Saliva cortisol levels and physiological parameter fluctuations in mild traumatic brain injury patients compared to controls.

BACKGROUND: Evidence suggests that fluctuations of cortisol and physiological parameters can emerge during the course of mild Traumatic Brain Injury (mTBI). OBJECTIVE: To investigate fluctuations of cortisol and physiological parametersduring the acute phase of mTBI in hospitalized patients. METHODS: 30 participants (19 patients with mTBI and 11 controls) were examined for saliva cortisol dynamics, heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and body temperature (BT) fluctuations for four consecutive days. Also, the participants completed the Athens Insomnia Scale and Epworth Sleepiness Scales, in order to check for sleep problems. RESULTS: Patients showed elevated levels of cortisol relative to controls (peak at 8 am and lowest levels at 12 am), as well as for most physiological parameters. MAP was significantly higher for patients throughout the measurement period, and BT was elevated for patients relative to controls at almost all measurements of the first and second day. Mean HR tended to track at non-significantly higher levels for the mTBI group. Patients' sleepiness and insomnia values (ESS and AIS) were initially significantly higher relative to controls but the difference dissipated by day 4. CONCLUSION: The increase in absolute values of cortisol and physiological parameters measurements, indicates that in the acute phase of mTBI, a stressful process is activated which may affect sleep quality as well.Supplemental data for this article is available online at at doi: 10.1080/00207454.2021.1951264.

Avascular necrosis of the femoral head: Evaluation of hyperbaric oxygen therapy and quality of life.

Introduction: The treatment of avascular necrosis of the femoral head (AVNFH) is based on invasive (e.g., core decompression) and non-invasive methods (e.g., hyperbaric oxygen therapy - HBO2). The purpose of the present study is to evaluate the effect of HBO2 on the quality of life (QoL) of patients with AVNFH. Methods: This was a prospective observational non-controlled study of patients with AVNFH treated by HBO2. It was conducted, with the use of Steinberg scale, on 73 patients with AVNFH Stage I or II who were treated with HBO2. Patients' QoL was assessed with EuroQol-5D-5L (EQ), Harris Hip Score (mHHS), MAHORN (MHOT), and VAS, in three different phases: before HBO2; after the completion of the first phase (20 HBO2 sessions, up to two months); and after the completion of the second phase (20 HBO2 sessions, up to two months after the first phase). A reassessment was made on the completion of each phase. Ratings were also made after the completion of each phase, over the first five months of follow-up. Results: All 73 patients (67.1% males, 32.9% females, mean age: 40.34, SD ±± 9.99) participated in the study. Steinberg scale, mean EQ (F (1, 57) = 25.18, η2 = .306 and F (1, 43) = 43.402, η2 = .502); mHHS (F (1, 61) = 67.13, η2 = .524) and F (1, 43) = 31.84, η2 = .425); MHOT (F (1, 61) = 11.68, η2 = .161) and F (1, 43) = 98.01, η2 = .695); and VAS (F (1, 53) = 24.11, η2 = .313) and F (1, 39) = 45.61, η2 = .539), improved between the first and second measurements and between the second and third measurement accordingly (p < .01). Conclusion: HBO2 treatment does not induce alteration of quality of life and is well tolerated and accepted by patients.

Light affects heart rate's 24-h rhythmicity in intensive care unit patients: an observational study.

BACKGROUND: Intensive care unit (ICU) patients experience two affronts to normal 24-h rhythms: largely internal events such as medication and external factors such as light, noise and nursing interventions. AIMS AND OBJECTIVES: We investigated the impact of light variance within an ICU on 24-h rhythmicity of three key physiological parameters: heart rate (HR), mean arterial blood pressure (MAP) and body temperature (BT) in this patient population. DESIGN: Patients were assigned to beds either in the 'light' or 'dark' side within a single ICU. An actigraph continuously recorded light intensity for a 24-72-h period. METHODS: Measurements of HR, MAP and BT were recorded every 30 min. RESULTS: HR, MAP and BT did not follow 24-h rhythmicity in all patients. Higher light exposure in the Light Side of the ICU (122·3 versus 50·6 lx) was related to higher HR (89·4 versus 79·8 bpm), which may translate to clinically relevant outcomes in a larger sample. Duration of stay, the one clinical outcome measured in this study, showed no significant variation between the groups (p = 0·147). CONCLUSIONS: ICU patients are exposed to varying light intensities depending on bed positioning relative to natural sunlight, affecting the 24-h rhythm of HR. Larger, well-controlled studies also investigating the effect of relevant light intensity are indicated. RELEVANCE TO CLINICAL PRACTICE: Light is a variable that can be manipulated in the constrained environment of an ICU, thus offering an avenue for relatively unobtrusive interventions.

