Fine singularity analysis of solutions to the Laplace equation: Berg's effect

We study Berg's effect on special domains. This effect is understood as monotonicity of a harmonic function (with respect to the distance from the center of a flat part of the boundary) restricted to the boundary. The harmonic function must satisfy piecewise constant Neumann boundary conditions. We show that Berg's effect is a rare and fragile phenomenon

Shadowing is generic on various one-dimensional continua with a special geometric structure

In the paper we use a special geometric structure of selected one-dimensional continua to prove that some stronger versions of the shadowing property are generic (or at least dense) for continuous maps acting on these spaces. Specifically, we prove that (i) the periodic TS-bi-shadowing property, where TS means some class of continuous methods, is generic as well as the s-limit shadowing property is dense in the space of all continuous maps (and all continuous surjective maps) of any topological graph; (ii) the TS-bi-shadowing property is generic as well as the s-limit shadowing property is dense in the space of all continuous maps of any dendrite; (iii) the TS-bi-shadowing property is generic in the space of all continuous maps of chainable continuum that can by approximated by arcs from the inside. The results of the paper extend ones obtained over the last few decades by various authors (see, e.g., Kościelniak in J Math Anal Appl 310:188–196, 2005; Kościelniak and Mazur in J Differ Equ Appl 16:667–674, 2010; Kościelniak et al. in Discret Contin Dyn Syst 34:3591–3609, 2014; Mazur and Oprocha in J Math Anal Appl 408:465–475, 2013; Mizera in Generic Properties of One-Dimensional Dynamical Systems, Ergodic Theory and Related Topics, III, Springer, Berlin, 1992; Odani in Proc Am Math Soc 110:281–284, 1990; Pilyugin and Plamenevskaya in Topol Appl 97:253–266, 1999; and Yano in J Fac Sci Univ Tokyo Sect IA Math 34:51-55, 1987) for both homeomorphisms and continuous maps of compact manifolds, including (in particular) an interval and a circle, which are the simplest examples of one-dimensional continua. Moreover, from a technical point of view our considerations are a continuation of those carried out in the earlier work by Mazur and Oprocha in J. Math. Anal. Appl. 408:465-475, 2013

ISAR-REACT 5 — czy to badanie powinno zmienić praktykę kliniczną?

Prasugrel and ticagrelor are oral P2Y12 receptor inhibitors indicated by the European Society of Cardiology as the preferred antiplatelet therapy in patients with acute coronary syndrome (ACS). Despite the long-term and widespread presence of these agents in clinical practice, to date they have never been directly compared in a large, randomised clinical trial. ISAR-REACT 5 was the first such study, and it reported the superiority of prasugrel over ticagrelor. However, due to the arguable methodology of both the planning and the execution of this study, its results should be interpreted with caution, and they should not be considered sufficient to justify any changes to the current treatment strategies for patients with ACS.Prasugrel i tikagrelor są doustnymi inhibitorami receptora P2Y12 wskazywanymi w wytycznych Europejskiego Towarzystwa Kardiologicznego jako preferowane leczenie przeciwpłytkowe u pacjentów z ostrymi zespołami wieńcowymi (ACS). Mimo wieloletniej i coraz powszechniejszej obecności w praktyce klinicznej obu tych leków, dotychczas nigdy nie porównywano ich bezpośrednio w dużym, randomizowanym badaniu klinicznym. Pierwszym takim badaniem była próba kliniczna ISAR-REACT 5, w której wykazano wyższość prasugrelu nad tikagrelorem. Tym niemniej, ze względu na wątpliwości odnośnie do metodologii planowania i przeprowadzenia tej próby klinicznej, jej wyniki należy interpretować z ostrożnością i nie powinno się ich uznawać za wystarczające do wprowadzenia zmian w dotychczasowej strategii leczenia pacjentów z ACS

The influence of naloxone on pharmacokinetics and pharmacodynamics of ticagrelor in patients with unstable angina pectoris receiving concomitant treatment with morphine — a protocol of a randomized trial

Rapid platelet inhibition plays pivotal role in contemporary treatment of patients presenting with acute coronary syndromes. Morphine, the most commonly used analgesic has been proven to impair both absorption and onset of action of P2Y12 receptor inhibitors, which can be described as “the morphine effect”. Most negative effects of morphine are caused by its undesirable influence on gastrointestinal tract. We hypothesized that naloxone, widely administered intravenous opioid reversing drug, may turn out to be beneficial if given orally in acute coronary syndrome patients previously treated with morphine. Therefore, a phase IV, randomized pilot study was designed so as to evaluate the impact of naloxone administration on pharmacokinetics and pharmacodynamics of P2Y12 inhibitor, ticagrelor in unstable angina patients. A group of 30 consecutive unstable angina patients treated with ticagrelor and morphine will be randomized in a 1:1 ratio into the study arms. To the best of our knowledge, no such approaches to overcome negativeinfluence of morphine in acute coronary syndrome patients have been described in literature so far

The impact of knowledge and effectiveness of educational intervention on readiness for hospital discharge and adherence to therapeutic recommendations in patients with acute coronary syndrome

