Cold Application Research Articles

The Effect of Cold Application on Relieving Drug Infusion-Related Pain in Children: A Randomized Controlled Experimental Trial in Turkey

BackgroundParenteral IV drug administration in hospital environments can cause many complications at the infusion site. Nerve endings on the venous walls may be affected during antibiotic drug infusion, depending on the drug molecule, which results in pain. PurposeThis study aims to assess the effect of cold application on relieving drug infusion-related pain (lincosamide class clindamycin phosphate) in children. Design & methodsThis study included 120 pediatric patients (40 in the experimental, 40 in the placebo, and 40 in the control groups) aged 6 to 18 and hospitalized in a pediatric hospital. In the experimental group, a cold pack kept in the refrigerator was applied to the area above the IV catheter before drug infusion, while a cold pack kept at room temperature was applied in the placebo group. In the control group, drug infusion was routinely administered. ResultsThe experimental, placebo and control groups' 5th minute mean VAS scores were 0.98 ± 2.17, 3.95 ± 4.08, and 4.73 ± 3.89, respectively (p < 0.001), being higher in the control and placebo groups compared to the experimental group. No difference was found between the groups based on the VAS measurements at the 10th minute (p = 0.053). A difference was found between the groups based on the VAS measurements at the 15th minute (p=0.026). The VAS score of control group was higher than that of the placebo group (p = 0.032). ConclusionCold application was effective in relieving drug infusion-related pain. Implications for practiceThis method may be recommended for general use in clinics since it is easy-to-use and economic. This method can ease the treatment process between nurses and children and increase patient satisfaction.

Pain on arteriovenous fistula cannulation: A narrative review.

Pain on arteriovenous fistula (AVF) cannulation is a rather persistent problem in the daily hemodialysis practice. Its prevalence varies from 12% to even 80% depending on the definition and the pain-assessment tools and it affects the quality of life of hemodialysis patients. It is associated with fear of the cannulation process, the decision of hemodialysis from an AVF and sometimes the hemodialysis itself. In this narrative review, we tried to tackle the extent of the problem and to present the available published solutions. The literature suggests a large array of methods based on the application of local anesthetic creams, application of cold or hot directly on the cannulation sites or on the contralateral arm, cannulation techniques and AVF localization, distraction as well as alternative treatments. All of them have shown a relative success. There is a serious lack of large multicenter randomized trials and a gap concerning work groups and guidelines or recommendations from national or international societies on this matter. Complementary training starting from the predialysis patient education programs may be useful. Alternative prophylactic measures including counseling, hypnosis, or other physicochemical interventions could also improve our knowledge on the treatment of this seriously uncomfortable condition.

Cold Application and Exercise on Development of Peripheral Neuropathy during Taxane Chemotherapy in Breast Cancer Patients: A Randomized Controlled Trial

Objective:Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment. There is no proven pharmacological application to prevent CIPN. This study was conducted to compare the effects of cold application and exercise on peripheral neuropathy development in patients with breast cancer who received taxane.Methods:This was a multicenter clinical trial. The study was conducted as a randomized controlled trial on breast cancer patients who had chemotherapy-induced peripheral neuropathy complaints between July 2017 and January 2018 in an outpatient chemotherapy unit of training-research and a university hospital. A standardized, home-based, 12-week exercise program involved progressive strengthening, stretching, and balance exercises. Cold packs were applied for the duration of all 12 taxane infusions and then continued at home. The standard care protocol (information about side effects) of the clinic was used for patients in the control group. Data were collected via Patient Identification Form and CIPN Assessment Tool. Demographic data were evaluated by number and percentage ratios, and the study groups' mean scores were compared by Kruskal–Wallis and Wilcoxon analyses. The data were collected at two time points including baseline (T1) and week 12 (T2).Results:The study was completed with a total of 90 patients, so that each of the study groups, exercise, cold application, and control groups, included 30 patients. The mean of pre- and posttest results in the cold applied group revealed an increase in hand numbness, weakness, and distress (P < 0.05). However, no significant difference existed between the means of the pre- and the posttests in the exercise group (P = 0.79–0.1). The mean scores of all the symptoms in the control group except the loss of balance increased significantly (P < 0.05). Exercise reduced CIPN symptoms of numbness in hands (P = 0.009) and in the feet (P = 0.005) significantly compared to the cold application and control.Conclusions:It was found that exercise was more effective than cold application in the management of CIPN.

