Readmission following both cardiac and non-cardiac acute dyspnoea is associated with a striking risk of death

Readmission and mortality are the most common and often combined endpoints in acute heart failure (AHF) trials, but an association between these two outcomes is poorly investigated. The aim of this study was to determine whether unplanned readmission is associated with a greater subsequent risk of death in patients with acute dyspnoea due to cardiac and non-cardiac causes.; Derivation cohort (1371 patients from the LEDA study) and validation cohort (1986 patients from the BASEL V study) included acute dyspnoea patients admitted to the emergency department. Cox regression analysis was used to determine the association of 6 month readmission and the risk of 1 year all-cause mortality in AHF and non-AHF patients and those readmitted due to cardiovascular and non-cardiovascular causes. In the derivation cohort, 666 (49%) of patients were readmitted at 6 months and 282 (21%) died within 1 year. Six month readmission was associated with an increased 1 year mortality risk in both the derivation cohort [adjusted hazard ratio (aHR) 3.0 (95% confidence interval, CI 2.2-4.0), P < 0.001] and the validation cohort (aHR 1.8, 95% CI 1.4-2.2, P < 0.001). The significant association was similarly observed in AHF (aHR 3.2, 95% CI 2.1-4.9, P < 0.001) and other causes of acute dyspnoea (aHR 2.9, 95% CI 1.9-4.5, P < 0.001), and it did not depend on the aetiology [aHR 2.2, 95% CI 1.6-3.1 for cardiovascular readmissions; aHR 4.1, 95% CI 2.9-5.7 for non-cardiovascular readmissions (P < 0.001 for both)] or timing of readmission. CONCLUSION​S: Our study demonstrated a long-lasting detrimental association between readmission and death in AHF and non-AHF patients with acute dyspnoea. These patients should be considered 'vulnerable patients' that require personalized follow-up for an extended period

Is there a correlation between qSOFA criteria positive patients and microbiology-positive sepsis?

Background & objectives Early sepsis diagnostics is still challenging in emergency department due to variety of symptoms presented. What is more, sepsis rates are still increasing and mortality rates remain significant despite optimal care. Many sepsis scores were created to evaluate risk for sepsis mortality, but recently qSOFA score was released for evaluating risk for mortality due to sepsis without laboratory findings. This study aim was to retrospectively evaluate correlation between microbiologically positive sepsis patients and their qSOFA validity on arrival to emergency department. Methods A retrospective observational study was performed in adult emergency department in tertiary, university-affiliated hospital. Patients were included in study if microbiological test and first antibiotic dose were initiated in emergency department for suspected sepsis and quick SOFA score was calculated. Exclusion criteria was trauma patients and departure to other hospitals. Results Much more patients were suspected for having a sepsis by qSOFA criteria based protocol. Further study results will be presented. Conclusions qSOFA is much promising score with ability not only recognising high risk mortality sepsis patients in hospital but also in emergency department or even pre-hospitaly without using laboratory tests. This study was created for accepting or refusing qSOFA criteria in emergency department, especially in poorly finansed emergency deprtments

Treating the trauma team

Background It's been decades since "golden hour" has been incorporated in trauma patient management and "trauma team" became the front line soldiers of ER. Many studies has shown the benefit on patients outcome after implementation of trauma system. However the best way of maintaining and improving trauma team performance especially on non-technical skills is still not well known. It is known that continues learning, quality measurement and feedback are the foundation of keeping high standards on patients safety. Methods Trauma team audit has been carried out in Lithuanian major level III trauma center. We incorporated two new components in trauma audit. First one was continuous simulation learning: every morning all trauma team members had to gather up in the ER for one simulation session. The second was measurement of non-technical skills and giving feedback after simulation learning and real-life experiences. Trauma team performance has been evaluated using our developed evaluation tool. Trauma team members has not been informed about the audit. Results Trauma team performance on non-technical skills has been evaluated before the intervention and after using our developed performance evaluation tool. Conclusion We still have a far way to a well-balanced and functioning trauma team. But "time offs" at the beginning of a shift seems to be an easily accomplished performance improvement strategy. "Time offs" drills, quality measurement and feedback should become a standard everyday procedure especially in less crowded emergency rooms, were real life practice is not that common

