14 research outputs found
Airway pressure and outcome of out-of-hospital cardiac arrest: A prospective observational study
No full textAim To assess the usefulness of airway pressure as predictor of return of spontaneous circulation (ROSC), as well as to investigate the optimized ventilation compression strategy during cardiopulmonary resuscitation (CPR). Methods In this prospective observational study, 300 out-of-hospital cardiac arrest victims were intubated and resuscitated with the use of a ventilator. Mean airway pressure (mPaw) was measured at pre-defined phases of CPR. Results A significant difference in mPaw was observed between survivors and non-survivors after the onset of the third minute of CPR. An mPaw value of 42.5 mbar during CPR had specificity and sensitivity of 0.788 and 0.804, respectively, for ROSC (AUC = 0.668, p = 0.047). During CPR, we found statistically significant differences in mPaw at phases zero (F = 4.526, p = 0.002), two (F = 4.506, p = 0.002), four (F = 8.187, p < 0.0001), five (F = 2.871, p = 0.024), and six (F = 5.364, p < 0.0001). Conclusion Mean airway pressure was higher in survivors. A value of 42.5 mbar was associated with ROSC
The correlation of inflammatory markers and insulin resistance indexes with the outcome of an acute coronary syndrome in known diabetes, newly diagnosed diabetes patients, IGT's and normoglycemics
No full textAim: The glucose metabolism disorder is frequent in patients who are admitted after an Acute Coronary Syndrome (ACS). The aim of this study is to examine the correlation of ACS with the markers of insulin resistance and inflammatory markers in known diabetes patients, newly diagnosed diabetes patients, patients with impaired glucose tolerance (IGT) and normoglycaemic patients. Material and Methods: 536 patients who were hospitalized at the Cardiology Department of Tzanio General Hospital of Piraeus from April 2007 to March 2009 were included in the study. All patients undewent a clinical laboratory testing. Fastubg glucose and insulin were recorded by morning blood testing during their first day of hospitalization in order to measure insulin-resistance indexes. All non diabetic patients went under an oral glucose tolerance test (OGTT) one month after discharge. Study’s end-points were death, a new ACS, arrythmias and acute pulmonary oedema of cardiological origin. End-points were registered during hospitalization and 12 months after the ACS. Results: 199 (37,12%) patients were norcmoglycemic while 168 (31,34%) were known diabetics, 59 (11%) newly diagnosed diabetic patients and 110 (20,52%) were IGT patients. 255 (47.6%) patients were hospitalized for acute myocardial infarction with ST elevation (STEMI), 180 (33,6%) patients for acute myocardial infarction without ST elevation (NSTEMI) and 101 (18,8%) patients for unstable angina. There was a statistically significant correlation of the hs-CRP with the outcome during hospitalization (p=0,004) for all patients. hs-CRP (p=0,001) and HOMA index (p=0,009) were significantly correlated with the appearance of a major cardiovascular event during hospitalization for all patients. Complications during the first 12 months after an ACS were significantly correlated with the hs-CRP, HOMA and QUICKI indexes in a univariate and multivariate analysis. The hs-CRP, HOMA and QUICKI indexes are indepedently associated with the 12 months outcome for all patients and for each group separately.Conclusions: hs-CRP is the inflammation marker which is correlated with the appearance of complications during hospitalization and 12 months after an ACS regardless of patients’ glycaemic profile, while HOMA and QUICKI indexes are correlated with the appearance of major cardiovascular events during hospitalization as well as the 12-month follow-up period. The combination of these indexes with hs-CR significantly improves the latter’s prognostic model in particular regarding major cardiovascular events.2.