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Background: People in receipt of community palliative care usually receive care from a range of services and require access to care 24/7. However, care outside of normal working hours varies, with little understanding of which models of care are optimal. Aim: To identify and characterise current models of out-of-hours community palliative care in the UK and explore healthcare professionals' views on the barriers and facilitators to providing high quality community out-of-hours care. Design: Exploratory qualitative study using semi-structured interviews, analysed using reflexive thematic analysis. Setting and participants: We recruited 39 healthcare professionals from 20 geographic areas. Participants were service leads from community palliative care, district/community nursing and primary care providers. Results: Four overarching models of out-of-hours palliative care identified, characterised by levels of integration between services, balance between generalist and specialist providers, availability of care and type of care provided (hands-on clinical care/ advisory care). Analysis of barriers and facilitators generated three themes: (1) 'It's never one service': challenges of coordination of care across multiple services, (2) Need for timely skilled management of distressing symptoms, (3) 'We're just plugging gaps': prioritising patient care within limited resources. Patterns within the themes varied across the four models. Conclusion: This study identifies key characteristics of four common models of out-of-hours palliative care, from the perspectives of professionals. Facilitators of high quality out-of-hours care include: a palliative care specific single point of access for patients; formal structures to integrate generalist/specialist services; and timely/skilled management of symptoms. We provide recommendations for a potential model incorporating these factors. [ABSTRACT FROM AUTHOR]

We present a case of the Lazarus phenomenon, which is to our knowledge first report from Poland. This is a phenomenon of the heart, which can resume its spontaneous activity and generate circulation. It can happen after ineffective cardiopulmonary resuscitation (CPR) or in a departed person when a resuscitation attempts were not undertaken but a circulation returned spontaneously. The victim was 86 years old woman. She suffered cardiac arrest in a church. The rescuers began CPR, administered one shock and continued pharmacotherapy. After 40 minutes, the CPR was discontinued and death was confirmed. Suddenly after 15 minutes return of spontaneous breathing was recognized. Upon arrival to the hospital her vital signs were: HR 84/min, NIBP 106/70 mmHg, saturation 93%, temperature 36,5 °C. An increase of troponin in repeatable laboratory tests was noticed, but taking into account the extended duration of the cardiac arrest, and the amount of time before CPR was administered as well as patient's age and unfavorable prognosis, the decision was made not to apply any invasive cardiologic intervention. At third day of hospitalization sudden ventricular tachycardia with narrow QRS complexes and destabilization of circulation was observed. At the beginning of a therapy an improvement of a condition of the patient was reported, but later sudden drop in blood pressure appeared with no reaction to the treatment. [ABSTRACT FROM AUTHOR]

Background: Community-based out-of-hours services are an integral component of end-of-life care. However, there is little understanding of how patients and families utilise these services. This additional analysis of a systematic review aims to understand and identify patterns of out-of-hours service use and produce recommendations for future service design. Method: Data on service use was extracted and secondary analysis undertaken, from a systematic review of models of community out-of-hours services. Narrative synthesis was completed, addressing four specific aspects of service use: 1.Times when patients/families/healthcare professionals need to contact out-of-hours services; 2. Who contacts out-of-hours services; 3. Whether a telephone call, centre visit or home visit is provided; 4. Who responds to out-of-hours calls. Results: Community-based out-of-hours palliative care services were most often accessed between 5pm and midnight, especially on weekdays (with reports of 69% of all calls being made out-of-hours). Family members and carers were the most frequent callers to of the services (making between 60% and 80% of all calls). The type of contact (telephone, centre visit or home visit) varied based on what was offered and on patient need. Over half of services were led by a single discipline (nurse). Conclusions: Out-of-hours services are highly used up to midnight, and particularly by patients' family and carers. Recommendations to commissioners and service providers are to: • Increase provision of out-of-hours services between 5pm and midnight to reflect the increased use at these times. • Ensure that family and carers are provided with clear contact details for out-of-hours support. • Ensure patient records can be easily accessed by health professionals responding to calls, making the triage process easier. • Listen to patients, family and carers in the design of out-of-hours services, including telephone services. • Collect data systematically on out-of-hours-service use and on outcomes for patients who use the service. [ABSTRACT FROM AUTHOR]

