Symptoms of Post-Traumatic Stress Disorder and the Sense of Gains and Losses during the COVID-19 Pandemic: An International Study.

This study was primarily designed to investigate the perception of changes in selected areas of life experienced by adults of various nationalities in connection to the long-lasting COVID-19 pandemic. The second objective was to identify the factors increasing the risk of perception of negative changes in life during the pandemic. The tools applied in the study include a self-report questionnaire designed to measure sociodemographic data and health status of the subjects, COVID-19 Sense of Life Changes Questionnaire, as well as the Impact of Event Scale: Revised. The study involved over 600 adult subjects. With increased intensity of intrusions, the likelihood of negative perception of the changes emerging as a result of the pandemic was reduced by approximately 7%, whereas a higher intensity of hyperarousal increased that risk. Individuals reporting a sense of negative changes presented a greater degree of hyperarousal compared to those reporting positive changes. In the group of subjects perceiving the changes in a positive way, increasing the intensity of intrusion and/or hyperarousal corresponded to a growing conviction about a negative nature of life changes concerning the relationship with their partner and affecting their work as well as regarding a positive meaning of the changes in relations with their parents and in daily life. Generally, there was a prevailing sense of negative changes; however, there was also a group of subjects that perceived these as positive. Intrusions and hyperarousal in certain individuals may play a role in motivating them to take action in protecting against effects of the pandemic and, in others, may lead to frustration and anxiety.

Levosimendan in the modern treatment of patients with acute heart failure of various aetiologies.

Acute decompensated heart failure (ADHF) is a common clinical problem associated with a high mortality rate. Because ADHF has various aetiologies, there are a range of therapeutic options, among others, positive inotropes (inotropic drugs). As an inotropic agent whose mechanism is different than that of "classical" medicines, levosimendan (LSM) is one of the most common therapeutic options. Despite many publications on LSM, some issues related to its application remain unclear. The authors of this paper have attempted to summarise expert recommendations and reports available in the literature.

Comparison of two methods of continuous femoral nerve block with elastomeric pump after total knee arthroplasty.

BACKGROUND: The best method of continuous femoral nerve block (CFNB) after total knee arthroplasty (TKA) has not been determined. The study aimed to assess the effectiveness of CFNB based on patient-controlled regional analgesia (PCRA) with basal infusion of local anesthetic in decreasing pain and providing functional restoration after TKA and to compare it with the method of basal infusion only. METHODS: The prospective randomized controlled trial included 90 patients who were divided into three groups. Group I: control group with basal morphine infusion, without CFNB. Group II: CFNB with continuous infusion of ropivacaine. Group III: CFNB with basal infusion of ropivacaine plus boluses. Intensity of pain, morphine consumption, patient satisfaction, adverse effects, the effect on range of motion (ROM) in the knee joint, as well as using the measure of a distance were analyzed. RESULTS: A lower level of pain was observed (P < 0.005), as was reduced opioid consumption (P < 0.005), a greater ROM (P < 0.005), a longer distance covered (P < 0.005), and a smaller incidence of nausea in group III when compared with group II. No statistically significant difference was noted between the groups in terms of other side effects. There was higher satisfaction between group II and group III on days 1 and 2 (P < 0.08). CONCLUSIONS: It was demonstrated that CFNB with continuous infusion of 5 mL h-1 of 0.2% ropivacaine plus 5 mL as a bolus causes a greater reduction in pain intensity and opioid consumption; it also shortens the time of functional restoration in comparison to perineural infusion of 5mL h-1 only during the first 4 days after TKA and constitutes an effective and safe alternative to using an electronic pump.

Cognitive illness representation and anxiety in older men and women with type 2 diabetes.

