Reading numbers aloud as a tool for the evaluation of breathlessness in Polish cancer patients

Background: The aim of the study was to verify the usefulness of the test of reading numbers aloud(ReNA) in the assessment of the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. Material and methods: The study group included patients with advanced cancer who were breathless at rest or on minimal exertion. A modified Borg scale, a numeric rating scale (NRS) and a visual analogue scale(VAS) to assess breathlessness and peak expiratory flow (PEF) were performed. Patients then read aloud from a page containing a grid of numbers as quickly and clearly as they could for 60 seconds. It was intended to repeat the reading five times. The maximal amount of numbers read during the test (NNmax) and the maximal numbers read per breath (NN/Bmax) were noted. Results: Thirty-one patients with evidence of cancer participated in the study. However, for statistical analysis we included 28 patients (17 males, mean age 64.1 ± SD = 8.8) who were able to read numbers aloud at least once. The mean value for the modified Borg scale was 4.07 ± 1.89, NRS 5.75 ± 2.37 and VAS 5.11 ± 2.34. The average value for PEF was 183.26 ± 89.97. Twelve patients (42.86%) were unable to complete all five readings due to tiredness and fatigue. The mean value for the NNmax was 50.39 ± 29.93 and for NN/Bmax was 2.92 ± 2.45. No correlation was observed between the results for NRS, VAS or PEF and NNmax or NN/Bmax. Only the modified Borg scale correlated moderately with NNmax and NN/Bmax (R = –0.52 and R = –0.44, respectively). Conclusion: The ReNA seems to be a useful tool for assessing the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. However, fatigue and tiredness due to the reading were a problem for almost half of the advanced cancer patients, who were unable to complete the whole test. Adv. Pall. Med. 2010; 9, 3: 73–80Background: The aim of the study was to verify the usefulness of the test of reading numbers aloud(ReNA) in the assessment of the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. Material and methods: The study group included patients with advanced cancer who were breathless at rest or on minimal exertion. A modified Borg scale, a numeric rating scale(NRS) and a visual analogue scale(VAS) to assess breathlessness and peak expiratory flow (PEF) were performed. Patients then read aloud from a page containing a grid of numbers as quickly and clearly as they could for 60 seconds. It was intended to repeat the reading five times. The maximal amount of numbers read during the test (NNmax) and the maximal numbers read per breath (NN/Bmax) were noted. Results: Thirty-one patients with evidence of cancer participated in the study. However, for statistical analysis we included 28 patients (17 males, mean age 64.1 ± SD = 8.8) who were able to read numbers aloud at least once. The mean value for the modified Borg scale was 4.07 ± 1.89, NRS 5.75 ± 2.37 and VAS 5.11 ± 2.34. The average value for PEF was 183.26 ± 89.97. Twelve patients (42.86%) were unable to complete all five readings due to tiredness and fatigue. The mean value for the NNmax was 50.39 ± 29.93 and for NN/Bmax was 2.92 ± 2.45. No correlation was observed between the results for NRS, VAS or PEF and NNmax or NN/Bmax. Only the modified Borg scale correlated moderately with NNmax and NN/Bmax (R = –0.52 and R = –0.44, respectively). Conclusion: The ReNA seems to be a useful tool for assessing the intensity of dyspnoea at rest or on minimal exertion in Polish patients with advanced cancer. However, fatigue and tiredness due to the reading were a problem for almost half of the advanced cancer patients, who were unable to complete the whole test. Adv. Pall. Med. 2010; 9, 3: 73–8

The marker of tubular Injury, kidneyiInjury molecule-1 (KIM-1), in acute kidney injury complicating acute pancreatitis : a preliminary sttudy

