In our study, only half the patients had been assessed for pain, two-thirds of patients receiving sedatives had formal assessment using a sedation score and a minority of patients had been formally assessed for delirium. Half of all study patients were receiving analgesics and over one-third were receiving sedatives. For patients who were mechanically ventilated, two-thirds were receiving analgesics and seda- tives, with sedatives titrated for almost half of this sub- sample. The most common analgesics and sedatives used to promote patientcomfort were morphine, fentanyl, propofol and midazolam, although prescribing patterns varied. For patients who were appropriate for prospective assessment of delirium, one in 10 were identified as delirious.
Our study has some limitations. First, its primary aim was to assess patientcomfort, which might be viewed only as a psychologic secondary outcome. However, pa- tients experience a sense of relief when their physical and psychologic comfort needs are met [9, 10], and com- fort might be an accurate multifaceted method to esti- mate and improve the effectiveness of non-invasive respiratory support [24–26]. Moreover, pilot data suggest a link between poor comfort early during application of HFNC and subsequent intubation . Second, the re- sults derive from a short-time observation (20 min for each phase) and they should be confirmed by more extensive surveillance. Third, we tried to precisely define AHRF but our population was likely highly heteroge- neous in terms of etiology, inflammation activation, and derangement of respiratory mechanics. Fourth, the more severe subgroup was identified by clinically set FiO 2 ,
The Nurses’ board of the French-speaking society of in- tensive care developed a questionnaire in April 2011. The questionnaire consisted of 52 closed-ended ques- tions relating to: respondent’s role and characteristics; ICU characteristics in terms of design, equipment and organizational aspects potentially influencing patientcomfort; how caregivers view sources of patient discom- fort; and how patient well-being is considered by care- givers in practice. These questions were developed based on the recommendations of the consensus conference on critical care . Most questions had four possible an- swers ranging from “never” to “always” for questions on practices or from “pointless” to “essential” for questions answered by opinions. Caregivers were asked to evaluate
Abstract: A sample size of 280 certified mammography technologists were surveyed to understand what factors affect patient discomfort during breast imaging. Given mammography technologists’ level of patient involvement, they are uniquely positioned to observe factors that affect patientcomfort. The findings suggest that according to technologists, multiple factors, including patient ethnicity, breast density, previous biopsy and lumpectomy experience, as well as psychological factors, impact breast discomfort during mammography. Additionally, with respect to imaging protocols, technologists attributed 80% of moderate-to-extreme discomfort to “length of compression time” (27%) and “compression force” (53%). Technologists also attributed “pinching at chest wall” and “hard edges of breast platform” to “very high” discomfort significantly more times (P,0.05) than “coolness and edges of paddle”. These findings confirm some of what has been reported to date and challenge other findings. Given that recent decline in breast cancer mortality has been attributed to improvements in early detection and treatment, approaches to reduce discomfort should be considered in order to promote screening compliance. Although more research is needed, it is apparent that the patient experience of comfort and pain during mammography is an area warranting increased research and solutions.
Precision radiotherapy warrants careful verification of setup before delivery of radiation. Errors in precision radiotherapy can cause serious consequences affecting long term and short term outcome of treatment. Positioning and immobilisation of a patient during radiotherapy plays a crucial role. Hence, in precision radiotherapy for breast cancer treatment, the patient alignment aided by an appropriate immobilisation is of prime importance(32). In our study we intended to compare the setup uncertainties between use of a breast board and vacuum bag in radiotherapy for breast cancer. A within subject study design was chosen to match various confounding factors between the two groups. Patientcomfort and treatment time were also compared across both immobilisation devices.
The scatter graph Figure 7 highlights the lack of relation- ship for the comfort of each condition. Each subject indi- cated different comfort scores for each of the toe props tested. There was little or no trend to be observed be- tween conditions. It was found that 32% (n = 7) of subjects using a toe prop were more comfortable when compared to the control condition, with no specific trend between which toe prop was most comfortable. Similarly, 18% (n = 4) found the control condition more comfortable than any of the toe prop conditions. The statistical analysis using the Friedman test indicated there was no significant difference in the comfort scores across the four variables measured ( p > 0.536. χ 2 (3,n = 22) = 2.18, p < .0.005). Me- dian values between control ( Md = 36.5) and gel ( Md = 29.8) leather ( Md = 28.1) decreased. There was an in- crease in values for silicone ( Md = 37.6) suggesting there may be a relationship in comfort for silicone toe props.
