Parental stress in paediatric day-case surgery

Day-case surgery involves a considerable amount of stress not only for the children who undergo surgery but also for their parents. In a prospective survey analysis performed in 1995/1996, we identified the following main factors influencing the amount of stress experienced by parents: feelings of insufficient preparation and problems with postoperative pain at home. As a consequence, measures were taken regarding information and pain management, including the creation of an interactive CD-ROM. We then analysed the consequences of our interventions regarding parental stress. In this study we collected the data of all patients who underwent day-case surgery during two additional 13-month periods in 1997/1998 and 1999/2000. The methods of data collection remained unchanged for all three periods and included a questionnaire for the parents. In total, 1,490 questionnaires were analysed. Comparing the three time periods, parents' feelings of being well-informed improved significantly (91% vs. 98% vs. 97%, P<0.0001). However, the percentage of those experiencing moderate to severe stress did not change substantially (16% vs. 9% vs. 19%, not significant). Analgaesics were given more frequently over the years in a general as well as a prophylactic manner (20% vs. 35% vs. 43%, P<0.0001). Nevertheless, problems with pain control at home remained unchanged (33% vs. 23% vs. 29%, not significant). Despite considerable efforts to improve information, parental stress did not significantly decrease. It cannot be assessed yet whether wrong information was given or whether a certain degree of stress cannot be prevented. There is some evidence that improvements in coping with pain-related problems might be a promising next ste

Oesophageal atresia: what has changed in the last 3 decades?

The aim of the study was to analyse the outcomes of children born with oesophageal atresia over the last 3 decades. The records of 104 patients born between 1973 and 1999 were reviewed retrospectively. To evaluate changes over time, the analysis was done for three consecutive time periods: 1973-79, 1980-89, and 1990-99. Mean birth weight was 2553g (SD 640), and mean gestational age was 39 weeks (SD 4). Forty-two newborns (40%) had one or more associated congenital malformations, and 30% had associated cardiac malformations. There was no change in incidence of associated anomalies over the three time periods studied. Mortality of patients decreased from 33% to 14% ( p =0.048). There was a significant association between the presence of a major cardiac malformation and survival (survival: 88% vs. 57%, p =0.004). Analysing the three different time periods separately reveals that cardiac disease was not a significant risk factor in the first period but became significant in the period from 1980-99 (relative risk: 6.76, 95% CI 1.44-31.77). Birth weight was significantly higher in infants who survived (2626g, SD 642) compared with those who died (2290, SD 570, p =0.028). This effect, however, is mainly based on the difference during the first period and is lost later. Early and late postoperative complications occurred in 44/102 patients. Strictures developed in 33/91 patients who survived the first month of life (33%). The rate of symptomatic strictures decreased significantly over the three time periods, from 50% to 23% ( p =0.022). In summary, this study shows no significant change in patient characteristics over the last 3 decades, but mortality and postoperative complication rates decreased, and associated cardiac anomalies became the far most important risk factor for mortalit

Analyzing the Psychological and Social Contents of Evidence—Experimental Comparison between Guessing, Naturalistic Observation, and Systematic Analysis

To improve inferences about psychological and social evidence contained in pictures and texts, a five-step algorithm—Systematic Analysis (SA)—was devised. It combines basic principles of interpretation in forensic science, providing a comprehensive record of signs of evidence. Criminal justice professionals evaluated the usefulness of SA. Effects of applying SA were tested experimentally with 41 subjects, compared to 39 subjects observing naturally (naturalistic observation) and 47 subjects guessing intuitively intuitive guessing group. After being trained in SA, prosecutors and police detectives (N = 217) attributed it a good usefulness for criminal investigation. Subjects (graduate students) using SA found significantly more details about four test cases than those observing naturally (Cohen’s d = 0.58). Subjects who learned SA well abducted significantly better hypotheses than those who observed naturally or who guessed intuitively. Internal validity of SA was a = 0.74. Applying SA improved observation significantly and reduced confirmation bias

Factors Affecting Cardiovascular Physiology in Cardiothoracic Surgery: Implications for Lumped-Parameter Modeling

