ETHICAL DIMENSIONS OF PROFESSIONAL DUTY IN NURSING

Over time, nursing practice has emerged as an independent profession based on theoretical knowledge, practical experience, and scientific justification. The professional duty of medical specialists corresponds to the rights of the patient. To be professionally responsible means to make decisions about what is good or bad, right or wrong, taking into account the final result of the actions - the greatest benefit to the patient. PURPOSE: The purpose of this paper is to examine the ethical aspects of professional duty in the nursing profession by analyzing international and national codes of ethics. METHODS: In order to achieve this goal, we have used general and private science methods and approaches, including documentary method, analysis and synthesis, comparative method. RESULTS: Various nursing codes of ethics were reviewed- The Nightingale Pledge, The ICN Code of Ethics for Nurses, The ANA Code of Ethics for Nurses with Interpretive Statements, The Code of Professional ethics for Nurses, Midwives and Associated Medical Specialists in the Republic of Bulgaria, Guidance for good medical practice. The codes were analyzed in a comparative aspect in terms of volume, content, and practical orientation. CONCLUSION: Codes of ethics are meaningless without professionals who are motivated to act morally in every situation containing ethical issue. Nursing students must understand their role as responsible future professionals and be familiar with the content of the Ethical code and the Guidance of good medical practice. The implementation of the ethical norms is controlled by specially formed bodies of the professional organization

AN ANALYSIS OF STUDENT SATISFACTION WITH THE ORGANIZATION OF HYBRID TEACHING IN THE DEPARTMENT OF HEALTH ECONOMICS

The PURPOSE of this research is for a survey to be conducted among the students of the Faculty of Public Health “Prof. Tzekomir Vodenicharov, МD, DSc” at Medical University – Sofia to study whether they are satisfied with how hybrid teaching has been organized in the Department of Health Economics. MATERIALS AND METHODS: An anonymous questionnaire survey was conducted. Out of all students who were invited to participate, 309 joined. The questionnaire was distributed through the Google Forms platform from June to October 2022. Chi-Quadrant analysis was used in order to find relationships between categorical variables. RESULTS: the result shows a statistically significant connection between the students who are studying different specialties in the FPH and their satisfaction with the organization of the hybrid classes carried out by the Department (p <0.001). From the participants’ responses, it is clear that the implementation of hybrid form of teaching (in-person classes for practical training and online classes for theoretical study) carried out through open educational resources and implementing innovative teaching methodology is preferred by the students. CONCLUSION: The scientific evidence arising from our empirical research can aid in the development of guidelines for practical improvement of the hybrid teaching organization in disciplines taught in the Department. The conclusions drawn presuppose continuous research with proper methodologies applied

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&nbsp;&lt;.001. Over 24&nbsp;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&nbsp;ml/min/1.73&nbsp;m2 decrease), that was most notable in patients with eGFR &lt;30&nbsp;ml/min/1.73&nbsp;m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90&nbsp;ml/min/1.73&nbsp;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 &lt;.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

Existing monitoring of Mediterranean sea: a gap analysis

The Marine Strategy Framework Directive (2008/56/EC) of the European Parliament and of the Council (17th June 2008) establishes a framework for community action in the field of marine environmental policy. A crucial issue will be to improve the existing marine monitoring programs to cover the MSFD requirements. The comparison and identification of gaps in the existent national monitoring is a first step to include new parameters and frequencies of observation according to all relevant Directives and specially to MSFD. Our report is a first, integrated, cross-state assessment of the present state of Mediterranean monitoring networks. Data on monitoring stations have been provided from all member states of IRIS-SES + Croatia and joint in a unique georeferenced dataset. We used the cross-classification to build contingency tables of the counts at each combination of factor levels. Distances from coastline, densities of sampling stations, spatial overlap across descriptors, were also reported. As main results, we observed a large heterogeneity across MS on the parameters measured for each descriptors, on the density of sampling stations and on the frequency of sampling. Larger gaps have been identified for the descriptors Mammals, Birds, Reptiles (D1, D4, D6), Litter (D10), Energy & Noise (D11). The outputs from this work will be included into a GIS planning tool (Activity 3) including many scales and levels on which the MSFD Directive has been built on, such as the characteristics level (e.g. biological features, physicochemical features), pressure and impact, indicator/threshold, spatial (location of monitoring stations) and temporal (frequency-periodicity) across regions-subregions-countries