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Objectives: The aim of this study was to identify independent predictors of procedural success after retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: Retrograde CTO PCI is an established technique, but predictors of success remain poorly understood. Methods: A multivariable logistic regression model was used to analyze potentially important demographic, clinical, anatomical, and technical aspects of retrograde CTO PCI cases uploaded to the multicenter European CTO (ERCTO) Club Registry. Results: In calendar years 2018 and 2019, 2,364 retrograde CTO PCI cases constituted the primary analysis cohort. A primary retrograde strategy was used in 1,953 cases (82.6%), and an initial antegrade approach was converted to retrograde in 411 cases (17.4%). Procedural success was achieved in 1,820 cases (77.0%) and was more likely to occur after a primary retrograde attempt versus conversion from an initial antegrade approach (80.9% vs 58.4%; P < 0.0001). After multivariable analysis, an absence of lesion calcification (OR: 1.86; 95% CI: 1.37-2.51; P < 0.0001), a higher degree of distal vessel opacification (OR: 2.47; 95% CI: 1.72-3.55; P < 0.0001), little or no proximal target vessel tortuosity (OR: 1.84; 95% CI: 1.28-2.64; P = 0.001), Werner collateral connection CC1 (OR: 4.87; 95% CI: 2.90-8.19; P < 0.0001) or CC2 (OR: 5.33; 95% CI: 3.02-9.42; P < 0.0001), and the top tertile of operator volume (>120 cases over 2 years) (OR: 1.88; 95% CI: 1.26-2.79; P = 0.002) were associated with the greatest chance of achieving angiographic success. Conclusions: Less calcification with good distal vessel opacification, little or absent proximal vessel tortuosity, and visible collateral connections, along with high-volume operator status, were all independently predictive of angiographically successful retrograde CTO PCI.

Background: An alarming cerebro/cardiovascular collateral damage, reflected by a decline in admissions for acute stroke (AS) and acute coronary syndrome (ACS), was observed during the initial phase of the COVID-19 pandemic, thereby leading to a re-design of public campaigns. However, there are limited data regarding the AS and ACS hospitalization rates during the second wave of the pandemic, which was followed by re-imposition of lockdowns. Methods: We calculated the rate of AS and ACS hospitalizations from three representative tertiary care hospitals in Greece during a 2-month period (November–December 2020) of the second wave of the COVID-19 pandemic compared with the corresponding control period in 2019 from three representative tertiary care hospitals in Greece. This was a follow-up study with identical design to our previous report evaluating AS and ACS hospitalizations during the first wave of the pandemic (March–April 2020). Results: Compared with 2019, there was a 34% relative reduction of AS hospitalizations [incidence rate ratio (IRR): 0.66, 95% confidence interval (CI): 0.48–0.92, p = 0.013] and 33% relative reduction of ACS hospitalizations (IRR: 0.67, 95% CI: 0.54–0.83, p < 0.001) during the second wave of the COVID-19 pandemic. The relative reduction was smaller and did not reach the level of statistical significance for the respective syndromes (haemorrhagic stroke: IRR 0.87, 95% CI: 0.41–1.82, p = 0.71; ST-elevation myocardial infarction: IRR 0.81, 95% CI: 0.57–1.14, p = 0.22). Conclusion: AS and ACS hospitalizations were persistently reduced during the second wave of the COVID-19 pandemic compared with 2019 in Greece. This decline was similar to the observations during the first wave despite the large differences in the epidemiological COVID-19 burden. Lockdowns, a common characteristic in both waves, appear to have a detrimental indirect impact on cerebro/cardiovascular diseases in the general population. © The Author(s), 2021.

