Patient anxiety of verticalization on day 0 after a Cesarean section.

PURPOSE: The ERAS protocol recommends fast mobilization of a patient along with providing psychological comfort; however, early verticalization can generate mental discomfort. In the post-operative period after Caesarean section (CC), a patient may experience pain, anxiety and negative affect. The main aim of the study was to investigate levels of patient anxiety concerning verticalization on day 0 after CC using. Also, the dependence between anxiety of verticalization and the following: pain, anxiety as a permanent disposition, resistance to pain, negative and positive emotions, and positive orientation was described. METHODS: The study included 150 women on day 0 after their CC. The measurement of anxiety concerning verticalization, pain, and also negative and positive emotions was conducted twice. During the first measurement, variables such as anxiety levels as a constant disposition, level of pain resistance and positive orientation were also monitored. RESULTS: Patients upon arrival at the post-operative room declared a higher level of anxiety of verticalization (p < 0.05) (Median = 4; IQR = 5) when compared to 6 h after surgery (Median = 3; IQR = 4). A weak correlation of anxiety and pain was noted (r = 0.264; p < 0.01) in the second measurement. In both measurements, negative emotions and pain resistance proved to be the strongest variables explaining anxiety concerning verticalization. CONCLUSIONS: Low levels of pain experienced by a patient after CC do not explain the variance in anxiety of verticalization. The use of the Numerical Rating Scale (NRS) of anxiety allows care givers to gain patients' psychological perspective in different moments after CC.

Anxiety and Psychological Flexibility in Women After Childbirth in the Rooming-in Unit during the COVID-19 Pandemic.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has intensified perinatal anxiety disorders. Psychological flexibility (PF), considered a specific mental toughness, has not been examined with regard to its relationship with anxiety in women after childbirth. We aimed to compare levels of anxiety, PF, and pain in women depending on the mode of birth, parity, and the magnitude of risk of developing an anxiety disorder. We also investigated the association of anxiety with PF and pain. METHODS: A total of 187 women after childbirth completed validated questionnaires for anxiety (State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale-Anxiety, Numerical Rating Scale for anxiety [NRS-A]), PF, and pain (Numerical Rating Scale for pain). Specific postpartum anxieties were assessed with a numerical scale from 0 to 10. The relationship of anxiety with PF and pain was examined. Women at low and high risk of developing anxiety disorder were compared in terms of PF, anxiety, and pain. RESULTS: On the second postpartum day, women after cesarean birth demonstrated significantly greater anxiety on NRS-A and pain than those after vaginal birth. Primiparous women experienced significantly greater anxieties and pain compared to multiparous women. The higher the PF patients demonstrated, the less anxiety and pain they had. Patients at high risk of developing an anxiety disorder had a lower level of PF (P < .001) and higher levels of anxiety (P < .001) and pain (P < .01) than patients at low risk of developing an anxiety disorder. No difference in the anxiety of getting COVID-19 was observed between the groups (P > .05). CONCLUSIONS: PF is an important psychological construct related to the mental and physical condition of women after childbirth. Increasing PF in women after childbirth may be considered as an important goal of preventive and intervention measures.

The concurrent impact of mild cognitive impairment and frailty syndrome in heart failure.

Pathological processes associated with ageing increase the risk of cognitive deficits and dementia. Frailty syndrome, also known as weakness or reserve depletion syndrome, may significantly accelerate these pathological processes in the elderly population. Frailty syndrome is characterized by decreased physiological function and neuropsychiatric symptoms, including cognitive decline and depressive states. In people with cardiovascular disease, the risk of frailty is 3 times higher. Frailty syndrome is particularly prevalent in severe heart failure, which increases the risk of mortality, increases hospital readmission, and reduces patients' quality of life. In addition, co-occurrence of cognitive impairment and frailty syndrome significantly increases the risk of dementia and other adverse outcomes, including mortality, in the heart failure population.

How to Improve the Care of Women after Childbirth in the Rooming-in Unit: A Prospective Observational Study.

Rooming-in is the WHO-recommended care system for mothers in the puerperium and their babies. This system allows the newborn to stay with the mother in the same room, 24 h a day. We aimed to investigate the need to entrust a newborn (NEN) in the care of maternity rooming-in staff during the COVID-19 pandemic, and its relationship to pain, anxiety, and blood loss after delivery. A prospective study of 200 adult women in the maternity ward operating in the rooming-in system focussed on NEN in the care of maternity rooming-in staff on the first (T1) and the second day of puerperium (T2). Women who declared having NEN were compared with women without NEN for anxiety, pain, and a drop in haemoglobin in the blood after delivery. In T1, 34% and in T2, 27% of women felt NEN in the care of maternity rooming-in staff. The NEN of women after a cesarean section was higher on both days than the NEN of women after vaginal delivery. Women with NEN had higher levels of pain, state anxiety, and higher levels of postpartum anxiety than women without NEN. Further research should be warranted to investigate whether women who give birth in hospitals that satisfy the NEN in the care of maternity rooming-in staff in their rooming-in units experience less pain and anxiety in comparison to those who give birth in hospital units without such a possibility and whether this factor is an important element in reducing anxiety and pain during puerperium.

Validation of the Numerical Anxiety Rating Scale in postpartum females: a prospective observational study.

