Geriatric patient in the practice of emergency medical teams - observation in 2020-2022.

Purpose: Analysis of interventions of medical rescue teams for geriatric patients in a three-year period, taking into account the causes, circumstances, medical management, pharmacology. Materials and methods: The study included a 3-year retrospective analysis of the trips of medical rescue teams in the northern part of the Lubelskie Voivodeship in the period from January 1, 2020 to December 31, 2022. The data comes from medical documentation. Interventions caused by a health risk in a patient in the 90+ age group were qualified as events. 897 EMT interventions were qualified (2020-327, 2021-269, 2022-301) constituting 4.29% of all interventions carried out in the operational area. In addition, a quantitative analysis of a comparative group of patients aged 80-89 was performed. Results: It was shown that the time of rescue activities was the longest for injuries and the shortest for mental disorders (60 ± 31 vs. 43 ± 21 min). It was shown that specialist EMT teams (S) were statistically significantly more often called for cardiology disorders (63%). It was shown that pharmacological agents were used statistically significantly more often in respiratory disorders (83%) compared to neurology disorders (47%, p < 0.001). It was also shown that patients whose call was caused by neurology disorders were statistically more often transported to the emergency department (N = 76, 76%, p < 0.001). Conclusion: The causes of calls regarding disorders of the circulatory and respiratory systems most often require the implementation of pharmacology during EMT interventions, mainly short-term and symptomatic drugs. Interventions to rural areas dominate in the presented analysis in each year of the analysis and in each group of reasons for calls, which may be associated with more difficult access to a primary care physician. Most EMT interventions concern exacerbation of chronic diseases. Transport to the hospital was necessary mainly due to neurological and traumatic calls.

Long-term Results of Kidney Transplantation: Analysis of Selected Factors.

BACKGROUND: Kidney transplantation is considered the most effective method of treating patients with end-stage renal disease. Despite continuous improvement of short-term outcomes, progression of long-term results is minimal. METHODS: The retrospective cohort study included 45 patients (24 women and 21 men). Terms of qualification for the study were time after kidney transplantation: minimum 25 years and satisfactory graft function. Medical documentation was analyzed from which specific laboratory parameters, information about transplantation procedure, and clinical data were selected. RESULTS: The average time since transplantation in the study group was 30 years. Chronic glomerulonephritis was a major cause that led to end-stage renal disease among the study group. The average age of the respondents was 62 years ± 8.5 years. The average time patients had hemodialysis procedures lasted 30 months. Current estimated glomerular filtration rate (eGFR) concentration was correlated with level of creatinine measured 10 years after transplantation and current hemoglobin level (r = 0.447, P = .003, r = 0.586 P < .001). No statistically significant differences were noted in the eGFR level, depending on the current age of recipients (t = 0.511, P = .612), total ischemia time (Z = 0.334, P = .729), or hemodialysis duration (t = -1.944, P = .058). CONCLUSIONS: The presented study emphasizes the impact of graft function on hemoglobin level and the predictive role of the creatinine measured 10 years after transplantation for long-term renal outcomes. Continuing research will enrich the knowledge about long-term care and treatment for patients after kidney transplantation.

Assessment of Knowledge and Attitudes Toward Transplantation Among Nursing Students.

INTRODUCTION: Despite legal regulations and social campaigns promoting the idea of organ transplantation, Poland still lacks organs for transplantation. Organ transplantation not only is the best method of treating the end-stage failure of many organs but also improves the lives of patients. PURPOSE: The purpose of the study was to assess nursing students' knowledge and opinions about transplantation. MATERIALS AND METHODS: The studies were conducted in February and March 2019, with 100 nursing BSc and MSc students selected at random. The study tool was the questionnaire. The questions contained in the questionnaire were closed questions. To answer them, statistical analyses were conducted using IBM SPSS Statistics 23. RESULTS: The study group included 96% of women and 4% of men. Of all respondents, 83% were aged 18 to 25. Almost half of respondents admitted that their close relatives do not realize that they agree to the removal of organs after death. As many as 59% of respondents firmly believe in the rightness of organ donation. The studies presented in this article demonstrate that only 57 of 100 respondents informed their close relatives about the will to donate their organs after death. CONCLUSIONS: Persons involved in the study support the idea of transplantation and would be willing to donate their organs if necessary. Both the studies presented in this article and articles written by other people show the need for more intense education of medical staff. The master studies help raise awareness and knowledge about transplantation.

Assessment of Hemodynamic Parameters in Recipients of a Liver Transplant.