Background and purpose: A remarkable decline in admissions for acute stroke and acute coronary syndrome (ACS) has been reported in countries severely hit by the COVID-19 pandemic. However, limited data are available from countries with less COVID-19 burden focusing on concurrent stroke and ACS hospitalisation rates from the same population. Methods: The study was conducted in three geographically and demographically representative COVID-19 referral university hospitals in Greece. We recorded the rate of stroke and ACS hospital admissions during a 6-week period of the COVID-19 outbreak in 2020 and compared them with the rates of the corresponding period in 2019. Results: We found a greater relative reduction of stroke admissions (51% [35 vs. 71]; incidence rate ratio [IRR]: 0.49, p = 0.001) compared with ACS admissions (27% [123 vs. 168]; IRR: 0.73, p = 0.009) during the COVID-19 outbreak (p = 0.097). Fewer older (>65 years) patients (stroke: 34.3% vs. 45.1%, odds ratio [OR]: 0.64, p = 0.291; ACS: 39.8% vs. 54.2%, OR: 0.56, p = 0.016) were admitted during the COVID-19 compared with the control period. Conclusions: Hospitalisation rates both for stroke and ACS were reduced during the COVID-19 outbreak in a country with strict social distancing measures, low COVID-19 incidence and low population mortality. Lack of triggers for stroke and ACS during social distancing/quarantining may explain these observations. However, medical care avoidance attitudes among cerebro/cardiovascular patients should be dissipated amidst the rising second COVID-19 wave. © 2020 European Academy of Neurology

Atrial fibrillation (AF) and diabetes mellitus (DM) are commonly encountered in clinical practice. Although, the long term macrovascular and microvascular sequela of DM are well validated, the association between the less prevalent type 1 DM (T1DM) and atrial arrhythmogenesis is poorly understood. In the present review we highlight the current experimental and clinical data addressing this complex interaction. Animal studies support that T1DM, characterized by insulin deficiency and glycemic variability, impairs phosphatidylinositol 3‑kinase (PI3K)/protein kinase B signaling pathway. This pathway holds a central role in atrial electrical and structural remodeling responsible for arrhythmia initiation and maintenance. The molecular ‘’footprint’’ of T1DM in atrial myocytes seems to involve a state of increased oxidative stress, impaired glucose transportation, ionic channel dysregulation and eventually fibrosis. On the contrary only a few clinical studies have examined the role of T1DM as an independent risk factor for AF development, and are discussed here. Further research is needed to solidify the real magnitude of this association and to investigate the clinical implications of PI3K molecular signaling pathway in atrial fibrillation management. © 2021 Elsevier B.V.

The optimal management for severely calcified coronary artery disease is multi-adjunctive. Different strategies with dedicated devices should be available in the cardiac catheterization laboratory with their selection depending on the nature of the calcific disease and its anatomical distribution. Shockwave Intravascular Lithotripsy (S-IVL) system offers a novel option for lesion preparation of heavily calcified plaques in coronary and peripheral vessels. S-IVL is based on the fundamental principles of lithotripsy, a technology that has been used to modify renal stones for over 30 years. Pulsatile mechanical energy is used to fragment selectively amorphous calcium, sparing soft tissue. S-IVL has the potential of more widespread adoption because of its proven safety, efficacy and operational simplicity, but cost-effectiveness of such advanced technology will need to be analyzed. © 2021 Elsevier Inc.

