Although survey results indicate clear connection between the physician-patient communication and health outcomes, mechanisms of their action are still insufficiently clear. The aim was to investigate the specificity of communication with patients suffering from gastrointestinal diseases and the impact of good communication on measurable outcomes. We performed PubMed (Medline) search using the following key words: communication, health outcomes, and gastrointestinal diseases. Seven pathways through which communication can lead to better health include increased access to care, greater patient knowledge and shared understanding, higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient agency and empowerment, and better management of emotions. Although these pathways were explored with respect to cancer care, they are certainly applicable to other health conditions as well, including the care of patients suffering from gastrointestinal diseases. Although proposing a number of pathways through which communication can lead to improved health, it should be emphasized that the relative importance of a particular pathway will depend on the outcome of interest, the health condition, where the patient is in the illness trajectory, and the patient’s life circumstances. Besides, research increasingly points to the importance of placebo effect, and it is recommended that health professionals encourage placebo effect by applying precisely targeted communication skills, as the unquestionable and successful part of many treatments. It is important that the clinician knows the possible positive and negative effects of communication on health outcomes, and in daily work consciously maximizes therapeutic effects of communication, reaching its proximal (understanding, satisfaction, clinician-patient agreement, trust, feeling known, rapport, motivation) and intermediate outcomes (access to care, quality medical decision, commitment to treatment, trust in the system, social support, self-care skills, emotional management) to improve the health of patients he cares for.
{"title":"[COMMUNICATION AND HEALTH OUTCOMES IN PATIENTS SUFFERING FROM GASTROINTESTINAL DISEASES].","authors":"G Petriček, V Cerovečki, Z Ožvačić Adžić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although survey results indicate clear connection between the physician-patient communication and health outcomes, mechanisms\u0000of their action are still insufficiently clear. The aim was to investigate the specificity of communication with patients suffering\u0000from gastrointestinal diseases and the impact of good communication on measurable outcomes. We performed PubMed\u0000(Medline) search using the following key words: communication, health outcomes, and gastrointestinal diseases. Seven pathways\u0000through which communication can lead to better health include increased access to care, greater patient knowledge and shared\u0000understanding, higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient agency and\u0000empowerment, and better management of emotions. Although these pathways were explored with respect to cancer care, they\u0000are certainly applicable to other health conditions as well, including the care of patients suffering from gastrointestinal diseases.\u0000Although proposing a number of pathways through which communication can lead to improved health, it should be emphasized\u0000that the relative importance of a particular pathway will depend on the outcome of interest, the health condition, where the patient\u0000is in the illness trajectory, and the patient’s life circumstances. Besides, research increasingly points to the importance of placebo\u0000effect, and it is recommended that health professionals encourage placebo effect by applying precisely targeted communication\u0000skills, as the unquestionable and successful part of many treatments. It is important that the clinician knows the possible positive\u0000and negative effects of communication on health outcomes, and in daily work consciously maximizes therapeutic effects\u0000of communication, reaching its proximal (understanding, satisfaction, clinician-patient agreement, trust, feeling known, rapport,\u0000motivation) and intermediate outcomes (access to care, quality medical decision, commitment to treatment, trust in the system,\u0000social support, self-care skills, emotional management) to improve the health of patients he cares for.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Colorectal cancer is a global problem worldwide because of its very high prevalence and mortality. Therefore, prevention of colorectal cancer and its early diagnosis is of great importance. In Croatia, the National Program for Colorectal Cancer has been carried out since 2007; however, the rate of response was about 18 percent, depending on the region. Such a great public health and social and economic problem requires multidisciplinary approach in which family physicians have an important role. The well spread and developed network of primary health care and the availability of family physicians to each inhabitant have not been sufficiently exploited, especially for such preventive activities where family physicians could supervise program implementation.