INTRODUCTION: The control of all hemodynamic parameters among patients after liver transplantation is critical for better graft survival and to reduce the risk of perioperative complications. The value of cardiac output (CO) and stroke volume (SV) below normal promote the development of cardiovascular diseases. MATERIALS AND METHODS: The study was conducted on a group of 43 patients after liver transplantation: 16 women and 27 men 0.5 to 29 years after the surgery at the Department of Transplantation Medicine, Nephrology and Internal Diseases, Institute of Transplantology, Medical University of Warsaw, Infant Jesus Clinical Hospital in Warsaw, Poland. The hemodynamic parameters were measured due to 4 electrocardiogram electrodes with the Cardiac Monitor ICON Osypka Medical. RESULTS: Patients after liver transplantation (LTx) showed values of CO (average 5.27 L/min, standard deviation [SD] = 0.92) and stroke volume (average 67.08 mL, SD = 10.96) below normal. The average thoracic fluid content value among women is 21.81 (1/kΩ), SD = 3.28, and for men 24.04 (1/kΩ), SD = 4.75. Only 37% of patients had a body mass index with normal values, with 63% above expected values: 42% with overwise and 21% with a first stage of obesity. CONCLUSION: The hemodynamic parameters should be controlled among patients after LTx. CO and SV below normal are predictors of a higher risk of cardiovascular diseases.

A Long-term Evaluation of Treatment Results of Pregnant Patients Following a Liver Transplant.

INTRODUCTION: Transplantation is not only the best method for treating end-stage failure of many organs but also the way to improve the quality of life of patients. For women of childbearing age, an organ transplant often brings a restoration of regular reproductive functions, which means, among other things, the possibility of having biological offspring. OBJECTIVES: The aim of the study was to analyze the medical records and assess the impact of a liver transplant on the course of pregnancy and labor. MATERIALS AND METHODS: The research was carried out from March to May 2019 in the Nephrology and Transplant Clinic Medical University of Warsaw. The study group consisted of 19 women after liver transplantation. Medical records were analyzed, and laboratory test results routinely performed on patients were also used for the study. RESULTS: The mean age of conception of the patients following transplantation was 30 ± 4 years old. In the analyzed period, 6 patients gave birth to 2 children each, and 8 patients to 1 child each. Only 3 patients experienced premature birth. Twelve patients gave birth by caesarean delivery. Fourteen patients took tacrolimus. CONCLUSIONS: Pregnancy is possible in patients following a liver transplant and does not appear to have a damaging effect on liver functionality. There is an increased risk of pre-eclampsia, intensified hypertension, and premature birth among patients following a transplant, which is why it is essential for these patients to remain under the care of a specialistic therapeutic team.

Comparison of 3 Times a Week 4- and 5-Hour In-Center Hemodialysis Sessions with Use of Continuous Non-Invasive Hemodynamic Monitoring.

BACKGROUND Very aggressive ultrafiltration rate (lasting 3.5-4 h) may result in inadequate hemodialysis (HD). Our aim was to characterize HD-induced cardiovascular adaptation and its links to fluid removal during 4- vs. 5-h HD sessions. MATERIAL AND METHODS The study involved 50 HD patients. A Cardioscreen device (Messtechnik, Ilmenau, Germany) was used to perform non-invasive hemodynamic measurements during mid-week HD sessions. Body fluids and nutritional status were assessed with a Body Composition Monitor (Fresenius Medical Care). Clinical and laboratory data were also analyzed. RESULTS It was shown that when comparing 3 times a week 4- vs. 5-h dialysis sessions, body mass index (BMI [kg/m²]), Kt/V, and ultrafiltration volume (UFV [mL]) were significantly lower in the 4-h dialysis group (23.1±3.5 vs. 27.1±4.7; 1.36±0.28 vs. 1.55±0.23; 1770±601 vs. 2831±836; P<0.05, respectively). Cardiac index (CI [L/min/m²]) and thoracic fluid content (TFC [1/kW]) were significantly reduced in 4-h dialysis sessions (3.1±0.6 to 2.7±0.7; 35.1±8.4 to 32.8±6.8; P<0.05, respectively). In patients treated with 5-h dialysis sessions, we found that heart rate (HR [bpm]) was significantly increased (69±10 to 74±15; P<0.05) and TFC was reduced (34.3±8.9 to 31.5±8.2; P<0.05). In patients treated with 4-h dialysis sessions, systemic vascular resistance index (SVRI [dyn·s·cm^-5/m²]) increased from 2369±799 before HD to 2592±735 after HD (P=0.342). CONCLUSIONS The obtained data indicate that in extended (5-h) HD sessions, hemodynamic compensation occurred with increased HR, while in short (4-h) HD sessions, compensation occurred with increased SVRI. Providing longer but less intensive HD is more physiologic than the conventional therapy, and will improve patient tolerability and clinical outcomes.

Assessment of Volumetric Hemodynamic Parameters and Body Composition in Stable Renal Transplant Recipients.

