Does Far-Infrared Therapy Improve Peritoneal Function and Reduce Recurrent Peritonitis in Peritoneal Dialysis Patients?

The use of peritoneal dialysis in end-stage renal disease is increasing in clinical practice. The main purpose of this study was to evaluate the effect of far-infrared radiation therapy on inflammation and the cellular immunity of patients undergoing peritoneal dialysis. We recruited 56 patients undergoing peritoneal dialysis, and we included 32 patients for the experimental group and 24 patients from the control group in the final analysis. The experimental evaluation in our study was as follows: (1) We used abdominal computed tomography to explore the changes in abdominal blood vessels. (2) We compared the effects of peritoneal dialysis using blood glucose, HbAlC, albumin, urea nitrogen, creatinine, white blood cells, hs-CRP; peritoneal Kt/V of peritoneal function, and eGFR. (3) We compared the cytokines' concentrations in the two groups while controlling for the other cytokines. Results and Discussion: (1) There was no significant difference in the abdominal blood vessels of the experimental group relative to the control group according to abdominal CT over the 6 months. (2) Our study demonstrates statistically significant effects of FIR therapy on the following parameters: creatinine (p = 0.039 *) and hs-CRP (p < 0.001 **) levels decreased significantly, and eGFR (p = 0.043 *), glucose (p < 0.001 **), and albumin (p = 0.048 *) levels increased significantly. Our study found that in the experimental group, creatinine and hs-CRP levels decreased significantly due to FIR therapy for 6 months. However, our study also found that the glucose level was significantly different after FIR therapy for 6 months. Peritoneal dialysis combined with FIR can reduce the side effects of the glucose in the dialysis buffer, which interferes with peritoneal inflammation and peritoneal mesothelial cell fibrosis. (3) In addition, we also found that no statistically significant difference in any inflammatory cytokine after FIR therapy. IFN-γ (p = 0.124), IL-12p70 (p = 0.093), IL-18 (p = 0.213), and TNF-α (p = 0.254) did not exhibit significant improvements after peritoneal dialysis with FIR treatment over 6 months. Conclusions: We found that the effectiveness of peritoneal dialysis was improved significantly with FIR therapy, and significant improvements in the peritoneal permeability and inflammatory response were observed.

Effectiveness of Self-administered Acupressure for Family Caregivers of Advanced Cancer Patients With Insomnia: A Randomized Controlled Trial.

BACKGROUND: Sleep disturbances are common among family caregivers (FCs) of patients with advanced cancer. Self-administered acupressure can combat insomnia, but no study has been conducted to evaluate its efficacy in caregivers of patients with advanced cancer. OBJECTIVE: The aim of this study is to investigate whether self-administered acupressure improves sleep quality for FCs of patients with advanced cancer. METHODS: Family caregivers of patients with advanced cancer who reported sleep disturbance (Pittsburgh Sleep Quality Index scores >5 in recent months) were recruited. The experimental group self-administered acupressure at the Baihui (GV20), Fengchi (GB20), Neiguan (PC6), and Shenmen (HT7) points over a 12-week period, whereas the comparison group received sleep hygiene education. Sleep quality was assessed subjectively at 4, 8, and 12 weeks after the intervention using the Pittsburgh Sleep Quality Index and objectively using actigraphy measurements. Improvements in sleep quality were analyzed using a generalized estimating equation. RESULTS: Compared with the control group, the experimental group demonstrated significantly lower sleep latency (Wald χ2 = 11.49, P = .001) and significantly better sleep efficiency (Wald χ2 = 5.24, P = .02) according to actigraphy measurements, but Pittsburgh Sleep Quality Index scores did not differ significantly between the groups. CONCLUSIONS: Self-administered acupressure did not demonstrate favorable effects on subjective sleep quality, but did reduce sleep latency and improve sleep efficiency, according to actigraphy measurements. Self-administered acupressure may help relaxation and sedation and promote sleep in FCs. IMPLICATIONS FOR PRACTICE: Healthcare providers may consider advising FCs to apply this self-administered acupressure to improve their sleep latency and sleep efficiency.

[Factors Related to Prodromal Symptoms in Patients With Acute Myocardial Infarction].