22 Comparison of post-exercise cooling methods in horses

Exertional heat illness (EHI) following strenuous exercise under hot and humid conditions can be detrimental in horses. Direct cooling after intense exercise is necessary to prevent EHI. Therefore, this study aimed to evaluate the efficacy of 3 cooling methods in horses post treadmill exercise. Five mature geldings were treadmill exercised on 3 consecutive weeks to determine the effect of 3 post-exercise cool-down methods (5 × 3 Latin square design). These methods were (i) no water application (W no ), (ii) cold water application only (W only ; pouring 30 L of cold water (6°C) every min for 6 min) and (iii) cold water application with scraping (W scraping ; cold water (6°C) application followed by scraping after each water application). After 6 min active cool-down phase, the horses were walked in-hand (walking phase) for 4 min and stood (standing phase) for 35 min. Central venous temperature (T CV ) and rectal temperature (T R ) were selected and measured simultaneously. The collected temperatures were paired and statistically analyzed by Wilcoxon signed rank test to assess the efficiency of cooling between methods. The room temperature and humidity in the treadmill room for the treadmill exercise was (mean ± SD) 27.2 ± 1.3°C and 49.9 ± 7.2% and in the corridor for cooling down was 30.0 ± 2.2°C and 49.0 ± 8.6%. Greater T CV and T R reductions were observed when cold water (W only & W scraping ) was applied compared with no water application (W no ) (T CV : −0.91°C for W only -W no , P < 0.001, −0.84°C for W scraping -W no , P < 0.001; T R : −0.31°C for W only -W no , P < 0.001, −0.29°C for W scraping -W no , P < 0.001), and overall the water application had more cooling down effect on T CV than T R (−0.57°C, P < 0.001). Between the 2 applied cold water methods, significantly lower body temperatures (T CV −0.11°C, P = 0.01; T R −0.03°C, P = 0.01) were observed with W only than W scraping . This study demonstrates that constant contact with water is more important for heat conduction and more effective than producing and using sweat evaporation to remove heat. Application of water without scraping may help decrease the core body temperature in horses more effectively in the early stage of EHI.

Microscale Physiological Events on the Human Cortical Surface.

Despite ongoing advances in our understanding of local single-cellular and network-level activity of neuronal populations in the human brain, extraordinarily little is known about their "intermediate" microscale local circuit dynamics. Here, we utilized ultra-high-density microelectrode arrays and a rare opportunity to perform intracranial recordings across multiple cortical areas in human participants to discover three distinct classes of cortical activity that are not locked to ongoing natural brain rhythmic activity. The first included fast waveforms similar to extracellular single-unit activity. The other two types were discrete events with slower waveform dynamics and were found preferentially in upper cortical layers. These second and third types were also observed in rodents, nonhuman primates, and semi-chronic recordings from humans via laminar and Utah array microelectrodes. The rates of all three events were selectively modulated by auditory and electrical stimuli, pharmacological manipulation, and cold saline application and had small causal co-occurrences. These results suggest that the proper combination of high-resolution microelectrodes and analytic techniques can capture neuronal dynamics that lay between somatic action potentials and aggregate population activity. Understanding intermediate microscale dynamics in relation to single-cell and network dynamics may reveal important details about activity in the full cortical circuit.