Σκοπός: Ο επιπολασμός της διαταραχής του μεταβολισμού της γλυκόζης είναι υψηλός μεταξύ των ατόμων που εισέρχονται για νοσηλεία μετά από Οξύ Στεφανιαίο Σύνδρομο. Σκοπός της παρούσας μελέτης είναι η διερεύνηση της συσχέτισης της έκβασης των Οξέων Στεφανιαίων Συνδρόμων με τους δείκτες ινσουλινοαντίστασης και τους δείκτες φλεγμονής σε γνωστούς διαβητικούς, σε νεοδιαγνωσμένους διαβητικούς, σε ασθενείς με παθολογική ανοχή γλυκόζης (IGT) και σε νορμογλυκαιμικούς ασθενείς.3.Υλικό και Μέθοδος: Στη μελέτη συμπεριληφθήκαν 536 ασθενείς οι οποίοι νοσηλεύθηκαν στην Καρδιολογική Κλινική του Γ. Ν. Π «Τζάνειο» από τον Απρίλιο του 2007 έως τον Μάρτιο του 2009 για Οξύ Στεφανιαίο Σύνδρομο. Οι ασθενείς υποβλήθηκαν σε κλινικοεργαστηριακό έλεγχο. Έγινε μέτρηση της γλυκόζης νηστείας και της ινσουλίνης με πρωινή αιμοληψία κατά την πρώτη ημέρα νοσηλείας των ασθενών για τον υπολογισμό των δεικτών ινσουλινοαντίστασης. Οι μη διαβητικοί ασθενείς υποβλήθηκαν σε δοκιμασία ανοχής γλυκόζης (OGTT) ένα μήνα μετά την έξοδο από το νοσοκομείο. Ως τελικά σημεία ορίστηκαν ο θάνατος, νέο επεισόδιο οξέος στεφανιαίου συνδρόμου, οι αρρυθμίες και το Οξύ Πνευμονικό Οίδημα καρδιακής αιτιολογίας. Έγινε καταγραφή αυτών κατά την νοσηλεία και κατά τους πρώτους 12 μήνες μετά το οξύ στεφανιαίο σύνδρομο. 4.Αποτελέσματα: Από τους 536 ασθενείς της μελέτης νορμογλυκαιμικοί ήταν οι 199 (37,12%), 168 (31,34%) ήταν γνωστοί διαβητικοί, 59 (11%) νεοδιαγνωσμένοι διαβητικοί και 110 (20,52%) ήταν οι ασθενείς με διαταραχή στην ανοχή της γλυκόζης (IGT). Με διάγνωση οξύ έμφραγμα του μυοκαρδίου με ανάσπαση του διαστήματος ST νοσηλεύθηκαν 255 (47,6%) ασθενείς, με οξύ έμφραγμα του μυοκαρδίου χωρίς ανάσπαση του διαστήματος ST 180 (33,6%) και με διάγνωση ασταθή στηθάγχη 101(18,8%) ασθενείς. Από τους υπό εξέταση δείκτες στατιστικά σημαντική η συσχέτιση της υψηλής ευαισθησίας CRP (hs-CRP) (p=0,004), με την έκβαση κατά την νοσηλεία για το σύνολο των ασθενών. Η hs-CRP (p=0,001) και ο δείκτης HOMA (p=0,009) παρουσίασαν στατιστικά σημαντική συσχέτιση και με την εμφάνιση μείζονων καρδιαγγειακών συμβαμάτων κατά τη νοσηλεία για το σύνολο των ασθενών. Η εμφάνιση επιπλοκών κατά τους πρώτους 12 μήνες μετά από οξύ στεφανιαίο σύνδρομο παρουσιάζει συσχέτιση με την hs-CRP και τους δείκτες ΗΟΜΑ και QUICKI τόσο σε μονοπαραγοντική όσο και σε πολυπαραγοντική ανάλυση. Την ανεξάρτητη συσχέτιση τους με την εμφάνιση μείζονων καρδιαγγειακών συμβαμάτων κατά τους πρώτους 12 μήνες, διατηρούν η hs-CRP και οι δείκτες HOMA και QUICKI τόσο για το σύνολο των ασθενών όσο και για τις επιμέρους ομάδες αυτών. 5.Συμπεράσματα: Η hs-CRP αποτελεί τον δείκτη φλεγμονής ο οποίος συνδέεται με την εμφάνιση επιπλοκών τόσο κατά τη νοσηλεία όσο και κατά τους 12 μήνες μετά από οξύ στεφανιαίο σύνδρομο ανεξάρτητα από το γλυκαιμικό προφίλ των ασθενών, ενώ οι δείκτες ινσουλινοαντίστασης HOMA και QUICKI σχετίζονται με την εμφάνιση μείζονων καρδιαγγειακών συμβαμάτων τόσο κατά την νοσηλεία όσο κατά τους 12 μήνες της παρακολούθησης. Η προσθήκη τους δε στην hs-CRP βελτιώνει το προγνωστικό μοντέλο της hs-CRP ειδικά για τα μείζονα καρδιαγγειακά συμβάματα
AP109 Influence of metro stations electromagnetic interference on AED function in Greece: Preliminary results
No full textReporting distress and quality of life of patients with diabetes mellitus in primary and secondary care in Greece
No full textBackground and aim: This study constitutes an initial attempt at elucidating the relationship between quality of life (QoL), health status and psychological distress in patients with diabetes mellitus (DM) in Greece, by comparing patients with DM registered at a rural primary healthcare centre (PHCC) and those attending a diabetes outpatient clinic (DOC) at an urban hospital.
