The effectiveness of information-sharing interventions to reduce anxiety in families waiting for surgical patients undergoing an elective surgical procedure: A systematic review

Background Whilst waiting for patients undergoing surgery, a lack of information regarding the patient’s status and the outcome of surgery, can contribute to the anxiety experienced by family members. Effective strategies for providing information to families are therefore required. Objectives To synthesize the best available evidence in relation to the most effective information-sharing interventions to reduce anxiety for families waiting for patients undergoing an elective surgical procedure. Inclusion criteria Types of participants All studies of family members over 18 years of age waiting for patients undergoing an elective surgical procedure were included, including those waiting for both adult and pediatric patients.   Types of intervention All information-sharing interventions for families of patients undergoing an elective surgical procedure were eligible for inclusion in the review. Types of studies All randomized controlled trials (RCTs) quasi-experimental studies, case-controlled and descriptive studies, comparing one information-sharing intervention to another or to usual care were eligible for inclusion in the review. Types of outcomes Primary outcome: The level of anxiety amongst family members or close relatives whilst waiting for patients undergoing surgery, as measured by a validated instrument such as the S-Anxiety portion of the State-Trait Anxiety Inventory (STAI). Secondary outcomes: Family satisfaction and other measurements that may be considered indicators of stress and anxiety, such as mean arterial pressure (MAP) and heart rate. Search strategy A comprehensive search, restricted to English language only, was undertaken of the following databases from 1990 to May 2013: Medline, CINAHL, EMBASE, ProQuest, Web of Science, PsycINFO, Scopus, Dissertation and Theses PQDT (via ProQuest), Current Contents, CENTRAL, Google Scholar, OpenGrey, Clinical Trials, Science.gov, Current Controlled Trials and National Institute for Clinical Studies (NHMRC). Methodological quality Two independent reviewers critically appraised retrieved papers for methodological quality using the standardized critical appraisal instruments for randomized controlled trials and descriptive studies from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instruments (JBI-MAStARI). Data extraction Two independent reviewers extracted data from included papers using a customized data extraction form. Data synthesis Statistical pooling was not possible, mainly due to issues with data reporting in two of the studies, therefore the results are presented in narrative form. Results Three studies with a total of 357 participants were included in the review. In-person reporting to family members was found to be effective in comparison with usual care in which no reports were provided. Telephone reporting was also found to be effective at reducing anxiety, in comparison with usual care, although not as effective as in-person reporting. The use of paging devices to keep family members informed were found to increase, rather than decrease anxiety. Conclusions Due to the lack of high quality research in this area, the strength of the conclusions are limited. It appears that in-person and telephone reporting to family members decreases anxiety, however the use of paging devices increases anxiety.

The time taken for the regional distribution of ventilation to stabilise: An investigation using electrical impedance tomography

Electrical impedance tomography is a novel technology capable of quantifying ventilation distribution in the lung in real time during various therapeutic manoeuvres. The technique requires changes to the patient’s position to place the electrical impedance tomography electrodes circumferentially around the thorax. The impact of these position changes on the time taken to stabilise the regional distribution of ventilation determined by electrical impedance tomography is unknown. This study aimed to determine the time taken for the regional distribution of ventilation determined by electrical impedance tomography to stabilise after changing position. Eight healthy, male volunteers were connected to electrical impedance tomography and a pneumotachometer. After 30 minutes stabilisation supine, participants were moved into 60 degrees Fowler’s position and then returned to supine. Thirty minutes was spent in each position. Concurrent readings of ventilation distribution and tidal volumes were taken every five minutes. A mixed regression model with a random intercept was used to compare the positions and changes over time. The anterior-posterior distribution stabilised after ten minutes in Fowler’s position and ten minutes after returning to supine. Left-right stabilisation was achieved after 15 minutes in Fowler’s position and supine. A minimum of 15 minutes of stabilisation should be allowed for spontaneously breathing individuals when assessing ventilation distribution. This time allows stabilisation to occur in the anterior-posterior direction as well as the left-right direction.

Investigation of the effect of balconies on natural ventilation of dwellings in high-rise residential buildings in subtropical climate

Balconies, as one of the main architectural features in subtropical climates, are assumed to enhance the ventilation performance of buildings by redirecting the wind. Although there are some studies on the effect of balconies on natural ventilation inside buildings, the majority have been conducted on single zone buildings with simple geometries. The purpose of this study is to explore the effect of balconies on the internal air flow pattern and ventilation performance of multi-storey residential buildings with internal partitions. To this end, a sample residential unit was selected for investigation and three different conditions tested, base case (no balcony), an open balcony and a semi-enclosed balcony. Computational Fluid Dynamics is used as an analysis method due to its accuracy and ability to provide detailed results. The cases are analysed in terms of average velocity, flow uniformity and number of Air Changes per Hour (ACH). The results suggest the introduction of a semi-enclosed balcony into high-rise dwellings improves the average velocity and flow uniformity. Integrating an open balcony results in reduction of the aforementioned parameters at 0° wind incidence.