AIM: In the elderly, type 2 diabetes is a frequent chronic condition that requires the attention of health care. As patient involvement is a prerequisite for treatment, it seems crucial to assess psychosocial aspects, including patient's cognitive component of attitude towards the condition, as early as upon diagnosis. The aim of this study was to examine whether the cognitive illness representation in older female and male patients with type 2 diabetes is differentiated. Considering disease duration, we determined the effect of cognitive illness representation on older diabetes emotional wellbeing. METHODS: The study in 99 older adults with type 2 diabetes used Disease-Related Appraisals Scale (Skala Oceny Wlasnej Choroby; SOWCh) to assess cognitive illness representation and State-Trait Anxiety Inventory (STAI) to assess the severity of state anxiety. RESULTS: In a subgroup with short-standing diagnosis, women scored significantly higher than men on subscales of Threat, Obstacle/Loss and Profit. In a subgroup with long-standing diagnosis, women scored significantly higher than men on the subscale of Threat and significantly lower than men on the subscale of Value. The associations between the individual dimensions of cognitive illness representation and anxiety were also determined. These correlations differed between sexes and stages of the disease. CONCLUSION: Both at early and late stages of type 2 diabetes, women perceive their illness as a threat significantly more than men do. This appraisal persists throughout the entire duration of the illness. Men with long-standing diagnosis, attribute higher value to diabetes than women do, perceiving it as an opportunity to appreciate values they did not pay attention to before. Anxiety reported by older women and men can be explained to a significant extent by certain dimensions of their respective cognitive illness representation.

Psychometric Assessment of Physiologic and Behavioral Pain Indicators in Polish Versions of the Pain Assessment Scales.

BACKGROUND: There is an urgent need to prepare a reliable and accurate tool for pain assessment in patients who are unable to self-report. Translating pain assessment scales into foreign languages requires further validation testing. AIM: The aim of the study was to carry out psychometric assessment of behavioral and physiological indicators of pain included in two Polish versions of pain assessment scales, the Behavioral Pain Scale (BPS) and the original Adult Non-Verbal Pain Scale (NVPS). DESIGN: A prospective repeated-measure descriptive study was conducted. SETTINGS AND PARTICIPANTS: Twenty-eight adult non-communicative mechanically ventilated ICU patients were included in the study. The study took place in five hospitals in Poland, one 15-bed general ICU of a university teaching hospital and four 6-bed medical ICUs of district hospitals. METHODS: Pain assessment was conducted at rest, during non-painful and painful procedures independently by two observers. RESULTS: Internal consistency of the Polish version of the scales was below the expected 0.7 value (Cronbach's alpha for the BPS 0.6883 and NVPS 0.6697). Principal component analysis showed that for the Polish version of the BPS, all three domains formed one separate factor (63.9%), while in the case of the NVPS two separate factors were found, one covering four domains of the NVPS (47.1%) and the other exclusively covering the category of Vital sign (20.2%). There was a significant difference between the pain scores with the NVPS (χ2 = 228.95 p < .001) and the BPS (χ2 = 236.46 p < .001) during three observation phases. There were no significant differences between scores obtained by different raters. The analysis of variance demonstrated a statistically significant difference in the values of physiological indicators of pain (SBP, DBP, MAP) between observation phases. CONCLUSIONS: The Polish version of the BPS has better psychometric properties than the Polish version of the NVPS. It is necessary to define precisely the descriptors used in the scales and to implement a staff training program.

Evaluation of the effectiveness of the Quadratus Lumborum Block type I using ropivacaine in postoperative analgesia after a cesarean section - a controlled clinical study.

OBJECTIVES: Quadratus Lumborum Block in contrast to Transversus Abdominis Plane Block contains a unique component which not only stops somatic pain but also inhibits visceral pain by spreading the local anesthetic to the paravertebral space. This study was designed to determine whether performing the Quadratus Lumborum Block type I in patients un-dergoing cesarean section would be associated with both decreased morphine consumption and decreased pain levels in the postoperative 48-hour period. MATERIAL AND METHODS: Sixty patients undergoing caesarean section under spinal anesthesia were randomly and equally assigned to one or other of two groups: QLB I (who received Bilateral Quadratus Lumborum Block type I with the use of 24 mL 0.375% ropivacaine per side) or a Control group. In both groups, on-demand morphine analgesia was administered postoperatively within the first 48 hours. The following were measured: the morphine consumption; the time elapsed from the C-section until the first dose of morphine; and the levels of pain intensity among patients in rest (numeral pain rating scale). RESULTS: There were no statistically significant demographic data differences between the QLB I and Control groups. The following significant differences were observed in the 48-hour postoperative period: morphine consumption was higher in the Control group (p = 0.000); the time elapsed from the C-section until the first dose of morphine was longer in QLB I group (p < 0.05); and the median of the pain numeric rating scale was higher in the Control group (p < 0.05). CONCLUSIONS: Quadratus Lumborum Block type I significantly reduces morphine consumption and pain levels up to 48 hours postoperatively.

