Patients In Poland Research Articles

Surgical treatment of rectal cancer in Poland — a report from a prospective, multi-centre observational study PSSO_01 conducted under the auspices of the Polish Society of Surgical Oncology

Introduction. Since 2016, as part of the PSSO_01 multi-centre research project conducted under the auspices of the Polish Society of Surgical Oncology, clinical data on rectal cancer treatment have been collected. The objective of the study was to illustrate the state of early results of surgical treatment. Material and methods. The research project is multi-centre in nature. Data shall be collected electronically. The study protocol does not impose or suggest any course of procedure. It only systematizes the way data are collected for scientific purposes. The analysis of early results of surgical treatment was compared with the results of population studies from other European countries (Netherlands, Belgium). Results . By the end of June 2018, 736 patients were registered in the study. In 399 (54.2%) an anterior resection was performed. More than half of patients undergoing subsequent surgical treatment (54.2%) receive neoadjuvant treatment, with the percentage of patients undergoing radiotherapy or radiochemical treatment for lower rectal cancer being about 70%. Most patients (96%) are operated in elective procedure. The percentage of laparoscopic surgeries is low (8.6%). Postoperative complications are observed in 21.1% of patients. Severe complications (grades III–V according to Clavien-Dindo classification) occur in 7.6% of patients undergoing surgery. Postoperative mortality is 1.1%. Discussion. Although the project does not have the character of a registry and does not allow for drawing wider conclusions concerning the compliance with the standards of qualification for neoadjuvant treatment, the important information is that more than half of rectal cancer patients receive preoperative treatment, and the percentage of severe postoperative complications does not exceed 10%. Conclusions. The results of the PSSO_01 project are representative and reflect the actual situation concerning surgical treatment of rectal cancer patients in Poland.

Internalized stigma and its correlates among patients with severe mental illness

PurposeThe aim of this study was to investigate the perceived level of internalized stigma among patients with severe mental illnesses and its relationship with demographic and clinical variables in Poland.Patients and methodsA study sample (n=114, mean age=42.46±14.1 years; 55% of females) consisting of patients with nonorganic psychotic disorders as well as unipolar and bipolar affective disorders was evaluated (58% of outpatients and 39% of inpatients). All patients filled in the Internalized Stigma of Mental Illness (ISMI) scale (maximum severity=4). The demographic and clinical data were collected.ResultsThe study population demonstrated a mild level of internalized stigma (2.23±0.5). The highest score was observed in the alienation domain (2.63±0.8) and reflected moderate severity. The lowest score was noted in the stereotype endorsement domain (2.08±0.6). Moreover, the highest degree of internalized stigma was present in participants with unipolar affective disorder and was of moderate severity (2.46±0.6), while the level was moderate in the alienation domain (2.85±0.8). The level of vocational training education was the only variable associated with higher internalized stigma (P=0.02). There were no associations between gender, employment, and marital status and internalized stigma. The duration of the disease was the only clinical factor showing a significant positive correlation with stigma internalization (r=0.23; P=0.01). The number of hospital admissions and suicide attempts was not significantly correlated with internalized stigma.ConclusionPeople with severe mental illnesses in Poland experience a mild level of self-reported internalized stigma. Internalized stigmatization was most strongly associated with alienation, which indicates the need for stigma assessment procedures followed by stigma intervention programs in daily clinical practice. This is in accordance with the trend of environmental “open door” psychiatry, which could be the first step to decrease the level of stigma and internalized stigma in psychiatric patients in Poland.

