Levels of Knowledge in Nursing Students on Hemodynamic Monitoring

Introduction. Hemodynamic monitoring is of great importance because it covers all vital organic systems and their functioning, and any error in the interpretation of the monitored parameters can lead to a drastic deterioration of the patient’s condition and cause death. Aim. The aim of this study was to determine the levels of knowledge about hemodynamic monitoring of full-time and part-time students of the first, second, and third year of the undergraduate study of nursing at the University of Applied Health Sciences in Zagreb. Methods. A cross sectional study was conducted. The survey subjects were students at the University of Applied Health Sciences in Zagreb (N=280) in the period between December 2020 and February 2021. For the purposes of the study, the authors created a questionnaire that students filled in using an online platform, and the results of the questionnaire were anonymous. Results. The research found that most students have an adequate level of knowledge in the field of hemodynamic monitoring. By determining differences in knowledge of part-time and full-time nursing students, it was observed that students with work experience showed statistically significantly better results (p<0.05). Conclusion. The conducted study showed an adequate level of knowledge of nursing studies, since a high number of students, outside of their faculty obligations, have not been in contact with hemodynamic monitoring. The specificity and complexity of work in the intensive care unit comes from a particularly vulnerable population of patients who require maximum care, which is why nurses need continuous education, skill improvement, and training regarding new monitoring methods.

The Role of Perforin

Some literature reviews have been carried out about the role of perforin in medicine. The first step involved a systematic search to identify relevant studies published between 2001 and 2019 in the following electronic databases - EBSCO host, Scopus, Science Direct, Web of Science, and Elsevier. By analyzing the available literature, it can be concluded that perforin plays an important role in cytoxical activity of natural killer cells (NK) and CD8+ T cell. NK and CD8+use the same mechanism for destroying target cells. This article cites the disease hemophagocytic lymphohistiocytosis (HLH) which is characterized by heavy abnormalities in the immune system. The point is that this disease is caused by perforin gene mutation. The key is the application of properly sensitized dendritic cells (DCs) because they are effective in immunotherapy against cancer. It may be effective in γ-irradiated colon cancer cell lines HT-29. Growth hormone inhibiting hormone (GIH) induces maturation and activation of DCs. In that way, GIH-Dcs shows increased cytotoxic activity and higher perforin and granzyme expression. So, this means that theoretical research has shown that efficient activity against cancer is induced when DCs are sensitized with γ-irradiated cancer cells. In that way, through a direct increase of cytotoxicity and indirect T cell activation,there can beanti-tumor activity. It is suggested to continue scientific research about the role of perforin in the future.

Quality of Life and Treatment Satisfaction of Hospitalized and Day Hospital Psychiatric Patients

Introduction. Day hospitals are becoming an increasingly common method of treatment for people with mental disorders in many Croatian psychiatric hospitals, but research examining their effectiveness is still rare. Aim. The aim of this study was to compare treatment satisfaction and quality of life between patients enrolled in a day hospital program and patients hospitalized on a psychiatric ward. Methods. The study design was cross-sectional with two outcome measures: treatment satisfaction and quality of life. The study sample consisted of 120 adult patients of the Clinic for Psychiatry of the University Hospital Centre Rijeka. The first group consisted of 60 patients included in the day hospital psychosocial program, while the second group consisted of 60 patients hospitalized on the inpatient ward. Results. Day hospital patients reported a significantly higher level of overall treatment satisfaction compared to hospitalized patients (mean rank: 55 vs. 17, p=0.000) and were significantly more satisfied in four out of seven different treatment domains: the explanations about treatment (mean rank: 68 vs. 53, p=0.013), carefulness and precision of medical examination (mean rank: 72 vs. 49, p=0.000), choices about treatment (mean rank: 67 vs. 57, p=0.027) and feeling of respect (mean rank: 68 vs. 53, p=0.010). Day hospital patients also reported a significant psychopaly higher level of overall subjective quality of life (mean: 4.26 vs. 3.71, p=0.005), being more satisfied with life in general (mean rank: 68 vs. 53, p=0,018), financial situation (mean rank: 67 vs. 54, p=0.046), accommodation (mean rank: 67 vs. 54, p=0.041), personal safety (mean rank: 68 vs. 53, p=0.014), people they live with or living alone (mean rank: 71 vs. 50, p=0.001), relationship with their family (mean rank: 49 vs. 53, p=0.000) and their mental health (mean rank: 69 vs. 52, p=0.008). Conclusion. Patients treated in the day hospital differed in the observed variables from those hospitalized on the ward, reporting higher levels of treatment satisfaction and higher subjective quality of life. Future studies should focus on different segments of day hospital programs and a broader set of outcomes.

