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INTRODUCTION: Trauma is one of the leading causes of death in the European Union. The European Trauma Course (ETC) is a training course that focuses on administering aid to trauma patients in a Hospital's Emergency Department by creating an effective and well-organized trauma team. The purpose of the study is to analyze how the ETC training is evaluated by its participants and whether it is tailored to local needs. MATERIALS AND METHODOLOGY: The study includes eight courses conducted between 2010 and 2015, involving 109 medical professionals. Participants were given questionnaires where they could evaluate the various aspects of the course and comment on each of them, using a four-level scale. Finally, 78 surveys were qualified for the study. RESULTS: The exercises were very highly rated (average 3.79 points), mainly for their interesting scenarios and station preparation. Equally well-evaluated was the short and concise method of instruction. The lowest ranked aspect was the course fee (2.41 points). There were o en negative comments about the use of English during the training (lectures and manuals). DISCUSSION: The opinions of Polish students were similar to those of ETC participants in other European countries. ere are many interesting advantages of workshop scenarios, while the downside is the time constraint. Nevertheless, the ETC has been very successful. High ratings and positive feedback affirm the high demand for such courses in Poland.
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Currículo , Educação Médica/organização & administração , Serviços Médicos de Emergência/métodos , Medicina de Emergência/educação , Pessoal de Saúde/educação , Ferimentos e Lesões/mortalidade , Adulto , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Trauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained. MATERIALS AND METHODS: We composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents' background, and their respective hospitals' trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27. RESULTS: We obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, "often" in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level. CONCLUSION: The number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings.
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Currículo , Ferida Cirúrgica , Humanos , Competência Clínica , Inquéritos e Questionários , Cuidados de Suporte Avançado de Vida no Trauma , Equipe de Assistência ao PacienteRESUMO
PURPOSE: The COVID-19 pandemic has changed working conditions for emergency surgical teams around the world. International surgical societies have issued clinical recommendations to optimize surgical management. This international study aimed to assess the degree of emergency surgical teams' adoption of recommendations during the pandemic. METHODS: Emergency surgical team members from over 30 countries were invited to answer an anonymous, prospective, online survey to assess team organization, PPE-related aspects, OR preparations, anesthesiologic considerations, and surgical management for emergency surgery during the pandemic. RESULTS: One-hundred-and-thirty-four questionnaires were returned (N = 134) from 26 countries, of which 88% were surgeons, 7% surgical trainees, 4% anesthetists. 81% of the respondents got involved with COVID-19 crisis management. Social media were used by 91% of the respondents to access the recommendations, and 66% used videoconference tools for team communication. 51% had not received PPE training before the pandemic, 73% reported equipment shortage, and 55% informed about re-use of N95/FPP2/3 respirators. Dedicated COVID operating areas were cited by 77% of the respondents, 44% had performed emergency surgical procedures on COVID-19 patients, and over half (52%), favored performing laparoscopic over open surgical procedures. CONCLUSION: Surgical team members have responded with leadership to the COVID-19 pandemic, with crisis management principles. Social media and videoconference have been used by the vast majority to access guidelines or to communicate during social distancing. The level of adoption of current recommendations is high for organizational aspects and surgical management, but not so for PPE training and availability, and anesthesiologic considerations.
