Medicina
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Review
New insights for adult cardiopulmonary resuscitation. Up-coming resuscitation guidelines 2010.
Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. ⋯ Current trends in cardiopulmonary resuscitation are toward minimizing the interruptions of chest compressions and improving the quality of cardiopulmonary resuscitation. In addition, attention should be paid to all the parts of chain of survival, which remains essential in improving survival rates.
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Metformin is an oral antidiabetic agent, used to reduce blood glucose concentration in patients with non-insulin-dependent diabetes mellitus. Metformin was approved in Europe in 1957, and it is used for the treatment of non-insulin-dependent diabetes mellitus for more than 50 years. One of the most serious complications of the treatment with this drug is metformin-induced lactic acidosis. ⋯ According to some investigators, metformin should be withdrawn before major surgery. Concerns have been raised for the use of metformin in patients with cardiovascular, renal, hepatic, and respiratory failure. The aim of the article is to overview the frequency of metformin-caused lactic acidosis and the latest recommendations for the use of metformin in the perioperative period proposed in recent years.
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Visibility in the surgical field reduced by bleeding is one of the most important problems of endoscopic sinus surgery. It causes the risk of serious complications and reduces intervention quality. ⋯ Since general anesthesia may influence surgical bleeding in physiological and pharmacological pathways, the role of an anesthesiologist is extremely important in reducing bleeding. The impact of different anesthesia methods on quality of the surgical field is being investigated, and the most effective medicines are being sought.
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Comparative Study
Incidence and risk factors for early postoperative cognitive decline after coronary artery bypass grafting.
BACKGROUND. The aim of our study was to evaluate the incidence of early postoperative cognitive decline (POCD) and determine perioperative risk factors as well as the impact of asymptomatic cerebral vascular lesion on the development of neurocognitive complications. MATERIALS AND METHODS. ⋯ Age of more than 65 years (OR, 2.7), asymptomatic carotid artery stenosis of more than 50% (OR, 26.89), duration of surgery of more than 4 hours (OR, 4.08), postoperative mechanical ventilation of more than 6 hours (OR, 3.33), and stay in an intensive care unit for more than 3 days (OR, 3.38) were significant independent predictors of cognitive decline. CONCLUSIONS. Increased age, preoperative prevalence of craniocervical atherosclerotic lesions, longer time in surgery, longer stay in an intensive care unit and mechanical ventilation time were found to be the risk factors for developing postoperative cognitive decline.
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Review Historical Article
[The International Classification of Functioning, Disability, and Health and experience of its implementation into practice].
The International Classification of Functioning, Disability, and Health (ICF) organizes and classifies health and other related conditions, their consequences, and factors. The aim of this article is to summarize the experience of implementation of the ICF and possibilities for its application based on the recent literature data. This article gives brief information about background and history of the ICF development; essential ICF regulations and aims are defined as well as data on designing the methods of evaluation of health and other conditions related to it according to the ICF and their practical use in various rehabilitation spheres are presented. ⋯ After summarizing the information on experience of the ICF implementation in other countries, the following aspects are emphasized: evaluation methods of functional state for patients and disabled are being developed and implemented according to the Comprehensive and Brief ICF Core Sets; the need for service in rehabilitation, geriatrics, and social security spheres is identified; the effectiveness of rehabilitation programs is evaluated based on the changes of personal functionality, described by the ICF categories. Development of a rehabilitation program is illustrated by the example of practical application of the ICF. According to the experience of other countries, guidelines of the ICF implementation into practice in Lithuania are given.