Femoral neck fractures in Lithuania and Sweden. The differences in care and outcome

Hip fractures constitute a serious and common health problem from both individual and public health perspectives. Unified data collection and comparison between countries is recognised as an effective tool for care improvements. However, the variation in patients' demography, treatment methods and other local cultural aspects in different countries should be considered. The aim of our study was to compare femoral neck fracture patients treated in Kaunas and Lund, concerning functional outcome and quality of life. We investigated 99 patients treated by arthroplasty in Kaunas Clinics and 117 patients in Lund University Hospital. Patients were investigated according to the National Swedish Hip Fracture Register model and were followed up for a period of four months after the injury. The patient's place of residence, mobility, complaints of pain and additional hospital stay were recorded. The EQ-5D questionnaire was used to evaluate quality of life. Patients in Kaunas were significantly younger, had lower ASA grade and were more mobile before trauma and at four moths follow-up. However, when comparing quality of life at four months follow-up between the institutions, Lund patients reported significantly better self care, felt less pain and discomfort, and had less symptoms of anxiety and depression. The difference observed in quality of life rating between institutions might be related to local cultures of the countries and should be considered when comparing the data

A comparison of outcomes and dislocation rates using dual articulation cups and THA for intracapsular femoral neck fractures.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageTotal hip arthroplasty for intracapsular femoral neck fractures (FNF) is associated with a greater risk of dislocation. Dual articulation systems in this group of patients may provide better implant stability and a reduced dislocation rate. The aim of our study was to investigate FNF patients treated with dual articulation cups (DAC) and conventional THA and compare their clinical results at four months and one year after surgery. Our study compared femoral neck fracture patients treated with either DAC or conventional THA during two different time periods. Before surgery and during follow-up, the patients answered questions regarding their mobility, pain and usage of walking aids. Additionally at four-month and one-year follow-ups EQ-5D and HOOS questionnaires were applied for those patients qualifying for functional and quality of life analysis. Out of 125 femoral neck fracture patients 58 were treated with DAC and 67 with conventional THA. At four months and one year follow-up the HOOS and EQ-5D results did not differ significantly between DAC and conventional THA. Five hips in the THA group were revised for recurrent dislocation and two had a single dislocation. One year after surgery, the functional result of DAC and conventional THA are comparable but DAC have a lower risk of dislocation.Lunds sjukvardsdistrikt/Region Skane Swedish Research Council/73X-09509 Swedish National Board of Health and Welfare Medical Faculty, University of Lund, Swede

Effects of weather conditions on emergency ambulance calls for acute coronary syndromes

Online ISSN 1432-1254The aim of this study was to evaluate the relationship between weather conditions and daily emergency ambulance calls for acute coronary syndromes (ACS). The study included data on 3631 patients who called the ambulance for chest pain and were admitted to the department of cardiology as patients with ACS. We investigated the effect of daily air temperature (T), barometric pressure (BP), relative humidity, and wind speed (WS) to detect the risk areas for low and high daily volume (DV) of emergency calls. We used the classification and regression tree method as well as cluster analysis. The clusters were created by applying the k-means cluster algorithm using the standardized daily weather variables. The analysis was performed separately during cold (October–April) and warm (May–September) seasons. During the cold period, the greatest DV was observed on days of low T during the 3-day sequence, on cold and windy days, and on days of low BP and high WS during the 3-day sequence; low DV was associated with high BP and decreased WS on the previous day. During June–September, a lower DV was associated with low BP, windless days, and high BP and low WS during the 3-day sequence. During the warm period, the greatest DV was associated with increased BP and changing WS during the 3-day sequence. These results suggest that daily T, BP, and WS on the day of the ambulance call and on the two previous days may be prognostic variables for the risk of ACSAplinkotyros katedraLietuvos sveikatos mokslų universitetasLietuvos sveikatos mokslų universitetas. Medicinos akademijaVytauto Didžiojo universiteta

Effects of Weather and Heliophysical Conditions on Emergency Ambulance Calls for Elevated Arterial Blood Pressure

We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009–2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs), in which the conditions for the emergency calls were made coded I.10–I.15. The Kaunas Weather Station provided daily records of air temperature (T), wind speed (WS), relative humidity, and barometric pressure (BP). We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS > 600 km/s) increased the daily number of elevated arterial blood pressure (EABP) by 12% (RR = 1.12; 95% confidence interval (CI) 1.04–1.21); and WS ≥ 3.5 knots during days of T < 1.5 °C and T ≥ 12.5 °C by 8% (RR = 1.08; CI 1.04–1.12). An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T ≥ 17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population’s sensitivity to different weather conditions

Effects of weather and heliophysical conditions on emergency ambulance calls for elevated arterial blood pressure

We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009–2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs), in which the conditions for the emergency calls were made coded I.10–I.15. The Kaunas Weather Station provided daily records of air temperature (T), wind speed (WS), relative humidity, and barometric pressure (BP). We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS > 600 km/s) increased the daily number of elevated arterial blood pressure (EABP) by 12% (RR = 1.12; 95% confidence interval (CI) 1.04–1.21); and WS ≥ 3.5 knots during days of T < 1.5 °C and T ≥ 12.5 °C by 8% (RR = 1.08; CI 1.04–1.12). An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T ≥ 17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population’s sensitivity to different weather conditionsAplinkotyros katedraKauno miesto greitosios medicinos pagalbos stotisLietuvos sveikatos mokslų universitetasVytauto Didžiojo universiteta

