Mariusz Panczyk

ABCB1/MDR1 gene polymorphisms as a prognostic factor in colorectal cancer

ObjectiveTo analyse the single-nucleotide polymorphisms (SNPs): ABCB11236C>T, ABCB12677G>T/A, ABCB13435C>T and haplotypes in the ABCB1/MDR1 gene, which could contribute to genetic risk of colorectal cancer (CRC). Disease association between the ABCB1/MDR1 genotype, allele, haplotype frequencies and histological features, such as TNM classification, localization of primary carcinoma, grade of malignancy, histological type of tumour, lymphoid infiltration and vessel invasion were estimated. In this study, the potential role of SNPs of the ABCB1/MDR1 gene as a prognostic marker for CRC was analysed.Materials and methodsTumour specimens of 95 patients with CRC were studied. Using automated sequencing or PCR-RFLP method, DNA for three common SNPs of ABCB1/MDR1 was extracted and analysed. The results of genotyping and haplotype analysis with histopathological features, grading and clinical staging of neoplasms were correlated.ResultsA statistically significant higher frequency of T1236 allele in T1/T2 (89.7%), M0 groups (81.6%) and I/II clinical staging (82.7%) in comparison with T3/T4 (68.2%), M1 groups (47.4%) and III/IV clinical staging (65.1%) was detected. Furthermore, multivariate analysis according to Coxs proportional hazard model indicated that the T1236 allele is a good, independent prognostic factor and the presence of this allele decreases the risk of death in comparison with a group without this allele (HR = 0.26; p = 0.0424). In addition, a statistically significant higher frequency of C3435 allele and significant differences in the C3435 allele distribution in N1/N2 group (91.7% and 62.5%, respectively) than N0 group (71.2% and 44.9%, respectively) was found. Each of the eight possible haplotypes was noted in M0 or I/II group and only seven in M1 or III/IV group. Haplotype T1236-G2677-C3435 only in less advanced CRC subjects (9.6% in I/II and 9.2% in M0 group) was detected. In addition, significant differences in haplotype distributions between M0 or I/II and M1 or III/IV group were found (p = 0.01 and p = 0.05, respectively).ConclusionsThese results suggest association between T1236 allele and T1236-G2677-C3435 haplotype and less advanced CRC, so these genetic markers may play a role as potentially good prognostic factors. Differences in haplotype distributions and degree of clinical staging may suggest that some other potential SNPs, especially in regulatory region of ABCB1/MDR1 gene, may influence P-glycoprotein function and CRC progression.

Pharmacogenetics research on chemotherapy resistance in colorectal cancer over the last 20 years

During the past two decades the first sequencing of the human genome was performed showing its high degree of inter-individual differentiation, as a result of large international research projects (Human Genome Project, the 1000 Genomes Project International HapMap Project, and Programs for Genomic Applications NHLBI-PGA). This period was also a time of intensive development of molecular biology techniques and enormous knowledge growth in the biology of cancer. For clinical use in the treatment of patients with colorectal cancer (CRC), in addition to fluoropyrimidines, another two new cytostatic drugs were allowed: irinotecan and oxaliplatin. Intensive research into new treatment regimens and a new generation of drugs used in targeted therapy has also been conducted. The last 20 years was a time of numerous in vitro and in vivo studies on the molecular basis of drug resistance. One of the most important factors limiting the effectiveness of chemotherapy is the primary and secondary resistance of cancer cells. Understanding the genetic factors and mechanisms that contribute to the lack of or low sensitivity of tumour tissue to cytostatics is a key element in the currently developing trend of personalized medicine. Scientists hope to increase the percentage of positive treatment response in CRC patients due to practical applications of pharmacogenetics/pharmacogenomics. Over the past 20 years the clinical usability of different predictive markers has been tested among which only a few have been confirmed to have high application potential. This review is a synthetic presentation of drug resistance in the context of CRC patient chemotherapy. The multifactorial nature and volume of the issues involved do not allow the author to present a comprehensive study on this subject in one review.

