Rejection in Łukasiewicz's and Słupecki's Sense

The idea of rejection originated by Aristotle. The notion of rejection was introduced into formal logic by Łukasiewicz [20]. He applied it to complete syntactic characterization of deductive systems using an axiomatic method of rejection of propositions [22, 23]. The paper gives not only genesis, but also development and generalization of the notion of rejection. It also emphasizes the methodological approach to biaspectual axiomatic method of characterization of deductive systems as acceptance (asserted) systems and rejection (refutation) systems, introduced by Łukasiewicz and developed by his student Słupecki, the pioneers of the method, which becomes relevant in modern approaches to logic

The evaluation of the quality of life in patients’ families during terminal malignancy at home

Wstęp. Okres terminalny to okres, gdy wyczerpały się możliwości dalszego przedłużania życia osoby przewlekle chorej bezpośrednim oddziaływaniem na przyczynę choroby, a chory wy-maga objęcia go opieką. Rodzina spotyka się wówczas z szeregiem problemów, w tym także ze zmianami swojej jakości życia. Problemy te rzadko poruszane w literaturze tematu skłoniły autorów do podjęcia badań własnych. Celem badań była ocena jakości życia członków rodzin pacjentów w terminalnym okresie choroby nowotworowej w warunkach domowych. Materiał i metody. Przebadano 60 osób – członków rodzin i jednocześnie opiekunów pacjentów będących w terminalnym okresie choroby nowotworowej, przebywających w domu. Sondaż został prze-prowadzony samodzielnie z uwzględnieniem wymagań etycznych tj. badanych poinformowano o anonimowości i celu przeprowadzonej ankiety. Pytania w nim zawarte dotyczyły sfery biopsycho-społecznej ankietowanych. Wyniki i wnioski. Jakość życia opiekunów chorych terminalnych obniża się. Pogorszenie jakości życia następuje zwłaszcza wtedy, gdy sprawowanie opieki spada na jedną osobę. Łączenie opieki z obowiązkami prowadzenia domu i pracy zawodowej, udzielanie wsparcia psychicznego choremu z jednoczesnym przeżywaniem perspektywy rozstania, rodzi uczucie przygnębienia i smutku. Także u chorego wywołuje to negatywne emocje np. drażliwość, gniew, depresję. Choroba w rodzinie wpływa na sytuację społeczno – zawodową badanych. 33,3% zmieniła całkowicie plany życiowe, co wiązało się z decyzją o zmniejszeniu czasu pracy i rezygnacji z dotychczasowego sposobu spędzania wolnego czasu. U respondentów, u których stwierdza się obniżenie jakości życia pomoc powinna obejmować sfery psychologiczno – bytowe rodziny. Sprawą podstawową byłoby podjęcie prób poprawy komunikacji i kontaktów wzajemnych z rodziną i poradnictwo psychologiczne. Równie ważna staje się opieka medyczna, nauka opiekunów zasad pielęgnacji, wiedza na temat możliwych nowych objawów chorobowych. Kolosalne znaczenie ma uświadomienie rodzinie, że choroba w fazie terminalnej jest nieodwracalną, nieuchronnie prowadzącą do śmierci.Introduction. Terminal malignancy is a period when the possibilities of prolonging a chronically ill patient’s life by means of affecting the cause of the disease are gone, and the patient is in need of care. Families encounter a lot of problems then, some of them related to the change in their quality of life. As these problems are infrequently undertaken in the literature of the field, the authors decided to conduct their own research. The purpose of it was to evaluate the quality of life of patients’ families during terminal malignancy at home. Materials and methods. 60 people were examined – they were all relatives and at the same time carers of terminal malignancy patients residing at their houses. The survey was conducted by authors them selves with a special consideration given to the ethical regulations, i.e. informing the interviewed about their anonymity and the purpose of the survey. The questions included in it were biological, psychological and social in nature. Results and conclusion. The quality of life is declining for carers of the terminally ill. The decline is the case especially when there is only one person to handle the related responsibilities. The care over the patient conjoined with running the household and professional life as well as supporting the patient while bearing the prospect of parting in mind are the sources of sadness and depression. Patients experience negative emotions as well, for instance irritation, anger, depression. The illness in a family affects the socio-professional situation of its members. 33,3% of them change their life plans entirely, which included decreasing the work frequency and giving up the previous leisure activities. The help offered to the respondents who experienced a decline in their quality of life should be psychological and existential. A basic issue here would be an attempt to make amends to the mutual communication and relations in the family as well as psychological counselling. Equally important is medical care as well as teaching the carers how to tend the sick person and what new symptoms may occur. Making it clear to the family that the terminal illness is irreversible and always leads to death is of utter importance

The quality of life depending on the patient’s condition

Artykuł dotyczy analizy jakości życia przy uwzględnieniu stany zdrowia. Autorzy definiują określenie jakości życia. Charakteryzują jakość życia z wykorzystaniem instrumentów subiektywnych, jak i obiektywnych. Dużo miejsca poświęcają kwestionariuszom ogólnym (generic scales) oceniającym w sposób najbardziej ramowy relacje pomiędzy stanem zdrowia chorego, a relacjami rodzinnymi, stanem emocjonalnym, aktywnością zawodową. Można je stosować zarówno u osób chorych, jak i zdrowych. Przykładem kwestionariuszy ogólnych są: WHOQOL- Bref, Sickness Impast Profile 136 (SIP), Short Form Health Survey (SF-36), Indeks Jakości Życia (QOL, Quality of Life).The article is concerned with the analysis of quality of life with the relation to health condition. The authors define the concept of the quality of life. They characterize quality of life using subjective as well as objective means. A lot of attention is devoted to generic scales which provide framework assessment of the relations between patients’ condition, the relationships with their families, their emotional state and their professional activity. They apply to both the sick and the healthy. The examples of generic scales include: WHOQOL- Bref, Sickness Impact Profile 136 (SIP), Short Form Health Survey (SF-36), Quality of Life Index (QOL, Quality of Life)

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

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 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