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Published in DiRROS: 24.03.2021; Views: 1048; Downloads: 380
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Abstract: Izhodišča: Pandemija koronavirusne bolezni 2019 (covid-19) je zaradi epidemioloških ukrepov, zlasti spodbujanja fizične distance, marsikje po svetu pospešila uvajanje telemedicine v klinično prakso. Zato smo želeli pridobiti stališča onkoloških bolnikov in zdravnikov do tovrstne obravnave v onkologiji. Metode: K izpolnjevanju dveh ločenih kvantitativnih vprašal-nikov smo med 27. majem in 11. junijem 2020 prek elektronske pošte ter s pomočjo Slovenskega združenja organizacij bolnikov z rakom (ONKO NET) povabili bolnike z rakom, ki so bili bodisi na aktivnem zdravljenju bodisi na sledenju po zaključenem zdravljenju, in zdravnike onkologe. Dodatno je bil v Sektorju radioterapije Onkološkega inštituta Ljubljana izveden presečni dan za bolnike med obsevanjem. Rezultati: Na spletni ali natisnjen vprašalnik za bolnike je odgovorilo 475 bolnikov, od tega 310 (65,3 %) na aktivnem onko-loškem zdravljenju in 132 (27,8 %) v fazi sledenja. Skoraj polovica bolnikov (48,4 %) je kot primarno diagnozo navedla rak dojk. Več kot desetina vseh (11,3 %) je zaradi pandemije želela opustiti zdravniški pregled. V zasebnem življenju jih pametni telefon ali tablico uporablja 72,4 % in vsaj 30 % bolnikov bi bilo pripravlje-nih v bodoče pogosteje uporabljati telemedicinske storitve. Od 168 povabljenih zdravnikov jih je na vprašalnik odgovoril 101 (60 %) in ocenil, da bi s pomočjo telemedicine lahko opravil 21 % (0%80 %) vseh svojih storitev. Če bi se sami znašli v vlogi bolnika, bi bila prip-ravljena po telemedicini poseči dobra polovica sodelujočih (54,5 %). Zaključki: Uporaba telemedicine v onkologiji bi bila ob upošteva-nju nekaterih omejitev sprejemljiva za pomemben del bolnikov in zdravnikov
Keywords: telemedicina, covid-19, onkologija
Published in DiRROS: 18.03.2021; Views: 1633; Downloads: 438
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Published in DiRROS: 18.01.2021; Views: 1543; Downloads: 1015
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Abstract: Purpose: To evaluate differences in the characteristics and outcomes of intensive care unit (ICU) patients over time. Methods: We reviewed all epidemiological data, including comorbidities, types and severity of organ failure, interventions, lengths of stay and outcome, for patients from the Sepsis Occurrence in Acutely ill Patients (SOAP) study, an observational study conducted in European intensive care units in 2002, and the Intensive Care Over Nations (ICON) audit, a survey of intensive care unit patients conducted in 2012. Results: We compared the 3147 patients from the SOAP study with the 4852 patients from the ICON audit admitted to intensive care units in the same countries as those in the SOAP study. The ICON patients were older (62.5 +/- 17.0 vs. 60.6 +/- 17.4 years) and had higher severity scores than the SOAP patients. The proportion of patients with sepsis at any time during the intensive care unit stay was slightly higher in the ICON study (31.9 vs. 29.6%, p = 0.03). In multilevel analysis, the adjusted odds of ICU mortality were significantly lower for ICON patients than for SOAP patients, particularly in patients with sepsis [OR 0.45 (0.35-0.59), p < 0.001]. Conclusions: Over the 10-year period between 2002 and 2012, the proportion of patients with sepsis admitted to European ICUs remained relatively stable, but the severity of disease increased. In multilevel analysis, the odds of ICU mortality were lower in our 2012 cohort compared to our 2002 cohort, particularly in patients with sepsis.
Keywords: intensive care units -- analysis -- epidemiology -- mortality, sepsis, severity of disease
Published in DiRROS: 30.11.2020; Views: 1676; Downloads: 1152
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Abstract: Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output < 0.5 ml/kg/h) in acutely ill patients and its association with the need for renal replacement therapy (RRT) and outcome. Methods: International observational study. All adult (> 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient-oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged-oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent-oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19%1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97%1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.
Keywords: critical care, critical illness, urine, oliguria, kidney, renal insufficiency, kidney diseases, acute kidney failure, mortality, urine output, renal replacement therapy
Published in DiRROS: 18.11.2020; Views: 1660; Downloads: 1034
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