Prehospital Stroke Care. Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019 and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics (or 49.4% of all paramedics from our stroke care network) were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8–57.6) vs. 28.1% (95% CI 20.1–27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5–90.5) vs. 69.8% (60.0–78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8–77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0–68.0), brain tumors (56.3%, 95% CI 48.5–63.8), and seizures (54.4%, 95% CI 46.7–62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4–11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusions: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving insufficient feedback on suspected stroke patients, even though its usefulness is perceived as paramount.publishersversionPeer reviewe

Ligonių, ilgai gydytų intensyviosios terapijos skyriuje, gyvenimo kokybės pokyčiai ir jų rizikos veiksniai

The doctoral dissertation investigates changes in health-related quality of life for long-term intensive care patients prior to ICU admission and 6 months after ICU discharge, exploring into the causes of impaired quality of life and the relationship between the quality of life and post-ICU mortality. It has already been established that the quality of life decreases after treatment in the intensive care unit. However, factors that have the strongest effect on the quality of life in ICU patients have not been identified. Information on post-ICU quality of life in long-term intensive care patients is particularly scarce. The findings of our research confirmed that long term treatment in the intensive care unit has major implications for the physical domains of health-related quality of life. The findings evidence that severity of illness on the first day in the ICU, number of therapeutic interventions upon ICU discharge and severe critical illness neuromuscular abnormalities are associated with impaired quality of life, while duration of mechanical ventilation is the factor with the strongest effect on reduced quality of life. Likewise, the findings demonstrate that usual systems for identification of severity of illness are not useful for predicting mortality in patients after discharge from the intensive care unit. Yet, identification of pre-ICU physical activity allows predicting post-ICU mortality

Changes in the quality of life in patients with prolonged stay in the intensive care unit and risk factors related to the changes

The doctoral dissertation investigates changes in health-related quality of life for long-term intensive care patients prior to ICU admission and 6 months after ICU discharge, exploring into the causes of impaired quality of life and the relationship between the quality of life and post-ICU mortality. It has already been established that the quality of life decreases after treatment in the intensive care unit. However, factors that have the strongest effect on the quality of life in ICU patients have not been identified. Information on post-ICU quality of life in long-term intensive care patients is particularly scarce. The findings of our research confirmed that long term treatment in the intensive care unit has major implications for the physical domains of health-related quality of life. The findings evidence that severity of illness on the first day in the ICU, number of therapeutic interventions upon ICU discharge and severe critical illness neuromuscular abnormalities are associated with impaired quality of life, while duration of mechanical ventilation is the factor with the strongest effect on reduced quality of life. Likewise, the findings demonstrate that usual systems for identification of severity of illness are not useful for predicting mortality in patients after discharge from the intensive care unit. Yet, identification of pre-ICU physical activity allows predicting post-ICU mortality

The Impact of Medical Conditions on the Quality of Life of Survivors at Discharge From Intensive Care Unit

Background and Objective. Impaired health-related quality of life (HRQOL) is one of the possible outcomes after discharge from an intensive care unit (ICU). Evaluation of patient health status on discharge from the ICU would help identify factors influencing changes in HRQOL after ICU discharge. The objective of the study was to identify whether health state on discharge from prolonged stay in the ICU has any influence on survivors’ HRQOL 6 months after intensive care. Material and Methods. A prospective study of patients with the prolonged length of stay (exceeding 7 days) in the ICU was conducted. The study covered the impact of organ system dysfunction (SOFA score), number of therapeutic interventions (TISS-28 score), and critical illness neuromuscular abnormalities (CINMA) on discharge from the ICU on HRQOL 6 months following ICU discharge. Results. In total, 137 patients were included in the study. The SOFA score on the last day in the ICU was 2.91 (SD, 1.57); the TISS-28 score on the last day in the ICU was 21.79 (SD, 4.53). Decreased physical functioning (PF) and role physical (RP) were identified. Circulatory impairment on discharge from the ICU had an impact on decreased PF (P=0.016), role physical (P=0.066), and role emotional (P=0.001). Patients with dysfunction in more than one organ system on ICU discharge had decreased role emotional (P=0.016). Severe CINMA was diagnosed in 18 patients. They had decreased PF (P=0.007) and RP (P=0.019). Patients with the TISS-28 score above or equal to 20 points showed lower HRQOL in the PF domain (P=0.077) and general health (P=0.038). Conclusions. HRQOL in patients with prolonged stay in the ICU is particularly impaired in the domains of physical functioning and role physical. It is associated with circulatory impairment, CINMA, and greater number of therapeutic interventions on discharge from the ICU

