Anna Andruszkiewicz

Cangrelor: an emerging therapeutic option for patients with coronary artery disease

Abstract Objectives: To perform a systematic up-to-date review and critical discussion of potential clinical applications of cangrelor based on its pharmacologic properties and the main findings from randomized clinical studies. Methods: A database search (PubMed, CENTRAL and Google Scholar) by two independent investigators, including proceedings from scientific sessions of ACC, AHA, ESC, TCT and EuroPCR, from January 1998 through December 2013. Results: Cangrelor is a potent, intravenous, direct-acting P2Y12 antagonist with rapid onset and quickly reversible action. In contrast to ticagrelor, cangrelor’s interaction with thienopiridines requires termination of cangrelor infusion before switching to clopidogrel or prasugrel. According to randomized trials, a cangrelor–clopidogrel combination is relatively safe and more effective than the standard clopidogrel regimen in both urgent and elective percutaneous coronary intervention (PCI) settings, with the advantage of this drug combination fully evident when the universal definition of myocardial infarction is applied. In contrast to available antiplatelet drugs with delayed onset and offset of action, its favorable properties make cangrelor a desirable agent for ad hoc elective PCI, high risk acute coronary syndromes treated with immediate coronary stenting and for bridging those surgery patients who require periprocedural P2Y12 inhibition. Current evidence on cangrelor therapy is limited by the lack of adequately powered studies assessing cangrelor co-administration either with prasugrel or ticagrelor, suboptimal design of some of the trials favoring cangrelor, potentially attenuated benefits with modern stent design, and finally, by the lack of survival advantage. Conclusions: With its pharmacokinetic and pharmacodynamic advantages, allowing consistent and strong P2Y12 inhibition, and with its rapid onset and swift reversal of action devoid of need for an antidote, cangrelor might improve clinical outcomes in clopidogrel-treated patients by reducing ischemic events, while maintaining a favorable safety profile. However, further studies, addressing the safety and efficacy of cangrelor on top of novel oral P2Y12 inhibitors, are warranted.

Time-related changes in determinants of antiplatelet effect of clopidogrel in patients after myocardial infarction☆

Substantial variability of antiplatelet action is an important limitation of clopidogrel. The aim of this study was to evaluate time-related changes in determinants of clopidogrel responsiveness in patients after myocardial infarction. The study population comprised 191 consecutive patients treated with primary percutaneous coronary intervention for acute myocardial infarction. Follow-up visits were scheduled at 3, 6 and 9 months after discharge. ADP-induced platelet aggregation was tested with Multiplate Analyzer. Patients with ADP-PA>46.8U were defined as clopidogrel non-responders. The prevalence of clopidogrel non-responsiveness was highest during hospitalization and at 9 month follow-up visit, while it was lowest at 3 and 6 months after myocardial infarction (P=0.004). According to multivariate analysis, platelet count, mean platelet volume, concentration of hsCRP and leukocyte count influenced ADP-induced platelet aggregation in multiple assessment points. BMI, concentrations of hemoglobin, glycated hemoglobin, and BNP, hematocrit, adherence to medication, and patient׳s age were found to be independent predictors of high on-treatment ADP-induced platelet aggregation only at a single follow-up visit. Determinants of clopidogrel responsiveness in patients after myocardial infarction change within the long-term therapy. During hospitalization and early after discharge only biological factors affect ADP-induced platelet aggregation, while non-adherence to antiplatelet therapy may be a significant factor in determining clopidogrel non-responsiveness during late follow-up visits.

