The importance of blood pressure measurements at the emergency department in detection of arterial hypertension.

BACKGROUND: Arterial hypertension (AH) is the most important modifiable risk factor for cardiovascular diseases in Poland and around the world. Unfortunately, despite its potentially catastrophic consequences, more than 30% of hypertensive patients in Poland remain undiagnosed. Therefore, emergency department (ED) triage may play a role in screening of a significant proportion of the population. The present study aimed to assess the prevalence of hypertension in patients reporting to the ED by verifying ad hoc measurements with ambulatory blood pressure monitoring (ABPM). METHODS: The study included 78,274 patients admitted to the ED of the University Clinical Center in Gdansk from 01.01.2019 to 31.12.2020, with elevated blood pressure values (systolic blood pressure [SBP] > 140 mmHg and/or diastolic blood pressure [DBP] > 90 mmHg) during triage according to the inclusion and exclusion criteria. RESULTS: Out of 34,597 patients with SBP > 140 mmHg and/or DBP > 90 mmHg, 27,896 patients (80.6% of patients) had previously been diagnosed with AH. Finally, a group of 6701 patients with elevated values of arterial blood pressure in triage, who had not yet been diagnosed with AH, was identified. This accounted for 8.6% of patients admitted to the ED. Ultimately, 58 patients (26 women and 36 men) agreed to undergo ABPM. Based on the analysis, AH 32 patients were diagnosed with AH (55.2%). CONCLUSIONS: The ED plays an essential role in diagnosing hypertension among people reporting to the ED for various reasons. There is a high probability of a diagnosis of AH in a group of patients who have elevated blood pressure values during triage and have not yet been diagnosed with hypertension.

Conflict Sources and Management in the ICU Setting before and during COVID-19: A Scoping Review of the Literature.

INTRODUCTION: Conflicts are an inherent part of work within any organisation. They can arise between members of an interdisciplinary team (or between teams representing different departments), between patients and team members/family members, and patients' families and team members. Various conflict situations among employees may occur, therefore it is very important to identify their causes and take preventive or targeted corrective measures. The aim of this study was to review the available literature concerning conflicts arising in ICUs-their types, methods of expression as well as their management and mitigation. In addition, we reviewed the available literature on the impact of the pandemic on the ICU environment caring for COVID-19 patients. METHODS: The databases were searched. Single key words or their combinations using AND or OR operators were entered. Eventually, 15 articles were included in our review, which included two identical papers. RESULTS: Conflicts occurred occasionally or rarely; researchers describing ethical conflicts demonstrated a moderate level of exposure to conflicts. The pandemic created many challenges and ethical dilemmas that are a source of ethical conflict. CONCLUSIONS: As conflict by nature remains inevitable, adequate procedures in conflict management should be developed and the leadership of managing personnel should be reinforced, because team members frequently expect guidance from their supervisors. The importance of training in interpersonal communication and crisis situation management in healthcare should therefore be emphasised.

Level and factors associated with physical activity among university teacher: an exploratory analysis.

BACKGROUND: Physical inactivity is one of the primary factors that leads to obesity and overweight. What is more, it is becoming an increasingly common problem among the population of those who work. The causes of obesity and the lack of physical activity are multifactorial. The aims of the study were: to (1) measure the level of physical activity among the university staff, (2) evaluate what factors have a significant influence on undertaking the physical activity and lack of. METHODS: A cross-sectional study was conducted via the Internet questionnaires among university staff in Northern Poland and Pomeranian Region. Taking into consideration the climate and cultural factors in Poland, a physical activity test with the usage of IPAQ scale was performed between September and November 2018 and between March and June 2019. The data was collected on the basis of the standardized long form of the IPQA questionnaire, the GSE Scale and the interview questionnaire including questions about sex, age and health assessment. RESULTS: The study group consisted of 276 respondents, including 143 women (51.8%) and 133 men (48.2%). The average age of the respondents was 42.22 with SD ± 11.01. The weight status was categorized with the use of BMI index. 51.3% (142) of the respondents had normal body mass, 93 (33.8%) were overweight, while 23 (8.4%) were obese. The mean BMI index was 25.23 points (SD ± 4.04). One hundred and twenty five (45.1%) respondents were the employees of the Medical University, and 54.9% were employed by the Technical University. Detailed analyses using Spearman correlation test confirmed the presence of a statistically higher level of physical activity among respondents employed at the Medical University (M 513.37; SD ± 609.13) than the employees of Technical University (M 378.38; SD ± 328.26). The odds ratio analysis shows that a low level of physical activity in the group of technical university staff has a significant correlation with the other social behavior which is the alcohol consumption. CONCLUSION: This study confirms that the number of points obtained in the IPAQ scale, classified the academics in the workgroup presenting low physical activity which does not exceed 600 MET-min/week. The most common form of activity in this group was walking. There was no correlation between physical activity and self-efficacy, age, marital status or the number of children.

The Occurrence of Postoperative Cognitive Dysfunction (POCD) - Systematic Review. / Wystepowanie zaburzen poznawczych po zabiegach chirurgicznych ­ przeglad systematyczny.

AIM: The aim of this systematic review was to summarize the present literature on cognitive dysfunctions in adults after surgical procedures. METHODS: MEDLINE: PubMed, OVID, Web of Science, EBSCO databases have been searched using relevant key words. The literature on cognitive dysfunctions after surgical procedures has been reviewed and the risk factors of POCD occurrence have been analyzed. RESULTS: The results from seven articles describing neuropsychological studies of 2,796 patients have been analyzed. The tests were conducted within a very short time after the procedure (7 days), within a short time (3 months) and within a long-term perspective (12-60 months). POCD within a very short time after the operation occurred with a different frequency: from 17 to 56% with a tendency to resolve over time (3-34.2%). POCD risk factors have been identified: advanced age, insulin resistance, a short education period. The type of surgical procedure, anesthesia or microembolization related to CPB, does not influence the occurrence of POCD. CONCLUSIONS: It seems that one should focus on searching risk factors outside the procedures, and that certain recommendations should be developed regarding perioperative proceedings which might be beneficial for patients at risk of the impairment of their cognitive functions after a surgical procedure.

A review of randomized trials comparisons of epidural with parenteral forms of pain relief during labour and its impact on operative and cesarean delivery rate.

OBJECTIVES: The aim of this review was to summarise the available literature on different modalities of labour pain relief (epidural vs. parenteral) and to assess their impact on the rate of caesarean section deliveries and instrumental deliveries, and on the need to support the uterine contractile function. MATERIAL AND METHODS: The PubMed, Web of Science and Cochrane databases were reviewed to identify articles describing the effect of labour pain relief on the course of labour. This review includes 16 studies with 7150 patients. RESULTS: The analysis of the obtained data revealed that epidural analgesia (EA) or combined epidural and spinal anaesthesia (CESA) provided significantly better labour pain relief when compared with parenteral opioids. Conduction anaesthesia was not associated with an increase in the caesarean section delivery rate. Some authors concluded that conduction anaesthesia was associated with the need for assisted delivery. CONCLUSIONS: Epidural analgesia is a well-recognised method of labour pain relief. It is associated with the parturient's higher satisfaction when compared to parenteral opioids. EA does not directly increase the caesarean section delivery rate, yet it can lead to instrumental deliveries (vacuum-assisted, obstetrics forceps) and a need to pharmacologically support the uterine contractile function. Further studies are required to evaluate the effect of EA on the course of labour, and methods of minimising its adverse effects.