CONCEPTION OF INTERMARIUM IN POLISH FOREIGN POLICY IN XXI CENTURY

Poland interests and her policy are strongly determined by her geopolitical conditions. More than 40 years of people democracy under USSR domination brings in whole region civilization and economic backwardness. After 1989 Poland attempts to “catch up” the Old Europe. Initiative of Three Seas is one of such attempt. Increasing relations with central and southern Europe especially in case of diversification of raw materials – like gas – can bring to region an independence from Russian supplies. Three Seas goes back to conception of Intermarium, and redefine her on amended conditions of modern world. In this article the Authors will present short history of conception Intermarium, main assumptions of polish foreign policy and will try to answer the question is this conception is still present in polish foreign policy, even if in changed form of Three Seas.   

Standards For Corporate Foundations

This handbook is a set of guidelines to help in effective management of foundations established by companies. It constitutes the fruit of three years of joint work of 45 corporate foundations carried out with the support of the Polish Donors Forum. The standards are a tool of self-regulation.The solutions developped in 12 different areas, based on good practices from Poland and abroad, and their efficiency has already been verified in practice by project participants, are recommended for all corporate foundations.It includes various sources of information. The report is also available in Polish (http://www.forumdarczyncow.pl/text.php?menu_id=625)

A child with Fetal Alcohol Syndrome (FAS) – nursing care

Fetal Alcohol Syndrome (FAS) is the group of conditions observed in children who happened to be exposed to the effects of alcohol in their prenatal development. Some very characteristic symptoms, belonging to three groups, such as: craniofacial abnormalities, physical development deficiency and the central nervous system damage, can be distinguished in people with FAS. It also significantly affects the person’s behaviour. The main objective of the research is to present the problems that a girl suffering from a fetal alcohol syndrome has to struggle with. The work has been prepared on the basis of the available literature analysis as well as of the nursing process. A method of an individual case study has been applied. The nursing care of a child with FAS should definitely involve routine caring activities, however with particular attention paid to their psychological aspect. The child suffering from FAS must be treated in a very individual way, basically due to his/her cognitive disorder. A nurse should strictly follow 8 precisely fixed principles

Analysis of blood coagulation factors in patients undergoing surgery due to endometrial cysts

Objectives: The study was undertaken to evaluate selected blood coagulation factors in patients undergoing surgery, due to endometrial cysts and other ovarian benign cysts. Materials and Methods: Women involved in our study had not received any previous treatment for endometriosis and they had no history of any prior haemostatic disorders. Blood samples were collected before surgery and investigated for plasminogen, α2-antyplasmin, PAI-1 and tPA activity. As a control group, we have analyzed patients with benign gynecological diseases treated in our Department. Results: We have noticed higher mean concentration of plasminogen and α2-antyplasmin and lower mean concentration of PAI-1 and tPA activity in our patients in comparison with control group. Obtained results did not show any statistical significance. Conclusions: Our analysis of haemostatic factors in blood samples did not show coagulation disorders in patients with endometriosis. Maybe there are only local coagulation disorders in endometrial tissue and its surrounding. In our opinion this problem requires further research and taking into consideration other factors

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes