Reduce The Incidence Perioperative Hypothermia Health And Social Care Essay

Reduce The Incidence Perioperative Hypothermia Health And Social Care Essay A Summary of fewer than 150 words should state the purpose of the study or investigation, basic procedures, main findings (giving actual results not just a broad description) and their statistical significance (using actual p values), and principal conclusions. The Summary should not be structured nor in note or abbreviated form. It should not state that the results are discussed or that work is presented. Abbreviations should not be used except for units of measurement. Use the same order when discussing the methods and results as in the main body of the text, and always mention the groups in the same order. Introduction: Perioperative hypothermia, defined as a core temperature below 36 °C, is still one of the most common side effects of general anaesthesia (1, 12) and results from low preoperative core temperatures (19), anaesthetic-induced inhibition of thermoregulatory defenses with redistribution of heat after induction of anaesthesia combined with a cold surgical environment, administration of unwarmed intravenous fluids, and evaporation from surgical incisions (25). Several prospective, randomized trials and retrospective studies have shown that perioperative hypothermia is associated with numerous adverse effects and outcomes (24). Following head and neck surgery perioperative hypothermia can cause delayed extubation, the development of early perioperative wound complications e.g. neck seromas, and flap dehiscence (2, 26). Although the authors of these studies recommend active warming for patients at risk for intraoperative hypothermia (2, 26) most patients are not actively warmed during head and neck surgery. The purpose of this prospective, randomized, controlled study was to test the hypothesis that the use of a new conductive warming system (PerfecTempà ¢Ã¢â‚¬Å¾Ã‚ ¢, The Laryngeal Mask Company Limited, St. Helier, Jersey) in combination with insulation is superior to reduce the incidence of intraoperative and postoperative hypothermia during head and neck surgery compared to insulation only. Methods: After approval of the protocol by our local hospital ethics committee, 40 patients were recruited. Written, informed consent was obtained from all patients on the day prior to anaesthesia and surgery. All patients in the study were required to be adults between 18 and 75 yrs, to have American Society of Anesthesiology physical status I-III and to undergo elective, head or neck surgery that was scheduled to last between 90 min and 180 min. The exclusion criteria were: age > 75 yr; body mass index 30 kg/m ²; preoperative temperature > 38 °C or 180 min. All patients were premedicated with 7.5 mg oral midazolam. General anaesthesia was induced with propofol (2 to 2.5 mg per kg of body weight) and remifentanil (0.2-0.5 µg/kg) followed by rocuronium (0.4-0.6 mg/kg) to facilitate tracheal intubation. Anaesthesia was maintained with infusions of remifentanil and propofol titrated to maintain adequate anaesthetic depth and hemodynamic stability. The ambient temperature of the O.R. was 19 °C. Sublingual temperatures were measured preoperatively with an electronic thermometer (Geratherm rapid, Geratherm Medical AG, Geschwenda, Germany). During all measurements, sublingual placement and mouth closure was carried out by member of the study team (A.R.) experienced in the use of this device. Following induction, until the end of surgery, oesophageal temperatures were measured every 15 minutes using a temperature probe (TEMPRECISE #4-1512-A, Arizant International Corp. Eden Prairie, MN, USA) inserted 30 to 35 cm into the distal oesophageus. All patients were identified through the daily surgical schedule. A computer generated randomisation list with four blocks of ten patients was used to allocate patients to either the treatment group (conductive warming and insulation) or control group (insulation only). In the treatment group the patients were positioned supine on the conductive warming mattress (190.5 cm x 50.8 cm) (LMA PerfecTempà ¢Ã¢â‚¬Å¾Ã‚ ¢, The Laryngeal Mask Company Limited, St. Helier, Jersey) placed on the operating table, as suggested by the manufacturer. Then the patients were immediately insulated with a standard hospital duvet (188 cm x 122 cm), filled with Trevira (100% polyester) (Brinkhaus GmbH Co. KG, Warendorf, Germany) with an insulation value of 1.29 clo (6). The conductive patient warming system was set to a temperature of 40.5 °C throughout the study and warming was stopped when the oesophageal temperature was > 37.5 °C. Patients of the control group were positioned supine on the operating table and were immediately insulated with the standard hospital duvet. All intravenous fluids were infused at