Review Articles

After the implementation of Common Assessment Framework (CAF) – a useful quality tool – in the ICU of General Hospital of Trikala from 2012 up to 2015, we integrated the first cycle of self assessment and we present our results and conclusions of the past 3-year-period (2012- 2013 -2014). We analyzed CAF, FS- ICU 24, TISS-28 and Burn out syndrome questionnaires and medical indicators as Standardized mortality rate (SMR), Length of Stay (LOS), Standardized Resource Use (SRU), SMR/SRU, Therapeutic intervention scoring system (TISS-28), TISS-28/days of hospitalization, Nurse/Patient ratio, cost indicators and mortality. Analyzing the CAF questionnaire the score was 2.5-3.5, counting the indicator TISS-28 we found an average value higher than 50, concerning the burn-out syndrome questionnaire it was found that 58.82% of the respondent employees working in the ICU had mild symptoms of the syndrome. We analyzed the true Level of ICU (TISS-28/days of hospitalization) with the Level of ICU (nurse /patient ratio) and we found that they were not alike. We found an increase of mortality rate and LOS (length of stay) during the period of 2011 –2015 but a gradual reduction of the SMR/SRU indicator (the whole period ≤ 1) and a decline of the average cost/ patient and the average cost/ day of hospitalization.

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Postoperative pain management has become pre-requisite for early recovery after laparoscopic chole-cystectomy and the ideal management of it is definitely multimodal due to the complexity of its na-ture. Many analgesic approaches have already been tested to relieve pain after laparoscopic cholecys-tectomy and anticonvulsants drugs, like pregabalin and gabapentin might be useful and effec-tive.Pregabalin is an antiepileptic drug that is often used to treat neuropathic pain. The use of pre-gabalin as part of multimodal analgesia is still under evaluation and may have a role in the postopera-tive management, as an adjunct. Several studies have evaluated the efficacy and adverse effects of pregabalin in reducing postoperative pain and opioid consumption.In this review, we discuss the role of pregabalin in acute postoperative management after laparoscopic cholecystectomy. Based on avail-able clinical trials it is difficult to draw solid conclusions. More studies and especially well designed clinical trials are required in order to clarify the optimal dose and the duration of therapy before adopt-ing pregabalin in routine clinical practice.

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Pain is a disastrous manifestation of cancer that influences the patients’ quality of life, their families, and health care providers. It is a multidimensional symptom that includes the physical, psychosocial, emotional and spiritual character of the human organism. Despite the development of new analgesic drugs and updated guidelines, the pain management remains insufficient, and some patients with mild to severe pain do not received adequate pain treatment. This insufficient management can be attributed to barriers related to health professionals, to the patients, and the health care system. Common professional barriers include the bad pain evaluation, the lack of knowledge and skills, and the doctors’ reluctance to prescribe opioids. The barriers related to the patient include cognitive factors, emotional factors, and the compliance with analgesic regimens. Barriers related to the health system, like the limited access to opioids, and limited availability of pain and palliative care experts, consist additional challenges, especially in poor countries. Given the multidimensional nature of cancer pain, and the multilevelbarriers involved, the effective pain management demands multimodal interventions from interscientific groups. Educational interventions to the patients and health professionals it is possible to improve the successof pain management.

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The objective of postoperative pain management after thoracotomy is the prevention of postoperative complications, the reduction of the length of hospital stay, the increase of the patient’s satisfaction and finally the resumption of the daily living’s normal activities.

Thoracic surgery affects postoperative respiratory function, along with a high risk of developing postoperative pulmonary complications. Pain is a subjective experience. Postoperative pain management in thoracic surgery patients should be individually applied, based on a well-organized health care system that emphasizes consistent nursing education regarding proper pain management techniques, with an effective communication between the patient and members of the existing multidisciplinary team, especially the nursing staff.

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Fractures of the proximal femur are of the most frequent, especially in elderly patients. The increased frequency of these fractures highlights the need for effective management of those patients and the impact of these fractures regarding the cost to the national health system. The effects of pain in elderly patients is extremely aggravating, frequently leading to mental (confusion, delirium) and physical (cardiovascular) deterioration and complications.