BrRH37, a Cabbage (Brassica rapa) DEAD-Box RNA Helicase, Confers Drought Tolerance and ABA Response in Transgenic Arabidopsis Plants

RNA helicases (RHs) are cellular proteins that help in the regulation of post-transcriptional mRNA metabolism, which is vital for the response of crops to abiotic stresses. In this study, we determined the functional role of a cabbage (Brassica rapa) DEAD-box RH, BrRH37, in abiotic stress and abscisic acid (ABA) responses using transgenic Arabidopsis plants. Although BrRH37 contains a putative chloroplast transit peptide and a potential nuclear localization signal, confocal analysis of the expression of the BrRH37-GFP protein in tobacco leaves revealed that BrRH37 is localized in the nucleus. The transcript levels of BrRH37 in cabbage were increased upon drought, cold, or ABA application, whereas its level was decreased by heat or UV stress. The transgenic Arabidopsis plants that constitutively express BrRH37 showed enhanced seedling and root growth or survival rate under drought stress or upon ABA application, whereas their growth and survival were decreased under cold or UV stress. Notably, transcript levels of ABA biosynthesis-related genes, including ABA1 and ABA3, were significantly increased in the transgenic plants compared with that in the wild type. Importantly, BrRH37 was found to recover the growth of the RNA chaperone-deficient Escherichia coli mutant at low temperature and had the ability to break up base pairs in RNA, suggesting that BrRH37 possesses RNA chaperone activity. Altogether, our results indicate that BrRH37 plays diverse functions in plant response to abiotic stress and ABA possibly via its RNA chaperone activity.

Influence of Caralluma adscendens Var. attenuata cold cream on UV-B damaged skin epidermal cells: a novel approach.

The online version contains supplementary material available at 10.1007/s13205-021-02694-y.

Effect of Non Pharmacological Interventions on Pain and Skin Erythema Associated with Cellulitis

Background: in this study the researcher describes effect of applying non pharmacological interventions including cold application and on pain and skin erythema associated with cellulitis. Purpose: this study aimed to evaluate the effect of non pharmacological interventions on pain and skin erythema associated with cellulitis. Design: Experimental design was utilized in this study, at male and female medical departments in the New General Mansoura hospital, Dakahlia Governorate, Egypt. Subjects: A purposive sample included (64) patients diagnosed of cellulits, admitted to inpatient ward and willing to participate included in the study.Those patients are randomly divided into two equal groups (study& control); study group used non pharmacological intervention for 20 minutes two times per day for 5 consecutive days plus pharmacological treatment, while control group used pharmacological treatment only. Tools: Two tools were used to assess pain and skin erythema associated with celluitis. Visual Analog Scale (VAS), which is utilized to detect pain level. While skin erythema (inflammation regression) was assessed by measuring level of superior edge moved down by labeling superior edge by ink pen before starting study and after completing the study to calculate shrinked area (inflammation regression). Results: There was significant reduction regarding pain level and skin erythema (inflammation) surface area among study group compared to control group. Conclusion/implication for future practice: non pharmacological interventions could be combined with pharmacological treatment to reduce cellulitis pain and skin erythema. Recommendations: educational program to nursing staff about non pharmacological interventions as nurses can aid in pain management after good training by applying non pharmacological interventions for patients who have no contraindications.

Effects of applying external cold and vibration to children during vaccination on pain, fear and anxiety

ObjectivesThis study aimed to evaluate the effectiveness of the application of external cold and vibration on children experiencing pain, fear and anxiety during vaccination. Design and settingThis randomized controlled, experimental study was conducted in primary schools selected within the scope of school immunization days by a community health center. The study population consisted of first grade students who were scheduled to receive a booster dose of diphtheria, tetanus, and acellular pertussis, inactivated poliovirus vaccine (DTaP-IPV) vaccine within the scope of the school immunization program of the said community health center and the study sample consisted of 90 students (experimental: 45, control:45). Main outcome measuresIn the experimental group, a device that applies external cold and vibration (Buzzy®) was placed on the injection site for 30 s before administration of the vaccine. The device was then placed above the injection site and kept there during the injection. No intervention was made during the injections in children included in the control group. The same nurse administered the injections in the experimental and control groups. ResultsIn the current study, it was found that there was a statistically significant difference between the experimental group and the control group in terms of the children’s pain, the nurse’s pain, the nurse’s fear and the children’s anxiety (p < 0.05), but no statistically significant difference in terms of the children’s fear (p > 0.05). Conclusions: It was concluded that applying external cold and vibration during vaccination has an effect on the level of children’s pain and anxiety.

