63 results on '"Dominika Szalewska"'
Search Results
2. Health-related quality of life and self-care in heart failure patients under telecare—insights from the randomized, prospective, controlled AMULET trial
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Katarzyna Piotrowicz, Paweł Krzesiński, Agata Galas, Adam Stańczyk, Janusz Siebert, Ewa Anita Jankowska, Paweł Siwołowski, Piotr Gutknecht, Piotr Murawski, Dominika Szalewska, Waldemar Banasiak, Piotr Ponikowski, and Grzegorz Gielerak
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heart failure ,health-related quality of life ,self-care ,telecare ,heart failure management ,Public aspects of medicine ,RA1-1270 - Abstract
IntroductionThe growing population of heart failure (HF) patients places a burden on the healthcare system. Patient-centered outcomes such as health-related quality of life (HRQoL) and self-care behaviors are key elements of modern HF management programs. Thus, optimized strategies to improve these outcomes are sought.PurposeTo assess the effects of a new model of medical telecare on HRQoL and self-care in patients with HF (the AMULET study).MethodsThe study was prospective, randomized, open-label, and controlled with two parallel groups: telecare and standard care. In the telecare group, HF nurses performed patient clinical assessments with telemedical support by a cardiologist and provided education focused on the prevention of HF exacerbation. In the standard care group, patients were followed according to standard practices in the existing healthcare system. At the baseline and at 12 months, HRQoL was assessed using the Short Form 36 (SF-36) questionnaire and the Minnesota Living with Heart Failure Questionnaire (MLwHF). The level of self-care was assessed with the 12-item standardized European Heart Failure Self-care Behavior Scale (EHFScBS-12).ResultsIn the overall study group, 79% of the subjects were male, the mean age was 67 ± 14 years, and 59% of the subjects were older than 65 years of age. The majority of the subjects (70%) had a left ventricular ejection fraction below 40%. After 12 months, statistically significant increases in physical component of the SF-36 (43.3 vs. 47.4 for telecare vs. 43.4 vs. 46.6 for standard care) and mental component of SF-36 (58.4 vs. 62 for telecare vs. 60.4 vs. 64.2 for standard care) were noted, with no intergroup differences. However, patients receiving telecare showed improvement in specific domains, such as physical functioning, role-physical, bodily pain, vitality, social functioning, role-emotional, and mental health. There was a significant decrease in MLwHF (29 vs. 35.0; lower is better) at follow-up for both groups. Telecare patients had a statistically significant decrease in EHFScBS-12 (lower is better) at 12 months.ConclusionAMULET outpatient telecare, which is based on nurse-led non-invasive assessments supported by specialist teleconsultations, improved the HRQoL and self-care of HF patients after an episode of acute HF.
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- 2024
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3. Effects of hybrid comprehensive telerehabilitation on cardiopulmonary capacity in heart failure patients depending on diabetes mellitus: subanalysis of the TELEREH-HF randomized clinical trial
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Renata Główczyńska, Ewa Piotrowicz, Dominika Szalewska, Ryszard Piotrowicz, Ilona Kowalik, Michael J. Pencina, Wojciech Zaręba, Maciej Banach, Piotr Orzechowski, Sławomir Pluta, Robert Irzmański, Zbigniew Kalarus, and Grzegorz Opolski
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Hybrid rehabilitation ,Telerehabilitation ,Heart failure ,Exercise training ,Diabetes mellitus ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Type 2 diabetes mellitus (DM) is one of the most common comorbidities among patients with heart failure (HF) with reduced ejection fraction (HFrEF). There are limited data regarding efficacy of hybrid comprehensive telerehabilitation (HCTR) on cardiopulmonary exercise capacity in patients with HFrEF with versus those without diabetes. Aim The aim of the present study was to analyze effects of 9-week HCTR in comparison to usual care on parameters of cardiopulmonary exercise capacity in HF patients according to history of DM. Methods Clinically stable HF patients with left ventricular ejection fraction [LVEF]
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- 2021
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4. Antiarrhythmic effect of 9-week hybrid comprehensive telerehabilitation and its influence on cardiovascular mortality in long-term follow-up – subanalysis of the TELEREHabilitation in Heart Failure Patients randomized clinical trial
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Piotr Orzechowski, Ryszard Piotrowicz, Wojciech Zareba, Michael J. Pencina, Ilona Kowalik, Ewa Komar, Grzegorz Opolski, Maciej Banach, Renata Główczyńska, Dominika Szalewska, Sławomir Pluta, Robert Irzmański, Zbigniew Kalarus, and Ewa Piotrowicz
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ventricular arrhythmia ,heart failure ,telerehabilitation ,Medicine - Abstract
Introduction Cardiac rehabilitation is a component of heart failure (HF) management, but its effect on ventricular arrhythmias is not well understood. We analyzed the antiarrhythmic effect of a 9-week hybrid comprehensive telerehabilitation (HCTR) program and its influence on long-term cardiovascular mortality in HF patients taken from the TELEREHabilitation in Heart Failure Patients (TELEREH-HF) trial. Material and methods We evaluated the presence of non-sustained ventricular tachycardia (nsVT) and frequent premature ventricular complexes ≥ 10 beats/hour (PVCs ≥ 10) in 24-hour ECG monitoring at baseline and after 9-week HCTR or usual care (UC) of 773 HF patients (NYHA I-III, LVEF ≤ 40%). Functional response for HCTR was assessed by changes – delta (Δ) – in peak oxygen consumption (pVO2) as a result of comparing pVO2 from the beginning and the end of the program. Results Among 143 patients with nsVT, arrhythmia subsided in 30.8% after HCTR. Similarly, among 165 patients randomized to UC who had nsVT 34.5% did not show it after 9 weeks (p = 0.481). There was no significant difference in the decrease in PVC ≥ 10 over 9 weeks between randomization arms (14.9% vs. 17.8%, respectively p = 0.410). Functional response for HCTR in ΔpVO2 > 2.0 ml/kg/min did not affect occurrence of arrhythmias. Multivariable analysis did not identify HCTR as an independent factor determining improvement of nsVT or PVCs ≥ 10. However, only in the HCTR group, the achievement of the antiarrhythmic effect significantly reduced the cardiovascular mortality in 2-year follow-up (p < 0.001). Conclusions Significant improvement in physical capacity after 9 weeks of HCTR did not correlate with the antiarrhythmic effect in terms of incidence of nsVT or PVCs ≥ 10. An antiarrhythmic effect after the 9-week HCTR affected long-term cardiovascular mortality in HF patients.
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- 2021
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5. Nurse‐led ambulatory care supported by non‐invasive haemodynamic assessment after acute heart failure decompensation
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Paweł Krzesiński, Janusz Siebert, Ewa Anita Jankowska, Agata Galas, Katarzyna Piotrowicz, Adam Stańczyk, Paweł Siwołowski, Piotr Gutknecht, Paweł Chrom, Piotr Murawski, Andrzej Walczak, Dominika Szalewska, Waldemar Banasiak, Piotr Ponikowski, and Grzegorz Gielerak
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Heart failure ,Outpatient care impedance cardiography ,Haemodynamics ,Congestion ,Discharge ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Heart failure (HF) is characterized by frequent decompensation and an unpredictable trajectory. To prevent early hospital readmission, coordinated discharge planning and individual therapeutic approach are recommended. Aims We aimed to assess the effect of 1 month of ambulatory care, led by nurses and supported by non‐invasive haemodynamic assessment, on the functional status, well‐being, and haemodynamic status of patients post‐acute HF decompensation. Methods and results This study had a multicentre, prospective, and observational design and included patients with at least one hospitalization due to acute HF decompensation within 6 months prior to enrolment. The 1 month ambulatory care included three visits led by a nurse when the haemodynamic state of each patient was assessed non‐invasively by impedance cardiography, including thoracic fluid content assessment. The pharmacotherapy was modified basing on haemodynamic assessment. Sixty eight of 73 recruited patients (median age = 67 years; median left ventricular ejection fraction = 30%) finished 1 month follow‐up. A significant improvement was observed in both the patients' functional status as defined by New York Heart Association class (P = 0.013) and sense of well‐being as evaluated by a visual analogue score (P = 0.002). The detailed patients' assessment on subsequent visits resulted in changes of pharmacotherapy in a significant percentage of patients (Visit 2 = 39% and Visit 3 = 44%). Conclusions The proposed model of nurse‐led ambulatory care for patients after acute HF decompensation, with consequent assessment of the haemodynamic profile, resulted in: (i) improvement in the functional status, (ii) improvement in the well‐being, and (iii) high rate of pharmacotherapy modifications.
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- 2021
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6. An aetiology‐based subanalysis of the Telerehabilitation in Heart Failure Patients (TELEREH‐HF) trial
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Dominika Szalewska, Renata Główczyńska, Ryszard Piotrowicz, Ilona Kowalik, Michael J. Pencina, Grzegorz Opolski, Wojciech Zaręba, Maciej Banach, Piotr Orzechowski, Sławomir Pluta, Robert Irzmański, Zbigniew Kalarus, and Ewa Piotrowicz
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Hybrid rehabilitation ,Telerehabilitation ,Heart failure ,Exercise training ,Remote monitoring ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims The aim of our study was to analyse the benefits of a 9 week hybrid comprehensive telerehabilitation (HCTR) programme in heart failure (HF) patients according to aetiology, as a subanalysis of the Telerehabilitation in Heart Failure Patients (TELEREH‐HF) trial. Methods and results Overall, 555 (65.3%) patients with ischaemic (IS) and 295 (34.7%) patients with non‐ischaemic (NIS) HF aetiology were randomized. There were no differences between the effect of HCTR and usual care (UC) on the primary outcome of number of days alive and out of the hospital in 26 months from the time of randomization in either aetiology (Wilcoxon–Mann–Whitney test), and no heterogeneity of effect between the aetiologies was noted (van Elteren test, P = 0.746). In Cox proportional hazards regression analysis, treatment was not independently associated with the secondary outcomes. For all‐cause mortality, the adjusted hazard ratio for HCTR vs. UC was 0.90 (95% confidence interval, 0.54–1.51) in IS and 1.42 (95% confidence interval, 0.69–2.94) in NIS (P interaction = 0.316). Differences between HCTR and UC in terms of change in the 6 min walk test distance and cardiopulmonary exercise test time after 9 weeks reached statistical significance in the IS arm (P = 0.015 and P
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- 2021
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7. Quality of life in heart failure patients undergoing hybrid comprehensive telerehabilitation versus usual care – results of the Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomized Clinical Trial
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Ewa Piotrowicz, Anna Mierzyńska, Maciej Banach, Izabela Jaworska, Michał Pencina, Ilona Kowalik, Sławomir Pluta, Dominika Szalewska, Grzegorz Opolski, Wojciech Zaręba, Renata Glowczynska, Robert Irzmański, Piotr Orzechowski, Zbigniew Kalarus, and Ryszard Piotrowicz
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quality of life ,heart failure ,hybrid telerehabilitation ,telemanagement ,Medicine - Abstract
Introduction Hybrid comprehensive telerehabilitation (HCTR) consisting of telecare (with psychological telesupport), telerehabilitation and remote monitoring of implantable devices might be an innovative option improving heart failure (HF) patients’ quality of life (QoL) and emotional health. The aim of the study was to investigate the influence of HCTR on various facets of QoL in HF patients in comparison with usual care (UC) alone. Material and methods The present analysis formed part of a multicenter, randomized trial that enrolled 850 HF patients (NYHA I–III, LVEF ≤ 40%). Patients were randomized 1 : 1 to HCTR plus UC or UC only. Patients underwent either an HCTR program or UC with observation. The psychological intervention in the HCTR group included supportive psychological counseling via mobile phone. The Medical Outcome Survey Short Form 36 Questionnaire was used to assess QoL. Measurements were made before and after a 9-week intervention (HCTR group)/observation (UC group). Results After the intervention, the HCTR group showed significant improvement in overall QoL, physical domain (PD) of QoL, and 4 areas of QoL (physical functioning (PhF), role functioning related to physical state (RF), general health (GH), vitality (VI)). A significant positive change in QoL in the UC group was observed only in VI and social functioning. There were also significant differences in QoL after 9-week intervention/observation between the two groups. The results showed greater improvement in HCTR for overall QoL (p = 0.009), PD of QoL (p = 0.0003) and three specific areas of QoL: PhF (p = 0.001), RF (p = 0.003), bodily pain (BP) (p = 0.015). Conclusions In comparison to UC, HCTR resulted in improvement in overall QoL, PD of QoL and 3 specific areas of QoL: PhF, RF and BP.
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- 2020
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8. Assessment of ECG during hybrid comprehensive telerehabilitation in heart failure patients—Subanalysis of the Telerehabilitation in Heart Failure Patients (TELEREH‐HF) randomized clinical trial
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Piotr Orzechowski, Ryszard Piotrowicz, Wojciech Zaręba, Renata Główczyńska, Dominika Szalewska, Sławomir Pluta, Robert Irzmański, Zbigniew Kalarus, Maciej Banach, Grzegorz Opolski, Michael J. Pencina, Ilona Kowalik, and Ewa Piotrowicz
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arrhythmia ,cardiac telerehabilitation ,ECG monitoring ,heart failure ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Exercise training in heart failure (HF) patients should be monitored to ensure patients’ safety. Electrocardiographic (ECG) telemonitoring was used to assess the safety of hybrid comprehensive telerehabilitation (HCTR). Objective Analysis of ECG recorded during HCTR in HF patients. Methods The TELEREH‐HF multicenter, randomized, controlled trial enrolled 850 HF patients with New York Heart Association class I‐III and left ventricular ejection fraction of ≤40%. This subanalysis focuses on 386 patients (aged 62 ± 11 years, LVEF 31 ± 7%) randomized to HCTR. HCTR was telemonitored with a device allowing to record 16‐s fragments of ECG and to transmit the data via mobile phone network to the monitoring center. ResultsIn 386 patients, 16,622 HCTR sessions were recorded and 66,488 ECGs fragments were evaluated. Sinus rhythm was present in 320 (83%) and permanent atrial fibrillation (AF) in 66 (17%) patients, respectively. The most common arrhythmias were ventricular and atrial premature beats, recorded in 76.4% and 27.7% of the patients, respectively. Non‐sustained ventricular tachycardia (21 episodes in 8 patients) and paroxysmal AF episodes (6 in 4 patients) were rare. None of the analyzed demographic and clinical characteristics was predictive for onset of the new arrhythmias on exercise. Conclusion Telerehabilitation in HF patients was safe without the evidence for symptomatic arrhythmias requiring discontinuation of telerehabilitation. Only one mildly symptomatic paroxysmal AF episode led to the short‐term suspension of the training program. The most common arrhythmias were atrial and ventricular premature beats. These arrhythmias did not result in any changes in rehabilitation and therapy regimens.
