Measures of preoperative anxiety: Part two.

The current literature indicates that routine evaluation of preoperative anxiety, its determinants, and patient-specific concerns is universally advocated. This aligns with the increasingly acknowledged importance of prehabilitation - a comprehensive process preparing patients for surgery. A crucial component of prehabilitation is assessing patients' mental health. Recommendations for psychological evaluations in prehabilitation encompass, inter alia, determining the severity of anxiety. This work builds on a 2019 article, which presented scales for preoperative anxiety assessment: the State Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS), the Amsterdam Preoperative Anxiety and Information Scale (APAIS), and the Visual Analogue Scale (VAS). This article extends the possibilities of preoperative anxiety assessment by introducing four additional methods: the Surgical Fear Questionnaire (SFQ), the Anxiety Specific to Surgery Questionnaire (ASSQ), the Surgical Anxiety Questionnaire (SAQ), and Anesthesia- and Surgery-dependent Preoperative Anxiety (ASPA). The authors provide comprehensive details on these instruments, including scoring, interpretation, availability, and usefulness both in scientific research and clinical practice. The authors also provide the data on the availability of Polish versions of the presented methods and preliminary data on the reliability of SFQ in patients awaiting cardiac surgery. This review seems relevant for professionals in multiple disciplines, including anesthesiology, surgery, clinical psychology, nursing, primary care and notably prehabilitation. It emphasizes the necessity of individualizing anxiety assessment and acknowledging patient subjectivity, which the presented methods facilitate through a thorough evaluation of specific patient concerns. The literature review also identifies concerns and future research avenues in this area. The importance of qualitative studies and those evaluating prehabilitation intervention is emphasized.

Cardiovascular risk factors among Polish employees of uniformed services.

OBJECTIVES: Employees of uniformed services (EoUS) were screened for cardiovascular risk factors. MATERIAL AND METHODS: A total of 1138 EoUS (age M±SD 49.9±6.0 years) and 263 controls (age M±SD 54.4±9.7 years) under the care of the cardiology clinic in Gdansk, Poland, were included in the study. Medical history and blood samples were collected, and a physical examination was performed. Ten-year cardiovascular risk of death was calculated using the systematic coronary risk evaluation (SCORE) risk algorithm for high-risk countries. RESULTS: Significantly higher values of mean systolic and mean diastolic blood pressure, mean total cholesterol level and mean BMI were recorded among the EoUS compared to controls (M±SD 141.7±11.6 mm Hg vs. 135.5±11.0 mm Hg, p < 0.001; 90.1±5.9 mm Hg vs. 84.5±6.8 mm Hg, p < 0.001; 6.01±0.76 mmol vs. 5.44±0.87 mmol, p < 0.001; 29.3±4.7 vs. 29.0±4.1, p < 0.001, respectively). Smoking cigarettes was most frequently reported by the youngest group (20-39 years old) - 47.7% and it was significantly higher in the entire EoUS group compared to control group (35.5% vs. 16.7%, p = 0.001). The occurrence of observed risk factors (blood pressure ≥140/90 mm Hg, total cholesterol concentration >5 mmol, smoking,) was significantly higher among EoUS compared to controls (92.1% vs. 57.8%, p < 0.001; 89.0% vs. 66.9%, p < 0.001; 35.5% vs. 16.7%, p < 0.001, respectively). In the male group, the mean calculated ten-year risk of fatal cardiovascular events, the percentage of high calculated risk, and very high risk were higher in the EoUS group compared to controls (M±SD 4.44±3.49 vs. 4.23±3.86, p = 0.001; 23.7% vs. 20.2%, p = 0.007; 7.4% vs. 6.5%, p = 0.03, respectively). CONCLUSIONS: The prevalence of all identified risk factors was found to be higher among employees of uniformed services when compared to the control group. The presence of these risk factors within the population of uniformed service employees results in a greater risk of mortality from cardiovascular diseases. Int J Occup Med Environ Health. 2023;36(5):656-71.

Non-invasive haemodynamic assessments among hypertensive patients in a routine family doctor's office.

