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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Month: October 2016 (Page 1 of 5)

Lung replacement therapies for acute respiratory failure

Abstract

Acute respiratory failure is one of the critical conditions with an increased mortality. In order to reverse lung injury and reduce the mortality rate, several lung replacement therapies have been developed, including the extracorporeal membrane oxygenation, the intravascular oxygenator and carbon dioxide removal device, the intravenous membrane oxygenator and the thoracic artificial lung. This article aims to present the properties, indications and advantages of these devices.

Key words: artificial organs, extracorporeal membrane oxygenation, respiratory insufficiency

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Nursing and Implementation of Modern Technology

Abstract

Introduction. Implementation of technology in health care has become a global trend. The society modernization has led to the increasing development of technology and information systems. Nurses in everyday work encounter with the application of communications and information technologies. The implementation of modern technology in nursing increases nurses efficiency, but it is also changing the way of care for patients. Implementation of modern technology in nursing is the result of interactions between technical skills, culture and social acceptance in the working environment.

Aim. The aim of this article was to investigate the application of modern technology in nursing and how it affects the nursing profession, what competencies are required for the introduction of technology and the role of nurses in the process.

Materials and methods. PubMed database, OJIN base (Online Journal of Issues in Nursing), HCA (Hospital Corporation of America) were searched with the aim of finding appropriate studies and articles. Keywords which were used: nursing, modern technology, nursing challenges, education.

Results. During a search of the databases, we found seven articles of which according to the inclusion criteria for this study we used three. Data from the literature that was used showed that the application of modern technology in nursing is still in the initial process of adaptation.

Conclusion. Modern technology in the nursing profession is in its infancy, a lot of factors are contributing to slower development such as high cost, a shortage of nurses and training of medical staff to work with the new technology.

Key words: nursing, modern technology, nursing challenges, education

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Genetic determinants of survival

Abstract

The human genome comprises some 20,000 genes, or 3 billion base pairs. Variation in this genetic sequence is common and some of these variants affect gene function or the protein transcribed from it. Human characteristics are determined by the interaction of the genome with environmental challenges, and differences between us thus result from variation in those challenges and in the genome itself. This is true of human susceptibility to disease, and survival from it. Genetic variation influences human behaviours which may predispose to health or disease; the risk of contracting an infectious disease, or of suffering diseases such as cancer or myocardial infarction; the development of complications; the response to any treatment administered; and thus the outcome of the disease state. Genetic studies can help shed light on the mechanisms which underpin disease processes, whilst perhaps suggesting ways in which treatment might be ‘personalised’, and novel therapeutic targets for drug development.

More sophisticated approaches to such endeavours are required, given the failure to identify the bulk of gene variants of influence using conventional strategies.

Key words: gene, polymorphism, survival, genome

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Can tablets be used as a simulator for automated external defibrillation during cardiopulmonary resuscitation courses?

Abstract

Background. A novel, tablet-based automated external defibrillator (AED) simulator has been developed to facilitate AED training.

Objective. To evaluate if the tablet AED simulator (an AED simulator based on mobile technology (M-AED)) can be successfully used during cardiopulmonary resuscitation (CPR) courses. To test medical and dental students’ CPR attitudes, knowledge and skills, and evaluate the impact of a one day CPR course.

Methods. One hundred and twenty-four medical and dental students of University of Zagreb participated in a basic life support and automated external defibrillator (BLS/AED) course. All students filled out demographic, CPR attitudes and knowledge questionnaires before and after the course. Half of the students practised AED skills during the course on a conventional AED trainer (C-AED), and half on M-AED. All underwent assessment of CPR skills after the course with C-AED. Those that used M-AED during training, rated its use.

Results. All students successfully completed the assessment of skills after the course, with no significant difference in the number of those who had to be retested between C-AED and M-AED. A significant improvement in CPR attitudes and knowledge was noted after the course among all students, with no difference between C-AED and M-AED groups. M-AED as an AED trainer was highly rated.

Conclusions. Tablet based AED simulators can be effectively utilized during BLS/AED courses as a substitute for conventional AED trainers.

Key words: defibrillators, computer simulation, mobile applications, cardiopulmonary resuscitation, European Resuscitation Council Guidelines

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Comparison of sevoflurane and propofol anaesthetic regimes in respect to the release of troponin I and cystatin C in off-pump myocardial revascularisation: a randomised controlled trial

Abstract

Objective. Sevoflurane has been used in cardiac surgery because of its protective effects on the myocardium from ischaemic injury. We wanted to test the hypothesis that sevoflurane has beneficial effects on the heart and kidneys in comparison to propofol.

Methods. We conducted a randomised controlled study, with balanced randomization blocked by sex. The participants were 62 patients undergoing off-pump myocardial revascularization (44 men and 18 women), who did not have a myocardial infarction less than 24 hours before the start of the operation and who had normal serum values of troponin I preoperatively. The surgery and the measurements were conducted according to the same protocol for both groups. Propofol was used for the induction of anaesthesia in both groups; anaesthesia was continued with either propofol or sevoflurane. Troponin I and cystatin C plasma concentrations were determined in eight consecutive blood samples, starting before induction of anaesthesia and ending 48 hours after admission to the intensive care unit (ICU). The data were log-transformed and analysed using analysis of variance.

Results. We observed a clear and highly statistically significant effect of time for troponin I (p<0.001) without statistically significant differences between the groups (either main or interaction effects). For the majority of patients, the measurements rose quickly upon reperfusion and reached a peak 12 hours after admission to the ICU, descending approximately back to the reperfusion level 48 hours after admission to the ICU. Similar inferences were reached for cystatin C, for which the time-course was approximately bath-shaped.

Conclusion. We observed no clear superiority of either sevoflurane or propofol anaesthetic regime in off-pump myocardial revascularisation.

Key words: anaesthetic regime, cardioprotection, kidney function, heart surgery

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