PGI30 - POLISH THERAPEUTIC ALGORITHMS IN PATIENTS WITH COMPLEX PERIANAL FISTULAS IN CROHN'S DISEASE

Complex perianal fistula (CPF) is a chronic and relapsing disease representing a serious therapeutic challenge for both gastroenterologists and surgeons. Main reason for that is lack of any standardized treatment approach for about 12-14% of young patients with Crohn’s disease (CD) who are affected by CPF. The aim of this study was to assess current therapeutic approach for the treatment of CPF in Poland. The study was held from February to April 2018. It consisted of two parts: direct interviews with physicians (30 gastroenterologists and 15 surgeons) and medical records analysis including 75 patients with CPF who failed to respond to standard therapy. The management of patients with CPF significantly differs depending on the experience of a medical center. The role of surgeon was differently perceived depending on the size and experience of the medical center, however the main approach was that gastroenterologists as physicians treating the underlying disease continue pharmacological treatment solely, whereas the surgeon is basically involved in treating complications specific to CPF that require surgical intervention. Among the analyzed 75 patients, in 41% pharmacological treatment solely was applied, whereas in 59% both pharmacological and surgical treatment was applied. The length of pharmacological therapy from the start to the decision to use the next line of treatment was 3 to 24 months. The time from the start of standard CPF treatment to the decision about surgical treatment was 10 to 18 weeks (only patients with surgical treatment analyzed) depending on the experience of the center. The study showed the lack of coordinated care of CPF patients in Poland, relevant differences in treatment patterns depending on the experience of the centers among medical centers and the necessity for extending the range and for improving collaboration between gastroenterologists and surgeons.

Comorbidities in chronic obstructive pulmonary disease: Results of a national multicenter research project

Chronic obstructive pulmonary disease (COPD) is associated with various comorbidities, which influence the course of COPD and worsen prognosis. The aim of this study was to analyze the comorbidities in a cohort of COPD patients in Poland during 12 months of observation. A total of 444 COPD patients (median age: 66.1 years) in all stages of airflow limitation severity were enrolled. Medical histories and a questionnaire concerning comorbidities were analyzed at baseline and after 12 months (data of 267 patients available). Anthropometric data, pulmonary function, and body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE index) were assessed. No comorbidities were reported in 9 patients (2.0%), 101 patients (22.7%) had 1-2 comorbidities, 243 (54.7%) had 3-5, and 91 (20.6%) had more than 5 comorbidities. Cardiovascular diseases (CVDs) were the most frequent ones, followed by peptic ulcer, obstructive sleep apnea (OSA), diabetes, gastroesophageal reflux disease (GERD), and osteoporosis; 11 patients had a history of lung cancer. Cachexia was observed in 11 cases, overweight in 136 cases and obesity in 139 cases. The incidence of CVDs increased with time. The number of comorbidities correlated with the body mass index (BMI) and the number of hospitalizations for extra-pulmonary causes, but not with airflow limitation. The BODE index score increased with the number of comorbidities. In a cohort of Polish COPD patients, the most frequent comorbidities were CVDs. The number of comorbidities affected the BODE index, but not airflow limitation. The BODE index is better than forced expiratory volume in 1 s (FEV1) in the rating of COPD patients' condition. The BMI correlated with the number of comorbidities as well as the number of hospitalizations for extra-pulmonary causes.

Management of Prader-Willi Syndrome (PWS) in adults - what an endocrinologist needs to know. Recommendations of the Polish Society of Endocrinology and the Polish Society of Paediatric Endocrinology and Diabetology.

Prader-Willi syndrome (PWS) is a complex genetic disorder characterised by a set of phenotypic traits, which include infantile hypotonia, short stature, and morbid obesity. Over the last 12 years, visible progress has been made in medical care management of PWS patients in Poland. Increasing awareness of the disorder in neonatal and paediatric care has led to early identification of the condition in neonates, followed by the institution of an appropriate dietary regime, introduction of physiotherapy, and early-onset recombinant human growth hormone (rhGH) treatment. Growth hormone (GH) therapy in Poland is conducted within the nationwide framework of the Therapeutic Programme: "Treatment of Prader-Willi Syndrome". The therapeutic interventions initiated in the paediatric centres need to be continued in multidisciplinary adult care settings. The main aim of PWS clinical management in adulthood is prevention of obesity and its comor-bidities, treatment of hormonal disorders, mental health stabilisation, nutritional guidance, as well as on-going physiotherapy. Integrated multidisciplinary therapeutic intervention is necessary if patients with such a complex genetic condition as PWS are to not only achieve an average life expectancy but also to enjoy higher quality of life.

