Medicina
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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.
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Major obstetric hemorrhage remains the leading cause of maternal morbidity and mortality worldwide. Even though blood transfusion may be a life-saving procedure, an inappropriate usage of blood products in obstetric emergencies especially in cases of massive bleeding is associated with increased morbidity and risk of death. Thorough knowledge of the etiology, pathophysiology, and optimal therapeutic options of major obstetric hemorrhage may help to avoid lethal outcomes. ⋯ The transfusion of each single blood product must be performed only in case of evaluation of expected effect. The need for blood products and for their combination is necessary to estimate for each patient individually in case of obstetric emergencies either. Indications for transfusion of blood components in obstetrics are presented in order to improve the skills of doctors and to optimize therapeutic options in obstetric emergencies.
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Crush injury is defined as compression of extremities or other parts of the body that causes muscle breakdown (traumatic rhabdomyolysis). Systemic consequences of crush injuries are as follows: rhabdomyolysis, electrolyte and acid-base abnormalities, hypovolemia, and acute renal failure. Crush injuries are important injuries in disaster situations: earthquakes, hurricanes, mining and road traffic accidents, war, collapse of buildings, etc. In this review article, there are discussed about epidemiology of crush syndrome, risk factors, pathophysiology (mechanisms of muscle cell injury, release of substances from injured muscles, other consequences of reperfusion), clinical features, differential diagnosis, investigations, complications (acute renal failure, hypovolemic shock, hyperkalemia, infection, compartment syndrome), approach to treatment (adequate rehydration, a forced mannitol-alkaline diuresis, intravenous fluids, management of hyperkalemia, wound care, hyperbaric oxygen, etc.), prognosis, the mortality rate and prevention (timely support may reduce morbidity and mortality).
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Review Comparative Study
[Postoperative cognitive dysfunction of older surgical patients].
Light changes in mental function after operation occur in patients of all ages, but more frequent they are observed in older patients. The incidence of early postoperative cognitive dysfunction varies depending on surgical procedure and may be as high as 20-90% in aged patients, and occurs most often in patients undergoing cardiovascular surgery. Early postoperative cognitive dysfunction is a predictor of late postoperative cognitive dysfunction. ⋯ An assessment of cognitive function should be completed as a routine in older patients, and effective prevention requires the identification of risk factors for delirium: advanced age, preexisting dementia and depression, visual and hearing impairment, Parkinson disease, emergency operation, anticholinergic drugs, and others. After operation, elderly patients must be carefully monitored for probable postoperative delirium. It is important to deepen health care professionals' knowledge of postoperative cognitive complications in older surgical patients.
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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.