{"title":"[PREVENTION AND EARLY DETECTION OF COLORECTAL CANCER].","authors":"B Bergman Marković","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Colorectal cancer is a global problem worldwide because of its very high prevalence and mortality. Therefore, prevention of\u0000colorectal cancer and its early diagnosis is of great importance. In Croatia, the National Program for Colorectal Cancer has been\u0000carried out since 2007; however, the rate of response was about 18 percent, depending on the region. Such a great public health\u0000and social and economic problem requires multidisciplinary approach in which family physicians have an important role. The well\u0000spread and developed network of primary health care and the availability of family physicians to each inhabitant have not been\u0000sufficiently exploited, especially for such preventive activities where family physicians could supervise program implementation.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35505157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M Bogdanović Dvorščak, T Lupis, M Adanić, J Pavičić Šarić
Acute respiratory distress syndrome (ARDS) develops in patients with predisposing conditions that induce systemic inflammatory response such as sepsis, pneumonia, acute pancreatitis, major trauma, or multiple transfusions. Sepsis is the most common cause of ARDS. Sepsis-related ARDS patients have significantly lower PaO2 /FiO2 ratios than patients with non-sepsis-related ARDS. Furthermore, their recovery from lung injury is prolonged, weaning from mechanical ventilation less successful, and extubation rate slower. Clinical outcomes in patients with sepsis-related ARDS are also worse, associated with significantly higher 28-day and 60-day mortality rates (31.1% vs. 16.3% and 38.2% vs. 22.6%, respectively). It is extremely important to optimally adjust ventilator setting to current condition of lungs, while providing all other therapeutic measures in the treatment of sepsis, severe sepsis and septic shock. The pool of data on treatment possibilities for patients with ARDS grows every year, with specifically designed mechanical ventilation strategies. Ventilator modes and adequate positive end-expiratory pressure (PEEP) settings play a major role in these strategies. However, how can we best apply these experimental and clinical data to everyday clinical practice? This article emphasizes protective ventilation as a measure that is proven to reduce mortality in this group of patients, when systematically and consistently applied.
{"title":"[ACUTE RESPIRATORY DISTRESS SYNDROME AND OTHER RESPIRATORY DISORDERS IN SEPSIS].","authors":"M Bogdanović Dvorščak, T Lupis, M Adanić, J Pavičić Šarić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) develops in patients with predisposing conditions that induce systemic inflammatory\u0000response such as sepsis, pneumonia, acute pancreatitis, major trauma, or multiple transfusions. Sepsis is the most common cause\u0000of ARDS. Sepsis-related ARDS patients have significantly lower PaO2 /FiO2 ratios than patients with non-sepsis-related ARDS.\u0000Furthermore, their recovery from lung injury is prolonged, weaning from mechanical ventilation less successful, and extubation\u0000rate slower. Clinical outcomes in patients with sepsis-related ARDS are also worse, associated with significantly higher 28-day\u0000and 60-day mortality rates (31.1% vs. 16.3% and 38.2% vs. 22.6%, respectively). It is extremely important to optimally adjust\u0000ventilator setting to current condition of lungs, while providing all other therapeutic measures in the treatment of sepsis, severe\u0000sepsis and septic shock. The pool of data on treatment possibilities for patients with ARDS grows every year, with specifically\u0000designed mechanical ventilation strategies. Ventilator modes and adequate positive end-expiratory pressure (PEEP) settings play\u0000a major role in these strategies. However, how can we best apply these experimental and clinical data to everyday clinical practice?\u0000This article emphasizes protective ventilation as a measure that is proven to reduce mortality in this group of patients, when\u0000systematically and consistently applied.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35498486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The most important multiresistant bacteria causing treatment failures are extended-spectrum β-lactamase and/or plasmid-mediated AmpC β-lactamase positive Enterobacteriaceae, carbapenemase producing Acinetobacter baumannii and Pseudomonas (P.) aeruginosa, methicillin-resistant Staphylococcus (S.) aureus, penicillin-resistant Streptococcus pneumoniae, and van-comycin- resistant Enterococcus spp. Extended-spectrum β-lactamases hydrolyze oxyimino-caphalosporins and aztreonam, are mostly produced by Enterobacteriaceae, and are encoded on transferable plasmids which often contain resistance genes to non--lactam antibiotics. Plasmid-mediated AmpC β-lactamases descend from the chromosomal