BACKGROUND: Prior to acute myocardial infarction (AMI), patients may experience different prodromal symptoms (PSs) that may delay their seeking medical treatment prior to hospitalization. PURPOSE: This study was designed to identify the relationship between PSs and demographics, including gender and age, acute symptoms, and pre-hospital delay time, in patients with AMI. METHODS: A cross-sectional study design was applied, and a convenience sampling approach was used to recruit 121 patients in the emergency room of a medical center located in southern Taiwan. Instruments, including a demographic and disease variables datasheet, acute symptoms of AMI, McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS), and pre-hospital delay time, were used. Chi-square, Fisher exact, and Spearman correlation coefficients tests were used to examine the respective relationships between the targeted variables and PSs. Binary logistic regression analysis was used to determine the important determinants of PSs. RESULTS: Most (83.5%) of the participants had experienced PSs. The MAPMISS score was significantly associated with age (ρ= -.20, p < .05) and marital status (Z = 2.23, p < .05). Three prodromal symptoms, including pain or discomfort in left breast, pain or discomfort in the legs, and change in headache intensity, were significantly different between male and female participants. Only one symptom, pain or discomfort in the central high chest area, differed significantly among age groups. Binary logistic regression analysis found that participants in the 40-60 years old age group were 3.19 times more likely to develop PSs than their peers in the 65 years old and older group. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of this study suggest that PSs should be incorporated into medical education to increase the cognition and awareness of healthcare professionals toward PSs and to improve patient education overall in order to strengthen public awareness regarding the relationship between PSs and AMI and subsequently increase the timeliness of their seeking appropriate medical help.

Effects of Far-Infrared Therapy on Foot Circulation Among Hemodialysis Patients With Diabetes Mellitus.

BACKGROUND: Far-infrared radiation (FIR) therapy improves vessel dilation, circulation, vessel endothelial function, and angiogenesis and reduces atherosclerosis. However, evidence of FIR therapy's effects on foot circulation among diabetic patients undergoing hemodialysis is scarce. AIM: To determine whether FIR therapy improves foot circulation in diabetic patients undergoing hemodialysis. DESIGN: Quasi-experimental. METHODS: In June to November 2017, diabetic patients undergoing hemodialysis (N = 58) at a hemodialysis center in northern Taiwan were divided into two groups: the experimental group (n = 31) received FIR therapy to the bilateral dorsalis pedis artery (40 min/session, 3 times/week for 6 months) and the control group (n = 27) received conventional dialysis care. Paired t test, independent samples t test, two-proportion Z test, and repeated-measures analysis of covariance were performed to compare changes from baseline to the end of the 6-month intervention between the groups. RESULTS: Significant positive effects of FIR therapy on temperature, pulse, and blood flow of the dorsalis pedis artery were observed. Sensitivity to pain, tactility, and pressure also improved significantly in the experimental group. The Edinburgh Claudication Questionnaire revealed that the experimental group had reductions in subjective experiences of soreness, tingling, and coldness in the feet. CONCLUSION: The findings of significant improvements to objective and subjective measures of blood flow and neural function in the experimental group indicate that FIR therapy improves blood circulation to the feet. This therapy thus has great potential to be an effective adjuvant treatment for patients with diabetes mellitus undergoing hemodialysis.

The development of a six-station OSCE for evaluating the clinical competency of the student nurses before graduation: A validity and reliability analysis.

BACKGROUND: Assessing clinical competency in undergraduate nursing students is essential before they enter clinical practice. The objective structured clinical examination (OSCE) is widely used and is part of clinical competency assessment. Aim The aim of this study was to develop and validate a six-station OSCE for evaluating the clinical competency of the student nurses before graduation. METHODS: One-group longitudinal observational study. An OSCE of 6 stations of 10 min each was adopted. Blueprint setting, checklist development, and standard patient and examiner training were conducted. The mean, standard deviation, item scale (item-total correlation) and comparisons of extreme groups for item analysis. The inter-coder of examiners and inter-case of students were used to test reliability. Content Validity and concurrent validity were used to evaluate validity of OSCE. RESULTS: One hundred nursing students participated in this study. The mean OSCE score of students who passed the registered nurses' examination was significantly higher than that of students who failed. Significant differences in OSCE score between students who remain versus left clinical job were observed at 3, 6 and 9 months after graduation. CONCLUSION: The OSCE is predictable method for assessing undergraduate students' first year clinical retention.

