National Health Service Research Articles

Medication Engagement, Determinants of Health, and A1C Levels Among Adults With Type 2 Diabetes within a Tribal Health System.

The purpose of this study was to examine the association between determinants of health, medication engagement, and A1C levels in adults with type 2 diabetes (T2DM) receiving Tribal health and pharmacy services. A retrospective analysis of 2020-2021 electronic health record data was conducted and included adult patients with T2DM using Choctaw Nation Health Services Authority prescribed ≥1 noninsulin glucose-lowering medication in 2020, had ≥1 A1C value in 2020 and 2021, and had a valid zip code in 2021. Patients receiving both insulin and other noninsulin glucose-lowering medication were included. The proportion of days covered (PDC) was used to calculate medication engagement. Statistical analyses included bivariate analysis and linear regression. There were 3787 patients included in the analyses; 62.5% were considered engaged (PDC ≥ 0.8). The mean 2020 A1C level was 8.0 (64 mmol/mol) ± 1.8; 33% had an A1C of <7%, 42% had an A1C of 7% to 9%, and 25% had an A1C >9%. The mean A1C in 2021 was 7.9 (63 mmol/mol) ± 1.7; 34% had an A1C of <7%, 44% had an A1C of 7% to 9%, and 22% had an A1C >9%. Older age was weakly correlated with higher engagement; higher engagement was associated with lower A1C levels while adjusting for covariates. Medication engagement was associated with lower A1C levels, and older age was weakly associated with higher engagement to noninsulin glucose-lowering medications, consistent with previous literature. No determinants of health were significantly associated with A1C levels while adjusting for covariates.

Ancillary hospital workers experience during COVID-19: systematic review and narrative synthesis

BackgroundCOVID-19 overwhelmed healthcare systems worldwide. Its impact on clinical staff is well documented, but little is known about the effects on ancillary staff (cleaners, porters and caterers).AimTo identify the evidence...

Don't forget the children-paediatric patients in mass casualty events and major incident planning.

Major incidents and mass casualty events can affect people of all ages. However, when planning the response to a major incident the focus is often on adult casualties rather than children. It is essential that the needs of paediatric patients are taken into account throughout major incident planning. Whether considering equipment, staffing or surgical and critical care capacity, hospitals should meet the needs of children as well as adults following a major incident and where possible, keep families together. The new Major Incident Triage Tool introduced in the National Health Service (NHS) in 2024 has a tendency to over triage paediatric casualties and so hospitals who may be receiving children following a UK major incident must be aware of this and plan for the potential implications. This article reviews the evidence and learning from previous mass casualty events and makes recommendations for hospitals to ensure that the needs of children will be met if a major incident occurs.

Evaluation of a Musculoskeletal Digital Assessment Routing Tool (DART): Crossover Noninferiority Randomized Pilot Trial.

