Background: While cardiopulmonary resuscitation (CPR) may be life-saving for patients in cardiac arrest, it simultaneously puts them at risk for skeletal and soft tissue injuries. The prevalence of cardiovascular and thoracic wall injuries related to CPR varies significantly in the literature, from 21% to more than 78%. After restoration of circulation, ischemia–reperfusion brain injury ensues. Sedation is one of the interventions that can reduce its effects on brain cells. The purpose of this study was to analyse the use of analgesics and sedatives in nontraumatic patients after sudden cardiac arrest in the peri-resuscitation period in the emergency department. Methods: This was a retrospective cohort study. An analysis was performed on the electronic health records of 131 patients who underwent CPR, with ages ranging from 24 to 96 years. The study protocol was in accordance with the Declaration of Helsinki. Results: Chest wall injuries were assessed based on the results of X-ray imaging (n = 39; 31%) and computed tomography (n = 87; 69%). Of the 126 cases, 17.5% had rib fractures and 6.3% had rib and sternal fractures. Almost 78% of the patients (n = 102) received sedatives and/or analgesics during the peri-resuscitation period. Monotherapy was used in 85 cases. Among these drugs the most frequently mentioned were midazolam (45.2%), fentanyl (26.8%), and propofol (20.8%). Conclusions: As only two-thirds of the patients received sedation and half received analgesics, there is still room for a broader incorporation of analgesia and sedation into peri-resuscitation care protocols.

INTRODUCTION:Cardiopulmonary resuscitation-induced consciousness is a newly recognized phenomenon with an increasing incidence. A return of consciousness during cardiopulmonary resuscitation affects up to 0.9% of cases. Patients may also experience physical pain associated with chest compressions, as most victims of cardiac arrest who are subjected to resuscitative efforts sustain ribs or sternum fractures.METHODS:A rapid review was carried out from August 2021 to December 2022.RESULTS:Thirty-two articles were included in the rapid review. Of these, eleven studies focused on the return of consciousness during CPR, and twenty-one on CPR-induced chest injuries.CONCLUSION:A small number of studies that have dealt with the return of consciousness associated with cardiopulmonary resuscitation made it hard to clearly determine how often this occurs. There were more studies that dealt with chest trauma during resuscitation, but no study considered the use of analgesics. Of note, there was no standardized therapeutic approach as far as the use of analgesics and/or sedatives was considered. This is probably due to the lack of guidelines for analgesic management during cardiopulmonary resuscitation and peri-resuscitative period.

Hospital emergency departments are units of the State Medical Rescue system in Poland, which was established to help people in a state of a health emergency. The aim of this study is to develop an optimal method of financing emergency departments in Poland. The study used Polish data from 2016–2019 on the financing of services at the Clinical Emergency Department of the University Clinical Center in Gdańsk. For benchmarking and mathematical modeling, data for the Czech Republic, Germany and Latvia was used. The results of the analysis shows significant differences, to the disadvantage of Clinical Emergency Department, between the potential contract values in the tested models and the actual amounts of funds transferred by the National Health Fund Pomeranian Voivodeship Branch for the activities of Clinical Emergency Department under the concluded contracts. The introduction of co-payment on the part of patients reporting to the emergency departments with minor ailments that do not require hospitalization generates financial revenues, but does not significantly improve the financial results of the analyzed ward. However, it may be educational for patients in terms of raising their awareness of the correct place to seek assistance in the event of a sudden illness.

Increase in demand for health services in HED (Hospital Emergency Department) and their increasing this greater overcrowding is known from the English language as overcrowding. The concept of overcrowding is also inherently related to the notion of frequent use of assistance in the SOR. However, no uniform criterion for defining this concept has been developed so far. The aim of this study is to present the causes of the phenomenon of overcrowding and the related issues of patients’ functioning in the health care system. The main reasons for this phenomenon are the demographic aspect, i.e. the extension of the average age of many societies, but also the tendency of patients to omit medical assistance at the primary health care level and go directly to the HED as facilities with greater diagnostic and therapeutic possibilities. The consequences of the overcrowding phenomenon are, above all, an increase in the costs of HED functioning, longer waiting times for health services provided in the HED and excessive workload of the staff employed there. Currently, overcrowding has been recognized as a global public health problem.

