Acute respiratory failure due to pneumonia is a significant cause of death in children 6-18 years old.; Objective - to find out whether diaphragm dysfunction might lead to unsuccessful weaning from MV in children 6-18 years old.; We provided prospective observational cohort study and included 104 patients, who were splitting in the study and the control groups and 2 age subgroups. To consider diaphragm function, we check amplitude of its movement and diaphragm thickening fraction (Dtf).; The primary outcome was the incidence of successful weaning from MV. The secondary outcomes were changes in diaphragm function parameters.; Dtf for right hemidiaphragm was significantly lower in the study group 1st subgroup on day 1 and day 5, and significantly higher on day 14 (p<0.05), while for left hemidiaphragm it was significantly higher on day 1 and lower on day 5 compared with the control group (p<0.05). In 2nd subgroup Dtf was significantly higher for both sides in the study group on day 1 compared with the control group (p<0.05). ; Amplitude of diaphragm movement was significantly decreased in 1st subgroup of the study group on day 1 and day 5 and increased on day 14 compared with the control group (p<0.05).; The incidence of successful weaning from MV in the study group was significantly lower compared with the control group.; Diaphragm dysfunction might alter weaning from MV in children 6-18 years old.
The textbook has been compiled in accordance with the requirements of the English language programme for students of medical educational establishments of the 1st-4th level of accreditation with basic knowledge of English. The aim of the textbook is to master skills in communication, reading and translation of scientific medical literature. The textbook includes 19 units which contain original texts on general medical issues, healthcare matters, anatomy, physiology, grammar material and exercises for practising and improving English language skills. The methodology integrates speaking, listening, writing and reading skills following the task-based approach.
A future medical practitioner is a holder of high moral qualities, possessing ethics and the method of aesthetic
communication. A good command of aesthetic communication in nursing practice has a positive impact on achieving
desired outcomes. The aim is to highlight the conceptual frame and the specificity of aesthetic communication for future nurses and how to implement it during the educational process. Analysis, synthesis, and systematization were used to shape the complex characteristics of developing aesthetic communication; comparative and descriptive methods were used to distinguish the effective features of aesthetic communication; the analytical method was applied to receive information about the theoretical and practical problems of developing aesthetic communication; and the Pearson test χ2 was used as a statistical method to compare and verify the obtained data. The research involved 90 students of the nursing faculty at Andrey Krupynsky Lviv Medical Academy in Ukraine, divided into experimental and comparison groups. The results showed a high level of aesthetic communication in the experimental group (42%), versus the comparison group (22%). Students’ academic performance improved in four language skills: reading, speaking, listening, and writing competence. All students demonstrated significant improvement in speaking fluently due to the implementation of aesthetic communication exercises into the teaching process. Our suggested technique for teaching a basic course, “Professional English”, in combination with an optional course, “Aesthetic Communication,” works properly and should be implemented in other higher educational institutions, as good aesthetic communication skills are crucial in building a nurse-patient relationship.
Keywords: aesthetic communication; external and internal personal communication; professional English; nursing
education; future nurses
Background and Goal of Study – non-cardiac surgery is assosiated with up to 1,5 % mortality rate and near 40 % of these are caused by cardiac complication (ESC/ESA Guidelines). The goal of study was to analise impact of multiple factors that can be assossiated with lethal prognosis in patients with cardiac pathology.
Materials and Methods. We have included 172 patients with documented cardiac pathology undergoing noncardiac surgery. Exclusion criterious were oncology, thraumatic injury and urgent surgery. We have analised surgical risk (SR) according to type of surgery, functional capacity (FC) of the patient, clinical risc factors (CRF) according to revised cardiac risk index (RCRI), ASA physical status, level of natriuretic peptide (NUP) before surgery and hs-troponins (hsTr) in patients with elevated NUP, myocardial performance index or Teiindex as combined marker of systolic and dyastolic
heart function assessed with heart sonography Results. 56 (32.56 %) patients had elevated NUP before surgery. 32 persons (18.61 %) among all died. But 28 deceased had an increased level of NUP. That is, half of patients with elevated NUP died. The average time of death was 30 days after surgery.