Emotional and social characteristics of stroke patients with low verbal memory.

BACKGROUND: Cognitive deficits, especially problems with memory observed after stroke often coexist with patients' experience of difficulties in everyday life situations. AIMS: The purposes of the study were to explore the relationships between verbal memory, emotional functioning and social competence in stroke patients, and to examine the emotional and social condition of stroke patients with low verbal memory. METHODS: Ninety-five participants were assessed with the Rey Auditory Verbal Learning Test, the Neuropsychology Behavior and Affect Profile, and the Social Competency Questionnaire. The participants' relatives (N = 95) also took part in the study evaluating patients' emotional and social functioning. RESULTS: Stroke patients with low verbal memory had higher scores in depression, indifference, and inappropriateness than the patients with normal memory. They also obtained higher scores in the self-reported intimacy and lower scores in objectively assessed social exposition than controls. DISCUSSION: It is worth considering patients' relationships with relatives that evolve after stroke, especially when the patients experience cognitive difficulties in gaining new information. Collecting verbal information seems to be important for the feeling of effectiveness in some dimensions of elders' social functioning. CONCLUSIONS: Because the social engagement may be treated as protective factor in the course of recovery we would recommend that during rehabilitation more attention should be paid to emotional and social functioning of stroke patients with low verbal memory.

Practical issues of nutrition during continuous renal replacement therapy.

Continuous renal replacement therapy (CRRT) in critically ill patients has significant impact on one's ability to provide efficient nutritional therapy. CRRT may help in the prevention of intestinal oedema and the maintenance of the proper function of the gastrointestinal tract by enabling strict control of the fluid balance. It facilitates early introduction of nutrition via the enteral route, as well as allowing for the composition of high-volume feeding mixtures. It is necessary to take into consideration that during CRRT, together with blood purification of toxic substances, nutritive elements are also eliminated to some extent (micro- and macronutrients). In this article, the authors discuss the impact of CRRT on nutritive elements loss, energetic balance and present the principles of adjusting feeding prescriptions to changes implied by CRRT.

Results of the severe sepsis registry in intensive care units in Poland from 2003-2009.

BACKGROUND: Severe sepsis remains the most common cause of death in intensive care units (ICUs) according to many epidemiological studies. There are no data in Poland on the extent of severe sepsis cases treated in ICUs. The aim of the study was to analyse the course and outcome of severe sepsis patients treated in Polish ICUs. METHODS: In 2003, the internet-based severe sepsis registry was created as a multicentre observational research project. An online questionnaire was made accessible to ICUs participating in the study. Questionnaires were completed after the discharge of patients and included demographic data, clinical and microbiological information about the cause, course, treatment and outcome of septic patients. All data were given voluntarily and anonymously. RESULTS: During the 7-year period (2003-2009), 4999 cases of severe sepsis were registered for analysis. The mean age of septic patients was 57 years, and the majority of the patients were men (58%). The mean length of stay in the ICU was 10 days. A significant decrease in the mortality rate was observed from 54% in 2003 and 56% in 2004 to 46% in 2009 (P < 0.05). Most of the patients were admitted to the ICU for surgical reasons (56%), and intra-abdominal infections predominated (49%). Severe sepsis patients were admitted to ICUs in critical condition, and the majority of them (89%) had 3 or more organs dysfunction. The APACHE II score on admission was 26 points. Community acquired infections were the most frequent cause of severe sepsis (53%). Most of the pathogens responsible for infection were Gram-negative bacteria (58%). Gram-positive bacteria were identified in 34% of patients and fungi in 16%. A positive blood culture was detected in 41% of patients. Vasopressors were administered to most of the patients (86%). There was a marked increase in the frequency of administering noradrenaline and a decrease in administering dopamine. Renal replacement therapy was applied in 22% of the patients, and there was a marked increase in this type of therapy in the last two years of the study period. CONCLUSIONS: Patients with severe sepsis involved in the 7-year registry were critically ill in half of the cases because of intra-abdominal infections, and the majority of them had multi-organ dysfunction. The mortality of registered patients was high, but it significantly decreased during the observation time. Based on the results obtained from this voluntary registry, the authors conclude that mandated sepsis registries should be established in Polish hospitals to improve the strategy of diagnosing and managing this syndrome.