Comparative analysis of opinions of Warsaw Medical University students on electronic examinations and final tests by their participation in this form of knowledge assessment – preliminary report

Abstract Introduction. Apart from the increasing popularity of modern information technologies and the development of e-learning methods used for teaching medicine and health sciences, there was a spike of interest in using modern computer techniques for checking students’ knowledge. Aim. The aim of the study was to compare the opinions of students of Medical University of Warsaw about the examinations and final tests conducted using the e-exam ASK Systems platform, measured by their participation in this form of assessmen knowledge. Material and methods. 148 students; group 1 comprised students participating in an e-exam (59 persons) and group 2 included students not participating in an e-exam (89 persons). A voluntary, anonymous questionnaire study, electronic questionnaire, 58 statements measured using the Likert scale. Questionnaire reliability assessment: analysis of internal consistency with Cronbach’s Alfa coefficient (α>0.70). Statistical analysis: STATISTICA 12.0 licensed to WMU, Mann-Whitney U test. Results. Cronbach’s α coefficient for the scale amounted to 0.70. Members of group 1 were more likely to admit that students need to put in extra effort into participating in an e-exam (p<0.001) and that test results might be worse than in case of a regular exam (p<0.050). Group 1 significantly more often reported that the participation in an e-exam can cause additional examination stress (p<0.002) and makes cheating during exams more probable (p<0.003). Conclusions. 1. An analysis of the questionnaire demonstrated that this tool is reliable and can be used in further studies. 2. The participation in an e-exam slightly influenced the opinions of students on this form of knowledge assessment, which may mean that the students’ expectations concerning e-exams were consistent with the actual course of the exam. Therefore, students do not need any special procedure to prepare for e-exams. 3. This was a pilot study and it needs to be continued among the same group of students before and after the e-exam.

Comparison of Knowledge and Attitudes Towards the Use of Scientific Research in Clinical Practice Among Departmental and Charge Nurses

Abstract Introduction. The awareness of benefits arising from the use of the latest results of scientific research (EBNP – Evidence-Based Nursing Practice) among departmental and charge nurses is a necessary condition to ensure effective and safe health services and nursing care meeting the highest standards of patient care. Aim. The comparison of knowledge of and attitudes towards EBNP among nurses depending on their position. Material and methods. Twenty one departmental nurses (PO) (mean age 50.38 years, min. 37, max. 62, SD=7.35) and 20 Bachelors degree students of a bridge programme (SSP) (mean age 43 years, min. 34, max. 55, SD=6.37). Qualitative study and analysis of the results, structured interview, extended focus. Results. PO and SSP were not able to define the acronyms EBM and EBP correctly and did not have detailed knowledge of the criteria for assessment of reliability of scientific literature. A majority of DN was familiar with the available journals for nurses and was aware of benefits resulting from using EBNP. The use of EBNP in everyday clinical practice in SSP group was limited by a lack of time, insufficient knowledge of English and access to the Internet, as well as working at the position that makes taking decisions on developing procedures and standards for nursing care impossible. Conclusions. 1. The level of knowledge about EBNP in both groups was inadequate and needs urgent supplementation of knowledge and skills of nurses with reference to this subject area. 2. The attitudes of nurses towards EBNP were different depending on their work position. Departmental nurses were aware of benefits resulting from using the most recent study results in everyday clinical practice and being up-to-date with medical knowledge. 3. The boundaries limiting the use of EBNP in everyday clinical practice by the study participants were objective and they require system changes with reference to the organization of work and the system of continuing education.

