Agata Kosobucka

Adherence to treatment assessed with the Adherence in Chronic Diseases Scale in patients after myocardial infarction

Introduction A substantial subset of patients after myocardial infarction (MI) discontinue pivotal medication early after discharge. In particular, cessation of antiplatelet treatment may lead to catastrophic ischemic events. Thus, adherence to prescribed medication in patients after MI is an issue of medical and social concern. Purpose The aim of the study was to evaluate the level of adherence to treatment using a newly developed scale in patients after MI treated with percutaneous coronary intervention. Patients and methods A single-center, prospective, observational cohort clinical study with a 6-month follow-up was performed. Patients with physical or cognitive impairment, prisoners, soldiers, and family members and coworkers of the researchers were excluded from the study. The impact of selected sociodemographic and clinical factors on adherence was evaluated in 221 patients (63 women and 158 men) aged 30 to 91 years. Results The results obtained with the Adherence in Chronic Diseases Scale (ACDS) ranged from 7 to 28 points; with the average and median scored being 23.35 and 24, respectively. The ACDS score reflects the level of adherence to prescribed medication. The high ACDS scores (>26 points) were obtained in 59 (26.7%) patients, intermediate scores (21–26 points) in 110 (49.8%) and low scores (<21 points) in 52 subjects (23.5%). Acute coronary syndrome (re-ACS) occurred in 18 (8.1%) patients during the follow-up period. The high-level adherence (ACDS score >26 points) was found in 11.1% of patients with re-ACS vs 28.4% of the remaining ones (P=0.1). Lower scores (mean ± standard deviation) in re-ACS patients were found for items 2 and 3 of the ACDS: 3.11±0.68 vs 3.45±0.73 (P=0.02) and 3.28±0.89 vs 3.64±0.64 (P=0.04), respectively. Conclusion Age and previous MI were found to be independent factors influencing adherence assessed with the ACDS.

Self-reported questionnaires for assessment adherence to treatment in patients with cardiovascular diseases

Introduction: The treatment of acute coronary syndromes, besides coronary interventions, includes pharmaco-therapy and lifestyle changes, which together determine a favourable prognosis. Adherence to treatment is a term describing a patient’s behaviour in respect to the patient’s maintenance of the health care provider’s recommendations. Unfortunately, according to WHO data, adherence to long-term therapies for chronic illnesses in developed countries averages only 50%. Covered areas: Our study focused on available questionnaires for adherence assessment in everyday practice. A comprehensive search of data bases was conducted using appropriate keywords. Out of an initially identified 2081 citations, 93 articles were considered eligible for further analysis. Eventually, nine adherence scales were identified and reviewed. Expert opinion: There is no so-called “gold standard survey” allowing accurate assessment of every patient for medication adherence. The use of a specific scale must be justified by its validation in a similar group of patients in well designed and properly conducted studies.

The Adherence Scale in Chronic Diseases (ASCD). The power of knowledge: the key to successful patient — health care provider cooperation

Introduction. Autotransfusions of ozonised blood or infusions of gaseous ozone into blood vessels andbody cavities are believed to exert therapeutic effects in some pathological states. Investigations on thereaction of ozone with biological molecules and membrane structures are a subject of crucial importance. The present study aimed to yield more precise data about the alterations, which occur in different erythrocytemembrane regions subjected to medical ozone. This could provide some additional informationabout the structural changes in the membrane at a molecular level. Material and methods. Blood was obtained from 22 healthy volunteers (aged 21 to 63) by vein puncture andmixed with 1/10 volume of 0.13 M trisodium citrate. Erythrocytes were isolated from fresh blood by centrifugationat 4°C, at 1,500 × g and purified by three cycles of resuspension and washing with PBS. Ozone was generatedby passing pure gaseous oxygen at 30 l/h through an apparatus producing silent electric discharges. EPRspectra were obtained at X-band (9.4 GHz), at modulation frequency of 100 kHz. The scan time was 4 min, and the time constant 0.3 s. Since biological membranes are heterogeneous systems composed of severalcoexisting domains, EPR spectra are superimpositions of several spectra with different fluidity parameters. Results. The effects of ozone at two concentrations (10 and 45 g/m3) on fluidity and phospholipid domainstructure of erythrocyte membranes were investigated by electron paramagnetic resonance (EPR). Atincreased ozone concentration (45 g/m3), the portion of the least ordered domains (WLO) increased, witha corresponding decrease of ordered (WMO, WO), more rigid regions. The order of lipid acyl chains of twoordered (MO and O) as well as the least ordered (LO) domains diminished, as expressed by smaller orderparameters. For ozone concentration of 10 g/m3 values of order parameter were slightly increased, whichindicates a tendency to rigidisation of lipid bilayer at this ozone concentration. This change was, however,statistically insignificant. There were no statistically significant differences in the thermotropic behaviour ofweight factor of ordered domains (WMO, WO) between ozonised and control red cells. Conclusion. The obtained data shows that ozonation of erythrocytes results in cell membrane fluidisationand an increase in red cell deformability. On the other hand, these results could suggest that ozonationof erythrocytes leads to structural changes in the membranes, especially in cytoskeletal proteins, but thiseffect is probably dose-dependent.

