Social work: why it's needed in intensive care units.
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Humans↗
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[Fear of flying].
All reliable data and statistics point to the safety of flying. Nevertheless many opinion surveys indicate that every third in the population is affected by aviophobia in one way or the other. Aviophobia is simply a specific phobia from which men and women suffer the same degree. It can be found in all social strata and all occupational groups. Aviophobia is felt in very subjective manners and different ways. The structure of reasons of aviophobia can be very complex, whereas it is somewhat easier to identify immediately the causes. Depending upon the degree of aviophobia different strategies of treatment are indicated. Next to the confrontation theraphy the most wellknown therapy is the systematic desensibilization, classic relaxation methods and cognitive strategies for overcoming the phobia. A high degree of success has been achieved with workshops on aviophobia. These workshops show an increasing tendency. It can be expected that in the future exposition treatment working with virtual realities will also prove successful in overcoming aviophobia. First case studies on the effectivity are all ready available and further effects towards corroborating the effectivity are being plant. Successful with a reduced and minimal input of therapeutic council are also self-management books. In order to master aviophobia, it may be sufficient in cases of less intensivity to work with self-management books in the sense of bibliotherapy.
Aerospace Medicine↗
[Carbohydrate-reduced diet and metabolism: about the influence of a 4-weeks isocaloric fat-rich, carbohydrate-reduced diet on body weight and metabolism (author's transl)].
The influence of a 4-weeks carbohydrate-reduced, fat-rich diet on 9 slightly overweighted men was investigated. Caloric and protein intake remained unchanged. 70% were fat, 20% carbohydrates. Glucose, cholesterol, triglycerids, serumproteins, urea, uric acid, sodium and potassium were measured in rest. At a 60 minutes bicycle ergometer test glucose, triglycerids, free fatty acids and glycerol were registrated before and after 20 and 60 minutes work. The intensity was 70% of the maximal oxygen uptake. These were the most important results: (1) Body weight decreased continuously. One of the causes is an elevated heat production. (2) Serum-protein and -glucose remained unchanged. Cholesterol and triglycerides were reduced. Serum-urea, -sodium and -potassium diminished continually. On the contrary, uric acid raised over the normal range. (3) Work performance was reduced for 20%. (4) Hypoglycemic values did not appear. The oxidation of fat by the working muscles, and fat mobilisation increased by a fat-rich diet.
Adult↗
Current problems in cardiology.
Many achievements in medicine in general, and in cardiology in particular, are the result of joint endeavors by cardiologists, surgeons, research workers and engineers. This paper deals briefly with some of the devices which have been developed as a result of this interdisciplinary cooperation. They included cardiac pace-makers, the use of computers in the analysis of electrocardiograms and echocardiograms in intensive coronary care units (ICCU) and in catheterization laboratories. Finally, the use of an intra-aortic balloon pump and other cardioassist devices will be mentioned. The joint efforts of medical and engineering workers have helped to improve diagnosis of acute myocardial infarction and to improbe techniques and results of cardiac surgery. Finally, it is anticipated that through this combined work, more intensive epidemiologic studies will be made possible, new risk factors uncovered with analysis of their significance - all of which will ad to the prevention of heart diseases.
Biomedical Engineering↗
Physiological effects of inspiratory resistance on progressive aerobic work.
The purpose of this study was to determine the potential effects on progressive aerobic work while breathing through a new military type chemical and biological (CB) respirator loaded with three different types of purifying canisters. Twelve healthy well-motivated male subjects (mean age 23 +/- 3 years) participated in the study. Results indicated that mean maximal oxygen uptake (VO2max), time to exhaustion, respiratory exchange ratio, rate of perceived exertion, respiratory rate and tidal volume at exhaustion, maximal lactate and the 2-min post-exercise lactate were not significantly influenced when breathing with the respirator and the canisters in comparison to a laboratory valve. Mean pulmonary ventilation, however, was reduced by 21% while oxygen and carbon dioxide ventilatory equivalents were significantly lower by 9% and 8% respectively. Review of the stage-by-stage responses to the treadmill test between the laboratory valve and respirator/canister conditions indicated no significant differences (NS) in oxygen uptake but slightly lower heart rates (NS). Ventilation was not influenced by the canisters until 80% of VO2max at which time the mean oxygen ventilatory equivalent became significantly lower. Blood lactate was significantly depressed between 60% and 90% VO2max under the respirator/canister conditions. It was concluded that, although physiological adaptation occurred, breathing with the new CB respirator and each of the three purifying canisters had no detrimental effect on progressive aerobic work to exhaustion. However, prolonged work at intensities greater than 80-85% of VO2max would in all probability be impaired when breathing with the CB mask and the canisters.
