scholarly journals Mitigating the stress response to improve outcomes for older patients undergoing emergency surgery with the addition of beta-adrenergic blockade

2021 ◽  
Author(s):  
Shahin Mohseni ◽  
Bellal Joseph ◽  
Carol Jane Peden
Keyword(s):  
Stress Response ◽  
Emergency Surgery ◽  
Surgical Intervention ◽  
Physiological Stress ◽  
Surgical Patient ◽  
Adrenergic Blockade ◽  
Proactive Management ◽  
Operative Care ◽  
Acute Condition ◽  
The Impact

AbstractAs population age, healthcare systems and providers are likely to experience a substantial increase in the proportion of elderly patients requiring emergency surgery. Emergency surgery, compared with planned surgery, is strongly associated with increased risks of adverse postoperative outcomes due to the short time available for diagnosis, optimization, and intervention in patients presenting with physiological derangement. These patient populations, who are often frail and burdened with a variety of co-morbidities, have lower reserves to deal with the stress of the acute condition and the required emergency surgical intervention. In this review article, we discuss topical areas where mitigation of the physiological stress posed by the acute condition and asociated surgical intervention may be feasible. We consider the impact of the adrenergic response and use of beta blockers for these high-risk patients and discuss common risk factors such as frailty and delirium. A proactive multidisciplinary approach to peri-operative care aimed at mitigation of the stress response and proactive management of common conditions in the older emergency surgical patient could yield more favorable outcomes.

Neighborhood Disorder, Psychophysiological Distress, and Health

2005 ◽  
Vol 46 (2) ◽  
pp. 170-186 ◽  
Author(s):  
Terrence D. Hill ◽  
Catherine E. Ross ◽  
Ronald J. Angel
Keyword(s):  
Stress Response ◽  
Physiological Stress ◽  
Signs And Symptoms ◽  
The Body ◽  
Neighborhood Disorder ◽  
Physiological Stress Response ◽  
Chronic Stressors ◽  
Upset Stomach ◽  
Using Data ◽  
The Impact

How do neighborhoods affect the health of residents? We propose that the impact of neighborhood disorder on self-reported health is mediated by psychological and physiological distress. We hypothesize a stress process in which chronic stressors in the environment give rise to a psychological and physiological stress response that ultimately affects health. The exogenous variable of interest is the neighborhood where disadvantaged persons live, which may expose them to chronic stressors in the form of crime, trouble, harassment, and other potentially distressing signs of disorder and decay. The mediator is the stress response that occurs in the body and brain. Of interest here is a psychological stress response in the form of fearful anxiety and depression, and a physiological stress response in the form of signs and symptoms of autonomic arousal, such as dizziness, chest pains, trouble breathing, nausea, upset stomach, and weakness. The outcome is poor health. This model is supported using data from the Welfare, Children, and Families project, a sample of 2,402 disadvantaged women in disadvantaged neighborhoods in Chicago, Boston, and San Antonio.

Physiological response of weaned piglets to two transport durations observed in a Canadian commercial setting

2021 ◽  
Author(s):  
Hannah R Golightly ◽  
Jennifer Brown ◽  
Renée Bergeron ◽  
Zvonimir Poljak ◽  
R Cyril Roy ◽  
...  
Keyword(s):  
Stress Response ◽  
Muscle Injury ◽  
Physiological Stress ◽  
Reference Ranges ◽  
Weaned Piglets ◽  
Water Losses ◽  
Physiological Stress Response ◽  
Long Duration ◽  
The Impact ◽  
Events Data

Abstract Observational studies describing the impact of transport duration on weaned piglet welfare are limited. Current Canadian transport regulations are heavily informed by studies involving market hogs. Due to physiological differences between weaned piglets and market hogs, additional data on their response to transport are needed for age-specific evidence-based recommendations. A cohort study was conducted to describe and compare mortality, injury, weight change, hematological or biochemical changes in hydration, muscle injury and stress response observed in weaned piglets undergoing short duration (SD, <3h), or long duration (LD, >30 h) commercial summertime transport events. Data collection on 440 of 11,434 transported piglets occurred the morning of the day before transport (T0), at arrival (T1) and approximately three to four days (78-93h) after arrival at the nursery barn (T2). Low mortality occurred over all transport events (0.06%) with no association observed between transport duration and odds of death during transport (P=0.62). The incidence of lameness between T0 and T1 was low (1.84% of the 435 focal piglets scored) with all lameness cases identified as mild in severity. Lesions on ears and skin were more prevalent than other injury types after transport (T1) and may have been related to mixing aggression associated with weaning rather than transport alone. LD piglets weighed 0.39 kg less than SD piglets at T1 (P<0.01), but no difference in group weight was observed at T2 (P=0.17). Hematological and biochemical differences were present between groups at T1. LD piglets had increased hematocrit levels compared to SD piglets (P=0.01) suggesting increased body water losses. SD piglets showed greater levels of muscle injury compared to LD piglets including elevated aspartate aminotransferase (P<0.01) and creatine kinase (P<0.01). However, these parameters were within normal reference ranges for piglets of this age group. Indicators of physiological stress response including cortisol and neutrophil to lymphocyte ratios were elevated in SD piglets compared to LD piglets (P=0.02 and P<0.01, respectively). The results of this study demonstrate that both short and long transport durations can result in detectable physiological changes in weaned piglets. The overall impact of these durations on piglet welfare should be further explored by analyzing behavioural time budgets during and after transport.