room temperature. The duration of anaesthesia and surgery (time from skin incision to last suture) were recorded. Power analysis, assuming a clinically important reduction in the incidence of intraoperative and postoperative hypothermia from 50 % to 90% suggested that eleven patients were required in each group (ÃŽÂ ± = 0.05; ÃŽÂ ² = 0.2). To compensate for unexpected dropout of patients with a shorter or longer duration of surgery than planned the initial total number of recruited patients was increased to 20 patients in each group. Comparisons of nominal data were made using the Fishers exact test. A Kolmogorov-Smirnov test was used prior to parametric testing to ascertain that values came from a Gaussian distribution. Comparisons of normally distributed data were made using the Students t-test. Comparisons of not normally distributed data were made using the Mann-Whitney-U test. Time-dependent changes of core temperature were evaluated using repeated-measures analysis of variance (ANOVA) and post hoc Scheffà ©s test. Results are expressed as means  ± SD or as median and interquantil range as appropriate. A value for p Results A total of 86 patients were assessed for eligibility. 25 patients could not be asked to participate, because they came to the hospital on the day of the operation. 21 patients refused to participate. Of the 40 patients recruited, 10 patients had to be excluded because of an operating time below 60 minutes (five patients in the treatment and four in the control group) or above 180 minutes (one patient). Figure 1: Flow diagram of the study In three patients the conductive warming mattress did not fully heat up to 40.5 °C for unknown technical reasons. These patients were still included in the data analyses. Data were therefore complete for 15 patients in each group. Patient characteristics, ambient temperature of the O.R., core temperatures before induction of anaesthesia and duration of surgery were not different (table 1). Table 1 Patient characteristics and perioperative variables. Values are presented as mean values  ± SD, median and interquantil range [IQR] or numbers of patients. Variable Treatment group (n = 15) Control group (n = 15) P-value Age [yr] 51 ±18 51 ±15 0.99 Sex [m/f] 7/8 10/5 0.46 Height [cm] 173 ±11 175 ±10 0.64 Weight [kg] 74 ±16 80 ±9 0.21 Temperature of the O.R [ °C] 19 ±1 19 ±1 0.3 Core temperature before induction of anaesthesia [ °C] 36.1 ±0.4 35.9 ±0.5 0.33 Duration from positioning on the conductive warming mattress to induction of anaesthesia [min] 7 [IQR: 5-9] Duration of anaesthesia [min] 118 ±28 122 ±38 0.74 Duration of surgery [min] 97 ±25 103 ±37 0.61 The ANOVA identified a significantly higher core temperature in the treatment group at 45, 60, 75, 90, 105 and 120 min (Figure 2). Further testing was futile as there were only three patients with a longer duration of surgery included. Figure 2 Mean pre- and intraoperative temperatures of the treatment group and control group. Error bars represent SD. In each group data were complete for at least sixty minutes. Furthermore, Fisherss exact test confirmed a lower incidence of intraoperative (3 vs. 9 patients; p = 0.03) and postoperative hypothermia (0 vs. 6 patients; p = 0.008) in the treatment group. However, the mean duration of hypothermia was not significantly shorter in the treatment group (55 ±17 min vs. 80 ±51 min; p = 0.42). No adverse effects could be observed. Discussion: This prospective, randomized, controlled study demonstrates that, during head and neck surgery under general anaesthesia, a conductive warming mattress combined with insulation significantly reduces the incidence of intraoperative and postoperative hypothermia compared to insulation only. With this approach the incidence of intraoperative and postoperative hypothermia could be reduced significantly. However, the mean intraoperative duration of mild hypothermia could not be reduced significantly. Redistribution of body heat from the core to the periphery was unusually small in this study and similar in both groups as core temperature decreased only 0.1 °C in the control group and 0.2 °C in the study group. In most clinical studies redistribution of heat after induction of anaesthesia leads to a reduction in core temperature of about 0.3 °C to 0.8  °C (3, 4, 8, 28) in the first hour whereas under experimental conditions it can reach up to 1.7 °C (17). This small decrease in core temperature may be explained by the fact that patients were kept comfortably warm during the whole preoperative period (ward, transport to the O.R. and induction of anaesthesia) with the same good insulating hospital blanket as used intraoperatively. This approach refers to the recent NICE guideline Inadvertent perioperative hypothermia. The management of inadvertent perioperative hypothermia in adults (22). Patients