Zbrinjavanje otežanog dišnog puta

Management of difficult airway is one of the most challenging tasks for anesthesiologists, and failure of securing it could have fatal consequences. We must be prepared to deal with problems in management of difficult airway at any time. Difficult intubation can either be anticipated or unanticipated. An anesthesiologist must be aware of the possibility of both situations to arise and preparations must be taken to deal with such cases and improve the safety of our patients. Practice guidelines are systematically developed recommendations that help anesthesiologists in the management of difficult airway.Zbrinjavanje otežanog dišnog puta je jedan od najzahtjevnijih postupaka u anesteziologiji i neuspjeh pri tome može imati fatalne posljedice. Anesteziolog mora u svakom trenutku biti pripremljen za ovaj postupak. Teška intubacija može biti očekivana i neočekivana. Posjedovanje posebnih znanja i vještina u zbrinjavanju navedenih situacija je ključni čimbenik za sigurnost bolesnika. Na temelju iskustava i preporuka su nastale smjernice koje pomažu anesteziologu u zbrinjavanju otežanog dišnog puta

Edukacija temeljena na simulacijama regionalne anestezije

Simulation-based training is a technique, which uses technological devices to reproduce different clinical situations like in the real world. Procedures and simulation scenarios performed on simulators can be planned and repeated with no harm for the patient. Simulation-based training introduced new educational applications in medicine to improve patient safety. Simulation education was introduced in the anesthesia curriculum in 2017 as a first specialization in Slovenia.Simulacijska edukacija je tehnika koja koristi tehnološku opremu da ustvari različite kliničke situacije kao u stvarnim kliničnim uvjetima. Zahvati i različiti scenariji izvedeni na simulatorima se mogu planirati i ponavljati bez opasnosti za pacijenta. Simulacijsko učenje uvodi nove edukacijske metode u medicinu kako bi se unaprijedila sigurnost u tretmanu pacijenata. U slovenski kurikulum specijalizacije iz Anesteziologije,reanimatologije i perioperativne intenzivne medicine je simulacijsko učenje uvedeno godine 2017 kao prvo u Sloveniji

ANTIPSYCHOTICS SIDE EFFECTS\u27 INFLUENCE ON STIGMA OF MENTAL ILLNESS: FOCUS GROUP STUDY RESULTS

Background: Little research was done on the influence of antipsychotics’ side effects on stigma of mental illness. An overview of studies shows that people with mental illness state that because of medication side effects they feel discriminated in the field of employment, observe worsening of family relations and tend to skip or discontinue their regular medication. It is difficult to discriminate between stigmatizing effects of antipsychotics and other stigma related factors such as illness symptoms. Subjects and methods: A focus group of ten patients with schizophrenia or schizoaffective disorder with severe and remitting mental illness treated with antipsychotic medication was conducted to obtain their personal views on how side effects of antipsychotic drugs affect their everyday lives and contribute to the stigmatization because of mental illness. Results: The patients felt most stigmatized in areas of employment and occupation. They repeatedly skipped or discontinued regular medication due to side effects. Their families supported them throughout treatment and recovery despite problems associated with psychotropic medication. Conclusion: Medication induced stigma affects patients’ lives in substantial ways and therefore merits further research, part of which is the patients’ personal experience

ANTIPSYCHOTICS SIDE EFFECTS\u27 INFLUENCE ON STIGMA OF MENTAL ILLNESS: FOCUS GROUP STUDY RESULTS

Background: Little research was done on the influence of antipsychotics’ side effects on stigma of mental illness. An overview of studies shows that people with mental illness state that because of medication side effects they feel discriminated in the field of employment, observe worsening of family relations and tend to skip or discontinue their regular medication. It is difficult to discriminate between stigmatizing effects of antipsychotics and other stigma related factors such as illness symptoms. Subjects and methods: A focus group of ten patients with schizophrenia or schizoaffective disorder with severe and remitting mental illness treated with antipsychotic medication was conducted to obtain their personal views on how side effects of antipsychotic drugs affect their everyday lives and contribute to the stigmatization because of mental illness. Results: The patients felt most stigmatized in areas of employment and occupation. They repeatedly skipped or discontinued regular medication due to side effects. Their families supported them throughout treatment and recovery despite problems associated with psychotropic medication. Conclusion: Medication induced stigma affects patients’ lives in substantial ways and therefore merits further research, part of which is the patients’ personal experience

