Ice Packs Research Articles

Evaluation of vaccine storage and distribution practices in rural healthcare facilities in Kenya

BackgroundVaccines require cold chain storage conditions, and good distribution practices throughout the supply chain to maintain their quality and potency. However, in the last mile of the vaccines supply chain, these requirements may not be guaranteed resulting in reduced effectiveness which could lead to an upsurge in vaccine preventable morbidity and mortality. The aim of this research was to evaluate vaccine storage and distribution practices in the last mile of vaccine supply chain in Turkana County.MethodsA descriptive cross-sectional study was conducted from January 2022 to February 2022 across seven sub-counties in Turkana County, Kenya, to assess vaccine storage and distribution practices. The study sample size was 128 county health professionals across 4 hospitals, 9 health centers, and 115 dispensaries. The respondents were selected using simple random sampling within the facilities strata. Data were collected using a structured questionnaire, adapted, and adopted from a standardized WHO questionnaire on effective vaccines management and administered to one healthcare personnel working in the immunization supply chain per facility. Data were analyzed using excel and presented as percentages in table forms.ResultsA total of 122 health care workers participated in the study. Most respondents (89%, n = 109) had utilized a vaccine forecasting sheet, but only 81% did have an established maximum–minimum level inventory control system. Many of the respondents had sufficient knowledge of ice pack conditioning although 72% had adequate vaccine carriers and ice packs. Only 67% of respondents had a complete set of twice-daily manual temperature records at the facility. Most refrigerators complied with the WHO specifications but only 80% of them had functional fridge-tags. The number of facilities that had a routine maintenance plan was below average while only 65% had an adequate contingency plan.ConclusionRural health facilities have suboptimal supply of vaccine carriers and icepacks for effective storage and distribution of vaccines. In addition, some vaccine fridges lack functional fridge-tags for proper temperature monitoring. Routine maintenance and contingency plans remain a challenge to ensure optimal service delivery.

Effects of combined interventions to optimize recovery during high-intensity exercises in trained individuals

Background
 Team sports such as ice hockey offer the opportunity of recovery breaks between high-intensity work intervals. Strategies aiming to mitigate fatigue during intermittent physical activity are seldom investigated in combination, although several different mechanisms of action exist, which might be cumulative and therefore beneficial for athletes. This study examined the effects of seven combined recovery interventions (enhanced recovery package, ERP) on exercise capacity during intermittent high-intensity cycling.
 Methods
 Sixteen trained men (age: 24.8 ± 3.4 y; maximal power output: 5.0 ± 0.5 W･kg-1) completed a repeated sprint exercise (RSE) protocol consisting of six 30-s cycling sprints with 3-min breaks between each sprint. The first sprint was always performed at a similar load, while sprints 2-6 were performed with the ergometer in cadence dependent mode (0.075 kg･kg-1). During the breaks, the ERP, Placebo, or Control protocols were applied, all on different days. The ERP condition combined 1) 3-min ice gel packs to the neck; 2, 3) 5-s mouth rinsing of a 10% carbohydrate and caffeine (6 mg･kg-1), 4) ingestion of 50 ml of a 6% carbohydrate solution, 5, 6) 30 s of all-out hyperventilation while breathing 100% O2 (hyperoxia); and finally, 7) potentiation maneuvers via performance of 3 half-squats at 75% of one maximal repetition. The placebo intervention masked the interventions except for the ice packs and potentiation maneuvers. Participants were told they were performing a simplified version with only the known beneficial interventions. Power output, heart rate, blood lactate concentration, rate of perceived exertion and gas exchange were compared between the ERP and Placebo conditions.
 Results
 Mean power output (W) was significantly higher for the ERP condition compared to Placebo (570 ± 74 W vs. 560 ± 71 W, t(15) = 4.603, P < 0.001, 95% CI diff = 5 – 14 W, dz = 1.15). The rate of power decrement over sprints 2-6 was very similar between trials (ERP -14.2 W per sprint, 95% CI = -21.6 – -6.8 W; Placebo -17.4 W per sprint, 95% CI = -24.7 – -10.2 W per sprint, P = 0.407). Mean heart rate was higher (3 ± 4 bpm, P = 0.012) for the ERP compared to the Placebo condition, as was breathing frequency (2.4 ± 4.0 breaths･min-1, P = 0.028) and respiratory exchange ratio (0.12 ± 0.06, P < 0.001). Oxygen uptake was 80 ± 109 ml･min-1 (P = 0.013) lower for ERP. No differences were found with regards to the rate of perceived exertion or blood lactate concentration.
 Conclusion
 ERP optimized recovery when applied during the breaks of a high-intensity repeated sprint exercise and shows a small but consistent increase in mean power output. It is possible that the ERP prevented a loss of aerobic efficiency. A top-down approach when tailoring packages for individual athletes might overcome the issue of small improvements that are difficult to detect when strategies are tested in isolation.