The Relationship Between Nursing Workload, Quality of Care, and Nursing Payment in Intensive Care Units.

BACKGROUND: Nursing workload is highly associated with patient safety. It has been argued that the imbalance between nursing payment and nursing workload in Taiwan National Health Insurance (NHI)-covered intensive care units (ICUs) has resulted in the inadequate allocation of nursing manpower. However, limited empirical data are currently available to support this argument. PURPOSE: The aim of this study was to investigate the correlation between nursing workload, quality of care, and NHI-covered nursing payments in ICU settings. METHODS: This macrodata analysis study retrieved data from the existing ICU patient classification system, nursing quality monitoring system, and infection control monitoring system of a medical center in central Taiwan. Data on the Therapeutic Intervention Scoring System-28 (TISS-28) and non-TISS-28 scores, nursing hours, and nursing labor utilization rate were retrieved for the 23-month period beginning in January 2013 and ending in November 2014. The indices of care quality used in this study included incidence of falls, pressure sore density, incidence of restraint use, incidence of tube self-extraction, and infection density. RESULTS: A total of 92,442 data sets were collected from eight ICUs, with 61% of the direct ICU nursing hours categorized as TISS-28 and 39% categorized as non-TISS-28. Mean nursing hours totaled 12.5 hours. The direct nursing hours, the total nursing hours, the bed occupancy rate, the nursing hours calculated by patient classification system, and the nursing hours calculated by nurse-patient ratio were statistically, significantly correlated respectively with all of the care quality indices except for incidence of falls. The number of items of patient care in the patient classification records was greater than that of NHI-covered nursing payments. The NHI-covered nursing payment for every patient accounted for only 4.77% of the total medical expenses in the ICU. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Data from the patient classification database, quality monitoring database, and medical cost database indicate excessive nursing workload and underpayment from the Taiwan NHI program. Current nursing workload was significantly associated with care quality. This study provides empirical data for administrators to consider when revising nursing staffing and NHI payment policies.

Situated teaching improves empathy learning of the students in a BSN program: A quasi-experimental study.

BACKGROUND: Empathy is an important clinical skill for nursing students, but it is a characteristic difficult to teach and assess. OBJECTIVE: To evaluate the effect of situated teaching on empathy learning among undergraduate nursing students. DESIGN: A cohort study with pre-post-test quasi-experimental design. PARTICIPANTS AND SETTING: The 2nd-year students were enrolled from two BSN programs. METHODS: The teaching program was completed over 4 months on the basis of experiential learning theory which integrated the following four elements: classroom-based role play, self-reflection, situated learning and acting. The Jefferson Scale of Empathy-Health Profession-Student version was administered before and after the program. Objective Structure Clinical Examination (OSCE) was administered at the end of program and a rubrics scale was used to measure empathy. A generalized estimation equation was used to identify the effect of subjective empathy, and an independent t-test was used for the objective assessment between two groups. RESULTS: A total of 103 students were enrolled. The results showed that subjective empathy increased significantly in experimental group. In the Objective Structured Clinical Examination, examiners and standard patients gave significantly higher empathy scores to the situated teaching group than the control group. CONCLUSIONS: The present study indicated that situated teaching can improve empathy learning of the nursing students. However different methods of assessment of empathy produce different results. We therefore recommend that multiple measurements from difference perspectives are preferable in the assessment of empathy.

Lipid Emulsion Enriched in Omega-3 PUFA Accelerates Wound Healing: A Placebo-Controlled Animal Study.

