Hospitals In Poland Research Articles

Practice in bronchiolitis management in Polish hospitals—a multicenter retrospective cohort study

Bronchiolitis is one of the main reasons for the hospitalization of young children. Based on updated recommendations, only supportive therapy is recommended for treatment. In Poland, many children that are hospitalized with bronchiolitis undergo a treatment that is not supported by current research. The study aimed to assess clinicians’ adherence to the guidelines. This was a multicenter retrospective study of hospitalized infants with bronchiolitis; a cohort study design was utilized. Data were collected in four Pediatric Departments in Poland. All infants aged less than 24 months that had been hospitalized for their first and subsequent episodes of acute bronchiolitis from January 1, 2021, to December 31, 2022, were included. The exclusion criterion was an age over 24 months. A total of 629 infants with a median age of 8.5 months were included in this study. The medical interventions and treatments varied between the four hospitals. Laboratory blood tests were run for almost all children (99.5%), and the percentage of children for which a chest X-ray was performed ranged from 1.3% to 44%. The other measures were the use of intravenous hydration (51.3%-93.3%), use of hypertonic saline nebulization (1.3%-43.6%), use of normal saline nebulization (10%-95.1%), use of oxygen (7.3%-42%), use of beta-mimetics (19.1%-89.4%), use of nebulized steroids (8%-76.9%), use of systemic steroids (0.9%-42%), use of nebulized adrenaline (0%-8.1%), and use of antibiotics (12%-21.8%).Conclusions: In total, 70% of infants who were hospitalized in four hospitals in Poland underwent examinations and treatment methods that are not supported by current guidelines and evidence-based research. This study shows that non-recommended medications are overused in bronchiolitis treatment, and there is a need to take action to implement the guidelines into healthcare providers’ work.What is Known:• Bronchiolitis is a lower respiratory tract viral infection and is one of the main reasons for hospitalization among young children.• Only supportive therapy is recommended in the guidelines.• Bronchodilators, nebulized adrenaline, nebulized or systemic steroids, and antibiotics are not recommended.What is New:• Non-recommended medications are overused in bronchiolitis treatment in Poland.• Up to 70% of hospitalized children in the studied centers underwent treatment that is not supported by guidelines.

Evaluation of the Use of Methylation as a New Tool for the Diagnostics and Progression of Squamous Intraepithelial Lesions

Vaccination against human papillomavirus (HPV) significantly reduces the incidence of HPV-related lesions worldwide. Considering the increasingly young age of patients in gynecological offices and earlier sexual initiation and potential contact with the HPV virus, doctors need the tools to verify diagnoses. Currently, women plan to pursue motherhood later, so it is necessary to consider whether sexual treatment in the form of, among others, loop electrosurgical excision procedures (LEEPs) may increase the risk of premature birth or difficulty dilating the cervix during labour. For this reason, to avoid the overtreatment of low-grade squamous intraepithelial lesions (LSILs), methylation testing may be considered. In patients with histopathologically confirmed high-grade squamous intraepithelial lesions (HSILs) during biopsy and, ultimately, a lower diagnosis, i.e., LSIL or no signs of atypia, methylation was found to be a useful tool. We performed a Pap smear, HPV genotyping, a punch biopsy, LEEP-conization (if needed), and methylation tests on 108 women admitted to the District Public Hospital in Poland. Women with a negative methylation test result were significantly more likely to be ultimately diagnosed with LSIL (p = 0.013). This means that in 85.7% of the patients with HSIL, major cervical surgery could be avoided if the methylation test was negative. Methylation testing, as well as dual-staining and diagnostics detecting the mRNA transcripts of highly oncogenic types of HPV, might be used in the future in the diagnosis of pre-cancerous conditions, mainly of the cervix, and in HPV-dependent cervical cancer screening. The methylation test may also be used in the diagnosis and identification of lesions within the cervical canal, including those located deep within the frontal crypts, not visible even during a professional colposcopic evaluation of the cervix.

The prevalence, patients characteristics and risk factors of hyper-Lp(a)-emia in the Polish population. The first results from the PMMHRI-Lp(a) Registry

