Hospital In Warsaw Research Articles

Computed tomography evaluation of patent paraumbilical vein and its aneurysm in relation to other portosystemic collateral channels in patients with liver cirrhosis and portal hypertension

PurposeThe aim of the study was to evaluate the relationship between the diameter and aneurysmal dilatation of the paraumbilical vein (PUV) and the presence of portosystemic collateral shunts and their relationship with age and portal vein diameter.Material and methodsThe retrospective analysis, performed in the II Department of Radiology, Medical University Hospital in Warsaw, included 126 patients (77 males and 49 females) with patent umbilical vein and signs of portal hypertension due to liver cirrhosis. All patients underwent contrast enhanced abdominal CT. The average age was 54.7 ±12.98. We analysed the number and type of portosystemic collateral channels in respect of age, sex, presence of oesophageal varices, and the diameter of the paraumbilical vein and the portal vein.ResultsOur results disclosed statistically significant negative correlation between patient age and diameter of paraumbilical vein, number of portosystemic collateral channels and diameter of portal vein and positive correlation between diameter of paraumbilical vein and diameter of portal vein. A statistically significant difference in diameter of portal vein and number of collateral channels was found in groups with and without oesophageal varices. No significant difference in age and portal vein diameter was found in these groups.ConclusionsOur study showed that younger patients with liver cirrhosis are characterised by wider paraumbilical veins and higher number of portosystemic collateral channels. The presence of oesophageal varices does not correlate with age, sex, diameter of paraumbilical vein, and number of collateral portosystemic channels.

Decreasing Vaccination Coverage Against Hepatitis B and Tuberculosis in Newborns.

The number of parents who refuse to vaccinate their children or present the so-called hesitant behavior, i.e., delay the moment of vaccination beyond the mandatory time, has increased in many developed countries. The purpose of this retrospective study was to evaluate the completeness and timeliness of vaccinations against hepatitis B (HBV) and tuberculosis (TB) in neonates in a single maternity hospital in Warsaw, Poland. We reviewed medical files of 14,785 children born in the hospital in 2015-2017 and calculated the proportion of newborns not vaccinated on time according to the Polish Immunization schedule that includes vaccination against HBV and TB in the first day of life. Newborns remained unvaccinated because of parental refusal (refusers) or decision for a delay (hesitants), or medical contraindications. The percentage of unvaccinated newborns in the 3years was as follows: 7.3% in 2015, 6.7% in 2016, and 10.1% in 2017. Parental decisions rather than medical contraindications caused nonvaccination (4.4% vs. 2.9% in 2015, 4.7% vs. 2.0% in 2016, and 7.5% vs. 2.6% in 2017). The majority of refusals concerned both vaccinations (67.3% in 2015, 74.8% in 2016, and 68% in 2017). Among parents who refused only one vaccination, TB vaccination was refused more often than HBV (9.2% vs. 7.1% in 2015, 8.3% vs. 5.7% in 2016, and 5.9% vs. 2.7% in 2017). Similar trends were observed among the hesitants. In conclusion, it seems essential to implement effective educational and informative activities targeted to parents to reinforce positive attitudes toward vaccinations.

The Influence of National Guidelines on the Management of Community-Acquired Pneumonia in Children. Do Pediatricians Follow the Recommendations?

