Levels In Unit Research Articles

A mixed methods study into the effectiveness of sensory rooms in reducing agitation levels in a psychiatric intensive care unit

Background:Reducing incidences of violence, and the use of restrictive interventions within psychiatric intensive care units (PICUs), is a priority nationally. One method for reducing violence and aggression from escalating in PICUs is sensory rooms. This study aimed to explore the effectiveness of sensory rooms as an alternative strategy to manage agitation levels in a PICU and understand the patient and staff experiences of using sensory rooms as an alternative intervention to standard approaches for agitation reduction. Method:A mixed methods approach collected data over six months using an observational rating scale pre and post-sensory room, and conducting nine semi-structured interviews with patients and staff. Results:71 patient contacts recorded, there was a statistically significant difference in pre and post-sensory room agitation ratings (p<0.001), with 66% (n = 47) experiencing a reduction in agitation rating post-usage. The sensory room was used as both a proactive and reactive strategy to manage agitation. Five themes emerged from the interviews: the sensory room supports emotional regulation, improves the patient's experience, develops therapeutic relationships, and offers an alternative agitation management strategy; however, it can be an underused resource due to access limitations. Conclusion:Staff and patients had positive experiences using a sensory room to manage agitation; it offers a safe space away from the busy ward environment. Several different factors impact staff using the intervention. Findings provide considerations for services when developing sensory rooms in PICUs, to ensure they are established as a reliable alternative for the management of agitation.

Reduction of sound levels in the intermediate care unit; a quasi-experimental time-series design study

ObjectivesThis study aimed to assess the effectiveness of an architectural redesign and a multicomponent intervention bundle on noise reduction to enhance workplace safety. Methods/DesignQuasi-experimental study with a time-series and intensified intervention design conducted in an intermediate care unit. Two interventions were sequential introduced: the installation of a partition wall in the medication preparation room (architectural redesign) and the implementation of an a bundle. Effects on outcomes were evaluated comparing baseline, after architectural redesign (period-1) and after implementation of the bundle (period-2). SettingIntermediate care unit. Main Outcome MeasuresA-weighted sound levels (LAeq), alarms/day/bed, annoyance ratings (numeric rating scale 0–10) and number of distractions of nurses during the medication preparation process. ResultsLAeq baseline vs period-1, decreased in the medication preparation area from 56.8 (±5.0) to 53.7 (±7.2) dBA (p < 0.001) and in the nursing station from 56.8 (±5.0) to 54.3 (±4.0) dBA (p < 0.001). During period-2, further noise reduction was minimal to absent. Distractions decreased from 58 % during baseline to 45 % (p < 0.001) during period-1, with no further reduction during period-2.The median [IQR] number of alarms/day/bed increased from 263 [IQR 193–320] during baseline to 394 [IQR 258–474] during period-1 (p < 0.001), then decreased to 303 [IQR 264–370] (p < 0.05) during period-2. Median annoyance ratings decreased from baseline 3.0 [IQR 2.0–6.0] to 2.0 [IQR 1.0–3.0] (p < 0.001) during period-2. ConclusionAn architectural redesign resulted in a significant, clinically relevant decrease in sound levels along with a notable reduction in distractions. The multicomponent bundle lowered alarms and annoyance ratings; however, its effectiveness on other outcomes seems less persuasive. Implications for Clinical PracticeArchitectural redesign seems to be effective in controlling environmental noise.Architectural redesign results in a decrease in nurses’ distractions during the medication preparation process.The effect of an intervention bundle is, despite a positive effect on alarms and perceived annoyance, still insufficiently clear.

IL-8 Induces Neutrophil Extracellular Trap Formation in Severe Thermal Injury.