ampC gene transferred to the plasmid. Those -lactamases confer resistance to first, second and third generation of cephalosporins, monobactams, and to -lactam--lactamase inhibitor combinations. Enterobacteriaceae may develop resistance to carbapenems due to the hyperproduction of ESBLs or plasmid-mediated AmpC β-lactamases in combination with porin loss or due to the production of carbapenemases of class A (KPC, IMI, NMC, SME), B (metallo-β-lactamases from VIM, IMP or NDM series), and D (OXA-48 β-lactamase). Carbapenemases found in Acinetobacter spp. belong to molecular class A (KPC), B (metallo-β-lactamases of IMP, VIM, NDM or SIM family) and D (OXA enzymes). The most frequent mechanism of carbapenem resistance in Acinetobacter spp. is through the production of OXA-enzymes but other various mechanisms including decreased permeability and efflux pump overexpression could also be involved. Carbapenem-resistance in P. aeruginosa is usually mediated by the production of metallo-β-lactamases of IMP, VIM, GIM, SPM or NDM series, loss of OprD outer membrane protein and/or upregulation of MexAB or MexCD efflux pumps. Methicillin-resistance in S. aureus occurs as the result of the acquisition of mecA gene that encodes novel PBP2a protein. Expression of PBP2a renders bacteria resistant to all -lactams including cephalosporins (with the exception of ceftaroline and ceftobiprole) and carbapenems. Most strains of penicillin resistant Streptococcus pneumoniae are often resistant to cephalosporins and antibiotics from other classes, presenting a serious problem in treating invasive infections. The most important therapeutic problem in enterococci is development of resistance to vancomycin.
{"title":"[MULTIRESISTANT BACTERIA].","authors":"B Bedenić, S Sardelić, M Ladavac","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The most important multiresistant bacteria causing treatment failures are extended-spectrum β-lactamase and/or plasmid-mediated\u0000AmpC β-lactamase positive Enterobacteriaceae, carbapenemase producing Acinetobacter baumannii and Pseudomonas\u0000(P.) aeruginosa, methicillin-resistant Staphylococcus (S.) aureus, penicillin-resistant Streptococcus pneumoniae, and van-comycin-\u0000resistant Enterococcus spp. Extended-spectrum β-lactamases hydrolyze oxyimino-caphalosporins and aztreonam, are\u0000mostly produced by Enterobacteriaceae, and are encoded on transferable plasmids which often contain resistance genes to\u0000non--lactam antibiotics. Plasmid-mediated AmpC β-lactamases descend from the chromosomal ampC gene transferred to the\u0000plasmid. Those -lactamases confer resistance to first, second and third generation of cephalosporins, monobactams, and to\u0000-lactam--lactamase inhibitor combinations. Enterobacteriaceae may develop resistance to carbapenems due to the hyperproduction\u0000of ESBLs or plasmid-mediated AmpC β-lactamases in combination with porin loss or due to the production of carbapenemases\u0000of class A (KPC, IMI, NMC, SME), B (metallo-β-lactamases from VIM, IMP or NDM series), and D (OXA-48 β-lactamase).\u0000Carbapenemases found in Acinetobacter spp. belong to molecular class A (KPC), B (metallo-β-lactamases of IMP, VIM, NDM or\u0000SIM family) and D (OXA enzymes). The most frequent mechanism of carbapenem resistance in Acinetobacter spp. is through the\u0000production of OXA-enzymes but other various mechanisms including decreased permeability and efflux pump overexpression\u0000could also be involved. Carbapenem-resistance in P. aeruginosa is usually mediated by the production of metallo-β-lactamases of\u0000IMP, VIM, GIM, SPM or NDM series, loss of OprD outer membrane protein and/or upregulation of MexAB or MexCD efflux pumps.\u0000Methicillin-resistance in S. aureus occurs as the result of the acquisition of mecA gene that encodes novel PBP2a protein. Expression\u0000of PBP2a renders bacteria resistant to all -lactams including cephalosporins (with the exception of ceftaroline and ceftobiprole)\u0000and carbapenems. Most strains of penicillin resistant Streptococcus pneumoniae are often resistant to cephalosporins\u0000and antibiotics from other classes, presenting a serious problem in treating invasive infections. The most important therapeutic\u0000problem in enterococci is development of resistance to vancomycin.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35498431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Early identification of sepsis is crucial to improve patient outcomes. Yet, sepsis can be difficult to differentiate in Emergency Unit. Sepsis treatment includes fluid resuscitation as soon as possible, starting with >1000 mL of crystalloids or 500 mL of colloids for 30 min. Acute kidney injury is a serious complication of sepsis, associated with increased mortality, prolonged hospital stay and increased cost of care. In patients with sepsis, it would be useful to have some biomarkers of early organ damage, to improve the capacity for early recognition and diagnosis of acute kidney injury.
