Between Autonomy and Paternalism: Attitudes of Nursing Personnel Towards Jehovah’s Witnesses’ Refusal of Blood Transfusion

Objectives: The study describes the attitudes of Polish nursing personnel towards Jehovah’s Witnesses’ (JWs’) refusal to receive blood and blood products.Methods: We developed an online survey assessing nurses’ knowledge and attitudes towards JWs’ refusal of blood transfusion in a life-threatening condition. It also examined nurses’ attitudes towards ethical and legal issues associated with JWs’ refusal of blood transfusions. These questions were explored using a sample of 202 Polish nurses.Results: Nurses’ knowledge of JWs’ stance towards blood transfusions is inadequate and they tended to be ill-disposed towards JWs’ refusal of blood transfusions. Although most nurses respected adult JW patients’ autonomy and supported their right to refuse blood, in the case of JW children they are guided by paternalism. Nurses’ attitudes were affected by whether they had children, whether they declared themselves religious, their level of education and prior experience with patients who had refused a blood transfusion.Conclusion: Since most nurses felt unprepared to care for JW patients, this study reveals an urgent need to train nurses in transcultural nursing and increase nurses’ cultural competencies, and that this should be incorporated into medical curricula

Obstructive sleep apnea — diagnosis and treatment options

Obturacyjny bezdech senny (OSA) jest schorzeniem polegającym na powtarzających się epizodach bezdechów i spłyceń oddechu spowodowanych całkowitą bądź częściową blokadą przepływu powietrza. Głównymi objawami OSA są: nadmierna senność w ciągu dnia, nagłe wybudzenia z uczuciem zatrzymania oddechu lub duszenia się, suchość w jamie ustnej po przebudzeniu, poranne bóle głowy, trudności w koncentracji, potliwość nocna i inne. Częstość występowania OSA jest wysoka i prawdopodobnie, z powodu zwiększającej się częstości otyłości, będzie większa w przyszłości. W wielu badaniach wykazano korelacje między OSA a innymi schorzeniami, takimi jak: nadciśnienie tętnicze, przewlekła niewydolność krążenia, choroba niedokrwienna serca, arytmie, udar mózgu. Istnieje również wiele publikacji wskazujących na korzystny wpływ terapii z użyciem stałego dodatniego ciśnienia w drogach oddechowych (CPAP) na schorzenia współistniejące. „Złotym standardem” w diagnostyce OSA jest tak zwana stacjonarna polisomnografia (PSG), ale urządzenia przenośne typu 3 (z min. 4 kanałami) również są akceptowalne w diagnostyce pacjentów wyjściowo obciążonych umiarkowanym lub wysokim ryzykiem OSA. Diagnozę stawia się na podstawie wyników PSG i objawów. Na podstawie wyniku PSG można podzielić OSA na 3 grupy — łagodne, umiarkowane i ciężkie. Według aktualnych wytycznych i publikacji CPAP jest leczeniem pierwszego wyboru w umiarkowanej i ciężkiej postaci OSA. Strategia lecznicza w przypadku bezdechu łagodnego zależy od zdrowia pacjenta, schorzeń współistniejących i indywidualnych decyzji chorego. Innymi opcjami leczenia są aparaty wewnątrzustne, leczenie pozycyjne i chirurgiczne, ale żadna z tych metod nie dorównuje korzyściom wynikającym z terapii CPAP.Obstructive sleep apnea (OSA) is a disease characterized by recurrent episodes of apneas and hypopneas, caused by total or partial airway obstruction. Main symptoms of OSA are: excessive daytime sleepiness, snoring, waking up suddenly feeling like gasping or choking, dry mouth or sore throat after waking up, morning headaches, trouble concentrating, night sweats and others. Prevalence of OSA is high and probably — due to increasing prevalence of obesity — will be higher in the future. Many studies show correlation between OSA and other diseases such as hypertension, chronic heart failure, coronary artery disease, arrhythmias and stroke. There are also many publications showing positive impact of CPAP treatment on managing comorbidities. Gold standard in diagnosis of OSA is in-laboratory polysomnography (PSG), although type 3 portable monitors (with at least 4 channels) are also acceptable to diagnose patients with pre- -test moderate to high risk of OSA. Diagnosis is made based on PSG results and symptoms. Based on PSG results, we can divide OSA into 3 groups: mild, moderate and severe. Based on current guidelines and publications, continuous positive airway pressure (CPAP) is a first choice treatment in moderate and severe OSA. Treatment strategies in mild OSA depend on patient health, comorbidities and individual patient decisions. Other treatment options are oral appliances, positional treatment and surgery but none of them equals CPAP’s benefits

Management of a patient with pulmonary embolism and symptoms of acute coronary syndrome — a case study

