Integrated care for patients with advanced chronic obstructive pulmonary disease

Przewlekła obturacyjna choroba płuc (POChP) jest trzecią przyczyną zgonów i trzecią przyczyną niesprawności (mierzonej za pomocą wskaźnika DALY) u osób powyżej 60. roku życia. Ciężką lub bardzo ciężką postać POChP (wskaźnik FEV1, odpowiednio, poniżej 50% i 30% należnej wartości) rozpoznaje się u mniej więcej jednej piątej ogółu chorych. Chorzy na zaawansowaną POChP z reguły cierpią z powodu fizycznej i umysłowej niepełnosprawności, w wielu przypadkach źle radzą sobie z problemami wynikającymi z choroby i współistniejących schorzeń. To z kolei stwarza duże ryzyko zaostrzeń POChP, które prowadzą do pogorszenia przebiegu choroby, istotnego zwiększenia kosztów medycznej opieki oraz zwiększenia ryzyka zgonu. Obecna organizacja medycznej opieki dla tej grupy chorych nie zapewnia odpowiednich warunków zdrowotnych i socjalnych. Wydaje się jednak, że zastosowanie modelu zintegrowanej opieki, zalecanego przez Światową Organizację Zdrowia stworzyłoby możliwość poprawy sytuacji chorych na zaawansowane POChP. W Polsce ta forma opieki jest realizowana od kilkunastu lat w zakładach medycyny paliatywnej i hospicjach w odniesieniu do chorych na zaawansowane nowotwory. Wykorzystanie tych doświadczeń powinno pomóc w integracji działań wokół lekarzy rodzinnych i wyspecjalizowanej pielęgniarki, z jednoczesnym zapewnieniem dostępu do specjalistów w zależności od indywidualnych potrzeb chorego. Powinno także umożliwić szersze wykorzystanie pracowników pomocniczych, jak: pracownicy socjalni, pomocnicy medyczni oraz wolontariusze, a także psycholodzy i duchowni (zwłaszcza w końcowej fazie choroby). Pneumonol. Alergol. Pol. 2010; 78, 2: 126-132Chronic obstructive pulmonary disease (COPD) is the third cause of mortality and disability (assed by DALY) among patients above 60 year old. Severe and very severe COPD (FEV1 = equal or less than 50% and 30% of expected value, respectively) is estimated at 20% of all COPD patients. Advanced COPD usually leads to physical and mental deterioration, the patients often manage with the problems caused by the disease and other comorbidities poorly. This leads to increased risk of COPD exacerbations and further deterioration of the patient’s status, increased costs of medical care and eventually increased risk of death. Current organization of medical care for those patients does not provide adequate health and social support for them. However, it seems that introducing an integrated approach proposed by World Health Organization, could improve the situation of advanced COPD patients. In Poland, this kind of care has been provided in advanced cancer patients throughout stationary palliative care units and hospices during the last several years. This experience should be helpful in integrating actions of general practitioners and specialized nurses, as well as providing access for the specialists’ consultations according to the individual needs of the patients. It should also allow for broad cooperation with auxiliary staff, such as social workers, medical assistants and volunteers, as well as psychologists and clergymen (especially in the terminal phase of the disease). Pneumonol. Alergol. Pol. 2010; 78, 2: 126-13

Poisoning deaths in Poland : types and frequencies reported in Łódź, Kraków, Sosnowiec, Gdańsk, Wrocław and Poznań during 2009-2013

