ABSTRACT
Inconsistency of care in the Neonatal Intensive Care Unit is a common complaint amongst caregivers. This paper discusses evidence-based medicine and standards of care in relation to personal preference where care-giving choices are concerned. It is suggested that moral distress may be diminished by consistently applying evidence-based practice, adhering to standards of care and optimizing the team dynamic by engaging in consensus-based collaboration.
Subject(s)
Clinical Competence/standards , Evidence-Based Medicine/standards , Intensive Care Units, Neonatal/standards , Patient Care Team/standards , Attitude of Health Personnel , Humans , Infant, Newborn , Patient Care Planning/standardsABSTRACT
The effects of acceleration (Gz) on changes in the levels of cortisol in saliva and of cortisol and testosterone in serum have been studied in 48 cadet pilots exposed to a linear acceleration gradient (0.2 G/s) until a loss of coordination when the mean G value was found to be 5.94 +/- 0.57. Three patterns of salivary cortisol responses were discerned based on Gz-induced significant changes: increase (I; n = 20), decrease (D; n = 8), the magnitude of changes being dependent on the pre-Gz values. Fifteen min after the Gz load, the mean salivary cortisol was significantly higher from the pre-Gz value in all subjects combined. In 19 subjects, who consented to blood sampling, significant increases in serum cortisol were observed both 3 and 15 min post-Gz (by 37 and 57% respectively) while, a significant increase in serum testosterone concentration has been observed only 3 min post-Gz. Testosterone levels 3 min post-Gz were significantly correlated with the final Gz values (r = 0.54; p < 0.05). A significant correlation was also observed between all salivary and serum cortisol values combined (r = 0.696; p < 0.001). It has been concluded that acceleration stress, although of very short duration, proved very potent in eliciting glucocorticoid and androgen responses.
Subject(s)
Acceleration/adverse effects , Hydrocortisone/metabolism , Saliva/metabolism , Stress, Physiological/metabolism , Testosterone/metabolism , Adult , Aircraft , Humans , Hydrocortisone/blood , Radioimmunoassay , Stress, Physiological/blood , Testosterone/bloodABSTRACT
INTRODUCTION: There has been limited characterization of the endocrine stress reactivity of aircraft pilots under the adverse environmental condition of hypobaric-hypoxia. This seems especially true with respect to using the non-invasive technique of salivary hormonal analysis. Thus, the purpose of this study was to characterize the salivary cortisol response to such an environmental stress. METHODS: Some 53 pilots were exposed to 30 min of hypobaric-hypoxia (final pressure, 540 hPa). The salivary cortisol levels were measured at baseline (0 min), at 15 and 30 min into exposure (+15 and +30 min) and 30 min after the exposure ended (+60 min). The cortisol response of each pilot was classified according to the difference between the +30 min and 0 min values. Responder categories were: increase (I), decrease (D) or no change (N). RESULTS: Subjects were not evenly distributed among the three response categories (p < 0.05). The distributions were as follows; D = 5 pilots (9.4%), N = 17 pilots (32.1%), and I = 31 pilots (58.5%). Further, significant (p < 0.05) changes in cortisol levels were noted over the sampling times for the D (+15 min to +60 min < 0 min) and 1 (+15 min to +60 min > 0 min) responders, as well as between the D, N, and I responders at the +15 to +60 min sampling times. CONCLUSIONS: We conclude that no single consistent change in salivary cortisol level occurred among the different subjects in response to the level and duration of hypobaric-hypoxia studied.
Subject(s)
Aerospace Medicine , Decompression Sickness/physiopathology , Hydrocortisone/analysis , Hypoxia/physiopathology , Saliva/chemistry , Stress, Physiological/physiopathology , Adult , Decompression Sickness/classification , Humans , Hypoxia/classification , Male , Stress, Physiological/classification , Time FactorsABSTRACT
The response of the adrenal cortex to a stressor consisting of information about a surgery to be performed the following day was studied in 34 patients by monitoring changes in salivary cortisol. From those, 18 patients were subjected to an individually selected 1 h music program, applied immediately following receipt of the information, and the remaining 16 patients formed a reference group. Another 10 patients, not awaiting surgery, served as controls. Saliva was sampled before the stressor and 5 more samples were collected at 15 min intervals. The stressor produced a 50% rise in salivary cortisol within 15 min. In patients not exposed to music, cortisol levels gradually decreased but after one hour they were markedly higher than the initial level. Listening to music resulted in a marked reduction in salivary cortisol level and after one hour the relative decrease was similar to that observed in control (non-surgical) patients.
Subject(s)
Hydrocortisone/metabolism , Music Therapy , Saliva/metabolism , Stress, Physiological/metabolism , Stress, Physiological/therapy , Adult , Humans , Male , Osmolar Concentration , Preoperative CareABSTRACT
Presence of a circannual rhythm of physical fitness and tolerance of hypoxia was demonstrated. The rhythm of physical fitness had two peaks, in April and September. Using cosinor analysis the acrophase of the circannual rhythm was found to be on Aug. 10 with a 95% confidence limit (May 30-October 16), and the amplitude of the rhythm was 1.6 ml O2/kg/min with a 95% confidence limit (0.22-2.96 ml/kg/min). The circannual rhythm of hypoxia tolerance showed a similar pattern of changes. The maximum value of this rhythm was observed also in April and in autumn, its acrophase was calculated to occur on Aug. 26 with a 95% confidence limit (May 10-October 2), and its amplitude was 33.4 sec with a 95% confidence limit (10.4-56.4 sec.). An analysis of the results of physical fitness tests carried out in training camps confirmed these circannual fluctuations of physical fitness.
Subject(s)
Hypoxia/physiopathology , Oxygen Consumption , Periodicity , Physical Fitness , Adult , Anaerobiosis , Humans , SeasonsABSTRACT
Total urine portions were collected from 31 pilots and candidates for pilots before hypobarism, during 35-40 minutes of hypobarism at a simulated altitude of 5000 m (540 hPa) and following hypobarism. The measured volume of urine portions and amounts of glycosaminoglycans (GAG) and hydroxyproline (Hp) were calculated in 30-minute periods before the test, during hypobaric test and following this test. The average urine volume during hypobarism and average amounts of GAG and Hp in the urine collected during this period were found to be significantly increased in comparison with similar quantities before hypobarism. After the hypobarism the average urine volume was still augmented, whereas the average amount of Hp was lower than before hypobarism. During hypobarism the volume of urine and the amount of GAG and Hp were significantly positively correlated.