Short- and long-term survival after out-of-hospital cardiac arrest in Kaunas (Lithuania) from 2016 to 2018

Abstract Background No studies analysing out-of-hospital cardiac arrest (OHCA) epidemiology and outcomes in Lithuania were published in the last decade. Methods We conducted a retrospective analysis of prospectively collected data. The incidence of OHCA and the demographics and outcomes of patients who were treated for OHCA between 1 and 2016 and 31 December 2018 at Kaunas Emergency Medical Service (EMS) were collected and are reported in accordance with the Utstein recommendations. Multivariable logistic regression analysis was used to identify predictors of survival to hospital discharge. Results In total, 838 OHCA cases of EMS-treated cardiac arrest (CA) were reported (95.8 per 100.000 inhabitants). The median age was 71 (IQR 58–81) years of age, and 66.7% of patients were males. A total of 73.8% of OHCA cases occurred at home, 59.3% were witnessed by a bystander, and 54.5% received bystander cardiopulmonary resuscitation. The median EMS response time was 10 min. Cardiac aetiology was the leading cause of CA (78.8%). The initial rhythm was shockable in 27.6% of all cases. Return of spontaneous circulation at hospital transfer was evident in 24.9% of all cases. The survival to hospital discharge rate was 10.9%, and the 1-year survival rate was 6.9%. The survival to hospital discharge rate in the Utstein comparator group was 36.1%, and the 1-year survival rate was 27.2%. Five factors were associated with improved survival to hospital discharge: shockable rhythm, time from call to arrival at the patient less than 10 min, witnessed OHCA, age < 80 years, and male sex. Conclusion This is the first OHCA study from Lithuania examining OHCA epidemiology and outcomes over a three year period. Routine OHCA data collection and analysis will allow us to track the efficacy of service improvements and should become a standard practice in all Lithuanian regions. Trial registration: This research was registered in the clinicaltrials.gov database: Identifiers: NCT04784117, Unique Protocol ID: LITOHCA. Brief Title: Out-of-hospital Cardiac Arrest Epidemiology and Outcomes in Kaunas 2016–2021

Additional file 1 of Electronic field protocols for prehospital care quality improvement in Lithuania: a randomized simulation-based study

Additional file 1. Participants’ checklist scores in simulations

Early course of microcirculatory perfusion in eye and digestive tract during hypodynamic sepsis

Introduction: The aim of the study was to evaluate and compare the microcirculatory perfusion during experimental sepsis in different potentially available parts of the body, such as sublingual mucosa, conjunctiva of the eye, and mucosa of jejunum and rectum. Methods: Pigs were randomly assigned to sepsis (n = 9) and sham (n = 4) groups. The sepsis group received a fixed dose of live Escherichia coli infusion over a 1-hour period (1.8 x 10(9)/kg colony-forming units). Animals were observed 5 hours after the start of E. coli infusion. In addition to systemic hemodynamic assessment, we performed conjunctival, sublingual, jejunal, and rectal evaluation of microcirculation by using Sidestream Dark Field (SDF) videomicroscopy at the same time points: at baseline, and at 3 and 5 hours after the start of live E. coli infusion. Assessment of microcirculatory parameters of convective oxygen transport (microvascular flow index (MFI) and proportion of perfused vessels (PPV)), and diffusion distance (perfused vessel density (PVD) and total vessel density (TVD)) was done by using a semiquantitative method. Results: Infusion of E. coli resulted in a hypodynamic state of sepsis associated with low cardiac output and increased systemic vascular resistance despite fluid administration. Significant decreases in MFI and PPV of small vessels were observed in sublingual, conjunctival, jejunal, and rectal locations 3 and 5 hours after the start of E. coli infusion in comparison with baseline variables. Correlation between sublingual and conjunctival (r = 0.80; P = 0.036), sublingual and jejunal (r = 0.80; P = 0.044), and sublingual and rectal (r = 0.79; P = 0.03) MFI was observed 3 hours after onset of sepsis. However, this strong correlation between the sublingual and other regions disappeared 5 hours after the start of E. coli infusion. Overall, the sublingual mucosa exhibited the most-pronounced alterations of microcirculatory flow in comparison with conjunctival, jejunal, and rectal microvasculature (P <0.05). Conclusions: In this pig model, a time-dependent correlation exists between sublingual and microvascular beds during the course of a hypodynamic state of sepsi

Communities creating health: application of open innovation perspective

Knowledge management in health is merely focused on the formal healing protocols, and patient data management despite of the broad knowledge base available outside of the formal medical domains, and an important need to integrate it into the health management systems. However, there is very little known on how to integrate this diversity of knowledge, and especially, direct it towards the innovation and co-creation activities. In this paper, we approach the health knowledge management from the community perspective, and aim to address the knowledge integration for open innovation across communities. 12 case studies were collected, which reveal the importance of trust, integrity and validity of the knowledge shared, and of the safe knowledge sharing and learning environments that would encourage collaborative innovation across different stakeholders. Finally, we propose the model for open innovation lab development in the hospital environment, which is being tested in the Clinical Hospital of the Lithuanian University of Health SciencesEdukologijos tyrimų institutasKauno technologijos universitetasLietuvos sveikatos mokslų universitetasMokslo ir inovacijų departamentasSocialinių mokslų fakultetasVytauto Didžiojo universiteta