Musculoskeletal conditions account for 16% of global disability, resulting in a negative effect on patients and increasing demand for health care use. Triage directing patients to appropriate level intervention improving health outcomes and efficiency has been prioritized. We developed a musculoskeletal digital assessment routing tool (DART) mobile health (mHealth) system, which requires evaluation prior to implementation. Such innovations are rarely rigorously tested in clinical trials-considered the gold standard for evaluating safety and efficacy. This pilot study is a precursor to a trial assessing DART performance with a physiotherapist-led triage assessment. The study aims to evaluate trial design, assess procedures, and collect exploratory data to establish the feasibility of delivering an adequately powered, definitive randomized trial, assessing DART safety and efficacy in an NHS primary care setting. A crossover, noninferiority pilot trial using an integrated knowledge translation approach within a National Health Service England primary care setting. Participants were patients seeking assessment for a musculoskeletal condition, completing a DART assessment and the history-taking element of a face-to-face physiotherapist-led triage in a randomized order. The primary outcome was agreement between DART and physiotherapist triage recommendation. Data allowed analysis of participant recruitment and retention, randomization, blinding, study burden, and potential barriers to intervention delivery. Participant satisfaction was measured using the System Usability Scale. Over 8 weeks, 129 patients were invited to participate. Of these, 92% (119/129) proceeded to eligibility assessment, with 60% (78/129) meeting the inclusion criteria and being randomized into each intervention arm (39/39). There were no dropouts and data were analyzed for all 78 participants. Agreement between physiotherapist and DART across all participants and all primary triage outcomes was 41% (32/78; 95% CI 22-45), intraclass correlation coefficient 0.37 (95% CI 0.16-0.55), indicating that the reliability of DART was poor to moderate. Feedback from the clinical service team led to an adjusted analysis yielding of 78% (61/78; 95% CI 47-78) and an intraclass correlation coefficient of 0.57 (95% CI 0.40-0.70). Participant satisfaction was measured quantitively using amalgamated System Usability Scale scores (n=78; mean score 84.0; 90% CI +2.94 to -2.94), equating to an "excellent" system. There were no study incidents, and the trial burden was acceptable. Physiotherapist-DART agreement of 78%, with no adverse triage decisions and high patient satisfaction, was sufficient to conclude DART had the potential to improve the musculoskeletal pathway. Study validity was enhanced by the recruitment of real-world patients and using an integrated knowledge translation approach. Completion of a context-specific consensus process is recommended to provide definitive definitions of safety criteria, range of appropriateness, noninferiority margin, and sample size. This pilot demonstrated an adequately powered definitive trial is feasible, which would provide evidence of DART safety and efficacy, ultimately informing potential for DART implementation. ClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029. RR2-10.2196/31541.

Elicitation of expert prior opinion to design the BARJDM trial in juvenile dermatomyositis.

To elicit and quantify expert opinion concerning the relative merits of two treatments for a rare inflammatory disease: Juvenile dermatomyositis (JDM). The formal expression of expert opinion reported in this paper will be used in a Bayesian analysis of a forthcoming randomised controlled trial known as BARJDM (baricitinib for juvenile dermatomyositis). A Bayesian prior elicitation meeting was convened, following a previously described methodological template. Opinion was sought on the probability that a patient in the BARJDM trial would achieve clinically inactive disease, off glucocorticoids (GC) within a 12-month period with either methotrexate (standard of care); or baricitinib (a Janus kinase inhibitor, JAKi), with GC schedules identical in both arms of the trial. Experts' views were discussed and refined following presentation and further discussion of summated published data regarding efficacy of methotrexate or JAKi for JDM. Ten UK paediatric rheumatology consultants (including one adolescent paediatric rheumatologist) participated in the elicitation meeting. All had expertise in JDM, leading active National Health Service clinics for this disease. Consensus expert prior opinion was that the most likely probability of clinically inactive disease off GC within 12 months was 0.55 on baricitinib and 0.23 on methotrexate, with a greater degree of uncertainty for baricitinib. Experts currently think that baricitinib is superior to MTX for the treatment of JDM, although there is uncertainty around this. BARJDM will therefore integrate randomised trial data with this expert prior opinion to derive a posterior distribution for the relative efficacy of baricitinib compared with MTX.

Medical school origins of award-winning pathologists; analysis of a complete national dataset

BackgroundThe ultimate aim of medical education is to produce successful practitioners, which is a goal that educators, students and stakeholders support. These groups consider success to comprise optimum patient care with consequently positive career progression. Accordingly, identification of the common educational features of such high-achieving doctors will facilitate the generation of clinical excellence amongst future medical trainees. In our study we source data from British clinical merit award schemes and subsequently identify the medical school origins of pathologists who have achieved at least national distinction.MethodsBritain operates Distinction Award/Clinical Excellence Award schemes which honour National Health Service doctors in Scotland, Wales and England who are identified as high achievers. This quantitative observational study used these awards as an outcome measure in an analysis of the 2019-20 dataset of all 901 national award-winning doctors. Where appropriate, Pearson’s Chi-Square test was applied.ResultsThe top five medical schools (London university medical schools, Aberdeen, Edinburgh, Oxford and Cambridge) were responsible for 60.4% of the pathologist award-winners, despite the dataset representing 85 medical schools. 96.4% of the pathologist merit award-winners were from European medical schools. 9.0% of the pathologist award-winners were international medical graduates in comparison with 11.4% of all 901 award-winners being international medical graduates.ConclusionsThe majority of pathologists who were national merit award-winners originated from only five, apparently overrepresented, UK university medical schools. In contrast, there was a greater diversity in medical school origin among the lower grade national award-winners; the largest number of international medical graduates were in these tier 3 awards (13.9%). As well as ranking educationally successful university medical schools, this study assists UK and international students, by providing a roadmap for rational decision making when selecting pathologist and non-pathologist medical education pathways that are more likely to fulfil their career ambitions.