Ice-POP: Ice Packs for Postoperative Pain: A Randomized Controlled Trial

To evaluate the benefit of ice packs as a supplement to standard pain management following laparoscopic hysterectomy (LH). This Institutional Review Board-approved randomized controlled trial involved patients undergoing LH for benign conditions. Subjects were randomized to receive standard enhanced recovery after surgery pain management or standard enhanced recovery after surgery plus ice packs. Two academic tertiary care centers PATIENTS: Patients undergoing planned outpatient LH with the minimally invasive gynecologic surgery team between February 2019 and November 2020 were considered. Patients with chronic pain, current opioid use ≥1 week, or planned overnight hospitalizations were excluded. Primary outcome data were available for 51 subjects (24 control, 27 intervention). Ice packs were placed on the abdomen in the operating room. Pain was assessed at multiple time points throughout the study using a visual analogue scale (VAS). Opioid requirement was assessed using morphine milligram equivalent. There was no difference between the groups on any demographic variables. Morphine milligram equivalent requirements were also not different between the groups (p=.63). Postoperative day 1 (POD#1) VAS scores were not different (p=.89). Eighty-five percent of subjects reported feeling that their pain was controlled. Subjects who reported that they did not feel their pain was controlled did not use more opioids on POD#1 (p=.37), nor did they have higher POD#1 VAS scores (p=.55). Eighty-seven percent of the intervention subjects said they would use ice again, and 82.6% of them said they would recommend ice to others. There were no adverse events related to ice. All subjects were prescribed 20 tablets oxycodone and averaged 2.9 (SD 3.4) tablets used after discharge. Ice packs are an acceptable supplement for postoperative pain control, but they do not reduce postoperative pain or opioid usage compared to standard pain management without ice packs.

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

Comparative evaluation of the effectiveness of intracanal and intraoral cryotherapy on postendodontic pain in patients with symptomatic apical periodontitis: A randomized clinical trial.

There is a rising need for controlling postendodontic pain (PEP) without using analgesics and other conventional methods. The aim of the study is to compare the effectiveness of various cryotherapy applications on controlling PEP in patients with symptomatic apical periodontitis. One hundred and eight patients were selected and preoperative pain and pain on percussion scores were recorded using Numeric Rating Scale (NRS) and Visual Analog Scale (VAS), respectively. After obtaining consent, the access cavity was prepared under local anesthesia. After cleaning and shaping, the patients were randomized into the following groups: Group A: Canals were given final irrigation with 20 mL room temperature saline solution for 5 min, Group B: Canals were given final irrigation with 20 mL cold (2°C-4°C) saline solution for 5 min, and Group C: After obturation and restoration procedures, small ice packs of size 2 cm × 2 cm × 2.5 cm (wrapped in sterile gauze) were placed intraorally on the vestibular surface of the treated tooth. At 6 h, postoperative pain was measured using NRS and at 24 h, pain and pain on percussion were measured using NRS and VAS, respectively. Data were analyzed using SPSS software. There was a significant reduction in postoperative pain in the intracanal and intraoral groups at 6 and 24 h when compared with the control group individually. There was no significant difference in postendodontic between intracanal and intraoral cryotherapy groups at 6 and 24 h. Both intracanal and intraoral cryotherapy applications are effective in reducing PEP in patients with symptomatic apical periodontitis.

