Procjena i zbrinjavanje politraumatiziranog bolesnika

Polytrauma is a simultaneous severe injury to at least two body regions where at least one injury, or a combination of multiple injuries, endangers life. The spectrum of injuries and posttraumatic disorders is extremely wide. Most commonly they include shock, hypotension due to bleeding or vital organs injury. Injuries are the leading cause of death in developed countries today, and proportion of people who experience polytrauma in the total number of the injured is 3%, with a high mortality rate of 22%. Reanimation procedures and understanding of pathophysiology have progressed remarkably, and in the last twenty years, mortality has decreased by twenty percent. Time is a very valuable factor in the treatment of a polytraumatized patient and requires initiation of injury treatment within 60 minutes of its occurrence. In the clinical approach to treatment, algorithms for the treatment of polytrauma are used to achieve the best results of treatment and to reduce posttraumatic complications. Triage is a formal process through which the condition of all the patients is evaluated right after their arrival at the Emergency Department. Triage determines the urgency of the problem and assesses the allowed and expected waiting time for the beginning of the physician’s examination and treatment of the patient. The approach to a polytraumatized patient is multidisciplinary, includes many specialties and requires continuous education and highly educated staff. High-quality skills, good communication and readiness to respond quickly and efficiently are just some of the key determinants of working with patients with life-threatening conditions.Politrauma je istodobna teška ozljeda najmanje dviju tjelesnih regija gdje najmanje jedna ozljeda ili kombinacija više njih ugrožavaju život. Spektar ozljeda i posttraumatskih poremećaja izrazito je širok. Najčešće uključuju šok, hipotenziju zbog krvarenja ili ozljeda vitalnih organa. Ozljede su danas vodeći uzrok smrti u razvijenim zemljama, a zastupljenost politraumatiziranih u ukupnom broju ozlijeđenih iznosi 3 % uz visoku stopu smrtnosti, koja doseže 22 %. Reanimacijski postupci i razumijevanje patofiziologije iznimno su napredovali te se u posljednjih dvadeset godina smrtnost smanjila za dvadeset posto. Vrijeme je vrlo dragocjen čimbenik u zbrinjavanju politraumatiziranog bolesnika te se zahtijeva početak zbrinjavanja ozljede unutar 60 minuta od njezina nastanka. U kliničkom pristupu liječenju primjenjuju se algoritmi za zbrinjavanje politraume s pomoću kojih se žele postići što bolji rezultati zbrinjavanja i smanjiti pojava posttraumatskih komplikacija. Trijaža je formalan proces kojim se svi bolesnici procjenjuju odmah nakon dolaska u odjel hitne medicine. Trijažom se određuje hitnost problema i procjenjuje dozvoljeno i očekivano vrijeme čekanja na početak pregleda liječnika i liječenja bolesnika. Pristup je politraumatiziranom bolesniku multidisciplinaran, uključuje brojne specijalnosti te zahtijeva kontinuiranu edukaciju i visokoobrazovano osoblje. Kvalitetne vještine, dobra komunikacija i spremnost da se reagira brzo i kvalitetno samo su neke od ključnih odrednica za rad s vitalno ugroženim bolesnicima

Intermittent tramadol vs tramadol administration via patient-controlled pump after lumbar discectomy: a randomized controlled trial

Aim To compare the effect of intermittent tramadol dosing vs tramadol administration via patient-controlled pump on pain after lumbar discectomy. Methods This randomized prospective study enrolled 100 patients who underwent elective LIV-LV lumbar discectomy in the neurosurgery department at Sestre Milosrdnice University Hospital Center from May 2016 to July 2017. Patients were randomized to receive either tramadol (600 mg daily) via a patient-controlled analgesia (PCA) pump or intermittently. Pain was evaluated by the Croatian version of Short-Form McGill Pain Questionnaire. Results Forty percent of patients were women. The median (interquartile range) age of the patients was 51 (40-61) years. The groups did not differ in pain at 7 pm on the day of discectomy. However, in the morning and evening on the first postoperative day and in the morning and evening of the second postoperative day, the PCA group had significantly lower pain (P=0.023, P<0.001, P<0.001, P=0.026, respectively). Conclusion This is the first study that used the Short Form McGill Pain Questionnaire to compare the effect of tramadol administration via PCA pump and intermittent administration on pain after LIV-LV discectomy in a neurosurgery department. Tramadol showed a good analgesic efficacy in lumbar spine surgery; tramadol via PCA controlled pain more effectively than intermittently administered tramadol

