Airtraq® is the preferred device for difficultintubation by residents?

Background: The Airtraq® optical laryngoscope is an intubation device designed to provide a view of the glottis without alignment of the oro-pharyngeal and laryngeal axes. Recent literature shows that, given its two significant features: time effectiveness and short learning curve, Airtraq® is the most favorable option when it comes to difficult intubation. Objectives: The goal was to analyze Airtraq® effectiveness when used by inexperienced physicians in anticipated difficult intubation in adult patients. Materials and methods: We conducted a prospective evaluation in ten medical residents using the Airtraq® device for the first time. All of them were experienced in using Macintosh. Each resident conducted laryngoscopy and intubation with the Airtraq® device after short didactic guidance. Eighteen patients were included, over a period of seven months. The patients showed four difficult intubation predictors: history of difficult intubation, thyromental distance less than 60 mm, mouth opening less than 35 mm and Mallampati class 3 or 4. All of them were clinically examined for difficult airway by an ENT specialist. Results: Before induction of anaesthesia all residents received a short demonstration on the use of the Airtraq®. Every participant was supervised by an Airtraq® handling specialist for each intubation maneuver. In sixteen patients, Airtraq® insertion, glottis visualization and subsequent intubation were easy and rapid, without arterial oxygen desaturation. In two patients the trachea was intubated from the second and third attempt. There were two tracheal intubation failures, associated with extended tracheal intubation and an Airtraq® specialist had to continue with intubation. The Airtraq® reduced the duration of intubation attempts in all cases, reduced the number of optimization maneuvers required, and reduced the potential for dental trauma. However, the two intubation failures emphasize the fact that Airtraq® laryngoscopy requires a clinical training process, especially in the event of anticipated difficult airway management situations. Conclusion: The residents participating the study, found the Airtraq® easier to use in all scenarios compared to the Macintosh laryngoscope. The Airtraq® may be the preferred device, required by inexperienced physicians in cases of difficult airwa

Stroke outcomes in Croatian and Bulgarian patients measured by modified Rankin scale