Factors affecting return visits to the emergency department within 30 days

Background and Objectives: The goal of this study is to determine the factors associated with the admission to hospital on a return visit to the ED. The reasons of return visits to the ED are complex and involve such causes as disease progression, medical errors, delayed diagnosis, or misdiagnosis. Materials and methods: A retrospective study was conducted in Vilnius University Hospital Santaros Klinikos. All the emergency visits from 1 January 2018 through 20 May 2019 were included. The patients were divided into two groups: the patients who visited the ED only once within a month were attributed to group 1, while those who paid two or more visits to the ED within 30 days belonged to group 2. The demographic data, the triage category, the number of laboratory and radiology tests, specialist consultations, diagnoses and the time spent in the ED were evaluated. The statistical analysis was performed using R statistical software package, non-parametric statistical methods were used. Results: 32,215 patients were included in the analysis, 3,243 patients (10.05%of all the initial visits) returned to the ED within 30 days. The number of laboratory tests had a statistically significant impact on admission to the ward both the first and the return visits. The triage category was associated with the admission on the return visit to the ED. Age, gender, number of consultations and radiology tests had no medium or large impact. Among the diagnoses, cardiovascular, gastrointestinal and renal diseases were related to the admission on return visit. Conclusions: Patients with cardiovascular, gastrointestinal and renal system diseases in all age groups, patients with medical conditions and advanced investigation (the increased number of laboratory testing and the time spent in the ED) have an increased risk for a return visit over a 30-day time frame and an increased rate of hospital admissions

Assessing the Hydraulic Conductivity of Open Drainage for Surface Water in Road Safety Zones

The relevance of research on removing surface water from the drained areas has increased along with a rising number of drainage systems. A large part of inlets for surface water are installed in the ditches of road safety zones and / or terrain drops in safety zones where flowing surface water accumulates. The practice of constructing and rebuilding roads in Lithuania shows that each new route of the road section most frequently passes through the drained area and redistributes runoff characteristics of that sector. Each subgrade passing through the watercourse of surface water is a local dam for surface runoff. The surface water that has accumulated in road safety zones have to be drained to avoid damage to road structures and from the flood in the drained roadside areas. The article discusses the efficiency of hydro technical measures such as inlets for surface water in the mining area and highlights the specificities of hydraulic calculations when the complete drainage system for surface water Inlet–Water Drainage Line is integrally assessed. The paper also proposes a methodology for the hydraulic calculations of the system Inlet–Water Drainage Line. The article examines the condition of water inlets having the F-5 or PN-42 structure. The findings of the research carried out in 2017 demonstrate that only 15.3% of inlets for surface water were completely clean, 45.2% of the inlets were found fully contaminated and 39.5% of those were partially silted up. Thus, a clear upward trend towards polluting the cross-sectional areas of inlets for surface water with soil and grass root plants and a strong downward trend towards clean cross-sectional areas of inlets for surface water are observed. 22.6% of inlets for surface water were found damaged by farmers using tillage machinery

Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients

Background: As the COVID-19 pandemic continues, the number of patients admitted to the intensive care unit (ICU) is still increasing. The aim of our article is to estimate which of the conventional ICU mortality risk scores is the most accurate at predicting mortality in COVID-19 patients and to determine how these scores can be used in combination with the 4C Mortality Score. Methods: This was a retrospective study of critically ill COVID-19 patients treated in tertiary reference COVID-19 hospitals during the year 2020. The 4C Mortality Score was calculated upon admission to the hospital. The Simplified Acute Physiology Score (SAPS) II, Acute Physiology and Chronic Health Evaluation (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores were calculated upon admission to the ICU. Patients were divided into two groups: ICU survivors and ICU non-survivors. Results: A total of 249 patients were included in the study, of which 63.1% were male. The average age of all patients was 61.32 ± 13.3 years. The all-cause ICU mortality ratio was 41.4% (n = 103). To determine the accuracy of the ICU mortality risk scores a ROC-AUC analysis was performed. The most accurate scale was the APACHE II, with an AUC value of 0.772 (95% CI 0.714–0.830; p < 0.001). All of the ICU risk scores and 4C Mortality Score were significant mortality predictors in the univariate regression analysis. The multivariate regression analysis was completed to elucidate which of the scores can be used in combination with the independent predictive value. In the final model, the APACHE II and 4C Mortality Score prevailed. For each point increase in the APACHE II, mortality risk increased by 1.155 (OR 1.155, 95% CI 1.085–1.229; p < 0.001), and for each point increase in the 4C Mortality Score, mortality risk increased by 1.191 (OR 1.191, 95% CI 1.086–1.306; p < 0.001), demonstrating the best overall calibration of the model. Conclusions: The study demonstrated that the APACHE II had the best discrimination of mortality in ICU patients. Both the APACHE II and 4C Mortality Score independently predict mortality risk and can be used concomitantly