Clinical Characteristics, Treatment, and Short-Term Outcome in Patients with Heart Failure and Cancer.

(1) Our study aimed to look at the clinical characteristics, treatment and short-term outcomes of patients hospitalized due to heart failure with coexisting cancer. (2) Methods: Seventy one cancer (Ca) patients and a randomly selected 70 patients without Ca, hospitalized due to heart failure exacerbation in the same time period constituted the study group (Ca patient group) and controls (non-Ca group), respectively. Data on clinical characteristics were collected retrospectively for both groups. (3) Results: Cancer patients presented with a less advanced NYHA class, had more frequent HFpEF, a higher peak troponin T level, and smaller left atrium size, as compared with controls. The in-hospital deaths of Ca patients were associated with: a higher New York Heart Association (NYHA) class, lower HgB level, worse renal function, higher K and AST levels, presence of diabetes mellitus, and HFpEF. By multivariate logistic regression analysis, impaired renal function was the only independent predictor of in-hospital death in Ca patients (OR-1.15; CI 1.05; 1.27); p = 0.017). The following covariates entered the regression: NYHA class, HgB, GFR, K+, AST, diabetes mellitus t.2, and HFpEF. (4) Conclusions: The clinical picture and the course of heart failure in patients with and without cancer are different

Developing a model of information transfer practice between institutions targeted at primary health care patients who are asymptomatic carriers of carbapenemase producing <i>Enterobacteriacae</i>

Background Drug-resistant bacteria are one of the main reasons of deaths worldwide. A significant group of these bacteria are carbapenemase producing Enterobacteriaceae (CPE). The goal of this study was to develop a diagnostic and therapeutic model targeted at asymptomatic carriers of CPE. Material and Methods A team of experts from different branches connected to health care, discussing the topic based on the data collected from previous research. Working sessions were dispersed between June and December 2022. The consensus has been reached via repeated discussion and literature search. Results The facility where CPE are detected is required to create an alert pathogen note and to notify sanitary-epidemiological station and National Reference Centre for Antimicrobial Susceptibility of Microorganisms – neither these institutions, nor the patient are required to notify the primary care physician. In primary care clinics, it is possible to work towards breaking the transmission of CPE by educating patients with CPE and persons who were in contact with them, and to undertake actions in order to look for patients with risk factors for CPE colonisation. In order to improve communication between individual levels of the health care system, standardised information could be introduced to the discharge note about a case of CPE, which will be electronically transmitted to the primary care facility. It might contribute to effective combating of the spread of CPE, by serving as a source of knowledge and education for patients and by checking the patient’s risk factors, which will improve the performance of tests for CPE colonisation. Conclusions The established model of good practice requires a change of legal regulations and its implementation, which will reduce the spread of CPE in health care facilities and will enable its future improvement

Frequency and Characteristics of Injuries and Rehabilitation Procedures in Rugby Players in Poland and France

Objectives: Rugby is sport with a high risk of injury. Repeated changes in exercise intensity and the high training intensity may cause to overuse injuries and long-term disability. The aim of the study was to analyze the prevalence of injuries during trainings and forms of rehabilitation procedures performed after their occurrence among elite and sub-elite rugby players. Methods: The data was obtained from 60 professional rugby males from France and Poland. Data were collected using paper-based recording form. It was a specially designed questionnaire which concerned specific details of the injury, including body location, type of injury, treatment and number of days off lost from playing rugby and on forms of rehabilitation procedures performed after their occurrence among elite and sub-elite rugby players. Results: During the study period, the overall incidence rate for injury suggested a 1.04 times more often injury occurrence (IRR = 1.04, 95% CI: 0.08; 2.00) among Polish players compared with French players; however, the distribution of injuries varied by country. The training injury incidence (TII) and incidence proportion (IP) were also higher in Poland than in France (p &lt; 0.05) with the sprain as the most frequent type of injury in all rugby players. France was 7.8 times (IRR = 7.88, 95% CI: 1.29; 3.21) more likely to sustain a fracture than Poland, which much often experienced less serious injuries (bruise, rapture of muscle and ligament) (IRR = 3.02, 95% CI: 2.06; 3.98). Polish players were provided with various forms of physiotherapy while Franch players often worked with a physiotherapist with a therapeutic method (p &lt; 0.005). Poland and France reported experiencing side effects after an injury and the most frequent was pain. In their opinions, the reasons influencing the effectiveness of rehabilitation are too quick return to the game and too short time of rehabilitation. Conclusions: The competitive level of the rugby player influences not only the frequency and type of injury occurrence, but also access to the different forms of rehabilitation. Nonetheless, the side effects occurring after injury and the causes of ineffective rehabilitation are still similar. Further studies are needed to gather significant data to accurately formulate future injury prevention protocols or recommend modifications to game laws or competition formats, aiming at players’ welfare

Organizational and financial changes in the work of primary health care workers during the COVID-19 pandemic in Poland