It should be noted that the level of troponins in the dynamics did not exceed the norm in any person with the initial elevation of NUP. In 4 persons without initial elevation of NUP the single jump of hsTr just after the surgery was revealed. Two of them had short clinical postoperative anginal symptoms but there was no changes on ECG or heart sonography. No peculiarities among SR, CRF was found. 20 patients (62.5 %) among deseased persons had ASA III status. Functional capacity turned out to be interesting – it was poor in 36 patients (20.93 %), and 28 among them died. The MPI, which according to the published data should be within 0.39±0,05 in norm, was significantly higher in all our patients – 0.60±0.09 (p˂0.05), that identified combined systolic and diastolic myocardial dysfunction. And, contrary to our expectations, MPI was 0.56±0.08 in those who died.
Conclusions. The results of our observation confirm the feasibility of determining the level of NUP in patients with concomitant cardiac pathology. Particular attention among them should be paid to persons with reduced functional capacity and higher class in the ASA physical status. Assessing of natriuretic peptide and/or troponins dynamic require some financial costs, while functional capacity assessment is an affordable clinical method that we should use more widely in routine practice to identify patients with increased cardiac risk.
ST2 and NT-proBNP are preferred biomarkers in clinical practice for the diagnosis, risk stratification and guided therapy of STEMI and Heart Failure (HF). Purpose of the study was to determine the dynamics of NT-proBNP and ST2 and their correlations with the development of cardiovascular (CV) complications in patients with STEMI.
Methods: In total 60 patients (50 males and 10 females, mean age 60.95±9.26 years) with STEMI were examined. Patients were divided into 2 groups: group I – 22 patients with STEMI complicated with acute HF with Killip class III-IV and rhythm disturbances; group II – 38 patients with STEMI with HF Killip I. NT-proBNP and ST2 concentration in the serum were determined twice, on admission and on the 10th day of treatment.
Results: At admission mean levels of NT-proBNP were higher in group I patients with CV complications (612.8 [489.5; 860.4] pg/ml – group I) when compared to group II patients without severe CV complications (598.6 [326.6; 913.1] pg/ml – group II, p > 0.05). On the 10th day of treatment serum levels of NT-proBNP decreased to 340 [188; 434.5] pg/ml (group I) and 190.1 [113.3; 355.3] pg/ml (group II), respectively (p > 0.05). Mean levels ofST2 at admission were higher in patients with severe CV complications (61.1 [44.8; 133.6] ng/ml – group I) when compared to group II patients (40.8 [33.1; 64.3] ng/ml – group II, p < 0.05). On the 10th day of treatment mean level of ST2 decreased to 23.7 [18.8; 28.3] ng/ml (group I) and 24 [19.7; 28.7] ng/ml (group II), respectively (p > 0.05). Significant direct correlations of moderate strength were found between ST2 and NT-proBNP levels in group I on day 1 and on the 10th day of treatment (r = 0.32; p < 0.05 and r = 0.36; p < 0.05, respectively). Significant direct correlations of moderate and high strength were found between ST2 and NT-proBNP levels in group II on day 1 and on the 10th day of treatment (r = 0.367; p < 0.05 and r = 0.768; p < 0.001, respectively). Increase of ST2 and NT-proBNP above its threshold values indicates a significant risk of CV complications (sensitivity – 95.5 %, specificity – 63.2 %, AUC – 0.849, p<0.05).
In conclusion, the concentration levels of ST2 and NT-proBNP at baseline allows to predict more severe course of STEMI and the risk of CV complications. Treatment with optimal medical therapy alows to decrease biomarkers of myocardial fibrosis sST2 lower than 35 ng/ml therefore downturn the posibility of adverse outcome development in STEMI patients.