Relevance factors of emergency department patients satisfaction

Sveikatos priežiūros įstaigų pacientų pasitenkinimo teikiamomis paslaugomis rodikliai yra veiksminga jų vertinimo priemonė. Šiems rodikliams didelę įtaką daro personalo bendravimo įgūdžiai ir mandagus elgesys su pacientu. Tyrimo tikslas yra įvertinti LSMU Kauno klinikų Skubios pagalbos skyriaus (SPS) pacientų skausmo malšinimo ir medicinos personalo bendravimo su pacientais reikšmę pacientų pasitenkinimui teikiamomis paslaugomis. Skubios pagalbos skyriaus pacientų momentinė anoniminė anketinė apklausa, tyrimo anketą adaptavus pagal JAV CAHPS ir Jungtinės Karalystės The Friends and Family test klausimynus. Anketą sudarė demografiniai ir su paciento vizitu susiję duomenys bei 14 vertinimui skirtų klausimų (pacientų nuomonė vertinta skalėje nuo 1 iki 7 balų). Apklausa vykdyta 2016 metų rugsėjo – 2017 metų vasario mėnesiais, tyrime dalyvavo 604 pacientai. SPS darbą geriausiai vertino pacientai, kurių amžius per 81 metai, balų vidurkis 6,79 (sn±0,413), o blogiausiai – 18 ir 30 metų amžiaus pacientai 6,5 (sn±1,019). Nustatytas vidutinio stiprumo ryšys tarp skausmo malšinimo efektyvumo ir pasitenkinimo skubios pagalbos skyriaus darbu (r=0,408; p<0,05). Pacientų pasitenkinimas SPS darbu labiausiai siejosi su gydytojo darbo įvertinimu (r=0,591, p<0,05), o skyriaus pagalbinio personalo (r=0,535) ir slaugytojų (r=0,481) atliekamo darbo vertinimas turėjo mažesnį, tačiau taip pat statistiškai reikšmingą ryšį (p<0,05) su pacientų pasitenkinimu SPS paslaugomis. Šiame tyrime atskleista, kad SPS pacientų pasitenkinimo lygis suteiktomis paslaugomis yra aukštas. Skausmo malšinimas siejasi su geriau vertinamomis paslaugomis. Viso personalo darbas yra reikšmingas, tačiau gydytojų darbas yra pagrindinis veiksnys, kuris siejasi su geresniais pacientų pasitenkinimo rodikliais.The indicators of patients' satisfaction in healthcare facilities is an effective quality measurement tool. These indicators are strongly influenced by staff communication skills and polite behavior with the patient. The aim of this study was to evaluate pain relief and medical staff communication skills impact on patients' satisfaction in LHSU Kaunas Clinics Emergency Department (ED). Methods. Patients of the Emergency department participated in a cross-sectional study - anonymous questionnaire. The survey was adapted by US CAHPS and United Kingdom's The Friends and Family test questionnaires. The questionnaire included demographic and patientrelated data, as well as 14 questions for evaluation (patients' opinions were assessed in a scale from 1 to 7 points). The survey was conducted on September 2016 - February 2017, and 604 patients participated in the study. Results. ED work was best evaluated by patients over the age of 81, the average score was 6.79 (sn ± 0.413), and worst by patients who were 18 and 30 years of age, 6.5 (sn ± 1.019). There was an avarage connection between pain relief efficiency and patient satisfaction with ED work (r = 0.408; p <0.05). Patient satisfaction with ED work was the most closely related to the assessment of the doctor's work (r = 0.591, p <0.05), and the assessment of the work performed by the support staff (r = 0.535) and nurses (r = 0.481) had a lower, but also statistically significant relationship (p <0.05) with patient satisfaction with ED services. Conclusions. This study revealed that ED patients' satisfaction with the services provided is high. Pain relief is associated with better evaluations. The work of the entire staff is significant, but the work of doctors is a key factor associated with better patient satisfaction rates

Magical manoeuvre : a 5-s instructor’s intervention helps lightweight female rescuers achieve the required chest compression depth

BACKGROUND: Adequate chest compression (CC) depth is crucial for resuscitation outcomes. Lightweight rescuers, particularly women, are often unable to achieve the required 5-6 cm CC depth. This nonrandomized cohort study investigated new strategies to improve CC performance. OBJECTIVE: To evaluate the effects of a 5-s instructor's intervention on the depth of CCs performed by female rescuers during standard video self-instruction basic life support training. METHODS: Data were prospectively collected from January 2011 to January 2012 from 336 female medical and pharmacy students undergoing cardiopulmonary resuscitation (CPR) training at the Lithuanian University of Health Sciences. During the training process, the instructors performed a simple 5-s intervention (Andrew's manoeuvre) with all of the rescuers in the study group. The instructor pushed 10 times on the shoulders of each trainee while she performed CCs to achieve the maximal required compression depth. Immediately after training, the participants were asked to perform a 6-min basic life support test on a manikin that was connected to a PC with Skill Reporter System software; the quality of the participants' CPR skills was then evaluated. RESULTS: The CC depth in the study group increased by 6.4 mm (P<0.001) compared with the control group (52.9 vs. 46.6 mm). A regression analysis showed that Andrew's manoeuvre increased the depth of the CCs among women by 14.87×(1-0.01×weight) mm. CONCLUSION: A simple 5-s instructor's intervention during the CPR training significantly improved the performance of the female rescuers and helped them achieve the CC depth required by 2010 resuscitation guidelines. Andrew's manoeuvre is most effective among the women with the lowest body weightAplinkotyros katedraLietuvos sveikatos mokslų universitetasLietuvos sveikatos mokslų universiteto ligoninė viešoji įstaiga Kauno klinikosVytauto Didžiojo universiteta

