Marcin Mikos

The strategy of training staff for a new type of helicopter as an element of raising the security level of flight operations

In 2008, the Polish Medical Air Rescue started replacing its fleet with modern EC135 machines. To ensure the maximum possible safety of the missions performed both in the period of implementing the change and later on, the management prepared a strategy of training its crews to use the new type of helicopter. The analysis of incidents that occurred during 2006–2009 showed that both the human and the technical factors must be carefully considered. Moreover, a risk analysis was conducted to reduce the risk both during general crew training and in the course of particular flight operations. A four-stage strategy of training pilots and crew members was worked out by weighing up all the risks. The analysis of data from 2010 to 2013 confirmed that the risk connected with flying and with all the activities involved in direct support aircraft operations is under control and lowered to an acceptable level.

Endometrial Polyps and Benign Endometrial Hyperplasia Present Increased Prevalence of Dna Fragmentation Factors 40 and 45 (dff40 and Dff45) Together With the Antiapoptotic B-cell Lymphoma (bcl-2) Protein Compared With Normal Human Endometria

DNA fragmentation factor 40 (DFF40) is a key executor of apoptosis. It localizes to the nucleus together with DNA fragmentation factor 45 (DFF45), which acts as a DFF40 inhibitor and chaperone. B-cell lymphoma (Bcl-2) protein is a proven antiapoptotic factor present in the cytoplasm. In this study, we aimed to investigate DFF40, DFF45, and Bcl-2 immunoexpression in endometrial polyps (EPs) and benign endometrial hyperplasia (BEH) tissue compared with that in normal proliferative endometrium (NPE) and normal secretory endometrium (NSE) as well as normal post menopausal endometrium (NAE). This study used archived samples from 65 and 62 cases of EPs and BEH, respectively. The control group consisted of 52 NPE, 54 NSE, and 54 NAE specimens. Immunohistochemistry was used to detect DFF40, DFF45, and Bcl-2. DFF40, DFF45, and Bcl-2 were more highly expressed in the glandular layer of EPs and BEH compared with the stroma, and this was not influenced by menopausal status. Both glandular and stromal expression of DFF40, DFF45, and Bcl-2 were significantly higher in EPs compared with NPE, NSE, and NAE. Glandular BEH tissue showed significantly higher DFF40, DFF45, and Bcl-2 expression than in NPE, NSE, and NAE. No differences in the glandular expression of DFF40, DFF45, and Bcl-2 were observed between EP and BEH tissues, while Bcl-2 stromal expression in BEH was significantly lower than in EPs. Glandular, menopause-independent DFF40, DFF45, and Bcl-2 overexpression may play an important role in the pathogenesis of EPs and BEH.

Immunoexpression of DNA fragmentation factor 40, DNA fragmentation factor 45, and B-cell lymphoma 2 protein in normal human endometrium and uterine myometrium depends on menstrual cycle phase and menopausal status

Introduction DNA fragmentation factors 40 and 45 (DFF40 and DFF45) are final executors of apoptosis, and B-cell lymphoma 2 (Bcl-2) is a well-recognized apoptosis inhibitor. We aimed to evaluate DFF40, DFF45 and Bcl-2 immunoexpression in the normal human endometrium with respect to the glandular and stromal layer and in uterine myometrium. Material and methods DFF40, DFF45, and Bcl-2 expression was assessed via immunohistochemistry in the endometrium and myometrium collected postmenopausally and premenopausally during the proliferative and secretory phases of the menstrual cycle. Results Compared to the myometrium and stroma, endometrial glands showed the highest DFF40 and DFF45 expression in pre- and postmenopausal specimens. DFF45, but not DFF40, glandular expression dependent on menstrual cycle phase and DFF40 and DFF45 scoring was significantly lower in postmenopausal specimens. Significantly higher Bcl-2 expression was observed in proliferative glandular endometrium compared to secretory and postmenopausal specimens. No cycle- or menopause-dependent changes were reported for stromal or myometrial DFF40, DFF45 or Bcl-2 expression. DFF40, DFF45 and Bcl-2 expression was independent of age, age at menarche and menopause, BMI, menstrual cycle and menses lengths, parity and gravidity. Conclusions The study provides important evidence regarding menstrual cycle-dependent changes in the expression of DFF40, DFF45 and Bcl-2 in the normal human endometrium, especially in the glandular layer, and shows that their levels are stable in the normal uterine myometrium.

