ABSTRACT
INTRODUCTION: Hyperlactatemia occurs during or after extracorporeal circulation in the form of lactic acidosis, increasing the risk of postoperative complications and the mortality rate. The aim of this study was to evaluate whether continuous high-volume hemofiltration with volume replacement through a polyethersulfone filter during the extracorporeal circulation procedure decreases postoperative lactatemia and its consequences. MATERIALS AND METHODS: This was a randomized controlled trial. Patients were randomly divided into two groups of 32: with or without continuous high-volume hemofiltration through a polyethersulfone membrane. Five patients were excluded from each group during the study period. The sociodemographic characteristics, filter effects, and blood lactate levels at different times during the procedure were evaluated. Secondary endpoints were studied, such as the reduction in the intubation time and time spent in ICU. RESULTS: Lactatemia measurements performed during the preoperative and intraoperative phases were not significantly different between the two groups. However, the blood lactate levels in the postoperative period and at 24 hours in the intensive care unit showed a significant reduction and a possible clinical benefit in the hemofiltered group. Following extracorporeal circulation, the mean lactate level was higher (difference: 0.77 mmol/L; CI 0.95: 0.01-1.53) in the nonhemofiltered group than in the hemofiltered group (p<0.05). This effect was greater at 24 hours (p = 0.019) in the nonhemofiltered group (difference: 1.06 mmol/L; CI 0.95: 0.18-1.93) than in the hemofiltered group. The reduction of lactatemia is associated with a reduction of inflammatory mediators and intubation time, with an improvement in liver function. CONCLUSIONS: The use and control of continuous high-volume hemofiltration through a polyethersulfone membrane during heart-lung surgery could potencially prevent postoperative complications. The reduction of lactatemia implied a reduction in intubation time, a decrease in morbidity and mortality in the intensive care unit and a shorter hospital stay.
Subject(s)
Extracorporeal Circulation/methods , Hyperlactatemia/therapy , Aged , Cardiac Surgical Procedures/methods , Continuous Renal Replacement Therapy/methods , Female , Humans , Intensive Care Units , Lactic Acid/analysis , Lactic Acid/blood , Male , Middle Aged , Ultrafiltration/methodsABSTRACT
INTRODUCTION: A favorable attitude toward organ donation and transplantation (ODT) is fundamental among health professionals at the time of transplant promotion. In this sense, the training and awareness of professionals are fundamental. OBJECTIVE: To analyze the differences in the attitude toward ODT and the factors that condition it among Andalusian medical and nursing students. METHODS AND DESIGN: The study is a sociologic, multicenter, observational study. The population includes medical and nursing students in Andalusian universities. Database of the Collaborative International Donor Project is used and data are stratified by geographic area and academic course. The instrument of measurement was a validated questionnaire (PCID-DTO-RIOS) that was handed out to every student in a compulsory session. Completion of the questionnaire was anonymous and self-administered. The sample included Andalusian medical and nursing students (99% confidence and precision of ±1%) stratified by geographic area and year of study. RESULTS: There was a completion rate of 91%; 79% (n = 2879) of Andalusian students were in favor of donation and 21% were not in favor. The attitude toward ODT is more favorable in medical compared with nursing students (80% vs 77%; P = .021). The psychosocial profile toward donation is similar in both groups relating to the following variables (P < .05): knowing a transplant patient, having received information about the subject, attitude toward family donation, and having discussed transplantation with family and friends. CONCLUSION: Andalusian medical students favored organ donation more than Andalusian nursing students, and the favorable attitude is associated with having an awareness of the subject.
Subject(s)
Health Knowledge, Attitudes, Practice , Organ Transplantation/psychology , Students, Medical/psychology , Students, Nursing/psychology , Tissue and Organ Procurement , Adult , Female , Humans , Male , Spain , Surveys and Questionnaires , Young AdultABSTRACT
Objetivo. Obtener índices útiles para la gestión hospitalaria basados en técnicas estadísticas multivariantes descriptivas. Material y métodos. Durante 1999 y 2000 se recogió información del Hospital de Algeciras correspondiente a los ingresos hospitalarios del periodo 1997-1998. Se estudiaron las variables habitualmente monitorizadas por el Servicio Andaluz de Salud, del Sistema Nacional de Salud Español: número de ingresos, mortalidad, número de reingresos, número de consultas externas, índice case-mix, número de estancias e índice funcional. Las variables se midieron en un total de 22 486 ingresos. Aplicamos la técnica de análisis de componentes principales (ACP), y se utilizó la matriz de correlaciones R. Resultados. Se seleccionaron las dos primeras componentes, con un porcentaje acumulado de variabilidad de 62.67 por ciento. Conclusiones. La primera componente puede ser asimilada a un nuevo índice que tiene que ver con la cuantía de personas atendidas, llamado demanda asistencial. La segunda explicaría la dificultad de los casos atendidos; le hemos llamado complejidad asistencial. Ambos índices permiten dar una clasificación de los servicios hospitalarios
Subject(s)
Hospital Administration/statistics & numerical data , Principal Component Analysis , SpainABSTRACT
OBJECTIVE: To construct useful indices for hospital management, based on descriptive multivariate techniques. MATERIAL AND METHODS: Data were collected during 1999 and 2000, on hospital admissions occurring during 1997-1998 at Hospital General de Algeciras, part of Servicio Andaluz de Salud (SAS) of Sistema Nacional de Salud Español (Spanish National Health Service). The following variables routinely monitored by health authorities were analyzed: number of admissions, mortality, number of re-admissions, number of outpatient consultations, case-mix index, number of stays, and functional index. Variables were measured in a total of 22486 admissions. We applied the Principal Components Analysis (PCA) method using the R correlation matrix. RESULTS: The first two components were selected, accounting cumulatively for 62.67% of the variability in the data. CONCLUSIONS: The first component represents a new index representing the number of attended persons, which we have termed Case Load. The second PC represents or explains the difficulty of the attended cases, which we have termed Case Complexity. These two indices are useful to classify hospital services.