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- 2021
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9. Heart Failure Patients’ Adherence to Hybrid Comprehensive Telerehabilitation and Its Impact on Prognosis Based on Data from TELEREH-HF Randomized Clinical Trial
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Ewa Piotrowicz, Michael Pencina, Grzegorz Opolski, Wojciech Zaręba, Maciej Banach, Ilona Kowalik, Piotr Orzechowski, Renata Główczyńska, Dominika Szalewska, Sławomir Pluta, Zbigniew Kalarus, Robert Irzmański, and Ryszard Piotrowicz
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telerehabilitation ,adherence ,heart failure ,Technology ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Biology (General) ,QH301-705.5 ,Physics ,QC1-999 ,Chemistry ,QD1-999 - Abstract
(1) Background Adherence to treatment guidelines in heart failure (HF) patients is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Introducing hybrid comprehensive telerehabilitation (HCTR) consisting of telecare, telerehabilitation, and remote monitoring of implantable devices might be an option to improve adherence to recommendation and can affect the prognosis. The purpose is to investigate the association of adherence to HCTR with mortality and hospitalization. (2) Methods This analysis formed part of TELEREH-HF multi-center, randomized trial that enrolled 850HF patients (NYHA I-III;LVEF ≤ 40%). Patients were randomized 1:1 to 9-week HCTR (1 week in hospital and 8 weeks at home) plus usual care or usual care only and followed-up for 14 to 26 months. This analysis focuses on the HCTR group. Adherent patients were those who adhered both to the number of training sessions prescribed and to the duration of the prescribed cycle by at least 80%; non-adherent patients were those who adhered(3) Results There were 350 (88.4%) adherent patients, 39 (9.8%) partially adherent patients, and 7 (1.8%) non-adherent patients. There were 46 deaths during follow-up. Non-adherence or partial adherence was associated with higher risk of cardiovascular (CV) mortality (hazard ratio (HR) = 2.62, p = 0.021); all-cause mortality or HF hospitalization (HR = 1.71, p = 0.038); CV mortality or HF hospitalization (HR = 1.89, p = 0.014). (4) Conclusions The adherence to HCTR was high. Adherence to HCTR was associated with improved prognosis for CV mortality and the reduction in the combined outcome of CV mortality or HF hospitalization.
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- 2022
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10. Assessment of awareness of post-hospital rehabilitation need in patients after acute coronary syndrome and after stroke
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Dominika Szalewska, Agnieszka Dudaniec-Tarkowska, and Piotr Zieliński
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rehabilitation ,acute coronary syndrome ,stroke ,Agriculture ,Environmental sciences ,GE1-350 - Abstract
Introduction Acute coronary syndrome (ACS) and stroke are the leading causes of mortality and long-term morbidity across the world. Post-hospital rehabilitation (PHR) is strongly recommended in both groups. Objective The purpose was assessment of awareness of the PHR need in patients after ACS and after ischaemic stroke (IS). Material and Methods The study included 60 patients (17 F, 43 M), 62 ± 13.6 years of age, admitted to hospital due to ACS (n=30 pts) or IS (n=30 pts). A cross-sectional survey was carried out in order to evaluate awareness of the PHR need through a questionnaire composed of 14 one-choice answer questions. Results There was no significant correlation between place of residence and willingness to participate in the PHR programme: 69.2% (n=9) of the pts living in rural areas and 80.9% (n=38) living in the city declared their willingness to partcipate. The majority of patients declared that PHR is needed (87.5% of pts with basic educational level, 63.2% with vocational education, 61.1% with technical education, 80% with university education level). 43.3% (n=13) of pts after ACS and 66.7% (n=20) pts after IS declared they had been informed about the possibility of PHR. Altogether, 46.7% (n=14) of pts after ACS and 33.3% (n=10) after stroke understood it to be a stay in a spa; only 10% (n=3) of pts after ACS and 33.3% (n=10) after IS understood it correctly. 30% (n=9) pts after ACS and 13.3% (n=4) after IS saw it as a change in lifestyle and 13.3% (n=4) pts after ACS and 20% (n=6) after IS declared they did not know what PHR was. Conclusions Type of place of residence and educational level had no association with the PHR need. Patients after IS were more aware than those after ACS. Increased independence was the main expectation in both groups. The majority of patients perceived PHR to consist of treatment in a spa. Too few patients were informed about the possibility of PHR.
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- 2017
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11. 'Center of Geriatric Care' project- the development of the interdisciplinary home-based care model for elderly patients in Gdansk, Poland. Pilot study
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Karol Wierzba, Hanna Kujawska-Danecka, Dominika Szalewska, Piotr Popowski, Iwona Damps-Konstańska, Marta Żarczyńska-Buchowiecka, Katarzyna Świętnicka, Adam Hajduk, Iwona Stopczyńska, Marzena Olszewska-Karaban, Zbigniew Zdrojewski, Marcin Gruchała, and Ewa Jas
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integrated care. elderly. home-based care. pre-frail. rehabilitation ,Medicine (General) ,R5-920 - Abstract
Introduction: Integrated care for elderly patients is not a standard in Central European Countries (CEC). Lack of coordination between healthcare service providers and social support, and diverse financing has led to low effectiveness of the whole care system for elderly. Short description of practice changes implemented: "Center of Geriatric Care" project assumes development of integrated model of care for elderly patients, managed by interdisciplinary geriatric team. The essential aims are: to develop an effective, coordinated and integrated management, based on the patient-centred triangle consisting of healthcare providers - social workers – family. to educate patients and caregivers extensively with the intension of lowering deterioration and exacerbations of the underlying chronic disease. Aim and theory of change: The aim of the study is to improve the management of elderly patients, to decrease the incidence of exacerbations (especially those requiring hospitalisation), to hamper the deterioration of general health condition, and finally to reduce the cost of care. Target population and stakeholders: In the pilot study, the model of care would be delivered to 90 multimorbid elderly, recruited from three different healthcare pathways (primary care, n=30; patients with chronic heart failure, n=30; patients with chronic obstructive pulmonary disease, n=30). In our model, existing healthcare services will be broadened by: 1- Periodic evaluation by geriatricians with use of comprehensive geriatric assessment tools. 2- Regular home visits of specially trained carers, which include monitoring of general condition, encouraging appropriate physical activity and supporting adherence to medical recommendations, alerting about significant symptoms. 3- Comprehensive rehabilitation based on regular physiotherapy. 4- Using selected, simple e-health interventions. Timeline: 24 months. Highlights (innovation, Impact and outcomes): The primary outcome of the project is to design and testing of a model of home-based integrated care, which is innovative in Poland and CEC. The expected results include improvement in functional and cognitive status and quality of life of patients, followed by decrease in general demand for medical services, especially in-hospital, and selected health economics indicators. The secondary outcome is to increase the knowledge and competencies of social workers, nurses, physiotherapists and family members on the management of elderly chronically ill patients, and to improve cooperation between these groups and medical staff. Comments on sustainability: After the pilot study, the implementation of the model, or further testing on larger population, would be a matter of discussion between team members and decision-makers on local and national level. Comments on transferability: The proposed model of care seems to be possible to implement in Polish healthcare system, as it enhances coordination between already existing institutions and local care-providing structures. Conclusions (comprising key findings): Current work on designing the model indicates, that crucial area for change is to coordinate already existing institutional structures. Discussions: Detailed conclusions would be drawn after the testing the model. Lessons learned: The work on designing the model has already resulted in the successful creation of an active network of specialists from different backgrounds and allowed sharing different scopes, how to use limited resources for the benefit of the elderly.
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- 2019
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12. Physical activity patterns, depressive symptoms and awareness of cardiovascular risk factors in postpartum women
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Dominika Szalewska and Magdalena Skrzypkowska
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physical activity ,depressive symptom ,health awareness ,postpartum ,Agriculture ,Environmental sciences ,GE1-350 - Abstract
Introduction and objectives Although physical activity has been found to reduce the risk of cardiovascular diseases and depression in the general population, little is known about physical patterns and the link with postnatal depressive symptoms and awareness of cardiovascular risk factors in postpartum women. The aim of this study was to examine physical activity patterns and their link to depressive symptoms in postpartum women. The secondary endpoint was the assessment of health awareness in women six months after delivery. Material and Methods Eighty postpartum women with a mean age of 27±4 years (group A – 40 physically active women, group B – 40 women leading a sedentary lifestyle) completed a self-report questionnaire and The Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Results In group A, the types of physical activity undertaken in the six-month period after delivery were as follows: 20 women – housework (180 min/session), 18 women – gentle walks (180 min/session), 16 women – group fitness classes (60 min/session), 6 – rapid walking (40 min/session), 3 women – swimming (60 min/session), 2 women – jogging (45 min/session), 1 woman – squash, (45 min/session) 1 – dancing (90 min/session), 1 – tennis (60min/session). Group B declared a sedentary lifestyle and physical activity of less than 30 min a day. The level of health awareness was statistically better in women who were physically active six months after delivery than in women who led a sedentary lifestyle. On a scale with a maximum 55 points, the mean scores were 47.4 in group A and 31.2 in group B (p=0.001). Depressive symptoms were more pronounced in group B. Twenty seven women from group A and three women from group B returned to their pre-pregnancy weight (p=0.04). Conclusions Women who were physically active after delivery were characterized by higher health awareness and more frequent return to pre-pregnancy weight. Physical activity may be important for reducing the risk of postnatal depression.
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- 2016
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13. The impact of professional status on the effects of and adherence to the outpatient followed by home-based telemonitored cardiac rehabilitation in patients referred by a social insurance institution
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Dominika Szalewska, Piotr Niedoszytko, and Katarzyna Gierat-Haponiuk
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rehabilitation ,coronary artery disease ,telemedicine ,cardiac rehabilitation ,social benefit ,occupational status ,Medicine - Abstract
Objectives: Legislators and policymakers have expressed strong interest in intervention programs to reduce dependence on social disability benefits. Hybrid: ambulatory followed by home-based cardiac telerehabilitation – hybrid cardiac rehabilitation (HCR) seems to be a novel alternative for standard cardiac rehabilitation for patients with cardiovascular diseases (CVD) as a form of pension prevention paid by the Social Insurance Institution (SII). The kind of professional status may bias the motivation to return to work after HCR. The aim of our study was to evaluate whether the professional status can affect the effects of HCR. Material and Methods: One hundred fifty-two patients with CVD referred by the SII for a 5-week HCR were qualified for the study. Patients (87.7% males), aged 57.31±5.61 years, were divided into 2 subgroups: W) white-collar employees (N = 22) and B) blue-collar employees (N = 130). To evaluate functional capacity, an exercise test on a treadmill was used. Results: The number of days of absence in the cardiac rehabilitation program did not differ between the groups (mean ± standard deviation – B: 1.09±3.10 days, W: 1.95±3.64 days). There were significant improvements (p < 0.05) in measured variables after HCR in both (W and B) groups (max workload: 8.21±2.88 METs (measured in metabolic equivalents) vs. 9.6±2.49 METs, 7.76±2.51 METs vs. 8.73±2.7 METs, resting heart rate (RHR): 77±16.22 bpm vs. 69.94±12.93 bpm, 79.59±14 bpm vs. 75.24±11.87 bpm; double product, i.e., product of heart rate and systolic BP (DP rest) 10 815.22±2968.24 vs. 9242.94±1923.08, 10 927.62±2508.47 vs. 9929.7±2304.94). In group B, a decrease in systolic blood pressure (BP syst. – 137.03±17.14 mm Hg vs. 131.82±21.13 mm Hg), heart rate recovery in the 1st minute after the end of peak exercise (HRR1) (99.38±19.25 vs. 93.9±19.48) and New York Heart Association (NYHA) class (1.22±0.53 vs. 1.11±0.36) was observed. In group W, a decrease in diastolic blood pressure (BP diast.) at rest was observed (88.28±9.79 mm Hg vs. 83.39±8.95 mm Hg). The decrease in resting HR was significantly greater in group W (69.94±12.93 vs. 75.24±11.87, p = 0.034). Conclusions: Hybrid cardiac rehabilitation is feasible and safe with high adherence to the program regardless of the patient’s professional status. Professional status did not influence the beneficial effect of HCR on exercise tolerance.
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- 2015
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14. Predictors of proarrhythmic effect in heart failure patients after 9-week hybrid comprehensive telerehabilitation and their influence on cardiovascular mortality in long-term follow-up: Subanalysis of the TELEREH-HF randomized clinical trial
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Ewa Piotrowicz, Piotr Orzechowski, Ilona Kowalik, Wojciech Zaręba, Michael Pencina, Ewa Komar, Grzegorz Opolski, Maciej Banach, Sławomir Pluta, Renata Główczyńska, Dominika Szalewska, Zbigniew Kalarus, Robert Irzmański, and Ryszard Piotrowicz
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Heart Failure ,Electrocardiography ,Natriuretic Peptide, Brain ,Humans ,Stroke Volume ,Prognosis ,Cardiology and Cardiovascular Medicine ,Ventricular Function, Left ,Peptide Fragments ,Biomarkers ,Telerehabilitation - Abstract
Regular exercise training is beneficial in heart failure (HF) patients. However, its potential proarrhythmic effect is possible but has not been sufficiently investigated.To identify patients at risk for proarrhythmic effect after the 9-week of hybrid comprehensive telerehabilitation (HCTR) program vs the 9-week of usual care (UC) and to investigate its predictors and impact on cardiovascular mortality based on data from the TELEREH-HF RCT.Proarrhythmic effect, strictly defined on the basis of available standards was evaluated by comparing 24-h Holter ECG before and after 9-week of HCTR or UC of 773 HF patients (The New York Heart Association class I-III, left ventricular ejection fraction ≤40%).The proarrhytmic effect was found in 78 (20.4%) and in 61 (15.6%) patients in the HCTR and UC group respectively, and the difference between groups was not statistically significant (p = 0.081). However, univariate analysis identified several statistically significant predictors of proarrhythmia in HCTR only vs the UC group. After a multivariate analysis ischaemic aetiology of HF (OR = 2.27, p = 0.008), peak oxygen consumption at baseline14 ml/kg/min (OR = 2.03, p = 0.012) and level of N-terminal-pro B-type natriuretic peptide (NT-proBNP) in the first and the second tercile (OR = 1.85, p = 0.043) were identified to be independent predictors of proarrhytmic effect of exercise training among the HF patients in HCTR group only.Patients who underwent a 9-week HCTR were not at a higher risk of proarrhythmic effect after its completion compared to UC. However, predictors of proarrhythmia such as ischemic aetiology of HF, poor physical capacity, lower NT-proBNP level were discovered in the HCTR group only, yet it does not cause a significant risk of cardiovascular mortality including sudden cardiac death in long-term follow-up.
