Studying of psycholinguistic features of doctors' professional communication under war conditions.

OBJECTIVE: Aim: Studying of psycholinguistic features of doctors' communication competence in Ukraine under war conditions. PATIENTS AND METHODS: Materials and Methods: Bibliosemantic method; method of system analysis, comparison and generalization; empirical methods - direct observation of the doctors' and patients' living language, typology of empirical data according to socio-demographic indicators. RESULTS: Results: Within the study, 286 dialogues were collected. With voluntary consent, they were recorded in video and audio formats in compliance with ethical, bioethical, and legal norms. Next, initial typology of dialogues, their lexical and semantic analysis with identification of typical positive and negative communicative strategies were carried out. With the help of the ≪Textanz≫ specialized computer software, 48 dialogues were subjected to the content analysis procedure for two separate ≪Doctors≫ and ≪Patients≫ samples. CONCLUSION: Conclusions: The results of the analysis of ≪Doctor-Patient≫ dialogues enabled identifying and describing psycholinguistic markers of typical physiological, mental, social, and spiritual states of individuals seeking medical help under martial law. Thus, the markers of positive emotional states (optimism, confidence, empathy, etc.) and affective, negative emotional processes (anxiety, fear, anger, aggression, sadness, depression, etc.) were identified.

New training, new attitudes: non-clinical components in Ukrainian medical PHDs training (regarding critical thinking, academic integrity and artificial intelligence use).

OBJECTIVE: Aim: The paper studies the attitude to critical thinking, academic integrity and the Artificial Intelligence use of the Ukrainian medical PhD students. PATIENTS AND METHODS: Materials and Methods: In 2023, 56 medical PhD students from the Bogomolets National Medical University, Kyiv, Ukraine, underwent the survey. The participation was voluntary, upon the oral consent. The data included in the survey questions include various aspects related to critical thinking, analysis skills, and attitudes towards plagiarism. RESULTS: Results: A significant majority of the medical PhD students (75%) place high importance on critical thinking. While a majority (89.29%) apply analysis and critical thinking skills in their English studies, there's a notable percentage (7.14%) that is uncertain. Although most are aware of the unacceptability of cheating and plagiarism (75%), a small proportion admit to having plagiarized (12.5%). Only 30.4% of the respondents reported using GPT Chat for study. Responses to witnessing peers plagiarize or using Artificial Intelligence show a varied attitude, with many expressing unwillingness to report such incidents (30.36%). CONCLUSION: Conclusions: The survey highlights the recognized importance of critical thinking in academic study among medical PhD students, while also points to areas where attitudes and practices regarding these skills could be improved. The study shows a vast area for improvement regarding academic integrity, as almost one-third of respondents need more defined standards. This definitely puts some questions before the present medical postgraduate education, and requires change of the educational paradigm, clear rules of academic conduct, and a system of control.

Patterns of anatomical injury and anaesthesia procedures in wounded Ukrainian soldiers from Anti-Terrorist Operation/Operation Joint Forces: 2014-2021.

INTRODUCTION: The study aims to analyse the causes and anatomical patterns of explosive and gunshot wounds in Ukrainian soldiers acquired during the Anti-Terrorist Operation/Operation Joint Forces. We also investigated how general and regional anaesthesia procedures affected post-operative pain in wounded soldiers. METHODS: A retrospective observational study was done based on the medical records of Ukrainian soldiers wounded in the Anti-Terrorist Operation/Operation Joint Forces between 2014 and 2021. The collected data included the American Society of Anesthesiologists score, mechanism of injury, the pattern of anatomical injury, pain intensity and the choice of anaesthesia given. Pain intensity was diagnosed using a Numerical Rating Scale. RESULTS: A total of 280 combat casualties with explosive (75.7%) and gunshot (24.3%) wound injuries were included in the study. Most of the wounded soldiers had one body region affected by injury (59.3%). In most of the cases, the affected body regions were lower (48.2%) and upper (33.8%) limbs. In 62.5% of patients, regional anaesthesia was used, while general anaesthesia was used in 37.5% of cases. The pain significantly decreased after initial treatment at the field medical unit regardless of the anaesthesia type or the number of affected body regions. CONCLUSION: Understanding the sources and anatomical patterns of war-related injuries in recent conflicts is an important element in reducing the mortality and suffering of wounded soldiers. The high percentage of injured extremities in our cohort emphasises the importance of regional anaesthesia in contemporary wars.