scholarly journals Impact of the SARS-CoV-2 pandemic on emergency surgery services—a multi-national survey among WSES members

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Martin Reichert ◽  
◽  
Massimo Sartelli ◽  
Markus A. Weigand ◽  
Christoph Doppstadt ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Elective Surgery ◽  
Perforated Appendicitis ◽  
Surgical Patients ◽  
Patient Treatment ◽  
Surgical Patient ◽  
Structural Problems ◽  
Number Of Patients ◽  
Time To Diagnosis ◽  
The Impact

Abstract Background The SARS-CoV-2 pandemic is a major challenge for health care services worldwide. It’s impact on oncologic therapies and elective surgery has been described recently, and the literature provides guidelines regarding appropriate elective patient treatment during the pandemic. However, the impact of SARS-CoV-2 pandemic on emergency surgery services has been poorly investigated up to now. Methods A 17-item web survey had been distributed to emergency surgeons in June 2020 around the world, investigating the impact of SARS-CoV-2 pandemic on patients and septic diseases both requiring emergency surgery and the time-to-intervention in emergency surgery routine, as well as experiences with surgery in COVID-19 patients. Results Ninety-eight collaborators from 31 countries responded to the survey. The majority (65.3%) estimated the impact of the SARS-CoV-2 pandemic on emergency surgical patient care as being strong or very strong. Due to the pandemic, 87.8% reported a decrease in the total number of patients undergoing emergency surgery and approximately 25% estimated a delay of more than 2 h in the time-to-diagnosis and another 2 h in the time-to-intervention. Fifty percent make structural problems with in-hospital logistics (e.g. transport of patients, closed normal wards etc.) mainly responsible for delayed emergency surgery and the frequent need (56.1%) for a triage of emergency surgical patients. 56.1% of the collaborators observed more severe septic abdominal diseases during the pandemic, especially for perforated appendicitis and severe septic cholecystitis (41.8% and 40.2%, respectively). 62.2% had experiences with surgery in COVID-19-infected patients. Conclusions The results of The WSES COVID-19 emergency surgery survey are alarming. The combination of an estimated decrease in numbers of emergency surgical patients and an observed increase in more severe septic diseases may be a result of the fear of patients from infection with COVID-19 and a consecutive delayed hospital admission and diagnosis. A critical delay in time-to-diagnosis and time-to-intervention may be a result of changes in in-hospital logistics and operating room as well as intensive care capacities. Both reflect the potentially harmful impact of SARS-CoV-2 pandemic on emergency surgery services.

scholarly journals The relationship between physiological stress and wildlife disease: consequences for health and conservation

2016 ◽  
Vol 43 (1) ◽  
pp. 51 ◽  
Author(s):  
Stephanie Hing ◽  
Edward J. Narayan ◽  
R. C. Andrew Thompson ◽  
Stephanie S. Godfrey
Keyword(s):  
Climate Change ◽  
Stress Response ◽  
Habitat Loss ◽  
Physiological Stress ◽  
Wildlife Disease ◽  
Hendra Virus ◽  
Management Interventions ◽  
Wildlife Populations ◽  
The Impact ◽  
The Relationship

Wildlife populations are under increasing pressure from a variety of threatening processes, ranging from climate change to habitat loss, that can incite a physiological stress response. The stress response influences immune function, with potential consequences for patterns of infection and transmission of disease among and within wildlife, domesticated animals and humans. This is concerning because stress may exacerbate the impact of disease on species vulnerable to extinction, with consequences for biodiversity conservation globally. Furthermore, stress may shape the role of wildlife in the spread of emerging infectious diseases (EID) such as Hendra virus (HeV) and Ebola virus. However, we still have a limited understanding of the influence of physiological stress on infectious disease in wildlife. We highlight key reasons why an improved understanding of the relationship between stress and wildlife disease could benefit conservation, and animal and public health, and discuss approaches for future investigation. In particular, we recommend that increased attention be given to the influence of anthropogenic stressors including climate change, habitat loss and management interventions on disease dynamics in wildlife populations.

scholarly journals O35 The impact of COVID-19 on access and availability of radiological imaging and surgical intervention at the east Midlands major trauma centre: an icon trauma study

