Medicina

592 KiB

Open AccessArticle

The evaluation of knowledge and activities of primary health care professionals in promoting breast-feeding

by Giedra Levinienė, Aušra Petrauskienė, Eglė Tamulevičienė, Jolanta Kudzytė and Liutauras Labanauskas

Medicina 2009, 45(3), 238; https://doi.org/10.3390/medicina45030031 - 11 Mar 2009

Cited by 20 | Viewed by 1512

Abstract

The objective of this study was to evaluate the knowledge and activities of Kaunas primary health care center professionals in promoting breast-feeding.
Material and methods. A total of 84 general practitioners and 52 nurses participated in the survey, which was carried out [...] Read more.

The objective of this study was to evaluate the knowledge and activities of Kaunas primary health care center professionals in promoting breast-feeding.
Material and methods. A total of 84 general practitioners and 52 nurses participated in the survey, which was carried out in Kaunas primary health care centers in 2006. Data were gathered from the anonymous questionnaire.
Results. Less than half of general practitioners (45.1%) and 65% of nurses were convinced that baby must be exclusively breast-fed until the age of 6 months, but only 21.6% of general practitioners and 27.5% of nurses knew that breast-feeding with complementary feeding should be continued until the age of 2 years and longer. Still 15.7% of general practitioners and 25% of nurses recommended pacifiers; 7.8% of general practitioners advised to breast-feed according to hours. Half of the health professionals recommended additional drinks between meals; onethird of them – to give complementary food for the babies before the age of 6 months. One-third (29.6%) of the health professionals surveyed recommended mothers to feed their babies more frequently in case the amount of breast milk decreased.
Conclusions. The survey showed that knowledge of medical personnel in primary health care centers about the advantages of breast-feeding, prophylaxis of hypogalactia, and duration of breast-feeding was still insufficient. Full article

261 KiB

Open AccessArticle

Inpatients’ opinion on quality of health care

by Daiva Brogienė and Romualdas Gurevičius

Medicina 2009, 45(3), 226; https://doi.org/10.3390/medicina45030030 - 11 Mar 2009

Cited by 1 | Viewed by 1043

Abstract

The aim of the study was to assess the inpatients’ opinion on the quality of hospital care based on the factor analysis and to identify the problem-oriented fields in quality of care.
Material and methods. A multistage stratified probability sampling was performed [...] Read more.

The aim of the study was to assess the inpatients’ opinion on the quality of hospital care based on the factor analysis and to identify the problem-oriented fields in quality of care.
Material and methods. A multistage stratified probability sampling was performed in 22 general hospitals in Lithuania. A total of 2060 questionnaires were distributed during November 2006 and February 2007. The response rate was 97.38%; 2006 inpatients responded to the questionnaire; 1917 questionnaires (93.06%) were eligible for analysis. The modified survey instrument of Picker Institute Europe was used for inpatients. The method of survey was follows: each discharged inpatient filled out the questionnaire on the day of his/her discharge. The assessment of quality of care involved such aspects as patients’ communication with medical personnel, organizational issues and coordination of care, patients’ possibility of participation in medical decision-making, physical environment, accessibility to services, and safety of health care.
Results. Six dimensions were identified from the factor analysis, explaining 51.48% of the variance. Cronbach alpha was 0.7931 for all dimensions. The majority (91.9%) of respondents evaluated health care services as good and very good. Inpatients were most satisfied with communication with their doctors. Even 91.5% of respondents noted that the doctors provided enough information about their health and treatment. The majority of inpatients gave high positive responses on respect showed to them and confidence with doctors. Correlation analysis confirmed a stronger positive correlation among three items of the global assessment of the quality and patients’ ratings on respect and confidence. Several problems were highlighted in the field of patients’ autonomy. The possibility of participation in medical decision-making was the dimension with the lowest level of patients’ rating. Less than half (42.3%) of inpatients noted that they did not have a possibility of participation in medical decision-making to the extent they were willing.
Conclusions. Patients gave highly positive responses on the overall evaluation of the quality of health care services. The priority field in the improvement of health care quality is to create more possibilities for patients’ participation in medical decision-making. Results of the present study indicate that future studies need to include more detailed measurements of patients’ autonomy as dynamic changes are observed today in this field. Full article