Clinical Decision Making of Electrophysiological Agents by Physical Therapists

Background: Therapeutic modalities play a major role in rehabilitation and assist other therapeutic treatments, such as physical exercise and manual therapy. Aim: To assess the factors that affect the clinical decision making of electrophysiological agents by physical therapists. Study design: Descriptive cross-sectional survey. Methodology: Sample was taken through non- probability sampling technique. Sample size was calculated through Census method. Data was collected through online survey and questionnaires that were randomly distributed to all clinical physical therapists. Data was evaluated by using SPSS vr 24. Quantitative variables are represented in the form of frequencies %age. Results: 31(54%) of PTs reported Research evidence as a strong factor, 30(52%) reported availability of equipment and 40(70%) of PTs reported past clinical experience as a strong factor that influence the decision of usage of electrophysiological agents. The most frequently available agents were ultrasound (96%), hot pack (98%), cold pack (96%) and TENS (98%). Practical Implication: This study has determined the influence of various factors that affect the clinical decision-making abilities of clinical physical therapists working in Pakistan. Conclusion: It was concluded that making a decision while using EPAs was a complex phenomenon. All the factors must be considered when using EPA as treatment modality. Furthermore, there must be a regular check-up regarding the availability and up-dated version of EPAs by health policy makers in all clinical settings. Keywords: Electrophysiological Agents, Therapeutic Modalities and Rehabilitation.

The effect of ice gel pack on pain reduction of sheath removal in post-cardiac catheterization patients

Background: Cardiac catheterization is a minimally invasive intervention that can cause complications of vascular access after compression of the femoral artery or sheath removal. Cold pack gel is a non-pharmacological therapy given after sheat removal to reduce pain. Objective:This study aimed to measure the effect of ice pack gel on pain reduction in arterial sheath removal post-cardiac catheterization patients. Methods: This interventional clinical study with control and group treatment was conducted in the cardiology room of Saiful Anwar Hospital Malang, Indonesia. The respondents (n=32) were divided into two groups in pre and post-test control group design. Group A receives pressure bandages as a standard protocol (control groups) while group B, ice-packed gel. Pain scale measured by Visual Analog Scale (VAS) by 1-10. Results: The Mann-Whitney test in two groups shows that there are differences in scores of pain reduction. The pain reduction difference in the treatment group (ice pack gel) was higher than the control ones (p < 0.001). The cold temperature of the cold-packed gel decreased the peripheral free nerve ending conductivity, furthermore, it made sensitivity stimulus or pain impulses slowed down then reduced the perception of pain. Conclusions: The intervention of ice-packed gel is more effective than the standard protocols to reduce the pain in the removal sheath post cardiac catheterization.

Assessment of cold chain and vaccine management practices in cold chain points of Bilaspur, Chhattisgarh: a cross-sectional study

Background: To maintain the immunization effectiveness, and uninterrupted availability of vaccine functional cold chain is required. This can be achieved by continuous monitoring and supervision. The objective was to assess the functionality and monitoring of cold chain points of Bilaspur district of Chhattisgarh. Methods: A cross-sectional study conducted in the month of January 2021 in 15 old and new cold chain points, which were selected randomly from all the five blocks of district. Block level “supportive supervision of cold chain and vaccine management” checklist was used to collect the data. The data was presented in frequency and percentages. Results: The key findings were shortage of staff, placement of cold chain equipment and ice packs not as per the guidelines, irregular monthly review of temperature, and periodic monitoring with available documentation. Conclusions: There were shortfalls in the basic components of cold chain which requires immediate attention from the officials.

