use of the supine position was back or leg pain in 6 patients and hemi-or quadriplegia in 4. The operators chose the posterolateral approach in all 15 patients. On 6 concurrent CT scans, the mean depth of effusion was significantly (p < 0.004) greater in the posterolateral approach (3.0 ± 2.2 vs. 1.5 ± 1.9 cm). There was no significant difference in the thickness of the chest wall between the two approaches (1.6 ± 0.3 vs. 1.8 ± 1.0 cm, p = 0.61). CONCLUSIONS: By using STB, supine thoracentesis can be done via the posterolateral approach, which was associated with greater depth of effusion in our study, and may be superior to the conventional lateral approach.

Synthesis and characterization of conducting polyaniline-copper composites.

Conducting polymer composites have many interesting physical properties and important application potentials. Suitable combinations of metal nanoparticles with conductive polymers can result in composite materials having unique physical and chemical properties that can have wide application potential in diverse areas. In this work, copper nanoparticles were fabricated by electrical explosion of wire (EEW) in solution of polyacrylic acid (PAA) and ethanol. Conductive polyaniline-copper (PANI-Cu) composites have been synthesized by in-situ polymerization of aniline in the fabricated copper suspension. Optical absorption in the UV-visible region of these suspensions was measured in the range of 200-900 nm. Morphology and structure of the composites were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD) and Fourier-transform infrared spectra (FTIR). Pure copper nanoparticles were uniformly dispersed into the polymer matrix. Thermal stability of the composites was characterized by thermogravimetric analysis (TGA). Electrical conductivity measurements indicated that the conductivity of the composites was higher than that of pure polyaniline and increased with increasing content of copper.