Use of Gloves to Examine Intermittent Palm Cooling's Impact on Rowing Ergometry.

O'Brien, IT, Kozerski, AE, Gray, WD, Chen, L, Vargas, LJ, McEnroe, CB, Vanhoover, AC, King, KM, Pantalos, GM, and Caruso, JF. Use of gloves to examine intermittent palm cooling's impact on rowing ergometry. J Strength Cond Res 35(4): 931-940, 2021-The aim of this study was to examine the use of gloves on intermittent palm cooling's impact on rowing ergometry workouts. Our methods had subjects (n = 34) complete 3 rowing ergometer workouts of up to 8 2-minute stages separated by 45- or 60-second rests. They were randomized to one of the following treatments per workout: no palm cooling (NoPC), intermittent palm cooling as they rowed (PCex), or intermittent palm cooling as they rowed and post-exercise (PCex&post). Palm cooling entailed intermittent cold (initial temperature: 8.1° C) application and totaled 10 (PCex) and 20 (PCex&post) minutes, respectively. Workouts began with 8 minutes of rest after which pre-exercise data were obtained, followed by a ten-minute warm-up and the workout, and 20 minutes of post-exercise recovery. Numerous physiological and performance variables were collected before, during, and after workouts, and each was analyzed with either a two- or three-way analysis of variance. Our results include, with a 0.05 alpha and a simple effects post hoc, the distance rowed analysis produced a significant workout effect with PCex, PCex&post > NoPC. There were also significant interworkout differences for heart rate (HR) (NoPC > PCex) and blood lactate concentration (NoPC > PCex, PCex&post). We conclude that lower HRs and blood lactate concentrations from intermittent cooling caused subjects to experience less fatigue during those workouts and enabled more work to be performed. Continued research should identify optimal cooling characteristics to expedite body heat removal. Practical applications suggest that intermittent palm cooling administered with gloves enhance performance by abating physiological markers of fatigue.

The Effect of Cold Application on Unconscious Patients’ Physiological Parameters during Arterial Puncture

Background: Arterial puncture is a common procedure performed for unconscious patients in intensive care units to assess their respiratory conditions. It is usually associated with pain resulting in significant physiological changes that can affect patients’ recovery and progression. Pain killers are the first choice for controlling pain in intensive care units but medications themselves have many adverse physiological effects on the body. Non-pharmacological pain management strategies have been advocated to control pain and avoid the side effects of medications. Aim: This study aimed to investigate the effect of the cold application on unconscious patients’ physiological parameters during arterial puncture. Method: A quasi-experimental research design was utilized to conduct this study among 86 unconscious patients in the surgical intensive care unit of the Critical Care and Convalescence Hospital at Mansoura University in Egypt. One tool was used to collect data for this study; unconscious patients’ physiological parameters assessment tool. Results: A statistically significant improvement was noted in the participants’ heart rate, respiratory rate, and oxygen saturation post-implementation of the cold application (p ≤0.05). However, there were no significant changes in the participants’ systolic or diastolic blood pressure after the cold application. Conclusion and Recommendations: Cold application is an effective method for improving unconscious patients’ physiological parameters during arterial puncture. Hence, critical care nurses can include the cold application in the routine nursing care of arterial puncture for unconscious patients in intensive care units.

Cryotherapy: treatment spectrum and setting up the service

The application of cold—also known as cryotherapy—can be used to treat a variety of issues, and it must be carried out by trained personnel. Paul Charlson details more

A technical, financial and CO2 emission analysis of the implementation of metal foam in a thermal battery for cold chain transport

