The Adherence in Chronic Diseases Scale — a new tool to monitor implementation of a treatment plan

Wstęp. Celem pracy była ocena adherence z zastosowaniem nowej skali w populacji osób z chorobą wieńcową (CAD) po zawale serca (MI) w odniesieniu do parametrów socjodemograficznych i klinicznych. Materiał i metody. Badanie przeprowadzono w populacji 100 kolejnych osób (40 kobiet, 60 mężczyzn) w wieku 30–88 lat, średnio 63,4 roku, pół roku po hospitalizacji z powodu MI. Wyniki. Wyniki oceny w Adherence in Chronic Diseases Scale (ACDS) zawierały się między 6 a 28 punktów; mediana wynosiła 24 punkty (21–28). Wynik wysoki (> 26 pkt.) osiągnęły 24 osoby, 53 badanych uzyskało wynik średni (między 21 a 26 pkt.), a 23 — niski wynik (< 21 pkt.). Dla optymalnego modelu regresji wielorakiej współczynnik korelacji R wynosił 0,539, a skorygowany współczynnik determinacji R2 — 0,26 (p = 0,000002). Niezależnymi czynnikami wpływającymi na adherence ocenianymi w ACDS były: subiektywna ocena stanu zdrowia (b = 0,48 ± 0,23; p = 0,036), wiek badanych (b = –0,11 ± 0,04; p = 0,004), więcej niż jeden pobyt w szpitalu z powodu CAD (b = –1,78 ± 0,87; p = 0,044) oraz cukrzyca (b = –2,02 ± 0,91; p = 0,029). Wnioski. Subiektywna ocena stanu zdrowia, wiek pacjentów, liczba hospitalizacji z powodu CAD oraz współwystępowanie cukrzycy wpływają na adherence w terapii przewlekłej po zawale serca.Introduction. The aim of this study was to assess adherence to treatment with use of the new scale in a population of patients with coronary artery disease (CAD) after myocardial infarction (MI) with respect to some socio-demographic and clinical factors. Material and methods. The study was conducted in a population of 100 consecutive patients (40 women, 60 men) aged from 30 to 88 years (mean 63.4), six months after hospitalization for MI. Results. The results of the assessment with the Adherence in Chronic Diseases Scale (ACDS) comprise between 6 and 28 points; median 24 points (21–28). Twenty-four patients had high score (> 26 pts.), 53 patients had intermediate score (between 21–26 pts.) and 23 — low score (< 21 pts.). For optimal model of multiple regression, the correlation coefficient R was 0.539; and the adjusted coefficient of determination R2 = 0.26, p = 0.000002. Independent factors affecting adherence according to the ACDS scale were: subjective assessment of health status (b = 0.48 ± ± 0.23, p = 0.036), age of the respondents (b = –0.11 ± 0.04, p = 0.004), more than one hospitalization due to CAD (b = –1.78 ± 0.87, p = 0.044), and diabetes mellitus (b = –2.02 ± 0.91, p = 0.029). Conclusions. Subjective assessment of health status, age of patients, the number of hospitalizations due to CAD and diabetes affect the adherence in the course of long-term treatment after myocardial infarction.

Przyczyny dyskwalifikacji pacjentów z chorobą Parkinsona z leczenia za pomocą głębokiej stymulacji mózgu

Choroba Parkinsona jest schorzeniem zwyrodnieniowym ośrodkowego układu nerwowego, w którym dochodzi do zmniejszenia aktywności układu dopaminergicznego, z towarzyszącymi zaburzeniami czynności wielu innych układów neuroprzekaźnikowych w jądrach podstawy i ich połączeniach. Choroba ma charakter postępujący i mimo stosowanego leczenia po pewnym czasie prowadzi do znacznego inwalidztwa. Po wyczerpaniu możliwości modyfikacji leczenia farmakologicznego u niektórych chorych można rozważyć leczenie neurochirurgiczne, którego celem jest poprawa jakości ich życia. Celem pracy była analiza najczęstszych przyczyn dyskwalifikacji z leczenia neurochirurgicznego za pomocą głębokiej stymulacji mózgu pacjentów z chorobą Parkinsona w Klinice Neurologicznej 10. Wojskowego Szpitala Klinicznego w Bydgoszczy. Analizą objęto 54 osoby z chorobą Parkinsona, w tym 38 mężczyzn i 16 kobiet, w wieku 48–82 lat, badanych w latach 2012–2014. Kryteriami dyskwalifikacji z leczenia neurochirurgicznego były: wiek powyżej 70 lat, czas trwania choroby krótszy niż 5 lat oraz ponad 15 lat, niewystarczająca odpowiedź na lewodopę (poprawa stanu ruchowego w fazie on w porównaniu z fazą off w III cz. UPDRS < 33%), poprawa stanu klinicznego po modyfikacji leczenia farmakologicznego, stwierdzenie otępienia lub innych zaburzeń psychicznych, w tym depresyjnych, a także istotnych zmian naczyniopochodnych w strukturach podkorowych mózgu oraz zanik korowy mózgowia w badaniu rezonansu magnetycznego. Najczęstszą przyczyną braku kwalifikacji do zabiegu głębokiej stymulacji mózgu były istotne zmiany naczyniopochodne w mózgowiu, co stwierdzono u 9 kobiet (56,2%) i 15 mężczyzn (39,4%). Drugą najczęstszą przyczyną w obu populacjach były nasilone zaburzenia depresyjne — u 6 kobiet (37,5%) i 14 mężczyzn (36,8%). Do leczenia operacyjnego chorych kwalifikował lekarz prowadzący; decyzja ta nie wynikała z sugestii chorego ani jego rodziny