The pain management of these patients in the emergency department (ED) with intravenous administered analgesics might complicate the status of these patients. The use of non-steroidal anti-inflammatory drugs (NSAID’s) might increase the risk of gastric ulceration, gastric haemorrhage and coronary syndromes, while the use of IV opioids–especially in elderly-incorporates the risk of respiratory depression, delirium, hypotension and constipation. The pain management of these patients with the use of fascia iliaca block applied in ED, or even in a prehospital setting from doctors of various specialties, paramedics or nurses seems to gain acceptance because of its steep learning curve, the simple technique, the high success rate and the low rate of significant complications.

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Οι δυσκολίες ή η αποτυχία στην διαχείριση του αεραγωγού είναι κοινοί παράγοντες που οδηγούν στο θάνατο και στην εγκεφαλική βλάβη, ως άμεσο αποτέλεσμα της αναισθησίας.

Η πρόβλεψη του δύσκολου αεραγωγού επιτρέπει στους αναισθησιολόγους να προετοιμαστούν για αυτό το δύσκολο κλινικό σενάριο. Παρά το γεγονός ότι η δυνατότητα να προβλέψουμε με ακρίβεια έναν δύσκολο αεραγωγό προεγχειρητικά έχει μεγάλη αξία, είναι προφανές από τη βιβλιογραφία ότι καμία μεμονωμένη αξιολόγηση των αεραγωγών δεν μπορεί να προβλέψει αξιόπιστα έναν δύσκολο αεραγωγό. Ο σκοπός της παρούσας εργασίας είναι να ορίσει τον δύσκολο αεραγωγό και να επανεξετάσει την τρέχουσα βιβλιογραφία σχετικά με τις μεθόδους που χρησιμοποιούνται για την πρόβλεψη του.

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The incidence of preeclampsia in the western countries is estimated to range from 2% to 6% in healthy, nulliparous women. In developing nations, the incidence of the disease is reported to be 4- 18%,with hypertensive disorders being the second most common obstetric cause of stillbirths and early neonatal deaths in these countries Etiology of the disease is multifactorial, with risk factors like ma-ternal age, oxidative stress, angiotensin T-235 homozygote having a different role in every case. Moreover, the disease its self is a multisystem expression of a complicated pathophysiology. Many attempts to explain the latter have been made with often controversial results. In the present article we explore the hypothesis of intra-abdominal pressure as possible causative factor of preeclampsia and the role ofthe maternal venous compartment and rennin-angiotensin-anldosterin system in this hypothesis. Continue reading
Effective postoperative analgesia in geriatric patients is both challenging and rewarding. Inadequate pain control after surgery is associated with adverse outcomes in the older patient. This review will attempt to describe the difficulty with assessment of pain and variations in pain experience of elder-ly patients. Physiological changes related to aging need to be also carefully considered, because a-ging is individualized and progressive. Pharmacokinetic and pharmacodynamic changes in geriatric patients, the higher incidence of co-morbidities and concurrent use of other drugs, must be carefully adjusted to suit each geriatric patient, concerning postoperative pain management. Medication for postoperative pain will be discussed. Unfortunately, many medications have not been studied well in the older population.Non-pharmacological approaches to postoperative pain management will not be discussed, although this would be an interesting topic for further discussion. Continue reading

Delirium, a serious and common manifestation of brain dysfunction in critically ill patients gained great attention over the last decade. Important risk factors such as use of benzodiazepines, coma, preexisting cognitive impairment, alcoholism and high severity of illness at ICU admission were i-dentified. Screening tools like the CAM-ICU and the ICDSC were extensively validated in many different ICU patient populations and are recommended for routine monitoring in everyday practice. Sedation with novel sedatives such as dexmedetomidine, implementation of non pharma-ceutical, preventive interventions and early mobilization of patients may reduce the incidence of this syndrome. The role of haloperidol and atypical antipsychotics in the prevention and treatment of ICU delirium is still under investigation.

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