Meeting Patient Expectations: Assessing Medical Service and Quality of Care Using the SERVQUAL Model in Dermatology Patients at a Single Center in Poland.

BACKGROUND This study applied the SERVQUAL model, a widely recognized tool for assessing the quality of services, to understand the gap between patient expectations and perceptions of care quality among 413 dermatology patients at a single medical center in Poland. MATERIAL AND METHODS The study cohort included 413 patients: 195 inpatients and 218 outpatients. The SERVQUAL model's 5 dimensions - reliability, assurance, tangibility, empathy, and responsiveness, each including multiple specific items - served as our assessment criteria. Patient responses to these items measured the perceived and expected quality of service. The service quality index (SQ), calculated as the difference between perception and expectation ratings, was the study's primary outcome measure. A negative SQ score was interpreted as patient dissatisfaction. RESULTS The study results showed a negative SQ score, which signified a discrepancy between high patient expectations and the actual perceived quality of service. The largest gap was seen in the tangibility dimension. Differences emerged based on treatment setting, with inpatient and outpatient settings showing varying expectations and perceptions. Patient sex and residential location also influenced the tangibility dimension. Employed patients and patients with diminished quality of life had heightened expectations in certain dimensions, while patients below 36 years of age expressed higher expectations in responsiveness, assurance, and empathy. CONCLUSIONS The findings emphasize the critical role of care quality in shaping patients' satisfaction and perception, particularly in dermatology. Using the SERVQUAL model, this study identified the tangibility dimension as an area needing improvement. This insight serves as a stepping stone toward enhancing patient satisfaction by addressing these unmet expectations.

Orthorexia nervosa in gay men-the result of a spanish-polish eating disorders study.

BACKGROUND: The purpose of this exploratory study was to identifying demographic factors and unique predictors of ON e.g., the use of pre-exposure prophylaxis (PrEP), the use of social media and the Grindr ® dating application among a sample group of Spanish and Polish identifying gay men. METHODS: The study was conducted in Poland and Spain between March and June 2021 using questionary: ORTO-15. Data was collected using a three-section self-administered questionnaire. The first section contained demographic data, the second part was the Polish and Spanish version of the Orto-15, and the third part was the Polish and Spanish version of the EAT-26. RESULTS: Total enrollment was 394 gay men. In regression proportional hazards single model, significant predictors of ON were: age (OR = 0.964, 95% CI, 0.944-0.984), BMI (OR = 0.895, 95% CI, 0.848-0.944), staying in an informal relationship compared to being single (OR = 2.138, 95%CI, 1.225-3.732), occasional use of Pre-exposure Prophylaxis (OR = 4.667, 95%CI, 1.186-18.362) and use of the Grindr application (OR = 5.312, 95%CI, 3.373-8.365). Instagram users had lower risk of ON (OR = 0.479, 95%CI, 0.279-0.822). The multivariate analysis showed that Grindr usages (OR = 4.72; 95%CI, 2.89-7.72) correlated with higher risk of ON. Higher BMI (OR = 0.913, 95%CI, 0.861-0.98) and daily use of Pre-exposure Prophylaxis (OR = 0.142, 95%CI, 0.03-0.674) is associated with lower risk of ON. CONCLUSIONS: The most important predictors of orthorexia nervosa in gay men are: low BMI and the use of Grindr. The effect of daily usage of PrEP is associated with lower risk, and occasional use is associated with increased risk, of orthorexia nervosa.

Risk of Falls in Patients Aged Over 65 in the Context of the Treatment Facility.