Introduction: ESC guidelines emphasize the importance of educating patients after acute coronary syndromes aimed at familiarizing the patient with the essence of the disease, the principles of self-control and self-care as well as actions enhancing health maintenance.Aim: The aim of the study was to assess the impact of knowledge and effectiveness of educational intervention on readiness for discharge from the hospital and compliance with therapeutic recommendationssix months after discharge.Material and methods: The study group consisted of 218 patients (28.9% women and 71.1% men) aged 31to 90 years (63.0 ± 11.24) treated with coronary angioplasty for myocardial infarction. The effectiveness of educational intervention was assessed by comparing patients’ knowledge on the day of admission (1KE)and discharge from the hospital (2KE). Knowledge was assessed in 3 aspects: knowledge of symptoms, knowledge of the disease, and knowledge of prevention. Education was provided between 1KE and 2KE based on the brochure entitled “Myocardial Infarction”. The level of knowledge on the day of discharge and the increase in knowledge obtained after education (ΔKE) were referred to the level of Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD-MIS) and to the level of adherence in chronic diseases scale (ACDS).Results: As a result of the education carried out between 1KE and 2KE, a significant increase in knowledgewas obtained (p < 0.05). There was no correlation between ΔKE and RHD-MIS. However, it was shown that a higher level of knowledge at discharge (2KE) was associated with a higher RHD-MIS result (R = 0.17; p = 0.01). The highest impact on the RHD-MIS result was due to the level of knowledge of disease symptoms in 2KE: 75.5 ± 19.5%, 76.4 ± 21.1%, 85.8 ± 16.4% for low, medium and high RHD-MIS results (p = 0.002) ; R = 0.15; p = 0.0003. Knowledge of the disease symptoms in 2KE was associated with the patient’s expectations in RHD-MIS - a higher level of knowledge was associated with higher patient expectations, respectively: 73.2 ± 21.7%, 80.0 ± 18.5%, 82.9 ± 19.2 for low, medium and high RHDMIS (p = 0.02); R = 0.19; p = 0.006. There was no correlation between ΔKE or 2KE and ACDS results 6 months after discharge.Conclusions: The educational brochure is an effective tool in improving patients’ level of knowledge. Better knowledge of the symptoms of coronary artery disease and myocardial infarction is associated with a higher degree of readiness for discharge from the hospital but does not affect the observance of therapeutic recommendations in the field of pharmacotherapy after 6 months

Creative scientific dispute — different points of view on the protocol and execution of the ISAR-REACT 5 trial

Discordant interpretations of the results of clinical trials often drive scientific disputes. Our position concerning the protocol and performance of the ISAR-REACT 5 trial have been termed as false and groundless in the recently published article. We deeply disagree with this judgement and still maintain all our opinions expressed in the previous publications, without any exceptions. As demonstrated in multiple studies, prasugrel has excellent effectiveness and predictability. In our previous publications, it was not the drug itself that we put under criticism, but rather the quality of the trial assessing the drug. As a consequence of this critical approach, we stated that taking into account the serious limitations of the ISAR-REACT 5 trial, its results should be taken with cautiousness. To summarize, we remain open to further creative scientific dispute enriching both readers and authors

Adherence to treatment – a pivotal issue in long-term treatment of patients with cardiovascular diseases. An expert stand-point

The adherence to treatment is defined as the extent to which a person’s behaviour, including taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health-care provider. Non-adherence to medication may lead to increased morbidity, mortality, and costs to the healthcare system. Therefore, it is pivotal to know the patient’s true adherence to medication, understand the causes of low adherence, and take actions to improve adherence. The authors assumed that individual, complex health education started during hospitalisation and continued after discharge, explaining the pathophysiology and symptoms of the disease, elucidating goals and potential benefits of treatment, and highlighting the risk of premature termination of therapy, with use of additional methods helping patients to remember treatment schedule will enhance adherence to treatment. There is an urgent need to develop and test a dedicated procedure covering all these activities. Introduction. A substantial proportion of patients with cardiovascular diseases do not respond to the treatment sufficiently [1–3]. Several factors of poor response to medication should be taken into ac-count, including inadequate drug intake [4–6]. To systematise the phenomenon of following medical recommendations, the term “adherence” was proposed. The World Health Organisation (WHO) defines “adherence” as “the extent to which a person’s behaviour, including taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare pro-vider” [7]. Adherence has been also defined as the “active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behaviour to produce a therapeutic result” [8]. Previously the term ‘compliance’ was widely used, particularly in negative concord as ‘non-compliance’. Nowadays ‘compliance’ is associated with a more pejorative connotation than ‘adherence’ because ‘non-compliance issues’ are mostly patient-oriented without a deeper view into the different set of factors, e.g. obstacles identified in the healthcare system. Thus, currently in scientific deliberations we usually prefer usage of the term ‘adherence’ [9].The adherence to treatment is defined as the extent to which a person’s behavior including taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider. Non-adherence to medication may lead to increased morbidity, mortality, and costs to the healthcare system. Therefore it is pivotal to know the true patient's adherence to medication, understand the causes of low adherence and take actions to improve adherence. The authors assumed that the individual, complex health education started during hospitalization and continued after discharge, explaining the pathophysiology and symptoms of the disease, elucidating goals and potential benefits of treatment, highlighting the risk of premature termination of therapy, with use of additional methods helping patients to remember treatment schedule will enhance adherence to treatment. There is an urgent need to develop and test a dedicated procedure covering all of these activities

Self-reported questionnaires for assessment adherence to treatment in patients with cardiovascular diseases

Introduction: The treatment of acute coronary syndromes, besides coronary interventions, includes pharmaco-therapy and lifestyle changes, which together determine a favourable prognosis. Adherence to treatment is a term describing a patient’s behaviour in respect to the patient’s maintenance of the health care provider’s recommendations. Unfortunately, according to WHO data, adherence to long-term therapies for chronic illnesses in developed countries averages only 50%. Covered areas: Our study focused on available questionnaires for adherence assessment in everyday practice. A comprehensive search of data bases was conducted using appropriate keywords. Out of an initially identified 2081 citations, 93 articles were considered eligible for further analysis. Eventually, nine adherence scales were identified and reviewed. Expert opinion: There is no so-called “gold standard survey” allowing accurate assessment of every patient for medication adherence. The use of a specific scale must be justified by its validation in a similar group of patients in well designed and properly conducted studies