Whilst only a single relevant paper was available for review, the study did directly compare the two drugs under identical conditions allowing a good assessment of clinical efficacy to be made between them. However, whilst the study did look at and compare many variables relating to meloxicam and robenacoxib no power calculation was demonstrated. One cannot help but be wary of the advanced statistics presented in this study given there were only eight dogs in the study. Also, this study was conducted by authors working for Novartis; the company producing the commercial brand of robenacoxib (Onsior). Finally, whilst experimental conditions were well matched, only efficacy in the acute stages of a joint inflammation were assessed. The study does not asses efficacy in naturally occurring disease and so there could be other factors (such as central sensitisation and patient physical abnormalities such as joint incongruity) affecting the perceived efficacy of the different products in the “real world”which were not considered here. Overall however this study would be useful when considered in the general practice situation as the two products have been compared directly and useful efficacy data has come from it. This usefulness would likely be reduced though should similar studies using patients with naturally occurring disease be available for review. When searching the literature, papers in which meloxicam and robenacoxib were not directly compared were excluded. Whilst these studies provided evidence of efficacy for both meloxicam and robenacoxib individually, they did not provide evidence for which drug would be more effective in the clinical setting and so would not suitably address the clinical question. Ideally larger studies are needed with power calculations to validate these results in patients with naturally occurring disease. Should sufficient data be available, a meta-analysis may also provide valuable data with regards to the clinical question posed. Given the prevalence of degenerative disease seen in practice, there would certainly be an appetite for such research.
Efficacy of the technique was evaluated by visual assessment of intraoperative bleeding in both the groups and recording of time taken. Post-operative patientcomfort was also recorded. Pain assessment was done after 24 h using a visual analog scale (VAS). Healing was assessed after 1 week. All of the above parameters were assessed by an independent senior fac- ulty who was blinded to the outcomes and parameters of the study. The excised samples were sent for histo- pathological analysis and various parameters such as loss of architecture in epithelium, loss of architecture in connective tissue, charring, and presence of artifacts were recorded. The data collected were tabulated and statistically analyzed.
Surgical site infection remains a complication of surgical procedures resulting in increased morbidity, mortality, and cost 5 . Infection remains the most significant factor affecting wound healing 6 . We have undertaken a comparative study of 162 cases between stapler, subcuticular and vertical mattress sutures in clean surgery to compare the merits and demerits of these techniques. Aim of the study was to compare the total cost, operative time required for skin closure, cosmetic outcome and patientcomfort by skin stapler, subcuticular suture and vertical mattress suture.
This study contributes to the current body of research in several ways. The findings from Amber, Belinda, and Camile are consistent with other research that shows manipulations in the environment can impact the patient. Most of these studies, however, focus on pain, not comfort (e.g., Halimaa, Vehviläinen-Julkunene, & Heinonen, 2001; Good, Anderson, Ahn, Cong, & Stanton-Hicks, 2005). Additionally, environmental impact studies in health psychology have predominately focused on environmental factors in hospital wards, such as lighting and noise in the neonatal intensive care unit. This study is unique in that it evaluates a specific apparatus designed for patientcomfort and recovery. Further, research has suggested that spinal-fusion surgery produces extreme pain and discomfort and that untreated pain can have significant long- term effects (Abbott, et al., 1992; Filos & Lehmann, 1999; Mayo Clinic Medical Services, 2006). Although pain data in the current project were low, this is a population that deserved further attention due to reports of high discomfort. In addition, a significant part of recovering from spinal fusion is maintaining proper positioning. This is the first study to date to have examined the impact of an environmental factor related to positioning on comfort and pain during spinal fusion recovery. This environmental factor, the BodyPillow®, appears to be fairly easy for nurses and caregivers to utilize as an intervention for comfort. Nursing staff has many responsibilities within the busy hospital environment and would not be able to implement an intervention that was too complex or decreased their overall efficiency. Caregivers are often present for their child’s recovery and are eager to increase their child’s comfort, the
One of the important responsibilities of nurses in clinical care is providing patientcomfort, which has priority from both the patient and family’s viewpoints (14, 15). The purpose of this study was to determine the effect of comfort-centered nursing care on comfort of patients undergoing CABG. Based on the results of this study, increase of comfort was significant after performing comfort-centered interventions in intervention group patients. Chen et al (2013) (31) reported the increase of comfort after massage in 64 patients with congestive heart failure. Also, Shafiee et al (2013) (32) reported significant increase of comfort in 72 patients undergoing CABG after stroke massage. Different researchers reported the effects of different types of massage on pain, relief, anxiety, decreased muscle tension and patient satisfaction (33,34,35). Therefore, it can be concluded that in the present study, increased comfort in the intervention group was achieved probably through the effect of the designed interventions. It should be noted that in various studies identical results have not been reported regarding the effect of different types of massage on comfort of patients. For example, Hatan et al (2002) (36) showed that foot massage in patients undergoing heart surgery could not significantly improve psychological factors including pain, anxiety, tension, relaxation, rest and hope in intervention group before and after intervention.
