Development of a continence assessment pathway in acute care

Incontinence is defined as any loss of urine or faeces that is involuntary (Abrahams et al, 2002). It can affect anyone at any age. The prevalence of incontinence increases with age, and in women it is often associated with childbearing and the menopause. Incontinence can have devastating effects on an individual's life (Laycock et al, 2001), with both emotional and financial costs (Paddison, 2002). In the UK, conservative estimates suggest that 424 million pounds per year is spent on urinary incontinence alone (Continence Foundation, 2000).     

Assessment of heart rate circadian rhythms in paroxysmal atrial fibrillation

Heart rate (HR) variations during night sleep and in the early predawn period in healthy subjects and patients with paroxisms of artrial fibrillation were used to assess HR circadian rhythms. Daily ECG monitoring was performed in 19 healthy subjects (mean age 36.0 +/- 7.05 years) and patients with paroxisms of atrial fibrillation (mean age 55.15 +/- 3.91 years). In healthy subjects, HR responsiveness during night sleep and in the early predawn hours was more prominent than in patients with paroxisms of atrial fibrillation. The number of HR spikes at night was 20.42 +/- 3.73 and 14.23 +/- 2.8 (p < 0.001) and one hour before waking 3.74 +/- 1.33 and 1.92 +/- 1.04 (p < 0.001) respectively; premorning activation coefficient was 0.19 +/- 0.007 and 0.13 +/- 0.007 (p < 0.05). It is concluded that HR responsiveness during the night sleep and the early predawn period in healthy subjects is higher than in patients with paroxisms of articular fibrillation. The number of HR spikes at night and one hour before waking as well as premorning activation coefficient can be used to assess RH circadian rhythms.     

Sleep syncope: treatment with a permanent pacemaker

Vasovagal syncope usually occurs during upright posture, but Jardine et al. have described a variant that occurs at night. During "sleep syncope" patients are awakened from sleep with nausea, abdominal cramping, or a sense of impending diarrhea; get up; and faint in the bathroom. We report on a patient with recurrent sleep syncope (with physical injury) in whom an asystolic pause was documented during one of her "sleep syncope" spells. Implantation of a dual chamber pacemaker (5-year follow-up) "cured" her of further syncope. This is a report of pacemaker use for this unusual form of reflex syncope.     

夜班护士睡眠质量的质性研究

目的:了解夜班护士睡眠质量状况,分析影响睡眠质量的因素,为提高夜班护士工作质量提供依据。方法:以质性研究中的现象学方法为指导,采用开放式访谈法,深入访问某医院上夜班的10名护士。结果:通过分析﹑归纳﹑比较得出影响夜班护士睡眠质量的主要因素有:不固定的睡眠时间使睡眠失去昼夜节律,夜班后睡眠质量差,夜班后睡眠时间不能保障。结论:通过对夜班护士睡眠质量的分析,夜班护士在固定的时间持续上夜班,形成新的睡眠节律,可提高病区夜间护理质量,同时可解决夜班护士睡眠质量问题。     

Childhood obesity: its incidence, consequences and prevention

In 1998 the World Health Organization declared childhood obesity a 'global epidemic' (WHO, 1998). The Department of Health has identified that prevention must be aimed at children to address its rise in future generations (DoH, 2002). Childhood obesity is recognised as a predictor of adolescent and adult obesity (Smith, 2002; Parsons et al, 1999; Whitaker et al, 1997). Without intervention to prevent the growing trend of childhood obesity there is a risk of increasing economic cost and human suffering in future generations (Laing, 2002).     

Community supports used by older people post hospital discharge

Community support in the post-discharge period is of importance, as difficulties managing at home can lead to readmission to hospital (Strunin et. al, 2007; Arbaje et al, 2009). There is evidence that support from family in the community is perceived to be the best option by older people (McCann and Evans 2002; Themessl-Huber et. al, 2007). However, during the transition from hospital to home gaps may occur in the continuity of support, with the potential for poor outcomes. Knowledge about how older people interact with supports in their communities is therefore important to inform health and social care policy and provision. This article presents the results of a southern Irish study to examine the use of informal and formal supports and services by older people in the post discharge period. Recommendations for practice and further research are included.     