Abstract Background Based on the recent data and existing guidelines Lp(a) is recognized, independent CVD risk factor. However, the knowledge on the prevalence of elevated Lp(a) levels, patients characteristics as well as non-genetic risk factors is scarce from some world regions including from Poland, the largest CEE country. Purpose We aim to present the first results from the Lp(a) registry established in the 2nd largest hospital in Poland - Polish Mother’s Memorial Hospital Research Institute (PMMHRI). Methods The PMMHRI-Lp(a)-Registry was established in 2022. The indications for Lp(a) measurement in the registry are based on the 2021 Polish Lipid Guidelines and new Polish recommendations on the management with elevated Lp(a) (2024). The PMMHRI-Lp(a)-Registry is a part of the being founded Lp(a) National Registry of the Polish Lipid Association. Results Based on the data from 302 consecutive patients (mean age 52.18 years; women 53%) the mean Lp(a) level was 30.3±39.4 mg/dl; it was numerically higher in woman (32.8 mg/dl), but there were no significant sex differences (men: 27.5 mg/dl; p=0.245). There were also no significant differences between those with and without CAD, stroke, HF, cancer, diabetes, kidney disease, and thyroid disease. The significant Lp(a) level difference was observed in those with diagnosed dyslipidemia in comparison to those without (31.9±40.6 vs 17.7±25.8 mg/dl, p=0.044) and in those with the history of myocardial infarction (MI) vs those without (50.1±50.3 vs 28.1±37.5 mg/dl, p=0.004). However, when we divided those with MI on premature vs no premature, no significant difference in Lp(a) level was observed (41,6±41.9 vs 57.6±56.7 mg/dl, p=0.39). Lipid lowering therapy did not significantly affect Lp(a) level, with only significant differences in those treated with ezetimibe (as a part of the combination therapy; 39.5±47.6 vs 27.5±36.3 mg/dl, p=0.027). For selected patients (n=31; 10.3%) with two Lp(a) measurements (mean time distance: 7±5 months) we did not observe any significant visit-to-visit variability (mean difference: 0.81 mg/dl; z=0.256, p=0.262) (Fig. 1). We did not also observe any percentage differences in variables (besides MI history, p=0.017) for different Lp(a) risk groups: 0-30, >30-50, >50-180 and >180 mg/dl. While dividing the population on those with Lp(a) ≤30 mg/dl vs >30 mg/dl, the only differences were seen for dyslipidemia diagnosis (p=0.044) and MI occurrence (6.98 vs 17.24%; p=0.007). Similar pattern was observed while dividing the whole population on those with Lp(a) ≤50 vs >50 mg/dl (Fig. 2). Conclusions These results strongly emphasize that Lp(a) should be measured commonly, as its high level is highly prevalent in patients at the risk both in primary and secondary prevention, what require risk re-stratification and treatment optimization. This is especially important in the regions that characterize of baseline high CVD risk, what refers to most of the CEE countries, including Poland.

Preliminary results from the Polish Infective Endocarditis Registry (POL-ENDO): time to change clinical approach?

Abstract Background/Aims: Infective endocarditis (IE) is a severe valve disease associated with high morbidity and mortality. The aim of this preliminary study was to evaluate the profile and treatment outcomes of IE in Poland based on the POL-ENDO registry. Methods A prospective cohort, multicenter, observational study - the POL ENDO registry - of IE patients from 134 hospitals in Poland recruited between August 2022 and August 2023 was performed. We evaluated demographic, clinical, imaging, and treatment outcome data. A comparison of the Polish patients with those assessed in the ESC-EORP EURO-ENDO registry was performed. Results Among a total of 880 IE patients, 622 were male (70.7%). The POL-ENDO participants were older (61.4±16.7 years vs. 59.25±18.03 years, p=0.001). Native valve IE (NVIE) occurred more often in Poland (82.3% vs. 56.6%, p <0.001). Transthoracic echocardiography (TTE) was performed more frequently in Poland (93.6% vs. 89.8% p<0.001). New imaging techniques (CT/MRI/PET/SPECT) were less frequently used in Poland (CT: 53.2% vs. 41.3%, p<0.001; MRI: 18.7% vs. 6.4%, p<0.001). Heart failure (HF) occurred more often in Poland as inhospital complication (31.4% vs. 14%, p<0.001). Surgical treatment was less performed in Poland (51.2% vs. 36.9%, p<0.001). Inhospital mortality was higher in Poland (21% vs. 17%, p=0.008). Conclusion Polish patients with IE were significantly older and more comorbid. New imaging techniques are less frequently used in Poland. Echocardiography was performed more frequently in Poland as the diagnostic mainstay. Surgical treatment was significantly less frequent in Poland. Inhospital mortality in Poland is greater. The change of clinical practice in Poland should be considered.

Clinical reality and challenges with familial hypercholesterolemia patients management. 2024 results from the Regional Center for Rare Diseases (RCRD) Registry in Poland