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Anestesiologia , COVID-19 , Emergências/epidemiologia , Controle de Infecções , Equipe de Assistência ao Paciente/organização & administração , Procedimentos Cirúrgicos Operatórios , Anestesiologia/métodos , Anestesiologia/tendências , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Serviço Hospitalar de Emergência , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/normas , Cooperação Internacional , Relações Interprofissionais , Exposição Ocupacional/classificação , Exposição Ocupacional/prevenção & controle , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/tendências , Equipamento de Proteção Individual/normas , Equipamento de Proteção Individual/provisão & distribuição , SARS-CoV-2 , Centro Cirúrgico Hospitalar , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Heart rate recovery (HRR) is a recognised marker used in clinical practice for assessing the risk of sudden cardiac death. Physical exercise leads to an improvement in HRR and has a proven beneficial effect on erection quality (EQ) related to the activity of the autonomic nervous system in men with ischaemic heart disease (IHD). This paper evaluates the relationship between HRR and EQ in patients with IHD and erectile dysfunction (ED) who underwent cardiac rehabilitation. METHODS: The main analysis was based on the Mann-Whitney U test, Wilcoxon signed-rank test, Spearman correlation coefficient, Pearson's chi-square test, chi-square test, with the Yates correction and (if possible) parametric tests were used. This prospective, non-randomised intervention study included 124 men with IHD and ED [International Index of Erectile Function (IIEF-5) scores of ≤21]. Of these, 89 patients underwent a 6-month cardiac rehabilitation phase III programme, whereas 35 did not. The results of the participants' total IIEF-5 scores and their HRR, demographic and clinical data were analysed. RESULTS: The results of the 89 rehabilitated patients (mean age: 60.44±9.29 years) and 35 controls (mean age: 61.43±8.81 years) were analysed. In the rehabilitated patients, the mean baseline IIEF-5 score was 13.15±5.76 (95% CI: 11.93-14.36) and HRR was 16.49±7.68/min (95% CI: 14.88-18.11). After cardiac rehabilitation, the parameters of ED and HRR improved significantly and were significantly higher than those of the controls; the mean IIEF-5 score of the rehabilitated group increased to 15.36±6.51 (95% CI: 13.99-16.73), while HRR increased to 21.40±7.25/min (95% CI: 19.88-22.93). A significant correlation was found between ∆HRR and ∆EQ (r=0.409791) as a result of the 6-month cardiac training programme. CONCLUSION: Cardiac rehabilitation assessed by HRR has a sizable effect on autonomic balance in patients with IHD and ED, which plays a significant role in the mechanism of erection improvement.
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Reabilitação Cardíaca , Disfunção Erétil/etiologia , Frequência Cardíaca , Isquemia Miocárdica/complicações , Idoso , Estudos de Casos e Controles , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/reabilitação , Estudos ProspectivosRESUMO
BACKGROUND: Cardiovascular disease is a major contributor to the global burden of disease. Further reduction of cardiovascular mortality will require multidirectional prevention. Popularizing prevention measures requires the involvement of qualified and well-educated personnel. Before any modifications of educational programs it is necessary to assess the level of knowledge of future physicians. OBJECTIVES: The aim of the study was to evaluate medical students' knowledge of cardiovascular (CV) risk factors. The paper presents the outcomes of a study investigating the knowledge of CV risk factors and the prevalence of those risk factors in the study population. MATERIAL AND METHODS: The study was conducted between 2007 and 2012 and the study population was comprised of 1406 students (497 men and 909 women) from South and South Western Poland. A survey designed by the authors, based on the Framingham survey, was used for the interviews. RESULTS: The students correctly identified 4.38 ± 0.91 CV risk factors. The most frequently listed risk factors for cardiovascular diseases were a lack of physical activity and a fat-rich diet. The study participants who identified CV risk factors more or less accurately do not follow the recommendations aimed at prevention. Awareness, even relatively high awareness, does not correlate with a healthy lifestyle. Extreme examples of this are people who are aware of the negative effects of cigarette smoking but continue to smoke. CONCLUSIONS: The study revealed an insufficient level of awareness of CV risk factors among medical students.
