Quality of life in adults with cystic fibrosis: the Greek experience

INTRODUCTION: Recent developments in treatment have steadily raised the median predicted age of survival for people with Cystic Fibrosis (CF). We report the health-related quality of life (HRQoL) in CF adult patients and correlate our findings with the patients’ demographic characteristics. MATERIAL AND METHODS: The Cystic Fibrosis Quality of Life (CFQoL) questionnaire was answered by 77 CF adult patients. The questionnaire included questions pertaining to age, sex and level of education and covered eight sections of functioning. RESULTS: The highest score was reported in the “Social Functioning” section, while the lowest in the “Concerns for the Future” section. When different age groups were compared, statistical significances were reported in “Physical Functioning”, “Interpersonal Relationships”, and the “Career Concerns” section, with older patients reporting statistically higher HRQoL scores than younger ones (p < 0.005). No statistically significant difference was reported amongst the scoring between male and female CF patients. When different educational levels were compared, patients that had received a higher educational training scored statistically higher in all but one sections of the questionnaire when compared with patients of a lower educational level (p < 0.005). CONCLUSION: More than half Greek adult CF patients report that they are capable to participate in social activities but most of them are worried about the outcome of their disease and its effect on their lives.INTRODUCTION: Recent developments in treatment have steadily raised the median predicted age of survival for people with Cystic Fibrosis (CF). We report the health-related quality of life (HRQoL) in CF adult patients and correlate our findings with the patients’ demographic characteristics. MATERIAL AND METHODS: The Cystic Fibrosis Quality of Life (CFQoL) questionnaire was answered by 77 CF adult patients. The questionnaire included questions pertaining to age, sex and level of education and covered eight sections of functioning. RESULTS: The highest score was reported in the “Social Functioning” section, while the lowest in the “Concerns for the Future” section. When different age groups were compared, statistical significances were reported in “Physical Functioning”, “Interpersonal Relationships”, and the “Career Concerns” section, with older patients reporting statistically higher HRQoL scores than younger ones (p < 0.005). No statistically significant difference was reported amongst the scoring between male and female CF patients. When different educational levels were compared, patients that had received a higher educational training scored statistically higher in all but one sections of the questionnaire when compared with patients of a lower educational level (p < 0.005). CONCLUSION: More than half Greek adult CF patients report that they are capable to participate in social activities but most of them are worried about the outcome of their disease and its effect on their lives

Study of the levels of adrenal hormones and their association with the outome of resuscitation