Abstract Background HeFH is one of the most prevalent genetic diseases significantly increasing the risk of CVD events and mortality. Despite new achievements with earlier diagnosis and new effective drugs, most of heFH patients do not achieve LDL-C goal and are still on residual CVD risk. Purpose We aimed to present the most recent data from the regional FH registry in Poland to show the challenges and reality of everyday clinical management with FH patients. Methods The registry is conducted at the RCRD in the 2nd largest, supraregional hospital in Poland. The main inclusion criteria were being phenotypically or genetically diagnosed with FH. Nonadherence was investigated based on detailed interview, monitoring the treatment’s effects and purchasing prescribed medications. For this analysis we investigated only adult FH patients from the registry. Due to small number of cases (n=5), patients treated with inclisiran were not included in this analysis. Results We included 142 consecutive heFH patients at mean age 45,8±14,9 years (min/max 18-75 years; 60% women). Mean BMI was 29.6±5.52 kg/m2, mean baseline TC was 282.9±80 mg/dl (the highest observed was 600 mg/dl), LDL-C 204.2±72.5 mg/dL (the highest observed -762 mg/dl), TG - 151.1±123.4 mg/dl, Lp(a) 37.6±41.5 mg/dl and HDL-C - 52.3±14.2 mg/dl. Most patients were diagnosed with LDLR (72%) or APOB (24%) mutations. High intensity statin therapy was used in 74.3% of patents, ezetimibe (mostly as a part of combination LLT) in 47.2%, and PCSK9 inhibitors in all those that met the reimbursement criteria – 25.6% of FH patients. Non-adherence to statin therapy and ezetimibe in the follow up of 2 years was 27%. In patients treated with statin therapy and ezetimibe mean achieved LDL-C was 153.6±82.82 mg/dl and on triple therapy - 64.5±43.73 mg/dl. Mean achieved LDL-C in the investigated population was 87.9±55.5 mg/dl. LDL-C goal was achieved in 39% of patients – in those treated with triple therapy with PCSK9 inhibitors it was 57.14%, and in those on statins and ezetimibe only 27.1%. Combination therapy of statins and ezetimibe did not significantly change baseline Lp(a) level (p=0.109), but when PCSK9 inhibitors were introduced the mean Lp(a) reduction by 34.2% (p=0.049) was observed. Based on the multivariable regression analysis, the following factors played the most important role for FH patients to be on LDL-C target: DLCN total score (OR 1.21, 95%CI: 1.04-1.40; p=0.013), DLCN category (10.39, 1.43-75.29; p=0.021), ezetimibe use (4.78, 1.15-19.92; p=0.031), and PCSK9 inhibitors use (4.56; 1.40-14.86; p=0.012). Conclusions FH patients in Poland are diagnosed definitely too late (45 years) and most of them are still not on LDL-C goal. Double and especially triple therapy significantly, even 5 times, increase the chance of achieving LDL-C goal, therefore PCSK9 inhibitors should be available for all FH patients, without the limitations existing currently e.g., within B101 drug program in Poland.

Clinical reality and challenges with familial hypercholesterolemia patients' management. 2024 results from the Regional Center for Rare Diseases (RCRD) Registry in Poland

BackgroundDespite advancements in early diagnosis and effective medications in last decade, most heterozygous familial hypercholesterolemia (heFH) patients still fail to achieve their low-density lipoprotein cholesterol (LDL-C) goals and remain at residual cardiovascular disease risk. We present recent data from the regional FH registry in Poland, highlighting the challenges and real-life clinical management of FH patients. MethodsThe registry is held at the Regional Centre for Rare Diseases, founded in 2016, at the 2nd largest, supraregional hospital in Poland, where >80 different rare diseases in patients from all over Poland are diagnosed and treated, including phenotypically or genetically diagnosed FH patients. Our analysis focused on both children and adult FH patients, excluding those treated with inclisiran due to a small sample size (n = 5). ResultsWe studied 173 consecutive heFH patients, median age for adult population was 40 years (range: 27–57), of whom 56.14 % were women. Among the population, 82.1 % were adults (n = 142), and 31 were children (17.92 %; median age 9 (8–13), females 58.16 %). Children exhibited lower total cholesterol and triglyceride levels compared to adults, with no significant differences in LDL-C and high-density lipoprotein cholesterol (HDL-C) levels. Molecular diagnosis in the whole population revealed that 76.6 % had an LDL receptor (LDLR) mutation, while 23.4 % had an apolipoprotein B (APOB) mutation. Risk assessment categorized patients into high (70.7 %), very high (22.1 %), and extremely high (7.1 %) risk groups. Triple therapy achieved treatment goals in 61.76 % of adults and 70.97 % of children. At baseline, 36.62 % of adult patients were not using statins. High-intensity statin therapy combined with ezetimibe was initiated for the remaining patients. Only 3.33 % of patients avoided statins due to complete intolerance. Ezetimibe was used in 57.27 % of patients (mostly in combination therapy), and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were prescribed for 28.17 % FH patients. In adults receiving statin and ezetimibe therapy, median achieved LDL-C was 141 mg/dl (107–184). For triple therapy, median achieved LDL-C was 52.5 mg/dL (32–86.5). Overall median achieved LDL-C in the study population was 99.5 mg/dl (57.5–145.4). PCSK9 inhibitors reduced LDL-C by 165.6 mg/dl. Combination therapy did not significantly alter baseline lipoprotein(a) (Lp(a)) levels (p = 0.134), and PCSK9 inhibitors led to a mean Lp(a) reduction of 18.66 mg/dl (45 % reduction; p = 0.013). Multivariable regression analysis identified key factors for achieving LDL-C targets in FH patients: DLCN total score, DLCN category, ezetimibe use, and PCSK9 inhibitors. ConclusionsIn Poland, FH patients are often diagnosed too late (usually over 40 years of age), and many still do not reach their LDL-C goals. Combination LLT double or triple therapy significantly increases the likelihood of achieving LDL-C targets – even up to fivefold. Therefore, unrestricted access to PCSK9 inhibitors for all FH patients is crucial, without the current limitations imposed by drug reimbursement programs like B101.

