Prematurity is the main cause for respiratory disorders in neonates. The goal in respiratory management is to maintain respiration with adequate oxygenation. Chest vibration(CV) prior to endotracheal suctioning(ETS) has been arbitrarily applied to ventilated premature infants without the scientific evaluation of its safety and efficacy. A repeated measure within subjects experimental study was conducted to investigate the effects of CV prior to ETS on oxygenation and lung secretions in twenty-one ventilated premature infants. The independent variable was the type of research protocol, the control type(ETS without CV) and the intervention(ETS with CV). The dependent variables were oxygen saturation(SpO2), heart rate (HR), measured by pulse oximeter, and the amount of lung secretions measured in gram, the results showed there was no difference in SpO2 responses regardless CV employed before ETS. But there was a significant difference in HR responses between the control and the intervention, even without clinical significance. There was a significant difference in the amount of lung secretions retrieved during ETS with CV, compared to ETS without CV. This study suggested the safety of CV by demonstrating no clinically significant changes in SoO2 and HR in premature infants. The efficacy of CV could be supported by the increases in the amount of sputum during ETS with CV compared to ETS without CV in premature infants.
Heart Rate* ; Heart* ; Humans ; Infant, Newborn ; Infant, Premature* ; Lung* ; Oxygen* ; Respiration ; Sputum ; Suction* ; Thorax* ; Vibration* ; Child Health

Newborn period is a transitional stage for independent adaptation from intrauterine to extrauterine life by maintaining respiration, temperature and nutrition. In general, the adaptability of the newborn is proportional to the gestational age(GA), so knowing the accurate GA is critical to develop nursing process in the newborn nursery. A newborn maturity rating, a Ballard examination, has been used to measure GA by assessing the maturity of newborn. It consists a total of 12 items, which is the 6 items for the neuromuscular maturity and the 6 items for the physical maturity. A total of 75 newborn were assessed for the maturity and GA using the Ballard examination. The results are follows: 1) The score of each item of Ballard examination is proportional to GA using the Ballard examination as well as LMP. 2) There was a greater positive relationship between neuromuscular, physical and total maturity, and the GA measured by Ballard examination, than the GA measured by LMP. 3) Any stressful environment to the newborn could influence to the maturity of newborn. In summary, the study showed the Ballard examination is more reliable and clinically feasible method to measure the accurate GA, compared to the GA by LMP. Therefore, it suggests the application of Ballard examination to measure the newborn maturity and GA is beneficial in developing nursing process. The expansion of the study with the variety of the subject characteristics will enhance the clinical applicability of the examination.
Gestational Age* ; Humans ; Infant, Newborn* ; Nurseries ; Nursing Process ; Respiration ; Child Health

No abstract available.
Humans ; Infant, Newborn ; Infant, Premature* ; Lung* ; Oxygen* ; Suction* ; Thorax* ; Vibration*

The article reports the process, contents and strategies in the development of community based-heath care management program for high-risk infants and family, which was based on literature review, empirical needs assessment from pilot study. The program was divided into two emphasis areas: (1) identification and home visiting nursing care program, and (2) the construction of self-supporting group. The contents of home visiting nursing care were developed from the pilot study of the direct home visiting to premature infants after discharge. The documentation form for home care was standardized, including the demographic data, birth history, home care services, education and counsels, and visiting schedules. The integrated education protocol was elaborated to enhance the body of knowledge as well as clinical competency in caring high-risk infants and family by the supports of neonatologists, nursing scholar, and clinical specialists. In addition, the process and strategies in developing self-supporting group, consisting the high-risk infants and family, and any significant others were addressed. Emphases were given to the role of public health center and the recycling health care referral system to maximize the growth and development of high-risk infants on the community-base, which in turn, contributing to decrease the postneonatal mortality rate.
Appointments and Schedules ; Delivery of Health Care* ; Education ; Growth and Development ; Home Care Services ; House Calls ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Infant, Premature* ; Needs Assessment ; Nursing ; Nursing Care ; Pilot Projects ; Public Health ; Recycling ; Referral and Consultation ; Reproductive History ; Specialization ; Child Health