The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review.

Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of "Institute for Healthcare Improvement Ventilator Bundle", i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the "IHI Ventilator Bundle" combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle's compliance should be the gold standard combination.

Patients' Satisfaction With Pharmaceutical Care Services Provided During COVID Pandemic: Experience From Greece.

Introduction Private pharmacies can contribute to the health care system through primary care. Purpose The purpose of this study is to determine patients' expectations of pharmaceutical care services during covid pandemic in order to measure the level of patient satisfaction provided by the Greek healthcare system. Also, it is important to identify the associated factors that might affect patient satisfaction. Material and Method The sample of the study consisted of 168 customers of pharmacies in Athens. A patient satisfaction survey was conducted at health facilities operating in Athens. Data regarding socio-demographic characteristics and parameters that measure patients' expectations and satisfaction were collected through a closed-ended questionnaire that had been tested for validity and reliability. The patient's point of view was evaluated based on their expectation and perception of the pharmaceutical care services they had received. Data were entered into SPSS version 22 (IBM Corp, Armonk, NY ), and descriptive statistics, cross-tabs, and binary logistic regressions were utilized. P < 0.05 was used to declare association. Results About 89.3% of the participants were insured in the Greek health system. The main reason for visiting the pharmacy was the purchase of medicines and products (95.2%), vaccinations (19.6%), and consulting services for first aid (17.3%). The pharmacist was rated for his courtesy, willingness, friendliness, and reliability. Only 48.2% of participants knew that the pharmacy provided primary care services during the pandemic. The most common services provided were blood pressure measurement and intramuscular injections. Around 64.2% of them were fully satisfied. Pharmacists in primary care teams are uniquely positioned to facilitate practice expansion and make medicine a trusted resource for physicians, as well as improve health outcomes for patients. Conclusions The pharmacy has a leading role in health care due to easy access, and fast and immediate service. Patient-clients in Greek society trust their pharmacist as a health professional. Further research is suggested to ensure that through the delivery of health services by pharmacies, the cost of primary care could be lower.

Rotating shift-related changes in hormone levels in intensive care unit nurses.

AIM: This paper is a report of a study to investigate if an irregular rotating shift system, including night shifts, can cause changes to the secretion of hormones in nurses. METHOD: In 2006, 32 healthy intensive care unit nurses completed the Standard Shiftwork Index (SSI) and blood samples were collected from each participant at the beginning and end of each shift. Change in hormone levels between the beginning and end of morning shifts were examined and compared between nurses on morning only and rotating shifts. Correlations between change in hormone concentrations and scores from the SSI are presented. RESULTS: The mean reduction of cortisol level between the two measurements was statistically significantly greater for the 'rotating' than 'morning' shift group (P = 0.032). There were no statistically significant differences between the two groups in overall mean change from the first to the second measurement of prolactin, triiodothyronine and thyroid-stimulating hormone. Levels of thyroxine increased statistically significantly in the 'rotating' group (P = 0.049) but not in the 'morning' group. The morningness scale score was greater for the 'rotating' group, while greater job satisfaction levels were found in the 'morning' group. Statistically significant correlations were found between thyroid-stimulating hormone, triiodothyronine, thyroxine and prolactin changes and specific scales of the SSI questionnaire. CONCLUSION: Ergonomic shift schedules sympathetic to the body clock and nurses' preferences should be adopted to mitigate the adverse effects on health.

Circadian disruption of ICU patients: A review of pathways, expression, and interventions.