198 KiB

Open AccessArticle

Monitoring changes in heart tissue temperature and evaluation of graft function after coronary artery bypass grafting surgery

by Raimundas Lekas, Povilas Jakuška, Algimantas Kriščiukaitis, Vincentas Veikutis, Gintautas Dzemyda, Tomas Mickevičius, Kristina Morkūnaitė, Alina Vilkė, Povilas Treigys, Genuvaitė Civinskienė, Jonas Andriuškevičius, Tomas Vanagas, Kęstutis Skauminas and Jurga Bernatonienė

Medicina 2009, 45(3), 221; https://doi.org/10.3390/medicina45030029 - 11 Mar 2009

Cited by 7 | Viewed by 1078

Abstract

Thermography is a relatively new contact-free method used in experimental and clinical studies and in cardiovascular surgery to investigate the myocardium and coronary artery function. Objects of complex study included mongrel dogs and patients with coronary artery disease who underwent cardiac surgery. For [...] Read more.

Thermography is a relatively new contact-free method used in experimental and clinical studies and in cardiovascular surgery to investigate the myocardium and coronary artery function. Objects of complex study included mongrel dogs and patients with coronary artery disease who underwent cardiac surgery. For active dynamic thermography, we used a thermovision camera “A20V” (FLIR Systems, USA). Our data indicate that both experimental and clinical study performed on beating hearts could be an important approach to interoperation inspection of autovenous graft function. An infrared camera also can be successfully used to determine the extent of ischemic damage to the myocardium, heart, and blood vessels during surgery as a significant prognostic tool for evaluating outcome after cardiac operation. Full article

198 KiB

Open AccessArticle

Parameters of the spectral analysis of the heart rate variability in treating depression

by Sergejus Andruškevičius

Medicina 2009, 45(3), 214; https://doi.org/10.3390/medicina45030028 - 11 Mar 2009

Cited by 5 | Viewed by 1264

Abstract

The objective of this work was to study circadian rhythms of the indicators of the spectral analysis of the heart rate variability in case of depression.
Materials and methods. A total of 37 patients, with a mean age of 46.7±10.3 years, were [...] Read more.

The objective of this work was to study circadian rhythms of the indicators of the spectral analysis of the heart rate variability in case of depression.
Materials and methods. A total of 37 patients, with a mean age of 46.7±10.3 years, were examined. According to the International Classification of Disease, 10th revision (ICD-10), endogenous depression was diagnosed for all of them (F 31.3–31.4, F 32.0–32.2, F 33.0–33.2). To assess the variability of the heart rhythm, the spectral analysis was used. The patients were examined at 1 AM, 7 AM, 1 PM, 7 PM prior to the beginning of treatment, following one week, and upon leaving the inpatient department. The control group consisted of 15 mentally healthy people.
Results. Before the beginning of treatment, desynchronization of circadian rhythms of the indicators studied and the sleep-wake cycle, the increase in the spectrum power within lowfrequency (LF) range, and the decrease in the spectrum power within high-frequency (HF) range were observed. Reduction of depression symptoms was followed by resynchronization of the rhythms under study, with a spectrum power within LF range being increased and that within HF range – decreased.
Conclusions. Changes in depression symptoms and chronobiological disorders testify to their close pathogenetic link. Full article

257 KiB

Open AccessArticle

Reduction of nosocomial infections and mortality attributable to nosocomial infections in pediatric intensive care units in Lithuania

by Vaidotas Gurskis, Jolanta Ašembergienė, Rimantas Kėvalas, Jolanta Miciulevičienė, Alvydas Pavilonis, Rolanda Valintėlienė and Algirdas Dagys

Medicina 2009, 45(3), 203; https://doi.org/10.3390/medicina45030027 - 11 Mar 2009

Cited by 14 | Viewed by 1222

Abstract

Objective. The aim of the study was to identify the most important risk factors for nosocomial infections, evaluate the incidence rates and risk changes after the multimodal intervention, and to assess mortality attributable to nosocomial infections.
Material and methods. This was a [...] Read more.