Correlation between Depression and Anxiety in Patients with Chronic Non-Malignant Pain

Introduction. Two-thirds of primary care patients with depression also have somatic symptoms present, making detection of depression more difficult. Primary health care is the first level of screening for depression, and early detection is key to treatment success. Anxiety also has a high comorbidity rate with chronic pain conditions. Generalized anxiety disorder (GAD) is common among patients with “medically unexplained” chronic pain and chronic physical illness and is also a predictor of chronic musculoskeletal pain after trauma. Belonging to different ethnic groups and ignorance of these differences by primary care physicians can be an obstacle to good health care, especially early recognition of depressive symptoms. Aim. The aim of this proposed, systematic work was to draw conclusions from empirical research dealing with the processes involved in the examination of depression, anxiety, and chronic non malignant pain. The research question for this review paper was to examine the correlation of depression and anxiety with chronic non-malignant pain. The aim was to examine the role of primary health care in recognizing, preventing, and treating depression and anxiety in patients with chronic non-malignant pain, and whether there is a difference in the correlation between depression, anxiety, and chronic non-malignant pain according to ethnicity. Methods. Methods for identifying the study were derived from the Medline database (via PubMed). The analysis included all scientific papers in English, regardless of methodology, published since 2011. The papers dealt with the correlation between depression, anxiety, and chronic non-malignant pain, and included the population of primary care patients over 18 years of age who suffer from chronic nonmalignant pain and at the same time have symptoms of depression and anxiety present or are members of ethnic groups. 403 articles were found, original and review papers, of which, after a detailed reading, 10 were selected that meet the inclusion criteria for the purposes of this review. Results. Depression and anxiety are significantly more present in people with chronic pain (23%), compared to those who do not have chronic pain (12%). The most common is chronic musculoskeletal pain, with one-third of patients having depression. Depression and anxiety are significantly associated with the intensity and duration of pain. Chronic pain and depression also differ according to ethnic groups, with cultural differences and language barriers being a barrier to early detection of depression. Conclusion. Depression is the most common mental health disorder associated with chronic pain. It is extremely important to treat both depression and pain, in order to prevent the development of severe depression and chronic pain at an early stage. The integrated program at the level of primary health care is expected to have positive effects on both the physical and mental condition of patients. Cultural differences and ethnicity, which can significantly reduce the detection of depressive symptoms at the primary health care level, should certainly be taken into account.

Risk for Falls in Patients with Limb Amputations in the Clinical Institute for Rehabilitation and Orthopedic Aids of the University Hospital Centre Zagreb

Introduction. Patient falls are a significant clinical problem, as the fall can result in disability and, in some cases, death. The fall affects the patients’ quality of life, prolongs hospitalization, and increases the cost of treatment. Falls are the result of interaction between various factors. In the hospital setting, falls are considered adverse events. Aim. To determine the number of patients’ falls at the Clinical Institute for Rehabilitation and Orthopedic Aids of the University Hospital Centre Zagreb (UHC Zagreb) between September 1, 2019, and February 29, 2020. Methods. The data was extracted after the event from the Hospital Information System (Nursing records) and then processed. The study included 212 patients with limb amputations (both sexes) who were hospitalized in the Clinical Institute for Rehabilitation and Orthopedic Aids. Results. The results showed that patients with limb amputations have a risk for falls when doing rehabilitation for their primary diagnosis. Of the 212 patients admitted, 209 were at risk of falling according to the Morse Falls Scale, but of the total number of patients, only 2 fell. Conclusion. Patients with limb amputations have a higher risk of falls. The retrospective study shows that despite the increased risk of falls, the actual number of falls is very small. This shows that the medical staff are doing excellent work.

