The Effect of Physical Restraint on a Violent Patient in the Prone Position on the Quality of Breathing: A Pilot Simulation Study.

OBJECTIVES: Physical restraint in the prone position is still utilized in healthcare facilities to immobilize violent patients. It is associated with the sudden death of violent patients. The aim of this study is to objectify the impact of physical restraint in the prone position on spirometric and ventilatory parameters. DESIGN: A pilot simulation study. MATERIAL AND METHODS: Ten university students were included in the study. They underwent two types of physical restraint: in the prone position with "chest kneeling" and in the lateral position. Spirometric parameters (FVC, PEF and FEV1%) and ventilatory parameters (EtCO2 and respiratory rate) were measured before initiation and after five minutes of physical restraint. RESULTS: Both methods of physical restraint resulted in a decrease in FVC (p = 0.005 or p = 0.047) and PEF (p = 0.005 or p = 0.028). No significant changes were observed in EtCO2 and respiratory rate. CONCLUSION: Physical restraint in the prone position should not be used in healthcare.

Perception of Work-Related Stress and Quality of Life among Nurses during COVID-19 Pandemic-An International, Multicenter Prospective Study.

The major focus of the study was the impact of the COVID-19 pandemic on healthcare workers' mental health. Nurses are the workers who were exposed to pandemic-related stress, being the most affected. The present cross-sectional study was focused on finding out the differences of the level of work-related stress and quality of life in nurses of the three Central European states, specifically the Czech Republic, the Slovak Republic, and Poland. A structured anonymous online questionnaire was created, and then the link was distributed to the target population through executives. Data analysis was performed by using the R programme-version 4.1.3. The study found that nurses from the Czech Republic achieved lower stress levels and had a higher quality of life than nurses from Poland and Slovakia.

Cerebellar syndrome as a complication of COVID-19 disease.

COVID-19 disease is caused by the new coronavirus SARS-CoV-2. The disease first appeared in China in 2019 and quickly spread throughout the world. It primarily affects the respiratory tract, manifested by fever, cough and the development of dyspnoea, but the symptoms and complications can affect any organ system. Neurological symptoms include headaches, muscle and joint pain, taste and smell disorders. Complications include inflammatory diseases of the central nervous system, ataxia, peripheral nerve and muscle diseases, worsening of extrapyramidal diseases, and neuropsychiatric disorders. This paper presents a case report of a 62-year-old man with cerebellar syndrome, ataxia, intentional tremor and hypermetria when dealing with COVID-19 disease.

Clinical and laboratory characteristics of the COVID-19 disease in adult patients.

BACKGROUND: In December 2019, a new coronavirus, SARS-CoV-2, appeared in Wuhan, China. This virus is the cause of the COVID-19 disease. This infection later spread to the whole world. The goal of this article is to present the clinical and laboratory characteristics of patients with COVID-19 treated in the Faculty Hospital Pilsen. METHODS: In this monocentric, retrospective study, clinical and biochemical data of 89 adult patients with COVID-19 was analyzed. These patients were in the care of the Faculty Hospital Pilsen between March 14 and April 7. RESULTS: In this cohort, made up of 89 patients, 63 were treated as outpatients and 26 were hospitalized. 10 patients required intensive care. The most common symptoms among patients were cough and fever. Dyspnea was present in 29 patients. A CT scan showed bilateral pneumonia in 23 of the admitted patients. Fever and bilateral pneumonia were significantly more common in patients ≥ 60 years old (p=0.047, and p=0.001, respectively). Of lab results, the patients in intensive care had significantly higher values of C-reactive protein, procalcitonin, lactate dehydrogenase, interleukin 6, myoglobin and ferritin. CONCLUSION: The most common symptoms of COVID-19 are fever and cough. These two symptoms are simultaneously present in more than half the cases. Approximately 1/10th of patients requires intensive care. Higher values of lactate dehydrogenase, myoglobin and ferritin on patient admission appear to be a strong predictive factor of the patient's status progressing into requiring ICU attention.

ABCDE cognitive aid tool in patient assessment - development and validation in a multicenter pilot simulation study.