Neutrophil extracellular traps (NETs) have a dual role in the innate immune response to thermal injuries. NETs provide an early line of defence against infection. However, excessive NETosis can mediate the pathogenesis of immunothrombosis, disseminated intravascular coagulation (DIC) and multiple organ failure (MOF) in sepsis. Recent studies suggest that high interleukin-8 (IL-8) levels in intensive care unit (ICU) patients significantly contribute to excessive NET generation. This study aimed to determine whether IL-8 also mediates NET generation in patients with severe thermal injuries. IL-8 levels were measured in serum samples from thermally injured patients with ≥15% of the total body surface area (TBSA) and healthy controls (HC). Ex vivo NET generation was also investigated by treating isolated neutrophils with serum from thermal injured patients or normal serum with and without IL-8 and anti-IL-8 antibodies. IL-8 levels were significantly increased compared to HC on days 3 and 5 (p < 0.05) following thermal injury. IL-8 levels were also significantly increased at day 5 in septic versus non-septic patients (p < 0.001). IL-8 levels were also increased in patients who developed sepsis compared to HC at days 3, 5 and 7 (p < 0.001), day 10 (p < 0.05) and days 12 and 14 (p < 0.01). Serum containing either low, medium or high levels of IL-8 was shown to induce ex vivo NETosis in an IL-8-dependent manner. Furthermore, the inhibition of DNase activity in serum increased the NET-inducing activity of IL-8 in vitro by preventing NET degradation. IL-8 is a major contributor to NET formation in severe thermal injury and is increased in patients who develop sepsis. We confirmed that DNase is an important regulator of NET degradation but also a potential confounder within assays that measure serum-induced ex vivo NETosis.

Sources of Sound Exposure in Pediatric Critical Care.

Sound levels in the pediatric intensive care unit (PICU) are often above recommended levels, but few researchers have identified the sound sources contributing to high levels. To identify sources of PICU sound exposure. This was a secondary analysis of continuous bedside video and dosimeter data (n = 220.7 hours). A reliable coding scheme developed to identify sound sources in the adult ICU was modified for pediatrics. Proportions of sound sources were compared between times of high (≥45 dB) and low (<45 dB) sound, during day (7 AM to 6:59 PM) and night (7 PM to 6:59 AM) shifts, and during sound peaks (≥70 dB). Overall, family vocalizations (38% of observation time, n = 83.9 hours), clinician vocalizations (32%, n = 70.6 hours), and child nonverbal vocalizations (29.4%, n = 64.9 hours) were the main human sound sources. Media sounds (57.7%, n = 127.3 hours), general activity (40.7%, n = 89.8 hours), and medical equipment (31.3%, n = 69.1 hours) were the main environmental sound sources. Media sounds occurred in more than half of video hours. Child nonverbal (71.6%, n = 10.2 hours) and family vocalizations (63.2%, n = 9 hours) were highly prevalent during sound peaks. General activity (32.1%, n = 33.2 hours), clinician vocalizations (22.5%, n = 23.3 hours), and medical equipment sounds (20.6, n = 21.3 hours) were prevalent during night shifts. Clinicians should partner with families to limit nighttime PICU noise pollution. Large-scale studies using this reliable coding scheme are needed to understand the PICU sound environment.

Evaluation of noise levels and noise sources in an Irish neonatal intensive care unit.

This study: (i) quantified the typical noise levels in an Irish neonatal intensive care unit (NICU) and compared the values to recommendations by the American Academy of Paediatrics (AAP) and the European Standards for Care for Newborn Health (EFCNI) and to occupational exposure limit value and exposure action values; and (ii) qualified the perception of noise levels and the sources of noise across the various stakeholders within a typical NICU. A noise survey was conducted in an Irish NICU. Observations identified practices and behaviours in the NICU that potentially had an impact on noise levels. Noise levels were compared to occupational exposure limits and AAP and EFCNI standards. A noise perception survey was conducted to identify noise sources and awareness of noise levels in the NICU. Results were analysed using SPSS Statistics to determine statistical significance. Noise levels recorded were consistent with previous similar studies and in all cases, the average noise levels recorded exceeded the 45 dBA as recommended by the AAP and EFCNI. There was a statistically significant difference (P < 0.01) between noise levels recorded on the day shift compared to the night shift. The perception of noise levels reported by nurses versus parents was found to be statistically significant (P = 0.001). 38.3% of all respondents reported having received no information or training with regard to noise in the NICU. There was a statistically significant difference in the perception of who is most likely to be affected by noise in the NICU, with nurses reporting those most likely to be affected by noise were patients, and parents reporting those most likely to be affected were staff (P = 0.003). This study supports the hypothesis that noise levels within the NICU are of concern and require regular assessment and monitoring. Training and awareness programmes are an important component to ensuring all persons in the NICU recognise their potential impact on noise levels in the NICU and in reducing the risk for patients and staff.