Effectiveness of therapeutic education in patients with myocardial infarction

Introduction. Notwithstanding the development of modern diagnostic-therapeutic techniques, cardiovascular diseases still pose a grave health, social, and economic issue. Patients hospitalised for acute coronary syndrome should, in addition to establishing an optimal pharmacotherapy, be made aware of how to prevent this disease and recognise it using its typical symptoms and signs. Objective. The objective of the study was to evaluate the effectiveness of educational intervention based on educational brochures in patients with myocardial infarction with regard to socio-demographic factors and baseline patients’ knowledge. Material and methods. The single-centre, prospective, observational study was conducted in a cohort of 248 patients with myocardial infarction (women n = 72, men n = 176), hospitalised between May 2015 and July 2016. Consistently with the results of univariate analysis, multivariate analysis identified age (–3.73/10 years; p < 0.0006) and the level of education (10.37; p < 0.0001) as independent factors influencing patients’ prehospital knowledge. Results. According to multivariate analysis of the level of knowledge following the educational intervention, the only factors affecting the process of learning were age (–2.04/10 years; p < 0.03) and remaining in a steady relationship (9.7; p = 0.0003). Among factors influencing the increase of knowledge, only the level of education was of statistical significance (–6.09; p < 0.02). Conclusions. The educational brochure proved to be an effective tool for therapeutic education, allowing minimisation of the disparities between the examined groups and improvement of the breadth of patients’ knowledge.

Assessment of adherence to medication in patients after myocardial infarction treated with percutaneous coronary intervention. Is there a place for newself-reported questionnaires?

Abstract Introduction: Non-adherence to medication regimen after myocardial infarction (MI) leads to increased morbidity and mortality and generates additional cost to the healthcare system. Objectives: The aim of this systematic review was to critically discuss assessment methods of adherence to medication in patients after myocardial infarction treated with percutaneous coronary intervention and the possible application of a new self-reported questionnaire. Methods: A systematic investigation of all published literature was conducted to minimize the risk of bias. A database search (PubMed, CENTRAL and Google Scholar databases) from January 1998 through December 2017. Results: Adequate assessment of patient adherence to treatment is necessary to understand the potential for adverse outcomes. Methods developed for adherence evaluation are classified as subjective and objective or as direct and indirect. Direct, objective measures reflect pharmacokinetics and include measurement of the drug or its metabolite concentration, evaluation of the presence of biological markers given with the drug and direct observation of patients’ medication-taking behavior. Several indirect, objective methods are based on evaluation of the availability of prescribed medications assuming that medication is taken exactly as prescribed. Assessment of the effectiveness of treatment, both at the pharmacodynamic and clinical level, indirectly but objectively reflects adherence to treatment. Subjective methods, including patient-kept diaries, patient interviews and self-reported questionnaires, due to their simplicity, real-time feedback and low cost, are often used for adherence evaluation in clinical practice. Conclusions: In spite of the availability, convenience and variety of methods, measuring adherence still remains a real challenge. Using a well designed questionnaire provides an opportunity to identify patients at increased risk of non-adherence and the obstacles impeding implementation of the treatment plan, allowing implementation of tailored interventions in order to improve patient medication-taking behavior.

Knowledge and learning preferences of patients with myocardial infarction

Introduction. The objective of the research was to study the knowledge about ischaemic heart disease and learning preferences of hospitalised patients as a result of myocardial infarction. Methods. The tested group comprised of 248 patients, aged 63 ± 11.25, who were hospitalised as a result of myocardial infarction A questionnaire with 20 single-choice questions was used in the research. The questionnaire tested the knowledge of the patients as far as ischaemic heart disease, myocardial infarction symptoms, and preventive healthcare are concerned. The patients were divided into groups depending on what knowledge sources on ischaemic heart disease they preferred — brochures, magazines, radio and TV, individual talks, group talks, films, the Internet. Results. The proportion of correct answers was 58.49 ± 19.89%; in the area of the disease knowledge 62.74 ± 31.52%; in the area of the preventive healthcare 57.14 ± 23.38%; and in the area of the disease symptoms 56.94 ± 25.84%. The source of health knowledge selected the most was educational brochures (80.2%), while radio and TV was selected the least (17.6%). The knowledge varied depending on patients’ preferences: so those who selected films — the knowledge of the disease symptoms was higher compared to the others (64.44 ± 26.93% vs. 55.27 ± 25.35%; p = 0.02; those who selected individual talks — the knowledge of the disease symptoms was lower compared to the others (55.33 ± 24.80 vs. 61.68 ± 26.51; p = 0.007); those who selected group talks — the knowledge of the disease symptoms was higher compared to the others (62.30 ± 28.07 vs. 55.16 ± 24.96; p = 0.02). As far the other two areas of knowledge are concerned, there were no significant differences in any group. Conclusions. Educational brochures are the most preferred source of knowledge about ischaemic heart disease by hospitalised patients as a result of myocardial infarction. The knowledge of ischaemic heart disease in patients with myocardial infarction is inadequate and it is not connected with patients’ preferences from the point of view of learning methods.