Analysis of Diagnostic Methods for Focal Lesions in Breast Glands with Use of Open Surgical Biopsies and Core-Needle Biopsies in Poland.

BackgroundNumerous studies confirm the benefits of using core-needle biopsy (CNB) for diagnosing patients with suspected breast cancer, thus reducing the costs and the stress, and allowing optimum treatment planning. The present study examined the number of patients in Poland who had been diagnosed with breast cancer through inpatient open surgical biopsy (OSB) and CNB by province.Material/MethodsThis retrospective study used a health needs map to identify patients in 2014 and partially in 2015 who had had OSB or CNB of the breast performed on an inpatient basis due to benign breast lesions and whose diagnosis had been changed from benign to malignant.ResultsAmong the total number of hospitalizations (13 718 cases with OSB) due to benign lesions of the breast, 1506 patients had their diagnosis changed to malignant, constituting 8.59% of new breast cancer diagnoses across the country. The resulting diagnosis change from benign to malignant varied significantly across provinces, from 5.3% to 23.4%. Among the total of 7205 hospitalizations in 2014 with CNB performed using different methods, there were 1574 malignancies, amounting to 8.9% of new diagnoses in Poland. The use of inpatient CNB to diagnose breast cancer differed significantly across provinces, from 0.6% to 34.4%.ConclusionsOSBs are too often used to diagnose focal lesions in breast glands in Poland. In some regions, CNBs are too frequently performed on an inpatient rather than outpatient basis, thereby requiring an analysis of the quality of and access to modern diagnostic methods.

Prevalence of Cryptosporidium, Blastocystis, and other opportunistic infections in patients with primary and acquired immunodeficiency

Intestinal opportunistic infections are often caused by unicellular parasites. Individuals with decreased immunity are particularly susceptible to infection by said microorganisms, and when they are infected, diarrhea can be the main clinical manifestation. However, intestinal parasites have rarely been taken into account in intestinal disorders. In our study, an investigation was conducted to determine the prevalence of intestinal micro-pathogens, such as Cryptosporidium, Giardia, Blastocystis, and microsporidia, in hospitalized patients with different immunological statuses. The study at hand indicates that protozoan parasitic infections are rare among immunodeficient patients in Poland. The overall prevalence of micro-pathogens among participants was 4.6%; it was three times higher in adults (12.5%) than in children (2.3%). Cryptosporidium and Cyclospora species (Apicomplexa) were diagnosed as the main cause of heavy diarrhea. Accordingly, adult patients were positive mainly for Blastocystis and microsporidia, while children were more often infected with the Cryptosporidium species.

Quality of Diabetes Care—Comparisons between Rzeszow, Podkarpacie, Poland and Waukesha, Wisconsin, U.S.

Introduction: Poland spent 6.4% of its GDP on healthcare in 2013, while the United States (U.S.) spent 16.9%, despite similar life expectancies. Type 2 diabetes mellitus (DM) was estimated to have cost the U.S. $176 billion in 2012. This study compares the quality of DM care between Waukesha in Wisconsin, U.S. and Rzeszow in Podkarpacie region of Poland—cities comparable in population size, age, race, and income levels. Methods: DM quality data for the Polish cohort was abstracted from the charts of 144 DM patients attending a regional diabetes clinic in Rzeszow, Podkarpacie from 2013-2014. Podkarpacie DM cost data was attained from the Polish National Health Fund. One hundred and forty-four DM patients, matched for age, BMI, and sex, from a diabetes clinic in Waukesha, WI were chosen as comparators. DM quality data was obtained through the Clinical Research Data Warehouse at the Medical College of Wisconsin. Cost data for WI was inferred from a previously published cost estimate for WI. Results: The mean (SD) for glycosylated hemoglobin (HbA1C, %) in the Polish and U.S. cohorts was 7.4 (1.3) and 7.8 (1.9) respectively (p=0.04). Mean systolic/diastolic blood pressures (BP, mm Hg) in the Polish and U.S. cohorts were 148 (20)/81 (0.3) and 132 (16)/74 (11) (p <0.001, p<0.001) respectively. Insulin was prescribed in 38% of patients in Poland and 58% in U.S. The cost of hospitalizations, outpatient care, and medications per Polish patient with DM was $781 or 3.2% of the gross national income (GNI) per capita. In 2012, the direct medical cost was estimated at $8,926 per adult with DM in Wisconsin, or 15.9% GNI income per capita. Discussion: Based on our results, Polish cohort had a slightly better HbA1C. The U.S. cohort had much better BP control compared to the Polish cohort. The cost of care at Podkarpacie was ∼10-fold lower compared to Waukesha. While both countries operate under different political and economic conditions, each could benefit from a deeper understanding of the other’s quality practices and cost structures. Disclosure J. Idso: None. G. Telega: Research Support; Self; Kadmon Corporation. M. Dąbrowski: Other Relationship; Self; Ascensia Diabetes Care, AstraZeneca, Berlin-Chemie AG, Eli Lilly and Company, MSD K.K., Sanofi-Aventis, Servier. S. Kidambi: None.