Assessment of select dimensions of patients' emotional functioning at different time periods after stroke.

A person's self-evaluation influences purposeful activity undertaken in the situation of illness. It is observed in neurological patients that limited self-awareness disturbs rehabilitation. The goal of the study was to investigate select dimensions of emotional state, the relationship between anxiety and emotional state, and the level of insight into emotional state in patients at different time periods after cerebral vascular accidents (CVAs). Sixty-five patients with short (n = 36) or long (n = 29) time periods following a stroke participated in this study. The patients' relatives (n = 65) evaluated their emotional functioning. The modified Neuropsychology Behavior and Affect Profile (NBAP; Nelson, Satz, & D'Elia, 1994 ) and State and Trait Anxiety Inventory were administered. Compared groups differed significantly in self-reporting and in relatives' reports on the NBAP scales. Patients with short and long time periods after stroke did not differ in terms of mania, indifference, depression, or inappropriateness. Significant positive moderate correlations between anxiety and depression were found in both groups. In the group with a long time period after CVA, ratings of depression, mania, indifference, and inappropriateness among patients with right-hemisphere damage were significantly correlated with their relatives' ratings. Biological and psychological factors determining emotional state and adequacy of patients' self-evaluations have also been discussed.

Multiwavelength time-resolved detection of fluorescence during the inflow of indocyanine green into the adult's brain.

Optical technique based on diffuse reflectance measurement combined with indocyanine green (ICG) bolus tracking is extensively tested as a method for clinical assessment of brain perfusion in adults at the bedside. Methodology of multiwavelength and time-resolved detection of fluorescence light excited in the ICG is presented and advantages of measurements at multiple wavelengths are discussed. Measurements were carried out: 1. on a physical homogeneous phantom to study the concentration dependence of the fluorescence signal, 2. on the phantom to simulate the dynamic inflow of ICG at different depths, and 3. in vivo on surface of the human head. Pattern of inflow and washout of ICG in the head of healthy volunteers after intravenous injection of the dye was observed for the first time with time-resolved instrumentation at multiple emission wavelengths. The multiwavelength detection of fluorescence signal confirms that at longer emission wavelengths, probability of reabsorption of the fluorescence light by the dye itself is reduced. Considering different light penetration depths at different wavelengths, and the pronounced reabsorption at longer wavelengths, the time-resolved multiwavelength technique may be useful in signal decomposition, leading to evaluation of extra- and intracerebral components of the measured signals.

Time-resolved detection of fluorescent light during inflow of ICG to the brain-a methodological study.

It was reported that time-resolved reflectance measurements carried out during inflow and washout of an optical contrast agent may provide information on the blood supply to the brain cortex of human adults. It was also shown that a measurement of fluorescence excited in the dye circulating in the brain is feasible. Unfortunately, patterns of time-resolved fluorescence signals observed during in vivo measurements are difficult to interpret. The aim of this study was to analyze the influence of several factors on the fluorescence signals measured during in vivo experiments. A laboratory instrument for recording the distributions of arrival of fluorescence photons was constructed and optimized for measurements on humans. Monte Carlo simulations and laboratory measurements on liquid phantoms as well as in vivo measurements on healthy volunteers were carried out. An influence of source-detector separation, position of the source-detector pair on the head, as well as a dose of the injected indocyanine green (ICG) on the fluorescence signals were studied in detail. It was shown that even for a small dose of ICG (0.025 mg kg(-1)) the time-resolved signals can be successfully detected on the surface of the head. Strong influence of the studied factors on the fluorescence signals was observed. It was also noted that the changes in moments of distributions of arrival times of fluorescence photons depend on the anatomical structure of the tissues located between the source and the detector.

