1.The Cardiovascular Effects of Thoracic Bolus Epidural Injection of Lidocaine, Morphine and Fentanyl during Sevoflurane General Anesthesia.
Hyunju SHIN ; Seunghwan OH ; Moonseok JANG ; Ilok LEE ; Mikyung LEE ; Sangho LIM ; Nansook KIM ; Myounghoon KONG
Korean Journal of Anesthesiology 2005;49(3):314-320
BACKGROUND: Sevoflurane is an inhalational anesthetic that produces rapid induction, emergence and little cardiovascular depression. Elevated sympathetic activity during surgery produces undesirable effects on the cardiovascular system, such as hypertension, tachycardia or arrhythmias. So combined general and epidural anesthesia have been used recently for the operation, especially the abdominal surgery. This study was performed to evaluate the cardiovascular effects of thoracic epidural anesthesia during sevoflurane general anesthesia. METHODS: Forty patients of ASA class 1-2 undergoing elective subtotal gastrectomy were divided into 5 groups. Thoracic epidural bolus injection was administered via an epidural catheter during sevoflurane general anesthesia in a double-blind random manner: Group 1; normal saline (N/S) 10 ml (placebo), Group 2; morphine 0.1 mg/kg mixed with N/S in 10 ml, Group 3; fentanyl 1 mcg/kg mixed with N/S in 10 ml, Group 4; 1% lidocaine 10 ml, and Group 5; 1% lidocaine 10 ml mixed with morphine 0.1 mg/kg and fentanyl 1 mcg/kg. Systolic and diastolic blood pressures, pulse rates, peripheral oxygen saturation levels (SpO2) and end-tidal carbon dioxide partial pressures (ETCO2) were measured every 5 minutes. RESULTS: Systolic and diastolic blood pressures were significantly reduced from 10 minutes after epidural bolus injection in groups 4 and 5, but these decreases in blood pressure were not severe enough to require treatment in either group. Pulse rates were significantly decreased from 10 minutes after injection in groups 3, 4, and 5, but these decreases in pulse rate were not so severe enough to require treatment in 3 groups. SpO2 and ETCO2 were stable, and arrhythmia was not observed. CONCLUSIONS: The thoracic epidural injection of 1% lidocaine mixed with morphine 0.1 mg/kg and fentanyl 1 mcg/kg can be safely used during sevoflurane anesthesia without severe cardiovascular complications during upper abdominal surgery in ASA 1-2 patients.
Anesthesia
;
Anesthesia, Epidural
;
Anesthesia, General*
;
Arrhythmias, Cardiac
;
Blood Pressure
;
Carbon Dioxide
;
Cardiovascular System
;
Catheters
;
Depression
;
Fentanyl*
;
Gastrectomy
;
Heart Rate
;
Humans
;
Hypertension
;
Injections, Epidural*
;
Lidocaine*
;
Morphine*
;
Oxygen
;
Partial Pressure
;
Tachycardia
2.The Use of Propensity Score Matching for Evaluation of the Effects of Nursing Interventions.
Suk Jeong LEE ; Ji Soo YOO ; Mikyung SHIN ; Chang Gi PARK ; Hyun Chul LEE ; Eun Jin CHOI
Journal of Korean Academy of Nursing 2007;37(3):414-421
BACKGROUND: Nursing intervention studies often suffer from a selection bias introduced by failure of random assignment. Evaluation with selection bias could under or over-estimate any intervention's effects. PS matching (PSM) can reduce a selection bias through matching similar Propensity Scores (PS). PS is defined as the conditional probability of being treated given the individual's covariates and it can be reused to balance the covariates of two groups. PURPOSE: This study was done to assess the significance of PSM as an alternative evaluation method of nursing interventions. METHOD: An intervention study for patients with some baseline individual characteristic differences between two groups was used for this demonstration. The result of a t-test with PSM was compared with a t-test without matching. RESULTS: The level of HbA1c at 12 months after baseline was different between the two groups in terms of matching or not. CONCLUSION: This study demonstrated the effects of a quasi-random assignment. Evaluation using PSM can reduce a selection bias impact that affects the result of the nursing intervention. Analyzing nursing research more objectively to reduce selection bias using PSM is needed.
Confounding Factors (Epidemiology)
;
Data Interpretation, Statistical
;
Diabetes Mellitus, Type 2/epidemiology/*nursing
;
Hemoglobin A, Glycosylated/analysis
;
Humans
;
*Models, Statistical
;
Outcome Assessment (Health Care)/*methods
;
Selection Bias
3.The Use of Propensity Score Matching for Evaluation of the Effects of Nursing Interventions.
