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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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Quality of life in lung cancer patients due to treatment

Abstract

Lung cancer is the second most common cancer in men and women. Survival has not significantly improved despite new therapeutic possibilities. Therefore, in patients with end-stage disease, the primary goal is to preserve the quality of life as long as possible.

The study included patients divided into four groups depending on the treatment: treated with chemotherapy, radiotherapy, a combination of chemotherapy and radiotherapy and patients treated with symptomatic therapy. Each group consists of 30 subjects. We measured quality of life using a questionnaire of the European Association for the Study and Treatment of Cancer in addition of no.13 for lung cancer (EORTC QLQ C30 + LC13), which is validated and translated in the native language and includes 43 questions.

Patients who are on symptomatic therapy have the worst quality of life, and all aspects of normal functioning are the most disturbed when compared to patients treated with other therapeutic modalities. Quality of life is best for patients who are treated with chemotherapy. Any modality of treatment, especially chemotherapy, is superior to the use of only symptomatic treatment.

Key words: lung cancer, quality of life, chemotherapy

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Epidemiology and fungal infection risk factors in patients hospitalized in neonatal and paediatric intensive care units – a multicentre pilot study

Abstract

Invasive fungal infections are associated with very high mortality and morbidity. Candida sp. is a leading etiological cause of invasive fungal infections (IFI). The aim of this study was to investigate the epidemiology of FI in patients admitted to neonatal and paediatric ICU (NICU and PICU) to investigate risk factors that may contribute to FI development. In this retrospective epidemiologic multicentre pilot study five neonatal and five paediatric intensive care units were included. The data about epidemiology, patient significant clinical data, chronic metabolic disease, surgery, mechanical ventilation, dialysis, central venous catheter, urinary catheter, arterial catheter, total parenteral nutrition, leucopenia, neutropenia, previous antimicrobial therapy or prophylaxis were collected. In this study 25 NICU and 40 PICU patients treated with antifungal drugs during 2014 were enrolled. Among patients with fungal infection from the NICU the most often diagnosis and reason for NICU hospitalization was prematurity. In four NICUs C. albicans was the most common clinically significant fungal isolate. In one NICU C. parapsilosis was the most frequently isolated yeast. From the urine of one NICU patient with urogenital disease C. krusei was isolated. In four of five PICUs C. albicans was the most common cause of fungal infections. C. glabrata and C. krusei were also recorded in PICUs. In one PICU patients with clinically important moulds were recorded – patients with haematological malignancy (Fusarium sp.) and solid organ transplantation (Aspergillus spp). Thus, surveillance of epidemiology, fungal susceptibility and risk factors associated with fungal infection in a prospective multicentre study could be of great value in the future.

Key words: fungal infection, fungal epidemiology, risk factors for FI, paediatric patient, neonatal patient

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Late onset perinatal sepsis in the neonatology intensive care unit – risk factors

Abstract

The lowest-birth-weight premature is very susceptible for nosocomial infections. These infants require the most invasive therapeutic interventions and the longest exposure to environment conductive for microbial colonization. Incidence of nosocomial infection and risk factors in premature has been compared over two years, 2010 and 2015. We examined the effects of common procedures on the incidence of nosocomial sepsis. Birth weight, distribution of pathogens and the therapeutically procedures had been analysed. We tried to find strategies to minimise the risks for acquiring sepsis. Hospital documentation from neonatal intensive care unit (NICU) has been analysed retrospectively during two different years in the University Hospital Osijek. Incidence of nosocomial sepsis among hospitalised premature has been 8.9% in 2010, and 4.8% in 2015. The highest rate of affected infants weighed below 1,500 g in both periods. Statistically significance in these two periods has been found in the percentage of pre-term infants with umbilical vein catheter (UVC), and in the number of pre-term on invasive mechanical ventilation. The most common pathogen in 2010 was methicillin-resistant Staphylococcus epidermidis (MRSE), and in 2015 coagulase negative Staphylococci (CONS). The percentage of Candida parapsylosis was higher in 2015. Lowering the incidence of late-onset sepsis has been accomplished by using peripherally inserted central catheters (PICCs) and non-invasive mechanical ventilation. Invasive procedures must be avoided as much as possible.

Key words: low-birth-weight pre-term infants, nosocomial infections, risk factors, umbilical venous catheters, NICU, PICC, mechanical ventilation, high-flow nasal cannula

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Treatment with Erythropoietin in Neonatology

Abstract

The article presents the basics and control of erythropoiesis in the fetus and the newborn, the development of anaemia of prematurity and its treatment, with an emphasis on the use of human recombinant erythropoietin. The Intensive Care Unit of the Paediatric Clinic Maribor began treating anaemia of prematurity with erythropoietin in 2000. After introducing the treatment, the clinic found that the number of blood product transfusions and the needed blood volume decreased. In addition to erythropoietin, this was the result of stricter criteria for applying transfusion of concentrated erythrocytes.

Key words: preterm infant, anaemia of prematurity, erythropoietin, transfusion

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Holistic and team approach in health care

Abstract

Holistic medicine means consideration of the complete person, physically, psychologically, socially, and spiritually, in the management and prevention of disease. These different states can be equally important. All healthcare practitioners should aspire towards a holistic approach to patients and attempt to practice it. Recognizing the ‘whole’ person in the prevention and treatment of a disease may hold the key to some diagnoses for doctors. It may also allow valuable and important help and guidance to be given to the patient. Patients tend to be more satisfied if a doctor takes a holistic approach, feeling that their doctor has time for them and their problems. In addition to a holistic approach, a team approach to a patient is also extremely important. There are three types of teams: a multidisciplinary, interdisciplinary and transdisciplinary team. Which team will be used depends on the possibility, knowledge and the patients’ needs. In a team approach the patient is the main focus and is thus the responsibility of every member of the team. The team has a responsibility towards one another to have open communication channels and mutual respect for different professions. Each member of the team should know his or her own abilities and limitations. In many articles the outcomes of treatment with a team approach have been reported positively, with no reports of negative consequences of team intervention. Furthermore, the use of a team approach has been demonstrated in all healthcare settings across the continuum. Forming a multidisciplinary team is only one aspect of providing a multidisciplinary health care service. Developing systems and resources that ensure the team can function effectively is also essential.

Key words: holistic approach, team work, multidisciplinary, interdisciplinary, transdisciplinary

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