Potential role of orexin and sleep modulation in the pathogenesis of Alzheimer’s disease

Age-related aggregation of amyloid-β (Aβ) is an upstream pathological event in Alzheimer’s disease (AD) pathogenesis, and it disrupts the sleep–wake cycle. The amount of sleep declines with aging and to a greater extent in AD. Poor sleep quality and insufficient amounts of sleep have been noted in humans with preclinical evidence of AD. However, how the amount and quality of sleep affects Aβ aggregation is not yet well understood. Orexins (hypocretins) initiate and maintain wakefulness, and loss of orexin-producing neurons causes narcolepsy. We tried to determine whether orexin release or secondary changes in sleep via orexin modulation affect Aβ pathology. Amyloid precursor protein (APP)/Presenilin 1 (PS1) transgenic mice, in which the orexin gene is knocked out, showed a marked decrease in the amount of Aβ pathology in the brain with an increase in sleep time. Focal overexpression of orexin in the hippocampus in APP/PS1 mice did not alter the total amount of sleep/wakefulness and the amount of Aβ pathology. In contrast, sleep deprivation or increasing wakefulness by rescue of orexinergic neurons in APP/PS1 mice lacking orexin increased the amount of Aβ pathology in the brain. Collectively, modulation of orexin and its effects on sleep appear to modulate Aβ pathology in the brain.Age-related aggregation of amyloid-β (Aβ) is an upstream pathological event in Alzheimer’s disease (AD) pathogenesis (Holtzman et al., 2011; Sperling et al., 2011). As the accumulation and aggregation of Aβ in the brain is known to develop ∼10–15 yr before the initial symptoms of AD, understanding the factors that lead to Aβ aggregation are likely to be important in delaying the onset of this pathology and delaying/preventing AD (Holtzman et al., 2011; Sperling et al., 2011). Diverse lines of in vitro and in vivo studies have shown that synaptic activity and specifically synaptic vesicle release is coupled with presynaptic Aβ release (Kamenetz et al., 2003; Cirrito et al., 2008; Bero et al., 2011; Roh et al., 2012). In addition, sleep plays a role in the regulation of synaptic weight in the brain such that sleep appears to downscale the slow wave activity of the brain caused by accumulated load of synaptic potentiation during wakefulness (Vyazovskiy et al., 2009). Poor sleep quality and insufficient amounts of sleep have been noted in humans with preclinical evidence of AD (Roh et al., 2012; Ju and Holtzman, 2013; Ju et al., 2014). These observations suggest that understanding how integrated synaptic and network activity as measured by the sleep–wake cycle regulates Aβ may provide novel insights into AD pathogenesis. However, how the amount and quality of sleep affect Aβ aggregation is not yet well understood (Ju et al., 2014). Orexins (hypocretins) initiate and maintain wakefulness, and loss of orexin-producing neurons causes narcolepsy (de Lecea et al., 1998; Chemelli et al., 1999).Levels of soluble Aβ in the extracellular interstitial fluid (ISF) of the hippocampus in mice are dynamically and positively associated with minutes awake per hour and negatively associated with time asleep (Kang et al., 2009). In addition, the sleep–wake cycle also affects the Aβ pathology in the brain. A study in mice showed that intracerebral administration of orexin can acutely increase both wakefulness and Aβ levels and systemic treatment with an orexin receptor antagonist decreased Aβ deposition in amyloid precursor protein (APP) transgenic mouse models (Kang et al., 2009). Pharmacological experiments suggest that orexin and the sleep–wake cycle appear to be related to regulation of Aβ levels. We sought to determine for the first time whether genetic manipulation of orexin has similar effects as pharmacological manipulation and, importantly, whether orexin is influencing Aβ levels and Aβ pathology directly via orexin signaling or indirectly via its effects on the sleep–wake cycle.     

Breast-feeding increases sleep duration of new parents

OBJECTIVES: This study describes sleep patterns for mothers and fathers after the birth of their first child and compares exclusive breast-feeding families with parents who used supplementation during the evening or night at 3 months postpartum. METHODS: As part of a randomized clinical trial, the study utilized infant feeding and sleep data at 3 months postpartum from 133 new mothers and fathers. Infant feeding type (breast milk or formula) was determined from parent diaries. Sleep was measured objectively using wrist actigraphy and subjectively using diaries. Lee's General Sleep Disturbance Scale was used to estimate perceived sleep disturbance. RESULTS: Parents of infants who were breastfed in the evening and/or at night slept an average of 40-45 minutes more than parents of infants given formula. Parents of infants given formula at night also self-reported more sleep disturbance than parents of infants who were exclusively breast-fed at night. CONCLUSIONS: Parents who supplement their infant feeding with formula under the impression that they will get more sleep should be encouraged to continue breast-feeding because sleep loss of more than 30 minutes each night can begin to affect daytime functioning, particularly in those parents who return to work.     

