Different Types of Intraoperative Hypotension and their Association with Post-Anesthesia Care Unit Recovery

Background: The underlying causative mechanism leading to intraoperative hypotension (IOH) may vary depending on the stage of anesthesia and surgery, resulting in different types of IOH. Consequently, the incidence, severity, and postoperative complications associated with IOH types may differ. This study explores the association between IOH types and post-anesthesia care unit (PACU) recovery, with a focus on duration and complications. Methods: From May 2022 to December 2022, we included 4776 consecutive surgical patients aged ≥18 who underwent elective surgery with planned overnight stays at Acibadem Altunizade Hospital and received general anesthesia. Post-induction hypotension (pIOH) was defined as a decrease in blood pressure during the first 20 minutes after anesthesia induction, while maintenance intraoperative hypotension (mIOH) referred to a decrease in blood pressure occurring after the 20th minute following induction, with or without preceding pIOH.Results: Among the included patients, 22.13% experienced IOH, with a higher prevalence observed among females. Patients with mIOH exhibited higher rates of bleeding, transfusions, hypothermia, longer stays in the PACU, and increased oxygen requirements. The duration of anesthesia did not increase the likelihood of IOH. Multivariate logistic regression analysis revealed that ephedrine usage, hypothermia, the need for additional analgesics, nausea, and vomiting were factors associated with longer PACU duration. Older patients (≥65), patients with ASA≥2 status, those undergoing major surgery, experiencing unexpected bleeding, and exhibiting hypothermia at the end of anesthesia had a higher likelihood of requiring vasopressor support. Conclusions: Patients experiencing hypotension, particularly during the maintenance of anesthesia, are more prone to complications in the PACU and require closer monitoring and treatment. Although less common, mIOH has a more significant impact on outcomes compared to other factors affecting PACU recovery. The impact of mIOH on PACU duration should not be overlooked in favor of other factors. Registration: Clinicaltrials.gov identifier: NCT05671783

Examining opportunities for risky play in preschool outdoor play areas

The aim of this study was to examine the opportunities for risky play that were present in six observed preschool outdoor play areas. Field observations were made in each play area based on the risky play categories. It was revealed that great heights and high speed were the most frequently observed risky play categories. However, the presence of these observed categories does not guarantee children engaged in quality play. Due to safety concerns or other restrictions, there were a very limited number of opportunities for risky play exhibited in the play areas of the current study. Therefore, designing play areas where children have a greater number of opportunities for more risky play experiences is necessary. Informing educators, school administrators, and policy makers about their role in providing such play environments could also improve their awareness and understanding of the importance and need for allowing children to engage in risky play

Attitudes Toward Patient Safety and Tendencies to Medical Error Among Turkish Cardiology and Cardiovascular Surgery Nurses

###EgeUn###Background Patient safety and medical errors are among the most discussed topics in recent years. Identifying and reporting medical errors is one of the most significant steps toward the adoption of measures to increase patient safety. Objectives The goal of this descriptive, cross-sectional study was to evaluate attitudes toward patient safety and the tendencies to medical error among cardiology and cardiovascular surgery nurses in Turkey. Methods The study sample consisted of nurses who worked in the cardiology and cardiovascular surgery departments of a University Hospital in Izmir, the third largest city in Turkey. A total of 103 nurses working in the day shift of the mentioned departments volunteered and participated in the study. A "Nurse Information Form," a "Patient Safety Attitude Questionnaire (PSAQ)," and a "Malpractice Tendency Scale in Nursing-(MTSN)" were used as data collection instruments. Results The mean +/- 1 standard deviation of the nurses' PSAQ scores were 141.86 +/- 18.39, whereas their MTSN scores were 237.20 +/- 18.12. Although no statistically significant difference could be evidenced between cardiology and cardiovascular surgery nurses in their total MTSN scores (t = -0.99, P = 0.32), their PSAQ scores showed a significant difference (t = 2.34, P = 0.02). Conclusions This study showed that the tendencies to medical error among cardiology and cardiovascular surgery nurses working in a Turkish facility were low, whereas their attitudes toward patient safety were not at a particularly satisfactory level. The cardiology nurses were found to have a more positive attitude toward patient safety than their colleagues in cardiovascular surgery

Surface spin disorder and spin-glass-like behaviour in manganese-substituted cobalt ferrite nanoparticles

Manganese-substituted cobalt ferrite nanoparticles coated with triethylene glycol (TREG) have been prepared by the glycothermal reaction. The effect of Mn substitution and coating on temperature-dependent magnetic properties of the TREG-coated MnxCo1-xFe2O4 nanoparticles (0.0 <= x <= 0.8) with size of similar to 5-7 nm has been investigated in the temperature range of 10-300 K in a magnetic field up to 9 T. After the irreversible processes of the magnetic hysteresis curves were completed, the high-field regions of these curves were fitted by using a 'law of approach to saturation' to extract the magnetic properties, such as the effective anisotropy constant (K-eff) and the anisotropy field (H-A) etc. High coercive field of 12.6 kOe is observed in pure cobalt ferrite coated with TREG at 10 K. The low temperature unsaturated magnetization behaviour indicates the core-shell structure of the MnxCo1-xFe2O4 NPs. Zero-field-cooled (ZFC) and field-cooled (FC) measurements revealed superparamagnetic phase of TREG-coated MnxCo1-xFe2O4 nanoparticles at room temperature. The blocking and irreversibility temperatures obtained from ZFC-FC curves decrease at highest Mn concentration (x = 0.8). The existence of spin-glass-like surface layer with freezing temperature of 215 K was established with the applied field dependence of the blocking temperatures following the de Almeida-Thouless line for the Mn0.6Co0.4Fe2O4 NPs. The shifted hysteresis loops with exchange bias field of 60 Oe and high-field irreversibility up to 60 kOe in FC M-H curve at 10 K show that spin-glass-like surface spins surrounds around ordered core material of the Mn0.6Co0.4Fe2O4 NPs. FMR measurement show that all the TREG-coated MnxCo1-xFe2O4 nanoparticles absorb microwave in broad field range of about ten thousands Oe. The spectra for all the samples have broad linewidth because of angular distributions of easy axis and internal fields of nanoparticles