Analiza interwencji z przyczyn kardiologicznych podejmowanych przez zespoły ratownictwa medycznego w powiecie brzeskim w roku 2010 i 2011

Wstęp. Częstą przyczyną wezwań zespołów ratownictwa medycznego są choroby układu krążenia. Celem pracy była analiza interwencji z przyczyn kardiologicznych podejmowanych przez zespoły ratownictwa medycznego w powiecie brzeskim. Materiał i metody: Analizą objęto 10 208 kart wyjazdów zespołów ratownictwa medycznego i medycznych czynności ratunkowych z roku 2010 i 2011, w tym 1082 z przyczyn kardiologicznych. Kryterium wyboru było rozpoznanie na podstawie procedur ICD-10: I20-I25 choroba niedokrwienna serca, I30-I52 inne choroby serca. Do analizy zastosowano statystykę opisową oraz nieparametryczny test zgodności χ2. Wyniki: Przyczyny kardiologiczne stanowiły 10,6 % wszystkich wyjazdów. W roku 2011 zanotowano o 56 mniej wyjazdów z przyczyn kardiologicznych w porównaniu z rokiem 2010. Ponad dwukrotnie częściej do wezwań wysyłany był zespół specjalistyczny. Mediana czasu dojazdu mieściła się w wymogach określonych w ustawie. Przyczyny wezwania zespołu ratownictwa medycznego były zróżnicowane, przeważały: bóle w klatce piersiowej i duszność. Większość interwencji dotyczyła obszarów wiejskich i osób po 61 roku życia. Odnotowano wzrost zgonów o 24 % w przypadku nagłego zatrzymania krążenia w roku 2011. Zdecydowanie częściej niektóre procedury i leki były stosowane przez zespoły specjalistyczne. Wnioski: Interwencje z przyczyn kardiologicznych nadal są częstą przyczyną wezwania zespołu ratownictwa medycznego. Właściwe rozmieszczenie ambulansów umożliwia dostosowanie me-diany czasu dojazdu zespołów do wymogów określonych w ustawie. Rodzaj podejmowanych interwencji jest zależny od rodzaju zespołu, a kwalifikacje ich członków nie mają wpływu rezultat końcowy.Introduction. Frequent paramedical emergency dispatch calls are caused by cardiovascular diseases. The aim of the study was to analyse medical intervention for cardiological causes undertaken by medical rescue teams in the Brzesko area. Materials and methods. The analysis covered 10,208 medical emergencies by medical rescue teams in 2010 and 2011, includ-ing 1,082 undertaken for cardiological reasons. The choice of criterion was a diagnosis based on ICD-10 procedures: I20-I25 - ischemic heart disease and I30-I52 - other heart diseases. Descriptive statistics and the nonparametric compliance χ2 test were used for the analysis. Results. Cardiovascular causes accounted for 10.6% of all ambulance departures. In 2011, there were 56 fewer dispatches due to cardiological reasons than in 2010. There were more than twice as many specialist team dispatches sent on call. The average travel time was within the requirements set forth in the Act. The reasons for calling for a medical rescue team varied, but mostly in-cluded chest pain and dyspnoea. Most of the interventions concerned rural areas and people over 61 years of age. There was an increase in deaths by 24% in the case of sudden cardiac arrest in 2011. Specialist teams used more procedures and medications than the basic teams. Conclusions. Cardiac interventions are still a frequent cause for calling for an emergency medical team. Properly locating ambulances allows the mediating time of arrival of the units to meet the requirements specified by regulations. The type of intervention is dependent on the type of the team and the qualifications of their members do not affect the final outcome

Topical Treatment of Nonhealing Venous Leg Ulcer with Propolis Ointment

An investigation of effectiveness of topical treatment of nonhealing chronic venous leg ulcers with propolis ointment was conducted. 56 patients were included in the study and randomized into two groups. In group 1, there were 28 patients (ulceration area: 6.9–9.78 cm2) treated by means of topical propolis ointment application and short stretch bandage compression. In group 2, there were 29 patients (ulceration area: 7.2–9.4 cm2) treated by means of Unna boot leg compression without topical propolis treatment. In the study, the efficacy of both treatment methods in patients with resistive venous leg ulcers was compared. The ulceration of patients from group 1 healed completely after 6 weeks of therapy in all cases. In all patients from group 2, the process of healing was longer but successfully completed after 16 weeks of the therapy. We found that an adjunctive propolis ointment treatment increases the efficacy of the short stretch bandage compression stocking, and this combined treatment is more effective than Unna’s boot compression alone