Transverse myelitis following general and thoracic epidural anaesthesia

Acute bacterial transverse myelitis, secondary to an epidural catheter, developed in a 49-year-old man who underwent surgery for carcinoma of the left lung. Left pneumonectomy was performed under combined general and epidural (Th6-7) anesthesia. The operative procedure, anaesthesia and early postoperative course were uneventful. On the fifth postoperative day, the patient developed neurological deficits consistent with high-level paraplegia. Elevated inflammatory parameters along with the results of cerebrospinal fluid analysis and magnetic resonance imaging were suggestive of acute transverse bacterial myelitis of the dorsal part of the spinal cord secondary to epidural analgesia. Despite prompt antibiotic therapy, anti-oedema treatment and rehabilitation, the neurological deficit failed to resolve

Regionalna anestezija u torakalnoj i abdominalnoj kirurgiji

Surgical procedure causes tissue damage which activates systemic inflammatory response and leads to changes in endocrine and metabolic system. Anaesthesia and pain can further disrupt immune performance. Regional anaesthesia causes afferent nerve blockade and in this way mediates immune protection. Thoracic epidural analgesia is the cornerstone of pain relief in thoracic and abdominal surgery. Alternatively thoracic paravertebral block can be used with less side effects and good analgesic properties. Drugs that interfere with blood coagulation obstruct the use of central regional blocks. Surgery has also changed recently from open to minimally invasive. Also pain treatment for this procedures has changed to less aggressive, systemic or locoregional techniques. It was shown that transversus abdominis plane block and epidural analgesia have the same effect on postoperative pain, but transversus abdominis plane block was better regarding hemodynamic stability and hospital stay. Multimodal approach combining regional and systemic analgesia is currently the most appropriate perioperative pain management strategy. More studies should be done to give recommendations.Kirurški zahvat uzrokuje tkivno oštećenje koje aktivira sistemski upalni odgovor i dovodi do promijena u endokrinom i metaboličkom sustavu pacijenta. Anestezija i bolovi mogu još dodatno utjecati na imunološki sustav. Regionalna anestezija uzrokuje aferentnu blokadu živaca i time dovodi do zaštite imunološkoga sustava. Torakalna epiduralna analgezija je zlatni standard za liječenje bolova u torakoabdominalnoj kirurgiji. Alternativna tehnika je torakalni paravertebralni blok koji ima manje nuspojava i dobar analgetski učinak. Antikoagulantni lijekovi ograničavaju upotrebu centralnih živčanih blokova. Kirurške se tehnike mijenjaju u smjeru minimalno invazivnih kirurških tehnika. Isto tako tehnike liječenja bolova se mijenjaju prema upotrebi manje agresivnih sistemskih i lokoregionalnih tehnika. Studije su pokazale da su “transversus abdominis block” (TAP) i epiduralna analgezija jednako učinkoviti u liječenju postoperativnih bolova, s tim da se kod TAP blokova puno rjeđe pojavljuje pad krvnoga tlaka i da je vrijeme hospitalizacije kraće. Multimodalni pristup s kombinacijom regionalne i sistemske analgezije je trenutno najbolja tehnika za liječenje perioperativnih bolova. Potrebna su dodatna istraživanja da bi se izradile smjernice