Health Locus of Control in Patients With Graves-Basedow Disease and Hashimoto Disease and Their Acceptance of Illness

Background Adaptation to a chronic somatic disease depends on a variety of factors, including belief in health locus of control. Objectives Correlation between health locus of control and illness acceptance in patients with Graves-Basedow and Hashimoto diseases as well as correlation between health locus of control, illness acceptance, sex, and age. Patients and Methods Three methods were applied: Multidimensional Health Locus of Control Scale by K.A. Wallston, B.S. Wallston and R. DeVellis; the Acceptance of Illness Scale by B.J. Felton, T.A. Revenson, and G.A. Hinrichsena; and a personal questionnaire. Two groups were subject to the research: 68 patients with Graves-Basedow disease and 54 patients with Hashimoto disease. Results Patients with Graves-Basedow disease, women above all, have their health locus of control in other persons (P = 0,001) and are less inclined to accept their illness (P = 0,005) when compared to patients with Hashimoto disease. A statistically significant correlation occurred between the age of patients and external (i.e., in other persons) health locus of control. Conclusions Beliefs in health locus of control and type of illness in female patient group are predictors of illness acceptance (P = 0,0009).

The determinants of coping with pain in chronically ill geriatric patients – the role of a sense of coherence

Background Given the rising population of the elderly in modern societies, the concern for their good functioning poses a challenge for the 21st century medicine and social services. Senior citizens are at an increased risk of developing chronic conditions, which in turn increase discomfort associated with physiological processes of aging. Sensations of pain have a particular influence on the mentioned discomfort, and pain is prevalent among older people. Therefore, from the perspective of an elderly person and senior care, it is crucial to identify determinants of effective coping with chronic pain. Objectives The aim of the research was to assess the relationship between a sense of coherence (SOC) and pain-coping strategies in chronically ill seniors. A total number of 188 individuals were included in the study, of whom 117 were female subjects and 71 were male subjects, with a mean age of 68.38 (standard deviation [SD] =6.35) years in the studied group. Subjects were sampled based on a diagnosis of a chronic medical illness with chronic pain as one of the major symptoms. Methods The Polish adaptation of the Orientation to Life Questionnaire (SOC-29) to assess an SOC, the Coping Strategies Questionnaire (CSQ) to assess pain-coping strategies, and the visual analog scale (VAS) to assess pain intensity were used in the study. Results and conclusion The mean score of respondents’ SOC was 133.44 (SD =24.35). Among most common pain-coping strategies used by the respondents were prayer and hope, and the declaration of coping with pain while redefining pain was the least often used coping strategy in the studied group. Individuals with stronger SOC were less prone to catastrophizing and more often declared that they were coping with and could control and reduce pain.

Types of work-related behavior and experiences and stress coping strategies among single mothers and mothers in relationships differentiating role of work satisfaction

OBJECTIVES The purpose of the study has been to describe functioning of single and mothers in relationships (married or in informal relationships) at work and verify if the declared degree of work satisfaction differentiates types of behavior at work and stress coping strategies in both groups of mothers. MATERIAL AND METHODS The study was conducted on equal samples of single mothers (N = 186) and mothers from 2-parent families (N = 186) using Latack Coping Scale that measures work-related stress coping strategies, the AVEM (Arbeitsbezogenes Verhaltens- und Erlebensmuster - Work-Related Behavior and Experience Pattern) questionnaire, and a survey. It showed similarity between the studied groups in terms of the measured variables. RESULTS There were considerable differences between single and married mothers in terms of support seeking strategies. The interaction of work satisfaction and the type of motherhood significantly differentiates (p = 0.03) the avoidance strategy of resignation. CONCLUSIONS That strategy of resignation was more frequently used by single mothers with lower work satisfaction, who were distinctly different from those whose work satisfaction was higher, and from the mothers in relationships (married or in informal relationships) (regardless of the level of their work satisfaction). Int J Occup Med Environ Health 2018;31(1):55-69.

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.

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.

