The impact of knowledge and effectiveness of educational intervention on readiness for hospital discharge and adherence to therapeutic recommendations in patients with acute coronary syndrome

Introduction: ESC guidelines emphasize the importance of educating patients after acute coronary syndromes aimed at familiarizing the patient with the essence of the disease, the principles of self-control and self-care as well as actions enhancing health maintenance.Aim: The aim of the study was to assess the impact of knowledge and effectiveness of educational intervention on readiness for discharge from the hospital and compliance with therapeutic recommendationssix months after discharge.Material and methods: The study group consisted of 218 patients (28.9% women and 71.1% men) aged 31to 90 years (63.0 ± 11.24) treated with coronary angioplasty for myocardial infarction. The effectiveness of educational intervention was assessed by comparing patients’ knowledge on the day of admission (1KE)and discharge from the hospital (2KE). Knowledge was assessed in 3 aspects: knowledge of symptoms, knowledge of the disease, and knowledge of prevention. Education was provided between 1KE and 2KE based on the brochure entitled “Myocardial Infarction”. The level of knowledge on the day of discharge and the increase in knowledge obtained after education (ΔKE) were referred to the level of Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD-MIS) and to the level of adherence in chronic diseases scale (ACDS).Results: As a result of the education carried out between 1KE and 2KE, a significant increase in knowledgewas obtained (p < 0.05). There was no correlation between ΔKE and RHD-MIS. However, it was shown that a higher level of knowledge at discharge (2KE) was associated with a higher RHD-MIS result (R = 0.17; p = 0.01). The highest impact on the RHD-MIS result was due to the level of knowledge of disease symptoms in 2KE: 75.5 ± 19.5%, 76.4 ± 21.1%, 85.8 ± 16.4% for low, medium and high RHD-MIS results (p = 0.002) ; R = 0.15; p = 0.0003. Knowledge of the disease symptoms in 2KE was associated with the patient’s expectations in RHD-MIS - a higher level of knowledge was associated with higher patient expectations, respectively: 73.2 ± 21.7%, 80.0 ± 18.5%, 82.9 ± 19.2 for low, medium and high RHDMIS (p = 0.02); R = 0.19; p = 0.006. There was no correlation between ΔKE or 2KE and ACDS results 6 months after discharge.Conclusions: The educational brochure is an effective tool in improving patients’ level of knowledge. Better knowledge of the symptoms of coronary artery disease and myocardial infarction is associated with a higher degree of readiness for discharge from the hospital but does not affect the observance of therapeutic recommendations in the field of pharmacotherapy after 6 months

Papillary fibroelastoma in a 63-year-old asymptomatic patient with paroxysmal atrial fibrillation

Papillary fibroelastoma (PFE) is the second most frequent benign cardiac tumor. It is located mainly in the heart valves. Because its course is usually clinically silent it is often detected accidentally in transthoracic echocardiography (TTE). Despite the benign nature of the lesion, the histological structure of PFE increases the risk of embolic episodes. Development of imaging techniques as well as their wider accessibility, especially TTE, contributes to the more common detection of this tumor in the general population. In this publication, we present a case of an asymptomatic 63-year-old woman in whom an aortic valve lesion resembling PFE was detected in TTE

Data Stream Classification Using Classifier Ensemble

For the contemporary business, the crucial factor is making smart decisions on the basis of the knowledge hidden in stored data. Unfortunately,m traditional simple methods of data analysis are not sufficient for efficient management of modern enterprizes, because they are not appropriate for the huge and growing amount of the data stored by them. Additionally data usually comes continuously in the form of so-called data stream. The great disadvantage of traditional classification methods is that they assume that statistical properties of the discovered concept are being unchanged, while in real situation, we could observe so-called concept drift, which could be caused by changes in the probabilities of classes or/and conditional probability distributions of classes. The potential for considering new training data is an important feature of machine learning methods used in security applications (spam filtering or intrusion detection) or decision support systems for marketing departments, which need to follow the changing client behavior. Unfortunately, the occurrence of concept drift dramatically decreases classification accuracy. This work presents the comprehensive study on the ensemble classifier approach applied to the problem of drifted data streams. Especially it reports the research on modifications of previously developed Weighted Aging Classifier Ensemble (WAE) algorithm, which is able to construct a valuable classifier ensemble for classification of incremental drifted stream data. We generalize WAE method and propose the general framework for this approach. Such framework can prune an classifier ensemble before or after assigning weights to individual classifiers. Additionally, we propose new classifier pruning criteria, weight calculation methods, and aging operators. We also propose rejuvenating operator, which is able to soften the aging effect, which could be useful, especially in the case if quite ”old” classifiers are high quality models, i.e., their presence increases ensemble accuracy, what could be found, e.g., in the case of recurring concept drift. The chosen characteristics of the proposed frameworks were evaluated on the basis of the wide range of computer experiments carried out on the two benchmark data streams. Obtained results confirmed the usability of proposed method to the data stream classification with the presence of incremental concept drift

Impact of health education on adherence to clopidogrel and clinical effectiveness of antiplatelet treatment in patients after myocardial infarction

