1,721,031 research outputs found
Savęs žalojimosi be tikslo nusižudyti skausmo jautrumo sisteminė apžvalga.
No full textAuthor: Ravi Rait Title: A Systematic Review of Pain Sensitivity in Non-Suicidal Self Injury Introduction: Non suicidal self-injury (NSSI) is pain inflicted to oneself to relieve unwanted negative emotional pain. The aim of this study is to develop an understanding of the relationship between pain and NSSI; how NSSI pain is perceived and its impact on levels of pain. Approximately 4-7% of adolescents worldwide are affected by NSSI. Adolescents from psychiatric community samples show prevalence of around 50%. Before the introduction of the DSM V, NSSI had been detailed as a symptom of borderline personality disorder (BPD). Aim and objectives: The aim of this study is to develop an understanding of the relationship between pain and NSSI. How those engage in NSSI perceive pain and how NSSI affects pain levels in those who engage in NSSI. Using all relevant material to decipher what can be learned from NSSI and pain threshold. Method: Thirteen viable papers were systematically reviewed using the Quality Assessment Framework. Eight papers were cross-sectional and five were case-control studies. The majority of studies were adult mixed –gender community and university samples with female participants and Caucasian (American of European descent) predominating. Of the various methods utilised to perform NSSI. Results: The clear outcome when comparing all papers suggest those who participate in NSSI possess a higher pain threshold when compared to control participants. Conclusions and Recommendations: While the results are clear the conclusions are fraught with ambiguity when explaining these results. Emotion and stress appear to have the strongest effects on the modulation of pain thresholds, however, there may be other variables that also play a role
Analysis of the attitude of health care specialists towards the right do not start resuscitation
No full textAuthor: Stasys Zilinskas Title: Analysis of the attitude of health care specialists towards the right do not start resuscitation. Aim: To determine the attitude of doctors towards the right do not start resuscitation at the terminal state of the patient, the peculiarities of resuscitation in Lithuania, and to assess the knowledge of the provisions of the law determining the state of human death and the state of critical conditions in the Republic of Lithuania (RL). Tasks: 1. To assess the distribution of respondents by age, religiousness, evaluate correlation between religiousness and attitude of respondents to the right not to start resuscitation 2. To evaluate the attitude of respondents to the right not to start resuscitation at the terminal state of the patient and the difference between this right and euthanasia. 3. To evaluate respondents‘ knowledge of the provisions of the law determining the state of human death and the state of critical conditions in the RL. 4. To evaluate the attitude of respondents towards the peculiarities of resuscitation in Lithuania. Methodology: An anonymous study was carried out using the original questionnaire (appendix No. 1), and anesthesiology and resuscitation specialists working and/or studying in Lithuania, resident physicians specializing in anesthesiology and resuscitation and medical students of V and VI year had participated in this study. Results: The study involved 195 respondents. There is a slight correlation between religiousness and doctors’ right not to start resuscitation (r = 0.31; p <0.05), while those who consider themselves more religious do not agree that the right not to start resuscitation should be given to doctors. 86.15% of respondents do not support futile resuscitation. 79.49% consider that non-resuscitation at the terminal state of the patient is ethical. Almost 90% of the respondents do not agree that the refusal to resuscitate a patient in the terminal state is the same as euthanasia. Almost 80% claim that they know the law determining the state of human death and the state of critical conditions in the RL. 83.08% believe that doctors should have the right not to start resuscitation at the terminal state of the patient. Conclusions: 1. More religious health care specialists do not agree that doctors should have the right no to resuscitate a patient in the terminal state. 2. Health care specialists believe that not all patients should be resuscitated and do not look at this as non-compliance with ethical principles. Almost 90% respondents do not agree that the refusal to resuscitate a patient in the terminal state is the same as euthanasia. 3. Health care specialists know the law determining the state of human death and the state of critical conditions in the RL, but do not remember non-resuscitation order which was in force in the past. 4. Almost 77 % of doctors did not resuscitate patients in terminal state. The most common causes for futile resuscitation at the terminal state of the patient are: compliance with laws and pressure of the relatives
Differential diagnosis of critical illness: focused ultrasonography diagnostic value in pulmonary embolism