Background: Functional treatment is a widely used and generally accepted treatment for ankle sprain. A meta-analysis comparing the different functional treatment options could not make definitive conclusions regarding the effectiveness, and until now, little was known about patient satisfaction in relation to the outcome. Methods: Patients with acute ankle sprain received rest, ice, compression and elevation with an compressive bandage at the emergency department. After 5-7 days, 100 patients with grade II and III sprains were randomized into two groups: one group was treated with tape and the other with a semi-rigid ankle brace, both for 4 weeks. Post-injury physical and proprioceptive training was standardized. As primary outcome parameter patient satisfaction and skin complications were evaluated using a predefined questionnaire and numeric rating scale. As secondary outcome parameter the ankle joint function was assessed using the Karlsson scoring scale and range of motion.
In this study, sub-Tenon ’ s anesthesia achieved great results with complete akinesia and we highlighted some advantages of this technique over cataract/refractive lens exchange performed with topical anesthesia only. There is a new challenge in intraocular surgery at the moment with the advent of immediate sequential bilateral cataract sur- gery (ISBCS) and its progressive acceptance in modern ophthalmic practice, 28 our clinics including. With this approach, full sub-Tenon ’ s block is not practical, as it would result in postoperative diplopia and therefore topi- cal anesthesia is often the preferred choice. However, we are currently investigating a technique called analgetic sub-Tenon ’ s block (ASTB). In sub-Tenon ’ s anesthesia, the nerve blocking, reduction of pain and motoric func- tion/akinesia depend on the concentration of the local anesthetic solution. On the other hand, the spread of anesthesia and its duration depend on the volume applied. In our new ASTB technique, we use 0.5% of Lidocaine concentration and a 2.0 mL volume of local anesthetic solution and achieve some advantages of sub-Tenon ’ s block (elimination of pain, patient unable to squeeze the eye and blink and at least partial akinetic effect) without inducing postoperative diplopia. This, in combination with mild conscious sedation, signi ﬁ cantly improves patient ’ s journey during ISBCS compared to topical anesthesia; however, the technique will be discussed and further ana- lysed in our future studies.
This study was evaluated and approved by the Nemours Insti- tutional Review Board, was deemed a quality improvement study and therefore exempt from informed consent; however, our current report is meant to be a retrospective descriptive study that will lay the groundwork for quality improvement. De-identified data were extracted from a total of the 161,943 procedures performed at two academic pediatric hospitals within one children’s health system between 2013 and 2016. These data comprise 52 clinics/units, 125 different proce- dures, and 785 different combinations of comfort measures. These data are filtered so that all procedures with missing information (eg, age not recorded) or implausible data (eg, 250 attempts at catheterization) are excluded. Consequently, 152,006 procedures remain for analyses. Of these, the top four procedures (in both female and male patients) comprise 117,480 procedures, which are further filtered to only those procedures fitting the appropriate comfort measure criterion discussed earlier. A complete breakdown of these procedures can be seen in Figure 1.
