Do trait anxiety and age predict state anxiety of school‐age children?

Aim. The aim of this study was to determine whether the trait anxiety scores and age of children could predict their state anxiety scores under stressful and relaxing situations. Background. Surgery can cause considerable stress and anxiety that can have a profound effect on children. It is crucial for nurses to differentiate preoperative anxiety levels in children and to identify those children who are most likely to exhibit high levels of anxiety when undergoing surgery before any intervention can be appropriately planned, provided and evaluated. Methods. A test‐retest within subjects design was used. Five hundred and nineteen primary school‐age children were invited to participate in the study. Participants were asked to respond to the Chinese version of the State‐Trait Anxiety Inventory for Children under stressful (pre‐academic examination) and relaxing (post‐academic examination) situations. Result. Multiple regression analysis showed that the trait anxiety of children was a strong predictor of their state anxiety in a stressful situation but not in a relaxed one. Compared to trait anxiety, age was found to be a weak predictor of the state anxiety of children in either situation. Conclusion. This study confirmed that trait anxiety of children could be predicted from their state anxiety under a stressful situation. Relevance to clinical practice. The trait anxiety scale could be a useful screening tool for nurses to identify those children who are most likely to exhibit high levels of anxiety when undergoing surgery. Understanding the trait anxiety of children in advance could help nurses implement appropriate preoperative psychological intervention that can meet the individual needs of the child and thus promote better recovery.     

The physics of Feldenkrais®Part 4: Axes,levers, struts and strain

This installment, the fourth in a series, presents information useful in harnessing the principles of physics to bodywork and movement therapy. It also provides encouragement towards developing skeletal awareness. This ‘felt-sense’ may help bind a better resolution of the spatial relationships of the human locomotor frame. In turn, this conception may assist in applying the Principle of Least Effort to good effect.Gravity, an unseen force of constant direction and intensity, may be another ally in our use of the Principle of Least Effort. An abstraction, the centre of gravity, may be useful in refining our sense of self as we orient and move through space. Leverage is the last concept presented; the fulcrum and common forms of leverage in the body are presented along with the idea of axes of rotation and instantaneous axes of rotation.     

The physics of Feldenkrais®: Part 2: no strain,no gain

In the last issue, which was the first of this series, the Principle of Least Effort was introduced. (Use the least effort necessary to achieve the maximum in efficiency). Two sitting self-awareness explorations were presented to help deepen this understanding and to encourage a visceral comprehension of another principle: Control follows awareness. This issue features additional clinical examples and an explanation of several terms of art in bodywork: stress, strain, translation and rotation. These words help to stake out the territory of bodywork. There are only five forms of strain and only two basic movements in any form of bodywork. We shall see the practical advantages of understanding the concepts these words carry. Clinical results may be enhanced with improved physical safety to both the therapist and client. Secondly, a sure grasp of the technical meanings of these words is essential for delving further into the treatment applications of the Principle of Least Effort.     

Fiberoptic-Guided and Blind Tracheal Intubation Through iLTS-D,Ambu® Auragain™, and I-Gel® Supraglottic Airway Devices: A Randomized Crossover Manikin Trial

BackgroundThe use of supraglottic airway devices (SADs) is becoming more widespread. However, there is little evidence to show which device is best in an emergent clinical scenario.ObjectiveWe compared both fiberoptic-guided and blind tracheal intubation through the Intubating Laryngeal Tube Suction-Disposal (iLTS-D), the AuraGain™, and the i-gel® in an airway manikin.MethodsThirty residents were included in a randomized trial to perform both fiberoptic-guided and blind tracheal intubation using the iLTS-D, the AuraGain, and the i-gel. The main endpoint was the total time taken to achieve successful fiberoptic intubation through the SAD. Additional endpoints included total time for blind intubation, SAD insertion time, tracheal tube insertion time, intubation success rate, fiberoptic view, and maneuvers performed to achieve tracheal intubation.ResultsAll participants performed fiberoptic intubation using all three SADs on the first attempt. The total time to fiberoptic tracheal intubation using the i-gel, AuraGain, and iLTS-D was 42 s, 56 s, and 56 s, respectively. The blind tracheal intubation success rate was 80% with the iLTS-D, 43% with the i-gel, and 0% with the AuraGain. The total time for blind tracheal intubation through the i-gel and the iLTS-D was 29 s and 40 s, respectively. Laryngeal view grades were significantly poorer with the iLTS-D compared to the other devices. The iLTS-D required significantly more maneuvers to achieve successful tracheal intubation.ConclusionsIn an airway manikin, the iLTS-D, AuraGain, and i-gel appear to be reliable devices for airway rescue and fiberoptic-guided tracheal intubation. The iLTS-D is recommended for blind tracheal intubation.     