Acute pancreatitis (AP) may be associated with severe inflammation and hypovolemia leading to organ complications including acute kidney injury (AKI). According to current guidelines, AKI diagnosis is based on dynamic increase in serum creatinine, however, creatinine increase may be influenced by nonrenal factor and appears late following kidney injury. Kidney injury molecule-1 (KIM-1) is a promising marker of renal tubular injury and it has not been studied in AP. Our aim was to assess if urinary KIM-1 may be used to diagnose AKI complicating the early stage of AP. We recruited 69 patients with mild to severe AP admitted to a secondary care hospital during the first 24 h from initial symptoms of AP. KIM-1 was measured in urine samples collected on the day of admission and two subsequent days of hospital stay. AKI was diagnosed based on creatinine increase according to Kidney Disease: Improving Global Outcomes 2012 guidelines. Urinary KIM-1 on study days 1 to 3 was not significantly higher in 10 patients who developed AKI as compared to those without AKI and did not correlate with serum creatinine or urea. On days 2 and 3, urinary KIM-1 correlated positively with urinary liver-type fatty acid-binding protein, another marker of tubular injury. On days 2 and 3, urinary KIM-1 was higher among patients with systemic inflammatory response syndrome, and several correlations between KIM-1 and inflammatory markers (procalcitonin, urokinase-type plasminogen activator receptor, C-reactive protein) were observed on days 1 to 3. With a limited number of patients, our study cannot exclude the diagnostic utility of KIM-1 in AP, however, our results do not support it. We hypothesize that the increase of KIM-1 in AKI complicating AP lasts a short time, and it may only be observed with more frequent monitoring of the marker. Moreover, urinary KIM-1 concentrations in AP are associated with inflammation severity

Difficult-to-treat asthma - an uncontrolled disease. Is there any relation to the experience from palliative medicine?

Background and aim. Difficult-to-treat asthma is characterized by uncontrolled symptoms occurring in spite of intensive treatment (corticosteroids and long-acting β2-agonists) for at least 6 months and is connected with severe obturation in the bronchotracheal tree. It still creates an important global medical and economical problem. The aim of the study was to evaluate the occurrence of persistent symptoms, exacerbating factors and co-morbidities in patients with difficult-to-treat asthma. It was also a challenging idea to apply palliative medicine to help patients with this type of asthma. Material and methods. Twenty-seven patients (21 women and 6 men, ages ranging from 23 to 60) diagnosed with difficult-to-treat asthma were included in the study. Data were collected from the internet database of severe, difficult-to-treat asthma, introduced to the Department of Allergology in 2005. All patients’ spirometries and additional factors were assessed. Results. The median predicted value of FEV1 was 55% (range: 34-104%) while 18 patients had FEV1 lower than the 60% predicted value. All patients suffered from dyspnoea, chronic cough and wheezing and had additional factors escalating the symptoms of asthma. The most important factor which leads to exacerbation was long-term stress and rhinitis. Twelve (45%) patients from this group have poor tolerance of exercise. In spite of intensive treatment, 17 (65%) patients constantly overused short-acting beta-agonists (SABA) and all had long-term treatment with oral steroids. In most cases, co-morbidities were recognized: obesity and hypertension. Conclusions. This study showed that the role of additional factors and co-morbidities plays a significant part in the course of asthma. It seems to be necessary to introduce a unified system of registering and managing patients with severe and difficult-to-treat asthma. That palliative care is very important for selected patients with chronic uncontrolled cough or dyspnoea should be a subject for newly planned clinical trials.Background and aim. Difficult-to-treat asthma is characterized by uncontrolled symptoms occurring in spite of intensive treatment (corticosteroids and long-acting β2-agonists) for at least 6 months and is connected with severe obturation in the bronchotracheal tree. It still creates an important global medical and economical problem. The aim of the study was to evaluate the occurrence of persistent symptoms, exacerbating factors and co-morbidities in patients with difficult-to-treat asthma. It was also a challenging idea to apply palliative medicine to help patients with this type of asthma. Material and methods. Twenty-seven patients (21 women and 6 men, ages ranging from 23 to 60) diagnosed with difficult-to-treat asthma were included in the study. Data were collected from the internet database of severe, difficult-to-treat asthma, introduced to the Department of Allergology in 2005. All patients’ spirometries and additional factors were assessed. Results. The median predicted value of FEV1 was 55% (range: 34-104%) while 18 patients had FEV1 lower than the 60% predicted value. All patients suffered from dyspnoea, chronic cough and wheezing and had additional factors escalating the symptoms of asthma. The most important factor which leads to exacerbation was long-term stress and rhinitis. Twelve (45%) patients from this group have poor tolerance of exercise. In spite of intensive treatment, 17 (65%) patients constantly overused short-acting beta-agonists (SABA) and all had long-term treatment with oral steroids. In most cases, co-morbidities were recognized: obesity and hypertension. Conclusions. This study showed that the role of additional factors and co-morbidities plays a significant part in the course of asthma. It seems to be necessary to introduce a unified system of registering and managing patients with severe and difficult-to-treat asthma. That palliative care is very important for selected patients with chronic uncontrolled cough or dyspnoea should be a subject for newly planned clinical trials