W związku z wybuchem pandemii COVID-19 cele systemu ochrony zdrowia musiały zostać dostosowane do zmieniającego się otoczenia, aby zrealizować potrzeby zdrowotne pacjentów i wypełnić oczekiwania personelu medycznego dotyczące zapewnienia bezpiecznych warunków pracy w zaistniałej sytuacji kryzysowej. Zmiany działalności personelu medycznego, które wynikają przede wszystkim ze zmian organizacyjno-finansowych, dotyczą systemów ochrony zdrowia na całym świecie i wpływają na funkcjonowanie wszystkich form opieki zdrowotnej. Celem tego artykułu jest wskazanie zmian organizacyjnych i finansowych wynikających z wprowadzonych od ogłoszenia przez WHO pandemii do 8 maja 2021 r. aktów prawnych i zaleceń wpływających na warunki pracy personelu medycznego podstawowej opieki zdrowotnej (POZ) w Polsce. Przegląd wprowadzonych działań w zakresie zapewnienia stabilności funkcjonowania POZ w warunkach pandemii pozwala stwierdzić, że sytuacja zagrożenia zdrowia publicznego ujawniła znaczną potrzebę wprowadzenia zmian organizacyjno-finansowych. Skutkiem zmian wynikających z legislacji oraz dobrych praktyk o istocie medycznej, organizacyjnej i finansowej są modyfikacje systemu ochrony zdrowia w Polsce, które mogą w nim pozostać. Warto jednak podkreślić, że jednym z istotnych wyzwań w zakresie przyszłych reakcji systemu ochrony zdrowia, w tym POZ, na stany zagrożenia zdrowia publicznego jest zachowanie spójności zmian organizacyjnych i finansowych wpływających na płynność oraz skuteczność działań podejmowanych przez personel POZ, a więc również na warunki jego pracy. Punktem wyjścia projektowania takich zmian powinna być analiza rozwiązań wprowadzonych od początku pandemii w Polsce. Można do nich zaliczyć nowe wymagania o charakterze organizacyjnym (warunki lokalowe, organizacja i stanowiska pracy, przepływ informacji czy sposób zaopatrzenia pacjenta) i zmiany finansowe (mobilizację dodatkowych zasobów finansowych w różnych formach). W artykule przedstawiono wiele pytań badawczych, które są warte rozważenia przy ustalaniu problemów i priorytetów w przyszłości, ponieważ zaistniałe zmiany i wnioski sformułowane na podstawie ich analizy mogą przyczynić się do wprowadzenia stałych modyfikacji funkcjonowania POZ w Polsce i ułatwić jej ewentualne dostosowanie do stanów ryzyka zdrowotnego. Med. Pr. 2021;72(5):591–604Following the outbreak of the COVID-19 pandemic, the objectives of the health care system had to be adapted to the changing circumstances, in order to meet the health needs of patients, but also the expectations of medical workers related to ensuring safe working conditions in the crisis situation. The activities of medical staff are greatly affected by organizational and financial changes in health care systems, which affect both the health care systems all over the world and the functioning of all forms of health care. The article examines the organizational and financial changes resulting from the introduction of regulations affecting the conditions of primary health care (PHC) workers in Poland from the beginning of the COVID-19 pandemic to May 8, 2021. The findings regarding measures taken to ensure the stability of PHC functioning during the pandemic highlight that the public health emergency exposed a significant need to introduce organizational and financial changes in PHC. The changes arising from legislation and good practices of medical, organizational and financial character resulted in health care system modernizations in Poland. It is worth stressing, however, that there is a great need to maintain coherence when implementing organizational and financial changes affecting the fluidity and effectiveness of the actions taken by PHC personnel, and thus their working conditions, when implementing future responses to public health emergencies. Such changes should be based on an analysis of the solutions introduced since the beginning of the pandemic in Poland: these include organizational changes such as housing conditions, organization of work and workplaces, flow of information and way of supplying the patient, and financial changes involving mobilization of additional financial resources. The article presents a list of future research questions that merit consideration when setting problems and priorities: these can be used to guide the introduction of permanent modifications to the functioning of PHC in Poland and to facilitate possible future adaptation in times of emergency. Med Pr. 2021;72(5):591–60

Epidemiology of Rheumatoid Arthritis (RA) in rural and urban areas of Poland – 2008–2012

Objective The aim of this study is to investigate the morbidity rate due to Rheumatoid Arthritis (RA) in the Polish population during 2008–2012, calculated per 1,000 inhabitants, and taking into account the differences between provincess, area of residence (urban or rural) and gender. Material and Methods From the NFZ IT systems, PESEL number information was obtained for all 17 types of services contracted in 2008–2012, for patients whose main diagnosis in the report was the ICD-10 disease code: M05.X – seropositive rheumatoid arthritis, or M06.X – other rheumatoid arthritis. The number of patients, gender and age were calculated based on the PESEL number provided in the statistical reports of the patient with the analysed ICD-10 diagnosis. Urban and rural cases were compared using commune zip codes. The basis for classifying the patient as a member of an urban or rural population was the Zip Code of the declared place of residence. Urban and rural areas are classified based on administrative criteria provided by the Central Statistical Office: the National Official Register of Territorial Division of the Country (TERYT). Results During the studied period the number of RA patients increased from 173,844–230,892. In urban areas, the most patients were recorded in the Śląskie Province, the least in Lubuskie Province. Patients from rural areas were approx. 1/3[sup]rd[/sup] of the total population of patients in Poland. In rural areas, the most patients were recorded in the Mazowieckie Province, the least in Lubuskie Province. The morbidity rate in cities was 5.08 in 2008 and increased to 8.14 in 2012 in rural areas, respectively, it was 3.74 and increased to 3.98. Regardless of the place of residence the women fell ill 3.5 times more frequently. The lowest morbidity rate, both in rural and urban areas, was recorded in the Lubuskie Province, the largest in Świętokrzyskie Province. The the most probable explanation of the highest morbidity rate in the latter province is a worse access to a rheumatologist: in this province there is the lowest number of inhabitants per one employed rheumatologist. Conclusions In Poland, the number of RA sufferers is increasing, which is probably a result of increasing life expectancy. In Poland, also exists a differences in morbidity between urban and rural inhabitants. Differences may also derive from undiagnosed cases of the disease