BACKGROUND: The Omega-3 (ω-3) polyunsaturated fatty acids (PUFAs) generate bioactive lipid mediators that reduce inflammation. The present study evaluated the effect of SMOFlipid containing ω-3 PUFAs on wound healing. METHODS: Rats were divided into a SMOFlipid (SMOF) group and a 0.9% saline (placebo) group, with eight rats in each group. Wound excision was performed on the dorsal surface of each rat. In the SMOF group, 1 gm/kg SMOFlipid was dissolved in 3 mL saline as a treatment; in the placebo group, 3 mL saline was prepared as a treatment. The treatments were administered intravenously at an initial rate of 0.2 mL/kg body weight/h immediately after wounding, for 72 h. Blood samples were collected for white blood cell, tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 measurements at the baseline and at 1, 6, 12, 24, 48, and 72 h after intervention. Wound areas were measured over a 2-week period after excision, and a histological examination was performed. RESULTS: Compared with the placebo group, SMOFlipid supplementation engendered significant decreases in the wound area on day 3 (78.28 ± 5.25 vs. 105.86 ± 8.89%), day 5 (72.20 ± 4.31 vs. 96.39 ± 4.72%), day 10 (20.78 ± 1.28 vs. 39.80 ± 10.38%), and day 14 (7.56 ± 0.61 vs. 15.10 ± 2.42%). The placebo group had a higher TNF-α level than the SMOF group at 72 h. The IL-10 level was higher in the SMOF group than in the placebo group at 48 h. Histological analysis revealed a higher rate of fibroblast distribution and collagen fiber organization in the SMOF group (P = 0.01). CONCLUSION: SMOFlipid enriched in ω-3 PUFA accelerates wound healing.

[The Effect of Family Member Reminders on Reducing Anxiety and Unplanned Extubation in ICU Patients].

BACKGROUND: Patients with endotracheal intubation often experience anxiety because they are unable to express their needs freely. However, the family members of these patients are able to provide encouragement, comfort, and substantive support. PURPOSE: The aims of the present study were: (1) to compare the anxiety scores, vital signs, and incidence of unplanned extubation (UE) between the two comparison groups; (2) to compare the differences in vital signs before and after the intervention in the experimental group; and (3) to explore the satisfaction of patients in the experimental group with the intervention. METHODS: A quasi-experimental, pretest-posttest design was carried out. A convenience sampling was adopted to recruit patients with endotracheal intubation in intensive care units (ICUs). The experimental group listened to the UE-prevention reminders of their family members for three times a day for 4 days. The control group was provided with usual care. RESULTS: (1) No significant difference was observed in the anxiety scores between the two groups (t = -1.282, p = .205). (2) A repeated-measures analysis found no significant difference in vital signs, taken nightly at 10 p.m., between the experimental and control groups (p > .05). (3) The experimental group registered significantly lower heart rates, systolic blood pressure, diastolic blood pressure, and mean arterial pressure after the conclusion of the intervention (p < .05). However, no significant pre-test / posttest difference in breathing rate was observed for this group. (4) A large majority (89%) of the experimental group expressed satisfaction with the intervention treatment program. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The present study, which used a DVD of family reminders encouraging and reminding patients about intubation safety, achieved a very high level of patient satisfaction and reduced their anxiety-related vital signs. The results may serve as a reference for providing intervention treatment to patients with endotracheal intubation in ICUs.

Prophylactic acetylsalicylic acid attenuates the inflammatory response but fails to protect exercise-induced liver damage in exercised rats.

This study evaluated the effects of acetylsalicylic acid (ASA) on exercise-induced inflammatory response, muscle damage, and liver injury in rats. Wistar-Kyoto (WKY) rats were divided into six groups: control (C), exercise (E), C+20mg ASA, E+20mg ASA, C+100mg/kg ASA, and E+100mg ASA groups. ASA or a vehicle was orally administered through gavage 1h before a treadmill test. Upon trial completion, blood was drawn at 1, 12, and 24h for biochemical analysis, and livers were excised at 24h for a histological assessment. Our results revealed that 100mg/kg ASA significantly reduced interleukin (IL)-6 and tumor necrosis factor (TNF)-α levels in the E groups; however, the IL-10 level was considerably increased. Moreover, aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels and histological hepatic damage increased significantly in the E+100mg ASA group compared with the corresponding changes in the E group. These results suggest that the prophylactic administration of particularly high-dose ASA alleviates exercise-induced inflammatory response but exacerbates liver injury.

Effect of integrated caregiver support on caregiver burden for people taking care of people with cancer at the end of life: A cohort and quasi-experimental clinical trial.

