Characteristics of shared decision making in Romania from the patient perspective: A cross-sectional multicentric study.

BACKGROUND: Shared decision making (SDM) is very important from patients' perspective. This process has not yet been evaluated in Romania. The study aims to evaluate SDM from the patients' perspective and to evaluate patients' characteristics that associate with SDM. MATERIAL AND METHODS: A cross-sectional multicentric study comprising eight recruitment centres was performed. Inpatients and outpatients who referred to Hospital Units treating autoimmune diseases or atrial fibrillation were included. Another sample consisted of members of the Autoimmune Disease Patient Society, who completed an online anonymous questionnaire. All participants completed the Romanian translated version of the 9-item Shared Decision Making Questionnaire (SDM-Q-9), as these samples were used for the validation of this questionnaire, too. Patients had to refer to the visit in which the decision concerning the antithrombotic treatment was taken (atrial fibrillation patients), or the immunosuppressive treatment was last time changed (autoimmune disease patients). Ordinal regression having the total SDM score as dependent variable was used. RESULTS: A total of 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n = 341; 51.3%). The median score for SDM was 34 of 45, but it differed between hospital completion -39/45 and online completion (anonymous) -20/45 (P < .001). Patients with higher education were influenced most by the setting, giving the best marks in hospital and low marks online, while those with lower education gave lower marks in both settings. In ordinal regression with SDM score as dependent variable, hospital completion of the questionnaire (OR = 9.5, 95% confidence interval, 5.69-16), collagen disease diagnosis (OR = 2.4, 95% confidence interval, 1.39-4.14), and immunosuppressive treatment (OR = 2.16, 95% confidence interval, 1.43-3.26) were independent predictors. CONCLUSION: In our study, full anonymity was associated with significantly lower scores for the SDM process. The patients with higher education were most influenced by this condition, while those with the lowest education were the most critical.

Romanian version of SDM-Q-9 validation in Internal Medicine and Cardiology setting: a multicentric cross-sectional study.

BACKGROUND: Shared decision making (SDM) is becoming more and more important for the patient-physician interaction. There has not been a study in Romania evaluating patients' point of view in the SDM process yet. Therefore, the present study aims to evaluate the psychometric parameters of the translated Romanian version of SDM-Q-9. MATERIAL AND METHODS: A multicentric cross-sectional study was performed comprising eight recruitment centers. The sample consisted of in- and outpatients who referred to Hospital Units for treatment for atrial fibrillation or collagen diseases. Furthermore, patients who were members of Autoimmune Disease Patient Society were able to participate via an online survey. All participants completed the Romanian translated SDM-Q-9. RESULTS: Altogether, 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n = 341; 51.3%). The Romanian version had good internal consistency (Cronbach α coefficient of 0.96.) Corrected item correlations were good ranging from 0.64 to 0.89 with low corrected item correlations for item 1 and item 7. PCA found a one-factorial solution (similar with previous reports) but the first item had the lowest loading. CONCLUSION: SDM-Q-9 is a useful tool for evaluation and improvement in health care that was validated in Romania and can be used in clinical setting in this country.

Ebstein's anomaly.

Ebstein's anomaly is a rare congenital heart disease, accounting for less than 1% of all congenital heart diseases, characterized by a wide clinical, electrocardiographic, echocardiographic, anatomic and prognostic polymorphism. The disease can be fatal since birth or may remain asymptomatic until adulthood, sometimes being associated with septal defects, transposition of great vessels, preexcitation syndromes, or left ventricular noncompaction. The genetic changes underlying this syndrome are not fully known, but in the cases associating left ventricular nonompaction a mutation in MYH7 gene encoding the beta-myosin heavy chain was recently detected. The authors present 2 cases of Ebstein's anomaly with different onset and course and discuss the current clinical, electrocardiographic and echocardiographic criteria used for prognostic stratification of Ebstein disease in relation to international literature.

[The influence of intermediate physical training on some non-enzyme antioxidants of oxidative stress, in moderate hypertension]. / Influenta antrenamentului fizic recuperator pe termen mediu asupra unor antioxidanti neenzimatici de stres oxidativ în HTA moderata.

A group of patients with moderate hypertension (149-150/90-99 mm Hg) performed physical exercise for 3 months; we determined the oxidative stress in blood samples, by calculating the level of some biochemical markers, non-enzyme antioxidants, glutathione (GSH), total -SH groups (G-STH), nonprotein -SH groups (G-SHNP), their G-SHT/G-SHNP ratio, uric acid, malondialdehyde (MDA) and comparing the results with the values obtained from a group of healthy subjects. We found an increased oxidative stress at the HTA patients, with initial (Vi) decreasing values of GSH and uric acid, and with higher values of MDA. After the 3 months (Vf) of physical training, the oxidative stress improved, with increasing GSH, uric acid and decreasing MDA, compared to normal subjects. The initial values of G-SHT, G-SHNP and their ratio, increased, but decreased after 3 months, with an inverse aspect to GSH. The clinical study proved that after 3 months of physical exercise, there wasn't any increased oxidative stress at the HTA patients; however, the oxidative stress is present, proved by the values of MDA, significantly higher compared to the normal subjects.

