New European tricksters: Polish jokes in the context of European Union labour migration

In the context of contemporary European labour migration, where the most publicised pattern of labour migration sees Eastern European migrants move West, the dominant scholarly interpretation of Polish jokes is not applicable for the analysis of much of the joking by or about the Poles. Humour scholars frequently categorise jokes about ethnic groups into stupid or canny categories, and the Poles have been the butt of stupidity (‘Polack’) jokes in Europe and the United States. Today, in the European Union, Polish stupidity stereotyping in humour is less active and the Polish immigrant is hard working and a threat to indigenous labour, yet joking does not depict this threat in a canny Pole. The article applies the liminal concept of the trickster – an ambiguous border crosser or traveller – to elaborate some of the characteristics of jokes told by and about Polish migrants in the EU, mainly in the British context. A more robust explanatory framework is thus offered than is currently available in humour studies

Running a hospital patient safety campaign: a qualitative study

Purpose – Research on patient safety campaigns has mostly concentrated on large-scale multi-organisation efforts, yet locally led improvement is increasingly promoted. The purpose of this paper is to characterise the design and implementation of an internal patient safety campaign at a large acute National Health Service hospital trust with a view to understanding how to optimise such campaigns. Design/methodology/approach – The authors conducted a qualitative study of a campaign that sought to achieve 12 patient safety goals. The authors interviewed 19 managers and 45 frontline staff, supplemented by 56 hours of non-participant observation. Data analysis was based on the constant comparative method. Findings – The campaign was motivated by senior managers’ commitment to patient safety improvement, a series of serious untoward incidents, and a history of campaign-style initiatives at the trust. While the campaign succeeded in generating enthusiasm and focus among managers and some frontline staff, it encountered three challenges. First, though many staff at the sharp end were aware of the campaign, their knowledge, and acceptance of its content, rationale, and relevance for distinct clinical areas were variable. Second, the mechanisms of change, albeit effective in creating focus, may have been too limited. Third, many saw the tempo of the campaign as too rapid. Overall, the campaign enjoyed some success in raising the profile of patient safety. However, its ability to promote change was mixed, and progress was difficult to evidence because of lack of reliable measurement. Originality/value – The study shows that single-organisation campaigns may help in raising the profile of patient safety. The authors offer important lessons for the successful running of such campaigns.The Department of Health Policy Research programme as part of a wider programme of research on behavioural and cultural change to support quality and safety in the NHS. Write up of this paper was supported by a Wellcome Trust Senior Investigator award (MDW) WT097899

Diagnosis, clinical course, and 1-year outcome in patients hospitalized for heart failure with preserved ejection fraction (from the Polish Cohort of the European Society of Cardiology Heart Failure Long-Term Registry)

[Abstract] Compared with heart failure (HF) with reduced ejection fraction (HF-REF), the diagnosis of HF with preserved EF (HF-PEF) is more challenging. The aim of the study was to assess the prevalence of HF-PEF among patients hospitalized for HF, to evaluate the pertinence of HF-PEF diagnosis and to compare HF-PEF and HF-REF patients with respect to outcomes. The analysis included 661 Polish patients hospitalized for HF, selected from the European Society of Cardiology (ESC)-HF Long-Term Registry. Patients with an EF of ≥50% were included in the HF-PEF group and patients with an EF of <50% - in the HF-REF group. The primary end point was all-cause death at 1 year. The secondary end point was a composite of all-cause death and rehospitalization for HF at 1 year. HF-PEF was present in 187 patients (28%). Of those 187 patients, mitral inflow pattern was echocardiographically assessed in 116 patients (62%) and classified as restrictive/pseudonormal in 37 patients (20%). Compared with HF-REF subjects, patients with HF-PEF were older, more often female, and had a higher prevalence of hypertension, atrial fibrillation and sleep apnea. Despite lower B-type natriuretic peptide concentrations and lower prevalence of moderate-to-severe mitral regurgitation in patients with HF-PEF, congestive symptoms at admission were as severe as in patients with HF-REF. There were no significant differences in in-hospital mortality between the HF groups. One-year mortality was high in both groups (17% in HF-PEF vs 21% in HF-REF, p = 0.22). There was a trend toward a lower frequency of the secondary end point in the HF-PEF group (32% vs 40%, p = 0.07). In conclusion, in clinical practice, even easily obtainable echocardiographic indexes of diastolic dysfunction are relatively rarely acquired. One-year survival rate of patients with HF-PEF is not significantly better than that of patients with HF-REF

Fifteen-year differences in indications for cardiac resynchronization therapy in international guidelines—insights from the heart failure registries of the European Society of Cardiology