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- 2022
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15. Relationship between physical capacity and depression in heart failure patients undergoing hybrid comprehensive telerehabilitation vs. usual care: subanalysis from the TELEREH-HF Randomized Clinical Trial
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Ewa Piotrowicz, Anna Mierzyńska, Izabela Jaworska, Grzegorz Opolski, Maciej Banach, Wojciech Zaręba, Ilona Kowalik, Michael Pencina, Piotr Orzechowski, Dominika Szalewska, Sławomir Pluta, Renata Glowczynska, Zbigniew Kalarus, Robert Irzmanski, and Ryszard Piotrowicz
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Heart Failure ,Advanced and Specialized Nursing ,Medical–Surgical Nursing ,Treatment Outcome ,Depression ,Quality of Life ,Humans ,Stroke Volume ,Cardiology and Cardiovascular Medicine ,Ventricular Function, Left ,Telerehabilitation - Abstract
Aims The hybrid comprehensive telerehabilitation (HCTR) consisting of telecare (with psychological telesupport), telerehabilitation, and remote monitoring of cardiovascular implantable electronic devices might be an option to improve both physical capacity and depressive symptoms. The aim of the study was to investigate the influence of HCTR on depressive symptoms and physical capacity in heart failure (HF) patients in comparison with usual care (UC). Methods and results The present analysis formed part of a multicentre, randomized trial that enrolled 850 HF patients (New York Heart Association I–III, left ventricular ejection fraction ≤ 40%). Patients were randomized 1:1 to HCTR or UC. Patients underwent an HCTR programme (1 week in hospital and 8 weeks at home; exercise training 5 times weekly) or UC with observation. The Beck Depression Inventory II (BDI-II) score (cut point for depression ≥ 14) was used to assess depression and the physical capacity was measured by peak oxygen consumption (peak VO2; mL/kg/min). Measurements were made before and after 9-week intervention/observation (HCTR/UC group). Both groups were comparable in terms of demographic and clinical characteristics. In HCTR group, at entry, 23% of the sample obtained BDI-II scores ≥14 vs. 27.5% in UC group. There were no significant differences between groups regarding ΔBDI-II score (P = 0.992) after 9-week HCTR/UC. There was a significant improvement in physical capacity only in the HCTR group in both patients with (P = 0.033) and without (P < 0.001) depression. Conclusions In HF patients, HCTR provided similar reduction of depressive symptoms as UC. HCTR resulted in a significant improvement in physical capacity in patients with and without depression.
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- 2022
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16. Effects of an outpatient intervention comprising nurse‐led non‐invasive assessments, telemedicine support and remote cardiologists' decisions in patients with heart failure ( <scp>AMULET</scp> study): a randomised controlled trial
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Paweł Siwołowski, Janusz Siebert, Paweł Chrom, Piotr Gutknecht, Ewa A. Jankowska, Paweł Krzesiński, Agata Galas, Katarzyna Piotrowicz, Dominika Szalewska, Piotr Murawski, Grzegorz Gielerak, Adam Stańczyk, Waldemar Banasiak, Andrzej Walczak, and Piotr Ponikowski
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Telemedicine ,medicine.medical_specialty ,Randomization ,Context (language use) ,Nurse's Role ,Ventricular Function, Left ,law.invention ,Cardiologists ,Ambulatory care ,Randomized controlled trial ,law ,Outpatients ,Humans ,Medicine ,Prospective Studies ,Heart Failure ,Ejection fraction ,business.industry ,Telecare ,Stroke Volume ,medicine.disease ,Hospitalization ,Heart failure ,Emergency medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aim Prevention of heart failure (HF) hospitalisations and deaths constitutes a major therapeutic aim in patients with HF. The role of telemedicine in this context remains equivocal. We investigated whether an outpatient telecare based on nurse-led non-invasive assessments supporting remote therapeutic decisions (AMULET telecare) could improve clinical outcomes in patients after an episode of acute HF during the12-month follow-up. Methods and results In this prospective randomised controlled trial, patients with HF and left ventricular ejection fraction (LVEF) ≤49%, after an episode of acute HF within recent 6 months, were randomly assigned to receive either an outpatient telecare based on nurse-led non-invasive assessments (n = 300) (AMULET model) or standard care (n = 305). The primary outcome, being a composite of unplanned HF hospitalisation or cardiovascular death, occurred in 51 (17.1%) patients in the telecare group and 73 (23.9%) patients in the standard care group up to 12 months after randomization (HR: 0.69, 95% CI: 0.48-0.99, p = 0.044). The implementation of AMULET telecare, as compared to the standard care, reduced the risk of first unplanned HF hospitalisation (HR: 0.62; 95% CI: 0.42-0.91, p = 0.015) as well as the risk of total unplanned HF hospitalisations (HR: 0.64, 95% CI: 0.41-0.99, p = 0.044).There was no difference in cardiovascular mortality between the study groups (HR: 1.03, 95% CI: 0.54-1.67, p = 0.930). Conclusion AMULET telecare as compared to standard care significantly reduced the risk of HF hospitalisation or cardiovascular death during the 12-month follow-up among patients with HF and LVEF≤49% after an episode of acute HF (ClinicalTrials.gov: NCT03476590).
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- 2021
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17. Impairment of Proprioception in Young Adult Nonradicular Patients with Lumbar Derangement Syndrome
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Andrzej Permoda, Anna K Permoda-Białozorczyk, Aneta Dąbrowska, Ewa Bandurska, Agnieszka Sobierajska-Rek, Jolanta Zajt, Marzena Olszewska-Karaban, and Dominika Szalewska
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Adult ,Male ,medicine.medical_specialty ,Article Subject ,Visual Analog Scale ,Posture ,Pain ,General Biochemistry, Genetics and Molecular Biology ,Disability Evaluation ,Young Adult ,Lumbar ,Physical medicine and rehabilitation ,Statistical significance ,Post-hoc analysis ,Humans ,Medicine ,Young adult ,Exercise ,Vestibular system ,Lumbar Vertebrae ,General Immunology and Microbiology ,Proprioception ,business.industry ,Syndrome ,General Medicine ,Physical activity level ,Female ,Analysis of variance ,business ,Research Article - Abstract
Maintaining body balance is a complex function based on the information deriving from the vestibular, visual, and proprioceptive systems. The aim of the study was to evaluate quiet single stance stability in young adults with lumbar derangement syndrome (LDS) and in the control group of the healthy subjects. The second aim of this study was to determine whether pain intensity, degree of disability, and the level of physical activity can influence postural control in patients with LDS. It is important to underline that selecting a homogeneous group of LBP patients using, for example, mechanical diagnosis and therapy method and Quebec Task Force Classification, can result in an increased sensitivity of the study. The study included 126 subjects: 70 patients with LDS (37 women, 33 men) and the control group 56 healthy volunteers (36 women, 20 men). In case of multiple group comparisons for variables with normal distribution, ANOVA post hoc test was used or, as the nonparametric equivalent, Kruskal-Wallis test. In all these calculations, the statistical significance level was set to p < 0.05 . The stability index eyes open for the study group was 88.34 and for the control group 89.86. There was no significant difference in the level of postural control between the study and control groups ( p > 0.05 ). The level of stability index eyes closed (SI EC) for the study group was 71.44 and for the control group 77.1. SI EC results showed significant differences in proprioceptive control during single leg stance between the study and control groups ( p < 0.05 ). The level of pain intensity, the degree of disability, and physical activity level did not influence postural control in the study group with LDS. In summary, patients with LDS showed significantly worse proprioceptive control.
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- 2021
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18. Comprehensive cardiac rehabilitation as the keystone in the secondary prevention of cardiovascular disease
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Ewa Straburzyńska-Migaj, Agnieszka Mawlichanów, Anna Jegier, Ryszard Piotrowicz, Zbigniew Eysymontt, Ewa Piotrowicz, Michał Gałaszek, Krzysztof Smarż, Dominika Szalewska, Anna Mierzyńska, Jadwiga Wolszakiewicz, Edyta Smolis-Bąk, Artur Mamcarz, and Tadeusz Bednarczyk
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medicine.medical_specialty ,Cardiac Rehabilitation ,Rehabilitation ,business.industry ,medicine.medical_treatment ,Cardiology ,Evidence-based medicine ,Disease ,medicine.disease ,Coronary artery disease ,Cardiovascular Diseases ,Risk Factors ,Heart failure ,Secondary Prevention ,medicine ,Humans ,Myocardial infarction ,Exercise physiology ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Psychosocial - Abstract
Comprehensive cardiac rehabilitation (CR) is a mainstay of the secondary prevention of cardiovascular disease. In the European Society of Cardiology guidelines, comprehensive cardiovascular rehabilitation has the highest class of recommendation and level of evidence as an effective method for the treatment of patients with ST-segment elevation myocardial infarction, after myocardial revascularization, with chronic coronary syndrome, for CVD prevention in clinical practice, and in patients with heart failure (HF). This document presents an expert opinion of the Cardiac Rehabilitation and Exercise Physiology Section of the Polish Cardiac Society concerning the definition, goals, target population, organization of rehabilitation services, standard clinical indications and methods of implementation. Moreover, it describes psychosocial risk factors influencing the course of CR and secondary prevention of cardiovascular disease in patients undergoing CR. Comprehensive CR is as a process that should be implemented as soon as possible, continued without interruption, and consist of multiple stages. Moreover, it should be tailored to the individual clinical situation and should be accepted by the patient and their family, friends, and caregivers.
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- 2021
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19. Quality of life in heart failure patients undergoing hybrid comprehensive telerehabilitation versus usual care – results of the Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomized Clinical Trial
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Renata Główczyńska, Maciej Banach, Ewa Piotrowicz, Ilona Kowalik, Michał Pencina, Anna Mierzyńska, Piotr Orzechowski, Wojciech Zareba, Sławomir Pluta, Ryszard Piotrowicz, Robert Irzmański, Grzegorz Opolski, Izabela Jaworska, Dominika Szalewska, and Zbigniew Kalarus
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medicine.medical_specialty ,business.industry ,heart failure ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,humanities ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Randomized controlled trial ,quality of life ,hybrid telerehabilitation ,telemanagement ,law ,Clinical Research ,Heart failure ,Telerehabilitation ,Usual care ,Physical therapy ,medicine ,030212 general & internal medicine ,business - Abstract
IntroductionHybrid comprehensive telerehabilitation (HCTR) consisting of telecare (with psychological telesupport), telerehabilitation and remote monitoring of implantable devices might be an innovative option improving heart failure (HF) patients’ quality of life (QoL) and emotional health. The aim of the study was to investigate the influence of HCTR on various facets of QoL in HF patients in comparison with usual care (UC) alone.Material and methodsThe present analysis formed part of a multicenter, randomized trial that enrolled 850 HF patients (NYHA I–III, LVEF ≤ 40%). Patients were randomized 1 : 1 to HCTR plus UC or UC only. Patients underwent either an HCTR program or UC with observation. The psychological intervention in the HCTR group included supportive psychological counseling via mobile phone. The Medical Outcome Survey Short Form 36 Questionnaire was used to assess QoL. Measurements were made before and after a 9-week intervention (HCTR group)/observation (UC group).ResultsAfter the intervention, the HCTR group showed significant improvement in overall QoL, physical domain (PD) of QoL, and 4 areas of QoL (physical functioning (PhF), role functioning related to physical state (RF), general health (GH), vitality (VI)). A significant positive change in QoL in the UC group was observed only in VI and social functioning. There were also significant differences in QoL after 9-week intervention/observation between the two groups. The results showed greater improvement in HCTR for overall QoL (p = 0.009), PD of QoL (p = 0.0003) and three specific areas of QoL: PhF (p = 0.001), RF (p = 0.003), bodily pain (BP) (p = 0.015).ConclusionsIn comparison to UC, HCTR resulted in improvement in overall QoL, PD of QoL and 3 specific areas of QoL: PhF, RF and BP.
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- 2020
20. Prognostic Impact of Hybrid Comprehensive Telerehabilitation Regarding Diastolic Dysfunction in Patients with Heart Failure with Reduced Ejection Fraction-Subanalysis of the TELEREH-HF Randomized Clinical Trial
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Robert Irzmański, Renata Glowczynska, Maciej Banach, Dominika Szalewska, Ryszard Piotrowicz, Ilona Kowalik, Michael J. Pencina, Wojciech Zareba, Piotr Orzechowski, Slawomir Pluta, Zbigniew Kalarus, Grzegorz Opolski, and Ewa Piotrowicz
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hybrid telerehabilitation ,heart failure with reduced ejection fraction ,diastolic function ,General Medicine - Abstract
Aims: The objective of the study was to evaluate the effects of individually prescribed hybrid comprehensive telerehabilitation (HCTR) implemented at patients’ homes on left ventricular (LV) diastolic function in heart failure (HF) patients. Methods and results: The Telerehabilitation in Heart Failure Patients trial (TELEREH-HF) is a multicenter, prospective, randomized (1:1), open-label, parallel-group, controlled trial involving HF patients assigned either to HCTR involving a remotely monitored home training program in conjunction with usual care (HCTR group) or usual care only (UC group). The patient in the HCTR group underwent a 9-week HCTR program consisting of two stages: an initial stage (1 week) conducted in hospital and the subsequent stage (eight weeks) of home-based HCTR five times weekly. Due to difficulties of proper assessment and differences in the evaluation of diastolic function in patients with atrial fibrillation, we included in our subanalysis only patients with sinus rhythm. Depending on the grade of diastolic dysfunction, patients were assigned to subgroups with mild diastolic (MDD) or severe diastolic dysfunction (SDD), both in HCTR (HCTR-MDD and HCTR-SDD) and UC groups (UC-MDD and UC-SDD). Changes from baseline to 9 weeks in echocardiographic parameters were seen only in A velocities in HCTR-MDD vs. UC-MDD; no significant shifts between groups of different diastolic dysfunction grades were observed after HCTR. All-cause mortality was higher in UC-SDD vs. UC-MDD with no difference between HCTR-SDD and HCTR-MDD. Higher probability of HF hospitalization was observed in HCTR-SDD than HCTR-MDD and in UC-SDD than UC-MDD. No differences in the probability of cardiovascular mortality and hospitalization were found. Conclusions: HCTR did not influence diastolic function in HF patients in a significant manner. The grade of diastolic dysfunction had an impact on mortality only in the UC group and HF hospitalization over a 12–24-month follow-up in HCTR and UC groups.