Does beta-trace protein (BTP) outperform cystatin C as a diagnostic marker of acute kidney injury complicating the early phase of acute pancreatitis?

Abstract: Acute pancreatitis (AP) belongs to the commonest acute gastrointestinal conditions requiring hospitalization. Acute kidney injury (AKI) often complicates moderately severe and severe AP, leading to increased mortality. Among the laboratory markers proposed for early diagnosis of AKI, few have been studied in AP, including cystatin C and neutrophil gelatinase-associated lipocalin (NGAL). Beta-trace protein (BTP), a low-molecular-weight glycoprotein proposed as an early marker of decreased glomerular filtration, has never been studied in AP. We investigated the diagnostic usefulness of serum BTP for early diagnosis of AKI complicating AP in comparison to previously studied markers. BTP was measured in serum samples collected over the first three days of hospital stay from 73 adult patients admitted within 24 h of mild to severe AP. Thirteen patients (18%) developed AKI in the early phase of AP. Serum BTP was higher in patients who developed AKI, starting from the first day of hospitalization. Strong correlations were observed between BTP and serum cystatin C but not serum or urine NGAL. On admission, BTP positively correlated with endothelial dysfunction. The diagnostic usefulness of BTP for AKI was similar to cystatin C and lower than NGAL. Increased BTP is an early predictor of AKI complicating AP. However, it does not outperform cystatin C or NGAL

Quality of life in asthmatic patients

Kompleksowe spojrzenie na zjawisko choroby ściśle wiąże się z określeniem jakości życia pacjentów. Jest to szczególnie istotne w przewlekłych chorobach układu oddechowego, takich jak astma oskrzelowa. Ostatnio coraz częściej przedstawia się problemy fizyczne, psychologiczne i społeczne, z którymi zmagają się chorzy na astmę. Doniesienia naukowe koncentrują się przede wszystkim na wpływie tej przewlekłej choroby somatycznej na stan psychiczny pacjentów, ich emocje, zmiany osobowościowe, zmiany w systemie wartości i zaburzenia funkcji poznawczych.Holistic approach to disease is strongly associated with assessment of patients’ quality of life. It is particularly important in chronic diseases such as bronchial asthma. Recently physical, psychological and social problems of patients with bronchial asthma have been discussed more often. These reports are generally focused on the influence of the chronic somatic illness on a patients’ psychical condition, their emotions, personality changes, changes in the value system as well as the cognitive functions

Hip-joint replacements in terms of operational nursing.

