Kairiojo skilvelio išstūmimo frakcijos įtakos mirštamumo prognozavimui po miokardo revaskulizacijos operacijų įvertinimas pagal EuroSCORE sistemą

Šarūnas Kinduris1,2, Giedrius Vanagas1,3 1 Kauno medicinos universiteto klinikų Širdies, krūtinės ir kraujagyslių chirurgijos klinika, Eivenių g. 2, LT-50009 Kaunas 2 Kauno medicinos universiteto Biomedicininių tyrimų institutas, Eivenių g. 4, LT-50009 Kaunas 3 Kauno medicinos universiteto Profilaktinės medicinos katedra, Eivenių g. 4, LT-50009 Kaunas El paštas: [email protected] Įvadas / tikslas Kardiochirurgijos operacijų rizikos įvertinimo EuroSCORE (European System for Cardiac Operative Risk Evaluation) sistema nuo 1999 metų naudojama Europos šalyse prognozuojant ankstyvąjį pooperacinį mirštamumą. Analizuojant EuroSCORE taikymo galimybes Lietuvoje paaiškėjo, kad ji nepasižymi nei didele prognozine verte, nei tikslumu. Darbo tikslas – įvertinti vieno iš EuroSCORE vertinimo sistemos rizikos veiksnių – kairiojo skilvelio išstūmimo frakcijos (KSIF) įtaką pooperacinio mirštamumo prognozavimui. Ligoniai ir metodai Atlikta retrospektyvioji duomenų analizė 1379 ligonių, sergančių išemine širdies liga. Jiems planine tvarka atlikta pirminė miokardo revaskulizacijos operacija Kauno medicinos universiteto klinikų Širdies, krūtinės ir angiochirurgijos klinikoje 2004 metų sausį – 2006 metų gruodį. Atsižvelgiant KSIF vertinimą pagal EuroSCORE sistemą ligoniai buvo suskirstyti į tris grupes: I grupę sudarė ligoniai, kuriems priešoperaciniu laikotarpiu KSIF nustatyta 50%. Rezultatai Ligoniai pagal EuroSCORE sistemos KSIF vertinimą pasiskirstė taip: I grupę sudarė 167 ligoniai, II grupę – 906 ligoniai ir III grupę – 306 ligoniai. Šio tyrimo metu vertinant operacinę riziką pagal EuroSCORE sistemos metodiką išskirtinis dėmesys kreiptas į KSIF įtaką pooperaciniam mirštamumui, lyginant jį su prognozuojamu. Kadangi II grupės ligoniai pagal stebėtą ir prognozuotą mirštamumą pasiskirstė netolygiai, buvo sudaryti du pogrupiai: IIA (n = 218) – ligonių, kurių KSIF 30–39%, o IIB (n = 688) – ligonių, kurių KSIF 40–50%. Šių grupių ligonių mirštamumo skirtumai buvo statistiškai reikšmingi (p < 0,05). Išvados Ligoniai, kuriems yra kairiojo skilvelio disfunkcija (išstūmimo frakcija < 50%), galėtų būti skirstomi į tris grupes (40–50%, 30–39% ir < 30%) pagal operacijos riziką, atitinkamai peržiūrint balų skyrimą pagal EuroSCORE. Be to, apibūdinant kairiojo skilvelio kontrakciją tikslinga naudoti ir kitus jos vertinimo kriterijus (pvz., sienelių kontrakcijos indeksą). Pagrindiniai žodžiai: miokardo revaskulizacija, rizikos vertinimas, kairiojo skilvelio išstūmimo frakcija Evaluation of left ventricle ejection fraction impact on cardiac surgery risk stratification by EuroSCORE system Šarūnas Kinduris1,2, Giedrius Vanagas1,3 1 Hospital of Kaunas University of Medicine, Department of Cardiothoracic and Vascular Surgery, Eivenių str. 2, LT-50009 Kaunas, Lithuania 2 Kaunas University of Medicine, Institute for Biomedical Research, Eivenių str. 4, LT-50009 Kaunas, Lithuania 3 Kaunas University of Medicine, Department of Preventive Medicine, Eivenių str. 4, LT-50009 Kaunas, Lithuania E-mail: [email protected] Background / objective EuroSCORE as the cardiac surgery risk stratification system is well known in Europe since 1999. Previous validity and accuracy assessments in Lithuania showed mortality overprediction by the EuroSCORE system in our patients’ population. The aim of the article is to analyze the impact of LVEF on cardiac surgery postoperative mortality prediction by EuroSCORE. Patients and methods It was implemented retrospective analysis of qualitative and quantitative data on 1379 patients that underwent CABG surgery at Kaunas University of Medicine during January 2004 – December 2006. According to LVEF evaluation by EuroSCORE, all patients were grouped to 3 groups: group I with LVEF 50%. Results According to LVEF evaluation by EuroSCORE, group I comprised 167, group II 906 and group III 306 patients. According to mortality evaluation there were significant discrepancies between the observed and the predicted by EuroSCORE mortality among patients in group II. It was decided to divide group II into two subgroups: IIA 30–39% and IIB 40–50% in which mortality differed statistically significantly (p < 0.05). Conclusions Patients with LVEF lower than < 50% could be grouped into three groups (40–50%, 30–39% and < 30%). Also, it is important to review the scoring system according to these groups. It would be reasonable to make further analysis of mortality prediction by other ejection fraction parameters. Key words: coronary artery bypass grafting, risk stratification, mortality, left ventricular ejection fraction, predictive valu