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

Background Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. Methods For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. Findings An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Interpretation Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. Funding European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Preferred patient behaviours related to health

Introduction: Health education is the child of medicine and pedagogy, and they share a common focus on humans. The aim of this study was to assess the preferred behaviours associated with health as well as the health locus of control of the tested patients.Materials and methods: The study included 300 patients from surgical wards (group I) and 300 from non-surgical wards (group II), studying them using the Health Behaviour Inventory (HBI) and the Multidimensional Health Locus of Control Scale (MHLC) scales.Results: For the six statements contained in the Sanitary Behaviours Letter concerning proper nutrition, the surveyed patients received the lowest average values. Among the preventive behaviours, participants reported that they complied with medical recommendations, conducted settled family and social life, and reduced their smoking, but that they did not attach sufficient importance to rest or weight control. In relation to the four examined categories of behaviour, general indicators of the severity of health behaviour did not differ significantly between the groups, which both reported a low level of health behaviour. The majority of women expressed the conviction that their health depends on themselves, demonstrating internal health control, while men tended to claim that their health was dependent on fate or luck. Inhabitants of rural areas exhibited internal control and blamed their own health behaviour for their well-being. Urban residents, on the other hand, showed a stronger belief in the influence of others on their health.Conclusions: The majority of patients showed poor attention to health matters, especially in terms of preferred health practices. However, the less education the participants had and the worse their financial situation grew, the stronger the care for their own health became.Key words:Health behaviours, patients, HBI, MHL

European perspective on the management of rheumatoid arthritis: clinical utility of tofacitinib

Paweł Kawalec,1 Katarzyna Śladowska,2 Iwona Malinowska-Lipień,3 Tomasz Brzostek,3 Maria K&oacute;zka4 1Drug Management Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 2Department of Experimental Hematology, Institute of Zoology and Biomedical Research, Faculty of Biology and Earth Sciences, Jagiellonian University, Krakow, Poland; 3Department of Internal and Community Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland; 4Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland Abstract: Xeljanz&reg; (tofacitinib) is an oral small-molecule inhibitor that reversibly inhibits Janus-activated kinase (JAK)-dependent cytokine signaling, thus reducing inflammation. As a result of these mechanisms, effects on the immune system such as a moderate decrease in the total lymphocyte count, a dose-dependent decrease in natural killer (NK) cell count, and an increase in B-cell count have been observed. Therefore, tofacitinib provides an innovative approach to modulating the immune and inflammatory responses in patients with rheumatoid arthritis (RA), which is especially important in individuals who do not respond to tumor necrosis factor inhibitors or show a loss of response over time. The aim of this article was to review studies on the pharmacology, mode of action, pharmacokinetics, efficacy, and safety of tofacitinib in patients with RA. Tofacitinib has been shown to reduce symptoms of RA and improve the quality of life in the analyzed groups of patients. Moreover, it showed high efficacy and an acceptable safety profile in Phase III randomized clinical trials on RA and was the first JAK inhibitor approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) in the RA therapy, thus providing a useful alternative treatment strategy. Randomized controlled studies revealed a significant benefit over placebo in efficacy outcomes (American College of Rheumatology [ACR] 20 and ACR50 response rates); accordingly, clinically meaningful improvements in patient-related outcomes compared with placebo have been reported. The safety profile seems acceptable, although some severe adverse effects have been observed, including serious infections, opportunistic infections (including tuberculosis and herpes zoster), malignancies, and cardiovascular events, which require strict monitoring irrespective of the duration of tofacitinib administration. As an oral drug, tofacitinib offers an alternative to subcutaneous or intravenous biologic drugs and should be recognized as a more convenient way of drug administration. Keywords: JAK inhibitor, tofacitinib, effectiveness, rheumatoid arthritis, treatmen

New alternative in the treatment of rheumatoid arthritis: clinical utility of baricitinib