BACKGROUND:The study was based on the Terror Management Theory. This theory assumes that self-preservation and awareness of imminent death create the potential to trigger fear. The "culture buffer" can protect people from fear, and it is composed of two factors: personal views on world issues and self-esteem. The aim of the study was to show that exposure to content that increases the availability of thoughts about death causes changes in medical personnel (doctors, nurses, and paramedics) in areas such as self-esteem, mood, sense of agency, and communion.METHODS:The research was experimental. Standardized psychometric tests were used, including the Rosenberg self-esteem scale (RSE), the University of Wales Institution of Science and Technology) Mood Adjective Check List (UMACL), scales measuring agency and communion, and an additional questionnaire containing two types of text. Respondents were divided into two text groups: A (exposed to increased availability of thoughts of death) and B (neutral).RESULTS:Reflection on death, triggered by the experimental manipulation of the independent variable (text version), did not modify mood (in groups of medical staff and students) or self-esteem of health care professionals but did modify scores on a single RSE item in the student's group. Moreover, age, income level, religious attitude, and belonging to a professional group had an impact on self-esteem, mood components, and other parameters but did not interact with the text group. Reflection on death modified the sense of agency and communion.CONCLUSIONS:Exposure to content increasing the availability of thoughts of death led to observable effects possible to observe in all groups only after taking into account an additional factor, which turned out to be the religious attitude of the respondents in the experiment. Specific tools should be selected or developed for the needs of research on respondents working in health care.

Physical therapy is part of the treatment for patients admitted to ICU. Proprioceptive neuromuscular facilitation (PNF) is one of the physiotherapy concepts including manual techniques and verbal stimulation. The purpose of this paper is to examine the feasibility of PNF techniques in mechanically ventilated (MV) ICU patients. Another aim is to verify whether the technique using resistance during the patient's inhalation will have a different effect than the technique used to teaching the correct breathing patterns.METHODS:Patients admitted to tertiary ICU were enrolled in this study, randomly divided into two groups, and received four 90-second manual breathing stimulations each. The following vital signs were assessed: HR, SBP, DBP, and SpO2.RESULTS:61 MV ICU adult patients (mean age 67.8; 25 female and 36 male) were enrolled in this study. No significant differences in HR, SBP, and DBP were observed both for two techniques measured separately and between them. Statistically significant differences were noticed analysing SpO2 in the rhythmic initiation technique (RIT) group (p-value = 0.013).CONCLUSIONS:Short-term PNF interventions did not influence clinically relevant vital parameters among MV patients and seem to be feasible in this group of ICU patients.

Poland is the only country in the world, which has a uniform nationwide command support system for medical rescue, integrated with the command support systems of the National Fire Service and the Police. SWD PRM is un-derstood as an ICT system that enables receiving alarm notifications from emergency notification centers and noti-fications about incidents, dispatching of emergency medical services, recording medical incidents, presentation of geographical location of the incident site, positioning of emergency medical services and support of tasks execution by emergency medical services and provincial coordinator of medical rescue. The purpose of this paper is to present assumptions of the SWD PRM system and history of its implementation as well as available technical and system capabilities. Its greatest advantage is the fact that it is a uniform nationwide teleinformatic system collecting data about medical events. Its functioning in terms of information and data collection allows for improvement of plan-ning and organization of the PRM system, which enables effective management of available forces and resources, which translates into shortening the waiting time for assistance for a person in a state of emergency by reducing the time of arrival of the Medical Rescue Unit at the scene of the event.

Background Subarachnoid hemorrhage (SAH) is rare but potentially life-threatening cause of acute headache. First diagnostic test performed in the Emergency Department (ED) for acute “thunderclap” headache is computed tomography of the head (CT) without contrast enhancement. Negative non-contrast head CT may be erroneously interpreted as an exclusion of SAH and lead to ED discharge. The consequences of overlooking SAH are of special interest to the Emergency Physician. The aim of this study was to assess prevalence and clinical picture of CT-negative cases of SAH admitted to the ED.