Objectives: The aim of the study was to evaluate the outcomes of retrograde versus antegrade approach in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: The retrograde approach has increased the success rate of CTO PCI but has been associated with a higher risk for complications. Methods: We conducted a meta-analysis of studies published between 2000 and August 2019 comparing the in-hospital and long-term outcomes with retrograde versus antegrade CTO PCI. Results: Twelve observational studies (10,240 patients) met our inclusion criteria (retrograde approach 2,789 patients, antegrade approach 7,451 patients). Lesions treated with the retrograde approach had higher J-CTO score (2.8 vs. 1.9, p < .001). Retrograde CTO PCI was associated with a lower success rate (80.9% vs. 87.4%, p < .001). Both approaches had similar in-hospital mortality, urgent revascularization, and cerebrovascular events. Retrograde CTO PCI was associated with higher risk of inhospital myocardial infarction (MI; odds ratio [OR] 2.37, 95% confidence intervals [CI] 1.7, 3.32, p < .001), urgent pericardiocentesis (OR 2.53, 95% CI 1.41–4.51, p = .002), and contrast-induced nephropathy (OR 2.12, 95% CI 1.47–3.08; p < .001). During a mean follow-up of 48 ± 31 months retrograde crossing had similar mortality (OR 1.79, 95% CI 0.84–3.81, p = .13), but a higher incidence of MI (OR 2.07, 95% CI 1.1–3.88, p = .02), target vessel revascularization (OR 1.92, 95% CI 1.49–2.46, p < .001), and target lesion revascularization (OR 2.08, 95% CI 1.33–3.28, p = .001). Conclusions: Compared with antegrade CTO PCI, retrograde CTO PCI is performed in more complex lesions and is associated with a higher risk for acute and long-term adverse events.

Importance: Severe acute respiratory syndrome coronavirus 2 infection has evolved into a global pandemic. Low-dose colchicine combines anti-inflammatory action with a favorable safety profile. Objective: To evaluate the effect of treatment with colchicine on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19). Design, Setting, and Participants: In this prospective, open-label, randomized clinical trial (the Greek Study in the Effects of Colchicine in COVID-19 Complications Prevention), 105 patients hospitalized with COVID-19 were randomized in a 1:1 allocation from April 3 to April 27, 2020, to either standard medical treatment or colchicine with standard medical treatment. The study took place in 16 tertiary hospitals in Greece. Intervention: Colchicine administration (1.5-mg loading dose followed by 0.5 mg after 60 min and maintenance doses of 0.5 mg twice daily) with standard medical treatment for as long as 3 weeks. Main Outcomes and Measures: Primary end points were (1) maximum high-sensitivity cardiac troponin level; (2) time for C-reactive protein to reach more than 3 times the upper reference limit; and (3) time to deterioration by 2 points on a 7-grade clinical status scale, ranging from able to resume normal activities to death. Secondary end points were (1) the percentage of participants requiring mechanical ventilation, (2) all-cause mortality, and (3) number, type, severity, and seriousness of adverse events. The primary efficacy analysis was performed on an intention-to-treat basis. Results: A total of 105 patients were evaluated (61 [58.1%] men; median [interquartile range] age, 64 [54-76] years) with 50 (47.6%) randomized to the control group and 55 (52.4%) to the colchicine group. Median (interquartile range) peak high-sensitivity cardiac troponin values were 0.0112 (0.0043-0.0093) ng/mL in the control group and 0.008 (0.004-0.0135) ng/mL in the colchicine group (P =.34). Median (interquartile range) maximum C-reactive protein levels were 4.5 (1.4-8.9) mg/dL vs 3.1 (0.8-9.8) mg/dL (P =.73), respectively. The clinical primary end point rate was 14.0% in the control group (7 of 50 patients) and 1.8% in the colchicine group (1 of 55 patients) (odds ratio, 0.11; 95% CI, 0.01-0.96; P =.02). Mean (SD) event-free survival time was 18.6 (0.83) days the in the control group vs 20.7 (0.31) in the colchicine group (log rank P =.03). Adverse events were similar in the 2 groups, except for diarrhea, which was more frequent with colchicine group than the control group (25 patients [45.5%] vs 9 patients [18.0%]; P =.003). Conclusions and Relevance: In this randomized clinical trial, participants who received colchicine had statistically significantly improved time to clinical deterioration. There were no significant differences in high-sensitivity cardiac troponin or C-reactive protein levels. These findings should be interpreted with caution. Trial Registration: ClinicalTrials.gov Identifier: NCT04326790. © 2020 Copernicus GmbH. All rights reserved.

Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.

