Anticipating Moral Injury In Medical Students Ivanović Martić, Laura; Katić, Borna; Zibar, Lada
Liječnički vjesnik,
4/2023, Letnik:
145, Številka:
Supp 2
Web Resource, Journal Article
Introduction: Present study examined the frequency of CMV infection during follow-up using quantitative nucleic acid amplification testing, the frequency of administration of infection prophylaxis, ...viremia and infection in kidney transplant recipients who underwent transplantation (TX) at the University Hospital Center Osijek.
Materials and Methods: 107 kidney recipients who underwent transplantation in the period 20 October 2007 – 24 August 2016 were included. Demographic and clinical data, data about pre-transplantation CMV IgG test results of recipients and their donors, data about CMV prophylaxis, viremia, infection, and kidney transplant function were taken from medical records and analyzed.
Results: 92.5% of kidney recipients and 86% of donors were CMV IgG positive before TX. 28% of recipients were CMV-DNA positive at some point after TX, none of whom received a transplant from an IgG negative donor. 89.7% of participants received CMV prophylaxis. Seven participants developed CMV disease, 2 of whom were not administered prophylaxis. Participants were tested for CMV-DNA once a year (median; min 0 max 6). CMV disease was marginally more frequent in those who did not receive valganciclovir prophylaxis (P = 0.066).
Conclusion: It seems wise to enforce the administration of CMV prophylaxis and CMV-DNA testing in accordance with protocol, in order to detect viremia on time and to implement preemptive treatment, aiming at prevention of clinical manifestation of infection and preservation of graft function.
Aim: Since its beginning, the COVID-19 pandemic has affected many people’s usual activities and lifestyle, including Croatian students’ lives. The aim of the study was to examine whether the ...attitudes and behaviour of students in the biomedical (B) field differed from those in other (O) fields at the Josip Juraj Strossmayer University of Osijek (JJSUO). The hypothesis was that B students would behave more responsibly.
Materials and Methods: A 10-question anonymous online survey on attitudes and behaviour related to the COVID-19 pandemic was designed and conducted. The research was carried out in November 2020 and it included a total of 348 students (46 % of B students) at the JJSUO. The data were statistically processed by the IBM ® SPSS ® Statistics 25.0 software at the statistical significance level of P < 0.05.
Results: Twenty-five percent of B students and 11.17 % of O students (P = 0.001) responded that they did not go to nightclubs, in accordance with the Civil Protection Headquarters’ recommendations. Regarding their indoor socialising, 24.38 % of B students and 45.21 % of O students behaved the same as before the pandemic (P < 0.01). A total of 63.13 % of B and 39.36 % of O students (P < 0.01) responded that they would receive a vaccine against SARS-CoV-2.
Conclusion: B students behaved more responsibly than O students by reducing their socialising and going to crowded places, probably because of their education and awareness of the severity of COVID-19. Accordingly, more of them were willing to get the vaccine against SARS-CoV-2..
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis-induced myocardial dysfunction represents reversible myocardial dysfunction which ...ultimately results in left ventricular dilatation or both, with consequent loss of contractility. Studies on septic cardiomyopathy report a wide range of prevalence ranging from 10% to 70%. Myocardial damage occurs as a result of weakened myocardial circulation, direct myocardial depression, and mitochondrial dysfunction. Mitochondrial dysfunction is the leading problem in the development of septic cardiomyopathy and includes oxidative phosphorylation, production of reactive oxygen radicals, reprogramming of energy metabolism, and mitophagy. Echocardiography provides several possibilities for the diagnosis of septic cardiomyopathy. Systolic and diastolic dysfunction of left ventricular is present in 50-60% of patients with sepsis. Right ventricular dysfunction is present in 50-55% of cases, while isolated right ventricular dysfunction is present in 47% of cases. Left ventricle (LV) diastolic dysfunction is very common in septic shock, and it represents an early biomarker, it has prognostic significance. Right ventricular dysfunction associated with sepsis patients with worse early prognosis. Global longitudinal stress and magnetic resonance imaging (MRI) of the heart are sufficiently sensitive methods, but at the same time MRI of the heart is difficult to access in intensive care units, especially when dealing with critically ill patients. Previous research has identified two biomarkers as a result of the integrated mitochondrial response to stress, and these are fibroblast growth factor-21 (FGF-21) and growth differentiation factor-15 (GDF-15). Both of the mentioned biomarkers can be easily quantified in serum or plasma, but they are difficult to be specific in patients with multiple comorbidities. Mitochondrial dysfunction is also associated with reduced levels of miRNA (microRNA), some research showed significance of miRNA in sepsis-induced myocardial dysfunction, but further research is needed to determine the clinical significance of these molecules in septic cardiomyopathy. Therapeutic options in the treatment of septic cardiomyopathy are not specific, and include the optimization of hemodynamic parameters and the use of antibiotic thera-pies with targeted action. Future research aims to find mechanisms of targeted action on the initial mechanisms of the development of septic cardiomyopathy.Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis-induced myocardial dysfunction represents reversible myocardial dysfunction which ultimately results in left ventricular dilatation or both, with consequent loss of contractility. Studies on septic cardiomyopathy report a wide range of prevalence ranging from 10% to 70%. Myocardial damage occurs as a result of weakened myocardial circulation, direct myocardial depression, and mitochondrial dysfunction. Mitochondrial dysfunction is the leading problem in the development of septic cardiomyopathy and includes oxidative phosphorylation, production of reactive oxygen radicals, reprogramming of energy metabolism, and mitophagy. Echocardiography provides several possibilities for the diagnosis of septic cardiomyopathy. Systolic and diastolic dysfunction of left ventricular is present in 50-60% of patients with sepsis. Right ventricular dysfunction is present in 50-55% of cases, while isolated right ventricular dysfunction is present in 47% of cases. Left ventricle (LV) diastolic dysfunction is very common in septic shock, and it represents an early biomarker, it has prognostic significance. Right ventricular dysfunction associated with sepsis patients with worse early prognosis. Global longitudinal stress and magnetic resonance imaging (MRI) of the heart are sufficiently sensitive methods, but at the same time MRI of the heart is difficult to access in intensive care units, especially when dealing with critically ill patients. Previous research has identified two biomarkers as a result of the integrated mitochondrial response to stress, and these are fibroblast growth factor-21 (FGF-21) and growth differentiation factor-15 (GDF-15). Both of the mentioned biomarkers can be easily quantified in serum or plasma, but they are difficult to be specific in patients with multiple comorbidities. Mitochondrial dysfunction is also associated with reduced levels of miRNA (microRNA), some research showed significance of miRNA in sepsis-induced myocardial dysfunction, but further research is needed to determine the clinical significance of these molecules in septic cardiomyopathy. Therapeutic options in the treatment of septic cardiomyopathy are not specific, and include the optimization of hemodynamic parameters and the use of antibiotic thera-pies with targeted action. Future research aims to find mechanisms of targeted action on the initial mechanisms of the development of septic cardiomyopathy.
Cilj istraživanja: Ispitati informiranost studenata fakulteta sastavnica Sveučilišta Josipa Jurja Strossmayera (JJS) u Osijeku o opt-out zakonu o doniranju organa nakon moždane smrti koji je ...trenutačno važeći u Hrvatskoj. Ispitanici i postupci: U presječnom istraživanju provedenom od 2. do 19. veljače 2023. sudjelovalo je 1.105 studenata Sveučilišta JJS u Osijeku. Podatci su prikupljeni pomoću online upitnika koji su sastavili autori, „snowball“ metodom. Statistički su obrađeni χ2 testom, uz statističku značajnost P < 0,05. Rezultati: Medijan dobi bio je 22 (interkvartilni raspon 21 – 23) godine. 71,6% bilo je ženskog spola. 22,5% studenata mislilo je da zna važeći zakon u Hrvatskoj o doniranju organa nakon moždane smrti, dok je 21% znalo objašnjenje toga zakona.
Objašnjenje moždane smrti znalo ih je 78,3%, stav Katoličke crkve o transplantaciji organa 31%, da je u Hrvatskoj zabranjeno doniranje organa radi stjecanja materijalne koristi 48,9%, a 30,5% da je Hrvatska u europskom i svjetskom vrhu prema broju doniranja i transplantacije organa (na milijun stanovnika). Studenti s medicinskog,
drugoga zdravstvenog i pravnog fakulteta značajno su češće od ispitanika ostalih fakulteta mislili da znaju važeći zakon (P < 0,001), objašnjenje tog zakona (P < 0,001), objašnjenje moždane smrti (P < 0,001), stav Katoličke crkve o transplantaciji organa (P = 0,005), da je u Hrvatskoj zabranjeno doniranje organa radi stjecanja materijalne koristi (P = 0,013) i da je Hrvatska u europskom i svjetskom vrhu prema broju doniranja i transplantacije organa (P < 0,001). Zaključak: Studenti su pokazali slabo poznavanje opt-out zakona o doniranju organa nakon moždane smrti i nedovoljnu informiranost o toj temi te samim time često ni sami ne znaju da su donori nakon moždane smrti ako se za života ne izjasne drukčije. Ipak, studenti medicine, drugih zdravstvenih studija i prava bili su bolje upoznati od ostalih, no, potrebno ih je sve o tome educirati.