BACKGROUND: Previous studies have shown small-to-medium effects of support on reducing the caregiver burden for advanced cancer patients. A dearth of studies utilized longitudinal design to examine and evaluate the effect of support for the caregiving burden till the patient's death. OBJECTIVES: To test the ability of an integrative intervention program for caregivers of advanced cancer patients to lower caregiving burden as death approaches. DESIGN: A two-group comparative design with repeated measures. SETTING: Two cancer wards of a single university hospital. PARTICIPANTS: Advanced cancer patients (N=81) and their caregivers were allocated into two groups: an experimental group (N=40) receiving coping strategies, assistance, recourses, and education intervention and a control group (N=41) receiving standard care. METHODS: Caregivers received training in the caregiver support intervention at least 3 times every 2 weeks to help them reduce their caregiving burden. Subjective (Caregiver Reaction Assessment) and objective (Heart Rate Variability) measures of caregiver burden were evaluated for caregivers of patients approaching death. Only data within 3 months before the patients' death were analyzed. RESULTS: Caregiver self-efficacy significantly increased and the subjective caregiving burden significantly decreased in the experimental group as patients' death approached. Heart Rate Variability also indicated a calming effect of the intervention, helping caregivers face patients' death. CONCLUSIONS: The caregiver support intervention can increase caregiver self-efficacy and reduce the subjective caregiving burden. Heart Rate Variability parameters have the potential to be useful for monitoring caregiver burden in facing patients' death.

Development of an Experience-Based Caregiver Burden Scale in Advanced Cancer.

BACKGROUND: Family caregivers complete caregiving tasks but may not explore their own feelings about their caregiving experience. OBJECTIVES: The objectives of this study were to develop an experience-based caregiving burden scale for caregivers of patients with advanced cancer and to estimate its predictive value for depression. METHODS: The instrument was first systematically constructed on the basis of data obtained from detailed interviews of 12 caregivers. Then, 134 caregivers completed the questionnaire as a field test to estimate the psychometric properties of the developed tool. RESULTS: We achieved a 13-item Caregiver Burden Scale (CBS) with 3 dimensions: health impact, role competence, and resource and growth. The construct validity, criterion-related validity, and internal consistency reliability of the CBS were satisfactory. A CBS score higher than 25.5, or health impact subscale score higher than 10.5, or role performance score higher than 7.5 indicated significant depression and the need for assistance from healthcare providers. CONCLUSION: The CBS has adequate reliability and validity to assess the burden experienced by caregivers of patients with advanced cancer. It was also predictive for significant depression. IMPLICATION FOR PRACTICE: Nurses may use the CBS to provide timely assistance to family caregivers during their caregiving for a patient with advanced-stage cancer.

A nurse-family partnership intervention to increase the self-efficacy of family caregivers and reduce catheter-associated urinary tract infection in catheterized patients.

The purpose of this study was to evaluate the effects of a nurse-family partnership model on the self-efficacy of family caregivers (FCs) and the incidence of catheter-associated urinary tract infection (CAUTI) among patients. A randomized controlled study was conducted. We recruited 61 patients and their FCs, who were randomly divided into an experimental group (n = 30) and a control group (n = 31). In the experimental group, the main caregivers comprised a nurse-family partnership, whereas the control participants received routine care. The findings were as follows: (i) the incidence of CAUTI was lower in the experimental group than in the control group (20% vs. 38.8%), but the difference was not statistically significant; and (ii) no significant difference emerged for reported Caregiver Self-Efficacy Score between the two groups. The nursing team and FCs must become partners in cooperative caregiving to enhance the quality of patient care.

Effects of a family involvement program in patients with central-line insertion.

The purpose of this study was to evaluate the effects of family-involved care on caregivers' self-efficacy, the degree of satisfaction with central-line care, and the occurrence of central-line-associated bloodstream infections (CLABSIs). We adopted a pretest-posttest quasi-experimental design, recruiting 62 participants from 2009 to 2010. Family caregivers in the experimental group received instructional guidance before collaboratively participating in patient care, whereas the control group received routine care. Our results indicated that in both groups, the overall posttest scores for self-efficacy were significantly higher than the pretest scores. The score for the question "When the patient moves around, how confident are you with ensuring catheter safety?" was significantly higher in the experimental group than in the control group. Satisfaction with the provision of central-line care was also significantly higher in the experimental group than in the control group. CLABSIs did not occur in either group of patients.