Improvement of balance of children with disorder of motor function by means of adapted physiotherapy

The aim of the research is to observe whether specific developmental disorder of motor function (SDDMF) in infancy affects 6-7 years old children’s balance and to find out does physiotherapy (PT) is beneficial for enhancing and maintaining this feature. The study involved 97 right-hand 6-7 years old children. Participants were divided into two groups: study and control group. In the study group, there were children who had SDDMF in infancy being 4-11 months old and participated in a PT program in infancy. Control group participants didn’t have SDDMF and PT in infancy. The balance was assessed using a computerized balance platform. The study group had 16 physiotherapy procedures. A data analysis showed significant differences of participants’ balance characteristics in frontal and sagittal planes: comparing study and control group results before PT in open eyes with feedback performance. There was a significant difference of balance between the study group before and after a PT with the control group when participants performed tasks with open eyes without a feedback. SDDMF in infancy affects 6-7 years old children’s balance and PT is beneficial for enhancing and maintaining these features for 6-7 years old children

Editorial - eHealth Solutions for the Integrated Healthcare

Information and communication technologies (ICT) bring a whole new dimension into the healthcare arena by introducing electronic media that open the door to the use of new methodologies. Today, ICT support electronic gathering, storage, processing, and exchange of information to treat disease, prevent illness, promote healthy lifestyle, manage patients with chronic illness, and many other applications [1, 2]. Electronic health (eHealth) has the ability to bridge gaps between patients and doctors, patients and relatives, doctors and administrative staff, and so on. Also, eHealth helps to overcome barriers by means that are significantly different from traditional healthcare solutions [3]. It has paved the way for the adoption of sophisticated forms of healthcare provision based on mobile devices and context-awareness, such as mobile health (mHealth) [4] and smart health (sHealth) [5], which require unprecedentedly complex integration strategies.The advances in healthcare and ICT serve the society as a whole (e.g., patients, healthcare professionals, relatives, and governments) and support the sustainability of healthcare systems. New health ICT systems offer opportunities to improve the effectiveness and efficiency of healthcare services through innovative approaches in clinical service delivery, personalized health, and public health, with a wide impact on the well-being of individuals. Clearly, the study of the integration of healthcare solutions based on ICT is a hot topic that deserves attention.Despite the well-known potential benefits of adopting eHealth solutions, approaches to ICT implementation used in other industries have had limited success in the healthcare sector. This is not surprising, especially if we take into account the complexity and nature of the healthcare ecosystem. Hence, the implementation of ICT in practice remains difficult and implies many challenges at different levels, involving patients, healthcare providers, and healthcare organizations [6]. Some of the most significant challenges for the adoption of eHealth (and its mHealth and sHealth derivations) are inherent to the complexity of the healthcare system. Take, for example, the interoperability problem, which is an old problem inherited from previous nonelectronic healthcare infrastructures that is also common in a variety of other domains [7]. Also, ethical issues such as privacy protection are a common problem that affects healthcare in general, but it is magnified by the use of ICT [8, 9]. Last but not least, the integration of new technologies based on artificial intelligence, smartphones, neural networks, and big data analysis (to name a few) into the healthcare sector poses magnificent challenges for the current healthcare system’s limitations, which the scientific community is struggling to overcome. In this sense, the feasibility of many applications, policies, and data concerning the costs, effects, and effectiveness of eHealth and telemedicine are at stake. There is a lack of research-based, empirically-tested models to progress towards large-scale use of ICT in the health sector.In this special issue, we have undertaken the task of collecting a set of articles that address some of the aforementioned challenges faced by current eHealth infrastructure and applications.Monitoring long-distance fast walking in daily activities is challenging due to the lack of specific scientific equipment. In the literature, most gait experiments are performed by walking on treadmills. Unfortunately, gait data acquired on treadmills are quite different from the real ones gotten on the ground. The article by W.-F. Wang et al. “Study on Tripping Risks in Fast Walking through Cadence-Controlled Gait Analysis” approaches this problem by performing all walking tests intended to reveal important clues for tripping risks in fast walking in a flat and straight pathway. The results show that fast walking with bigger strides and lower cadence is the best way to keep safety on ordinary ground.Similarly, the monitoring of vital signs is a very active research area. In the article “Analysis of a Pulse Rate Variability Measurement Using a Smartphone Camera,” A. Bánhalmi et al. approach the problem of using off-the-shelf technology (e.g., smartphones) to gather biometric data efficiently and reliably. More specifically, the authors analyse the possibility of using a smartphone camera to measure the pulse rate variability of patients. Their experiments show that photoplethysmography has high accuracy and does not differ more from ECG than ECG channels