Ocena gotowości do wypisu pacjentów z chorobami przewlekłymi

Introduction: The most common cause of ineffectiveness in the treatment of chronic diseases is a lack of cooperation between the patient and the therapeutic team. An important factor that could change the situation is education of the patient, which would allow the patient to assume the role of an expert and become an active participant in the therapeutic process. The main purpose of the study: The main purpose was to assess the readiness for discharge of hospitalized patients. Material and methods: The study evaluated 325 chronically ill patients who were hospitalized. On the day of release from the hospital, the patients assessed their preparedness for discharge. Results:Studies showed that in all analyzed aspects of readiness for discharge there are statistically significant differences depending on the type of diagnosed chronic illness in a patient. Conclusions:The readiness for discharge of patients hospitalized because of chronic disease is insufficient

Skala oczekiwań od edukacji terapeutycznej osób chorych przewlekle

Wstep. W ciągu ostatnich lat edukacja terapeutyczna pacjenta stala sie istotnym elementem w leczeniu chorob przewleklych, gdyz skutecznośc tego procesu zalezy miedzy innymi od uwzglednienia potrzeb pacjenta, jego oczekiwan i dotychczasowych doświadczen związanych z chorobą. Celem publikacji byla prezentacja skali do badania oczekiwan od edukacji terapeutycznej osob chorych. Ponadto sprawdzono, czy oczekiwania pacjentow ulegają zroznicowaniu w zalezności od plci, wieku, wyksztalcenia i miejsca zamieszkania. Material i metody. Przebadano 503 osoby przewlekle chore leczone ambulatoryjnie, 301 kobiet i 202 mezczyzn. Średni wiek badanych wynosil 52,06 (SD = 14,30) lata. Wiekszośc badanych pacjentow pozostawala pod opieką poradni specjalistycznej (n = 294; 62,55%). Średni czas chorowania wynosil M = 9,12 lat (SD = 8,53). Zastosowano autorską Skale Oczekiwan od Edukacji Terapeutycznej OE-15, Liste Oczekiwan Pacjenta PRF i metryczke. Wyniki. Wykonane analizy pozwalają stwierdzic, ze skala do badania Oczekiwan od Edukacji Terapeutycznej OE-15 jest skalą rzetelną i trafną. Wiek i plec roznicują oczekiwania od edukacji w grupie pacjentow przewlekle chorych. Wnioski. Skala do badania oczekiwan moze znaleźc zastosowanie w procesie edukacji terapeutycznej pacjentow. Pozwala na ocene ich oczekiwan w zakresie: informacji o chorobie i jej leczeniu, wyjaśnienia wplywu choroby na sfery zycia oraz informacji koniecznych pacjentowi do podjecia dzialan profilaktyki trzeciorzedowej związanej z chorobą.

Impact of health education on adherence to clopidogrel and clinical effectiveness of antiplatelet treatment in patients after myocardial infarction

Non-adherence rates to antiplatelet drugs in patients with acute myocardial infarction (AMI) range from 13% to 60%. We aimed to evaluate whether individual health education can improve adherence to treatment with clopidogrel in patients after AMI. This was a prospective, single-center, randomized clinical trial with a 12-month follow-up. Patients with AMI treated with percutaneous coronary intervention (PCI) were enrolled. The primary endpoint was defined as non-adherence to clopidogrel during follow-up (drug availability ≤ 80%). Secondary endpoints included platelet function assessment, adverse cardiovascular (CV) events (CV death, PCI for ACS, unscheduled CV hospitalization). There were 191 patients enrolled in the study and divided into two groups: the individual education (IE) group (100 patients) and the standard treatment (ST) group (91 patients). Adherence to the treatment with clopidogrel based on the data from the National Health Fund did not differ significantly between the IE and ST groups [76.7% (30.7–99.7%) v. 84.4% (46.5–99.7%); p = 0.25]. There was a substantial difference in the prevalence of unscheduled CV hospitalizations between both groups, IE and ST respectively [22 (22.0%) v. 10 (11.0%); p = 0.042]. The rate of CV death and ACS treated with PCI during follow-up was low and did not differ between groups. In conclusion, the program of individual health education did not improve adherence to treatment with clopidogrel. The expected benefits of medication are not achievable at current levels of adherence. The self-reported adherence assessment is unreliable and cannot be used for effective treatment guidance.