BACKGROUND A retrograde approach improves the success rate of percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs). OBJECTIVES The authors describe the European experience with and outcomes of retrograde PCI revascularization for coronary CTOs. METHODS Follow-up data were collected from 1,395 patients with 1,582 CTO lesions enrolled between January 2008 and December 2012 for retrograde CTO PCI at 44 European centers. Major adverse cardiac and cerebrovascular events were defined as the composite of cardiac death, myocardial infarction, stroke, and further revascularization. RESULTS The mean patient age was 62.0 +/- 10.4 years; 88.5% were men. Procedural and clinical success rates were 75.3% and 71.2%, respectively. The mean clinical follow-up duration was 24.7 +/- 15.0 months. Compared with patients with failed retrograde PCI, successfully revascularized patients showed lower rates of cardiac death (0.6% vs. 4.3%, respectively; p < 0.001), myocardial infarction (2.3% vs. 5.4%, respectively; p = 0.001), further revascularization (8.6% vs. 23.6%, respectively; p < 0.001), and major adverse cardiac and cerebrovascular events (8.7% vs. 23.9%, respectively; p < 0.001). Female sex (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.33 to 3.18; p = 0.001), prior PCI (HR: 1.73; 95% CI: 1.16 to 2.60; p = 0.011), low left ventricular ejection fraction (HR: 2.43; 95% CI: 1.22 to 4.83; p = 0.011), J-CTO (Multicenter CTO Registry in Japan) score >= 3 (HR: 2.08; 95% CI: 1.32 to 3.27; p = 0.002), and procedural failure (HR: 2.48; 95% CI: 1.72 to 3.57; p < 0.001) were independent predictors of major adverse cardiac and cerebrovascular events at long-term follow-up. CONCLUSIONS The number of retrograde procedures in Europe has increased, with high percents of success, low rates of major complications, and good long-term outcomes. (C) 2015 by the American College of Cardiology Foundation.

Autorzy dokonali szczegółowej analizy badań laboratoryjnych i czynnościowych służących diagnostyce nietrzymania moczu. Omówili szczegółowo m.in. Bridge Fluid Test, test kaszlowy, próbę Sanda, test podpaskowy. Jeszcze jednym niezwykle użytecznym narzędziem umożliwiającym ocenę zaburzeń jest dzienniczek mikcji. Dzienniczek mikcji jest szczególnie przydatny w ocenie poliurii (nadmiernej produkcji moczu) oraz nocnej poliurii (nadmiernej produkcji moczu podczas spoczynku nocnego). Autorzy zwrócili uwagę na zasadnicze elementy prawidłowego prowadzenia dzienniczka. Dokonano także omówienia wybranych badań urodynamicznych. The authors have performed a thorough analysis of laboratory and functional examinations used in the diagnostics of urinary incontinence. They have discussed in detail the Bridge Fluid Test, cough test, Sand’s test, pad test, etc. Yet another tool that is very useful in assessing the disorders is a micturition diary. This diary is especially helpful in diagnosing polyuria (excessive urine production) and night polyuria (excessive urine production during sleep). The authors have emphasised the basic elements of keeping such a diary. Furthermore, selected urodynamic tests have been discussed at length.

Autorzy scharakteryzowali czynniki powodujące występowanie nietrzymania moczu, podkreślili ich interferencyjne działanie przyczynowe. Szczegółowo zostały omówione takie czynniki jak czynniki predysponujące: płeć, rasa, czynniki genetyczne, anatomiczne, neurologiczne, związane z tkanką łączną, kulturowe, środowiskowe. Przedstawiono znaczenie czynników promujących: otyłość, wykonywany zawód, rekreacja, przebyte operacje, palenie papierosów, przewlekły kaszel, zakażenia dróg moczowych, nieregularne miesiączkowanie, polekowe, dietetyczne, menopauza, oraz czynników dekompensacyjne: wiek, demencja, niedorozwój umysłowy, inne schorzenia, działanie leków, czynniki środowiskowe. The authors have discussed the factors causing urinary incontinence and emphasised their interferential activity. Such pre-disposing factors as: sex, race, genetics, anatomy, neurology, connective tissue issues, cultural and environmental background have been discussed in detail. The significance of the following promoting factors has been presented: obesity, occupation, recreation, surgeries undergone, smoking, chronic cough, urinary tract infections, irregular menstruation, medication effects, diet, menopause, and decompensation factors (age, dementia, mental handicap, other diseases, medication effects, and environmental factors).