Section Editor’s note. Awareness of burden of brain disorders and the Brain Awareness Week 2005

PUBLIC HEALTH SECTION

Section Editors note. Awareness of burden of brain disorders and the Brain Awareness Week 2005     

Long-term stability of procalcitonin in frozen samples and comparison of Kryptor® and VIDAS® automated immunoassays

ObjectivesTo assess long-term stability of PCT in deep-frozen samples and assess whether Kryptor procalcitonin cutoff ranges can be transferred on the bioMérieux VIDAS system.Design and methodsSamples from two intervention studies (ProRESP and ProCAP) were retested on both systems and compared with Passing–Bablok regression, Bland–Altman difference plot, and analysis of concordance over 4 medically relevant cutoff ranges.ResultsProlonged storage resulted in a significant decline of median procalcitonin values of 11.4% and 13.5% in ProRESP and ProCAP cohorts. Regression analysis showed that both methods correlated well (r = 0.982, n = 304) but with a deviation from the line of identity (y = 1.234x ? 0.018). The Bland–Altman plot indicated an average relative bias of 17.1% (2 SD limits: ? 56.4% to 90.5%). Concordance over all 4 categories was 82.6%, without a significant difference in frequency distribution between methods.ConclusionAn only modest decline of measured PCT levels of around 10% after long-term deep-frozen storage was found. The VIDAS procalcitonin assay showed good correlation and concordance with the established Kryptor method. Both techniques can be used with the same nominal procalcitonin cutoff ranges in clinical routine.     

Rapid and accurate eXDR screening: use Xpert Carba-R® with FecalSwab®

The FecalSwab® displays high performances for stool culture, but it was not assessed for carbapenemase-producing Enterobacterales (CPE) screening. We assess the performances of the Xpert Carba-R v2® with the FecalSwab®. Using a collection of 12 CPE strains, the limit of detection was assessed at 158 CFU/swab [interquartile range 93–589]. In 2019, 1540 swabs were included by 4 hospital laboratories, of which 39 (2.5%) yield an invalid result. Among the 1501 valid, 87 (5.8%) were positives by culture and PCR and 25 (1.7%) were discrepant: 7 PCR-negative culture-positive, and 18 PCR-positive culture-negative. Two PCR-positive culture-negative results involved non-Enterobacterales strains: a KPC-producing Acinetobacter baumannii and a KPC-producing Aeromonas spp. The overall percent agreement was 98.3% and the Kappa value was 0.88. FecalSwab® is an accurate sampling device for CPE screening. It allows performing all eXDR screening using a single swab, simplifying the sample collection, and improving the patient comfort. Regarding discrepant, we suggest combining a CPE screening by both culture and Xpert Carba-R v2® methods.     

Nurse outcomes in Magnet® and non-magnet hospitals

The important goals of Magnet hospitals are to create supportive professional nursing care environments. A recently published paper found little difference in work environments between Magnet and non-Magnet hospitals. The aim of this study was to determine whether work environments, staffing, and nurse outcomes differ between Magnet and non-Magnet hospitals. A secondary analysis of data from a 4-state survey of 26,276 nurses in 567 acute care hospitals to evaluate differences in work environments and nurse outcomes in Magnet and non-Magnet hospitals was conducted. Magnet hospitals had significantly better work environments (t = -5.29, P < .001) and more highly educated nurses (t = -2.27, P < .001). Magnet hospital nurses were 18% less likely to be dissatisfied with their job (P < .05) and 13% less likely to report high burnout (P < .05). Magnet hospitals have significantly better work environments than non-Magnet hospitals. The better work environments of Magnet hospitals are associated with lower levels of nurse job dissatisfaction and burnout.     