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- 2022
21. Value-Based Integrated Care (VBIC) Concept Implementation in a Real-World Setting—Problem-Based Analysis of Barriers and Challenges
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Ewa Bandurska, Weronika Ciećko, Marzena Olszewska-Karaban, Iwona Damps-Konstańska, Dominika Szalewska, Piotr Janowiak, and Ewa Jassem
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Health Information Management ,Leadership and Management ,Health Policy ,Health Informatics - Abstract
Healthcare effectiveness measurement and value in health have been common topics in public health literature since 2006 when value-based healthcare (VBHC) was first defined by Porter and Teisberg. The aim of this study was to identify the barriers and challenges related to the implementation of VBHC solutions in the example of Poland. A case presentation was used as a method. The national integrated care programs (KOS-Infarction, POZ-Plus, and comprehensive treatment of chronic wounds) were used to present general challenges, along with the Integrated Care Model (ICM) for patients with advanced chronic obstructive pulmonary disease (COPD), to determine specific difficulties. ICM has been operating since 2012 in Gdańsk and gradually adapted the value-based integrated care (VBIC) approach. An analysis of the available data showed that the greatest difficulties related to the implementation of the VBHC and VBIC concepts are a lack of legal and reimbursement solutions, staff shortages, a lack of educational standards for some members of the multidisciplinary team, and insufficient awareness of the role of integrated care. As the level of preparation to implement VBHC policies varies between individual countries, the conclusions drawn from the experience of ICM and other Polish projects may be a valuable voice in discussion.
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- 2023
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22. Assessment of ECG during hybrid comprehensive telerehabilitation in heart failure patients—Subanalysis of the Telerehabilitation in Heart Failure Patients (TELEREH‐HF) randomized clinical trial
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Renata Główczyńska, Ewa Piotrowicz, Wojciech Zareba, Maciej Banach, Ryszard Piotrowicz, Zbigniew Kalarus, Dominika Szalewska, Grzegorz Opolski, Michael J. Pencina, Robert Irzmański, Piotr Orzechowski, Sławomir Pluta, and Ilona Kowalik
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medicine.medical_specialty ,heart failure ,ECG monitoring ,Ventricular tachycardia ,arrhythmia ,Ventricular Function, Left ,law.invention ,Electrocardiography ,Randomized controlled trial ,cardiac telerehabilitation ,law ,Physiology (medical) ,Telerehabilitation ,Internal medicine ,Atrial Fibrillation ,Medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Sinus rhythm ,cardiovascular diseases ,Ejection fraction ,business.industry ,Atrial fibrillation ,Stroke Volume ,General Medicine ,Original Articles ,medicine.disease ,Discontinuation ,Heart failure ,RC666-701 ,Cardiology ,cardiovascular system ,Original Article ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Exercise training in heart failure (HF) patients should be monitored to ensure patients’ safety. Electrocardiographic (ECG) telemonitoring was used to assess the safety of hybrid comprehensive telerehabilitation (HCTR). Objective Analysis of ECG recorded during HCTR in HF patients. Methods The TELEREH‐HF multicenter, randomized, controlled trial enrolled 850 HF patients with New York Heart Association class I‐III and left ventricular ejection fraction of ≤40%. This subanalysis focuses on 386 patients (aged 62 ± 11 years, LVEF 31 ± 7%) randomized to HCTR. HCTR was telemonitored with a device allowing to record 16‐s fragments of ECG and to transmit the data via mobile phone network to the monitoring center. ResultsIn 386 patients, 16,622 HCTR sessions were recorded and 66,488 ECGs fragments were evaluated. Sinus rhythm was present in 320 (83%) and permanent atrial fibrillation (AF) in 66 (17%) patients, respectively. The most common arrhythmias were ventricular and atrial premature beats, recorded in 76.4% and 27.7% of the patients, respectively. Non‐sustained ventricular tachycardia (21 episodes in 8 patients) and paroxysmal AF episodes (6 in 4 patients) were rare. None of the analyzed demographic and clinical characteristics was predictive for onset of the new arrhythmias on exercise. Conclusion Telerehabilitation in HF patients was safe without the evidence for symptomatic arrhythmias requiring discontinuation of telerehabilitation. Only one mildly symptomatic paroxysmal AF episode led to the short‐term suspension of the training program. The most common arrhythmias were atrial and ventricular premature beats. These arrhythmias did not result in any changes in rehabilitation and therapy regimens.
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- 2021
23. Relationships between physical capacity and depression in heart failure patients undergoing hybrid comprehensive telerehabilitation vs usual care results of the TELEREH-HF randomized clinical trial
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I Jaworska, Ewa Piotrowicz, Renata Główczyńska, Michael J. Pencina, A Mierzynska, Piotr Orzechowski, Maciej Banach, Sławomir Pluta, Grzegorz Opolski, Robert Irzmański, Ryszard Piotrowicz, Ilona Kowalik, W. Zareba, Dominika Szalewska, and Zbigniew Kalarus
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medicine.medical_specialty ,business.industry ,medicine.disease ,law.invention ,Randomized controlled trial ,law ,Telerehabilitation ,Heart failure ,Usual care ,Physical therapy ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Depression (differential diagnoses) - Abstract
Introduction The novel hybrid comprehensive telerehabilitation (HCTR) consisting of telecare (with psychological telesupport), telerehabilitation and remote monitoring of cardiovascular implantable electronic devices might be an option to improve both physical capacity and depressive symptoms. Purpose The aim of the study was to investigate the influence of HCTR on depressive symptoms and physical capacity in heart failure (HF) patients in comparison with usual care (UC) alone. Methods The present analysis formed part of a multicenter, randomized trial that enrolled 850 HF patients (New York Heart Association class I–III, left ventricular ejection fraction ≤40%). Patients were randomized 1:1 to HCTR plus UC or UC only. Patients underwent either an HCTR program (1 week in hospital and 8 weeks at home; exercise training 5 times weekly) or UC with observation. The psychological intervention in the HCTR group included supportive psychological counseling via mobile phone. The Beck Depression Inventory II (BDI II) score (cut point for depression ≥14) was used to assess depression and the physical capacity was measured by peak oxygen consumption (peak VO2). Measurements were made before and after a 9-week intervention (HCTR group)/ observation (UC group). Results Both groups were comparable in terms of demographic, clinical characteristics and medical therapy. In HCTR group at entry 23% of the sample (n=88/382) obtaining BDI-II scores ≥14 vs 27.5% (n=107/389) in UC group. The BDI II score at study entry was 9.8±6.6 and after intervention was 9.2±6.6, p=0.016 (HCTR group) vs at entry 10.6±8.2 and after observation 10.0±8.3, p=0.022 (UC group). There were no significant differences between groups regarding ΔBDI II score p=0.992. There was a significant improvement in physical capacity assessed by peak VO2 only in the HCTR group, both in patients with (p=0.033) and without (p Conclusions In heart failure patients, HCTR provided similar reduction of depressive symptoms as UC. Hybrid comprehensive telerehabilitation resulted in a significant improvement in physical capacity both in patients with and without depression. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The National Centre for Research and Development, Warsaw, Poland.
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- 2021
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24. Cardiopulmonary exercise testing in adult cardiology: expert opinion of the Working Group of Cardiac Rehabilitation and Exercise Physiology of the Polish Cardiac Society
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Jerzy Rybicki, Tomasz Jaxa-Chamiec, Ewa Straburzyńska-Migaj, Renata Główczyńska, Ewa Piotrowicz, Tomasz Chwyczko, Piotr Niedoszytko, Jadwiga Wolszakiewicz, Anna Jegier, Dominika Szalewska, Sebastian Szmit, and Krzysztof Smarż
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Male ,medicine.medical_specialty ,Sports medicine ,medicine.medical_treatment ,Cardiology ,MEDLINE ,Exercise intolerance ,030204 cardiovascular system & hematology ,Cardiovascular System ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Exercise physiology ,Societies, Medical ,Cardiac Rehabilitation ,Exercise Tolerance ,Rehabilitation ,business.industry ,Perioperative ,Test (assessment) ,Pulmonology ,Cardiovascular Diseases ,Female ,Poland ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Cardiopulmonary exercise testing (CPET) is an important diagnostic tool in contemporary clinical practice. This document presents an expert opinion from the Working Group on Cardiac Rehabilitation and Exercise Physiology of the Polish Cardiac Society concerning the indications, performance technique, and interpretation of results for CPET in adult cardiology. CPET is an electrocardiographic exercise test expanded with exercise evaluation of ventilatory and gas exchange parameters. It allows for a global assessment of the exercise performance including the pulmonary, cardiovascular, hematopoietic, neuropsychological, and musculoskeletal systems. It provides a noninvasive dynamic evaluation during exercise and is a reference modality for exercise capacity assessment. Moreover, it allows the measurement of numerous prognostic parameters. It is useful in cardiology, pulmonology, oncology, perioperative assessment, rehabilitation as well as in sports medicine and in the evaluation of healthy people. This test not only helps to diagnose the causes of exercise intolerance but also supports the evaluation of the treatment. New opportunities are offered by combining CPET with imaging such as exercise stress echocardiography. These tests are complementary and synergistic in their diagnostic and prognostic strength.
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- 2019
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25. Electrocardiographic exercise testing in adults: performance and interpretation. An expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology
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Zbigniew Eysymontt, Jerzy Rybicki, Tomasz Jaxa-Chamiec, Agnieszka Mawlichanów, Jadwiga Wolszakiewicz, Dominika Szalewska, Krzysztof Smarż, Iwona Korzeniowska-Kubacka, Artur Mamcarz, Ewa Straburzyńska-Migaj, Ryszard Piotrowicz, Bronisław Bednarz, Michał Gałaszek, Tadeusz Bednarczyk, and Anna Jegier
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiology ,Coronary Artery Disease ,Coronary artery disease ,Humans ,Medicine ,cardiovascular diseases ,Exercise physiology ,Expert Testimony ,Societies, Medical ,Protocol (science) ,Rehabilitation ,medicine.diagnostic_test ,business.industry ,Workload ,medicine.disease ,Test (assessment) ,Expert opinion ,Practice Guidelines as Topic ,Exercise Test ,Physical therapy ,Poland ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography ,Echocardiography, Stress - Abstract
Electrocardiographic (ECG) exercise stress test has been a major diagnostic test in cardiology for several decades. Ongoing technological advances that have led to a wide use of imaging techniques and development of new guidelines have called for a revised and updated approach to the technique and interpretation of the ECG exercise testing. The present document outlines an expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology regarding the performance and interpretation of ECG exercise testing in adults. We discussed technical requirements and necessary equipment for the exercise testing laboratory as well as healthcare personnel competencies necessary to supervise ECG exercise testing and fully interpret test findings. Broad indications for ECG exercise testing include diagnostic assessment of coronary artery disease (CAD), including pre-test probability of CAD, evaluation of functional disease severity and risk strati- fication in patients with established CAD, assessment of response to treatment, evaluation of exercise-related symptoms and exercise capacity, patient evaluation before exercise training/cardiac rehabilitation, and risk stratification prior to non-cardiac surgery. ECG exercise testing is safe if indications and contraindications are observed, testing is appropriately monitored, and indications for test termination are clearly established. The exercise protocol should be adjusted to the expected exercise capacity of a patient so as to limit the duration of exercise to 8-12 min. Clinical, haemodynamic, and ECG response to exercise is evaluated during the test. The test report should include information about the exercise protocol used, reason for test termination, perceived exertion, presence/severity of anginal symptoms, peak exercise capacity or tolerated workload in relation to the predicted exercise capacity, heart rate response, and the presence or absence of ST-T changes. The test report should conclude with a summary including clinical and ECG assessment.
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- 2019
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26. The Association between the Respiratory System and Upper Limb Strength in Males with Duchenne Muscular Dystrophy: A New Field for Intervention?
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Agnieszka Sobierajska-Rek, Eliza Wasilewska, Karolina Śledzińska, Joanna Jabłońska-Brudło, Sylwia Małgorzewicz, Andrzej Wasilewski, and Dominika Szalewska
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Health, Toxicology and Mutagenesis ,Public Health, Environmental and Occupational Health ,Duchenne muscular dystrophy ,pulmonary function ,pulmonary function test ,MIP ,MEP ,upper limbs ,respiratory muscles ,hand grip ,hand grip strength ,PUL - Abstract
Progressive, irreversible muscle weakness is the leading symptom of Duchenne muscular dystrophy (DMD), often resulting in death from respiratory muscle failure. Little is known about the relationship between the functioning of the respiratory system and the hand grip—a function which remains long preserved. This study aimed to investigate the interdependence between muscle strength and the function of both hand grip and the respiratory system in patients with DMD. Materials and Method: The study included cohort patients, aged 6–17, with DMD, recruited from the Rare Disease Centre, Gdansk, Poland. Clinical status (Vignos scale, Brook scale), pulmonary function (respiratory muscle strength—MIP, MEP); spirometry (FEV1; FVC), as well as upper limb function (performance of the upper limb—PUL 2.0) and hand grip strength (HGS) (hand-held dynamometer) were evaluated in all participants. Results: Finally, 53 boys (mean age 11.41 ± 3.70 years, 25 non-ambulant) were included. Each of the participants presented a lower %pv of MIP (48.11 ± 27), MEP (38.11 ± 22), PUL (75.64 ± 27), and HGS (33.28 ± 18). There were differences between the ambulatory and non-ambulatory groups in values of MIP, MEP, FVC, PUL, HGS (p < 0.001 for all), and FEV1 (p < 0.013). There were correlations between PUL, HGS, and MIP (R = 0.56; R = 0.61, p < 0.001 both), MEP (R = 0.59; R = 0.62, p < 0.001), FVC (R = 0.77; R = 0.77, p < 0.001), and FEV1 (R = 0.77; R = 0.79; p < 0.001). These correlations were found for all participants, but non-ambulatory patients presented stronger relationships. Conclusions: 1. The pulmonary and upper limb functions were within the normal range in ambulatory and low in non-ambulatory patients with DMD, but the muscle strength of both systems was low, regardless of the stage of the disease. 2. There seems to be an interdependence between the respiratory system and upper limb strength in terms of muscle strength and function in DMD patients, which is stronger in non-ambulatory patients. This may be the basis for the creation of a new personalized plan in rehabilitation—the simultaneous rehabilitation of the respiratory and upper limb muscles. Further studies on this theory should be conducted.
