Burnout syndrome among healthcare workers employed in intensive care units: Experiences from three large university hospitals in the Southeast Balkans: Burnout syndrome among healthcare workers of intensive care units in the Southeast Balkans

Summary Introduction: Burnout syndrome at work is a response to chronic emotional and interpersonal stressors associated with the workplace, and occurs in workers without previous psychopathological illnesses or organic diseases. Aim: The aim of the research was to examine the prevalence of stress and burnout syndrome, among physicians and nurses working in the intensive care units (MICU) of 3 regional centers (Banja Luka, Novi Sad and Ljubljana), and to determine the differences between the centers and the causes of these differences. Methods: It is a cross-sectional study conducted during August and September 2020 (at the peak of the COVID-19 pandemic) by surveying healthcare workers (doctors and nurses/technicians) from three intensive care units of the former Yugoslavia. The participantsfulfilled the Questionnaire for self-assessment of stress levels and the Maslach burnout inventory, which were supplemented with sociodemographic parameters. The obtained data were statistically processed using the SPSS 21 program. Results: 91 participantsfrom all 3 regional centers were included in th study. A statistically significant difference was found in terms of age, degree of professional education, length of service, gender, marital and parental status, where respondents from Ljubljana show the greatest deviations comparedto subjects from the other two centers. The sociodemographic characteristics of the respondents only showed that gender had a statistically significant influence on the degree of personal achievement. Conclusion: The attributes of healthcare professionals who work in MICUs with the same level of life support (level III) may be influenced by the development level and length of tradition of intensive care units. Additionally, factors such as legislation and other external and internal elements unique to each organizational unit can also play a role

Population Pharmacokinetic Model of Linezolid and Probability of Target Attainment in Patients with COVID-19-Associated Acute Respiratory Distress Syndrome on Veno-Venous Extracorporeal Membrane Oxygenation—A Step toward Correct Dosing

During veno-venous extracorporeal membrane oxygenation (vv ECMO) therapy, antimicrobial drugs are frequently used, and appropriate dosing is challenging due to there being limited data to support the dosage. Linezolid is effective against multidrug-resistant Gram-positive pathogens frequently isolated in ECMO patients. In total, 53 steady-state linezolid levels were obtained following 600 mg intravenous (IV) injections every 8 h, and these were used to develop a population pharmacokinetic (PopPK) model in patients with COVID-19-associated acute respiratory distress syndrome (CARDS) on vv ECMO. The data were analyzed using a nonlinear mixed-effects modelling approach. Monte Carlo simulation generated 5000 patients’ individual PK parameters and corresponding concentration–time profiles using the PopPK model, following the administration of 600 mg/8 h (a higher-than-standard dosing) and 600 mg/12 h (standard). The probabilities of pharmacokinetic/pharmacodynamic (PK/PD) target attainment (PTA) and the cumulative fraction of responses (CFR) for three pathogens were calculated and compared between the two dosing scenarios. Linezolid 600 mg/8 h was predicted to achieve greater than or equal to 85%Tf>MIC in at least 90% of the patients with CARDS on vv ECMO compared to only approximately two thirds of the patients after dosing every 12 h at a minimal inhibitory concentration (MIC) of 2 mg/L. In addition, for the same MIC, fAUC24/MIC ≥ 80 was achieved in almost three times the number of patients following an 8-h versus a 12-h interval. PopPK simulation predicted that a significantly higher proportion of the patients with CARDS on vv ECMO would achieve the PK/PD targets following the 8-h dosing interval compared to standard linezolid dosing. Nevertheless, the safety concern, in particular, for thrombocytopenia, with higher-than-standard linezolid dosage is reasonable, and consequently, monitoring is essential

Video consultation in a medical intensive care unit based on CERTAIN platform- a pilot study

