Challenges and opportunities in the Polish healthcare sector from the implementation of telemedicine solutions in the field of gerontology and geriatric medicine: own experience.

OBJECTIVE: Aim: To analyze and summarize the implementation of telemedical solutions in geriatrics and gerontology within the Polish healthcare sector, aiming to develop innovative strategies for improving elderly care through telemedical technologies. PATIENTS AND METHODS: Materials and Methods: An interdisciplinary pilot project in geriatrics was implemented, focusing on health, organizational, and technological areas. The project involved continuous monitoring of health parameters, remote consultations, and the use of telemedical devices and platforms. Key data collection tools included digital clinimetric outcomes from the FRA-MNA-SARC model, with data transmitted to a telemedical platform. RESULTS: Results: The pilot project demonstrated significant positive outcomes for senior participants. Continuous monitoring of health parameters allowed for early detection and timely intervention, leading to noticeable improvements in chronic disease management. This proactive approach reduced emergency hospital visits and enhanced overall health stability. The medication adherence support system, with automated reminders, ensured patients took their medications as prescribed, resulting in improved compliance and health outcomes. Telemedical solutions efficiently reduced the need for frequent in-person visits, allowing healthcare providers to monitor progress and adjust therapies in real-time. The project also effectively engaged patients and caregivers, increasing confidence in health management and providing valuable support and real-time information. CONCLUSION: Conclusions: Implementing telemedical solutions in geriatrics within the Polish healthcare sector shows significant potential to improve elderly care. Telemedicine can effectively support chronic disease management, enhance seniors' quality of life through continuous health monitoring, and provide a practical framework for personalized and efficient healthcare delivery.

THE FRAMEWORK OF THE PILOT PROJECT FOR TESTING A TELEMEDICINE MODEL IN THE FIELD OF GERIATRICS - HEALTH CHALLENGES AND JUSTIFICATION OF THE PROJECT IMPLEMENTATION.

OBJECTIVE: Aim: To present the essentials of the pilot project for testing a telemedicine model in the field of geriatrics, along with a snapshot of the health challenges. PATIENTS AND METHODS: Materials and Methods: This review paper use the synthetic method summarizing the main objectives of the telemedicine project in the field of geriatrics. The described project involving telemedical care of patients with geriatric complexes in the area of frailty syndrome, sarcopenia and malnutrition, according to the proposed model addresses the aforementioned problems. The project provides a holistic model of home and outpatient care, which will allow concerting on 3 groups of the above-mentioned geriatric syndromes. The project will have a pilot character and is aimed at clinical verification through the introduction (implementation) of the new method and accompanying organizational and technological solutions (platform, equipment) in an area where current models and schemes of therapeutic and diagnostic support were insufficient. CONCLUSION: Conclusions: The implementation of telemedicine solutions creates an opportunity for geriatric patients and their families by improving access to specialized medical care. This project will support patients, but also caregivers, who (through training and telemedicine) will be better able to provide care services with the ability to reconcile them with their own work.

THE FRAMEWORK OF THE PILOT PROJECT FOR TESTING A TELEMEDICINE MODEL IN THE FIELD OF CHRONIC DISEASES - HEALTH CHALLENGES AND JUSTIFICATION OF THE PROJECT IMPLEMENTATION.

OBJECTIVE: Aim: To present the essentials of the pilot project for testing a telemedicine model in the field of chronic diseases, along with a snapshot of the health challenges. PATIENTS AND METHODS: Materials and Methods: This review paper use the synthetic method summarizing the main objectives of the telemedicine project in the field of chronic diseases with a focus on COPD. The described project will have a pilot character and is aimed at clinical verification through the implementation of a new method and accompanying organizational and technological solutions (platform, devices) in an area where current models and schemes of therapeutic and diagnostic support were insufficient. The main (primary) outcome will be the leveling of social inequalities in health by reducing the residence and income factor in access to screening and medical services through the use of telemedicine. CONCLUSION: Conclusions: Implementation of telemedicine solutions creates an opportunity for patients diagnosed with COPD and their families by improving access to specialized medical care. With early detection of COPD exacerbation symptoms (deterioration of remotely monitored spirometric parameters), it will be possible to introduce appropriate preventive measures for these patients offsetting the adverse consequences.

