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Research Paper
Assessment of Risk Factors for Postoperative Delirium in Older Adults Who Underwent Spinal Surgery and Identifying Associated Biomarkers Using Exosomal Protein
Baek, Wonhee , Lee, JuHee , Jang, Yeonsoo , Kim, Jeongmin , Shin, Dong Ah , Park, Hyunki , Koo, Bon-Nyeo , Lee, Hyangkyu
J Korean Acad Nurs 2023;53(4):371-384.   Published online August 31, 2023
DOI: https://doi.org/10.4040/jkan.22146
AbstractAbstract PDF
Purpose
With an increase in the aging population, the number of patients with degenerative spinal diseases undergoing surgery has risen, as has the incidence of postoperative delirium. This study aimed to investigate the risk factors affecting postoperative delirium in older adults who had undergone spine surgery and to identify the associated biomarkers.
Methods
This study is a prospective study. Data of 100 patients aged ≥ 70 years who underwent spinal surgery were analyzed. Demographic data, medical history, clinical characteristics, cognitive function, depression symptoms, functional status, frailty, and nutritional status were investigated to identify the risk factors for delirium. The Confusion Assessment Method, Delirium Rating Scale-R-98, and Nursing Delirium Scale were also used for diagnosing deliri-um. To discover the biomarkers, urine extracellular vesicles (EVs) were analyzed for tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), neurofilament light, and glial fibrillary acidic protein using digital immunoassay technology.
Results
Nine patients were excluded, and data obtained from the remaining 91 were analyzed. Among them, 18 (19.8%) developed delirium. Differences were observed between partici-pants with and without delirium in the contexts of a history of mental disorder and use of benzodiazepines (p = .005 and p = .026, respectively). Tau and UCH-L1—concentrations of urine EVs—were comparatively higher in participants with severe delirium than that in partici-pants without delirium (p = .002 and p = .001, respectively).
Conclusion
These findings can assist clinicians in accurately identifying the risk factors before surgery, classifying high-risk patients, and predicting and detecting delirium in older patients. Moreover, urine EV analysis revealed that postoperative delirium following spinal surgery is most likely associated with brain damage.
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Review Paper
Effects of Early Oral Feeding versus Delayed Oral Feeding on Bowel Function, Gastrointestinal Complications and Surgical Recovery after Cesarean Section under Regional Anesthesia: Systematic Review and Meta-Analysis
Kim, HyoJin , Jeon, YeongKyung , Yoon, SoYoung , Lee, GeumMoon
J Korean Acad Nurs 2021;51(6):732-745.   Published online December 31, 2021
DOI: https://doi.org/10.4040/jkan.21127
AbstractAbstract PDF
Purpose
This study aimed to assess combined effects of early oral feeding after Cesarean section (C/S) under regional anesthesia on bowel function, gastrointestinal complications and surgical recovery.
Methods
A systematic literature search was conducted using KISS, RISS, PubMed, CINAHL, EMBASE, CENTRAL and Google Scholar to identify randomized clinical trials comparing early oral feeding (EOF) with delayed oral feeding (DOF) after C/S. Outcome variables were bowel function and gastrointestinal complications and surgical recovery. Effect size was calculated using weighted mean differences (WMDs) and relative risks (RRs), with 95% confidence intervals (CIs).
Results
Seven studies involving 1,911 patients from 568 studies, 7 studies were included in meta-analysis. EOF was significantly associated with shorter time to recover bowel movement compared with DOF (WMD, - 2.50; CI, - 3.50~- 1.50). EOF was not associated with nausea (RR, 1.15; CI, 0.87~1.53) and vomiting (RR, 0.96; CI, 0.65~1.42), but lower incidence of abdominal distension (RR, 0.70; CI, 0.50~0.98). EOF was significantly associated with shorter time to discontinuation of intravenous fluids (WMD, - 8.88; 95% CI, - 16.65~- 1.11) and removal of urinary catheter (WMD, - 15.23; CI, - 25.62~- 4.85).
Conclusion
This meta-analysis provides evidence that EOF after C/S under regional anesthesia not only accelerates return of bowel function and surgical recovery but also reduces gastrointestinal complications. These results suggest that EOF should be offered to women who have undergone C/S to improve the recovery experience and reduce overall medical costs.
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Review Article
Factors Related to Persistent Postoperative Pain after Cardiac Surgery: A Systematic Review and Meta-Analysis
Bae, Jaewon , Shin, Sujin
J Korean Acad Nurs 2020;50(2):159-177.   Published online April 30, 2020
DOI: https://doi.org/10.4040/jkan.2020.50.2.159
AbstractAbstract PDF
Purpose
This study aimed at identifying factors related to persistent postoperative pain after cardiac surgery and estimating their effect sizes.
Methods
The literature search and selection was conducted in four different databases (CINAHL, Cochrane Library, PubMed, and PQDT) using the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement. A total of 14 studies met the inclusion criteria and were systematically reviewed. For the meta-analysis, R was used to analyze 30 effect sizes of for both individual and operative factors as well as publication biases from a total of nine studies.
Results
The meta-analysis revealed that persistent postoperative pain after cardiac surgery was related to one individual factor (gender) and two operative factors (acute postoperative pain and use of the internal mammary artery). Operative factors (OR=5.26) had a larger effect size than individual factors (OR=1.53).
Conclusion
Female gender, acute pain after surgery, and use of the internal mammary artery are related factors to persistent postoperative pain. The development of interventions focusing on modifiable related factors, such as acute postoperative pain, may help to minimize or prevent PPP after cardiac surgery.
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Original Articles
Effect of Breathing Exercise Using Panflutes on the Postoperative Compliance, Pulmonary Infections and Life Satisfaction in Elderly Patients Undergoing Spinal Surgery
Hyun Mi Jo, Hyunsook Shin
J Korean Acad Nurs 2018;48(3):279-288.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.3.279
AbstractAbstract PDF
Abstract Purpose