Difficult airway simulation-based training for anaesthesiologists: efficacy and skills retention within six months.

BACKGROUND: The aim of this study was to evaluate how anaesthesiologists manage a "cannot intubate, can ventilate" (CI) and "cannot intubate, cannot ventilate" (CICV) scenarios, and how following simulation training will affect their guideline adherence, skills and decision-making immediately after training and 6 months later. METHODS: A prospective controlled study was conducted from July to December 2022. Anaesthesiologists who applied for the continuous medical education course "Difficult Airway Management" were involved in the study. Each volunteer participated in two simulation scenarios (CI, CICV) with structural debriefing after each scenario. After the first simulation round, volunteers were trained in difficult airway management according to DAS guidelines, using the same equipment as during the simulation. The participants repeated the simulation scenarios the day after the training and six months later. The primary and secondary endpoints were compared between three rounds: initial simulation (Group 1), immediately after training (Group 2), and six months after training (Group 3). RESULTS: A total of 24 anaesthesiologists consented to participate in the study and completed the initial survey form. During the first session, 83.3% of participants had at least one major deviation from the DAS protocol. During the first CICV scenario, 79% of participants made at least one deviation from the DAS protocol. The second time after simulation training, significantly better results were achieved: the number of anaesthesiologists, who attempted more than 3 laryngoscopies decreased (OR = 7 [1.8-26.8], p = 0.006 right after training and OR = 3.9 [1.06-14.4], p = 0.035 6 month later); the number, who skipped the supralaryngeal device attempt, call for help and failure to initiate surgical airway also decreased. Simulation training also significantly decreases the time to call for help, cricothyroidotomy initiation time, and mean desaturation time and increases the odds ratio of successful cricothyroidotomy (OR 0.02 [0.003-0.14], p < 0.0001 right after training and OR = OR 0.02 [0.003-0.16] 6 months after training). CONCLUSIONS: Anaesthesiologists usually display major deviations from DAS guidelines while managing CI and CICV scenarios. Simulation training improves their guideline adherence, skills, and decision-making when repeating the simulation immediately after training and 6 months later. STUDY REGISTRATION: NCT05913492, clinicaltrials.gov, 22/06/2023.

WHO Surgical Safety Checklist and Anesthesia Equipment Checklist efficacy in war-affected low-resource settings: a prospective two-arm multicenter study.

INTRODUCTION: The Russian invasion of Ukraine has caused huge damage to all medical infrastructure and impairs patient safety. The aim of our study was to assess the impact of implementation of the WHO Surgical Safety Checklist and Anesthesia Equipment Checklist on patient outcomes and adherence to safety standards in low-resource settings, affected by an ongoing war. MATERIAL AND METHODS: A prospective multicenter study was conducted in 6 large Ukrainian hospitals. The study was conducted in two phases: a control period, lasting five months, followed by a study period, when the two checklists (the WHO Surgical Safety Checklist and Anesthetic Equipment Checklist) were introduced in the designated operating rooms. The primary outcomes were any major complications, including death, during 30 days after surgery. RESULTS: A total of 2237 surgical procedures were recorded - 1178 in the control group and 1059 in the intervention group. Major postoperative complications occurred in 82 (6.9%) patients in the control group and in 25 (2.4%) in the study group (OR = 0.32 [0.19-0.52], P < 0.001). The effect on the incidence of specific postoperative complications was statistically significant for the "surgical infection" (1.5% vs. 0.1%; OR = 0.31 [0.1-0.8], P = 0.01) and "reoperation" (1.7% vs. 0.5%; OR = 0.32 [0.1-0.8], P = 0.01) cate-gories as well as for the 30-day mortality (1.3% vs. 0.3%; OR = 0.35 [0.1-0.9], P = 0.03). Better adherence to basic WHO surgical safety recommendations was observed for every check mentioned in the WHO Surgical Safety Checklist ( P < 0.05). CONCLUSIONS: The WHO Surgical Safety Checklist and the Anesthesia Equipment Checklist improve patient outcomes in war-affected low-resource settings.

