Mobbing, kişilerin etrafında, kişiliğine bağlı olarak tek veya fazla sayıda taraftar toplayarak zarar verilmek istenen kimseye baskı kurması, dalga geçmesi, çalıştığı işyerinde saygınlığını ...zedeleyecek girişimlerde bulunarak işi terk etmeye zorlaması şeklinde tanımlanabilir. Bu tür ruhsal saldırılar duygusal tükenme, duyarsızlaşma ve kişisel başarı hissinde azalma şeklinde kişilerde tükenmişliğe neden olabilmektedir. Mobbing davranışlarının hastane personeli üzerinde tükenmişliğe ne derece etkili olduğunu amaç edinen çalışmada bir kamu üniversitesi hastanesi çalışanlarına doğrudan uygulanan anket yöntemiyle veriler elde edilmiş ve SPSS 22.0 yardımıyla analiz edilmiştir. Korelasyon analizinde, mobbing davranışları ile çalışanların tükenmişliği arasında pozitif yönlü güçlü, istatistiksel bakımdan anlamlı ilişki olduğu ve doğrusal regresyon analizi ile mobbing davranışı ortalamasındaki bir puanlık artış tükenmişlik düzeyini 0,57 puan arttırmaktadır. Tek yönlü anova testine göre, öğrenim düzeyi değişkeninin bireylerin kişisel başarı hissinde azalma ortalamalarını istatistiksel olarak etkilediği; t testi ile medeni durum değişkeninin bireylerin duygusal tükenme ortalamaları ile kişisel başarı hissinde azalma ortalamalarını istatistiksel olarak etkilemediği tespit edilmiştir.
Mobbing can be defined as putting pressure on the person who wants to be harmed by gathering a single or more supporters around people, depending on their personality, making fun of them, and forcing them to leave their job by making attempts to damage their reputation in the workplace. Such mental attacks can cause burnout in individuals in the form of emotional exhaustion, depersonalization and a decrease in personal accomplishment. In the study aiming to what extent mobbing behaviors are effective on burnout on hospital staff, data have been obtained with a questionnaire method applied directly to a public university hospital staff and analyzed with the help of SPSS 22.0. In correlation analysis, there is a positive strong, statistically significant relationship between mobbing behavior and employee burnout, and a one-point increase in the average mobbing behavior with linear regression analysis increases the burnout level by 0.57 points. According to the one-way ANOVA test, it has been found that the education level variable has a statistically significant effect on the average decrease in individuals' sense of personal accomplishment; With the t test, it has been determined that the marital status variable does not statistically affect the individuals' average emotional exhaustion and the decrease in their sense of personal accomplishment.
Background To determine predictors of mortality after surgical management of post-infarction ventricular septal rupture repair. Methods A total of 63 patients (73.2%, mean age 67.22±7.71 years, ...male:female ratio; 35:28) underwent open heart surgery for post-infarction ventricular septal rupture repair. Patient demographics, operative data and postoperative parameters were analysed to reveal predictors of early mortality and long-term survival. Results In-hospital mortality was 54.0% (34/63). Time from myocardial infarction to operation ≤ 14 days (OR: 4.10, 95% CI 1.16-14.46, p=0.02), systolic pulmonary artery pressure > 45 mmHg (OR: 4.14, 95% CI 1.110-15.496, p=0.03) and age (years) (OR: 1.09, 95% CI 1.002-1.194, p=0.04) were found to be independent predictors of in-hospital mortality. In multivariate Cox regression analysis, presence of pulmonary oedema on admission (HR: 4.95, 95% CI 1.58-15.54, p=0.006), age (years) (HR: 1.09, 95% CI 1.009-1.180, p= 0.02) and cross-clamp time <60 min (HR: 3.93, 95% CI 1.13-13.64, p=0.03) were found to be independent predictors of long-term survival. Within a follow-up of a median of 60.0 months, five-year survival rate was 67±9.0%. Conclusion In line with the previous studies, our study demonstrated the benefits of delaying the repair for post-infarction ventricular septal rupture to allow adequate myocardial healing if haemodynamic status of the patient allows.
Prosthetic vascular access is the other choice when the superficial venous system is inadequate to perform a simple radio-cephalic and brachio-cephalic fistula.
This paper reports the outcomes of a ...prospective cohort study of 54 patients who underwent either saphenous vein (SVI Group, n=29) or PTFE graft (PTFE Group, n=25) interposition surgery for prosthetic hemodialysis access. All patients were evaluated via color Doppler ultrasonography during preoperative course and superficial venous systems of these patients were found inadequate to perform simple radial/brachial artery-cephalic vein anastomosis. Follow-up was performed for every 6-months period. Kaplan-Meier analysis and Log Rank test was used for estimation and comparison of the patency.