themselves. This study opens the door to simplified remote monitoring of the heart function.In a related topic, haemovigilance is attracting attention. It is the set of surveillance procedures covering the entire blood transfusion chain, from the donation and processing of blood and its components, through to their provision and transfusion to patients, and including their follow-up [10]. In the article “The Evolving Role of Information Technology in Haemovigilance Systems,” A. Ramoa et al. study 23 haemovigilance organizations in their use of information systems. They find an increasing number of these organizations choosing web-based solutions to take care of haemovigilance. There are still some nonelectronic notification systems, but they lack in data completeness and consistency. The authors support the development of electronic haemovigilance systems and conclude that national haemovigilance systems could benefit from international guidelines for their implementation and maintenance.There are a number of approaches to develop functionalities for medical decision support systems, which involve some extra efforts from users, thus limiting the spread of such systems in practice. V. L. Malykh and S. V. Rudetskiy provide a review of general approaches to decision support systems development based on nonreduced big clinical data in their article “Approaches to Medical Decision-Making Based on Big Clinical Data.” The article discusses different approaches to building a medical decision support system based on big data. The authors sought to abstain from any data reduction and apply universal teaching and big data processing methods independent of disease classification standards. The paper assesses and compares the accuracy of recommendations among three options: case-based reasoning, simple single-layer neural network, and probabilistic neural network. Further, the paper substantiates the assumption regarding the most efficient approach to solving the specified problem.In a similar research line, knowledge-based systems can notably improve the management of distributed eHealth systems, where communication and understanding between medical professionals and different tasks become essential. Usually, medical texts are full of references to medical entities, which could be utilized by knowledge-based medical decision support systems. However, the diverse and ambiguous nature of linguistic ME forms are challenging and hinder automatic medical entities recognition and linking, hence requiring tedious work to annotate data and define features. Xu et al. propose an unsupervised framework for recognizing and linking medical entities mentioned in Chinese online medical texts. Their solution is the first complete unsupervised solution for Chinese medical text with both medical entity recognition and linking, which has considerable value in many applications such as medical knowledge-based construction and expansion, semantic comprehension of medical text, and medical Q&A systems.Interacting with healthcare systems and applications is an emerging topic that deserves special attention when dealing with disabled people. The article “Projection mapping user interface for disabled people” by J. Gelšvartas et al. seeks to help improve user interfaces for people with motoric or speech disabilities through projection mapping. This technique makes possible to create a natural augmented reality information presentation environment. The authors provide a detailed description of a camera-projector system calibration procedure. The described system performs tabletop object detection and automatic projection mapping. The proposed system was tested with real users and, overall, the interface was evaluated positively by the system users, which in most cases were able to learn how to use the system very quickly. The article clearly opens ways for new ideas to produce support systems for motoric or speech disabled people.Last but not least, the constant aging of the population raises a new set of problems for eHealth systems. In coming years, age-related and degenerative diseases will become the main burden for public health systems. Lauraitis et al. address the problem of identifying Huntington’s disease (HD) at its early stage, so that elder patients could benefit from future medical interventions that may help delaying the progress of the disease. They created a computerized behavioural model, which allows predicting an impaired reaction condition for HD patients. The model is embodied in a mobile application available on smartphones and tablet PCs, which allows predicting the functional capacity level of subjects by performing an on-screen touch-based test, thus providing a low-cost alternative to the currently used HD symptom assessment procedures.The integration of eHealth solutions is far from simple, and it must capture the attention of the healthcare research community for the next years. The adoption of new mobile and context-aware technologies will multiply the benefits for patients and doctors but, at the same time, it will increase the complexity of the eHealth systems and it will be associated to major challenges. In this special issue, we have gathered some relevant examples of research studies that have put their efforts towards this direction. Notwithstanding, there is a lot of unused potential in information systems to support eHealth and its mHealth and sHealth derivations.It has become clear that technology is not the limiting factor for future progress in healthcare. On the contrary, the main limitations come from the lack of innovativeness of ICT use and the lack of incentives from users and communities to adopt new technology-based solutions for the integrated healthcare. We hope that these limitations will be solved in the next years and that the articles collected in this special issue will contribute with their grain of sand to the overall improvement of healthcare systems worldwide.</p