No full textAim: To investigate focused ultrasonography diagnostic value in pulmonaty embolism. Objective: 1. To investigate focused ultrasonography applicability and value of the differential diagnosis of pulmonary embolism. 2. Compare right heart overload frequency in echocardiography in patients with confirmed pulmonary embolism and patients without this disease. Methods: This was a prospective case-control study, in which to LSMUL KK Cardiology Intensive care unit patients with comfirmed pulmonary embolism and patients without right ventricular pathology underwent transthoracic echocardiography (TTTE) by FATE (Focus assessed transthoracic echocardiography) protocol. During examination were searched for right heart overload signs: right ventricular dilatation, „D“ form left ventricular and dilatated vena cava interior (diameter ≥2.1 cm). Results: A total of 20 participants were included in this study. Ten of 20 patients had a pulmonary embolism. Pulmonary embolism occurred more frequently in patients who had risk factors, p=0.001 (Cramer`s V=0.812, p=0.004). Patients with confirmed pulmonary embolism had statistically significant greater right ventricular than left ventricular and „D“ form left ventricular more often: subcostal 4-chamber view, p=<0.0001 (Cramer`s V=0.849, p=<0.002); parasternal long and short axis view, p=<0.0001 (Cramer`s V=0.905, p=<0.0001); „D“ form left ventricular in parasternal short axis view, p=<0.0001 (Cramer`s V=0.905, p=<0.0001). Inferior vena cava diameter in both groups were not statistically significant, p=0.06 (Cramer`s V=0.528, p=0.03). TTTE by FATE protocol were performed in 20 patients, good quality of images were obtained in 93.75% cases. Conclusions: 1. Focused ultrasonography diagnostic applicability are limited, but their value in diagnosis of pulmonary embolism is highly significant. 2. Patients with confirmed pulmonary embolism statistically significant more had right ventricular overload signs than patients without this pathology
Anesthesiologists-reanimatologists view of the advanced practice nurses competencies and legal protection
No full textThe aim: to evaluate competence limits and legal protection of advanced practice nurses from doctors-anesthesiologists reanimatologists perspective. The objectives: To investigate doctors-anesthesiologists reanimatologists attitude of nurses competencies and expansion opportunities; 2. To investigate doctors-anesthesiologists reanimatologists perspective on advanced practice nurses in the limits of liability; 3. To evaluate advanced practice nurses possibilities of cooperation from doctors-anesthesiologists reanimatologists perspective. Research methodology: The study included 131 participants from Lithuanian anesthesiologists – reanimatologists Society, who participated in the year 2016 on 14 October in the conference organized by the Society, which was held LUHS TLC. The a quantitative research method – a questionnaire survey was used. The questionnaire consists of fifteen questions that help to to evaluate competence limits and legal protection of advanced practice nurses from doctors-anesthesiologists reanimatologists perspective. Results of the study. The results showed that the respondents who believe that the existing competences are adequate does not feel the need to expand the competence of nurses (p = 0.000). The majority of respondents (75.6 per cent. of respondents) believe that the advanced practice nurse has more competence than the nurse. It was found that significantly higher proportion of respondents who believe that the current lack of competence of nurses than that sufficient to think that advanced practice nurse is a nurse who has a master's degree (54.8 per cent. of respondents) (p = 0.021). The data analysis showed that the greater part of those who believe that the current lack of cooperation, or that good, believe that advanced practice nurse should have a master's degree (54.4 per cent. of respondents) (p = 0.004). The vast majority of respondents (92.4 per cent. of respondents) say that they lack knowledge about the advanced practice nurse profession. The majority of respondents believe that the advanced practice nurse in anaesthesiology and intensive care to fill in documentation (84.7 per cent. of all respondents), prepare anesthesia technique work (96.9 per cent. of all respondents), know how to manage pain (59.5 per cent. of all respondents), to order diagnostic procedures (51.9 per cent. of all respondents). The majority of respondents would allow advanced practice nurses punktuoti and vein catheterization (67.2 per cent. Of all respondents) and intubation (65.6 per cent. of all respondents). Agreeing that documentation completion is advanced nurse competence significantly higher proportion (38.7 percent.) than disagree think (10.0 percent.) that advanced practice nurse anesthetist should document the work of doctors-anesthesiologists reanimatologists (p = 0.013). It can be said that the majority of respondents to work in a team with a nurse having completed advanced nursing education (89.3 per cent. Of all respondents). There were statistically significant differences between the team working with a nurse having completed advanced studies in nursing and current competency assessment (p = 0.009), current nurses knowledge assessment (p = 0.015) and the current cooperation with the carers assessment (p = 0.000). Conclusions. Examination of doctors anesthesiologists – reanimatologists attitude of nurses competencies and expansion possibilities found that advanced practice nurse anesteziologinėje and intensive therapy should complete the documentation, prepare anesthesia technique work, know how to manage pain, to order diagnostic procedures. Doctors-anesthesiologists reanimatologists allow intubated patient punktuoti and artery catheterization, but the performance of anesthesia or central venous should be assigned. However, other powers, which are classified as advanced practice nurses globally, Lithuania respondents believe they should be assigned. It was found that the current cooperation is not sufficient, but in cooperation with the advanced practice nurses are viewed positively. It was also found that this cooperation could put forward by both the advanced practice nurse and a doctor