The Burden of Caregiving and Sleep Disturbance Among Family Caregivers of Advanced Cancer Patients.

BACKGROUND: Sleep disturbance may cause physical and psychological problems. The relationship between sleep disturbance and the burden of caregiving among family caregivers (FCs) has not previously been investigated. OBJECTIVE: The purposes of this study were to (1) assess subjective and objective information on the sleep patterns of FCs of advanced cancer patients and (2) identify the components of caregiving burden that are risk factors for sleep disturbance among these FCs. METHODS: A prospective, cross-sectional study of 176 FCs was conducted. Subjective and objective tools measuring sleep quality and caregiver burden were used. A hierarchical regression model was applied to identify the predictive factors for sleep disturbance among FCs. RESULTS: Approximately 72.2% of FCs experienced sleep disturbance. The major sleep disturbance was frequent "wake after sleep onset" to provide patient care; a nap during the day was necessary. Correlations were strong between caregiver burden and sleep quality. The final regression model, which included subjective and objective burden, predicted 56.6% of the variance in sleep disturbance. CONCLUSIONS: Sleep disturbance was common in FCs of advanced cancer patient, and our results demonstrated the relationship between sleep disturbance and caregiving burden. IMPLICATIONS FOR PRACTICE: Family caregivers with risk factors for sleep disturbance should be identified and be provided resources for sleep quality improvement.

Development and preliminary validation of a questionnaire on regular exercise beliefs among patients with chronic obstructive pulmonary disease.

AIMS AND OBJECTIVES: To develop a Regular Exercise Belief Questionnaire and test its psychometric properties for patients with chronic obstructive pulmonary disease. BACKGROUND: Regular exercise has been shown to significantly improve physical capacity and the quality of life of patients with chronic obstructive pulmonary disease. However, their adherence to long-term exercise is low. To develop an effective strategy for promoting good exercise behaviours, it is important to have a validated instrument to evaluate factors related to engaging in exercise. DESIGN AND METHODS: A cross-sectional design was used for the study. Construction of the Regular Exercise Belief Questionnaire was based on the Theory of Planned Behaviour Reliability and validity were assessed using a sample of 136 male patients with chronic obstructive pulmonary disease. The construct validity of the questionnaire was confirmed through exploratory factor analysis and known group technique. RESULTS: Exploratory factor analysis resulted in an eight-factor solution that explained 70·4% of the total variance. The internal consistency of the Regular Exercise Belief Questionnaire was 0·83-0·93. The Regular Exercise Belief Questionnaire was preliminarily found to be reliable and exhibited satisfactory validity for patients with chronic obstructive pulmonary disease. CONCLUSION: The Regular Exercise Belief Questionnaire is the first theory-based measure of exercise beliefs among patients with chronic obstructive pulmonary disease. The questionnaire provides an effective method to examine behaviour beliefs, normative beliefs and control beliefs about regular exercise. CLINICAL RELEVANCE: The measure can be used to periodically evaluate the exercise beliefs in clinics and to examine the effectiveness of exercise programmes in patients with chronic obstructive pulmonary disease. The result of the evaluation could also apply to identify strategies related to promoting exercise behaviours.

An exploration of beliefs regarding exercise among Taiwanese patients with chronic obstructive pulmonary disease.

OBJECTIVES: To explore the beliefs regarding regular exercise among patients with chronic obstructive pulmonary disease (COPD). BACKGROUND: Low adherence to exercise has been observed in patients with COPD. It is important to identify factors regarding exercise from the patients' viewpoint. METHODS: Thirty-one patients were recruited from a medical center in Taiwan. Semi-structured, in-depth, one-on-one interviews were conducted to collect data. The narratives of the interviews were analyzed via content analysis. RESULTS: The majority of the participants affirmed the benefits of regular exercise; however, concerns about personal comfort and safety affected their actual exercise behavior. Five normative references were found to support exercise behavior, and several exercise promoters were identified. CONCLUSION: This study provides an understanding of exercise beliefs of Taiwanese patients with COPD stage II-IV and suggests several ideas for their exercise maintenance. There is a need to provide individualized exercise guides and reinforced programs for patients with chronic obstructive pulmonary disease.