Autoresuscitation is a phenomenon of the heart during which it can resume its spontaneous activity and generate circulation. It was described for the first time by K. Linko in 1982 as a recovery after discontinued cardiopulmonary resuscitation (CPR). J.G. Bray named the recovery from death the Lazarus phenomenon in 1993. It is based on a biblical story of Jesus' resurrection of Lazarus four days after confirmation of his death. Up to the end of 2022, 76 cases (coming from 27 countries) of spontaneous recovery after death were reported; among them, 10 occurred in children. The youngest patient was 9 months old, and the oldest was 97 years old. The longest resuscitation lasted 90 min, but the shortest was 6 min. Cardiac arrest occurred in and out of the hospital. The majority of the patients suffered from many diseases. In most cases of the Lazarus phenomenon, the observed rhythms at cardiac arrest were non-shockable (Asystole, PEA). Survival time after death ranged from minutes to hours, days, and even months. Six patients with the Lazarus phenomenon reached full recovery without neurological impairment. Some of the causes leading to autoresuscitation presented here are hyperventilation and alkalosis, auto-PEEP, delayed drug action, hypothermia, intoxication, metabolic disorders (hyperkalemia), and unobserved minimal vital signs. To avoid Lazarus Syndrome, it is recommended that the patient be monitored for 10 min after discontinuing CPR. Knowledge about this phenomenon should be disseminated in the medical community in order to improve the reporting of such cases. The probability of autoresuscitation among older people is possible. [ABSTRACT FROM AUTHOR]

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Background: Deaths in the community are increasing. However, community palliative care out-of-hours is variable. We lack detailed understanding of how care is provided out-of-hours and the associated outcomes. Aim: To review systematically the components, outcomes and economic evaluation of community-based ‘out-of-hours’ care for patients near the end of life and their families. Design: Mixed method systematic narrative review. Narrative synthesis, development and application of a typology to categorise out-of-hours provision. Qualitative data were synthesised thematically and integrated at the level of interpretation and reporting. Data sources: Systematic review searching; MEDLINE, EMBASE, PsycINFO, CINAHL from January 1990 to 1st August 2022. Results: About 64 publications from 54 studies were synthesised (from 9259 retrieved). Two main themes were identified: (1) importance of being known to a service and (2) high-quality coordination of care. A typology of out-of-hours service provision was constructed using three overarching dimensions (service times, focus of team delivering the care and type of care delivered) resulting in 15 categories of care. Only nine papers were randomised control trials or controlled cohorts reporting outcomes. Evidence on effectiveness was apparent for providing 24/7 specialist palliative care with both hands-on clinical care and advisory care. Only nine publications reported economic evaluation. Conclusions: The typological framework allows models of out-of-hours care to be systematically defined and compared. We highlight the models of out-of-hours care which are linked with improvement of patient outcomes. There is a need for effectiveness and cost effectiveness studies which define and categorise out-of-hours care to allow thorough evaluation of services. [ABSTRACT FROM AUTHOR]