Adult↗
Adaptive stress response of glutathione and uric acid metabolism in man following controlled exercise and diet.
Ergometer cycling performance as well as acute exercise-induced changes in the metabolism of energy-intermediates and glutathione (GSH) were investigated in skeletal muscle (SM) of 15 healthy young male subjects (VO(2max) approximately 54.7 mL kg(-1) min(-1), age approximately 25 years), before and after 3 days of controlled 'ìoverload-training' in combination with either high (62% of energy intake) or low (26% of energy intake) dietary intake of carbohydrates. The intake of a carbohydrate-rich diet clearly reduced the depletion of SM glycogen following the short-term training period, paralleled with a positive effect on the endurance performance, but not on high-intensity work-performance. An 'delayed over-reaching effect', defined as impaired work-performance, was observed after 2.5 days of recovery from the short-term training period, irrespective of the carbohydrate content of the diet and basal glycogen level in SM. Taken together, the main and novel findings of present investigation are: (1) an acute decrease of reduced GSH content and altered thiol-redox homeostasis in SM induced by strenuous high-intensity exercise; (2) an adaptive elevation of basal GSH level following the short-term training period; (3) an adaptive decrease of basal GSH level following 2.5 days recovery from training; (4) evidence of a relationship between the SM fibre type, physical performance capacity and GSH turnover during acute bouts of exercise; and (5) no evident effect of the level of carbohydrate intake on metabolism of GSH or energy intermediates. Furthermore, the induction of acute oxidative stress in exercising human SM and the adaptive responses to training are suggested to provide a protective antioxidant phenotype to the exercising SM during periods with repeated intense intermittent training.
Adaptation, Physiological↗
Assessing need for intensive case management in long-term care.
This article presents a brief screening tool to help case managers identify clients in a home- and community-based services (HCBS) program who need more intensive social work case management (CM). Using existing data from a case management time study (N = 242) and a content analysis of 70 cases in a Medicaid waiver-funded HCBS program, this study highlights a number of issues, such as dementia-related behavior problems, noncompliance with treatment, poor informal caregiver health and mental health, and a conflicted or problematic relationship between client and caregiver, which are useful in predicting need for intensive case management. Kappas for interrater reliability and t tests for discriminant validity show these items to be reliable and valid. This tool will allow for better allocation of CM resources in terms of case manager time and type of expertise needed to address these issues.
Aged↗
Effect of increasing work rate on metabolic responses of the donkey (Equus asinus).
Oxygen consumption (VO2) and concentration of venous blood metabolites were measured in donkeys trained to run and to pull loads on a treadmill. VO2 in two donkeys running at maximal speed on a 9.8% slope was 110 +/- 2 ml.min-1.kg-1, approximately 22 times preexercise VO2. Average heart rate at maximal VO2 (VO2max) was 223 +/- 2 beats/min, five times the preexercise heart rate. Blood lactate increased 14-fold, and blood glucose did not change (P > 0.05). Animals running up a 4% incline and incremental draft loading of five donkeys walking on the level were also studied. The total energy cost of walking unloaded was 2.86 +/- 0.06 J.m-1.kg live wt-1. During low- to medium-intensity draft work for 25 min, glucose fell below preexercise values (P < 0.05), whereas plasma hematocrit and cortisol increased (P < 0.05). Blood lactate remained unchanged up to approximately 40% VO2 max but increased 170% at approximately 60% VO2max. The responses in donkeys are similar to those of exercising horses except for the rapid decline in blood glucose observed during low-intensity exercise and the lower lactate levels at both the high-intensity exercise and the apparent anaerobic threshold.
Animals↗
[Sports and type I diabetes: personal experience].