[Polish guidelines for the prevention and treatment of venous thromboembolism. 2012 update]. / Polskie wytyczne profilaktyki i leczenia zylnej choroby zakrzepowo-zatorowej. Aktualizacja 2012.

The overall objective of the Polish guidelines for the prevention and treatment of venous thromboembolism is to increase patient benefit and safety by appropriate prevention and treatment of deep vein thrombosis and pulmonary embolism as well as proper management of the complications associated with antithrombotic and thrombolytic therapy. These guidelines apply to adult trauma, cancer, surgical, and medical patients as well as those at increased risk of venous thromboembolism. Specific recommendations have been formulated for pregnant women, patients requiring surgery while receiving long-term oral anticoagulant treatment, and patients undergoing regional anesthesia and/or analgesia. We chose to update the existing Polish guidelines with the use of the most recent high-quality international guidelines that we identified and adjusted the final product to Polish cultural and organizational setting. We based our recommendations primarily on the 9th edition of the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines on Antithrombotic Therapy and Prevention of Thrombosis, the European Society of Cardiology Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism, the 3rd edition of the American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines on Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy, the ACOG practice bulletin on thromboembolism in pregnancy (Number 123), and Guidance from the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis on the Duration of Anticoagulant Therapy after a First Episode of Unprovoked Pulmonary Embolus or Deep Vein Thrombosis, as well as two other Polish practice guidelines on the prophylaxis and treatment of venous thromboembolism and the management of patients treated with oral direct inhibitors of factor X or factor II. To make recommendations regarding specific management issues that had not been addressed in other guidelines, or whenever the panel members felt they needed additional information to reach the decision, we also consulted the authors of guidelines developed by other professional societies and organizations as well as additional sources of evidence. For each adapted recommendation, we explicitly assessed its relevance and applicability in the context of the healthcare system in Poland. When necessary, we explicitly stated the rationale for modification of the previously published recommendations and judgements about the values and preferences we assumed. The information regarding reimbursement of drugs mentioned in the recommendations was added in chapters 6-9 and 13 and approved by the National Health Fund. The final version of the practice guidelines was officially approved by the scientific societies and institutions listed at the beginning of the document.  

Recommendations for the management of trauma or surgery-related massive blood loss.

UNLABELLED: Exsanguination is an underestimated cause of treatment failures in patients with severe trauma or undergoing surgery. In some patients the primary dysfunction of blood clot formation is a direct cause of a massive blood loss. Patients without previous coagulation disorders are at risk of coagulopathy following intraoperative or post-traumatic bleeding, where the local haemostasis does not warrant bleeding cessation. THE AIM OF THE STUDY: was to assess the therapeutic value of various components of a complex interdisciplinary approach, based on the opinion of the experts treating patients with massive bleeding. MATERIAL AND METHODS: The study was conducted by anonymous questionnaire, using the analogue representation of the argument strength. The results were analyzed based on the techniques of descriptive statistics. The argument was considered a key parameter, when the median value of strength was located in the highest quartile. RESULTS: It was found that the arguments of the highest strength for the risk of developing the posthaemorrhagic coagulation disorders are: loss of more than one third of blood volume, fluid therapy in an amount greater than 35 ml/kg, administration of more than 5 units of packed red blood cells, insufficient supply of fresh frozen plasma and platelets in proportion to packed red blood cells, severe acidosis and hypothermia. The most important tests for post-haemorrhage coagulopathy are: anatomically non-localized bleed, abnormal values of the standard coagulation parameters and fibrinogen level below 1 g/L. In the treatment of post-haemorrhagic coagulopathy the team of experts pointed out the benefits of antifibrinolytic drugs, concentrates of prothrombin complex and recombinant activated coagulation factor VII. CONCLUSIONS: Multidisciplinary therapeutic management of bleeding patients is associated with employment of appropriate treatment methods to achieve the best possible outcome. Factors influencing the development of coagulopathy, the methods of diagnosis and proposed techniques of treatment may facilitate therapeutic decisions in bleeding patients requiring massive transfusion of blood components.

Assessment of inflow and washout of indocyanine green in the adult human brain by monitoring of diffuse reflectance at large source-detector separation.