This is a retrospective study whose main objective was to analyze the influence of the Polish Guidelines for the Management of Respiratory Tract Infections of 2010 (PGMRTI) on in-hospital treatment of children with community-acquired pneumonia (CAP). Files from four Warsaw hospitals were reviewed to identify children with uncomplicated CAP, treated before (2008-2009) (pre-PGMRTI) and after (2011-2012) (post-PGMRTI) publication of the guidelines. Predefined data on the management were compared. A cohort of 2,359 children (1,081 pre-PGMRTI and 1,278 post-PGMRTI) was included. We found that co-amoxiclav was the most common first-line therapy in children >3months of age (34.6% and 40.4% pre- and post-PGMRTI, respectively), followed by cefuroxime (31.8% and 20.9% pre- and post-PGMRTI, respectively; p<0.0001) and macrolides (17.4% and 24.5% pre- and post-PGMRTI, respectively; p<0.0001). Amoxicillin was rarely used (5.4% and 4.9%, pre- and post-PGMRTI, respectively). The study revealed an overuse of inhaled bronchodilators, corticosteroids, and mucoactive drugs. Blood diagnostic tests were applied to a significant percentage of patients: blood cultures (41.2% and 44.5% pre-and post-PGMRTI, respectively) and serology for atypical pathogens (27.9% and 44.9% pre-and post-PGMRTI, respectively; p<0.0001). The number of follow-up chest X-rays increased (30.5% and 53.8% pre- and post-PGMRTI, respectively; p<0.0001). In conclusion, the study demonstrates an unsatisfactory influence of the guidelines on in-hospital management of CAP in children. Despite an explicit recommendation for the use of amoxicillin, it was still underused. Other methods of education and guideline dissemination are needed to optimize the prescribing of antibiotics.

Assessment of the exposure of nurses from Emergency Departments to aggressive behavior of patients

INTRODUCTION: A large number of patients and their families waiting for help in ED, deteriorating health, high levels of stress and a recent sudden event, such as an accident, assault, life or health threaten the patient’s anxiety, fear or fright that may result in irrational or violent behavior. These behaviors may be a threat to both the patient and the environment. This work aims to determine the exposure of nursing staff employed in ED for aggression on the part of patients. METHODS: The research was carried out in the Masovian Province, in the Prague Hospital in Warsaw, in the Brodnowski Mazowieckie Hospital in Warsaw and in the Independent Public Health Care Team in Minsk Mazowiecki, from January to March 2018. The study was attended by 50 nurses working in ED. RESULTS: According to the surveys carried out, nursing Staff in ED meets with the aggression of patients very often, ie at least once every few days — this is confirmed by as many as 60% of the respondents. For frequent contact with aggressive patients (ie on average once a week) indicates 28% of respondents, and the remaining 12% contact aggressive patients on average once a month. The most frequent type of aggres- sion manifested by ED patients is verbal aggression — 68% of respondents contact it. 22% indicate physical aggression directed to nursing staff, and 10% for physical aggression but directed to objects. CONCLUSIONS: In conclusion, our data indicate that: (1) Aggression of patients in ED is a very frequent phenomenon, and the level of high personnel exposure — aggression is recorded at least once every few days. There is no clear relationship between the increase in the number of aggressive patients on certain days of the week or the time of day, although there is a tendency to note such cases on weekends and at night; (2) The most common type of aggression undertaken by ED patients is verbal aggression manifested in insults, insults, shouting, threats and intimidation;

Characteristics of glycopeptide-resistant Staphylococcus aureus strains isolated from inpatients of three teaching hospitals in Warsaw, Poland

BackgroundVancomycin is still one of the most commonly used drug for treatment of severe methicillin-resistant Staphylococcus aureus (MRSA) infections. Vancomycin-resistant S. aureus (VRSA) strains are a serious danger for public health. This study aimed to characterize healthcare-associated MRSA (HA-MRSA) strains, resistant to at least one of glycopeptide antibiotics: vancomycin (VRSA) and/or teicoplanin (TRSA), isolated at three Warsaw hospitals over a period of 17-years (1991–2007).MethodsAmong 600 HA-MRSA strains, isolated from patients with symptomatic infections, 47 were subjected to detailed analysis. In the study, mechanisms behind VRSA phenotypes were determined (E-tests, GRD-test, agar-dilution method and vanA/B detection). Characteristics of selected isolates on molecular level: i) by detection of resistance genes ermA/ermB/ermC, msrA/msrB, linA/linA’, aacA-aphD, aadD, aph(3”)-IIIa; ii) SCCmec-typing and iii) MLST-typing was done.ResultsIn general population of studied strains, 11/47 (23.4%) were VRSA and 36/47 (76.6%) were resistant only to teicoplanin. All isolates exhibited van-independent mechanisms of resistance. Over 80% of isolates belonged to clonal complex CC8, with the following predominant sequence types (STs)/clones: ST247-IA/Iberian, ST241-III/Finland-UK, and ST239-III/Brazilian. Most of the isolated strains harboured ermA and aacA-aphD genes, encoding additional resistance to macrolides, lincosamides, streptogramin B, and majority of aminoglycosides. They occurred also in Polish VRSA/TRSA population over the period, which was subjected for analysis: an increase in MIC values for glycopeptides, evolution in terms of the level and extent of resistance, and genetic re-assortment in epidemic clones.ConclusionsVRSA strains isolated from patients hospitalized at three Warsaw teaching hospitals in Poland, over a period of 17-years do not pose a threat as potential donors of van genes in horizontal-gene transfer processes, but are constantly evolving and represent international epidemic clones.