Autorzy przedstawili rys historyczny badań urodynamicznych, podkreślili znaczenie dobrze zebranego wywiadzie diagnostyce zaburzeń czynnościowych dolnych dróg moczowych. Scharakteryzowali poszczególne składowe postępowania wstępnego. Przypomnieli o istnieniu szeregu kwestionariuszy np. ICIQ-SF, UDI 6SF, Gaudenza, MESA pomocnych w szczegółowej ocenie zaburzeń. The authors have presented the historical background of urodynamic tests and emphasised the significance of wellcollected medical history to the diagnostics of lower urinary tract functional disorders. They have characterised the initial treatment. They pointed out the helpfulness of the questionnaires to be used: ICIQ-SF, UDI 6SF, the Gaudenz Questionnaire, MESA etc.

Autorzy przedstawili krótki rys historyczny tworzenia i ewolucji definicji niedotrzymania moczu. Scharakteryzowali kliniczne postacie niedotrzymania moczu u kobiet: wysiłkowe nietrzymanie moczu, naglące nietrzymanie moczu, nietrzymanie moczu z przepełnienia, nietrzymanie moczu pozazwieraczowe. The authors have presented a concise historical overview of the origin and evolution of urinary incontinence. They have characterised the clinical forms of urinary incontinence in women: stress incontinence, urge incontinence, overflow incontinence, extra-urethral incontinence.

Background and purpose An internet-based discrete choice\ud experiment (DCE) was conducted to elicit preferences for a wide\ud range of Dupuytren’s contracture (DC)-related health states. An\ud algorithm was subsequently developed to convert these preferences\ud into health state utilities that can be used to assess DC’s\ud impact on quality of life and the value of its treatments.\ud Methods Health state preferences for varying levels of DC\ud hand severity were elicited via an internet survey from a sample\ud of the UK adult population. Severity levels were deined using a\ud combination of contractures (0, 45, or 90 degrees) in 8 proximal\ud interphalangeal and metacarpophalangeal joints of the index,\ud middle, ring, and little ingers. Right-handed, left-handed, and\ud ambidextrous respondents indicated which hand was preferable\ud in each of the 10 randomly-selected hand-pairings comparing\ud different DC severity levels. For consistency across comparisons,\ud anatomically precise digital hand drawings were used. To anchor\ud preferences onto the traditional 0–1 utility scale used in health\ud economic evaluations, unaffected hands were assigned a utility\ud of 1.0 whereas the utility for a maximally affected hand (i.e., all\ud 8 joints set at 90 degrees of contracture) was derived by asking\ud respondents to indicate what combination of attributes and levels\ud of the EQ-5D-5L proile most accurately relects the impact of\ud living with such hand. Conditional logistic models were used to\ud estimate indirect utilities, then rescaled to the anchor points on\ud the EQ-5D-5L.\ud Results Estimated utilities based on the responses of 1,745\ud qualiied respondents were 0.49, 0.57, and 0.63 for completely\ud affected dominant hands, non-dominant hands, or ambidextrous\ud hands, respectively. Utility for a dominant hand with 90-degree\ud contracture in t h e metacarpophalangeal joints of the ring and\ud little ingers was estimated to be 0.89. Separately, reducing the\ud contracture of metacarpophalangeal joint for a little inger from\ud 50 to 12 degrees would improve utility by 0.02.\ud Interpretation DC is associated with substantial utility decrements.\ud The algorithms presented herein provide a robust and lexible\ud framework to assess utility for varying degrees of DC severity. \ud