This study assessed the risk of falls, the incidence of frailty, cognition, and nutritional status in people aged over 65 in the context of the treatment facility. To this end, we compared a group of 99 non-hospitalized patients treated in primary healthcare facilities with a group of 100 patients hospitalized in a geriatric ward. It was a survey-type study based on the following questionnaires: Mini-Mental State Examination, Tilburg Frailty Indicator, Mini Nutritional Assessment, and the Tinetti Balance and Gait Assessment. We found significant differences between non-hospitalized and hospitalized patients to the advantage of the former. A risk of falls was 56.6% vs. 85% (p < 0.001), the incidence of frailty was 51% vs. 71% (p = 0.005), and cognitive decline was 35% vs. 61% (p = 0.120), respectively. Additionally, nutritional detriment also was less expressed in outpatients. A distinctly worse overall health performance, with increased risk of falls, was confirmed in multifactorial regression analysis in hospitalized patients. We conclude that geriatric hospital setting is an independent risk factor aggravating the risk of falls, frailty, and cognitive weakness in senior persons.

Factors affecting work ability index among polish nurses working in hospitals - A prospective observational survey.

AIMS: To assess the ability to work of Polish nurses by age groups. BACKGROUND: The ability to work is widely discussed in the literature in the context of nurses' productivity; thus, it is necessary to identify the ability to work when facing an increasing demand for services. METHODS: The observational study involved 349 professionally active nurses aged 46.9 ± 9.7 years, with a length of service of 23.5 ± 9.6 years. The Work Ability Index (WAI) was used to assess the nurses' ability to work. RESULTS: The ability to work decreases with age (rs  = -0.324, p < .000) and with seniority (rs  = -0.257; p < .000). Nurses with higher education presented higher Work Ability Index scores. Also, the age (B = -0.25, p < .001), work seniority (B = -0.19, p < .001) and education (masters' degree: B = 1.41, p = .012; ref. secondary) affect work ability. CONCLUSIONS: The ageing process and seniority of nurses negatively affect their ability to work. A lack of programmes to maintain physical condition for nurses can result in a shortage of staff. IMPLICATIONS FOR NURSING MANAGEMENT: Programmes can be developed to create or improve healthy working environments to increase productivity.

Complication during transportation and 30 days mortality of patients with acute coronary syndrome.

BACKGROUND: Patients with acute coronary syndrome (ACS) who present to hospitals without interventional facilities frequently require transfer to another hospital equipped with a cardiac catheterization laboratory. This retrospective cohort study evaluates the association of the type of medical transport with patient outcomes. METHODS: A retrospective analysis of medical records of patients with ACS transported by basic (BT) and specialist transfer (ST) by emergency medical teams (EMTs). We analyzed age, gender, hemodynamic parameters, type of the emergency medical team, and complications during transport as well as patient survival to hospital admission, survival time and the 30-day mortality rate. RESULTS: Of 500 patients who underwent transfer, ST transported 368 (73.6%) and BT 132 (26.4%) patients (p < 0.001). Complications during transportation occurred in 3 (1%) in the ST group and 2 (1.5%) in and BT group. Cardiac arrest during transfer occurred in no (0%) patients in the ST group, and 2 (1.5%) in the BT group (p = 0.118). Survival to admission was recorded in all patients in the ST group and 131/132 (0.8%) patients in the BT group (p = 0.592). 40 (12%) of patients in the ST group and 13 (11%) patients in the BT group (p = 0.731) died within 30 days of transfer. CONCLUSIONS: Complications during medical transport of ACS patients from hospitals without a cardiac catheter lab to hospitals equipped with such a lab were rare and their incidence was not associated with the type of transporting EMT. The type of EMT was not associated with 30-day patient mortality.

Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland: a one-year retrospective study.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a common reason for calls for intervention by emergency medical teams (EMTs) in Poland. Regardless of the mechanism, OHCA is a state in which the chance of survival is dependent on rapid action from bystanders and responding health professionals in emergency medical services (EMS). We aimed to identify factors associated with return of spontaneous circulation (ROSC). METHODS: The medical records of 2137 EMS responses to OHCA in the city of Wroclaw, Poland between July 2017 and June 2018 were analyzed. RESULTS: The OHCA incidence rate for the year studied was 102 cases per 100,000 inhabitants. EMS were called to 2317 OHCA events of which 1167 (50.4%) did not have resuscitation attempted on EMS arrival. The difference between the number of successful and failed cardiopulmonary resuscitations (CPRs) was statistically significant (p < 0.001). Of 1150 patients in whom resuscitation was attempted, ROSC was achieved in 250 (27.8%). Rate of ROSC was significantly higher when CPR was initiated by bystanders (p < 0.001). Patients presenting with asystole or pulseless electrical activity (PEA) had a higher risk of CPR failure (86%) than those with ventricular fibrillation/ventricular tachycardia (VF/VT). Patients with VF/VT had a higher chance of ROSC (OR 2.68, 1.86-3.85) than those with asystole (p < 0.001). The chance of ROSC was 1.78 times higher when the event occurred in a public place (p < 0.001). CONCLUSIONS: The factors associated with ROSC were occurrence in a public place, CPR initiation by witnesses, and presence of a shockable rhythm. Gender, age, and the type of EMT did not influence ROSC. Low bystander CPR rates reinforce the need for further efforts to train the public in CPR.

Evaluation of the occurrence of work-related musculoskeletal pain among anesthesiology, intensive care, and surgical nurses: An observational and descriptive study.

Clinical nurses can encounter musculoskeletal pain episodes stemming from regular exposure to workplace risk factors that contribute to overloads. This study aimed to evaluate the occurrence and location of work-related musculoskeletal pain among Polish nurses. An observational and descriptive survey study was conducted among 136 nurses working in the anesthesiology, intensive care, and surgery units. An extended version of the Nordic Musculoskeletal Questionnaire was used to investigate musculoskeletal pain. Only 8% of the participating nurses experienced no musculoskeletal pain, while 85% suffered from pain in more than one location. The lower back (67%), upper back (59%), and neck (66%) were the most common pain locations. In summary, nurses experienced multiple musculoskeletal pain episodes, occurring most frequently in the spinal region (lower and upper back and neck). It is crucial to determine the real causes of musculoskeletal pain and to take appropriate preventive measures to improve workplace ergonomics.

The relationship between burnout, job satisfaction and the rationing of nursing care-A cross-sectional study.

AIMS: To assess the impacts of burnout and job satisfaction on the rationing of care in the professional group of nurses. BACKGROUND: The shortage of nursing staff is currently one of the most significant health care problems. It is not clear how burnout and job satisfaction affect the rationing of nursing care. METHODS: We included 594 nurses, and we used the Basel Extent of Rationing of Nursing Care-R (BERNCA-R), the Maslach Burnout Inventory (MBI) and the Job Satisfaction Scale (JSS). RESULTS: The average scores were 1.72 ± 0.87 points for the BERNCA-R, 36.08 ± 21.25 for the MBI and 19.74 ± 5.57 for the JSS. A statistically significant positive correlation between the BERNCA-R and the MBI (p < .05) and a negative correlation between the BERNCA-R and the JSS (p < .05) were observed. Independent predictors of the BERNCA-R were the result of emotional exhaustion of the MBI and the assessment of the impact of independence on job satisfaction (p < .05). CONCLUSION: Occupational burnout can decrease job satisfaction in nursing staff and result in adverse outcomes of rationing care. Nursing managers should pay more attention to individual differences in nursing-care workers linked with nursing burnout, job satisfaction and the rationing of care. IMPLICATIONS FOR NURSING MANAGEMENT: Interventions aimed at counteracting burnout are the key to improving job satisfaction in nurses.

The influence of selected psychological variables on quality of life of chronically dialysed patients.