Improved treatment of sudden hearing loss by specific fibrinogen aphaeresis

The etiology of sudden sensorineural hearing loss is still unclear and is thought to result from disturbances of microcirculation, infectious causes, or autoimmune disorders. So far standard therapy did not show clear improvement over spontaneous remission rate, which is assumed to be about 50% [Nakashima et al., Acta. Otolaryngol. Stockh. 514:14-16, 1994; Schuknecht and Donovan, Arch. Otorhinolaryngol. 243:1-15, 1986; Harris and Sharp, Laryngoscope 100:516-524, 1990; Mayot et al., Clin. Immunol. Immunopath. 68:41-45, 1993; Gussen, Ann. Otol. Rhinol. Laryngol. 85:94-100, 1976]. Elevated blood viscosity due to high fibrinogen levels is supposed to cause decreased cochlear blood flow and thus initiate sudden hearing loss. The specific lowering of fibrinogen immediately decreases plasma viscosity exactly to the desired extent and should lead to improved cochlear blood flow [Suckfüll et al., Acta. Otolaryngol 119:763-766, 1999; Suckfüll, Lancet 360:1811-1817, 2002; Walch et al., Laryngol. Rhino. Otol. 75:641-645, 1996; Suckfüll et al., Otol. Neurotol. 23:309-311, 2002]. In a prospective uncontrolled pilot study on 36 patients with unilateral sudden onset sensorineural hearing loss (SHL) we tried to establish that 1-3 specific fibrinogen aphaereses alone improve recovery of hearing and that it is possible to lower fibrinogen to the target of 80-100 mg/dl without important side effects. Pure tone audiometry was carried out immediately before and after each aphaeresis as well as at 2 and 4 weeks and 6 months after treatment. Sixteen patients recovered spontaneously before undergoing fibrinogen adsorption. All 20 aphaeresis patients improved during immunoadsorption; in 60% of patients auditory thresholds returned to normal after the first immunoadsorption and treatment could be discontinued, in another 20% of patients complete recovery was reached after 4 weeks. The mean plasma fibrinogen concentration of the 20 patients before the first aphaeresis session was 308.1 +/- 51.5 mg/dl. Immediately after the first treatment session, the fibrinogen concentration was lowered to 100.7 +/- 25.3 mg/dl (P < 0.001). The second and third sessions also showed highly significant reductions in plasma fibrinogen. No important side effects were seen.In conclusion, specific fibrinogen adsorption is a promising new treatment modality that should be tested in a prospective, randomized controlled trial in patients with sudden hearing loss.     

Children's palliative care: a global concern

Children's palliative care (CPC) is a specialty in itself, albeit closely related to adult palliative care (World Health Organization (WHO), 2002). However, although there are many children who require palliative care, in much of the world CPC has a poor profile and is inaccessible to those who need it (Downing et al, 2010; Knapp et al, 2011). The provision of high-quality palliative care for children is a global concern, with 27% of the world population being under the age of 15, rising to as many as 49% in countries such as Uganda (WHO, 2010). It has been estimated that as many as 7 million of these children around the world will need palliative care each year (Rushton et al, 2002), although the true figure is likely to be higher. The public health approach to palliative care is key to the development of CPC services, as is the development of models that integrate services into existing health structures.     

