Effects of a Technical Solution on Stress of Surgical Staff in Operating Theatres.

BACKGROUND: Noise in operating theaters (OT) exceeds safety standards with detrimental effects on the health and performance of OT crews as well as patient safety. One of the reasons for these effects is the stress response to noise, which could be minimized by the Silent Operating Theater Optimisation System (SOTOS), a noise-reductive headset solution. METHODS: This study evaluates the effects of the SOTOS on the stress perceived by OT crew members, operationalized through stress level and exhaustion. Twenty-one heart surgeries and 32 robot-assisted prostatectomies at the University Medical Center Goettingen, Germany were examined. Twenty-six surgeries were conducted with and 27 without the SOTOS. The SOTOS-effect is defined as a more beneficial stress course from before to after surgery, when comparing the experimental group with and control group without SOTOS. FINDINGS: Eighty-one OT workers were investigated. The linear multilevel models revealed significant interactions between treatment and time of measurement on stress level (F[1, 406.66] = 3.62, p = 0.029) and exhaustion (F[1, 397.62] = 13.12, p = 0.00017). Nevertheless, there was no a significant main effect of surgery type on stress level (F[1, 82.69] = 1.00, p = 0.32) or on exhaustion (F[1, 80.61] = 0.58, p = 0.45). Additionally, no significant three-way interaction including surgery type, for stress level (F[1, 406.66] = 0.32, p = 0.29) or exhaustion (F[1, 397.62] = 0.03, p = 0.43), was found. INTERPRETATION: An SOTOS-effect was confirmed: the development of stress over the course of an operation was beneficially modified by the SOTOS. Both surgery types are perceived as similarly stressful, and the staff benefits equally strongly from the intervention in both settings.

Response to Comment on "Estimating the reproducibility of psychological science".

Gilbert et al. conclude that evidence from the Open Science Collaboration's Reproducibility Project: Psychology indicates high reproducibility, given the study methodology. Their very optimistic assessment is limited by statistical misconceptions and by causal inferences from selectively interpreted, correlational data. Using the Reproducibility Project: Psychology data, both optimistic and pessimistic conclusions about reproducibility are possible, and neither are yet warranted.

[Postoperative care after cataract surgery]. / Die Staroperation Medikamentöse Prophylaxe und Therapie im Umfeld der Operation.

The postoperative treatment of cataract surgery is an important element for success of the surgery. The postoperative therapy primarily aims at the prevention of intraocular bacterial infection by administration of antibiotics. Anti-inflammatory drugs can suppress the operation-related inflammation. In addition to fundamental risks of topical eye drop application, this review article discusses the current therapeutic strategies for the prevention of postoperative bacterial infection and suppression of surgically induced inflammation.

Serum levels of interleukin-6 and interleukin-10 in relation to depression scores in patients with cardiovascular risk factors.

It is currently unknown whether elevated cytokine levels in depression are confined to any specific subgroup of depressive patients. In this study, medical out-patients presenting with cardiovascular risk factors (N = 356) were assessed for both cognitive-affective and physical symptoms of depression using the Hospital Anxiety and Depression Scale (HADS) and the Maastricht questionnaire (MQ), respectively. In study participants assigned to the highest (≥21) and lowest (≤5) quartile for the MQ score, serum levels of cytokines were measured. We found highly significant associations between cognitive-affective symptoms of depression and elevated serum levels of interleukin-6 (IL-6; ρ = .231; p = .002) and interleukin-10 (IL-10; ρ = .370; p < .001), respectively. In multiple regression models elevated IL-10 serum concentration was independently related to cognitive-affective symptoms of depression (ρ = .165; p = .002). When all cytokines were included in one model, elevated IL-10 serum concentrations remained a significant predictor for depressive mood (ρ = .157; p = .009). In patients with cardiovascular risk factors and extreme scores for vital exhaustion, elevated serum IL-6 and even more IL-10 concentrations are linked to the presence of depressive mood. Future studies will have to test whether the so far unreported association of IL-10 with depressive mood represents a causal pathway involved in the pathogenesis or in the prognostic effect of depressive mood in cardiac patients.

Autologous translocation of the retinal pigment epithelium and choroid in the treatment of neovascular age-related macular degeneration.