Adherence to dietary recommendations in diabetes mellitus: disease acceptance as a potential mediator

Background Adherence by diabetic patients to dietary recommendations is important for effective therapy. Considering patients’ expectations in case of diet is significant in this regard. The aim of this paper was to analyze the relationship between selected independent variables (eg, regular blood glucose testing) and patients’ adherence to dietary recommendations, bearing in mind that the degree of disease acceptance might play a mediation role. Subjects and methods A cross-sectional study was conducted in 91 patients treated for type 2 diabetes mellitus in a public medical facility. Paper-and-pencil interviewing was administered ahead of the planned visit with a diabetes specialist. Two measures were applied in the study: the Acceptance and Action Diabetes Questionnaire and the Patient Diet Adherence in Diabetes Scale. Additionally, data related to sociodemographic characteristics, lifestyle-related factors, and the course of the disease (management, incidence of complications, and dietician’s supervision) were also collected. The regression method was used in the analysis, and Cohen’s methodology was used to estimate partial mediation. Significance of the mediation effect was assessed by the Goodman test. P-values of <0.05 were considered statistically significant. Results Patients’ non-adherence to dietary recommendations was related to a low level of disease acceptance (standardized regression coefficient =−0.266; P=0.010). Moreover, failure to perform regular blood glucose testing was associated with a lack of disease acceptance (standardized regression coefficient =−0.455; P=0.000). However, the lack of regular blood glucose testing and low level of acceptance had only partially negative impacts on adherence to dietary recommendations (Goodman mediation test, Z=1.939; P=0.054). This dependence was not seen in patients treated with diet and concomitant oral medicines and/or insulin therapy. Conclusion Effective dietary education should include activities promoting a more positive attitude toward the disease. This may be obtained by individual counseling, respecting the patient’s needs, and focus on regular blood glucose testing.

Analysis concerning nutritional behaviors in the context of the risk of orthorexia

Orthorexia is recognized as an eating disorder, an obsessive–compulsive spectrum disorder, or a somatoform disorder. The aim of our research was to analyze nutritional behaviors for the assessment of the risk of orthorexia. The authors developed a questionnaire in which 981 respondents participated and used it as a research method. Both men and women ate mostly 4–5 meals per day (46.30% women versus 34.74% men); however, more men than women ate 1–2 meals daily (18.95% men versus 7.9% women). Both place of birth and field of study did not differ in terms of the number of meals. Moreover, it was observed that the number of meals per day was correlated with the declared time spent on planning a diet. People who ate over 3 meals per day more often indicates that they spent >3 h per day on planning their diet in comparison with people who ate only 1–2 meals. Only 17.6% of the respondents declared that they most often ate meals in a company of someone, whereas 45.3% indicated that there was no rule. The remaining 37.1% of the respondents most often consumed their meals alone. Almost twice as many men as women never paid attention to the qualitative composition of nutrition. Women followed a slimming diet more often than men (20.3% versus 5.8%) and this indicated >4 attempts of losing weight. Around one-third of all the respondents suffered or suffer from eating disorders. Owing to insufficient information on orthorexia, it is essential to conduct further research to determine the characteristics of high-risk groups. Taking the growing interest in a healthy lifestyle into account, there is a need to address the problem of orthorexia in the public space.

Validation study of the Polish version of the Evidence-Based Practice Profile Questionnaire

BackgroundDecisions about patient care in clinical practice should be made based on proven scientific evidence of efficacy and safety (i.e., evidence-based practice [EBP]). Currently, there are no available tools in Poland for assessing the knowledge and attitudes of specialists in health sciences towards EBP. Therefore, by validating the Polish version of the original English Evidence-Based Practice Profile Questionnaire (EBP2Q), we may provide an appropriate instrument for assessing EBP.MethodsThe validation group consisted of 1,362 people, including nurses and midwives taking the specialization exam, second-degree students in nursing/midwifery, and staff of selected municipal and clinical hospitals in Warsaw, Pruszkow, and Chelm. The study was conducted from March to June 2014. The following psychometric properties of the EBP2Q were assessed: reliability (Cronbach’s alpha coefficient, and test-retest), validity (exploratory factor analysis, Spearman’s r correlation coefficient, and assessment of inter-group differences), as well as unidimensionality of domains (principal component analysis).ResultsAll domains of the EBP2Q were characterized by high reliability (Cronbach’s alpha ranging from 0.800 to 0.972). The Polish version showed a strong similarity of factor structure with the original English EBP2Q, indicating that the condition for theoretical validity is fulfilled. Maintenance of the theoretical and discriminative validity and unidimensionality of five domains of the EBP2Q was confirmed.ConclusionsThe Polish version of the EBP2Q is comparable in terms of psychometry to the original English version. This questionnaire can be used to assess knowledge, attitudes, and skills concerning EBP among students and practicing professional nurses and midwives. The future validation of the EBP2Q in other groups of specialists in health sciences may increase the scope of applicability of this tool.

