Machine Learning and Clinical Predictors of Mortality in Cardiac Arrest Patients: A Comprehensive Analysis.

BACKGROUND Cardiac arrest (CA) is a global public health challenge. This study explored the predictors of mortality and their interactions utilizing machine learning algorithms and their related mortality odds among patients following CA. MATERIAL AND METHODS The study retrospectively investigated 161 medical records of CA patients admitted to the Intensive Care Unit (ICU). The random forest classifier algorithm was used to assess the parameters of mortality. The best classification trees were chosen from a set of 100 trees proposed by the algorithm. Conditional mortality odds were investigated with the use of logistic regression models featuring interactions between variables. RESULTS In the logistic regression model, male sex was associated with 5.68-fold higher mortality odds. The mortality odds among the asystole/pulseless electrical activity (PEA) patients were modulated by body mass index (BMI) and among ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) patients were by serum albumin concentration (decrease by 2.85-fold with 1 g/dl increase). Procalcitonin (PCT) concentration, age, high-sensitivity C-reactive protein (hsCRP), albumin, and potassium were the most influential parameters for mortality prediction with the use of the random forest classifier. Nutritional status-associated parameters (serum albumin concentration, BMI, and Nutritional Risk Score 2002 [NRS-2002]) may be useful in predicting mortality in patients with CA, especially in patients with PCT >0.17 ng/ml, as showed by the decision tree chosen from the random forest classifier based on goodness of fit (AUC score). CONCLUSIONS Mortality in patients following CA is modulated by many co-existing factors. The conclusions refer to sets of conditions rather than universal truths. For individual factors, the 5 most important classifiers of mortality (in descending order of importance) were PCT, age, hsCRP, albumin, and potassium.

Comprehensive Cardiac Care: How Much Does It Cost?

The benefits of coordinating care between healthcare professionals and institutions are the main drivers behind reforms to the payment and delivery system for healthcare services. The purpose of this study was to analyse the costs incurred by the National Health Fund in Poland related to the comprehensive care model for patients after myocardial infarction (CCMI, in Polish: KOS-Zawal). METHODS: The analysis involved data from 1 October 2017 to 31 March 2020 for 263,619 patients who received treatment after a diagnosis of first or recurrent myocardial infarction as well as data for 26,457 patients treated during that period under the CCMI programme. RESULTS: The average costs of treating patients covered by the full scope of comprehensive care and cardiac rehabilitation under the programme (EUR 3113.74/person) were higher than the costs of treating patients outside of that programme (EUR 2238.08/person). At the same time, a survival analysis revealed a statistically significantly lower probability of death (p < 0.0001) in the group of patients covered by CCMI compared to the group not covered by the programme. CONCLUSIONS: The coordinated care programme introduced for patients after myocardial infarction is more expensive than the care for patients who do not participate in the programme. Patients covered by the programme were more often hospitalised, which might have been due to the good coordination between specialists and responses to sudden changes in patients' conditions.

Comprehensive Care after Myocardial Infarction (CCMI): Long-Term Investment in the Health of Polish Citizens.

The comprehensive care model after myocardial infarction (CCMI, in Polish: KOS-Zawal) has been in effect continuously since October 2017. Within the bundle of services financed by the Polish National Health Fund (NHF), patients receive a diagnosis, conservative and invasive treatment, early cardiac rehabilitation and follow-up visits for 12 months. The existing model of managing patients after myocardial infarction (MI) implements all crucial aspects of care recommended by the European Society of Cardiology (ESC), emphasised many times. The purpose of this paper was to report and describe the course of the implementation of the unique concept-CCMI model, including the scope of the introduced changes and the implementation and structural evaluation of its effects over the period 2017-2021. Our preliminary study reported that the CCMI programme reduces the risk of patient death in the first year after MI by 29%. Furthermore, the authors point out the strict cause and effect relationship between the cardiovascular disease prevention programme since 2004 as the key instrument for the primary systemic prevention implemented outside the CCMI model.

Survival analysis of patients with acute coronary syndrome receiving comprehensive coordinated care after myocardial infarction (KOS-Zawal).

BACKGROUND: This study aimed to analyze survival rates among patients with acute coronary syndrome (ACS) covered and not covered by the National Comprehensive Care after Myocardial Infarction (KOS-Zawal) program. METHODS: A total of 179972 patients after myocardial infarction (MI) were enrolled in KOS-Zawal program between October 2017 and March 2020 and were included in the comparative analysis with survival analysis. A group of 24496 (13.61%) patients received KOS-Zawal services, while a group of 155476 (86.39%) were not covered by the KOS-Zawal program. The time points for observation of the incidence of death were set at 30, 180, and 365 days from the end of the first hospitalization. RESULTS: There was a lower incidence of death in favor of the KOS-Zawal group relative to the non-KOS-Zawal group both in hospital and at 30, 180, and 365 days after the end of hospitalization, respectively: 0.19% vs. 6.55%; 0.80% vs. 8.39%; 2.92% vs. 10.74%; and 6.35% vs. 13.40%. Survival analysis revealed a statistically significantly lower (P <0.0001) probability of death in the KOS-Zawal group compared with the non-KOS-Zawal group. Also, logistic regression analysis confirmed that patients in the KOS-Zawal group had a significantly lower risk of death than those in the non-KOS-Zawal group (odds ratio, 0.710; 95% confidence interval, 0.554-0.908; P = 0.007). CONCLUSIONS: The KOS-Zawal comprehensive care program reduces the risk of death in the first year after MI by 29%. There are indications of a biased interpretation of the data due to the initial better clinical status of post-MI patients covered by the KOS-Zawal program.

Rationing of Nursing Care and Professional Burnout Among Nurses Working in Cardiovascular Settings.