The effectiveness of online teaching and learning compared to in-person instruction in science for junior secondary students: a case study in the Kurunegala education zone

Schools and Universities in Sri Lanka have been closed intermittently during the past three years due to COVID-19 and fuel shortages. During this period, in-person teaching became impossible, and online teaching was developed. However, schools have been reopened for in-person teaching and learning at present. In contrast, other countries adopted both methods, online and in-person. It was noticed that a decline in test scores among junior secondary students in some education zones during online learning. This study aimed to assess and compare the effectiveness of online and in-person teaching and learning science among junior secondary students in a selected school within the Kurunegala education zone. The study objectives were to 1). conduct both online and in-person science lessons for two groups separately and compare grade-eight students' performance in both settings; 2) compare teacher-student interaction, learning resources, peer group interaction, and motivation in both sittings; and 3) make suggestions for effective teaching and learning process. Two equally weighted courses were used to teach the two groups. Convenience sample of 72 Grade 8 students was used in the data collection with mixed methods approach. Pre-tests, post-tests, and questionnaires were used in the quantitative data collection. Qualitative data were collected via interviews with ten randomly selected students. The findings revealed that the performance scores of in-person group in Unit 4 (Properties of Matter) of grade-eight Science evaluation were slightly higher than that of online group. Both groups demonstrated similar performance levels in Unit 8 (Changes in Matter). However, in-person teaching exhibited significantly higher scores (p &lt; 0.05) than the online group for factors such as teacher-student interaction, peer group interaction, learning resources, and motivation. Students achieved high results in both settings but needed more resources, reliable internet facilities, and adequate technology skills for online teaching and learning. The study suggests adapting effective instructional methods, technology usage, resource availability, training, participation, peer interactions, and monitoring well-being for effective online science teaching.

Effect of Neonatal Intensive Care Unit (NICU) Humidity on Neonates: A Systematic Review.

This study explores the role of room humidity levels in the neonate intensive care unit (NICU) and how they impact their growth and development in this fragile stage. The study considers seven relevant studies that have explored this factor in different settings. Humidity's role in developing neonatal conditions, such as respiratory distress and fungal infections, is also elaborated on. For the literature review, the study utilized PubMed, Embase, and Scopusdatabases to guarantee comprehensive findings on the role of NICU room humidity on neonates. By examining these studies' evidence, the research highlights the paramount need to ensure that the room has adequate moisture, as exposure to less desirable humidity levels increases mortality and the severity of morbidity rates among neonates. The fact that the majority of NICUs lack humidity control, which is required, stimulated us to conduct this review.

Provider moral distress in caring for tracheostomy and ventilator dependent children: A single institution cross-sectional evaluation.

To determine levels of moral distress in a pediatric unit caring for patients with tracheostomy/ventilator dependence. Moral distress will be significant in a dedicated pediatric trach/vent unit. The Moral Distress Survey-Revised (MDS-R) is a 21-question survey measuring moral distress in pediatrics. The MDS-R was anonymously distributed to medical degree/doctor of osteopathy(MD/DOs), advanced practice practitioners (APPs), registered nurses(RNs), and respiratory therapists (RTs) in a unit caring for tracheostomy/ventilator dependent patients. Descriptive statistics, bivariate and multivariate analysis were performed. Response rate was 48% (61/127). Mean MDS-R score was 83 (range 43-119), which is comparable to reported levels in the pediatric intensive care unit (ICU). APPs had the highest median rate of moral distress (112, interquartilerange[IQR], 72-138), while MD/DOs had the lowest median score (49, IQR, 43-77). RNs and RTs had MDS-R scores between these two groups (medians of 91 and 84, respectively). Moral distress levels in a unit caring for long term tracheostomy and ventilator dependent patients are high, comparable to levels in pediatric ICUs. APPs.APPs had higher levels of distress compared to other groups. This may be attributable to the constant stressors of being the primary provider for complex patients, especially in a high-volume inpatient setting.