BACKGROUND: The impact of illness acceptance in assessment of health-related quality (HRQoL) between chronic diseases remains unclear. Depression and anxiety reduce HRQoL and worsen prognosis. We describe the relationship between illness acceptance, anxiety and depression, and HRQoL in chronic dialysis patients. MATERIAL: The study included 105 patients with chronic kidney disease (mean age 65.8 years), treated with chronic dialysis. Three validated instruments were used, including the Acceptance of Illness Scale (AIS), the Hospital Anxiety and Depression Scale (HADS) and the Short Form Health Survey (SF-36). For statistical analysis, Student's t-test and Pearson's r correlation coefficient were carried out. RESULTS: Spearman's rho correlation analyses were carried out on the patients' quality of life (PCS and MCS), and their anxiety, depression and illness acceptance scores. The results showed acceptance of illness to be positively correlated with quality of life in terms of PCS (rho = 0.43) and MCS (rho = 0.36), and depression and anxiety to be negatively correlated with quality of life in both domains (PCS: rho = -0.39 and rho = -0.56, respectively; MCS: rho = -0.56 and rho = -0.78, respectively). The multiple-factor analysis for anxiety, depression and acceptance of illness showed acceptance of illness to be a significant independent determinant of higher quality of life in the PCS (ß = 1.580; p < 0.000) and MCS (ß = 1.980; p < 0.000) domains. The analysis also showed anxiety to be a significant independent determinant of lower quality of life in the MCS domain (ß = -0.432; p = 0.041), while depression was found to be a significant independent determinant of lower scores in both the PCS (ß = -3.557; p < 0.00) and the MCS (ß = -1.257; p < 0.00) domains. CONCLUSION: Acceptance of illness significantly affects HRQoL in dialysis patients - higher acceptance scores result in higher quality-of-life scores. Symptoms of depression and anxiety also significantly affect HRQoL in dialysis patients - a higher intensity of symptoms lead to lower quality-of-life scores.

Psychometric Properties and Cultural Adaptation of the Polish Version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT- DOCSS-PL).

People from the LGBT+ community often face unique healthcare disparities, including barriers to accessing appropriate and respectful care. The purpose of this study was to test the psychometric properties of the Polish-language version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT- DOCSS-PL). Before testing its psychometric properties, the LGBT-DOCSS was translated and adapted from the original English version into Polish. Subsequently, we tested the instrument's psychometric properties on a sample of 415 participants. In addition, internal consistency of the questionnaire was checked with confirmatory factor analysis (CFA). Cronbach's alpha together with discriminative power index were uses as internal consistency measures. There were more female than male participants (58%). More than 57% of the participants were heterosexual and the average age of the respondents was approximately 30 years. The internal consistency of the Polish version and its domains was strong with an overall Cronbach's alpha of 0.789. The alpha ranges for each subscale domains were between 0.780-0.824. The McDonald's omega coefficient was 0.86. The Polish version of the LGBT-DOCSS-PL has good properties of factorial validity.

Psychometric properties and cultural adaptation of the Polish Version of the Gay Affirmative Practice Scale.

Introduction: The lesbian, gay, bisexual, and transgender (LGBT) people often face unique medical disparities, including obstacles to accessing adequate and respectful care. The purpose of this study was to test the psychometric properties(internal consistency, reliability, and factor structure) of the Polish-language version of the Gay Affirmative Practice Scale (GAP-PL). Material: The study was conducted over a 6-month period in 2023, from February to June, involving 329 medical students and professionals who evaluated the GAP-PL. Methods: Before testing the psychometric properties of the original Gay Affirmative Practice Scale (GAP), it was translated and adapted from the original English language version into the Polish language. Authors then tested the psychometric properties of the tool on a sample of 329 participants. The internal coherence of the questionnaire was tested with the analysis of verifying factors (Confirmatory Factor Analysis). Cronbach alpha and the discriminatory power index were used as internal consistency measures. Results: There were more female than male participants (55.32%). More than 53% of the participants were heterosexual, and the average age of the respondents was ~30 years. The internal consistency of the Polish-language version and its domains was strong with the overall Cronbach's alpha ranges for each subscale domains ranging between 0.936 and 0.949. The McDonald's omega coefficient was 0.963. Conclusion: The GAP-PL has excellent properties of factorial validity and can be used in research and clinical practice in Polish-speaking populations.

