Indicators of integrated care for patients with chronic cardiovascular disease in ambulatory care.

BACKGROUND: Patients with cardiovascular disease (CVD) have an increased need for medical care and a high risk of hospitalization. It is necessary to improve the integration between healthcare, long-term care and social care for these individuals, as poor integration limits the full potential of care. OBJECTIVES: This study aims to identify effective indicators of CVD management, including variables that promote the horizontal and vertical integration of planned interventions. MATERIAL AND METHODS: Patients with chronic CVD managed by a general practitioner (GP) or a primary care cardiologist will be enrolled in the study. The study will use the World Health Organization Quality of Life Questionnaire (WHOQOL)-BREF, the Health Behavior Inventory (HBI) questionnaire, the Camberwell Assessment of Need (CAN) Short Appraisal Schedule, the Hospital Anxiety and Depression Scale-Modified Version (HADS-M), a Self-Description Questionnaire, and the authors' self-prepared questionnaire to collect data. RESULTS: The main results will allow for the identification of the variables that influence the effectiveness of healthcare (understood as the synergy of high quality of life, intensification of health behaviors and high satisfaction of needs) for patients with CVD. In addition, an examination of the relationships between quality of life and health behaviors, assessment of needs (health and social), level of religiosity and spirituality, expectations, and variables affecting anxiety and depressive symptoms will allow for the identification of indicators that favor the integration of care both horizontally and vertically. CONCLUSION: The results of this study will support the development of systems aimed at identifying CVD patients at risk for lower effectiveness of care in integrated care. In addition, the results may help to develop clinical information and decision support systems aimed at designing personalized care models for patients with CVD. They may also help to develop coordinated care plans and patient education programs, and obtain data useful for implementing system changes.

Social Prescribing and Lifestyle Medicine-A Remedy to Chronic Health Problems?

Social prescribing has been identified as a chance to take a holistic approach to people's health and wellbeing, especially for people with one or more long-term conditions. Its systemic implementation was a part of the recent United Kingdom National Health Service Long Term Plan. With a lifestyle medicine focus on equipping patients in tools necessary for self-care and self-management of their lifestyle-related health problems that coexists with the need for creating an environment supporting healthy choices, a social prescribing model seems to offer a promising strategy for advancing lifestyle medicine. This idea was discussed during a meeting hosted by the Polish Society of Lifestyle Medicine in collaboration with European Rural and Isolated Practitioners Association, Polish Society of Young Family Doctors ("Mlodzi Lekarze Rodzinni"), British Society of Lifestyle Medicine and European Lifestyle Medicine Council in June 2020. The aftermath-this position statement is an Authors' attempt at summarizing the common ground for social prescribing and lifestyle medicine. It collects experiences of practitioners and researchers from five European countries as well as making recommendations for applying this model in Poland. Despite referring to local conditions, it might provide universal takeaway messages for any healthcare providers interested in combining social prescribing with lifestyle medicine practice.

The Environmental Domain of Quality of Life in Patients with Chronic Respiratory Diseases.

The literature lacks reports on the role played by the Environmental domain of quality of life (QoL) in care for patients with chronic respiratory diseases. Such information has a high potential for implementation in modern medicine based on a 'tailor-made' holistic healthcare model. The purpose of this study was to determine the components that shape the Environmental domain of QoL in patients with chronic respiratory diseases. The study group consisted of 305 adult patients (median age 65 years) with at least one chronic respiratory disease. The greatest contribution to a high value of QoL in the Environmental domain among patients with chronic respiratory diseases was made by the coexistence of high QoL levels in other domains and in satisfaction with QoL. Programs for preventing a decline in QoL in the Environmental domain should include patients with low scores for the above variables as well as those with a low level of education, those who have not shown an improvement in their psychological well-being in the past 12 months, those with a low level of positive mental attitudes or healthy eating habits, a low Camberwell index, and low levels of overall pro-health behavior.

The Application of Tensegrity Massage in a Professionally Active Musician - Case Report.