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- 2022
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27. Is It Possible to Have Home E-Monitoring of Pulmonary Function in Our Patients with Duchenne Muscular Dystrophy in the COVID-19 Pandemic?—A One Center Pilot Study
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Dominika Szalewska, Sylwia Małgorzewicz, Eliza Wasilewska, Mateusz Soliński, Ewa Jassem, and Agnieszka Sobierajska-Rek
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Male ,Spirometry ,Duchenne muscular dystrophy ,medicine.medical_specialty ,Vital capacity ,Evening ,Health, Toxicology and Mutagenesis ,Vital Capacity ,spirometry ,digital health ,home monitoring pulmonary function ,Pilot Projects ,e-monitoring of pulmonary function ,Article ,law.invention ,Pulmonary function testing ,FEV1/FVC ratio ,pulmonary function test ,law ,Humans ,Medicine ,home monitoring ,Medical history ,Prospective Studies ,Child ,Lung ,Pandemics ,AioCare ,medicine.diagnostic_test ,SARS-CoV-2 ,business.industry ,Public Health, Environmental and Occupational Health ,COVID-19 ,rare diseases ,Muscular Dystrophy, Duchenne ,Ambulatory ,Physical therapy ,business ,Spirometer - Abstract
Background: Duchenne muscular dystrophy (DMD) is the most common, progressive, irreversible muscular dystrophy. Pulmonary function is crucial for duration of life in this disease. Currently, the European Respiratory Society is focused on digital health, seeking innovations that will be realistic for digital respiratory medicine to support professionals and patients during the COVID-19 pandemic. Aims: The aim of this study was to investigate whether it is possible to monitor pulmonary function at home using an individual electronic spirometry system in boys with Duchenne muscular dystrophy. Materials and methods: In this observational, prospective study, conducted from March 2021 to June 2021, twenty boys with DMD (aged 8–16) were enrolled. The patients were recruited from the Rare Disease Centre, University Clinical Centre, of Gdańsk, Poland. Medical history and anthropometric data were collected, and spirometry (Jaeger, Germany) was performed in all patients at the start of the study. Each patient received an electronic individual spirometer (AioCare) and was asked to perform spirometry on their own every day, morning and evening, at home for a period of 4 weeks. The number of measurements, correctness of performing measurements, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF) were evaluated. Results: Finally, 14 out of 20 boys enrolled in the study with a mean age of 12.5 years (7 non-ambulatory) applied and received a home spirometer (AioCare). A total of 283 measurements were performed by all patients at home for 4 weeks. Half of the patients were able to perform measurements correctly. There were no significant differences between mean values of FVC, FE1, PEF between home and hospital spirometry (p >, 0.05) expect PEF pv% (p <, 0.00046). Patients with higher FEV1 (p = 0.0387) and lower BMI (p = 0.0494) were more likely to take home spirometer measurements. The mean general satisfaction rating of home-spirometry was 4.33/5 (SD 0.78), the mean intelligibility rating was 4.83/5 (SD 0.58). Reasons for irregular measurements were: forgetting (43%), lack of motivation (29%), difficulty (14%), lack of time (14%). Conclusion: Home electronic monitoring of pulmonary function in patients with DMD is possible to implement in daily routines at home. This protocol should be introduced as early as possible in patients 7–8 years old with good, preserved lung function. Patients accept this form of medical care but require more education about the benefits of e-monitoring. There is a need to implement a system to remind patients of the use of electronic medical devices at home, e.g., via SMS (short message service).
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- 2021
28. The short-term benefit from nurse-led ambulatory care supported by non-invasive haemodynamic assessment in patients after acute heart failure decompensation depends on time since hospital discharge
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Piotr Ponikowski, Waldemar Banasiak, Adam Stańczyk, Grzegorz Gielerak, Paweł Krzesiński, Piotr Gutknecht, Paweł Chrom, Ewa A. Jankowska, Katarzyna Piotrowicz, Janusz Siebert, Agata Galas, Dominika Szalewska, and Paweł Siwołowski
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Heart Failure ,medicine.medical_specialty ,business.industry ,Non invasive ,Hemodynamics ,medicine.disease ,Nurse's Role ,Hospitals ,Patient Discharge ,Term (time) ,Ambulatory care ,Heart failure ,medicine ,Hospital discharge ,Ambulatory Care ,Humans ,Decompensation ,In patient ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2021
29. Effects of hybrid comprehensive telerehabilitation on cardiopulmonary capacity in heart failure patients depending on diabetes mellitus: subanalysis of the TELEREH-HF randomized clinical trial
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Ewa Piotrowicz, Renata Główczyńska, Ryszard Piotrowicz, Ilona Kowalik, Dominika Szalewska, Piotr Orzechowski, Sławomir Pluta, Zbigniew Kalarus, Michael J. Pencina, Grzegorz Opolski, Maciej Banach, Wojciech Zareba, and Robert Irzmański
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Male ,medicine.medical_specialty ,Time Factors ,Endocrinology, Diabetes and Metabolism ,Heart failure ,Ventricular Function, Left ,law.invention ,Exercise training ,Diabetes mellitus ,Randomized controlled trial ,law ,Telerehabilitation ,Internal medicine ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Prospective Studies ,Treadmill ,Hybrid rehabilitation ,Lung ,Angiology ,Original Investigation ,Aged ,Ejection fraction ,Cardiac Rehabilitation ,Exercise Tolerance ,business.industry ,Pulmonary Gas Exchange ,Type 2 Diabetes Mellitus ,Stroke Volume ,Recovery of Function ,Middle Aged ,medicine.disease ,Exercise Therapy ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,RC666-701 ,Exercise Test ,Female ,Poland ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Ventilation - Abstract
Background Type 2 diabetes mellitus (DM) is one of the most common comorbidities among patients with heart failure (HF) with reduced ejection fraction (HFrEF). There are limited data regarding efficacy of hybrid comprehensive telerehabilitation (HCTR) on cardiopulmonary exercise capacity in patients with HFrEF with versus those without diabetes. Aim The aim of the present study was to analyze effects of 9-week HCTR in comparison to usual care on parameters of cardiopulmonary exercise capacity in HF patients according to history of DM. Methods Clinically stable HF patients with left ventricular ejection fraction [LVEF] Results CPET was performed in 385 patients assigned to HCTR group: 129 (33.5%) had DM (HCTR-DM group) and 256 patients (66.5%) did not have DM (HCTR-nonDM group). Among 397 patients assigned to UC group who had CPET: 137 (34.5%) had DM (UC-DM group) and 260 patients (65.5%) did not have DM (UC-nonDM group). Among DM patients, differences in cardiopulmonary parameters from baseline to 9 weeks remained similar among HCTR and UC patients. In contrast, among patients without DM, HCTR was associated with greater 9-week changes than UC in exercise time, which resulted in a statistically significant interaction between patients with and without DM: difference in changes in exercise time between HCTR versus UC was 12.0 s [95% CI − 15.1, 39.1 s] in DM and 43.1 s [95% CI 24.0, 63.0 s] in non-DM, interaction p-value = 0.016. Furthermore, statistically significant differences in the effect of HCTR versus UC between DM and non-DM were observed in ventilation at rest: − 0.34 l/min [95% CI − 1.60, 0.91 l/min] in DM and 0.83 l/min [95% CI − 0.06, 1.73 l/min] in non-DM, interaction p value = 0.0496 and in VE/VCO2 slope: 1.52 [95% CI − 1.55, 4.59] for DM vs. − 1.44 [95% CI − 3.64, 0.77] for non-DM, interaction p value = 0.044. Conclusions The benefits of hybrid comprehensive telerehabilitation versus usual care on the improvement of physical performance, ventilatory profile and gas exchange parameters were more pronounced in patients with HFrEF without DM as compared to patients with DM. Trial registration: ClinicalTrials.gov Identifier: NCT02523560. Registered 3rd August 2015. https://clinicaltrials.gov/ct2/show/NCT02523560?term=NCT02523560&draw=2&rank=1. Other Study ID Numbers: STRATEGME1/233547/13/NCBR/2015
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- 2021
30. Antiarrhythmic effect of 9-week hybrid cardiac telerehabilitation - subanalysis of the TELEREHabilitation in Heart Failure patients - TELEREH-HF randomized clinical trial
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Piotr Orzechowski, Sławomir Pluta, Maciej Banach, Renata Główczyńska, Michael J. Pencina, Robert Irzmański, Ewa Piotrowicz, Grzegorz Opolski, Z Karalus, E Komar, Ilona Kowalik, Dominika Szalewska, Ryszard Piotrowicz, and Wojciech Zareba
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medicine.medical_specialty ,Ejection fraction ,business.industry ,Cardiac arrhythmia ,medicine.disease ,law.invention ,New York Heart Association Classification ,Randomized controlled trial ,law ,Physiology (medical) ,Heart failure ,Telerehabilitation ,Internal medicine ,medicine ,Cardiology ,Antiarrhythmic effect ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The National Centre for Research and Development, Warsaw, Poland. Background. Cardiac rehabilitation is a component of heart failure (HF) management but its effect on ventricular arrhythmias is not well recognized. Purpose. We analyzed the antiarrhythmic effect of a 9-week hybrid cardiac telerehabilitation (HCTR) and its influence on long term cardiovascular mortality in HF patients taken from the TELEREH-HF trial. Methods. We evaluated the presence of non-sustained ventricular tachycardia (nsVT) and frequent premature ventricular complexes ≥10 beats/hour (PVCs ≥10) with 24-hour ECG monitoring at the baseline and after 9-week HCTR or usual care (UC) of 773 HF patients (NYHA I-III, LVEF ≤ 40%). Results. Among 143 patients with nsVT, arrhythmia subsided in 30.8% after HCTR, similarly among 165 patients randomized to UC who had nsVT 34.5% did not show them after 9 weeks (p = 0.481). There was no significant difference in the decrease in PVC ≥10 over 9 weeks between randomization arms (14.9% vs. 17.8%, respectively p = 0.410). Functional response for HCTR (Δ peak oxygen consumption [pVO2] in cardiopulmonary exercise test >2.0 ml/kg/min) did not affect occurrence of arrhythmias. The multivariable analysis of the entire population did not identify HCTR as an independent factor determining improvement in terms of nsVT or PVCs >10. However, only in the HCTR group, the achievement of the antiarrhythmic effect significantly reduced the cardiovascular mortality in 2 years follow-up (Logrank p = 0.0009) (Figure). Conclusions. Significant improvement in physical capacity after 9 weeks of HCTR did not correlate with the antiarrhythmic effect in terms of incidence of nsVT or PVCs ≥10. An antiarrhythmic effect after the 9-week HCTR affected long term cardiovascular mortality in HF patients. Abstract Figure
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- 2021
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31. Respiratory Telerehabilitation of Boys and Young Men with Duchenne Muscular Dystrophy in the COVID-19 Pandemic
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Karolina Śledzińska, Eliza Wasilewska, Agnieszka Sobierajska-Rek, Dominika Szalewska, Joanna Jabłońska-Brudło, and Łukasz Mański
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Male ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Health, Toxicology and Mutagenesis ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Duchenne muscular dystrophy ,medicine.medical_treatment ,Article ,03 medical and health sciences ,0302 clinical medicine ,children ,Telerehabilitation ,Pandemic ,DMD ,Medicine ,Humans ,Pandemics ,Rehabilitation ,business.industry ,SARS-CoV-2 ,Public Health, Environmental and Occupational Health ,COVID-19 ,medicine.disease ,Muscular Dystrophy, Duchenne ,030228 respiratory system ,respiratory rehabilitation ,Physical therapy ,Poland ,business ,030217 neurology & neurosurgery ,Healthcare system - Abstract
Background: The COVID-19 pandemic forced reorganization of the multidisciplinary healthcare system for Duchenne muscular dystrophy. Digital solutions seem to be optimal for providing rehabilitation at this time. The aim of this study was to investigate whether it is possible to conduct respiratory physical therapy with the use of telerehabilitation in Duchenne muscular dystrophy. Methods: The study was conducted during an online conference for families with DMD. During the physical therapy panel we showed the video with the instructions of respiratory exercises. All participants (n = 152) were asked to fill in the online survey evaluating the quality, acceptance, and understanding of the instructions. Results: The survey was filled in by 45 (29.6%) participants. The mean rating of satisfaction was 4.70/5, and for intelligibility was 4.78/5. Thirty-seven (82.2%) patients declared that they had performed the exercises, all caregivers declared that it was possible to perform the proposed exercises a few times a week or daily, and only two respondents replied to invitations to individual online sessions. Conclusions: Findings from the study show that respiratory telerehabilitation may be implemented for DMD patients, however, the interest in digital rehabilitation among caregivers of DMD boys in Poland is low. The reasons for this situation require further research.