Descriptive study on substance uses and risk of sexually transmitted infections in the practice of Chemsex in Spain.

Background: In recent years, there has been an increasing use of sex-related substances (known as "Chemsex") to facilitate, intensify, and prolong the sexual experience of men who have sex with men. This phenomenon poses a public health problem, increasing the risk of sexually transmitted infections (STIs) and mental disorders. Objective: The primary aim of this study was to delve into the correlation between substance use and sexual health, specifically examining the association between different substances used and the risk of sexually transmitted infections (STIs) in the context of Chemsex in Spain. Methods: An observational, descriptive, cross-sectional study was conducted among 563 Spanish participants between January and April 2023. Non-probabilistic purposive sampling was used by the investigators. The researchers administered a questionnaire to men who have sex with men who use substances, especially in the sexual sphere, in all the autonomous communities of Spain. Results: 14.7% reported having practiced slamsex in the last year, and 17.94% were diagnosed with a Sexually Transmitted Infection in the previous 6 months. Of these, 21% were on PREP treatment, with the main STIs being gonorrhea (p < 0.001), chlamydia (p < 0.001), genital herpes (p = 0.020), and syphilis (p < 0.001). The 63.7% used methamphetamines as the main drug in the practice of chemsex. Discussion: Chemsex in Spain is linked to a high prevalence of STIs, especially gonorrhea and chlamydia, even among those on PrEP treatment. The use of various drugs during chemsex, such as amyl nitrite, GHB, ecstasy, and others, correlates with higher rates of STIs, highlighting the need for interventions to reduce risk and harm. The drugs most associated with slamsex include ketamine, mephedrone, and methamphetamine, underscoring the importance of addressing the risk behaviors associated with this activity. Conclusion: This study shows that chemsex appears to be associated with a high prevalence among men who have sex with men. Who use multiple substances in a sexual context, and are particularly exposed to sexually transmitted infections (STIs), indicating a particular need for STI prevention and care in this group.

Effectiveness of Harm Reduction Interventions in Chemsex: A Systematic Review.

The phenomenon of chemsex has emerged as an essential public health issue in recent years. This systematic review aimed to investigate currently available harm reduction strategies and to evaluate the efficacy of the corresponding interventions. METHODS: A systematic review of the scientific literature related to harm and risk reduction strategies and the effectiveness of chemsex interventions. Between January 2024 and May 2024, the articles were retrieved from the electronic databases Pubmed, Web of Science, Scopus, PsycInfo, Cochrane, Dialnet, CUIDEN, and SciELO. The review protocol was registered in the PROSPERO database (registration number CRD42024508953). The inclusion criteria were as follows: (I) original studies published in peer-reviewed journals, (II) studies exploring harm reduction interventions for chemsex, and (III) studies reflecting the efficacy of harm reduction interventions for chemsex. Two reviewers independently selected articles by title, abstract, and full paper review and extracted data. Two authors described the selected studies and assessed their methodological quality. RESULTS: The systematic review comprised six scientific papers that met the selection criteria and were obtained from five countries. Although a limited number of studies were included, it was observed that they presented a medium-high methodological quality. Programs evaluated interventions to reduce harm from chemsex, such as a web-based intervention that improved self-efficacy to refuse risky behaviors and accept HIV testing. The studies suggested that peer-led programs can be effective, especially with facilitators who have experienced chemsex dependence. CONCLUSION: Harm reduction strategies in chemsex are effective and should be promoted by health professionals. Interventions should be accessible, personalized, and non-judgmental to provide appropriate care and support, ensuring a comprehensive and effective public health response.

The Impact of Body Mass Index on In-Hospital Mortality in Post-Cardiac-Arrest Patients-Does Sex Matter?