PURPOSE: The purpose of our study was to present options for the application of tensegrity massage to manage pain caused by the overload of soft tissues in musicians. DESIGN: Tensegrity massage was applied to a 34-year-old male violinist. METHODS: The methodology included a correct positioning and tensegrity massage with individually designed procedure. FINDINGS: After therapy, the patient achieved complete pain relief, and relaxation of muscles in the shoulder girdle and free part of the upper arm. The analgesic effect lasted for 6 months after the end of therapy. CONCLUSIONS: Massage is an effective method in eliminating pain caused by the overload of soft tissues. If used regularly before physical effort, it can prevent muscle overload. CLINICAL RELEVANCE: The presented massage procedure is an effective therapy in pain caused by the overload of soft tissues in musicians and it can be one of the elements of complex physiotherapy in active musicians.

The effectiveness of massage based on the tensegrity principle compared with classical abdominal massage performed on patients with constipation.

PURPOSE OF THE RESEARCH: The purpose of the study was to compare the effectiveness of massage based on the tensegrity principle and classical abdominal massage performed on patients with constipation. MATERIALS AND METHODS: The study group consisted of 29 subjects with a pre-existing diagnosis of constipation based on the Rome III criteria. The patients were divided into two groups: the first group was made up of 15 patients who underwent tensegrity massage (average age: 59.8 years), and the second was made up of 14 patients who were given classical abdominal massage (average age: 55.7 years). The study consisted of six massage sessions in both groups, with two sessions per week performed over 21 days. The assessment was based on a patient questionnaire, the Rome III questionnaire and a diary of bowel movements. The results were analyzed before therapy, after one week of therapy and after the third (final) week of therapy. RESULTS: Changes in the number of defecations were compared between the two groups; the biggest changes occurred in the first and third week of therapy (P<0.01, calculated by the Mann-Whitey test). As a result of the therapy, tension during defecation dropped from 60% to 20% in Group I, and from 42.8% to 35.7% in Group II. The influence of the applied therapy was evaluated positively by 80% of the tensegrity massage group and 29% of the classical abdominal massage group. CONCLUSIONS: Massage based on the tensegrity principle may have a greater positive influence on the quality and quantity of bowel movements than classical abdominal massage.

Massage may initiate tendon structural changes--a preliminary study.

BACKGROUND: Physical exercise is now a widely known and studied factor of the proper functioning of living organisms. Many questions remain unanswered concerning various aspects of the changes in the morphology of structures subjected to chronic physical exercise. MATERIALS AND METHODS: This study was conducted on fifty Buffalo strain rats, randomly divided into two equal (experimental and control) groups. All animals were subjected to physical training on a running track for 10 weeks, whereas only in the experimental group, massage was additionally applied five-times per week. RESULTS: An increase in the percentage of collagen fibers in tendons with the smallest diameter (≤100 nm) was observed only in the experimental group in week 3, followed by a decrease in weeks 5 and 7. A subsequent repeated increase was observed in week 10 of the study. No significant differences were observed for either study group in the number of collagen fibers based on fiber diameter (101-200 nm, 201-300 nm and 301-400 nm). CONCLUSION: The results of this preliminary study showed that long-term massage performed during running training may initiate for small structural changes in the rat tendon. Further morphological studies with prolonged observation periods are recommended.

Application of Tensegrity Massage to Relive Complications After Mastectomy--Case Report.

PURPOSE: The case study was to determine the effectiveness of tensegrity massage in a patient after mastectomy. DESIGN: Tensegrity massage was performed in a 50-year-old woman after mastectomy. The purpose of the massage was to normalize the tension of musculo-ligamento-fascial system in the chest, shoulder girdle, and back. METHODS: The patient was subjected to a series of six massage sessions, 45 minutes each, twice a week. FINDINGS: The applied massage therapy contributed to the reduction of the postoperative scar tenderness and painfulness, to the relaxation of the muscular tone within the shoulder girdle, and to the improvement of the patient's general feeling. CONCLUSIONS: Tensegrity massage is an effective therapy in the elimination of pain and abnormal tissue tension induced by extensive scarring after mastectomy. CLINICAL RELEVANCE: The presented massage procedure had a positive effect immediately after the therapy and after 1-month follow-up.

