scholarly journals Giving Birth on a Beach Women's Experiences of Using Virtual Reality in Labour A Pragmatic Mixed Methods Approach

2021 ◽  
Author(s):  
◽  
Lorna Massov
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Virtual Reality ◽  
Pain Relief ◽  
Pain Intensity ◽  
Labour Pain ◽  
Active Labour ◽  
Pharmacological Method ◽  
Physiological Markers ◽  
The Impact

<p><b>Birth is a normal physiological process, and many women want a natural birth. However, there is worldwide concern over the increasing use of epidural analgesia and other pharmacological pain relief methods for women in labour. This tendency renders birth non-physiological by increasing the use of obstetric interventions with associated risks. Women use a range of non-pharmacological pain relief methods to reduce labour pain intensity, to help manage labour pain and to induce relaxation. The purpose of this study was to explore the experiences of women using virtual reality (VR) as a non-pharmacological method of pain relief in labour and to determine whether there was an effect on labour pain intensity. Virtual reality has been shown to be an effective distraction technique in other acute pain settings and also reduces anxiety.</b></p> <p>This study used a pragmatic mixed method approach with a sequential exploratory design, combining in-depth antenatal and postnatal interviews with an intervention study in labour in a cross-over within-subjects trial. Thematic analysis was used to analyse the qualitative data.</p> <p>Twenty-six pregnant women were recruited to the study. Fourteen participants reported their pain and had their heart rate and blood pressure measured during active labour while using and not using VR. There were significantly lower reported pain scores (6.14 compared to 7.61, p =<.001) and maternal heart rate (79.86 beats per minute compared to 85.57, p = .033) and mean arterial pressure (88.78 mmHg compared to 92.61 mmHg, p = .022) were lower when using VR during active labour. These differences were all statistically significant. Findings from qualitative postnatal interviews indicated a positive response to the use of VR in labour. Several themes were identified in the data. The first theme, Impact of VR on Labour, described the impact of VR on labour in terms of distraction, relaxation, enjoyment and a positive birth experience. The second theme, Managing the Pain, describes how VR was used by the women to manage their labour pain using breathing techniques and gaining a sense of control. In the third theme, The Challenges and Surprises of Using VR in Labour, women’s narratives recounted the various challenges of using the VR technology. Despite these challenges, ninety-four percent of women reported that they would use VR in labour again and would recommend it to a pregnant friend.</p> <p>This study provides a unique and original contribution to the field of VR in labour and birth. It is consistent with other recent findings of reduced pain with the use of VR, and links decreased pain scales to heart rate and blood pressure, the physiological markers of pain. It also identifies VR as an acceptable and positive experience in the management of labour pain. Results from this study have the potential to inform design for future labour specific VR environments and expand its application in the field of biomedical technology.</p>

scholarly journals Giving Birth on a Beach Women's Experiences of Using Virtual Reality in Labour A Pragmatic Mixed Methods Approach

2021 ◽  
Author(s):  
◽  
Lorna Massov
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Virtual Reality ◽  
Pain Relief ◽  
Pain Intensity ◽  
Labour Pain ◽  
Active Labour ◽  
Pharmacological Method ◽  
Physiological Markers ◽  
The Impact

<p><b>Birth is a normal physiological process, and many women want a natural birth. However, there is worldwide concern over the increasing use of epidural analgesia and other pharmacological pain relief methods for women in labour. This tendency renders birth non-physiological by increasing the use of obstetric interventions with associated risks. Women use a range of non-pharmacological pain relief methods to reduce labour pain intensity, to help manage labour pain and to induce relaxation. The purpose of this study was to explore the experiences of women using virtual reality (VR) as a non-pharmacological method of pain relief in labour and to determine whether there was an effect on labour pain intensity. Virtual reality has been shown to be an effective distraction technique in other acute pain settings and also reduces anxiety.</b></p> <p>This study used a pragmatic mixed method approach with a sequential exploratory design, combining in-depth antenatal and postnatal interviews with an intervention study in labour in a cross-over within-subjects trial. Thematic analysis was used to analyse the qualitative data.</p> <p>Twenty-six pregnant women were recruited to the study. Fourteen participants reported their pain and had their heart rate and blood pressure measured during active labour while using and not using VR. There were significantly lower reported pain scores (6.14 compared to 7.61, p =<.001) and maternal heart rate (79.86 beats per minute compared to 85.57, p = .033) and mean arterial pressure (88.78 mmHg compared to 92.61 mmHg, p = .022) were lower when using VR during active labour. These differences were all statistically significant. Findings from qualitative postnatal interviews indicated a positive response to the use of VR in labour. Several themes were identified in the data. The first theme, Impact of VR on Labour, described the impact of VR on labour in terms of distraction, relaxation, enjoyment and a positive birth experience. The second theme, Managing the Pain, describes how VR was used by the women to manage their labour pain using breathing techniques and gaining a sense of control. In the third theme, The Challenges and Surprises of Using VR in Labour, women’s narratives recounted the various challenges of using the VR technology. Despite these challenges, ninety-four percent of women reported that they would use VR in labour again and would recommend it to a pregnant friend.</p> <p>This study provides a unique and original contribution to the field of VR in labour and birth. It is consistent with other recent findings of reduced pain with the use of VR, and links decreased pain scales to heart rate and blood pressure, the physiological markers of pain. It also identifies VR as an acceptable and positive experience in the management of labour pain. Results from this study have the potential to inform design for future labour specific VR environments and expand its application in the field of biomedical technology.</p>