Objective: The etiology of non‐syndromic cleft lip with or without cleft palate (nsCL/P) is multifactorial, heterogeneous, and still not completely understood. The aim of the present study was to examine the associations between common and rare PAX7 nucleotide variants and the risk of this common congenital anomaly in a Polish population. Subjects and methods: Eight top nsCL/P‐associated PAX7 variants identified in our cleft genome‐wide association study (GWAS) were selected for replication analysis in an independent group of patients and controls (n = 247 and n = 445, respectively). In addition, mutation screening of the PAX7 protein‐coding region was conducted. Results: Analysis of the pooled data from the GWAS and replication study confirmed that common PAX7 nucleotide variants are significantly associated with the increased risk of nsCL/P. The strongest individual variant was rs1339062 (c.586 + 15617T > C) with a p‐value = 2.47E−05 (OR = 1.4, 95%CI: 1.20–1.64). Sequencing analysis identified a novel synonymous PAX7 substitution (c.87G > A, p.Val29Val) in a single patient with nsCLP. This transition located in the early exonic position was predicted to disrupt potential splice enhancer elements. Conclusion: Our study confirmed that PAX7 is a strong candidate gene for nsCL/P. Nucleotide variants of this gene contribute to the etiology of nsCL/P in the homogenous Polish population. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiology & Rescue Medicine / Anestezjologia i Ratownictwo is the property of Akademia Medycyny Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Non‐syndromic cleft lip with or without cleft palate (nsCL/P) is a common craniofacial anomaly with a complex and heterogeneous aetiology. Knowledge regarding specific genetic factors underlying this birth defect is still not well understood. Therefore, we conducted an independent replication analysis for the top‐associated variants located within the DLG1 locus at chromosome 3q29, which was identified as a novel cleft‐susceptibility locus in our genome‐wide association study (GWAS). Mega‐analysis of the pooled individual data from the GWAS and replication study confirmed that common DLG1 variants are associated with the risk of nsCL/P. Two single nucleotide polymorphisms (SNPs), rs338217 and rs7649443, were statistically significant even at the genome‐wide level (Ptrend = 9.70E−10 and Ptrend = 8.96E−09, respectively). Three other SNPs, rs9826379, rs6805920 and rs6583202, reached a suggestive genome‐wide significance threshold (Ptrend < 1.00E−05). The location of the strongest individual SNP in the intronic sequence of the gene encoding DLG1 antisense RNA suggests that the true causal variant implicated in the risk of nsCL/P may affect the DLG1 gene expression level rather than structure of the encoded protein. In conclusion, we identified a novel cleft‐susceptibility locus at chromosome 3q29 with a DLG1 as a novel candidate gene for this common craniofacial anomaly. [ABSTRACT FROM AUTHOR]

Non-syndromic orofacial clefts and tooth agenesis are two of the most common craniofacial birth defects. Both of them have a complex etiology, with genetic and environmental factors involved. Additionally, the epigenetic modifications have been implicated in the pathogenesis of these structural malformations. Despite an increasing number of research studies, using a variety of methodological approaches, the role of genetic factors in the etiology of orofacial clefts and tooth agenesis is still not well elucidated. The most consistent findings across studies concerning the genetic factors influencing the risk to orofacial clefts include the association of polymorphic variants of the IRF6 gene and the chromosomal locus 8q24.21. The major candidate gene for tooth agenesis in the European populations is WNT10A; its pathogenic mutations are present in more than 50% of patients with this dental anomaly. It has been found that both orofacial clefts and tooth agenesis, which co-occurrence is often reported, may share common candidate genes. [ABSTRACT FROM AUTHOR]

Background: The endomyocardial biopsy has proven to be an integral diagnostic tool for surveillance of cardiac allograft rejection and identification of myocardial diseases. Nevertheless, this invasive procedure is not risk-free. This study focuses on the risk of complications and diagnostic performance of right ventricular endomyocardial biopsy (EMB). Methods: In this single-center retrospective study, we analyzed 315 EMB procedures performed between July 2008 and May 2015 in 73 patients. All EMBs were made via the right femoral vein approach under fluoroscopic control to evaluate suspected myocarditis, unclear heart failure, unexplained cardiomyopathy, assumed infiltrative and storage disease or as a part of routine allograft rejection monitoring and clinically suspected rejection diagnosis after heart transplantation (HTx). Obtained specimens were diagnosed histopathologically by one experienced pathologist. All patients underwent a 12-lead electrocardiogram (ECG), ECG monitoring, transthoracic echocardiography before and after EMB to obtain a detailed assessment of the incidence of heart rhythm disorders, pericardial effusions or worsening valve insufficiency. Complications resulting from the procedure were classified as major or minor according to the risk of death. Results: Among all the 315 biopsies, 86.67% were performed in 32 patients after HTx, 3.81% in patients with myocarditis, 2.54% in patients with dilated cardiomyopathy and 1.9% in patients with amyloidosis. The overall complications rate was 1.9% (6 of 315 procedures). Major complications included perforation with pericardial tamponade requiring surgical intervention (0.64%, 2 of 315 procedures). Minor complications included: pericardial effusion (0.32%, 1 of 315 procedures), local hematoma (0.64%, 2 of 315 procedures) and right coronary artery-right ventricle fistula in HTx recipient (0.32%, 1 of 315 procedures). Conclusions: EMB is a safe procedure with low risk of serious complications and high effectiveness for the evaluation of unexplained left ventricle dysfunction and monitoring allograft rejection after HTx. [ABSTRACT FROM AUTHOR]