Seasonal and monthly stroke incidence in relation to weather variables: a preliminary single-centre epidemiologic study

This single-centre epidemiologic study investigated seasonal/monthly stroke incidence and stroke-related mortality in relation to weather variables, gender, age, as well as stroke subtype and stroke aetiology. The study involved 638 patients hospitalised due to stroke at the Neurology Ward with a stroke unit at the Regional Hospital in Poland, during one complete calendar year. The data collected included the date of admission to the ward, year of birth, sex, type and subtype of stroke relative to the aetiology and location within different arteries as well as mortality. The data related to wind speed, atmospheric pressure, and temperature were acquired from the archive at the weather station in Tarnów, Poland. Majority of the patients in the study group were aged 66–85 years (57.2%), and there were more women than men. Ischaemic stroke was significantly more common than haemorrhagic stroke (87 vs 13%). Large artery atherosclerosis was the predominant cause of stroke, particularly in June and October, and total anterior circulation stroke (TACS) was the most common type, particularly in January and December. The analysis showed that stroke type and aetiology, as well as weather variables such as temperature and pressure, were associated with stroke incidence and mortality rates. The findings suggest that both high and low temperatures may contribute to an increased stroke incidence, as significant differences in the number of stroke cases are observed during periods of extreme temperatures. Therefore, increased vigilance is necessary during periods of both hot and cold weather. Further research is needed to better understand these relationships and develop effective prevention strategies.

Quality of life and health behaviors of patients diagnosed with cardiovascular disease

Background: Cardiovascular diseases are the leading cause of death, both in Poland and worldwide, significantly impacting patients' quality of life. Health behaviors, whether positive or negative, play a crucial role in influencing the incidence of cardiovascular diseases. This study aims to analyze the correlation between health behaviors and the quality of life among patients with cardiovascular diseases. Materials and Methods: The study was conducted among 120 patients (116 eligible) at the Independent Public Provincial Hospital in Poland. Standardized tools including the Health-Related Behavior Inventory (HBI) questionnaire developed by Zygfryd Juczyński, the WHOQOL-BREF Questionnaire, and an original questionnaire with metric data were employed for diagnostic survey. Statistical analysis was performed using the Statistica 10.0 program, with a significance level set at p ≤ 0.05. Results: The respondents' average HBI score was 5.09, while the average overall quality of life score was 3.42, and the average overall health score in the study group was 3.07. Statistically significant correlations were observed between health practices and the assessment of general health, the general index of health behaviors and the level of quality of life in the physical domain, as well as positive mental attitude and quality of life in the psychological domain. Lower quality of life and poorer health status among patients with cardiovascular diseases were associated with increased preventive behaviors and intensified health practices. Conclusions: Despite having a good quality of life on average, individuals with cardiovascular diseases demonstrated moderate health behavior scores. The coexistence of lower quality of life and poorer health status with intensified preventive activities and health behaviors suggests a need for support in mental functioning, as well as adequate education and motivation regarding diet and eating habits. Moreover, it's essential to utilize appropriate techniques to motivate patients to adopt healthier behaviors.

Klebsiella Pneumoniae – Taxonomy, Occurrence, Identification, Virulence Factors and Pathogenicity

Abstract Gram-negative bacilli Klebsiella pneumoniae are among the most important pathogens responsible for healthcare-associated infections (HAIs). These bacteria often have high pathogenic and epidemic potential, contributing to infection outbreaks worldwide. K. pneumoniae is part of the natural microbiota of humans. At the same time, as an opportunistic microorganism, when the host organism is weakened, it can cause serious infections such as pneumonia, urinary tract infections, septic infections and intra-organ abscesses. Widespread distribution in nature and exceptional adaptability provide K. pneumoniae with the opportunity to master new niches in the hospital environment, which poses a threat to hospitalized patients. Also, the bacteria are increasingly causing life-threatening infections in the non-hospital environment. The pathogenicity of K. pneumoniae is determined by the presence of many virulence factors such as capsular polysaccharide (CPS, K antigen), lipopolysaccharid (LPS, O antigen), fimbrial and non-fimbrial adhesins, siderophores (aero-bactin, enterobactin, salmochelin and yersiniabactin), heat-stabile and heat-labile enterotoxins, cytotoxins and biofilm-forming ability. Currently, hypervirulent strains of K. pneumoniae (hvKp) equipped with new virulence traits constitute a significant danger. The paper presents these bacteria concerning the global threat arising from the dynamic spread of hvKp strains in hospitals in Poland and worldwide.