Knowledge and learning preferences of patients with myocardial infarction

Introduction. The objective of the research was to study the knowledge about ischaemic heart disease and learning preferences of hospitalised patients as a result of myocardial infarction. Methods. The tested group comprised of 248 patients, aged 63 ± 11.25, who were hospitalised as a result of myocardial infarction A questionnaire with 20 single-choice questions was used in the research. The questionnaire tested the knowledge of the patients as far as ischaemic heart disease, myocardial infarction symptoms, and preventive healthcare are concerned. The patients were divided into groups depending on what knowledge sources on ischaemic heart disease they preferred — brochures, magazines, radio and TV, individual talks, group talks, films, the Internet. Results. The proportion of correct answers was 58.49 ± 19.89%; in the area of the disease knowledge 62.74 ± 31.52%; in the area of the preventive healthcare 57.14 ± 23.38%; and in the area of the disease symptoms 56.94 ± 25.84%. The source of health knowledge selected the most was educational brochures (80.2%), while radio and TV was selected the least (17.6%). The knowledge varied depending on patients’ preferences: so those who selected films — the knowledge of the disease symptoms was higher compared to the others (64.44 ± 26.93% vs. 55.27 ± 25.35%; p = 0.02; those who selected individual talks — the knowledge of the disease symptoms was lower compared to the others (55.33 ± 24.80 vs. 61.68 ± 26.51; p = 0.007); those who selected group talks — the knowledge of the disease symptoms was higher compared to the others (62.30 ± 28.07 vs. 55.16 ± 24.96; p = 0.02). As far the other two areas of knowledge are concerned, there were no significant differences in any group. Conclusions. Educational brochures are the most preferred source of knowledge about ischaemic heart disease by hospitalised patients as a result of myocardial infarction. The knowledge of ischaemic heart disease in patients with myocardial infarction is inadequate and it is not connected with patients’ preferences from the point of view of learning methods.

The readiness for hospital discharge of patients after acute myocardial infarction: a new self-reported questionnaire

Introduction. Medical care providers are responsible for adequate preparation of patients for discharge from the hospital. The purpose of this study was to validate a new self-reported questionnaire assessing the readiness of patients for hospital discharge. Methods. The Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD MIS) was validated in 201 patients, 57 (29%) females and 144 (71%) males (mean age 63.3 ± 11.3), hospitalised due to myocardial infarction. Results. For the considered 23 items the a-Cronbach coefficient was 0.789, indicating a high level of reliability and homogeneity of the questionnaire. The RHD MIS fulfilled the assumption of factor analysis: the determinant of correlation matrix was 0.001, Kaiser-Mayer-Olkin (K-M-O) statistic was 0.723, and the Bartlett’ test of sphericity was statistically significant. The analysis of internal consistency of the three areas confirm the rightness of the distinguishing of three subscales. Answers to each item were assigned a score from 0 to 3. The highest total score is 69 points. The total score of the scale and total scores of the subscales have skewed distributions and statistically significant results of Shapiro-Wilk test (p < 0.001). The scoring less than 44 points for the entire questionnaire indicates low readiness, obtaining between 44 and 57 points indicates medium readiness, and scores over 57 points are classified as high readiness for discharge from hospital. Conclusions. The validation procedure revealed that RHD MIS is a reliable and homogeneous tool to measure the readiness of patients for hospital discharge. The set of items divided into three subscales allows subjective and objective evaluation of the patient’s knowledge and expectations. Further investigation is needed to assess the potential impact of RHD MIS scoring on long-term outcome

The Adherence Scale in Chronic Diseases (ASCD). The power of knowledge: the key to successful patient — health care provider cooperation