The cost analysis and the assessment of intoxicated patients in the Emergency Unit of the Child Jesus Clinical Hospital in Warsaw in 2013

The cost analysis and the assessment of intoxicated patients in the Emergency Unit of the Child Jesus Clinical Hospital in Warsaw in 2013

Perinatal care needs and expectations of women with low vision or total blindness in Warsaw, Poland

BackgroundAs estimated from the number of published studies, in Poland the research into the perinatal care experiences of women with low vision or total blindness remains limited. ObjectivesThe purpose of the study was to fill this gap by investigating satisfaction with perinatal care received by women with visual impairment in four city hospitals in Warsaw, Poland, and to recommend, if required, modifications in midwives' education and care standards based on the women's perceptions and expectations. MethodsHour-long interviews were conducted between 30 August 2014 and 2 September 2015 with 16 blind or low vision women in perinatal care, audio-recorded and transcribed verbatim. The accounts were subsequently evaluated using the Interpretative Phenomenological Analysis (IPA) approach. Five major themes were pre-selected: perceived stigma and lack of affirmation for the interviewee's motherhood, accessibility of childbirth preparation, accessibility of perinatal care and hospital facilities, midwives' attitudes and the interviewees' expectations for care improvements. ResultsOverall, the accounts demonstrated the lack of satisfaction with the quality of perinatal care, including the childbirth preparation classes, hospital facilities and hospital staff approach as not actually meeting specific functional needs. They also suggested how the quality of care could be improved. ConclusionsSpecific standards and procedures for perinatal care for women who are blind or have low vision should be developed and introduced in clinical practice in Poland based on research into the experiences of these women. Also, the training of health care professionals should be modified and their attitudes changed to meet maternal needs.

Cytrulline as a marker of complete or partial weaning off parenteral nutrition in adult patients – observatory pilot study

Aim of the study: Citrulline is a recognized marker of small bowel mass and function. The aim of this study was to identify plasma citrulline concentration that permitted adult patients to be partially or completely weaned off total parenteral nutrtion (TPN).&lt;br&gt;Materials and Methods: We measured plasma citrulline in 29 adult TPN patients in Warsaw hospital in 2014 and 2015. We evaluated how many of those patients were weaned from TPN or whether there was a decrease in the frequency of parenteral nutrition (PN) over the following year. Citrulline was assayed in deproteinised plasma samples using HPLC with fluorescence detection after derivatization in a timed reaction with o-phtalaldehyde and mercaptoethanol as described by Kilpatric. The group of weaned patients were compared to the TPN-dependent using Student’s t-test.&lt;br&gt;Results: Citrulline levels among the 29 patients ranged from 6.1 to 44.9 μmol/L (average 19.9 μmol/L). Six patients were completely weaned off PN over one year. Their citrulline levels were between 19,5 and 44.9 (average 28,7) μmol/L and were the highest measured in the patient population. Four patients with citrulline levels between 19.0 and 30.6 (average 23.8) μmol/L) had PN 5 days each week. The 19 patients who were totally dependent on PN had citrulline levels between 6.1 and 18.8 (average 15.3) μmol/L. There was a statistically significant difference between weaned and dependent on parenteral nutrition patients (p=0.0001).&lt;br&gt;Conclusions: Patients receiving TPN who have a high blood citrulline level may be able to be weaned off PN. This may reflect better intestinal mass and function. Citrulline levels may be a good predictor for weaning patients off PN or diminishing the frequency of PN.

