Metoda PCA w zwalczaniu bólu w pierwszej dobie po operacji kręgosłupa

Background. Patient-controlled analgesia is a method allowing a patient to self-administer pain medications by means of a computerized infusion pump. By pushing a demand button, the patient activates the system introducing specific doses of pain relieving medicine in the exact amount programmed by the caregiver.Aim. To determine the efficacy of post-operative pain relief treatment with the usage of PCA-iv infusion pump, as well as to estimate pain levels in every two hours in the first twelve hours after spine surgery.Material and methods. The survey was held in the 10th Military Research Hospital and Polyclinic in Bydgoszcz. From January to December 2010 a group of 40 spine surgery patients participated in the research. The methods comprised of authorial survey questionnaire, analysis of medical documentation, as well as pain intensity estimation measured with VAS scale every two hours in the first twelve hours after spine surgery.Results. The analysis shows that pain was gradually alleviated from the moment the IV-PCA pump was applied.Conclusions. PCA-iv offers high analgesic efficacy, faster alleviation of post-operative pain and helps to create a sense of safety and comfort after the surgery. (PNN 2013;2(2):57-62)Wprowadzenie. Leczenie przeciwbólowe sterowane przez pacjenta (PCA – patient controlled analgesia) jest metodą polegającą na zastosowaniu pompy infuzyjnej wyposażonej w urządzenie będące w zasięgu ręki pacjenta. Gdy ból się nasila pacjent sam uruchamia system dozujący powodując otrzymanie dodatkowej dawki leku przeciwbólowego zaprogramowanej przez zespół terapeutyczny.Cel. Celem pracy była ocena zmniejszenia dolegliwości bólowych kręgosłupa u pacjentów w pierwszej dobie po operacji z zastosowaniem pompy infuzyjnej z systemem PCA-iv do uśmierzania bólu pooperacyjnego, jak również ocena doznań bólowych dokonywana co 2 godziny przez pierwsze 12 godzin po operacji kręgosłupa.Materiał i metody. Badania zostały przeprowadzone w Klinice Neurochirurgii 10. Wojskowego Szpitala Klinicznego z Polikliniką w Bydgoszczy od stycznia do grudnia 2010 roku. W przeprowadzonych badaniach uczestniczyła 40-osobowa grupa pacjentów poddanych zabiegom neurochirurgicznym z powodu chorób kręgosłupa. Metody i narzędzia użyte w badaniu to autorski kwestionariusz ankiety, analiza dokumentacji medycznej, ocena natężenia bólu dokonywana co 2 godziny przez pierwsze 12 godzin po operacji kręgosłupa z użyciem skali VAS.Wyniki. Na podstawie analizy przeprowadzonych badań stwierdzono, że dolegliwości bólowe znacznie zmniejszają się wraz z upływem czasu od momentu podłączenia pompy PCA-iv.Wnioski. Zastosowanie pomp przeciwbólowych z systemem PCA-iv pozwala na osiągnięcie skutecznej analgezji oraz skrócenie czasu leczenia bólu pooperacyjnego, jak również zapewnienia poczucia bezpieczeństwa i komfortu po zabiegu. (PNN 2013;2(2):57-62

Humanitarian aid of the European Union and United Nations: actions, responsibilities, and finances

This work attempts to underline that motivating and managing change in the mentality of its environment, and being in tune with society's changing needs is the basis of successful strategic planning. Our aim is to highlight planning as a way of learning, that is, planning implies changing ways of thinking, not making plans. Strategic learning requires releasing the mind in order to slip flexibly into the continuous line and to achieve the creation of possible action courses from a fertile dialogue between thought and action. Using our insights from the two literatures, we propose a dynamic, integrative conceptual model of change based on organizational learning. This practice has been analysed in three Spanish cities where important events have taken place

Clipping versus coiling for intracranial aneurysms

Background and purpose The aim of this study was to compare results of clipping and coiling for aneurysms of the anterior circle of Willis. Previous studies have not identified a clear superiority of one method over the other. Material and methods The study group included 165 consecutive patients. The assessment took into account the risk of death, neurological status according to the scale of the GOS and mRS, the incidence of early complications and quality of life measured by own surveys and questionnaire EORTC QLQ-C30 v. 3.0. Results Mean follow-up was more than four years. Early and late results of treatment after embolization and clipping for all patients did not differ. Evaluation of patients with bleeding aneurysms demonstrated better outcomes after embolization, however statistical significance was observed only in terms of symptomatic scale score of QLQ-C30 questionnaire (p=0.02). For patients with non-bleeding aneurysms better outcomes were obtained after clipping, but statistical significance was found only in the early results: more excellent results in GOS score at discharge (p<0.03) and fewer complications during hospitalization (p=0.02). Conclusions Results of treatment after clipping and coiling do not differ in total for all patients, but differ depending on the presence of bleeding. Patients with bleeding aneurysms achieve better outcomes after coiling, and patients with non-bleeding aneurysms achieve better outcomes after clipping

The Sum of Tumour-to-Brain Ratios Improves the Accuracy of Diagnosing Gliomas Using 18F-FET PET.

