Anxiety and depression among surgical patients

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Iðulega er meiri áhersla lögð á líkamlega umönnun en sálræna þegar hjúkrunarþjónusta er veitt á skurðdeildum. Tilgangur rannsóknarinnar var að lýsa sálrænni líðan skurðsjúklinga með því að meta kvíða- og þunglyndiseinkenni þeirra á spítala og heima fjórum vikum síðar og athuga tengsl við verki, almenn einkenni, þætti tengda heilsu og spítalalegu og bakgrunn. Gagna var aflað með spurningalistum og voru einkenni kvíða og þunglyndis metin með HADS-kvarðanum. Fleiri stig á kvarðanum benda til að einstaklingur hafi mörg einkenni um kvíða eða þunglyndi. Úrtakið var 733 innkallaðir sjúklingar sem fóru í aðgerð 15. janúar til 15. júlí 2007 og var svörun 56,8%. Niðurstöður sýna sterk tengsl á milli einkenna kvíða og þunglyndis á spítala (r=0,76) og heima (r=0,78). Á spítalanum voru 25 sjúklingar með einkenni hugsanlegs eða líklegs kvíða og þunglyndis, 21 sjúklingur heima og sjö sjúklingar bæði á spítalanum og heima. Almennt voru veik til miðlungssterk tengsl á milli almennra einkenna og kvíða- og þunglyndiseinkenna. Sterkust voru tengslin við minnisskerðingu, erfiðleika með hreyfingu, erfiðleika í kynlífi og mæði. Miðlungssterk tengsl voru á milli þess að vera með mörg almenn einkenni á spítala og einkenni kvíða og þunglyndis á spítala. Sambærileg tengsl komu fram heima. Sjúklingarnir voru ánægðari með umönnunina sem þeir fengu á spítalanum aðspurðir þar heldur en heima. Hærri aldur og meiri ánægja með umönnun hafði veika neikvæða tengingu við kvíða og þunglyndi, bæði á spítala og heima. Konur, sjúklingar með börn á heimilinu, sjúklingar þar sem heimilismeðlimur átti við veikindi að stríða eða þurfti aðstoð við daglegt atferli ásamt þeim sem töldu bata sinn og árangur aðgerðar ekki í samræmi við væntingar fengu að jafnaði fleiri stig á kvíða- og þunglyndiskvörðum HADS. Lagt er til að á Landspítala verði útbúin aðferð til að greina sálræna vanlíðan skurðsjúklinga og benda á íhlutun. Eftirfylgni í síma, þar sem leitað er eftir ákveðnum einkennum, er einföld leið til að finna sjúklinga sem gætu talist í áhættuhópi.Perioperative nursing care is mainly focused on physical care with psychological needs less addressed. The objective of this study was to describe surgical patients psychological well-being by assessing symptoms of anxiety and depression, pain, general symptoms and care among surgical patients at Landspitali- University Hospital (LUH). Higher scores on HADS indicate more symptoms of anxiety and depression. Data were collected with a questionnaire, at the hospital and at home four weeks later. Symptoms of anxiety and depression were measured by HADS. The sample was 733 patients who had surgery from January 15 until July 15, 2007 and response rate was 56.8%. Findings revealed a correlation between symptoms of anxiety and depression at the hospital (r=0.76) and at home (r=0.78). Twenty five patients were diagnosed with “doubtful” or definite symptoms of anxiety and depression at the hospital, 21 patients at home and seven patients at both hospital and home. In general, weak or medium significant correlations were found between general symptoms and symptoms of anxiety and depression. The correlation was strongest with memory impairment, sexual difficulties, difficulties with movement and dyspnoea. Medium correlation was also found between having a number of general symptoms and symptoms of anxiety and depression. Patients’ satisfaction with care was significantly higher when asked at the hospital than at home. Satisfaction with care and age had a weak significant negative correlation with anxiety and depression at both time points. Female patients, patients with children at home, those living with sick relatives, with relatives needing assistance with daily activities and those who found their recovery and the success of the operation not as expected experienced significantly more symptoms of anxiety and depression. The perioperative wards at LUH should develop an intervention to detect psychological distress in surgical patients and provide resources. Furthermore, a follow-up telephone call consisting of symptom specified questions can be effective to detect patients at risk

An exploratory study into the role and interplay of intrinsic and extrinsic cues in Australian consumers’ evaluations of fish.

