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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.

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.

Background: The aim of the study was to assess the impact of having various sources of information in the field of first aid on the level of knowledge of dental and medical students, as well as to recognize if medical stereotypes exist in the domain of first aid. Methods: We tested 818 Native-(N) and English (E)—speaking students of medicine (M) and dentistry (D). The questionnaire was constructed in a way that it could detect the issues which created the biggest challenges to the students. It consisted of both theoretical and clinical questions. The intention was to find out whether there were any medical stereotypes. The students were asked to provide the sources of their knowledge to each question, and information about the presence of first aid classes at school. Results: We found medical stereotypes, but only in the questions pertaining to theory: questions concerning defibrillation, opening the airway in infants and the causes of airway obstruction of an unconscious adult. Correlations were found between the sources of knowledge with answers to the questions in each group of students and between the groups. The sources of knowledge in N students came mostly from school, or the students were not able (NA) to indicate the source of knowledge, but E groups gave out of school courses, mass media and their own knowledge (or from the others), as well as NA answers. Interestingly in ED group, among other answers, students also indicated schools as a source of their knowledge. Conclusions: We confirmed that medical stereotypes among dental and medical students exist, and they were not related to multiculturalism or the use of different sources of knowledge.

BZgA-Forschungsbericht

[Purpose] The risk of falls in the elderly is an important public health problem. Suitable tests may help detect those at risk of falling. This study determined which balance test for older adults generates the most reliable results in terms of fall risk assessment, based on the number of falls over the last 12 months. [Subjects and Methods] A total of 153 individuals (31 males, 122 females, aged 76.67 ± 8.3 years; median 76.5, range 65-94) were investigated. The subjects were subdivided between fallers (a fall over the last 12 months) and non-fallers (no falls over the last 12 months). All participants were assessed with the following: Barthel Scale, Mini-Mental State Examination, Timed Up and Go, Tinetti Performance-Oriented Mobility Assessment), Berg Balance Test, and One-Legged Stance Test. [Results] Statistically significant differences were detected between fallers and non-fallers in TUG, POMA, BBS, and OLST scores. The number of falls correlated positively with the results for TUG, POMA, and OLST. [Conclusion] TUG and POMA were the most useful screening tests for balance and gait impairment in elderly nursing home residents. Two or more tests should be performed for more precise assessment of the risk of falling. Language: en

Although the aetiology of non-syndromic cleft lip with or without cleft palate (nsCL/P) has been studied extensively, knowledge regarding the role of genetic factors in the pathogenesis of this common craniofacial anomaly is still limited. We conducted a follow-up association study to confirm that CDKAL1 nucleotide variants identified in our genome-wide association study (GWAS) for nsCL/P are associated with the risk of this anomaly. In addition, we performed a sequence analysis of the selected CDKAL1 exons. A mega-analysis of the pooled individual data from the GWAS and a replication study revealed that six out of thirteen CDKAL1 variants were positively replicated and reached the threshold of statistical significance (Ptrend

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.

Summary The aim of this study was to determine changes in the content of flavonoids in fleshy scales of shallot bulbs in relation to different compositions of atmosphere during storage. Also antioxidant activity of the bulbs was determined. Bulbs of shallot cvs. Bonilla F1, Conservor F1 and Matador F1 were stored in two storage seasons at the normal atmosphere (NA) and controlled atmosphere (CA) of the 4 compositions: 5% CO2 + 5% O2, 5% CO2 + 2% O2, 2% CO2 + 5% O2, 2% CO2 + 2% O2. The temperature of storage was 0-1°C and RH 65%. Before and after 7-month storage the bulbs were examined in respect of flavonoids content and antioxidant activity (AA). Flavonoids were identified in methanolic extracts with HPLC, AA was determined with FRAP and DPPH assays. Three flavonoid compounds were identified in the plants extracts. Quercetin 3,4’ di-O-glucoside and quercetin 4’-glucoside (spiraeoside) were present in the highest amounts. CA conditions influenced content of flavonoids in the bulbs. The highest content after storage was observed at gas composition of 5% CO2 + 5% O2. Two major flavonoid compounds, quercetin 3,4’-di-O-glucoside and quercetin 4’-O-glucoside (spiraeoside) showed the increasing tendency, however not all changes were significant. No significant differences were observed between cultivars, but ‘Bonilla’ F1 showed slightly higher flavonoids content than the other ones. Investigated cultivars did not differ in respect of AA, measured both with DPPH and FRAP assay. There was no significant influence of storage conditions on DPPH level, while FRAP level was influenced significantly. Bulbs from 5% CO2 + 2% O2 composition were characterized by the highest FRAP values and the bulbs stored at normal atmosphere - by the lowest.

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.

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.

Cybercrime rates are increasing in Poland and throughout the world. There are many types of offences concerning internet domains, among others, cybersquatting, typosquatting, cyber smearing, and cyberwildcatting. The following article is a comparative study of the settlement of disputes concerning internet domain names taking as an example the Domain Name Court of Arbitration at the Polish Chamber of Information Technology and Telecommunications (PIIT) and the World Intellectual Property Organization (WIPO) Arbitration and Mediation Center. Between the two processes of recovery of the domains there are many similarities. During the study legislation was sought in the Polish legal system, which is related to internet domains. In Poland, there is no particular legal regulation regarding internet domain names. One may search for protective measures in the Act on Combating Unfair Competition [o zwalczaniu nieuczciwej konkurencji], Industrial Property Law [Prawo wlasności przemyslowej], and the Civil Code [Kodeks cywilny]. This article commends the settlement of disputes through arbitration and describes them in detail.