Significance of Screening Tests and the Incidence of New Delhi Metallo-beta-lactamase-Producing Gram-negative Bacilli in the Surgery and Transplantation Wards of a Warsaw Medical Center During the Period From April 2014 to May 2017

BackgroundThe first New Delhi metallo-beta-lactamase (NDM)-producing bacteria were isolated in 2008 in the world, and in 2011 in Poland. Due to the high clonal diversity (17 types) of their blaNDM gene, encoded on (Tn125-like) mobile genetic elements, these strains usually exhibit resistance to nearly all available antibiotics, which is particularly dangerous for organ transplant recipients. PurposeTo assess of the prevalence of Gram-negative NDM-positive bacilli in surgery/transplantation wards of a teaching hospital in Warsaw and to ascertain the significance of screening tests on the rates and nature of colonization. Materials and MethodsThe evaluated strains were isolated from 30 patients (between April 2014 and May 2017). The species were identified with VITEK-MS, antibiotic susceptibility was determined with VITEK 2, disk-diffusion, and/or E-test methods, according to EUCAST guidelines. The presence of the blaNDM-1 gene was confirmed using the polymerase chain reaction technique. Results and ConclusionsThere were 77 blaNDM-1-positive Klebsiella pneumoniae strains isolated from 30 patients. Cultures from individual patients, mainly from rectal swabs (53.9%) and urine samples (39.8%), yielded 1–11 isolates. Fifteen patients were already colonized on admission, and the other 15 developed a symptomatic infection. In total, 24 (80%) patients were carriers, and their colonizations persisted for <1–20 months. Most isolates were susceptible only to colistin, gentamicin, amikacin, tigecycline, and/or sulfamethoxazole/trimethoprim. Gastrointestinal-tract-colonizing K pneumoniae are the main reservoir of the blaNDM-1 gene. Following the introduction of on-admission mandatory screening for carbapenem-resistant strains, the rates of NDM-producing K pneumoniae isolation increased (7.5-fold), while the rates of isolation from patients with symptomatic infections considerably decreased (2.8-fold).

Patient Quality of Life After Liver Transplantation in Terms of Emotional Problems and the Impact of Sociodemographic Factors

IntroductionLiver transplantation is recognized as an effective and necessary treatment of chronic as well as acute hepatic failure. The assessment of quality of life (QoL) after transplantation represents an ancillary tool to evaluate the efficacy of solid organ transplantation in addition to graft and patient survival rates and complications. The global assessment of QoL after transplantation usually confirms improvement compared to pretransplant conditions. PurposeAn attempt to evaluate the quality of life of patients after liver transplantation, with particular reference to sociodemographic factors and emotional problems. Materials and methodsThe study group included 121 patients (55 women and 66 men) at the age of 19 to 71 years who underwent surgery in the Central Teaching Hospital of the Medical University of Warsaw and the Infant Jesus Teaching Hospital in Warsaw, and were subsequently treated in an outpatient transplant clinic. The scoring procedure for the areas analyzed was based on the 36-Item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). ResultsHigher patients age was correlated with lower quality of life of patients after liver transplantation, including physical functioning (patients >40 years of age declared lower physical performance, and patients <30 years of age indicated greatest limitations in their kind of work or other activities). The frequency of pain was also age-dependent (mostly patients >50 years of age). Women more often than men had worrying thoughts, were feeling tense or wound up, and had sudden feelings of anxiety or panic. By contrast, older people often declared that they felt to be slowed down. ConclusionsTo reduce pain and to improve physical performance of the study patients, rehabilitation procedures should be considered. Patients indicating symptoms associated with anxiety and depression should be referred to a clinical psychologist.

Polish Experience with Liver Transplantation and Post-Transplant Outcomes in Children with Urea Cycle Disorders.