The value of installing work organization systems for operations and work planning optimization and improvement of employees' working conditions
No full textDifferent methodologies are used to assess the effectiveness of hospitals in the health care system. The most commonly used model is data aggregation, which assesses not only the efficiency of the hospital's activities but also the usefulness of its services. The model takes into consideration and is made up for all services provided by third-level medical institutions, but it is universal and can be adapted to each health facility or its separate unit. Resource allocation mechanisms vary according to the organization's structure. The analysis of the distribution mechanisms of the anesthetic clinic, as well as the distribution factors, is very important for improving the efficiency of the clinic. The aim of the work: Assess if the working conditions got better in the LHSU KK Anestheology Clinic after the implementation of operational work organization systems. Research tasks: 1. Find out what the staff knows about the implementation of new operating systems. 2. Analyze if the attitude of employees changed towards the introduction of operational work organization systems immediately after their introduction and after 6 months. 3. Assess whether the implementation of could have contributed to the emergence of stress at work. The study was attended by 92 respondents, 38 (41.30%) physicians, anaesthesiologists - reanimatologists (referred to as doctors) and 54 (58.70%) nurses. In the summer, 24 (26,09%) doctors and 30 (32,60%) nurses were interviewed, in the autumn 14 (15,22%) doctors and 24 (26,09%) nurses. The study revealed that judging by emploeeys opinion their knowledge on how to use the operation workplan system was inadequate. Six months after the system was intalled and in use, employees evaluated system negatively. Operational work systems implementation did not have negative outcome on stress at work
The Value of multimodal neuromonitoring for prediction of traumatic brain injury postoperative course, complications, treatment efficiency and outcomes
No full text[...]. Aim of the study. To establish the predictive value for course characteristics of traumatic brain injury, the risk of developing complications, the treatment effectiveness and endpoint according to components of the brain multimodal neuromonitoring - the brain tissue oximetry, nervous cell damage markers. Objectives of the study. 1. To establish change dynamics of the brain tissue oximetry during TBI. To establish limitary values of the brain tissue oximetry for prediction of secondary brain damage development. 2. To establish change of nervous cell damage markers (S100B ir NSE) during TBI. 3. To assess the relationship between brain tissue oximetry, nervous cell damage markers (S100B ir NSE) and other indexes of multimodal neuromonitoring during TBI. 4. To determine the value of separate and integrated multimodal neuromonitoring parameters for the prediction of brain trauma and outcomes. [...]
The aspects of nursing to patients, who are sick with acute myocardial infarct, and whom the disorder of cognitive functions is diagnosed
No full textPurpose.To evaluate the aspects of nursing and care and the frequency of disorder of cognitive functions to patients, who are sick with acute myocardial infarct and whom the disorder of cognitive functions was diagnosed. Methods. 101 patients took part in the research. They were cured in the section of cardiology and intensive therapy in November, 2011 and in February, 2012. They were sick with acute myocardial infarct. The cognitive functions were evaluated to patients that took part in the research. It was used a short research of standardized mental status and an enquiry questionnaire which consist of sociodemographic data, the factors of risk.117 nurses took part in the research that filled in the enquiry anonymously. The statistical analysis of the data was accomplished by the programme of SPSS 13.0 and the programme of Excel 2007. Results. The results of the research showed that disorders of cognitive functions were harder to older patients. Patients having difficult disorder were approximately of 83,5±8,5 years old and those patients who were 60,1±10,6 years old had no disorders. When the cognitive functions of the patients were evaluated by MMSE approximately 24,74±5,8 points were received. To 4, 0 percent of patients was diagnosed heavy disorder of cognitive functions, 13,9 percent – average, 18,8 percent – easy disorder of cognitive functions. 63,4percent had no disorders of cognitive functions. The results of the research showed that a large part of nurses, who work in sections of cardio logical intensive therapy, do not evaluate the disorders of cognitive functions to patients and do not mark them in the sheet of intensive observation. Conclusions. The disorders of cognitive functions belong to the factors of the risks of heart diseases – the use of salt, smoking, age and inactivity. When a person is older the disorder is more difficult.More than 1/3 of nurses answered that they never evaluate patients’ cognitive functions. Almost unanimous answers were confirming that the evaluation of cognitive functions is not a nurse’s responsibility. The Mini Mental State Examination (MMSE) that is used for diagnosis of patients’ disorders of cognitive functions was used in different towns statistically differently. Nurses of Panevėžys hospital always use the test, however, 65,4 percent of nurses of Šiauliai hospital do not know the test. The attention paid to patients’ disorders of cognitive functions differed statistically and significantly in different towns (p=0,001)
Perioperaciniai širides kontrakcijos pokyčiai I ir II NYHA klasės pacientams nekardiochirurginių operacijų metu.
