Perioperative echocardiography-guided hemodynamic therapy in high-risk patients:a practical expert approach of hemodynamically focused echocardiography

The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. Various techniques are available to monitor the hemodynamic status of the patient, however due to intrinsic limitations, many of these methods may not be able to directly identify the underlying cause of cardiovascular impairment. Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy

Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study

Background: COVID-19 is a multisystem disease and patients who survive might have in-hospital complications. These complications are likely to have important short-term and long-term consequences for patients, health-care utilisation, health-care system preparedness, and society amidst the ongoing COVID-19 pandemic. Our aim was to characterise the extent and effect of COVID-19 complications, particularly in those who survive, using the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK. Methods: We did a prospective, multicentre cohort study in 302 UK health-care facilities. Adult patients aged 19 years or older, with confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 were included in the study. The primary outcome of this study was the incidence of in-hospital complications, defined as organ-specific diagnoses occurring alone or in addition to any hallmarks of COVID-19 illness. We used multilevel logistic regression and survival models to explore associations between these outcomes and in-hospital complications, age, and pre-existing comorbidities. Findings: Between Jan 17 and Aug 4, 2020, 80 388 patients were included in the study. Of the patients admitted to hospital for management of COVID-19, 49·7% (36 367 of 73 197) had at least one complication. The mean age of our cohort was 71·1 years (SD 18·7), with 56·0% (41 025 of 73 197) being male and 81·0% (59 289 of 73 197) having at least one comorbidity. Males and those aged older than 60 years were most likely to have a complication (aged ≥60 years: 54·5% [16 579 of 30 416] in males and 48·2% [11 707 of 24 288] in females; aged <60 years: 48·8% [5179 of 10 609] in males and 36·6% [2814 of 7689] in females). Renal (24·3%, 17 752 of 73 197), complex respiratory (18·4%, 13 486 of 73 197), and systemic (16·3%, 11 895 of 73 197) complications were the most frequent. Cardiovascular (12·3%, 8973 of 73 197), neurological (4·3%, 3115 of 73 197), and gastrointestinal or liver (0·8%, 7901 of 73 197) complications were also reported. Interpretation: Complications and worse functional outcomes in patients admitted to hospital with COVID-19 are high, even in young, previously healthy individuals. Acute complications are associated with reduced ability to self-care at discharge, with neurological complications being associated with the worst functional outcomes. COVID-19 complications are likely to cause a substantial strain on health and social care in the coming years. These data will help in the design and provision of services aimed at the post-hospitalisation care of patients with COVID-19. Funding: National Institute for Health Research and the UK Medical Research Council

Sosialisasi Peran Orang Tua Terhadap Perkembangan Anak Usia Dini

AbstrakSebagian orang tua banyak yang menganggap perkembangan pada Anak Usia Dini tidak penting, mereka lebih mementingkan untuk mencari nafkah demi menghidupkan anak-anaknya, sehingga tidak memperhatikan perkembangan yang terjadi pada Anak Usia Dini. Maka dari itu, kami tertarik untuk sosialisasi di Desa Morikana, untuk memberikan pemahaman kepada orang tua tentang betapa pentingnya perkembangan pada Anak Usia Sini, agar orang tua mengetahui dan mampu untuk membantu dan mengontrol perkembangan yang telah di capai oleh Anak Usia Dini. Pelaksanaan Kegiatan Pengabdian Kepada Masyarakat tentang “Sosialisasi Peran Orang Tua Terhadap Perkembangan Anak Usia dini†ini dilakukan dengan pendekatan kepada masyarakat secara langsung, pada saat melakukan kegiatan ini ada tiga tahapan yang telah dilaksanakan antara lain Tahap Persiapan, Tahap Pelaksanaan, dan Tahap Evaluasi. Terbentuknya orang tua bijak dan mampu berperan dalam perkembangan anak usia dini, Terbentuknya kesadaran orang tua tentang perilaku kesehatan yang harus di berikan pada anak usia dini dan dengan adanya peran orangtua terhadap perkembangan anak usia dini, anak akan lebih mudah untuk bisa memahami nilai-nilai dari aspek perkembangan. Terselenggaranya Pengabdian Kepada Mahasiswa sebagai upaya meningkatkan kesadaran masyarakat terutama orang tua bahwa peran orangtua terhadap perkembangan anak usia dini itu sangat penting di dalam keluarga, Agar perkembangan anak usia dini sedini mungkin kita harus menanamkan nilai-nilai yang ada dalam perkembangan enam aspek tersebut, sehingga ini dapat diterapkan dilingkungan sosial atau lingkungan masyarakat.Kata Kunci: Anak, Orangtua, Perkembangan AbstractSome parents think that development in Early Childhood is not important, they are more concerned with earning a living to revive their children, so they do not pay attention to the developments that occur in Early Childhood. Therefore, we are interested in socializing in Morikana Village, to provide understanding to parents about the importance of development in Early Childhood, so that parents know and are able to assist and control the developments that have been achieved by Early Childhood. Implementation of Community Service Activities on "Socialization of the Role of Parents in Early Childhood Development" is carried out with a direct approach to the community, when carrying out this activity there are three stages that have been carried out including the Preparation Stage, Implementation Stage, and Evaluation Stage. The formation of wise parents who are able to play a role in the development of early childhood, The formation of parental awareness about health behaviors that must be given to early childhood and with the role of parents in early childhood development, children will be easier to understand the values of developmental aspect. The implementation of Student Service as an effort to increase public awareness, especially parents that the role of parents in early childhood development is very important in the family, so that early childhood development as early as possible we must instill the values that exist in the development of these six aspects, can be applied in the social environment or community environment.Keywords: Children, Parents, Developmen