The Effect of Iron Supplementation on Work Fatigue Level in Female Nurses

Iron fulfillment refers to an attempt to achieve the ideal conditions of every human body’s metabolism stability, so it is crucial, especially for women considering the monthly cycle that reduces it. Dual role existence as an additional burden for working women also makes female workers vulnerable to work stress and job burnout. The nursing sector at Sultan Agung Islamic Hospital Semarang, which is dominated by women with an increasingly workload due to being one of the referral centers for health facilities on the north coast and locations that often experience flooding, is very close to excessive job fatigue. This study aims to analyze iron tablet supplementation’s effect on female nurses’ fatigue levels in an inpatient unit. This research is quantitative with a quasi-experimental method and one group pre-test and post-test design. This study populations were female nurses in the inpatient unit at Sultan Agung Islamic Hospital Semarang, with 40 people as a sample using the purposive sampling method. The dependent variable in this study was work fatigue level measured using reaction time application to determine reaction speed, while the independent variable was iron tablet supplementation for 4 weeks with 2 consumptions each week. The results showed that there was an increase in the reaction speed of respondents with an average of 44.8 milliseconds. The statistical test used was a Paired T-test test with measurement results showing a p-value of 0.0001 (p&lt;0.05), so it is known that there is a difference before and after supplementation. It can be concluded that iron tablet supplementation has an effect in increasing the reaction speed of respondents which means a decrease in work fatigue level.

Management of Critical Glucose Values in Hospice.

Objectives: This quality improvement (QI) project was to lean the process for managing critical high and low glucose levels in the hospice unit and to simplify the pharmacologic options for hypoglycemic management for nursing staff. Methods: The process for developing and refining the recommendations involved a modified Delphi approach with a team of key stakeholders with overlapping expertise in hospice care practice. Recommendations were based on literature review, judgement of experts, and clinical experience. Stakeholders ranked six potential solutions and two were prioritized within the scope of this project. Results: From 1/1/21 - 12/31/21, there were 48 veterans with insulin sliding scale orders in the hospice unit, of which there were six critical values acted on. A standard operating procedure (SOP) for the management of critical glucose values in hospice was developed based on updated processes. In addition, hospice patient specific insulin sliding scale order sets were created and endorsed for utilization and dissemination. Following implementation on 3/1/22, no critical values were found in the hospice unit from 3/1/22 - 6/1/22 during the sustainment period. Conclusions: The implementation of hospice insulin sliding scale order sets and SOP on the management of critical glucose values in hospice reduced the number of critical glucose values.

Analysis of noise levels in the neonatal intensive care unit: the impact of clinical microsystems.

Reorganization of neonatal intensive care by introducing clinical microsystems may help to allocate nursing time more appropriately to the needs of patients. However, there is concern that cohorting infants according to acuity may enhance noise levels. This single-center study investigated the impact of reorganization of neonatal intensive care unit by implementing clinical microsystems in a Level III NICU on environmental noise. This prospective study measured 24-h noise levels over a period of 6months during pre- and post-implementation of microsystems cohorting infants of similar acuity. Comparative analyses of the mixed acuity (i.e., before) and the cohorting (i.e., after) model were performed by creating daily profiles from continuous noise level measurements and calculating the length of exposure to predefined noise levels. Compared to baseline daytime measurements, noise levels were 3-6 dBA higher during physician handover. Noise levels were 2-3 dBA lower on weekends and 3-4 dBA lower at night, independent of the organizational model. The introduction of clinical microsystems slightly increased average noise levels for high-acuity pods (A and B) but produced a much more substantial decrease for low-acuity pods (E), leading to an overall reduction in unit-wide noise levels. Conclusion: Our data show that noise levels are more driven by human behavior than by technical devices. Implementation of microsystems may help to reduce noise exposure in the lower acuity pods in a NICU. What is Known: • Excessive noise levels can lead to adverse effects on the health and development of premature infants and other critically ill newborns. • The reorganization of the neonatal intensive care unit following the clinical microsystems principles might improve quality of care but also affect noise exposure of staff and patients. What is New: • The transition from a mixed -acuity to cohorting model is associated with an overall reduction in noise levels, particularly in low-acuity pods requiring less nursing care. • Nevertheless, baseline noise levels in both models exceeded the standard permissible limits.