Suk Jeong LEE ; Ji Soo YOO ; Mikyung SHIN ; Chang Gi PARK ; Hyun Chul LEE ; Eun Jin CHOI
Journal of Korean Academy of Nursing 2007;37(3):414-421
BACKGROUND: Nursing intervention studies often suffer from a selection bias introduced by failure of random assignment. Evaluation with selection bias could under or over-estimate any intervention's effects. PS matching (PSM) can reduce a selection bias through matching similar Propensity Scores (PS). PS is defined as the conditional probability of being treated given the individual's covariates and it can be reused to balance the covariates of two groups. PURPOSE: This study was done to assess the significance of PSM as an alternative evaluation method of nursing interventions. METHOD: An intervention study for patients with some baseline individual characteristic differences between two groups was used for this demonstration. The result of a t-test with PSM was compared with a t-test without matching. RESULTS: The level of HbA1c at 12 months after baseline was different between the two groups in terms of matching or not. CONCLUSION: This study demonstrated the effects of a quasi-random assignment. Evaluation using PSM can reduce a selection bias impact that affects the result of the nursing intervention. Analyzing nursing research more objectively to reduce selection bias using PSM is needed.
Confounding Factors (Epidemiology)
;
Data Interpretation, Statistical
;
Diabetes Mellitus, Type 2/epidemiology/*nursing
;
Hemoglobin A, Glycosylated/analysis
;
Humans
;
*Models, Statistical
;
Outcome Assessment (Health Care)/*methods
;
Selection Bias
4.The Effects of Prostacyclin Aerosol and Infusion on Pulmonary Hypertension.
Mikyung YANG ; Ok Hwan LIM ; Hyun Hwa LEE ; Baekhyo SHIN ; Chong Sung KIM ; Seong Deok KIM
Korean Journal of Anesthesiology 1998;35(3):413-422
BACKGROUND: Prostacyclin administered intravenously has demonstrated intermediate pulmonary specificity and its aerosol form has an even greater pulmonary selectivity. There have been few systematic analyses of the difference in response according to the route of administration and the dose of administration of prostacyclin. So we have compared prostacyclin infusion versus inhalation in various concentrations in an animal model. METHODS: Pulmonary hypertension was induced by continuous intravenous infusion of the vasoconstrictor U46619 and prostacyclin solutions of 10, 50, 100, 200 mcg/ml were inhaled using a jet nebulizer. Prostacyclin infusion was done at a rate of 100, 200, 400 ng/kg/min. RESULTS: With inhalation of 10, 50, 100, 200 mcg/ml prostacyclin, PVR fell to values of 85%, 76%, 64%, 55% of the preinhalation value and SVR fell to values of 94%, 80%, 76%, 64% of the preinhalation value, respectively (p<0.05). PVR/SVR ratios decreased significantly in all inhalation doses (p<0.05). With infusion of prostacyclin at a rate of 100, 200, 400 ng/kg/min, PVR fell to values of 73%, 60%, 50% of the preinfusion value and SVR fell to values of 68%, 54%, 38% of the preinfusion value, respectively (p<0.05). PVR/SVR ratios increased at an infusion rate of 400 ng/kg/min. CONCLUSION: Prostacyclin inhalation did not result in selective pulmonary vasodilation without causing any efects on the systemic vascular bed (absolute pulmonary selectivity). But it did cause more predominant vasodilation on the pulmonary vascular bed (relative pulmonary selectivity). By contrast, prostacyclin infusion caused more predominant vasodilation on the systemic vascular bed, creating the risk of severe systemic hypotension.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid
;
Epoprostenol*
;
Hypertension, Pulmonary*
;
Hypotension
;
Infusions, Intravenous
;
Inhalation
;
Models, Animal
;
Nebulizers and Vaporizers
;
Sensitivity and Specificity
;
Vasodilation
5.Diagnostic Accuracy of Temporal Artery Temperatures Measurements
Yumi PARK ; Wonje JUNG ; Hyun OH ; Yoonkyoung KIM ; Eunyoung KIM ; Mikyung KIM ; Heeyeon SHIN
Journal of Korean Clinical Nursing Research 2018;24(2):227-234
PURPOSE: This study compared the temporal artery temperature (TAT) measured by infrared temporal artery thermometers to the axillary temperature (AT) measured by standard mercury-in-glass thermometers, and evaluated accuracy of the TAT measurement for clinical practice. METHODS: A total of 247 adult inpatients in general wards in a tertiary medical center located in Seoul participated in the study. The TAT was measured within one minute after the AT measurement. Data were analyzed using descriptive statistics, paired t-test, Pearson correlation coefficient, linear regression, and the Bland-Altman plot. RESULTS: There was a significant difference in mean temperature between AT and TAT, 36.89℃ (SD=0.70) versus 37.35℃ (SD=0.72). The Bland-Altman plots demonstrated the difference between the AT and TAT as −1.29 to +0.33. The specificity and sensitivity of the TAT in detecting fever were high. The positive predictive values were 57.5% and 71.0% when the AT were higher than 38.0℃ and the TAT fever cutoff levels were 38.0℃ and 38.3℃ respectively. CONCLUSION: TAT and AT were highly correlated and agreeable, indicating that TAT is as accurate as AT. The findings suggested that TAT measurement can be used in clinical practice. For accurate communication between medical personnel, medical institutions need to provide guidelines for temperature measurement, especially for the use of thermometer and measurement sites.
