Ocena skuteczności zestawów edukacyjnych w podejmowaniu zmiany zachowań ryzykownych wśród pacjentów z nadciśnieniem tętniczym

Wstęp Celem badania była ocena skuteczności oddziaływań polegających na zastosowaniu zestawów edukacyjnych dotyczących modyfikacji stylu życia wśród chorych na nadciśnienie tętnicze. Materiał i metody W badaniach wzięło udział 99 pacjentów poniżej 65 roku życia ze zdiagnozowanym nadciśnieniem tętniczym bez współwystępowania schorzeń przewlekłych. Badania przeprowadzono w schemacie dwugrupowym (grupa eksperymentalna, która otrzymała zestaw edukacyjny, i grupa kontrolna) z pomiarem początkowym przed zastosowaniem oddziaływania oraz pomiarem końcowym, po upływie 3 miesięcy. Pomiary obejmowały parametry medyczne (ciśnienie tętnicze, BP; wskaźnik masy ciała, BMI; całkowity cholesterol, TCh i obwód pasa, WC), kwestionariuszową ocenę zachowań ryzykownych (IZZ i narzędzie własne do ewaluacji zaleceń z zestawu edukacyjnego) oraz uogólnionego poczucia własnej skuteczności (GSES). Wyniki Przeprowadzone analizy wariancji wykazały, że średnia wyników zachowań ogólnych (IZZ) oraz ryzykownych zawartych w zestawie edukacyjnym w pomiarze końcowym była istotnie wyższa w porównaniu ze średnią wyników w pomiarze początkowym przy kontroli uogólnionego poczucia własnej skuteczności. Modyfikacja stylu życia łączyła się z istotnym statystycznie obniżeniem parametrów medycznych, przy czym nie wykazano zmian BP. Nie uzyskano istotnych efektów interakcji, zatem różnica wyników pomiędzy pomiarami nie zależała od zastosowania zestawu edukacyjnego. Po wprowadzeniu do analiz parametrów medycznych jako zmiennych objaśniających wykazano, że w grupie eksperymentalnej, inaczej niż kontrolnej, względna zmiana zachowań zawartych w zestawie edukacyjnym była wyższa jedynie w grupie z prawidłowymi wartościami BP. Wnioski Celem modyfikacji stylu życia chorych na nadciśnienie tętnicze jest obniżenie ryzyka sercowonaczyniowego, zatem jego ewaluacja powinna uwzględniać monitorowanie nie tylko BP, ale także parametrów medycznych pozostających w relacji do zachowań ryzykownych. Oddziaływania o charakterze edukacyjnym są efektywne wówczas, gdy dotychczasowe leczenie nadciśnienia było skuteczne

Cardiac tumors : leiomyosarcoma - a case report

We present a case report of a 60-year-old woman with a long history of leiomyosarcoma in different locations. She was admitted to the clinic due to a left ventricular tumor diagnosed in ECHO examination. The patient was qualified for radical tumor resection. The early postoperative period was complicated due to low cardiac output syndrome and bradyarrhythmia requiring temporary cardiac pacing. Optimized pharmacological therapy resulted in a gradual reduction of symptoms and a clinical improvement of congestive heart failure (NYHA III – NYHA II). Due to the radical nature of the surgery, the patient was not referred for supplementary treatment. The follow-up currently exceeds 12 months – no new metastases have been found. This case provides an example of how to diagnose and treat heart tumors

The prevalence of left atrial enlargement in Polish patients with atrial fibrillation — a single center study

Background. Atrial fibrillation (AF) remains one of the major causes of cardiovascular morbidity worldwide. Left atrial enlargement (LAE) is a common risk factor of AF. Left atrial enlargement is also connected with a higher prevalence of heart failure in AF patients. The aim of this study was to assess the prevalence of LAE in Polish patients with AF. Material and methods. Transthoracic echocardiography was performed in consecutive AF patients hospitalized in the Department of Heart Diseases. We assessed LAE using a two-dimensional method. Left atrial (LA) size was classified into the 4 categories: normal (LAE values < 39 mm in women and < 41 mm in men), mildly enlarged (39–42 mm in women and 41–46 mm in men), moderately enlarged (43–46 mm in women and 47–51 mm in men), and severely enlarged (≥ 47 mm in women and ≥ 52 mm in men). Results. We analyzed 113 individuals with AF (mean age 77.2 ± 9.8 years; 37.2% men). Of these, 71 (62.8%) patients had LAE (age 77.6 ± 9.9 years; 36.6% men). LA was mildly enlarged (39–42 mm in women and 41–46 mm in men) in 20 (28.2%) patients, moderately enlarged (43–46 mm in women and 47–51 mm in men) was observed in 30 (42.3%), and severely enlarged (≥ 47 mm in women and ≥ 52 mm in men) in 21 (29.6%) patients. The incidence of heart failure was significantly higher in AF patients with LAE [39 (54.9%) compared to the patients without LAE — 12 (28.6%) p = 0.01]. Conclusions. In patients with AF, LAE was highly prevalent. Patients with AF and LAE have more often HF compared to AF patients without LAE

