Tracheal tube cuff pressure monitoring: Assessing current practice in critically ill patients at chris hani baragwanath academic hospital

Background. Intubated patients with a high tracheal tube cuff pressure (CP) are at risk of developing tracheal or subglottic stenosis. Recently an increasing number of patients have presented to our hospital with these complications.  Objectives. To determine the frequency of tracheal tube CP measurements and the range of CP and to explore nursing knowledge regarding CP monitoring. Methods. Frequency of CP measurement was assessed using a prospective chart review, followed by an interventionalcomponent. In the final stage nurses completed a self-administered questionnaire. Results. A total of 304 charts from 61 patients were reviewed. Patientsâ€â„¢ ages ranged from 1 to 71 years, with a male preponderance (1.5:1). The majority of charts (87%) did not reflect a documented CP measurement and only 12 charts showed at least one measurement per shift. Only 17% of recorded CPs were within the recommended range; 59% were too low. The questionnaire was completed by only 51% of the 75 respondents. Nursing experience ranged from 3 to 35 years and 92% of respondents were trained in critical care. Knowledge of current critical care CP monitoring guidelines was reported by 62% of the respondents (n=23/37). Only 53% (20/38) reported routinely measuring CP. Almost all respondents (94%) knew of at least one complication of abnormal CP. Conclusion. Having a basic knowledge of CP measurement, having awareness of the complications of abnormal CP and the availability of national best practice guidelines did not translate into appropriate ICU practice. Research into effective implementation strategies to achieve best practice is needed

Health effects of noise exposure levels among instrumentalists in pentecostal churches in port harcourt city, Nigeria

BACKGROUND: Noise is everywhere in our daily lives and becomes very important as it affects our health. Religion is anintegr al part of daily lives and the use of acoustic and electronic instruments in worship. With the increase in sophistry of these instruments come their attendant untoward effects on the auditory organs of the body. This study was to assess noise exposure levels amongst instrumentalists in Pentecostal churches in Port Harcourt City, Nigeria.MATERIALS & METHODS: Following ethical consideration, 216 consenting respondents from 30 churches in Port Harcourt were recruited by table of random numbers. Structured close ended interviewer administered questionnaire incorporating the Hearing Health Quick Test (HHQT) was used to access demographic data. Hearing assessments were also performed using tonal audiometry. The data were entered and analyzed using SPSS version 20.0 and presented using descriptive and inferential statistics.RESULTS: Most 90.28% and 37.96% of respondents were male and within the 39-45 year-old age range respectively. Also, 80.56% of respondents were aware that loud music can cause permanent hearing loss. The prevalence of NIHL andTinnitus was 39% and 38% respectively; and only 19% used Hearing Protection Devices (HPD). Statistically significant risk of NIHL was observed in musicians who had experienced tinnitus, played only amplified instruments and Music experience greater or equal to 10 years (p=0.001).CONCLUSION: Gospel instrumentalists are exposed to noise in the course of their duties which have significant effect on their hearing. Use of Hearing Protection Devices (HPD) as a personal protective equipment is encouraged just as health education of this group of workers is necessary

Effects of Aerobic Exercise Training on Psychosocial Status and Serum Uric Acid in Men with Essential Hypertension: A Randomized Controlled Trial

Chronic psychosocial stress and serum uric acid (SUA) level have been implicated in the etiology and cardiovascular events risk factors in hypertension. Studies have reported significant benefit of exercise in the overall management of hypertension. However; studies on the effect of exercise on psychosocial stress and SUA in the management of hypertension seem scanty. Aim: The aim of this study was to determine the effect of continuous training program on SUA and psychosocial status of black African (Nigerian) population with hypertension. Subjects and Methods: Age-matched randomized controlled trial was used; subjects with diagnosis of hypertension attending the hypertensive clinic of Murtala Muhammed Specialist Hospital (MMSH); Kano; Nigeria form the population for the study. Two hundred and seventeen subjects with mild to moderate (systolic blood pressure (SBP) between 140 and180 and diastolic blood pressure (DBP) between 90 and 109 mmHg) essential hypertension were grouped into continuous (112) and control groups (105). The continuous group involved in an 8 weeks continuous training (60-79 HR max) of between 45 and 60 min; 3 times per week; while the controls group remain sedentary. SBP; DBP; SUA; VO 2 max and psychosocial status were assessed. Student t-test and Pearson correlation test were used in data analysis. Results: The study revealed significant beneficial effect of continuous training programs on VO 2 max; SBP; DBP; SUA; and psychosocial status (P 0.05). Psychosocial status and SUA was significantly and positively and negatively correlated respectively with VO 2 max at P 0.01. Conclusions: This study concludes and supports the recommendations of moderate intensity (continuous) training program in blood pressure reduction; SUA and psychosocial stress management in hypertension

Carotid Artery Stump Pressure and Associated Neurological Changes in Predominantly Symptomatic Carotid Artery Disease Patients Undergoing Awake Carotid Endarterectomy : Cardiovascular Topics

Aim : To determine the mean carotid artery stump pressure (SP) at which patients develop neurological changes while undergoing awake carotid artery endarterectomy (CEA) under cervical block anaesthesia (CBA). Methods : A prospective analysis was carried out of patients undergoing awake CEA under CBA between February 2004 and April 2007. All patients had mean SP measured; with selective shunting on those who developed neurological symptoms on carotid artery clamping regardless of stump pressure. A ball connected to a pressure sensor was put in the patient's contra-lateral hand. Results : Fifty-nine patients had awake CEA; 40 were males with a mean age of 64 years. Indications for CEA were asymptomatic high-grade stenosis in 12 (20) patients and symptomatic stenosis in 47 (80). Seven (12) patients required shunting; one for transient ischaemic attack (TIA) and six for loss of consciousness. Six of these patients had presented with symptomatic disease. Taking the threshold of mean carotid SP of 50 mmHg as an indication for shunting; 22(6 / 27) of patients with a mean SP of 50 mmHg required shunting and only 3(1 / 32) with a mean carotid SP of 50 mmHg needed a shunt. This was not statistically significant. Using a mean carotid SP of ? 40 mmHg as the threshold for shunting; 40(4 / 10) of patients required shunting and 3(1 / 31) with a mean carotid SP of 40 mmHg required shunting. This was statistically significant. Thirteen (22) patients were complicated by transient hoarseness of voice. One (2) had a haematoma that required re-exploration. None of these patients had any major postoperative neurological or cardiological complications. Conclusion : Even though the sample in this study was small; awake CEA under local anaesthesia was seen as a safe procedure. It would appear to be safe to use the mean SP of 40 mmHg as a threshold for selective shunting in CEA under general anaesthesia

Effects of blood pressure and blood pressure reactivity on experimental pain in healthy females

The study investigated whether the relationship between sex and experimental pain report was explained by blood pressure at rest; or during pain task; or both in healthy; young adult females. Univariate analyses indicated significant positive correlation between baseline systolic blood pressure; systolic blood pressure reactivity; and heart rate reactivity ; but not baseline diastolic blood pressure; diastolic blood pressure reactivity; heart rate; weight; height and pain sensitivity. However none of the positively correlated parameters could significantly predict pain threshold or pain tolerance