Prospective pilot study evaluating a vitamin D3 loading dose in critically ill children with vitamin D deficiency.

Vitamin D deficiency is a common finding in critically ill children. However, the optimal supplementation strategy in this patient population is unknown. The objective of this study was to evaluate the effects of high-dose (10 000 IU/kg, max. 400 000IU) vitamin D supplementation on 25-hydroxyvitamin D3 (25[OH]D3) levels in pediatric intensive care unit (PICU) patients with baseline vitamin D deficiency. This was a prospective, institutional review board-approved pilot research study performed at the University of South Alabama Women's and Children's Hospital in Mobile, AL. The study sample consisted of patients less than 18 years old admitted to the PICU with baseline 25-hydroxyvitamin D (25[OH]D) level less than 30 ng/ml. Included patients received a one-time dose of vitamin D3 orally or via gastric tube (10 000 IU/kg, max. 400 000IU). A total of 17 patients were screened with 11 included in the study. Blood analysis revealed a significant increase in 25(OH)D3 level from baseline to 12-h post dose (21.6 [4.5] ng/ml vs. 46.7 [15.5] ng/ml, P < 0.001). At the 12-h post-dose time point, 10/11 patients (91%) had 25(OH)D3 levels that were greater than 30 ng/ml. No adverse effects were observed. Vitamin D3 supplementation at a dose of 10 000 IU/kg (max. 400 000IU) significantly increased 25(OH)D3 levels in critically ill pediatric patients.

The Relationship of Knowledge about Patient Care with Family Anxiety Levels in Intensive Care Unit of Antonius Pontianak Hospital

In the intensive care unit of Santo Antonius Hospital Pontianak with p value = 0.00 Family members will experience anxiety when facing one of the family members who is admitted to the ICU. Anxiety in the family can interfere with the patient's treatment process, because anxiety can cause stress in the family that can affect treatment support. Method: This study is a quantitative research that uses a correlative descriptive design with a cross sectional design. Sampling sampling technique with Total Sampling of 41 people. Croncbach's Alpha validity test result of 0.901 and proven reliable with &gt; result of 0.6 Result: Most of the respondents (56.1%) had good knowledge about treatment in the ICU of St. Antonius Hospital Pontianak. Almost half of the respondents (36.6%) experienced mild anxiety because their families were treated at St. Anthony's Hospital. The results of statistical tests using Chi Square and the level of significance (α) 0.05 were obtained There is a relationship between knowledge about patient care and the level of family anxiety in the intensive care unit room of St. Antonius Hospital Pontianak with a p value = 0.001. Conclusion: There is a relationship between knowledge about patient care and the level of family anxiety.

