Decreasing Stress Levels through Animal Interaction

The purpose of this qualitative study is to examine college students\u27 feelings after playing with a support dog during a stressful time such as midterm exams and final exams. The goal of the research is to determine how effective the students perceive playing with pets has on decreasing their stress levels during stressful times. The reason this study is being conducted is to focus on the students\u27 experiences and the thoughts and feelings that are occurring within themselves personally during the interaction with the dogs. It is based on their perception and feelings of stress relief rather than their physiologic proof of stress relief. For this study, seven students apart of Cleveland State University\u27s Accelerated Nursing Program voluntarily participated in interacting with three dogs before their exam. During this time, they focused on playing with the dogs and forgot about their study notes or exam. They all interacted with the dogs at the same time, allowing them to see that their classmates are also relaxing. When the students returned from their exam, they engaged in a focus group in which they were asked several questions about their experience when interacting with the dogs. It was found that students did indeed experience a reduction in stress levels and felt more relaxed. Students also reported that they were more focused and concentrated during their exam and attributed that gained focus to interacting with the dogs earlier that day. They felt like they benefited from this experience and wanted more opportunities like it.https://engagedscholarship.csuohio.edu/u_poster_2017/1049/thumbnail.jp

Issues of consent for regional analgesia in labour: A survey of obstetric anaesthetists

Publisher's copy made available with the permission of the publisherAnaesthetists are legally obliged to obtain consent and inform patients of material risks prior to administering regional analgesia in labour. We surveyed consultant members of the Australian and New Zealand College of Anaesthetists with a special interest in obstetric anaesthesia, in order to identify and compare which risks of regional analgesia they report discussing with women prior to and during labour. We also asked about obstetric anaesthetists’ beliefs about informed consent, the type of consent obtained and its documentation. Of 542 questionnaires distributed, 291 responses (54%) were suitable for analysis. The five most commonly discussed risks were post dural puncture headache, block failure, permanent neurological injury, temporary leg weakness and hypotension. Obstetric anaesthetists reported discussing a mean of 8.0 (SD 3.8) and 10 (SD 3.8) risks in the labour and antenatal settings respectively. Nearly 20% of respondents did not rank post dural puncture headache among their top five most important risks for discussion. Seventy percent of respondents indicated that they believe active labour inhibits a woman’s ability to give ‘fully informed consent’. Over 80% of respondents obtain verbal consent and 57 (20%) have no record of the consent or its discussion. Obstetric anaesthetists reported making a considerable effort to inform patients of risks prior to the provision of regional analgesia in labour. Verbal consent may be appropriate for labouring women, using standardized forms that serve as a reminder of the risks, and a record of the discussion. Consensus is required as to what are the levels of risk from regional analgesia in labour.J. D. B. Black, A. M. Cynahttp://www.aaic.net.au/Article.asp?D=200525

Unexpected difficulty administering an epidural top-up for caesarean section

Publisher's copy made available with the permission of the publisher © Australian Society of AnaesthetistsP-C. Lim, A. Cynahttp://www.aaic.net.au/Article.asp?D=200121

Antenatal self-hypnosis for labour and childbirth: A pilot study

Publisher's copy made available with the permission of the publisher © Australian Society of AnaesthetistsIn our institution we have used antenatal training in self-hypnosis for over three years as a tool to provide relaxation, anxiolysis and analgesia for women in labour. To assess the effects of hypnotherapy, we prospectively collected data related to the use of hypnosis in preparation for childbirth, and compared the birth outcomes of women experiencing antenatal hypnosis with parity and gestational age matched controls. Methods: Prospective data about women taught self-hypnosis in preparation for childbirth were collected between August 2002 and August 2004. Birth outcome data of women using hypnosis were compared with routinely collected retrospective data from parity and gestational age matched women delivering after 37 weeks gestation during 2003. Results: Seventy-seven antenatal women consecutively taught self-hypnosis in preparation for childbirth were compared with 3,249 parity and gestational age matched controls. Of the women taught antenatal self-hypnosis, nulliparous parturients used fewer epidurals: 36% (18/50) compared with 53% (765/1436) of controls (RR 0.68 [95% CI 0.47-0.98]); and required less augmentation: 18% (9/50) vs 36% (523/1436) (RR 0.48 [95%CI 0.27-0.90]). Conclusions: Our clinical findings are consistent with recent meta-analyses showing beneficial outcomes associated with the use of hypnosis in childbirth. Adequately powered, randomized trials are required to further elucidate the effects of hypnosis preparation for childbirth.A. M. Cyna, M. I. Andrew, G. L. McAuliff