Objectives: The aim of this study has been to assess the characteristics of acute poisoning deaths in Poland over a period of time 2009–2013. Material and Methods: The analysis was based on the data obtained from the patient records stored in toxicology departments in 6 cities – Łódź, Kraków, Sosnowiec, Gdańsk, Wrocław and Poznań. Toxicological analyses were routinely performed in blood and/or urine. Major toxic substances were classified to one of the following categories: pharmaceuticals, alcohol group poisonings (ethanol and other alcohols), gases, solvents, drugs of abuse, pesticides, metals, mushrooms, others. Cases were analyzed according to the following criteria: year, age and gender of analyzed patients, toxic substance category and type of poisoning. The recorded fatal poisonings were classified according to the International Classification of Diseases. Results: The record of 261 deaths were retrospectively reviewed. There were 187 males (71.64%) and 74 females (28.36%) and the male to female ratio was 2.52. Alcohol group poisonings were more frequently responsible for deaths in men compared to all poisonings, 91.1% vs. 71.6%, respectively (p < 0.05), and pharmaceutical agents were more frequently responsible for deaths in women, 47.4% vs. 28.4%, (p < 0.05). Methanol was the most common agent in the alcohol group poisonings, accounting for 43.75% (N = 49), followed by ethylene glycol, 39.29% (N = 44), and ethanol, 16.96% (N = 19). Conclusions: Epidemiological profile data from investigation of poisoning deaths in Poland may be very useful for the development of preventive programs. Int J Occup Med Environ Health 2017;30(6):897–90

Pro Libris: Lubuskie Pismo Literacko-Kulturalne, nr 3 (2009)

134 s. : il.

A new approach to ticagrelor-based de-escalation of antiplatelet therapy after acute coronary syndrome. A rationale for a randomized, double-blind, placebo-controlled, investigator-initiated, multicenter clinical study

© 2021 Via Medica. This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license. https://creativecommons.org/licenses/by/4.0/The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Moreover, improved safety of treatment and preserved anti-ischemic benefit may also be expected with additional acetylsalicylic acid (ASA) withdrawal. To evaluate these hypotheses, we designed the Evaluating Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome — a randomized clinical trial (ELECTRA-SIRIO 2), to assess the influence of ticagrelor dose reduction with or without continuation of ASA versus DAPT with standard dose ticagrelor in reducing clinically relevant bleeding and main-taining anti-ischemic efficacy in ACS patients. The study was designed as a phase III, randomized, multicenter, double-blind, investigator-initiated clinical study with a 12-month follow-up.Peer reviewedFinal Published versio

Application of the Westergaard method to calculate the pavement loaded by leg of wheels in tandem

The paper includes the methodology followed for the calculation of elastic pavements loaded by the leg of aircraft in arrangement of wheels in tandem. Using the Ray Pickett method, the nomograms are developed to determine the equilibrated load, which are necessary for calculation of pavements by the Westergaard method. The derived formula and nomogram are original solutions that have not yet occurred. Next, calculations of pavement, loaded by legs of CASA military transport plane, were performed. Also, diagrams of stresses and deflections, depending on the thickness of the pavement and the subsoil parameters were made. The resulting graphs significantly speed up the procedure for calculating the pavements what is desirable for military terms.[b]Keywords[/b]: calculation of pavement, leg of aircraft, system wheels in tande

Analysis of operation and reaction time of a motorcycle braking system

The paper presents a description and methodology of testing brake systems in single-trackvehicles. The construction of the stand, which was used to determine the value of force and pressureon a single brake caliper of the brake circuit in the tested motorcycle, was described. The followingsection pre-sents the methodology of elaborating the results of bench tests. The operation of eachcircuit was ana-lysed separately. Graphs describing the determined response times for both brakingcircuits are present-ed. The obtained results of bench tests show that the average time of activation ofthe braking system from the moment of applying force to the brake lever to reaching the full value ofthe braking force is 0.2 secondsKeywords: braking system, reaction time, motorcycle brake system testing, brake system pressure valu

The Risk of Avascular Necrosis Following the Stabilization of Femoral Neck Fractures: A Systematic Review and Meta-Analysis