The impact of intra- and postoperative fluid balance in pancreatic surgery - A retrospective cohort study.

BACKGROUND/OBJECTIVES: The aim of this study was to evaluate the impact of perioperative fluid administration in pancreatic surgery. METHODS: Patients who underwent pancreatic resections were identified from our institution's prospectively maintained database. Fluid balances were recorded intraoperatively and at 24hr postoperatively. Patients were stratified into tertiles of fluid administration (low, medium, high). Adjusted multivariable analysis was performed and outcome measures were postoperative complications. RESULTS: A total of 211 patients were included from 2012 to 2017. Complication rates were POPF(B/C) 19.4%, DGE(B/C) 14.7%, PPH(C) 10.0% and CDC ≥ IIIb 26.1%. In multivariable analysis, high perioperative fluid balance was an independent risk factor associated with POPF (OR = 10.5, 95%CI 2.7-40.7, p = .001), CDC (OR = 2.5, 95%CI 1.2-5.3, p < .002), DGE (OR = 2.3, 95%CI 1.0-5.2, p = .017), PPH (OR = 6.7 95%CI 2.2-20.0, p = .038) and reoperation (OR = 3.1, 95%CI 1.6-6.2, p = .006). In multivariable analysis with intraoperative and postoperative fluid balances as separate predictors, intraoperative (OR = 2,5, 95%CI 1.2-5.5, p = .04) and postoperative fluid balance (OR = 2.5, 95%CI 1.2-5.5, p = .02) were predictors of POPF. Postoperative fluid balance was the only predictor for mortality (OR = 4.5, 95%CI 1.0-18.9, p = .041) and predictor for CDC (OR = 2.0, 95%CI 1.0-4.0, p = .043) and OHS days (OR = 6.9, 95%CI 0.03-13.7, p = .038). CONCLUSIONS: High postoperative fluid balance in particular is associated with postoperative morbidity. Maintaining a fluid-restrictive strategy postoperatively should be recommended for patients undergoing pancreatic surgery.

PHYSICAL HEALTH OF STUDENTS AND DIGITALIZATION OF HIGHER MEDICAL EDUCATION: RISK FACTORS.

OBJECTIVE: The aim: To study the dynamics of gadget use by higher education students of the Bogomolets National Medical University and to assess technological impact on the physical health of students. PATIENTS AND METHODS: Materials and methods: To accomplish the tasks set using theoretical and experimental methods of scientific research: systematic analysis, comparison and generalization of the bibliosemantic method, questionnaires, and interviews with students. Quantitative data collected during the survey of students studying in the «Dentistry¼, «Pediatrics¼, «Medicine¼, «Pharmacy, Industrial Pharmacy¼, «Physical Therapy, Occupational Therapy¼, and «Medical Psychology¼ specialties were processed using the MedCalc statistical software, and there was carried out comparative analysis afterwards. RESULTS: Results: During the quarantine and martial law, medical university students were forced to study distantly or in a mixed format using various gadgets and computers. It is obvious that the physical condition of a person is affected by the duration of their use of various devices. In this paper, therefore, the risks and the researched dynamics of gadget use by higher education students of the Bogomolets National Medical University were identified. Thus, the technological impact on the physical health of students was also defined. Moreover, the data based on the results of height and weigh calculation of higher education students, which used to diagnose types of obesity by anthropometric indicators, were also collected. CONCLUSION: Conclusions: According to the results of the research, it was established that the students of the Bogomolets National Medical University spent a significant part of their study time sitting in the classroom or at the computer (40 hours weekly average). We found that in the process of distance learning, prolonged sitting at a PC or other gadget (as well as general sedentary lifestyle) has affected the female higher education students majoring in 222 «Medicine¼ course their body mass index. The time spent using gadgets both in the educational and non-formal education (self-education) processes has increased significantly. We attribute this fact to the emergence of a significant number of online educational resources in the public domain, the growing number of webinars, trainings, and master classes conducted by both domestic and foreign experts online.