Methods: Cross-sectional study. Participants were consecutive, consenting patients with a known history of type 2DM(T2 DM), currently registered at either of the two centres. All patients were administered the Short Form-36 version 2 (SF-36 v2) and the Problem Areas In Diabetes (PAID) questionnaire, and information in relation to socio-demographic data and clinical characteristics were also obtained.
Results: Patients with DM had a lower QoL over all domains when compared with general population normative data. In addition, mean scores for the SF-36 v2 Physical Component Summary (PCS) and Mental Component Summary (MCS) and six subscales of the SF-36 v2 demonstrated significant differences between the two participating centres (P < 0.0001). The mean PAID score was 19.18 (+ or - 15.58) for patients from the PHCC, versus 40.19 (+ or - 17.36) for the DOC (P < 0.0001). Lower scores on the MCS of the SF-36 v2, and higher scores on PAID in patients with T2 DM were related to major co-morbidities, insulin use and duration of DM.
Conclusions: Patients with T2 DM from the urban DOC had significantly higher levels of distress and consequently lower levels of QoL compared with patients from the rural PHCC. The findings from this study may have important implications with regard to the individualisation of patient
care in Greece, and encouragement of patient participation in the treatment process
Cardiac arrest in Greek primary health care and willingness of general practitioners to use automatic external defibrillator
No full textTHE ASSOCIATION BETWEEN THE RESULTS OF VIBRATION SENSATION TESTING WITH POTENTIOMETER AND PERSPIRATION TESTING
No full textClinical audit as a tool to optimize contracted private healthcare provision: Testing the waters in resource-deprived Greece
No full textBackground and Aims: Clinical audit is applied to optimize clinical practice and quality of healthcare services while controlling for money spent, critically in resource-deprived settings. This case study reports on the outcomes of a retrospective clinical audit on private hospitalizations, for which reimbursement had been pending by the Health Care Organization for Public Servants (OPAD) in Greece. This case study is the first effort by a social insurance organization in Greece to employ external clinical audit before settling contracted private healthcare charges. Methods: One thousand two hundred hospitalization records were reviewed retrospectively and a fully anonymized clinical audit summary report created for each one of them by a team of clinical audit experts, proposing evidence-based cuts in pending charges where medical services were deemed clinically unnecessary. These audit reports were then collated and analysed to test trends in overcharges among hospitalized insureds per reason for hospitalization. Results: The clinical audit report concluded that 17.4% of a total reimbursement claim of €12,387,702.18 should not be reimbursed, as it corresponded to unnecessary or not fully justifiable according to evidence-based, best practice, medical service provision. The majority of proposed cuts were related to charges for medical devices, which are borne directly by social insurance with no patient or private insurance co-payment. Conclusion: Clinical audit of hospital practice may be a key tool to optimize care provision, address supplier-induced demand and effectively manage costs for national health insurance, especially in circumstances of budgetary constraints, such as in austerity-stricken settings or developing national healthcare systems
Patients With Colorectal Cancer Are Characterized by Increased Concentration of Fecal Hb-Hp Complex, Myeloperoxidase, and Secretory IgA
No full textAddition of glucagon to adrenaline improves hemodynamics in a porcine model of prolonged ventricular fibrillation
No full text
