Migration intentions of Lithuanian physicians, nurses, residents and medical students.

Due to a flow of healthcare professionals and students from emerging to industrialized economies, healthcare systems in source countries are facing increasing threats to a people-centered quality of care. This study investigates the prevalence and underlying reasons for emigration intentions among physicians, nurses, residents, and medical students in Lithuania (total N = 1080). In our sample, 39% of students, 21% of residents, 12% of nurses, and 6% of physicians had decided to emigrate within the next two years. Based on statistical analyses of the survey data, we conclude that emigration decisions are linked to socio-demographic (age, gender, family situation), financial, organizational (teamwork climate in hospital) and social (perceived social worth) factors. Implications for policy-making and retention of healthcare workforce are discussed.

Penetrating Anterior Skull Base Fracture Inflicted by a Cow's Horn.

Farm workers are at increased risk for animal-inflicted head injuries that are associated with significant morbidity and occasionally may be fatal. These injuries may cause permanent eye damage with or without concomitant skull base fracture. Here, we present a male farmer who suffered a cow attack that resulted in perforating orbital injury with comminuted frontobasal cranial fracture caused by a cow's horn. The next day, the patient developed nasal and orbital cerebrospinal fluid (CSF) leak. Computed Tomography cisternography revealed CSF leakage to frontal and maxillary sinuses. The patient was treated using prophylactic antibiotic therapy, lumbar drainage, and underwent craniotomy for debridement and dural tear plastic. Post operative course was uneventful and there were no signs of CSF leak 1 year after the surgery. The case illustrates unusual injury inflicted by a cow's horn and underscores the importance of careful investigation for underlying skull base fracture and CSF leakage in patients sustaining perforating orbital injuries. Adequate and timely management of dural tears is associated with favorable outcomes.