Sprawność funkcjonalna polskich stulatków

The functional status of Polish centenarians For elderly subjects their independence in activities of daily living is the most important. The aim of the study was to characterize the functional status of Polish centenarians based on their independence in the basic activities of daily living according to ADL scale and their cognitive functions estimated by MMSE. The study included centenarians of PolStu 2001 program. ADL was estimated in 340 subjects (292 females and 48 males) but MMSE only in 293 mainly due to severe hearing impairment (251 females and 42 males). Only 4.8% of studied centenarians (14 subjects) had no dementia according to MMSE and was independent in ADL (ADL 0). Their was 9 females and 5 males (3.6% vs. 11,9%; p=0,016).The strong positive correlation was found between the results obtained in ADL and MMSE (p=0,000). It seems possible that cognitive impairment is a very important component of ADL. Further studied are necessary to prove this hypothesis

Pain management and functional recovery after pericapsular nerve group (PENG) block for total hip arthroplasty: A prospective, randomized, double-blinded clinical trial

Background: The immediate postoperative period after total hip arthroplasty can be associated with significant pain. Therefore, this study aimed to evaluate the effect of pericapsular nerve block on pain management and functional recovery after total hip arthroplasty. Methods: This prospective, randomized, double-blinded, placebo-controlled trial was conducted on 489 adult patients scheduled for total hip arthroplasty, ASA 1-2, operated under spinal analgesia. Participants were assigned to receive either a pericapsular nerve group (PENG) block with 20 mL of 0.5% ropivacaine or a sham block. Results: The primary outcome measure was the postoperative NRS score in motion. The secondary outcomes were cumulative opioid consumption, the time to the first opioid, and functional recovery. Demographic characteristics were similar in both groups. Intraoperative pain scores were significantly lower in patients who received the PENG block than in the control group (p < 0.0001). Also, the time to the first opioid was considerably longer in the PENG group (p < 0.0001). Additionally, 24% of PENG patients did not require opioids (p < 0.0001). Conclusions: The pericapsular nerve group showed significantly decreased opioid consumption and improved functional recovery. Pericapsular nerve group block improved pain management and postoperative functional recovery following total hip arthroplasty

Validity of the EASYCare Standard 2010 assessment instrument for self-assessment of health, independence, and well-being of older people living at home in Poland

EASYCare Standard 2010 is a brief instrument identifying concerns in health, functional independence, and well-being, from older persons’ perspective. It has not previously been validated for self-assessment. Our aim was to determine whether self-assessment (EC1) can give comparable results to an evaluation performed by professionals (EC2), for older people living at home. The study included community-dwelling individuals (aged at least 60 years, n = 100; 67 females) without dementia (abbreviated mental test score [AMTS] above 6). It comprised two assessments (self and professional), including summarising indexes: Independence score [IS], Risk of breakdown in care [RBC], Risk of falls [RF], performed within a period between 1 and 2 weeks. Additionally, during EC1, reference tests of physical and mental function (Barthel Index: 96.3 ± 6.5, Lawton scale: 6.7 ± 2.0, geriatric depression scale: 3.0 ± 2.7, AMTS: 10.2 ± 1.0) were applied to test for concurrent validity. Cohen’s kappa values (self-assessment vs. professional assessment) across all EASYCare domains were high (0.89–0.95). Results of all summarising indexes derived from self-assessment correlated strongly with reference tests. No differences were found in IS and RBC between EC1 and EC2 (8.6 ± 12.0 vs. 9.0 ± 12.7 and 1.0 ± 1.1 vs. 1.2 ± 1.4). Results of RF were higher in EC2 (1.0 ± 1.1 vs. 1.1 ± 1.4; p = 0.005), due to a different response to the item “Do you feel safe outside your home?” We conclude that self-assessment with EASYCare Standard in older people without severe functional impairment living at home can deliver valid results, similar to those obtained through professional assessment, thus providing an efficient system for assessment of relatively independent individuals

Knowledge of medical students on the use of opioids in the management of pain in patients receiving palliative care