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- 2021
32. Nurse-led ambulatory care supported by non-invasive haemodynamic assessment after acute heart failure decompensation
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Ewa A. Jankowska, Katarzyna Piotrowicz, Andrzej Walczak, Piotr Gutknecht, Paweł Chrom, Grzegorz Gielerak, Adam Stańczyk, Janusz Siebert, Piotr Ponikowski, Paweł Krzesiński, Dominika Szalewska, Piotr Murawski, Agata Galas, Waldemar Banasiak, and Paweł Siwołowski
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medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,New York Heart Association Class ,Hemodynamics ,030204 cardiovascular system & hematology ,Nurse's Role ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Ambulatory care ,Original Research Articles ,Ambulatory Care ,Medicine ,Humans ,Decompensation ,030212 general & internal medicine ,Prospective Studies ,Original Research Article ,Aged ,Heart Failure ,Ejection fraction ,medicine.diagnostic_test ,Haemodynamics ,business.industry ,Stroke Volume ,medicine.disease ,Impedance cardiography ,lcsh:RC666-701 ,Heart failure ,Emergency medicine ,Congestion ,Outpatient care impedance cardiography ,Discharge ,Cardiology and Cardiovascular Medicine ,business - Abstract
Heart failure (HF) is characterized by frequent decompensation and an unpredictable trajectory. To prevent early hospital readmission, coordinated discharge planning and individual therapeutic approach are recommended. Aims We aimed to assess the effect of 1 month of ambulatory care, led by nurses and supported by non‐invasive haemodynamic assessment, on the functional status, well‐being, and haemodynamic status of patients post‐acute HF decompensation. Methods and results This study had a multicentre, prospective, and observational design and included patients with at least one hospitalization due to acute HF decompensation within 6 months prior to enrolment. The 1 month ambulatory care included three visits led by a nurse when the haemodynamic state of each patient was assessed non‐invasively by impedance cardiography, including thoracic fluid content assessment. The pharmacotherapy was modified basing on haemodynamic assessment. Sixty eight of 73 recruited patients (median age = 67 years; median left ventricular ejection fraction = 30%) finished 1 month follow‐up. A significant improvement was observed in both the patients' functional status as defined by New York Heart Association class (P = 0.013) and sense of well‐being as evaluated by a visual analogue score (P = 0.002). The detailed patients' assessment on subsequent visits resulted in changes of pharmacotherapy in a significant percentage of patients (Visit 2 = 39% and Visit 3 = 44%). Conclusions The proposed model of nurse‐led ambulatory care for patients after acute HF decompensation, with consequent assessment of the haemodynamic profile, resulted in: (i) improvement in the functional status, (ii) improvement in the well‐being, and (iii) high rate of pharmacotherapy modifications.
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- 2020
33. Heart failure patients' adherence to hybrid comprehensive telerehabilitation and its impact on prognosis based on data from TELEREH-HF randomized clinical trial
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Renata Główczyńska, Piotr Orzechowski, Ryszard Piotrowicz, Sławomir Pluta, Michael J. Pencina, Ilona Kowalik, Wojciech Zareba, Maciej Banach, Ewa Piotrowicz, Zbigniew Kalarus, Grzegorz Opolski, Dominika Szalewska, and Robert Irzmański
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Fluid Flow and Transfer Processes ,medicine.medical_specialty ,Telemedicine ,Remote patient monitoring ,business.industry ,Process Chemistry and Technology ,General Engineering ,telerehabilitation ,adherence ,heart failure ,medicine.disease ,Device implant ,Computer Science Applications ,law.invention ,New York Heart Association Classification ,Randomized controlled trial ,law ,Telerehabilitation ,Heart failure ,Emergency medicine ,medicine ,General Materials Science ,Cardiology and Cardiovascular Medicine ,Patient compliance ,business ,Instrumentation - Abstract
Background Adherence to treatment guidelines in heart failure (HF) patients (pts) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Introducing hybrid comprehensive telerehabilitation (HCTR) consisting of telecare, telerehabilitation and remote monitoring of implantable devices might be an option to improve adherence to recommendation and can affect the prognosis. Purpose to investigate the association of adherence to HCTR with mortality and hospitalization. Methods The present analysis formed part of TELEREH-HF multicenter, randomized trial that enrolled 850 HF pts (NYHA I-III,LVEF≤40%). Patients were randomized 1:1 to HCTR plus usual care or usual care only and followed up for 14 to 26 months. During the first 9 weeks, pts underwent either an HCTR (1 week in hospital and 8 weeks at home) or usual care. This analysis focuses on pts randomized to HCTR. Adherent pts were those who adhered both to the number of training sessions prescribed and to the duration of the prescribed cycle by at least80%; non-adherent pts, were those who adhered Results There were 350 (88.4%) adherent pts, 39 (9.8%) partially adherent pts and 7 (1.8%) non-adherent pts. There were 54 deaths during follow-up in the HCTR arm. Non-adherence or partial adherence was associated with statistically significantly higher risk of cardiovascular (CV) mortality (hazard ratio (HR) = 2.62, p=0.021); all-cause mortality or HF hospitalization (HR=1.71, p=0.038); CV mortality or HF hospitalization (HR=1.89, p=0.014). Conclusion The adherence to HCTR was very high. Adherence to HCTR was associated with improved prognosis for CV mortality. Kaplan-Meier Probability of CV Mortality Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Centre for Research and Development, Warsaw, Poland
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- 2020
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34. Quality of life in heart failure patients undergoing hybrid comprehensive telerehabilitation versus usual care results of TELEREH-HF randomized clinical trial
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A Mierzynska, Maciej Banach, Renata Główczyńska, Robert Irzmański, Piotr Orzechowski, Sławomir Pluta, Zbigniew Kalarus, Ewa Piotrowicz, Michael J. Pencina, Ryszard Piotrowicz, Grzegorz Opolski, Dominika Szalewska, Ilona Kowalik, W. Zareba, and I Jaworska
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medicine.medical_specialty ,Telemedicine ,SF-36 ,business.industry ,Physical function ,medicine.disease ,humanities ,law.invention ,Quality of life (healthcare) ,Randomized controlled trial ,law ,Heart failure ,Telerehabilitation ,Usual care ,medicine ,Physical therapy ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Heart failure (HF) is a clinical syndrome associated with physical capacity impairment and poor quality of life (QoL). The hybrid comprehensive telerehabilitation (HCTR) consisting of telecare, telerehabilitation and homemonitoring of implantable devices might be an option to improve QoL. Purpose to investigate the influence of HCTR on various facets of QoL in HF pts in comparison to usual care (UC). Methods The present analysis formed part of TELEREH-HF multicenter, randomized trial that enrolled 850 HF pts (NYHA I-III, LVEF≤40%). Patients were randomized 1:1 to HCTR plus UC or UC. Patients underwent either an HCTR (1 week in hospital and 8 weeks at home) or UC with observation. The psychology telecare had a form of supportive psychotherapy via phone. The Short Form 36 Questionnaire was used to assess QoL. Measurements were made before and after intervention/observation. Results HCTR group showed significant improvement in overall QoL, physical domain, and 4 areas of QoL (physical functioning [PF], role functioning related to physical state, general health, vitality). A significant positive change in QoL in UC group was observed in vitality and social functioning. There were significant differences in QoL after intervention/observation between groups. Results showed higher improvement in HCTR for overall QoL, physical domain and 3 areas of QoL (PF, role functioning related to physical state and bodily pain [BP]), Table 1. Conclusion In comparison to UC, HCTR resulted in significant improvement in overall QoL, physical domain and 3 specific areas of QoL: PF, role functioning related to physical state and BP. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Centre for Research and Development, Warsaw, Poland
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- 2020
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35. Differences in gene expression related to the outcomes of obesity treatment, peak oxygen uptake, and fatty acid metabolism measured in a cardiopulmonary exercise test
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Dominika Szalewska, Sylwia Małgorzewicz, Aleksandra Śliwińska, Piotr Niedoszytko, Katarzyna Gierat-Haponiuk, Małgorzata Kaczkan, Marek Niedoszytko, Pieter van der Vlies, Bahram Sanjabi, Marta Gruchała-Niedoszytko, and Magdalena Pieszko
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Adult ,Male ,obesity ,DIABETES PREVENTION PROGRAM ,Physiology ,Adipose tissue ,WEIGHT-LOSS ,Overweight ,BLOOD MONONUCLEAR-CELLS ,DISEASE ,ADIPOSE-TISSUE INFLAMMATION ,Young Adult ,chemistry.chemical_compound ,HLA Antigens ,Weight loss ,Internal Medicine ,cardiopulmonary exercise testing ,Humans ,Medicine ,Lectins, C-Type ,Life Style ,Adaptor Proteins, Signal Transducing ,BARIATRIC SURGERY ,RISK ,OVERWEIGHT ,Fatty acid metabolism ,business.industry ,Gene Expression Profiling ,Fatty Acids ,RNA-Binding Proteins ,VO2 max ,Middle Aged ,medicine.disease ,Obesity ,DEFICIENCY ,Treatment Outcome ,Gene Expression Regulation ,chemistry ,Receptors, Mitogen ,Basal metabolic rate ,Exercise Test ,gene expression ,SECRETION ,Female ,medicine.symptom ,Carrier Proteins ,business ,Bioelectrical impedance analysis - Abstract
INTRODUCTION The obesity pandemic requires development of methods that could be used on a large scale, such as the cardiopulmonary exercise test (CPET). Gene expression may explain CPET results on the molecular level.OBJECTIVES The aim of this study was to compare gene expression in obesity, depending on CPET results.PATIENTS AND METHODS The study group consisted of 9 obese patients and 7 controls. The treatment encompassed diet, rehabilitation, and behavioral therapy. Diet was based on the body composition analyzed by bioelectrical impedance, resting metabolic rate, and subjective patient preferences. The rehabilitation depended on the CPET results: maximal oxygen uptake and fatty acid metabolism. Behavioral intervention focused on the diagnosis of health problems leading to obesity, lifestyle modification, training in self-assessment, and development of healthy habits. The intensive treatment lasted for 12 weeks and consisted of consultations with a physician, dietitian, and medical rehabilitation specialist. RNA was isolated from the whole blood. A total of 47 323 transcripts were analyzed, of which 32 379 entities were confirmed to have high quality of RNA.RESULTS We observed differences in gene expression related to the CPET results indicating abnormalities in fat oxidation and maximal oxygen uptake. The genes with major differences in expression were: CLEC12A, HLA-DRB1, HLA-DRB4, HLA-A29.1, IFIT1, and LOC100133662.CONCLUSIONS The differences in gene expression may account for the outcomes of treatment related to inflammation caused by obesity, which affects the muscles, fat tissue, and fatty acid metabolism.
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- 2018
36. The Postural Control Indexes during Unipodal Support in Patients with Idiopathic Scoliosis
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Anna K Permoda-Białozorczyk, Marzena Olszewska-Karaban, Dominika Szalewska, and Aneta Dąbrowska
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Male ,medicine.medical_specialty ,Adolescent ,Article Subject ,Scoliosis ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Physical medicine and rehabilitation ,Statistical significance ,Post-hoc analysis ,Medicine ,Humans ,Postural Balance ,Rank correlation ,Balance (ability) ,030222 orthopedics ,General Immunology and Microbiology ,Cobb angle ,Proprioception ,business.industry ,General Medicine ,medicine.disease ,Female ,Analysis of variance ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Proper posture provides the best balance and body stability at minimal muscular effort. It is constantly controlled by the central nervous system, which integrates the stimuli from the proprioceptors (deep feeling sensors), vision receptors, and balance receptors through the subcortical structures. The main purpose of the study was to describe single stance stability and its correlation with the degree of scoliosis and trunk rotation among patients suffering from idiopathic scoliosis and in the control group without scoliosis. The study included 80 patients (69 girls and 11 boys) and 40 healthy children without scoliosis (21 girls and 19 boys). The Cobb angle technique was used to determine the magnitude of the deformity. All subjects were divided into three subgroups according to Bogdanov’s classification. Single stance stability with eyes open and eyes closed was assessed with an electronic postural station—Delos Postural Proprioceptive System (DPPS). In case of multiple group comparisons for variables with normal distribution ANOVA with Scheffe, post hoc test was used or Kruskal-Wallis test was used as the nonparametric equivalent. The relationship between the two continuous variables was investigated using either Pearson product-moment correlation or Spearman’s rank correlation. In all these calculations, the statistical significance level was set to p<0.05. The single stance test showed a significant difference between the stability index with eyes open and stability index with eyes closed in study and control groups. The character of these alterations is influenced by the degree of trunk rotation. The degree of scoliosis according to Bogdanov classification does not determine the decrease in stability indexes. In summary, significantly lower values of the stability index during one-leg standing with eyes closed indicated balance impairment, which is mainly connected with inadequate functioning of the proprioceptive system.