Cilj istraživanja: Predstaviti iskustva našega transplantacijskog središta vezano za odstranjivanje tuneliranoga dijaliznog katetera (TDK) nakon bubrežne presadbe (TX, od engl. transplantation). ...Optimalno vrijeme uklanjanja TDK-a nakon TX-a nije poznato. Ispitanici i postupci: U 41 bolesnika (24 muška, medijan dobi 60 godina, 30 – 73) učinjeno je odstranjivanje TDK-a nakon TX-a (izolirano bubreg ili simultano s gušteračom ili jetrom) od 1. srpnja 2018. do 30. lipnja 2023. (tri od živog darovatelja, ostalo od preminulih). Ukupan broj bolesnika s TDK-om zbog provođenja hemodijalize (HD) u vrijeme TX-a među ukupno 249 bolesnika kojima je u opisanom razdoblju učinjen TX u našem središtu bio je 41 (16,5%). Vrijeme odstranjivanja planirano je nakon prve
protokolarne biopsije bubrega dva mjeseca nakon TX-a, a odluka je temeljena na rezultatima biopsije i stabilnoj funkciji presatka. Kateter je odstranjen standardnim postupkom, a pacijent je otpušten nekoliko sati poslije u slučaju izostanka razvoja komplikacija. Rezultati: Trideset i sedam bolesnika imalo je Hickmanov, a četiri Tesio tip
TDK-a, njih dvadeset i devet smješten u desnoj, osam u lijevoj unutarnjoj jugularnoj veni, tri u desnoj potključnoj veni, te jedan u lijevoj femoralnoj veni. Medijan vremena odstranjivanja TDK-a nakon TX-a (n = 36) bio je četiri mjeseca (1 – 14, interkvartilni raspon 2 – 5). Kaplan-Meierova analiza s pet cenzoriranih slučajeva koji još uvijek
čekaju odstranjenje TDK-a pokazala je medijan vremena od TX-a do uklanjanja TDK-a od četiri mjeseca, 95% intervali pouzdanosti 3,249 – 4,751. Jedan bolesnik imao je znakove infekcije tunela, a jedno odstranjivanje učinjeno je zbog sepse koja nije bila povezana s kateterom. Tri bolesnika su imala neuspjeh pri prvom odstranjivanju katetera, a jedan je imao umjereno poslijeproceduralno krvarenje. Zaključci: Iskustvo našeg središta pokazuje sigurnost u pristupu uklanjanja TDK-a tri do pet mjeseci nakon TX-a, s malim rizikom infekcije i krvarenja.
Introduction: To determine the prevalence and rate of employment of patients on renal replacement therapy (RRT) for end-stage renal disease (ESRD), to study the difference in the rate of employment ...between patients on hemodialysis (HD) and those with functioning kidney transplant (FKT) and to compare the rate of employment with patients’ opinions about their working ability and determine the possible reasons for the presumed disproportion..
Methods: 220 RRT patients (126 on HD and 94 with FKT) at the University Hospital Centre Osijek were surveyed. We created and used a questionnaire about the level of education, occupation, employment, professional timeline during the course of RRT, personal opinion about working ability and potential reasons for unemployment. Research was conducted during April and May 2017. The data were analyzed using SPSS (version 16.0. Inc., Chicago, IL, USA).
Results: At the time of our research, 13.7% of patients on RRT were employed. Employment of FKT patients prevailed, without significant difference compared with dialyzed patients of working age (15 to 65 years old). 38.3% of patients in that age group felt capable of working. Transplantation did not improve access to employment. Highly educated people were employed more frequently. The main reasons for unemployment were poor health caused by CKD, advanced age, and employers’ unwillingness to hire chronically ill persons because of the potential need to adjust working hours.