Latent thermal energy storage (LTES) can be a valuable component in a wide range of energy systems. The low thermal conductivity of most phase change materials (PCMs) has resulted in the development of several PCM enhancement methods. However, most of the comparisons of enhancement techniques implemented in LTES heat exchangers are based on a single operating point which limits the findings to the tested heat transfer fluid inlet temperature and mass flow rate. Furthermore, an analysis of the financial impact of an enhancement method is not available. In this article, the validity of implementing metal foam as a thermal conductivity enhancer is assessed in a cold chain application. A modular LTES design is constructed with and without metal foam. The charging time of both thermal batteries is experimentally correlated as a function of the heat transfer fluid inlet temperature and mass flow rate. The metal foam reduces the charging time of the battery between 24 % and 40 % depending on the heat transfer fluid inlet condition. Discounted savings for the implementation of metal foam of up to 10 times the investment cost are possible but depend on the number of cycles per year and the rate of return.

Optimization of a slab geometry type cold neutron moderator for RIKEN accelerator-driven compact neutron source

We have optimized a cold neutron moderator to be operated at the RIKEN accelerator-driven compact neutron source (RANS) to broaden cold neutron applications and provide more choices for RANS users. We selected a safe and easy to manage material, mesitylene, as the RANS cold moderator. An efficient moderator system was designed by studying and optimizing a coupled cold neutron moderator of mesitylene at 20 K with a polyethylene (PE) pre-moderator at room temperature in the slab geometry with Particle and Heavy Ion Transport code System (PHITS) simulations. The parameters of mesitylene and PE thickness, the reflector, and the shielding configuration were studied to increase cold neutron intensities within [0.1 meV, 10 meV] and thermal neutron intensities within [10 meV, 100 meV]. Consequently, an integrated cold neutron intensity of 1.15 ×103n/cm2∕μA at 2 m from the neutron-producing target was finally achieved, which was 12 times higher than that of the current RANS moderator with 4 cm PE according to simulation results. The cold and thermal neutron intensities of the optimized cold neutron moderator was compared with a cold neutron source based on solid methane, which has a beryllium target and the same proton energy as RANS. The results showed attractive application prospect of mesitylene as cold neutron moderator material.

A Song of Ice and Fire: Cold and Hot Properties of Traditional Chinese Medicines.

The theory of cold and hot properties is the basic theory of traditional Chinese medicines (TCMs) and has been successfully applied to combat human diseases for thousands of years. Although the theory of cold and hot is very important to guide the clinical application of TCMs, this ancient theory remains an enigma for a long time. In recent years, more and more researchers have tried to uncover this ancient theory with the help of modern techniques, and the cold and hot properties of a myriad of TCMs have been studied. However, there is no review of cold and hot properties. In this review, we first briefly introduced the basic theories about cold and hot properties, including how to distinguish between the cold and hot properties of TCMs and the classification and treatment of cold and hot syndromes. Then, focusing on the application of cold and hot properties, we take several important TCMs with cold or hot property as examples to summarize their traditional usage, phytochemistry, and pharmacology. In addition, the mechanisms of thermogenesis and antipyretic effect of these important TCMs, which are related to the cold and hot properties, were summarized. At the end of this review, the perspectives on research strategies and research directions of hot and cold properties were also offered.

Effect of 940nm laser diode irradiation prior to bonding procedure on postoperative sensitivity following class II composite restorations: a split-mouth randomized clinical trial.

The aim of this study was to evaluate the effect of 940nm laser diode on class II composite cavities prior to bonding and restoration process on the postoperative sensitivity (POS). Thirty patients with two bilateral premolars with mesio or disto-occlusal carious lesions were evaluated. In each patient, the teeth were randomly divided into the control and laser groups. After cavity preparation and isolation and before the bonding process, the laser group was subjected to 940nm irradiation (Epic 10, Biolase, USA) by 400μ tip continuously at 100mW with 398J/cm2 energy density of tip, which was applied for 5s at a distance of 2mm on the axial wall of the cavity. In the control group, irradiation was performed by using the aiming beam. Access cavity was then restored with a composite resin. Cold sensitivity was measured using a cold spray application on the middle third of teeth buccal surface at baseline (before the intervention), 1, 14, and 30days after the restoration by visual analog scale (VAS) criteria. The mean Friedman and Wilcoxon signed-rank tests were used for data analysis. It was shown that in both laser and control groups, the VAS was significantly decreased at all times compared to the baseline (p≤0.05). There was no statistically significant difference between the mean VAS of two groups at baseline and first day (p≤0.05), but at 14 and 30days after the intervention, it was significantly lower in the laser group (p≤0.05). The results of this study demonstrated that the cavity pretreatment with laser diode (940nm) effectively reduces the postoperative sensitivity in class II composite restorations.