In SVI group access failure was observed in 5 of 29 patients (17.2%). In PTFE group, access failure was observed in 13 of the 25 patients (52%). Primary patency rate was 93% in 12th month and 82% in 24th month in SVI group while it was 88% in 12th month and 56% in 24th month in PTFE group. According to the Kaplan-Meier method, mean time of primary patency was significantly higher in SVI group when compared to PTFE group (33.03±1.32 months vs. 28.16±1.91 months, Log Rank chi-square value: 7.01, df:1, p=0.008). Secondary patency rate was 96% in 12th month and 93% in 24th month for SVI group while 96% in 12th month and 84% in 24th month for PTFE group. According to the Kaplan-Meier method, mean time of secondary patency was significantly higher in SVI group when compared to PTFE group (34.27±0.95 months vs. 31.16±1.40 months, Log Rank chi-square value: 7.33, df:1, p=0.007).
Autologous saphenous vein can be preferably chosen as a prosthetic hemodialysis access graft due its higher primary and secondary patency, lower complication rate and cost when compared with PTFE grafts.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The aim of our study was to compare the outcome of patients who underwent mitral valve anterior leaflet repair with and without chordal replacement for degenerative mitral valve insufficiency.
This ...study was conducted at our center between May 2006 and May 2013. The study included 125 patients with degenerative mitral valve insufficiency (64 males, 61 females; mean age 47 years, age range 16-78 years) who underwent mitral valve repair with anterior leaflet procedures. The patients were divided into 2 groups. Group A consisted of 56 patients with chordal replacement, and group B consisted of 69 patients with other repair techniques performed.
No significant difference was determined between the 2 groups in mortality, recurrence, and reoperation rates. The mortality rate was 3.6% in group A and 1.4% in group B. During the follow-up period, 3 patients were reoperated on (mitral valve replacement) because of severe mitral valve insufficiency. Two of these patients were from group A (3.6%), and the other was from group B (1.4%). One patient in group A underwent intraoperative mitral valve replacement after unsuccessful chordal replacement. Fifty patients (89.3%) in group A and 65 patients (94.2%) in group B exhibited no or mild recurrence of mitral valve insufficiency.
Mitral valve repair in patients with degenerative mitral valve insufficiency resulting from anterior leaflet pathology is a safe procedure because of its durability and good long-term results. Despite the difficulty of the chordal replacement procedure, it may be used as an alternative technique for anterior mitral valve leaflet repair.
In this case report, we present a patient scheduled for operation due to critical leg ischemia in whom a bilateral great saphenous vein (GSV) had already been used during previous cardiac and ...peripheral vascular surgeries. The patient underwent femorofemoral crossover bypass from left to right with a small saphenous vein and right femoropopliteal bypass with cephalic vein (CV) during the same session. Distal pulses became palpable, and symptoms regressed dramatically following the operation. A control computed tomographic angiography scan revealed no signs of graft stenosis 32 months after the surgery. Despite the recent advances in synthetic graft materials, small saphenous and CVs should be remembered as alternative long-standing conduits in the absence of the GSV.
Background
Today, repair techniques almost completely take place of the mitral valve replacement, especially in patients with degenerative disease. Majority of the surgeons hesitate to prefer repair ...in patients with bileaflet prolapse. In this study we aimed to investigate postoperative results of our patients with mitral valve insufficiency due to bileaflet prolapse and treated with repair techniques
Methods
89 patients who underwent mitral valve repair by the same surgical team due to bileaflet prolapse, between January 2006 and January 2016 in Turkiye Yuksek Ihtisas Hospital were included to this study. Preoperative, operative and postoperative data such as mortality, recurrent mitral insufficiency, echocardiographic parameters and reoperation rates were investigated.
Results
Mean follow up duration was 25.3±17.7 months. Mean age was 46.6±17.4 years. According to the transthoracic echocardiographic evaluations, 8 (9%) patients had moderate and 81 (91%) patients had severe mitral insufficiency. When preoperative and postoperative values were compared statistically significant improvement in functional capacity of patients according to NYHA classification has been noted. (2.1±0.5 ; 1, , p=0.001) Improvements in left ventricular end diastolic diameter (5.5±0.7 cm ; 5±0.6 cm, p=0.001), left ventricular end sistolic diameter (3.8±0.6 cm ; 3.6±0.6 cm, p=0.004 ), left atrium diameter (4.8±0.9 cm ; 4.3±0.6 cm, p=0.001) and pulmonary artery pressure (44.3±13.4 mmHg; 32.1±5.4 mmHg, p=0.001) were statistically significant.
Conclusions
In the lights of findings about good postoperative results and durability rates, mitral valve repair can be safely used in patients with mitral valve insufficiency due to bileaflet prolapse especially with chordae replacement technique which can be feasible after improvements in suture technologies.