Characterization of a human placental clearance system to regulate serotonin levels in the fetoplacental unit

BackgroundSerotonin (5-HT) is a biogenic monoamine with diverse functions in multiple human organs and tissues. During pregnancy, tightly regulated levels of 5-HT in the fetoplacental unit are critical for proper placental functions, fetal development, and programming. Despite being a non-neuronal organ, the placenta expresses a suite of homeostatic proteins, membrane transporters and metabolizing enzymes, to regulate monoamine levels. We hypothesized that placental 5-HT clearance is important for maintaining 5-HT levels in the fetoplacental unit. We therefore investigated placental 5-HT uptake from the umbilical circulation at physiological and supraphysiological levels as well as placental metabolism of 5-HT to 5-hydroxyindoleacetic acid (5-HIAA) and 5-HIAA efflux from trophoblast cells.MethodsWe employed a systematic approach using advanced organ-, tissue-, and cellular-level models of the human placenta to investigate the transport and metabolism of 5-HT in the fetoplacental unit. Human placentas from uncomplicated term pregnancies were used for perfusion studies, culturing explants, and isolating primary trophoblast cells.ResultsUsing the dually perfused placenta, we observed a high and concentration-dependent placental extraction of 5-HT from the fetal circulation. Subsequently, within the placenta, 5-HT was metabolized to 5-hydroxyindoleacetic acid (5-HIAA), which was then unidirectionally excreted to the maternal circulation. In the explant cultures and primary trophoblast cells, we show concentration- and inhibitor-dependent 5-HT uptake and metabolism and subsequent 5-HIAA release into the media. Droplet digital PCR revealed that the dominant gene in all models was MAO-A, supporting the crucial role of 5-HT metabolism in placental 5-HT clearance.ConclusionsTaken together, we present transcriptional and functional evidence that the human placenta has an efficient 5-HT clearance system involving (1) removal of 5-HT from the fetal circulation by OCT3, (2) metabolism to 5-HIAA by MAO-A, and (3) selective 5-HIAA excretion to the maternal circulation via the MRP2 transporter. This synchronized mechanism is critical for regulating 5-HT in the fetoplacental unit; however, it can be compromised by external insults such as antidepressant drugs.

The Impact of Structural Changes on Sound Pressure Levels in a Neonatal Intensive Care Unit

The design of neonatal intensive care units (NICU) influences both patient safety and clinical outcomes as well as the acoustic conditions. In NICU exposure to sound pressure levels above the recommended can affect both neonates and healthcare staff. This study aimed to evaluate the sound pressure levels and to assess noise perception of professionals in a NICU before and after structural modifications and layout redesign. The measurements were performed with a sound level meter. A questionnaire was given to staff before and after the intervention. The opinion of healthcare staff regarding noise in NICU was better after the intervention, when compared with the responses previously given. The results showed that noise levels were excessive in the NICU (before and after), exceeding the international recommendations, with the levels ranging between 46.6 dBA to 57.8 dBA before and 52.0 dBA to 54.0 dBA after intervention. Overall, there is a need for more research in order to verify the effectiveness of some actions and strategies to reduce the impact of noise in NICU.

Sound levels and its effect on physiology of low birth weight newborns in a special care newborn unit — a prospective observational study

BackgroundFrom quiet environment in uterus, neonates in special care newborn units (SCNU) get exposed to a stressful technology-driven environment. Noise level in neonatal intensive care units (NICU) depends on social and psychological realm of people working there. In NICU, an hourly Leq (median equivalent continuous sound level) of sound should be 45 dB, Lmax, 60 dB, and L10 not exceeding 50 dB (AAP, 2007). Noise level in SCNUs of northeast India has not been studied.AimCreate awareness among health workers (HW) regarding noise.ObjectiveTo study (a) noise level in special care newborn unit and (b) its effect on neonatal physiology.MethodologyA prospective observational study was conducted in a teaching hospital in northeast India for 1 month. After IEC approval, ambient sound levels in intensive care unit (ICU) (levels 2 & 3) and kangaroo mother care (KMC) area were measured using inVH by Bosch Engineering Solution (android app) in 3 shifts. Forty hemodynamically stable quiet low birth weight neonates (level 2: 16, level 3: 14, KMC: 10) were evaluated for heart rate and respiratory rate at same time. Acutely sick neonates were excluded. Statistical analysis was done using SPSS.ResultsAverage sound at 10 am, 5 pm, and 11 pm in level 2 was 70.2 (+ 3.78) dB, 71.9 (+ 4.21) dB, and 54.6 (+ 5.38) dB; in level 3: 66.4 (+ 3.71) dB, 64.9 (+ 3.88) dB, and 63.5 (+ 2.52) dB; and KMC: 55.06 (+ 5), 54.66 (+ 5.38), and 47.7 (+ 5.1) dB (p = 0.0052). Of included neonates, mean birthweight in intensive vs KMC area was 1.378 (+ 0.017) vs 1.337 (+ 0.02) kg (p = 0.1) and gestational age 35.45 (+ 0.25) weeks and 34.8 (+ 0.91) weeks (p = 0.2). The mean neonatal heart rate and respiratory rates in level 2 were 154/min and 44 cycles/min, level 3: 148/min and 47 cycles/min; and KMC: 124/min and 40 cycles/min.ConclusionSignificant noise pollution is detected in levels 2 and 3 neonatal intensive care units and minimal in kangaroo mother care area. Raised neonatal heart rates and respiratory rates in intensive care units with respect to KMC area may be related to noise. The social and psychological realm of healthcare workers and caregivers needs urgent improvement so as to reduce ambient noise pollution in special care newborn units.