Introduction: Nursing needs close interpersonal contact with the patient and emotional involvement, therefore can contribute to professional burnout and rationing of nursing care. Aim: Assessing the relationship between the rationing of nursing care and professional burnout in nursing staff. Materials and Methods: The study included a group of 219 nurses working in cardiovascular facilities. This was a cross-sectional study designed to investigate the relationship between factors of the care rationing and professional burnout. The survey data was collected with standardised and research instruments such as the revised Basel Extent of Rationing of Nursing Care questionnaire (BERNCA-R) and the Maslach Burnout Inventory (MBI). Results: The total mean BERNCA-R score was 1.38 (SD = 0.62), while the total MBI score amounted to 38.14 (SD = 22.93). The specific components of professional burnout yielded the values: emotional exhaustion (M = 44.8), job dissatisfaction (M = 40.66), and depersonalisation (M = 28.95). Multiple linear regression showed that independent predictors of BERNCA-R score were emotional exhaustion, depersonalisation, job dissatisfaction, and multi-jobs activity (p < 0.001). Conclusion: The level of rationing of nursing care in cardiovascular facilities increases along with emotional exhaustion, depersonalisation and job dissatisfaction, and multi-jobs activity.

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.

Readiness for Discharge from Hospital after Myocardial Infarction: A Cross-Sectional Study.

Myocardial infarction (MI) is a common cause of cardiovascular deaths. Education of patients with myocardial infarctions essential to prevent further cardiovascular events and reduce the risk of mortality. The study aimed to evaluate the associations between patients' readiness for hospital discharge after myocardial infarction, acceptance of illness, social, demographic, and clinical factors. The study used a cross-sectional design and included 102 patients, who were hospitalized for myocardial infarction after percutaneous coronary intervention (PCI). Two questionnaires were used: The Readiness for Hospital Discharge After Myocardial Infarction Scale (RHD-MIS) and Acceptance of Illness Scale (AIS). Low readiness characterized nearly half of patients (47.06%), 27.45% of patients showed an intermediate level of readiness, while 25.49% of patients had high readiness. Readiness for hospital discharge was higher among younger patients, respondents living in relationships, living with a family, with tertiary or secondary education, and professionally active. Acceptance of illness was higher among male patients, respondents living in relationships, and family, with secondary education and professionally active. The AIS score positively correlated with readiness for hospital discharge.

In Vitro Efficacy of Bacterial Cellulose Dressings Chemisorbed with Antiseptics against Biofilm Formed by Pathogens Isolated from Chronic Wounds.

Local administration of antiseptics is required to prevent and fight against biofilm-based infections of chronic wounds. One of the methods used for delivering antiseptics to infected wounds is the application of dressings chemisorbed with antimicrobials. Dressings made of bacterial cellulose (BC) display several features, making them suitable for such a purpose. This work aimed to compare the activity of commonly used antiseptic molecules: octenidine, polyhexanide, povidone-iodine, chlorhexidine, ethacridine lactate, and hypochlorous solutions and to evaluate their usefulness as active substances of BC dressings against 48 bacterial strains (8 species) and 6 yeast strains (1 species). A silver dressing was applied as a control material of proven antimicrobial activity. The methodology applied included the assessment of minimal inhibitory concentrations (MIC) and minimal biofilm eradication concentration (MBEC), the modified disc-diffusion method, and the modified antibiofilm dressing activity measurement (A.D.A.M.) method. While in 96-well plate-based methods (MIC and MBEC assessment), the highest antimicrobial activity was recorded for chlorhexidine, in the modified disc-diffusion method and in the modified A.D.A.M test, povidone-iodine performed the best. In an in vitro setting simulating chronic wound conditions, BC dressings chemisorbed with polyhexanide, octenidine, or povidone-iodine displayed a similar or even higher antibiofilm activity than the control dressing containing silver molecules. If translated into clinical conditions, the obtained results suggest high applicability of BC dressings chemisorbed with antiseptics to eradicate biofilm from chronic wounds.

Cardiac Cachexia: A Well-Known but Challenging Complication of Heart Failure.

Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient's prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF ("cardiac cachexia").

Project of the Health Policy Program: Access to Vessels in Renal Replacement Therapy - Fistula First/Catheter Last.

INTRODUCTION: The number of patients with end-stage renal failure (ESRF) that require inclusion in the renal replacement therapy program (RRT) is steadily increasing. This fact caused an increase in vascular operations involving the production of vascular access. According to the current guidelines, the best and safest option for a patient with chronic kidney disease (CKD) is the early creation of arteriovenous fistula (AVF). An efficient vascular access to haemodialysis determines the procedure and directly affects the quality of life of a patient with CKD. AIM: The aim of this paper is to present the author's project of the health policy program "Vascular access in renal replacement therapy - fistula first/catheter last", the essence of which is to assess the practical effectiveness and develop an optimal model of CKD patient care organization qualified for the chronic RRT program. MATERIAL AND METHODS: The target population of the program consists of all patients diagnosed with CKD, qualified for the RRT program. The basic measures of the program's effectiveness include: (1) reduction in the number of re-hospitalizations related to vascular access, (2) reduction in the number of complications associated with haemofiltration surgery, (3) reduction in general mortality among patients undergoing dialysis in a 12-month perspective, (4) increasing knowledge in the field of self-care and self-care of arteriovenous anastomosis, and (5) creating a register of vascular access in Poland. CONCLUSIONS: To sum up, health policy programme "Vascular access in renal replacement therapy - fistula first/catheter last" covering health care services provided in the scope and on the conditions specified in the regulations issued on the basis of article 31d of the Act of 27 August 2004 on health care benefits financed from public funds, is to check whether planned changes in the organization and delivery of services will improve the situation of patients with CKD eligible for chronic RRT and whether it will be effective the point of view of the health care system.