Percepcija študentov glede kadrovskih kompetenc

Background and purpose: Human resource professionalism receives considerable attention in terms of the competence of individual. In this article, we want to bridge the existing competencies of students and the perceived competencies that they assume will be developed and obtained during their studies. The purpose of our paper is a) to present competencies in general, b) to determine the meaning of the development of competencies in the field of higher education, and c) to present the role of competencies in human resource management. The aim of this paper is to examine the human resource competencies among students, and their judgments regarding the competencies they have already received during their studies. Methodology: The questionnaire was distributed to full-time students of the Faculty of Organizational Science, University of Maribor, in such a way that both genders, both undergraduate and graduate studies, and all years of study were represented. We have measured students’ opinions concerning their current and future perceptions about professional competencies in the HR field. Results: Based on the self-assessment of fifteen HR competencies, we used hierarchical clustering performed with Ward\u27s method and standardized variables and got two clusters. A t-test was used according to low or high levels of students’ current competencies. The positive association between satisfaction with study programme and student\u27s opinion on development of competencies during their studies was confirmed with one-tailed Pearson correlation coefficient. Conclusion: The majority of students believe that they possess significant HR competencies. They have expressed a need for further education and training in that field. The students have assessed that the study programme allows them to acquire and develop the competencies for a successful task performance of the HR professional.Namen: Kadrovska stroka pripisuje visoko pomembnost kompetencam posameznika. V prispevku želimo povezati obstoječe kompetence študentov in kompetence, ki jih bodo po pričakovanjih pridobili in razvijali tekom študija. Namen prispevka je: a) predstaviti kompetence v splošnem, b) določiti pomen razvoja kompetenc na področju visokega šolstva in c) osvetliti vlogo kompetenc na kadrovskem področju. Cilj članka je raziskati kadrovske kompetence med študenti in ugotoviti njihovo mnenje o kompetencah, ki so jih že razvili tekom študija. Metodologija: Anketni vprašalnik smo razdelili rednim študentov Fakultete za organizacijske vede, Univerze v Mariboru. V raziskavo smo zajeli oba spola, visokošolski in univerzitetni študijski program ter vse letnike študija. Merili smo percepcijo študentov glede kadrovskih kompetenc. Rezultati: Na podlagi samoocen petnajstih kompetenc s kadrovskega področja smo izvedli razvrščanje v skupine z Ward-ovo metodo in standardiziranimi spremenljivkami in dobili dve skupini. Nato smo uporabili t-test s skupinama glede na nizko oziroma visoko stopnjo razvitih kompetenc. Potrdili smo pozitivno povezanost med zadovoljstvom s študijskim programom in mnenjem študentov o razvoju kompetenc med študijem, kar smo preučili z enostranskim Pearsonovim korelacijskim koe­ficientom. Zaključek: Večina študentov meni, da imajo kadrovske kompetence prisotne v večji meri. Izrazili so potrebo po dodatnem izobraževanju in usposabljanju na področju kadrovskih kompetenc. Študenti so ocenili, da program študija omogoča, da bodo pridobili oz. razvili kompetence za uspešno opravljanje nalog kadrovskega strokovnjaka

Otežani dišni put i ventilacija jednog pluća

The number of indications for lung collapse during different procedures is rising. Difficult upper airway is more often encountered with the need for single lung ventilation. In patients with difficult airway, the safest approach is by placing a single-lumen endotracheal tube with the aid of a flexible fiberoptic bronchoscope. Lung isolation in these patients is then achieved by means of a bronchial blocker. An alternative technique is exchanging the single-lumen for a double-lumen tube using an airway exchange catheter. When there is a tracheostomy in place, an independent bronchial blocker is recommended.Broj indikacija za kolaps pluća tijekom različitih kirurških postupaka je u porastu. Otežani gornji dišni put je češće povezan s potrebom ventilacije jednog pluća. U bolesnika s otežanim dišnim putom najsigurniji pristup zbrinjavanja dišnog puta je postavljanje jednolumenskog endotrahealnog tubusa pomoću fleksibilnog fiberoptičkog bronhoskopa. Izolacija jednog plućnog krila se u tim slučajevima postiže postavljanjem bronhijalnog blokatora. Alternativna tehnika je izmjena jednolumenskog u dvolumenski endotrahealni tubus pomoću specijalnog katetera, tzv. “izmjenjivača”. Kada je prisutna traheostoma preporuča se postavljanje neovisnog bronhijalnog blokatora