Developing a model of information transfer practice between institutions targeted at primary health care patients who are asymptomatic carriers of carbapenemase producing Enterobacteriacae

BACKGROUND

Drug-resistant bacteria are one of the main reasons of deaths worldwide. A significant group of these bacteria are carbapenemase producing Enterobacteriaceae (CPE). The goal of this study was to develop a diagnostic and therapeutic model targeted at asymptomatic carriers of CPE.

MATERIAL AND METHODS

A team of experts from different branches connected to health care, discussing the topic based on the data collected from previous research. Working sessions were dispersed between June and December 2022. The consensus has been reached via repeated discussion and literature search.

RESULTS

The facility where CPE are detected is required to create an alert pathogen note and to notify sanitary-epidemiological station and National Reference Centre for Antimicrobial Susceptibility of Microorganisms - neither these institutions, nor the patient are required to notify the primary care physician. In primary care clinics, it is possible to work towards breaking the transmission of CPE by educating patients with CPE and persons who were in contact with them, and to undertake actions in order to look for patients with risk factors for CPE colonisation. In order to improve communication between individual levels of the health care system, standardised information could be introduced to the discharge note about a case of CPE, which will be electronically transmitted to the primary care facility. It might contribute to effective combating of the spread of CPE, by serving as a source of knowledge and education for patients and by checking the patient's risk factors, which will improve the performance of tests for CPE colonisation.

CONCLUSIONS

The established model of good practice requires a change of legal regulations and its implementation, which will reduce the spread of CPE in health care facilities and will enable its future improvement. Med Pr Work Health Saf. 2023;74(4):263-70.

Identification and Preliminary Hierarchisation of Selected Risk Factors for Carbapenemase-Producing Enterobacteriaceae (CPE) Colonisation: A Prospective Study

Drug-resistant bacteria are one of the main reasons of deaths worldwide. One of the significant groups of these bacteria are carbapenemase-producing Enterobacteriaceae (CPE). The goal of this cross-sectional study was the identification and hierarchisation of selected risk factors of CPE colonisation. To achieve that goal, we examined 236 patients for the presence of CPE using the standard method of anal swabs. The patients were divided into three groups: hospitalised patients; those chronically dialysed; those requiring home care. A very thorough medical interview was conducted for comorbidities. A statistical analysis relationship between comorbidities and locations of the patient's stay with the positive result of the culture was investigated. A significant relationship was demonstrated between the positive result of the culture and confirmed dementia, heart failure, connective tissue diseases, and established irregularities in the level of leukocytes. No significant relationship was demonstrated with the remaining comorbidities considered in the study. Afterwards these factors were compared for importance for the assessment of risk of a positive swab result-the biggest importance was found in establishing connective tissue disease. Next were dementia, abnormal values of leukocytes, heart failure, and at the end, stay at the orthopaedics ward. Conclusions: The study identified asymptomatic carriers of CPE, which demonstrates the need for further studies in order to identify infection risk factors. The connective tissue diseases are the most important variable which enable the prediction of CPE colonisation-the next ones are dementia, abnormal values of leukocytes, heart failure, and stay at the orthopaedics ward.

Clinical Characteristics, Treatment, and Short-Term Outcome in Patients with Heart Failure and Cancer

(1) Our study aimed to look at the clinical characteristics, treatment and short-term outcomes of patients hospitalized due to heart failure with coexisting cancer. (2) Methods: Seventy one cancer (Ca) patients and a randomly selected 70 patients without Ca, hospitalized due to heart failure exacerbation in the same time period constituted the study group (Ca patient group) and controls (non-Ca group), respectively. Data on clinical characteristics were collected retrospectively for both groups. (3) Results: Cancer patients presented with a less advanced NYHA class, had more frequent HFpEF, a higher peak troponin T level, and smaller left atrium size, as compared with controls. The in-hospital deaths of Ca patients were associated with: a higher New York Heart Association (NYHA) class, lower HgB level, worse renal function, higher K and AST levels, presence of diabetes mellitus, and HFpEF. By multivariate logistic regression analysis, impaired renal function was the only independent predictor of in-hospital death in Ca patients (OR-1.15; CI 1.05; 1.27); p = 0.017). The following covariates entered the regression: NYHA class, HgB, GFR, K⁺, AST, diabetes mellitus t.2, and HFpEF. (4) Conclusions: The clinical picture and the course of heart failure in patients with and without cancer are different.