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Doenças Cardiovasculares/etiologia , Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Medicina/psicologia , Conscientização , Doenças Cardiovasculares/prevenção & controle , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Entrevistas como Assunto , Estilo de Vida , Masculino , Polônia , Fatores de Risco , Comportamento de Redução do Risco , Faculdades de Medicina , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: It is believed that lower pole crossing vessels may play an important role in the etiology of ureteropelvic junction obstruction (UPJO). A conventional operative technique, which seems to be widely used in patients with UPJO, is Anderson-Hynes (A-H) plasty with dorsal transposition of the vessel. An attractive alternative to dorsal transposition of the vessel might be its cephalad translocation. AIM: To assess the effectiveness of cephalad translocation of the crossing vessel in patients who underwent laparoscopic A-H or Y-V pyeloplasty. MATERIAL AND METHODS: Eighty-five patients were included in the study. To assess the effectiveness of cephalad translocation of the crossing vessel in patients who underwent laparoscopic pyeloplasty, the results of the procedure were compared to the results of laparoscopic pyeloplasties performed in patients without crossing vessels (control group). Success was defined as the following factors taken collectively: 80% or greater pain relief according to VAS, no sign of obstruction on intravenous urography (patent UPJ), decreasing excretion curve with T1/2 < 12 min, and improved or stable differential renal function on diuretic renography. RESULTS: The mean follow-up was 53.7 months. There was no statistically significant difference in the success rate between the compared groups (group 1 - cases with cephalad translocation of the crossing artery, and group 2 - cases without crossing vessels) in patients who underwent A-H plasty or Y-V plasty. CONCLUSIONS: The analysis of our data seems to indicate that cephalad translocation of the anterior crossing vessel gives good therapeutic results in patients who undergo laparoscopic pyeloplasty.
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BACKGROUND: Bladder cancer occurs mainly in adults. In children, younger than 10 years in particular, it is very rare. OBJECTIVES: The aim of the study is to retrospectively evaluate the efficacy of transurethral resection of the bladder tumour (TUR-BT) of transitional cell carcinoma (TCC) of the bladder in children. MATERIAL AND METHODS: Transurethral resection of the bladder tumour was performed in 7 boys aged 4 to 17 years (median 12.1 years). In all cases laboratory tests, ultrasound, and cystoscopic tumour biopsy were carried out prior to the resection. Doxorubicin was additionally instilled intravesically as one dose in two patients. The Foley catheter was left in the bladder for 1 to 4 days (median 1.85 days). The follow-up period ranged from 10 months to 10 years (median 4 years). RESULTS: Papillary urothelial neoplasm of low malignant potential (PUNLMP) was diagnosed in 5 patients and urothelial papilloma in 2. Local recurrence was observed in one case two years after the resection. In all other cases complete remission was achieved. CONCLUSIONS: Transitional cell carcinoma of the bladder in children is usually benign and endoscopic treatment (TUR-BT) seems to be the treatment of choice. To determine a follow-up schedule a more substantial group of children with bladder cancer should be analysed.
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Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Neoplasias da Bexiga Urinária/cirurgia , Administração Intravesical , Adolescente , Fatores Etários , Antibióticos Antineoplásicos/administração & dosagem , Carcinoma de Células de Transição/patologia , Quimioterapia Adjuvante , Criança , Pré-Escolar , Cistectomia/efeitos adversos , Doxorrubicina/administração & dosagem , Humanos , Masculino , Recidiva Local de Neoplasia , Polônia , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologiaRESUMO
The protective effect of physical activity on arteries is not limited to coronary vessels, but extends to the whole arterial system, including arteries, in which endothelial dysfunction and atherosclerotic changes are one of the key factors affecting erectile dysfunction development. The objective of this study was to report whether the endurance training intensity and training-induced chronotropic response are linked with a change in erectile dysfunction intensity in men with ischemic heart disease. A total of 150 men treated for ischemic heart disease, who suffered from erectile dysfunction, were analyzed. The study group consisted of 115 patients who were subjected to a cardiac rehabilitation program. The control group consisted of 35 patients who were not subjected to any cardiac rehabilitation. An IIEF-5 (International Index of Erectile Function) questionnaire was used for determining erectile dysfunction before and after cardiac rehabilitation. Cardiac training intensity was objectified by parameters describing work of endurance training. The mean initial intensity of erectile dysfunction in the study group was 12.46 ± 6.01 (95% confidence interval [CI] = 11.35-13.57). Final erectile dysfunction intensity (EDI) assessed after the cardiac rehabilitation program in the study group was 14.35 ± 6.88 (95% CI = 13.08-15.62), and it was statistically significantly greater from initial EDI. Mean final training work was statistically significantly greater than mean initial training work. From among the parameters describing training work, none were related significantly to reduction of EDI. In conclusion, cardiac rehabilitation program-induced improvement in erection severity is not correlated with endurance training intensity. Chronotropic response during exercise may be used for initial assessment of change in cardiac rehabilitation program-induced erection severity.
