Medicinos ir slaugos padaliniai (K550000)

Introduction. Timely prevention of chronic kidney disease (CKD) and fibrosis is critical, as ~ 15% of acute kidney injury (AKI) cases progress to CKD. Identifying reliable biomarkers to assess AKI-to- CKD progression and developing preventive strategies are therefore essential. Human placental stem cells (hpMSCs), with low immunogenicity and abundant availability, are a promising source. Objectives. This study evaluated the sensitivity and correlation of AKI and CKD biomarkers, as well as the preventive effects of hpMSCs on kidney function and fibrosis. Methods. In a rat ischaemia-reperfusion injury (IRI) model, both renal pedicles were clamped for 60 minutes. The treatment group received 3 x 105 hpMSCs per kidney, while the control groups received a phosphate buffer solution (IRI-PBS), underwent IRI only, or received no intervention (healthy control). hpMSCs were isolated, cultured, and characterised for yield, viability, phenotype, and immunosuppressive capacity. Blood (creatinine), urine (KIM-1, cystatin C, NG AL) and kidney samples (acute tubular necrosis (ATN), tubular dilatation (TD), casts, loss of brush border (LBB), interstitial fibrosis and tubular atrophy (IFTA), with injury quantified by a renal injury score (RIS)) were collected on days 0, 3, 7, 14, 21-28 and 56 (n > 3 per time point; total n = 75). Correlations and comparative statistical analysis was performed using SPSS 17.0 and GraphPad Prism 7.04 with non¬parametric tests (p < 0.05) and survival curve analysis. Results. hpMSCs showed stable viability, MSC marker expression, and dose-dependent T-cell suppression. Survival reached 100% in the IRI-hpMSCs group vs. 68% (IRI-PBS, p = 0.010) and 72% (IRI, p = 0.021). Kidney function improved significantly, with lower median serum creatinine on day 7 hpMSCs vs. survived controls (IRI-hpMSCs vs. IRI, p = 0.014; IRI-PBS, p = 0.034), being ~3.5x lower than IRI- PBS and 1.6x lower than IRI. Urine cystatin C was significantly lower in the IRI-hpMSCs group on day 3 vs. IRI (p = 0.005) and IRI-PBS (p = 0.025), and urine KIM-1 was lower on day 14 vs. PBS (p = 0.02). NGAL did not differ on day 3, but was higher in the hpMSCs group on day 14 vs. IRI (p = 0.018) and PBS (p = 0.02), indicating more active tubular re-epithelialization compared to controls. Histology showed that hpMSCs reduced renal injury in both early and late phases. By day 3, ATN and casts were significantly reduced, with no focal coagulative necrosis by day 7 in the IRI - hpMSCs group. On day 14, TD, IFTA, and RIS were significantly lower in the IRI-hpMSCs vs. controls, and this reduction (TD, LBB, casts, IFTA, RIS) continued on days 21-28. IFTA remained lower on day 56 in the IRI-hpMSCs group (vs. IRI, p = 0.018; vs. IRI-PBS, p = 0.049). Serum creatinine normalized by days 28 and 56, while fibrosis persisted only in controls. Despite the limited sample size, very strong correlations (r = ±1.000; p < 0.01) were observed between urinary biomarkers (KIM-1 day 14, cystatin C day 3) and later histological IFTA scores (days 28 and 56). In the IRI-PBS group, higher KIM-1 (day 14) and cystatin C (day 3) were significantly associated with increased IFTA at day 28, compared to the IRI-hpMSCs group. A smaller decrease in median KIM-1 was still leading to increased IFTA and was inversely correlated with IFTA at day 56, suggesting possible prolonged kidney damage and delayed regeneration in the IRI-PBS group. In the IRI group, the higher cystatin C (day 3) compared to the IRI-hpMSCs group was strongly associated with increased IFTA on day 56 (p = 0.001). In the IRI-hpMSCs group bigger decrease in median KIM-1 (day 14) was leading near-zero IFTA, showing a very strong inverse correlation (p = 0.001) between still numerically higher KIM-1 (day 14) as compared to day 0. Similarly, decreased cystatin C levels on day 3 are strongly associated with lower IFTA values in the cell group on day 28 (p = 0.001). Conclusion. We demonstrated the potential of hPSCs to prevent the initial cascade of kidney fibrosis and death by reducing early renal injury and improving kidney function in both the acute and late phases of AKI. 'Ihe 100% survival rate in the hPSCs-treated group highlights their potential for further mechanistic, large-scale studies, and subsequent clinical trials.