Changes in five-year relative survival rates in Poland in patients diagnosed in the years 1999–2010

Introduction. Survival rates are a tool that allows evaluation of healthcare quality and cancer treatment efficiency. The main aim of this article is to present tendencies in curability of Polish patients diagnosed between 1999–2010 and followed up until the end of 2015. Materials and methods. Survival analysis was performed using data from the Polish National Cancer Registry and Statistics Poland. The survival rates were calculated using Hakulinen method. Results. In Poland, five-year survival rates in men for all cancers increased from 32.9% (diagnosis 1999–2001) to 41.3% (diagnosis 2008–2010), whereas in women, from 50.9% to 56.1% respectively. The biggest improvement was found in therapy of prostate cancer (by 15.5 percentage points), hematological malignancies (7–13 p.p.), malignancies of bone and cartilage (10–14 p.p.), thyroid gland cancers (5–9 p.p.) and kidney cancer (7–9 p.p.). Discussion. Although survival rates are lower than in other European countries, survival of oncology patients in Poland has improved. Conclusions. 1. In Poland, survival of patients with majority of cancer types has improved. 2. The greatest increase in survival rates was observed for rare malignancies. 3. The improvement occurred during the time when the National Cancer Control Program was implemented.

Alcohol Drinking Pattern Is Associated with Demographic Features of Primary Health Care Patients in Poland: A Cross-Sectional Study.

BackgroundThe Optimizing Delivery of Health Care Interventions (ODHIN) project focused on the implementation of screening and brief intervention for hazardous and harmful alcohol consumption in primary health care. The aim of the present study was to investigate whether alcohol drinking pattern is associated with demographic features of primary health care patients in Poland and if it is possible to identify groups at highest risk for hazardous and harmful drinking.Material/MethodsThe study enrolled 8805 adult (mean age 54.98±16.94, M/F – 3581/5224) patients reporting to 30 general practitioners working in 10 primary health care units located in urban and partially rural areas in Poland. The shortened, 3-item version of the Alcohol Use Disorders Identification Test (AUDIT-C) was the screening tool used.ResultsPlace of residence was significantly associated with higher odds of hazardous and harmful drinking diagnosis, referred to as AUDIT-C (+). Age and sex were significantly associated with AUDIT-C (+) and suspicion of alcohol dependence, referred to as AUDIT-C ≥8 scores. Logistic regression revealed that males had 5-fold higher odds for hazardous and harmful drinking diagnosis and almost 28-fold higher odds for suspected alcohol dependence compared to females.ConclusionsDemographic features are associated with drinking pattern of primary health patients in Poland. Young males and those inhabiting rural areas are at highest risk of being hazardous or harmful drinkers and of being alcohol dependent. There is a growing need for development of national guidelines to address the prevention of alcohol-related health problems by general practitioners.

The Technical Supervising System Organization of Patients Supported by HVAD in Poland

HVAD is the most frequently implanted rotary MCS system in Poland. In order to support clinicians and patients team of technical specialists has been established. Aim of work is to present the organization style and results of technical supervision of HVAD supported patients in Poland.