Amyloidosis is a heterogeneous group of disorders associated with pathological deposition of amyloid. We can recognize two major categories of amyloidosis: primary (AL) and secondary (AA) type. Systemic monoclonal immunoglobulin light-chain (AL) is the most common form of systemic amyloidosis. Systemic AA amyloidosis is associated with chronic inflammation or infective diseases and is the second common form of systemic amyloidosis. The golden standard in diagnosis of amyloidosis is biopsy. The model of treatment depends of type of amyloidosis. In some cases cell transplantation can be considered. In AA the purpose is to decrease inflammation. [ABSTRACT FROM AUTHOR]

Introduction. Non-syndromic cleft lip with or without cleft palate (NSCL/P) is a common developmental anomaly, which etiology is complex and not completely elucidated. Therefore, the aim of the present study was to evaluate whether common polymorphisms in the distal-less homeobox gene 1 (DLX1) may contribute to the risk of orofacial clefts in the Polish population. Material and methods. Five single nucleotide variants were genotyped using high-resolution melting curve analysis in a group of 278 patients with NSCL/P and properly matched controls (n = 574). Results. Statistical analysis revealed that two variants located in the 3' untranslated region of DLX1, rs788172 and rs788173, were associated with a decreased risk of NSCL/P (ptrend = 0.041 and ptrend = 0.025, respectively). The allelic frequencies for these polymorphisms were significantly lower in patients compared to healthy individuals (p = 0.040 and p = 0.024, respectively). However, all these results did not remain statistically significant after applying the Bonferroni correction for multiple comparisons. The results of single-marker analysis for DLX1 were confirmed by haplotype analysis. The best evidence of the haplotype association with the risk of NSCL/P was observed for the T-G-G haplotype consisting of rs1047889, rs788172 and rs788173 major alleles. This high risk haplotype was more frequent among cases than controls (p = 0.013, pcorrected = 0.026). Conclusions. We found evidence for the association between DLX1 gene variants and the risk of NSCL/P in the Polish population. To confirm our preliminary findings further, larger sample size studies are required. [ABSTRACT FROM AUTHOR]

Introduction. Alcohol, together with drug use such as marijuana, is a major health concern that may influence the life of both doctors and medicine students. It is therefore important to investigate their habits associated with those hazardous behaviors. Material and methods. A voluntary survey containing 12 questions regarding their drinking habits and marijuana use was sent to law and medicine students from two cities in Poland, Poznan and Lublin. 814 responses were collected and the results were compiled using STATISTICA 10 program. Results. Mean age of alcohol initiation was revealed to be very similar in all groups at below 16 years of age. Although majority of students drink less than once a week (41% male and 65.7% female), men were found to use alcohol much more frequently and in higher quantities than female students. Half of future doctors would stop at the lowest stage on a proposed alcohol intoxication scale, while 11.6% would venture to the highest, third one. Those values for law students were 36.2% and 26%, respectively. 70% of men and 52.9% of women have tried marijuana. Majority of them smoke less than once a month, but almost a quarter of law students and 15% of medicine students do it at least once a month. Conclusions. More emphasis should be put on educating future doctors and general public about dangers associated with hazardous drinking and cannabis use. Prevention of such behaviors should be conducted at an age as young as possible. [ABSTRACT FROM AUTHOR]

