Compassion Fatigue and Compassion Satisfaction among Staff Nurses Working in Critical Care Units

When compassion has been demonstrated for a long time, compassion fatigue could manifest as a negative outcome. Nurses who are affected by compassion fatigue have expressed feelings of depression, which may be related to the constant emotional trauma they experience by virtue of being employed in critical care areas. A cross-sectional descriptive study was conducted to assess compassion fatigue in terms of burnout and secondary traumatic stress and compassion satisfaction among nurses working in the critical care units of a tertiary care hospital in Punjab. A total of 100 staff nurses were selected by convenience sampling technique. Data was collected by socio-demographic profile, professional profile and Professional Quality of Life Scale (ProQOL) Version 5 (2009). The results revealed that 65 percent of the subjects had average level, 34 percent had low and only 1 percent had high level of burnout. It was found that 59 percent of the subjects had average level of secondary traumatic stress, 40 percent had low level and only 1 percent had high level of secondary traumatic stress. Majority (54%) had average level, 45 percent had high level and only 1 percent had low level of compassion satisfaction. Secondary traumatic stress was found to be significantly associated with socio-economic status, duration of work experience in critical care units and leave in past one week. Compassion satisfaction was significantly associated with age, habitat, professional qualification and extra duties performed. Majority of the subjects had average level of burnout and secondary traumatic stress. Secondary traumatic stress was higher in staff nurses who belonged to lower middle class (p=0.05) and who had not taken leave in the past one weak and among staff nurses who had 11-15 years of work experience in critical care units.

Skin camouflage therapy

Camouflage is defined as a combination of materials, colouration or illumination for concealing something. Skin camouflage therapy is the use of specially formulated products to conceal skin diseases and disfigurements, with the goal of giving a temporarily normal appearance. It gives immediate relief in various dermatological disorders, especially those affecting the visible areas, which are known to be associated with profound psychosocial impact. Despite considerable evidence for its emotional benefits, its utilisation among dermatologists in clinical practice remains low. This article is intended to familiarise dermatologists with the use of skin camouflage therapy including its availability, indications, contraindications, techniques, limitations and future trends

Animals models of spinal cord contusion injury

Spinal cord contusion injury is one of the most serious nervous system disorders, characterized by high morbidity and disability. To mimic spinal cord contusion in humans, various animal models of spinal contusion injury have been developed. These models have been developed in rats, mice, and monkeys. However, most of these models are developed using rats. Two types of animal models, i.e. bilateral contusion injury and unilateral contusion injury models, are developed using either a weight drop method or impactor method. In the weight drop method, a specific weight or a rod, having a specific weight and diameter, is dropped from a specific height on to the exposed spinal cord. Low intensity injury is produced by dropping a 5 g weight from a height of 8 cm, moderate injury by dropping 10 g weight from a height of 12.5–25 mm, and high intensity injury by dropping a 25 g weight from a height of 50 mm. In the impactor method, injury is produced through an impactor by delivering a specific force to the exposed spinal cord area. Mild injury is produced by delivering 100 ± 5 kdyn of force, moderate injury by delivering 200 ± 10 kdyn of force, and severe injury by delivering 300 ± 10 kdyn of force. The contusion injury produces a significant development of locomotor dysfunction, which is generally evident from the 0–14(th) day of surgery and is at its peak after the 28–56th day. The present review discusses different animal models of spinal contusion injury.

Conditioning-induced cardioprotection: Aging as a confounding factor

The aging process induces a plethora of changes in the body including alterations in hormonal regulation and metabolism in various organs including the heart. Aging is associated with marked increase in the vulnerability of the heart to ischemia-reperfusion injury. Furthermore, it significantly hampers the development of adaptive response to various forms of conditioning stimuli (pre/post/remote conditioning). Aging significantly impairs the activation of signaling pathways that mediate preconditioning-induced cardioprotection. It possibly impairs the uptake and release of adenosine, decreases the number of adenosine transporter sites and down-regulates the transcription of adenosine receptors in the myocardium to attenuate adenosine-mediated cardioprotection. Furthermore, aging decreases the expression of peroxisome proliferator-activated receptor gamma co-activator 1-alpha (PGC-1α) and subsequent transcription of catalase enzyme which subsequently increases the oxidative stress and decreases the responsiveness to preconditioning stimuli in the senescent diabetic hearts. In addition, in the aged rat hearts, the conditioning stimulus fails to phosphorylate Akt kinase that is required for mediating cardioprotective signaling in the heart. Moreover, aging increases the concentration of Na⁺ and K⁺, connexin expression and caveolin abundance in the myocardium and increases the susceptibility to ischemia-reperfusion injury. In addition, aging also reduces the responsiveness to conditioning stimuli possibly due to reduced kinase signaling and reduced STAT-3 phosphorylation. However, aging is associated with an increase in MKP-1 phosphorylation, which dephosphorylates (deactivates) mitogen activated protein kinase that is involved in cardioprotective signaling. The present review describes aging as one of the major confounding factors in attenuating remote ischemic preconditioning-induced cardioprotection along with the possible mechanisms.