Implementation of the TALK© clinical self-debriefing tool in operating theatres: a single-centre interventional study

BackgroundDebriefing in operating theatre environments leads to benefits in mortality, efficiency, productivity, and safety culture; however, it is still not regularly performed. TALK© is a simple and widely applicable team self-debriefing method to collaboratively learn and improve. MethodsAn interventional study introducing TALK© for voluntary clinical debriefing was carried out in operating theatre environments in a UK National Health Service hospital over 18 months. It explored compliance with the Five Steps to Safer Surgery and changes in behaviour in surgical teams regarding consideration and completion of debriefing. ResultsTeam briefing and compliance with the WHO surgical safety checklist were performed consistently (>95% and >98%, respectively) throughout the study, which included 460 surgical lists. Consideration of debriefing increased at all data collection periods after intervention, from 35.6% to 60.3–97.4% (P≤0.003). Performance of debriefing, which was 23.3% at baseline, reached 39% at 6 months (P=0.039). Team planning of actions for improvement during debriefing also increased (P<0.001). A decline in performance of debriefing and subsequent improvement actions was observed after 6 months, albeit rates were above baseline at 18 months. The most reported reason not to carry out a debriefing was ‘lack of issues’. After implementation, nurses and allied healthcare professionals increased their contribution to initiating and leading debriefing. Reported barriers were <18% at baseline, and decreased after intervention. ConclusionsA simple intervention introducing TALK© for voluntary debriefing in theatres prompted significant changes in team behaviour and sustained growth regarding consideration and performance of debriefing, especially in the first 6 months.

Effectiveness and cost-effectiveness of radiofrequency denervation versus placebo for chronic and moderate to severe low back pain: study protocol for the RADICAL randomised controlled trial

IntroductionLow back pain (LBP) is the leading global cause of disability. Patients with moderate to severe LBP who respond positively to a diagnostic medial nerve branch block can be offered...

Factors Affecting Specialty Training Preference Among UK Medical Students (FAST): Protocol for a National Cross-Sectional Survey.

The UK medical education system faces a complex landscape of specialty training choices and heightened competition. The Factors Affecting Specialty Training Preference Among UK Medical Students (FAST) study addresses the need to understand the factors influencing UK medical students' specialty choices, against a backdrop of increasing challenges in health care workforce planning. The primary objectives of the FAST study are to explore UK medical students' preferred specialties and the factors that influence these choices. Secondary objectives are to evaluate students' confidence in securing their chosen specialty, to understand how demographic and academic backgrounds affect their decisions, and to examine how specialty preferences and confidence levels vary across different UK medical schools. A cross-sectional survey design will be used to collect data from UK medical students. The survey, comprising 17 questions, uses Likert scales, multiple-choice formats, and free-text entry to capture nuanced insights into specialty choice factors. The methodology, adapted from the Ascertaining the Career Intentions of UK Medical Students (AIMS) study, incorporates adjustments based on literature review, clinical staff feedback, and pilot group insights. This approach ensures comprehensive and nondirective questioning. Data analysis will include descriptive statistics to establish basic patterns, ANOVA for group comparisons, logistic regression for outcome modeling, and discrete choice models for specialty preference analysis. The study was launched nationally on December 4, 2023. Data collection is anticipated to end on March 1, 2024, with data analysis beginning thereafter. The results are expected to be available later in 2024. The FAST study represents an important step in understanding the factors influencing UK medical students' career pathways. By integrating diverse student perspectives across year groups and medical schools, this study seeks to provide critical insights into the dynamics of specialty, or residency, selection. The findings are anticipated to inform both policy and educational strategies, aiming to align training opportunities with the evolving needs and aspirations of the future medical workforce. Ultimately, the insights gained may guide initiatives to balance specialty distribution, improve career guidance, and improve overall student satisfaction within the National Health Service, contributing to a more stable and effective health care system. DERR1-10.2196/55155.