BACKGROUND: A number of factors influence mortality in post-cardiac-arrest (CA) patients, nutritional status being one of them. The aim of this study was to assess whether there are sex differences in the prognostic impact of BMI, as calculated on admission to an intensive care unit, on in-hospital mortality in sudden cardiac arrest (SCA) survivors. METHODS: We carried out a retrospective analysis of data of 129 post-cardiac-arrest patients with return of spontaneous circulation (ROSC) admitted to the Intensive Care Unit (ICU) of the University Teaching Hospital in Wroclaw between 2017 and 2022. RESULTS: Female patients were significantly older than male patients (68.62 ± 14.77 vs. 62.7 ± 13.95). The results of univariable logistic regression analysis showed that BMI was not associated with the odds of in-hospital death in either male or female patients. In an age-adjusted model, age was an independent predictor of the odds of in-hospital death only in male patients (OR = 1.034). In our final multiple logistic regression model, adjusted for the remaining variables, none of the traits analysed were a significant independent predictor of the odds of in-hospital death in female patients, whereas an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) was an independent predictor of the odds of in-hospital death in male patients (OR = 0.247). CONCLUSIONS: BMI on admission to ICU is not a predictor of the odds of in-hospital death in either male or female SCA survivors.

The Servqual Method as an Assessment Tool of the Quality of Medical Services in Selected Asian Countries.

INTRODUCTION: The Servqual (an acronym from the words "service" and "quality") method is used to assess the quality of provided services on the basis of standardised evaluation parameters. This method is based on five gaps resulting from the discrepancy between expected and received service quality. The aim of this meta-analysis and the systematic review was to view and assess the major differences in the five dimensions of the Servqual method used to evaluate the quality of delivered health care services in selected Asian countries. Another goal of the study was to confirm the use of the Servqual method as a suitable tool for assessing the quality of health care services. METHODS: This study followed the PRISMA guidelines for systemic reviews and meta-analyses. The following electronic databases for medical publications were used: PubMed, Medline, Scopus, and Cochrane were searched for articles published from January 2000 to April 2020. The databases were explored with original search queries containing the following terms: "Servqual", "service quality", "Servqual model", "servqual questionnaire", "health service quality", "health care services", "patients' expectation", "patients' perception", "expectation", "perception", and "health care services", in combination using "AND" and "OR". In order to minimize bias, two researchers (PK and DK) independently performed an online search for peer-reviewed papers, using the combinations of the above-mentioned words. In addition, references of eligible publications were checked. All disagreements, regarding the inclusion or exclusion of specific studies, were resolved through consultations among all the authors. RESULTS: A total of 96 reports were identified and submitted to a preliminary screening selection. As a result of the pre-screening stage, 64 papers were qualified to further evaluation. The output of the evaluation brought 15 reported studies, meeting the pre-defined inclusion/exclusion criteria. The total number of participants was 5903 (ranging from 20 to 439 in individual reports), and 54% of them were women. Eight studies (53%) were from Iran, two from Pakistan (13%) and one each from Arabia, Malaysia, South Korea, Bangladesh, and Iraq (each-about 7%). The results showed gaps between patients' expectations and perceptions in all five dimensions of Servqual in almost each analysed study. The highest and lowest values of the gaps in quality scores were associated with the dimensions of reliability, tangibility, empathy, and responsiveness, respectively. CONCLUSIONS: The study demonstrated that the method of Servqual is broadly used in various medical sectors to assess the quality of medical services provided. In addition, the study demonstrated that patients had significantly higher expectations of the medical services offered in the five dimensions studied. The results, obtained through the Servqual method, may help improve and monitor the quality of services provided by different institutions.

The Association between Nutritional Status and Length of Hospital Stay among Patients with Hypertension.