The readiness for hospital discharge of patients after acute myocardial infarction: a new self-reported questionnaire

Introduction. Medical care providers are responsible for adequate preparation of patients for discharge from the hospital. The purpose of this study was to validate a new self-reported questionnaire assessing the readiness of patients for hospital discharge. Methods. The Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD MIS) was validated in 201 patients, 57 (29%) females and 144 (71%) males (mean age 63.3 ± 11.3), hospitalised due to myocardial infarction. Results. For the considered 23 items the a-Cronbach coefficient was 0.789, indicating a high level of reliability and homogeneity of the questionnaire. The RHD MIS fulfilled the assumption of factor analysis: the determinant of correlation matrix was 0.001, Kaiser-Mayer-Olkin (K-M-O) statistic was 0.723, and the Bartlett’ test of sphericity was statistically significant. The analysis of internal consistency of the three areas confirm the rightness of the distinguishing of three subscales. Answers to each item were assigned a score from 0 to 3. The highest total score is 69 points. The total score of the scale and total scores of the subscales have skewed distributions and statistically significant results of Shapiro-Wilk test (p < 0.001). The scoring less than 44 points for the entire questionnaire indicates low readiness, obtaining between 44 and 57 points indicates medium readiness, and scores over 57 points are classified as high readiness for discharge from hospital. Conclusions. The validation procedure revealed that RHD MIS is a reliable and homogeneous tool to measure the readiness of patients for hospital discharge. The set of items divided into three subscales allows subjective and objective evaluation of the patient’s knowledge and expectations. Further investigation is needed to assess the potential impact of RHD MIS scoring on long-term outcome.

Edukacja zdrowotna pacjentów z chorobami układu sercowo-naczyniowego

Choroby ukladu sercowo-naczyniowego są glowną przyczyną zgonow w Polsce oraz w pozostalych krajach Europy. Nalezą one do grupy chorob przewleklych. Jak wykazują wyniki badan epidemiologicznych, zalezą od wystepowania wielu czynnikow ryzyka — modyfikowalnych i niemodyfikowalnych. Do najwazniejszych z grupy czynnikow modyfikowalnych zalicza sie otylośc, hiperlipidemie, nadciśnienie tetnicze, cukrzyce, palenie tytoniu, malą aktywnośc fizyczną oraz czynniki psychospoleczne. Dzialania edukacyjne prowadzone u pacjentow z rozpoznanymi chorobami ukladu sercowo-naczyniowego mają na celu wyeliminowanie lub modyfikacje istniejących czynnikow poprzez przekazanie wiedzy na temat wlaściwego postepowania oraz zmotywowanie do przestrzegania wdrazanych zalecen terapeutycznych. Jak pokazują liczne doniesienia naukowe, wdrazanie interwencji edukacyjnych z zastosowaniem metod ustnych i pisemnych oraz zlozonych programow rehabilitacyjno-edukacyjnych sprzyja podniesieniu poziomu wiedzy, co moze zwiekszyc efektywnośc zastosowanej terapii.

The adaptation of the Caring Nurse-Patient Interaction scale (CNPI-70) to polish conditions on the basis of nursing students self-assessment of their caring competencies

The aim of the study and the undertaken research is to adapt the CNPI-70tool to Polish conditions and then to use this scale for the evaluation of nursing students competencies. Material and methods. A CNPI -70scale survey was conducted among486nursing students analyzing their self-assessment of caring competencies at various levels of university. Results. The reliability of the scale is very high (Cronbach’s α is O,97), analyzing the70questions of the scale it can be concluded that all, except questions no5 and21,have an average or above average correlation with the result of the overall tool. The analysis also indicates that the removal of a single question from the tool does not affect its overall high reliability. The results of the self-assessment of caring competencies among nursing students show an increase in competence at the successive levels of the university course. The level of competence is also influenced by the experience of part time students. Conclusions. The Polish version of the CNPI-70scale, assessing the caring competence of nurses, takes into account the wide range of professional roles of nurses. Research confirms the high reliability of the scale thus recommending its use in research in nursing and education.