Innowacyjne aplikacje telemedyczne i usługi e-zdrowia w opiece nad pacjentami w starszym wieku

Innovative telemedicine applications and e-health services in the care of older patients Telemedicine, using modern information and communications technology, combines the needs of patients and technological progress, crossing the barriers of traditional health care systems. At the same time, as indicated by demographic forecasts around the world, especially in Europe, there is the phenomenon of fast aging population. Although older people certainly do not belong to the biggest and most active supporters of Internet users and telemedicine services, it is the elderly because of their special multimorbidity, the need for taking multiple medications and regular check-ups, are the most common and most demanding beneficiaries of medical services. Modern information and communication tools can become essential support for them, by which elderly, remaining under constant supervision and care, may stay in a friendly home environment. The paper defines the concept of telemedicine, e- health and e – health services and extensively presents the latest telemedicine applications, e-health services and medical information management systems, dedicated in particular older people

Pacjent z półpaścem w praktyce lekarza rodzinnego

Shingles and its complications are a global health problem, especially for older people. After the age of 85, the risk of the disease is as high as 50%. Shingles is a secondary infection of VZV (Varicella Zoster Virus) and occurs in people who have previously had a primary infection in the form of chickenpox or, less commonly, asymptomatically. The disease is manifested by a rash on the evolution of varicella-like lesions, but unlike it, it usually involves only one dermatome and the infectivity of shingles is much lower and limited to people sensitive to VZV infection in case of their contact with follicular changes on the patient’s skin. The interview with a patient and a characteristic clinical picture are usually sufficient to diagnose herpes zoster. Specific forms of herpes zoster are ophthalmic and otic forms. In the case of changes spread over a larger body surface than one dermatome, an in-depth diagnosis of immunodeficiency should be performed. A significant problem as­sociated with herpes zoster are its complications, especially postherpetic neuralgia, which may last many months after the disappearance of skin symptoms and lead to depression or even suicide attempts. Postherpetic neuralgia (PHN) most often affects the elderly. For treatment, in addition to conventional analgetics in various forms (pills, ointments, transdermal systems), it is often necessary to add koanalgetics such as antidepressants and anticonvulsants. Antiviral therapy with acyclovir, valcyclovir or famicyclovir should be prescribed only in some patients, such as: in people over 50 (due to the high risk of postherpetic neuralgia), when the lesions are located outside the trunk and in patients with severely reduced immunity, which should be immediately referred to the hospital. The most effective prophylaxis of shingles is vaccination against varicella and zoster.Półpasiec oraz jego powikłania są globalnym problemem zdrowotnym, dotyczącym szczególnie osób starszych. Po 85 roku życia ryzyko wystąpienia tej choroby wynosi aż 50%. Półpasiec jest wtórnym zakażeniem VZV (Varicella Zoster Virus) i pojawia się u osób, które wcześniej przebyły zakażenie pierwotne w formie ospy wietrznej lub rzadziej bezobjawowo. Choroba objawia się wysypką o ewolucji zmian podobnej do ospy wietrznej, w przeciwieństwie do niej jednak obejmuje zazwyczaj tylko jeden dermatom a zakaźność jest dużo niższa i ogranicza się jedynie do osób wrażliwych na zakażenie VZV w przypadku kontaktu ze zmianami pęcherzykowymi na skórze chorego. Do zdiagnozowania półpaśca wystarcza zazwyczaj wywiad oraz charakterystyczny obraz kliniczny. Szczególnymi postaciami półpaśca są postacie oczna i uszna. W razie zmian rozsianych na większej powierzchni ciała niż jeden dermatom należy przeprowadzić pogłębioną diagnostykę niedoborów odporności. Znaczącym problemem związanym z półpaścem są jego powikłania a zwłaszcza nerwoból postherpetyczny mogący trwać wiele miesięcy po ustąpieniu objawów skórnych i prowadzić do depresji a nawet prób samobójczych. Nerwoból postherpetyczny najczęściej dotyczy osób starszych. Do leczenia, oprócz konwencjonalnych leków przeciwbólowych w różnych formach (tabletki, maści, systemy transdermalne), często niezbędne jest włączenie koanalgetylów w postaci leków przeciwdepresyjnych oraz przeciwdrgawkowych. Leczenie przeciwwirusowe acyklowirem, walcyklowirem lub famicyklowirem należy włączyć tylko u niektórych pacjentów, tzn.: u osób po 50 r. ż. (ze względu na wysokie ryzyko wystąpienia nerwobólu postherpetycznego), gdy zmiany są zlokalizowane poza tułowiem oraz u pacjentów ze znacznie obniżoną odpornością, których należy niezwłocznie kierować do szpitala. Najskuteczniejszą profilaktyką półpaśca są szczepienia przeciwko ospie wietrznej i półpaścowi