How the changes in the system affect trauma care provision: The assessment of and implications for Lithuanian trauma service performance in 2007–2012

Objective: The aim of this study was to identify and assess the effects of changes in the Lithuanian trauma service from 2007 to 2012. We postulate that the implications derived from this study will be of importance to trauma policy planners and makers in Lithuania and throughout other countries of Eastern and Central Europe. Materials and methods: Out of 10,390 trauma admissions to four trauma centers in 2007, 294 patients (2.8%) were randomly selected for the first arm of a representative study sample. Similarly, of 9918 trauma admissions in 2012, 250 (2.5%) were randomly chosen for comparison in the study arm. Only cases with a diagnosis falling into the ICD-10 “S” and “T” codes were included. A survey of whom regarding changes in quality of trauma care from 2007 to 2012 was carried out by emergency medical service (EMS) providers. Results: The Revised Trauma Score (RTS) mean value was 7.45 ± 1.04 for the 2007 year arm; it was 7.53 ± 0.93 for the 2012 year arm (P = 0.33). Mean time from the moment of a call from the site of the traumatic event to the patient's arrival at the trauma center did not differ between the arms of the sample: 49.95 min in 2007 vs. 51.6 min in 2012 (P = 0.81). An application of the operational procedures such as a cervical spine protection using a hard collar, oxygen therapy, infusion of intravenous fluids, and pain relief on the trauma scene was more frequent in 2012 than in 2007. Management of trauma patients in the emergency department improved regarding the availability of 24/7 computed tomography scanner facilities and an on-site radiographer. Time to CT-scanning was reduced by 38.8%, and time to decision-making was reduced by 16.5% in 2012. Conclusions: Changes in operational procedures in the Lithuanian pre-hospital care provision and management of trauma patients in emergency departments of trauma centers improved the efficiency of trauma care delivery over the 2007–2012 period

Проекты ЦИК и ЛУНЗ 2010–2012 г.: путешествие по Шёлковому пути к более безопасному и современному здравоохранению

Подготавливая это издание, мы хотели сами осознать масштаб проделанной за три года работы, поделиться накопленным опытом сотрудничества, оставить для истории страницы о дружбе, взаимопонимании, доверии, стремлении к улучшению здравоохра- нения в наших странах

Biologically Active Adrenomedullin (bio-ADM) is of potential value in identifying congestion and selecting patients for neurohormonal blockade in acute dyspnea

PURPOSE: . This study was designed to evaluate the role of bio-ADM in congestion assessment and risk stratification in acute dyspnea. METHODS: . This is a sub-analysis of Lithuanian Echocardiography Study of Dyspnea in Acute Settings. Congestion was assessed by means of clinical (peripheral oedema, rales) and sonographic (estimated right atrial pressure [eRAP]) parameters. Ninety-day mortality was chosen for outcome analysis. RESULTS: . 1188 patients were included. Bio-ADM concentration was higher in patients with peripheral oedema at admission (48.2 [28.2-92.6] vs 35.4 [20.9-59.2] ng/L, p 35.5 ng/L were at more than two-fold increased risk of dying (p<0.001). Survival in those with high bio-ADM was significantly modified by neurohormonal blockade at admission (p<0.05), especially if NT-proBNP levels were lower than the median (p = 0.002 for interaction). CONCLUSION: . Bio-ADM reflects the presence and the degree of pulmonary, peripheral, and intravascular volume overload and is strongly related to 90-day mortality in acute dyspnea. Patients with high bio-ADM levels demonstrated survival benefit from neurohormonal blockade

Проекты ЦИК и ЛУНЗ 2010–2012 г.: путешествие по Шёлковому пути к более безопасному и современному здравоохранению

Подготавливая это издание, мы хотели сами осознать масштаб проделанной за три года работы, поделиться накопленным опытом сотрудничества, оставить для истории страницы о дружбе, взаимопонимании, доверии, стремлении к улучшению здравоохра- нения в наших странах