Recently, it was shown in measurements carried out on humans that time-resolved near-infrared reflectometry and fluorescence spectroscopy may allow for discrimination of information originating directly from the brain avoiding influence of contaminating signals related to the perfusion of extracerebral tissues. We report on continuation of these studies, showing that the near-infrared light can be detected noninvasively on the surface of the tissue at large interoptode distance. A multichannel time-resolved optical monitoring system was constructed for measurements of diffuse reflectance in optically turbid medium at very large source-detector separation up to 9 cm. The instrument was applied during intravenous injection of indocyanine green and the distributions of times of flight of photons were successfully acquired showing inflow and washout of the dye in the tissue. Time courses of the statistical moments of distributions of times of flight of photons are presented and compared to the results obtained simultaneously at shorter source-detector separations (3, 4, and 5 cm). We show in a series of experiments carried out on physical phantom and healthy volunteers that the time-resolved data acquisition in combination with very large source-detector separation may allow one to improve depth selectivity of perfusion assessment in the brain.

[The influence of epidural analgesia on the course of labor]. / Wplyw znieczulenia zewnatrzoponowego na poród.

OBJECTIVE: The aim of the study was to analyze the influence of epidural analgesia (EA) on the course of labor. MATERIAL AND METHODS: The study group consisted of 191 women with EA ("walking anesthesia"). 209 women without EA were chosen for controls. All the patients delivered at the 1st Dept of Obstetrics and Gynecology Medical University of Warsaw, Poland. T-test and chi2 test were used for statistical analysis and p < 0.05 was considered statistically significant. RESULTS: There were no significant differences between the groups regarding age, parity weight, average birth weight of newborns and the rate of preterm deliveries. The first and second stage of labor were significantly longer in EA group (p < 0.01). The velocity of dilatation was significantly slower in the study group until 3-5cm (0.87 vs. 1.34 cm/h). After EA was applied, the acceleration of dilatation was, however significantly greater than among controls (4.27 times vs. 3.2 times). The rate of CS was similar in both groups, however the indications for it differed significantly: fetal asphyxia 22% vs. 50% (p = 0.04), occiput posterior 22% vs. 4% (p = 0.009) in EA vs. controls, respectively. There were no differences between the groups regarding the general condition of the newborns. CONCLUSIONS: The overall longer first stage of labor in patients from the study group can result from the characteristics of women more than from EA itself, as EA seems to accelerate the dilatation of the cervix. EA does not affect the incidence of operative delivery however it may change the indications to cesarean section. EA has no impact on the condition of the newborns.

Polish guidelines for the prevention and treatment of venous thromboembolism 2009 update

The overall objective of the Polish guidelines for the prevention and treatment of venous thromboembolism is to increase patient benefit and safety by appropriate prevention and treatment of deep vein thrombosis and pulmonary embolism as well as proper management of the complications associated with antithrombotic and thrombolytic therapy. These guidelines apply to adult trauma, cancer, surgical, and medical patients as well as those at increased risk of venous thromboembolism. Specific recommendations have been formulated for pregnant women, patients requiring surgery while receiving long-term oral anticoagulant treatment, and patients undergoing regional anesthesia and/or analgesia. We systematically identified all current clinical practice guidelines concerning the prevention and/or treatment of venous thromboembolism and assessed their methodological quality using the AGREE instrument. We chose to update existing Polish guidelines by adapting the most recent high quality guidelines that we identified to Polish cultural and organizational setting rather than develop all recommendations de novo. We based our recommendations primarily on the 8th edition of the American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines on Antithrombotic and Thrombolytic Therapy and on the European Society of Cardiology (ESC) Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism. To make recommendations regarding specific management issues that had not been addressed in ACCP guidelines, or whenever panel members felt they needed additional information to reach the decision we also consulted guidelines developed by other professional societies and organizations as well as additional sources of evidence. For each recommendation we explicitly assessed its relevance and applicability in the context of health care system in Poland. We adapted recommendations when necessary, explicitly stating the rationale for modification and judgements about the values and preferences we assumed. We developed original recommendations on the use of new oral anticoagulants that have recently become available, following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.