Cardiothoracic surgeries are complex procedures during which the patient cardiovascular physiology is constantly changing due to various factors. Physiological changes begin with the induction of anesthesia, whose effects remain active into the postoperative period. Depending on the surgery, patients may require the use of cardiopulmonary bypass and cardioplegia, both of which affect postoperative physiology such as cardiac index and vascular resistance. Complications may arise due to adverse reactions to the surgery, causing hemodynamic instability. In response, fluid resuscitation and/or vasoactive agents with varying effects may be used in the intraoperative or postoperative periods to improve patient hemodynamics. These factors have important implications for lumped-parameter computational models which aim to assist surgical planning and medical device evaluation. Patient-specific models are typically tuned based on patient clinical data which may be asynchronously acquired through invasive techniques such as catheterization, during which the patient may be under the effects of drugs such as anesthesia. Due to the limited clinical data available and the inability to foresee short-term physiological regulation, models often retain preoperative parameters for postoperative predictions; however, without accounting for the physiologic changes that may occur during surgical procedures, the accuracy of these predictive models remains limited. Understanding and incorporating the effects of these factors in cardiovascular models will improve the model fidelity and predictive capabilities

Influence of hypothermia on right atrial cardiomyocyte apoptosis in patients undergoing aortic valve replacement

BACKGROUND: There is increasing evidence that programmed cell death can be triggered during cardiopulmonary bypass (CPB) and may be involved in postoperative complications. The purpose of this study was to investigate whether apoptosis occurs during aortic valve surgery and whether modifying temperature during CPB has any influence on cardiomyocyte apoptotic death rate. METHODS: 20 patients undergoing elective aortic valve replacement for aortic stenosis were randomly assigned to either moderate hypothermic (ModHT group, n = 10, 28°C) or mild hypothermic (MiHT group, n = 10, 34°C) CPB. Myocardial samples were obtained from the right atrium before and after weaning from CPB. Specimens were examined for apoptosis by flow cytometry analysis of annexin V-propidium iodide (PI) and Fas death receptor staining. RESULTS: In the ModHT group, non apoptotic non necrotic cells (annexin negative, PI negative) decreased after CPB, while early apoptotic (annexin positive, PI negative) and late apoptotic or necrotic (PI positive) cells increased. In contrast, no change in the different cell populations was observed over time in the MiHT group. Fas expression rose after reperfusion in the ModHT group but not in MiHT patients, in which there was even a trend for a lower Fas staining after CPB (p = 0.08). In ModHT patients, a prolonged ischemic time tended to induce a higher increase of Fas (p = 0.061). CONCLUSION: Our data suggest that apoptosis signal cascade is activated at early stages during aortic valve replacement under ModHT CPB. This apoptosis induction can effectively be attenuated by a more normothermic procedure

Delirium management : nursing interventions and factors influencing their implementation from the nurses' perspectives

Delirium is a common and serious complication in clinical practice. Adequate nursing interventions for the prevention, early detection and treatment of deliriums are central to delirium management programmes. Little is known about the factors that influence the implementation of delirium management interventions. This study aimed to explore how nurses trained in delirium management experience the implementation of nursing interventions for the prevention and treatment of deliriums, how they proceed with this and which factors have an impact on this. Four focus group interviews with 27 nurses from a Swiss hospital were conducted, and data were analysed with qualitative content analysis. The results show a structured nursing care process and the associated structured nursing care planning are central factors for ensuring the adequate implementation of nursing delirium management interventions. Experience and knowledge, organisational framework conditions, and aspects of collaboration are other relevant influencing factors. Lack of expertise and experience, coupled with insufficient resources, emerged as the most important influencing factors, which mainly affect the recognition of delirium risk and prevention. Here it is important to deepen specialized knowledge and optimize the available resources

New concept for designing multimodal user interfaces

This paper proposes a new concept for the design of multimodal user interfaces (MMUIs) based on so-called Multimodal Objects (MMOs). MMOs are a new kind of multimodal components we propose in order to simplify the construction of consistent MMUIs. An MMO is in the simplest case a basic interaction element like a single multimodal button or textfield. These MMOs are built according to the model-view-controller pattern. The model of the MMO is responsible for the logic of the MMO. The view of the MMO has different aspects, one for each modality. The controller of the MMO is responsible for the event fusion, i.e. to coordinate the different events coming from the different aspects of the view and compiling them into a semantic event of the MMO. This semantic event is then transmitted to the model of the MMO which normally results in a state change of the model