INDIVIDUAL FACTORS OF MEDICAL PHD STUDENTS' ENGLISH COMMUNICATIVE COMPETENCE.

OBJECTIVE: The aim: The paper is aimed to find correlations between English language communicative academic and medical competence components (theoretical, practical, and individual by certain methods), to improve design of the course "Academic English for PhDs in Medicine", its methods and strategy. PATIENTS AND METHODS: Materials and methods: The study sample includes postgraduate groups studying for PhD in Healthcare, aged 21-59 years, in Bukovinian State Medical University (39 respondents), Zaporizhzhia State Medical University (32 respondents), Kharkiv Medical Academy of Postgraduate Education (33 respondents), and Bogomolets National Medical University (318 respondents). The study was held in 2019-2023. We assessed theoretical and practical components using our tests, individual component - psychological methods. The values of three components were transformed into general English communicative academic and medical competence level. The data were treated with SPSS Statistica 18.0, using Spearman correlation significance. RESULTS: Results: We found positive correlation between English communicative competence and communicative tolerance, general communicative skills level, and high or medium communicative control level. Also, positive correlation characterizes interaction as a conflict-resolving strategy and communicative competence. Highly manifested intolerance in communication, predominance of negative mindsets, intolerance to stress negatively affect the level of English communicative academic and professional competence of PhD students. CONCLUSION: Conclusions: Analysis of the English speaking competence, and its components, showed positive correlation between interaction as a conflict-resolving strategy and English communicative competence of respondents. Regarding the results, the curriculum of the "Academic English for Medical PhDs" should be modified, including interactive methods, case studies, problem solving, and other methods for individual component training.

One Year On: Poland's Public Health Initiatives and National Response to Millions of Refugees from Ukraine.

The Russian military invasion of Ukraine on February 24, 2022, resulted in the largest refugee crisis in Europe since World War II. As a neighboring country to Ukraine, Poland was the main country to initially receive refugees. Between February 24, 2022, and February 24, 2023, 10.056 million refugees from Ukraine, mainly women and children, crossed the Polish-Ukrainian border. Up to 2 million of these refugees from Ukraine found shelter in private homes throughout Poland. More than 90% of the resident refugees in Poland were women and children, and approximately 900 000 refugees from Ukraine have sought employment, mainly in the services sector. Since February 2022, there has been rapid development of a national legal framework to ensure access to healthcare, including providing refugees who are healthcare workers with job opportunities. Epidemiological surveillance and prevention programs for infectious diseases and mental health support systems have been implemented. These initiatives have required the use of language translators to ensure that there are no barriers to understanding and implementing public health measures. Hopefully, the lessons learned from Poland and neighboring countries that have hosted millions of Ukrainian refugees can help future preparedness for supporting refugees. This review aims to summarize the lessons learned by the Polish public health services during the past year and outlines the public health initiatives that have been implemented and are still ongoing.

Chronic pain in patients with gunshot wounds.