Uvod: Razvoj intenzivne medicine u zemljama u razvoju ograničen je nedostatkom učinkovite globalne infrastrukture koja podupire obrazovni proces liječnika i drugog medicinskog osoblja. Načela suvremene telemedicine mogu poslužiti kao alat za podizanje kvalitete liječenja, ali i kao "tehnika e-učenja ili drugog stručnog mišljenja". Cilj: Ispitati učinke jednogodišnje primjene telekonzultacija u jedinicama intenzivnog liječenja prema unaprijed određenim pokazateljima djelotvornosti i učinkovitosti. Materijal i metode: Ovo je studija presjeka koja prati smrtnost, dužinu hospitalizacije, brzinu stjecanja novih znanja, ekonomski aspekt i zadovoljstvo korisnika godinu dana prije i godinu dana nakon uvođenja teleedukacije na temelju CERTAIN platforme koju su razvili stručnjaci iz Klinike Mayo. Podaci su obrađeni deskriptivnom statističkom metodom i primjenom statističkih zaključaka te su prikazani tablično i grafički. Rezultati: Rezultati pokazuju smanjenje smrtnosti, skraćivanje prosječne dužine hospitalizacije, visoku razinu zadovoljstva korisnika, brzo usvajanje novih znanja i značajne ekonomske koristi. Zaključak: Telekonzultacije u jedinicama za intenzivno liječenje temeljene na prilagodbi postojećih resursa (posebno u zemljama u tranziciji) mogu poslužiti kao dobar model za poboljšanje liječenja kritično oboljelih bolesnika i za obrazovanje zdravstvenih djelatnika.Introduction: The development of intensive care medicine in developing countries is limited by the lack of effective global infrastructure that supports the educational process of doctors and other medical personnel. The principles of modern telemedicine can serve as a tool for raising the quality of treatment but also as an "e-learning technique or expert second opinion". Objective: To examine the effects of a one-year application of teleconsultations in the ICU on predefined indicators of effectiveness and efficiency. Material and Methods: This is a cross section study that monitors mortality, length of hospitalization, the speed of new knowledge aquisition, the economic aspect and user satisfaction a year before and a year after the introduction of tele-education based on CERTAIN platform developed by the experts from Mayo Clinic. The data was processed by a descriptive statistical method and application of statistical conclusions, and is tabulated and graphically presented. Results: The results showed a decrease in mortality, a shortening of the average length of hospitalization, a high level of user satisfaction, rapid adoption of new knowledge, and significant economic benefits. Conclusion: Teleconsultation mode in intensive units based on the adaptation of existing resources (especially for countries in transition) can serve as a good model for improving the treatment of critically ill patients and for educating health workers

The Effect of Hypoalbuminemia on the Therapeutic Concentration and Dosage of Vancomycin in Critically Ill Septic Patients in Low-Resource Countries

Purpose: To determine whether severe hypoalbuminemia ( lt 25 mg/L) has a significant effect on serum levels of vancomycin and whether it can effect vancomycin dosage regimen and the loading dose administration. Material and Methods: Prospective, cohort, and a single-center study included 61 patients whose vancomycin serum levels were measured in steady state. Vancomycin trough levels (C-min) that were in the range 15 to 20 mu g/mL were considered therapeutic and trough levels higher than 15 mu g/mL were considered potentially nephrotoxic. Results: In the group of patients with severe hypoalbuminemia, C-min was significantly higher compared to the those with nonsevere hypoalbuminemia (>25 mg/L; 23.04 [19.14] vs 13.28 [11.28], P = .01). In the group of patients who received the vancomycin loading dose of 2 g, C-min was significantly higher in patients with severe hypoalbuminemia compared to the patients with nonsevere hypoalbuminemia (34.52 [25.93] vs 15.37 [10.48], P = .04). Conclusion: In critically ill septic patients with severe hypoalbuminemia, there is a high probability that the loading dose of vancomycin is not necessary since it is associated with potentially toxic vancomycin C-min, while in the patients with nonsevere hypoalbuminemia the loading dose may be necessary to achieving therapeutic C-min

Advances in formal Slavic linguistics 2016

Advances in Formal Slavic Linguistics 2016 initiates a new series of collective volumes on formal Slavic linguistics. It presents a selection of high quality papers authored by young and senior linguists from around the world and contains both empirically oriented work, underpinned by up-to-date experimental methods, as well as more theoretically grounded contributions. The volume covers all major linguistic areas, including morphosyntax, semantics, pragmatics, phonology, and their mutual interfaces. The particular topics discussed include argument structure, word order, case, agreement, tense, aspect, clausal left periphery, or segmental phonology. The topical breadth and analytical depth of the contributions reflect the vitality of the field of formal Slavic linguistics and prove its relevance to the global linguistic endeavour. Early versions of the papers included in this volume were presented at the conference on Formal Description of Slavic Languages 12 or at the satellite Workshop on Formal and Experimental Semantics and Pragmatics, which were held on December 7-10, 2016 in Berlin