[Abstract] Cardiac resynchronization therapy (CRT) applied to selected patients with heart failure (HF) improves their prognosis. In recent years, eligibility criteria for CRT have regularly changed. This study aimed to investigate the changes in eligibility of real-life HF patients for CRT over the past fifteen years. We reviewed European and North American guidelines from this period and applied them to HF patients from the ESC-HF Pilot and ESC-Long-Term Registries. Taking into consideration the criteria assessed in this study (including all classes of recommendations i.e., class I, IIa and IIb, as well as patients with AF and SR), the 2013 (ESC) guidelines would have qualified the most patients for CRT (266, 18.3%), while the 2015 (ESC) guidelines would have qualified the least (115, 7.9%; p-value for differences between all analyzed papers &lt;0.0001). There were only 26 patients (1.8%) who would be eligible for CRT using the class I recommendations across all of the guidelines. These results demonstrate the variability in recommendations for CRT over the years. Moreover, this data indicates underuse of this form of pacing in HF and highlights the need for more studies in order to improve the outcomes of HF patients and further personalize their management

Anemia at hospital admission and its relation to outcomes in patients with heart failure (from the polish cohort of 2 European Society of Cardiology Heart Failure Registries)

[Abstract] Anemia is a commonly observed co-morbidity in heart failure (HF). The aim of the study was to assess prevalence, risk factors for, and effect of anemia on short- and long-term outcomes in HF. The study included 1,394 Caucasian patients hospitalized for HF, with known hemoglobin concentration on hospital admission, participating in 2 HF registries of the European Society of Cardiology (Pilot and Long-Term). Anemia was defined as hemoglobin concentration of <13 g/dl for men and <12 g/dl for women. Primary end points were (1) all-cause death at 1 year and (2) a composite of all-cause death and rehospitalization for HF at 1 year. Secondary end points included inter alia death during index hospitalization. In addition, we investigated the effect of changes in hemoglobin concentration during hospitalization on prognosis. Anemia occurred in 33% of patients. Predictors of anemia included older age, diabetes, greater New York Heart Association class at hospital admission and kidney disease. During 1-year follow-up, 21% of anemic and 13% of nonanemic patients died (p <0.0001). Combined primary end point occurred in 45% of anemic and in 33% of nonanemic patients (p <0.0001). Anemia was strongly predictive of all the prespecified clinical end points in univariate analyses but not in multivariate analyses. Changes in hemoglobin concentration during hospitalization had no effect on 1-year outcomes. In conclusion, anemia was present in 1/3 of patients with HF. Mild-to-moderate anemia seems more a marker of older age, worse clinical condition, and a higher co-morbidity burden, rather than an independent risk factor in HF

Differences in clinical characteristics and 1-year outcomes of hospitalized patients with heart failure in ESC-HF Pilot and ESC-HF-LT registries

[Abstract] INTRODUCTION The management of heart failure (HF) has changed significantly in recent decades. OBJECTIVES We analyzed the clinical profile, 1‑year outcomes, predictors of mortality, and hospital readmissions in hospitalized patients enrolled in the European Society of Cardiology Heart Failure Pilot Survey (ESC‑HF Pilot) and Heart Failure Long‑Term Registry (ESC‑HF‑LT). PATIENTS AND METHODS The analysis included hospitalized Polish patients from both registries. The primary endpoint was all‑cause death at 1 year, while the secondary endpoint was all‑cause death or hospitalization for worsening HF at 1 year. RESULTS The study included a total of 1415 hospitalized patients (650 from ESC‑HF Pilot; 765 from ESC‑HF‑LT). The primary endpoint occurred in 89 of the 650 patients (13.7%) and in 120 of the 711 patients (16.9%) from ESC‑HF Pilot and ESC‑HF‑LT, respectively (P = 0.11). The secondary endpoint was more frequent in ESC‑HF Pilot than in ESC‑HF‑LT (201 of 509 [39.5%] vs 222 of 663 [33.5%]; P = 0.04). Compared with ESC‑HF Pilot, patients from the ESC‑HF‑LT registry were older and more often had hypertension, atrial fibrillation, peripheral artery disease, and chronic kidney disease, while the incidence of chronic obstructive pulmonary disease was lower. The percentage of patients receiving drugs for HF (diuretics, angiotensin‑converting enzyme inhibitors, angiotensin receptor blockers, β‑blockers, mineralocorticoid receptor antagonists), anticoagulants, cardiac resynchronization therapy, and implantable cardioverter‑defibrillator were higher in the ESC‑HF‑LT group in comparison with the ESC‑HF Pilot group. CONCLUSIONS Patients from the ESC‑HF‑LT registry had a lower risk of death or hospitalization for worsening HF despite the fact that they were older and had more comorbidities. The results might suggest an improvement in physicians’ adherence to the guidelines on the management of HF in the ESC‑HF‑LT registry

One-year outcome in patients with heart failure with mid-range ejection fraction hospitalized due to worsening heart failure

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Effect of β-blockers on 1-year survival and hospitalizations in patients with heart failure and atrial fibrillation: results from ESC-HF pilot and ESC-HF long-term registry