BACKGROUND: In civilian life, from 11 to 40% of patients suffer from chronic pain after receiving injuries. There are almost no data on chronic pain in patients with gunshot wounds, isolated clinical cases have been published. The purpose of our study is to determine the factors that can potentially affect the results of treatment of such patients, namely the frequency of development of chronic pain, acute stress reactions, satisfaction with the results of treatment and the number of wound localizations. METHODS: The treatment of 769 patients was analyzed. Pain intensity was diagnosed using a visual analog scale (VAS). To detect neuropathic pain, the Douleur Neuropathique 4 questions (DN4). The presence of an acute stress reaction (ASR) was diagnosed using The hospital anxiety and depression scale (HADS) and medical history, the diagnosis was established by a psychiatrist. Satisfaction with treatment results was studied using the Chaban quality of life scale (CQLS). Group comparisons were made using the Mann-Whitney test and the chi-square test, taking into account continuity correction. RESULTS: Chronic pain was observed in 538 (70% 95% CI 66.7%-73.1%) patients with gunshot wounds: of them, 439 patients had wounds in 1, 2 anatomical parts of the body, here the frequency of pain chronicity is 69.7% (95% CI 66.0%-78.5%), and 99 patients had wounds in 3 or more anatomical parts of the body - 71.2% (95%CI 63.4%-78.5%). DN4 data suggest the presence of a neuropathic pain component in these patients. Also, all patients were diagnosed with ASR upon admission: the number of HADS points ranged from 9 to 25 points. CQLS data indicate that satisfaction with treatment outcomes was high (76 points) before hospital discharge, but subsequently decreased to a low level (64 points). CONCLUSIONS: Patients with gunshot wounds have a high risk of chronic pain, averaging 45% higher than the general population in civilian trauma patients. A greater frequency of the neuropathic component of pain and acute stress reactions is the reason for such chronicity. A decrease in the level of satisfaction with the results of treatment, in the remote period of observation, compared to the level at the time of discharge from the hospital, is probably a consequence of the formation of chronic pain. TRIAL REGISTRATION: ClinicalTrials.gov: Retrospectively registered on August 1, 2022, NCT05489029.

Placental vascular remodeling in pregnant women with COVID-19.

Severe acute respiratory syndrome coronavirus 2 has been causing the pandemic of coronavirus disease 2019 (COVID-19) that has so far resulted in over 450 million infections and six million deaths. This respiratory virus uses angiotensin-converting enzyme 2 as a receptor to enter host cells and affects various tissues in addition to the lungs. The present study reports that the placental arteries of women who gave birth to live full-term newborns while developing COVID-19 during pregnancy exhibit severe vascular wall thickening and the occlusion of the vascular lumen. A morphometric analysis of the placental arteries stained with hematoxylin and eosin suggests a 2-fold increase in wall thickness and a 5-fold decrease in the lumen area. Placental vascular remodeling was found to occur in all of SARS-CoV-2-positive mothers as defined by RT-PCR. Immunohistochemistry with α-smooth muscle actin and the Kv11.1 channel as well as Masson's trichrome staining showed that such placental vascular remodeling in COVID-19 is associated with smooth muscle proliferation and fibrosis. Placental vascular remodeling may represent a response mechanism to the clinical problems associated with childbirth in COVID-19 patients.

SIMULATION TRAINING AND VIRTUAL PATIENTS AS A COMPONENT OF CLASSROOM TRAINING OF FUTURE DOCTORS UNDER COVID-19 CONDITIONS.

OBJECTIVE: The aim: To present and substantiate the theoretical and applied aspects of the organization of simulation training for higher education applicants in the field of health care based on the analysis and generalization of the experience of the Bogomolets National Medical University. PATIENTS AND METHODS: Materials and methods: To perform the set tasks, the following theoretical and empirical methods of scientific research were used: system analysis; comparison and generalization; bibliosemantic method; the analysis and simulation methods. RESULTS: Results: The experience of organizing simulation training for higher education students in the field of health care was analyzed and summarized. There have been investigated the functional capabilities of the most common "virtual patient" modeling systems for the formation of the practical component of the future doctors' professional competence. Finally, the features of the organization of the educational process at a medical university in classroom, mixed (classroom-distance) and synchronous (hybrid) forms of education during the period of quarantine restrictions have been described. CONCLUSION: Conclusions: A technology for conducting an objective structured practical (clinical) exam has been developed. It helps to standardize the procedure for checking the level formation of the clinical professional competence of a future doctor in accordance with the requirements the standard of higher medical education. It is shown that the use of simulation training and modeling systems "virtual patient" in the preparation of future healthcare professionals increases the effectiveness of training, the interest of students and interns, motivating them to develop the necessary components of the future doctor's professional competence.