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Copyright of Vegetable Crops Research Bulletin is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: CMD Clinic is a primary care facility based in Siedlce, Poland. It has around 70,000 patients under its care. In 2006 basic elements of care coordination were implemented eg. planned preventive visits, team work. Since then, different organisational and financial outcomes were observed in 3 GPs practises taking care of the population, mostly due to different doctors behaviours (1. full implementation of care coordination guidelines, 2. partial implementation and 3. total negligence). Observations are based on analysis of data from years 2006-2016. Description of policy context and objective: One of most effective interventions to support quality improvement is to directly relate a proportion of the remuneration of providers to the achieved result on quality indicators. In CMD Clinic in 2006 after implementation of basic care coordination model, few measures were presented eg.: number of patient's visits per GP, number of patient's visit per whole facility practise, visit time and visit reimbursement. Population targeted is around 70 000 people, patients of CMD Clinic in Siedlce. Observations: were based on 9,5 year period (between years 2006-2016 - fist half). Three different GP offices were taken under the observation. Three doctors had different approach to implement rules of the care coordination. One who was engaged and fully cooperative had much better results than doctors who were working with guidelines partially or not at all. After almost 10 year period, GP who cooperated had decreasing number of patient's visits per GP per year (from 12648 to 4450 per year together with longer time of work from 120 starting in 2006 to160 hours per month in 2016), number of patient's visit per whole facility practise (from 5.0 to 1.8 in 2016), visit time (starting with 6.83 minutes in 2016 to 12.94 in 2016) and visit reimbursement (5.88 PLN in 2006 to 12.94 in 2016). In the same time the GP who didn't apply to the rules had much more worse. Results: number of patient's visits per GP per year (from 2784 to 2589 per year), visit time (starting with 8.60 minutes in 2016 to 6.82 in 2016) and visit reimbursement (15.20 PLN in 2006 to 12.48 in 2016). Hence, much more better organizational results were achieved in the GP office that fully implemented care coordination model - less patient's visits per GP, longer visit time, and higher visit reimbursement. The present literature review shows that we do not currently possess much evidence of the influence of the determinants on collaboration. However, our study shows that efficient doctors can have a positive impact on a implementation of coordinated care and have better and faster organisational and financial outcomes. Also better and more effective financial management is related to more engaged doctors. We also observed that implementation of basic cared coordination model is associated with increased responsibilities of personnel especially in beginning of the process. Additionally, positive attitude to change and patient cope results in faster and more visible change. [ABSTRACT FROM AUTHOR]

Poland has one of the lowest patient satisfaction ant it is manifestated in many international surveys, where Poland is one of the last countries in the rankings and where responsiveness assessment is the lowest. It is mainly due to high fragmentation of services, long waiting lists and low level of implementation of comprehensive prevention programs. In 2013 Ministry of Health (MoH), the National Health Fund (NFZ) and The World Bank (WB) launched an integrated care discussion. The Project dedicated to the development of the 3 models of the population based integrations has been developed. The envisaged integrated delivery models will focus on two key areas: (i) reform on contractual arrangements between National Health Fund (Narodowy Fundusz Zdrowia-NFZ) and service providears to encourage service integration and coordination, (ii) The reform on provider contractual arrangements is coupled with reform on service organization solutions and structures to explore integrated care options. The objective will be to present the process leading to integrated care population model for Poland, in the context of the lessons learned from Polish and international integrated care examples. The new model of care will be composed of the regular primary health care services provided by the PHC/family doctors and nurses, with new in scope and volume of prevention and education activities, additional services for chronic patient's, diagnostic tests and rehabilitation delivered in a coordinated, well managed and monitored way. The new tasks will be provided by the health teams and supported with the modern IT systems to facilitate the flow of information about the patients in real time. Within the new system, a set of monitoring and evaluation activities will be implemented reinforced with the capacity building systems for patient's provides and health stakeholders. Population targeted is 250 000-500 000 people, who will be enrolled in the study starting January 2017. Planned integrated care model in Poland is being perceived as a strategy towards patient's centric health care system with the shift from hospital's service delivery to the greater importance and wider implementation of prevention tools to meet the modern health challenges. This will be done in the long term, strategic approach towards the change of the health care system. As a result, it is expected that there will be: integration of care on primary and ambulatory level for the chronic patients, organizational integration of services tailored to patient's needs with their active participation as well as integration of clinical pathways and higher patient satisfaction. Based on the results of the pilot, further models of integrated care on different levels will be developed. After the four years of the implementation of the pilots, based on evaluation, a scaling up the integration of care is being planned for Poland. Due to the similarities in the epidemiological issues and health systems organization in Central Europe and historical approach towards the health care, it is very likely, that the models, after some adjustments could be transferable cross borders. [ABSTRACT FROM AUTHOR]