Refusal to take a sick leave as an estimate of the phenomenon of presenteeism in Poland

Introduction Absenteeism and presenteeism are two main phenomena related to health problems and professional activity. Presenteeism is the involvement in a professional activity despite being ill. The purpose of the current study is to estimate the prevalence of presenteeism in Poland on the basis of medical records and to explore associations between presenteeism and patients’ age, gender and type of medical problem. Another purpose is to provide estimates of the length of sick leave if it was accepted. Results The amount of patients who refused to take a sick leave was 27.4%. There was a minor relationship between the refusals and gender (slightly higher in men) as well as strong effects of the age of patients (periods of sick leave were longer in older patients) and ICD-10 diagnosis (largely in acute diseases of the upper respiratory tract). The estimated number of days spent on sick leave in the group of patients that refused to take it, assuming that they made a different decision and complied to it, was in the range between 5 and 10 days. Discussion The prevalence of presenteeism in Poland is relatively high. Since the largest proportion of refusals took place in the case of potentially contagious diseases, the negative impact on productivity may be even higher. Even though the relationship between presenteeism and wages remains unclear, the remarkable increase of wages in Poland within the last 20 years may explain the propensity to work despite being ill. Further research needs to consider the simultaneous use of medical records and self-measured productivity loss. Materials and Methods The current study is based on data from medical records concerning 550,360 patients aged 19–64. Associations between refusals to take a sick leave and patients’ age, gender, as well as diagnosis in terms of ICD-10 (International Statistical Classification of Diseases and Related Health Problems), were tested. Linear regression analysis on the data acquired from the patients who accepted to take a sick leave were further used to estimate the possible length of sick leave in the group of patients that refused to take it.

Immunity to hepatitis A virus among working professionals in Poland – Results of a 3-year serological survey 2013–2015

INTRODUCTION Hepatitis A (HA) is caused by infection with the hepatitis A virus (HAV). The differential etiological diagnosis of acute hepatitis is based on a positive result of the serological test detecting IgM class anti-HAV. For epidemiological studies on past infection and seroprevalence of HAV in populations, the tests measuring IgG class anti-HAV or total anti-HAV are used. Since the 1990s, specific prophylaxis is possible by vaccination against HA. In Poland, vaccination is recommended and in majority is performed at own cost. MATERIAL AND METHODS Database was obtained from electronic medical records of the 2 major private health care providers networks (Luxmed and Medicover) operating in Poland. During a 3-year period (2013-2015), 1,124 persons with unknown status of anti-HA vaccination were tested for the presence of total anti-HAV. Objective. The aim of the study was to evaluate the seroprevalence of anti-HAV among working professionals in Poland. RESULTS Anti-HAV were detected in 603 (53.6%) persons, while 521 (46.3%) tested negative. The study group was divided into 2 subgroups: 25-44 and 45-64-years-old. For detailed statistical analysis, the presence of anti-HAV was considered as a dependent variable, and its predictors were gender, age and the year of the test performance. The presence of anti-HAV was significantly more prevalent in older age group. The lack of specific antibodies was more prevalent in younger age group. CONCLUSIONS Results of the study show increasing susceptibility to HAV infection in the younger age group, compared with the older age group of corporate professional employees in large cities in Poland. Since the epidemiological situation of HA is currently changing with increasing number of symptomatic cases of HA, it is suggested that employers might consider including an additional procedure of vaccination against HA into their private health insurance portfolio.