Patient safety during anesthesia in Ukraine: national audit results.

BACKGROUND: Although anesthesiologists are one of the leaders in patient safety, anesthesia in low and low-middle income countries still need improvement in safety mesures with evidence-based practice application. The study aim was to audit the safety principles implementation in the Ukrainian anesthesiologist`s practice. METHODS: The study was held in March 2021-Februrary 2022 by filling out an online questionnarie. The link to the survey was distributed through Ukrainian Anesthesiologists Association (UAA) members emails and also published on UAA webpage and facebook page. The email was sent to 1000 UAA members. RESULTS: Summary 210 respondents took part in the study. Among the respondents, 79.1% of respondents are aware of the Helsinki Declaration on Patient Safety in Anesthesiology, but only 40,3% declared that the principles of this Declaration had been implemented in their medical institutions. Even though most of the respondents declared that the quality of the work has improved with the application of the Helsinki Declaration, 16% stated, that there is no positive impact. Most of the medical institutions include mandatory perioperative monitoring, while 17% of hospitals have no access to pulse oximetry for all patients in the operating room and intensive care unit. Concerning using clinical protocols, the one on the treatment of massive bleeding is used in 60.3% of cases, on infection control in 60.5%. In relation to checklists, 28.2% of respondents have never heard about the WHO Safe Surgery checklist. Checklists for equipment inspection are used in only 27.8% of medical institutions. 72.8% hospitals keep records of anaesthesia complications. CONCLUSION: The study showed that significant positive steps are being taken to improve patient safety in Ukraine, where most hospitals comply with the minimum standarts of monitoring during anesthesia. Although there are many challenges for improvement, more hospitals need to implement WHO Safe Surgery and equipment checklists, protocols etc. These areas are a priority for further development in Ukraine. TRIAL REGISTRATION: Clinicaltrials.gov NCT05175976 on 04/01/2022.

Predictors of treatment failure among patients with gunshot wounds and post-traumatic stress disorder.

BACKGROUND: The 82.1% treatment failure of post-traumatic stress disorder (PTSD), associated with gunshot wounds, is related to high incidence of chronic pain syndrome as well as resistance to the PTSD treatment. Defining treatment failure predictors among the PTSD patients with gunshot extremity wounds and the following therapy would improve treatment outcomes. METHODS: A total of 218 patients completed the study. The Mississippi Scale for Combat-Related PTSD (M-PTSD) was used for assessment of the treatment outcome rate. The risk relation between treatment failure and factors was assessed by a univariate or multivariate logistic regression method, with the model accuracy measured by the AUC - Area under the ROC curve. The odds ratio (OR) was considered for the qualitative factor assessment. RESULTS: The predictors of the PTSD treatment failure among the patients with gunshot wounds to the extremities are: 1) anesthesia type: the risk of failure is higher with the general anesthesia compared to the regional (p = 0.002), OR = 0.30 (95% CI 0.13-0.69) and the regional one with sedation (p = 0.004), OR = 0.30 (95% CI 0,14-0.65); 2) severe postoperative pain: the risk of treatment failure rises with increased pain intensity assessed by the visual analogue scale (p = 0.02), OR = 3.2 (95% CI 1.2-8.3). CONCLUSIONS: The analysis showed that administration of general anesthesia compared to the regional one (regardless of the sedation) and high postoperative pain intensity are associated with higher risk of the PTSD treatment failure among patients with gunshot wounds to the extremities. The preference of regional anesthesia and postoperative pain control may potentially improve the treatment outcomes. TRIAL REGISTRATION: ClinicalTrials.gov: Retrospectively registered on December 30, 2020, NCT04689022 .

Psoas compartment block efficacy and safety for perioperative analgesia in the elderly with proximal femur fractures: a randomized controlled study.