Aim: During cardiac arrest, catecholamines rise. The aim of the present study was to investigate 1) whether the levels of endogenous catecholamine release are associated with the result of resuscitation 2) there is any association with the pathology of the adrenal glands and 3) to investigate whether the exogenous administration of erythropoietin affects catecholamine release Methods: Twenty pigs were intubated and instrumented. Ventricular fibrillation was induced and remained untreated for 8 minutes. The animals were resuscitated according to the guidelines. Bloods were drawn throughout the experiment. Animals that achieved spontaneous circulation were monitored for 48 hours and the adrenal glands were removed after euthanasia.Results-Conclusions: Erythropoietin administration significantly affected some hormones. A statistical significant difference was noted for adrenaline (p=0.034) and cortisol (p<0.001) but not for nor-adrenaline (p=0.211) between groups, as well as the association between groups for all the phases of the experiment for adrenaline (p=0.037) and cortisol (p=0.017), but not for nor-adrenaline (p=0.140). High endogenous cortisol is associated with return of spontaneous circulation but not with a favourable neurological outcome. Erythropoetin increases the rate of return of spontaneous circulation, reduces the adverse effects of adrenaline increases 48 hour survival and reduces histologically the injury in the adrenal glands.Αντικείμενο-στόχος: Κατά τη διάρκεια της καρδιακής ανακοπής παρατηρείται αύξηση των κατεχολαμινών.Σκοπός αυτής της μελέτης είναι 1) να διερευνηθεί αν τα επίπεδα των ενδογενώς παραγομένων κατεχολαμινών σχετίζονται με το αποτέλεσμα της αναζωογόνησης 2) με την τελική ιστοπαθολογική βλάβη των επινεφριδίων 3)να διερευνηθεί αν η εξωγενής χορήγηση ερυθροποιητίνης επηρεάζει τις κατεχολαμίνες Μεθοδολογία: Είκοσι χοίροι διασωληνώθηκαν , έγινε καθετηριασμός των κεντρικών αγγείων και προκλήθηκε κοιλιακή μαρμαρυγή, η οποία παρέμεινε αθεράπευτη για 8 λεπτά. Τα ζώα αναζωογονήθηκαν σύμφωνα με τις κατευθυντήριες οδηγίες. Αιμοληψίες πραγματοποιήθηκαν καθόλη τη διάρκεια του πειράματος. Όσα ζώα αναζωογονήθηκαν παρακολουθήθηκαν για 48 ώρες στο τέλος των οποίων έγινε λήψη επινεφριδίων.Αποτελέσματα-Συμπεράσματα: Η χορήγηση ερυθροποιητίνης επηρέασε σημαντικά σχεδόν όλες τις εξεταζόμενες ορμόνες. Υπάρχει στατιστικά σημαντική διαφορά για την αδρεναλίνη (p=0.034) και την κορτιζόλη (p<0.001) αλλά όχι για την νοραδρεναλίνη (p=0.211) μεταξύ των ομάδων, καθώς και κατά την αλληλεπίδραση των ομάδων με τις φάσεις της μελέτης για τις ίδιες παραμέτρους (p=0.037) για την αδρεναλίνη και για την κορτιζόλη (p=0.017) ενώ δεν διαπιστώθηκε στις επιμέρους ομάδες για την νοραδρεναλίνη (p=0.140) Η κορτιζόλη σχετίζεται με ανάκτηση της αυτόματης κυκλοφορίας, αλλά όχι με καλή νευρολογική έκβαση. Η ερυθροποιητίνη αυξάνει το ποσοστό ανάκτησης αυτόματης κυκλοφορίας, μειώνει την αρνητική δράση της αδρεναλίνης, αυξάνει επιβίωση στο 48ωρο, μειώνει την ιστική επινεφριδιακή βλάβη

Medication administration prior to cardiac arrest and during cardiopulmonary resuscitation: a comparative study on the knowledge of cardiology residents and nursing personnel working in anesthetics department, cardiology ward, coronary care unit and emergency department

Introduction: Τhere is increased interest of the scientific community in assessing the level of knowledge on Cardiopulmonary Resuscitation (CPR) among health care professionals, mainly due to the high prevalence of cardiac arrest (CA). Research data demonstrate the health care professionals’ lack of knowledge regarding medication used in CA and during CPR. Aim: To assess health care professionals’ knowledge (residents, nurses and nurse assistants) on medication in CA and during CPR. Methods: A cross-sectional study was conducted in four big tertiary hospitals in Athens, Greece and in a large resuscitation educational center, in November and December 2016. Two hundred fifty six healthcare professionals, nursing personnel and doctors, working in various wards participated in the study. The participants completed a 14 questions research tool, assessing knowledge regarding medicine administration in CA and during CPR. Data were analyzed using statistical package SPSS 20. The statistical difference was set to p<0,005. Results: The majority of the sample was female (77,3%), with 57% of respondents having attended advanced life support training. The correlations between demographic characteristics and total score of correct answers showed statistical significance with age (p<0,05), educational level (p=0,011), years of working experience (p=0,033) and attendance of advanced life support seminar (p<0,01) with total score of correct answers. There was also statistically significance between total score of correct answers among nurses and doctors, with doctors showing higher score (p<0,05). Conclusions: Continuous education through seminars has a positive impact on health professionals’ knowledge on medicines used during CA and CPR. It is necessary to standardize undergraduate healthcare professionals’ education on pharmacokinetics aiming at the optimal management of the critically ill patient during CPR in clinical settings

Oxygen therapy practices in the acutely ill medical patients: A social media-based nationwide study of clinicians&apos; preferences and summary of current recommendations