Adult
;
Body Temperature
;
Fever
;
Humans
;
Inpatients
;
Linear Models
;
Patients' Rooms
;
Sensitivity and Specificity
;
Seoul
;
Temporal Arteries
;
Thermometers
6.Development and Evaluation of Empowering Education Program for Maternal Fetal Intensive Care Unit (MFICU) Nurses
Jeung Im KIM ; Mikyung PARK ; Gisoo SHIN ; Insook CHO ; So Young CHOI ; Eun Mi JUN ; Yunmi KIM ; Sukhee AHN
Korean Journal of Women Health Nursing 2019;25(3):345-358
PURPOSE: This study was conducted to develop an empowering education program for Maternal-Fetal Intensive Care Unit (MFICU) nurses who provide intensive care to high-risk mother and fetus at hospitals, to test effects of the education program on nursing care confidence and nursing knowledge, and to examine program satisfaction. METHODS: This study comprised of 2 phases: program development and evaluation. First, we have followed a process of program development to develop and refine an empowering education program for MFICU nurses through collaborative works among clinical obstetrics and gynecology doctors and nurses and academic nursing professors. Second, the empowering education program was provided to 49 nurses and evaluated from July 5 to 6, 2019. Levels of MFICU nursing care confidence and knowledge were measured. RESULTS: The empowering education program included 18 hours of lectures, discussion, and Q & A, which continued for 2 days. This program significantly improved high-risk maternal-fetal nursing care confidence and knowledge of nurses. The program was well met with nurses' education need and goals, and found to be highly satisfactory. CONCLUSION: The empowering education program was observed to be effective in terms of improve nursing care confidence and knowledge of nurses in MFICU. It is proposed that this program should be open regularly for nurses to obtain and improve their clinical knowledge, confidence, and competency. Further study is needed to develop and run 2-levels of education such as basic and advanced levels based on nurses' clinical background and competency.
Critical Care
;
Education
;
Fetus
;
Gynecology
;
Humans
;
Intensive Care Units
;
Lectures
;
Mothers
;
Nursing
;
Nursing Care
;
Obstetrics
;
Pregnancy, High-Risk
;
Program Development
7.Causal association between serum bilirubin and ischemic stroke: multivariable Mendelian randomization
Jong Won SHIN ; Keum Ji JUNG ; Mikyung RYU ; Jungeun KIM ; Heejin KIMM ; Sun Ha JEE
Epidemiology and Health 2024;46(1):e2024070-
OBJECTIVES:
Previous research has predominantly focused on total bilirubin levels without clearly distinguishing between direct and indirect bilirubin. In this study, the differences between these forms were examined, and their potential causal relationships with ischemic stroke were investigated.
METHODS:
Two-sample multivariable Mendelian randomization (MVMR) analysis was employed, extracting summary data on bilirubin from the Korean Cancer Prevention Study-II (n=159,844) and the Korean Genome and Epidemiology Study (n=72,299). Data on ischemic stroke were obtained from BioBank Japan (n=201,800). Colocalization analysis was performed, focusing on the UGT1A1, SLCO1B1, and SLCO1B3 genes, which are the primary loci associated with serum bilirubin levels.
RESULTS:
Crude 2-sample Mendelian randomization analysis revealed a significant negative association between total bilirubin levels and ischemic stroke. However, in MVMR analyses, only indirect bilirubin demonstrated a significant negative association with ischemic stroke (odds ratio, 0.76; 95% confidence interval, 0.59 to 0.98). Colocalization analysis did not identify a shared causal variant between the 3 genetic loci related to indirect bilirubin and the risk of ischemic stroke.
CONCLUSIONS
Our study establishes a causal association between higher genetically determined levels of serum indirect bilirubin and reduced risk of ischemic stroke in an Asian population. Future research should include more in-depth analysis of shared genetic variants between indirect bilirubin and ischemic stroke.
8.Causal association between serum bilirubin and ischemic stroke: multivariable Mendelian randomization
Jong Won SHIN ; Keum Ji JUNG ; Mikyung RYU ; Jungeun KIM ; Heejin KIMM ; Sun Ha JEE
Epidemiology and Health 2024;46(1):e2024070-
OBJECTIVES:
Previous research has predominantly focused on total bilirubin levels without clearly distinguishing between direct and indirect bilirubin. In this study, the differences between these forms were examined, and their potential causal relationships with ischemic stroke were investigated.