The relation between oral hygiene skills and the prevalence of dental caries among 4 -6-year-old children

SUMMARY Aim of the study. To evaluate the tooth brushing skills and the prevalence of dental caries as well as its intensity in relation to oral hygiene skills among 4 -6-year-old children. Material and methods. The cross-sectional study was performed from November 16, 2009 to January 12, 2010. 235 children (4 -6-year old) were randomly selected from kindergartens in Plungė and Jonava in Lithuania. The results of study were registered in the special forms prepared in accordance with the recommendations of WHO. Parents of the children were asked to ll in the questionnaires. Results. The results of the study show that 91% (Plungė) and 90% (Jonava) of 4 -6-year-old children have caries in their primary teeth. The prevalence of caries is different in relation to age: 78.7% of 4-year-old children, 97.3% of 5-year-old children, and 95.3% of 6-year-old children. The intensity of caries is as follows: 4.9 (SN=±4.9), 7.5 (SN=±4.5), and 8.2 (SN=±4.7). Conclusions. There is the high prevalence of caries, particularly of not treated forms, among 4 -6-year-old children. The oral hygiene index is just satisfactory

The factors associated to psychosocial stress among general practitioners in Lithuania. Cross-sectional study

BACKGROUND: There are number of studies showing that general practice is one of the most stressful workplace among health care workers. Since Baltic States regained independence in 1990, the reform of the health care system took place in which new role and more responsibilities were allocated to general practitioners' in Lithuania. This study aimed to explore the psychosocial stress level among Lithuanian general practitioner's and examine the relationship between psychosocial stress and work characteristics. METHODS: The cross-sectional study of 300 Lithuanian General practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the R. Karasek scale. The analysis included descriptive statistics; interrelationship analysis between characteristics and multivariate logistic regression to estimate odds ratios for each of the independent variables in the model. RESULTS: Response rate 66% (N = 197). Our study highlighted highest prevalence of psychosocial stress among widowed, single and female general practitioners. Lowest prevalence of psychosocial stress was among males and older age general practitioners. Psychosocial stress occurs when job demands are high and job decision latitude is low (χ(2 )= 18,9; p < 0,01). The multivariate analysis shows that high job demands (OR 4,128; CI 2,102–8,104; p < 0,001), patient load more than 18 patients per day (OR 5,863; CI 1,549–22,188; p < 0,01) and young age of GP's (OR 6,874; CI 1,292–36,582; p < 0,05) can be assigned as significant predictors for psychosocial stress. CONCLUSION: One half of respondents suffering from work related psychosocial stress. High psychological workload demands combined with low decision latitude has the greatest impact to stress caseness among GP's. High job demands, high patient load and young age of GP's can be assigned as significant predictors of psychosocial stress among GP's

