Effect of the use of earplugs and eye mask on the quality of sleep in intensive care patients: a systematic review.

Intensive care unit (ICU) environment has a very strong and unavoidable negative impact on patients' sleep. Sleep deprivation in ICU patients has been already studied and negative effects on their outcome (prolonged ICU stay, decreased recovery) and complication rates (incidence of delirium, neuropsychological sequels of critical illness) discussed. Several interventions potentially improving the sleep disturbance in ICU (sleep-promotion strategies) have been assumed and tested for clinical practice. We present a review of recent literature focused on chosen types of non-pharmacological interventions (earplugs and eye mask) analysing their effect on sleep quality/quantity. From the total amount of 82 papers found in biomedical databases (CINAHL, PubMed and SCOPUS) we included the 19 most eligible studies meeting defined inclusion/exclusion criteria involving 1 379 participants. Both experimental and clinical trials, either ICU and non-ICU patient populations were analysed in the review. Most of the reviewed studies showed a significant improvement of subjective sleep quality when using described non-pharmacological interventions (objective parameters were not significantly validated). Measuring the sleep quality is a major concern limiting the objective comparison of the studies' results since non-standardised (and mainly individual) tools for sleep quality assessment were used. Despite the heterogeneity of analysed studies and some common methodological issues (sample size, design, outcome parameters choice and comparison) earplugs and eye mask showed potential positive effects on sleep quality and the incidence of delirium in ICU patients.

How Protective Eyewear Has Changed Dramatically Over the Decades.

Today's safety eyewear can be so lightweight and comfortable that at times workers don't even notice they are wearing it once it's on.

Cuidados oftalmológicos en la Guerra de Vietnam, medio siglo después. Datos obtenidos del Ejército Estadounidense / Ophthalmic care in the Vietnam War, half a century later. Data obtained from United States Army

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Evolution of Military Combat Eye Protection.

Appreciation for combat eye protection steadily increased following World War II. Products derived from experiences in World War I, World War II, Korea, Vietnam, and the Iran/Iraq war drove technical improvements throughout the 1980s and 1990s. Dismal wear compliance prior to 2004 indicates Soldiers and their leaders did not appreciate these improvements and found little value in the bulky, ugly, and uncomfortable products. In 2003, the 10th Mountain Division requested enhanced eye protection. Program Executive Office Soldier, the optometry consultant to the Army Surgeon General, members of the Tri-Service Vision Conservation and Readiness Program, and other subject matter experts selected and tested commercial off-the-shelf eye protection against military ballistic impact standards. Optical devices that met ballistic standards formed the first Authorized Protective Eyewear List and were fielded beginning in 2004. Wear compliance rose dramatically for the stylish protective eyewear, reaching 85% to 95% and eye injuries decreased across the Department of Defense even as the incidence of attacks in Iraq increased. Researchers continue to evaluate new materials and designs to increase the capabilities, features and level of protection of future ballistic eyewear.

Exploraciones otorrinolaringológicas recomendables previas al inicio de actividades subacuáticas o aeronáuticas. Legislación vigente / Recommended otorhinolaryngological examination prior to diving or flying. Current legislation

Introducción, objetivos y métodos: El organismo humano está relativamente bien adaptado a los cambios de presión a los que se somete durante las actividades aeronáuticas e, incluso, las subacuáticas. Pequeñas alteraciones anatómicas o funcionales que no constituyen un problema a una presión atmosférica habitual, pueden originar complicaciones al someter al organismo a medios hipobáricoshiperbáricos. El objetivo de este capítulo es hacer una revisión de los criterios de aptitud en la legislación vigente, valorar las contraindicaciones para la práctica de buceo o actividades aeronáuticas y repasar las exploraciones necesarias en el área otorrinolaringológica (ORL) que permitan detectar procesos patológicos. Resultados: La valoración anatómica y funcional ORL nos permite descartar candidatos con distintas alteraciones que contraindican la práctica de estas actividades. No está tan claro cómo explorar las alteraciones funcionales y si hay relación entre los hallazgos y la posibilidad de aparición de complicaciones. La legislación vigente es poco clara en las actividades subacuáticas. Contraindica la actividad en personas con afectaciones que pruebas científicas recientes muestran que podrían ser aptas. La legislación en cuanto a pilotos y tripulantes de cabina de pasajeros de aeronaves comerciales estipula perfectamente las revisiones que se deben realizar, así como las contraindicaciones para la concesión de certificados de aptitud. Conclusiones: Es necesario realizar reconocimientos médicos en las personas que se someten a cambios de presión. En el área ORL, las exploraciones permiten hacer una buena valoración de los posibles problemas que pueden aparecer en los distintos candidatos (AU)