The Effectivness of Five-Finger Hypnosis Theraphy to Decrease on Family’s Anxiety Levels in the Intensive Care Unit

Patients in critical or life-threatening conditions who require quick and appropriate help in the emergency room (IGD) with uncertainty about the situation and patient safety, families often experience anxiety. Therapeutic hypnosis five fingers can help mengatatasi anxiety. Five- finger hypnosis therapy is a form of self-hypnosis that can cause a high relaxation effect, so it will reduce tension and anxiety from one's mind. The purpose of this study was to prove the effect of five-finger hypnosis therapy on the level of family anxiety in the emergency department (IGD) RSUD RA Basoeni Mojokerto. The research method used was pre-experimental design with one group pre-test-post-test design. The population of all patients' families in the emergency department (IGD ) RSUD RA Basoeni Mojokerto amounted to 129 . The sampling technique used in this research is Concecutive sampling. so that the sample obtained as many as 17 respondents . The instrument in this study was a questionnaire. Based on the results of the Wilcoxon signed rank test analysis, it was found that the p value = 0.000 and = 0.05 then this shows p &lt; which means this research shows that there is a meaning that there is an effect of five finger hypnosis therapy on the level of family anxiety in the Emergency Installation of RA Basoeni General Hospital Mojokerto . Giving five-finger hypnosis therapy is a form of diverting self-hypnosis situations that can cause a relaxing effect, so that it will reduce anxiety, tension, and stress from one's mind which can have an effect on decreasing anxiety level scores.

Ultrasound-guided anterior iliopsoas muscle space block effectively reduces intraoperative hypotension in elderly adults undergoing hip surgery: A randomised controlled trial.

Hypotension often occurs during hip surgery in elderly adults with conventional posterior lumbosacral plexus block. We conducted a randomised controlled trial to determine if simple iliopsoas space block can lower the incidence of intraoperative hypotension (IOH) and provide sufficient perioperative pain relief during hip fracture surgery in elderly adults. Patients undergoing surgery for elderly hip fracture were randomised to receive either an anterior iliopsoas space block with a lateral femoral cutaneous nerve block or a posterior lumbosacral plexus block. The primary outcome was a composite measure of IOH incidence comprising frequency, absolute and relative hypotension durations. Compared to the posterior group, the iliopsoas space block group had a decreased median frequency of IOH [1.09 (0-2. 14) vs. 3 (1.6-4.8), p = 0.001, respectively] along with lower absolute [5 (0-10) min] and relative [minutes below systolic blood pressure of 100 mmHg in % of total anaesthesia time, 6.67 (0-7.65)] duration of IOH compared to the posterior group [35 (10-45) min, p = 0.008; 37.6 (12.99-66.18), p = 0.004, respectively]. The median pain levels in the post-anaesthesia care unit and median intraoperative sufentanil usage were comparable between the iliopsoas space group [2 (1-3); 8 (6-10) μg] and posterior group [1 (0-3); 5 (5-8) μg]. Thermal imaging revealed that the limb injected with the iliopsoas space block had a higher skin temperature than the unblocked limb in the sacral plexus innervated region. A single iliopsoas space block lowers the IOH incidence and provides comparable perioperative analgesia to conventional lumbosacral plexus block. Trial registration at www.chictr.org.cn (ChiCTR2100051394); registered 22 September 2021.