during head and neck surgery are often thought to have a relatively low risk for perioperative hypothermia because in most cases no body cavity is opened, the surgical incisions as well as blood losses are small. This is probably why there are almost no studies about perioperative hypothermia and its prevention during head and neck surgery. However, many patients undergoing head and neck surgery are prone to hypothermia by advanced age (2, 14, 27) and cancer with associated malnutrition and low body weight (2, 16). According to their preoperative risk profile (e.g. ischemic heart disease, diabetes mellitus, chronic obstructive pulmonary disease, preoperative radiotherapy, preoperative chemotherapy) (20, 26) they are often vulnerable to hypothermia associated complications. These complications include an increasing incidence of myocardial ischemia (10, 11, 11) which is also a relevant complication after reconstructive head and neck surgery (7), augmenting blood loss (23), dec reasing resistance to surgical wound infections or increasing local wound complications (2, 15, 18, 26), thus prolonging hospitalization. The few existing studies were particularly focused on longer operations like parotidectomies, neck dissections (2) and reconstructive surgery with free tissue or regional flaps (13, 26). In the study of Agrawal et al. (2) the incidence of perioperative hypothermia was 65% in the unwarmed group showing clearly the high risk of perioperative hypothermia in patients during head and neck surgery. In our study with relatively short operations we observed an incidence of perioperative hypothermia of 40% in the control group. In contrast to the study of Agrawal et al. (2) we used a high insulation of 1.29 clo for these patients which is much more than the insulation value of most commercially available materials designed for use in the operating room. With this insulation heat losses from the covered skin can be reduced about 70%. (6). In most of our patients this insulation was able to maintain a stable thermal steady state with a relative constant core temperature. However, this thermal s teady state was at a core temperature of about 36.0 °C with many patients being hypothermic. In general the efficacy of posterior patient-warming systems is limited (5, 9, 13, 21). These devices have the disadvantage that warming the back of the patient in the supine position is suboptimal. During surgery, little heat is lost from the back (9) and heat gain via the back is also limited, resulting in a small change in heat balance. However, in this special setting the additional heat generated by the conductive warming system leads to a positive thermal balance and an increasing core temperature after 30 minutes. In contrast to conventional circulating water mattresses the new conductive system is made of thick viscoelastic foam. This material enhances contact between the mattress and the back, thereby reducing thermal contact resistance and increasing the efficacy of heat exchange. In contrast to forced-air warming the combination of good insulation and conductive warming has several advantages. There are no expensive disposables elements, low costs for maintenance, low power consumption and no relevant noise emission (28). Another advantage is that is very easy to use the system for prewarming as soon as the patient can be placed on the operating table when the controller unit is mounted at the operating table. Our study has several limitations. First, two different anatomic locations were used to measure core temperature (oral temperature before induction of anaesthesia and oesophageal during general anaesthesia). However, both methods are reasonable methods for core temperature measurements and we could record the first reliable oesophageal temperature 5 minutes after induction of anaesthesia so that this temperature can serve as a reliable starting temperature. Second, five patients per group had to be excluded from data analyses because the operation time was shorter or longer than planned. Nevertheless, we had to exclude these patients because it is not advisable to compare operations with durations of 30 minutes with operations of more than 3 hours. Finally we did not fully take advantage of the possibility to prewarm our patients with the conductive system. On average time from the beginning of warming to induction of anaesthesia was only seven minutes. It seems to be likely that longer prewarming periods would enhance the efficacy of the conductive warming mattress. Conclusion The combination of good thermal insulation and conductive warming is effective to prevent perioperative hypothermia during head and neck surgery. In contrast to other warming methods there are no expensive disposables, low costs for maintenance, low power consumption and no relevant noise emssion.