Conclusions from the analysis of adverse events in the Polish health care system in judicial decisions of civil courts between 2011 and 2013

564 resulted from failure to exercise due diligence in providing medical services (n = 57; 31.15%). Oth‐ er recorded reasons included diagnostic error in‐ volving failure to establish a correct diagnosis (n = 34; 18.58%), therapeutic error in using an out‐ dated or inappropriate method of treatment (n = 31; 16.94%), delay in providing medical services (n = 29; 15.85%), and diagnostic error of a mis‐ diagnosis (n = 23; 12.57%). Of the 183 cases analyzed, 48% (n = 88) were discontinued because the court did not find that an adverse event had occurred. However, in 95 cases (51.91%), the court ruled that an adverse event had indeed occurred. The most common cause of the successfully established adverse events that occurred in the course of medical treatment was failure to exercise due diligence in providing medical services (n = 19; 20%). The sec‐ ond most frequent cause of successfully estab‐ lished adverse events was a hospital ‐acquired in‐ fection (n = 14; 14.73%). Irregularities pertain‐ ing to the very treatment of the infection were far less frequent and occurred only in 3.16% (n = 3) of the successfully established cases of adverse events. Human error involving surgical intervention/ operation was indicated as the cause of nearly ev‐ ery tenth successfully established adverse event (n = 8; 8.42%). A significant number of events were caused by delaying the provision of medical services (n = 7; 7.36%) and by a diagnostic error consisting in failure to perform appropriate di‐ agnostic tests (n = 9; 9.47%). A diagnostic error consisting in a misdiagnosis occurred in 4 suc‐ cessfully established adverse events (4.21%). Ir‐ regularities involving the area of patient autono‐ my, as well as duties connected with keeping med‐ ical records, constituted 12 cases (12.63%). Defi‐ ciencies concerning the choice of the method of treatment, such as a therapeutic error consist‐ ing in using an outdated or inappropriate meth‐ od of treatment, and failure to implement the ap‐ propriate method of treatment, caused slightly more than every twentieth successfully estab‐ lished adverse event (n = 5; 5.26%). The number To the Editor Adverse events are an inevitable part of the process of providing medical servic‐ es. An analysis of what causes them allows for the adoption of preventive measures that avert the recurrence of similar incidents in medical practice. Court files are a crucial source of infor‐ mation about the occurrence of adverse events. The collection of information on adverse events in the health care system could have a major im‐ pact on patient safety in the course of providing medical services. The purpose of the analysis was to evaluate the occurrence of adverse events in health care facilities in Poland on the basis of information contained in court files from civil proceedings brought by patients against hospitals. The anal‐ ysis was undertaken within the project: “Safe Hospital – Safe Patient” (in Polish, “Bezpieczny Szpital – Bezpieczny Pacjent”), coordinated by the Centre for Monitoring Health Care Quality. The research used the technique of examining files, whereby files from civil cases were analyzed in the seats of the courts. The source of the data consisted of 183 files pertaining to civil cases, in which a final judgment was entered in the years 2011–2013, brought against hospitals in connec‐ tion with claims for damages, compensation, and disability pension for injury suffered in the course of medical treatment. The files were examined in 5 out of the total 45 district courts nationwide, which were selected according to a discrete size and number of inhabitants and the annual num‐ ber of cases and their type. The 4 ‐year follow‐up was selected to obtain an appropriate number of cases for conclusive analyses. In the statements of claim, patients or their family members indicated 1 or more reasons (therefore, the frequency exceeded 100% in total) that in their view caused the adverse event and led to filing an action against the medical facili‐ ty. The most common reason for bringing a law‐ suit was attributed to a hospital ‐acquired infec‐ tion (n = 66; 36.07%). More than 1 of 3 lawsuits provided surgical errors as the basis for the claims (n = 65; 35.52%). The third most frequent claim LETTER TO THE EDITOR