Alloplastyka stawu biodrowego jest najczęściej stosowanym sposobem leczeniazmian zwyrodnieniowych stawu biodrowego. Na podstawie literatury oraz własnego,wieloletniego doświadczenia z pracy w bloku operacyjnym podjęto próbę przedstawieniaidei tak specyficznej i waażnej specjalności jaką jest pielęgniarstwo operacyjne. Celempracy jest przedstawienie i scharakteryzowanie zadań pielęgniarki operacyjnej asystującejdo zabiegu alloplastyki stawu biodrowego. Poprzez specjalistyczne oraz podstawowewiadomości opracowanie to może być pomocne do nauki zawodu dla pielęgniarekrozpoczynających pracę w bloku operacyjnym. Postęp cywilozacyjny i związane z nimwydłużenie życia człowieka oraz stały rozwój technik operacyjnych wymusza napielęgniarkach operacyjnych ciągłe podnoszenie kwalifikacji zawodowych, co skutkujewysoką jakością świadczonych usług medycznych oraz zapewnia bezpieczeństwo pacjentapodczas zabiegu operacyjnego.The alloplastic hip-joint reconstruction is the major therapy in the treatment of thedegenerative hip-joint disease. According to the latest scientific publications and my ownwork experience on the surgey department the idea of the surgical nursing has beenproposed. Thanks to the research the work of both junior and senior surgical nurses wouldbe easier and more effective. The constant civilization progress, latest surgical techniquesand connected to that the patient's long life force the surgical nurses to improve theirqualifications in medical field. The higher the surgical nurse service the more benefits forthe patients during the operation. The aim of the research is to present and characterize thelist of duties and obligations for the surgical nurse assisting surgeons during the alloplastichip-joint reconstruction

Acquisition of Significant Portfolio of Shares in Domestic Insurance Companies – Legal Characteristics and Analyses

This paper is an attempt to solve problems which may arise – and in practice they do – in the course of proceedings conducted by the Polish Financial Supervision Authority (KNF) concerning the expression of its position on the acquisition of a qualifying holding in a domestic insurance company (i.e. in fact, the analysis of the institution objecting to the acquisition of a qualifying holding in a domestic insurance company, referred to in Articles 82–98 of the Act of 15 September 2015 on insurance and reinsurance activities)

The legal mechanisms to ensure the exercise of voting rights attached to shares in an investment fund manager or the powers of the investment fund manager's parent company (part 1)

W ostatnich latach na krajowym rynku funduszy inwestycyjnych widoczna jest tendencja wyrażająca się w konsolidacji tego rynku, która to konsolidacja — jakkolwiek na pierwszy rzut oka wydaje się zjawiskiem właściwym tylko dla prawa prywatnego — ma szczególne aspekty tak prywatno-, jak i publicznoprawne. Najważniejszym elementem w ramach tego procesu jest bowiem uprawnienie KNF do sprawowania kontroli nad przepływami kapitałowymi zachodzącymi w obrębie danej instytucji finansowej, tj. w danym towarzystwie funduszy inwestycyjnych. Naczelną ideą tej regulacji jest niedopuszczenie do przejęcia kontroli nad danym TFI i niedopuszczenie do uzyskania znacznego wpływu na zarządzanie TFI przez akcjonariuszy, którzy nie dają rękojmi prawidłowego funkcjonowania TFI i nie zapewniają stabilności i bezpieczeństwa jego dalszej działalności. Mechanizm ten jest złożony z dwóch części. Po pierwsze, z mechanizmu zawiadomienia, na mocy którego KNF została wyposażona w kompetencje do wyrażenia sprzeciwu odnośnie do zamiaru bezpośredniego albo pośredniego nabycia albo objęcia akcji lub praw z akcji TFI w liczbie zapewniającej osiągnięcie lub przekroczenie odpowiednio 10%, 20%, jednej trzeciej, 50% ogólnej liczby głosów na walnym zgromadzeniu lub udziału w kapitale zakładowym. Po drugie zaś, co będzie przedmiotem analizy w niniejszej publikacji, z mechanizmu decyzji KNF w sprawie zakazu wykonywania prawa głosu z akcji TFI lub zakazu wykonywania uprawnień podmiotu dominującego TFI. Uwzględniając okoliczność, że decyzja ta wywiera skutki tak w sferze prawa administracyjnego, jak i handlowego, oraz że pozostaje ona poza głównym nurtem zainteresowań doktryny, celowe jest bliższe i szczegółowe scharakteryzowanie tej decyzji, procedury jej wydawania oraz konsekwencji prawnych jej wejścia do obrotu prawnego.In recent years, the domestic market for investment funds has been witnessing a trend towards consolidation of this market, which — although at first glance it seems to be a phenomenon characteristic only of private law — has its specific private and public law aspects. The most important element within this process is the PFSA's power to control the capital flows occurring within a given financial institution, i.e. a given investment fund company. The main idea of this regulation is to prevent a takeover of control over a given TFI and to prevent gaining significant influence over TFI management by shareholders who do not ensure correct functioning of the TFI and do not provide stability and security for its further activity. This mechanism is in fact composed of two parts. First, i.e. the notification mechanism, under which the PFSA has been provided with powers to object to an intention of direct or indirect acquisition or subscription for shares or rights attached to shares of the TFI, in a number ensuring reaching or exceeding, respectively, 10%, 20%, one-third, 50% of the total number of votes at the general meeting or participation in the share capital. Secondly — which will be analysed in this publication — the mechanism of the PFSA's decision regarding the prohibition on exercising voting rights from TFI shares or prohibition on exercising rights of the TFI parent entity. Taking into account the fact that this decision has effects both in the sphere of administrative and commercial law, and that it remains outside the mainstream of doctrinal interest, it is appropriate to characterise this decision, the procedure for its issuance, as well as the legal consequences of its entry into legal circulation, in a closer and detailed manner