Paweł Kawalec,1 Katarzyna Śladowska,2 Iwona Malinowska-Lipień,3 Tomasz Brzostek,3 Maria K&oacute;zka4 1Drug Management Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krak&oacute;w, Poland; 2Department of Experimental Hematology, Institute of Zoology and Biomedical Research, Faculty of Biology and Earth Sciences, Jagiellonian University, Krak&oacute;w, Poland; 3Department of Internal and Community Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Krak&oacute;w, Poland; 4Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Krak&oacute;w, Poland Abstract: Baricitinib is an innovative small-molecule drug that reversibly inhibits continuous activation of JAK/STAT pathway, thus reducing joint inflammation. The drug was approved for use as monotherapy or in combination with methotrexate (MTX) in the treatment of adults with moderately to severely active rheumatoid arthritis (RA). The aim of this paper was to review the studies on pharmacology, mode of action, pharmacokinetics, efficacy, and safety of baricitinib in patients with RA. Baricitinib provides an innovative approach to modulating the immune and inflammatory response in patients with RA, which is especially important in individuals who do not respond to disease-modifying antirheumatic drugs or standard biologic drugs (tumor necrosis factor inhibitors) or who lose response over time. Baricitinib therapy reduces symptoms of RA and improves the quality of life. Moreover, it has shown high efficacy and an acceptable safety profile in Phase III randomized controlled trials (RCTs) and become another JAK inhibitor approved for RA treatment, providing a useful alternative option. RCTs have revealed a significant benefit of baricitinib over placebo, MTX, and adalimumab in terms of standard efficacy outcomes, especially the American College of Rheumatology ACR20, ACR50, and ACR70 response rates. Additionally, a clinically meaningful improvement in patient-reported outcomes, including the quality of life, compared with placebo has been reported. The safety profile seems acceptable, although some rare but potentially severe adverse events have been observed, such as serious infections, opportunistic infections (eg, herpes zoster), malignancies, and cardiac or hepatic disorders. Baricitinib administered at an approved dose of 2 or 4 mg once daily offers a novel and promising alternative to parenterally administered biologic drugs used in RA treatment. Keywords: JAK inhibitor, baricitinib, efficacy, rheumatoid arthritis, safet

The prevalence of malnutrition in patients with gastrointestinal malignant tumors

Wstęp. Niedożywienie jest zjawiskiem nieodłącznie związanym z chorobami nowotworowymi przewodu pokarmowego i występuje u około 30&#8211;50% pacjentów w momencie przyjęcia do szpitala. Stan ten sprzyja występowaniu powikłań i pogarsza rokowanie. Dlatego istotna jest wczesna identyfikacja chorych z niedożywieniem i wdrożenie adekwatnego leczenia. Cel pracy. Celem pracy było określenie, czy wyniki wybranych metod oceny stanu odżywienia są porównywalne u chorych z nowotworami złośliwymi przewodu pokarmowego. Materiał i metody. Wybrano cztery najczęściej stosowane wskaźniki oceny stanu odżywienia (% utratę masy ciała, wskaźnik masy ciała, stężenie albumin i całkowitą liczbę limfocytów). Dokonano porównania wyników uzyskanych po analizie dokumentacji 915 pacjentów z rozpoznanym rakiem żołądka, trzustki i jelita grubego. Wyniki i wnioski. Stan niedożywienia uzyskany na podstawie wskaźnika % utraty masy ciała charakteryzował 41,0% wszystkich chorych, 46,7% chorych na raka żołądka, 63,4% na raka trzustki i 32,7% na raka jelita grubego. Zbliżone wartości obserwowano dla całkowitej liczby limfocytów (cll) i wynosiły odpowiednio 42,3%; 41,7%; 40,0%; 43,0%. Niedożywienie ze względu na stężenie albumin (alb) rozpoznano odpowiednio u 16,9%; 21%; 16,3%; 14,4% pacjentów. Ocena wskaźnika masy ciała wskazała na niedożywienie u 9,9% wszystkich chorych. Powiązania statystyczne wykazano między stężeniem albumin a % utratą masy ciała, czego nie stwierdzono między % utratą masy ciała a całkowitą liczbą limfocytów. Wyniki przeprowadzonych badań sugerują, że wstępnym przesiewowym kryterium rozpoznania niedożywienia może być % utrata masy ciała z ostatnich 3-6 miesięcy, a dopiero w przypadku jej stwierdzenia dokonanie pogłębionego badania oceny stanu odżywienia. Ocena wskaźnika masy ciała ma w tym przypadku ograniczone znaczenie. Problemy Pielęgniarstwa 2010; 18 (4): 384-392Introduction. Malnutrition is the immanent part of gastrointestinal malignant diseases. The prevalence of malnutrition is as high as 30-50% of patients on hospital admission. Perioperative mortality and morbidity in malnourished patients is higher and the prognosis poorer. Therefore, the proper early identification of malnourished patients and appropriate treatment is of high importance. The aim of the study. The aim of the study was the comparison of the results of selected screening methods for malnutrition in patients with gastrointestinal malignancies. Material and methods. Four commonly used measures of nutritional status were selected: percent of body weight loss, serum albumin level, absolute lymphocyte count and body mass index. Files of 915 patients with gastric cancer, pancreatic cancer and colorectal cancer were analyzed in order to determine their nutritional status using the methods listed above. Results and conclusions. According to the percent of weight loss parameter, 41% of the entire group were malnourished, 46.7% of gastric cancer patients, 63.4% of pancreatic cancer patients and 32.7% of colorectal cancer patients. Similar results were observed for absolute lymphocyte count 42.3%, 41.7%, 40% and 43% respectively. Low albumin level was observed in 16.9% of all patients, 21% of gastric cancer, 16.3% of pancreatic cancer and 14.4% of colorectal cancer patients. Low BMI was observed only in 9.9% of the entire group. Albumin level and the percent of weight loss were statistically correlated while this correlation was not observed for lymphocyte count and percent of weight loss. Our results suggest that the appropriate screening test for malnutrition may be the weight loss during 3-6 months prior to hospital admission. After this parameter is positive, further nutritional investigation is recommended. BMI has limited xalue as the screening test for malnutrition. Nursing Topics 2010; 18 (4): 384-39