Oxygen is the most commonly used drug in emergency medicine. The aim of this study was to identify healthcare professionals&apos; preferences regarding oxygen therapy in common medical emergencies. An online 9-part-questionnaire was distributed through Facebook to doctors and nurses working in Greek hospitals. The questionnaire included background information of the respondents and addressed individual preferences regarding best oxygenation parameter and oxygen targets in specific acute settings. We received 678 responses and we included 663 in our analysis. We found significant differences between doctors&apos; and nurses&apos; attitudes towards oxygenation targets in ARDS, sepsis, acute coronary syndrome, and post cardiac-arrest patients. Nurses preferred a more conservative oxygen strategy compared to doctors. Furthermore, nurses favor SaO(2) as the best oxygenation parameter, while doctors prefer PaO2. In our survey, the type of hospital and department of the respondents did not affect the preferred oxygen strategy. Social media-based survey research is feasible and effective. In this single country study, doctors showed a tendency to liberally administer oxygen in acutely ill medical patients. On the other hand, Greek nurses preferred a more conservative approach

Jakość życia u dorosłych chorych na mukowiscydozę — doświadczenia greckie

WSTĘP: Postępy w leczeniu spowodowały stabilny wzrost mediany przewidywanego czasu przeżycia chorych na mukowiscydozę. W prezentowanej pracy zbadano jakość życia zależną od zdrowia (HRQoL, health-related quality of life) u dorosłych chorych na mukowiscydozę, a wyniki skorelowano z danymi demograficznymi. MATERIAŁ I METODY: Użyto kwestionariusza jakości życia dla chorych na mukowiscydozę (CFQoL, Cystic Fibrosis Quality of Life). Kwestionariusz zawierał pytania dotyczące wieku, płci, wykształcenia i obejmował osiem sekcji oceniających różnorodne funkcje życiowe. W grupie badanej znalazło się 77 dorosłych chorych na mukowiscydozę. WYNIKI: Najwyższą punktację uzyskano w sekcji „Funkcje społeczne” a najniższą w sekcji „Troska o przyszłość”. Gdy porównano różne grupy wiekowe, różnice znamienne statystycznie uzyskano w sekcjach „Funkcjonowanie fizyczne”, „Relacje interpersonalne” oraz „Obawy związane z karierą”, a starsi pacjenci uzyskiwali statystycznie wyższą punktację w kwestionariuszu HRQoL niż młodsi (p &lt; 0,005). Nie stwierdzono różnic pomiędzy kobietami i mężczyznami. Pacjenci o wyższym poziomie edukacji uzyskiwali znamiennie wyższą punktację (p &lt; 0,005). WNIOSKI: Więcej niż połowa greckich chorych na mukowiscydozę deklaruje gotowość do podejmowania społecznej aktywności, ale większość obawia się o odległe rokowanie i wpływ choroby na ich życie.WSTĘP: Postępy w leczeniu spowodowały stabilny wzrost mediany przewidywanego czasu przeżycia chorych na mukowiscydozę. W prezentowanej pracy zbadano jakość życia zależną od zdrowia (HRQoL, health-related quality of life) u dorosłych chorych na mukowiscydozę, a wyniki skorelowano z danymi demograficznymi. MATERIAŁ I METODY: Użyto kwestionariusza jakości życia dla chorych na mukowiscydozę (CFQoL, Cystic Fibrosis Quality of Life). Kwestionariusz zawierał pytania dotyczące wieku, płci, wykształcenia i obejmował osiem sekcji oceniających różnorodne funkcje życiowe. W grupie badanej znalazło się 77 dorosłych chorych na mukowiscydozę. WYNIKI: Najwyższą punktację uzyskano w sekcji „Funkcje społeczne” a najniższą w sekcji „Troska o przyszłość”. Gdy porównano różne grupy wiekowe, różnice znamienne statystycznie uzyskano w sekcjach „Funkcjonowanie fizyczne”, „Relacje interpersonalne” oraz „Obawy związane z karierą”, a starsi pacjenci uzyskiwali statystycznie wyższą punktację w kwestionariuszu HRQoL niż młodsi (p &lt; 0,005). Nie stwierdzono różnic pomiędzy kobietami i mężczyznami. Pacjenci o wyższym poziomie edukacji uzyskiwali znamiennie wyższą punktację (p &lt; 0,005). WNIOSKI: Więcej niż połowa greckich chorych na mukowiscydozę deklaruje gotowość do podejmowania społecznej aktywności, ale większość obawia się o odległe rokowanie i wpływ choroby na ich życie

Theoretical knowledge and skill retention 4 months after a European Paediatric Life Support course