Emvolio - A battery operated portable refrigerator preserves biochemical and haematological integrity of biological samples in preclinical studies

Background: Emvolio is a non-medical device, indigenously developed portable refrigeration for maintaining the internal temperature 2–8˚C. The Indian Patent Office has granted patent for applications such as preservation and transport of medicines, vaccines, food, beverages, dairy etc. Further, use of Emvolio can be utilized in transport and store biologicals to preserve their biochemical and cellular integrity. The objective of this study was to evaluate the biochemical and haematological integrity of biological samples such as rat blood, serum and liver. Methods: The steady temperature was maintained inside the Emvolio, and it was compared to that of thermocol and polypropylene boxes aided with frozen gel packs. The blood and liver samples were isolated from Wistar rats and kept in Emvolio, thermocol and polypropylene boxes for 10 hrs, and the temperature was monitored. The blood parameters, namely red blood cells (RBC), white blood cells (WBC), platelets, haematocrit, haemoglobin, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC) and red cell distribution width (RDW), serum parameters like alanine transaminase, alkaline phosphatase, total protein, albumin, creatine kinase, blood urea nitrogen and liver parameters like superoxide dismutase (SOD), glutathione (GSH), catalase were estimated and compared. Results: Emvolio maintained a constant inner temperature range of 2–8˚C, whereas a significant temperature variation was seen in thermocol and polypropylene boxes. There was no significant deviation in the parameters tested when samples were kept in Emvolio for six hours compared to the zero hour readings. In contrast, there was a significant deviation among the parameters for the samples kept in thermocol and polypropylene boxes for six hours compared to zero hour parameters. Conclusions: Emvolio maintained constant temperature and preserved the biological integrity of rat blood, serum and liver. Thus, Emvolio can be efficiently used as a biological sample carrier, especially in preclinical studies.

Continuous cryotherapy vs. traditional cryotherapy after total knee arthroplasty: A systematic review and meta-analysis of randomized controlled trials.

Cryotherapy is widely applied to relieve pain and improve functional outcomes after total knee arthroplasty (TKA). New cryotherapy devices have recently been developed to guarantee a fixed temperature for a prolonged time. Therefore, we conducted a systematic review and meta-analysis to compare continuous cryotherapy and traditional cryotherapy (ice bag or gel pack) for patients after TKA. This study was conducted according to a predefined protocol registered on PROSPERO. Two independent reviewers performed an electronic database search of PubMed, Embase, Cochrane, Web of Science, Google Scholar, and ClinicalTrials.gov. Dichotomous outcomes were reported as risk difference (RD) with 95% confidence intervals (CIs), and continuous outcomes were reported as mean difference (MD), or standardized mean difference (SMD) with 95% CIs. Seven trials enrolling a total of 519 patients were included. There were no differences in pain intensity (MD: -0.54, 95% CI: -1.55 to 0.47; P = 0.30), analgesics consumption (MD: -0.37, 95% CI: -1.28 to 0.55; P = 0.43), postoperative range of motion (MD: 0.47, 95% CI: -4.09 to 5.03; P = 0.84), swelling of the knee joint, blood loss, change in hemoglobin, or transfusion rate. Meanwhile, there were no differences in length of hospital stay (MD: -0.77, 95% CI: -1.62 to 0.08; P = 0.07) and adverse events (RD: 0, 95% CI: -0.02 to 0.03; P = 0.74). In addition, continuous cryotherapy leads to extra costs and resources than traditional cryotherapy. Continuous cryotherapy does not appear to offer significant benefits for TKA when compared with traditional cryotherapy. Based on currently available evidence, traditional cryotherapy is still recommended as continuous cryotherapy is not cost-effective. Further well-designed studies with larger sample sizes are warranted to further confirm these preliminary results. PROSPERO Registration: Identifier [CRD42022308217].

Murine and Human Gastric Tissue Establishes Organoids after 48 Hours of Cold Ischemia Time during Shipment.