No full textThe aim of this study is to evaluate cardiac contractility changes in the perioperative period for I and II NYHA class patients undergoing non-cardiac surgery. We have performed echocardiographies in the after anesthesia ward and assessed regional and global cardiac contractile function using FATE protocol. In the theoretical part we reviewed targeted echocardiographic monitoring protocols used in the world. We studied 16 patients (I or II NYHA class and II or III ASA class), and 3 of them (18.75 percent.) had cardiac contractility disorders. The study concluded that FATE protocol is appropriate and informative for perioperative contractility evaluation and between NYHA class II patients in the perioperative period global and regional contractility disorders are observed
Anesthesiology in Independent Lithuania in 1918-1940 and now: Are there really many differences
No full textAim: to compare the tendencies of anesthesia in Independent Lithuania in 1918-1940 with these prevailing days and to check the knowledge of anaesthesiologist-reanimatologist on the history of anaesthesiology. Tasks: 1) To determine whether the anesthesia of this time has changed significantly from the ones applied in the Independent Lithuania in 1918-1940. 2) Determine whether anaesthesiologist-reanimatologists are better able to understand the history of anesthesia compared with residents of anaesthesiology-reanimatology. 3) Determine whether anaesthesiologist-reanimatologists who have a better understanding of history of anesthesiology have better knowledge of anesthesia at this time. Methodology: I compared the principles of anesthesiology of 1918-1940, based on Prof. Vladas Kuzma's textbook \"Skausmas ir skausmo malšinimo būdai\", with anesthesia of this time, based on various scientific articles. 30 questionnaires, 15 anaesthesiology-reanimatology doctors and 15 residents of anaesthesiology-reanimatology were included in the questionnaire. The study assessed the knowledge of physicians about the history of anesthesiology and today's anesthesia, based on their completed questionnaire. Results: After calculations, it was observed that anaesthesiology-reanimatology doctors made an average of 1.20 errors in answering questions about the history of anaesthesiology, while residents of anaesthesiology-reanimatology responded with an average of 2.73 errors (p = 0.003). Anaesthesiology- reanimatology doctors answered questions about anesthesia of this time and made an average of 0.66 errors, while residents of anaesthesiology-reanimatology responded to the same questions with an average of 1.86 errors (p <0.001). There is a strong link between the knowledge of the history of anesthesiology and better knowledge of anesthetics of this time (Spearman correlation index 0.67). Conclusions: 1) The principles of anesthesia nowadays remained the same as in 1918-1940, but the medicines, equipment and specialist skills improved. 2)Doctors have a better understanding of the history of anesthesia comparing to residents of anaesthesiology-reanimatology. 3) Anesthesiology-reanimatology doctors who have better knowledge of the history of anesthesia are also better aware of anesthesia of this time.
The value of biochemical brain damage markers S100B and/or NSE in perioperative treatment progression and outcome prediction: a prospective study.
No full textAim: To determine the value of biochemical brain damage markers in predicting the course and outcome of treatment in patients who have suffered a traumatic brain injury (TBI). Objectives: 1. To determine the changes in biochemical parameters (S100B and NSE) in patients suffering from TBI. 2. To determine the prognostic importance of S100B, NSE and their connection with long-term survival rate. Method: A prospective observational study was carried out at the LUHS Kaunas clinics Anaesthesiology Clinic on neurosurgery patients admitted to the hospital for a TBI in 2013-2017. The study group consisted of 183 adult patients who required an emergency operation for TBI. In order to test the markers, a blood sample was taken from the patients 4 times: immediately after the patient was admitted to the hospital (N1), 24 hrs (N2), 48 hrs (N3) and 72 hrs (N4) after admittion. P-value <0.05 is considered statistically significant. Results: Every patient’s blood sample was tested and the mean concentrations of S100B and NSE were measured and compared. The concentrations of both markers in all 4 blood samples were compared with that of TBI survivors and of patients who died at the hospital. After measuring the concentrations of NSE and S100B markers at N3 and N4, there was a statistically significant difference between 2 markers, however at N2, only S100B showed a significant difference. The concentrations of both markers in all 4 samples showed a significant difference between the survival group and the study groups who died. ROC analysis was used in order to distinguish certain marker concentration limits in all measurement cases. The marker’s concentrations were compared between those who died at the hospital and those patients who survived a TBI. Conclusion: S100B and NSE are statistically significant predictive factors for long-term survival rate for patients suffering from TBI. S100B is more reliable and significant at predicting a patient’s mortality at the hospital
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