With the aging process, the senile lids are manifested by the excessive skin, decreased height of palpebral fissures with interference of the vision. Sometimes these patients often complained the blepharitis on the lateral canthal area and phtophobia. But there are many diseases to differentiate from senile lids such as dermatochalasia, blepharochalasia, hypertrophy of orbicularis oculi, herniation of orbital fat, myasthenia gravis, and blepharoptosis. Blepharospasm must also be differentiated because of sysmptoms similar to the above described senile lids. Essential blepharospam is an idiopathic progressively debilitating desease which involve bilateral spasm of the orbicularis oculi. So just only an conventional blepharoplasty could not get an improvement of symptoms and some times it makes the symptoms worsen. This case report is about blepharospasm patients visiting for blepharoplasty. And the patients got relatively the satisfied results with the injection of botulinum A toxin, aided by neurologist, instead of blepharoplasty. In conslutions, The blepharospasm in required to detect in preoperative evaluation for blepharoplasty. Once the blepharospasm is diagnosed, it is better to cooperate with neurologist and to do the blepharoplasty.
Aging ; Blepharitis ; Blepharoplasty* ; Blepharoptosis ; Blepharospasm* ; Botulinum Toxins ; Botulinum Toxins, Type A ; Humans ; Hypertrophy ; Myasthenia Gravis ; Orbit ; Skin ; Spasm

No abstract available.
Pancytopenia* ; Pneumonia*

BACKGROUND AND PURPOSE: It is recommended that Botox be used within 5 hours of reconstitution, which results in substantial quantities being discarded. This is not only uneconomic, but also inconvenient for treating patients. The aim of this study was to determine the potencies of Botox used within 2 hours of reconstitution with unpreserved saline, the same Botox refrigerated (at +4degrees C) 72 hours after reconstitution, and during the next 4 consecutive weeks (weeks 1, 2, 3, and 4). This comparison was used to determine the length of refrigeration time during which reconstituted Botox will maintain the same efficacy as freshly reconstituted toxin. METHODS: Individual paralysis rates in the extensor digitorum brevis (EDB) compound muscle action potential (CMAP) amplitude and area were measured 1 week after injecting fresh reconstituted 2.5 MU of Botox on one side of the foot, and when the same quantity of Botox that had been refrigerated for a designated time (i.e., 72 h, or 1, 2, 3, or 4 weeks) into the other side of the foot. The EDB CMAP amplitude and area at 12 and 16 weeks postinjection were also measured to compare the efficacy durations in all five comparative groups. RESULTS: Ninety-four volunteers were divided into five groups according to the refrigerator storage time of the second Botox injection. The paralysis of the EDBs was significant for each injection of Botox, both fresh and refrigerated, with no statistically significant differences between them, regardless of the refrigeration time. There was a tendency toward increased CMAP amplitude and area at 12 or 16 weeks postinjection (p<0.0001). The duration of effective muscle paralysis did not differ significantly throughout the 16-week follow-up period between all five groups. CONCLUSIONS: The potency of reconstituted Botox is not degraded by subsequent refrigeration for 4 weeks. However, there are definite concerns regarding its sterility, and hence its safety, since multiple withdrawals from the same vial over long periods can introduce bacterial contamination.
Action Potentials ; Botulinum Toxins, Type A ; Follow-Up Studies ; Foot ; Humans ; Infertility ; Muscles ; Paralysis ; Refrigeration

