External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland

Introduction. The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year. Material and methods. This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually. Results. Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable. Conclusions. Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic

Evaluation of potentially inappropriate prescribing and deprescription as elements of good medical practice in elderly patient care

The ongoing increase in the proportion of elderly people in society, sometimes referred to as the aging societies phenomenon, has numerous effects. Multimorbidity affects about every third person in the general population and, on average, the likelihood of chronic illness increases with age, so multimorbidity is more common in older age groups. This increases the demand for medication, leading to concurrent use of many drugs, which is referred to as polypharmacy. We carried out a literature review to identify the problems associated with the use of medications in people sixty years and older. Aging societies contain an increasing number of elderly people struggling with the burden of multimorbidity and the resulting polypharmacy. They require a systemic approach to prescription problems, which include potentially inappropriate medication (PIM) and overprescription, as well as potential prescribing omission (PPO), taking into account issues like lack of patient compliance and self-medication. Any attempt to solve these problems requires tools to objectively evaluate prescription practice, using the existing and emerging capabilities of electronic health records (EHR), actively encouraging all medical personnel who prescribe medications or evaluate their use (including physicians, nurses and pharmacists) to join rational deprescribing attempts, and convincing patients that more drugs are not always better

Physical activity and forms of leisure activities among adolescents aged 12–15

Wprowadzenie. Aktywność fizyczna stanowi bardzo ważny element w życiu człowieka. W okresie dorastania pozwala prawidłowo kształtować szeroko rozumiane postawy dzieci i młodzieży oraz wpływa na prawidłowy rozwój psychomotoryczny. Podejmowanie przez uczniów aktywności fizycznej w czasie lekcji wychowania fizycznego oraz pozalekcyjnej pozwala na wzmocnienie prozdrowotnego stylu życia oraz podejmowania odpowiedzialności za własne zdrowie. Cel pracy. Celem pracy jest ocena podejmowania aktywności fizycznej oraz form spędzania czasu wolnego wśróduczniów. Materiał i metody. Badania przeprowadzono w województwie podkarpackim, wśród 125 uczniów Zespołu Szkół nr 5 w Jarosławiu. Metodą sondażu diagnostycznego, z wykorzystaniem autorskiego kwestionariusza ankiety, zebrano informacje dotyczące aktywności fizycznej, które poddano statystycznej analizie komputerowej. Wyniki. Wyniki badań ukazują, iż uczniowie podejmują aktywność fizyczną na poziomie zalecanej dla tej grupy wiekowej 1godziny umiarkowanych wysiłków w ciągu dnia. Zdecydowana większość respondentów regularnie uczestniczy w zajęciach wychowania fizycznego oraz podejmuje dodatkową aktywność fizyczną w ciągu dnia. Najczęściej wybieraną formą dodatkowej aktywności jest jazda na rowerze. Niepokojącym faktem jest ilość czasu spędzanego przy komputerze, która w dość dużym odsetku wynosi powyżej 3 godzin każdego dnia. Wnioski. Opuszczanie obowiązkowych zajęć fizycznych z innych powodów niż zdrowotne, powinno zostać całkowicie wyeliminowane z nawyków i zachowań zdrowotnych uczniów. Codzienna aktywność fizyczna uczniów, w postaci jazdy na rowerze, powinna zostać wykorzystana przez rodziców, opiekunów oraz nauczycieli, jako okazja do wzmacniania prozdrowotnego stylu życia, a co za tym idzie, kształtowania wśród osób młodych postaw sprzyjających zdrowiu.Introduction. Physical activity is a very important element in human life. Adolescence allows the proper shaping of widely understood attitudes of children and young people, and affects normal psychomotor development. Physical activity undertaken by adolescents during physical education classes and after-school helps to strengthen a healthy lifestyle and take responsibility for their own health. Objective. The aim of this study is to assess the physical activity and leisure activities among adolescents. Materials and method. The study was conducted in the Rzeszow Region among 125 adolescents attending School No. 5 in Jarosław. A diagnostic survey method, with the use of a questionnaire designed by the author allowed the collection of information on physical activity, which was subjected to statistical computer analysis. Results. The test results revealed that the adolescents performed physical activity on level recommended for this age group of 1 hour of moderate efforts daily. The vast majority of respondents regularly participated in physical education classes and undertook additional physical activity during the day. The most frequently chosen form of additional activity was cycling. It is an alarming fact that the amount of time spent at the computer by a considerable percentage of adolescents was more than three hours daily. Conclusion. Not attending compulsory physical education classes, for reasons other than health, should be completely eliminated from the habits and health behaviours of adolescents. Daily physical activity of adolescents in the form of cycling, should be used by parents, caregivers and teachers, as an opportunity to strengthen a healthy lifestyle, and thus shaping health promoting attitudes among young people

Global Impact of COVID-19 on Stroke Care and IV Thrombolysis

Objective To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods. We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results. There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] −11.7 to −11.3, p \u3c 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI −13.8 to −12.7, p \u3c 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI −13.7 to −10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2–9.8, p \u3c 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions. The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months