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- 2020
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37. Effects of a 9-Week Hybrid Comprehensive Telerehabilitation Program on Long-term Outcomes in Patients With Heart Failure: The Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomized Clinical Trial
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Renata Główczyńska, Artur Oręziak, Anna Mierzyńska, Robert Irzmański, Piotr Orzechowski, Sławomir Pluta, Ewa Piotrowicz, Grzegorz Opolski, Ilona Kowalik, Ewa Lewicka, Ryszard Piotrowicz, Zbigniew Kalarus, Michael J. Pencina, Andrzej Cacko, Maciej Banach, Dominika Szalewska, and Wojciech Zareba
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Male ,medicine.medical_specialty ,Randomization ,Walk Test ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Oxygen Consumption ,Randomized controlled trial ,law ,Telerehabilitation ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Original Investigation ,Heart Failure ,Ejection fraction ,business.industry ,Mortality rate ,Hazard ratio ,Middle Aged ,medicine.disease ,Hospitalization ,Heart failure ,Quality of Life ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
IMPORTANCE: Guidelines recommend exercise training as a component of heart failure management. There are large disparities in access to rehabilitation, and introducing hybrid comprehensive telerehabilitation (HCTR) consisting of remote monitoring of training at patients’ homes might be an appealing alternative. OBJECTIVE: To assess whether potential improvements in quality-of-life outcomes after a 9-week HCTR intervention in patients with heart failure translate into improvement in clinical outcomes during extended 12 to 24 months of follow-up, compared with usual care. DESIGN, SETTING, AND PARTICIPANTS: The Telerehabilitation in Heart Failure Patients (TELEREH-HF) trial is a multicenter, prospective, open-label, parallel-group randomized clinical trial that enrolled 850 patients with heart failure up to 6 months after a cardiovascular hospitalization with New York Heart Association levels I, II, or III and left ventricular ejection fraction of 40% or less. Patients from 5 centers in Poland were randomized 1:1 to HCTR plus usual care or usual care only and followed up for 14 to 26 months after randomization. INTERVENTIONS: During the first 9 weeks, patients underwent either an HCTR program (1 week in hospital and 8 weeks at home) or usual care with observation. The HCTR intervention encompassed telecare, telerehabilitation, and remote monitoring of implantable devices. No intervention occurred in the remaining study period. MAIN OUTCOMES AND MEASURES: The percentage of days alive and out of the hospital from randomization through the end of follow-up at 14 to 26 months. RESULTS: A total of 850 patients were enrolled, with 425 randomized to the HCTR group (377 male patients [88.7%]; mean [SD] age, 62.6 [10.8] years) and 425 randomized to usual care (376 male patients [88.5%]; mean [SD] age, 62.2 [10.2] years). The HCTR intervention did not extend the percentage of days alive and out of the hospital. The mean (SD) days were 91.9 (19.3) days in the HCTR group vs 92.8 (18.3) days in the usual-care group, with the probability that HCTR extends days alive and out of the hospital equal to 0.49 (95% CI, 0.46-0.53; P = .74) vs usual care. During follow-up, 54 patients died in the HCTR arm and 52 in the usual-care arm, with mortality rates at 26 months of 12.5% vs 12.4%, respectively (hazard ratio, 1.03 [95% CI, 0.70-1.51]). There were also no differences in hospitalization rates (hazard ratio, 0.94 [95% CI, 0.79-1.13]). The HCTR intervention was effective at 9 weeks, significantly improving peak oxygen consumption (0.95 [95% CI, 0.65-1.26] mL/kg/min vs 0.00 [95% CI, −0.31 to 0.30] mL/kg/min; P
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- 2019
38. 'Center of Geriatric Care' project- the development of the interdisciplinary home-based care model for elderly patients in Gdansk, Poland. Pilot study
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Hanna Kujawska-Danecka, Piotr Popowski, Marzena Olszewska-Karaban, Zbigniew Zdrojewski, Karol Wierzba, Marcin Gruchała, Dominika Szalewska, Iwona Stopczyńska, Marta Żarczyńska-Buchowiecka, Adam Hajduk, Iwona Damps-Konstańska, Ewa Jas, and Katarzyna Świętnicka
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education.field_of_study ,lcsh:R5-920 ,Health (social science) ,Health economics ,Sociology and Political Science ,Social work ,business.industry ,Health Policy ,Population ,Theory of change ,Integrated care ,Social support ,integrated care. elderly. home-based care. pre-frail. rehabilitation ,Quality of life (healthcare) ,Nursing ,Health care ,Medicine ,education ,business ,lcsh:Medicine (General) - Abstract
Introduction: Integrated care for elderly patients is not a standard in Central European Countries (CEC). Lack of coordination between healthcare service providers and social support, and diverse financing has led to low effectiveness of the whole care system for elderly. Short description of practice changes implemented: "Center of Geriatric Care" project assumes development of integrated model of care for elderly patients, managed by interdisciplinary geriatric team. The essential aims are: to develop an effective, coordinated and integrated management, based on the patient-centred triangle consisting of healthcare providers - social workers – family. to educate patients and caregivers extensively with the intension of lowering deterioration and exacerbations of the underlying chronic disease. Aim and theory of change: The aim of the study is to improve the management of elderly patients, to decrease the incidence of exacerbations (especially those requiring hospitalisation), to hamper the deterioration of general health condition, and finally to reduce the cost of care. Target population and stakeholders: In the pilot study, the model of care would be delivered to 90 multimorbid elderly, recruited from three different healthcare pathways (primary care, n=30; patients with chronic heart failure, n=30; patients with chronic obstructive pulmonary disease, n=30). In our model, existing healthcare services will be broadened by: 1- Periodic evaluation by geriatricians with use of comprehensive geriatric assessment tools. 2- Regular home visits of specially trained carers, which include monitoring of general condition, encouraging appropriate physical activity and supporting adherence to medical recommendations, alerting about significant symptoms. 3- Comprehensive rehabilitation based on regular physiotherapy. 4- Using selected, simple e-health interventions. Timeline: 24 months. Highlights (innovation, Impact and outcomes): The primary outcome of the project is to design and testing of a model of home-based integrated care, which is innovative in Poland and CEC. The expected results include improvement in functional and cognitive status and quality of life of patients, followed by decrease in general demand for medical services, especially in-hospital, and selected health economics indicators. The secondary outcome is to increase the knowledge and competencies of social workers, nurses, physiotherapists and family members on the management of elderly chronically ill patients, and to improve cooperation between these groups and medical staff. Comments on sustainability: After the pilot study, the implementation of the model, or further testing on larger population, would be a matter of discussion between team members and decision-makers on local and national level. Comments on transferability: The proposed model of care seems to be possible to implement in Polish healthcare system, as it enhances coordination between already existing institutions and local care-providing structures. Conclusions (comprising key findings): Current work on designing the model indicates, that crucial area for change is to coordinate already existing institutional structures. Discussions: Detailed conclusions would be drawn after the testing the model. Lessons learned: The work on designing the model has already resulted in the successful creation of an active network of specialists from different backgrounds and allowed sharing different scopes, how to use limited resources for the benefit of the elderly.
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- 2019
39. Cardiopulmonary Excercise Test and Bioimpedance as prediction tools used to predict the outcomes of obesity treatment
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Magdalena Pieszko, Magdalena Skotnicka, Marta Gruchała-Niedoszytko, Aleksandra Śliwińska, Sylwia Małgorzewicz, Małgorzata Kaczkan, Katarzyna Gierat-Haponiuk, Piotr Niedoszytko, and Dominika Szalewska
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Adult ,Male ,medicine.medical_specialty ,Young Adult ,Weight loss ,Internal medicine ,Weight Loss ,Heart rate ,Electric Impedance ,Internal Medicine ,medicine ,Humans ,Obesity ,Respiratory exchange ratio ,business.industry ,VO2 max ,Middle Aged ,medicine.disease ,Obesity Management ,Treatment Outcome ,Case-Control Studies ,Basal metabolic rate ,Body Composition ,Exercise Test ,Cardiology ,Female ,medicine.symptom ,business ,Anaerobic exercise ,Bioelectrical impedance analysis - Abstract
INTRODUCTION Obesity impacts the global population. Bioelectrical impedance analysis (BIA) and cardiopulmonary exercise test [CPET]) may help modify the treatment. OBJECTIVES We aimed to compare BIA and CPET results in obese and lean indivisuals, assess changes in BIA and CPET during obesity treatment, and indentify parameters predicting treatment outcome. PATIENTS AND METHODS We enrolled 200 obese patients, of whom 45 underwent a lifestyle modification treatment, and 32 lean individuals (controls). Lifestyle modifications included diet, rehabilitation, education, and behavioral therapy. The diet was based on body composition assessed by BIA and fat metabolism assessed by CPET. The intensity of exercise in the rehabilitation program was based on CPET, mainly peak oxygen uptake (VO2peak), fat metabolism (FAT), and fat heart rate (FAT HR). The protocol duration was 12 weeks. RESULTS Obese patients differed from lean controls with regard to VO2peak (P
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- 2019
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40. Mountain climbing of the grown-up patient with non-corrected congenital heart defect
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Piotr Niedoszytko, Maciej Chojnicki, Ireneusz Haponiuk, Dominika Szalewska, Stanisław Bakuła, and Katarzyna Gierat-Haponiuk
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medicine.medical_specialty ,Rehabilitation ,Mountaineering ,Heart disease ,business.industry ,medicine.medical_treatment ,Physical activity ,physical activity ,Case Report ,medicine.disease ,Pulmonary hypertension ,grown-up patients with congenital heart disease (GUCH) ,GUCH ,endurance training ,GUCH comprehensive cardiac rehabilitation (CCR-GUCH) ,Endurance training ,Climbing ,medicine ,Physical therapy ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,congenital heart defects (CHD) - Abstract
Congenital heart defects (CHD) are the cause of reduced physical performance. The presence of congenital abnormalities in the heart of grown-up patients contributes to excessive hypo-kinesia. We present endurance parameters and a personalized comprehensive cardiac rehabilitation program before an extreme mountain climbing of a 27-year-old patient with an uncorrected ventricular septal defect (VSD). A 26-year-old female patient with an uncorrected congenital VSD was admitted to the department of cardiac rehabilitation before the planned high-mountain expedition. Professional preparation and assessment of actual exercise capacity was performed before scheduled extreme climbing. We conclude that physical activity associated with a heavy load in people with uncorrected CHD who have not developed pulmonary hypertension and reverse right-to-left flow seems to be safe, while participation of grown-up patients with congenital heart disease (GUCH) in extreme mountain climbing requires special preparation, individually designed endurance training and education program, conducted by the team of professionals in specialist centers.
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- 2016
41. Remote Monitoring of Cardiac Implantable Electronic Devices in Patients Undergoing Hybrid Comprehensive Telerehabilitation in Comparison to the Usual Care. Subanalysis from Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomised Clinical Trial
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Michael J. Pencina, Renata Główczyńska, Ewa Piotrowicz, Andrzej Cacko, Maciej Banach, Ryszard Piotrowicz, Robert Irzmański, Piotr Orzechowski, Ewa Lewicka, Wojciech Zareba, Sławomir Pluta, Grzegorz Opolski, Monika Kozieł, Dominika Szalewska, Zbigniew Kalarus, Ilona Kowalik, and Artur Oręziak
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medicine.medical_specialty ,medicine.medical_treatment ,heart failure ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Telerehabilitation ,Internal medicine ,medicine ,In patient ,030212 general & internal medicine ,hybrid comprehensive telerehabilitation ,remote monitoring ,cardiac implantable electronic devices ,Ejection fraction ,Rehabilitation ,business.industry ,lcsh:R ,Atrial fibrillation ,General Medicine ,medicine.disease ,Clinical trial ,Heart failure ,Usual care ,cardiovascular system ,Cardiology ,business - Abstract
Background: The impact of cardiac rehabilitation on the number of alerts in patients with remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is unknown. We compared alerts in RM and outcomes in patients with CIEDs undergoing hybrid comprehensive telerehabilitation (HCTR) versus usual care (UC). Methods: Patients with heart failure (HF) after a hospitalization due to worsening HF within the last 6 months (New York Heart Association (NYHA) class I-III and left ventricular ejection fraction (LVEF) &le, 40%) were enrolled in the TELEREH-HF study and randomised 1:1 to HCTR or UC. Patients with HCTR and CIEDs received RM (HCTR-RM). Patients with UC and CIEDs were offered RM optionally (UC-RM). Data from the initial 9 weeks of the study were analysed. Results: Of 850 enrolled patients, 208 were in the HCTR-RM group and 62 in the UC-RM group. The HCTR-RM group was less likely to have alerts of intrathoracic impedance (TI) decrease (p <, 0.001), atrial fibrillation (AF) occurrence (p = 0.031) and lower mean number of alerts per patient associated with TI decrease (p <, 0.0001) and AF (p = 0.019) than the UC-RM group. HCTR significantly decreased the occurrence of alerts in RM of CIEDs, 0.360 (95%CI, 0.189&ndash, 0.686, p = 0.002), in multivariable regression analysis. There were two deaths in the HCTR-RM group (0.96%) and no deaths in the UC-RM group (p = 1.0). There were no differences in the number of hospitalised patients between the HCTR-RM and UC-RM group (p = 1.0). Conclusions: HCTR significantly reduced the number of patients with RM alerts of CIEDs related to TI decrease and AF occurrence. There were no differences in mortality or hospitalisation rates between HCTR-RM and UC-RM groups.
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- 2020
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42. Depression symptoms, anxiety and personality traits in patients with coronary artery disease versus patients with chronic pancreatitis hospitalised due to exacerbation of the disease
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Marta Skoczkowska-Nedoszytko, Dominika Szalewska, Mohamed Amr Elkady, and Małgorzata Szidlewska
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medicine.medical_specialty ,Exacerbation ,lcsh:Medicine ,Disease ,030204 cardiovascular system & hematology ,chronic pancreatitis ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,In patient ,cardiovascular diseases ,Big Five personality traits ,Psychiatry ,Depression (differential diagnoses) ,business.industry ,lcsh:R ,General Medicine ,anxiety ,medicine.disease ,depression ,Pancreatitis ,Anxiety ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,coronary artery disease - Abstract
Background . Coronary artery disease (CAD ) is a common cause of hospitalisation in cardiac wards, while chronic pancreatitis (CP) is in gastroenterology wards. Both diseases are chronic and the clinical picture is dominated by pain. Objectives . The objective was to describe the psychological characteristics of patients hospitalised for the worsening of CAD and CP. Material and methods. The sample comprised 30 patients with CAD and 30 with CP. Participants completed personal questionnaires, the Eysenck Personality Questionnaire-Revised, STAI , Beck Depression Inventory and Scale A-Framingham. Results . Mild depression occurred in 20% of patients with CAD and 30% with CP. A severe degree of depression was found in 20% of patients with CAD and in 15% with CP while the highest levels of anxiety (9–10 sten) were found in 30% of patients with CP and in 20% of patients with CAD . In relation to introversion-extraversion personality dimension, 74% of patients with CAD and 53% of patients with CP were classified as ambivert or introvert. In both groups, most patients had moderate emotional balance as follows: 47% patients with CAD and 43% with CP. Conclusions . Compared to patients with CAD , patients with CP presented more severe depression symptoms and anxiety. The subjects with high intensification of neurotic traits more often presented high levels of anxiety and depression wherein more than half of these patients had severe anxiety and depression. Patients with low physical activity had significantly higher levels of anxiety than patients who were active daily or several times per week.
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- 2016
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43. Clinical characteristics and outcomes of patients with and without diabetes in the Surgical Treatment for Ischemic Heart Failure (STICH) trial
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Kerry L. Lee, George Sopko, Torsten Doenst, Christopher Adlbrecht, Mark C. Petrie, Serenella Castelvecchio, Lilin She, Philip F. Binkley, Rafal Dabrowski, Dominika Szalewska, Eric J. Velazquez, Myron A. Waclawiw, Robert E. Michler, Jean L. Rouleau, Ru San Tan, Jae K. Oh, Michael R. MacDonald, and Alan B. Miller
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medicine.medical_specialty ,Ejection fraction ,business.industry ,Hazard ratio ,Stroke volume ,medicine.disease ,Confidence interval ,surgical procedures, operative ,Internal medicine ,Diabetes mellitus ,Heart failure ,medicine ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,Prospective cohort study ,business ,Surgical treatment - Abstract
The characteristics and clinical outcomes of patients with and without DM randomized to CABG and MED or MED alone were compared. DM was present in 40%. At baseline, patients with DM had more triple vessel CAD, higher LVEF, and smaller left ventricular volumes. In patients with DM, the primary outcome of all-cause mortality occurred in 39% of patients in the MED group and 39% in the CABG group [hazard ratio (HR) with CABG 0.96, 95% confidence interval (CI) 0.73–1.26]. In patients without DM, the primary outcome occurred in 41% of patients in the MED group and 32% in the CABG group (HR with CABG 0.80, 95% CI 0.63–1.02). While numerically it would appear that the treatment effect of CABG is blunted in patients with DM, there was no significant interaction between DM and treatment group on formal statistical testing.