Hypothermia caused by slow and limited-volume fluid resuscitation decreases organ damage by hemorrhagic shock.

BACKGROUND: Hypothermia frequently occurs during fluid resuscitation of trauma victims, especially in patients with a major blood loss. Recent studies have suggested that mild hypothermia may ameliorate hemorrhagic shock (HS) induced splanchnic damage. OBJECTIVE: The aim of the present study is to compare the status of body temperature and splanchnic injury under different resuscitation speeds for HS in conscious rats. METHODS: Experimental study in an animal model of HS. Twenty-four male Wistar-Kyoto rats were used in the study. To mimic HS, 40% of the total blood volume was withdrawn. Fluid resuscitation was given 30 min after blood withdrawal. The rats were randomly divided into three groups; the control group, the 10-min rapid group, and the 12-h slow group. RESULTS: Levels of blood biochemical parameters, including aspartate transferase (GOT), and alanine transferase (GPT), were measured. Levels of serum tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) were measured and levels of bronchoalveolar lavage fluid (BALF) TNF-α and nitric oxide (NO) were measured by ELISA. The lung, liver and small intestine were examined for pathological changes 48 h after HS. CONCLUSIONS: Initially slow rate resuscitation with limited-volume significantly decreased body temperature, serum GOT, GPT, TNF-α, and IL-6 levels, levels of TNF-α, and NO in BALF. Moreover, the slow group had lower injury scores in the lung, liver and small intestine than the rapid group after HS. This finding suggests that mild hypothermia induced by a slow fluid resuscitation rate with limited-volume ameliorates HS-induced splanchnic damage in conscious rats.

"Inflammatory response to colloids compared to crystalloid priming in cardiac surgery patients with cardiopulmonary bypass".

"Cardiac surgery with cardiopulmonary bypass (CPB) induces a systemic inflammatory response syndrome that may contribute to postoperative morbidity and mortality. We investigated the in-flammatory responses to colloids compared to crystalloid priming in cardiac surgery patients with cardiopulmonary bypass. Thirty patients undergoing coronary artery bypass grafting (CABG) preparing for CPB were randomized into Ringer's solution (RS), 10% hydroxyethyl starch (HES) or 25% human albumin (HA) group. Serum concentrations of tumor necrosis factor-α (TNF-α), interleukin-1 ß (IL-1ß ), interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured before CPB, at the end of CPB and 1, 6 and 12 h after CPB. Serum C-reactive protein (CRP) was determined pre-operatively and then daily for 2 days. Body-weight gain was significantly decreased on the day after surgery in the HES group than in the RS group. Volume priming in CPB for CABG patients using HA or HES preparation had less tendency for intense inflammatory response with lower levels of TNF-α, IL-1 ß , IL-6 and higher levels of IL-10 compared to patients treated with RS. HES prime had lower levels of circulating CRP than in patients treated with HA or Ringer prime on the second post-operative day. Our data indicate that volume priming using colloid during CPB in CABG patients might exert beneficial effects on inflammatory responses."

The effectiveness of valerian acupressure on the sleep of ICU patients: a randomized clinical trial.

BACKGROUND: Severely ill patients often experience problems with sleep. Either acupressure or valerian aromatherapy are reported as helpful in promoting sleep. OBJECTIVES: The purpose of this study was to explore the effectiveness of valerian acupressure on the sleep of patients in the intensive care unit (ICU). DESIGN: A randomized clinical trial. SETTING: A 42-bed adult intensive care unit. PARTICIPANTS: Forty-one subjects in the experimental group and 44 subjects in the control group. METHODS: The measurement included observation, and actigraphy measures during 10 pm-6 am, and the Stanford Sleepiness Scale (SSS) measures on the next morning. Experimental groups received valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints between 7 pm and 10 pm of the second day while control groups received regular treatment. Heart rate was measured for 5 min before and after valerian acupressure present for HR variability analysis to measure relaxation response. RESULTS: The results indicated that after receiving valerian acupressure, patients' sleeping hours increased, wake frequency reduced and SSS grades declined. The HR variability data indicated relaxation response immediately after valerian acupressure. CONCLUSION: This study supports the hypothesis that valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints could improve the sleeping time and quality of ICU patients.