Perception vs pain and beliefs about pain control and Type A behavior pattern in patients with chronic ischemia of lower extremities or with rheumatoid arthritis

Monika Kadłubowska,1 Ewelina Bąk,1 Czesław Marcisz,2 Maria K&oacute;zka,3 Anna Michalik,1 Jolanta Kolonko,1 Bożena Krawczyk,1 Dorota Dobrzyń-Matusiak,4 Zofia Kapusta-Nowak5 1University of Bielsko-Biała, Department of Nursing, Faculty of Health Sciences, Bielsko-Biała, Poland; 2Medical University of Silesia, Department of Gerontology and Geriatric Nursing, School of Health Sciences, Katowice, Poland; 3Jagiellonian University Medical College, Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Cracow, Poland; 4Medical University of Silesia, Department of Nursing Propaedeutics, School of Health Sciences, Katowice, Poland; 5Medical University of Silesia, Department of Health Promotion and Community Nursing, School of Health Sciences, Katowice, Poland Objective: The study aimed at determining the experience of pain taking into consideration beliefs about pain control, Type A behavior pattern and sociodemographic factors in patients with chronic ischemia of the lower extremities or with rheumatoid arthritis (RA).Methods: The study enrolled 100 patients with peripheral arterial disease (PAD) and 100 patients with RA. The subjective sensation of pain was assessed using the Visual Analog Scale (VAS); beliefs about pain control were analyzed using the Beliefs about Pain Control Questionnaire (BPCQ), taking into consideration internal factors, the influence of physicians and accidental events (chance); and Type A behavior features (haste and competition) were analyzed using the Framingham Type A Scale. The multiple regression model was used to assess associations between the experienced pain and the BPCQ value, the Framingham Type A Scale and sociodemographic factors.Results: The pain intensity degree was found to be comparable in patients with PAD and with RA. The median determined using the VAS was 5.75 in both of the studied groups. In patients with PAD, lower VAS values were associated with the BPCQ &ndash; internal factors (P&lt;0.05) whereas a higher VAS value was related to the BPCQ &ndash; physicians&rsquo; influence (P&lt;0.001). In patients with RA, a higher VAS value was associated with BPCQ &ndash; physicians&rsquo; influence (P&lt;0.05), disease duration (P&lt;0.05) and smoking cigarettes (P&lt;0.05).Conclusion: Experiencing pain by patients with chronic ischemia of the lower extremities occurs at a moderate level and is beneficially connected with the internal factors and adversely connected with the external factors of beliefs about pain control. Patients with RA reported pain ailments of a moderate level in connection with the adverse influence of the external factors of beliefs about pain control, the duration of the disease and smoking cigarettes. Experiencing pain by patients with chronic ischemia of the lower extremities and RA does not seem to be related to Type A behavior. Keywords: inflammatory process, atherosclerosis, discomfort, temperament, patients&rsquo; beliefs about pain control&nbsp