Advances in formal Slavic linguistics 2016

Advances in Formal Slavic Linguistics 2016 initiates a new series of collective volumes on formal Slavic linguistics. It presents a selection of high quality papers authored by young and senior linguists from around the world and contains both empirically oriented work, underpinned by up-to-date experimental methods, as well as more theoretically grounded contributions. The volume covers all major linguistic areas, including morphosyntax, semantics, pragmatics, phonology, and their mutual interfaces. The particular topics discussed include argument structure, word order, case, agreement, tense, aspect, clausal left periphery, or segmental phonology. The topical breadth and analytical depth of the contributions reflect the vitality of the field of formal Slavic linguistics and prove its relevance to the global linguistic endeavour. Early versions of the papers included in this volume were presented at the conference on Formal Description of Slavic Languages 12 or at the satellite Workshop on Formal and Experimental Semantics and Pragmatics, which were held on December 7-10, 2016 in Berlin

Advances in formal Slavic linguistics 2016

Advances in Formal Slavic Linguistics 2016 initiates a new series of collective volumes on formal Slavic linguistics. It presents a selection of high quality papers authored by young and senior linguists from around the world and contains both empirically oriented work, underpinned by up-to-date experimental methods, as well as more theoretically grounded contributions. The volume covers all major linguistic areas, including morphosyntax, semantics, pragmatics, phonology, and their mutual interfaces. The particular topics discussed include argument structure, word order, case, agreement, tense, aspect, clausal left periphery, or segmental phonology. The topical breadth and analytical depth of the contributions reflect the vitality of the field of formal Slavic linguistics and prove its relevance to the global linguistic endeavour. Early versions of the papers included in this volume were presented at the conference on Formal Description of Slavic Languages 12 or at the satellite Workshop on Formal and Experimental Semantics and Pragmatics, which were held on December 7-10, 2016 in Berlin

Advances in formal Slavic linguistics 2016

Advances in Formal Slavic Linguistics 2016 initiates a new series of collective volumes on formal Slavic linguistics. It presents a selection of high quality papers authored by young and senior linguists from around the world and contains both empirically oriented work, underpinned by up-to-date experimental methods, as well as more theoretically grounded contributions. The volume covers all major linguistic areas, including morphosyntax, semantics, pragmatics, phonology, and their mutual interfaces. The particular topics discussed include argument structure, word order, case, agreement, tense, aspect, clausal left periphery, or segmental phonology. The topical breadth and analytical depth of the contributions reflect the vitality of the field of formal Slavic linguistics and prove its relevance to the global linguistic endeavour. Early versions of the papers included in this volume were presented at the conference on Formal Description of Slavic Languages 12 or at the satellite Workshop on Formal and Experimental Semantics and Pragmatics, which were held on December 7-10, 2016 in Berlin

Advances in formal Slavic linguistics 2016

Advances in Formal Slavic Linguistics 2016 initiates a new series of collective volumes on formal Slavic linguistics. It presents a selection of high quality papers authored by young and senior linguists from around the world and contains both empirically oriented work, underpinned by up-to-date experimental methods, as well as more theoretically grounded contributions. The volume covers all major linguistic areas, including morphosyntax, semantics, pragmatics, phonology, and their mutual interfaces. The particular topics discussed include argument structure, word order, case, agreement, tense, aspect, clausal left periphery, or segmental phonology. The topical breadth and analytical depth of the contributions reflect the vitality of the field of formal Slavic linguistics and prove its relevance to the global linguistic endeavour. Early versions of the papers included in this volume were presented at the conference on Formal Description of Slavic Languages 12 or at the satellite Workshop on Formal and Experimental Semantics and Pragmatics, which were held on December 7-10, 2016 in Berlin