Risk assessment of night-eating syndrome occurrence in women in Poland, considering the obesity factor in particular

Introduction Night-eating syndrome (NES) involves uncontrolled and most often repeated binge eating during the night. It is related with mood disorders as well as sleep disorders and it may cause obesity. Risks related to NES are obesity, binge eating disorder, bulimia nervosa, affective disorders, and sleep disorders. The objective of this study is to analyze eating habits in terms of the risk assessment of NES occurrence in the population of women in the Masovian Voivodeship (in Poland). Patients and methods Six hundred and eleven women living in the Masovian Voivodeship participated in the study. The average age of the respondents was 22.7 years (median = 23.0; interquartile range = 3.0). The Night Eating Questionnaire (NEQ) was used to assess the risk of NES. Results In the studied group of women, 1.3% of cases (N = 12) reached a NEQ total score of ≥25, which indicates a probability of 40.7% for NES, while 0.7% (N = 4) reached a score of ≥30, which indicates a probability of 72.2% for occurrence of this syndrome. The highest average total score was observed in the group of obese people. The level of education of the participants did not significantly affect the NEQ score. A weak correlation was observed between the place of residence variable and the mood/sleep subscale (r = 0.11, P < 0.01). Conclusion NES may be one of the causes of overweight and obesity; therefore, the need for further studies on this health issue is justified. It is worth pointing out that knowing the conditions responsible for the occurrence of NES, it is possible to suggest a prevention procedure for this condition.

Do results of the recruitment of candidates for a bachelor’s degree course in nursing correctly predict the level of social skills of a graduate? Preliminary study

Introduction: For several years we have seen growing interest of the role social skills of nurses in efficient and safe patient care. Aim of the research: To evaluate to what extent the results of the recruitment of candidates for a bachelor’s degree course in nursing correlate with a social skills profile evaluated at the end of the course. Material and methods: A total of 113 graduates from the Medical University of Warsaw were involved in the study. The analysis concerned data on the admission procedure, namely the matura exam (secondary school exit exam) results in Polish, foreign language, and an additional subject. A standardised PROKOS questionnaire that permits the measurement of psychometrics in five specific scopes was used to assess the social skills profile of the graduates. Non-parametric Spearman’s correlation (rs) was used in the study, and calculations were performed using Statistica 12.5 software. Results: Exam results in Polish were positively correlated with the level of assertive (rs = 0.23) and community-focused (rs = 0.21) skills. Moreover, the level of social skills depended significantly on the matura exam results in an additional subject (rs = 0.21). A correlation between age at admission and the scope of cooperative skills (rs = 0.17) was also observed. However, neither of the domains of the profile was related significantly with ranking scores for a foreign language. Conclusions: Admission criteria used in the selection procedure for nursing insufficiently predicted the level of future social skills of graduates. It is recommended to introduce an assessment of non-cognitive skills at the stage of recruiting candidates to increase the validity of the admission procedure.

Should the family witness cardiopulmonary resuscitation? Perceptions of health professionals in Poland

1Department of Emergency Medicine, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland 2Chair and Department of Family Medicine, First Faculty of Medicine, Medical University of Lublin, Lublin, Poland 3Division of Teaching and Outcomes of Education, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland 4Department of Emergency Medical Services, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland 5Polish Medical Air Rescue, Poland