METHODS:
Two-sample multivariable Mendelian randomization (MVMR) analysis was employed, extracting summary data on bilirubin from the Korean Cancer Prevention Study-II (n=159,844) and the Korean Genome and Epidemiology Study (n=72,299). Data on ischemic stroke were obtained from BioBank Japan (n=201,800). Colocalization analysis was performed, focusing on the UGT1A1, SLCO1B1, and SLCO1B3 genes, which are the primary loci associated with serum bilirubin levels.
RESULTS:
Crude 2-sample Mendelian randomization analysis revealed a significant negative association between total bilirubin levels and ischemic stroke. However, in MVMR analyses, only indirect bilirubin demonstrated a significant negative association with ischemic stroke (odds ratio, 0.76; 95% confidence interval, 0.59 to 0.98). Colocalization analysis did not identify a shared causal variant between the 3 genetic loci related to indirect bilirubin and the risk of ischemic stroke.
CONCLUSIONS
Our study establishes a causal association between higher genetically determined levels of serum indirect bilirubin and reduced risk of ischemic stroke in an Asian population. Future research should include more in-depth analysis of shared genetic variants between indirect bilirubin and ischemic stroke.
9.Causal association between serum bilirubin and ischemic stroke: multivariable Mendelian randomization
Jong Won SHIN ; Keum Ji JUNG ; Mikyung RYU ; Jungeun KIM ; Heejin KIMM ; Sun Ha JEE
Epidemiology and Health 2024;46(1):e2024070-
OBJECTIVES:
Previous research has predominantly focused on total bilirubin levels without clearly distinguishing between direct and indirect bilirubin. In this study, the differences between these forms were examined, and their potential causal relationships with ischemic stroke were investigated.
METHODS:
Two-sample multivariable Mendelian randomization (MVMR) analysis was employed, extracting summary data on bilirubin from the Korean Cancer Prevention Study-II (n=159,844) and the Korean Genome and Epidemiology Study (n=72,299). Data on ischemic stroke were obtained from BioBank Japan (n=201,800). Colocalization analysis was performed, focusing on the UGT1A1, SLCO1B1, and SLCO1B3 genes, which are the primary loci associated with serum bilirubin levels.
RESULTS:
Crude 2-sample Mendelian randomization analysis revealed a significant negative association between total bilirubin levels and ischemic stroke. However, in MVMR analyses, only indirect bilirubin demonstrated a significant negative association with ischemic stroke (odds ratio, 0.76; 95% confidence interval, 0.59 to 0.98). Colocalization analysis did not identify a shared causal variant between the 3 genetic loci related to indirect bilirubin and the risk of ischemic stroke.
CONCLUSIONS
Our study establishes a causal association between higher genetically determined levels of serum indirect bilirubin and reduced risk of ischemic stroke in an Asian population. Future research should include more in-depth analysis of shared genetic variants between indirect bilirubin and ischemic stroke.
10.Causal association between serum bilirubin and ischemic stroke: multivariable Mendelian randomization
Jong Won SHIN ; Keum Ji JUNG ; Mikyung RYU ; Jungeun KIM ; Heejin KIMM ; Sun Ha JEE
Epidemiology and Health 2024;46(1):e2024070-
OBJECTIVES:
Previous research has predominantly focused on total bilirubin levels without clearly distinguishing between direct and indirect bilirubin. In this study, the differences between these forms were examined, and their potential causal relationships with ischemic stroke were investigated.
METHODS:
Two-sample multivariable Mendelian randomization (MVMR) analysis was employed, extracting summary data on bilirubin from the Korean Cancer Prevention Study-II (n=159,844) and the Korean Genome and Epidemiology Study (n=72,299). Data on ischemic stroke were obtained from BioBank Japan (n=201,800). Colocalization analysis was performed, focusing on the UGT1A1, SLCO1B1, and SLCO1B3 genes, which are the primary loci associated with serum bilirubin levels.
RESULTS:
Crude 2-sample Mendelian randomization analysis revealed a significant negative association between total bilirubin levels and ischemic stroke. However, in MVMR analyses, only indirect bilirubin demonstrated a significant negative association with ischemic stroke (odds ratio, 0.76; 95% confidence interval, 0.59 to 0.98). Colocalization analysis did not identify a shared causal variant between the 3 genetic loci related to indirect bilirubin and the risk of ischemic stroke.
CONCLUSIONS
Our study establishes a causal association between higher genetically determined levels of serum indirect bilirubin and reduced risk of ischemic stroke in an Asian population. Future research should include more in-depth analysis of shared genetic variants between indirect bilirubin and ischemic stroke.