Very early and early nutrition in children with pancreatitis-A randomised trial.

The aim of our study was to assess the impact of the very early introduction of refeeding on the course of acute pancreatitis (AP) in children. Additionally, we evaluated the effect of nutrition on inflammatory markers, including cytokines. This prospective randomised study was conducted in three university hospitals in Poland. Patients, aged 1-18 years with AP, were randomised into two groups: A-refeeding within 24 h of hospital admission (very early), and B-refeeding at least 24 h after admission (early nutrition). The severity of AP was assessed after 48 h. The serum concentrations of four cytokines (tumour necrosis factor α [TNFα], interleukin-1β [IL-1β], interleukin-6 [IL-6] and interleukin-8 [IL-8]) and C-reactive protein, as well as the activity of amylase, lipase and aminotransferases, were measured during the first 3 days of hospitalisation. A total of 94 children were recruited to participate in the study. The statistical analysis included 75 patients with mild pancreatitis: 42-group A and 33-group B. The two groups did not differ in the length of hospitalisation (p = 0.22), AP symptoms or results of laboratory tests. Analysis of cytokine levels was conducted for 64 children: 38-group A and 26-group B. We did not find a difference in concentrations of the measured cytokines, except for IL-1β on the third day of hospitalisation (p = 0.01). The time of initiation of oral nutrition within 24 h (very early) or after 24 h (early) from the beginning of hospitalisation had no impact on the length of hospitalisation, concentrations of TNF-α, IL-1β, IL-6 and IL-8, activity of amylase and lipase or occurrence of symptoms in children with mild AP.

Correlations between well-being of nurses and psychosocial working conditions - a descriptive cross-sectional study.

Work in health care is classified as a difficult profession and nurses are considered among the professional group that is exposed to the permanent impact of occupational stress. Psychosocial working conditions and related hazards are defined as those aspects that have the potential to cause harm to an employee's mental or physical health. Lack of psycho-physical health well-being reduces job satisfaction and thus job commitment. The aim of this study was to assess the overall well-being of nurses and examine the correlation between nurses' well-being and their assessment of psychosocial working conditions in conjunction with occupational and demographic factors. A descriptive cross-sectional survey was conducted among 526 nurses employed in a selected public clinical hospital in Poland. All nurses provided labor during the survey. A diagnostic survey method using the standardized Psychosocial Working Conditions questionnaire based on the demands-control-support stress model was used for measurement. The examined nurses rated highly job demands (mean 3.46) as well as the scale of desired changes (mean 3.44). The ability to control their work (mean 3.19) and the level of social support (mean 3.21) were rated at a slightly lower level. The scale of well-being was rated highest by respondents (mean 3.68). Several statistically significant correlations (p < 0.05) can be observed between the well-being scale and the other scales of psychosocial working conditions across age categories. The least correlated are the well-being and demands scales, although as age increases with higher levels of well-being, the demands scale scores decrease. The well-being of the examined nurses was closely related to sociodemographic data and the individual scales of the Psychosocial Working Conditions questionnaire. Chronic diseases are associated with greater demands at work and reduced well-being. Respondents who receive higher levels of support at work experience higher levels of well-being.

Pre-COVID-19‑pandemic differentiation of employment and wages in county hospitals in Poland

The difficult current global situation in the aspect of Human Resources for Health was clearly seen during the COVID-19 pandemic. The spending on healthcare is still increasing and the rate of increase outpaces the growth rate of GDP. Only part of these funds is dedicated to the training of new staff and current healthcare employees migrate in search for better job conditions and worklife balance. Personnel migration combined with the demographic structure in the high-income countries simultaneously leads to increasing demand for healthcare services and limits the supply of specialists who can provide such services. The confrontation between the demand for medical personnel and its supply will lead to a reduction in the quality of care and accessibility of services. In the study based on the large group of Polish county hospitals in 2015–2018, differences and similarities between the hospitals in terms of employment, measured in full-time equivalents (FTEs) and in terms of wages were analyzed. Similarity and dissimilarity analysis was conducted, based on distance measures and cluster analysis. Bigger differences between the hospitals were found for wages than employment levels. The hospitals with an ED and efficient units were less similar to one another than their counterparts in terms of employment (FTEs), except for 2016. When it comes to wages and both types of variables (wages and employment) considered simultaneously, the hospitals with an ED and high number of beds were characterized by lower similarity to one another than their counterparts during the whole period. Clustering all the 3 approaches (FTEs, wages, FTEs and wages) the results were the same. One of these groups was characterized by a rather low employment level per bed, while the other one – by high.

Preliminary results from the Polish Infective Endocarditis Registry (POL-ENDO): Time to change clinical practice?