{"title":"[MANAGEMENT OF ADULT SEPTIC PATIENT IN EMERGENCY UNIT].","authors":"I Prkačin, G Cavrić, D Bartolek-Hamp","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Early identification of sepsis is crucial to improve patient outcomes. Yet, sepsis can be difficult to differentiate in Emergency Unit.\u0000Sepsis treatment includes fluid resuscitation as soon as possible, starting with >1000 mL of crystalloids or 500 mL of colloids for\u000030 min. Acute kidney injury is a serious complication of sepsis, associated with increased mortality, prolonged hospital stay and\u0000increased cost of care. In patients with sepsis, it would be useful to have some biomarkers of early organ damage, to improve the\u0000capacity for early recognition and diagnosis of acute kidney injury.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35498433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sepsis is a growing global problem with high health care costs. Therefore, it is important to start treatment on time. Nutrition support is the main element of modern therapy for sepsis. Enteral nutrition has some advantage to parenteral nutrition because it prevents bacterial translocation into systemic circulation, thus reducing the number of infections. Appropriate nutritional support has a direct impact on the patient clinical outcome.
{"title":"[NUTRITION SUPPORT IN PATIENTS WITH SEPSIS].","authors":"S Naumovski-Mihalić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Sepsis is a growing global problem with high health care costs. Therefore, it is important to start treatment on time. Nutrition\u0000support is the main element of modern therapy for sepsis. Enteral nutrition has some advantage to parenteral nutrition because it\u0000prevents bacterial translocation into systemic circulation, thus reducing the number of infections. Appropriate nutritional support\u0000has a direct impact on the patient clinical outcome.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35498428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Febrile neutropenia is a common and potentially fatal complication of intense cytotoxic therapy, which makes it the main cause of non-relapse mortality in patients with hematologic malignancies. Some of the patients are at risk of specific infections due to underlying disease of previous treatment regimens. Considering that most febrile neutropenic patients can be diagnosed with sepsis, diagnosis and treatment should be treated as septic. It is important to recognize patients at high risk since the incidence of sepsis in neutropenic patients can be significantly reduced using antimicrobial prophylaxis and granulocyte growth factors. Once sepsis occurs, prompt treatment according to guidelines, individualized based on the specific problems of each patient, and microbiological situation can significantly reduce mortality and morbidity.