Non-adherence rates to antiplatelet drugs in patients with acute myocardial infarction (AMI) range from 13% to 60%. We aimed to evaluate whether individual health education can improve adherence to treatment with clopidogrel in patients after AMI. This was a prospective, single-center, randomized clinical trial with a 12-month follow-up. Patients with AMI treated with percutaneous coronary intervention (PCI) were enrolled. The primary endpoint was defined as non-adherence to clopidogrel during follow-up (drug availability ≤ 80%). Secondary endpoints included platelet function assessment, adverse cardiovascular (CV) events (CV death, PCI for ACS, unscheduled CV hospitalization). There were 191 patients enrolled in the study and divided into two groups: the individual education (IE) group (100 patients) and the standard treatment (ST) group (91 patients). Adherence to the treatment with clopidogrel based on the data from the National Health Fund did not differ significantly between the IE and ST groups [76.7% (30.7–99.7%) v. 84.4% (46.5–99.7%); p = 0.25]. There was a substantial difference in the prevalence of unscheduled CV hospitalizations between both groups, IE and ST respectively [22 (22.0%) v. 10 (11.0%); p = 0.042]. The rate of CV death and ACS treated with PCI during follow-up was low and did not differ between groups. In conclusion, the program of individual health education did not improve adherence to treatment with clopidogrel. The expected benefits of medication are not achievable at current levels of adherence. The self-reported adherence assessment is unreliable and cannot be used for effective treatment guidance

Implantation of a Occlutech Figulla® PFO occluder in a patient with patent foramen ovale and history of embolic stroke

The most common interventions in structural heart diseases for various age groups are percutaneous occlusions of septal defects. We present the case of a woman with patent foramen ovale (PFO) periodically causing a right-to-left shunt, after an incident of stroke, with migraine attacks, treated by percutaneous closure of PFO with use of a novel occluder device - an Occlutech Figulla®. The procedure was performed under X-ray and transesophageal echocardiographic monitoring. The novel Occlutech device described above features easy manipulation, good safety and some constructional innovations that enable the time of antiplatelet prophylaxis to be shortened, thus potentially minimizing procedure related risk

Influence of deep-freezing on the autofluorescent properties of human plasma proteins

Background. Fluorescence-based techniques are powerful and valuable tools for studying biological materials. Fluorescence spectroscopy is one of these techniques which measures autofluorescence from a sample containing components such as proteins. The aim of this study was to evaluate the influence of deep freezing on spectroscopic properties of human plasma using fluorescence spectroscopy.Patients, materials and methods. The study group consisted of patients admitted to the Department of Cardiology and Internal Medicine at the University Hospital in Bydgoszcz, due to a preliminary diagnosis of acute coronary syndrome. The overall group comprised 27 patients. From each patient, 4 ml of blood was taken to obtainplasma that was used for further examination. In order to measure plasma spectroscopic properties, a Hitachi F-7000 spectrofluorimeter was used. The received results were analysed and evaluated with Origin 9.0 (OriginLab).Results. Spectroscopic analysis of human plasma before and after freezing allowed us to divide plasma samples into three different subgroups, depending on their fluorescent properties. The first subgroup consisted of plasma samples, which showed entirely differently in spectroscopic analysis after one week of deep-freezing. The second subgroup of plasma samples showed partial changes in the measurements of autofluorescence, and in the third subgroup freezing-resistant plasma samples were included.Conclusions. It seems that the process of deep-freezing could affect the autofluorescent properties of human plasma proteins. The explanation of the specific mechanisms responsible for the change of plasma fluorescent properties during the process of deep-freezing requires further elucidation

The impact of readiness to discharge from hospital on adherence to treatment in patients after myocardial infarction

Background: The healthcare professionals involved in in-hospital treatment of myocardial infarction (MI) are also responsible to patients for their education before leaving the hospital.   This education aims to modify patient behaviour in order to reduce relevant risk factors and improve self-control and adherence to medications. The aim of the study was to analyse the relationship between readiness for discharge from hospital and adherence to treatment at follow-up in MI patients. Methods: An observational, single-center, MI cohort study with  6-month follow-up was conducted between May 2015 and July 2016.  The Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD-MIS) and the Adherence in Chronic Diseases Scale (ACDS) were applied. Results: Two hundred and thirteen patients aged 30–91 years (62.91 ± 11.26) were enrolled in the study. The RHD-MIS general score ranged from 29 to 69 points (51.16 ± 9.87).   A high level of readiness was found in 66 patients (31%), intermediate in 92 (43.2%), and low in 55 (25.8%) of patients. Adherence level assessed with the ACDS 6-months after discharge from hospital ranged from 7 to 28 points (23.34 ± 4.06). An increase in objective assessment of patient knowledge according to RHD-MIS subscale resulted in significantly higher level of adherence at the follow-up visit (p = 0.0154); R Spearman = 0.16671, p = 0.015; p for trend = 0.005. During the 6-month follow-up 3 (1.41%) patients died and 17 (7.98%) were hospitalized for a subsequent acute coronary syndrome. Conclusions: This study provided preliminary evidence of a long-term association between the results of assessment of readiness for discharge from hospital and adherence to treatment in patients after MI

Relation of the Readiness for Hospital Discharge after Myocardial Infarction Scale to socio-demographic and clinical factors. An observational study

Introduction: The aim of the study was to analyse the relationship between the Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD MIS) scores and socio-demographic and clinical factors in patients after acute myocardial infarction (AMI) treated with percutaneous coronary angioplasty. Material and methods: The study was conducted as a single-centre, prospective, cohort, 6-month observa-tion, including 213 patients: 59 women and 154 men aged 30–91 years (average age of 62,91 ± 11.26 years). Results: Patients’ economic status was found to have a significant impact on the readiness for discharge measured by RHD-MIS general score. Among all three investigated RHD-MIS subscales, objective assessment of knowledge was influenced by gender (p = 0.012) and place of residence (p = 0.025). There was a linear trend for increase of knowledge along with increase in education level (p = 0.030). The only factor influencing patients’ expectations was their economic status (p value for heterogeneity: 0.014). A linear correlation between growing of patients’ expectations and worsening of their economic status (p = 0.008) was observed. Conclusion: Readiness to discharge should be routinely assessed in all patients hospitalized with myo-cardial infarction. The result of this assessment should be used to identify patients requiring additional education. Further research is prompted to determine the cut-off values of RHD-MIS results qualifying patients for additional educational interventions