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Disfunção Erétil/complicações , Terapia por Exercício , Isquemia Miocárdica/reabilitação , Resistência Física , Índice de Gravidade de Doença , Estudos de Casos e Controles , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicaçõesRESUMO
Interstitial cells of Cajal (ICCs) were discovered in the gastrointestinal tract over 100 years ago and since then numerous digestive tract pathologies involving ICCs have been described. Many researchers explored ICCs presence and function in the upper urinary tract. Currently, we know that ICCs have potential plasticity, their own spontaneous activity and that they are responsible for Ca2+ waves generation and neuromuscular transmission. ICCs are also involved in the conjugation, propagation and modulation of peristaltic waves in the upper urinary tract. Despite everything we know about ICCs, their role in the pathogenesis of the upper urinary tract abnormalities remains still unclear and results of published studies are confusing. The authors' intention was to review the scientific literature regarding ICCs and to summarise the current knowledge about their nature in the upper urinary tract.
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Células Intersticiais de Cajal/fisiologia , Sistema Urinário/citologia , Animais , HumanosRESUMO
BACKGROUND: Urethral stenosis or abnormalities in the external urethral meatus in girls may lead to serious functional bladder outlet obstruction and recurrent urinary tract infections. OBJECTIVES: The aim of the study was to analyze the efficacy of meatotomy in girls with an anterior deflected urinary stream (ADUS) and symptoms of detrusor overactivity. MATERIAL AND METHODS: A group of 67 girls between the ages of 5 and 16 (mean age: 8.6 years) with symptoms of detrusor overactivity participated in the study. The girls were treated with oxybutinin in the years 2010-2011. The group included 37 girls with ADUS (the ADUS group) while the remaining 30 girls (the OXY group) were found to have a normal urinary stream. In the ADUS group an external urethral meatus incision was performed. The follow-up period was three months. The presence of urinary tract infections (UTI) as well as nocturnal bedwetting and daytime incontinence were analyzed before and after treatment. RESULTS: After three months, in the ADUS group no UTI was found in 12 children (32%) (p < 0.05), including 11 patients with prior febrile UTI (p < 0.05). Recovery from daytime urinary incontinence was observed in 20 girls (54%) and recovery from nocturnal bedwetting in 8 girls (22%). In the OXY group no infections were found in three girls (10%); recovery from daytime urinary incontinence was noted in 21 girls (70%) and from nocturnal bedwetting in 10 girls (33%). CONCLUSIONS: Girls with symptoms of detrusor overactivity accompanied by an anterior deflected urinary stream experience UTIs and fever more often than girls with detrusor overactivity and a normal urinary stream. An incision in the external urethral meatus in girls with ADUS and detrusor overactivity seems to be effective treatment for recurrent urinary tract infections, especially febrile ones.
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Uretra/anormalidades , Uretra/cirurgia , Bexiga Urinária Hiperativa/cirurgia , Transtornos Urinários/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , HumanosRESUMO
PURPOSE: The authors analysed the distribution of c-kit-positive interstitial cells of Cajal (ICCs) in obstructed ureteropelvic junction (UPJ) and its age-related changes. METHODS: Twenty specimens were obtained from children with intrinsic ureteropelvic junction obstruction (UPJO), at the average age of 8.1 years (8 months-16.8 years), fixed in formalin and embedded in paraffin. Five control samples were taken from children at the average age of 2.3 years (2.4 months-7.4 years). All specimens were analysed by the immunohistochemistry test with light microscopy with respect to c-kit expression. The distribution of c-kit-positive ICCs in the two groups was compared and the correlation between the distribution of c-kit-positive ICCs and the patients' age in UPJO cases was analysed. The results were examined by Yates' χ(2) test, Mann-Whitney U test, and t test for Pearson's correlation coefficient. A P value < 0.05 was considered as statistically significant. RESULTS: No statistically significant differences were found in the distribution of c-kit-positive ICCs between UPJO and the control group. No correlation was established between the age of patients with UPJO and the distribution of c-kit-positive ICCs. CONCLUSION: No distributional difference found in obstructed and unobstructed UPJ seems to indicate that UPJO is not associated with anomalous distribution of c-kit-positive ICCs. Age-related changes in the expression of c-kit-positive ICCs are equally distributed in obstructed UPJ.