BACKGROUND: The so called ABCDE approach (Airway-Breathing-Circulation-Disability-Exposure) is a golden standard of patient assessment. The efficacy of using cognitive aids (CA) in resuscitation and peri-arrest situations remains an important knowledge gap. This work aims to develop an ABCDE CA tool (CAT) and study its potential benefits in patient condition assessment. METHODS: The development of the ABCDE CAT was done by 3 rounds of modified Delphi method performed by the members of the Advanced Life Support Science and Education Committee of the European Resuscitation Council. A pilot multicentre study on 48 paramedic students performing patient assessment in pre-post cohorts (without and with the ABCDA CAT) was made in order to validate and evaluate the impact of the tool in simulated clinical scenarios. The cumulative number and proper order of steps in clinical assessment in simulated scenarios were recorded and the time of the assessment was measured. RESULTS: The Delphi method resulted in the ABCDE CAT. The use of ABCDE CAT was associated with more performed assessment steps (804: 868; OR = 1.17, 95% CI: 1.02 to 1.35, p = 0.023) which were significantly more frequently performed in proper order (220: 338; OR = 1.68, 95% CI: 1.40 to 2.02, p < 0.0001). The use of ABCDE CAT did not prolong the time of patient assessment. CONCLUSION: The cognitive aid for ABCDE assessment was developed. The use of this cognitive aid for ABCDE helps paramedics to perform more procedures, more frequently in the right order and did not prolong the patient assessment in advanced life support and peri-arrest care.

Anaphylaxis in Public Health.

The increasing number of patients with anaphylactic reactions is a modern challenge for healthcare professionals in clinical practice and public health professionals. It remains difficult to determine the prevalence or incidence of anaphylaxis in the population due to the long absence of a consensus definition, the fact that analyses are performed on various population groups and the use of different data collection methodologies. In the United States, anaphylaxis mortality ranges from 0.63 to 0.76 cases per million inhabitants, with 58% of these deaths due to drug anaphylaxis. The risk factors for anaphylaxis are ramipril and metoprolol use, which is common in patients with cardiovascular disease. Also, a higher level of gliadin following excess gluten intake is associated with a higher incidence of anaphylaxis. Drugs, food and insect stings have long been known as anaphylaxis inductors. In diagnosis, determination of serum tryptase concentration is used. In patients with normal tryptase concentration, it is appropriate to screen other inflammatory mediators. The authors of this article present new findings on anaphylaxis in the literature and recommended practices of professional societies in the context of public health.

Lithium intoxication in the pre-hospital care with stroke symptoms - Case report.

Lithium is widely used in psychiatry to treat bipolar affective disorders since 1970 but little is known about the incidence, clinical course and associated factors of acute lithium intoxication. Moderate and severe cases of lithium intoxication are rare. This case reports a patient with acute lithium intoxication (serum level of 3.7 mmol/L) with neurological symptoms imitating stroke, which affects the differential diagnosis in the pre-hospital and hospital care. Patient was treated with forced diuresis and dismissed 21 days after admission.

Combined Therapy for Patients after Ischemic Stroke as a Support of Social Adaptability.

THE OBJECTIVE: The main objective of the research was to find out the effectivity of the combined therapy suitable for patients after ischemic stroke (promoting social adaptability). The therapy itself is then focused on robotic, psychomotor and cognitive therapy. The research indicators were divided into three categories of psychological, social and cognitive indicators. PROBAND SAMPLE: We have a 58 probands diagnosed with a stroke participated on the research (ischemic type I60-I69; ICD-10; the 10th revision of the International Statistical Classification of Diseases and Related Health Problem), out of which 49 were male patients ages between 48-55 and women between the age of 45-51. The data collection was then done during 2018. Indicators were evaluated and tested firstly after the initiation of the combined therapy, then after 10 weeks of intensive therapy, which took place 3 times a week 45 minutes for each patient participating in the research. RESULTS: The results of the research point to the fact, that combined therapy of robotic, psychomotor and cognitive can have positive effect on, and be suitable as a treatment for patients after ischemic stroke, regarding their productive age. Positive results have been therefore overt among all tested areas. CONCLUSION: The results of the research point to the fact, that combined therapy of robotic, psychomotor and cognitive can have positive effect on, and be suitable as a treatment for patients after ischemic stroke, regarding their productive age. Positive results have been therefore overt among all tested areas.