Wstęp: Zatorowość płucna jest stanem bezpośredniego zagrożenia życia. Stanowi trzeci z kolei, po zawale serca i udarze mózgu, powód zgonów z przyczyn sercowo-naczyniowych. Różnorodność i nasilenie objawów sugerują często inną przyczynę ciężkiego stanu chorego i mogą powodować trudności oraz opóźnienie prawidłowego rozpoznania i rozpoczęcia właściwego leczenia. W diagnostyce różnicowej zatorowości płucnej należy brać pod uwagę między innymi ostry zespół wieńcowy, zapalenie płuc, zaostrzenie przewlekłej obturacyjnej choroby płuc, astmę oskrzelową, odmę opłucnową, tamponadę serca, rozwarstwienie aorty oraz inne schorzenia. Opis przypadku: Pacjent, 67-letni mężczyzna, został przekazany do Kliniki Kardiologii w ramach ostrego dyżuru z rozpoznaniem ostrego zespołu wieńcowego bez uniesienia odcinka ST. Stan ogólny chorego w chwili przyjęcia był bardzo ciężki, pacjent był osłabiony, z utrudnionym kontaktem słownym, skarżył się na ból w górnej połowie klatki piersiowej oraz duszności. Na podstawie całości obrazu klinicznego i wyników przeprowadzonych badań dodatkowych w izbie przyjęć u chorego podejrzewano zatorowość płucną. Rozpoznanie choroby potwierdzono na podstawie uwidocznienia charakterystycznych zmian w wykonanych badaniach obrazowych: echokardiografii i tomografii komputerowej. Umożliwiło to szybkie zastosowanie właściwego algorytmu postępowania. Obecnie chory pozostaje pod opieką ambulatoryjną przyklinicznej poradni kardiologicznej i kardiochirurgicznej. Wnioski: Historia opisanego przypadku zatorowości płucnej dowodzi realnych trudności w rozpoznawaniu tej jednostki chorobowej, która może przybierać obraz kliniczny imitujący różne schorzenia. Pomyślne wyniki leczenia chorego z zatorowością płucną w klinice dowodzą ogromnej roli czynnika czasowego, jak i posiadanych możliwości diagnostyczno-leczniczych, a tym samym zasadności niezwłocznego przekazywania tych pacjentów do ośrodków specjalistycznych. Chirurgia Polska 2010, 12, 2, 103–111Background: Pulmonary embolism (PE) is a life-threatening condition. It is the third leading cause of cardiovascular-related deaths after myocardial infarction and cerebral stroke. The diversity and intensity of PE symptoms often suggest another cause of gravity of patient’s condition; this can create problems and delays in correctly diagnosing and starting suitable treatment of PE. Differential diagnosis of pulmonary embolism requires taking into consideration acute coronary syndrome, pneumonia, exacerbation of chronic obturatory pulmonary disease, bronchial asthma, pneumothorax, cardiac tamponade and aortic dissection. Case description: A 67 year-old man was air-lifted from a regional hospital to the emergency room at the Clinic of Cardiology, Medical University of Silesia in Katowice. He had been diagnosed with acute coronary syndrome without ST segment elevation. The patient’s condition at admission was very serious; he presented with general weakness, difficulties in verbal communication, upper chest pain, and considerable dyspnea. Total clinical picture and additional tests performed at the emergency room indicated pulmonary embolism. The PE diagnosis was confirmed based on characteristic changes visualized by echocardiographic and CT scans; appropriate treatment was then initiated. Currently, the patient is under cardiological ambulatory care. Conclusions: The described case of pulmonary embolism presents an example of actual difficulties experienced when diagnosing this disease unit since its clinical picture can imitate various other conditions. The successful treatment of a pulmonary embolism patient at the Center of Cardiology underscores the paramount role of the time factor and diagnostic/treatment capabilities in such an outcome. It demonstrates the relevance of prompt transfer of such patients to facilities offering specialized treatment. Polish Surgery 2010, 12, 2, 103–11

State-of-the-art of transcatheter treatment of aortic valve stenosis and the overview of the InFlow project aiming at developing the first Polish TAVI system

Initial experience of transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has ap-peared as a promising minimally invasive technology for patients disqualified from surgical treatment (SAVR). Safety and efficacy of TAVI has been analyzed and assessed through numerous registries and trials. Furthermore, results obtained from comparative TAVI vs. SAVR trials proved that both treat¬ments can be considered equal in terms of post-procedural mortality and morbidity in high-risk, as well as lower risk patients. However, there are still some issues that have to be addressed, such as higher chance of paravalvular leakage, vascular injuries, conduction disturbances, malpositioning and the yet unmet problem of insufficient biological valves durability. Recent technological developments along with the learning curve of operators prove a great potential for improvement of TAVI and a chance of surpassing SAVR in various groups of patients in the near future. In pursuit of finding new solutions, the CardValve Consortium consisting of leading scientific and research institutions in Poland has been created. Under the name of InFlow and financial support from the National Center for Research and Development, they have started a project with the aim to design, create and implement into clinical practice the first, Polish, low-profile TAVI valve system, utilizing not only biological but also artificial, polymeric-based prosthesis. This review focuses on current developments in TAVI technologies including the InFlow project