{"title":"[TREATMENT OF SEPSIS IN NEUTROPENIC PATIENTS].","authors":"V Zatezalo, N J Gredelj Šimec","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Febrile neutropenia is a common and potentially fatal complication of intense cytotoxic therapy, which makes it the main cause\u0000of non-relapse mortality in patients with hematologic malignancies. Some of the patients are at risk of specific infections due to\u0000underlying disease of previous treatment regimens. Considering that most febrile neutropenic patients can be diagnosed with\u0000sepsis, diagnosis and treatment should be treated as septic. It is important to recognize patients at high risk since the incidence\u0000of sepsis in neutropenic patients can be significantly reduced using antimicrobial prophylaxis and granulocyte growth factors.\u0000Once sepsis occurs, prompt treatment according to guidelines, individualized based on the specific problems of each patient,\u0000and microbiological situation can significantly reduce mortality and morbidity.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35498483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Septic cardiomyopathy is a reversible myocardial dysfunction in patients with sepsis. Depression in myocardial contractility is detected in more than 40% of patients with severe sepsis or septic shock. Sepsis-induced myocardial dysfunction (SIMD) is one of the main predictors of poor outcome in patients with sepsis. Mortality rate in patients with sepsis and SIMD is 70%-90%, while it is only 20% in patients without SIMD. SIMD is characterized by ventricular dilatation, decreased ejection fraction, less response to fluid replacement and catecholamines. It is reversible within 7-10 days. Many extracellular and intracellular mechanisms and mediators included in the regulation of the heart muscle cell contraction may contribute to septic cardiomyopathy. The underlying cause is disorder in communication between the intracellular contractile apparatus and extracellular matrix, resulting in attenuation of the myocardial contraction. Hemodynamic monitoring, ECG, transthoracic and transesophageal echocardiography, and various laboratory tests are used in the diagnostic work-up. There are several therapeutic interventions such as infection control, optimization of hemodynamic parameters, adequate volume resuscitation, inotropic drugs, transfusion of blood derivatives, and statins. However, for now, there is no efficient therapy for septic cardiomyopathy. The management of SIMD includes cardio-protective therapy, etiologic treatment of sepsis and septic shock, and supportive measures.
{"title":"[SEPTIC CARDIOMYOPATHY].","authors":"J Vincelj","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Septic cardiomyopathy is a reversible myocardial dysfunction in patients with sepsis. Depression in myocardial contractility is\u0000detected in more than 40% of patients with severe sepsis or septic shock. Sepsis-induced myocardial dysfunction (SIMD) is one\u0000of the main predictors of poor outcome in patients with sepsis. Mortality rate in patients with sepsis and SIMD is 70%-90%, while\u0000it is only 20% in patients without SIMD. SIMD is characterized by ventricular dilatation, decreased ejection fraction, less response\u0000to fluid replacement and catecholamines. It is reversible within 7-10 days. Many extracellular and intracellular mechanisms and\u0000mediators included in the regulation of the heart muscle cell contraction may contribute to septic cardiomyopathy. The underlying\u0000cause is disorder in communication between the intracellular contractile apparatus and extracellular matrix, resulting in attenuation\u0000of the myocardial contraction. Hemodynamic monitoring, ECG, transthoracic and transesophageal echocardiography, and\u0000various laboratory tests are used in the diagnostic work-up. There are several therapeutic interventions such as infection control,\u0000optimization of hemodynamic parameters, adequate volume resuscitation, inotropic drugs, transfusion of blood derivatives, and\u0000statins. However, for now, there is no efficient therapy for septic cardiomyopathy. The management of SIMD includes cardio-protective\u0000therapy, etiologic treatment of sepsis and septic shock, and supportive measures.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35498487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Epidemiological studies indicate a large incidence of sepsis in the general population. Despite advances in surgery, surgical patients with sepsis make almost one-third of all cases of sepsis. Sepsis is the leading cause of morbidity and mortality among surgical patients, with intra-abdominal infection as the main source of sepsis. According to some authors, sepsis in surgical patients is different from those in non-surgical patients because of the immune function modulation that occurs as a result of surgery and anesthesia applied; therefore, these two groups should be monitored separately. In the treatment of sepsis, the key steps are early recognition of sepsis, rapid diagnosis, and aggressive treatment that includes the choice of intervention with the least physiological insult to control the sources of infection. Emphasis should be placed on the prevention of sepsis throughout the perioperative period. In surgical septic patients, treatment is complex and requires a multidisciplinary approach.
{"title":"[SEPSIS IN SURGICAL PATIENT].","authors":"D Guštin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Epidemiological studies indicate a large incidence of sepsis in the general population. Despite advances in surgery, surgical\u0000patients with sepsis make almost one-third of all cases of sepsis. Sepsis is the leading cause of morbidity and mortality among\u0000surgical patients, with intra-abdominal infection as the main source of sepsis. According to some authors, sepsis in surgical\u0000patients is different from those in non-surgical patients because of the immune function modulation that occurs as a result of\u0000surgery and anesthesia applied; therefore, these two groups should be monitored separately. In the treatment of sepsis, the key\u0000steps are early recognition of sepsis, rapid diagnosis, and aggressive treatment that includes the choice of intervention with the\u0000least physiological insult to control the sources of infection. Emphasis should be placed on the prevention of sepsis throughout\u0000the perioperative period. In surgical septic patients, treatment is complex and requires a multidisciplinary approach.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35498485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D Bartolek Hamp, G Cavrić, I Prkačin, K Houra, D Perović, T Ljubičić, A Elezović
The incidence of healthcare-associated infections and sepsis (HAIs) is 5-10 times higher in patients in intensive care units (ICUs) than in those at other hospital departments. Predisposition for these lies in many intrinsic (disease severity, loss of immunity) and extrinsic factors (frequent use of broad-spectrum antibiotics with consequent presence of antibiotic-resistant pathogens). The majority of HAIs in ICUs are associated with the use of invasive devices (DA-HAIs; device-associated healthcare-associated infections) (19%). Their incidence differs among specific types of ICUs (2%-49%). The most frequent DA-HAI are central line-associated bloodstream infections (CLA-BSI), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI) and surgical site infections (SSI). SSI is most often described as a distinct and separate entity of HAIs in ICUs. Recently, gram-negative bacilli (Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter spp.) are more frequently isolated in DA-HAIs than gram-positive ones (Staphylococcus aureus, Enterococcus spp.), often present as resistant strains. On the other hand, urinary or/and systemic infections tend to increase. DA-HAIs endanger and slow down patient recovery, prolong hospital stay, and generally increase the mortality rate. DA-HAIs are of special interest of the Hospital Committee Center for Infective Disease in order to improve patient safety and reduce total cost allocated for prevention of DA-HAIs. DA-HAI rate is the most useful intra- and inter-hospital measure to compare surveillance and effectiveness of preventive procedures among different ICU types.
{"title":"[DEVICE-ASSOCIATED HEALTHCARE INFECTION AND SEPSIS IN INTENSIVE CARE UNIT].","authors":"D Bartolek Hamp, G Cavrić, I Prkačin, K Houra, D Perović, T Ljubičić, A Elezović","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The incidence of healthcare-associated infections and sepsis (HAIs) is 5-10 times higher in patients in intensive care units (ICUs)\u0000than in those at other hospital departments. Predisposition for these lies in many intrinsic (disease severity, loss of immunity) and\u0000extrinsic factors (frequent use of broad-spectrum antibiotics with consequent presence of antibiotic-resistant pathogens). The\u0000majority of HAIs in ICUs are associated with the use of invasive devices (DA-HAIs; device-associated healthcare-associated infections)\u0000(19%). Their incidence differs among specific types of ICUs (2%-49%). The most frequent DA-HAI are central line-associated\u0000bloodstream infections (CLA-BSI), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection\u0000(CAUTI) and surgical site infections (SSI). SSI is most often described as a distinct and separate entity of HAIs in ICUs. Recently,\u0000gram-negative bacilli (Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter spp.) are more frequently isolated in\u0000DA-HAIs than gram-positive ones (Staphylococcus aureus, Enterococcus spp.), often present as resistant strains. On the other\u0000hand, urinary or/and systemic infections tend to increase. DA-HAIs endanger and slow down patient recovery, prolong hospital\u0000stay, and generally increase the mortality rate. DA-HAIs are of special interest of the Hospital Committee Center for Infective Disease\u0000in order to improve patient safety and reduce total cost allocated for prevention of DA-HAIs. DA-HAI rate is the most useful\u0000intra- and inter-hospital measure to compare surveillance and effectiveness of preventive procedures among different ICU types.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35498430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}