Ishodi izvanbolničkog srčanog zastoja - poboljšanje uspješnosti kardiopulmonalne reanimacije od strane laika

Approximately 8000 people suffer from an out-of-hospital cardiac arrest (OHCA) in the Republic of Croatia every year. OHCA survival rates generally remain low despite major advances in resuscitation. Its incidence and survival rate are well known in many European countries, but reliable data on OHCA in Croatia are lacking. The aim of the study was to determine survival rate of patients with OHCA in the Republic of Croatia and the importance of the community bystander cardiopulmonary resuscitation (CPR) rates in the survival chain. This prospective observational study performed between October 1, 2017 and December 31, 2017 included all adult patients with OHCA in Croatia who were treated by Emergency Medical Services (EMS). OHCA data were collected from the Croatian Institute of Emergency Medicine database and Utstein cardiac arrest data collection form. Descriptive data presentation was used in the analyses. Data were expressed as absolute frequencies and percentages and central tendency measures. Testing of correlations in return of spontaneous circulation (ROSC) was performed by logistic regression. During the observation period, a total of 1763 adult patients without signs of circulation were assessed by EMS in Croatia and 760 (43%) adult patients were resuscitated by EMS personnel. Outcomes measured in ROSC until emergency department admission were reported in 126 (17%) cases. Shockable rhythm vs. non-shockable rhythm (OR: 5.832, 95% CI: 3.621-9.392; p<0.001) and bystander witnessed cardiac arrest (OR: 8.213, 95% CI: 2.554-26.411, p<0.001) were significantly associated with a higher probability of survival. There was no significant difference in correlation with day or night shift, etiology of cardiac arrest and bystander CPR variables. Survival rate of OHCA patients who received CPR until emergency department admission in Croatia was 17%. A higher survival rate post-OHCA was more likely among patients who received bystander CPR and had shockable rhythm.U Republici Hrvatskoj izvanbolnički srčani zastoj (ISZ) doživi oko 8000 osoba na godinu. Preživljenje od ISZ općenito ostaje nisko unatoč velikom napretku u reanimaciji. Njegova incidencija i stopa preživljenja dobro su poznati u mnogim europskim zemljama, ali pouzdani podaci o ISZ u Hrvatskoj nedostaju. Cilj istraživanja bio je utvrditi stopu preživljenja bolesnika s ISZ u Republici Hrvatskoj i važnost kardiopulmonalne reanimacije (KPR) provedenu od strane laika u cjelokupnom lancu preživljenja. Ova prospektivna opservacijska studija provedena od 1. listopada 2017. do 31. prosinca 2017. obuhvatila je sve odrasle bolesnike s ISZ u Hrvatskoj koji su bili zbrinjavani od djelatnika hitne medicinske službe (HMS). Podaci o ISZ prikupljeni su iz baze podataka Hrvatskoga zavoda za hitnu medicinu i obrasca za prikupljanje podataka o srčanom arestu Utstein. U analizama je primijenjen deskriptivni prikaz podataka. Podaci su izraženi kao apsolutne frekvencije i postoci te mjere središnje tendencije. Testiranje korelacija povratka spontane cirkulacije (return of spontaneous circulation, ROSC) provedeno je logističkom regresijom. Tijekom razdoblja promatranja ukupno su u izvanbolničkoj HMS na području Republike Hrvatske bile 1763 odrasle osobe bez znakova cirkulacije, a 760 (43%) odraslih bolesnika reanimirano je od strane osoblja HMS. Ishodi mjereni po povratku spontane cirkulacije (ROSC) do prijma u hitnu bolničku službu prijavljeni su u 126 (17%) slučajeva. Ritam koji je za defibrilaciju u odnosu na ritmove srčanog zastoja koji se ne defibriliraju (OR: 5,832, 95% CI: 3,621-9,392; p<0,001) i osvjedočeni srčani zastoj od strane laika (OR: 8,213, 95% CI: 2,554-26,411, p<0,001) bili su značajno povezani s većom vjerojatnošću preživljavanja. Nije bilo značajne razlike u korelaciji s dnevnom ili noćnom smjenom i etiologijom srčanog zastoja. Stopa preživljenja bolesnika s ISZ u Republici Hrvatskoj kod kojih je provedena kardiopulmonalna reanimacija do prijma u hitnu bolničku službu bila je 17%. Veća stopa preživljenja nakon ISZ bila je vjerojatnija među bolesnicima kod kojih je započeta kardiopulmonalna reanimacija od strane laika i koji su imali srčani ritam za defibrilaciju