INTRODUCTION AND OBJECTIVE: Difficult-to-control blood pressure can be attributed to a mismatch between the haemodynamic type of hypertension and the drug class used in treatment. Impedance cardiography may be a useful tool for enabling the individualization of antihypertensive therapy. The aim was to investigate the distribution of haemodynamic types of HT among hypertensive patients in an outpatient clinic. MATERIAL AND METHODS: This was a prospective, observational study of patients with primary hypertension at an outpatient clinic. A 10-minute ICG examination was performed in 189 consecutive, patients (118 men and 71 women). Patients were divided into groups based on whether their hypertension was well-controlled (140/90 mmHg, n=95). They were also stratified according to haemodynamic states. RESULTS: Patients with poorly controlled blood pressure compared to patients with well controlled blood pressure had a high haemodynamic output in 6.3% vs. 2.1% (p=0.153), and high vascular resistance in 41.1% vs. 27.7% (p=0.037), and balanced haemodynamic states in 52.6% vs. 70.2% (0 80 beats/min) and fluid retention (p<0.01). CONCLUSIONS: Half of the examined patients did not achieve the therapeutic goals for hypertension treatment. Differences in haemodynamic state of well and poor controlled hypertension groups suggests the usefulness of impedance cardiography-targeted hypertension treatment.

Cardiovascular testing of seasickness in healthy volunteers on life rafts.

OBJECTIVES: The role of the cardiovascular system in the development of seasickness remains uncertain. MATERIAL AND METHODS: Overall, 18 healthy students (10 males and 8 females) aged 18-24 years volunteered in the project, spending 2-7 h on life rafts. The cardiovascular system was examined with impedance cardiography. Susceptibility and symptoms of seasickness were evaluated by the Motion Sickness Susceptibility Questionnaire Shortform (MSSQ-Short) and the Motion Sickness Assessment Questionnaire (MSAQ). The Visual Analogue Scale (VAS), ranging 0-10, was used to assess nausea, dizziness and mood. The parameters were assessed at 2 time points. RESULTS: Differences in the heart rate (HR), the thoracic fluid content index (TFCI), the stroke index (SI) and the Heather index (HI) before launching the life rafts and after leaving them were observed (78.6, 20.8, 55.6 and 15.9 vs. 70.1, 19.7, 60.5 and 17.9, with p-values of 0.002, <0.001, 0.003 and 0.004, respectively). Females reacted with changes in SI and HR more vividly, whereas males regulated more HI and TFCI. In addition, HR correlated significantly with the central and peripheral symptoms in MSAQ, stroke volume (SV) with peripheral and sopite-related ones, SI with overall ones, and pulse pressure with overall, gastrointestinal and central ones (Spearman's rank correlation coefficient [ρ] was -0.478, -0.711, 0.476, 0.472, 0.525, -0.476, -0.579 and -0.584, respectively). As regards MSSQ-Short, it correlated negatively with sopite-related symptoms in MSAQ (ρ= -0.486). Mood in VAS correlated significantly with gastrointestinal symptoms, SI and the cardiac index (CI) (ρ = -0.752, -0.492 and -0.489, respectively). CONCLUSIONS: It was found that HR correlated negatively, and SV/SI correlated positively, with the severity of seasickness symptoms measured with MSAQ. Gender is probably an independent factor influencing reactions to motion. Women react with SI increase whereas men react with increased heart contractility (HI rise). Negative mood in seasickness evaluated with VAS seems to be mostly determined by gastrointestinal symptoms assessed with MSAQ and diminished cardiovascular indices (both CI and SI). Int J Occup Med Environ Health. 2020;33(4):467-77.

Haemodynamic parameters in postmenopausal women - beneficial effect of moderate continuous exercise training.