Objective : The European Paediatric Life Support (EPLS) provider course aims at training doctors and nurses in the efficient and prompt management of cardiopulmonary arrest in children. EPLS is a 2-day European Resuscitation Council course, involving the teaching of theoretical knowledge and practical skills. The aim of the study was to evaluate the retention of theoretical knowledge and certain skills of EPLS providers 4 months after the course. Materials and methods : In total, 80 doctors and nurses who attended three EPLS provider courses, from May 2012 to December 2012, were asked to participate in the study and only 50 responded positively. Demographic data (age, sex, occupation) of the participants were collected. The European Resuscitation Council-approved EPLS written test was used to assess theoretical knowledge right after the course and after 4 months. The retention of certain skills (airway opening, bag-mask ventilation, chest compressions) was also examined. Results : The theoretical knowledge decreased significantly (P < 0.001) 4 months after the course. Age, sex and occupational status (medical or nursing profession) had no effect in theoretical knowledge retention. Interestingly, certain skills such as the application of airway opening manoeuvres and effective bag-mask ventilation were retained 4 months after the course, whereas chest compression skill retention significantly declined (P=0.012). Conclusion : According to our findings, theoretical knowledge of the EPLS course uniformly declines, irrespective of the provider characteristics, whereas retention of certain skills is evident 4 months after the course

Stress hormones kinetics in ventricular fibrillation cardiac arrest and resuscitation: Translational and therapeutic implications

Background: Knowing the kinetics of endogenous stress hormones during cardiac arrest and cardiopulmonary resuscitation (CRP) will help to optimize personalized physiology-guided treatment. The aim of this study was to examine the dynamic changes in stress hormones in a swine model of ventricular fibrillation (VF) cardiac arrest. Methods: Ventricular fibrillation was induced in 10 healthy Landrace/Large White piglets, which were subsequently left untreated for 8 min. All animals were resuscitated according to the 2015 European Resuscitation Council guidelines. The concentration of adrenalin, noradrenalin, and cortisol was measured at baseline and at the 4th and 8th minute of VF-cardiac arrest, as well as at 30-min, 60-min, 24 h and 48 h post-ROSC. Results: By the end of the 4th min of VF, the animals of the ROSC group exhibited significantly higher adrenaline levels compared to those of the no-ROSC group (7264 pg/ml vs. 1648 pg/ml. p - 0.03). Noradrenaline was higher in the ROSC group at the 4th min of VI (3021 pg/ml vs. 1626 pg/ml, p = 0.02). Cortisol levels in the ROSC group were significantly lower by the end of the 8th min of VF[16.25 ng/ml vs. 92.82 ng/ml, p 0.031. With a cut-off point of 5970 pg/ml, adrenaline at the 4th min of VF exhibited 100% sensitivity and 80% specificity for predicting ROSC. Conclusion: Higher endogenous adrenaline and lower endogenous cortisol levels were associated with ROSC. (C) 2021 Elsevier Inc. All rights reserved

Effect of Erythropoietin on Postresuscitation Renal Function in a Swine Model of Ventricular Fibrillation

Purpose. To investigate the effect of EPO administration on postresuscitation renal function. Methods. Twenty-four female Landrace/Large-White piglets aged 10–15 weeks with average weight of 19±2 kg were randomly assigned to 2 different groups of 12 subjects each. After the end of an 8-minute ventricular fibrillation, the control group (Group C) received saline as placebo, whereas the EPO group (Group E) received EPO 5000 U/kg. The animals were resuscitated according to the 2010 European Resuscitation Council Guidelines for Resuscitation. Results. Five animals (41.67%) from Group C and 11 animals (91.67%) from Group E achieved ROSC (p=0.027). Eight animals (66.67%, 5 surviving and 3 nonsurviving) from Group C suffered severe kidney damage or AKI compared to animals from Group E, in which none of the swine had evidence of severe kidney damage or AKI (p=0.001). There was a statistically significant difference in all tested biochemical markers between the two groups, as well as a positive correlation of creatinine with NGAL, L-FABP, and IL-18 (summed mean values’ p=0.049, 0.01, and 0.004, resp.). Conclusions. Administration of EPO protected swine from postresuscitation acute kidney injury

Cardiopulmonary resuscitation in adults over 80 : outcome and the perception of appropriateness by clinicians

OBJECTIVES: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN: Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE). SETTING: Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39–45, 201