Suradljivost zdravstvenih djelatnika pri provedbi higijene ruku u sprječavanju infekcija povezanih sa zdravstvenom skrbi – sustavni pregled literature

Introduction: Healthcare associated infections (HCAIs) represent a major public health issue. In Europe, 37 000 patients are affected annually by some sort of HCAI. HCAIs are preventable, and hand hygiene is an important measure in their prevention. During daily clinical practice, hands of healthcare workers (HCWs) are exposed to surfaces, various substances and objects; therefore, proper hand hygiene is the first step in preventing microorganism transmission. Aim: To determine the HCWs hand hygiene compliance with the guidelines of the World Health Organization through a systematic review of literature. Methods: A systematic review of literature based on the PRISMA statement guidelines using the PubMed database in a search for articles that evaluate the hand hygiene compliance among HCWs. Results: Six articles were taken into consideration by the availability of full-text articles and years of publication between 2010 and 2020. Results showed that compliance rate was the highest in studies that implemented World Health Organisation’s Multimodal Hand Hygiene Improvement Strategy or its modifications. Conclusion: The multimodal approach, as World Health Organisation’s multimodal strategy or its local modifications, has been shown as the best approach addressing the problem of hand hygiene compliance. Further areas for research include finding a better method of measuring compliance, technology-driven solutions for both delivery of alcohol-based handrub and monitoring of its use, a greater focus on evaluating proper hand hygiene techniques, and insuring longer-term programs of training and education to achieve the best effectiveness of hand hygiene compliance among HCWs.Uvod: Suradljivost zdravstvenih djelatnika pri provedbi higijene ruku predstavlja vodeći javnozdravstveni problem. Godišnje 37 000 pacijenata umre od neke bolničke infekcije. Pojava bolničkih infekcija može se prevenirati, a higijena ruku jedna je od osnovnih mjera prevencije. Tijekom svakodnevne prakse ruke zdravstvenih djelatnika dodiruju neprekidni slijed površina, različitih tvari i neživih predmeta, stoga je pravilna higijena ruku prvi korak u sprječavanju prijenosa mikroorganizama između pacijenta, okoline i zdravstvenog djelatnika. Cilj: Utvrditi suradljivost zdravstvenih djelatnika pri provedbi higijene ruku u skladu sa smjernicama Svjetske zdravstvene organizacije kroz sustavni pregled literature. Metode: Sustavni pregled literature s pomoću smjernica PRISMA u bazi podataka PubMed u cilju pronalaženja članaka koji evaluiraju provođenje smjernica higijene ruku zdravstvenih djelatnika i stupanj suradljivosti prema smjernicama Svjetske zdravstvene organizacije. Rezultati: U obradu je uključeno šest članaka analiziranih na temelju kriterija dostupnosti cjelovitog teksta i godina publikacije između 2010. i 2020. godine. Stopa suradljivosti bila je najveća u studijama koje su primjenjivale multimodalnu strategiju higijene ruku Svjetske zdravstvene organizacije ili njezine modifikacije. Zaključak: Višedimenzionalni pristup poput multimodalne strategije Svjetske zdravstvene organizacije ili njezinih lokalnih modifikacija pokazuje se kao najbolji pristup u rješavanju problema suradljivosti zdravstvenih djelatnika pri provedbi higijene ruku. Prostor daljnjim istraživanjima otvara se u pronalaženju bolje metode mjerenja suradljivosti, tehnološki usmjerenom pronalasku boljeg rješenja za primjenu alkoholnog dezinficijensa, većoj usmjerenosti k evaluaciji pravilne tehnike higijene ruku te osiguravanju dugoročnijih programa edukacije u cilju ostvarenja najbolje efikasnosti provedbe higijene ruku među zdravstvenim djelatnicima

Coping with Stress of Nurses Employed in the Internal Medicine and Surgical Departments