Cel badań: ocena poczucia własnej skuteczności po radykalnym leczeniu raka piersi. Materiał i metody: Badaniami objęto 82 kobiety w wieku 31 – 63 lata leczonych radykalnie z powodu raka piersi. Grupę kontrolą stanowiły studentki kierunku pielęgniarstwa. Grupa ta liczyła 39 osób w wieku 27 – 49 lat. Obie grupy poddano badaniom z wykorzystaniem Skali Uogólnionej Własnej Skuteczności. Wyniki badań odniesiono do wybranych cech socjo-demograficznych kobiet leczonych radykalnie z powody raka piersi takich jak wiek, wykształcenie, czas jaki upłynął od zakończenia radykalnego leczenia choroby nowotworowej do momentu badań. Wyniki i wnioski: Stwierdzono, że średnia wartość testu GSES dla całej badanej grupy kobiet poddanych radykalnemu leczeniu z powodu raka piersi była znamiennie statystycznie niższa niż grupie kontrolnej. Wykazano, że począwszy od 45 rż. u kobiet leczonych radykalnie z powodu raka piersi znamiennie statystycznie obniża się po-ziom poczucia własnej skuteczności. Najniższy i to istotnie statystycznie w porównaniu do pozostałych dekad życia, jest w przedziale wieku 56 – 65 lat. Ponadto stwierdzono, że w miarę upływu czasu po zakończeniu leczenia radykalnego raka piersi poczucie sensu życia oraz własnej skuteczności u badanych kobiet wrastało, a znamienny statystycznie wzrost poczucia własnej skuteczności nastąpił po upływie roku od zakończenia leczenia i utrzymywał się już na porównywalnym poziomie. The purpose of the research: the estimation of the sense of self-efficiency after a radical treatment of a breast cancer. The material under investigation and methods: The research was conducted on a group of 82 women who have undergone a radical treatment of a breast cancer, their ages varying from 31 to 63. The control group comprised of the nursing faculty students. It was a group of 39 people, aged from 27 to 49. Both groups were tested using the General Self-Efficacy Scale. The relations were found be-tween the results of the research and the selected socio-demographic features of women treated radically for a breast cancer like age, edu-cation and the period of time between the end of the radical treatment and the current research. The results and conclusions: It was stated that the average result of the GSES test for the whole group of women who have undergone a radical treatment for a breast cancer was significantly lower than in the control group. It was indicated that, starting from 45 years of age, the women who were treated for a breast cancer statistically have a significantly dropping level of the sense of self-efficiency. The lowest level, in comparison with the other decades of a lifetime, is between 56 and 65 years of age, which is statistically relevant. Moreover, it was stated that, with the passing of time, after the end of the radical breast cancer treatment the sense of self-efficiency and the meaning of life were increasing and after a year there was a statistically signifi-cant increase of the sense of self-efficiency, plus its level remained stable after that.

W pracy przedstawiono zmiany zachodzące na rynku ubezpieczeń zdrowotnych w Wielkiej Brytanii powstające pod wpływem wybranych europejskich uregulowań prawnych. Analizą objęto przepisy The Third Non-Life Assurance Directive 92/96 (OJ L 92.360.1), przepisy regulujące funkcjonowanie brytyjskiej służby zdrowia (NHS), oraz uregulowania rynku dobrowolnych ubezpieczeń zdrowotnych. Szczególną uwagę poświęcono faktycznej współpracy pomiędzy NHS a Ubezpieczycielami. The paper presents changes which United Kingdom health care market undergo under the influence of selected European Union legal regulation. The analysis covers The Third Non-Life Assurance Directive 92/96 (OJ L 92.360.1), regulations of British National Health Service (NHS) functioning, as well as regulations of voluntary health insurances. The cooperation between NHS and private insures is particularly scrutinized.