Time Analysis in Emergency Medical Service Reporting Unit

Aim. The aim of this paper was to determine whether there are any differences in the time of mobilisation and response time of the emergency medical service (EMS) team with respect to the location of the emergency call. Methods. The data for this paper was collected and analysed in detail using the program “e-hitna” (“e-emergency”). The sample consists of all calls received in the period between 1 January and 31 December 2019 in the Medical Reporting Unit of the Department of Emergency Medicine of Zagreb County (DEMZC; Zavod za hitnu medicinu zagrebačke županije). This paper presents the number, category, place of intervention, time of mobilisation of the emergency medical service team, and the response time of the emergency services team to emergency calls designated as priority 1 (A). Results. A total of 47,060 calls were recorded in the “e-hitna” system. We found that out of the total number of calls received, 49% (23,235) were related to emergency interventions. In 38% (8,841) of calls, the medical dispatcher opted for priority 1 (A). According to the place of emergency, 53% (4,691) of priority 1 (A) cases take place in the apartment, while 46% (4,071) occur in a public place. The average mobilisation time of an EMS team for priority 1 (A) cases for apartments is 1.87 ± 1.27, while for public places it is 1.92 ± 0.78 min. (Mann Whitney U test, p<0.001). The average response time of an EMS team for priority 1 (A) cases for apartments is 11.02 ± 4.27, and for public places it is 6.57 ± 3.78 min. The response time was on average much shorter for calls related to emergencies in public places (Mann Whitney U test, p<0,001). Conclusion. The collected data showed that the Department of Emergency Medicine of the Zagreb County effectively aligns their working processes as well as resources with the needs of the population regarding emergency medical care. Creativity, imagination, and constant time analysis are the determinants of the work of a medical dispatcher.

Nurses' Knowledge of Palliative Care at Primary, Secondary and Tertiary Levels of Health Care

Introduction. Comprehensive care for patients who no longer respond to treatment procedures is called palliative care. Palliative medicine does not delay or accelerate death, it promotes life, and considers dying as a normal process. In palliative medicine and care there is no place for hierarchy - teamwork, focus on the patient and respect for his autonomy are what is important. Aim. The conducted research shows the knowledge of nurses about palliative care at the primary, secondary and tertiary levels of health care. Methods. Prospective research in the Republic of Croatia at three levels of health care has been conducted. The sample included 150 nurses. The instrument used in the study was the Palliative Care Quiz for Nursing (PCQN). Results. The results showed that the nurses’ knowledge of palliative care is insufficient among the nursing population. Despite numerous training activities conducted over the past ten years, levels of knowledge are still lower than expected. Nurses at the primary level of health care have far greater knowledge than nurses at secondary and tertiary levels. Conclusion. Results of the study showed the need for quality education with real-life examples in order to achieve higher levels of empathy, spread knowledge about palliative care and about the importance of care for palliative patients. It is recommended to increase the number of educational activities in small groups, in the local language, adaptable and understandable to all health professionals.