Nagłe zatrzymanie krążenia u pacjentki z kardiomiopatią okołoporodową i zatorowością płucną

Peripartum cardiomyopathy is a type of dilatated cardiomyopathy, occuring with symptoms of heart failure (HF) during lastmonth of pregnancy or within 5 months after labour. Authors are presenting the case of patient admitted to hospital primarywith diagnosis of non-high risk pulmonary embolism 6 weeks after delivery, who developed episode of sudden cardiac deathfollowed by symptoms of cardiogenic shock. Peripartum cardiomyopathy was additionally diagnosed. After HF treatment withbromocriptine supply, gradual clinical improvement was achieved. The patient was discharged after 15 days of hospitalisationwith diagnosis of peripartum cardiomyopathy with non-high risk pulmonary embolism

Left atrial appendage thrombus in patients with atrial fibrillation who underwent oral anticoagulation

Background: Electric cardioversion of atrial fibrillation (AF) is associated with an increased risk of embolism, with embolic material existing in the heart cavities. The initiation of oral anticoagulation therapy reduces the risk of thromboembolic events. The aims of this study were to evaluate the prevalence of left atrial appendage (LAA) thrombi in non-valvular AF, to compare vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulants (NOACs) with respect to thrombus prevalence, and to evaluate the rate of LAA thrombus persistence on repeat transesophageal echocardiography (TEE) after treatment change. Methods: We enrolled 160 consecutive AF patients who presented with an AF duration > 48 h and had undergone TEE before cardioversion. Results: Left atrial appendage thrombus was observed in 12 (7.5%) patients, and spontaneous echo contrast 4 was observed in 19 (11.8%) patients; the incidence was similar between the NOAC and VKA groups (8.9% vs. 3.6% and 12.4% vs. 18.5 %, respectively). Among patients on NOAC, thrombus prevalence was detected in 8.4% of users of rivaroxaban, 8% of users of dabigatran, and 12.5% of users of apixaban. Conclusions: The LAA thrombus developed in 7.5% of patients despite anticoagulation therapy, demonstrating similar prevalence rates among patients either on NOAC or VKA. Lower mean LAA flow velocity and a history of vascular disease were independent predictors of embolic material in the LAA. It seems that in the case of embolic materials in LAA under NOAC treatment, switching to VKA provides additional clinical benefit to the patients

Chorzy trudni nietypowiPodejrzenie zatorowości płucnej u młodej kobiety z zespołem Pageta i Schröttera

Deep upper limbs veins thrombosis is a relatively rare condition in comparison to the lower limbs thrombosis. Most commonly occurs as a complication of major veins catheterisation. It may also be caused by stenosis of axillar or subclavian veins due to neoplastic infiltration, enlarged lymph nodes or congenital thrombophilia. The Paget-von Schrötter syndrome caused by exercise – induced thrombosis described in this case report is very infrequent

The relationship between general and specifi c self-effi cacy during the decision-making process considering treatment

The aim of the study was to confi rm the mediation effects of the task-specifi c self-effi cacy on the relationship between the general self-effi cacy and intention and planning considering treatment. The study comprised 265 subjects, of which 165 were post-mastectomy women and 100 patients hospitalized due to acute coronary syndrome (ACS). The variables were assessed using the Generalized Self-Effi cacy Scale (GSES) and tools developed to examine the context of treatment. The data were analyzed using the bootstrapping procedure. The results confi rmed the indirect effects of task-specifi c self-effi cacy, both in women making a decision to undergo breast reconstruction, and in patients after ACS formulating intention to change risk behaviours. As smoking was considered to be a moderator in the post-ACS group, the obtained associations were observed only among the patients declaring quitting smoking. In view of the fact that taskspecifi c self-effi cacy is susceptible to context (e.g. it may depend on quitting smoking), it is useful to assess it in order to increase treatment effectiveness

How to measure motivation to change risk behaviours in the self-determination perspective? The Polish adaptation of the Treatment Self-Regulation Questionnaire (TSRQ) among patients with chronic diseases

The aim of this study was to validate the Polish adaptation of the Treatment Self-Regulation Questionnaire (TSRQ; Ryan, Conell, 1989), which measures the degree of self-determination in risk behaviour changes (diet, exercise and smoking). The study comprised 219 patients (101 after acute coronary syndrome and 118 with type 2 diabetes), beginning to undergo treatment. The Global Motivation Scale was used to test a convergent validity. The confi rmatory factor analysis (CFA) did not support the theoretical four-factor model, thus an exploratory analysis was conducted to determine an optimal model across risk behaviours. The adopted two-factor model matched original TSRQ subscales: autonomous motivation and external regulation (it did not contain the items from the introjected regulation and amotivation subscales). The internal consistency of factors (Cronbach’s α) ranging from .78 to .89. Structural equation modeling revealed the impact of global motivation on contextual motivation, limited to the equivalent type of regulation. The action aimed at supporting patient’s autonomy should consider the particular behaviour and the global motivation as a resource in disease