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.

Simple demographic characteristics and laboratory findings on admission may predict in-hospital mortality in patients with SARS-CoV-2 infection: development and validation of the covid-19 score.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a major health burden worldwide due to high mortality rates and hospital bed shortages. SARS-CoV-2 infection is associated with several laboratory abnormalities. We aimed to develop and validate a risk score based on simple demographic and laboratory data that could be used on admission in patients with SARS-CoV-2 infection to predict in-hospital mortality. METHODS: Three cohorts of patients from different hospitals were studied consecutively (developing, validation, and prospective cohorts). The following demographic and laboratory data were obtained from medical records: sex, age, hemoglobin, mean corpuscular volume (MCV), platelets, leukocytes, sodium, potassium, creatinine, and C-reactive protein (CRP). For each variable, classification and regression tree analysis were used to establish the cut-off point(s) associated with in-hospital mortality outcome based on data from developing cohort and before they were used for analysis in the validation and prospective cohort. The covid-19 score was calculated as a sum of cut-off points associated with mortality outcome. RESULTS: The developing, validation, and prospective cohorts included 129, 239, and 497 patients, respectively (median age, 71, 67, and 70 years, respectively). The following cut of points associated with in-hospital mortality: age > 56 years, male sex, hemoglobin < 10.55 g/dL, MCV > 92.9 fL, leukocyte count > 9.635 or < 2.64 103/µL, platelet count, < 81.49 or > 315.5 103/µL, CRP > 51.14 mg/dL, creatinine > 1.115 mg/dL, sodium < 134.7 or > 145.4 mEq/L, and potassium < 3.65 or > 6.255 mEq/L. The AUC of the covid-19 score for predicting in-hospital mortality was 0.89 (0.84-0.95), 0.850 (0.75-0.88), and 0.773 (0.731-0.816) in the developing, validation, and prospective cohorts, respectively (P < 0.001The mortality of the prospective cohort stratified on the basis of the covid-19 score was as follows: 0-2 points,4.2%; 3 points, 15%; 4 points, 29%; 5 points, 38.2%; 6 and more points, 60%. CONCLUSION: The covid-19 score based on simple demographic and laboratory parameters may become an easy-to-use, widely accessible, and objective tool for predicting mortality in hospitalized patients with SARS-CoV-2 infection.

Benefit of Biological Drugs for Quality of Life in Patients with Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of Clinical Trials.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease involving the axial skeleton, peripheral joints, and extra-articular manifestations like psoriasis, inflammatory bowel disease, or uveitis. A deterioration of quality of life (QoL) affects the disease management and therapeutic decision-making. This meta-analysis focused on the influence of biological drugs on the QoL in SA compared to the effects of other therapeutic modalities. We searched the databases of MedLine, Academic Search Ultimate, CINAHL Complete, and Health Source - Nursing/Academic Edition for articles related to AS treatment using the terms "ankylosing spondylitis" OR "rheumatoid spondylitis" OR "spondylitis" AND "quality of life" OR "patient-reported outcomes" OR "well-being" OR "health-related quality of life" OR "biological treatment". The search came up with 10 English-language articles published between 2010 and 2020. Patients were evaluated with the following indexes and questionnaires: Assessment of Spondyloarthritis International Society (ASAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Quality of Life (ASQoL), 36-Item Short-Form Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), and the Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Functional (BASFI) Indexes. We found that the QoL, assessed with the ASQoL, improved significantly better in patients treated with biological drugs when compared to those treated with other standard therapies or placebo at a 4-month follow-up. However, improvements in other disease characteristics could not be differentiated based on the therapy modality. The finding that biological drugs are superior in improving the QoL should strengthen the recommendations for their use in patients with AS.