A Cross-Sectional Evaluation of the Virtual Outpatient Management of People With Mpox.

To report on the implementation and outcomes of a virtual ward established for the management of mpox during the 2022 outbreak, we conducted a 2-center, observational, cross-sectional study over a 3-month period. All patients aged ≥17 years with laboratory polymerase chain reaction-confirmed monkeypox virus managed between 14 May and 15 August 2022, at the Hospital for Tropical Diseases at University College London Hospitals National Health Service (NHS) Foundation Trust and sexual health services at Central North and West London NHS Foundation Trust, were included. Main outcomes included the proportion of patients managed exclusively on the virtual ward, proportion of patients requiring inpatient admission, proportion of patients with human immunodeficiency virus, and duration of lesion reepithelialization. Among confirmed cases (N = 221), 86% (191/221) were managed exclusively on the virtual ward, while 14% (30/221) required admission. Treatment for concomitant sexually transmitted infections was provided to 25% (55/221) of patients, antibiotics for other infective complications to 16% (35/221), and symptomatic relief to 27% (60/221). The median time from onset to complete lesion reepithelialization and de-isolation was 18 days (range, 8-56 days). Eleven percent (24/221) of individuals disengaged from services within 4 days of testing. The virtual ward model facilitated safe and holistic outpatient management of mpox, while minimizing admissions. This approach could serve as a model for future outbreak responses.

Systematic Review of Economic Evaluations of Systemic Treatments for Advanced and Metastatic Gastric Cancer.

Recent advances in the development of biomarker-directed therapy and immunotherapy, for advanced and metastatic gastric cancers, have the potential to improve survival and quality of life.Much attention has been directed towards second- and later-line treatments, and the landscape here is evolving rapidly. However, uncertainty in relative effectiveness, high costs and uncertainty in cost effectiveness represent challenges for decision makers. To identify economic evaluations for the second-line or later-line treatment of advanced and metastatic gastric cancer. Also, to assess key criteria (including model assumptions, inputs and outcomes), reporting completeness andmethodological quality to inform future cost-effectiveness evaluations. A systematic literature search (from database inception to 5 March 2023) of EconLit via EBSCOhost, Cochrane Library (restricted to National Health Service [NHS] Economic Evaluation Database and Health Technology Assessment [HTA] Database), Embase, MEDLINE and of grey literature was conducted. This aimed to identify systemic treatments that align with National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) Clinical Practice Guidelines. Data were collected on key criteria and on reporting completeness and methodological quality. A narrative synthesis focussed on cost-effectiveness and cost-of-illness studies. Outcomes of interest included total and incremental costs and outcomes (life-years and quality-adjusted life-years), ratios of incremental costs per unit outcome and other summary cost and outcome measures. Also, for cost-effectiveness studies, reporting completeness and the methodological quality were assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and the Philips Checklist, respectively. A total of 19 eligible economic evaluations were identified (cost-effectiveness studies [n = 15] and cost-of-illness studies [n = 4]). There was a general lack of consistency in the methodological approaches taken across studies. In the main, the cost-effectiveness studies indicated that the intervention under consideration was more effective and more costly than the comparator(s). However, most interventions were not cost effective. No studies were fully compliant with reporting-completeness and methodological-quality requirements. Given the lack of consistency in the approaches taken across cost-of-illness studies, outcomes could not be directly compared. To our knowledge, this is the first published systematic literature review that has qualitatively synthesised economic evaluations for advanced and metastatic gastric cancer. There were differences in the approaches taken across the cost-effectiveness studies and the cost-of-illness studies. The conclusions of most of the cost-effectiveness studies were consistent despite identified differences in approaches. In the main, the interventions under consideration were not cost effective, presenting challenges to sustainability and affordability. We highlight a requirement for cost-effectiveness evaluations and for second-line or later-line treatments of advanced and metastatic gastric cancer that consider all relevant comparators and that are compliant with reporting-completeness and methodological-quality requirements. By addressing the methodological gaps identified here, future healthcare decision-making, within the context of this rapidly changing treatment landscape, would be better informed. CRD42023405951.