BACKGROUND Liver transplantation (LT) is recommended for various metabolic diseases, including urea cycle disorders (UCDs). The aim of this study was to determine indications and outcomes of LT for UCDs in the tertiary reference Children's Hospital in Warsaw, Poland. MATERIAL AND METHODS Medical charts of children with UCD who underwent LT between 2008 and July 2016 were retrospectively reviewed. The following parameters were analyzed: symptoms at time of diagnosis, age at diagnosis, age at transplantation, graft characteristics and survival, postsurgical complications, and biochemical and laboratory results before and after transplantation. RESULTS Twelve patients with UCD who underwent LT at a mean age of 5 y (0.5-14 y) received a total of 14 liver grafts. Four children (33%) received a living donor graft, while 8 (68%) got a deceased donor liver graft. A total number of transplanted organs consisted of 9 (64%) whole-liver grafts and 5 (36%) reduced-size grafts. The 30-day post-transplant patient survival rate was 100% and graft survival rate was 93% (13/14). For those with a post-transplant follow-up of at least 1 year (n=10/12), the 1-year patient survival rate was 100% and the graft survival rate was 85.7% (12/14). Median peak of blood ammonia at presentation was 653 (159-2613) µg/dL (normal <80 µg/dl), and median peak of blood glutamine was 1273.2 µmol/l (964-3900 µmol/l). There was 1 episode of hyperammonemia following LT, but it was not due to UCD. Six (50%) patients were diagnosed with some degree of developmental delay/neurological impairment before transplantation, which remained stable or slightly improved after transplantation. Patients without developmental delay before transplantation maintained their cognitive abilities at follow-up. CONCLUSIONS LT leads to eradication of hyperammonemia, withdrawal of dietary restrictions with low-protein diet, and potentially improved neurocognitive development.

Analysis of implementiation of 4th Head and Neck Cancer Awareness Week in Department of Otolaryngology in Międzyleski Hospital in Warsaw.

The aim of the study was to analyze the profile of patients applying for free preventive examinations within The Forth European Head an Neck Cancer (HNC) Awareness Week in the Department of Otorhynolaryngology in Międzyleski Hospital in Warsaw (ORL MSS). A media campaign was designed to inform HNC risk patients about the opportunity to receive free preventive examinations in ORL MSS. 225 patients were enrolled to the study. Patient age ranged from 26 to 92 (average 63 years). Women accounted for 66% (149) and males 34% (76). Each patient completed a questionnaire assessing risk factors for HNC, including reported symptoms and lifestyle. ENT examination was performed. Some patients were referred for further diagnostics and treatment. The following HNC risk factors connected with lifestyle were found: nicotine in 22%, alcohol in more than once a week in 12%, oral sex in 17%, multiple sexual partners in 10%, rare dental tests in 24%, prosthetic restorations in 45%. The symptom that most often prompted patients to participate in the HNC prevention week was chronic hoarseness (64%) of people, dry mouth (39%), swallowing (37%), nasal obstruction (6%), neck tumour (5%). One per every five patients was referred to further diagnostics: imaging screening 7% (15 persons), fiber optic examination 11% (25 persons), the excision of the lesion 8% (18 persons). 17 patients were referred for further oncological treatment, of which 13 had benign tumors and 4 had malignant tumors. The HNC Awareness Program increases public consciousness and should systematically includes people with risk factors. The introduction of the Program in the ORL Department has made possible to detect and treat cancer in early stages in 7.5% of those who applied for the program. The use of adequate diagnostics and treatment requires, however, adequate financial resources and systemic solutions.

Prevalence of ESBL-producing Pseudomonas aeruginosa isolates in Warsaw, Poland, detected by various phenotypic and genotypic methods.