Changing anesthesia trends in cardiothoracic surgeries: a fast changing perspective

Off late, many complicated procedures are being performed throughout the globe in cardiothoracic surgery departments. Many of these advancements can be attributed to advancements in anesthesia techniques, availability of newer and safer anesthetic drugs. However, such role has never been stressed upon whereby advancements became possible in cardiothoracic surgeries. However the journey of advancements and refining of surgical and anesthetic techniques is never ending. The current narrative review throws light on the facts due to which cardiothoracic surgery has become highly safe

Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery: a randomized clinical study

Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. The present study compared the efficacy and safety profile of epidurally administered butorphanol and fentanyl combined with bupivacaine [B]. A total of 75 adult patients of either sex of American Society of Anesthesiologist physical status I and II, aged 20-60 years, undergoing lower abdominal under epidural anesthesia were enrolled into the study. Patients were randomly divided into three groups of 25 each: B, bupivacaine and butorphanol [BB] and bupivacaine + fentanyl [BF]. B [0.5%] 20 ml was administered epidurally in all the three groups with the addition of 1 mg butorphanol in BB group and 100 microg fentanyl in the BF group. The hemodynamic parameters as well as various block characteristics including onset, completion, level and duration of sensory analgesia as well as onset, completion and regression of motor block were observed and compared. Adverse events and post-operative visual analgesia scale scores were also noted and compared. Data was analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher's exact test. Value of P < 0.05 was considered significant and P < 0.001 as highly significant. The demographic profile of patients was comparable in all the three groups. Onset and completion of sensory analgesia was earliest in BF group, followed by BB and B group. The duration of analgesia was significantly prolonged in BB group followed by BF as compared with group B. Addition of butorphanol and fentanyl to B had no effect on the time of onset, completion and regression of motor block. No serious cardio-respiratory side effects were observed in any group. Butorphanol and fentanyl as epidural adjuvants are equally safe and provide comparable stable hemodynamics, early onset and establishment of sensory anesthesia. Butorphanol provides a significantly prolonged post-operative analgesia.

Dose sparing of induction dose of propofol by fentanyl and butorphanol: a comparison based on entropy analysis

The induction dose of propofol is reduced with concomitant use of opioids as a result of a possible synergistic action. The present study compared the effect of fentanyl and two doses of butorphanol pre-treatment on the induction dose of propofol, with specific emphasis on entropy. Three groups of 40 patients each, of the American Society of Anaesthesiologistsphysical status I and II, were randomized to receive fentanyl 2 microg/kg [Group F], butorphanol 20 microg/kg [Group B 20] or 40 microg/kg [Group B 40] as pre-treatment. Five minutes later, the degree of sedation was assessed by the observer's assessment of alertness scale [OAA/S]. Induction of anesthesia was done with propofol [30 mg/10 s] till the loss of response to verbal commands. Thereafter, rocuronium 1 mg/kg was administered and endotracheal intubation was performed 2 min later. OAA/S, propofol induction dose, heart rate, blood pressure, oxygen saturation and entropy [response and state] were compared in the three groups. Data was analyzed using ANOVA test with posthoc significance, Kruskal-Wallis test, Chi-square test and Fischer exact test. A P<0.05 was considered as significant. The induction dose of propofol [mg/kg] was observed to be 1.1 +/- 0.50 in Group F, 1.05 +/- 0.35 in Group B 20 and 1.18 +/- 0.41 in Group B 40. Induction with propofol occurred at higher entropy values on pre-treatment with both fentanyl as well as butorphanol. Hemodynamic variables were comparable in all the three groups. Butorphanol 20 microg/kg and 40 microg/kg reduce the induction requirement of propofol, comparable to that of fentanyl 2 microg/kg, and confer hemodynamic stability at induction and intubation

Approach to a patient with postherpetic neuralgia - a review

Postherpetic neuralgia is a type of neuropathic intractable pain which develops as a sequel of acute herpes zoster infection [shingles]. Postherpetic neuralgia is a vexing problem. The effective treatment of these patients remains a clinical challenge despite a standard pharmacological approach in combination with anticonvulsants and antidepressants. This constant or intermittent pain may go on for months or years and can lead to depression and even suicidal ideations. Here we will discuss the different treatment modalities in present and future scenario