Psychological and work-related factors predicting work engagement in Malaysian employees.

BACKGROUND: Past research on work engagement has focused almost exclusively on either psychological or work-related factors in almost wholly separate literature. There is therefore a need to examine how these factors collectively influence work engagement. AIMS: To determine levels of work engagement and to identify psychological and work-related characteristics predicting work engagement in employees in Malaysia. METHODS: We recruited 5235 employees from 47 public and private organizations in Malaysia who responded to an online health survey. We assessed work engagement with the 9-item Utrecht Work Engagement Scale (UWES-9) and psychological distress using the 6-item Kessler scale. We performed multiple linear regression to determine predictors of work engagement. RESULTS: Employee mean age was 33.8 years (standard deviation [SD] ± 8.8). The mean work engagement score on the UWES-9 was 3.53 (SD ± 0.94). Eleven of 18 variables on multiple regression predicted work engagement, F(18, 4925) = 69.02, P < 0.001, R2 = 0.201. Factors that predicted higher work engagement were age, marital status, education level, job type, job permanency, longer sleep duration, lower psychological distress and no history of workplace bullying. CONCLUSIONS: Key factors associated with poorer work engagement in Malaysian employees include inadequate sleep, psychological distress and a history of workplace bullying. These are modifiable factors that individuals and employers can target to improve work engagement, ideally tailored according to occupational type.

Potential rapid solutions to maintain ventilation in the event of anaesthesia machine failure with no access to the patient's airway.

Anaesthesia machine failure requires rapid solutions to maintain ventilation and anaesthesia. During procedures with poor access to the patient's airway, it may not be possible to use a self-inflating mechanical ventilation device (SIMVD) for emergency ventilation, and alternative solutions are needed. We evaluated five methods for rescue ventilation using a patient simulator. In Method 1, we used the inspiratory and expiratory tubes and the alternative common gas outlet (ACGO) on the anaesthesia machine to produce a Mapleson E system. In Method 2, we used the tubes, ACGO and an open-ended reservoir bag to produce a Mapleson F system, controlling the bag to achieve ventilation. In Method 3, we attached a SIMVD to the inspiratory tube, and controlled occlusion of the expiratory tube. In Method 4, we used the tubes and ACGO in a Mapleson F configuration, replacing the open-ended bag with a SIMVD to facilitate manual ventilation. In Method 5, we attached a SIMVD to the expiratory tube and left the inspiratory tube attached to its mounting. We were able to achieve ventilation, maintain inhalational anaesthesia, and prevent expired gas rebreathing in Methods 1 and 2. In Method 3 ventilation was achieved with minimal rebreathing of expiratory gas, but with no inhalational agent. Methods 4 and 5 led to rebreathing. Our findings indicate that Methods 1 or 2 are the preferred rapid solutions to maintain ventilation and inhalational anaesthesia in the event of anaesthesia machine failure where there is poor airway access.

Influenza A H1N1 (2009): clinical spectrum of disease among adult patients admitted to a regional hospital in Singapore.

INTRODUCTION: The worldwide spread of Influenza A H1N1 (2009) has proceeded at an unprecedented rate, with the World Health Organization rapidly raising its influenza pandemic alert to phase six. We describe the disease spectrum of H1N1 (2009) to aid the triaging and identification of patients at risk. METHODS: This is a retrospective chart review of all confirmed H1N1 (2009) cases admitted to our institution between June and September 2009. RESULTS: The disease severity of the 153 patients studied was classified as mild (n is 75), moderate (n is 55) and severe (n is 23). 81 patients were female. The median age was 26 years. While comorbidities were more prevalent among patients with moderate-severe illness, 47.4 percent reported no pre-existing illness. Presenting complaints of breathlessness, tachycardia, low-pulse oximetry, higher leukocyte counts and C-reactive protein with low albumin levels were more commonly noted in moderate-severe illness (p-value less than 0.001). All patients received oseltamivir at a median of four days from illness onset. 18 required intensive care unit admission, with the majority (94.4 percent) within the first 24 hours of hospitalisation. The overall mortality rate was 4.6 percent. Median lengths of hospitalisation were four and nine days for moderate and severe cases, respectively. CONCLUSION: While the majority of H1N1 (2009) patients have mild illness, a subgroup can become critically ill. Prior good health is not necessarily a good discriminator against severe illness. The presence of dyspnoea, tachycardia and desaturation at triage should heighten the index of suspicion for H1N1 (2009)-related complications.

Severe refractory hypoxaemia in H1N1 (2009) intensive care patients: initial experience in an Asian regional hospital.

INTRODUCTION: The management of Influenza A (H1N1) patients with acute respiratory distress syndrome (ARDS) is an emerging challenge, especially during the 2009 pandemic. These patients frequently require advanced mechanical ventilation (MV) and on occasion, rescue therapy. We describe the demographics, presentation, course and outcomes of the first 12 H1N1 patients with ARDS who were admitted to our institution. METHODS: This was a retrospective chart review of H1N1 patients with ARDS who were admitted to our intensive care unit (ICU) between July and September 2009. RESULTS: Seven of the 12 patients were female. The median age was 46 (range 27-66) years. 25 percent of the patients had good health prior to the infection. The presenting symptoms were mainly cough (100 percent), fever (92 percent) and dyspnoea (64 percent). The median times from symptom onset to both hospitalisation and ICU admission were five (range 2-9) days. Ten (83 percent) patients required invasive MV within 24 hours of presentation. The mean PaO2/ FiO2 ratio was 87.9 +/- 37.3 mmHg, with a mean positive end expiratory pressure at 16.1 +/- 7.3 cm H2O. Three patients required either unconventional MV and/or prone positioning, inhaled nitric oxide or nebulised prostacyclin. The mean Acute Physiology and Chronic Health Evaluation II score was 12.7 +/- 9.1. Among survivors, the median number of ventilator days was 7.5 (range 5-11), with a median length of ICU stay of ten (range 6-14) days. The median length of hospitalisation was 13.5 (range 9-31) days. The mortality rate in our case series was 50 percent. CONCLUSION: Unlike patients of seasonal influenza, our severe H1N1 patients were of a younger age. A significant proportion had no underlying risk factors. Despite high ventilatory requirements, unconventional MV and adjunct therapy, the mortality rate remained high.