Knowledge of the prevalence of ESBL enzymes among P. aeruginosa strains compared to the Enterobacteraiceae family is limited. The phenotypic tests recommended by EUCAST for the detection of ESBL-producing Enterobacteriaceae are not always suited for P. aeruginosa strains. This is mainly due to the presence of other families of ESBLs in P. aeruginosa isolates more often than in Enterobacteriaceae, production of natural AmpC cephalosporinase and its overexpression, and co-production of metallo-β-lactamases. The aim of this study was to determine the occurrence of ESBLs in P. aeruginosa isolated from patients from hospitals in Warsaw, to evaluate the ESBL production of these isolates using currently available phenotypic tests, their modifications, multiplex PCR and molecular typing of ESBL-positive isolates by PFGE. Clinical isolates of P. aeruginosa were collected in 2000-2014 from four Warsaw hospitals. Based on the data obtained in this study, we suggest using three DDST methods with inhibitors, such as clavulanic acid, sulbactam and imipenem, to detect ESBL-producing P. aeruginosa strains. Depending on the appearance of the plates, we suggest a reduction in the distance between discs with antibiotics to 15 mm and the addition of boronic acid at 0.4 mg per disc. The analysed isolates carried genes encoding ESBL from the families VEB (69 isolates with VEB-9), GES (6 with GES-1, 1 GES-5, 5 GES-13 and 2 with GES-15), OXA-2 (12 with OXA-15, 1 OXA-141, 1 OXA-210, 1 OXA-543 and 1 with OXA-544) and OXA-10 (5 isolates with OXA-74 and one with OXA-142). The most important result of this study was the discovery of three new genes, blaGES-15, blaOXA-141 and blaOXA-142; their nucleotide sequences have been submitted to the NCBI GenBank. It is also very important to note that this is the first report on the epidemiological problem of VEB-9-producing bacterial strains, not only in Poland but also worldwide.

Knowledge of and attitudes towards extending professional powers among departmental nurses with respect to issuing prescriptions and independent referring for diagnostic tests – preliminary report

Abstract Introduction. An independent prescribing certain drugs, including issuing prescriptions, as well as an entitlement to refer patients for certain diagnostic tests, constitute the key competences of an advanced nurse/midwife practice. Aim. To analyze knowledge and attitudes of departmental nurses (DN) towards extending professional powers of nurses and midwives. Material and methods. The sample involved 23 DN (women: 100%) working in the Independent Public Children’s Teaching Hospital in Warsaw. The mean age was 49 years (mode and median: 50; min. 31, max. 61, SD=7.95). The mean of professional experience was 30 years (mode: 25, median: 30, min. 17, max. 40, SD=6.38). A voluntary and anonymous questionnaire with 10 questions referring to knowledge and 32 statements concerning attitudes evaluated in the Likert scale was conducted. Results. Almost all DN knew that prescribing drugs is a right and not an obligation. Nearly half of the DN knew when the new regulations shall enter into force. DN believed that the new regulations shall improve patient care and increase patient’s comfort and access to services. DN concern about preparation of nurses and midwives for new competences. Conclusions. 1. The study group’s level of knowledge about the new competences was insufficient and requires supplementing. 2. The attitudes of the study group towards the new competences were not unambiguous. It should, however, be noted that the study was conducted in a specialized children’s teaching hospital, where the application of the amended regulations is limited. 3. Although the nursing management staff supports the legislative changes, they object to the process of introducing them. This applies particularly to the necessity of an adequate preparation of nurses and midwives. 4. The study should be continued among a representative group of nurses with a similar level of education, professional experience, and place of work, with particular consideration of nurses working in the outpatient health care.

Viral etiologies in adult patients with encephalitis in Poland: A prospective single center study.

Encephalitis is a severe neurological syndrome associated with high morbidity and mortality as well as long-term neurological sequelae. Despite being an important public health problem, very few extensive population-based studies were conducted so far in the world and none in Central Europe. Altogether 114 consecutive patients meeting the initial criteria for encephalitis were enrolled at the Warsaw Hospital for Infectious Diseases between June 2012 and July 2015. Eighteen patients were secondarily excluded from the analysis due to incomplete data or noinfectious cause. Potential pathogen sequences were searched for by molecular methods in the cerebrospinal fluid (CSF) and specific antibodies were detected in CSF and sera. An infectious agent was identified in 41 patients (42.7%). The most frequently diagnosed infections were Human herpesvirus 1 (HHV-1) (22 cases, 24%) followed by Enterovirus (6 cases, 6.3%), Varicella zoster virus (VZV) (5 cases, 5.2%), Tick-borne encephalitis virus (TBEV) (6 cases, 6.3%) and Cytomegalovirus (CMV) (2 cases, 2.1%). There were no cases of human adenovirus, Human herpesvirus 6 (HHV-6) or West Nile virus (WNV) infection identified. In 55 cases (57.3%) the cause of encephalitis remained unknown. Compared to patients in whom the diagnosis was determined the latter group contained more women, was less likely to manifest fever and had lower CSF pleocytosis (p < 0.05) In summary, we identified HHV-1 followed by Enterovirus, VZV and TBEV as the most common causes of encephalitis among adult patients in Poland. In a large proportion of patients the cause of encephalitis remained unknown.

Validation study of the Polish version of the Evidence-Based Practice Profile Questionnaire

BackgroundDecisions about patient care in clinical practice should be made based on proven scientific evidence of efficacy and safety (i.e., evidence-based practice [EBP]). Currently, there are no available tools in Poland for assessing the knowledge and attitudes of specialists in health sciences towards EBP. Therefore, by validating the Polish version of the original English Evidence-Based Practice Profile Questionnaire (EBP2Q), we may provide an appropriate instrument for assessing EBP.MethodsThe validation group consisted of 1,362 people, including nurses and midwives taking the specialization exam, second-degree students in nursing/midwifery, and staff of selected municipal and clinical hospitals in Warsaw, Pruszkow, and Chelm. The study was conducted from March to June 2014. The following psychometric properties of the EBP2Q were assessed: reliability (Cronbach’s alpha coefficient, and test-retest), validity (exploratory factor analysis, Spearman’s r correlation coefficient, and assessment of inter-group differences), as well as unidimensionality of domains (principal component analysis).ResultsAll domains of the EBP2Q were characterized by high reliability (Cronbach’s alpha ranging from 0.800 to 0.972). The Polish version showed a strong similarity of factor structure with the original English EBP2Q, indicating that the condition for theoretical validity is fulfilled. Maintenance of the theoretical and discriminative validity and unidimensionality of five domains of the EBP2Q was confirmed.ConclusionsThe Polish version of the EBP2Q is comparable in terms of psychometry to the original English version. This questionnaire can be used to assess knowledge, attitudes, and skills concerning EBP among students and practicing professional nurses and midwives. The future validation of the EBP2Q in other groups of specialists in health sciences may increase the scope of applicability of this tool.

Mortality Due to Nosocomial Infection with Klebsiella pneumoniae ESBL.

Klebsiella pneumoniae is one of the most important hospital pathogens, particularly concerning the multidrug-resistant strain ESBL+. The aim of this study was to evaluate nosocomial infections with K. pneumoniae ESBL+ in the context of infection location, risk factors, and prognosis. This hospital study was conducted retrospectively and covered a 3months' period. The infection with K. pneumoniae ESBL+ was diagnosed in 36 patients (19 women and 17 men) of the mean age of 74.2±14.8years. The number of infected patients amounted to 2.2% of all patients admitted to Czerniakowski Hospital in Warsaw, Poland, over the study time. Twenty of these patients died (13 women and 7 men), representing 14% of all hospital deaths at the time. The infection with K. pneumoniae ESBL+ occurred most frequently in the department of internal diseases, and rarely in neurology or intensive care wards. Bacteria was most often isolated from the urine, with the most distinct association between the use of urinary catheters and death (p=0.019). We conclude that infections with K. pneumoniae ESBL+ were associated with over 55% mortality and usually occurred in the setting of internal diseases. Deaths due to K. pneumoniae ESBL+ infection were significantly related to the use of urinary bladder catheters.