Gliomas are common brain tumours, but obtaining tissue for definitive diagnosis can be difficult. There is, therefore, interest in the use of non-invasive methods to diagnose and grade the disease. Although positron emission tomography (PET) with 18F-fluorethyltyrosine (18F-FET) can be used to differentiate between low-grade (LGG) and high-grade (HGG) gliomas, the optimal parameters to measure and their cut-points have yet to be established. We therefore assessed the value of single and dual time-point acquisition of 18F-FET PET parameters to differentiate between primary LGGs (n = 22) and HGGs (n = 24). PET examination was considered positive for glioma if the metabolic activity was 1.6-times higher than that of background (contralateral) brain, and maximum tissue-brain ratios (TBRmax) were calculated 10 and 60 min after isotope administration with their sums and differences calculated from individual time-point values. Using a threshold-based method, the overall sensitivity of PET was 97%. Several analysed parameters were significantly different between LGGs and HGGs. However, in a receiver operating characteristics analysis, TBR sum had the best diagnostic accuracy of 87% and sensitivity, specificity, and positive and negative predictive values of 100%, 72.7%, 80%, and 100%, respectively. 18F-FET PET is valuable for the non-invasive determination of glioma grade, especially when dual time-point metrics are used. TBR sum shows the greatest accuracy, sensitivity, and negative predictive value for tumour grade differentiation and is a simple method to implement. However, the cut-off may differ between institutions and calibration strategies would be useful

Case of emergency and sudden illness in Poland based on correlation descriptive study on cause ambulance service according to ICD-10: head to head analysis data from ambulance station Bydgoszcz vs. Konin

Wstęp. W stanie nagłego zagrożenia zdrowia lub życia do pierwszego kontaktu między pacjentem a systemem opieki zdrowotnej dochodzi w pogotowiu ratunkowym. Cel pracy. Określenie najczęstszych przyczyn wzywania pogotowia ratunkowego według klasyfikacji ICD-10. Materiał i metody. Opis zgodnie z ICD-10 przyczyn interwencji zespołów PR (pogotowia ratunkowego) na podstawie danych Wojewódzkiej Stacji Pogotowia Ratunkowego (WSPR) z Bydgoszczy i z Konina, które pracują na tym samym systemie teleinformatycznym wspomagającym zarządzanie zasobami PR. Wyniki. Procentowa struktura wyjazdów PR: „R” 23,91–37,61 (średnio 30), „I” 15,34–23,81 (nieco ponad 20), „S–T” 18,77–21,80 (ok. 20), zaś najrzadziej (< 1%): „A”, „B”, „C”, „D”, „H”, „L”, „M”, „P”, „Q” oraz „V”. Wnioski. 1. Struktura interwencji w poszczególnych stacjach PR jest do siebie podobna. 2. Według ICD-10, najczęstszą przyczyną interwencji zespołów wyjazdowych PR są rozpoznania „R” (prawie 30%), następnie „I” (ponad 20%) oraz „S–T” (ok. 20%). 3. Najrzadsze (< 1%) przyczyny według klasyfikacji ICD-10 to: „A”, „B”, C”, „D”, „H”, „L”, „M”, „P”, „Q” oraz „V”. Słowa kluczowe: stany zagrożenia życia i nagłe zachorowanie, biofizyka i biostatystyka, bierne badanie korelacyjne i porównanie bezpośrednie, pogotowie ratunkowe, dane podstawowe i statystyka w pogotowiu ratunkowym, inżynieria procesów.Background. In case of emergency or sudden illness the first contact of patients with health care system takes place in emergency ambulance service. Objectives. The authors determined the most common causes of emergency calls according to ICD-10. Material and methods. The authors described causes of intervention according to ICD-10 based on data from WSPR (regional centre of emergency medical service in Poland) from Bydgoszcz and Konin, which use one IT system – a new idea system to support lead ambulances. Results. Percent structure of emergency medical intervention according to ICD-10 is as follows: “R” 23.91–37.61 (on average 30), “I” 15.34–23.81 (slightly above 20), “S–T” 18.77–21.80 (around 20), and least often (< 1%): “A”, “B”, “C”, “D”, “H”, “L”, “M”, “P”, “Q”, and “V”. Conclusions. Structure of emergency medical intervention in different PR station is similar. The most frequent cause of accidents are “I”, next “R” and “S–T”, and rarely: “A”, “B”, “C”, “D”, “H”, “L”, “M”, “P”, “Q” and “V”

SUV kinetics for high (left graph) and low (right graph) grade gliomas.

<p>SUV kinetics for high (left graph) and low (right graph) grade gliomas.</p

Values of single and dual time-point PET parameters for high-grade and low-grade gliomas.

<p>Values of single and dual time-point PET parameters for high-grade and low-grade gliomas.</p

Studies estimating TBR_max values in gliomas.

<p>Studies estimating TBR_max values in gliomas.</p

ROC curve for the combined parameter TBR10 + TBR difference; Threshold = 1.602.

<p>ROC curve for the combined parameter TBR10 + TBR difference; Threshold = 1.602.</p

Parameter values as predictive factors for high-grade glioma.

<p>Parameter values as predictive factors for high-grade glioma.</p