highlighted the dynamics of the environmental factors aﬀect- ing thermal comfort. Indraganti (2010a) argued that the indi- vidual is an active member of the environment. Therefore, an individual thermal comfort can be determined by two factors. Namely, the body and its surrounding environment. Once one factor is altered, then an adjustment should be made to preserve the thermal equilibrium (Alahmer et al. 2011). Humphreys and Nicol (2002) and Nicol and Humphreys (2002) suggested that “if a change occurs such as to produce discomfort, people react in ways which tend to restore their comfort” (p. 992). Although, this adaption may be conscious or unconscious (Holopainen et al. 2014). Clothing insulation also aﬀects thermal comfort since garments and the body are in a continuously dynamic condition (Huang 2006). Choi et al. (2012) suggested that since these two factors aﬀect ther- moregulation, an individuals’ heart rate can be considered as an additional index for thermal comfort. Gender subjective thermal comfort was shown by Parsons (2002) to be related to their clothing styles, fabrics, and trends. The author noticed that women generally evaluate their thermal sensation cooler than men in cold environments. The Arabian traditional gar- ments can provide adequate insulation for optimal thermal comfort under hot and arid conditions (Al-ajmi et al. 2008).
There were a number of limitations in this study. First, this was a convenience sample of pediatric trau- mas. We had incomplete enrollment, with 42% of eligi- ble pediatric traumas being missed for FP data collection. Eligible patients were missed for several reasons, includ- ing incomplete study staff coverage during normal study hours and occasional lack of advance notification about the presence of a trauma patient. The missed cases were overall similar to those enrolled except that those missed had a lower mean GCS score that did not seem to be clinically significant. Missed patients were discharged from the hos- pital more often than those who were enrolled, perhaps suggesting that enrolled patients may have been somewhat more ill overall. Therefore, it seems unlikely that conve- nience sampling underrepresented situations that would be considered higher risk for FP.
patient outcomes. To reach their goal, the students had to work together as a health- care team, instead of as separate entities. The students were able to see that being questioned by other professions or questioning other professions is not meant to be personal, but rather is meant to clarify or ensure that correct decisions have been made for the patient, thus improving patient care. Students who have only experi- enced the LACE NPLH visit also demonstrated a signiﬁcant increase in their feeling of reliability and accuracy of information from the nursing profession and a non-sig- niﬁcant increase in their feeling of reliability and accuracy of information from the medical profession. Responses from students who participated in only the IPE activ- ity as a P4 showed an increase in the feeling of reliability and accuracy of informa- tion for the nursing profession, though it was not signiﬁcant. In the same group, the level of reliably accurate information from the medical profession remained rela- tively unchanged. Analysis of the responses from students who experienced both of the activities showed a non-signiﬁcant increase in the feeling of reliability and accu- racy of information from the nursing profession and a non-signiﬁcant decrease in the feeling of reliability and accuracy of information from the medical profession. The differences seen in these groups could be from different levels of experience with and exposure to the other professions. Fourth-year pharmacy students fre- quently work with medical students, physicians, and nurses while on their Advanced Pharmacy Practice Experience (APPE) rotations. Some students commented that past work-related or APPE experiences outweighed their IPE experiences in regards to their perceptions of the other professions.
The quality of landscape setting at both residential college area and the internal courtyard area was ‘good’ with 48.7% and 48.9% of total respondents, respectively. About 47.7% of respondents claimed that the landscape setting in both areas was ‘very’ influential to the life quality. The advantage of the internal courtyard in promoting day lighting and natural ventilation would not be denied as the presence of a landscape with green trees provides better environment than the open sky (Monteiro & Alucci, 2009) and they improve the room and building conditions even when receiving direct heat radiation and penetration from the worst orientations for the equatorial region; east and west (Jughans, 2008). The tree canopies have significant filtration capabilities which contribute to the reduction of terrestrial radiation, cooling the ground surfaces by capturing more latent heat, reducing air temperature by promoting more evapotranspiration, and effectively improve the outdoor thermal comfort, especially in open spaces of the tropical climate region (Shahidan et al., 2010). It also indirectly affects the indoor temperature and the cooling load of the building through shading and insulation effects (Yeang, 2008). Moreover, the vegetation-integrated buildings are more liked, aesthetically pleasing, and restorative than the houses without vegetation (White & Gatersleben, 2011).
sensation data are used to examine the influence of thermal sensation on the existing thermal variables. This has been conducted by another research in his field of study to examine the neutral temperature and comfort temperature of campus buildings. The regression equation of AMV (Actual Mean Vote) with the climate variables (air temperature and operative temperature) was described . The data are collected three times a day at the same time with the measured climate variables based on the following seven scale points: very cold (-3), cold (-2), cool (-1), neutral (0), warm (+1), hot (+2), very hot (+3) . The height of the measuring devices is shown in fig 1.