BACKGROUND: Proximal femur fractures are most common fractures in the elderly and associated with significant mortality and morbidity, with high economic and social impact. Perioperative pain management influence outcomes and mortality after surgery with early mobilization being possible. The goal of the study was to compare the efficacy and safety of the psoas compartment block (PCB) with spinal and general anesthesia. METHODS: We included 90 patients in this randomized controlled study and divided them into three groups. For patients in group 1 ultrasound-guided PCB with bupivacaine 0.125% 6-8 ml / h was performed. Intraoperative anesthesia was provided with PCB and a sciatic nerve block. Postoperative analgesia include prolonged CPB with bupivacaine 0.125% 6-8 ml / h. In group 2 intraoperative spinal anaesthesia were performed. Group 3 patients underwent general sevoflurane inhalation anaesthesia with fentanyl infusion for analgesia. All patients received paracetamol 3 g/day and dexketoprofen 75 mg/day during hospitalization. On-demand, nalbuphine 5 mg SC was used for analgesia. Efficacy outcomes were the ICU length of stay and the total duration of hospitalization, number of patients who had severe pain after surgery, incidence of on-demand analgesia, sleep quality, postoperative mobilization time. Safety outcomes include complication incidence. RESULTS: There were no differences in the duration of ICU stay - gr.1 72 [70-75], gr.2 74 [72-76], gr.3 72 [70-75] hours respectively (p = 0.29), and the total duration of hospitalization - gr.1144 [170-184], gr.2170 [148-188], gr.3178 [144-200] hours respectively. Patients in gr.1 had significantly lower nalbuphine consumption in the first 24 h after surgery and total during hospitalization (0 [0-5] mg versus 15 [10-20] and 20 [15-25] mg in the first 24 h in groups 2 and 3, respectively (p < 0.001). Gr. 1 had lower number of patients with severe pain (10% vs. 47 and 60% in groups 2 and 3, respectively, p < 0.05), lower number of on demand analgesia (0 [0-1] vs. 3 [2-4] and 4 [3, 4] in groups 2 and 3, respectively), better sleep quality (8 [7-9] vs. 6 [5-7] and 4 [3, 4] in groups 2 and 3, respectively, p < 0.001), significantly faster mobilization after surgery - sitting in bed and getting to his feet. MINS was diagnosed significantly more often in gr. 2 and 3 compared with gr. 1 (OR 9 95 CI 1,01-77, p = 0,048 for gr. 2 and OR 11 95 CI 1,2-91, p = 0, 03 for gr. 3). However, none of the patients had symptoms of myocardial ischemia and was not diagnosed with myocardial infarction. There were no difference in the incidence of nosocomial pneumonia and delirium. CONCLUSION: Perioperative PCB in elderly patients with a proximal femur fracture could be an effective analgesia technique, as it decrease the number of patients with severe pain, need for on demand analgesia and opioid consumption. PCB also decrease the incidence of opioid-associated nausea and vomiting, comparing to general anesthesia, and increase the number of patients, who was mobilized in the 1st day (sitting) and 2nd day (getting up) after surgery. PCB may reduce the incidence of MINS, although to assess this outcome more studies are needed. TRIAL REGISTRATION: Clinicaltrials.gov: NCT04648332 , first registration date 1/12/2020.

Dexmedetomidine infusion as an analgesic adjuvant during laparoscopic сholecystectomy: a randomized controlled study.

