Evaluacija ishoda sestrinske skrbi bolesnika nakon postupka trombolize – retrospektivna studija

Introduction. Nursing documentation is an indicator of healthcare quality. After extensive data analysis, it has been shown that nursing documentation has become an assessment tool and a tool to change clinical practice. Stroke is the most significant individual cause of disability in the adult population. In instances of ischemic stroke, brain circulation is abruptly disconnected. Causes of this break in blood flow may be blockage or compression of blood vessels due to thrombosis, embolism or systemic hypoperfusion. Therapy administered in cases of acute ischemic stroke includes intravenous thrombolytic therapy – recombined tissue activator of plasminogen within 180, i.e. 270 minutes of the stroke. Aim. To determine the quality of outcomes as regards patient care after administering thrombolytic therapy in a display of progress notes of patients’ condition during their stay in the hospital, both before and after administering thrombolytic therapy. Methods. A retrospective study was carried out at the neurology department of „Dr. Ivo Pedišić“ General Hospital in Sisak during 43 months from January 1, 2013 to May 31, 2017. 85 patients participated in the study. Data were obtained from one component of nursing documentation in electronic form, namely progress notes on the patients’ conditions. Results. With a 95% confidence level, a statistically significant difference (p<0.05) was found for parameters of hygiene, feeding, elimination, dressing, walking, moving, sitting, standing, turning, nutrition - diet, strain tolerance, Braden scale and categorization, before and after thrombolytic therapy. Statistical significance was not found in the parameters of pain (p=0.067), GCS/Trauma score scale (p=0.339), risk of fall (p=0.072). Conclusion. The implementation of the healthcare process, continued monitoring of the patient’s condition and progress, as well as validation of nursing activities provide an imperative for the application of nursing documentation as an essential tool in describing regular nursing activities. Application of documentation enables a more permanent insight into a patient’s general state, data availability, care continuity, progress chronology and result evaluation, as well as a material background for professional, expert and scientific development of nurses through studies in the field of nursing.Uvod. Sestrinska dokumentacija pokazatelj je kvalitete zdravstvene njege. Analizom podataka, sestrinska dokumentacija postaje alat u procjeni i promjeni kliničke prakse. Moždani udar najveći je pojedinačni uzrok invaliditeta kod odrasle populacije. Kod ishemijskoga moždanog udara dolazi do naglog prekida moždane cirkulacije. Uzroci prekida cirkulacije mogu biti začepljenje ili suženje krvne žile uzrokovane trombozom, embolijom ili sustavnom hipoperfuzijom. U praksi se primjenjuje terapija za akutni ishemijski moždani udar koja uključuje intravensku primjenu trombolitičke terapije – rekombiniranoga tkivnog aktivatora plazminogena unutar prvih 180 odnosno 270 minuta od nastanka moždanog udara. Cilj. Utvrditi ishode skrbi bolesnika nakon primjene trombolitičke terapije prikazom sažetka praćenja stanja bolesnika tijekom hospitalizacije, a u vremenu prije i nakon primijenjene trombolize. Metode. Retrospektivna studija provedena je na odjelu neurologije u Općoj bolnici „Dr. Ivo Pedišić” u Sisku kroz 43 mjeseca u periodu od 1. siječnja 2013. do 31. svibnja 2017. U provedenoj studiji sudjelovalo je 85 ispitanika. Podaci su prikupljeni na temelju sastavnice sestrinske dokumentacije u elektroničkom obliku: sažetka praćenja stanja bolesnika. Rezultati. S razinom pouzdanosti od 95 % utvrđena je statistički značajna razlika (p < 0,05) kod parametara higijene, hranjenja, eliminacije, oblačenja, hodanja, premještanja, sjedanja, stajanja, okretanja, prehrane – dijete, podnošenja napora, Bradenove skale i kategorizacije, a prije i poslije trombolize. Statistička značajnost nije utvrđena kod parametara bol (p = 0,067), GCS / Trauma score ljestvice (p = 0,339) i rizik za pad (p = 0,072). Zaključak. Primjena procesa zdravstvene njege, kontinuirano praćenje stanja bolesnika, ali i vrednovanje sestrinskog rada daje imperativ primjeni sestrinske dokumentacije kao važnom alatu za opis sestrinske prakse. Primjena dokumentacije omogućuje trajni uvid u stanje bolesnika, dostupnost podataka, kontinuitet skrbi, kronološki pregled i evaluaciju rezultata, kao i materijalnu podlogu za profesionalni, stručni i znanstveni razvoj medicinskih sestara kroz istraživanja u sestrinstvu