The Effect of Cold on the Trigeminal Reflexes

Objective: Effects of muscle cooling on the spinal stretch and monosynaptic reflexes have been studied to describe the properties of Group I and II afferents of muscle spindles. Masseter muscle differs from extremity muscles in structural and numerical features of the muscle spindles. The aim of this study was to examine the muscle spindle afferent features of masseter muscle by applying cold to understand the role of Group I and II afferents in reflexes of masseter. Patients and Methods: We included 12 healthy subjects (7 females and 5 males) in the study. Masseter inhibitory reflex (MIR), jaw tendon reflex (JTR), trigeminal motor evoked potential (MEP), and trigeminal somatosensory evoked potential (SEP) were studied before and after cold application. Left masseter muscle was cooled down to 18°C. We compared the data obtained before and after cold application. Results: After cold application, the mean total duration of MIR was shortened and it was absent in four subjects. The mean amplitude of JTR was higher after cold application (P = 0.018) without any significant change in latency. The mean latency of MEP was delayed without any change in amplitude (P = 0.003). There was no significant difference in SEPs. Conclusions: Changes observed in MIR, JTR, and MEP could not be ascribed to any specific type of muscle spindle afferents. Delayed mean reflex latencies were attributed to the effect of cold on nerve conduction. Summation of peripheral cold and pain receptor features, spindle afferents, and cortical mechanisms might have caused cold-associated changes.

Comparison of the Efficacy of Magnesium Sulphate and Cold Application for the Treatment of Thrombo Phlebitis in Patients Undergoing Intravenous Therapy at a Tertiary Care Hospital

Introduction: In hospitals, providing care for patients typically includes the utilization of various intravenous devices. The monitoring of a patient’s hemodynamic condition as well as the delivery of fluids, nutrition, medicines, and blood products are all accomplished with the assistance of these instruments. Up to eighty percent of hospitalized patients in contemporary medical practice are given intravenous therapy at some point during their hospitalization. This treatment can be given at any time during the patient’s stay. Even though peripheral IVs seldom cause serious difficulties, problems might arise, especially when they are used for an extended period of time. Because of this, different hospitals have developed different sets of rules about the suggested amount of time that a peripheral IV should be in place. Early detection, as well as clear and open communication between the patient and the healthcare provider, is essential in the event that a medical procedure results in a side effect or complication of any kind. Aims: The purpose of this study is to compare the efficacy of magnesium sulphate application and cold application for the treatment of thrombophlebitis in patients who are receiving intravenous therapy in a tertiary care hospital. Objectives to determine whether or not the application of cold can effectively treat thrombophlebitis. To determine whether or not magnesium sulphate is effective in treating thrombophlebitis. In order to evaluate the relative efficacy of magnesium sulphate and cold application in the treatment of thrombophlebitis. Material and Method: Techniques and Components Among the 32 patients who participated in the study, an evaluation was carried out using a method called straightforward random sampling. A total of 16 samples were allotted to the group that was to receive the cold treatment, and the same number of samples were given to the group that was to receive the magnesium sulphate application. The research approach known as the pre-experimental two-group design was utilised for the investigation. The medical and surgical wards of the tertiary care hospital located in Karad were chosen as the location for this particular research project. Patients who have acquired thrombophlebitis and are now being treated in medical and/or surgical wards at tertiary care hospitals make up the population of the current research study. Results: In order to determine whether or not there was an effect of cold treatment on thrombophlebitis in group A, a non-parametric repeated ANOVA was carried out using the Friedman test. It was discovered that, beginning on day 2 and continuing onwards, there was a significant decrease in the readings of score on the thrombophlebitis measuring chart when cold treatment was performed each time in group A (p 0.001). When performing a non-parametric repeated ANOVA, the Friedman test was utilised to determine whether or not there was an effect of magnesium sulphate treatment on thrombophlebitis in group B. It was shown that there was a substantial drop in the readings of score of thrombophlebitis measurement chart, beginning on day 1 and continuing onwards for magnesium sulphate application three times in group B (p less than 0.001) According to the findings of the Mann Whitney U test, there was a statistically significant difference between groups A and B regarding the thrombophlebitis assessment grading scale for the various therapies (p less than 0.05). The fact that the median score for magnesium sulphate application, group B was constantly reduced (meaning the level of pain decreased), demonstrates that the magnesium sulphate paste application was more effective than the cold application. Conclusion: The findings of the study indicated that there was a significant difference between groups A and B with regard to the thrombophlebitis assessment grading scale for various therapies (p less than 0.05). The fact that the median score in magnesium sulphate application, group B was constantly reduced (meaning the level of pain decreased), demonstrates that magnesium sulphate application was more effective than the application of cold.