Rhabdomyosarcoma of Reproductive Organs in Adult Females. Description of 5 Cases- Literature Review

Background: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcomas. It was described for the first time by Weber in 1854. RMS is recognized in approx. 90% of patients fewer than 20 years of age. The disease in adults is extremely rare. Materials and methods: A retrospective analysis was performed on 5 cases of RMS of the female genital tract. These 5 cases of the disease in women aged 20 and 87 years of age treated in a Warsaw hospital from 1991 to 2013. In all women the diagnosis was made on the basis of histopathological examination of tissues after excision of changes in the vulva and vagina. Tumors were classified according to the Intergroup Rhabdomyosarcoma Study (IRS) staging. All patients were treated with multimodality treatment: surgery, chemotherapy and/or ratiotherapy. Results: Of the five patients with RMS, three originated from the vagina one from vulvae and one from Bartholin’s glands. Two out of 5 patients presented with distant metastasis and death after 9 and 4 years. Tree patients alive for 3, 10, 11 years without recurrence or active disease a median duration was of 7.7 years. Conclusion: RMS in adults have poor prognosis as compared to childhood RMS. Adult RMS should therefore be treated aggressively with multidisciplinary approach comprising of surgery, radiation, and chemotherapy to achieve cure and prolonged survival. The prognosis of embryonal rhabdomyosarcoma of female genital tract is good. The standard treatment for adults RMS consisting the multimodal therapy with radical surgery and chemotherapy and radiotherapy.

Infections due to alphaherpesviruses in early post-transplant period after allogeneic haematopoietic stem cell transplantation: Results of a 5-year survey

BackgroundInfections caused by human α-herpesviruses usually have a benign course with recurrencies. However, they may become dangerous in immunocompromised hosts. In this case, molecular methods constitute a reliable diagnostic tool enabling rapid assessment of the efficacy of antiviral treatment strategies. ObjectivesWe estimated the frequency of alphaherpesviral DNAemia and the viral load during early post-transplantation period after alloHSCT; we also analyzed association of the DNAemia and chosen parameters of the patients. Study designA cohort of 190 alloHSCT recipients from two hospitals in Warsaw, Poland, was examined weekly during 100-day early post-transplantation period using quantitative real time PCR assays. A total of 2475 sera samples were evaluated for the presence of α-herpesviral DNA in patients, of whom 117 (62%) received unrelated grafts, while the remaining 73 (38%) received grafts from sibling donors. All patients received standard antiviral prophylaxis with acyclovir. In the examined group, anti-HSV-1, anti-HSV-2 and anti-VZV IgGs were examined prior to transplantation, ResultsWithin the study period, DNA of α-herpesviruses was detected in 44 patients (23.2%). Most patients tested positive for HSV-1 DNA (43 patients, 22.6%), single patient for HSV-2, and no patient positive for VZV. Clinical symptoms such as pneumonia, skin changes, elevated levels of aminotransferases were observed in five patients, four of these patients presented symptoms of GvHD at the same time. (2,6%). Statistics shows that GvHD (P<0.001) and matched unrelated donor as a source of HSCT (P=0.048) are associated with the development of HSV-1 DNAemia. ConclusionsAlthough our data demonstrate frequent reactivation of HSV-1 in the early post-transplant period, the rate of symptomatic infections was low. We did not find association between HSV-1 viremia and mortality, but significant association with GvHD and donor source was observed.

The Impact of Ischemic Cerebral Stroke on the Quality of Life of Patients Based on Clinical, Social, and Psychoemotional Factors

Cerebral stroke is the major cause of disability in the modern world and, given its consequences, poses serious medical and social problems. The purpose of the study was to evaluate the quality of life of patients who suffered from an ischemic cerebral stroke with respect to various areas of life, including, in particular, clinical and psychoemotional factors. The study hypothesis states that the poststroke quality of life is reduced in the general context as well as in the context of specific areas of life. It was also considered of key importance to assess how the quality of life of patients is affected by depression. The study included 44 patients with the first ischemic cerebral stroke of moderate and mild severity according to the National Institutes of Health Stroke Scale, currently treated in the Neurology Department of the Międzyleski Specialist Hospital in Warsaw. The quality of life was measured based on the standardized Ferrans and Powers Quality of Life Index questionnaire and the Beck Depression Inventory. Based on the results, it was demonstrated that the quality of life of the patients was significantly reduced on the psychological and spiritual well-being subscale and that depression is a more frequent occurrence among patients with cerebral stroke of moderate severity. Continued and complex posthospitalization care, including treatment for depression and increased social support, may to a significant extent reduce the negative impact of the disease on the perceived quality of life.