Background: In-hospital cardiac arrest is a common situation in hospital settings. Therefore, healthcare providers should understand the reasons that could affect the results of cardiopulmonary resuscitation. We aimed to determine the independent predictors for poor outcomes after the return of spontaneous circulation in in-hospital cardiac arrest patients, and also look for a relationship between patient's background parameters and the status at intensive care unit.Methods: We did a retrospective cohort study using cardiac arrest patients admitted to the intensive care unit after successful cardiopulmonary resuscitation between 2011-2015. Patients' data were gathered from hospital database. Estimated probabilities of survival were computed using the Kaplan-Meier method. Cox proportional hazard models were used to determine associated risk factors for mortality.Results: In total, 197 cardiac arrest patients were admitted to anesthesia intensive care unit after successful cardiopulmonary resuscitation in a 4-years period. Of 197 patients, 170 (86.3%) died in intensive care unit. Median of survival days was 4 days. Comorbidity (p = 0.01), higher duration of cardiopulmonary resuscitation (p = 0.02), lower Glasgow Coma Score (p = 0.00), abnormal lactate level (p = 0.00), and abnormal mean blood pressure (p = 0.01) were the main predictors for increased mortality in cardiac arrest patients after intensive care unit admission.Conclusion: The consequent clinical status of the patients is affected by the physiological state after return of spontaneous circulation. Comorbidity, higher duration of cardiopulmonary resuscitation, lower arrival Glasgow Coma Score, abnormal lactate level, and abnormal mean blood pressure were the main predictors for increased mortality in patients admitted to the intensive care unit after successful cardiopulmonary resuscitation.& COPY; 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Abstract Background- Sepsis remains a common cause of death. Involving in important cellular processes, the cereblon (CRBN) protein plays a role in sepsis. This study aimed to show the CRBN protein expression and its effects on the patients in the intensive care unit. Methods- Samples were taken by deep tracheal aspiration from patients. The presence of CRBN was pathologically investigated by using immunohistochemical tests and polyclonal antibodies against CRBN. The relationship between gender, sepsis, steroid, survival, and the presence of CRBN was examined. Results- Respiratory and neurologic diseases were the most common reasons for admission. Acinetobacter was the most frequent microorganism. In patients with more than normal inflammatory cells, we observed a negative correlation between CRBN expression and PNL rate (p = 0.031). In patients with CRBN, there was no correlation between steroid and mortality, APACHE/Glasgow score, length of stay in hospital and ICU. Conclusion- Although the prognosis in sepsis is better in CRBN-deficiency animals, the presence of CRBN in humans does not affect it. The more we saw inflammatory cells in aspiration material, the less there was a CRBN. The response to steroids, an immunomodulator, did not change with the presence of the immunomodulator target molecule, CRBN. This requires us to reconsider using immunomodulators in the treatment of sepsis.

The aim of this study is to compare the effects of the propofol, desflurane and isoflurane on blood glu-cose levels in cranial surgery. Ninety, ASA I-II patients aged between 18-60 years old were scheduled for study. Induction was per-formed with fentanyl, propofol and cisatracurium in all patients. Anaesthesia was maintained using propofol 4-6 mg/kg/h in propofol group (Group P), desflurane and isoflurane 0.5-1 MAC in group desflurane (Group D) and group isoflurane (Group I). Remifentanil infusion was applied 0.5 µg/kg/min in all groups. Plasma glucose (PG) levels, systolic arterial pressure (SAP), diastolic arterial pressure, mean arterial pressure and heart rate measured. In the 1st, 2nd and 5th hour, PG levels were significantly lower in group P than group D. In the 2nd and 3rd hour, PG levels were significantly lower in group P than group I (p <0.05). In addition, SAP values in group D were found to be significantly lower than group P and group I. With this study, it was concluded that total intravenous anesthesia with propofol infusion in intracranial mass surgery is more effective than inhalation anesthesia such as desflurane and isoflurane in preventing the hyperglycemic response caused by surgical stress.

Introduction Preoperative anxiety due to anesthesia is a common situation and decreases with preoperative evaluation. The aim of this study is to determine whether utilization of BATHE method further decreases the anxiety scores of patients who are evaluated at an anesthesia clinic for preoperative examination. Methods The patients were randomized into "BATHE" and "Control" groups by using the closed envelope technique. State-Trait Anxiety Inventory (STAI) scores were recorded as entrance STAI for all patients. During preoperative evaluation, BATHE method was applied to the BATHE Group whereas it was not applied to the Control Group. Post-examination, STAI scores were recorded as exit STAI and the patients were later asked questions about their contentment. Results Data of 463 patients were included in the analysis. Demographic data was similar in the groups. In both groups the exit STAI scores (BATHE: 34.27±10.30, Control: 34.90±9.54) were lower in comparison to the entrance STAI scores (BATHE: 38.21±9.86, Control: 37.09±9.93). The mean gap between the entrance STAI and exit STAI scores of the BATHE (3.94±6.05) and Control groups (2.19±6.14) were statistically significant (p<0.001). Conclusion Utilization of BATHE method decreases the anxiety scores of preoperative patients to a greater extent, as measured by STAI index, in comparison to standard preoperative evaluation.