Background: The analysis of nurses' job satisfaction indicators is one of the most relevant goals of the hospital's strategy, as it helps to identify problems with working conditions, reduce staff turnover and emigration of nurses, improve the quality of healthcare services provided, and ensure the sustainable development of the health system. In Lithuania in 2023, there were approximately 7.8 nurses per 1,000 inhabitants, compared to an EU average of about 8.5-9, and in countries such as Germany or the Scandinavian countries, the number exceeds 12. This indicates a shortage of nurses, which is directly related to workload and job satisfaction. Surveys reveal that more than 40% of nurses are considering changing careers or emigrating, mostly due to excessive workload, emotional burnout, and insufficient compensation. The average salary of nurses in Lithuania in 2024 amounted to around 1,400-1,600 euros "without taxes", when it often exceeds 2,500-3,000 euros in the old EU countries. In addition, research indicates that facilities with low levels of nurse satisfaction have a higher risk of patient safety incidents, ranging from 20-30%, longer treatment times, and lower patient satisfaction scores. Therefore, a systematic analysis of nurses' satisfaction allows making data-based decisions, improving working conditions, reducing staff shortages, and ensuring a higher quality of healthcare services. The aim: to evaluate the factors influencing nurses' job satisfaction in a university hospital Methods: A quantitative cross-sectional study design in the Lithuanian University Hospital was conducted three times - in 2023, 2024, and 2025. The questionnaire was filled out by 765 nurses in 2023, 511 nurses in 2024, and 504 nurses in 2025 out of 2630. Respondents rated 14 factors affecting their job satisfaction. Results: Every year, the university hospital's administration analyses the factors influencing nurses' job satisfaction and develops strategies to address the problems that arise. Therefore, the results show that relations with colleagues and direct managers improved by 3 percent, employee engagement, personal development, and autonomy improved by 4 percent, conflict management improved by 6 percent, satisfaction with wages improved by 8 percent, and assessment of the psycho-emotional environment improved by 6 percent. High workload and vaguely defined work tasks are still cited as factors having the greatest negative impact on job satisfaction. Conclusion: Analysing factors influencing satisfaction would not only reduce staff turnover and improve patient safety but would also reduce system costs in the long run. Therefore, to increase nurses' motivation and job satisfaction, it is necessary to seek innovative solutions, not only by applying financial incentives, but also by employing tactics that help ensure nurses' professional identity, facilitate timely conflict management, and thus create a motivating, safe, and emotionally supportive work environment. Increasing satisfaction should be considered a strategic direction of health policy.