[Organizational and financial changes in the work of primary health care workers during the COVID-19 pandemic inPoland]

Following the outbreak of the COVID-19 pandemic, the objectives of the health care system had to be adapted to the changing circumstances, in order to meet the health needs of patients, but also the expectations of medical workers related to ensuring safe working conditions in the crisis situation. The activities of medical staff are greatly affected by organizational and financial changes in health care systems, which affect both the health care systems all over the world and the functioning of all forms of health care. The article examines the organizational and financial changes resulting from the introduction of regulations affecting the conditions of primary health care (PHC) workers in Poland from the beginning of the COVID-19 pandemic to May 8, 2021. The findings regarding measures taken to ensure the stability of PHC functioning during the pandemic highlight that the public health emergency exposed a significant need to introduce organizational and financial changes in PHC. The changes arising from legislation and good practices of medical, organizational and financial character resulted in health care system modernizations in Poland. It is worth stressing, however, that there is a great need to maintain coherence when implementing organizational and financial changes affecting the fluidity and effectiveness of the actions taken by PHC personnel, and thus their working conditions, when implementing future responses to public health emergencies. Such changes should be based on an analysis of the solutions introduced since the beginning of the pandemic in Poland: these include organizational changes such as housing conditions, organization of work and workplaces, flow of information and way of supplying the patient, and financial changes involving mobilization of additional financial resources. The article presents a list of future research questions that merit consideration when setting problems and priorities: these can be used to guide the introduction of permanent modifications to the functioning of PHC in Poland and to facilitate possible future adaptation in times of emergency. Med Pr. 2021;72(5):591-604.

The Impact of COVID-19 on Admissions and Management of Patients with Atrial Fibrillation Episodes in the Emergency Department

BACKGROUND

During the COVID-19 pandemic, the number of admissions to the emergency department (ED) due to a primary diagnosis of atrial fibrillation (AF) has decreased when compared to pre-pandemic times. The principal aim of the study was to assess the frequency of SARS-CoV-2 infections and sinus rhythm restoration among patients who arrived at the ED with AF. Secondary aims included determining whether patients arriving at the ED principally due to AF delayed their presentations and whether the frequency of successful cardioversion for AF was decreased during the pandemic period.

MATERIALS AND METHODS

A retrospective analysis of medical records of patients admitted to two hospital EDs due to AF during July-December 2019 (pre-pandemic period) versus July-December 2020 (pandemic period) was performed.

RESULTS

During the study periods, 601 ED visits by 497 patients were made due to the primary diagnosis of AF. The patients were aged 71.2+/-13.5 years and 51.3% were male. The duration of an AF episode before the ED admission was 10 h (4.5-30 h) during the pandemic period vs. 5 h (3-24 h) during the non-pandemic period (p = 0.001). A shorter duration of the AF episode before ED admission was associated with the successful restoration of the sinus rhythm. During the pandemic period, among patients with short-lasting AF who were not treated with Phenazolinum, the restoration of the sinus rhythm was more frequent in the Copernicus Memorial Hospital than in the University Hospital (p = 0.026). A positive SARS-CoV-2 test was found in 5 (1%) patients, while 2 other patients (0.5%) had a prior diagnosis of COVID-19 disease noted in their medical history.

CONCLUSIONS

1. The number of AF episodes treated in these two EDs was lower during the pandemic than non-pandemic period. 2. The patients with AF appeared at the ED later after AF onset in the pandemic period. 3. Successful cardioversion of atrial fibrillation was more frequent during the pre-pandemic period in one of the two hospitals. 4. A difference of approaches to the treatment of short-lasting AF episodes between EDs during the pandemic period may exist between these two EDs. 5. The patients with SARS-CoV-2 infection during the second wave of the COVID-19 pandemic constituted a small percentage of the patients admitted to EDs due to an AF episode.