Impact of COVID-19 on home care provision: A qualitative study

Summary The COVID-19 pandemic and subsequent public health restrictions caused an unprecedented impact on long-term care services in the United Kingdom (UK). A qualitative study was conducted in the East Midlands, UK, to explore how home care provision was perceived and experienced, by those organizing, commissioning, or providing care, and those receiving care, during the pandemic. Fifteen semi-structured telephone interviews were conducted between September to December 2020 with people who organize, commission, or provide home care ( n = 9), recipients of home care ( n = 3), and their informal carers ( n = 6). Findings Three broad themes were constructed through a thematic analysis: (1) positive about home care; (2) fear of infection; and (3) social isolation. In addition to these overarching themes, specific group themes were identified amongst group one: those organizing, commissioning, or providing care, and group two: those in receipt of the care and informal carers. Those in group one spoke about the pandemic creating stressful working conditions, regardless of whether organizing, commissioning, or providing care. Despite working throughout the pandemic, they felt a forgotten part of the essential workforce, when compared to those employed in the National Health Service and institutional care. Those in group two experienced a loss of control with visits cancelled or frequently occurring outside of scheduled times. Dissatisfaction with the visits was directed at the management level, rather than at the staff visiting the homes. Applications Awareness and understanding of the experiences of home care will provide useful knowledge when commissioning future services.

Associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with type 2 diabetes under the national essential public health services program

BackgroundThe rising prevalence of Type 2 diabetes (T2D) in China poses a critical health challenge, necessitating effective management strategies. The National Essential Public Health Services Program (NEPHSP), initiated in 2009, focuses on equitable access to health services, including T2D management. This study investigates the associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with T2D under NEPHSP, particularly examining the mediating role of self-care behaviors.MethodsConducted from April to November 2020 in Huai’an City, Jiangsu Province, this study involved 1,577 T2D patients enrolled in NEPHSP. We assessed perceived care quality using the Patient Assessment of Chronic Illness Care (PACIC) scale and developed a comprehensive self-care behavior score, covering nine essential health practices. Glycemic control was evaluated using HbA1c levels. Linear regression models were used to explore these associations, adjusting for demographic and clinical factors, while causal mediation analyses examined the role of intermediate variables.ResultsHigher PACIC scores significantly correlated with improved self-care behaviors (β = 0.294, 95% CI: 0.233 to 0.354) and were negatively associated with HbA1c levels (β=-0.109, 95% CI: -0.192 to -0.026). The self-care behavior score inversely related to HbA1c levels (β=-0.197, 95% CI: -0.263 to -0.132). Notably, self-care behaviors mediated 50.41% (P < 0.05) of the effect of perceived care quality on HbA1c levels.ConclusionsThis study demonstrates a substantial association between perceived care quality and better glycemic control in Chinese adults with T2D under NEPHSP, with self-care behaviors playing a crucial mediating role. These findings suggest that patient-centered care and comprehensive self-care practices are essential for effective T2D management within NEPHSP.

Research on Public Management Strategy of Optimizing the Service Efficiency of NHS System in Britain

In this paper, the optimization of the service efficiency of the National Health Service (NHS) in Britain is deeply discussed, and the corresponding public management strategies are put forward. In order to improve the service efficiency of NHS system, this paper puts forward a number of public management strategies. First of all, improve the management system, introduce performance evaluation mechanism and strengthen cross-departmental cooperation to motivate medical service providers and managers to improve their work efficiency. Secondly, optimize the allocation of resources, dynamically adjust the allocation of medical personnel and beds according to seasonal and regional needs, and improve the efficiency of human resources. Finally, strengthen information construction, promote electronic medical record system, and use big data and artificial intelligence technology to improve the accuracy and efficiency of medical services. By drawing lessons from successful public management strategy cases at home and abroad, this paper provides practical reference for optimizing the service efficiency of NHS system. The British government and relevant institutions should formulate detailed implementation plans to ensure that these strategies are effectively implemented, so as to improve the overall service level and patient satisfaction of the NHS system. The research in this paper provides valuable insights and strategic suggestions for optimizing the service efficiency of NHS system in Britain, which is of great significance for improving the quality and efficiency of medical services.