Objective. The aim of the study was to identify the most important risk factors for nosocomial infections, evaluate the incidence rates and risk changes after the multimodal intervention, and to assess mortality attributable to nosocomial infections.
Material and methods. This was a prospective surveillance study. Data were collected from January 2005 until December 2007 in three pediatric intensive care units. All patients aged between 1 month and 18 years hospitalized in units for more than 48 hours were included in the study. The patients were divided into preintervention (2006) and postintervention (2007) groups. The multimodal intervention included education of the staff and implementation of evidencebased infection control measures.
Results. A total of 755 children were included in the study. Major risk factors for nosocomial infections were identified: mechanical ventilation, central line, intracranial pressure device, and tracheostomy. Overall, the incidence rate (15.6 vs. 7.5 cases per 100 patients, P=0.002), incidence density (19.1 vs. 10.4 cases per 1000 patient-days, P=0.015), and the incidence of pneumonia (5.6 vs. 1.9 per 100 patients, P=0.016) have decreased in the postintervention as compared with the preintervention group. The relative risk reduction, absolute risk reduction, and number needed to treat were statistically significant for ventilator-associated pneumonia (66.5%, 3.7%, 27, respectively; P=0.016). There was no significant difference in survival time by the presence of nosocomial infection (83.67 patient-days without vs. 74.33 patient-days with infection, P>0.05)
Conclusions. The most important risk factors for nosocomial infections were mechanical ventilation, central line, intracranial pressure device, and tracheostomy. After the multimodal intervention, there was a statistically significant decrease in the incidence rates of nosocomial infections and the risk reduction for ventilator-associated pneumonia. No significant impact of nosocomial infections on mortality was determined. Full article

179 KiB

Open AccessArticle

Surgical treatment of acute type A aortic dissection

by Juozas Sakalauskas, Šarūnas Kinduris, Rimas Benetis, Saulius Giedraitis, Povilas Jakuška, Vladas Tamošiūnas and Ina Aleksonienė

Medicina 2009, 45(3), 192; https://doi.org/10.3390/medicina45030025 - 11 Mar 2009

Cited by 1 | Viewed by 1102

Abstract

The objective of this study was to evaluate the short-term results of surgical treatment in patients with acute aortic dissection.
Patients and methods. A retrospective analysis of 38 patients with acute type A aortic dissection who were surgically treated at the Clinic [...] Read more.

The objective of this study was to evaluate the short-term results of surgical treatment in patients with acute aortic dissection.
Patients and methods. A retrospective analysis of 38 patients with acute type A aortic dissection who were surgically treated at the Clinic of Cardiac, Thoracic, and Vascular Surgery, Hospital of Kaunas University of Medicine, from January 2004 to December 2007 was conducted. The diagnosis of aortic dissection was confirmed by employing special techniques. Two-dimensional transthoracic echocardiography was performed in 34 (89.5%) patients; transesophageal echocardiography, in 24 (63.1%); computed tomography, in 29 (76.3%); coronagraphy and angiography, in 20 (52.6%). Preoperative shock was reported in 3 (7.9%) and cardiac tamponade in 18 (47.4%) cases. More than half (57.9%) of patients were operated on within the first 24 hours after admission. In the majority of cases (73.7%), the diameter of the aorta exceeded 4 cm. In the presence of type A aortic dissection, all patients underwent surgery on cardiopulmonary bypass; its duration varied from 20 to 485 min, with a mean of 214.6±102.9 min. The mean aortic cross-clamp time was 114.5±62.7 min. Complete circulatory arrest was needed in the majority of cases (86.8%), and it lasted 2 to 97 min (mean, 27.4±18.6 min). During cardiopulmonary bypass, body temperature was decreased to 17–28°C (mean, 18.9±1.95°C). The duration of surgery ranged from 1 to 14 hours, with a mean of 6.1±2.49 hours. During the early postoperative period, 12 (31.6%) patients died. Postoperative bleeding was seen in 16 (42.1%) patients, and 6 of them died later. Due to prolonged bleeding, 4 (10.5%) patients were left with an open sternum after surgery. Resternotomy was performed in 9 patients; 3 of them died due to multiorgan injury. During postoperative period, cardiogenic shock of various degrees was seen in 7 (18.4%) patients. Central nervous system injury occurred in 9 (23.7%) patients.
Conclusion. The main risk factor for acute aortic dissection is the diameter of the aorta exceeding 4 cm (diagnosed in 73.7% of cases). The main postoperative complications are bleeding (42.1%), injuries of central nervous system (23.7%), and cardiogenic shock (18.4%). Full article