This study explores the role and interplay of intrinsic and extrinsic cues when evaluating fish quality and in shaping consumers' attitudes toward fish consumption. A sensory analysis of nine different fish including five variants of barramundi was conducted to determine how consumers evaluated the fish on intrinsic cues. Focus groups were then conducted to explore the impact of extrinsic cues on attitudes and purchase intentions. While the sensory analysis revealed distinct differences between barramundi variants on intrinsic cues (notably taste), the focus groups revealed that, as a brand, barramundi is perceived much more favourably and consistently. Consumers used extrinsic cues, particularly country of origin, as surrogate indicators of quality. Aquaculture producers need to ensure intrinsic product quality and consistency, as while consumers use the extrinsic cue of "Australian grown" as a surrogate indicator of quality, as their familiarity and confidence with seafood grows, this overreliance on extrinsic cues may diminish

HRS1 Acts as a Negative Regulator of Abscisic Acid Signaling to Promote Timely Germination of Arabidopsis Seeds

In this work, we conducted functional analysis of Arabidopsis HRS1 gene in order to provide new insights into the mechanisms governing seed germination. Compared with wild type (WT) control, HRS1 knockout mutant (hrs1-1) exhibited significant germination delays on either normal medium or those supplemented with abscisic acid (ABA) or sodium chloride (NaCl), with the magnitude of the delay being substantially larger on the latter media. The hypersensitivity of hrs1-1 germination to ABA and NaCl required ABI3, ABI4 and ABI5, and was aggravated in the double mutant hrs1-1abi1-2 and triple mutant hrs1-1hab1-1abi1-2, indicating that HRS1 acts as a negative regulator of ABA signaling during seed germination. Consistent with this notion, HRS1 expression was found in the embryo axis, and was regulated both temporally and spatially, during seed germination. Further analysis showed that the delay of hrs1-1 germination under normal conditions was associated with reduction in the elongation of the cells located in the lower hypocotyl (LH) and transition zone (TZ) of embryo axis. Interestingly, the germination rate of hrs1-1 was more severely reduced by the inhibitor of cell elongation, and more significantly decreased by the suppressors of plasmalemma H+-ATPase activity, than that of WT control. The plasmalemma H+-ATPase activity in the germinating seeds of hrs1-1 was substantially lower than that exhibited by WT control, and fusicoccin, an activator of this pump, corrected the transient germination delay of hrs1-1. Together, our data suggest that HRS1 may be needed for suppressing ABA signaling in germinating embryo axis, which promotes the timely germination of Arabidopsis seeds probably by facilitating the proper function of plasmalemma H+-ATPase and the efficient elongation of LH and TZ cells

Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadImportance: Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research. Objective: To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease. Design, setting, and participants: In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook. Main outcomes and measures: The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications. Results: Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk. Conclusions and relevance: In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.Patient-Centered Outcomes Research Institute - PCOR

Are the target exposure index and deviation index used efficiently?

To access publisher's full text version of this article click on the hyperlink belowExposure index (EI) is important to evaluate correct exposure in radiography and thus important for image quality. The purpose of this study was to evaluate whether the target exposure index (EIT) and deviation index (DI) were used efficiently.Introduction: Exposure index (EI) is important to evaluate correct exposure in radiography and thus important for image quality. The purpose of this study was to evaluate whether the target exposure index (EIT) and deviation index (DI) were used efficiently. Methods: Radiography departments in Iceland, using <10 years old equipment, were invited to participate. For each x-ray unit, admin users were asked about the use of EIT and data was gathered on EIT for five body parts (BP); lumbar spine, chest, hip, knee and hand. For each of the five BP, 100 examinations from the past year were selected randomly (or all, if < 100). The EI from one predefined view was recorded and the corresponding DI calculated. Results: A total of ten x-ray units, from four manufacturers and located at eight departments, were included in the study. The departments involved are comprised of a university hospital, smaller hospitals, and miscellaneous private departments. Two departments (25%) had not set EIT, five (62.5%) used default values and only one had revised EIT values. In four departments (50%) radiographers favored "acceptable EI range" over DI. The mean EI was significantly different (p < 0.05) from the EIT in the majority of the five BP, in four out of the six departments that had defined EIT. In total 30% of images from all departments combined had DI outside the range of -3.0 < DI < +3.0. The standard deviation of DI was from 1.4 to 2.7. Conclusion: The study shows that the EIT and DI are not used efficiently, regardless of equipment vendor or department characteristics. Implications for practice: Current recommendations on targeting the mean DI of 0 need to be reinforced. Theoretical knowledge and training need to be improved. Keywords: Digital radiography; Dose indicator; Dose optimization; Radiation exposure