Damage to skin integrity in immobile neurological patients

Dekubitus je žarišna ozljeda kože i potkožnog tkiva uzrokovana pritiskom ili trenjem ili oboma uzrocima. Obično nastaje na koštanim izbočenjima. Najčešće pogađa osobe smanjene pokretljivosti nakon dugotrajnih neuroloških stanja. Jedan je od najčešćih uzroka neplanirane hospitalizacije kod pacijenata s ozljedom kralježnične moždine. Mogu se klinički prezentirati kao trajno hiperemična, puna mjehura, oštećena ili nekrotična koža koja se može proširiti na temeljne strukture, uključujući mišiće i kosti, a ponekad čak i zglobove. Dekubitusi suogroman ekonomski i zdravstveni teret pružateljima skrbi i zdravstvenom sustavu u cjelini. Stogaje prevencija dekubitusa visoko prioritetna. U vrijeme kada su resursi ograničeni, neophodno je izračunati troškove prevencije i liječenja dekubitusa kako bi se procijenio učinak koji ima na zdravstveni sustav i društvo. U diplomskom radu prikazan je dekubitus, čimbenici rizika i načini liječenja. Najveći je naglasak na prevenciji. Medicinska sestra primarno zbrinjava pacijenta s dekubitusom te je u tom pogledu od velike važnosti poznavanje svih čimbenika rizika i načinanjegova zbrinjavanja uz provođenje posebnih mjera prevencije nastanka oštećenja integriteta kože nepokretnog neurološkog pacijenta.Decubitus is a focal injury to the skin and subcutaneous tissue caused by pressure or friction or both. It is localized on bony protrusions. They most often affect people with reduced mobility after long-term neurological conditions. They are one of the most common causes of unplanned hospitalizations in patients with spinal cord injury. They can present clinically as permanently hyperemic, blistered, damaged or necrotic skin that can extend to underlying structures, including muscles and bones, and sometimes even joints. Decubitus poses a huge economic and health burden to caregivers and the health care system as a whole. Prevention of pressure ulcers is therefore a high priority. At a time when resources are limited, it is necessary to calculate the costs of prevention and treatment of pressure ulcers in order to assess the impact it has on the healthcare system and society. The diploma thesis presents pressure ulcers, risk factors, and methods of treatment. The emphasis is on prevention. The nurse primarily cares for a patient with pressure ulcers, and in this regard it is important to know all the risk factors and methods of its care, with the implementation of special measures to prevent damage to the integrity of the skin of an immobile neurological patient

Damage to skin integrity in immobile neurological patients

Dekubitus je žarišna ozljeda kože i potkožnog tkiva uzrokovana pritiskom ili trenjem ili oboma uzrocima. Obično nastaje na koštanim izbočenjima. Najčešće pogađa osobe smanjene pokretljivosti nakon dugotrajnih neuroloških stanja. Jedan je od najčešćih uzroka neplanirane hospitalizacije kod pacijenata s ozljedom kralježnične moždine. Mogu se klinički prezentirati kao trajno hiperemična, puna mjehura, oštećena ili nekrotična koža koja se može proširiti na temeljne strukture, uključujući mišiće i kosti, a ponekad čak i zglobove. Dekubitusi suogroman ekonomski i zdravstveni teret pružateljima skrbi i zdravstvenom sustavu u cjelini. Stogaje prevencija dekubitusa visoko prioritetna. U vrijeme kada su resursi ograničeni, neophodno je izračunati troškove prevencije i liječenja dekubitusa kako bi se procijenio učinak koji ima na zdravstveni sustav i društvo. U diplomskom radu prikazan je dekubitus, čimbenici rizika i načini liječenja. Najveći je naglasak na prevenciji. Medicinska sestra primarno zbrinjava pacijenta s dekubitusom te je u tom pogledu od velike važnosti poznavanje svih čimbenika rizika i načinanjegova zbrinjavanja uz provođenje posebnih mjera prevencije nastanka oštećenja integriteta kože nepokretnog neurološkog pacijenta.Decubitus is a focal injury to the skin and subcutaneous tissue caused by pressure or friction or both. It is localized on bony protrusions. They most often affect people with reduced mobility after long-term neurological conditions. They are one of the most common causes of unplanned hospitalizations in patients with spinal cord injury. They can present clinically as permanently hyperemic, blistered, damaged or necrotic skin that can extend to underlying structures, including muscles and bones, and sometimes even joints. Decubitus poses a huge economic and health burden to caregivers and the health care system as a whole. Prevention of pressure ulcers is therefore a high priority. At a time when resources are limited, it is necessary to calculate the costs of prevention and treatment of pressure ulcers in order to assess the impact it has on the healthcare system and society. The diploma thesis presents pressure ulcers, risk factors, and methods of treatment. The emphasis is on prevention. The nurse primarily cares for a patient with pressure ulcers, and in this regard it is important to know all the risk factors and methods of its care, with the implementation of special measures to prevent damage to the integrity of the skin of an immobile neurological patient