Development of an intervention for patients following an anterior cruciate ligament rupture: an online nominal group technique consensus study

Objectives(1) To develop an intervention for to support patients diagnosed with an anterior cruciate ligament (ACL) rupture with decision-making regarding treatment. (2) To define evidence-based recommendations for the treatment of...

Evaluating the Acceptability of the Drink Less App and the National Health Service Alcohol Advice Web Page: Qualitative Interview Process Evaluation.

The extent to which interventions are perceived as acceptable to users impacts engagement and efficacy. In this study, we evaluated the acceptability of (1) the smartphone app Drink Less (intervention) and (2) the National Health Service (NHS) alcohol advice web page (usual digital care and comparator) among adult drinkers in the United Kingdom participating in a randomized controlled trial evaluating the effectiveness of the Drink Less app. A subsample of 26 increasing- and higher-risk drinkers (Alcohol Use Disorders Identification Test score≥8) assigned to the intervention group (Drink Less; n=14, 54%; female: n=10, 71%; age: 22-72 years; White: n=9, 64%) or usual digital care group (NHS alcohol advice web page; n=12, 46%; female: n=5, 42%; age: 23-68 years: White: n=9, 75%) took part in semistructured interviews. The interview questions were mapped on to the 7 facets of acceptability according to the Theoretical Framework of Acceptability: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Alongside these constructs, we also included a question on perceived personal relevance, which previous research has linked to acceptability and engagement. Framework and thematic analysis of data was undertaken. The Drink Less app was perceived as being ethical, easy, user-friendly, and effective for the period the app was used. Participants reported particularly liking the tracking and feedback sections of the app, which they reported increased personal relevance and which resulted in positive affect when achieving their goals. They reported no opportunity cost. Factors such as negative affect when not meeting goals and boredom led to disengagement in the longer term for some participants. The NHS alcohol advice web page was rated as being easy and user-friendly with no opportunity costs. However, the information presented was not perceived as being personally relevant or effective in changing drinking behavior. Most participants reported neutral or negative affect, most participants thought the alcohol advice web page was accessible, and some participants reported ethical concerns around the availability of suggested resources. Some participants reported that it had acted as a starting point or a signpost to other resources. Participants in both groups discussed motivation to change and contextual factors such as COVID-19 lockdowns, which influenced their perceived self-efficacy regardless of their assigned intervention. Drink Less appears to be an acceptable digital intervention among the recruited sample. The NHS alcohol advice web page was generally considered unacceptable as a stand-alone intervention among the recruited sample, although it may signpost and help people access other resources and interventions.

Safety, resource use and nutritional content of home-blended diets in children who are gastrostomy fed: findings from ‘YourTube’ – a prospective cohort study

ObjectiveTo assess the risks, benefits and resource implications of using home-blended food in children with gastrostomy tubes compared with currently recommended formula feeds.DesignThis is a cohort study. Data were collected...

An Activity-Based Costing model applied to the management process of patients with migraine at IRCCS Mondino Foundation

Background and aim: The ageing of the general population, with the increase in chronic diseases, poses the need for using technological innovation to face the growing healthcare needs. The present analysis applied the Activity-Based Costing tool in migraine patients followed at the IRCCS Mondino of Pavia to formalize and quantify the costs of the whole patient’s management process and to estimate the overall economic burden of migraine from the perspective of the National Health Service (NHS). Methods: A two-stage analysis was conducted. The first stage aimed at drawing patient’s pathway, defining all the possible activities and actors involved in the healthcare delivery and treatment for migraine at the IRCCS during year 2022. The second phase was the development of a model to estimate the costs of the entire process by pricing the individual activities. Results: The described model yielded an estimated total annual cost for the overall management of migraine of € 1,222,392, corresponding to a direct cost for a therapy of approximately 6 months per single patient of € 814. The most impactive items on the estimated annual expenditures were hospitalizations, followed by diagnostic examinations after follow-up visits and drugs dispensed by Hospital Pharmacy for home-administration (monoclonal antibodies). Conclusions: This analysis allowed detailing the single activities and resources used in migraine patient’s pathway and then estimating the direct costs sustained by the NHS. The model could be translated to other diseases for optimizing the diagnostic/therapeutic and economic management of assisted patients and improving healthcare resource allocation.