Objective: Abdominal obesity causes many health problems such as cardiovascular diseases and metabolic disorders.Body mass index (BMI) does not give us information about body fat distribution.Waist circumference measurements demonstrate abdominal obesity more accurately.Therefore, we think that it will be more accurate to use waist circumference in intensive care scoring systems in predicting mortality. Material and Method:In this study we investigated the patients' ages, BMIs, waist circumference, chest circumference, waist circumference/chest circumference ratio, APACHE 2 scores, SOFA scores, duration of mechanical ventilation and length of stay in ICU.We searched the effects of waist circumference/chest circumference ratio on mortality, and whether this ratio is more sensitive than body mass index by itself in determining mortality and its relationship between length of stay in ICU and duration of mechanical ventilation. Results:We found no statistically significant difference between waist circumference, chest circumference and mortality.Similarly, there was not a significant difference between BMI and mortality. Conclusion:We think that we need large, multi-centered studies to be able to determine the exact relationship between waist circumference and mortality in ICU.

Objective: Although central venous catheter (CVC) is a vital initiative, it causes serious complication among intensive care unit (ICU) patients. The most important of these is catheter related bloodstream infection (CRBSI). CRBSI increases morbidity, mortality and costs. The aim of this review is to examine the results of implemented interventions as the bundle of evidence-based guidelines recommendations for prevention and/ or reduction of CRBSI among adult hospitalized patients in the ICU. Material and Methods: In order to reach the relevant study, BMJ Online Journals, Cochrane, EBSCOhost, Elsevier Science Direct, Medline, OVID-Lippincott Williams & Wilkins database were scanned. The full text can be accessed, published between 2000-2014, English studies were included in the review. All studies that have implemented the preventive bundle approach in adult patients who had non-tunneled central line in the ICU and have reported the CRBSI rate or number of event were included in the review. A standard assessment has not been made with regard to design or methodological quality of reached studies. Results: Twenty one studies were included in the review. The initiatives implemented in the study were presented in the following categories: education, prefer to subclavian site, evaluation of CVC requirements, hand hygiene, maximal sterile barrier precautions, chlorhexidine for skin antisepsis, checklist, empowering nurses to stop procedures, CVC insertion cart, adequate catheter care, replacement of administration sets, needleless intravascular catheter systems, evaluation of adherence to guidelines and other initiatives. Statistically significant reduction was found between the preintervention and postintervention period for CRBSI rate in 18 studies except only one study. In only one study, CRBSI rates between preintervention and postintervention period were equal. Conclusions: CRBSI rate was shown to decrease between 26% at first year of intervention and 95% at second year after intervention with implemented as the bundle of recommended interventions in the guidelines. As a result, the bundle approach has been revealed to be effective and sustainable to reduce CRBSI in adult ICU patients.

McKesson is America's oldest and largest healthcare services company. IBM Research developed an innovative scenario modeling and analysis tool, supply chain scenario modeler (SCSM), for McKesson to optimize its end-to-end pharmaceutical supply chain policies. Through integrated operations research (OR) models, SCSM optimizes the distribution network, supply flow, inventory, and transportation policies, and quantifies the impacts of changes on financial, operational, and environmental metrics. The modeling work spawned a roadmap of projects with quantified opportunities, including a new air freight supply chain path, and provided new insights that have been critical to improving McKesson's performance as a pharmaceutical industry leader. A structured data model supporting the OR models has provided a basis for additional improvement projects. The model directly links OR modeling results to a detailed profit-and-loss statement by product category for the different supply chain paths that McKesson uses. Since this effort began in 2009, McKesson Pharmaceutical division has reduced its committed capital by more than $1 billion.

In Application Management Services (AMS), high resource utilization, effective resource planning and optimal assignment of service requests to resources are critical to success. Meeting these objectives requires a systematic and repeatable approach for determining the best way of measuring resource utilization, assessing workload and assigning service requests. In this paper, we present a two-step approach to help achieve the above objectives. We first measure the actual amount of effort that each resource spends on handling each service request (SR) based on a metadata model and a set of SR handling priority rules. Then, we proceed to measure resource utilization and assess SR assignment process based on the effort data calculated in step one.

In this paper, service transition stands for the process of taking over responsibility for management and enhancement of a client's IT applications. While more and more clients see benefits in outsourcing their IT applications, the competition between providers of application management services grows fiercer. Here, an efficient transition process provides a substantial competitive advantage, and effective knowledge transfer and management are its crucial ingredients. We have identified two potential obstacles to effective knowledge transfer: (1) the client's application knowledge may not explicitly and transparently be available, and (2) the provider's knowledge management approach may be distributed and highly fluctuating teams may lack proper technology and discipline. In this paper, we present a method to harvest, share and grow application knowledge systematically; an architecture to store, link, and access knowledge efficiently; as well as a management model to reward generation and consumption of application knowledge.