Introduction. Patients’ adherence to long-term therapies is low. It translates into reduced quality of life and significant deterioration of health economics. Identification of potential barriers of medication-related adherence is a starting point allowing implementation of more advanced interventions directed to adherence improvement. Aim. The purpose of our study was to create and validate a simple instrument used to assess patients’ adherence to recommended medications. Material and methods. The Adherence Scale in Chronic Diseases is a self-reported questionnaire with 8 items and with proposed 5 sets of answers. The total score in the Adherence Scale in Chronic Diseases ranges from 0 to 32 points. Three levels of adherence were considered (low: scores of 0 to 20; medium 21 to 25; high > 26). The validation of the questionnaire was conducted in accordance with the validation procedure. Assessment of the internal consistency was performed using a-Cronbach coefficient. In order to conduct the factor analysis, we assessed: the determinant of correlation matrix, Kaiser-Mayer-Olkin (K-M-O) statistic and the Bartlett’s test of sphericity. Factor analysis was conducted using principal component analysis with Oblimin rotation. The Kaiser criterion and scree plot were used in order to determine components of the questionnaire. Adherence levels were determined based on the percentiles. Results. Grand total of 413 patients with a cardiovascular disease were included in the study. The reliability and homogeneity of the questionnaire were confirmed by a-Cronbach coefficient (0.739). Factor analysis showed that in this questionnaire we can extract two components. The analysis of factor loadings indicated excluding item 2 from the questionnaire. After exclusion of the mentioned item, we repeated the validation procedure. For such a new dataset, according to the Kaiser criterion, only one component was extracted. Conclusions. The Adherence Scale in Chronic Diseases is a practical, reliable, consistent and well validated instrument for identifying specific obstacles to medication adherence. Its simplicity causes that it can be successfully applied in daily practice by health care professionals. Our survey has the potential to improve patient — health care professional communication and relationship.

Climate indices of environmental change in the High Arctic: Study from Hornsund, SW Spitsbergen, 1979–2019

An analysis of a suite of climatological indices was undertaken on the basis of long-term (1979–2019) climatological data from the Polish Polar Station in Hornsund, SW Spitsbergen. It was followed by an attempt to assess the scale of their impact on the local environment. The temperature and precipitation indices were based on percentiles of the variables calculated for a population of daily values from the climate normals for 1981–2010. A greater share of both cyclonic and anticyclonic circulations from the S and SW sectors, forcing the advection of warm air masses from the south, was decisive for the trends of change in comparison with the long-term mean. Both extreme precipitation and drought events depend on the 500 hPa geopotential height and precipitable water anomalies, determined by the baric field over the North Atlantic. Climate changes impact on the dynamics of local geoecosystems by causing faster glacier ablation and retreat, permafrost degradation, intensification of the hydrological cycle in glaciated and unglaciated catchments, and changes in the condition and growth of tundra vegetation

Geophysical imaging of permafrost in the SW Svalbard – the result of two high arctic expeditions to Spitsbergen

"The Arctic regions are the place of the fastest observed climate change. One of the indicators of such evolution are changes occurring in the glaciers and the subsurface in the permafrost. The active layer of the permafrost as the shallowest one is well measured by multiple geophysical techniques and in-situ measurements." (fragm.

Recognition of the varying permafrost conditions in the SW Svalbard by multiple geophysical methods [abstract]

"In recent years, rapid climatic changes and their impact are widely visible and recognizable around the world. The Atlantic sector of the Arctic is the place of the strongest observed changes. As a result, such changes are already destabilizing the arctic systems including the glaciers and the permafrost that strongly affects the Arctic’s physical and biological systems."[...] (fragm.

Early administration of LEvosimendan in Patients witH decompensAted chroNic hearT failure (ELEPHANT) study. Rationale and protocol of the study

Dobutamine and levosimendan are both indicated for inotropic support in acute decompensated heart failure (HF). The study aimed to assess the impact of early administration of levosimendan (first iv therapeutic approach) versus dobutamine (first iv therapeutic approach) on in-hospital treatment expenses and clinical outcomes in patients with decompensated chronic HF. The ELEPHANT study was designed as a phase III, multicentre, randomized 1:1, double-blind, active-controlled trial that will include patients admitted to the hospital due to HF decompensation. Co-primary endpoints were defined as total in-hospital expenses/survivor and duration of hospitalization/survivor. Secondary efficacy endpoints: on the last day of hospitalization: occurrence of treatment side effects, body weight change during hospitalization, BNP change during hospitalization, in-hospital mortality, additional levosimendan administration due to the ineffectiveness of the initial treatment. Patients will be randomized 1:1 to the active group receiving continuous infusion 24 h of levosimendan 0.1 μg/kg/min or to the control group receiving continuous infusion 24 h of dobutamine 3 μg/kg/min. After the enrolment of 20 patients, results analysis will be performed (pilot phase — single centre). Based on this analysis conducted according to the intention-to-treat principle, the final population size will be defined. The multicentre phase of the study will be initiated after the pilot phase