The Prognostic Impact of Renal Function Decline during Hospitalization for Heart Failure

Introduction: We aimed to evaluate the prognostic impact of renal insufficiency and fluctuation of glomerular filtration observed during hospitalization for heart failure (HF). Methods: We followed 3,639 patients hospitalized for acute HF and assessed the mortality risk associated with moderate or severe renal insufficiency, either permanent or transient. Results: After adjustment, severe renal failure defined as estimated glomerular filtration (eGFR) <30 mL/min indicates ≈60% increase in 5-year mortality risk. Similar risk also had patients with only transient decline of eGFR to this range. In contrast, we did not observe any apparent mortality risk attributable to mild/moderate renal insufficiency (eGFR 30–59.9 mL/min), regardless of whether it was transient or permanent. Conclusion: Even transient severe renal failure during hospitalization indicates poor long-term prognosis of patients with manifested HF. In contrast, only moderate renal insufficiency observed during hospitalization has no additive long-term mortality impact

Reduction of pain in selected diagnostic and nursing performances based on best practices in the care of the newborns

This thesis deals with neonatal pain and possibility of its reduction during three most painful interventions, to which newborns are exposed. The interventions were selected based on the study of literature, among them belongs collection of capillary blood for screening of newborns, insertion and removal of a gastric tube and airway suctioning of the newborn. Pain has protective reasons as it shall protect us from harming tissues. But sometimes it is necessary to cause pain for the purpose of performing a diagnostic or medical treatment. But there are some ways how to reduce pain at newborns. The theoretical part describes the basic facts about pain, its origin and transfer, importance and types of pain. This thesis also describes the specifics of fetus nervous system maturation during pregnancy. Furthermore, it mentions evaluation of pain manifestation and ways of treating it. Another sub-chapter contains a description of selected medical treatments and ways of palliating pain during their implementation. The last section is dedicated to clinical recommended procedures. The practical part of the work was carried out in four neonatal intensive care units. There were intentionally selected three respondents in each unit, with whom were led guided interviews which are recorded in chapter 4.2. Results of interviews with each respondent are summarized in transparent tables. This thesis had three objectives. The first objective was to compare the method of implementation of selected painful procedures at newborns in theory and practice. We wanted to know whether nursing procedures carried out in selected neonatal units correspond with procedures described in literature. By questioning and observation was found out that some respondents did not follow recommendations. The differences are described in chapter "Results and discussion". The second objective was to determine whether nurses at selected wards have selected performance standards and whether they are also interested in latest procedures of palliating pain at newborns. All respondents stated that performance standards are selected, but not all are prescribed only for newborns. Almost all respondents (except one) have stated that they were interested in new ways of reducing pain, but not all methods are listed in the standards. The third objective was to determine whether nurses abide selected nursing care standards and whether they employ their most recent knowledge about neonatal pain reduction in practice. By observiation was not found non-observance of standards, but also was not found implementation of new procedure knowledge that respondents stated in an interview. At the same time the respondents (except two) reported that there was no need to change the standards at selected performances. The outcome of this work is a new standard for each performance which was dealt with in this thesis. Standards were created eventhough the respondents stated that there was no need to change them. It is necessary to verify new standards in practice

Enhanced vitamin K expenditure as a major contributor to vitamin K deficiency in COVID-19

Objectives: Vitamin K deficiency consistently associates with worse clinical outcome in COVID-19 patients. However, whether this is due to increased expenditure during inflammation or poor vitamin K status prior to infection remained unknown. Methods: Dp-ucMGP levels of 128 individuals were measured for the post-MONICA study and were compared to SARS-CoV-2 PCR testing results. Results: Dp-ucMGP levels prior to COVID-19 infection were not significantly different comparing PCR-negative, PCR-positive and not hospitalized, and PCR-positive and hospitalized patients. Conclusion: In this study, we demonstrate normal vitamin K status prior to infection in SARS-CoV-2 positive patients, supporting the theory of increased utilisation during disease