Energy for muscular exercise is derived initially from the breakdown of muscle glycogen, and later from circulating glucose released by the liver and from non-esterified fatty acids. Muscle glucose uptake may increase 20-fold. In normal subjects, insulin secretion declines and release of counter-regulatory hormones increases. In type 1 diabetes, glycaemic changes during exercise depend largely on blood insulin levels. In the young diabetic, during insulin deficiency, and therefore in a poor degree of metabolic control, i.e. hyperglycaemic and ketotic, exercise accentuates hyperglycaemia and ketosis, leading to extreme fatigue. If the insulin dosage is too high, the increase in muscular assimilation, combined with the shutdown of liver glucose production, may result in a severe hypoglycaemia. During the recovery period, the repletion of muscular and hepatic glycogen stores may also provoke an hypoglycaemia during hours after the cessation of muscular work. The recommendations for physical activity in type 1 diabetes include: 1) obtain good metabolic control; 2) in the few hours preceding the exercise, ingest complex carbohydrates; 3) in the case of unforeseen physical activity, increase glucose consumption immediately before, during, and after the activity; 4) in the case of foreseen activity, decrease the insulin dose (from 10 to 50%) acting during and even after intense muscular work; 5) do not inject the insulin at a site that will be heavily involved in the muscular activity.
Blood Glucose↗
[A hygienic assessment of the work of students on Macintosh computers].
Various kinds of works of 6-11th-form schoolchildren on Macintosh computers were physiologically and hygienically assessed at the lesson of information science and computer engineering (ISCE), as well as typing. The fatigue of a visual analyzer was due to the time of looking through the data available on the display; the adverse changes of the higher nervous activity depends on the complexity of educational materials and the intensity of work on a computer. Three-hour studies in ISCE should be excluded from the time able of lessons as they do not meet hygienic requirements.
Adolescent↗
[Multidisciplinary treatment program for chronic low back pain, part 1. Overview].
UNLABELLED: A multimodal treatment program is presented in cases of functional restoration for chronic low back pain. The study comprises four parts. Part I gives an overview of the different results of the study. Part II focuses on the medical and functional examination in comparison with persons who do not suffer from back pain. Part III describes psychosocial aspects (depression, complaints, ways of coping, disability) and psychotherapy. In part IV prognostic factors and their reliability for predicting treatment outcome (return to work, pain intensity, self-assessment of success by patients) are examined. In addition the relevant effects of the program on social and health care systems are also addressed. PROBLEM: The incidence of low back pain is continuously increasing, causing tremendous costs for the health insurance system. Therefore effective treatment methods are needed that take into account somatic, psychological and social factors. Chronic low back pain is conceptualized as a complex phenomenon including biological, social and psychological aspects, all of which should be addressed in a treatment program. A multimodal treatment program for chronic low back pain is presented, in which physical activity and cooperation of the patient are the primary targets. Therapeutic aims focus less on pain reduction and emphasize instead pain control, individual responsibility of the patient, and early reintegration into the working environment. The specific goals of the program are to increase the physical abilities of the patients (i. e., flexibility, strength and endurance), to increase patients' knowledge and the use of body mechanics and back protection techniques, to decrease medication-intake, to decrease dependency on the medical community, to improve patients' own positive coping skills and levels of emotional control, to increase the patient's activity level at home and to facilitate a return to work. METHODS: A total of 90 disabled patients with chronic low back pain were admitted to an 8-week program of functional restoration and behavioral support. The program consisted of a pre-program (3 weeks: education, stretching and calisthenic exercises) and an intensive treatment period (aerobics, functional strength and endurance exercises, back exercises, cognitive behavioral group therapy, relaxation training, socioeconomic and vocational counseling) which took place for 5 weeks, 7 h a day, on an outpatient basis. Apart from a medical examination and a personal interview, the patients' physical impairment, pain descriptions, and psychological distress (according to different criteria for evaluation) were also measured. This includes variables such as depression, psychovegetative complaints, quality of life and workplace satisfaction, disability, and coping with disease. Measurements were repeated at the end of the 8-week program, and after 6 and 12 months. RESULTS: In total 84 patients (94 %) were examined following treatment. There was a statistically significant improvement in flexibility, strength, lifting capacity, and endurance measurements ( p < 0.001) at the end of the treatment. In addition, significant reductions in pain, disability, depression, and psychovegetative signs were demonstrated ( p < 0.001). There was a decreased use of medical treatment for back pain following the program, with 42 % of the patients refraining from the intake of analgesics, followed by a significant reduction in physiotherapy and the consultation of physicians. Assessment of the patients' reported increased activity levels at home also supported findings that statistical improvements were significant. Sixty-three percent of the patients were found to have returned to active, productive work following discharge from the program. Most of the improvements remained stable at the 6- and 12-month follow-up examinations. CONCLUSION: The results demonstrate the effectiveness of the multimodal program of functional restoration, not only concerning positive changes in somatic, psychological and physical variables, but also with respect to the number of patients who returned to work. Our methods are also compared with the discrepant results of multimodal treatment in the United States and Scandinavia.