BACKGROUND: Nutritional status is related to the prognosis and length of hospital stay (LOS) of patients with hypertension (HT). This study aimed to assess how nutritional status and body mass index (BMI) affect LOS for patients with hypertension. METHOD: We performed a retrospective analysis of 586 medical records of patients who had been admitted to the Institute of Heart Diseases of the University Clinical Hospital in Wroclaw, Poland. RESULTS: A total of 586 individuals were included in the analysis. Individuals who were at a nutritional risk represented less than 2% of the study population, but more than 60% were overweight or obese. The mean BMI was 28.4 kg/m2 (SD: 5.16). LOS averaged 3.53 days (SD = 2.78). In the case of obese individuals, hospitalisation lasted for 3.4 ± 2.43 days, which was significantly longer than for patients of normal weight. For underweight patients, hospitalisation lasted for 5.14 ± 2.27 days, which was also significantly longer than for those in other BMI categories (p = 0.017). The independent predictors of shorter hospitalisations involved higher LDL concentration (parameter of regression: -0.015) and HDL concentration (parameter of regression: -0.04). CONCLUSIONS: The study revealed that with regard to the nutritional status of hypertensive patients, being either underweight or obese was associated with longer LOS. Additional factors that related to prolonged LOS were lower LDL and HDL levels and higher CRP concentrations.

SERVQUAL Method as an "Old New" Tool for Improving the Quality of Medical Services: A Literature Review.

The second half of the 20th century saw the development of a new trend in the management of medical services across Europe. Those shifts were associated with the transformation of various spheres of human life, both on professional and private levels. The service market then turned back to "quality", already known in antiquity. According to Aristotle, "quality" is one of the basic categories of thought and reality of the human population. The research material was obtained from literature databases, including Scopus, Cochrane, Medline, and PubMed, as well as from literature reports, including monographs, research papers (e.g., doctoral dissertations), and others. The available literature was assessed with regards to the abovementioned objectives of our study and considering possible advantages from its implementation. Therefore, the applied research method was based on a bibliographic query and desktop data analysis. The adopted research methodology hinged on exploration, compilation, analysis, and processing of data and information from available sources, resulting in drawing up of summary conclusions. The obtained data were subjected to reciprocal confrontation with an attempt to evaluate new possibilities of using the method in other medical specialties. The Servqual method enables us to learn the patient's expectations, while the service provider can identify irregularities and implement corrections. It allows the executive staff of medical facilities to change elements of medical procedures, which improves the quality of the service provided and thus increases the satisfaction and compliance of patients.

The Association between Nutritional Status and In-Hospital Mortality among Patients with Heart Failure-A Result of the Retrospective Nutritional Status Heart Study 2 (NSHS2).

BACKGROUND: A nutritional status is related to the prognosis and length of hospitalisation of patients with heart failure (HF). This study aims to assess the effect of nutritional status on in-hospital mortality in patients with heart failure. METHODS: We conducted a retrospective study and analysis of medical records of 1056 patients admitted to the cardiology department of the University Clinical Hospital in Wroclaw (Poland). RESULTS: A total of 1056 individuals were included in the analysis. A total of 5.5% of patients died during an in-hospital stay. It was found that in the sample group, 25% of patients who died had a BMI (body mass index) within the normal range, 6% were underweight, 47% were overweight, and 22% were obese. Our results show that non-survivors have a significantly higher nutrition risk screening (NRS) ≥3 (21% vs. 3%; p < 0.001); NYHA (New York Heart Association) grade 4 (70% vs. 24%; p < 0.001). The risk of death was lower in obese patients (HR = 0.51; p = 0.028) and those with LDL (low-density lipoprotein) levels from 116 to <190 mg/dL (HR = 0.10; p = 0.009, compared to those with LDL <55 mg/dL). The risk of death was higher in those with NRS (nutritional risk score) score ≥3 (HR = 2.31; p = 0.014), HFmrEF fraction (HR = 4.69; p < 0.001), and LDL levels > 190 mg/dL (HR = 3.20; p = 0.038). CONCLUSION: The malnutrition status correlates with an increased risk of death during hospitalisation. Higher TC (total cholesterol) level were related to a lower risk of death, which may indicate the "lipid paradox". Higher BMI results were related to a lower risk of death, which may indicate the "obesity paradox".