Modifying effects of the R389G β1-adrenoceptor polymorphism on resting heart rate and blood pressure in patients with obstructive sleep apnoea

2005 ◽  
Vol 110 (1) ◽  
pp. 117-123 ◽  
Author(s):  
Jan Börgel ◽  
Tino Schulz ◽  
Nina K. Bartels ◽  
Jörg T. Epplen ◽  
Nikolaus Büchner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Obstructive Sleep Apnoea ◽  
Nervous Activity ◽  
Sleep Apnoea ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

OSA (obstructive sleep apnoea) stimulates sympathetic nervous activity and elevates resting HR (heart rate) and BP (blood pressure). In the present study in a cohort of 309 untreated OSA patients, the resting HR and BP during the daytime were correlated with AHI (apnoea/hypopnea index) and compared with patients with R389R (n=162), R389G (n=125) and G389G (n=22) genotypes of the β1-adrenoreceptor R389G polymorphism. We analysed the impact of the genotype on the decline of HR and BP in a subgroup of 148 patients (R389R, n=86; R389G, n=54; G389G, n=8) during a 6-month follow-up period under CPAP (continuous positive airway pressure) therapy during which cardiovascular medication remained unchanged. In untreated OSA patients, we found an independent relationship between AHI and resting HR (β=0.096, P<0.001), systolic BP (β=0.09, P=0.021) and diastolic BP (β=0.059, P=0.016). The resting HR/BP, however, did not differ among carriers with the R389R, R389G and G389G genotypes. CPAP therapy significantly reduced HR [−2.5 (−1.1 to −4.0) beats/min; values are mean difference (95% confidence intervals)] and diastolic BP [−3.2 (−1.5 to −5.0) mmHg]. The decline in HR was more significantly pronounced in the R389R group compared with the Gly389 carriers [−4.1 (−2.3 to −5.9) beats/min (P<0.001) compared with −0.2 (2.1 to −2.6) beats/min (P=0.854) respectively; Student's t test between groups, P=0.008]. Diastolic BP was decreased significantly (P<0.001) only in Gly389 carriers (R389G or G389G) compared with R389R carriers [−5.0 (−2.3 to −7.6) mmHg compared with −2.0 (0.4 to −4.3) mmHg respectively]. ANOVA revealed a significant difference (P=0.023) in HR reduction between the three genotypes [−4.1 (±8.4) beats/min for R389R, −0.5 (±9.3) beats/min for R389G and +1.9 (±7.2) beats/min for G389G]. In conclusion, although the R389G polymorphism of the β1-adrenoceptor gene did not influence resting HR or BP in untreated OSA patients, it may modify the beneficial effects of CPAP therapy on these parameters.

scholarly journals Evaluation of Methods to Minimize Pain in Newborns during Capillary Blood Sampling for Screening: A Randomized Clinical Trial

2022 ◽  
Vol 19 (2) ◽  
pp. 870
Author(s):  
Magdalena Napiórkowska-Orkisz ◽  
Aleksandra Gutysz-Wojnicka ◽  
Mariola Tanajewska ◽  
Iwona Sadowska-Krawczenko
Keyword(s):  
Clinical Trial ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Pain Management ◽  
Pain Relief ◽  
Pain Intensity ◽  
Randomized Clinical Trial ◽  
Capillary Blood ◽  
Pain Outcome ◽  
Capillary Blood Sampling