Infective endocarditis (IE) is a severe valvular disease associated with high morbidity and mortality. This preliminary study aimed to evaluate patient profiles and treatment outcomes of IE in Poland and compare them with European IE characteristics. We conducted a prospective multicenter observational cohort study - the POL-ENDO registry - in IE patients from 134 hospitals in Poland recruited between August 2022 and August 2023. We evaluated demographic, clinical, imaging, and treatment outcome data. A comparison of the Polish patients with those assessed in the EURO-ENDO registry between January 2016 and March 2018 was performed. Of a total of 880 IE patients, 622 were male (70.7%). The POL-ENDO participants were older (61.4 [16.7] years vs. 59.25 [18.03] years; P = 0.001). Native-valve IE occurred more often in Poland (82.3% vs. 56.6%; P <0.001). Transthoracic echocardiography was performed more frequently in Poland (93.6% vs. 89.8%; P <0.001). New imaging techniques (computed tomography/magnetic resonance imaging/positron emission tomography/single-photon emission computed tomography) were less frequently used in Poland (computed tomography: 41.3% vs. 53.2%; P <0.001; magnetic resonance imaging: 6.4% vs. 18.7%; P <0.001). Heart failure occurred more often in Poland as an in-hospital complication (31.4% vs. 14.1%; P <0.001). Surgical treatment was less frequently performed in Poland (36.9% vs. 51.2%; P <0.001). In-hospital mortality was higher in Poland (21% vs. 17%; P = 0.008). Polish IE patients were significantly older and had more comorbidities. New imaging techniques are less frequently used in Poland. Echocardiography was performed more frequently in Poland as the diagnostic mainstay. Surgical treatment was significantly less frequent in Poland. In-hospital mortality in Poland is higher.

Mortality in clostridioides difficile infection among patients hospitalized at the university clinical hospital in Wroclaw, Poland – a 3-year observational study

BackgroundIn the last two decades, a significant increase in the number of Clostridioides difficile infection (CDI) cases has been observed. It is understandable to attempt to determine the factors that can predict the severity of the course of the infection and identify patients at risk of death. This study aimed to analyze the factors affecting the incidence and mortality of CDI in inpatient treatment at the University Clinical Hospital in Wrocław in 2016–2018.MethodsStatistical analysis of data obtained from patients’ medical records was performed. Only patients with symptoms of infection and infection confirmed by laboratory tests were enrolled in the study. When analyzing the number of deaths, only adult patients who died in hospital wards were included. The quantitative data including laboratory tests, used antibiotics and Nutritional Risk Screening (NRS) were assessed. Also, the qualitative data such as sex, year of hospitalization, occurrence of diarrhoea on admission to the hospital, presence of additional diseases, as wee ad the use of antibacterial drugs or proton pump blockers and ranitidine during hospitalization were analyzed.ResultsA total of 319 adult CDI patients (178 women and 141 men) were enrolled of which 80 people died (50 women and 30 men). The mean age of the patients was 72.08 ± 16.74 years. Over the entire period studied, the morbidity was 174 cases per 100,000 hospitalizations while mortality was 25.08%. The group of deceased patients was characterized by: older age (by 9.24 years), longer duration of hospitalization (by 10 days), reduced albumin levels (Rho = -0.235, p < 0.001), higher urea levels, use of more antibiotics, higher risk of malnutrition in NRS (Rho = 0.219, p < 0.001), higher incidence of sepsis, heart failure, stroke, hypothyroidism. Pneumonia was diagnosed twice as often. It was also shown that deceased patients were significantly more likely to take penicillin and fluoroquinolones.ConclusionsIn this study, the morbidity was lower, but mortality was higher compared to similar hospitals in Poland. CDI patients were characterized by older age, multimorbidity, extended hospitalization, and the use of broad-spectrum antibiotics. Risk factors for death included advanced age, prolonged hospital stays, lower albumin, higher urea, malnutrition, and comorbidities like heart failure, stroke, pneumonia, sepsis, and hypothyroidism. Increased antibiotic use, particularly penicillin and fluoroquinolones, was associated with a higher mortality risk.

Efficacy of Dequalinium Chloride vs Metronidazole for the Treatment of Bacterial Vaginosis