Psychometric Properties of the Polish Version of the Self-care of Hypertension Inventory.

BACKGROUND: According to evidence-based guidelines, adherence to blood pressure-lowering medication and lifestyle modifications is a crucial part of hypertension management. Self-care is an effective method for secondary prevention. However, patients continue to exhibit major deficits in terms of adherence, self-control, and self-care. Standardized instruments for the effective monitoring of patients' self-care abilities are still lacking. OBJECTIVE: The objectives of this study were to produce a translation and cross-cultural adaptation of the Self-care of Hypertension Inventory (SC-HI) and to evaluate the psychometric properties of its Polish version. METHODS: The scale underwent translation and psychometric assessment using the standard methodology (forward-backward translation, review, psychometric analysis, criterion validity). The study included 250 patients, with a mean age of 61.23 ± 14.34 years, treated in a hypertension clinic. RESULTS: Mean self-care levels were evaluated in 3 domains: self-care maintenance (56.73 ± 18.57), self-care management (64.17 ± 21.18), and self-care confidence (62.47 ± 24.39). The Cronbach α for each domain showed satisfactory parameters: 0.755 for maintenance, 0.746 for management, and 0.892 for confidence. In the Polish version, the 3-factor structure of the SC-HI was not directly confirmed. Therefore, so-called modification indices were applied to obtain a standardized root mean square residual value less than 0.09 and a root mean square error of approximation value less than 0.06. CONCLUSIONS: The SC-HI has been successfully translated and adapted for Polish settings, and is suitable for application among patients with hypertension.

Impact of fatigue on nursing care rationing in paediatric haematology and oncology departments - a cross-sectional study.

BACKGROUND: Rationing of nursing care is a relatively new concept. It refers to an error of omission and has a direct influence on the quality of nursing care and treatment outcomes. Nurses who experience chronic fatigue often fail to perform their duties properly, which may lead, for instance, to medical errors attributed to impaired judgment. Therefore, it is necessary to identify factors which give rise to fatigue, leading to rationing of nursing care, and develop strategies to eliminate them. The primary objective of the study was to assess the impact of fatigue on nursing care rationing in paediatric haematology and oncology departments. The secondary objective of this study was to identify the factors, which may influence the nursing care rationing. METHODS: The study was conducted among 95 nurses (aged between 23 and 58 years) workinginthe Department of Paediatric Oncology, Haematology and Bone Marrow Transplantation of the University Teaching Hospital in Wroclaw. Participation in the study was voluntary and anonymous. Our own sociodemographic questionnaire, the Basel Extent of Rationing of Nursing Carequestionnaire and the modified fatigue impact scale (MFIS) were used in the study. RESULTS: The level of fatigue among the nurses participating in the study, as measured by the MFIS, was high, namely 28.97 ± 16.78. It was found that the fatigue of the nurses influenced most often the psycho-social dimension of QoL (1.78 ± 1.05), and least often - cognitive (1.24 ± 0.78). A correlation analysis showed that all aspects of fatigue had a statistically significant positive impact on care rationing (p < 0.05), i.e. the greater the fatigue, the higher the level of care rationing. A regression analysis showed that a 12-h shift pattern was an independent predictor of the level of care rationing (r = 0.771, p < 0.05). CONCLUSIONS: Nurses working in paediatric haematology departments report a high level of fatigue. Work pattern is an independent determinant of nursing carerationing. A high level of nursing care rationing was found for nurses working 12-h shifts. TRIAL REGISTRATION: The study was approved by the Bioethics Committee of the Wroclaw Medical University, Poland (February 8th 2019, No. 205/2019).

Impact of satisfaction with physician-patient communication on self-care and adherence in patients with hypertension: cross-sectional study.