Wstęp. Powszechnie podkreśla się, ze ryzyko rozwoju odleżyn jest związane z synergią wielu czynników. Jednym z nich jest na pewno choroba podstawowa będąca przyczyną hospitalizacji. Panuje powszechna zgoda, że chorzy hospitalizowani na oddziałach ortopedycznych stanowią grupę narażoną na ryzyko rozwoju odleżyn. To przekonanie skłoniło autorów do podjęcia badań własnych, których celem była ocena ryzyka i działań profilaktycznych zapobiegających powstaniu odleżyn u chorych hospitalizowanych na oddziale ortopedycznym. Materiał i metody. Przebadano 20 pielęgniarek pracujących na od-dziale ortopedyczno-traumatologicznym jednego ze szpitali warszawskich. Metodą badawczą był sondaż diagnostyczny wykonany techniką ankiety. Jako narzędzia badawczego użyto kwestionariusz ankiety. Przebadano także dokumentację pielęgniarską 40 pacjentów w zakresie ryzyka występowania odleżyn według skali Weterlow. Wyniki i wnioski. Na oddziale ortopedycznym istnieje bardzo wysokie zagrożenie występowania odleżyn sięgające 25%. Oddział jest przygotowany do pielęgnacji chorych. Wprowadzono standard profilaktyki odleżyn, prowadzona jest dokumentacja pielęgniarska, występowanie odleżyn odnotowane jest w karcie profilaktyki odleżyn oraz w raporcie pielęgniarskim. Prowadzona jest obserwacja ryzyka wy-stępowania odleżyn (skala Weterlow-15 odpowiedzi). Wyposażenie oddziału w sprzęt ułatwiający pielęgnację chorych jest niewystarczający. Za mało jest łóżek z automatyczną regulacją, zbyt mało materacy przeciwodleżynowych. Czynności, jakie podejmują pielęgniarki w celu zapobiegania odleżynom to: wczesne rozpoznanie pacjentów z grupy wysokiego ryzyka, stosowanie materacy przeciwodleżynowych, nacieranie spirytusem, oklepywanie i masaż, natłuszczanie skóry chorego, utrzymanie całego ciała w czystości, stosowanie udogodnień, prześcielanie łóżka. Introduction. It is generally underlined that the risk of bedsores is related to the synergy of many factors. One of them is certainly the basic illness constituting the cause of the hospitalization. It is a commonly acknowledged truth that the patients of orthopaedic wards are exposed to potential bedsores. This fact encouraged the authors to undertake their own research, the purpose of which was to assess the risk and preventive measures against bedsores of the orthopaedic patients. Materials and methods. A group of 20 nurses working at the orthopaedic-and-traumatological ward in one of the hospitals in Warsaw was interviewed. The research tool was a diagnostic poll in the form of a survey. Moreover, the nursing documentation of 40 patients was examined with the relation to bedsores (Waterlow score was utilized). Results and conclusion. Orthopaedic wards pose a significant risk of bedsores of 25%. The ward is prepared for admitting patients. The standards of bedsore preventive measures were introduced, nursing record is kept and any bedsores are recorded in the bedsore prevention chart as well as in the nursing report. The bedsore risk is constantly under observation (Waterlow score – 15 answers). The ward is insufficiently equipped as far as the handling of patients is concerned. Too few beds are fixed with autoadjustment mechanism; there is not enough antipressure sore mattresses. The measures taken against bedsores by the nurses are: early diagnosis of a highrisk patient, the use of anti-pressure sore mattress, rubbing in spirit, percussion and massages, lubrication the patient’s skin, keeping the patient’s body clean, the use of convenient measures and using new bedclothes regularly.

Autorzy umówili podstawowe cechy anatomiczno-fizjologiczne skóry i tkanki podskórnej. Przedstawili cechy charakterystyczne odleżyn, rolę czynników sprzyjających ich powstawaniu, oraz sposoby oceny odleżyn oraz leczenia. The authors discuss basic anatomical and physiological features of skin and subcutaneous tissue. They present the characteristic features of bedsores, the significance of the factors that contribute to them and the ways to assess and treat bedsores.