Characterising smoking among cancer patients in Poland - a cross-sectional pilot survey

Characterising smoking among cancer patients in Poland - a cross-sectional pilot survey

Paget disease of bone among hospitalized patients in Poland.

Paget's disease (PDB) is a focal disorder of bone remodeling that occurs commonly in older people with decreasing prevalence reported in European countries. This disease is most often asymptomatic, but it can cause a variety of medical complications resulting in considerable morbidity and reduced quality of life. There is little information regarding the epidemiology of PDB in Poland. To the best of the authors' knowledge, this is the first large epidemiological analysis of this disease in Poland. The aim of this study was to analyze factors that may be related to the PDB epidemiology among hospitalized patients in Poland. The analysis was conducted on the basis of population-based administrative data, taken from a Polish hospital morbidity study carried out by the National Institute of Public Health between January 2008 - December 2014. Analyzed data covered 662 hospitalization records. The final study sample comprised 94 (41.8%) male and 131 (58.2%) female patients with first-time hospitalizations for PDB, with a significant predominance of females (P<0.02), and the predominance of patients living in urban (73%) than in rural areas (27%), P<0.001. The average age of the sample was 56.8 years (CI: 54.3-59.3; SD 18.8; range 1-93 years). The number of PDB cases hospitalized in Poland significantly decreased during the analyzed period of time. PDB is a rare disease with decreasing trends observed among hospitalized patients in Poland. The study results may suggest the existence of environmental risk factors for the development of PDB.

Initial experience with intracorporeal continuous ow LVAD in pediatric patients in Poland.

The aim of the study is to present the initial experience with continuous flow left ventricle assist device (CF-LVAD) in pediatric patients with BSA below 1.5 m2. Between 2016 and 2017, CF-LVAD (the Heartware System) have been implanted in three pediatric patients in the Department of Pediatric Cardiac Surgery, Jagiellonian University, Krakow, Poland. The indications for initiating CF-LVAD were end-stage congestive heart failure due to dilated cardiomyopathy in all children. Implanted patients have had BSA of 1.09, 1.42, 1.2 m2, and 37, 34, 34 kg of body weight and the age 12, 11, 12 years, respectively. The time of support was 550 days in two patients and 127 in another one, and is ongoing. The main complication has been driveline infection. The outcomes from our single-center experience using the HeartWare CF-LVAD have been excellent with a low incidence of complication and no necessity to reoperation in our patients. Children could be successfully and safely discharged home.

Assessment of efficacy of trastuzumab (Herceptin) comprising adjuvant therapy of HER2+ breast cancer patients determined based upon statistical analysis of overall survival (OS) and disease-free survival (PFS)

Introduction&#x0D; In patients suffering from breast cancer, adjuvant radiation, chemotherapy, or immunotherapy, which immediately follow the surgery as the first line therapy, greatly improve overall (OS) and disease-free survival (DFS). Various regimens of adjuvant therapy for these patients have been tested contingent upon the clinical staging. Inclusion of adjuvant immunotherapy is particularly promising.&#x0D; Specific aim&#x0D; The aim of this study was to assess efficacy of trastuzumab (Herceptin) - comprising adjuvant immunotherapy in terms of overall and disease-free survival as compared to other adjuvant therapies.&#x0D; Patients &#x0D; All patients were presented with the Patient Bill of Rights and have provided the Patient Informed Consent to participate in this study. Eligible patients include those with primary tumors initially staged at the clinical stages: I-T1c N0, II-T0-2, N0-1, or IIIA-T3 N1, or patients for whom neoadjuvant chemotherapy provides the possibility to remove surgically a tumor at the stage IIIA T0-3 N2.&#x0D; Of 9,058 patients enrolled in the Breast Cancer Treatment Program between 2008 and 2015, 6,832 fulfilled the inclusion criteria.&#x0D; Statistical Analysis &#x0D; The effects of clinical and demographic factors on overall survival (OS) and disease-free survival (DFS) were assessed using Cox’s proportional hazards regression models. OS and DFS were evaluated with Kaplan-Meier calculations. The study was meeting the criteria for a controlled, open-access clinical trial.&#x0D; Results &#x0D; OS rates for years 1-7 were, respectively, 99.42%, 97.26%, 94.57%, 92.41%, 90.48%,&#x0D; 88.63%, and 88.23%; thus with the 5-year survival at 90.48%. The corresponding data for DFS were 96.17%, 84.07%, 77.26%, 72.57%, 68.59%, 65.04%, and 63.05%, respectively; thus with the 5-year DFS at 68.59%.&#x0D; Adverse effects, with the exception of cardiac complications, occurred in 1194 (17%), while causing withdrawal of 421 (6%) patients. Most of other adverse events were related to hepatotoxicity 1755 (25%) and fatigue 681 (9.7%).&#x0D; Conclusion &#x0D; These results demonstrate the great benefits of inclusion of immunotherapy as the adjuvant component as currently the best overall therapeutic strategy for the patients suffering breast cancers. As this strategy greatly exceeds any other therapeutic options available for practicing oncologists at the present time, it definitely justifies allocation of all needed public resources, while assuring highest quality health service for the patients in Poland.