Introduction, objectives and methods. The human body is relatively well adapted to the pressure changes experienced during flying and even diving. Small anatomical or functional alterations that would not cause problems at a normal atmospheric pressure can cause complications when the body is subjected to hypobaric-hyperbaric environments. The present article aims to provide a review of the criteria for fitness to dive or fly according to current legislation, to evaluate the contraindications for the practice of diving or flying, and to describe the otorhinolaryngological (ORL) examinations that allow abnormalities to be detected. Results. Anatomical and functional ORL examination allows candidates with various alterations that contraindicate the practice of these activities to be excluded. Less clear are the methods for examining functional alterations and whether there is a relationship between these findings and the possible development of complications. Current legislation on diving is unclear. Subaquatic activities are contraindicated in persons with certain alterations, although recent scientific tests show that they may be fit to dive. Legislation on the pilots and cabin crews of commercial airplanes stipulate the examinations that should be performed as well as the contraindications for issuing certificates of fitness to fly. Conclusions. Medical examinations should be performed in persons undergoing changes in atmospheric pressure. ORL examinations allow the possible problems that may develop in distinct candidates to be thoroughly evaluated (AU)

Have the attitudes of Australian squash players towards protective eyewear changed over the past decade?

OBJECTIVE: To assess indicative trends in the use of protective eyewear by Australian squash players and their attitudes towards its use since 1989. METHODS: Data were extracted from three Australian surveys of squash players conducted in 1989, 1995, and 2000. Responses to directly similar attitudinal questions relating to protective eyewear use from each survey were compared. The proportion of players giving each response was calculated for each survey, along with 95% confidence intervals for the differences between the 2000 survey and those from the earlier surveys. RESULTS: Self reported use of protective eyewear ranged from 10.0% in 1989, to 8.6% in 1995, and 18.8% in 2000. However, only 8.9% of the players surveyed in 2000 actually wore appropriate standards approved/polycarbonate lens eyewear. This can be compared with 8.0% and 2.0% of players who reported wearing appropriate polycarbonate lens eyewear in the 1989 and 1995 surveys respectively. Compared with the 1995 survey, significantly more players in 2000 believed that more players should wear protective eyewear (95% confidence interval (CI) for difference 1 to 18). A significantly higher proportion of players also supported the compulsory use of protective eyewear by juniors in 2000 than in both 1989 (95% CI for difference 6 to 24) and 1995 (95% CI for difference 5 to 22). No other attitudes had significantly changed over the decade. CONCLUSION: These data suggest that self reported use of protective eyewear has probably increased over the past decade. However, many players report wearing inappropriate eyewear. A transition from positive attitudes to appropriate eyewear behaviours is required before mandatory protective eyewear use can be effectively introduced.

Effect of heated and humidified carbon dioxide gas on core temperature and postoperative pain: a randomized trial.

BACKGROUND: Intraoperative hypothermia is a common event during laparoscopic operations. An external warming blanket has been shown to be effective in preventing hypothermia. It has now been proposed that using heated and humidified insufflation gas can prevent hypothermia and decrease postoperative pain. Therefore, we examined the extent of intraoperative hypothermia in patients undergoing laparoscopic Nissen fundoplication using an upper body warming blanket. We also attempted to determine whether using heated and humidified insufflation gas in addition to an external warming blanket would help to maintain intraoperative core temperature or decrease postoperative pain. METHODS: Twenty patients were randomized to receive either standard carbon dioxide (CO2) gas (control, n = 10) or heated and humidified gas (heated and humidified, n = 10). After the induction of anesthesia, an external warming blanket was placed on all patients in both groups. Intraoperative core temperature and intraabdominal temperature were measured at 15-min intervals. Postoperative pain intensity was assessed using a visual analogue pain scale, and the amount of analgesic consumption was recorded. Volume of gas delivered, number of lens-fogging episodes, intraoperative urine output, and hemodynamic data were also recorded. RESULTS: There was no significant difference between the two groups in age, length of operation, or volume of CO2 gas delivered. Compared with baseline value, mean core temperature increased by 0.4 degrees C in the heated and humidified group and by 0.3 degrees C in the control group at 1.5 h after surgical incision. Intraabdominal temperature increased by 0.2 degrees C in the heated and humidified group but decreased by 0.5 degrees C in the control group at 1.5 h after abdominal insufflation. There was no significant difference between the two groups in visual analog pain scale (5.4 +/- 1.6 control vs 4.5 +/- 2.8 heated and humidified), morphine consumed (27 +/- 26 mg control vs 32 +/- 19 mg heated and humidified), urine output, lens-fogging episodes, or hemodynamic parameters. CONCLUSION: Heated and humidified gas, when used in addition to an external warming blanket, minimized the reduction of intraabdominal temperature but did not alter core temperature or reduce postoperative pain.