Chronic morphine administration results in tolerance to delta opioid receptor-mediated antinociception.

Delta opioid receptor agonists produce only a moderate degree of antinociception, possibly reflecting the predominantly intracellular location of delta opioid receptor. However, recent studies suggest that short term morphine pretreatment can increase delta opioid receptor-mediated antinociception by promoting the translocation of delta opioid receptor to the cell surface. Even more striking sensitization has been reported after long term morphine pretreatment and withdrawal in locomotor tests. In the present study we therefore examined the effects of longer term morphine pretreatment and withdrawal on delta opioid receptor-mediated antinociception in the formalin test. Male adult rats were pretreated daily with morphine (10 mg/kg s.c.) or saline for 10 days, and were tested acutely with the delta opioid receptor agonist [D-Ala2,Glu4]-deltorphin (intrathecal) at 0, 7 and 14 days of withdrawal. Unexpectedly, chronic morphine pre-exposure resulted in tolerance to [D-Ala2,Glu4]-deltorphin-induced antinociception, and this occurred at 0 and 7 but not 14 days of morphine withdrawal. Morphine challenge at withdrawal day 7 confirmed the presence of tolerance to the antinociceptive effects of this drug. Chronic morphine pretreatment also resulted in tolerance to the locomotor stimulant effect of [D-Ala2,Glu4]-deltorphin (given i.c.v.), contrary to a previous report of sensitization. However, consistent with previous reports, short term (2 day) pretreatment with morphine did result in sensitization to [D-Ala2,Glu4]-deltorphin. Subsequent in vitro analysis, using [125I][D-Ala2,Glu4]-deltorphin or guanosine 5'(gamma-35S-thio) triphosphate autoradiography, did not reveal any changes in delta opioid receptor binding or function resulting from chronic morphine pretreatment. In conclusion, chronic morphine pretreatment caused tolerance to delta opioid receptor-mediated behavioral effects with no clear change at the receptor level.

In vitro effects of local anaesthetics on the thromboelastographic profile of parturients.

BACKGROUND: Post-dural puncture headache can be an incapacitating complication of obstetric epidural analgesia/anaesthesia and early or prophylactic epidural blood patch (EBP) is one of the treatment options. Although local anaesthetic (LA) agents have been shown to have anticoagulation effects in vitro, peri-partum women are known to be hypercoagulable. We postulated that the presence of residual LA might not result in impaired haemostasis of the EBP in parturients. METHODS: Blood samples from 10 healthy term parturients were subjected to thromboelastography after the addition of four different LA (lidocaine, bupivacaine, levobupivacaine, and ropivacaine) preparations. RESULTS: There was a significant reduction in reaction (R) and coagulation (K) time (P<0.001, P<0.05) and an increase in alpha degrees angle (P<0.01) when comparing undiluted blood with the saline control group. Maximum amplitude (MA) and clot lysis (Ly30) did not change significantly despite the 50% dilution. The thromboelastographic parameters of all four LA-treated groups were no different from their saline controls and from each other. CONCLUSION: At clinical dosages, LA did not cause any hypocoagulable changes on the thromboelastographic profile of healthy parturients.

Nitrous oxide does not improve sevoflurane induction of anesthesia in adults.

STUDY OBJECTIVE: To compare the characteristics of sevoflurane induction with and without the addition of nitrous oxide (N(2)O) using tidal breathing inhalation induction without priming of the breathing circuit. DESIGN: Randomized, double-blind study. SETTING: Operating rooms of an ambulatory surgery suite at a university hospital. PATIENTS: 60 ASA physical status I and II adult patients undergoing elective surgery. INTERVENTIONS: Patients were randomized into two groups. During induction, Group 1 received 8% sevoflurane in N(2)O 4L/min and oxygen (O(2)) 2L/min; Group 2 received 8% sevoflurane in O(2) 6L/min. The time to cessation of finger tapping was used as the main index for induction time. Any adverse effects such as coughing, apnea, excessive oral secretions, laryngospasm, excitatory movements, and hemodynamic changes were also noted. MEASUREMENTS AND MAIN RESULTS: There were no significant differences in the induction times (Group 1: 62.0 vs. Group 2: 60.0 sec), number of breaths taken to this time (15.0 vs. 14.0), expired sevoflurane concentration at this time (3.4 vs. 3.2%), and time to Laryngeal Mask Airway insertion (160.0 vs. 195.0 sec). The frequencies of induction-related adverse events were similar in both study groups. CONCLUSION: The addition of N(2)O does not confer any clinically significant advantage in this method of sevoflurane induction in adults.