BACKGROUND: Hypertension (HT) requires patients to continuously monitor their blood pressure, strictly adhere to therapeutic recommendations, and self-manage their illness. A few studies indicate that physician-patient communication and the patient's satisfaction with the therapeutic relationship may affect the course and outcomes of the treatment process. Research is still lacking on the association between satisfaction with physician-patient communication and adherence to treatment or self-care in chronically ill patients. The aim of the study was to evaluate the relationship between satisfaction with physician-patient communication and self-care and adherence in patients with HT undergoing chronic treatment. METHODS: The following instruments were used: the Adherence to Refills and Medication Scale (ARMS) for evaluating adherence (12-48 points), the Self-Care of Hypertension Inventory (SCHI) for self-care level (0-100 points), and the Communication Assessment Tool (CAT) for evaluating satisfaction with physician-patient communication. Socio-demographic and clinical data were obtained from patients' medical records. The research has a cross-sectional and observational study design. Inclusion criteria were as follows: age > 18 years, hypertension diagnosed per European Society of Hypertension (ESH) guidelines, treatment with at least one antihypertensive drug for the past 6 months, and informed consent. Cognitively impaired patients unable to complete the surveys without assistance were excluded (MMSE ≤18). Correlations between quantitative variables were analyzed using Pearson's or Spearman's correlation coefficient. Linear regression was performed. Variable distribution normality was verified using the Shapiro-Wilk test. RESULTS: The study included 250 patients (110 male, mean age 61.23 ± 14.34) with HT, treated at a hypertension clinic. In the CAT questionnaire individual questions pertaining to satisfaction with physician communication (on the CAT) were rated "excellent" 28.4-50.4% of the time. The best-rated aspects of communication included: letting the patient talk without interruptions (50.4% "excellent" ratings), speaking in a way the patient can understand (47.6%), and paying attention to the patient (47.2%). According to patient reports, physicians most commonly omitted such aspects as encouraging the patient to ask questions (28.4%), involving them in decisions (29.2%), and discussing the next steps (35.2%). The respondents had a low level of adherence to pharmaceutical treatment (16.63 ± 4.6). In terms of self-care, they scored highest in self-care management (64.17 ± 21.18), and lowest in self-care maintenance (56.73 ± 18.57). In correlation analysis, satisfaction with physician-patient communication (total CAT score) was positively correlated with all SCHI domains (self-care maintenance ß = 0.276, self-care management ß = 0.208, self-care confidence ß = 0.286, p < 0.05), and negatively correlated with ARMS scores (indicating better adherence). CONCLUSIONS: Satisfaction with physician-patient communication has a significant impact on self-care and pharmaceutical adherence in patients with hypertension. The more satisfied the patient is with communication, the better their adherence and self-care. TRIAL REGISTRATION: SIMPLE: RID.Z501.19.016.

Influence of Coping Strategy on Perception of Anxiety and Depression in Patients with Non-small Cell Lung Cancer.

The purpose of this study was to evaluate the influence of cognitive adjustment to cancer, assessed on the mini-Mental Adjustment to Cancer (mini-MAC) scale, on perception of anxiety and depression, assessed with the Hospital Anxiety and Depression Scale, in patients with non-small cell lung carcinoma (NSCLC). There were 185 patients, grouped according to the score of mini-MAC into constructive coping strategies, balanced coping strategies, and destructive coping strategies. We found that patients with predominantly destructive coping strategies had a higher level of anxiety than those with balanced or constructive strategies (10.9 vs. 9.3 vs. 6.3 points, respectively; p < 0.001). Likewise, symptoms of depression were more pronounced in patients having destructive coping strategies than in those with balanced or constructive strategies (11.9 vs. 8.8 vs. 5.8 points, respectively; p < 0.001). We further found that constructive coping strategy was a significant independent predictor of lower levels of anxiety and depressive symptoms. Other predictors included symptomatic treatment and a good nutritional status, while pain, chemotherapy, and poor performance status exacerbated the negative emotions. We conclude that cognitive adjustments to having cancer outstandingly modify the development of anxiety and depression in NSCLC patients, which also influences the choice of treatment and the treatment process itself. Thus, psychological assessment is essential in clinical practice and care for patients with lung cancer.