PURPOSE: A botulinum toxin type A(BoNT-A) injection has been used as a noninvasive management for lower face contouring since 2000. The aim of this study is to compare reduction rate of lower face width for a longtime according to repeated Botox(R) injections on masseter muscles for lower face contouring procedure. METHODS: Forty-five patients were analyzed for single session of Botox(R) injection and 13 patients were evaluated for repeated Botox(R) injections for over two years. Single injection group was tracked regular intervals at 1, 3, 6, 10, 12 months after the injection, and repeated injection group was measured at every injection time. Twenty-five to thirty units of Botox(R) was injected into each masseteric muscle at five to six points at the prominent portions of the mandibular angle. Standardized frontal view of digital photographs were analyzed by Adobe Photoshop(R)(version CS3) to measure an reduction rate of lower face's width. RESULTS: Reduction rate was 3.7%, 6.9%, 6.2%, 4%, 4% at 1, 3, 6, 10, 12 months post injection each other in single injection group. However, more than 8% reduction rate was found in repeated injection group persistently for more than two years. CONCLUSION: This study shows that effective duration of Botox(R) injection for lower face contouring is expected to continue over one year clinically. Moreover, repeated injections maintained lower reduction rate consistently for a long time. Therefore, repeated injections on masseter muscles at regular intervals is the most effective procedure for lower face contouring.
Botulinum Toxins ; Humans ; Masseter Muscle ; Muscles ; Track and Field

Botulinum toxin type A (BoNT-A), onabotulinumtoxinA (Botox) was approved by the United States Food and Drug Administration for temporary improvement of glabellar lines in patients 65 years and younger in 2002, and has also been used widely for aesthetic purposes such as hyperhidrosis, body shape contouring, and other noninvasive facial procedures. BoNT-A inhibits presynaptic exocytosis of acetylcholine (ACh)-containing vesicles into the neuromuscular junction at cholinergic nerve endings of the peripheral nervous system, thereby paralyzing skeletal muscles. ACh is the most broadly used neurotransmitter in the somatic nervous system, preganglionic and postganglionic fibers of parasympathetic nerves, and preganglionic fibers or postganglionic sudomotor nerves of sympathetic nerves. The scientific basis for using BoNT-A in various cosmetic procedures is that its function goes beyond the dual role of muscle paralysis and neuromodulation by inhibiting the secretion of ACh. Although the major target organs for aesthetic procedures are facial expression muscles, skeletal body muscles, salivary glands, and sweat glands, which are innervated by the somatic or autonomic nerves of the peripheral cholinergic nerve system, few studies have attempted to directly explain the anatomy of the areas targeted for injection by addressing the neural physiology and rationale for specific aesthetic applications of BoNT-A therapy. In this article, we classify the various cosmetic uses of BoNT-A according to the relevant component of the peripheral nervous system, and describe scientific theories regarding the anatomy and physiology of the cholinergic nervous system. We also review critical physiological factors and conditions influencing the efficacy of BoNT-A for the rational aesthetic use of BoNT-A. We hope that this comprehensive review helps promote management policies to support long-term, safe, successful practice. Furthermore, based on this, we look forward to developing and expanding new advanced indications for the aesthetic use of BoNT-A in the future.

PURPOSE: This was a cross sectional descriptive study to introduce the Infants Coma Scale (ICS), describe mental status of high risk infants using ICS and explore the relationships between ICS and clinical variables in infants hospitalized in a neonatal intensive care unit of a university hospital in Korea. METHODS: After ICS was developed and tested by the authors, a research nurse evaluated the mental status of the infants using the English version of ICS and obtained clinical information on the infants from their medical records. RESULTS: Data from 88 infants were analyzed. About 60% were male, 90% were preterm births, and 40% had pathologic abnormalities. Their mean gestational age was 32.4 (+/-3.50) weeks and the mean birth weight was 1,842 (+/-728.6) grams. The Cronbach's alpha for the ICS was .78. There was a statistically significant positive correlation between ICS total score and five clinical variables including gestational age, birth weight, 1 and 5 min Apgar scores and respiration status. CONCLUSION: Mental status is an important parameter in nursing assessment. ICS is a valid and reliable instrument, which clinicians can easily use to evaluate the mental status of high risk infants.
Birth Weight ; Brain Injuries/diagnosis/ultrasonography ; Female ; Gestational Age ; *Glasgow Coma Scale ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Neonatal ; Male ; *Mental Health ; Premature Birth ; Program Evaluation ; Respiration, Artificial