Introduction. Pre- and post-graduate education, provided for many years, has quite significantly changedthe perception of the role of opioids in the treatment of patients with pain, mainly chronic pain. However,research on the knowledge of students on opioids has not been conducted, which makes it difficult toimplement desired changes in educational programmes. The aim of the paper was to evaluate the knowledgeof medical students on selected opioid drugs: tramadol, buprenorphine and oxycodone, based ona survey filled in after one-week classes in palliative medicine and pain management.Respondents and methods. The study included 140 fourth-year students of medicine at the University ofMedical Sciences in Poznań who completed one-week classes in palliative medicine and pain management.Their knowledge on opioid analgesics was checked using an anonymous survey that included 7 statements.Results. Students demonstrated better knowledge in statements regarding theoretical aspects of the useof specific opioids and their mechanisms of action. The percentage of correct answers in the group ofstatements concerning the availability of specific opioid analgesics was much lower, which confirms thatthey have less knowledge in this area.Conclusions. Paying attention to the characteristics of specific opioids should improve the individual selection,effectiveness and safety of treatment. Better knowledge on pain management among students,doctors and the general public may dispel their concerns about using opioid analgesics as well as increasethe effectiveness of pain management and improve the quality of life of patients with cancer and chronicpain in palliative care

Use of renal risk drugs in a nation-wide Polish older adult population : an analysis of PolSenior database

Abstract Background Numerous medications should be avoided, or require dose adjustment in subjects with impaired kidney function. We aimed to assess the prevalence of potentially inappropriate use of renal risk drugs in a nation-wide, community-dwelling Polish older adult population. Methods We analysed regular intake of 38 medications that should be avoided, requiring dose modification, increase the risk of pre-renal kidney injury, or may cause potassium retention in subjects with moderately to severely impaired renal function in the PolSenior data base (N = 4514, mean age 76 ± 11 yrs). Kidney function was assessed with short Modification of Diet in Renal Disease formula estimated glomerular filtration rate (sMDRD) and Cockcroft-Gault creatinine clearance (CC). Results There were 855 (19%) individuals with sMDRD < 60 ml/min/1.73m2, and 1734 (38%) with CC <  60 ml/min. Among drugs that should be avoided, spironolactone (20.4% of patients as classified by sMDRD and 17.5% by CC), non-steroidal anti-inflammatory drugs (13.4 and 11.3%), hydrochlorothiazide (11.1 and 11.0%), and metformin (6.9 and 8.2%) were most frequently used. The most frequently used drugs requiring dose modification were piracetam (13.9% by sMDRD, and 11.9% by CC), digoxin (8.3 and 8.8%), and gliclazide (6.8 and 5.9%). Classification of a drug use as ‘appropriate’ or ‘inappropriate’ was discordant depending on the method of kidney function assessment (sMDRD or CC) in up to 30%. Subgroups with sMDRD < 60 ml/min/1.73m2 and with CC <  60 ml/min were taking ≥2 drugs increasing the risk of pre-renal kidney injury more frequently than individuals with better kidney function (46.6 vs. 23.1 and 33.0% vs. 24.4%, respectively). There were 24.7% of individuals with sMDRD < 60 ml/min/1.73m2 and 18.0% with CC <  60 ml/min taking 2 or more drugs increasing serum potassium level. The proportion of subjects with hyperkalaemia increased with the number of such drugs. Conclusions Use of drugs that should be avoided or require dose adjustment due to renal impairment, and potentially inappropriate drug combinations is a common problem in older adults in Poland. Assessment of kidney function with sMDRD may result in overlooking of requirements for dose adjustment formulated based on creatinine clearance. Trial registration Not applicable

The Camberwell Assessment of Need for the Elderly questionnaire as a tool for the assessment of needs in elderly individuals living in long-term care institutions

AbstractObjectivesThe aim of the study was to evaluate the Camberwell Assessment of Need for the Elderly questionnaire (CANE) in assessing the needs of elderly individuals living in long-term care institutions (LTCI) in Poland.Setting and ParticipantsThe needs of 173 residents were assessed. The inclusion criteria were age (at least 75 years of age) and the lack of severe cognitive impairment (Mini Mental Scale Examination score of at least 15 points).MeasurementsIn all participants, met and unmet needs were assessed by themselves and by the nursing staff involved in care activities.ResultsThe number of met needs assessed by the staff was higher than in the users’ opinions (p<0.0001), whereas the number of unmet needs was lower (p<0.001). However, the average percentage of the agreement between the user and the staff was as high as 86.2%. The areas characterized by the lowest agreement were Company (65.3%), Memory (75.7%), Eyesight/hearing/communication (70.5%) and Psychological distress (70.5%).ConclusionsDespite a high percentage of agreement reached between the staff and user assessments of needs in our study, we were able to identify the areas of discrepancies between these two perceptions of needs. These can be treated as signals pointing to those aspects of care that should be addressed