Benefits Of Gardening

Benefits Of Gardening Gardening is a hobby for many people. Gardening means nothing to some people. Gardening is done all over the world in any type of weather. Gardening gives us pleasure and is very effective to our minds. Gardening is done at homes, hotels, parks etc. Nowadays there is barely any gardening done. Most people have forgotten the benefits of gardening. In the olden days every house had a garden. It was filled with vegetables, fruits and flowers. Nowadays most people think that gardening is useless.They buy all their vegetables and fruits from the market, but do they know whether the vegetables or fruits they eat are chemicalised or not? If we have our own garden there are two main and basic benefits. One is we can eat the fruits and vegetables without buying thus, reducing the expenditure. Two is we can be sure that the fruits we eat are fresh, healthy and non-chemicalised. The place where I live, gardening is done by most people but still some think it's useless. In my hometown, every house has a garden.It is a shelter from sunlight and it gives us an exercise. Most people nowadays fall sick when they are 40 or 50 years old but in my hometown it's quite different, all work in the garden from early morning till sunrise. It gives us a morning exercise and it makes us very energetic to do our work for the rest of the day. For most people gardening is a remedy for diseases like cholesterol and diabetes. It creates a peaceful mind. In the early morning when you wake up you hear the birds chirping in your garden. You can see green in front of you.People who have eye roblems are advised by the doctors to wake up early in the morning and see green plants. They will help to cure your eye problems. When you have a garden of flowers the fragrance that come from the flowers and the different beautiful colours are a real treat in the morning. Our life expectancy rate goes up if we are physically and mentally healthy, gardening helps in that case as well. I would say that overall gardening is a physical and psychological medicine for everybody. I encourage everyone to do gardening and you will find that you will get very good benefits from it.

Multiple Sclerosis Essay - 959 Words

Multiple Sclerosis Look around, chances are you or someone in the room either has or knows someone with multiple sclerosis. However, you probably would not be able to tell just by looking at someone if they have MS and that is arguably one of the most frustrating effects of MS. In fact there are a lot of frustrations related to this disease, it affects every patient differently, it is difficult to diagnose, symptoms are merely managed, it is unpredictable and life altering for those with it and for those that care for them. It is estimated that over two and a half million people worldwide are affected by MS. Two hundred new diagnosis are reported every week in the United States alone, and the numbers of cases are likely much higher than†¦show more content†¦Brain signals can often not reach their destination because of the damage to the nerves. What causes the damage to the myelin? Basically, T-cells which are part of white blood cells. Normally, white blood cells attack foreign substances suc h as viruses and bacteria or other foreign tissues but in people with MS these cells get confused and attack myelin which is why MS is considered an autoimmune deficiency. MS is often disabling meaning that a wheelchair is needed. However, people with this disease suffer from a wide variety of problems, from trouble walking and maintaining balance, muscle weakness, spasms, pain, fatigue, sensation of numbness, and vision problems to name a few. These symptoms are often in recurring periods of time with worsening symptoms, people who suffer from MS have moments where the symptoms are hardly noticeable, and moments when the symptoms are very severe (NMSS). Even though, we understand that T-cells have gone rogue and cause the damage to the myelin no one understands why the T-cells start to attack the myelin to begin with. However, there is interesting data that suggest that genetics, a persons environment, and possibly even a virus may play a role†(WebMD). These theories have yet to be proven and subsequently prevents a cure. It is for that reason, symptoms are treated and managed to try to improve the life of people that have MS. Treatment typically focuses on speedingShow MoreRelatedEssay Multiple Sclerosis1206 Words   |  5 PagesMultiple Sclerosis The primary objective of this paper is to raise fundamental questions in regards to multiple sclerosis, and to explore possibilities that attempt to answer these inquiries. Second, the prospective outcome is to provide a solid knowledge base for which my peers may begin to understand the relationship between multiple sclerosis and neurobiology and behavior. The first question to address in the general schema of this essay is: What is Multiple Sclerosis? 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Mental Health Through Forgiveness - Free Essay Example