Quality control of oral anticoagulation with vitamin K antagonists in primary care patients in Poland: a multi-centre study.

Vitamin K antagonists (VKAs) remain the mainstay of anticoagulation therapy, which requires monitoring of international normalised ratio (INR). Quality of oral anticoagulation, clinical benefits, and the risk related to VKA use are determined by the time in therapeutic range (TTR). The aim of this study was to assess the therapeutic quality of oral anticoagulation and to determine the factors that affect the incidence of INR outside the recommended range in primary care patients undergoing long-term VKA therapy in Poland. A multi-centre cross-sectional analysis was carried out in 15 general practices from three voivodeships of Poland. At the planned time, INRs measured closest to the designated date in all patients were assessed in terms of being within the therapeutic range. TTR was determined as the percentage of visits with INR in therapeutic range on a given date. Overall, 430 patients aged 70.3 ± 12.7 years (222 men aged 72 ± 12.8 years and 208 women aged 68.5 ± 12.4 years) were included in the study. In the groups with INR below, within, and above therapeutic range, the patients' age was 67.3 ± 13.4, 72 ± 12, and 70.5 ± 13 years (p = 0.001), respectively. TTR for all the participants was 55%. Statistically significant factors associated with INRs outside the therapeutic range were: age below 60 years (compared to older persons; p = 0.003), more or less frequent INR control compared to the recommended intervals of four to eight weeks (p < 0.001), and the type of the VKA used, i.e. acenocoumarol compared to warfarin (p < 0.001). Logarithmic regression analysis showed that the use of acenocoumarol compared to warfarin, increased the chances of INRs below therapeutic range (odds ratio [OR] 3.19; 95% confidence interval [Cl] 1.65-6.16), while male sex increased the probability of INR being above this range (OR 2.01; 95% Cl 1.12- 3.59). The TTR in primary care patients on VKA therapy was 55%. Better quality of oral anticoagulation with VKA could be achieved by using warfarin instead of acenocoumarol, proper INR monitoring in the recommended interval of four to eight weeks, and tighter INR control in younger and male patients.

Perception of preventive care and readiness for lifestyle change in rural and urban patients in Poland: a questionnaire study.

The idiosyncrasies of rural health demand further research to instigate rural health initiatives and to monitor progress in rural health care. In 2008, a study examined health-related behaviour, perception of importance of preventive interventions, readiness to change lifestyle and willingness to receive support from GPs, according to gender and place of residence. A cross-sectional survey was conducted among patients who visited any of ten randomly-selected general practices in Poland. Four hundred patients were enrolled: 50% from rural areas, 50.3% were females; 23.8% declared a primary level of education (35% rural vs. 12.5% urban) respondents; the median age was 50 years (IQR=18), The predicted means for prevention importance scores for rural residents were 0.623 and for urban residents - 0.682. Place of residence had a significant effect on the importance of prevention (p<0.05; ICC=0.048). Area and gender have a statistically significant effect on preventive behaviour importance scores (p<0.05; ICC=0.0526). Patient expectations of individual counselling by GPs were highest for eating habits - 35.5% rural vs. 16% urban residents (p<0.0001). Patient importance scores for prevention were associated with residence and gender. The villagers attached less importance to prevention. They also declared less willingness to change their lifestyle. Women had higher scores regarding prevention than men. More rural respondents would like to receive individual counselling from their GP regarding eating habits, physical activity, body weight, giving up smoking and safe alcohol use. Urban respondents were more likely to expect leaflets from their GPs on normalizing body weight.