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- 2015
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44. Effect of complex cardiac rehabilitation on physical activity and quality of life during long-term follow-up after surgical correction of congenital heart disease
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Katarzyna Gierat-Haponiuk, Radoslaw Jaworski, Ireneusz Haponiuk, Piotr Niedoszytko, Maciej Chojnicki, Stanisław Bakuła, Dominika Szalewska, and Katarzyna Leszczyńska
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Adult ,Heart Septal Defects, Ventricular ,Male ,medicine.medical_specialty ,Long term follow up ,Treatment outcome ,Physical activity ,Heart Septal Defects, Atrial ,Young Adult ,Oxygen Consumption ,Surveys and Questionnaires ,medicine ,Humans ,Exercise ,Gynecology ,Cardiac Rehabilitation ,Exercise Tolerance ,Depression ,business.industry ,Follow up studies ,Surgical correction ,Surgery ,Treatment Outcome ,Quality of Life ,Female ,Poland ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Wstep: Waznym etapem leczenia doroslych pacjentow z wrodzonymi wadami serca po operacjach kardiochirurgicznych jest kompleksowa rehabilitacja kardiologiczna (CCR), jednak dostep do tej formy terapii jest wciąz ograniczony. Brakuje polskich wytycznych dotyczących prowadzenia CCR, w tym treningow kontrolowanych u ,,mlodych doroslych”, kilkanaście lat po zabiegu korygującym wrodzoną wade serca. Cel: Celem pracy byla ocena wplywu CCR na wydolnośc fizyczną, tolerancje wysilku, jakośc zycia i nasilenie objawow depresyjnych pacjentow w odleglym okresie po chirurgicznej korekcji wrodzonych wad serca. Metody: Do badania wlączono 57 pacjentow z wrodzonymi wadami serca (30 kobiet i 27 mezczyzn) w wieku 23 ± 3,4 roku, w okresie minimum 12 miesiecy po zabiegu zamkniecia ubytku w przegrodzie miedzykomorowej (VSD) lub ubytku w przegrodzie miedzyprzedsionkowej typu ostium secundum (ASD II). Wszystkim pacjentom zaproponowano udzial w programie CCR: 31 pacjentow wzielo udzial w programie (grupa Reh), natomiast 26 pacjentow odmowilo udzialu w programie CCR (grupa NReh). U wszystkich pacjentow wykonano wstepny test wysilkowy spiroergometryczny na cykloergometrze rowerowym, stosując protokol typu ramp o początkowym obciązeniu 20 W i przyroście obciązenia 10 W na minute. Test byl limitowany maksymalnym zmeczeniem i standardowymi wskazaniami do przerwania proby wysilkowej. Do oceny psychologicznej wykorzystano kwestionariusz Becka i test sluzący do oceny jakości zycia — Euro QoL 5D. Po 30 dniach od badania wstepnego ponownie oceniono pacjentow z obu grup, stosując takie same narzedzia badawcze jak we wstepnym badaniu. Wyniki: Podczas prob wysilkowych wszyscy pacjenci osiągneli maksymalny poziom zmeczenia na poziomie 15–17 punktow w skali Borga, bez towarzyszących powiklan. Spoczynkowy rytm serca byl nizszy w grupie Reh (74 ± 8/min) niz w grupie NReh (81 ± 14/min). Pacjenci z grupy Reh osiągneli istotnie wyzszy maksymalny rytm serca w czasie proby wysilkowej; rowniez wspolczynnik tetna maksymalnego byl wyzszy u osob trenujących. Obciązenie wysilkiem bylo nieistotnie wieksze, natomiast czas trwania wysilku znamiennie dluzszy w grupie Reh niz w grupie NReh, odpowiednio 144 W vs . 124 W (p = 0,121) oraz 14 min vs . 11 min (p = 0,001). Wyzsze szczytowe zuzycie tlenu (VO2peak) uzyskaly osoby z grupy Reh w porownaniu z pacjentami z grupy NReh (27,5 ml/kg/min vs . 23 ml/kg/min; p = 0,003). Wyzsze nasilenie objawow depresyjnych wg Becka po zakonczeniu programu stwierdzono w grupie NReh niz w grupie Reh (średnio 4,8 vs . 2,2 pkt; p = 0,59). Natomiast subiektywna i obiektywna jakośc zycia byla wyzsza w grupie Reh niz w grupie NReh, odpowiednio 89 vs . 74,4 pkt (p < 0,01) oraz 94 vs . 83 pkt (p < 0,01). Wnioski: Wdrozenie programu CCR poprawia wydolnośc fizyczną, tolerancje wysilku fizycznego, jakośc zycia i zmniejsza objawy depresyjne pacjentow w poźnym okresie po chirurgicznej korekcji wrodzonych wad serca. Wprowadzenie programu CCR wydaje sie celowe jako uzupelnienie holistycznej opieki w tej grupie pacjentow.
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- 2015
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45. Oscillations of Subarachnoid Space Width as a Potential Marker of Cerebrospinal Fluid Pulsatility
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Marcin, Gruszecki, Magdalena K, Nuckowska, Arkadiusz, Szarmach, Marek, Radkowski, Dominika, Szalewska, Monika, Waskow, Edyta, Szurowska, Andrzej F, Frydrychowski, Urszula, Demkow, and Pawel J, Winklewski
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Pulsatile Flow ,Humans ,Subarachnoid Space ,Cerebrospinal Fluid - Abstract
In the cerebrospinal fluid (CSF) circulation, two components can be distinguished: bulk flow (circulation) and pulsatile flow (back and forth motion). CSF pulsatile flow is generated by both cardiac and respiratory cycles. Recent years have seen increased interest in cardiac- and respiratory-driven CSF pulsatility as an important component of cerebral homeostasis. CSF pulsatility is affected by cerebral arterial inflow and jugular outflow and potentially linked to white matter abnormalities in various diseases, such as multiple sclerosis or hypertension. In this review, we discuss the physiological mechanisms associated with CSF pulsation and its clinical significance. Finally, we explain the concept of using the oscillations of subarachnoid space width as a surrogate for CSF pulsatility.
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- 2018
46. Oscillations of Subarachnoid Space Width as a Potential Marker of Cerebrospinal Fluid Pulsatility
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Marcin Gruszecki, Pawel J. Winklewski, Andrzej F. Frydrychowski, Dominika Szalewska, Urszula Demkow, Magdalena K. Nuckowska, Monika Waskow, Edyta Szurowska, Arkadiusz Szarmach, and Marek Radkowski
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Arterial inflow ,medicine.medical_specialty ,business.industry ,Multiple sclerosis ,Pulsatile flow ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,medicine.anatomical_structure ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,White matter abnormalities ,Respiratory system ,Subarachnoid space ,business ,030217 neurology & neurosurgery ,Homeostasis - Abstract
In the cerebrospinal fluid (CSF) circulation, two components can be distinguished: bulk flow (circulation) and pulsatile flow (back and forth motion). CSF pulsatile flow is generated by both cardiac and respiratory cycles. Recent years have seen increased interest in cardiac- and respiratory-driven CSF pulsatility as an important component of cerebral homeostasis. CSF pulsatility is affected by cerebral arterial inflow and jugular outflow and potentially linked to white matter abnormalities in various diseases, such as multiple sclerosis or hypertension. In this review, we discuss the physiological mechanisms associated with CSF pulsation and its clinical significance. Finally, we explain the concept of using the oscillations of subarachnoid space width as a surrogate for CSF pulsatility.
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- 2018
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47. Exercise Strategies to Counteract Brain Aging Effects
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Dominika, Szalewska, Marek, Radkowski, Urszula, Demkow, and Pawel J, Winklewski
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Aging ,Cognition ,Brain ,Humans ,Cognition Disorders ,Exercise ,Exercise Therapy - Abstract
Stimulating structural and functional adaptation that improves cognitive performance in specific tasks is the major objective of therapeutic exercise training. In this review we briefly summarize central physiological mechanisms activated by exercise. We further discuss the influence of different kinds of exercise on cognitive improvement. In particular, the effects on cognitive function of aerobic endurance, resistance and respiratory exercise, and combinations thereof are presented. The accumulating evidence reinforces the position that regular aerobic, and possibly also resistance training, offers a powerful tool to cope with biologic aging of central nervous system functions. Nevertheless, the potential magnitude of cognition improvement or restrain of age-related cognition deterioration and the quantity of physical activity required to induce meaningful responses remain to be clarified.
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- 2017
48. Exercise Capacity and Mortality in Patients With Ischemic Left Ventricular Dysfunction Randomized to Coronary Artery Bypass Graft Surgery or Medical Therapy
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John G.F. Cleland, Shiv Kumar Choudhary, Barbara Lubiszewska, Mark H. Drazner, Daniel B. Mark, Dragana Kosevic, Andrzej Rynkiewicz, Kerry L. Lee, Lilin She, Ileana L. Piña, Jose C. Nicolau, Benoit Coutu, Ralph A.H. Stewart, Eric J. Velazquez, Harvey D. White, Permyos Ruengsakulrach, and Dominika Szalewska
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medicine.medical_specialty ,Randomization ,business.industry ,Hazard ratio ,Exercise capacity ,medicine.disease ,Confidence interval ,Surgery ,Coronary artery disease ,medicine.anatomical_structure ,Interquartile range ,Heart failure ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Objectives The objective of this study was to assess the prognostic significance of exercise capacity in patients with ischemic left ventricular (LV) dysfunction eligible for coronary artery bypass graft surgery (CABG). Background Poor exercise capacity is associated with mortality, but it is not known how this influences the benefits and risks of CABG compared with medical therapy. Methods In an exploratory analysis, physical activity was assessed by questionnaire and 6-min walk test in 1,212 patients before randomization to CABG (n = 610) or medical management (n = 602) in the STICH (Surgical Treatment for Ischemic Heart Failure) trial. Mortality (n = 462) was compared by treatment allocation during 56 months (interquartile range: 48 to 68 months) of follow-up for subjects able (n = 682) and unable (n = 530) to walk 300 m in 6 min and with less (Physical Ability Score [PAS] >55, n = 749) and more (PAS ≤55, n = 433) limitation by dyspnea or fatigue. Results Compared with medical therapy, mortality was lower for patients randomized to CABG who walked ≥300 m (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.59 to 0.99; p = 0.038) and those with a PAS >55 (HR: 0.79; 95% CI: 0.62 to 1.01; p = 0.061). Patients unable to walk 300 m or with a PAS ≤55 had higher mortality during the first 60 days with CABG (HR: 3.24; 95% CI: 1.64 to 6.83; p = 0.002) and no significant benefit from CABG during total follow-up (HR: 0.95; 95% CI: 0.75 to 1.19; p = 0.626; interaction p = 0.167). Conclusions These observations suggest that patients with ischemic left ventricular dysfunction and poor exercise capacity have increased early risk and similar 5-year mortality with CABG compared with medical therapy, whereas those with better exercise capacity have improved survival with CABG. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595 )
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- 2014
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49. REHABILITATION Physical activity in patients with grown-up congenital heart defects after comprehensive cardiac rehabilitation
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Katarzyna Leszczyńska, Stanisław Bakuła, Radoslaw Jaworski, Katarzyna Gierat-Haponiuk, Ireneusz Haponiuk, Dominika Szalewska, and Maciej Chojnicki
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medicine.medical_specialty ,Rehabilitation ,business.industry ,medicine.medical_treatment ,Physical activity ,Mean age ,Surgical correction ,Atrial septal defects ,GUCH ,medicine ,Physical therapy ,Surgery ,In patient ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: The group of grown-up patients with congenital heart defects (grown-up congenital heart – GUCH) complains of a number of specific medical and non-medical problems. The presented program of comprehensive cardiac rehabilitation (CCR-GUCH), dedicated to the above mentioned group, can potentially improve the physical activity of GUCH patients. Aim: The aim of the study was to assess the effect of the comprehensive cardiac rehabilitation program on the physical activity of GUCH patients. Material and methods: The invitation to take part in the CCR-GUCH program was addressed to a group of 57 patients (mean age: 23.7 ± 4.1 years) who had undergone the surgical correction of ventricular septal defects (VSD) or atrial septal defects (ASD) at least 12 months earlier. The pa tients were divided into two groups: A – patients undergoing rehabilitation, and B – patients who did not participate in the program. The patients were initially examined using functional and stress tests, and the program of comprehensive cardiac rehabilitation was started in group A. After 30 days, the patients from both groups underwent further testing using the same methods as during the initial evaluation. Results: After one month of rehabilitation, the physical activity parameters of patients participating in the CCR-GUCH program (group A) were significantly better than those observed among non-participants (group B). Conclusions: The introduction of the comprehensive rehabilitation program improves the physical activity and, consequently, the quality of life of GUCH patients. The CCR-GUCH program appears to be a justified supplement to holistic care
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- 2014
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50. Exercise Strategies to Counteract Brain Aging Effects
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Dominika Szalewska, Marek Radkowski, Urszula Demkow, and Pawel J. Winklewski
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0301 basic medicine ,Physical activity ,Resistance training ,Cognition ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Therapeutic exercise ,Aerobic exercise ,Effects of sleep deprivation on cognitive performance ,Psychology ,Neuroscience ,Brain aging ,030217 neurology & neurosurgery - Abstract
Stimulating structural and functional adaptation that improves cognitive performance in specific tasks is the major objective of therapeutic exercise training. In this review we briefly summarize central physiological mechanisms activated by exercise. We further discuss the influence of different kinds of exercise on cognitive improvement. In particular, the effects on cognitive function of aerobic endurance, resistance and respiratory exercise, and combinations thereof are presented. The accumulating evidence reinforces the position that regular aerobic, and possibly also resistance training, offers a powerful tool to cope with biologic aging of central nervous system functions. Nevertheless, the potential magnitude of cognition improvement or restrain of age-related cognition deterioration and the quantity of physical activity required to induce meaningful responses remain to be clarified.
- Published
- 2017
- Full Text
- View/download PDF
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