An inadequate supply of fresh tissue is a major limitation of three-dimensional patient-derived gastric organoid research. We propose that tissue procurement for organoid culture could be increased by developing a cold storage shipment protocol for fresh surgical tissues. Sixty stomach specimens from C57BL/6J mice were resected, of which forty-five were stored in Hank's Balanced Salt (HBSS), University of Wisconsin (UW), or Histidine-Tryptophan-Ketoglutarate (HTK) solutions for subsequent organoid culture. Stomachs were dissociated and processed into gastric organoids as fresh tissue or after transport at 4 °C for 24 or 48 h. All gastric organoid cultures were established and maintained for 10 passages. Cold storage for 24 or 48 h did not significantly affect organoid viability. Although cold storage was associated with decreased organoid growth rate, there were no differences in viability, cytotoxic dose response, or LGR5 and TROY stem cell gene expression compared to organoids prepared from fresh tissue. As a proof of concept, six human gastric cancer organoids were established after 24 or 48 h of storage. Patient-derived gastric organoids from mouse and human gastric tissue can be established after 48 h of cold ischemia. Our method, which only requires ice packs, standard shipping containers, and HBSS is feasible and reliable. This method does not affect the reliability of downstream dose-response assays and maintains organoid viability for at least 10 passages. The shipment of fresh tissue for organoid procurement could serve to enhance multicenter collaboration and achieve more elaborate or controlled organoid experimentation.

What’s He Building in There

What’s He Building in There Cat Powell (bio) After Tom Waits Your father has been spending a lot of time in the basement recently, and I’m hoping you will speak with him about this. I know you keep saying you won’t get involved in things between us anymore, but he is your father and I am concerned. On the one hand, at least he’s not following me around the house watching me do chores like he did in the early months of his retirement. On the other hand, it is concerning. When I say a lot of time, I mean a lot of time. Please call or email him. I think he is lonely and possibly depressed. _______ I saw the photos you posted on the Facebook. I’m glad that you are having fun, but I feel like if you have time to post those photos, you have time to at least email your father. _______ You are right. That email was passive aggressive. See? I can “evolve,” too. Unlike your father. The other day I had to explain to him what passive aggressive meant, and then when we were in line at the supermarket he turned to the perfect stranger behind us and said, “I’m passive aggressive. Do you know what that means?” I wanted to crawl under the candy rack. I think you have a point about social isolation not doing him any favors. He does sometimes go to watch the game and have a pitcher with Ted, but that relationship isn’t very deep. I don’t think he’s had any close friends since his brother died. [End Page 83] I’m glad to hear that work is going well, but don’t forget that your career is only one part of your life. And not the part that’s going to give me grandkids! Just kidding. (Haha, not really.) The decorations for Sherri’s baby shower arrived yesterday. I think they’re going to look really nice. I’ll send you pictures once I get them up. _______ Don’t be silly! You can’t throw your own daughter’s baby shower! That’s why I did Sherri’s for Margene. (It went well, by the way. Pictures attached.) Honestly, if the topic upsets you that much, maybe it’s time to revisit the idea of freezing your eggs. You’re clearly not taking dating seriously, and I told you we could use some of the money we set aside for your wedding. Maybe one of your gay friends could be a sperm donor. Honestly, that is probably a much better idea than trying to raise a child with a straight man. It’s not all it’s cracked up to be. Your father, for example, is still obsessed with his mystery project in the basement. He never came to bed Saturday night, and when I woke up, the truck was gone. Then an hour later he was back with a truck bed full of sheet-rock panels. I told him he was going to destroy his back carrying them by himself, but he said he’d be fine, he was wearing a belt. You know how he is about hiring help for anything. Remember the fuse box? He did manage to get the panels down, though—with a lot of bumping and cursing. Then he stayed down in the basement all day. When I called him for dinner, he didn’t answer. So I finally went down there and found him lying flat on his back on the floor in literal agony. He said he was just resting, but when he tried to get up, he couldn’t. He wouldn’t let me call an ambulance or even a neighbor, so I brought him some ice packs and Advil and tried to make him comfortable. I couldn’t help pointing out that none of this would have happened if he’d hired the neighbor kid, and he said that kids these days don’t know how to do a job properly and it would have been like lighting money on fire. I was tempted to tell him...

Efficacy and safety of the Arctic Sun device for hypoxic-ischemic encephalopathy in adult patients following cardiopulmonary resuscitation: A systematic review and meta-analysis.