Variable Effects of the In Ovo Administration of an Escherichia coli Vaccine in the Amnion or Air Cell on Commercial Layer Embryo and Hatchling Development

The effects of injecting the Poulvac E. coli vaccine (PECV) into either the air cell (AC) or amnion (AM) at different dosages at 18 days of incubation (DOI) on Hy-Line W-36-layer embryo and hatchling development were investigated. Serial dilutions of the PECV in diluent provided either 6.5 × 104, 6.5 × 103, 6.5 × 102, or 6.5 × 101 CFU dosages of E. coli. A diluent only injection treatment was included as a control. A total of 19 live embryonated eggs in each of 10 treatment groups were represented on each of 16 replicate levels (3040 total) in the hatcher unit. At 19 DOI, swabs of the AM indicated that the 6.5 × 101 and 6.5 × 102 CFU dosages provided a 50% level of PECV presence, whereas the 6.5 × 103 and 6.5 × 104 CFU dosages provided a 100% level of PECV presence. Conversely, only the 6.5 × 103 and 6.5 × 104 CFU dosages provided a 50% level of PECV presence in the AC. At all E. coli dosage levels, injection in the AM led to higher percentages of live or dead embryos that failed to pip (PEIS) (p = 0.001) or complete hatch (PEPE) (p ≤ 0.001) and a lower percentage of live fully hatched chicks (HI) (p ≤ 0.001), when compared to those injected in the AC. Like HI, significantly lower percentages of female hatchlings were also observed at 22 DOI for the AM compared to the AC injection, for all dosages except for the 6.5 × 102 CFU dosage. However, at all the dosages above the 6.5 × 101 CFU dosage, the AM injection resulted in a lower mean hatchling body weight (p = 0.010) at 22 DOI. In conclusion, E. coli populations were more prevalent in the AM than in the AC after the injection of the PECV in those sites. Furthermore, the injection of the PECV in the AM at all E. coli dosages generally increased late embryo mortality and decreased hatchability and hatchling body weight in comparison to an AC injection. It is concluded that the negative impact of the in ovo administration of the PECV in the AM at 18 DOI on the hatch process is dose dependent. However, effects of an increase in AC dosages and a decrease in AM dosages should be further investigated.

Assessment of soil-gas radon concentration over lithologies: a case study from district Karak, Khyber Pakhtunkhwa, Pakistan.

The current study is aimed to determine the variation of soil-gas radon concentrations over different rock formations representing diverse lithologies in the district of Karak, Khyber Pakhtunkhwa, Pakistan. The stratigraphic units were grouped on the basis of lithological contents into four categories, i.e., limestone, evaporites, claystone/mudstone, and sandstone. The highest average soil-gas 222Rn concentration (544Bq/L) was found in the uranium-bearing Dhok Pathan Formation of the Pliocene age, while the lowest radon levels (0.15Bq/L) were observed in the salt-bearing strata of Bahadurkhel Salt of Eocene age showing the non-uraniferous nature of the salt. High radon potential associated with the Dhok Pathan Formation is likely to be related to the high degree of uranium mineralization which is contributing to the elevated soil-gas radon levels. The study revealed that the soil-gas radon concentration in all lithologies is varying in the order of RnSandstone > RnLimestone > RnClaystone/Mudstone > RnEvaporites with the highest radon levels in the sandstone unit of uranium-bearing Dhok Pathan Formation. High fluctuations of soil-gas radon levels observed in this study evidently show that lithology and uranium mineralization have strong control over the 222Rn concentrations.