Introduction. Stress is a state of tension that arises when events or requests from the environment are assessed as threatening or too demanding. in the process of coping, we use different cognitive and behavioral strategies. problem-oriented coping involves strategies aimed at changing or removing stressors. emotion-focused coping encompasses stress-induced arousal management strategies. no coping strategy is universally effective, but the success of coping is assessed in the interaction of an individual’s characteristics and a stressful situation. The prevalence of individual coping patterns among nurses may depend on their workplace. Aim. To determine nurses in the internal medicine and surgical departments of two croatian hospitals cope with stress. Methods. The participants were 163 nurses from the internal medicine and surgical departments of the Sisak general Hospital “dr. Ivo Pedišić” and the general Hospital Karlovac. The measuring instruments used are the Questionnaire on how to deal with stress and the Scale for assessing the importance of events and the possibility of control. Results. The most common ways of coping with stress are planned problem solving, seeking social support, and self-control, while the rarest way of coping is avoidance. nurses perceive the success of coping with stress as moderate, and the degree of control over stressful situations as rather low. Stressful situations are most often perceived as a threat, and least often as a challenge.With the perception of a greater degree of control over the situation, they more often choose to accept responsibility as a way of coping. In internal medicine departments, stressful events are assessed as significantly more disturbing than in surgical departments. Conclusion. The results confirm that for further education of nurses on successful coping with stress, it is important to examine and further explore cognitive processes in selecting ways of coping: the meaning they attach to the situation, assessing control over the situation, and self-assessing coping success

Uloga regulatornih T limfocita u imunosnoj kontroli MC-2 fibrosarkoma

The role of T regulatory lymphocytes (Treg) particularly in cancer is well known. The goal of the present study was to determine the contribution of these lymphocytes in the regulation of anti-tumor immunity of CBA/HZgr mice against MC-2 fibrosarcoma (4th generation of methylcholanthrene induced tumor). The levels of T lymphocytes (CD4+, CD8+ and CD4+CD25+) were determined 8 and 20 days after tumor transplantation. Further, the role of CD4+CD25+ (Tregs) in tumor-host interaction was evaluated in vitro and in vivo by using specific monoclonal antibodies. We found that splenocytes of both control and Treg depleted tumor bearing mice strongly but differently inhibited growth of tumor cells in vitro. While splenocytes of untreated mice exhibited significant decrease of this activity (from 74.4% to 62.6% and 32.95%), the splenocytes of Treg depleted mice showed increase of this activity (from 79.5% to 84.3% and 86.2%) from day 6 to day 13 and day 21 after tumor grafting, respectively. Further, upon i.v. injecting specific monoclonal anti-Treg antibody tumor immediately prior to tumor cell intracutaneous transplantation, the tumor was rejected after initial growth. In treated mice, the incidence of Treg cells was very low initially, reaching normal values two weeks later. These animals were shown to be resistant to tumor transplantation four months later.Uloga T regulatornih limfocita dobro je poznata, osobito kod tumora. Cilj ovoga istraživanja bio je utvrditi doprinos ovih limfocita u regulaciji antitumorske imunosti CBA/HZgr miševa protiv MC-2 fibrosarkoma (4. generacija metilkolantrenom izazvanog tumora). Razine T limfocita (CD4+, CD8+ and CD4+CD25+) određivale su se 8 i 20 dana nakon transplantacije tumora. Nadalje, uloga CD4+CD25+ T limfocita (Treg) u interakciji tumora i domaćina procijenjena je in vitro i in vivo primjenom specifičnih monoklonskih protutijela. Utvrdili smo da splenociti kako kontrolnih miševa tako i miševa s tumorom bez Treg snažno, ali različito suzbijaju rast tumorskih stanica in vitro. Dok su splenociti netretiranih miševa pokazivali značajno smanjenje ove aktivnosti (sa 74,4% na 62,6% i 32,95%), splenociti miševa bez Treg pokazivali su porast ove aktivnosti (sa 79,5% na 84,3% i 86,2%) od 6. do 13. i 21. dana nakon transplantacije tumora. Uz to, nakon i.v. injektiranja specifičnog monoklonskog anti-Treg tumorskog protutijela neposredno prije intrakutane transplantacije tumorskih stanica, nakon početkog rasta nastupilo je odbacivanje tumora. Kod tretiranih miševa incidencija Treg stanica bila u početku vrlo niska i dostigla je normalne vrijednosti dva tjedna kasnije. Nakon četiri mjeseca pokazalo se da su ove životinje otporne na transplantaciju tumora