PURPOSE: To evaluate clinical results of an autologous translocation of retinal pigment epithelium (RPE) and choroid in the treatment of neovascular age-related macular degeneration (AMD). METHODS: Twelve eyes which underwent surgery for neovascular AMD were included into the study, in four eyes moderate or massive submacular haemorrhage was present. The surgical procedure included standard pars plana vitrectomy; cataract surgery in phakic patients; peripheral 180°-retinotomy; extraction of the submacular neovascular complex and removal of blood if present; preparation of a full-thickness graft consisting of RPE, Bruch's membrane and choroid; translocation of the graft to the macular area; and silicone oil endotamponade. RESULTS: Visual acuity (VA) ranged from perception of hand movements (HM) to 20/125 (median, counting fingers (CF)-1/50) before surgery. During follow-up (FU) mean, 11.1 months, VA increased to a maximum median of 1/10 (range, HM-20/40). At the end of FU, VA had dropped to a median of CF-1/40 (range, HM-20/50). Comparing VA preoperatively and at the end of FU, VA had improved in six eyes, was unchanged in three eyes, and had deteriorated in three eyes. One eye had reading ability. Surgery-associated postoperative complications impairing the functional outcome occurred in five eyes, including rhegmatogenous retinal detachment and proliferative vitreoretinopathy. Revision surgery had to be performed in four eyes (30%). Three eyes had to be left with permanent silicone endotamponade. Results tended to be better in the subgroup of eyes with massive submacular haemorrhage preoperatively. CONCLUSION: Functional results of a translocation of RPE and choroid were heterogeneous and rather disappointing in this study. Results may have been influenced negatively by case selection. We found a relatively high rate of adverse events in the postoperative course. In selected cases, e.g. massive submacular haemorrhage or progressive neovascular AMD unresponsive to other treatment options, autologous translocation of RPE and choroid may still be considered.

Elevated serum levels of interleukin-10 and tumor necrosis factor α [corrected] are both associated with vital exhaustion in patients with cardiovascular risk factors.

BACKGROUND: Vital exhaustion, a psychological state characterized by unusual fatigue, irritability, and feelings of demoralization, has been identified as a risk factor for cardiovascular diseases and linked to elevated levels of pro-inflammatory cytokines. OBJECTIVE: The purpose of this study was to investigate the relationship between vital exhaustion and cytokine levels in patients with cardiovascular risk factors. METHOD: The entire cohort consisted of 356 primary-care patients with cardiovascular risk factors who participated in a study of early recognition of heart failure. All participants completed the Maastricht questionnaire (MQ) for assessing vital exhaustion. Cytokine serum levels were measured in all those subjects (N=178) who were assigned to the highest and lowest quartiles of the MQ, respectively. RESULTS: We found that elevated serum concentrations of IL-6, TNFα, and IL-10, but not IL-1ß or natriuretic peptides were associated with high MQ scores indicative of vital exhaustion. Using logistic regression analyses controlling for clinical variables and Type D personality, both TNFα (multivariate odds ratio [OR] =1.86; 95%-confidence interval [CI] =1.30-2.68; p=0.001) and IL-10(OR=1.62; 95%-CI=1.15-2.28; p=0.006), but not other cytokines significantly predicted vital exhaustion independently of other clinical and laboratory parameters examined [corrected]. CONCLUSION: The subjective state of vital exhaustion is linked to a substantial alteration in the pattern of secreted cytokines. Data suggest that a disturbance in the levels of both pro-inflammatory and anti-inflammatory mediators, rather than isolated stimulation by pro-inflammatory cytokines, is associated with the mental and physical changes of vital exhaustion.

Dronabinol and retinal hemodynamics in humans.

PURPOSE: To investigate the effects of oral cannabinoids on retinal hemodynamics assessed by video fluorescein angiography in healthy subjects. DESIGN: Interventional study. METHODS: In a self-experiment, the cannabinoid dronabinol (delta-9-tetrahydrocannabinol [THC]) was administered orally to eight healthy medical doctors (7.5 mg Marinol; Unimed Pharmaceuticals, Chicago, Illinois, USA). At baseline and two hours after dronabinol intake, intraocular pressure (IOP) was measured and retinal hemodynamics were assessed by fluorescein angiography. The retinal arteriovenous passage time was determined on the basis of dye dilution curves by means of digital image analysis in a masked fashion. RESULTS: Dronabinol resulted in a significant IOP reduction from 13.2 +/- 1.9 mm Hg to 11.8 +/- 2.0 mm Hg (P = .038). The retinal arteriovenous passage time decreased from 1.77 +/- 0.35 seconds to 1.57 +/- 0.31 seconds (P = .028). Systemic blood pressure and heart rate were not statistically significantly altered. CONCLUSIONS: Cannabinoids, already known for their ability to reduce IOP, may result in increased retinal hemodynamics. This may be beneficial in ocular circulatory disorders, including glaucoma.