242 KiB

Open AccessArticle

Survival rate of patients with ascending aorta aneurysm and aortic valve regurgitation in the late postoperative period

by Rasa Čypienė, Arimantas Grebelis, Palmyra Semėnienė, Diana Zakarkaitė, Giedrė Nogienė, Giedrius Uždavinys and Vytautas Sirvydis

Medicina 2009, 45(3), 186; https://doi.org/10.3390/medicina45030024 - 11 Mar 2009

Viewed by 951

Abstract

The aim of the study was to evaluate the long-term survival in patients undergoing surgical treatment for chronic aortic aneurysms with aortic regurgitation.
Material and methods. We analyzed survival data of 188 patients during follow-up period of 1 month to 20 years [...] Read more.

The aim of the study was to evaluate the long-term survival in patients undergoing surgical treatment for chronic aortic aneurysms with aortic regurgitation.
Material and methods. We analyzed survival data of 188 patients during follow-up period of 1 month to 20 years postoperatively. The patients were divided into the following groups according to the clinical course: Group 1 – chronic dissecting aneurysm of ascending aorta with aortic regurgitation (42 patients, 22.3%); Group 2 – chronic nondissecting aneurysm of ascending aorta with aortic regurgitation (146 patients, 77.7%). Mean NYHA functional class of the patients was 3.5±0.06. In the Group 1, 64.3% of the patients were in NYHA functional class IV; 35.7% of the patients were in NYHA class III. In the Group 2, the majority of the patients (58.2%) were in class III; in class IV – 41.8%. The most common etiological factors in both groups were atherosclerosis, arterial hypertension, and Marfan’s syndrome.
Results. No differences in overall and long-term survival rates between the groups were found. However, the patients who were in class III before the operation showed significantly higher overall and long-term survival rates in comparison with the survival rate of the patients who were in NYHA class IV preoperatively (overall survival rate, 91.4±3.0% vs 62.9±6.9%; and long-term survival rate, 93.2±2.7% vs 72.9±5.6; respectively). There were 24 deaths (12.8%) during the late postoperative period. The main causes of death were progressive heart failure and infective prosthetic endocarditis (Group 2), chronic heart failure and dysfunction of the conduit (Group 1).
Conclusions. The analysis of patients’ long-term survival demonstrated the efficacy of surgical treatment of such a complex pathology as chronic aneurysm of the ascending aorta with aortic valve regurgitation. The survival rate in the late postoperative period was higher in NYHA class III patients. The main causes of death were chronic heart failure and infective prosthetic endocarditis. Full article

222 KiB

Open AccessArticle

Cross-cultural adaptation and validation of Lithuanian questionnaires for the spondyloarthropathies

by Lina Vencevičienė, Rita Rugienė, Algirdas Venalis and Irena Butrimienė

Medicina 2009, 45(3), 177; https://doi.org/10.3390/medicina45030023 - 11 Mar 2009

Viewed by 989

Abstract

Original English questionnaires – Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Patient Global Score, and Bath Ankylosing Spondylitis Disease Activity Index – are designed to evaluate health, physical and psychical state of patients with spondyloarthropathies and to assess efficiency of the treatment. [...] Read more.