(A)simetrija muških sijedih brada kao indikacija programiranog procesa starenja

Aging interventions will be ineffective if we do not understand the basic principles of aging. Currently, there is no consensus on the issue whether aging is programmed or not. The hypothesis presented in this article indicates that aging (at least graying of male hairs) is programmed. This hypothesis is supported by the symmetry of the graying of male beard hairs. According to stochastic theories of aging, aging is a passive non-programmed process where random dispersion of graying hairs should result. On the contrary, programmed theories of aging would predict that there should be symmetry on the left and right parts of the face showing the same proportion, pattern and time of appearance of graying hairs.Intervencije starenja bit će neučinkovite ako ne razumijemo osnovne principe starenja. Trenutno ne postoji konsenzus o tome je li starenje programirano ili ne. Hipoteza postavljena u ovom članku ukazuje na to da je starenje (barem posijeđivanje muških dlaka) programirano. Tu hipotezu potkrepljuje simetrija posijeđivanja dlaka muške brade. Stohastička teorija starenja tvrdi da je starenje pasivni neprogramirani proces u kojem bi se trebala dogoditi slučajna disperzija sijedih vlasi. Suprotno tome, programirane teorije starenja predviđaju da na lijevom i desnom dijelu lica treba postojati simetrija koja pokazuje jednak omjer, uzorak i vrijeme pojave sijedih dlačica

Visoka učestalost neliječene i nedovoljno liječene deficijencije i insuficijencije vitamina D u bolesnika s upalnim bolestima crijeva

Inflammatory bowel disease (IBD) patients with vitamin D deficiency show an increased risk of hospital admission, surgery, and loss of response to biologic therapy while high vitamin D levels are identified as a protective factor. Our goal was to investigate the prevalence of untreated and undertreated vitamin D deficiency and factors associated with vitamin D deficiency. In this cross-sectional study, we measured serum vitamin D in a random sample of Caucasian IBD patients. Vitamin D deficiency was defined as <50 nmol/L and insufficiency as 50-75 nmol/L. Supplementation was defined as taking 800-2000 IU vitamin D daily. Untreated patients were defined as not taking supplementation and undertreated group as receiving supplementation but showing vitamin D deficiency or insufficiency despite treatment. Our study included 185 IBD patients, i.e. 126 (68.1%) with Crohn’s disease (CD) and 59 (31.9%) with ulcerative colitis (UC). Overall, 108 (58.4%) patients had vitamin D deficiency and 60 (32.4%) patients vitamin D insufficiency. There were 16 (14.8%) and 11 (18.3%) treated patients in vitamin D deficiency and vitamin D insufficiency group, respectively. The rate of untreated patients was 81.7% (n=49) in vitamin D deficiency group and 85.2% (n=92) in vitamin D insufficiency group. Tumor necrosis factor alpha inhibitors were associated with higher serum vitamin D levels in CD and UC, and ileal involvement, ileal and ileocolonic resection with lower levels. In conclusion, not only is vitamin D deficiency common in IBD patients but the proportion of untreated and undertreated patients is considerably high. We suggest regular monitoring of vitamin D levels in IBD patients regardless of receiving vitamin D supplementation therapy.Bolesnici s upalnim bolestima crijeva (inflammatory bowel disease, IBD) i manjkom vitamina D su pod povećanim rizikom hospitalizacije, operacije i gubitka odgovora na biološku terapiju, dok visoke serumske razine vitamina D predstavljaju zaštitni čimbenik. Cilj ove studije bio je istražiti učestalost neliječenih i nedovoljno liječenih bolesnika s IBD i manjkom vitamina D te čimbenike rizika. U ovoj presječnoj studiji mjerene su serumske razine vitamina D u slučajnom uzorku bolesnika s IBD bijele rase. Deficijencija je definirana kao razine <50 nmol/L, a insuficijencija kao 50-75 nmol/L. Nadoknada vitamina D je definirana kao uzimanje 800-2000 IJ vitamina D na dan. Neliječeni bolesnici su oni bez nadoknade, a nedovoljno liječeni oni s deficijencijom ili insuficijencijom usprkos nadoknadi. Uključeno je ukupno 185 bolesnika s IBD, tj. 126 (68,1%) s Crohnovom bolešću i 59 (31,9%) s ulceroznim kolitisom. Ukupno je 108 (58,4%) bolesnika imalo deficijenciju, a 60 (32,4%) insuficijenciju. Udio liječenih bolesnika s deficijencijom i insuficijencijom vitamina D iznosio je 14,8% (n=16) i 18,3% (n=11). Udio neliječenih s deficijencijom iznosio je 81,7% (n=49), a s insuficijencijom 85,2% (n=92). Terapija inhibitorima faktora tumorske nekroze alfa bila je povezana s višim razinama vitamina D. Niže razine vitamina D su zabilježene kod bolesnika s upalom u području ileuma i resekcijom ileuma ili ileokolona. U zaključku, niske serumske razine vitamina D su česta pojava kod bolesnika s IBD, a dodatno je udio neliječenih i nedovoljno liječenih također visok. Naša preporuka je kontinuirano praćenje razina vitamina D u serumu svih bolesnika s IBD uključujući i one na nadoknadi vitaminom D

