Browsing by Author "Sijacki, Ana (35460103000)"

Objective: To identify the risk factors of the adverse outcomes following surgery for the acute bowel obstruction (ABO). Methods: Annual cross-section included patients undergoing surgery for the acute bowel obstruction, at the Clinic for Emergency Surgery, from December 2009 to December 2010. Patients had non-resection procedures or bowel resection with the intestinal anastomosis or temporary intestinal diversion. Demographic and perioperative data as well as outcome results were collected. Stepwise logistic regression was used to build models predicting 30-day morbidity and mortality and derive risk index values. Results: Out of 272 patients, 145 underwent non-resection surgical procedures and 127 underwent bowel resection. The median ICU stay and median hospital stay was significantly higher among patients who underwent bowel resection (p=0,001 and p<0.0001,respectively). Morbidity was 37.1%. In multivariate analysis, the variables with the highest risk values included age over 65 years and ASA class 4-5, for 30-day morbidity. The overall 30-day mortality was 10.3%. For 30-day mortality, age over 65 years, comorbidity conditions, ASA class 4-5 and malignant etiology of ABO were the variables with the highest risk values. Conclusions: Advanced age and ASA score with delayed operation were the risk factors significantly associated with the increased complication rate, while the advanced age and ASA score, comorbidity and malignant etiology were the risk factors significantly associated with the increased death rate. Surgery type was not a predictor of the adverse outcomes. Identification of risk factors is useful to predict outcomes and provide supportive care to high-risk patients undergoing surgery for ABO.

Introduction: A large numbers of patients who are resuscitated in out-of-hospital settings are not admitted or discharged from the hospital, for one year after cardiac arrest. Objective: The aim of this research was to evaluate immediate (return of spontaneous circulation - ROSC >24), short-term (until discharge from hospital) and long-term (12 months after arrest) survival of patients who underwent out-of-hospital cardiopulmonary resuscitation (CPR) by using Resuscitation Prediction Scoring (RPS), Advanced Cardiac Life Support (ACLS) and Early Prediction Score (EPS), as well as identification of individual outcome predictors and development of new prediction scores. Methods: A prospective, two-year, multicentric study (conducted in Belgrade, Novi Sad, Nis, and Kragujevac) was used to evaluate outcomes of out-of-hospital CPR in the following groups: Group 1 - CPR within 4 minutes from arrest; Group 2 - CPR 4 minutes after arrest (survival or death). Emergency Medical Service (EMS) team (physician, technician and driver) conducted CPR according to ERC ALS algorithm from 2005. The research instruments were Utstein Template, RPS, ACLS, and EPS. The first batch of results consists of descriptive presentation of Utstein variables obtained by univariate analysis, while second batch represents ROC analysis using RPS, ACLS and EPS. New SRQOL (i,s,l) numeric models have been created by identifying risk factors (p<0.05), as well as by using successive-logistic and linear-regression method. Results: Out of a total number of patients (n=591), 27.2% were assigned to Group 1 - CPR within 4 minutes from arrest, while 62.8% were assigned to Group 2, accompanied by a significant difference in survival (p<0.001). The predictive ability of the RPS scale in Group 1 (ROC=0.691) was poor, while in Group 2 (ROC=0.704) it was satisfying; the ACLS score in Group 1 (ROC=0.850) was good, while in Group 2 (ROC=0.630) it was poor; the EPS score (ROC=0.823) in both Groups 1 and 2 (ROC=0.821) was good. Univariate variables were: younger age, arrest developed in front of EMS team, laymen CPR, cardiac cause of arrest, CT/VF rhythm, initially responsive pupils, initial swallowing reflex, and early professional CPR (CPR within 4 minutes). SR-QOL survival prediction models have been created. SR-QOLi (ROC=0.833) and SR-QOLs (ROC=0,882) represent good models for prediction of immediate and short-term survival, respectively. SR-QOLl (ROC=0.913) is an excellent model for prediction of long-term survival. Cumulative survival of our patients by evaluated time points was: ROSC: 12.7%; until discharge from hospital: 11.3%, and until 12 months: 10.0%. Conclusion: The research created SR-QOL models for prediction of immediate (SR-QOLi), short-term (SR-QOLs) and long-term (SRQOLl) survival after out-of-hospital CPR, which are characterized by their superior prediction ability in local settings compared to standard scores (RPS, ACLS and EPS). Further investigations and evaluations of validity are needed in order to enhance their predictive value. © 2012 Nova Science Publishers, Inc.

In this study, a research of injuries of passengers in city buses is presented, which are not a consequence of collision of buses with other objects. The number of injured passengers in the territory of Belgrade was registered, during three consecutive years. Most frequently injured body part was the head, while women over the age of 60 are the most vulnerable population of passengers. The most often reason for the appearance of injuries was the effect of acceleration. Also, it is pointed out to the importance of consideration of the problem of multiple injuries. These injuries are more complex than the individual ones, and they may indicate to the existence of greater omissions in the design of the interior of the bus. Proposals for certain system solutions, as well as some recommendations for designing are given, which can improve the safety of passengers who use the city bus as a means of transportation. © 2012 - IOS Press and the authors. All rights reserved.

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