Effect of cold application on incisional pain associated with incentive spirometry after coronary artery bypass graft surgery

Introduction: The use of incentive spirometry after coronary artery bypass graft surgery is accompanied by severe postoperative incisional pain. Consequently, pain reduction after cardiac surgery is considered the foremost postoperative care strategy. Various methods are administered to reduce or control pain effectively. One of these methods is cold application, which is considered a simple, cost efficient, and non-pharmacological pain relief method. Aim: This study aimed to determine the effect of cold application on incisional pain associated with incentive spirometry after coronary artery bypass graft surgery. Methods: A crossover study design was used. Sixty eligible and consenting patients were recruited. All participants were subjected to the use of incentive spirometry with and without cold gel pack application. Subjective and objective pain assessments were undertaken before and after the use of incentive spirometry with and without cold gel pack application for two consecutive days. Results: Data analysis showed significant reduction in pain scores on pain intensity and pain distress, as well as the critical care pain observation tool (P < 0.001) after the cold gel application. Univariate binary logistic regression analysis of predictive factors regarding pain intensity showed that being married, older, and having social support were protective factors against pain. Conclusions: Cold application reduces incisional pain associated with incentive spirometry in patients undergoing coronary artery bypass grafting.

Effect of tempering and cryogenic treatment on wear and mechanical properties of hot work tool steel (H13)

The AISI H13 is a chromium based, medium carbon content hot work tool steel which is widely used in hot working as well as cold working applications. These steels are very popular because of their key characteristics such as high hardness, high strength, high fracture toughness and high wear resistance. These steels are continuously subjected to high mechanical stresses and temperature fluctuations, fatigue and wear loss which results in limited die life. It is therefore necessary to improve the properties of these tool steels. One of the methods to improve the properties of these tool steels is with the help of conventional heat treatment. But no significant improvements in the properties were observed. From the literature survey, it is realized that implementation of cryogenic treatment can improve the properties of tool steel. In the present paper, cryogenic treatment on AISI H13 hot work tool steel is studied with the help of characterization techniques such as hardness, wear and microstructure study. One set of specimens were subjected to conventional heat treatment (HTT) viz. hardening at 1020 °C followed by double tempering at 500 °C. Another set of specimens were subjected to conventional heat treatment followed by deep cryogenic treatment at −196 °C and soft tempering at three different temperatures viz. 200 °C, 300 °C and 400 °C (HTTCT). A modified heat treatment cycle (HTCT) is also proposed with varying soft tempering temperatures viz. 200 °C, 300 °C and 400 °C and comparison is made with HTT and HTTCT. The specimens were tested for hardness, wear and microstructure study. The experimental investigation shows that cryogenically treated specimens shows significant improvement in the hardness and carbide density as compared to conventionally treated specimens. It is thus concluded that HTTCT cycle gives two times higher wear resistance than conventional heat treatment cycle (HTT) because of precipitation of fine tertiary carbides.