The cost analysis of pain treatment is not a topic often taken up by the health economists community. The subjective dimension and pain assessment by the patient is one of the main determinants of the lack of interest in this topic. Work carried out on this topic currently includes analysis accompanying the process of pharmacotherapy treatment, care provided by medical personnel as well as costs resulting from administrative services. The aim of the work is to present the cost analysis of care for a „pain” patient and to indicate the most optimal financial package of these activities. The study was performed on the basis of financial data of the Clinical Emergency Department of the University Clinical Center in Gdańsk for the last year. We analyzed the cases of patients complaining of pain who received pharmacotherapy. Results The total cost for 2017 amounted to 1.128.668 PLN. The largest amount of money was allocated to the group of patients qualified to the group R: „Symptoms, disease features and abnormal results of clinical trials not classified elsewhere” – 327.313.72 PLN. The symptom of pain is one of the most frequently indicated symptoms among patients who receive medical help at the Clinical Emergency Department of the University Clinical Center in Gdańsk, which should be associated with a greater degree of involvement in analgesic therapy in patients who require it.

Jacek Kubica, Piotr Adamski, Przemysław Paciorek , Jerzy R. Ładny, Zbigniew Kalarus, Waldemar Banasiak, Wacław Kochman, Jarosław Gorący, Beata Wożakowska-Kapłon, Eliano Pio Navarese, Andrzej Kleinrok, Robert Gil, Maciej Lesiak, Jarosław Drożdż, Aldona Kubica, Krzysztof J. Filipiak, Jarosław Kaźmierczak, Aleksander Goch, Stefan Grajek, Andrzej Basiński, Łukasz Szarpak, Grzegorz Grześk, Piotr Hoffman, Wojciech Wojakowski, Zbigniew Gąsior, Sławomir Dobrzycki, Jolanta M. Siller-Matula, Adam Witkowski, Wiktor Kuliczkowski, Marcin Gruchała, Dariusz Timler, Grzegorz Opolski, Dariusz Dudek, Jacek Legutko, Marzenna Zielińska, Jarosław Wójcik

PURPOSE:The purpose of this study was to identify Polish nurses' experiences and perceptions about the barriers to postoperative pain management in older adults. DESIGN:The study was conducted using a dedicated questionnaire. METHODS:Eleven hospitals participated in this study. The project involved 1,602 nurses working on surgical hospital wards. A descriptive exploratory survey and a qualitative content analysis were used. FINDINGS:Access to journals on evidence-based practice related to pain assessment and management in elderly patients was assessed as less important by the respondents. Knowledge drawn from the media and scientific and medical journals was assessed by the respondents as unsatisfactory. The greatest barrier to nurses was that scientific articles are published in English. CONCLUSIONS:Nurses' awareness of evidence-based practice increases with their education. Among the key problems is the lack of available professional publications in the Polish literature, ignorance of English, shortage of time, and lack of support from chief physicians of the ward.

In last time major changes in the system of National Medical Rescue (Państwowe Ratownictwo Medyczne, PRM) occurred. Changes between the others concerned increasing permissions of medical rescuers. For a long time we discussed wide spectrum of actions and autonomy of this professional group and in latest term benefit package of this group was additionally expanded. Is such a varied list of medical procedures, in it pharmacotherapy, is a proper growth of system is subject at issue. Authors of the article decided to look into selected fragments of actions of the system of Medical Rescue and analyze one of import_ant elements of departure team actions, namely relieving pain of injured after the injury. Asking following questions is justified: Is increasing the pool of permissions caused by depleting previous therapeutical possibilities, or were there other reasons to add changes; Is releasing pain on prehospital level enough? Should the attention be focused on this subject and possibly implement repair procedures and educative? To define issues above, medical documentation of trustees of medical teams on the area of Pomeranian Voivodeship were analyzed. Among all provided documents, the ones in which reason of the call was injury were chosen. Tens of thousands cards with different types of injuries were obtained, insulated, multiple and generalized injuries. In how many cases, the procedure of pain relieving were applied was examined and what medicines were used the most. Unfortunately as seen on the presented statistics, only small percentage of cases there were tries of decreasing complaints of injured despite the wide amount available resources. These preliminary studies show the necessity of inputting repair procedures in terms of relieving the pain of injured after injuries by departure teams of Medical Rescue.