Background: Avascular necrosis (AVN) of the femoral head often requires surgical treatment and is often associated with femoral neck fractures. We conducted a systematic review and meta-analysis of recent research on the risk of AVN following the stabilization of fractured femoral neck with implants in PubMed. We assessed the effect of age on AVN incidence among patients aged &gt; 50 and younger, depending on fracture type, Garden stage, Pouwels degree, Delbet stage, and age category. We followed PRISMA guidelines. Relevant studies were defined as research articles describing real-world studies reporting on the risk of AVN following primary surgical fracture stabilization with implants, published between 1 January 2011 and 22 April 2021. Fifty-two papers met the inclusion criteria, with a total of N = 5930 with surgically managed fractures. The pooled mean AVN incidence was significantly higher among patients with displaced fractures (20.7%; 95% CI: 12.8&ndash;28.5%) vs. those with undisplaced fractures (4.7%; 95% CI: 3.4&ndash;6.0%). No significant correlation was observed between AVN incidence weighted by sample size and time interval from injury to surgery (p = 0.843, R2 = 0.01). In conclusion, the risk of AVN following femoral neck fractures was generally high, especially in patients with displaced fractures. The time from injury to surgery did not correlate with AVN incidence

Avascular Necrosis of Femoral Head&mdash;Overview and Current State of the Art

Avascular necrosis (AVN) of the femoral head is caused by disruption of the blood supply to the proximal femur. The alterations in the blood supply may occur following a traumatic event or result from a non-traumatic cause. Femoral neck fracture and hip dislocation and associated surgical procedures, corticosteroid therapy, and alcohol abuse frequently lead to AVN development. Type of fracture (displaced or undisplaced) and time between injury and surgery are the most critical factors in assessing the risk of developing AVN. Diagnosis of AVN can be established based on patients&rsquo; complaints, medical history, and radiographic findings. There is no consensus on the treatment of patients with AVN to date. Non-surgical methods are dedicated to patients in the early pre-collapse stages of the disease and consist of pharmacotherapy and physiotherapy. Surgery is recommended for patients with advanced disease

Bone Infarcts and Tumorigenesis&mdash;Is There a Connection? A Mini-Mapping Review

(1) Background: Avascular necrosis (AVN) may affect every part of the bone. Epiphyseal infarcts are likely to be treated early because most are symptomatic. However, meta- and diaphyseal infarcts are silent and are diagnosed incidentally. Sarcomas developing in the necrotic bone are extremely rare, but they have been reported in the literature. (2) Methods: We conducted a mapping review of recent evidence regarding these malignancies. Methods: A mapping review using a systematic search strategy was conducted to answer research questions. We limited our research to the last ten years (2012&ndash;2022). (3) Results: A total of 11 papers were identified, including 9 case reports and 3 case series. The pathomechanism of carcinogenesis in AVN was not investigated to date. Histologically, most tumors were malignant fibrous histiocytoma. The prognosis is relatively poor, especially for patients with metastases, but adjuvant chemotherapy may increase short- and long-term survival. (4) Conclusions: Since AVN-related malignancies are sporadic, no prospective studies have been conducted. The majority of evidence comes from small case series. More research is needed to identify the risk factors that would justify follow-up of patients after bone infarcts at higher risk of developing a malignancy

Exploring the Impact of Novel Anti-Cancer Therapies on Jaw Osteonecrosis and Other Bones: A Comprehensive Review

Osteonecrosis is a debilitating condition characterized by the loss of blood supply to the bones, leading to bone death. This condition can impact various bones, including the jaw, which significantly affects patients’ quality of life by causing difficulties in swallowing, feeding, chewing, and speaking, along with swollen, painful mucous membranes and chronic sinusitis. Osteonecrosis can arise due to treatment with antiresorptive drugs. However, there is a growing number of reports of osteonecrosis following novel targeted anti-cancer treatments, such as tyrosine kinase inhibitors (TKIs) and biological therapies. The pathogenesis of osteonecrosis is linked to the side effects of the antiangiogenic mechanisms of these medications, leading to a disrupted blood flow. Our review aims to examine recent insights into osteonecrosis triggered by new anti-cancer drugs. Most reports focus on the osteonecrosis of the jaw (ONJ); however, we discovered that some authors have described cases of osteonecrosis affecting the femoral head or elbow following novel anti-cancer treatments. Prevention is a key component in managing osteonecrosis. Therefore, a comprehensive risk assessment should always be performed before and during anti-cancer therapy