Damage to skin integrity in immobile neurological patients

Dekubitus je žarišna ozljeda kože i potkožnog tkiva uzrokovana pritiskom ili trenjem ili oboma uzrocima. Obično nastaje na koštanim izbočenjima. Najčešće pogađa osobe smanjene pokretljivosti nakon dugotrajnih neuroloških stanja. Jedan je od najčešćih uzroka neplanirane hospitalizacije kod pacijenata s ozljedom kralježnične moždine. Mogu se klinički prezentirati kao trajno hiperemična, puna mjehura, oštećena ili nekrotična koža koja se može proširiti na temeljne strukture, uključujući mišiće i kosti, a ponekad čak i zglobove. Dekubitusi suogroman ekonomski i zdravstveni teret pružateljima skrbi i zdravstvenom sustavu u cjelini. Stogaje prevencija dekubitusa visoko prioritetna. U vrijeme kada su resursi ograničeni, neophodno je izračunati troškove prevencije i liječenja dekubitusa kako bi se procijenio učinak koji ima na zdravstveni sustav i društvo. U diplomskom radu prikazan je dekubitus, čimbenici rizika i načini liječenja. Najveći je naglasak na prevenciji. Medicinska sestra primarno zbrinjava pacijenta s dekubitusom te je u tom pogledu od velike važnosti poznavanje svih čimbenika rizika i načinanjegova zbrinjavanja uz provođenje posebnih mjera prevencije nastanka oštećenja integriteta kože nepokretnog neurološkog pacijenta.Decubitus is a focal injury to the skin and subcutaneous tissue caused by pressure or friction or both. It is localized on bony protrusions. They most often affect people with reduced mobility after long-term neurological conditions. They are one of the most common causes of unplanned hospitalizations in patients with spinal cord injury. They can present clinically as permanently hyperemic, blistered, damaged or necrotic skin that can extend to underlying structures, including muscles and bones, and sometimes even joints. Decubitus poses a huge economic and health burden to caregivers and the health care system as a whole. Prevention of pressure ulcers is therefore a high priority. At a time when resources are limited, it is necessary to calculate the costs of prevention and treatment of pressure ulcers in order to assess the impact it has on the healthcare system and society. The diploma thesis presents pressure ulcers, risk factors, and methods of treatment. The emphasis is on prevention. The nurse primarily cares for a patient with pressure ulcers, and in this regard it is important to know all the risk factors and methods of its care, with the implementation of special measures to prevent damage to the integrity of the skin of an immobile neurological patient

Metabolic independence drives gut microbial colonization and resilience in health and disease

Background: Changes in microbial community composition as a function of human health and disease states have sparked remarkable interest in the human gut microbiome. However, establishing reproducible insights into the determinants of microbial succession in disease has been a formidable challenge. Results: Here we use fecal microbiota transplantation (FMT) as an in natura experimental model to investigate the association between metabolic independence and resilience in stressed gut environments. Our genome-resolved metagenomics survey suggests that FMT serves as an environmental filter that favors populations with higher metabolic independence, the genomes of which encode complete metabolic modules to synthesize critical metabolites, including amino acids, nucleotides, and vitamins. Interestingly, we observe higher completion of the same biosynthetic pathways in microbes enriched in IBD patients. Conclusions: These observations suggest a general mechanism that underlies changes in diversity in perturbed gut environments and reveal taxon-independent markers of “dysbiosis” that may explain why widespread yet typically low-abundance members of healthy gut microbiomes can dominate under inflammatory conditions without any causal association with disease.</p

Additional file 3 of Metabolic independence drives gut microbial colonization and resilience in health and disease

Additional file 3. Description of FMT metagenomes and co-assemblies. a Metagenome SRA accession numbers and number of metagenomic short-reads sequenced and mapped to co-assemblies and MAGs. b) Phylum level taxonomic composition of metagenomes. c) Genus level taxonomic composition of metagenomes. d) Summary statistics for contigs from metagenome co-assemblies

Additional file 11 of Metabolic independence drives gut microbial colonization and resilience in health and disease

Additional file 11. Review history

Additional file 10 of Metabolic independence drives gut microbial colonization and resilience in health and disease

Additional file 10. a List of genomes from healthy individuals and individuals with IBD. b Module completion values across genomes

Additional file 9 of Metabolic independence drives gut microbial colonization and resilience in health and disease

Additional file 9. Description of HMI vs. LMI populations. a Taxonomic assignments and genome size estimates for high- and low-metabolic independence populations. b KEGG module completeness information for high- and low-metabolic independence populations. c Raw KEGG module enrichment information for high- and low-metabolic independence populations. d KEGG module enrichment and categorical information for the 33 modules enriched in high-metabolic independence populations. e and f Completeness information for the 33 modules enriched in high-metabolic independence populations in all high- and low-metabolic independence populations

Additional file 5 of Metabolic independence drives gut microbial colonization and resilience in health and disease

Additional file 5. Accession numbers of gut metagenomes from 17 countries