A cerebral network model of speech prosody comprehension

Comprehension of information conveyed by the tone of voice is highly important for successful social interactions (Grandjean et al., 2006). Based on lesion data, a superiority of the right hemisphere for cerebral processing of speech prosody has been assumed. According to an early neuroanatomical model, prosodic information is encoded within distinct right-sided perisylvian regions which are organized in complete analogy to the left-sided language areas (Ross, 1981). While the majority of lesion studies are in line with the assumption that the right temporal cortex is highly important for the comprehension of speech melody (Adolphs et al., 2001; Borod et al., 2002; Heilman et al., 1984), some studies indicate a widespread network of partially bilateral cerebral regions to contribute to prosody processing including the frontal cortex (Adolphs et al., 2002; Hornak et al., 2003; Rolls, 1999) and the basal ganglia (Cancellieve & Kertesz, 1990; Pell & Leonard, 2003). More recently, functional imaging experiments have helped to differentiate specific functions of distinct brain areas contributing to recognition of speech prosody (Ackermann et al., 2004; Schirmer & Kotz, 2006; Wildgruber et al., 2006). Observations in healthy subjects indicate a strong association of cerebral responses and acoustic voice properties in some regions (stimulus-driven effects), whereas other areas show modulation of activation linked to the focusing of attention to specific task components (task-dependent effects). Here we present a refined model of prosody processing and cross-modal integration of emotional signals from face and voice which differentiates successive steps of cerebral processing involving auditory analysis and multimodal integration of communicative signals within the temporal cortex and evaluative judgements within the frontal lobes.     

Current treatments for patients with stress urinary incontinence

Stress urinary incontinence (SUI) has been defined as the complaint of involuntary leakage of urine on effort, exertion, sneezing or coughing (Abrams et al, 2002). It becomes known as urodynamically proven stress incontinence (USI) when filling cystometry (a test of bladder function) shows a rise in intra-abdominal pressure, without a detrusor muscle (bladder muscle) contraction, causing urine loss via the urethra.     

呼吸机辅助下手术治疗阻塞性睡眠呼吸暂停低通气综合征疗效分析

目的:阻塞性睡眠呼吸暂停低通气综合征患者通过术前应用呼吸机治疗,然后进行手术,对患者获得的手术效果进行评价分析.方法:选取2017年1月至2020年1月到重庆市綦江区人民医院收=治的阻塞性睡眠呼吸暂停低通气综合征患者60例作为研究对象,随机分为观察组和对照组,每组30例.对照组通过常规手术进行治疗,观察组在对照组患者的...     

Laparoscopic adjustable gastric banding

Laparoscopic adjustable gastric banding is one of several weight loss procedures in the bariatric surgeon's armamentarium to treat morbid obesity. Laparoscopic gastric banding has the lowest perioperative risk compared to laparoscopic gastric bypass, sleeve gastrectomy, and duodenal switch (Buchwald et al., JAMA 292:1724-1737, 2004). The adjustable gastric band results in approximately 50% excess weight loss at 5?years (O'Brien and Dixon,J Laparoendosc Adv Surg Tech A 13:265-270, 2003). In the long-term, reoperation rates can be high with the percentage of reoperations varying enormously in reported studies from 2% to 80% (Schouten et al., Surg Obes Relat Dis 7:99-109, 2011), although with changes in technique, reoperation rates after gastric banding have decreased (O'Brien et al., Obes Surg 15:820-826, 2005). Aftercare is critical to the success of the banded patient, in terms of adjusting the band as well as monitoring the patient's symptoms (Weichman et al., Surg Endosc 25:397-403, 2011). Several studies have shown that patients who are seen more than six to seven times in the first postoperative year have better weight loss.     

The importance of the STOP- BANG questionnaire as a preoperative assessment tool for the elderly population

Undiagnosed obstructive sleep apnea (OSA) may adversely impact surgical patients and can lead to increased morbidity and mortality during the perioperative period, especially among the geriatric patient population (Chung et al. 2008, 2012, 2014; McDonald et al., 2018; Zietlow et al., 2018; Singh et al., 2012). The setting of this quality improvement project was a preoperative anesthesia and geriatric evaluation clinic housed within a 957-bed tertiary academic affiliated hospital. The sample included 45 patients who met the criteria established for surgery and OSA screening preoperatively. Nine patients (20.0%) were assessed as low risk (Stop-bang [SB] score </=2) for OSA, and 36 patients (80.0%) had a prior diagnosis from an ICD-9/10 code or a SB score >/= 3 indicative of high-risk for OSA. The retrospective utilization of a modified SB screening on charts that did not receive a clinical OSA evaluation (n = 52) detected 23 (44.2%) patients who were considered high-risk for OSA but were not identified prior to surgery. The SB questionnaire is underutilized, and patients’ OSA is often unidentified prior to surgery.     