Awareness of do-not-resuscitate orders: What do patients know and want?

Objective

To assess outpatient understanding of and previous experiences with do-not-resuscitate (DNR) orders and to gauge patient preferences with respect to DNR discussions.

Design

Cross-sectional, self-administered survey.

Setting

Four urban primary care physician offices in Vancouver, BC.

Participants

A total of 429 consecutive patients 40 years of age and older presenting for routine primary care between March and May 2009.

Main outcome measures

Awareness of, knowledge about, and experiences with DNR decisions; when, where, and with whom patients wished to discuss DNR decisions; and differences in responses by sex, age, and ethnicity, assessed using χ² tests of independence.

Results

The response rate was 90%, with 386 of 429 patients completing the surveys. Most (84%) respondents had heard of the terms do not resuscitate or DNR. Eighty-six percent chose family physicians as among the people they most preferred to discuss DNR decisions with; 56% believed that initial DNR discussions should occur while they were healthy; and 46% thought the discussion should take place in the office setting. Of those who were previously aware of DNR orders, 70% had contemplated DNR for their own care, with those older than 60 years more likely to have done so (P = .02); however, only 8% of respondents who were aware of DNR orders had ever discussed the subject with a health care provider. Few patients (16%) found this topic stressful.

Conclusion

Most respondents were well informed about the meaning of DNR, thought DNR discussions should take place when patients were still healthy, preferred to discuss DNR decisions with family physicians, and did not consider the topic stressful. Yet few respondents reported having had a conversation about DNR decisions with any health care provider. Disparity between patient preferences and experiences suggests that family physicians can and should initiate DNR discussions with younger and healthier patients.     

TEG® and RapidTEG® are unreliable for detecting warfarin-coagulopathy: a prospective cohort study

Background

Thromboelastography^® (TEG) utilizes kaolin, an intrinsic pathway activator, to assess clotting function. Recent published studies suggest that TEG results are commonly normal in patients receiving warfarin, despite an increased International Normalized Ratio (INR). Because RapidTEG? includes tissue factor, an extrinsic pathway activator, as well as kaolin, we hypothesized that RapidTEG would be more sensitive in detecting a warfarin-effect.

Methods

Included in this prospective study were 22 consecutive patients undergoing elective cardioversion and receiving warfarin. Prior to cardioversion, blood was collected to assess INR, Prothrombin Time, TEG, and RapidTEG.

Results

INR Results: 2.8?±?0.5 (1.6 to 4.2). Prothrombin Time Results: 19.1?±?2.2 (13.9. to 24.3). TEG Results (Reference Range): R-Time: 8.3?±?2.7 (2–8); K-Time: 2.1?±?1.4 (1–3); Angle: 62.5?±?10.3 (55–78); MA: 63.2?±?10.3 (51–69); G: 9.4?±?3.5 (4.6-10.9); R-Time within normal range: 10 (45.5%) with INR 2.9?±?0.3; Correlation coefficients for INR and each of the 5 TEG variables were insignificant (P?>?0.05). RapidTEG Results (Reference Range): ACT: 132?±?58 (86–118); K-Time: 1.2?±?0.5 (1–2); Angle: 75.4?±?5.2 (64–80); MA: 63.4?±?5.1 (52–71); G: 8.9?±?2.0 (5.0-11.6); ACT within normal range: 9 (40.9%) with INR 2.7?±?0.5; Correlation coefficients for INR and each of the 5 RapidTEG variables were insignificant (P?>?0.05).