English Abstract↗
[Taking care of the caregiver in the working setting: an action proposal].
This is an experience report that aimed to stimulate the sensitiveness of a nursing team towards their self care and to develop on the working environment actions to promote it. The theoretical framework adopted followed the assumptions of Watson. The subjects were two nursing teams who work in intensive care unities in which different activities were made such as extreching, dynamics and relaxing activities. It obtained a positive answer from the groups which experienced the feeling of been taken care of and valued and could know themselves better and practice some actions of care towards their self. In this way, the performed actions and interactions could stimulate and propitiate the self care inside and outside of the working environment and could also make them aware to the importance of this kind of care in their working practices.
Nursing, Team↗
The human endometrium as a fertility-determining factor.
Intensive research work has been performed to better understand the regulation of the endometrium and its clinical implications to improve implantation. Although many proteins and molecules may influence endometrial development, their co-ordinated contribution to the implantation process is still poorly understood and a translation into clinical use has not sufficiently been performed. Clinical evaluation of the endometrium by ultrasound and other techniques, like endometrial biopsy and analysis of uterine secretions, has been intensively studied and therapeutic options to improve endometrial function have been suggested and tested. Systemic treatment with heparin, aspirin or corticosteroids did not result in improved implantation rates. Gene therapy and cervical treatment, e.g. with seminal plasma, are still in the phase of clinical research. Therefore, this review focuses on different aspects of endometrial research, which all contribute to the diagnosis, evaluation and therapy of endometrial function and dysfunction. First, the endometrial development towards a receptive milieu is described. Second, the actual clinical evaluation of endometrial receptivity, possible therapeutic strategies and in particular, the evaluation of endometrial function in the non-natural situation of hormonal stimulation is critically evaluated. In conclusion, the endometrium shall be considered as an important fertility-determining factor and therapeutic options should be developed in near future.
Animals↗
Chemoreflex modulation of ventilatory dynamics during exercise in humans.
The precision of arterial blood gas homeostasis following a change of work rate depends on the response kinetics of ventilation. The carotid bodies (CB's) have been proposed as modulators of these kinetics. The present investigation was undertaken to determine whether the effect is specific to CB activation or whether other factors that augment the exercise hyperpnea would produce a similar response. We therefore established the effects of increased CB and central (C) chemoreflex activation on the inspired ventilatory (VI) dynamics for moderate-intensity cycling. Work tests were separately performed with air, 12% O2 to increase CB activity, 100% O2 to "abolish" CB activity, and CO2 in O2 to increase C activity. The time constant of the VI response was substantially shortened by hypoxia (40 s) compared with air breathing (58 s) and increased by 100% O2 (92 s) and, even more so, by CO2 in O2 (101 s). We conclude that increased carotid (but not central) chemoreflex responsiveness speeds the kinetics of the exercise hyperpnea by a process that is not merely the consequence of increased ventilatory drive.
Adult↗
Workers' beliefs and expectations affect return to work over 12 months.