Frequency and Characteristics of Injuries and Rehabilitation Procedures in Rugby Players in Poland and France

Objectives: Rugby is sport with a high risk of injury. Repeated changes in exercise intensity and the high training intensity may cause to overuse injuries and long-term disability. The aim of the study was to analyze the prevalence of injuries during trainings and forms of rehabilitation procedures performed after their occurrence among elite and sub-elite rugby players. Methods: The data was obtained from 60 professional rugby males from France and Poland. Data were collected using paper-based recording form. It was a specially designed questionnaire which concerned specific details of the injury, including body location, type of injury, treatment and number of days off lost from playing rugby and on forms of rehabilitation procedures performed after their occurrence among elite and sub-elite rugby players. Results: During the study period, the overall incidence rate for injury suggested a 1.04 times more often injury occurrence (IRR = 1.04, 95% CI: 0.08; 2.00) among Polish players compared with French players; however, the distribution of injuries varied by country. The training injury incidence (TII) and incidence proportion (IP) were also higher in Poland than in France (p < 0.05) with the sprain as the most frequent type of injury in all rugby players. France was 7.8 times (IRR = 7.88, 95% CI: 1.29; 3.21) more likely to sustain a fracture than Poland, which much often experienced less serious injuries (bruise, rapture of muscle and ligament) (IRR = 3.02, 95% CI: 2.06; 3.98). Polish players were provided with various forms of physiotherapy while Franch players often worked with a physiotherapist with a therapeutic method (p < 0.005). Poland and France reported experiencing side effects after an injury and the most frequent was pain. In their opinions, the reasons influencing the effectiveness of rehabilitation are too quick return to the game and too short time of rehabilitation. Conclusions: The competitive level of the rugby player influences not only the frequency and type of injury occurrence, but also access to the different forms of rehabilitation. Nonetheless, the side effects occurring after injury and the causes of ineffective rehabilitation are still similar. Further studies are needed to gather significant data to accurately formulate future injury prevention protocols or recommend modifications to game laws or competition formats, aiming at players’ welfare.

Comparison of American guidelines for field triage and Polish criteria as qualification to a trauma center

INTRODUCTION

Trauma is the third cause of death among the general population in Poland, and the first in people aged 1-44 years. Trauma centers are hospitals dedicated to treating patients with multiple organ injuries, in a complex way that endeavours to ensure a lower mortality rate, shorter hospital stay and better outcomes if the patients are transferred to such a center. Worldwide, there are many models on how to treat a trauma patient, but them to be qualified for the procedure, the selection of potential patients is crucial.

OBJECTIVE

The aim of the study was to compare the Polish model for qualification to a trauma center and American Guidelines for Field Triage.

MATERIAL AND METHODS

Retrospective analysis of medical documentation recorded between 1 January 2014 - 31 December 2014 was undertaken. The study concerned trauma patients admitted to the Emergency Department of the Regional Trauma Center at the Copernicus Memorial Hospital in Łódź, Poland. Inclusion criterion was initial diagnosis 'multiple-organ injury' among patients transported by the Emergency Medical Service (EMS).

RESULTS

In the period indicated, 3,173 patients were admitted to the Emergency Department at the Copernicus Memorial Hospital. From among them, 159 patients were included in the study. Only 13.2% of the patients fulfilled the Polish Qualification Criteria to Trauma Center in comparison to 87.4% who fulfilled the American Guidelines for Field Triage.

CONCLUSIONS

Polish qualification criteria do not consider the large group of patients with severe injuries (ISS>15), but indicate patients with minimal chance of survival. Polish criteria do not consider the mechanism of injury, which is a relevant predictive indicator of severe or extremely severe injuries (ISS>15). Further studies should be undertaken to improve the qualification and treatment of trauma patients in Poland.