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
J K Seehra ◽  
C Lewis-Lloyd ◽  
G Gida ◽  
A Adiamah ◽  
A Brooks
Keyword(s):  
Ct Scan ◽  
Major Trauma ◽  
Surgical Intervention ◽  
Ct Scanning ◽  
Fold Increase ◽  
Trauma Centre ◽  
Similar Time ◽  
Operative Care ◽  
Major Trauma Centre ◽  
The Impact

Abstract Introduction During the COVID-19 pandemic, Major Trauma services were subject to significant challenges including reduced access to Computed Tomography (CT) scanning and restrictions on operative intervention due to limited intensive care beds. This study evaluated the pandemic’s impact on access and timeliness of imaging and surgical intervention. Method This observational study compared 2 cohorts of patients admitted in a 10-week period during the COVID-19 pandemic and a similar time period in 2019. Variables included demographics, time to CT scan and to surgery and operative characteristics. Statistical comparisons were undertaken using Mann Whitney U, Fisher’s exact and Chi-squared tests. Result Of 642 patients, 405 were admitted in 2019 and 237 in 2020 representing a 41.5% absolute reduction in trauma admissions during the pandemic. There were no statistical differences (P = 0.2585) between arrival to the Emergency Department and time to CT scan across both years (median 42 minutes) or between operative approach (P = 0.728) and level of post-operative care (P = 0.788). However, there were statistical differences in time to surgery (P = 0.0193) and operative length (P = 0.0141) with a 2-fold increase in overnight operating, 31.2% increase in patients operated on < 24 hours from admission, and 42.9% reduction in surgery lasting >120 minutes during the COVID-19 pandemic. Conclusion Early robust restructuring of trauma services during the COVID-19 pandemic ensured timely access to appropriate imaging and surgery for major trauma injured patients. The higher rates of overnight surgery and shorter duration of procedure were likely explained by the increased onsite availability of suitably trained trauma surgical teams. Take-home Message COVID-19 had the potential to significantly impact Major Trauma services, however excellence in patient care was maintained by quick restructuring to staff, space and services Improvements to the Major Trauma pathway have become ingrained into daily practice and optimised for future outbreaks.

Emotions and health: The impact of emotions, emotions regulation, music, and acculturation on health

2008 ◽  
Vol 16 (3) ◽  
pp. 112-115 ◽  
Author(s):  
Stephan Bongard ◽  
Volker Hodapp ◽  
Sonja Rohrmann
Keyword(s):  
Stress Responses ◽  
Physiological Stress ◽  
Anger Expression ◽  
Domain Specific ◽  
Cardiovascular Stress ◽  
Expression Behavior ◽  
Cardio Vascular ◽  
And Coping ◽  
Relationship Of ◽  
The Impact

Abstract. Our unit investigates the relationship of emotional processes (experience, expression, and coping), their physiological correlates and possible health outcomes. We study domain specific anger expression behavior and associated cardio-vascular loads and found e.g. that particularly an open anger expression at work is associated with greater blood pressure. Furthermore, we demonstrated that women may be predisposed for the development of certain mental disorders because of their higher disgust sensitivity. We also pointed out that the suppression of negative emotions leads to increased physiological stress responses which results in a higher risk for cardiovascular diseases. We could show that relaxation as well as music activity like singing in a choir causes increases in the local immune parameter immunoglobuline A. Finally, we are investigating connections between migrants’ strategy of acculturation and health and found e.g. elevated cardiovascular stress responses in migrants when they where highly adapted to the German culture.

scholarly journals The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Francesco A. Ciarleglio ◽  
Marta Rigoni ◽  
Liliana Mereu ◽  
Cai Tommaso ◽  
Alessandro Carrara ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Transfusion ◽  
Emergency Surgery ◽  
Surgical Care ◽  
Close Correlation ◽  
Negative Effects ◽  
Group 2 ◽  
Retrospective Comparative Study ◽  
The Impact ◽  
Group 1

Abstract Background The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March–May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March–May 2020, group 2). Methods A comparison (groups 1 versus 2) and subgroup analysis were performed between patients’ demographic, medical history, surgical, clinical and management characteristics. Results Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08–4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33–5.50, =0.68) were significantly higher in group 2. The delayed access cohort showed a close correlation with increased morbidity (OR = 3.19, 95% CI 0.89–11.44, p = 0.07), blood transfusion (OR = 5.13, 95% CI 1.05–25.15, p = 0.04) and 30-day mortality risk (OR = 8.00, 95% CI 1.01–63.23, p = 0.05). SARS-CoV-2-positive patients had higher risk of blood transfusion (20% vs 7.8%, p = 0.37) and ICU admissions (20% vs 2.6%, p = 0.17) and a longer median LOS (9 days vs 4 days, p = 0.11). Conclusions This article provides enhanced understanding of the effects of the COVID-19 pandemic on patient access to emergency surgical care. Our findings suggest that COVID-19 changed the quality of surgical care with poorer prognosis and higher morbidity rates. Delayed emergency department access and a “filter effect” induced by a fear of COVID-19 infection in the population resulted in only the most severe cases reaching the emergency department in time.

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