Intensive care unit patients typically exhibit pathologic wakefulness, poor quality of daytime sleep, nocturnal sleep fragmentation, and sleep patterns that feature the absence of slow wave sleep and rapid eye movement. This article offers a review of the existing literature examining circadian desynchronization in critically ill patients, highlighting contributing factors identified by scholars, and circadian abnormalities observed in these patients. It discusses potential implications for clinical practice and suggests avenues of future research. Elucidating the role of circadian rhythms in the management of critical illness can guide future chronotherapeutic approaches and optimize patient outcomes.

Evaluation of Bone Metabolism in Critically Ill Patients Using CTx and PINP.

Background. Prolonged immobilization, nutritional and vitamin D deficiency, and specific drug administration may lead to significant bone resorption. Methods and Patients. We prospectively evaluated critically ill patients admitted to the ICU for at least 10 days. Demographics, APACHE II, SOFA scores, length of stay (LOS), and drug administration were recorded. Blood collections were performed at baseline and on a weekly basis for five consecutive weeks. Serum levels of PINP, ß-CTx, iPTH, and 25(OH)vitamin D were measured at each time-point. Results. We enrolled 28 patients of mean age 67.4 ± 2.3 years, mean APACHE II 22.2 ± 0.9, SOFA 10.1 ± 0.6, and LOS 31.6 ± 5.7 days. Nineteen patients were receiving low molecular weight heparin, 17 nor-epinephrine and low dose hydrocortisone, 18 transfusions, and 3 phenytoin. 25(OH)vitamin D serum levels were very low in all patients at all time-points; iPTH serum levels were increased at baseline tending to normalize on 5th week; ß-CTx serum levels were significantly increased compared to baseline on 2nd week (peak values), whereas PINP levels were increased significantly after the 4th week. Conclusions. Our data show that critically ill patients had a pattern of hypovitaminosis D, increased iPTH, hypocalcaemia, and BTMs compatible with altered bone metabolism.

Ad libitum and restricted day and night sleep architecture.

This study represents a first controlled comparison of restricted versus unrestricted sleep in both day and night sleep categories. A repeated measures study of a homogenous group of young women without sleep disorders (n=14) found that stage 1, 2, 3 and REM sleep, as well as sleep latency were not statistically different between day ad libitum sleep (DAL) and day interrupted (DI) sleep categories, while night interrupted (NI) and ad libitum (NAL) sleep showed strikingly different architecture.

Influence of shiftwork on greek nursing personnel.

BACKGROUND: The aim of this study was to investigate the burden experienced by nursing personnel working irregular shifts in Greece and to conduct the first test of a Greek version of the Standard Shiftwork Index (SSI). METHODS: A cross-sectional survey was carried out. The SSI was completed by 365 nurses and nursing assistants working shifts, including nights. RESULTS: Female nursing personnel and those suffering from a chronic disease were most affected by working rotating shifts as they had elevated scores on the majority of the SSI scales, such as sleep, chronic fatigue, digestive and cardiovascular problems, general health questionnaire, cognitive and somatic anxiety, shift time satisfaction, engagement and disengagement strategies, languidity, flexibility, and neurotisicm. Nurses with longer working experience and those with family responsibilities also scored higher on some of the SSI scales, such as the sleep, shift time satisfaction, social and domestic disruption, disengagement strategies, morningness, and languidity scales. CONCLUSION: Shiftwork affects female nurses, those with chronic disease, older age, and domestic responsibilities more severely. Therefore management should take these factors into account when designing work schedules to alleviate the burden caused by shiftwork.

Sleep disturbance in nursing personnel working shifts.

OBJECTIVE: The aim of the present study was to explore the factors that are associated with sleep disturbance in nursing personnel working irregular shifts. METHODS: A cross-sectional survey was carried out. The Standard Shiftwork Index was used for data collection, which was completed by 365 nurses and nurse assistants working shifts including nights. RESULTS: Female nurses and nurses with elevated levels of chronic fatigue were found with greater sleep disturbance between all shifts. Sleep disturbance between most shifts was greater in participants with more than 18 years of working experience and those having family members to look after. No differences were observed in family status, professional training, or circadian characteristics. CONCLUSION: Our results suggest that demographics, working characteristics, and family structure are associated with sleep disturbance between shifts in nursing personnel. The modification of shift schedules according to individual needs and preferences is necessary for the reduction of sleeping problems.