BACKGROUND: Dexmedetomidine (DEX) has sedative, sympatholytic and analgesic effects and might be beneficial if used as an adjuvant to: improve analgesia; modulate haemodynamic responses to intubation and pneumoperitoneum and; reduce the number of opioid-associated adverse events. The aim of this study was to evaluate the efficacy and safety of DEX infusion during elective laparoscopic cholecystectomy (LC). METHODS: A randomized, single-centre, parallel-group, placebo-controlled study was carried out between May 2016 and June 2017. Adult patients (18-79 years) with American Society of Anesthesiology (ASA) physical status I-II were randomly assigned to 0.5 µg/kg/h DEX infusion from induction of anaesthesia to extubation (Group D; n = 30) or normal saline infusion (Group C; n = 30). The primary efficacy outcomes were postoperative morphine consumption. Secondary efficacy outcomes included: time to first use of rescue analgesia; postoperative morphine consumption; intraoperative fentanyl consumption; time from end of surgery to extubation; lengths of intensive care unit (ICU) and general ward stay; degree of postoperative pain 3, 6, 12 and 24 h after surgery; incidence of persistent post-surgical pain. RESULTS: DEX infusion was associated with a decrease in postoperative morphine consumption (p = 0.001), lower incidence of severe postoperative pain (odds ratio [OR] 9, 95% confidence interval [CI] 1.1-77, p = 0.04) and significantly longer time to first use of rescue analgesia (p = 0.001). Group D also had significantly lower fentanyl consumption both intraoperatively (p = 0.001) and in the time from end of surgery to extubation (p = 0.001) plus decreased incidence of persistent post-surgical pain (OR 14.5, 95% CI 1.7-122, p = 0.005). The incidence of postoperative nausea and vomiting was lower in Group D than Group C (OR 5, 95% CI 1.1-26, p = 0.005). Median pain intensity did not differ between the groups 3, 6, 12 or 24 h after surgery and there were no inter-group differences in the lengths of ICU stay or overall hospital stay between groups. The incidence of hypertension was significantly higher in Group C (OR 13.8, 95% CI 4-48, p < 0.0001); there were no inter-group differences in incidences of hypotension and bradycardia. CONCLUSIONS: Intraoperative DEX infusion is safe and effective for improving analgesia during and after elective LC. DEX appears to significantly reduce the number of patients with severe postoperative pain, postoperative morphine consumption and prolong time to first use of rescue analgesia. TRIAL REGISTRATION: ClinicalTrials.gov: Retrospectively registered on July 7, 2017,  NCT03211871 .

Addition of dexmedetomidine to benzodiazepines for patients with alcohol withdrawal syndrome in the intensive care unit: a randomized controlled study.

BACKGROUND: Dexmedetomidine (DEX) is a centrally acting alpha-2-adrenoceptor agonist that has potential in the management of alcohol withdrawal syndrome (AWS) owing to its ability to produce arousable sedation and to inhibit the adrenergic system without respiratory depression. The objective of this randomized controlled study was to evaluate whether addition of DEX to benzodiazepine (BZD) therapy is effective and safe for AWS patients in the intensive care unit (ICU). METHODS: Eligible participants were randomly assigned to intervention (Group D; n = 36) or control (Group C; n = 36). In Group D, DEX infusion was started at a dose of 0.2-1.4 µg/kg/h and titrated to achieve the target sedation level (-2 to 0 on the Richmond Agitation Sedation Scale (RASS)) with symptom-triggered BZD (10 mg diazepam bolus) was used as needed. Patients in Group C received only symptom-triggered 10 mg boluses of diazepam. The primary efficacy outcomes were 24-h diazepam consumption and cumulative diazepam dose required over the course of the ICU stay; secondary outcomes included length of ICU stay, sedation and communication quality and haloperidol requirements. RESULTS: Median 24-h diazepam consumption during the study was significantly lower in Group D (20 vs. 40 mg, p < 0.001), as well as median cumulative diazepam dose during the ICU stay (60 vs. 90 mg, p < 0.001). The median percentage of time in the target sedation range was higher in Group D (median 90 % (90-95) vs. 64.5 % (60-72.5; p < 0.001). DEX infusion was also associated with better nurse-assessed patient communication (<0.001) and fewer patients requiring haloperidol treatment (2 vs. 10 p = 0.02). One patient in Group D and four in Group C were excluded owing to insufficient control of AWS symptoms and use of additional sedatives (p = 0.36). There were no severe adverse events in either group. Spontaneous breathing remained normal in all patients. Bradycardia was a common adverse event in Group D (10 vs. 2; p = 0.03). CONCLUSIONS: DEX significantly reduced diazepam requirements in ICU patients with AWS and decreased the number of patients who required haloperidol for severe agitation and hallucinations. DEX use was also associated with improvement in diverse aspects of sedation quality and the quality of patient communication. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02496650.