The purpose of this study was to examine the effects of breathing exercises performed using panflutes in elderly patients undergoing spinal surgery.

Methods

The study design was a nonequivalent control group non-synchronized pre-post test. The study included 24 patients in both the experimental group and the control group. The experimental group completed a daily breathing exercise regimen using panflutes for 30minutes after meals, whereas the control group was provided standard preoperative education, including breathing exercises using incentive spirometers. After the exercise regimen, breathing exercise compliance, pulmonary infections, and life satisfaction were measured in both groups, and the data were analyzed using the SPSS/WIN program.

Results

The compliance rate of breathing exercises was significantly higher in the experimental group. The experimental group presented no pulmonary infections in the later period, whereas the control group presented higher pulmonary infection rates in the same period. In addition, the life satisfaction score in the experimental group significantly increased.

Conclusion

The breathing exercise program using panflutes for elderly patients undergoing spinal surgery enhanced their breathing exercise compliance and their daily life satisfaction in addition to reducing their pulmonary infection rates.

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A Study on Postoperative Pain Perception by Effects of the Video Program as Preoperative Nursing Intervention
Mee Kyung Joo
Journal of Nurses Academic Society 1995;25(2):210-221.   Published online March 30, 2017
DOI: https://doi.org/10.4040/jnas.1995.25.2.210
AbstractAbstract PDF

The purpose of this study was to identify relationships between a preoperative video program as nursing intervention and the perception of postoperative pain. The subjects consisted of an experimental group of 17 children and a control group of 13 children, for a total of 30 patients who were admitted the ENT Department for tonsilectomies. Data were collected from August 1, 1993 to September 31. The video program was made by the pediatric operating theater nursing staff. Postoperative pain was measured using the Face Pain Rating Scales devised by Beyer in 1984. The data were analyzed by a SPSS using frequencies, means, percentages, t-test and ANOVA to analyze the variables and demographic characteristics. The results of this study are as follows: The hypothesis, "Score of the experimental group which was shown the preoperative video program as a nursing intervention will be lower than the control group which did not see the video in postoperative pain perception." was rejected by t= -.42, p>.05. No significant difference was found between the experimental group and the control group according demographic characteristics. From the above findings, this study suggests the following: 1. Further studies as randomized control-group pretest-posttest design are needed to control the extraneous variables. 2. A review will be suggested to be done by the preoperative video program as nursing intervention and an exploration to improve preoperative nursing care for pediatric patients with the inclusion such activities as preoperative visiting, operation theater tour etc.

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Effects of Pain Control Education on Pain Control Barrier, Postoperative Pain and Pain Control Satisfaction in Gynecological Patients
Bok Nam Lee, Ga Eon Lee
Journal of Korean Academy of Nursing 2006;36(6):968-975.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2006.36.6.968
AbstractAbstract PDF
Purpose

The purpose of this study was to evaluate the effects of preoperative pain control education on the pain control barrier, postoperative pain and pain control satisfaction in gynecological patients.

Method

The study was a quasi-experimental research design. There were 58 subjects who were admitted for gynecological surgery to D University Hospital in B city. Pain control education was provided individually to the experimental group one day before their operation day for 20 minutes with the ‘ Pain Control Guide Book’ in the patient's admission room. The education book was made by researchers based on pain management references and patient interviews. For assessing the pain control barrier, a simplified version of Barriers Questionnaire was used, postoperative pain was assessed on a numeric scale(0-10) and satisfaction of pain control was assessed by one question.

Results

The pain control barrier(F=15.828, p<.001) and the post pain score of the experimental group was lower than that of the control group. In addition, pain control satisfaction of the experimental group(t=3.612, p<.001) was higher than the control group's.