The principal objective of this study was to carry out a comprehensive and thorough analysis to compare the safety and effectiveness of the Arctic Sun, a servo-controlled surface cooling device, with conventional cooling techniques for providing therapeutic hypothermia in adult patients who had experienced hypoxic-ischemic brain injury following cardiopulmonary resuscitation. In order to achieve our goal, we conducted an extensive search of multiple databases including PubMed, Embase, Cochrane, and ClinicalTrials.gov up to the date of July 30, 2021. We only included studies that compared the safety and efficacy of the Arctic Sun surface cooling equipment with standard cooling approaches such as cooling blankets, ice packs, and intravenous cold saline for treating comatose adult patients who had recovered after experiencing cardiac arrest. We evaluated various outcomes, including all-cause mortality, good neurological outcome at 1 month, and the occurrence of adverse effects such as infections, shock, and bleeding. We employed a random-effects meta-analysis to estimate the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes. One hundred and fourteen records were identified through our search; however, only three studies met our eligibility criteria, resulting in overall 187 patients incorporated in the meta-analysis. The findings indicated no significant difference in mortality rates among the Arctic Sun device and conventional cooling techniques (OR: 0.64; 95% CI: 0.34-1.19; P = 0.16; I2 = 0%). In addition, we found no significant difference in occurrence of good neurological outcomes (OR: 1.74; 95% CI: 0.94-3.25; P = 0.08; I2 = 0%) between the two cooling methods. However, the application of the Arctic Sun device was associated with increased incidence of infections compared to standard cooling methods (OR: 2.46; 95% CI: 1.18-5.11; P = 0.02; I2 = 0%). While no significant difference occurred in the incidence of shock (OR: 0.29; 95% CI: 0.07-1.18; P = 0.08; I2 = 40%), the use of the Arctic Sun device was linked to significantly fewer bleeding complications compared to standard cooling methods (OR: 0.11; 95% CI: 0.02-0.79; P = 0.03; I2 = 0%). After analyzing the results of our meta-analysis, we concluded that the use of the Arctic Sun device for targeted temperature management following cardiopulmonary resuscitation did not result in significant differences in mortality rates or improve neurological outcomes when compared to standard cooling techniques.

Satisfaction and Reduction of Pain Following Tele-Physiotherapy of Patients with Musculoskeletal Disorders during the COVID- 19 Pandemic Disorders

Introduction: This study aimed to investigate the rate of satisfaction and pain reduction in musculoskeletal patients by using tele-physiotherapy during the COVID-19 pandemic infection disease. Methods: Eighteen patients with shoulder, knee, neck, and thoracic pain received some advice through video conferencing or video calls. All participants received different exercises based on the patient’s pathology or using some accessible modalities such as cold or hot packs. Interventions were followed by online platforms such as chat/massage and video conferencing by WhatsApp or Telegram program. Pain intensity was assessed by the Numeric Rating Scale, and satisfaction was evaluated by the Telehealth Satisfaction Questionnaire. Results: Statistical analysis showed a significant reduction of pain (p< 0.001), with a high effect size = 2.9. The rate of satisfaction of patients was detected high about all questions. Conclusion: This study suggests that tele-physiotherapy can effectively reduce pain and increase satisfaction during pandemic infected disease or for patients in remote areas.

PERINEOTOMY CARE AFTER CHILDBIRTH

Every woman who became pregnant has to undergo the process of delivery. In normal process of delivery the baby is delivered per vagina, an episiotomy is performed by health care provider or midwife. Episiotomy is a surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labour to enlarge the vaginal introits so as to facilitate easy and safe delivery of the fetus. Episiotomy may be advice in the situations such as inelastic perineum, fetal distress, and complicated birth, prolonged second stage of labor, instrumental vaginal delivery and previous perineal surgeries .There are four types of episiotomy: midline, mediolateral, lateral and J shaped. Care of episiotomy involves perineal care, sitz bath, infrared heat, perineal exercises, antiseptic ointments, cold and hot packs The REEDA scale is used for assessing the perineal healing. Complications of episiotomy include perineal discomfort, perineal pain, difculty with breast feeding and walking, perineal bleeding, infection, wound dehiscence and dyspareunia.