Determinants of anxiety and depression disorders among patients with pulmonary arterial hypertension

Abstract Introduction Pulmonary arterial hypertension (PAH) is a rare chronic disease that, as it progresses, contributes to decreased ability to perform daily activities, deterioration of physical and mental well-being and social functioning. Patients with PAH experience anxiety and depression-like disorders that directly affect their quality of life. In view of the above, it is necessary to determine the determinants that affect the deterioration of mental functioning in this group of patients. Purpose The aim of the study was to determine the prevalence of anxiety and depression and their determinants. Material and methods The study included 89 patients , pulmonary arterial hypertension (PAH), who participated in the Therapeutic Treatment of Pulmonary Arterial Hypertension program by the National Health Service. Patients were asked to complete a standardized questionnaire (HADS) to assess Anxiety and Depression and a self-report questionnaire assessing sociodemographic factors and severity of symptoms. Medical data were taken from the hospital registry. Results In the study group, the mean anxiety score (HADS-A) was M=5.33 (SD=3.31), and the mean depression score (HADS-D) was M=4.4 (SD=3.78), indicating their low level of severity. Significant levels of the studied mood disorders are observed in one in five patients covered by the NHF drug program. Factors significantly (p&amp;lt;0.05) correlating with the severity of anxiety symptoms were chest pain (r=0.343), weakness (r=0.256), fatigue (r=0.327), MWT score 6 (r= -0.266), and arrhythmias (r=0.42). In addition to the above-mentioned factors, significant correlations (p&amp;lt;0.05) were obtained with the severity of depressive symptoms, for such factors as WHO FC Class (r=0.427), eldery age (r=0.263), NT-pro BNP (r=0.239). Conclusions Drug and depressive disorders in the study group of PAH patients are not common and may affect one in five patients (study participants on PAH treatment). The occurrence of anxiety disorders correlates with many PAH symptoms, sociodemographic and clinical factors. Learning about the factors associated with the occurrence of mental disorders can help to better identify them and prevent their occurrence.

Determinants of sleep disturbances in patients with pulmonary arterial hypertension

Abstract Introduction Pulmonary arterial hypertension (PAH) is a rare, chronic disease that leads to the development of a range of cardiopulmonary and cardiovascular symptoms. Studies indicate that sleep problems may contribute to the deterioration of function in patients with PAH. Identifying factors that are related to the occurrence of sleep disorders can help identify them, and will also allow you to take steps to minimize the risk of insomnia. Purpose The aim of this study was to determine the determinants affecting the incidence of sleep disorders among patients with pulmonary arterial hypertension. Material and methods The study included 89 patients with a diagnosis of pulmonary arterial hypertension (PAH) who are chronically treated and participate in the state program for Therapeutic Treatment of Pulmonary Arterial Hypertension by the National Health Service. The study used standardized tools: a self-administered survey questionnaire, as well as the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Results Patients had a mean PSQI score of M=8.7 (SD=4.64), indicating low sleep quality. Factors that had a significant impact on sleep disturbance were: old age (r=0.373), chest pain (r=0.307), weakness (r=0.296), fatigue (r=0.316), shortness of breath (r=0.242), MWT score 6 (r= -0.237), NT-proBNP (r=0, 517), social support (r=0.237), staying in a relationship (r= -0.21), arrhythmia (r=0.211), number of hospitalizations (r=0.33), male gender (r=0.257), WHO FC class (r=0.503). Conclusions In the study group of patients with PAH, sleep disorders are present in the majority. The progression of clinical symptoms and selected sociodemographic data significantly correlate with the occurrence of insomnia.