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Células Intersticiais de Cajal/patologia , Pelve Renal/patologia , Ureter/patologia , Obstrução Ureteral/congênito , Adolescente , Criança , Pré-Escolar , Constrição Patológica/congênito , Constrição Patológica/patologia , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Lactente , Masculino , Obstrução Ureteral/patologiaRESUMO
BACKGROUND: Rehabilitation therapy in children with neuromotor development disorders can be carried out with the use of various methods. OBJECTIVES: The aim of this study was to determine the efficiency of rehabilitation carried out with the use of the new therapeutic method MNRI (Masgutova Neurosensorimotor Reflex Integration) in children with cerebral palsy (CP) by objective measurements with a brainstem auditory evoked potentials (BAEP) examination. MATERIAL AND METHODS: Besides the known parameters, Interpeak Latency I-V (IPL I-V) in BAEP, an original parameter proposed by Pilecki was introduced, called a relative IPL I-V value. The study involved a group of 17 children (9 girls and 8 boys) aged from 1.3 to 5.9 years (mean = 3.8 years, SD = 1.3) with cerebral palsy. Due to difficulty in co-operation, analysis of only 15 children could be finished. RESULTS: Analysis of the absolute IPL I-V values showed that after rehabilitation the percentage of the results with slowed transmission, i.e. those in which the IPL I-V value was prolonged, decreased from more than 88% to 60%. The assessment of the relative IPL I-V values showed that the results obtained after rehabilitation are more advantageous. CONCLUSIONS: As a result of rehabilitation carried out by the MNRI method in children with CP, a significant improvement in the transmission in the brain stem section of the auditory pathway was observed based on the absolute and relative IPL I-V values. However, the change obtained in children was various.
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Vias Auditivas/fisiopatologia , Paralisia Cerebral/reabilitação , Crianças com Deficiência/reabilitação , Potenciais Evocados Auditivos do Tronco Encefálico , Atividade Motora , Modalidades de Fisioterapia , Reflexo Anormal , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/psicologia , Criança , Desenvolvimento Infantil , Pré-Escolar , Crianças com Deficiência/psicologia , Feminino , Humanos , Lactente , Masculino , Exame Neurológico , Polônia , Tempo de Reação , Transmissão Sináptica , Resultado do TratamentoRESUMO
PURPOSE: The authors examined the number of interstitial cells of Cajal-like cells (ICC-LCs) in obstructed ureteropelvic junction (UPJ) in comparison with normal UPJ specimens and age-related changes. MATERIALS AND METHODS: A total of 20 human formalin fixed, paraffin-embedded specimens of intrinsic UPJO from children at the mean age of 8.1 years (age range: 8 months-16.8 years) and 5 control samples from children at the mean age of 2.3 years (range 2.4 months-7.4 years) were investigated immunohistochemically for the expression of c-kit proto-oncogene by light microscopy with computerized image analysis. The results were examined by Fisher's exact test, Yates' chi-square test, and t test for Pearson's correlation coefficient. A P value less than 0.05 was considered statistically significant. RESULTS: The number of ICC-LCs-dense fields was significantly higher in UPJO specimens in comparison with the normal group (P = 0.0004). The number of ICC-LCs-sparse fields was significantly lowered in UPJO specimens in comparison with the normal group (P = 0.0122). There was no significant difference in the number of ICC-LCs-medium fields in obstructed and normal UPJ specimens. The number of ICC-LCs was decreasing significantly with increasing age of the patients with UPJO (P = 0.0038). CONCLUSIONS: The higher density of c-kit-positive ICC-LCs in UPJ may manifest the compensation of altered peristalsis in UPJO. The number of ICC-LCs-dense fields decreasing with age may show the failure of compensation and regression of the compensatory changes.