An Experimental Education Project for Consultations of Older Adults during the Pandemic and Healthcare Lockdown

Objective: To develop a mentor-supervised, interprofessional, geriatric telemedicine experiential education project in response to the COVID-19 pandemic. Method: Medical and pharmacy students collaborated via remote consultations to address the coexistence of multimorbidity and polypharmacy in geriatric patients. In-depth interviews of students and patients as well as Likert scale-based telephonic survey were performed for a comprehensive evaluation of the project’s significance. Results: To date, 49 consultations have been conducted. Remote consultations performed by medical and pharmacy students working collaboratively were beneficial for both students, participants. Conclusions and Practice Implications: This experimental education project provided students with authentic challenges while simultaneously delivering care to the older adults who are susceptible to disruption of care associated with the pandemic. Further development and expanded implementation of such approaches may be a post-pandemic practice to provide more accessible care for senior patients while incorporating interprofessional education

Dialysis solution containing hyaluronan: Effect on peritoneal permeability and inflammation in rats

Dialysis solution containing hyaluronan: Effect on peritoneal permeability and inflammation in rats.BackgroundHyaluronan (HA), a high molecular weight mucopolysaccharide found in interstitial tissues and fluid, is lost from the peritoneal cavity during peritoneal dialysis. In order to determine the role of HA in peritoneal function, we investigated the effects of exogenous HA on peritoneal permeability, markers of intraperitoneal inflammation, and peritoneal morphology in rats exposed to peritoneal dialysis solution for four weeks.MethodsWistar rats were infused intraperitoneally, twice daily, with conventional, hypertonic dialysis solution (Dianeal 3.86%; control) or Dianeal solution containing 10 mg/dL of high molecular weight HA. Peritoneal permeabilities and clearances of solutes and protein were determined using a modified peritoneal permeability test (peritoneal equilibration test) at the beginning and the end of the treatment. Peritoneal volume and ultrafiltration were determined using a macromolecular marker and by gravimetric methods. Peritoneal inflammation was determined by cell counts and differential and by the measurement of cytokine concentrations in the dialysate effluent. Peritoneal thickness and HA content were determined in liver and mesentery biopsies taken at the end of the experiment.ResultsAfter four weeks of exposure to the dialysis solution, transperitoneal protein equilibration was significantly lower in HA-treated rats compared with rats treated with Dianeal alone (46% lower for albumin, P < 0.001; 33% lower for total protein, P < 0.001). The total drained volume after a four hour dwell was 29% higher in the HA group compared with the control (P < 0.001), yielding a positive net ultrafiltration in the HA group versus a negative net ultrafiltration in controls. Peritoneal clearances of urea and creatinine tended to be elevated in HA-treated rats, while clearances of total protein and albumin tended to be lower. Dialysate effluent from rats exposed to HA contained a lower percentage of neutrophils (8.8 ± 6.7 vs. 22.8 ± 9.5%, P < 0.01) and lower levels of the cytokines, tumor necrosis factor-α (11.2 ± 14.7 vs. 42.3 ± 35.3 pg/mL, P < 0.05) and monocyte chemoattractant protein-1 MCP-1 (72.0 ± 86.5 vs. 402.4 ± 258.3 pg/mL, P < 0.02), compared with rats treated with Dianeal alone. The thickness of the peritoneal interstitium showed a similar increase in both groups, but mesenteric tissue from the HA group contained more HA (48%, P < 0.01) than tissue from control animals.ConclusionsThe addition of HA to peritoneal dialysis solution decreases protein permeability, increases ultrafiltration, and decreases cytokine levels and the proportion of peritoneal neutrophils in dialysate from rats exposed to hypertonic dialysis solution. These results suggest that exogenous HA may help to protect the peritoneal membrane during exposure to dialysis solutions. These benefits, if sustained in the clinical setting, could lead to improvements in the therapy of peritoneal dialysis