Sample details Pages: 3 Words: 904 Downloads: 5 Date added: 2019/07/01 Category Society Essay Level High school Tags: Forgiveness Essay Did you like this example? Forgiveness is an integral part of our life. It basically subsumes forgiving self and forgiving others. Forgiveness is important to move on from any situation. As a cognitive, emotional, and behavioral response to interpersonal conflict, forgiveness generally refers to exonerating another person of blame or giving up claims on another of debt, loan, obligation, or other claims, which is different from condoning, excusing, forgetting, pardoning, and reconciliation (Eaton Struthers, 2006). Generally, the offended individuals can use forgiveness as an effective coping strategy to promote their happiness and well-being (Worthington Scherer, 2004). Forgiveness is a response to harm or injustice who has been treated unjustly and decides to reduce anger and hostility, work hard to provide benevolence towards the offender (Exline, Worthington, Hill, McCullough, 2003; Toussaint Friedman, 2009; Wade Worthington, 2005). It usually incorporates a decrease in negative affect, emotions, cognitions, motivations, and behavior toward the offender (Rye Pargament, 2002). Don’t waste time! Our writers will create an original "Mental Health Through Forgiveness" essay for you Create order Various areas of the brain are activated during forgiveness response. Farrow et al. (2001) used functional MRI to detect brain regions engaged by judging others emotional states and the forgivability of their crimes. Ten volunteers were involved. They read and make judgments based on social scenarios and a high-level baseline task (social reasoning). Both empathic and forgivability judgments activated left superior frontal gyrus, orbitofrontal gyrus, and precuneus. in addition, Empathic judgments also activated left anterior middle temporal and left inferior frontal gyri, while forgivability judgments activated posterior cingulate gyrus. According to Erikson (1993), a human has eight different development stages. In each stage, there are various conflicts and psychological problems that one needs to resolve. Successful resolution of these conflicts leads to better well-being. However, one needs to have a higher tolerance, compromise and acceptance ability which means letting go of the situation and forgiving self and others (Slater, 2003). Although forgiveness increases with age, the changes in a different aspect of forgiveness might not be the same. For instance, a study by Charzy?„ska and Heszen (2013) reported a positive correlation between age and the capacity to forgive. There were significant associations between age and forgiveness of others, the feeling of being forgiven by God, and a general tendency to forgive, but not with self-forgiveness. In contrast to this, a study showed that there was an association between age and negative strategy of forgiveness which included revenge and avoidance rather tha n a positive strategy which means benevolence (Ghaemmaghami, Allemand, and Martin., 2011). Giving forgiveness can differ according to age. A study conducted by few researchers examined age-related differences and similarities in forgiveness seeking. Students from third, seventh, and 12th grade were involved and they were made to imagine themselves committing various transgressions and the characteristics of this transgression, which included the severity of the consequences and type of offense, were manipulated. Across the age groups, forgiveness-seeking was followed by guilt, whereas withdrawal was followed by shame. Older students were more likely to seek forgiveness when the offense was high rather than low in severity, but younger students did not show this difference. Finally, according to the teachers rating, students overall prosocial behavior was positively correlated with forgiveness seeking (Riek, B. M., DeWit, C. C., 2018). Similar to this, study results reported that there was a robust relationship between a different aspect of disposition and life satisfacti on. The study used Heartland Forgiveness Scale (adapted by Kaleta, Mrz, and Guzewicz, 2016) and The Satisfaction with Life Scale by Diener et al. (SWLS, 1985) adapted by Juczy?„ski (2012). As the age advances, there was a positive correlation between forgiveness and life satisfaction. (Kaleta Mrz, 2018) In terms of self-forgiving reaction, a study by Cornish et al, (2001) showed that individual differences were associated with measures that confound self-forgiveness with other hedonic traits, that is, the ability to release negative emotion following failure. Cluster analysis was used to distinguish genuine self-forgiveness from simply letting oneself off the hook through self-exoneration. It revealed three patterns of responding to interpersonal offenses: self-forgiving (high responsibility and end-state self-forgiveness and low self-condemnation), self-condemning (high responsibility and self-condemnation and low end-state self-forgiveness), and self-exonerating (high end-state self-forgiveness and low responsibility and self-condemnation). When we seek a relationship between forgiveness and health promotion, a study by Toussaint et al. (2018) claimed that there is a strong association between them resulting in a good outcome. There was an inverse relationship between forgiveness and unproductivity, mental and physical health problem. Forgiveness is seen to be an effective coping mechanism for workplace offenses as it promotes good health, well-being, and productivity (Toussaint et al., 2018). The study conducted by Akhtar Barlow (2018) supported the findings of Toussaint. A systematic review and meta-analysis of the efficacy of process-based forgiveness interventions were done across a different sample of adolescents and adults who have experienced hurt and violence against them. Randomized control trial was done to retrieve electronic database and standard mean differences and confidence interval was assessed to measure treatment effects. Forgiveness therapy was found effective in reducing depression, anger and hosti lity, stress and distress, and in promoting mental well-being (Akhtar, S., Barlow, J., 2018). Analyzing the relationship between forgiveness and mental health from a different angle, a study claimed that there was a significant association between poor mental health and depressive symptoms. The study included a total of 311 Korean teachers who were asked to complete self-report questionnaires of Forgivingness Scale, the Self-Compassion Scale, and the Center for Epidemiologic Studies Depression Scale. Multiple regression analysis revealed that self-compassion moderated the relationship between lack of forgiveness and depression; the relationship was stronger for those low on self-compassion (Chung, 2006)