[Evaluation of oxidative stress and enzymatic antioxidants in medium physical training of moderate arterial hypertension]. / Evaluarea stresului oxidativ si antioxidantilor enzimatici în antrenamentul fizic recuperator pe termen mediu al HTA moderate.

A group of patients with moderate hypertension (149-150/90-99 mmHg) performed physical exercise for 3 months; we determined the oxidative stress in blood samples, by calculating the level of some antioxidative markers, the enzymes SOD, CAT, GPx, MDA and comparing the results with the values obtained from a group of healthy subjects. We found an increased oxidative stress at the hypertensive patients, with initial higher values of SOD and MDA and with lower values of CAT and GPx, compared to the normal subjects. After the 3 months of physical training, the oxidative stress improved, with decreasing activity of SOD, GPx, MDA and increasing CAT, maintaining the ratio CAT/SOD and GPx/SOD superior compared to normal subjects. The clinical study proved that after 3 months of physical exercise, there wasn't any increased oxidative stress at the hypertensive patients; however, the oxidative stress is present, proved by the values of MDA, significantly higher compared to the normal subjects.

[The effects of the physical training on the hypertensive patients with glycoregulation disorder]. / Efectele antrenamentului fizic la hipertensivii cu tulburari de glicoreglare.

UNLABELLED: The purpose of our clinical study was the evaluation of moderate physical training on hypertensive patients with the impaired glycoregulation, for a determinate period of time. METHODS: The study included 80 patients with moderate hypertension, divided in two groups: group B formed of 40 patients that followed an associated treatment (physical exercises 3-5 times/week, 45-60 min. for one training and antihypertensive drug therapy) and group C formed of 40 patients that followed only drug therapy for controlling blood pressure. The glycoregulation disorder was appreciated by determining a jeune glycemia to all the patients, the oral glucose tolerance test at the patients who were until 60 years old and for which there wasn't any evidence of glucose intolerance a jeune. The uniform pattern of OGTT values was considered due to insulin resistance and hyperinsulinism. We obtained the values of cholesterol, triglycerides, HDL-C, LDL-C and atherogenesis index. RESULTS: The patients with impaired glycoregulation had significant increased values of cholesterol (p = 0.03) and triglycerides (p < 0.001), decreased HDL-C (p = 0.004), compared to the patients without glycoregulation disorder. LDL-C didn't vary significantly (p = 0.2). The patients with impaired glycoregulation had the value of ventricular mass 254.46 +/- 38 g, compared to 239.52 +/- 41 g for the patients without glycoregulation disorder. In group B, we found 14 patients with impaired glycoregulation (35%) and 11 patients in group C (27.5%) with the same metabolic disorder. After 6 month, only 9 patients with glycoregulation disorder (22.5) were left in group B and also 10 patients (25%) with the same disorder in group C. CONCLUSION: Moderate physical exercise associated with antihypertensive therapy induced, besides the decrease of blood pressure values, a good control of lipids and glucose markers of metabolism.

[The beneficial effect of physical training in hypertension]. / Beneficille exercitiului fizic în hipertensiunea arteriala.

Hypertension is present in epidemic proportion and is associated with a markedly increased risk of developing numerous cardiovascular disorders. All current treatment guidelines emphasise the role of nonpharmacological interventions, physical activity included, in the treatment of mild to moderate hypertension. A large number of studies have demonstrated that regular exercise reduces the incidence of hypertension. In addition to preventing hypertension, regular exercise has been found to lower blood pressure (10 mmHg average reduction in both systolic and diastolic pressure), improve lipoprotein-lipid profiles and insulin sensitivity. As part of the initial treatment, exercise is recommended for 12 months in patients with stage 1 hypertension, with no other coronary risk factors and no evidence of cardiovascular disease, and for as long as 6 months in those with other risk factor, but not diabetes. In patients with diabetes, cardiovascular disease or with stage 2 or 3 hypertension, drug therapy should be initiated first. Dynamic exercise of moderate intensity, 50-75% VO2max, (e.g. brisk walking, cycling) for 50-60 minutes, 3-5 times per week, is preferable to vigorous exercise because it appears to be more effective in lowering blood pressure. In addition to reducing hypertension, physical activity improves other cardiovascular risk factors.