Conclusion: CKD reduced working ability and employment opportunities. Only a minority of patients on RRT were employed. Kidney transplantation did not increase the rate of employment. Patients should therefore be provided with education, appropriate guidelines and support for finding employment.
Impedance Cardiography (ICG) is a non-invasive tool for continuous hemodynamic monitoring. Aims of our study were to assess the utility of ICG to evaluate the hemodynamic impact of 6 mg (GL6) vs 8 mg ...(GL8) levobupivacaine combined with fentanyl in healthy patients undergoing elective cesarean section; secondary, to compare the duration and quality of analgesia and anesthesia.
Sixty-two women receiving combined spinal-epidural (CSE) for elective cesarean delivery were randomly allocated to GL6 or GL8 groups. Mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), heart rate (HR), stroke volume index (SVI) were recorded from Tbaseline to 31 min after CSE by ICG. Sensory and motor blocks, patients and surgeons satisfaction, neonatal data were also recorded.
Fifteen of 32 patients in GL6 and 15 of 30 patients in GL8 experienced hypotension at T2 vs Tbaseline (P < .001) and SVRI reduction (P = .035 and P < .001 respectively). MAP, CI and SVRI were always slightly higher in GL6 vs GL8. HR and SVI remained stable until the end of surgery in all patients. Total ephedrine requirements was higher in GL8 (P = .010). The onset and offset time of sensory and motor block were similar in both groups, but the number of patients with motor block was lower in GL6 vs GL8 (P = .001). Patients and surgeon satisfaction scores, the number of patients needed systemic rescue doses, neonatal data were similar in both groups.
ICG is a useful noninvasive tool to monitor continuously hemodynamics during cesarean section. The hemodynamic stability, the satisfying sensory block and rapid mobilization provided by low levobupivacaine dose may be particularly advantageous in obstetric patients.
ClinicalTrials.gov: NCT03170427 . Retrospectively Registered (Date of registration: May 2017).
Aim: To determine the prevalence of employment of patients after liver transplantation (TX) and the history of employment, to compare employment with patients’ opinions about their ability to work ...and to establish possible reasons for frequent unemployment.
Methods: Ninety-eight respondents participated in the study. They were the first 98 liver transplant patients who came for a check-up at Merkur University Hospital by the time of the research and agreed to participate in the study. We created and used a questionnaire about the level of education and employment prior to and after the liver TX.
Results: Before the diagnosis of liver disease, 59.18 % of the patients were employed, while after liver TX, at the time of the research, the employment rate decreased to 8.2 %. During the same time span, the number of retired patients increased from 3.1 % before the diagnosis to 63.3 % after liver TX at the time of the research. The main reasons for unemployment were poor health due to liver disease and employers’ unwillingness to hire these patients because of a potential risk of adjustment of working hours. Median follow-up time after liver TX was 3 years (interquartile range 2 – 6).
Conclusion: Many patients with severe liver disease are unemployed. Liver TX did not increase the rate of employment of Croatian patients. Patients should be supported by society in finding appropriate employment.
(Holetić A, Đukić M, Zibar* L. Employment of Patients After Liver Transplantation. SEEMEDJ 2020; 4(1); 49-54)
Hemodijaliza (HD) je najčešća metoda nadomještanja bubrežne funkcije u svijetu. Tunelirani dijalizni kateteri (TDK) predstavljaju jednu od najčešće korištenih mogućnosti u osiguravanju žilnog ...pristupa za HD. Cilj retrospektivnog istraživanja bio je prikazati desetogodišnje iskustvo u postavljanju dijaliznih katetera u našem središtu. U razdoblju od 2012. do 2021. godine postavljeno je 1.660 dijaliznih katetera, od kojih su 80% bili TDK. Najčešće mjesto pristupa bila je desna unutarnja jugularna vena, potom lijeva unutarnja jugularna vena, femoralne vene te subklavijske vene. Svim bolesnicima dijalizni kateter je uspješno postavljen, a u postupcima je sudjelovalo dvanaest liječnika Zavoda za nefrologiju, od čega je sedam liječnika postavilo 89% svih katetera, a četvero
liječnika ima više od 300 postavljenih dijaliznih katetera po osobi. Zaključno možemo reći da organizirani programi postavljanja katetera osiguravaju velik broj bolesnika i iskustvo operaterima za učinkovito postizanje žilnog pristupa i najsloženijim bolesnicima.
PDF