Original English questionnaires – Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Patient Global Score, and Bath Ankylosing Spondylitis Disease Activity Index – are designed to evaluate health, physical and psychical state of patients with spondyloarthropathies and to assess efficiency of the treatment.
Objective. The objective of the study was to adapt Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Patient Global Score, Bath Ankylosing Spondylitis Disease Activity Index questionnaires to the Lithuanian context and examine their psychometric aspects: reliability and validity.
Patients and methods. Validation and linguistic and cultural adaptation of Lithuanian questionnaires were performed according to the requirements for adaptation of the international questionnaires. Psychometric features of Lithuanian questionnaires were examined in 139 patients with spondyloarthropathies. The validity of questionnaires was tested by comparing these questionnaires with Health Assessment Questionnaire Modified for Spondyloarthropathies, metrology indices (tragus-to-wall distance, lateral flexion, modified Schober’s distance, intermalleolar distance), pain intensity, patient’s well-being, physician’s assessment of the disease activity, and total enthesis count. The reliability of questionnaires was assessed by determining internal consistency of scales and scale stability and by calculating the intraclass correlation coefficient.
Results. The linguistic and cultural adaptation of these questionnaires was made during the study. Internal consistency was high for functional and disease activity index (Cronbach a³0.80) and moderate for the Bath Ankylosing Spondylitis Patient Global Score (Cronbach a=0.58). High stability in regard to time was characteristic of all three questionnaires (intraclass correlation coefficient >0.95). A significant association between the separate questions of examined instruments, their joint results and other factors reflecting patient’s health was established.
Conclusions. Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Patient Global Score, and Bath Ankylosing Spondylitis Disease Activity Index questionnaires in Lithuanian fully correspond to psychometric requirements. They are appropriate and relevant in assessing the influence of spondyloarthropathies on a patient’s health. Full article

183 KiB

Open AccessArticle

Aortic root surgery: Early postoperative results of different surgical techniques

by Rimantas Benetis, Eglė Ereminienė, Povilas Jakuška, Dainius Karčiauskas, Šarūnas Kinduris, Algimantas Budrikis, Adakrius Siudikas, Jolanta Justina Vaškelytė, Algimantas Sasnauskas, Juozas Sakalauskas and Kastytis Vaičiulis

Medicina 2009, 45(3), 197; https://doi.org/10.3390/medicina45030026 - 10 Mar 2009

Cited by 1 | Viewed by 956

Abstract

The aim of the study was to evaluate early postoperative results of different surgical techniques of aortic root surgery.
Material and methods. Between January 2004 and November 2007, a cohort of 83 patients underwent aortic root surgery in the Heart Center, Hospital [...] Read more.

The aim of the study was to evaluate early postoperative results of different surgical techniques of aortic root surgery.
Material and methods. Between January 2004 and November 2007, a cohort of 83 patients underwent aortic root surgery in the Heart Center, Hospital of Kaunas University of Medicine. Patients were divided into three groups: Group 1 (18 patients) – reimplantation of the aortic valve within a vascular graft (David operation), Group 2 (48 patients) – replacement of the ascending aorta and aortic valve using a valved conduit (Bentall de Bono operation), and Group 3 (17 patients) – biological aortic root replacement. Study protocol included clinical data, operative data, and postoperative major adverse effects: reoperations for bleeding, stroke and lethal outcomes.
Results. Patients undergoing biological aortic root replacement were older as compared with other groups. The mean age in the Group 1 was 50.3±3.5 years vs. 57±2.0 years in the Group 2 and 67.8±3.3 years in the Group 3 (P<0.05). The main indication for the aortic root surgery was the aneurysm of the aortic root and ascending aorta in the Group 1 and 2 patients (64.7% and 72%), while in the Group 3, the main indication was fibrocalcinosis of aortic valve, aortic annulus, and ascending aorta (61.1%). The 30-day hospital mortality rates were as follows: 5.8% (n=1), in the Group 1; 10.4% (n=5), in the Group 2; 5.5% (n=1), in the Group 3. In the early postoperative period, 11 reoperations were performed due to bleeding events: in the Group 1, after planned/emergency surgery (n=2/2), and in the Group 2 (n=1/6), respectively. The function of aortic valve improved significantly in all groups of patients early after surgery. In the Group 1, the degree of aortic regurgitation decreased from 2.5±0.8 to 1.1±0.6 (P<0.05); in the Groups 2 and 3, the mean gradient through the aortic valve decreased from 39.9±7.5 to 17.1±5.3 mm Hg and from 48.8±18.0 to 20.1±11.0 mm Hg, respectively (P<0.05). No reoperation for aortic valve failure before the discharge was required in all groups of patients, and neither thromboembolic complications nor stroke events were noted in any group.
Conclusions. Different aortic root surgery techniques showed similar postoperative results. New aortic root surgery methods such as aortic root-preserving/sparing procedures and concurrent aortic valve leaflet repair or aortic root replacement with the bioprosthesis can be selected for a diverse class of aortic root pathology with low perioperative mortality rates and good early postoperative results. Full article