Cilj rada bio je usporedba funkcijskih ishoda pacijenata s moždanim udarom tijekom rehabilitacije u Hrvatskoj i Bugarskoj s pomoću modificirane Rankinove ljestvice (mRS) kao kliničke mjere opće nesposobnosti. Broj rehabilitacijskih dana u Bugarskoj je, sukladno nacionalnim pravilnicima, manji nego u Hrvatskoj. Stoga je namjera studije bila ocijeniti utjecaj duljine rehabilitacije na napredak pacijenata. Korišteni su podaci 50 pacijenata iz svake od zemalja, koji su bili usklađeni prema spolu dobi u vrijeme udara, proteka vremena od udara do rehabilitacije, tipa udara, zahvaćene strane i težine udara, komorbiditeta i programa rehabilitacije. U obje skupine zabilježeni su početni i završni rezultati mRS-a, promjene (napredak) funkcijskih mogućnosti i duljina boravka na rehabilitaciji. Također su zabilježene niže početne vrijednosti mRS-a (4,06 ± 1,02 u hrvatskoj i 3,88 ± 0,96 u bugarskoj skupini) što je upućivalo na veliku ovisnost i potrebu temeljitog pristupa i angažmana cijelog rehabilitacijskog tima. Zabilježene su značajne promjene mRSa (napredaka) u obje skupine, ali je napredak bio statistički bolji u hrvatskoj s promjenom od 0,96 ± 0,67 u odnosu prema bugarskoj skupini u kojoj je bio 0,42 ± 0,50. Pritom je rehabilitacija pacijenata iz hrvatske skupine trajala mnogo dulje (33 ± 15 dana) nego bugarskih (8 ± 2 dana). Promjena u jednoj razini mRS-a može značiti funkcijski važan napredak s velikim utjecajem na pacijenta i njegovu/ njezinu okolinu. Bugarski pacijenti, iako su značajno napredovali u odnosu na početne rezultate, nisu postizali funkcijske napretke kao hrvatski pacijenti. Stoga možemo predložiti da rehabilitacija bugarskih pacijenata (8 ± 2 dana) traje, barem, koliko i hrvatskih (33 ± 15 dana) kako bi se postigao isti funkcijski napredak mjeren modificiranom Rankinovom ljestvicom.The purpose of the study was to measure functional outcomes of stroke patients undergoing rehabilitation in Croatia and Bulgaria using modified Rankin scale (mRS) as a clinician-reported measure of global disability. Fewer days are allowed for rehabilitation in Bulgaria than in Croatia according to the payers’ rules, and the aim of the study was to assess the impact of length of stay to the progress of patients. Data on 50 stroke patients from each of two countries were analyzed that were matched by gender, age at stroke, days from stroke to the onset of rehabilitation, type, side and severity of stroke, co-morbidity and the programme of rehabilitation. Initial and final mRS results and the change (progress) of patients` functional abilities and lengths of stay of both groups were recorded. Both groups presented with lower mRS results at rehabilitation onset (4.06±1.02 in Croatian and 3.88±0.96 in Bulgarian patients) indicating high dependency and the need for thorough approach and engagement of the whole rehabilitation team. There were significant changes of mRS (improvement) in both groups, but the progress was statistically better in Croatian with change of mRS of 0.96±0.67, than in Bulgarian patients (0.42±0.50), whereas the length of stay was significantly longer in Croatian patients (33±15 days) than in Bulgarian (8±2 days). The change in Stručni rad Professional article ISSN 1846-1867 Fiz. rehabil. med. 2012; 24 (3-4): 115-122 116 one mRS level may represent functionally important progress with significant impact for the patient and his/her carers. Bulgarian patients, although significant in before-after comparison of mRS results, do not reach functional goals as Croatian patients. Therefore, we may suggest that the length of stay of Bulgarian patients (8±2 days) should be prolonged to, at least, the length of stay present in Croatian patients (33±15 days) to achieve the same functional improvement measured by the modified Rankin scale

Stroke outcomes in Croatian and Bulgarian patients measured by modified Rankin scale

Cilj rada bio je usporedba funkcijskih ishoda pacijenata s moždanim udarom tijekom rehabilitacije u Hrvatskoj i Bugarskoj s pomoću modificirane Rankinove ljestvice (mRS) kao kliničke mjere opće nesposobnosti. Broj rehabilitacijskih dana u Bugarskoj je, sukladno nacionalnim pravilnicima, manji nego u Hrvatskoj. Stoga je namjera studije bila ocijeniti utjecaj duljine rehabilitacije na napredak pacijenata. Korišteni su podaci 50 pacijenata iz svake od zemalja, koji su bili usklađeni prema spolu dobi u vrijeme udara, proteka vremena od udara do rehabilitacije, tipa udara, zahvaćene strane i težine udara, komorbiditeta i programa rehabilitacije. U obje skupine zabilježeni su početni i završni rezultati mRS-a, promjene (napredak) funkcijskih mogućnosti i duljina boravka na rehabilitaciji. Također su zabilježene niže početne vrijednosti mRS-a (4,06 ± 1,02 u hrvatskoj i 3,88 ± 0,96 u bugarskoj skupini) što je upućivalo na veliku ovisnost i potrebu temeljitog pristupa i angažmana cijelog rehabilitacijskog tima. Zabilježene su značajne promjene mRSa (napredaka) u obje skupine, ali je napredak bio statistički bolji u hrvatskoj s promjenom od 0,96 ± 0,67 u odnosu prema bugarskoj skupini u kojoj je bio 0,42 ± 0,50. Pritom je rehabilitacija pacijenata iz hrvatske skupine trajala mnogo dulje (33 ± 15 dana) nego bugarskih (8 ± 2 dana). Promjena u jednoj razini mRS-a može značiti funkcijski važan napredak s velikim utjecajem na pacijenta i njegovu/ njezinu okolinu. Bugarski pacijenti, iako su značajno napredovali u odnosu na početne rezultate, nisu postizali funkcijske napretke kao hrvatski pacijenti. Stoga možemo predložiti da rehabilitacija bugarskih pacijenata (8 ± 2 dana) traje, barem, koliko i hrvatskih (33 ± 15 dana) kako bi se postigao isti funkcijski napredak mjeren modificiranom Rankinovom ljestvicom.The purpose of the study was to measure functional outcomes of stroke patients undergoing rehabilitation in Croatia and Bulgaria using modified Rankin scale (mRS) as a clinician-reported measure of global disability. Fewer days are allowed for rehabilitation in Bulgaria than in Croatia according to the payers’ rules, and the aim of the study was to assess the impact of length of stay to the progress of patients. Data on 50 stroke patients from each of two countries were analyzed that were matched by gender, age at stroke, days from stroke to the onset of rehabilitation, type, side and severity of stroke, co-morbidity and the programme of rehabilitation. Initial and final mRS results and the change (progress) of patients` functional abilities and lengths of stay of both groups were recorded. Both groups presented with lower mRS results at rehabilitation onset (4.06±1.02 in Croatian and 3.88±0.96 in Bulgarian patients) indicating high dependency and the need for thorough approach and engagement of the whole rehabilitation team. There were significant changes of mRS (improvement) in both groups, but the progress was statistically better in Croatian with change of mRS of 0.96±0.67, than in Bulgarian patients (0.42±0.50), whereas the length of stay was significantly longer in Croatian patients (33±15 days) than in Bulgarian (8±2 days). The change in Stručni rad Professional article ISSN 1846-1867 Fiz. rehabil. med. 2012; 24 (3-4): 115-122 116 one mRS level may represent functionally important progress with significant impact for the patient and his/her carers. Bulgarian patients, although significant in before-after comparison of mRS results, do not reach functional goals as Croatian patients. Therefore, we may suggest that the length of stay of Bulgarian patients (8±2 days) should be prolonged to, at least, the length of stay present in Croatian patients (33±15 days) to achieve the same functional improvement measured by the modified Rankin scale

Safety and immunogenicity of a seasonal trivalent inactivated split influenza vaccine: a phase I randomized clinical trial in healthy Serbian adults

This study was a phase I double-blind, randomized, placebo-controlled trial to evaluate the safety and immunogenicity of a Serbian-produced seasonal trivalent split, inactivated influenza vaccine in healthy adults. The vaccine was manufactured in eggs by the Torlak Institute of Virology, Vaccines and Sera, Belgrade, Serbia and contained A/H1N1, A/H3N2 and B viruses. The clinical trial took place at the Clinical Center of Serbia in Belgrade. Sixty healthy volunteers, aged 18-45years, were enrolled in the trial. On the day of immunization, volunteers were randomly assigned to receive either a single dose of the trivalent seasonal influenza vaccine (15g of hemagglutinin per strain) or placebo (phosphate-buffered saline). Subjects were monitored for adverse events through a clinical history and physical examination, and blood was taken for testing at screening and on day 8 to assess vaccine safety. Serum samples obtained before and 21days after immunization were tested for influenza antibody titers using hemagglutination-inhibition (HAI) and microneutralization (MN) tests. No serious adverse events were reported. Pain and tenderness at the injection site were the most commonly reported symptoms in both vaccine and placebo groups. Overall, serum HAI responses of fourfold or greater magnitude were observed to H1, H3, and B antigen in 80%, 75%, and 70% of subjects, respectively. Seroprotection rates as measured by HAI were also high (100%, 100% and 86.67%, respectively, for H1, H3 and B). Thus, Torlak's seasonal trivalent influenza vaccine was not associated with adverse events, was well-tolerated and immunogenic. It should be further evaluated in clinical trials to provide sufficient safety and immunogenicity data for licensing in Serbia

Re-reading Nāgārjuna with Resources from Richard Rorty

The central aim of this dissertation is to bring into dialogue certain themes, methods, and concepts drawn from, on the one hand, the 2nd century CE Mahāyāna Buddhist thinker, Nāgārjuna, and, on the other, the Neo-Pragmatist philosopher, Richard Rorty (1931-2007). I highlight two core types of exegetical disagreement amongst Madhyamaka scholars in their philosophical readings of Nāgārjuna’s central texts (the *Mūla-madhyamaka-kārikā* and the *Vigraha-vyāvartanī*), and I re-articulate these debates through a Rortyan Neo-Pragmatist lens. I describe these two types of ongoing disagreement, which I characterise using the metaphor of an oscillation, as metaphilosophical and metalinguistic. They are thematically intertwined – the former is a disagreement over whether we should read Nāgārjuna as primarily engaging in *philosophy* and the latter is a disagreement over whether we should read Nāgārjuna’s *statements* as primarily useful to follow for the goal of liberation or accurately capturing facts about reality. In analysing what these Western interpreters are doing in their philosophical readings, I introduce Rorty as a lively conversational partner with whom to revisit their methodological preferences and conceptual presuppositions. My aim is not to conclusively settle these exegetical debates. Instead, I propose that Rorty’s work can give us some valuable conceptual resources for sidestepping their disagreements because of its extensive engagement with metaphilosophical and metalinguistic motifs in Western academic philosophy. My core argument is that by focussing on Rorty’s articulation of semantic anti-representationalism, that is, the view that the function of language is not to “mirror” or re-present the world, we can reconceptualise these exegetical debates as structured by forced choices which can be avoided. Therefore, the Rortyan (second-order) perspective that I will develop in this dissertation stands at a right angle to the (first-order) contemporary exegetical field where the idiom of representationalism is not directly opposed. I will argue that by not clearly rejecting the idioms and the imageries of representationalism from the outset, the interpretive terrain of Madhyamaka becomes associated with representationalist presuppositions, especially of a semantic variety, and it is these presuppositions that generate and sustain the exegetical debates. Once we have reconfigured, with the help of Rorty, the scholarly terrain anti-representationally and pointed to ways of bypassing these exegetical impasses, I then trace the implications of re-reading Nāgārjuna as an anti-representationalist. In so doing, I show that my proposals have the additional advantage of giving us Neo-Pragmatist tools with which to re-read Nāgārjuna’s Madhyamaka in a way that renders his message less exegetically tortuous and more straightforwardly intelligible.AHRC Cambridge Trus

Managing with organizational environments - strategy of e-business

The last few decades have been very turbulent due to significant growth of the usage and interest in the Internet. Everyday life of each individual has been affected by the development of computers and related technologies, making information more accessible to a wider pool of audience. This, of course, has been significantly changing the way of doing business, emphasizing new possibilities for potential entrepreneurs. Business and companies have been affected by the rising pressure of information and communication technologies, making distances and locations diminish. The paper is focused on the advantages or opportunities created by the boom of the technology and especially e-business on one side, and of course, the downsides considering the raised exposure in view of the presence of the Internet as a tool in busines

Awareness about mediation as an alternative form of dispute resolution: Practices in the republic of Macedonia

Disputes resolved with the use of mediation as a form of dispute resolution are rare (or at striking level) in the practice in our country. In order to increase the number of disputes that were successfully completed based on mediation, it is necessary for the people to know about the alternative forms of resolving litigation. The lack of information contributes to the lack of trust in any resolution of the dispute except in the court. There is also the positive practice of resolving disputes through mediation macular placed in public. This Paper treats the action research which aims to connect the people awareness of mediation as a form of negotiation through which can quickly and easily, without major financial implications, to resolve any dispute. This paper is based on a survey with the members of Chamber of Mediators of the Republic of Macedonia. These results clearly confirm the lack of information among the local population about the forms of dispute resolution that are available and the benefits they offer.