Zadania podstawowej opieki zdrowotnej w zakresie opieki nad pacjentami z chorobami przewlekłymi

The tasks of primary health care in the chronically ill care Chronically ill care, carried out within primary care by physicians specialized in family medicine, is the most effective clinically, socially and economically. In countries that have attempted to shape health care in the direction of meeting the chronically ill expectations, it was noticed the evolution of patient care from reactive, that activates when the patient reports with the disorder, to proactive - aiming at maintain a high quality of life. Primary health care, which is shaped and evaluated in accordance with the guidelines set out in the paper, improves the functioning of the chronically ill patients, which is evaluated within the biopsychosocial model. Such primary health care has also been recognized as the level of health care system that fully realizes assumptions of the Chronic Care Model

Approaches to therapy and prevention of frailty in the light of contemporary medicine

Over the last several decades, the growing number of patients with geriatric problems has become a serious challenge for primary care physicians. Frailty is an often encountered condition in older age. This is a state of increased vulnerability and loss of total physiological reserves, needed to maintain physiological and psychosocial homeostasis. Definition of physical frailty is based on the following criteria: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity, where 3 out of 5 these criteria confirms frailty. It is a dynamic, transitional process which constantly progresses, although it is potentially reversible. Frailty often co-exists with other severe diseases, affecting general well-being of the patient. Therefore, it is important for the family doctor to understand diagnosis and treatment to protect from an invasive procedure or potentially harmful medication, and prevent decline of functional independence. The aim of this review is to present current available treatment options and their effectiveness for frailty. Data from many observational studies were collected. The most beneficial seems to be combined multidisciplinary treatment including physical exercises, nutritional supplementation and cognitive training. Additionally, the further positive results of physical activity training on mobility, balance, coordination, muscle strength and reducing falls in frail elderly were also confirmed by many scientific reports. Pharmacological, nutritional, psychological and other interventions solely can also be helpful but the evidence is low. Preventive actions at many stages in the process leading to frailty can be applied

Opportunities, challenges and learnings from qualitative research with stakeholders in frailty in three European countries

The aims of this paper are to reflect upon the experiences of researchers involved in a cross-national qualitative study with stakeholders in three European countries (Italy, Poland and UK), within the context of the FOCUS project on frailty management and optimisation (see http://focus-aha.eu/en/home). Six researchers’ reflections were gathered using open-ended questions. Responses were thematically analysed. We report on our team diversity including cultural differences in epistemological stances and describe how working remotely challenged clear communication. We comment on linguistic issues, our data collection approaches and methods of analysis. However, we also reflect upon the ability of such projects to build knowledge, generate capacity and promote the value of qualitative research in healthcare across Europe. Finally, we advocate an approach to cross-national research that is as much about building a cohesive knowledge exchange network as it is about understanding the lives, perspectives and experiences of our stakeholders

Social prescribing and lifestyle medicine—a remedy to chronic health problems?

Social prescribing has been identified as a chance to take a holistic approach to people’s health and wellbeing, especially for people with one or more long-term conditions. Its systemic implementation was a part of the recent United Kingdom National Health Service Long Term Plan. With a lifestyle medicine focus on equipping patients in tools necessary for self-care and self-management of their lifestyle-related health problems that coexists with the need for creating an environment supporting healthy choices, a social prescribing model seems to offer a promising strategy for advancing lifestyle medicine. This idea was discussed during a meeting hosted by the Polish Society of Lifestyle Medicine in collaboration with European Rural and Isolated Practitioners Association, Polish Society of Young Family Doctors (“Młodzi Lekarze Rodzinni”), British Society of Lifestyle Medicine and European Lifestyle Medicine Council in June 2020. The aftermath—this position statement is an Authors’ attempt at summarizing the common ground for social prescribing and lifestyle medicine. It collects experiences of practitioners and researchers from five European countries as well as making recommendations for applying this model in Poland. Despite referring to local conditions, it might provide universal takeaway messages for any healthcare providers interested in combining social prescribing with lifestyle medicine practice

Understanding frailty:meanings and beliefs about screening and prevention across key stakeholder groups in Europe