Have actual waiting times been reduced by introducing the DILO reform for cancer patients in Poland?

Introduction. Relative 5-year cancer survival rates in Poland are around 10% lower than the average of the whole EU. One of the likely factors for poorer treatment outcomes in Poland may be the long times between when cancer is suspected to starting treatment. This study has thus aimed to determine whether the introduced oncology reforms have succeeded in reducing such times. Materials and methods. The study survey was undertaken at 6 oncological centres on patient subjects before (n = 1373) and after (n = 431) the oncological reform ( DILO ) had been introduced. Data was obtained from an in-house devised questionnaire together with patient interview and their medical history. The following waiting times were estimated: A) from suspicion of cancer, (date of first doctor visit due to appearance of symptoms, screening/follow-up or prevention), to diagnosis (date of histopathological confirmation), B) from suspicion of cancer to the start of treatment and C) from diagnosis to starting treatment before and after the DILO reform had been introduced. Results. The median waiting time between suspicion of cancer and treatment was 11 weeks before the DILO reform but was not significantly shortened after its introduction; the reduction being barely 3 days. This waiting time was however increased by 8 days in those patients without DILO cards. Before the DILO reform, the median time from diagnosis was 5.9 weeks, but was reduced by 8 days in patients bearing the DILO card and indeed increased in those without the DILO card by over 2 weeks. Conclusions. Cancer treatment waiting times in Poland is still somewhat long (over 9 weeks in most cases). Introducing the oncological reform has not significantly impacted on shortening the waiting times in cancer patients for receiving oncological treatment.

Dietary magnesium intake in a population of oncological patients in Poland

Dietary magnesium intake in a population of oncological patients in Poland

Contemporary use of P2Y12 inhibitors in patients with ST-segment elevation myocardial infarction referred to primary percutaneous coronary interventions in Poland: Data from ORPKI national registry

According to guidelines, it is recommended to give P2Y12 inhibitors (preferably ticagrelor or prasugrel) at the time of first medical contact in patients with STEMI. However, in real life antiplatelet treatment strategies are different among countries. We analyzed data on antiplatelet treatment in STEMI patients included into Polish ORPKI national registry. A total of 23,139 STEMI patients from 153 invasive cardiology centers were reported in ORPKI registry between September 2015 and August 2016. Finally 19,437 patients from 122 centers (immediate PCI in 94%) were included into the analysis (lack of ticagrelor or prasugrel usage reported in 31 centers). The dominant P2Y12 inhibitor was clopidogrel (69%) with a high rate of precathlab administration (51.3%). Ticagrelor was administered in 10.1% of patients (2.3% during precathlab phase) and prasugrel in 1.1% (0.4% precathlab). The periprocedural switch from clopidogrel to newer generation oral P2Y12 inhibitors was rare (to ticagrelor: 2%; to prasugrel: 0.15%). Analysis of data from top 10 centers with the highest rate of newer generation P2Y12 inhibitors usage (1295 patients) revealed ticagrelor administration in 43.1% (prasugrel in 3%). During precathlab phase higher proportion of ticagrelor instead of clopidogrel (ticagrelor 17.9%, clopidogrel 29.8%) and higher rate of periprocedural switch from clopidogrel to ticagrelor (11.9%) was found comparing to all centers data (p < 0.001 for all). The strategy of precathlab administration of P2Y12 inhibitors applies to about half of STEMI patients in Poland. Generally, ticagrelor or prasugrel use is low, and not equally distributed among centers. In centers with high usage, ticagrelor is main newer generation P2Y12 inhibitor for precathlab and periprocedural administration.