Chitinase 3-Like 1, Nestin, and Testin Proteins as Novel Biomarkers of Potential Clinical Use in Colorectal Cancer: A Review.

Colorectal cancer is the third most commonly diagnosed cancer in males and the second most common in females. Only 10-20% of patients are diagnosed at the early stage of disease. Recently, the role of novel biomarkers of the neoplastic process in the early detection of colorectal cancer has been widely discussed. In this review, we focused on the three novel biomarkers that are of potential clinical importance in diagnosing and monitoring colorectal cancer. Chitinase 3-like 1 protein, also known as YKL-40, and nestin and testin proteins are produced by colorectal cancer cells. YKL-40 protein is a marker of proliferation, differentiation, and tissue morphogenetic changes. The level of YKL-40 is elevated in about 20% of patients with colorectal cancer. An increased expression of nestin indicates immaturity. It is a marker of angiogenesis in neoplastic processes. Testin protein is a component of cell-cell connections and focal adhesions. The protein is produced in normal human tissues, but not in tumor tissues. Downregulation of testin increases cell motility, spread, and proliferation, and decreases apoptosis. The usefulness and role of these biomarkers, both alone and combined, in the diagnostics of colorectal cancer should be further explored as early cancer detection may substantially improve treatment outcome and patient survival.

Adherence to Therapy in Chronic Obstructive Pulmonary Disease: A Systematic Review.

Adherence to therapy plays a key role in treatment optimization and clinical outcome in patients with chronic obstructive pulmonary disease (COPD). The adherence to inhaled medications is poor, ranging from 20% to 60%. In this study we searched Medline and PubMed literature regarding factors that could have an impact on therapy adherence in COPD patients, using the key words "COPD" or "chronic obstructive pulmonary disease" and "adherence". The search was limited to the English language article published between January 2013 and December 2019. Review papers, study protocols, and meta-analyses were excluded. The final material included 25 articles. The evaluation was performed using the Cochrane Review Manager guidelines. The 25 articles represented 29 countries from 5 continents. We assessed adherence to therapy and the impact of selected factors on the adherence in 27,660 COPD patients (60.9% of whom were male, mean age 64 years). The factors affecting adherence were broken down into three categories: sociodemographic, clinical, and psychological. There were two standardized instruments used in the analyzed studies: Test of Adherence to Inhalers (TAI) and self-reported Morisky Medication Adherence Scale (MMAS-8). We found that 46.3% of patients had a moderately good level of adherence to inhaled therapy (TAI range around 50 points), while 41.6% of patients had a high level of adherence to oral therapy. The nature of non-adherence was in most cases inadvertent rather than an erratic or deliberate demeanor (48.5% vs. 38.9% vs. 42.4%, respectively). We conclude that standardized instruments enable the prediction of adherence to therapy and should be used in clinical practice. The assessment of adherence is essential for undertaking interventions to counteract plausible non-adherence. Collaboration between an educator and a psychologist is required to evaluate the patient's motivation and to ensure his comprehension of treatment prescribed.

Medication Compliance in COPD Patients.