Innovative methods to manage frailty are critical to managing the needs of an ageing population. Evidence suggests there are opportunities to reverse or prevent frailty through early intervention. However, little is known about older adults’, families’ and practitioners’ beliefs about the malleability of frailty. This study examined European stakeholders’ accounts of the acceptability and feasibility of frailty screening and prevention to inform future intervention development. Semi-structured focus groups and individual interviews were conducted in three European Union countries (Italy, Poland and the United Kingdom) with key stakeholders – frail and non-frail older adults, family care-givers, and health and social care professionals. Thematic analysis identified four themes: synchronicity between the physical and the psychological in frailty, living with frailty in the social world, the need for a new kind of care, and screening for and preventing frailty. Findings emphasised the need for a holistic approach to frailty care and early intervention. Integrated care services and advocacy were important in the organisation of care. Central to all stakeholders was the significance of the psychological and social alongside the physical elements of frailty and frailty prevention. Support and care for older adults and their family care-givers needs to be accessible and co-ordinated. Interventions to prevent frailty must encompass a social dimension to help older adults maintain a sense of self while building physical and psychological resilience

A qualitative study examining everyday frailty management strategies adopted by Polish stakeholders

Background: Frailty is a multidimensional clinical state that is common in older age and can be managed through intervention. Strategies to manage frailty have not been previously explored with stakeholders in Poland. This may stem from misperceptions about the nature and malleability of frailty, which has resulted in it being viewed as a lower priority healthcare concern. Objectives: To explore stakeholders' views to determine whether there are effective everyday strategies that they can adopt to reduce, reverse or prevent frailty. Methods: Semi-structured focus groups were conducted with five stakeholder groups (frail/pre-frail and robust older adults, health and social care professionals and family caregivers) in Poland ( n  = 44). Data was analysed using a reflexive thematic analysis approach. Results: Two themes were developed. The first emphasized both the positive everyday and more effortful strategies used by individuals to counter frailty; these included the adoption of healthy lifestyle behaviours, social engagement and shared experiences. Stakeholders perceived that older adults, even frail ones, might benefit from engaging in meaningful activities to build resilience against frailty. The second examined formal interventions delivered by health and social care professionals. Stakeholders noted the need to increase awareness of the malleability of frailty among professionals. Conclusion: Raising awareness of the malleability of frailty amongst health and social care professionals is critical. Further, information provision and personal support should be essential elements of health interventions aimed at older adults and family caregivers. Interventions to support resilience building in older adults should also be framed within a model of fostering self-efficacy.[Box: see text]

Is a practice-based rural research network feasible in Europe?

Research in family medicine is a well-established entity nationally and internationally, covering all aspects of primary care including remote and isolated practices. However, due to limited capacity and resources in rural family medicine, its potential is not fully exploited yet. An idea to foster European rural primary care research by establishing a practice-based research network has been recently put forward by several members of the European Rural and Isolated Practitioners Association (EURIPA) and the European General Practice Research Network (EGPRN). Two workshops on why, and how to design a practice-based research network among rural family practices in Europe were conducted at two international meetings. This paper revisits the definition of practice-based research in family medicine, reflects on the current situation in Europe regarding the research in rural family practice, and discusses a rationale for practice-based research in rural family medicine. A SWOT analysis was used as the main tool to analyse the current situation in Europe regarding the research in rural family practice at both meetings. The key messages gained from these meetings may be employed by the Wonca Working Party on research, the International Federation of Primary Care Research Network and the EGPRN that seek to introduce a practice-based research approach. The cooperation and collaboration between EURIPA and EGPRN creates a fertile ground to discuss further the prospect of a European practice-based rural family medicine research network, and to draw on the joint experience

Massage-induced morphological changes of dense connective tissue in rat’s tendon

The aim of the experiment was to determine if possible changes in connective tissue induced by massage could have a positive effect justifing the use of massage in all post-traumatic connective tissue conditions, e.g. tendon injuries. The investigations were performed in a group of 18 Buffalo rats. The rats were divided into two groups (experimental and control). To standardize the massage procedure, it was performed with an algometer probe of 0.5 cm2 with constant pressure force of 1 kG (9,81 N). To analyse the number and diameter of collagen fibrils, two electron micrographs were performed for each rat of the collected segments of tendons of rat tail lateral extensor muscle. After image digitalization and calibration, the measurements were carried out using iTEM 5.0 software. The number of fibrils, their diameter and area were measured in a cross-sectional area. An increase of the number of collagen fibrils was observed in the tendons of massaged animals compared to the control group. Our study demonstrated that massage may cause a beneficial effect on metabolic activity of tendon’s fibroblasts and, in consequence, may be applied for more effective use of massage for the prevention of tendon injury as well as after the injury has occurred. (Folia Histochemica et Cytobiologica 2013, Vol. 51, No. 1, 103–106

Correction:Stakeholders' views and experiences of care and interventions for addressing frailty and pre-frailty: A meta-synthesis of qualitative evidence

[This corrects the article DOI: 10.1371/journal.pone.0180127.]