Perception Of Stress and Illness Among Nurses in Psychiatry

Homeostasis is important for maintaining balance and normal functioning of the organism. Allostatic mechanisms further help to establish this balance. If the body is under stress for a longer period, a complex condition in the body called allostatic load occurs. If such a load lasts longer, the risk of developing diseases increases significantly. This study was conducted anonymously with the aim of determining the health status of male and female nurses in the Neuropsychiatric hospital “Dr. Ivan Barbot” in Popovača and their exposure to everyday stressors in the workplace. The main purpose was to examine the relationship between stress and the health status of nurses in relation to gender, age, and seniority. A total of 142 nurses participated. The Health Questionnaire and Workplace Stress Questionnaire were used. The results showed that the most common diseases nurses suffer from are cardiovascular diseases, thyroid diseases, gastrointestinal diseases, and allergies. Women showed higher sensitivity to stress than men. The most common stressors faced by nurses in the workplace are inadequate personal income, inadequate workspace and material resources for work, lack of staff, daily contingencies, 24-hour responsibility, and administrative work. This study found an association between age and, consequently, work experience with the likelihood of illness, although both the healthy and the sick perceive equal levels of stress. One disadvantage of this study is that it covers a large area and deals with general issues, but it can certainly be a starting point for further research. Many questions remain open, which means there is a need for further research and study of the link between stress and illness.

Chronic Alcohol Use and Accompanying Noncommunicable Diseases

Introduction. Heavy and chronic alcohol use connotes frequent, continuous and persistent consumption of alcoholic drinks over an extended period of time. Importantly, heavy consumption of alcohol causes many health problems to the drinker and the society at large, as over 5.1% of the global burden of morbidity and injuries are attributable to alcohol usage alone. Aim. The purpose of this study is to identify some of the noncommunicable diseases that are associated with chronic alcohol consumption through a systematic and narrative review, with detailed descriptions of the occurrences. Methods. A systematic and narrative review of literature that evaluates noncommunicable diseases associated with chronic alcohol consumption was carried out using Google, Medline and databases of major international health organizations. Keywords used as search terms were alcoholism, chronic alcohol use and heavy alcohol use; these terms were matched with occurrences and risk of noncommunicable diseases. Studies included in this review are clinical trials, meta-analyses, randomized controlled trials, and systematic and review articles. Results. The findings revealed that chronic alcohol use is either a single or joint risk factor for Alzheimer’s disease and dementia, arthritis, brain malfunction, cancer (most commonly of the oropharynx, larynx, oesophagus, liver, colon, rectum or breast), chronic obstructive pulmonary disease (COPD), diabetes, epilepsy, heart diseases and cardiovascular diseases, immune system dysfunction, malnourishment and vitamin deficiencies, mood disorders, bipolar disorder and depression, osteoporosis and bone malformation, pancreatitis, and ulcers and gastrointestinal problems. Conclusion. These findings are background information as they revealed some of the noncommunicable diseases associated with chronic alcohol use. Hence, more and precise long-term cohort studies are necessary for a better understanding of the occurrences and epidemiology of noncommunicable diseases as a result of chronic alcohol use.

Attitudes and Knowledge of Students on Sexuality in Three Secondary Schools

Introduction. Sexuality of children and adolescents in Croatia is still considered a taboo, and sexually transmitted diseases are a significant global public health problem that is constantly growing. As a frequent consequence of irresponsible sexual behaviour and early sexual intercourse, we are faced with the problem of juvenile, most often unwanted, pregnancy. Contraceptives are used to prevent sexually transmitted diseases and unwanted pregnancies, and the most vulnerable group are the adolescents. The primary task is to educate the youth prior to them entering active sexual life. Aim. To collect and analyse data on sexual habits, attitudes and knowledge of adolescents. To assess the need for additional education and preventive programmes. Methods. 130 high school students, aged 17-19, participated in the survey. For testing purposes, a questionnaire was used. The questionnaire was conducted voluntarily and was completely anonymous, and a written consent was obtained from parents of juvenile participants. Results. The adolescent subjects in this study showed insufficient knowledge of sexuality, namely the menstrual cycle, contraceptives and emergency contraception, and sexually transmitted diseases. They showed knowledge of things they could get acquainted with on a daily basis through the media and other information outlets. Conclusion. According to the results obtained by the research, we can conclude that higher quality education of the youth is necessary, with the aim of expanding their knowledge of sexuality in order to prevent sexually transmitted diseases and the occurrence of unwanted juvenile pregnancies.