Background: Adherence to nursing protocols is one of the cornerstones of patient safety in healthcare. Research shows that adherence to protocols is closely related to protecting patients from adverse events, hospital-acquired infections, and other complications that can have serious consequences for patients' health. Statistical data show that compliance with protocols in different health care systems is uneven and often lower than recommended - the level of compliance with Standard Preventive Measures among nurses can be only about 53.5%, so almost half of the protocols are not applied consistently in daily practice. Across countries, compliance rates ranged from 64% in China to 82.6% in the Philippines and only 12% in Ethiopia, depending on training, resources, and organisational culture. Such statistical indicators reveal that although protocols exist, they are not always properly applied in practice, which poses a real risk to patient safety. A low level of adherence to protocols can lead to a higher chance of hospital-acquired infections and adverse events. Estimates from the World Health Organisation indicate that more than 100 million patients experience healthcare-acquired infections or complications each year, often related to non-compliance with protocols and safety guidelines. Searching for and creating educational tools that make it easier to remember the steps of nursing protocols is one of the most relevant priority strategic areas for hospital administration, because educational tools help to ensure patient safety, improve the quality of work, speed up the learning process, and reduce the likelihood of errors. It is an investment in safer and more effective nursing practice. Aim: Development and evaluation of the effectiveness of educational tools that facilitate the memorisation of nursing protocols. Methods: The following methods were used in the study: • Descriptive statistics: 3 educational tools for memorising the nursing protocol were presented, and 120 nursing protocol implementation cases were observed in 2 stages, in 18 departments of the university hospital. Comparing the obtained data, the effectiveness of the educational tools that help memorise the nursing protocol was analysed. • A quantitative cross-sectional study. In a university hospital, 190 nurses were surveyed about continuing education methods for better memorisation of nursing protocols. Results: The most effective learning tool for memorising the main steps of the nursing protocol is the nursing protocol performance video material. This is confirmed by the results obtained during the observation of nursing protocol cases and the nurses' survey. Conclusion: Developing and searching for educational tools is a very important strategic area of the hospital, because educational tools help to memorise and apply nursing protocols more effectively. Properly prepared tools ensure that nurses learn procedures faster, comply with safety requirements, and reduce the likelihood of errors. In this way, not only does the quality of patient care improve, but also the nurses' confidence in their competence and ability to react quickly in emergencies increases. Educational tools also facilitate continuous professional development and help standardise work processes, so their development and application in nursing practice are relevant and useful for both patients and health care personnel.

Context: In Lithuania, a national system is used to assess nursing workload in healthcare institutions, incorporating variables such as service type, patient autonomy level, and clinical setting. At the Hospital of the Lithuanian University of Health Sciences, Kaunas Clinics, patient autonomy assessment has been incorporated into the nursing incentive mechanism as a quantitative indicator. However, existing guidelines describe autonomy assessment in abstract and non-standardised terms, limiting practical applicability. This highlighted the need for a standardised instrument to ensure consistent and objective evaluation of patient autonomy. Methods: The assessment instrument was developed by a multidisciplinary working group. The tool was based on the Roper–Logan–Tierney nursing model, assessing patient functioning across activities of daily living. Four autonomy levels (S1–S4), ranging from fully independent to fully dependent and requiring continuous monitoring, were defined using operationalised criteria. Implementation into the Hospital Information System occurred in stages, including pilot testing, iterative revisions, and staff training. The instrument enabled the transition from paper-based nursing documentation to a fully digitalised nursing record that calculates patient autonomy levels and generates standardised clinical documentation. Results: Implementation of the instrument enabled standardised, objective, and real-time assessment of patient autonomy across clinical departments. The digitalised nursing record improved data consistency, while automated calculation of autonomy levels supported transparent workload evaluation and nursing incentive allocation. Autonomy scores were integrated into clinical management processes, facilitating individualised care planning and improved workload distribution. Data were automatically collated within the Hospital Information System, enhancing accessibility for both operational and administrative purposes. Overall, the instrument contributed to increased fairness in incentive distribution and improved efficiency of nursing workload assessment. Discussion: The developed instrument provides a structured and measurable approach to patient autonomy assessment within the Lithuanian nursing workload model. Its integration into the Hospital Information System supports the systematic identification of prevalent patient care needs, the development of individualised nursing plans, and the consistent evaluation of patient independence across the hospital. However, applying a single standardised instrument across diverse clinical profiles remains challenging, as patient needs and care intensity vary significantly between specialties. Therefore, ongoing evaluation, user feedback, and methodological refinement are required to ensure adaptability and sustained validity. Further research, including multicenter studies and staff surveys, is recommended to assess long-term impact, optimise applicability across clinical contexts, and support sustainable nursing workforce management while minimising professional burnout.

Prieširdžių virpėjimas gali būti gydomas kontroliuojant širdies susitraukimų dažnį arba atkuriant ir palaikant normalų sinusinį ritmą. Skubiosios pagalbos situacijose pirmiausia siekiama sumažinti širdies susitraukimų dažnį, kad būtų stabilizuota paciento būklė. Ankstyva ritmo kontrolė gali sumažinti insulto, širdies nepakankamumo ir kardiovaskulinės mirties riziką. Strategijos pasirinkimą lemia paciento simptomai, amžius, gretutinės ligos ir prieširdžių virpėjimo trukmė. Jaunesniems, turintiems simptomų ar didelės rizikos pacientams dažniau taikoma ritmo kontrolė, o vyresniems ar neturintiems simptomų dažnai pakanka dažnio kontrolės.

Laktato kiekis yra itin svarbus gydant kritinės būklės pacientus, ypač sergančius sepsiu, nes jis rodo audinių hipoksiją ir medžiagų apykaitos sutrikimus. Padidėjęs laktato kiekis glaudžiai siejamas su bloga prognoze, įskaitant didesnį mirtingumą, todėl jis laikomas svarbiu prognostiniu rodikliu sergant sepsiu. Net ir vidutiniškai padidėjęs laktatas (> 2 mmol/l) rodo blogesnę prognozę, be to, jis gali būti padidėjęs dar prieš pasireiškiant septiniam šokui būdingai hipotenzijai. Laktato stebėjimas yra naudingas vertinant ligos sunkumą ir priimant tinkamus gydymo sprendimus. Naujausi tyrimai taip pat rodo, kad laktato klirensas gali būti naudojamas kaip gydymo tikslas, ypač esant septiniam šokui, ir gali pagerinti gydymo rezultatus. Tarptautinės kampanijos „Išgyvenusiųjų sepsis“ (angl. Surviving Sepsis) 2021 m. paskelbtos tarptautinės sepsio ir septinio šoko valdymo gairės rekomenduoja siekti laktato lygio normalizavimo ankstyvuoju gydymo periodu [10].

Background and Objectives: Post-surgical central nervous system (CNS) infections are severe complications associated with high morbidity and mortality. Vancomycin is a key antibiotic used in their management. However, because of the restrictive properties of the blood–brain barrier (BBB), plasma concentrations may not accurately reflect drug exposure in the brain extracellular fluid (ECF), the presumed site of infection. Cerebral microdialysis enables direct measurement of unbound drug levels in brain ECF. This study aimed to assess vancomycin penetration into brain ECF in patients with suspected or confirmed post-surgical CNS infection. Materials and Methods: Five patients with suspected or confirmed post-surgical CNS infections were enrolled. Paired brain ECF microdialysate and plasma samples (and cerebrospinal fluid (CSF) samples, when available) were collected over two consecutive days at vancomycin steady state. Vancomycin concentrations were determined using a homogeneous enzyme immunoassay and corrected for probe recovery based on in vitro calibration. Pharmacokinetic parameters, including mean concentrations and 24-h area under the concentration–time curve (AUC24), were calculated for plasma and ECF, and ECF-to-plasma ratios were derived. Results: Two subgroups could be identified: patients with negligible ECF concentrations (“low penetrators”), and those with higher ECF levels (“high penetrators”). Mean (SD) ECF-to-plasma concentration ratios were 0.07 (0.04) in “low penetrators” and 0.44 (0.10) in “high penetrators”. The corresponding AUC24 ratios were 0.06 (0.03) and 0.40 (0.03), respectively. The presence of systemic inflammatory response syndrome (SIRS) was considered the most plausible factor differentiating these two subgroups. Conclusions: Vancomycin exposure in brain ECF demonstrated substantial interpatient variability in post-surgical CNS infections, with some patients showing minimal drug penetration.