Effects of synergistic massage and physical exercise on the expression of angiogenic markers in rat tendons.

Physical exercise and massage are regarded as key factors in regulating tendon structure. However, information on the mechanism through which massage influences the structure and biology of a tendon is scarce. In this study, we attempted to define the impact of these two activities on rat tendons by using morphological and molecular techniques, determining the expression of VEGF-A, FGF-2, and CD34 in the tendons of rats subjected to 10 weeks of physical exercise (running) with massage of varied duration. The group of rats that was trained and massaged during the entire study was characterized by the highest expression of these markers, compared to the rats subjected to massage before training and to the control group subjected to physical exercises only. The greatest significant differences, compared to the control, were noted in the expression of all the studied markers at mRNA level, and in the case of VEGF-A, at protein level, in the third and fifth weeks of the experiment. The results of this study could point to the synergistic impact of simultaneous massage and physical exercise on the expression of angiogenesis markers in rat tendons.

The effectiveness of massage in therapy for obturator nerve dysfunction as complication of hip joint alloplasty-case report.

UNLABELLED: The purpose of our case presentation was to reveal effectiveness of medical massage in the therapy for obturator nerve dysfunction as a complication of hip joint alloplasty. DESIGN: Medical massage was carried out in a 58-year-old man after hip joint alloplasty. The aim was to normalize tension of muscle-ligament-fascia apparatus within pelvic girdle and reconstruct correct structural conditions in the course of obturator nerve. METHODS: The methodology included correct positioning and medical massage with individually designed procedures. FINDINGS: Full normalization of muscular tone and subsidence of pain complaints were obtained. CONCLUSIONS: Massage has a positive influence on subsidence of pain complaints; however, effectiveness of the procedure depends on an appropriate methodology. CLINICAL RELEVANCE: The presented massage procedure is an effective therapy in obturator nerve dysfunction as complication after alloplasty and it can be one of elements of complex improvement after surgical joint procedures within the scope of nursing rehabilitation.

The quality of primary health care for chronically ill patients: a cross-sectional study.

BACKGROUND: Patients with at least one chronic disease requiring regular contact with their GP, additional tests and systematic use of medicines constitute one of the challenges for the future of primary medical care. To date, no studies have been published describing the most important factors in increasing the quality of care for the chronically ill. OBJECTIVES: To evaluate correlations between patients' characteristics and their assessments of the quality of health care and to identify the primary factors influencing the quality of care for chronically ill patients. MATERIAL AND METHODS: The sample for the current analysis included 232 chronically ill adult patients of primary care clinics in Poland. The patients' opinions regarding subjective and objective examinations, their participation in clinical decision-making processes, psychosocial factors, contact with the doctor in emergency situations and confidence in the doctor were investigated. RESULTS: The strongest correlations defining the quality of care for the chronically ill were identified as the occurrence of hypertension (0.248, p < 0.001), the patient's gender (0.271, p < 0.001), the patient's level of education (0.169, p < 0.01) and the patient's age (0.155, p = 0.018). The results of the ANOVA test were statistically significant (p < 0.05) for the occurrence of myocardial infarction, hypertension, type 2 diabetes, psoriasis, multiple sclerosis, the doctor's gender, the patient's gender, age and education. CONCLUSIONS: The areas that the participants gave the highest ratings to are subjective and objective examinations, kindness and willingness to help. The strongest correlations between high assessments of the quality of care provided for chronically ill patients at primary care clinics were observed in the following variables: gender, age, level of education, frequency of visits, therapy conducted by a doctor at a specialist clinic, arterial hypertension, COPD and/or myocardial infarction.

Comparison of massage based on the tensegrity principle and classic massage in treating chronic shoulder pain.