Bacterial vaginosis (BV) is a common cause of vaginal infection. First-line treatments of BV are metronidazole and clindamycin. Due to the increase in antibiotic resistance, effective nonantibiotic treatments for BV are needed. To examine whether dequalinium chloride, a broad-spectrum antiseptic, is noninferior to oral metronidazole for the treatment of BV. This phase 4, multicenter, triple-blind, double-dummy, parallel, noninferiority randomized clinical trial was conducted from July 29, 2021, to August 25, 2022, with a 1-month follow-up. Participants were premenopausal women 18 years or older with BV from 11 gynecologic practices and 1 hospital in Poland, Slovakia, and the Czech. Patients were randomized to treatment with dequalinium chloride vaginal tablets (10 mg once daily for 6 days) or oral metronidazole (500 mg twice daily for 7 days). Double-dummy medication kits contained vaginal and oral tablets with placebo and active medication. The main outcome was the noninferiority margin (of 15 percentage points) in the absolute difference in clinical cure rates between dequalinium chloride and metronidazole 7 to 11 days after start of treatment (visit 1). Noninferiority was met if the lower 95% CI for the difference in clinical cure rate was less than 15 percentage points at visit 1. A total of 147 women (mean [SD] age, 36.7 [9.0] years) were treated with dequalinium chloride (n = 72) or metronidazole (n = 75). The clinical cure rates at visit 1 were 64 of 69 (92.8%) for dequalinium chloride vs 69 of 74 (93.2%) for metronidazole in the intention-to-treat population, whereas in the per-protocol population, cure rates were 54 of 58 (93.1%) for dequalinium chloride vs 48 of 53 (90.6%) for metronidazole. The treatment differences of -0.5 percentage points (95% CI, -10.8 to 9.8 percentage points; P = .002) in the intention-to-treat population and 2.5 percentage points (95% CI, -9.4 to 14.4 percentage points; P = .001) in the per-protocol population confirmed the noninferiority of dequalinium chloride. The tolerability of dequalinium chloride was rated as very good by 30 of 50 patients (60.0%) but only by 21 of 54 (38.9%) for metronidazole. Three patients in the metronidazole group suspended treatment due to an adverse event. This randomized clinical trial showed that dequalinium chloride was not inferior to metronidazole for the treatment of BV. Dequalinium chloride had a similarly high cure rate but with better tolerability and fewer adverse events. With a similar efficacy to metronidazole and clindamycin, dequalinium chloride warrants consideration as first-line treatment for BV to help reduce antibiotic consumption. EudraCT: 2020-002489-15.

Effectiveness of antazoline versus amiodarone, flecainide and propafenone in restoring sinus rhythm at the emergency department

PurposeLittle is known about the effectiveness of pharmacological cardioversion (PCV) with antazoline in comparison to flecainide. The aim of this study was to compare the effectiveness of antazoline in restoring sinus rhythm (SR) versus amiodarone, flecainide and propafenone in a group of emergency department (ED) patients. Materials/methodsThis was a single-centre retrospective analysis of patient records from an ED in a large hospital in Poland. We analysed a total of 1878 patient records, divided based on the anti-arrhythmic drug (AAD) administered during PCV: antazoline (n ​= ​1080), antazoline ​+ ​β-blocker (n ​= ​479), amiodarone (n ​= ​129), flecainide (n ​= ​102), propafenone (n ​= ​88). Of the patients, 63.5 ​% were female (median 65 years, [19–100]). ResultsThe percentage of successful PCV was significantly higher in the antazoline group (84.3 ​%) than in the antazoline ​+ ​β-blocker (75.8 ​%, p ​= ​0.0001), propafenone (75.6 ​%, p ​= ​0.0364) and amiodarone (68.8 ​%, p ​< ​0.0001) groups. Post-hoc analysis revealed that patients who received PCV with antazoline, antazoline ​+ ​β-blocker, flecainide and propafenone had significantly shorter time to SR than those who received amiodarone (p ​< ​0.0001). Univariate regression analysis revealed that patients who underwent PCV with antazoline were almost twice as likely to return to SR compared to the other groups (p ​< ​0.0001, OR 1.81, 95 ​% CI 1.44–2.27). ConclusionsThis is the first study comparing the effectiveness of antazoline in PCV versus flecainide in addition to the previously studied amiodarone and propafenone. Our results indicate that antazoline is more effective in restoring SR than amiodarone, flecainide and propafenone. In addition, antazoline restored SR significantly faster than amiodarone or propafenone.

Areas of professional life and job satisfaction of nurses.

Job satisfaction among nurses is closely related to work environment as well as organizational and professional commitment. Satisfaction is a concept derived from Latin, where "satis" means "enough," as much as is needed to fully satisfy expectations, needs, aspirations, in such a way that there is no room for complaint. Job satisfaction, on the other hand, is formulated as a positive attitude of employees toward the duties of the job, the work environment and other employees. The aim of this paper was to demonstrate how the different areas of nurses' professional life, i.e., workload, control, rewards, community, sense of justice and values, correlate with their perceived job satisfaction. A cross-sectional study was conducted in a group of 509 nurses working in a public hospital in Poland. Data were collected using a survey questionnaire, which consisted of a section containing sociodemographic data and standardized instruments: The Minnesota Satisfaction Questionnaire (MSQ) and The Areas of Worklife Survey (AWS) developed by Maslach and Leiter. Correlations were made using Spearman's rho coefficient. The calculations also used stepwise linear regression analysis after checking certain assumptions, including checking the assumption of normality of residuals and the Durbin-Watson Test. The mean score for the 20 items of the MSQ questionnaire ranged from 3.05 to 3.43 on a 5-point Likert scale. Support from the interdisciplinary team, which concerned assessing the quality of the social environment in the workplace, cooperation and showing positive feelings received the highest rating among respondents (3.51 ± 0.76). The sense of fair treatment at work averaged 3.26 ± 0.58. The area of value conflict within the organization itself or between the employee's values and those of the organization, respondents rated an average of 3.26 ± 0.65. The mean score for all areas of professional work in the surveyed group was 3.09 ± 0.45. As satisfaction in particular areas of work life increases, so does the level of satisfaction in such aspects of work as achievement and a sense of fairness. The higher the level of satisfaction in the area of control, the more the sense of satisfaction with independence increases. The higher the satisfaction of respondents in the areas of values, workload and control, the higher the level of satisfaction with working conditions occurs.