Chronic obstructive pulmonary disease (COPD) is one of the most severe public health problems and a leading cause of death worldwide. One of the main reasons for poor control of the disease is low patient compliance with treatment plan. The aim of the study was to investigate sociodemographic and health status factors that may have an influence on adherence to treatment. There were 106 inpatients (F/M, 42/64; mean age 70 ± 6 years) with COPD enrolled into this retrospective study. Patients completed the Adherence to Refills and Medications Scale (ARMS) to assess adherence to therapy. We found that the mean ARMS score was 23.1 ± 6.8. About 86% of patients had low adherence, and 14% had good adherence (mean score 3.2 ± 2.4). The low-adherence patients were more likely to be older (p = 0.020), female (p = 0.011), single (p = 0.019), not professionally active (p = 0.049), hospitalized more often (p = 0.005) and for a longer time (p = 0.046), feel worse (p = 0.023), experience a greater impact of the disease on sleep quality (p = 0.008) and daily activities (p = 0.001), and had a higher GOLD stage of COPD when compared to patients with good adherence patients (p = 0.012). Multiple factor analysis demonstrates that independent adverse predictors of the ARMS score included the following: being single (OR = 3.18), having had more than eight hospitalizations (OR = 1.18), and experiencing dysfunction in daily activities (OR = 1.79). Male gender (OR = 0.77) and longer than 21-day hospitalizations (OR = 0.93) were independent positive predictors of adherence. In conclusion, COPD patients demonstrate a low level of adherence to pharmacotherapy. Adherence is adversely affected by sociodemographic (older age, female gender, being single, and professionally inactive) and clinical factors (more frequent hospitalizations, perception of poor well-being, disordered sleep and daily functioning, and a higher GOLD stage).

Quality of life in children with acute lymphoblastic leukaemia.

INTRODUCTION: Acute lymphoblastic leukaemia (ALL) is one of the most common neoplasms in children, that is. 3,000 new cases are diagnosed in the USA each year. The assessment of the quality of life (QoL) by the patient is the important indicator of the effects of treatment by the means of physical, psychical and social functioning. AIM: The aim of the study was to evaluate the QoL of children treated for ALL and the stress levels of their parents. Additionally, the impact of the most common symptoms on perceived QoL was analysed. MATERIAL AND METHODS: Seventy-four patients with ALL (mean age 9.03) were enrolled in the study. The questionnaire of Paediatric Quality of Life (PedsQL) and the medical records as the source of the socio-clinical data were applied in this study. RESULTS: In QoL assessment, the social functioning reached the highest score (67.57 ± 21.33), and physical functioning - the lowest score (51.1 ± 25.59). The analysis of the symptoms showed that the most intensive were stress (7.19 ± 2.71), fatigue and weakness (5.19 ± 2.76). In Spearman's rank correlation analysis the depressed mood, fatigue and weakness were significant negative predictors influencing QoL in all the domains of PedsQoL. In the linear regression analysis only the depressed mood was the significant independent determinant of the decreased QoL in the majority of the domains of PedsQoL, respectively: the general QoL (ß = -0.314; p = 0.002); psychosocial functioning (ß = -3.44; p < 0.01); role functioning (ß = -3.18; p = 0.004); social functioning (ß = -3.5; p = 0.007) and emotional functioning (ß = -3.012; p = 0.002). CONCLUSIONS: Quality of life of children with ALL is decreased and of the lowest value in the range of physical health. The factors negatively influencing the QoL are depressed mood, fatigue and weakness. The significant independent determinant of the decreased QoL is children's depressed mood.

Quality of Foot Care Among Patients With Diabetes: A Study Using a Polish Version of the Diabetes Foot Disease and Foot Care Questionnaire.