[Abstract] Introduction The positive effect of β-blocker therapy in patients with heart failure (HF) and atrial fibrillation (AF) has been questioned. Objectives We aimed to assess the effect of β-blockers and heart rate (HR) control on 1-year outcomes in patients with HF and AF. Patients and methods Of the 2019 Polish patients enrolled in ESC-HF Pilot and ESC-HF Long-Term Registry, 797 patients with HF and AF were classified into 2 groups depending on β-blocker use. Additionally, patient survival was compared between 3 groups classified according to HR: lower than 80 bpm, between 80 and 109 bpm, and of 110 bpm or higher. The primary endpoint was all-cause death and the secondary endpoint was all-cause death or HF hospitalization. Results In patients treated with β-blockers, the primary and secondary endpoints were less frequent than in patients not using β-blockers (10.9% vs 25.6%, P = 0.001 and 30.6% vs 44.2%, P = 0.02, respectively). Absence of β-blocker treatment was a predictor of both endpoints in a univariate analysis but remained an independent predictor only of the primary endpoint in a multivariate analysis (hazard ratio for β-blocker use, 0.52; 95% CI, 0.31–0.89; P = 0.02). The primary and secondary endpoints were more frequent in patients with a HR of 110 bpm or higher, but the HR itself did not predict the study endpoints in the univariate analysis. Conclusions β-blocker use might decrease mortality in patients with HF and AF, but it seems to have no impact on the risk of HF hospitalization. An HR of 110 bpm or higher may be related to worse survival in these patients

The prevalence and association of major ECG abnormalities with clinical characteristics and the outcomes of real-life heart failure patients - Heart Failure Registries of the European Society of Cardiology

[Abstract] Background: Electrocardiogram (ECG) abnormalities increase the likelihood of heart failure (HF) but have low specificity and their occurrence is multifactorial. Aim: This study aimed to investigate the prevalence and association of major ECG abnormalities with clinical characteristics and outcomes in a large cohort of real-life HF patients enrolled in HF Registries (Pilot and Long-Term) of the European Society of Cardiology. Methods: Standard 12-lead ECG containing at least one of the following simple parameters was considered a major abnormality: abnormal rhythm; >100 bpm; QRS ≥120 ms; QTc ≥450 ms; pathological Q-wave; left ventricle hypertrophy; left bundle branch block. A Cox proportional hazards regression model was used to identify predictors of the primary (all-cause death) and secondary (all-cause death or hospitalization for worsening HF) endpoints. Results: Patients with abnormal ECG (1222/1460; 83.7%) were older, more frequently were male and had HF with reduced ejection fraction, valvular heart disease, comorbidities, higher New York Heart Association class, or higher concentrations of natriuretic peptides as compared to those with normal ECG. In a one-year follow-up, the primary and secondary endpoints occurred more frequently in patients with abnormal ECG compared to normal ECG (13.8% vs 8.4%; P = 0.021 and 33.0% vs 24.7%; P = 0.016; respectively). Abnormal rhythm, tachycardia, QRS ≥120 ms, and QTc ≥450 ms were significant in univariable (both endpoints) analyses but only tachycardia remained an independent predictor of the primary endpoint. Conclusions: HF patients with major ECG abnormalities were characterized by worse clinical status and one-year outcomes. Only tachycardia was an independent predictor of all-cause death

Ischemic cardiomyopathy versus non-ischemic dilated cardiomyopathy in patients with reduced ejection fraction-clinical characteristics and prognosis depending on heart failure etiology (data from European Society of Cardiology heart failure registries)

[Abstract] Personalized management involving heart failure (HF) etiology is crucial for better prognoses for HF patients. This study aimed to compare patients with ischemic cardiomyopathy (ICM) and patients with non-ischemic dilated cardiomyopathy (NIDCM) in terms of baseline characteristics and prognosis. We assessed 895 patients with HF with reduced left ventricular ejection fraction participating in the Polish part of the European Society of Cardiology (ESC)-HF registries. ICM was present in 583 patients (65%), NIDCM in 312 patients (35%). The ICM patients were older (p < 0.001) and had more comorbidities. The NIDCM patients more frequently had atrial fibrillation (p = 0.04) and lower LVEF (p = 0.01); therefore, they were treated more often with anticoagulants (p = 0.01) and digitalis (p < 0.001). The NIDCM patients were prescribed aldosterone antagonists more often (p = 0.01). There were no other differences as regards the use of HF guideline-recommended medications, implantable cardioverter defibrillators or cardiac resynchronization therapy. The ICM patients were more likely to be treated with statins (p < 0.001) and antiplatelet agents (p < 0.001). All-cause death, as well as all-cause death and readmissions for HF at 12 months, occurred more often in the ICM group compared with the NIDCM group (15.9% vs. 10%, p = 0.016; and 40.9% vs. 28.6%, p = 0.00089, respectively). ICM etiology was an independent predictor of the composite endpoint in the total cohort (p = 0.003). The ICM patients were older and had more comorbidities, whereas the NIDCM patients had lower LVEF. One-year prognosis was worse in the ICM patients than in the NIDCM patients. ICM etiology was independently associated with a worse one-year outcome