Social perception of psychiatric treatment of adolescents in Poland and quality of hospital space from the perspective of potential patients

The social perception of psychiatric treatment and the quality of the treatment space is important in the field of prevention, given the increase in the number of diseases among children and adolescents, not only in Poland, but also worldwide. The peculiarities of the state of child psychiatry in Poland and the inadequacy of social provision in this area were the reason for taking up this research topic and conducting a two-stage authoritative qualitative study in an interdisciplinary approach. The aim of the study was to assess the perception of psychiatric treatment based on the designed architecture of the space supporting the treatment process of adolescents, using the example of selected psychiatric hospitals in Poland, based on a survey research.A total of 300 people participated in the study, of whom 54 (12%) were men and 246 (82%) were women (2% of respondents identified as non-binary). For both men and women, the most common age range was 18-25 years (62.4% for both groups combined), followed by 26-35 years (23% for both groups combined).The experiment was carried out in two stages: (1) stage one was an in situ study in three randomly selected psychiatric hospitals in Poland to verify the quality of the built environment of therapy and to clarify the architectural context of the study; (2) stage two was an online survey using a self-administered questionnaire consisting of 20 questions appropriately tailored to the purpose of the study.Answers were obtained from all respondents. The analysis of the obtained information shows that all respondents did not have negative social attitudes towards psychiatric therapy. The respondents emphasised that the designed architecture of the space supporting the therapy process in the example of the evaluated psychiatric hospitals in Poland encourages the use of therapy. At the same time, it was confirmed that the quality of the evaluated psychiatric hospitals in Poland, i.e. the desirable functional-spatial aspects of the treatment environment, is directly related to the accessibility of therapy and its social perception.Desirable functional-spatial aspects of the treatment environment influence the process of perception of psychiatric therapy and the absence of negative attitudes towards it. This topic is extremely important in the context of the global development of young generations and should be continuously reviewed from the perspective of interdisciplinary research.

Selected aspects of project management for the implementation of a new standard of cost accounting in health care units

Purpose: The aim of the article is to discuss the most important aspects related to the management of the project of implementing the cost accounting standard in hospitals in Poland. A properly implemented standard is to enable the support of management processes and proper financial management in the health care system at the macro level as well as at the level of the healthcare entity. The first period of operation of these regulations is an opportunity to take stock in this respect. Design/methodology/approach: The research was conducted by using a survey questionnaire. On the basis of the questionnaire survey in 52 hospitals in Poland. The obtained test results were subjected to the basic statistical analyses. Findings: On the basis of the analyses of the results of empirical research, recommendations were formulated regarding the principles of implementation of the cost accounting standard in hospitals and the directions of its effective use in management processes in the future. Research limitations/implications: The utilization of survey research is associated with the presence of subjectivity in assessments by respondents. Originality/value: The article presents important recommendations for health care managers on projects to implement the new cost accounting standard in health care entities in Poland. Keywords: hospital, cost accounting, project management. Category of the paper: Research paper.

Osteonecrosis of the jaw: surgical treatment results before and during the COVID-19 pandemic in one of the reference hospitals in Poland.

The COVID-19 pandemic has had a huge impact not only on everyday life but, above all, on the functioning of medical entities. During its duration, there were problems with access to health care, including maxillofacial surgery departments. The aim of the study is to analyze how the pandemic affected the surgical results of the treatment of osteonecrosis of the jaws at the Clinic of Maxillofacial Surgery in Poznań which delivers services in maxillofacial surgery for almost 4.5 million inhabitants in Poland. We conducted a retrospective analysis of patients' medical records before and during the pandemic restrictions. The data was obtained by entering the appropriate passwords and ICD-10 diagnoses (e.g., M87) in the hospital's IT system. The obtained information was subjected to statistical analysis. The number of patients before and during the pandemic did not differ significantly. During the COVID-19 pandemic, the waiting time of patients after admission to the hospital for surgery and the total time of hospitalization were shortened. The number of complications was similar in both groups. However, the waiting time for a follow-up visit was longer during restriction time. The COVID-19 pandemic had an impact on the course of surgical treatment in patients with osteonecrosis of the jaws. The outcomes of the medical procedure remained consistent with the ones observed before the implementation of restrictions. This is likely due to the urgency of the illness. Despite the pandemic, a critical condition called osteonecrosis of the jaw was treated promptly.