BACKGROUND Cardiovascular disease (CVD) has been associated with decreased graft survival and increased complications in renal transplant recipients (RTRs). The objectives of this study were to explore the relationship between body composition and hemodynamic parameters (cardiac index [CI] and systemic vascular resistance index [SVRI]) in RTRs. MATERIAL AND METHODS The study included 80 RTRs (mean age: 51±8 yrs) who had been admitted to our Nephrology and Transplantology Clinic at 0.5 to 28 years after KTx. The control groups consisted of the 40 patients receiving hemodialysis and 20 health-care professionals. A Cardioscreen 1000 monitor (Messtechnik, Ilmenau, Germany) was used to perform non-invasive hemodynamic measurements. Body composition was studied using a Tanita BC 418 body composition analyzer (Tanita Corp., Tokyo, Japan). Clinical and laboratory data were also analyzed. RESULTS One-way ANOVA confirmed statistically significant differences between RTRs, HD patients, and the control group in CI (2.8±0.3 vs. 3.1±0.7 vs. 3.5±0.6 L/min/m2, P<0.001, respectively) and SVRI (2619±492 vs. 2307±701 vs. 2012±452 d·s/cm-5/m², P<0.001, respectively). In RTRs with functioning AVF, our study revealed significantly higher CI (2.9±0.3 vs. 2.7±0.4 L/min/m², P=0.004) and significantly lower SVRI (2497±286 vs. 2729±605 d·s/cm-5/m², P=0.035). CONCLUSIONS In conclusion, our data indicate that cardiovascular manifestations in the RTRs group are mainly related to decreased CI and HR in addition to increased SVRI with high arterial blood pressure.

Contribution of volume overload to the arterial stiffness of hemodialysis patients.

Arterial stiffness is evaluated with the measurement of pulse wave velocity (PWV), while overhydration (OH) and nutritional status are evaluated with bioimpedance spectroscopy (BIS). In this study, we investigated the effect of a single dialysis session on arterial stiffness, hydration status, and laboratory parameters. The observational, cross-sectional, cohort study included 71 HD patients with mean age 64 ± 16 yrs. A Complior device was used to perform PWV measurements. The patients were examined immediately before and 15 min after a mid-week hemodialysis session. Body fluids and nutritional status were studied using a Body Composition Monitor (BCM), Fresenius Medical Care. Clinical and laboratory data were also analyzed. Multivariate regression analysis of PWV before HD showed that an OH increase of 1 L relate to a PWV parameter rise before HD of 0.523 m/s. Multivariate regression analysis of PWV after HD showed that a rise of central SBP after HD of 10 mmHg relate to a PWV increase after HD of 0.707 m/s. Our data indicate that hydration status and blood pressure may be major determinants of PWV in HD patients.

Pregnancy in the liver transplant recipient.

During gestation, the woman's body undergoes various changes, and the line between physiology and pathology is very thin even in healthy women. Today, many of the liver transplant recipients are young women, who at one point in their lives may consider the possibility of pregnancy. Clinicians have to counsel them about the time of conception, the risk of miscarriage, the deterioration of the mother's health status, and the risk of birth defects. This review, based on our 20 years of clinical experience and up-to-date literature, provides comprehensive guidelines on pregnancy management in liver transplant recipients. Pregnancy in liver transplant recipients is possible but never physiological. Proper management and pharmacotherapy lowers the incidence of complications and birth defects. Critical factors for perinatal success include stable graft function before pregnancy, proper preparation for pregnancy, and cautious observation during its course. Liver Transplantation 22 1408-1417 2016 AASLD.

Assessment of Arterial Stiffness, Volume, and Nutritional Status in Stable Renal Transplant Recipients.

Reduction of cardiovascular death might have a significant effect on the long-term survival rates of renal transplant recipients (RTRs). The aim of the study was to assess the relation between arterial stiffness and graft function, adipose tissue content, and hydration status in patients after kidney transplantation (KTx).The study included 83 RTR patients (mean age: 55 ±â€Š13 years) who had been admitted to a nephrology-transplantation outpatient clinic 0.5 to 24 years after KTx. Clinical and laboratory data were analyzed and eGFR was calculated with the CKD-EPI formula. Arterial stiffness was assessed in all RTRs with pulse wave propagation velocity (PWV) with the use of a complior device. In addition, fluid and nutritional status was assessed with a Tanita BC 418 body composition analyzer. The control group consisted of 31 hospital workers who received no medication and had no history of cardiovascular disease.Multivariable linear regression analysis, with PWV as a dependent variable, retained the following independent predictors in the final regression model: red blood cell distribution width (RDW) (B = 0.323; P = 0.004), age (B = 0.297; P = 0.005), tacrolimus therapy (B = -0.286; P = 0.004), and central DBP (B = 0.185; P = 0.041). Multivariable linear regression analysis with eGFR as a dependent variable retained the following independent predictors in the final regression model; creatinine concentration (B = -0.632; P = 0.000), hemoglobin (B = 0.280; P = 0.000), CRP (B = -0.172; P = 0.011), tacrolimus therapy (B = 0.142; P = 0.039), and triglycerides (B = -0.142; P = 0.035).Our data indicates that: kidney transplant recipients can present modifiable CVD risk factors linked to increased arterial stiffness, DBP, waist circumference, SCr, time on dialysis, CyA therapy, and visceral fat mass; RDW is a parameter associated with arterial stiffness; and parameters such as CyA therapy, time on dialysis, PWV, RDW, and triglycerides show negative associations with the allograft function assessed with eGFR.