Giriş
Günümüzde mitral kapak onarım teknikleri, özellikle dejeneratif hastalığı olan hastalarda neredeyse tamamen mitral kapak replasmanının yerini almaktadır. Cerrahların çoğu biliflet prolapsusu olan hastalarda onarımı tercih etmekten çekinmektedir. Bu çalışmada mitral kapak yetmezliği olan ve biliflet prolapsusu nedeniyle onarım teknikleri ile tedavi edilen hastalarımızın ameliyat sonrası sonuçlarını araştırmayı amaçladık.
Metodlar
Bu çalışmaya Ocak 2006-Ocak 2016 tarihleri arasında Türkiye Yüksek İhtisas Hastanesi'nde biliflet prolapsus nedeniyle aynı cerrahi ekip tarafından mitral kapak tamiri yapılan 89 hasta dahil edildi. Mortalite, tekrarlayan mitral yetmezlik, ekokardiyografik parametreler ve tekrar operasyon oranları gibi preoperatif, operatif ve postoperatif veriler araştırıldı.
Bulgular
Ortalama takip süresi 25,3±17,7 aydı. Ortalama yaş 46,6±17,4 idi. Transtorasik ekokardiyografik değerlendirmelere göre 8 (%9) hastada orta, 81 (%91) hastada ciddi mitral yetmezlik vardı. Preoperatif ve postoperatif değerler karşılaştırıldığında, NYHA sınıflamasına göre hastaların fonksiyonel kapasitelerinde istatistiksel olarak anlamlı iyileşme kaydedilmiştir. (2,1±0,5 ; 1, , p=0,001) Sol ventrikül diyastol sonu çapında (5,5±0,7 cm ; 5±0,6 cm, p=0,001), sol ventrikül sistol sonu çapında (3,8±0,6 cm ; 3,6±0,6 cm, p=0,004), sol atriyum çapı (4,8±0,9 cm; 4,3±0,6 cm, p=0,001) ve pulmoner arter basıncındaki (44,3±13,4 mmHg; 32,1±5,4 mmHg, p=0,001) düzelemeler istatistiksel olarak anlamlıydı.
Sonuç
İyi postoperatif sonuçlar ve dayanıklılık oranları göz önünde bulundurularak, özellikle sütür teknolojilerindeki gelişmelerle mümkün olabilen korda replasman tekniği ile bileaflet prolapsusa bağlı mitral kapak yetmezliği olan hastalarda mitral kapak onarımı güvenle kullanılabilir.
Many mechanical complications associated with insertion, maintenance, and removal of the hemodialysis catheters have been reported in the literature. A 47-year-old man was consulted to our hospital ...because of an entrapped hemodialysis catheter guidewire. Computed tomographic scan revealed that the right subclavian vein was perforated by the guidewire and the wire was knotted over itself, one loop inside the vein and two loops in the extravascular site. Guidewire is pulled out from a 3-cm incision over the wire loops lateral to the right sternocleidomastoid muscle. He was discharged home on postoperative day 2 without any complication. Our suggestion is that any abnormal resistance should be immediately evaluated for the presence of any potential knots using the most appropriate imaging technique.
Acute aortic dissection is a life-threatening cardiovascular emergency. Neutrophil-to-lymphocyte ratio is proposed as a prognostic marker and found to be related to worse clinical outcomes in various ...cardiovascular diseases. The aim of the present study was to evaluate the relationship between admission neutrophil-to-lymphocyte ratio and in-hospital mortality in acute type I aortic dissection.
We retrospectively evaluated 123 consecutive patients who had undergone emergent surgery for acute type I aortic dissection. Patients were divided into 2 groups as patients dying in the hospital (Group 1) and those discharged alive (Group 2). All parameters, including neutrophil-to-lymphocyte ratio, were compared between the 2 groups and predictors of mortality was estimated by using multivariate analysis.
A total of 104 patients (79 males, mean age: 55.2 + 14 years) were included in the final analysis. In multivariate analyses, cross- clamp time, cardiopulmonary bypass time, intensive care-unit duration, platelet count, and neutrophil-to-lymphocyte ratio were found to be independent predictors of mortality. Patients with higher neutrophil-to-lymphocyte ratios had a significantly higher mortality rate (hazard ratio: 1.05; 95% CI: 1.01-1.10; P = 0.033). Receiver operating characteristic analysis revealed that using a cut-off point of 8, neutrophil-to-lymphocyte ratio predicts mortality with a sensitivity of 70% and specificity of 53%.
This study suggests that admission neutrophil-to-lymphocyte ratio is a potential predictive parameter for determining the in-hospital mortality of acute type I aortic dissection.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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