Conclusions

TEG, using kaolin activation, and RapidTEG, with kaolin and tissue factor activation, were normal in a substantial percent of warfarin patients, despite an increased INR. The false-negative rate for detecting warfarin coagulopathy with either test is unacceptable. The lack of correlation between INR and all TEG and RapidTEG components further indicates that these methodologies are insensitive to warfarin effects. Findings suggest that intrinsic pathway activation may mitigate detection of an extrinsic pathway coagulopathy.     

Efficacy and safety of the remOVE System for OTSC® and FTRD® clip removal: data from a PMCF analysis

Introduction: The remOVE System (Ovesco Endoscopy AG, Tuebingen, Germany) is a medical device for the endoscopic removal of OTSC or FTRD clips (Ovesco Endoscopy AG, Tuebingen, Germany). The aim of this paper is to assess the efficacy and safety of this system.

Material and methods: A total of 74 patients underwent clip extraction. The standard removal procedure comprises fragmenting the clip by applying an electrical direct current pulse at two opposing sides of the clip.

Results: Clip fragmentation was successful in 72 of 74 patients (97.3%). In two cases (2.7%) clip fragmentation was not possible. In nine cases (12.2%) a clip fragment could not be removed and was left in place. Complications occurred in three cases (4.1%): two minor bleedings near the clip removal site (2.7%), and one superficial mucosal tear resulting from clip fragment extraction (1.4%).

Discussion: Based on this study, the use of the remOVE System for OTSC or FTRD clip removal can be considered safe and effective.     

What determines the management of anxiety disorders and its improvement?

Introduction Although anxiety disorders are highly prevalent, lack of correct diagnosis and related concerns about treatment are serious clinical problems. Several factors affect, positively or negatively, management of anxiety and its improvement. A literature review and thematic analysis was executed to obtain an overview of the types of determinants of anxiety care and its improvement. Methods Literature was identified from electronic database searching (January 1995–March 2006), contact with authors of studies, and searching of websites of organizations concerned with mental health. By using a template analysis approach, a set of strong themes relating to determinants of anxiety care and its improvement was identified. Results The 15 eligible studies identified 43 factors that impeded or facilitated optimal anxiety care and its improvement. Individual characteristics of both patients (n = 13) and professionals (n = 6) were most frequently reported as determinants of anxiety care and its improvement. A considerable number of factors were related to the organizational context (n = 12), such as practice type and location. Some factors related to the social context (n = 4), the economic context (n = 2), or to the innovation itself (n = 6) were identified. Conclusion The findings show that there is a multitude of barriers and facilitators to optimal anxiety care and its improvement. Some determinants are modifiable, and thus responsive to interventions. Examples are collaboration within and between organizations, financial resources and assignment of both an opinion leader and responsible staff. The quality of anxiety care can be improved by systematically designing innovation strategies which are tailored to a selection of the determinants identified in this study.     

The interaction of Geliperm® and cells in culture

The polyacrylamide agarose wound dressing Geliperm® may exert an effect upon cells and may have potential as a tissue culture support material. These two aspects were examined: (a) the ability of the Geliperm to support growth of attachment-dependent and attachment-independent cells; (b) the effect upon cell growth and division in vitro. HeLa and Hep 2, peripheral blood mononuclear and gingival epithelial cells were innoculated onto hydrated Geliperm previously placed into tissue culture trays. Millipore® filters were seeded with HeLa and Hep 2 cells, overlaid with hydrated Geliperm, placed on rings and immersed in tissue culture medium in petri dishes. The cultures were examined at 24-hour intervals for up to five days by light and scanning electron microscopy; cell counts and viability were also determined. None of the cell types seeded on to the Geliperm remained at 24 hours and growth, continuing beneath the Geliperm was significantly impaired in terms of viability and total count for cells examined. Cells cultured on Millipore filter, beneath gel, were of improved appearance compared to cells not covered by Geliperm; cell counts and viabilities at each time were higher in the presence of the Geliperm. It would appear that Geliperm favourably affected the growth of the cells examined when grown in vitro beneath the Geliperm and on a Millipore filter.