Chronic obstructive pulmonary disease: a non-pharmalogical approach

Chronic obstructive pulmonary disease (COPD) is now regarded as one of the worlds most prevalent chronic disorders and is listed in the top five leading causes of death worldwide (Donaldson et al 2002). Studies have shown that a significant improvement can be made in morbidity and mortality rates, through earlier intervention and management (Hernadez M et al 2000). Therefore, the focus of treatment has moved away from crisis intervention towards helping people manage their condition. This article will explore the physical, social and psychological issues that arise in the management of COPD and discuss the various non-pharmacological approaches that the nurse can recommend to help improve the quality of life of a patient.     

Effects of ibuprofen on sleep quality as measured using polysomnography and subjective measures in healthy adults

BACKGROUND: Although some literature has suggested that NSAIDs may affect sleep physiology, this observation is not consistent with clinical use of these drugs and has not been verified using standard sleep-research methodologies. OBJECTIVE: This study was undertaken to determine whether ibuprofen 400 mg administered at 3, 7, and 11 pm (total daily dose, 1200 mg) produced any significant alterations in the character and quality of night-time sleep as measured by standard sleep laboratory polysomnography (PSG) and subjective measures. METHODS: This 4-day, multiple-dose, double-blind, randomized, placebo-controlled trial was conducted in a hospital-based, sleep laboratory in the United States (DENT Neurological Institute at Millard Fillmore Hospital, Buffalo, New York). Healthy subjects aged > or = 18 years spent 3 consecutive nights in a sleep laboratory. Day 1/night 1 was for acclimation; day 2/night 2, for baseline PSG and subjective sleep assessments; and day 3/night 3, for treatment effects on sleep character and quality. All subjects received placebo on days 1 and 2. On day 3, subjects received ibuprofen 400 mg or placebo TID. RESULTS: All 30 subjects (15 per group) completed the study (18 men, 12 women; all white). The mean age (SD) was 28.6 years and mean body weight was 71.4 kg. In both groups, mean values for sleep efficiency and quality of sleep were significantly higher on night 3 compared with baseline; the mean (SD) changes from baseline were not significantly different between the ibuprofen and control groups (sleep efficiency, 0.4 [6.3] and 0.3 [6.2]; quality of sleep, 8.6 [26.8] and 3.3 [21.3]). Mean night-3 sleep efficiency in the ibuprofen group was 88.6%--substantially higher than the minimally acceptable sleep efficiency of 75% stated in the protocol. Three mild adverse events were reported in 2 subjects. CONCLUSION: This study found that in these subjects a total daily dose of 1200 mg ibuprofen did not produce any clinically or statistically significant alterations in the character and quality of nighttime sleep as measured using standard sleep laboratory PSF and subjective measures.     

Sleep patterns and fatigue in new mothers and fathers

The purpose of this study was to describe the sleep patterns and fatigue of both mothers and fathers before and after childbirth. The authors used wrist actigraphy and questionnaires to estimate sleep and fatigue in 72 couples during their last month of pregnancy and 1st month postpartum. Both parents experienced more sleep disruption at night during the postpartum period as compared to the last month of pregnancy. Compared to fathers, with their stable 24-h sleep patterns over time, mothers had less sleep at night and more sleep during the day after the baby was born. Sleep patterns were also related to parents' work status and type of infant feeding. Both parents self-reported more sleep disturbance and fatigue during the 1st month postpartum than during pregnancy. Mothers reported more sleep disturbance than fathers, but there was no gender difference in ratings of fatigue. At both time points, fathers obtained less total sleep than mothers when sleep was objectively measured throughout the entire 24-h day. Further research is needed to determine the duration of sleep loss for both mothers and fathers, to evaluate the effect of disrupted sleep and sleep loss on psychosocial functioning and job performance, and to develop interventions for improving sleep patterns of new parents.     

Pelvic floor muscle exercises

The ICS Standardisation Committee (Abrams et al, 2002) defines the symptom of stress urinary incontinence as the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing. Genuine stress incontinence (now known as urodynamically proven stress incontinence) is the involuntary loss of urine occurring when, in the absence of a detrusor contraction, the intravesical pressure exceeds the maximal urethral pressure. These definitions tend to look at the urinary mechanism in isolation, and many clinicians now advocate that a more holistic view should be taken of this problem.     

从肝藏血论治产后失眠

产后失眠是临床常见的产后病。肝藏血,为睡眠活动提供物质基础。分娩出血、流汗、用劲都可能导致产后肝血亏损。肝血亏虚,神魂失养,则夜寐难安。肝血亏虚为产后失眠的病理基础,因此调补肝血法为治疗产后失眠症的重要治法。