Stanje uhranjenosti i kvaliteta prehrane u bolesnika s nealkoholnom bolešću masne jetre

Non-alcoholic fatty liver disease (NAFLD) is becoming a major health burden with increasing prevalence worldwide due to its close association with the epidemic of obesity. Currently there is no standardized pharmacological treatment, and the only proven effective therapeutic strategy is lifestyle modification, therefore it is important to determine the potential dietary targets for the prevention and treatment of NAFLD. We assessed nutritional status in 30 patients diagnosed with NAFLD using anthropometric parameters, hand grip strength, and lifestyle and dietetic parameters (physical activity, NRS2002 form and three-day food diary). The mean body mass index was 29.62±4.61 kg/m2, yielding 86.67% of obese or overweight patients. Physical activity results indicat-ed poorly active subjects. Excessive energy intake was recorded in 27.78% of patients. The mean in-take of macronutrients was as follows: 15.5% of proteins, 42.3% of carbohydrates and 42.2% of fat, with ­deficient micronutrient intake of calcium, magnesium, iron, zinc, and vitamins A, B1 and B2. The ­results showed that the quality of nutrition in study subjects was not accordant to current rec-ommendations and that they consumed a high proportion of fat, especially saturated fatty acids, along with low micronutrient intake. The results obtained might point to the importance of unbalanced diet as a contributing factor in NAFLD development.Nealkoholna bolest masne jetre (NAFLD) postaje velik zdravstveni problem s povećanom učestalosti u svijetu zbog bliske povezanosti s epidemijom pretilosti. Kako zasad ne postoji standardizirano farmakološko liječenje i jedina dokazana učinkovita terapijska strategija je promjena načina života, važno je odrediti potencijalne prehrambne ciljeve za prevenciju i liječenje NAFLD. Procijenili smo nutritivni status 30 bolesnika s dijagnosticiranim NAFLD primjenom antropometrijskih parametara, mjerenjem snage ruke dinamometrom i dijetetskim parametrima (tjelesna aktivnost, upitnik NRS 2002 i tro­dnevni dnevnik prehrane). Srednja vrijednost indeksa tjelesne mase bila je 29,62±4,61 kg/m2 s 86,67% bolesnika koji su bili prekomjerne tjelesne mase ili pretili. Rezultati tjelesne aktivnosti pokazuju da su ispitanici bili slabo aktivni. Prekomjerni energetski unos u odnosu na dnevne potrebe imalo je 27,78% bolesnika. Prosječan dnevni unos makronutrijenata je iznosio: 15,5% proteina, 42,3% ugljikohidrata i 42,2% masti s nedostatnim unosom sljedećih mikronutrijenata: kalcij, magnezij, ­željezo, cink, vitamini A, B1 i B2. Rezultati istraživanja pokazuju da kvaliteta prehrane naših ispitanika nije bila u skladu s aktualnim preporukama i da su konzumirali velike količine masti, pogotovo zasićenih masnih kiselina s niskim unosom ­mikronutrijenata. Dobiveni rezulatati bi mogli ukazati na ulogu nepravilne prehrane kao važnog čimbenika razvoja NAFLD-a