BACKGROUND: Successful management of workers on sick leave due to low back pain depends on the identification by the occupational physician of modifiable prognostic factors in the early phase of sick-leave. The prognostic value of factors which influence the course of low back pain and return to work in occupational health care is unclear. METHODS: Secondary data analysis in a cohort of 299 workers on sick leave between 3 and 6 weeks due to low back pain was applied. We investigated the association of a broad set of prognostic indicators related to characteristics of worker, job, low back pain and psychosocial issues on return to work lasting at least 4 weeks (lasting-RTW) and minimally 1 day of first return to work (first-RTW). Relationships were studied using Cox regression analysis and covered a follow-up period of 12 months. The explained variation of the models was also calculated. RESULTS: The median time to return to work using lasting-RTW and first-RTW was 76 and 71 days respectively. In addition to individual analysis of potential predictive factors a backward selection procedure resulted in the following multivariable model: self-predicted timing of return to work, pain intensity, job satisfaction, social support, pain radiation, expectations of treatment succes of the occupational physician. Similar results were found for first-RTW. The explained variance of the multivariate model of lasting-RTW was 18%. CONCLUSIONS: Factors concerning the expectations and beliefs of the worker affected the RTW process. Knowledge of these factors by the occupational physician in the early phase of low back pain and sick-leave may contribute to solutions to promote return to work.
Adolescent↗
Clinical review: the Israeli experience: conventional terrorism and critical care.
Over the past four years there have been 93 multiple-casualty terrorist attacks in Israel, 33 of them in Jerusalem. The Hadassah-Hebrew University Medical Center is the only Level I trauma center in Jerusalem and has therefore gained important experience in caring for critically injured patients. To do so we have developed a highly flexible operational system for managing the general intensive care unit (GICU). The focus of this review will be on the organizational steps needed to provide operational flexibility, emphasizing the importance of forward deployment of intensive care unit personnel to the trauma bay and emergency room and the existence of a chain of command to limit chaos. A retrospective review of the hospital's response to multiple-casualty terror incidents occurring between 1 October 2000 and 1 September 2004 was performed. Information was assembled from the medical center's trauma registry and from GICU patient admission and discharge records. Patients are described with regard to the severity and type of injury. The organizational work within intensive care is described. Finally, specific issues related to the diagnosis and management of lung, brain, orthopedic and abdominal injuries, caused by bomb blast events associated with shrapnel, are described. This review emphasizes the importance of a multidisciplinary team approach in caring for these patients.
Abdominal Injuries↗
Effects of fire fighting uniform (modern, modified modern, and traditional) design changes on exercise duration in New York City Firefighters.
Fire departments have replaced traditional uniforms with modern, more thermal protective gear. Although the new uniforms afford superior burn protection, they may reduce work time. Our purpose was to determine if exercise time was (1) reduced by wearing the modern versus traditional uniform, and (2) increased by a design change to a modified modern uniform (T-shirt and short pants rather than a shirt and long pants under the outer uniform). Male firefighters (n = 23; age 27 to 59) performed a maximum exercise test in gym clothes (maximal oxygen consumption = 46 +/- 9 ml/kg/min) and then returned on separate days to exercise using a moderately high intensity, constant work rate treadmill protocol while wearing fire fighting breathing apparatus and each of three uniforms. Firefighters exceeded anaerobic threshold by 1 minute and eventually reached or exceeded maximum heart rate and maximal oxygen consumption. Exercise time in modern (15 +/- 3 min) was significantly less than in traditional (18 +/- 5 min) uniform. Exercise time in modified modern (17 +/- 5 min) was significantly greater than in modern and not significantly different than in traditional uniforms. The rate of change in oxygen consumption and water loss were significantly affected by uniform type, with faster rates in modern compared with modified modern or traditional uniforms. These findings show the impact that design changes have on energy demands and exercise duration.
Adult↗
Nurses' attitudes toward computerised care plans in intensive care. Part 1.
The purpose of this quantitative study was to measure nurses' attitudes towards the use of computerised nursing care plans in intensive care. 41 nurses, working in an adult intensive care unit (ICU), completed the closed-structured questionnaire. The results of the study revealed that age, type of shift worked, length of time qualified and length of time employed on the unit influenced nurses' attitudes towards computerised care plans. It was concluded that prior to the introduction of a computerised care planning system, it is essential that nurses' attitudes are identified. In so doing, a system can be introduced that will match the capabilities of and acceptance by the nursing staff.
Attitude of Health Personnel↗