Interaction among general practitioners age and patient load in the prediction of job strain, decision latitude and perception of job demands. A Cross-sectional study

BACKGROUND: It is widely recognized and accepted that job strain adversely impacts the workforce. Individual responses to stressful situations can vary greatly and it has been shown that certain people are more likely to experience high levels of stress in their job than others. Studies highlighted that there can be age differences in job strain perception. METHODS: Cross-sectional postal survey of 300 Lithuanian general practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the Karasek scale. The analysis included descriptive statistics; logistic regression beta coefficients to find out predictors and interactions between characteristics and predictors. RESULTS: Response rate was 66% (N = 197). Logistic regression as significant predictors for job strain assigned – duration of work in primary care; for job demands- age and duration of working in primary care; for decision latitude- age and patient load. The interactions with regard to job strain showed that GP's age and job strain are negatively associated to a low patient load. Lower decision latitude for older GP age is strongly related to higher patient load. Job demands and GP age are slightly positively related at low patient load. CONCLUSIONS: Lithuanian GP's have high patient load and are at risk of stress, they have high job demands and low decision latitude. Older GP's perceive less strain, lower job demands and higher decision latitude in case of low patient load. Young GP's decision latitude has week association to patient load. Regarding to the changes in patient load younger GP's perceive it more sensitively as changes in job demands

Work characteristics and work-related psychosocial stress among general practitioners in Lithuania

Background. There are a number of studies showing that general practice is oneof the most stressful workplaces for health care workers. Since the Baltic States regained independence in 1990, a reform of the health care systems took place in which a new role and more responsibilities were allocated to general practitioners. This study aimed to explore the psychosocial stress level among Lithuanian general practitioners (GPs) and examine the relationship between their psychosocial stress and work characteristics. Methods. A cross-sectional study was madeof 300 Lithuanian general practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the Karasek scale. The analyses included descriptive statistics, interrelationship analysis between the different characteristics, and multivariate logistic regression to estimate odd ratios for each of the independent variables in the model. Results. The study shows that 48% of the respondents could be classified as suffering from work related psychosocial stress by the Reeder scale. The highest job strain prevalence was among widowed, single and female GPs. The lowest job strain prevalence was among males and GPs of older age. Job strain occurs when job demands are high and jobdecision latitude is low. Conclusions. The greatest risk tophysical and mental health from stress occurs to general practitioners facing high psychological workload demands combined with low decision latitude in meeting those demands. High job demands, patient load more than 18 patients per day and young age of general practitioners can predict a statistically significant effect on job strain.ISBN 91-7997-095-8</p

Alkoholio suvartojimas Lietuvoje 1994-1996 metais ekonominiu ir finansiniu aspektu

Tikslas - palyginti alkoholio suvartojimą Lietuvoje 1994-1996 metais su gyventojų disponuojamomis pajamomis. Uždaviniai: * Palyginti alkoholio suvartojimą lietuvoje 1994-1996 metais; * palyginti Lietuvos gyventojų disponuojamas pajamas 1994-1996 metais; * Įvertinti Lietuvos gyventojų disponuojamas pajamas ir alkoholio suvartojimą. Darbo metodika: naudojantis Lietuvos statistikos metraščiais už 1994, 1995 ir 1996 metus palyginti duomenys apie alkoholio suvartojimą 1 namų ūkio nariui per 1 mėn. litais, vidutines disponuojamas Lietuvos gyventojų pajamas 1 namų ūkio nariui per 1 mėn. litais. alkoholinių gėrimų (40%, 1 litras) vidutinę metinę pardavimo kainą, mažmeninę alkoholio prekybos apyvartą, vidutines namų ūkių alkoholinių gėrimų vartojimo išlaidas 1 namų ūkio nariui per 1 mėn. procentais nuo pajamų dydžio. [...]Kauno medicinos universiteta