Diabetic foot syndrome is a common, yet serious complication of diabetes, affecting 4% to 10% of patients with diabetes. Polish Diabetes Association guidelines emphasize the need for prevention among patients with diabetes; a key role is played by consistent education on foot care and ulceration prevention. The Diabetes Foot Disease and Foot Care Questionnaire (DFDFC-Q) is the only research instrument available for comprehensive assessment of foot self-care. The study purposes were to explore the quality of foot care among patients with diabetes and to evaluate the psychometric properties of the Polish version of the DFDFC-Q in adult patients with diabetes. The study included 180 patients (112 females and 68 males, mean age 62 ± 14.1 years) with clinically confirmed diabetes mellitus and was performed between January 2017 and May 2018. The questionnaire was translated into Polis, and evaluated by using Cronbach's α coefficient. Of the 180 patients, 39.7% demonstrated good quality of self-care, 44.7% demonstrated moderate quality, and 15.6% demonstrated low quality. Mean score in the group was 22 ± 4.18 points. Scale reliability as measured by Cronbach's α was 0.672. One hundred thirteen (62.78%) patients inspected their feet daily. Many patients wore improper footwear: flip-flops (69.44%) or sandals (58.89%). The aspect most commonly omitted in diabetes education was inspection of the soles of one's feet using a mirror (17.7%). We found that 16.1% of patients visited a podologist in the past year. Comparative analysis demonstrated that a good-quality foot self-care was associated with high school education (p = .008), not having a partner (p = .046), and adhering to dietary recommendations (p = .014). In the linear regression model, independent predictors of better foot self-care included high school and vocational education (ß = 7.439, p = .001 and ß = 5.539, p = .014, respectively), marital status (divorced and single: ß = 3.496, p = .025, widowed: ß = 3.466, p = .048), professional inactivity (retirees: ß = 7.679, p = .001; disability pensioners: ß = 3.522, p = .049; unemployed: ß = 4.631, p = .017), and adhering to a diet (ß = 5.065, p = .001). An independent negative predictor (i.e., one associated with lower scores in the questionnaire) was male sex (ß = -2.853, p = .024). The Polish version of the DFDFC-Q has moderate psychometric properties, but because of the lack of other available instruments for foot self-care assessment, it can be used in the population of Polish diabetic patients. Better quality of foot self-care is determined by high school education, marital status (not having a partner), and adhering to dietary treatment recommendations.

Assessment of frailty syndrome using Edmonton frailty scale in Polish elderly sample.

The aim of the study was to assess the incidence and severity of the frailty syndrome assessed with the Edmonton Frailty Scale. This is a cross-sectional study conducted among 382 patients (236 men and 146 women, mean age 71.9 years). The Edmonton Frailty Scale was administered during the patient's admission to the hospital. The Polish adaptation was performed using the standard methodology. The Cronbach's alpha coefficient for the whole Edmonton Frailty Scale was 0.709. The mean correlation between positions and the overall result was r = 0.180. There were no statistically significant differences between women and men in the area of Edmonton Frailty Scale mean score (p < 0.05). The socio-clinical analysis, showed statistically significant differences in the age of respondents, educational attainment, occupational activity, number of drugs taken and co-occurrence of chronic diseases. A higher values of the Edmonton Frailty Scale were indicated for individuals >70 years than for those <70 years (p < 0.001). The Edmonton Frailty Scale proved to be a reliable tool which may be used in the Polish population. The use of this questionnaire for frailty syndrome may be helpful in everyday clinical practice.

Sleep Disorders and Adherence to Inhalation Therapy in Patients with Chronic Obstructive Pulmonary Disease.

Sleep disorders are common in patients with chronic obstructive pulmonary disease (COPD) and are associated with greater disease severity, more frequent exacerbations, greater use of emergency health care, and higher mortality. They may contribute to worsening of COPD course by reducing patients' adherence to treatment. The aim of this study was to evaluate quality of sleep in COPD patients and to assess the relationship between impaired sleep and adherence to inhalation therapy. The study included 106 COPD patients who were asked to answer the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Adherence to Refills and Medications Scale (ARMS). Clinical and demographic data were also collected. We found that over 60% of patients presented with sleep disorders (PSQI ≥5) and 75% with daytime sleepiness. None of the patients presented with optimal adherence to pharmacotherapy. Worse adherence was correlated with greater sleep disorders (r = 0.56; p < 0.001). ARMS questionnaire proved to be of high overall internal consistency (Cronbach's alpha = 0.85). In conclusion, poor quality of sleep coexists with poor adherence to treatment among COPD patients. ARMS was proved to be a reliable tool for the assessment of adherence. Interventions aimed at improving sleep quality may be helpful to improve adherence to inhalation therapy in COPD patients.