Rationing of Nursing Care and Patient Safety.

Background: Nursing care has a significant impact on patient safety, which affects clinical outcomes, patients' satisfaction with the care received and nursing personnel's satisfaction with the care provided. This study aimed to determine the extent of nursing care rationing and its relationship with patient safety including identification of the specific reasons. Methods: This cross-sectional study involved 245 nurses and was performed between April-June 2019 in four hospitals in Wroclaw, Poland. The standardized and relevant research tools such as Hospital Survey on Patient Safety Culture (HSOPSC) and the Perceived Implicit Rationing of Nursing Care (PIRNCA) were used. The data was submitted to hierarchical multiple regression analysis. The study was approved by the Bioethics Committee and was followed with the STROBE guidelines. Results: The PIRNCA scores were negatively correlated with the HSOPSC subscales, which indicates that more frequent rationing of nursing care was associated with lower levels of patient safety parameters. It was shown that the highest level of unfinished nursing care was associated with decreases in patient safety factors linked with supervisor manager expectations actions promoting safety (rs = -0.321, p < 0.001), teamwork within hospital units (rs = -0.377, p < 0.001), feedback and communication about error (rs = -0.271, p < 0.001), teamwork across hospital units (rs = -0.221, p < 0.01), and hospital handoffs transitions (rs = -0.179, p < 0.01). Moreover, the strongest association was observed between the PIRNCA scores with patient safety grade (rs = 0.477, p < 0.001). Also, the PIRNCA scores among the internal unit were significantly higher than in the intensive care and surgical units. Conclusion: Our study indicated the presence of nursing care rationing. Regarding patient safety, we found insufficient numbers of medical personnel and excessive personnel workload for providing safe care to patients, a lack of transparency in handling adverse event reports and analyses, and a lack of cooperation between hospital units regarding patient safety.

Influential factors in adherence to the therapeutic regime in patients with type 2 diabetes and hypertension.

BACKGROUND: Medication non-adherence is a global problem and the most common cause of treatment failure. Researchers warn that only one in two patients with chronic conditions adhere to their medication. Therefore, the primary objective of the study was to assess influential factors in adherence to the therapeutic regime in patients with type 2 diabetes and hypertension. The secondary objective was to evaluate medication adherence in patients with hypertension (HT) and/or diabetes (DM) and compare the level of adherence among patients with either diabetes or hypertension. METHODS: The study included 1303 patients divided into three groups according to the type of chronic condition. The Adherence to Refills and Medications Scale (ARMS) was used to assess the level of adherence with pharmacological recommendations. RESULTS: A comparison of adherence between the groups demonstrated that the level of adherence was highest in patients with diabetes alone (17 ± 5.15) and was lowest in patients with co-existing HT and diabetes (19.9 ± 7.51). A single-factor linear regression model analysis showed that the presence of hypertension alone has a positive effect on adherence to medications, while the co-existence of diabetes and hypertension has a statistically significantly negative impact on medication adherence. The sociodemographic predictors of higher adherence included female gender (ß = -0.06; p = 0.024), high school education (ß = -0.16 and p = 0.001) and being unemployed (ß = -0.08; p = 0.0100). CONCLUSION: Patients with co-existing diabetes and HT taking antihypertensive and antidiabetic drugs have the lowest adherence rates, and the co-existence of two chronic conditions is a statistically significant independent determinant of decreased adherence. Variables confirmed in the multiple-factor model as having an independent impact on the level of adherence include the type of condition suffered, female gender, education and professional status. Practical implication. The primary objective is to undertake actions whose aim is to improve adherence in order to enhance patients' functioning, reduce the number of follow-up visits and the hospitalisation rate, and thus limit the economic consequences of treating disease complications.