An Evidence-based Practice Project: Using Cryotherapy for Headaches

This evidence-based practice project addresses the use of cryotherapy as an intervention in reducing the symptom of pain in patients with headaches. A literature review was conducted using PubMed, ProQuest Nursing and Allied Health, Cochrane Reviews, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The articles identified were evaluated to determine evidence level and quality. Seven articles were determined to be eligible to answer the following PICO question: In patients with headaches (P), how does cryotherapy (I) compare to standard care (C) with pain (O)? A total of seven articles were used in the review. Level I, II, IV, and V articles were identified ranging from high quality (A) to good quality (B). Each article focused on using cryotherapy in treating pain during headaches, either in conjunction with other analgesia or on its own. Each article identified an overall positive effect on pain. There is compelling evidence to treat a headache with cryotherapy. The recommendation includes using an ice or cool gel pack in conjunction with the standard treatment of headache to relieve headache pain.

Vaccine Management Knowledge and Practice of Health workers in Yemen

Vaccine management comprises of estimation of vaccine needs, ordering, storage, distribution, monitoring vaccines use and limiting vaccine wastage. Yemen has been in conflict situation for over 7 years and remains one of the world’s worst humanitarian crises, with an estimated 23.4 million people in need of humanitarian assistance. This descriptive cross-sectional study to assess the vaccine management knowledge and practice in Yemen was carried out among health workers in 6 governorates. 536 health workers at different levels provided responses to the online questionnaire which were imported into the Statistical Package for Social Sciences (SPSS) platform for relevant descriptive and inferential analysis. Chi square test was used to determine statistical significance of observed difference in knowledge and vaccine management practice against relevant socio-demographic and work-related variables. The level of significance was set at p value <0.05. The study showed that 429(80%) had good knowledge while 63(11.8%) and 44(8.2%) had fair and poor knowledge of vaccine management respectively. More than two-thirds of respondents only receive vaccines 411(76.7%), 124(23.1%) receive and distribute vaccines. Vaccine distribution included use of refrigerated vehicles (15.2%), cold boxes (32.8%) and vaccine carrier (41.6%) both with conditioned ice packs. A total of 432(63.8%) have experienced vaccine stock-out and mostly for 1-2weeks (75.6%). Association between age and vaccine management knowledge was statistically significant with p-value of 0.006. The vaccine management knowledge and practice as shown from the findings of the study are commendable. However, there is need to address the artificial stock-out of vaccines to avoid missed opportunities. Keywords: Knowledge, Practice, Vaccine Management.

There's something in the water: an overview of jellyfish, their stings, and treatment.

An increasing presence on many beaches worldwide, jellyfish are a diverse group of Cnidarians equipped with stinging cells termed cnidocytes. Though few of the over 10,000 species are dangerous to humans, and most that are produce no more than a painful sting, some jellyfish can produce systemic symptoms and even death. Chironex fleckeri, the Australian box jellyfish, has a venom potent enough to kill in less than 10 minutes, and for which there is an antivenom of debatable efficacy. Stings from Carukia barnesi can cause Irukandji syndrome, characterised by severe pain and hypertension. Jellyfish stings have also been associated with Guillain-Barre syndrome and anaphylaxis. Though optimal treatment of stings remains controversial, after removal from the water and addressing any immediate life threats, the tentacles should be removed and the area washed, with seawater being the best choice due to its low likelihood of inducing further cnidocyte discharge. Hot water immersion may be beneficial for pain control for non-tropical jellyfish stings, and cold packs for tropical stings. In general, there is no consensus for the optimal treatment of jellyfish stings, and so further research is needed into species-specific guidelines and whether there are any overarching rules.