Aim: The aim of the study was to assess the severity of pain experienced by a newborn during a heel puncture for screening using the Newborn Pain Scale (NIPS), measure the heart rate and compare the effectiveness of non-pharmacological methods of pain control. Design: Randomized clinical trial. No experimental factors. The test was performed during routine screening. Surroundings: Provincial Specialist Hospital in Olsztyn. Patients/Participants: Pain was assessed in 90 full-term newborns. The newborns were rooming in with their mothers in the hospital. Interventions: Newborns were divided into three groups. Three different methods of pain relief were used: breastfeeding, 20% glucose administered orally and non-nutritional sucking. Main Outcome Measures: The primary pain outcome was measured using the NIPS and the secondary pain outcome measures (heart rate, oxygen saturation) were measured using a pulse oximeter. Results: During capillary blood sampling from the heel, most newborns, n = 56 (62.2%), experienced no pain or mild discomfort, severe pain occurred in n = 23 (25.6%) and moderate pain occurred in n = 11 (12.2%). No significant statistical differences were found between the degree of pain intensity and the intervention used to minimize the pain p = 0.24. Statistically significant relationships were demonstrated between heart rate variability and the degree of pain intensity (p = 0. 01). There were no statistically significant differences between the newborn’s pain intensity and the mother’s opinion on the effectiveness of breastfeeding in minimizing pain. Conclusions: This study did not answer the question of which pain management method used during the heel prick was statistically more effective in reducing pain. However, the results indicate that each of the non-pharmacological interventions (breastfeeding, oral glucose dosing and non-nutritive sucking) applied during heel puncture resulted in effective pain management in most of the newborns enrolled in the study. The relationship between heart rate variability and the severity of pain was confirmed. Mothers of newborns in the breastfeeding group were satisfied with the pain relief methods used in the child and the opportunity to console their newborn during painful procedures in a technologically invasive environment.

scholarly journals Do you mind if I take your blood pressure? Physical health monitoring of children and young people on ADHD medication amidst a pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S183-S184
Author(s):  
Emma Davies ◽  
Maham Khan ◽  
Claire Jones
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Young People ◽  
Physical Health ◽  
Health Monitoring ◽  
Neurodevelopmental Disorder ◽  
Adhd Medication ◽  
Children And Young People ◽  
Nice Guidance ◽  
The Impact

AimsTo establish whether physical health monitoring for CYP on ADHD medication is according to NICE guidance (2018).To determine the impact of COVID-19 pandemic restrictions on physical health monitoring for CYP on ADHD medication.Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity, directly impacting on academic, occupational, or social functioning. It affects between 1-5% of children and young people (CYP) most often presenting in early-mid childhood.Pharmacological treatment can be considered in CYP if certain criteria are met, where licensed medications include methylphenidate, dexamfetamine, lisdexamfetamine, atomoxetine and guanfacine. Stimulant and non-stimulant medications require frequent physical health monitoring due to their side effects including an increase in blood pressure and/or heart rate, loss of appetite, growth restriction and tics.MethodStandards and criteria were derived from the NICE guidance (2018), whilst local trust policies were reviewed, demonstrating discrepancies. Standards were expected to be met for 100% of patients.Electronic patient records were reviewed retrospectively from a representative cohort of CYP reviewed by clinicians in a community CAMHS service during March-November 2020. Data were entered manually into a spreadsheet for evaluation.ResultA total of 27 CYP records were reviewed, average age 13yo, on a range of stimulant/non-stimulant preparations.5 (19%) had height checked every 6 months, with 4 delayed to 7-8 months.For those >10yo, only 5 (19%) had weight checked every 6 months.Only 2 (7%) had their height and weight plotted on a growth chart and reviewed by the healthcare professional responsible for treatment.Just 4 (15%) had heart rate and blood pressure recorded before and after each dose change, whilst similarly only 4 (not the same) had these parameters recorded every 6 months.17 patients were reviewed by telephone/video call, where 5 patients provided physical health parameters (measured at home).ConclusionAcross all parameters, standards are not being met for the required physical health monitoring for CYP on ADHD medication.The COVID-19 pandemic has significantly changed the working conditions for community teams, impacting face to face reviews, creating challenges for physical health monitoring.Our ongoing implementations for change include the use of a proforma for physical health measurements, improving psychoeducation for families, exploring potential barriers with senior colleagues and collaborating with pharmacy colleagues to update local guidelines in accordance with the latest NICE recommendations. We aim to re-audit in June 2021.