Long-term bio-functional performance of a novel, self-positioning balloon expandable transcatheter biological aortic valve system in the ovine aortic banding model

Background: The aim of the study was to evaluate bio-functionality of a novel, proprietary balloon-expandable biological transcatheter aortic valve implantation (TAVI) system (InFlow, CardValve Consortium, Poland) in an ovine model of aortic banding. Methods: Surgical ascending aorta banding was created in 21 sheep. Two weeks later, 18 biological valves were implanted within the model using 15–16 F InFlow TAVI systems and carotid cut-down approach. Follow-up transthoracic echocardiography was performed at 30, 90, and 180-day. At designated time, animals were euthanized and valves harvested for analysis. Results: All sheep survived the banding procedure. There were 4 (22%) procedure related deaths within a 7-day period. During the observation an additional 2 sheep died. In one, the valve dislocated after the procedure — the animal was excluded. Two animals completed 30-day follow up, five 90-day follow-up and four terminal follow-up of 180 days. Valves examined via transesophageal echocardiography showed proper hemodynamic parameters without evidence of structural valve deterioration. The maximum and average flow gradients at 180 days were 31.4 (23.3–37.7) and 17.5 (13.1–20.2) mmHg, respectively. There was one case of moderate insufficiency and no case of perivalvular leaks. By histopathology, there were no inflammation, thrombosis, nor calcifications in any tested valves at long-term follow-up. Neointimal coverage of stent struts increased with time from basal part in “early” groups to nearly 3/4 of stent length in the 180-day group. The pannus tissue showed maturation that increased with time with no stenotic “collar” visible in orthotopically implanted valves. Conclusions: The study showed good hemodynamic performance, durability and biocompatibility of the novel biological THV

A finite-volume module for simulating global all-scale atmospheric flows

This paper was accepted for publication in the Journal of Computational Physics and the definitive published version is available at http://dx.doi.org/10.1016/j.jcp.2016.03.015.The paper documents the development of a global nonhydrostatic finite-volume module designed to enhance an established spectral-transform based numerical weather prediction (NWP) model. The module adheres to NWP standards, with formulation of the governing equations based on the classical meteorological latitude-longitude spherical framework. In the horizontal, a bespoke unstructured mesh with finite-volumes built about the reduced Gaussian grid of the existing NWP model circumvents the notorious stiffness in the polar regions of the spherical framework. All dependent variables are co-located, accommodating both spectral-transform and grid-point solutions at the same physical locations. In the vertical, a uniform finite-difference discretisation facilitates the solution of intricate elliptic problems in thin spherical shells, while the pliancy of the physical vertical coordinate is delegated to generalised continuous transformations between computational and physical space. The newly developed module assumes the compressible Euler equations as default, but includes reduced soundproof PDEs as an option. Furthermore, it employs semi-implicit forward-in-time integrators of the governing PDE systems, akin to but more general than those used in the NWP model. The module shares the equal regions parallelisation scheme with the NWP model, with multiple layers of parallelism hybridising MPI tasks and OpenMP threads. The efficacy of the developed nonhydrostatic module is illustrated with benchmarks of idealised global weather

Fatty Acid Composition of Muscle and Adipose Tissue in Pigs Fed with Addition of Natural Sorbents

The fatty acid composition of meat and fat was studied in Choice Genetics line pigs fed a diet with three natural sorbents. Control (C1 and C2), biochar (D, 0.5%), bentonite–montmorillonite (A, 1.5%) and zeolite–clinoptilolite (B, 1.5%) diets were used in two trials. The samples of back fat, kidney fat and Longissimus lumborum (MLL) and Semimembranosus (MSM) muscle were examined. All sorbents (D, A and B) had no effect on fatty acid composition in MLL, whereas in MSM turned out to be very limited and inconsistent. Although A and B sorbents had a significant impact on the fatty acid profile of kidney fat, their effect was often opposite. Sorbent B’s effects were less beneficial due to a significantly higher proportion of saturated fatty acids, higher value of thrombogenic and atherogenic indexes, n-6/n-3 ratio but lower h/H ratio. Sorbent A’s effects significantly increased polyunsaturated fatty acids, and positively influenced lipid health quality indices. In summary, the feeding of natural sorbents slightly modified the fatty acid profile of muscle tissue, kidney fat and back fat; however, it did not have a negative effect on the indices of nutritional and pro-health quality of adipose tissue of pigs during fattening