Avoiding inadvertent epidural injection of drugs intended for non-epidural use

Publisher's copy made available with the permission of the publisher © Australian Society of AnaesthetistsInadvertent administration of non-epidural medications into the epidural space has the potential for serious morbidity and mortality. The aim of this study was to collate reported incidents of this type, describe the potential mechanisms of occurrence and identify possible solutions. We searched medical databases and reviewed reference lists of papers retrieved, covering a period of 35 years, regarding this type of medication incident. The 31 reports of 37 cases found is likely to represent a gross underestimation of the actual number of incidents that occur. 'Syringe swap', 'ampoule error', and epidural/intravenous line confusion were the main sources of error in 36/37 cases (97%). Given that no effective treatment for such errors has been identified, prevention should be the main defence strategy. Despite all the precautions that are currently undertaken, accidents will inevitably occur. We have identified areas for systemwide change that may prevent these types of incidents from occurring in future.http://www.aaic.net.au/Article.asp?D=200213

Fatal epidural infusion - call for a system-wide change

Publisher's copy made available with the permission of the publisher © Australian Society of Anaesthetistshttp://www.aaic.net.au/Article.asp?D=200132

Preoperative anemia management with intravenous iron: a systematic review

Background Iron deficiency anemia is a common condition in patients presenting for surgery, but despite its negative health impacts, the condition remains frequently unmanaged. Optimizing the patient's own red cell mass should be addressed in the preoperative period. Intravenous iron has been advocated as an effective treatment modality. Objectives The objective of this systematic review was to critically appraise and synthesize the best available evidence related to the effectiveness and economic aspects of intravenous iron administration on the correction of iron deficiency anemia in the preoperative period. Inclusion criteria Types of participants Adult patients 18 years of age and older receiving intravenous iron compared with those taking iron orally, and those who were not on iron or were transfused with red blood cells for the correction of anemia. Studies assessing the economic aspects of anemia management were also considered. Types of intervention(s)/phenomena of interest The quantitative component of the review considered studies that evaluated the management of anemia with iron infusions compared to oral iron treatment alone, oral iron in combination with erythropoietin, erythropoietin alone or hemoglobin correction with blood transfusion. The economic component of this review considered studies that evaluated the costs and benefits of iron infusions compared to oral iron treatment or hemoglobin correction with blood transfusion for the treatment of preoperative anemia. Types of studies The quantitative component of the review considered any experimental study design including randomized controlled trials (RCTs), non-RCTs and quasi-experimental studies for inclusion. The economic component of the review considered cost effectiveness, cost utility and cost benefit studies for inclusion. Types of outcomes The quantitative component of this review considered studies that reported on the impact of intravenous iron administration on: hemoglobin levels, red blood cell transfusion, length of stay in hospital, rate of readmission within 30 days of discharge, incidence of transfusion-related complications and changes in functional outcomes. The economic component of the review focused on cost benefits resulting from intravenous iron administration. Search strategy The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. Studies published in English, German, Italian and Dutch from 2001 until December 2012 were considered for inclusion in this review. Methodological quality The studies were independently assessed by two reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute. Data collection Quantitative data was extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute, specifically the Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Economic data was extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Analysis of Cost, Technology and Utilisation Assessment and Review Instrument (JBI-ACTUARI). Data synthesis This review set out to conduct both meta-analyses of the findings of effectiveness studies using JBI-MAStARI and pooling of economic findings using JBI-ACTUARI. Because of the number of studies found, this was not possible and the findings are therefore presented in tabular or narrative form. Results The quantitative component of the review identified two RCTs for inclusion with one of the trials favoring intravenous iron over oral iron for anemia correction. Only a subgroup could be included from the second trial and the results were inconclusive. Data was heterogeneous and did not allow a meta-analysis. The search for the economic component of the review revealed no examination of the cost effectiveness of preoperative correction of iron deficiency anemia with intravenous iron. Conclusions The review found insufficient data to make firm conclusions about the effectiveness of preoperative intravenous iron administration for the correction of anemia. Neither could we establish firm conclusions on the potential cost savings due to intravenous iron supplementation.Bernd Froessler, Catalin Tufanaru, Allan Cyna, Alan Pearso

MODELE KONSUMPCJI NAWOZÓW MINERALNYCH W KRAJACH EUROPY CENTRALNEJ – WPŁYW NA TRENDY PLONÓW RZECZYWISTYCH W LATACH 1986- 2005 – ANALIZA PORÓWNAWCZA REPUBLIKI CZESKIEJ I POLSKI

This study outlines the long-term trends of fertilizers consumption in the Czech Republic and Poland and their impact on actual yield development of main crops for the period 1986-2005. In both countries dynamics of N, P, K fertilizers use showed analogical trends. Based on amounts and nutrient ratio of consumed fertilizer, as expressed as P2O5:N and K2O:N ratios, there were distinguished three phases of fertilizers use: i) high ii) collapse and iii) restoration/stagnation. The stagnation phase was attributed for P and K in the Czech Republic. The observed yield depressions since the 1990s reflect changes in farmer’s long-term fertilization and has been termed a temporary yield gap (TYG). However, its long-term existence negatively affects crop production stability. The development of new, country specific strategies in the management of P and K, i.e. adopted to natural soil fertility conditions, is a main goal of present agriculture of both countries, compared in the presented study.Przeprowadzone badania przedstawiają długoterminowe trendy zużycia nawozów mineralnych w Republice Czeskiej i w Polsce oraz ich wpływ na trendy plonów rzeczywistych, roślin uprawnych w okresie 1986-2005. W obu krajach w tym okresie dynamika zużycia nawozów N, P i K przebiegała analogicznie. Na podstawie ilości stosowanych nawozów i ich struktury, przedstawionych jako stosunki P2O5:N i K2O:N, wyróżniono trzy, zmienne w długości, fazy konsumpcji : i) dużej ii) załamanie, iii) restaurację/stagnację. Stan stagnacji odnotowano dla P i K tylko w Czechach. Depresję plonów roślin uprawnych, ujawnioną z początkiem lat 90-tych a odzwierciedlająca zmiany w strategii nawożenia, określono terminem tymczasowa redukcja plonów (TRP). Wieloletnia trwałość tego stanu wpływa jednak ujemnie na stabilność produkcji roślinnej. Budowa nowych strategii gospodarki P i K, dostosowanych do warunków naturalnych, to znaczy warunków naturalnej żyzności gleby, jest zatem głównym zadaniem obu porównywanych w tym opracowaniu krajów

Unexpected Consequences: Women’s experiences of a self-hypnosis intervention to help with pain relief during labour.

Background Self-hypnosis is becoming increasingly popular as a means of labour pain management. Previous studies have produced mixed results. There are very few data on women’s views and experiences of using hypnosis in this context. As part of a randomized controlled trial of self-hypnosis for intra-partum pain relief (the SHIP Trial) we conducted qualitative interviews with women randomized to the intervention arm to explore their views and experiences of using self-hypnosis during labour and birth. Methods Participants were randomly selected from the intervention arm of the study, which consisted of two antenatal self-hypnosis training sessions and a supporting CD that women were encouraged to listen to daily from 32 weeks gestation until the birth of their baby. Those who consented were interviewed in their own homes 8-12 weeks after birth. Following transcription, the interviews were analysed iteratively and emerging concepts were discussed amongst the authors to generate organizing themes. These were then used to develop a principal organizing metaphor or global theme, in a process known as thematic networks analysis. Results Of the 343 women in the intervention group, 48 were invited to interview, and 16 were interviewed over a 12 month period from February 2012 to January 2013. Coding of the data and subsequent analysis revealed a global theme of ‘unexpected consequences’, supported by 5 organising themes, ‘calmness in a climate of fear’, ‘from sceptic to believer’, ‘finding my space’, ‘delays and disappointments’ and ‘personal preferences’. Most respondents reported positive experiences of self-hypnosis and highlighted feelings of calmness, confidence and empowerment. They found the intervention to be beneficial and used a range of novel strategies to personalize their self-hypnosis practice. Occasionally women reported feeling frustrated or disappointed when their relaxed state was misinterpreted by midwives on admission or when their labour and birth experiences did not match their expectations. Conclusion The women in this study generally appreciated antenatal self-hypnosis training and found it to be beneficial during labour and birth. The state of focused relaxation experienced by women using the technique needs to be recognized by providers if the intervention is to be implemented into the maternity service