Advances in the study of pain and the methods for its relief since the late 1980s have led to a rise in the role of the nurse in pain management and monitoring. The application of Evidence-Based Practice (EBP) related to acute pain is on the increase in the world at large. The purpose of this study is to describe current practices, perceived barriers and perceived facilitators of Polish nurses on using EBP) for assessing and managing acute pain in postoperative older adults on the basis of the Acute Pain Evidence-Based Practice Questionnaire for Gerontological Nursing (APEBPQ). The project involved 1300 nurses working on surgical hospital wards. A mixed method, a descriptive exploratory survey and a qualitative content analysis, were used. Study was conducted using the Acute Pain Evidence-Based Practice Questionnaire for Gerontological Nursing. Range of responses concerned (and was) the assessment of knowledge, needs, skills and deployment context of Evidence-Based Medicine (EBM) (medium range = 3.04-4.06), use of sources of knowledge about pain and its treatment (mean range = 2.80-4.05), the assessment of current practice in assessing and controlling pain in elderly patients (mean range = 2.64-4.24), the assessment of obstacles for the evidence-based practice (medium range = 2.82-3.54), and the assessment of the extent to which people working with nurses are useful in the practice of evidence-based (medium range = 2.96-3.32). Nurses’ awareness of EBP and use of current practices related to pain assessment and management in elderly patients increases with their level of education. One of the major problems hindering the use of EBP is not enough available professional literature in Polish literature for nurses, unfamiliarity with the English language, lack of time, as well as a lack of support from the Head of the Department.

Aim The purpose of the paper was to compare the prevalence of barriers to optimum postoperative pain management in elderly patients, observed by nurses in a clinical, provincial and municipal hospital in Poland. Background It is currently estimated that the lack of adequate pain management affects 80% of the global population and the phenomenon poses a serious problem in more than 150 countries. Methods A questionnaire-based study of 1602 nurses working at clinical, provincial and municipal hospitals. Results In the clinical hospitals barriers more often related to a poorly organised systems of care and obstacles in discussing pain management within the team. In provincial and municipal hospitals lack of uninform pain measurement was more evident. Conclusions Despite the availability of effective pain treatments in hospitals difficulties continue with communication, poorly organised care and limited access to clinical guidelines. Implications for nursing management Although there are possibilities of pain relief after surgery, they are still used insufficiently. Postoperative pain management in Poland needs considerable improvement. This study can contribute to the improvement of pain management quality by supporting and developing practical guidelines or management algorithms for nurses, facilitating the effective implementation of new pain management practices.

AIM:The aim of this work was to present current practices, perceived barriers and perceived facilitators of Polish nurses in using EBP in the assessment and management of acute pain during the postoperative period in elderly patients.BACKGROUND:Advances in the study of pain and the methods for its relief since the late 1980s have led to a rise in the role of the nurse in pain management and monitoring.INTRODUCTION:The application of evidence-based practice associated with acute pain is on the increase in the world at large.METHODS:Eleven hospitals participated in this study. The project involved 1300 nurses working on surgical hospital wards. In this study, case study research and qualitative content analysis were used. The study was conducted using a dedicated questionnaire.RESULTS:Access to journals on evidence-based practice on the assessment and management of pain in elderly patients was assessed as less important by the respondents. Knowledge drawn from the media, scientific and medical journals was assessed by the respondents as unsatisfactory. The greatest barrier to nurses was the fact that scientific articles were published in English.CONCLUSION:Nurses' awareness of evidence-based practice increases with their education. Among the key problems are the lack of available professional publications in Polish literature, ignorance of English, shortage of time and lack of support from chief physicians of the ward.IMPLICATIONS FOR NURSING AND HEALTH POLICY:There is a need for the introduction of innovative strategies of teaching and approaches to the problem of evidence-based practice in approach to pain management in elder people among the Polish nurses. It is necessary to promote these issues in Polish scientific literature.

Background: Research into the quality of life (QoL) of people with cancer is relevant for the diagnosis of the patient's health. The collected data are used to determine somatic complaints, psychological state and the needs for nursing care.Aim: The study aimed to assess the overall QoL and functional status in relation to basic activities of daily living of patients diagnosed with cancer in our region.Methods: Using questionnaires for assessment of QoL and functional status (Barthel Index), we surveyed 500 adult patients (250 women and 250 men) diagnosed with neoplasms of varying etiology and staying at home.Results: The average QoL (+/- standard deviation) in the study population was low and amounted to 34.5 (+/- 22.7) on the scale of 0-100. The most intensive symptoms were fatigue (69.9 +/- 25.5) and pain (62.7 +/- 29.1). The greatest demand for nursing care concerned grooming and bathing.Conclusions: The QoL and functioning scores of patients with neoplasmic disease were low. The caregivers (usually nurses) should strive to minimize patients' fatigue and pain. (C) 2016 Elsevier Inc. All rights reserved.