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

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]

Pain management in family doctors practices

WSTĘP. Stosowanie opioidów związane jest z dużą skutecznością terapii przeciwbólowej, ale również z działaniami niepożądanymi i obawami pacjentów i lekarzy. Opioidy stosowane są również w terapii bólu nienowotworowego. Celem pracy była ocena stosowania opioidów w leczeniu bólu w praktyce lekarza rodzinnego. MATERIAŁ I METODY. Do badania wykorzystano sporządzony przez autorów formularz ankietowy, który rozdano wśród lekarzy rodzinnych. WYNIKI. Na pytanie, czy do leczenia bólu w praktyce lekarza rodzinnego stosuje Pan/Pani oprócz paracetamolu i niesteroidowych leków przeciwzapalnych (NLPZ) również opioidy, około 81,5% lekarzy rodzinnych udzieliło odpowiedzi twierdzącej. 19,2% respondentów stosuje opioidy tylko w leczeniu bólu nowotworowego. Około 65,4% ankietowanych lekarzy rodzinnych stosuje opioidy również w przebiegu leczenia dyskopatii, 30,8% w przebiegu leczenia neuralgii nerwu trójdzielnego, 30,8% w przebiegu leczenia półpaśca, 26,9% w przebiegu bólu trzewnego. Z badań autorów pracy wynika, że około 61,5% pacjentów chętnie przyjmuje opioidy, około 38,5% czyni to niechętnie. Najczęstsze obawy pacjentów związane z leczeniem opioidami to: uzależnienie, zawroty głowy, nudności, osłabienie, zaparcia, spowolnienie reakcji, senność, uzależnienie, stygmatyzacja morfinista, zespół odstawienny po przerwaniu terapii, powrót dolegliwości bólowych. WNIOSKI. Opioidy mają szerokie zastosowanie nie tylko w leczeniu bólu nowotworowego. Większość pacjentów chętnie przyjmuje zalecone przez lekarza opioidy. W ponad połowie przypadków opioidy są stosowane z powodów innych niż ból nowotworowy w praktyce lekarza rodzinnego.BACKGROUND. The use of opioids is associated with high efficiency analgesic therapy, but also with the side effects and concerns of patients and physicians. Opioids are also used in the treatment of non-malignant pain. The aim of the study was to evaluate the use of opioids in the treatment of pain in general practice. MATERIAL AND METHODS. The study used a specially designed questionnaire which were distributed among family physicians. RESULTS. The question of whether to treat pain in general practice u sing paracetamol and NSAIDs in addition to the opioids, approx. 81.5% of family doctors replied in the affirmative. 19.2% of respondents used only opioids in treating pain associated with cancer. Approximately 65.4% of the surveyed family physicians also used opioids in the course of treatment disc disease, 30.8% in the course of the treatment of n. trigeminal neuralgia, 30.8% in herpes zoster treatment, 26.9% in the course of visceral pain. Our research shows that about 61.5% of the patients willingly use opioids, about 38.5% do so reluctantly. The most common concerns of patients associated with opioid treatment include: addiction, dizziness, nausea, weakness, constipation, slow reactions, somnolence, addiction, stigma morphine, withdrawal syndrome after discontinuation of therapy, back pain. CONCLUSIONS. Opioids are widely used not only in the treatment of cancer pain. Most patients willingly accept opioids prescribed by their doctor. More than half of opioids are used for reasons other than cancer pain in general practice