Slaugytojų trūkumas – viena didžiausių sveikatos priežiūros sistemos problemų, su kuria susiduria daugelis pasaulio šalių. Visame pasaulyje trūksta daugiau nei 5 milijonų slaugytojų, o tai daro didžiulę įtaką sveikatos paslaugų kokybei. Prognozuojama, kad 2030 m. Lietuvoje truks virš 3 tūkst. slaugos specialistų. Dėl slaugytojų trūkumo gali pablogėti pacientų sauga ir priežiūros kokybė, padidėti komplikacijų dažnis ir sumažėti pacientų pasitenkinimo rodikliai. Slaugytojų trūkumo priežastys:

1. Slaugytojų senėjimu.
2. Emigracija ir tarptautinis mobilumas.
3. Darbo sąlygų iššūkiai, tokie kaip pervargimas, didelis darbo krūvis, nepakankamas atlygis ir nepalanki darbo aplinka, dažnai lemia slaugytojų sprendimą palikti profesiją arba pereiti į kitą sritį. Slaugytojų vaidmuo sveikatos sistemoje Slaugytojai yra sveikatos priežiūros sistemos stuburas. Jie tiesiogiai dalyvauja pacientų priežiūroje, o jų kompetencija ir gebėjimas reaguoti į kritines situacijas turi didžiulį poveikį pacientų sveikatai. PSO ataskaitoje pateikiama keletas politikos priemonių, kurios gali padėti spręsti slaugytojų trūkumo problemą ir užtikrinti ilgalaikį sprendimą:
4. Investicijos į slaugytojų švietimą ir mokymą – siekiant užtikrinti nuolatinį slaugytojų poreikį, svarbu investuoti į švietimo programas, kurios paruoštų pakankamai kvalifikuotų specialistų. PSO rekomenduoja stiprinti slaugytojų profesinio tobulėjimo programas, kad jie galėtų įgyti reikiamų žinių ir įgūdžių.
5. Darbo sąlygų gerinimas – PSO pabrėžia būtinybę gerinti slaugytojų darbo sąlygas, siekiant išlaikyti specialistus ir užtikrinti jų motyvaciją atlikti darbą. Tai apima konkurencingus atlyginimus, saugią darbo aplinką ir gebėjimą susidoroti su stresinėmis situacijomis.
6. Tarptautinės darbo jėgos pritraukimas – daugelis šalių susiduria su darbuotojų trūkumu ir gali pasinaudoti tarptautiniu darbuotojų judumu. PSO rekomenduoja kurti darbo migracijos politiką, leidžiančią užpildyti trūkstamas pozicijas ir užtikrinti sveikatos sistemos stabilumą.
7. Tvarus finansavimas – norint užtikrinti, kad sveikatos priežiūros sistema galėtų pasinaudoti slaugytojais, reikia skirti daugiau lėšų sveikatos sektoriui. Tai apima ne tik atlyginimų didinimą, bet ir investicijas į sveikatos infrastruktūrą bei švietimo programas. Išvados ir rekomendacijos: Slaugytojų trūkumo problema yra pasaulinė ir tiesiogiai veikia pacientų sveikatą bei sveikatos sistemos veiksmingumą. Siekiant spręsti šią krizę ir užtikrinti sveikatos sistemos efektyvumą, svarbu investuoti į slaugytojų švietimą, gerinti darbo sąlygas ir skatinti tarptautinį bendradarbiavimą. PSO rekomenduoja kiekvienai šaliai ieškoti sprendimų, atsižvelgiant į vietos ypatumus, tačiau pagrindinis tikslas turėtų būti slaugytojų darbo sąlygų gerinimas ir jų profesinės karjeros patrauklumo didinimas.

Over the past few decades, knowledge of women's health regarding sex and gender differences in health has increased but transfer of these new insights into medical education and clinical practice is lagging, resulting in substandard care for women compared with men. This study aimed to reach consensus on what all physicians taking care of women should know about women's health.