1733. Stability of Imipenem/Cilastatin/Relebactam under Different Temperature and Administration Conditions

Abstract Background Imipenem/Cilastatin/Relebactam is an FDA-approved combination antibiotic indicated for resistant infections. There is a practical need to extend the shelf life of parenterals given to patients with such life-threatening infections in the hospital setting. The reconstituted drug's shelf life can be extended by storing at subzero temperatures to slow the degradation kinetics. Package insert indicate stability is 2 hrs at room temperature and refrigeration up to 24 hr. The study aims to determine the stability of the combination in polyvinyl chloride (PVC) infusion (IV) bags when stored at room temperature, refrigerated in addition to continuous infusion CADD pumps. Methods Drug vials (Merck & Co) were reconstituted to 5mg/mL (imipenem) in a 100mL normal saline. To avoid further degradation, samples were collected and mixed 1:1 with stabilizing buffer, then frozen at -80 °C within 5 minutes. For room temperature stability, 6 bags were prepared and stored at (24°C). 0.5ml samples were collected at 0, 2, 4, 6, 8, 12, 24 h from each bag at each time point. For refrigeration stability, 6 bags were prepared and refrigerated at 4 °C. At each time point (24, 36, 48, 60, 72, 84, 96,108, 120h), a sample of 0.5-mL is taken from each bag and frozen at −80 °C. For continuous ambulatory drug delivery (CADD) infusion devices stability, the reconstituted drug is loaded to 2g/200 mL cassettes (for 24-hr infusion) continuous infusion and 1g/100mL (for 12-hr infusion). The cassettes are immediately attached to the infusion pump and placed in a cold pouch with gel packs. After the initial 0.5 mL, 0-h samples from each pump, the pumps are sampled at 4, 8,12, 16, 20, and 24 hours for 2g/ 200mL cassettes and 2, 4, 8, 12 h for 1g/100 mL. Cut off for stability was set at 90% of the original concentration. Chemical assay was performed by a validated HPLC method. Results See tables Table 1:CADD pumps, concentrations are in mg/mL. Imi; imipenem, Rel; relebactam, Cil; Cilastatin, CADD; continuous ambulatory delivery device, SD; standard deviationTable 2:PCV bags, concentrations are in mg/mL. Imi; imipenem, Rel; relebactam, Cil; Cilastatin, PVC; polyvinyl chloride, SD; standard deviation Conclusion Imipenem/relebactam/cilastatin drug product was stable for 12 hrs in CADD pumps 100mL, 16 hrs in 200 mL, 108 hours in refrigerated PVC bags and 12 hrs at room temperature. The extended stability data will assistant pharmacy departments in optimizing drug preparation and storage, nursing time and minimize drug waste improving overall cost and efficiency of drug administration. Disclosures Islam Ghazi, PharmD, Merck And Co Inc: Grant/Research Support David Nicolau, PharmD, Marck and Co Inc: Advisor/Consultant|Marck and Co Inc: Grant/Research Support.

The Role of Cryotherapy After Total Knee Arthroplasty: A Systematic Review

BackgroundPrevious research shows conflicting evidence regarding the postoperative role of cryotherapy after total knee arthroplasty (TKA). This systematic review aims to further investigate the effect of various methods of cryotherapy on the following: (1) pain; (2) swelling; (3) postoperative opioid use; and (4) range of motion (ROM). MethodsA strategic keyword search of Medline, Cochrane, Embase, and CINAHL retrieved randomized controlled trials examining cryotherapy following TKA published between February 1, 2017, and February 24, 2022. The studied outcomes included pain ratings, knee/limb swelling, opioid use, and ROM. Six studies were selected for inclusion in this review. ResultsOpioid use was significantly decreased in cryotherapy groups compared to noncryotherapy groups within the first postoperative week only (P < .05). This effect may be augmented by the use of computer-assisted (temperature regulated) cryotherapy devices, compared to other modalities including ice packs. Pain ratings also decrease, but this decrease may not be clinically relevant. Cryotherapy appears to confer no consistent benefit to ROM and swelling at any time point. Computer-assisted cryotherapy may be associated with decreased opioid consumption after TKA compared to traditional ice packs. ConclusionCryotherapy’s role after TKA appears to be in decreasing opioid consumption primarily in the first postoperative week. Pain ratings also decrease consistently with cryotherapy use, but this decrease may not be clinically relevant. Study heterogeneity requires further research focusing on optimizing cryotherapy modalities within the first postoperative week, and analyzing cost associated with modern outpatient postoperative TKA protocols.