Acceptance of Illness Associates with Better Quality of Life in Patients with Nonmalignant Pulmonary Diseases.

Chronic nonmalignant pulmonary diseases impose a heavy burden on patients, generate health-care costs, and contribute to poor health-related quality of life. It has been found that a wide range of factors negatively affects quality of life, but the role of acceptance of illness needs to be further investigated. The aim of the study was to evaluate the relationship between acceptance of illness and quality of life in patients with chronic nonmalignant pulmonary diseases. The study encompassed 200 patients of the mean age 58 ± 16 years who were mainly diagnosed with asthma (n = 72; 36%), COPD (n = 52; 26%), and obstructive sleep apnea (n = 38; 19%). The patients answered the Acceptance of Illness Scale (AIS) and the St. George's Respiratory Questionnaire (SGRQ). Sociodemographical and clinical data were collected. The level of acceptance of illness significantly associated with each of the SGRQ domains. The greater the acceptance of illness, the lowest was the SGRQ score. The mean total score of SGRQ was 44.6 ± 24.9 and that of AIS was 26.1 ± 8.2. Higher AIS scores significantly associated with lower SGRQ scores, i.e., with better quality of life (p < 0.001 for each domain). We conclude that in patients with chronic nonmalignant pulmonary diseases, acceptance of illness plays an important role and is closely related to the general level of quality of life. Interventions aimed at improving acceptance of illness may be considered to improve quality of life.

Strategies of Coping with Pain: Differences Associated with the Histological Type of Lung Cancer.

Behavioral cognitive therapy is recommended for lung cancer-related pain. The aim of the study was to analyze the strategies of coping with pain in relation to the histological type of lung cancer. The study included 257 lung cancer patients, divided into small cell lung carcinoma (SCLC) group (n = 72) and non-small cell lung carcinoma (NSCLC) group (n = 185). Pain was evaluated on a visual analog scale (VAS), while pain-coping strategies with the Coping Strategies Questionnaire. The two groups differed concerning the perception of pain - VAS score of 4.8 ± 2.0 in SCLC vs. 4.2 ± 2.0 in NSCLC group (p = 0.003). SCLC patients were less likely to use the active coping strategies, such as increasing behavioral activity (13.6 ± 7.0 vs. 16.9 ± 6.9; p = 0.001), and pain control (2.5 ± 1.2 vs. 3.4 ± 1.2; p < 0.001), and were lees able to decrease pain (2.4 ± 1.3 vs. 3.5 ± 1.3; p < 0.001). The most common pain-coping strategy in SCLC was praying or hoping, while it consisted of increased behavioral activity and active coping in NSCLC. Correlation analysis for coping strategies and pain intensity showed a negative influence (increased pain) for the following domains: diverting attention (r = 0.264, ß = 0.93); reinterpreting of pain sensations (r = 0.327, ß = 0.97); catastrophizing (r = 0.383, ß = 1.11); ignoring pain sensations (r = 0.306, ß = 0.93), praying or hoping (r = 0.220, ß = 0.76), coping self-statements (r = 0.358, ß = 1.10), and increased behavioral activity (r = 0.159, ß = 0.57). For pain control (r = -0.423, ß = -0.27) and the ability to decrease pain (r = -0.359, ß = -0.27), a positive influence (decreased pain) was found. The significant independent determinants of pain perception in the NSCLC group were: pain control strategy (ß = -0.39) and coping self-statement (ß = 0.72). We conclude that in NSCLC patients both pain control and the ability to decrease pain are the strategies which decrease the intensity of perceived pain. In contrast, SCLC patients have no clear strategy for pain-coping.

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.