Resuscitation Council

Diagnosis of cancer undeniably triggers significant stress in patients. Constant thoughts about upcoming treatments and fear of death increase anxiety inevitably. Consequently, this stress, intended as an adaptive mechanism, becomes distress associated with pathological reactions depleting the body. Clinical manifestations of stress may occur in perioperative period and complicate primary disease. Assessment of preoperative anxiety is important worldwide. However, none available method for identifying preoperative anxiety covers all predisposing factors and fears affecting psychological state. Objective. To identify specific anxiety factors concerning patients with their subsequent correction. Material and methods. The study enrolled 50 female breast cancer patients scheduled for mastectomy or breast resection. In the main group, patients underwent preoperative examination by anesthesiologist two weeks before surgery. The purpose of examination was to identify the main factors of anxiety according to original questionnaire for subsequent correction. In the control group, patients did not receive correction of anxiety factors. We analyzed anxiety levels considering salivary free cortisol and visual analogue scale. Results. According to univariate analysis, the main group was characterized by significantly lower VAS score of anxiety after conversation with anesthesiologist (6.4 [4.9; 7.6] vs. 1.8 [1.4; 3.3], p<0.001). Salivary cortisol two weeks before surgery (125.1 [88.9; 200.3] vs. 80 [55.3; 97.8]), immediately before surgery (116.1 [93.9; 206.2] vs. 95.1 [80; 119.4]), and three hours after surgery (129.7 [88.2; 230.4] vs. 82.7 [59.6; 105]) was significantly lower (p=0.002, p=0.007, p=0.007, respectively) in the main group. Conclusion. The questionnaire “Identification by anesthesiologist of the main preoperative anxiety factors” allows us to know the exact reasons of increased anxiety. Discussions addressing fears noted in the questionnaire reduce anxiety. This is confirmed by reduced number of fears upon re-surveying, VAS scores and free cortisol levels.

This study analyzes the implementation of the freight transport restriction policy in Balikpapan City by examining the dynamics of operator compliance, institutional coordination, and the policy’s impact on urban mobility and the local economy. Using a qualitative research method with a case study approach, data were collected through in-depth interviews, document analysis, and field observations to understand how the policy functions in practice. The findings reveal that the success of policy implementation depends on the adaptive strategies of freight operators, the effectiveness of institutional coordination, and the suitability of policy design with local urban conditions. While the restriction policies have contributed to reducing congestion and improving urban order, challenges remain in terms of enforcement consistency, resource limitations, and inter-agency collaboration. The study highlights the importance of integrating regulatory control with supportive mechanisms and adaptive governance to achieve sustainable freight transport management in developing urban contexts

Background: Current neonatal resuscitation guidelines recommend epinephrine preferably be given via intravenous (IV) or intraosseous (IO) routes during cardiac arrest. Vasopressin might be an alternative during asphyxial cardiac arrest; however, whether it remains effective when administered via IO is unclear. Objective: We aimed to compare IO with IV vasopressin or epinephrine on incidence and time to return of spontaneous circulation (ROSC) in asphyxiated newborn piglets. Design/Methods: Thirty-two newborn piglets ( n =8/group) were anesthetized, intubated, instrumented, and exposed to 45 minutes of normocapnic hypoxia, followed by asphyxiation till asystolic cardiac arrest. Piglets were randomized to 0.4IU/kg IV or IO vasopressin, or 0.02mg/kg IV or IO epinephrine. Drug was administered via IV or IO 1 minute after the start of chest compressions (CCs) and administered every 3 minutes as needed if no return of spontaneous circulation (ROSC) was observed, to a maximum of three doses. Results: Rates of ROSC were not different between IV or IO vasopressin, 5/8(63%) vs 3/8(38%), respectively ( p =0.619), or between IV or IO epinephrine, 2/8(25%) vs 6/8(75%), respectively ( p =0.132). Rates of ROSC were similar between all four groups ( p =0.233). Median (IQR) time to ROSC was 254 (220-473)sec and 215 (200-240)sec for IV and IO vasopressin, respectively ( p =0.143), and 272 (265-278)sec and 233 (203-266)sec for IV and IO epinephrine, respectively ( p =0.286). Time to ROSC was similar amongst all groups ( p =0.312). Conclusions: In a neonatal piglet model of asystolic cardiac arrest, administration of IO vasopressin or epinephrine resulted in similar resuscitative outcomes to IV vasopressin or epinephrine. Our findings suggest that IO vasopressor administration is effective during neonatal resuscitation, and that IO vasopressin is a feasible alternative to IV vasopressin.

Background: Cardiovascular disease and cancer share overlapping risk factors, and as cancer survival improves, a growing population of survivors faces long-term cardiovascular risks. Despite this growing concern, trends in cardiovascular mortality among U.S. population suffering from cancer remain unclear. Hypothesis: We hypothesized that, after an initial decline, cardiovascular mortality among patients with cancer has increased in recent years reflecting the cumulative effects of treatment-related cardiotoxicity, aging survivorship, and emerging public health stressors such as obesity and COVID-19. Methods: We used data from the Centers for Disease Control and Prevention’s Multiple Cause of Death database (CDC WONDER) from 1999 to 2023. Mortality rates were extracted using ICD-10 codes: I00–I99 and C00–C97 for cardiovascular deaths and malignant neoplasms as underlying and contributing causes of death, respectively. Age-adjusted mortality rates (AAMRs) per 100,000 individuals aged ≥15 years were analyzed with Joinpoint regression. Annual percentage changes (APCs) and 95% confidence intervals (CIs) were calculated. Cancer incidence was obtained from U.S. Cancer Statistics from 1999 to 2021. Results: Among 16,002,473 cancer-related deaths, 688,810 (4.30%) occurred due to cardiovascular disease since 1999. AAMR declined from 16.30 to 14.70 by 2002 (APC: –3.49%, 95% CI: –5.76 to -1.17, P=0.006). From 2002 to 2012, it dropped significantly to 8.70 (APC: –5.34%, 95% CI: –5.93 to –4.74, p<0.001), followed by a slight non-significant decline to 7.80 in 2017 (APC: –1.84%, 95% CI: –3.72 to 0.07, p=0.058), then a significant rise to 9.0 by 2023 (APC: 3.01%, 95% CI: 2.00 to 4.05, p<0.001). After adjusting for cancer incidence, the cardiovascular death rate per 100,000 patients with cancer declined by 23.7%, from 2,676 in 1999 to 2,041 in 2005, and further decreased by 18.4% to 1,664 in 2008. This downward trend continued, reaching 1,365 in 2017 (a 21.9% decrease), but was followed by a 17.5% increase to 1,605 in 2021. Conclusion: Following a prolonged decline, cardiovascular mortality among patients with cancer has begun to rise. This resurgence highlights the urgent need for proactive cardiovascular risk assessment and targeted prevention strategies in cancer care and survivorship.