204 KiB

Open AccessArticle

Use of recombinant activated factor VII

by Dagmara Reingardienė and Robertas Lažauskas

Medicina 2009, 45(3), 248; https://doi.org/10.3390/medicina45030032 - 16 Feb 2009

Cited by 1 | Viewed by 1056

Abstract

Recombinant activated factor VII (rFVIIa) has been used in the treatment of various congenital and acquired hemostatic disorders for more than 10 years. Hemostasis is initiated by the FVIIa bound to tissue factor (TF), which constitutes only approximately 1% of total amount of [...] Read more.

Recombinant activated factor VII (rFVIIa) has been used in the treatment of various congenital and acquired hemostatic disorders for more than 10 years. Hemostasis is initiated by the FVIIa bound to tissue factor (TF), which constitutes only approximately 1% of total amount of the FVII protein existing in the blood. rFVII becomes activated only after the binding to the TF, released at the site of tissue injury. The efficiency of rFVIIa in the treatment of such life-threatening hemorrhagic states like hemophilia reaches up to 76–84%. rFVIIa is successfully used in the treatment of congenital deficiency of factor VII. It normalizes prothrombin time in the patients with the liver diseases and in cases of overdose of indirect anticoagulants. It is also useful for patients suffering from thrombocytopenia, thrombocyte function disorders, hemophilia A and B with development of inhibitors. rFVIIa allows overcoming uncontrollable hemorrhages, etc. It is supposed that rFVIIa is becoming a universal hemostatic drug. Full article

Open AccessArticle

Factors influencing development of atrial fibrillation after implantation of cardiac pacemaker for sinus node dysfunction

by Audrius Aidietis, Jūratė Barysienė, Germanas Marinskis, Sigita Aidietienė, Diana Kairevičiūtė, Paulius Jurkuvėnas, Jūratė Aganauskienė, Kęstutis Bagdonas, Vladimiras Ježovas and Aleksandras Laucevičius

Medicina 2009, 45(3), 169; https://doi.org/10.3390/medicina45030022 - 10 Feb 2009

Viewed by 1122

Abstract

Objective. The aim of this study was to evaluate factors influencing the success of atrial fibrillation treatment associated with the sick sinus syndrome after pacemaker implantation.
Methods and results. In 163 patients with sick sinus syndrome followed up after pacemaker implantation, [...] Read more.

Objective. The aim of this study was to evaluate factors influencing the success of atrial fibrillation treatment associated with the sick sinus syndrome after pacemaker implantation.
Methods and results. In 163 patients with sick sinus syndrome followed up after pacemaker implantation, statistical analysis showed that the recurrence of atrial fibrillation increased 2.8 times and 2.5 times when the left atrium or the right atrium, respectively, were increased by 1 cm (P=0.001). In addition, the recurrence of atrial fibrillation increased 2.5 times when the interventricular septum was thickened (P=0.007). Probability of atrial fibrillation recurrence was 2.73 times higher in the presence of grade II mitral regurgitation as compared to absent or grade I mitral regurgitation (P=0.029). The results of atrial fibrillation treatment did not significantly depend on age, gender, duration of atrial fibrillation symptoms, other cardiac structural changes, and concomitant noncardiac diseases.
Conclusions. In patients with sick sinus syndrome, the effectiveness of atrial fibrillation treatment after pacemaker implantation is influenced by enlargement of the left and the right atria, increased interventricular septum thickness, and grade II mitral regurgitation. Evaluation of echocardiographic data before pacemaker implantation has prognostic value for determining the probability of maintenance of sinus rhythm. Full article

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Medicina, Volume 45, Issue 3 (March 2009) – 11 articles

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