Conclusion

With the above results, preoperative pain control education could be an effective nursing intervention for pain control of surgical patients.

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Combination Effects of Capsicum Plaster at the Korean Hand Acupuncture Points K-D2 with Prophylactic Antiemetic on Postoperative Nausea and Vomiting after Gynecologic Laparoscopy
Hyun Jung Jung, Sang Youn Park
J Korean Acad Nurs 2013;43(2):215-224.   Published online April 30, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.2.215
AbstractAbstract PDF
Purpose

This study was done to evaluate the combination effects of capsicum plaster at the Korean hand acupuncture points K-D2 with prophylactic antiemetic on Postoperative Nausea and Vomiting (PONV).

Methods

An experimental research design (a randomized, a double-blinded, and a placebo-control procedure) was used. The participants were female patients undergoing gynecologic laparoscopy; the control group (n=34) received intravenous prophylactic ramosetron 0.3mg, while the experimental group (n=34) had Korean Hand Therapy additionally. In the experimental group, capsicum plaster was applied at K-D2 of both 2nd and 4th fingers by means of Korean Hand Therapy for a period of 30 minutes before the induction of anesthesia and removed 8 hours after the laparoscopy.

Results

The occurrence of nausea, nausea intensity and need for rescue with antiemetic in the experimental group was significantly less than in the control group 2 hours after surgery.

Conclusion

Results of the study show capsicum plaster at K-D2 is an effective method for reducing PONV in spite of the low occurrence of PONV because of the prophylactic antiemetic medication.

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Effect of Ondansetron combined with Dexamethasone on Postoperative Nausea & Vomiting and Pain of Patients with Laparoscopic Hysterectomy
Miok Nam, Haesang Yoon
J Korean Acad Nurs 2009;39(1):44-52.   Published online February 17, 2009
DOI: https://doi.org/10.4040/jkan.2009.39.1.44
AbstractAbstract PDF
Purpose:

The purpose of this study was to compare the effects of ondansetron combined with dexamethasone on Post-Operative Nausea and Vomiting (PONV) and pain with ondansetron alone in patients with laparoscopy assisted vaginal hysterectomy under general anesthesia.

Methods:

Data were collected from April 1 through September 30, 2005 using a double blind method. Ondansetron 4 mg and dexamethasone 10 mg were administered to the experimental group (25 patients), and ondansetron 4 mg only to the control group (25 patients). The medications were administered through an intravenous line at the beginning peritoneum suture. PONV by Index of Nausea Vomiting and Retching (INVR), nausea by Visual Analogue Scale (VAS), and pain (VAS) were assessed at postoperative 1 hr, 3 hr, 6 hr, 24 hr, and 48 hr. Data were analyzed using repeated measures ANOVA, and Bonferroni methods.

Results:

The experimental group that received ondansetron combined with dexamethasone had less PONV (p=.048), and nausea (p=.012) than control group that received ondansetron alone. However, there was no difference in pain (p=.557) between the patients in the two groups.

Conclusion:

We conclude that the administration of ondansetron combined with dexamethasone is more effective than the administration of ondansetron alone to reduce PONV in patients with laparoscopic hysterectomy.

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The Effects of Ketamine Preemptive Analgesia on Postoperative Pain in Patients undergoing a Hystrectomy
Hong Yeon Kim, Hae Sang Yoon
Journal of Korean Academy of Nursing 2006;36(1):114-126.   Published online February 28, 2006
DOI: https://doi.org/10.4040/jkan.2006.36.1.114
AbstractAbstract PDF
Purpose

This study was performed to evaluate the pre-emptive analgesic effects of a small dose of intravenous ketamine on postoperative pain in patients undergoing a hysterectomy.

Method

Sixty patients undergoing a hystrectomy under general anesthesia were randomly allocated to 2 groups. The experimental group(30 patients) received 0.3mg/kg of ketamine after induction of anesthesia, approximately 5 min prior to surgery, but the control group(30 patients)did not receive ketamine. Data was collected in a double-blind manner from April 1st, to October 30th, 2004. Postoperatively, the patients used a patient-controlled analgesia(PCA) pump. Blood pressure, pulse rate, pain, anxiety, count of times pressing the PCA button, administeration of additional analgesics and side effects of ketamine were measured at 1 hour, 3 hours, 6 hours and 24 hours after the operation.

Result

There were no statistical differences in blood pressure, pulse rate, pain and anxiety between the experimental and control groups. There were statistical differences in blood pressure, pulse rate, pain and anxiety during the 24 hours postoperatively. In the experimental group, the number of times pressing the PCA button and administering additional analgesic drugs were significantly lower than those of the control group.

Conclusion

A 0.3 mg/kg dose of ketamine given at approximately 5 min before surgery resulted in decreasing the number of times pressing the PCA and the administration of additional analgesics.

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