Improving the prediction of odour impacts from meat chicken farms with detailed ventilation and odour data

Odour from meat chicken (broiler) farms is an environmental issue affecting the sustainable development of the chicken meat industry but is a normal part of broiler production. Odour plumes exhausted from broiler sheds interact with the environment, where dispersion and dilution of the odours varies constantly, especially diurnally. The potential for odour impacts is greatest when odour emission rates are high and/or when atmospheric dispersion and dilution of odour plumes is limited (i.e. during stable conditions). We continuously monitored ventilation rate, on-site weather conditions, atmospheric stability, and estimated odour concentration with an artificial olfaction system. Detailed inspection of odour emission rates at critical times, i.e. dawn, dusk and night time, revealed that maximum daily and batch odour emission rates are not necessarily the cause of odour impacts. Periods of lower odour emission rates on each day are more likely to correspond with odour impacts. Odour emission rates need to be measured at the times when odour impacts are most likely to occur, which is likely to be at night. Additionally, high resolution ventilation rate data should be sought after to improve odour emission models, especially at critical times of the day. Consultants, regulators and researchers need to give more thought to odour emission rates from meat chicken farms to improved prediction and management of odour impacts.

Risk assessment for airborne infectious diseases between natural ventilation and split-system air conditioner in a university classroom

Indoor air quality is a critical factor in the classroom due to high people concentration in a unique space. Indoor air pollutant might increase the chance of both long and short-term health problems among students and staff, reduce the productivity of teachers and degrade the student’s learning environment and comfort. Adequate air distribution strategies may reduce risk of infection in classroom. So, the purpose of air distribution systems in a classroom is not only to maximize conditions for thermal comfort, but also to remove indoor contaminants. Natural ventilation has the potential to play a significant role in achieving improvements in IAQ. The present study compares the risk of airborne infection between Natural Ventilation (opening windows and doors) and a Split-System Air Conditioner in a university classroom. The Wells-Riley model was used to predict the risk of indoor airborne transmission of infectious diseases such as influenza, measles and tuberculosis. For each case, the air exchange rate was measured using a CO2 tracer gas technique. It was found that opening windows and doors provided an air exchange rate of 2.3 air changes/hour (ACH), while with the Split System it was 0.6 ACH. The risk of airborne infection ranged between 4.24 to 30.86 % when using the Natural Ventilation and between 8.99 to 43.19% when using the Split System. The difference of airborne infection risk between the Split System and the Natural Ventilation ranged from 47 to 56%. Opening windows and doors maximize Natural Ventilation so that the risk of airborne contagion is much lower than with Split System.

Nutrition during noninvasive ventilation: clinical determinants and key practical recommendations

Malnutrition and poor nutritional intake have been identified as key issues associated with poorer clinical outcomes in chronic obstructive pulmonary disease (COPD) patients. There is strong evidence showing nutritional support is effective in treating malnutrition in stable COPD, but there is only limited research regarding nutritional status in patients treated with noninvasive ventilation (NIV). The impact of NIV during acute exacerbations of respiratory disease on nutritional status requires further investigation.