Acquisition of a significant block of shares in an investment fund company — legal analysis with particular emphasis on the institution of objection of the Polish Financial Supervision Authority (part 2)

Niniejszy artykuł został poświęcony analizie publicz- noprawnych aspektów transakcji nabywania znacznych pakietów akcji towarzystw firm inwestycyjnych. W artykule scharakteryzowano procedurę ustalania przez Komisję Nadzoru Finansowego, czy nabywca znacznego pakietu akcji daje rękojmię prawidłowego, bezpiecznego i stabilnego działania towarzystw funduszy inwestycyjnych, jak również kwestię tak wyrażenia, jak i braku wyrażenia (sprzeciwu) przez Komisję Nadzoru Finansowego zgody na nabycie znacznego pakietu akcji towarzystwa funduszy inwestycyjnych. Elementem rozważania jest także przedstawienie mechanizmów zabezpieczających respektowanie obowiązków związanych z nabywaniem znacznych pakietów akcji, jak i ocena samej instytucji nadzoru nad nabywaniem znacznych pakietów akcji towarzystw funduszy inwestycyjnych.This article is devoted to the analysis of public law aspects of transactions of acquisition of significant stakes in investment funds managers. The article describes the procedure that is being used by the Polish Financial Supervision Authority to determine whether the purchaser of a significant portfolio of shares gives a guarantee of proper, safe and stable operation of investment fund manager, as well as the issue by the Polish Financial Supervision Authority of the decision expressing or not expressing (objection) consent to the acquisition of a significant portfolio of shares of an investment fund manager. Another element of consideration is the presentation of mechanisms to ensure compliance with the obligations related to the acquisition of significant portfolio of shares, as well as the assessment of the institution itself as regards the supervision of the acquisition of significant blocks of shares of investment fund managers

Acquisition of a significant block of shares in an investment fund company — legal analysis with particular emphasis on the institution of objection of the Polish Financial Supervision Authority (part 1)

Niniejszy artykuł został poświęcony analizie prawnej transakcji nabywania znacznych pakietów akcji towarzystw firm inwestycyjnych. Autorzy skupili się w jego treści wyłącznie na kwestiach najważniejszych z punktu widzenia praktyki prowadzenia takich transakcji. W artykule przedstawili w szczególności specyfikę takich transakcji, ratio poddania ich przebiegu nadzorowi sprawowanemu przez Komisję Nadzoru Finansowego, jak również szczegółowo scharakteryzowali instytucję zawiadomienia o nabyciu znacznego pakietu akcji towarzystwa funduszy inwestycyjnych.This article is devoted to the legal analysis of transactions involving the acquisition of significant stakes in investment funds managers that are managing the investment funds. The authors focused on the most important issues from the point of view of the practice of conducting such transactions. The article presents, in particular, the specificity of such transactions, the ratio why such transactions are the subject of supervisions conducted by the Polish Financial Supervision Authority, as well as detailed description of the institution of notification of the acquisition of a significant stake in an investment fund managers