OBJECTIVE: The purpose of this study was to compare the clinical outcomes of classic massage to massage based on the tensegrity principle for patients with chronic idiopathic shoulder pain. METHODS: Thirty subjects with chronic shoulder pain symptoms were divided into 2 groups, 15 subjects received classic (Swedish) massage to tissues surrounding the glenohumeral joint and 15 subjects received the massage using techniques based on the tensegrity principle. The tensegrity principle is based on directing treatment to the painful area and the tissues (muscles, fascia, and ligaments) that structurally support the painful area, thus treating tissues that have direct and indirect influence on the motion segment. Both treatment groups received 10 sessions over 2 weeks, each session lasted 20 minutes. The McGill Pain Questionnaire and glenohumeral ranges of motion were measured immediately before the first massage session, on the day the therapy ended 2 weeks after therapy started, and 1 month after the last massage. RESULTS: Subjects receiving massage based on the tensegrity principle demonstrated statistically significance improvement in the passive and active ranges of flexion and abduction of the glenohumeral joint. Pain decreased in both massage groups. CONCLUSIONS: This study showed increases in passive and active ranges of motion for flexion and abduction in patients who had massage based on the tensegrity principle. For pain outcomes, both classic and tensegrity massage groups demonstrated improvement.

The effectiveness of massage in stress urinary incontinence-case study.

PURPOSE: The aim of the case study was to determine the effectiveness of massage in the management of stress urinary incontinence. DESIGN: A 50-year-old woman with many years' history of stress incontinence was treated with massage. METHODS: The methodology involved positioning of the patient and massage according to an original method including the initial, main, and final parts. FINDINGS: The applied therapy contributed to a decreased amount of urine leakage (immediately following the therapy-by 21%, a month later-by 100%) and improved the quality of patient's life. CONCLUSIONS: A decrease in the amount of urinary leakage was observed immediately after therapy. One month after termination of massage therapy, a complete remission of symptoms was observed. CLINICAL RELEVANCE: The presented massage procedure had a positive effect on the amount of urinary leakage on effort immediately after therapy and on few-month follow-up produced complete relief from the distress.

Massage-induced morphological changes of dense connective tissue in rat's tendon.

The aim of the experiment was to determine if possible changes in connective tissue induced by massage could have a positive effect justifing the use of massage in all post-traumatic connective tissue conditions, e.g. tendon injuries. The investigations were performed in a group of 18 Buffalo rats. The rats were divided into two groups (experimental and control). To standardize the massage procedure, it was performed with an algometer probe of 0.5 cm2 with constant pressure force of 1 kG (9,81 N). To analyse the number and diameter of collagen fibrils, two electron micrographs were performed for each rat of the collected segments of tendons of rat tail lateral extensor muscle. After image digitalization and calibration, the measurements were carried out using iTEM 5.0 software. The number of fibrils, their diameter and area were measured in a cross-sectional area. An increase of the number of collagen fibrils was observed in the tendons of massaged animals compared to the control group. Our study demonstrated that massage may cause a beneficial effect on metabolic activity of tendon's fibroblasts and, in consequence, may be applied for more effective use of massage for the prevention of tendon injury as well as after the injury has occurred. (Folia Histochemica et Cytobiologica 2013, Vol. 51, No. 1, 103-106).

[The students of Public Higher Medical Professional School in Opole spreading anti-tobacco advice]. / Studenci Panstwowej Medycznej Wyzszej Szkoly Zawodowej w Opolu wobec poradnictwa antytoniowego.

Smoking tobacco in our society is the primary risk factor in the emergence of many diseases, including cardiovascular and cancer, elevating the risk of mortality before 65 years of age. Very important is the fact that this is a removable, which can be completely eliminated. The smoker health could be in better conditions and also other people from his environment. A man who is messed up is the sick man who, while having the motivation to stop smoking, need a comprehensive and specialized medical treatment. Respondents nursing and midwifery students in Opole PMWSZ most important in providing advice to patients students choose family doctors (34.1%) and internists (17.9%). According to the respondents, patients who, despite a strong motivation to stop smoking can not, should find help in specialized anti-tobacco clinic (27.8%), substance abuse treatment clinic (16.5%), and psychological counseling (11.4%). Half of the surveyed students (51.35%) declared the ability to advice patients, while only 18.7% of respondents correctly answered the question what is the minimum intervention of tobacco control, 56% of respondents claimed that it is information to the patient of the consequences of smoking. Important in reducing the health effects of smoking is to prepare health workers to diagnose the problem of addiction and comprehensive professional treatment.