Effects of opioids on ventilation and hemodynamics

Opioids are most commonly used for treatment of severe pain. However, the fear of respiratory depression has restricted the use of opioids. Depending on the monitoring system used, different modes of opioid respiratory effects have been noted in previous studies. All opioids also cause alterations in hemodynamics at least to some extent. The main goal of this series of investigations was to elucidate the native ventilatory and hemodynamic effects of different opioids. Studies I-IV each involved 8 healthy male volunteers. Study V involved 13 patients with lower or upper extremity traumas. The opioids studied were morphine, oxycodone, pethidine, fentanyl, alfentanil, tramadol and ketamine. The respiratory parameters used in this study were breathing pattern measured with respiratory inductive plethysmography, gas exchange measured with indirect calorimetry, blood gas analysis and pulse oximetry. Hemodynamics was measured with arterial blood pressure, heart rate and oxygen consumption. Plasma catecholamine and histamine concentrations were also determined. All opioids studied caused an alteration in respiratory function. Respiratory rate, alveolar ventilation and minute ventilation decreased, while tidal volume increased in most situations. Breathing pattern was also significantly affected after opioid administration. The respiratory depression caused by oxycodone was deeper than the one caused by same dose of morphine. An equianalgesic dose of tramadol caused markedly smaller respiratory depression compared to pethidine. The potency ratio for respiratory depression of fentanyl and alfentanil is similar to analgesic potency ratio studied elsewhere. Racemic ketamine attenuated the respiratory depression caused by fentanyl, if measured with minute ventilation. However, this effect was counteracted by increased oxygen consumption. Supplemental oxygen did not offer any benefits, nor did it cause any atelectasis when given to opioid treated trauma patients. Morphine caused a transient hemodynamic stimulation, which was accompanied by an increase in oxygen consumption. Oxycodone, alfentanil, fentanyl, tramadol and pethidine infusions had minimal effects on hemodynamics. Plasma catecholamine concentrations were increased after high dose opioid administration. Plasma histamine concentrations were not elevated after morphine nor oxycodone administration. Respiratory depression is a side effect noted with all opioids. The profile of this phenomenon is quite similar with different opioid-receptor agonists. The hemodynamic effects of opioids may vary depending on the opioid used, morphine causing a slight hemodynamic stimulation. However, all opioids studied could be considered hemodynamically stable.

Effect of natural ventilation on the boundary layer separation and near-wake vortex shedding characteristics of a sphere

Experiments were conducted in water and wind tunnels on spheres in the Reynolds number range 6 x 10(3) to 6.5 x 10(5) to study the effect of natural ventilation on the boundary layer separation and near-wake Vortex shedding characteristics. In the subcritical range of Re (<2 x 10(5)), ventilation caused a marginal downstream shift in the location of laminar boundary layer separation; there was only a small change in the vortex shedding frequency. In the supercritical range (Re > 4 x 10(5)), ventilation caused a downstream shift in the mean locations of boundary layer separation and reattachment; these lines showed significant axisymmetry in the presence of venting. No distinct vortex shedding frequency was found. Instead, a dramatic reduction occurred in the wake unsteadiness at all frequencies. The reduction of wake unsteadiness is consistent with the reduction in total drag already reported. Based on the present results and those reported earlier, the effects of natural ventilation on the flow past a sphere can be categorized in two broad regimes, viz., weak and strong interaction regimes. In the weak interaction regime (subcritical Re), the broad features of the basic sphere are largely unaltered despite the large addition of mass in the near wake. Strong interaction is promoted by the closer proximity of the inner and outer shear layers at supercritical Re. This results in a modified and steady near-wake flow, characterized by reduced unsteadiness and small drag.

Study of buoyant jets in natural ventilation of a model room

Buoyant jets in natural ventilation of a model room with water as the fluid medium have been studied. A constant heat flux has been maintained on the bottom surface of the room. The buoyancy causes flow to enter through the bottom opening and leave through the top opening. The shadowgraph technique is used for visualization. At the inlet, a negatively buoyant jet is observed, whereas a positively buoyant jet is observed at the outlet. The theoretical results for the centerline trajectories of these buoyant jets using both Gaussian and top-hat profiles are discussed considering the variation of the entrainment coefficient with the local Froude number and the variation of the spreading ratio of buoyancy to velocity profile with the distance from the source. The shape of the profiles is found to evolve from top-hat to Gaussian geometry.

Stable isotopic signature of Southern Ocean deep water CO2 ventilation

The link between atmospheric CO2 level and ventilation state of the deep ocean is poorly understood due to the lack of coherent observations on the partitioning of carbon between atmosphere and ocean. In this Southern Ocean study, we have classified the Southern Ocean into different zones based on its hydrological features and have binned the variability in latitudinal air-CO2 concentration and its isotopic ratios. Together with air-CO2, we analysed the surface water for the isotopic ratios in dissolved inorganic carbon (DIC). Using the binary mixing approach on the isotopic ratio of atmospheric CO2 and its concentration, we identified the delta C-13 value of source CO2. The isotopic composition of source CO2 was around -9.22 +/- 0.26 parts per thousand for the year 2011 and 2012, while a composition of -13.49 +/- 4.07 parts per thousand was registered for the year 2013. We used the delta C-13 of DIC to predict the CO2 composition in air under equilibrium and compared our estimates with actual observations. We suggest that the degeneration of the DIC in presence of warm water in the region was the factor responsible for adding the CO2 to the atmosphere above. The place of observation coincides with the zone of high wind speed which promotes the process of CO2 exsolution from sea water. (C) 2015 Elsevier Ltd. All rights reserved.