OBJECTIVES: Perinatal anxiety is important for the quality of life of mothers and their offspring. The Numerical Anxiety Rating Scale (NRS-A) allows the level of anxiety in patients to be quickly assessed. Until now, the NRS-A has not been validated in the postpartum female population. The aim of this study was to assess the accuracy and reliability of the NRS-A when compared with the reference methods for measuring anxiety. MATERIAL AND METHODS: The observational prospective study included a group of 200 adult postpartum females of a hospital maternity ward. The validity between the Numerical Rating Scale for Anxiety (NRS-A) and the State and Trait Anxiety Inventory (STAI), and between the NRS-A and the Hospital Anxiety and Depression Scale (HADS-A), was determined. The detection thresholds for high anxiety were examined. RESULTS: Both measurements showed a positive high correlation between the NRS and STAI-S (in T1 rho = 0.807, in T2 rho = 0.778; p < 0.001), and a comparable relationship of both scales (STAI-S and NRS-A) with the STAI-T and HADS-A. The analysis of the ROC curve indicated that the value of the NRS-A equal to 3.5/10 can be considered the threshold that allows for a differentiation of patients with high anxiety from those without high anxiety in the studied population. CONCLUSIONS: The NRS-A is an accurate tool for measuring anxiety in Polish postpartum females. Routine anxiety measurements using the NRS-A can be used to identify people with high anxiety in order to provide emotional support to patients in the early postpartum period.

Effectiveness of mental simulations on the early mobilization of patients after cesarean section: a randomized controlled trial.

We aimed to investigate whether psychological intervention (single mental simulation) among women after cesarean surgery (CC) can affect their willingness to verticalize, actual verticalization, and the duration of the first mobilization. In this prospective randomised, controlled study, 150 women after CC were divided into 3 groups: experimental group with process-simulation with elements of relaxation, experimental group with outcome-simulation with elements of relaxation and control group with elements of relaxation only. After a 5-h stay in the post-operative room, women listened to a recording with a stimulation. Pain and anxiety of verticalization were measured before and after listening to the recording and after verticalization. Almost 12% more patients verticalized in the process-simulation group than in the control group. Percentages of mobilized patients were: 39.4% the process-simulation group; 32.8% in the outcome-simulation group; 27.7% controls (p = 0.073). Mobilization was 5 min longer in the process-simulation group then in control (p < 0.01). Anxiety after the simulation was a significant covariate of the willingness to verticalize, actual verticalization and time spent in mobilization. We conclude that a single mental simulation can effectively motivate patients for their first verticalization after CC. Perceived anxiety before verticalization may affect the effectiveness of interventions, so we recommend to check it at the postoperative care.ClinicalTrials.gov Identifier: NCT04829266.

Occurrence of Professional Burnout and Severity of Depressive Symptoms among Cardiac Nurses: A Cross-Sectional Study.

Nurses with depression are not only likely to suffer themselves, but it may have an impact on their coworkers and potentially the quality of care they provide. This study aimed to determine the prevalence of depression and its association with burnout in cardiac nurses. A group of 400 cardiac nurses (361 women and 39 men) was enrolled. The standardized tools such as Maslach Burnout Inventory (MBI), Beck Depression Inventory (BDI), and Patient Health Questionaire-9 (PHQ-9) were used. A high level of professional burnout regarding emotional exhaustion was observed in 53.3% of nurses, high depersonalization in 52.5%, and low personal accomplishment in 72.8%. PHQ-9 and BDI were shown to correlate significantly and positively with all three MBI subscales (p < 0.05). High depressive symptoms and occupational burnout were correlated with depression (p < 0.05). In conclusion, nurses were found to have high levels of depression and professional burnout, which may have resulted in a negative impact on the quality of patient care. Identification of burnout in cardiac nurses is necessary to consider interventions to prevent stress and depression.

Fusiforma themisticola n. gen., n. sp., a new genus and species of apostome ciliate infecting the hyperiid amphipod Themisto libellula in the Canadian Beaufort Sea (Arctic Ocean), and establishment of the Pseudocolliniidae (Ciliophora, Apostomatia).

A novel parasitic ciliate Fusiforma themisticola n. gen., n. sp. was discovered infecting 4.4% of the hyperiid amphipod Themisto libellula. Ciliates were isolated from a formaldehyde-fixed whole amphipod and the DNA was extracted for amplification of the small subunit (SSU) rRNA gene. Sequence and phylogenetic analyses showed unambiguously that this ciliate is an apostome and about 2% divergent from the krill-infesting apostome species assigned to the genus Pseudocollinia. Protargol silver impregnation showed a highly unusual infraciliature for an apostome. There are typically 8 (6-9) bipolar somatic kineties covering the banana-shaped body. The anterior end of the oral cavity begins about 1/3 of the body length from the anterior end and is composed of an inpocketing that is lined on its anterior and left wall with an oral field of densely packed ciliated kinetosomes. Stomatogenesis begins with some dedifferentiation of the parental oral field and elongation of its paroral and oral kineties. A new oral field develops midventrally and the paroral and oral kineties break to form the oral apparatus of the opisthe, which completes development by additional kinetosomal proliferation and migration of the paroral. This morphology is novel among apostomes and justifies the establishment of a new genus and species.