What do we know about written assessment of health professionals’ communication skills? A scoping review

Objective - The aim of this scoping review was to investigate the published literature on written assessment of communication skills in health professionals’ education. Methods - Pubmed, Embase, Cinahl and Psychnfo were screened for the period 1/1995–7/2020. Selection was conducted by four pairs of reviewers. Four reviewers extracted and analyzed the data regarding study, instrument, item, and psychometric characteristics. Results - From 20,456 assessed abstracts, 74 articles were included which described 70 different instruments. Two thirds of the studies used written assessment to measure training effects, the others focused on the development/validation of the instrument. Instruments were usually developed by the authors, often with little mention of the test development criteria. The type of knowledge assessed was rarely specified. Most instruments included clinical vignettes. Instrument properties and psychometric characteristics were seldom reported. Conclusion - There are a number of written assessments available in the literature. However, the reporting of the development and psychometric properties of these instruments is often incomplete. Practice implications written assessment of communication skills is widely used in health professions education. Improvement in the reporting of instrument development, items and psychometrics may help communication skills teachers better identify when, how and for whom written assessment of communication should be used

FOCUS : frailty management optimisation through EIPAHA commitments and utilisation of stakeholders’ input – an innovative European project in elderly care

The goal of FOCUS, which stands for Frailty Management Optimization through EIPAHA Commitments and Utilization of Stakeholders’ Input, is to reduce the burden of frailty in Europe. The partners are working on advancing knowledge of frailty detection, assessment, and management, including biological, clinical, cognitive and psychosocial markers, in order to change the paradigm of frailty care from acute intervention to prevention. FOCUS partners are working on ways to integrate the best available evidence from frailty-related screening tools, epidemiological and interventional studies into the care of frail people and their quality of life. Frail citizens in Italy, Poland and the UK and their caregivers are being called to express their views and their experiences with treatments and interventions aimed at improving quality of life. The FOCUS Consortium is developing pathways to leverage the knowledge available and to put it in the service of frail citizens. In order to reach out to the broadest audience possible, the FOCUS Platform for Knowledge Exchange and the platform for Scaling Up are being developed with the collaboration of stakeholders. The FOCUS project is a development of the work being done by the European Innovation Partnership on Active and Healthy Ageing (EIPAHA), which aims to increase the average healthy lifespan in Europe by 2020 while fostering sustainability of health/social care systems and innovation in Europe. The knowledge and tools developed by the FOCUS project, with input from stakeholders, will be deployed to all EIPAHA participants dealing with frail older citizens to support activities and optimize performance

Innowacyjne aplikacje telemedyczne i usługi e-zdrowia w opiece nad pacjentami w starszym wieku

Innovative telemedicine applications and e-health services in the care of older patients Telemedicine, using modern information and communications technology, combines the needs of patients and technological progress, crossing the barriers of traditional health care systems. At the same time, as indicated by demographic forecasts around the world, especially in Europe, there is the phenomenon of fast aging population. Although older people certainly do not belong to the biggest and most active supporters of Internet users and telemedicine services, it is the elderly because of their special multimorbidity, the need for taking multiple medications and regular check-ups, are the most common and most demanding beneficiaries of medical services. Modern information and communication tools can become essential support for them, by which elderly, remaining under constant supervision and care, may stay in a friendly home environment. The paper defines the concept of telemedicine, e- health and e – health services and extensively presents the latest telemedicine applications, e-health services and medical information management systems, dedicated in particular older people