Abstract 328: Hemodynamic Comparison of Zucker Diabetic Fatty Rats to Their Lean Littermates After Asphyxial Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Claudius Balzer ◽  
Franz Baudenbacher ◽  
Michele M Salzman ◽  
William J Cleveland ◽  
Susan Eagle ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Arrest ◽  
Ejection Fraction ◽  
Ischemia Reperfusion ◽  
Diabetic Rats ◽  
Arterial Blood ◽  
Zucker Diabetic Fatty Rats ◽  
Zdf Rats ◽  
The Impact

Patients with metabolic syndrome are at higher risk for cardiac arrest (CA), and also have worse neurologic outcome after CA related to their comorbidities (e.g., Type 2 Diabetes Mellitus [T2DM]). Using Zucker Diabetic Fatty (ZDF) rats as a new and relevant model with common comorbidities for CA and cardiopulmonary resuscitation (CPR), we hypothesized that T2DM is associated with a lower chance for return of spontaneous circulation (ROSC) and/or a worse outcome regarding heart function after asphyxial CA compared to their lean littermates. Two groups of rats (8 ZDF, 7 lean) were monitored for 37±2 weeks. The rats were anesthetized and intubated; heart rate was monitored by subcutaneous ECG needles. Femoral artery and vein were cannulated for continuous blood pressure measurement and delivery of fluids and medications, respectively. Before ventilation was stopped to initiate asphyxial CA, rocuronium was given. After 8 minutes of CA, ventilation was re-initiated with FiO 2 1.0, epinephrine and sodium-bicarbonate were administered, and pneumatic chest compression were started with 200 compressions per minute. Chest compressions were stopped when a systolic blood pressure of 120 mmHg was achieved. During 4 hours of observation, vital parameters were closely monitored, blood gases were measured, and ejection fraction (EF %) was assessed with ultrasound. Data are mean ± SD. Statistics: Unpaired student’s t-test (two-tailed), α.05. At baseline, ZDF rats showed significantly higher blood glucose levels (504±52 vs 174±14 mg/dl) compared to their lean littermates. All ZDF and lean rats achieved ROSC, and measurements taken directly after ROSC and after the first hour showed no relevant differences. After four hours, there was no difference in heart rate between ZDF and lean rats. However, diabetic rats had a significantly higher mean arterial blood pressure (142±24vs. 107±19 mmHg) and ejection fraction (42±16%vs 20±8%) compared to their lean littermates. The hypothesis that ROSC-rate in diabetic rats would be lower could not be proven. Conversely, the ZDF rats showed a significantly higher blood pressure related to an increased EF%. Further analysis in this study will focus on the impact of T2DM on cardiac and neurological ischemia-reperfusion injury.

scholarly journals Vitamin D Receptor Activation Mitigates the Impact of Uremia on Endothelial Function in the 5/6 Nephrectomized Rats

2010 ◽  
Vol 2010 ◽  
pp. 1-10 ◽  
Author(s):  
J. Ruth Wu-Wong ◽  
William Noonan ◽  
Masaki Nakane ◽  
Kristin A. Brooks ◽  
Jason A. Segreti ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Heart Rate ◽  
Vitamin D ◽  
Endothelial Function ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Receptor Activation ◽  
The Impact

Endothelial dysfunction increases cardiovascular disease risk in chronic kidney disease (CKD). This study investigates whether VDR activation affects endothelial function in CKD. The 5/6 nephrectomized (NX) rats with experimental chronic renal insufficiency were treated with or without paricalcitol, a VDR activator. Thoracic aortic rings were precontracted with phenylephrine and then treated with acetylcholine or sodium nitroprusside. Uremia significantly affected aortic relaxation (% in NX rats versus % in SHAM at 30 M acetylcholine). The endothelial-dependent relaxation was improved to –%, –%, and –% in NX rats treated with paricalcitol at 0.021, 0.042, and 0.083 g/kg for two weeks, respectively, while paricalcitol at 0.042 g/kg did not affect blood pressure and heart rate. Parathyroid hormone (PTH) suppression alone did not improve endothelial function since cinacalcet suppressed PTH without affecting endothelial-dependent vasorelaxation. N-omega-nitro-L-arginine methyl ester completely abolished the effect of paricalcitol on improving endothelial function. These results demonstrate that VDR activation improves endothelial function in CKD.

Pharmacoequivalence of Enoxaparin and Contaminated Enoxaparin

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3018-3018
Author(s):  
Jacqueline Kuziej ◽  
Walter Jeske ◽  
Debra Hoppensteadt ◽  
Evangelos Litinas ◽  
Elizabeth McGeehan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Drug Administration ◽  
Jugular Vein ◽  
Ex Vivo ◽  
Subcutaneous Administration ◽  
Saline Control ◽  
Control Group ◽  
Serious Adverse Events ◽  
The Impact

Abstract Introduction: Earlier this year, heparin was found to be contaminated with a non-heparin sulfated polymer identified as oversulfated chondroitin sulfate (OSCS). The presence of this contaminant was associated with severe adverse reactions such as hypotension and anaphylaxis, leading to death in some patients. Some batches of a widely used low-molecular heparin, enoxaparin, also contained OSCS. However, the amount of this contaminant was much lower (less than 5%) in the low-molecular weight heparin batches compared to unfractionated heparin where the amount of the contaminant was up to 30%. Owing to the sizeable number of syringes in Europe that contained the low level of OSCS and the absence of any serious adverse events, the European Medicines Equivalence Agency (EMEA) allowed the qualified use of the subcutaneous administration of the contaminated enoxaparin to ensure access to this essential medication. Despite this, no studies on the anti-thrombotic and bleeding effects or basic physiologic parameters have been reported. To address the bioequivalence of enoxaparin and its contaminated version, studies were undertaken in established animal models of bleeding and thrombosis. Materials & Methods: Contaminant-free enoxaparin (CFE) and one of the commercially available contaminated enoxaparin (CCE) batches were compared at an equivalent subcutaneous dosage of 2.5 mg/kg in a jugular vein clamping model of thrombosis (n=6/group). A separate group comprised of saline control animals served as control. Blood pressure and heart rate measurements were made at 90 minutes after drug administration, followed by jugular vein clamping model at 120 minutes after drug administration. After the completion of the jugular vein clamping model, blood samples were collected via cardiac puncture for ex-vivo monitoring of anti-coagulant and anti-protease effects. Results: No differences in the blood pressure and heart rate were observed between the two groups. The anti-thrombotic effects of both the CCE and CFE were measured by jugular vein clamping model. In comparison to the saline treated group (3.5 ± 0.5 clampings), both the CCE and CFE treated animals required a significantly higher number of clampings to induce thrombosis (4.8 ± 0.7 and 5.0 ± 0.6, respectively; p = 0.001 vs. saline; p=0.658 CFE vs. CCE). The ex-vivo analysis of whole blood aPTT revealed a slight elevation in both of the enoxaparin-treated groups in comparison to saline control. (CFE: 36.8 ± 18.6 sec; CCE: 30.5 ± 10.9 sec vs. saline: 26.7 ± 3.9 sec). The anti-Xa effects in plasma were significantly higher with the CFE (84.4 ± 1.5% inhibition) compared to that observed with the CCE (80.5 ± 2.9 % inhibition; p=0.026) while the anti-IIa levels were comparable in the two groups (37.1 ± 22.0 and 30.6 ± 17.9 % inhibition). Ex-vivo analysis of plasma samples from the control group did not reveal any anti-protease or anti-coagulant activity. Discussion: These results demonstrate that small amounts of OSCS (less than 5%) in enoxaparin do not impact its anti-thrombotic effects when administered subcutaneously. Since OSCS exhibits only anti-IIa activity and does not have any anti-Xa effects, the observed anti-Xa activity of the CCE was less than that of CFE. Other plasmatic anti-coagulant and anti-protease activities were not altered by the presence of OSCS. Since OSCS is highly charged it is likely that upon subcutaneous administration it is not absorbed. This observation is supported by the fact that the anti-Xa and IIa ratios of the samples collected after jugular vein clamping are approximately equal. Thus, the anti-thrombotic and pharmacodynamic effects of the two versions of enoxaparin are identical. The impact of repeated administration of contaminated enoxaparins and long-term pharmacodynamic and immunogenic effects need to be further explored.

Sign in / Sign up

Export Citation Format

Share Document