INTRODUCTION AND OBJECTIVE: Physical effort plays a positive role in reducing the risk of cardiovascular diseases. The aim of this study was to assess the cardiovascular status in postmenopausal women after several years of regular amateur training. MATERIAL AND METHODS: A total of 55 generally healthy females aged 50-70 years, of whom 38 were members of a senior exercise group and 17 comprised a control group, were enrolled in the study. Parameters of blood flow, vascular resistance, myocardial contractility and thoracic fluid content were measured in a 10-minute supine resting test by impedance cardiography. Thereafter, central blood pressure, augmentation index and pulse wave velocity were measured by applanation tonometry. RESULTS: Exercising women have a better outcome than the control group, when evaluated both with impedance cardiography and with applanation tonometry. They have a lower heart rate - HR (65.1 vs 71.5; p = 0.033), higher blood flow (stroke index - SI, 58.6 vs 50.3; p = 0.040), better myocardial contractility (acceleration index - ACI, 108.8 vs 88.1; p = 0.027), higher preload (thoracic fluid content index - TFCI, 20.5 vs 18.1; p = 0.002), lower afterload (systemic vascular resistance index - SVRI, 1972.9 vs 2110.5; p = 0.026), lower central systolic blood pressure - cBPsys (119.0 vs 129.5; p = 0.037), lower augmentation pressure - AP (10.3 vs 15.0; p = 0.044) and lower pulse wave velocity - PWV (7.4 vs 8.4; p = 0.001). CONCLUSIONS: Regular moderate continuous aerobic exercise training has a beneficial impact on the cardiovascular system in postmenopausal women.

Fatal cardiovascular risk in Poland as determined via Internet.

[b]Abstract Introduction.[/b] Web information systems can serve as a diagnostic tool for Internet users and to support the epidemiological work of doctors and health care providers. As part of this work, a system for detecting and calculating cardiovascular risk has been created. [b]Objectives[/b]. 1) Application of web-based risk assessment of cardiovascular death; 2) an attempt to evaluate the distribution of selected risk factors among the population of Polish Internet users; 3) implementation of the epidemiological imaging system of cardiovascular risk factors. [b]Materials and method[/b]. The 'Ryzyko' programme (www.ryzyko.gumed.edu.pl.) available on the Internet. To assess cardiovascular death risk in a ten year period the algorithm of the SCORE project was used. 28,320 solutions of the algorithm have been registered. [b]Results[/b]. Over 28,000 webpage visitors entered the required data and received the outcome. More than 71% of Internauts who entered the data received the recommendation for medical control. The result of the programme is a graphic presentation of the distribution of the calculated risk of death, based on previously gathered information given by the Internauts in particular provinces in Poland. [b]Conclusion[/b]. Automatic monitoring of the incidence of cardiovascular risk factors in Poland provides information for epidemiological studies. The system meets the characteristics of diagnostic programmes that can assist epidemiologic-based and therapeutic decisions.

Cardiovascular risk factors determined via the Internet in 2 periods of time: 2004-2009 and 2010-2015 in Poland.

OBJECTIVES: Web information systems may serve as a diagnostic tool for the Internet users and they also support the epidemiological work of doctors and health care providers. As part of this study, a system has been created for detecting and calculating cardiovascular risk. The aim of this study has been the comparison of cardiovascular risk factors and calculated fatal cardiovascular risk in 2 periods of time: 2004-2009 and 2010-2015 in Poland, as determined via the Internet. MATERIAL AND METHODS: The "Ryzyko program" ("Risk program") is available on the website of the Medical University of Gdansk. To assess the cardiovascular death risk in a 10-year period, the algorithm of the SCORE (Systematic Coronary Risk Evaluation) project was used and 30 402 results of the algorithm have been analyzed. RESULTS: Over 30 402 webpage visitors entered the required data and received the outcome. More than 78% of the Internet users who had entered the data, received a recommendation for medical check-up. Significant differences between the data collected in 2004- 2009 and 2010-2015 were noticed. Hypercholesterolemia prevalence (67.3% vs. 70.8%; p < 0.001), mean total cholesterol concentration in blood (5.60±1.65 mml/l vs. 5.66±1.35 mml/l; p < 0.001), prevalence of hypertension (36.6% vs. 35.3%; p = 0.039), mean systolic blood pressure (131.5±20.3 mm Hg vs. 132.6±18.0 mm Hg; p < 0.001), prevalence of declared smoking (30.7% vs. 26.5%; p < 0.001), declared diabetes mellitus (DM) (6.4% vs. 9.7%; p < 0.001), and declared coronary artery disease (CAD) (7.2% vs. 14.1%; p < 0.001), respectively. CONCLUSIONS: The prevalence of cardiovascular risk factors has changed during the observed period of time. Online automatic gathering of new data by "Ryzyko program" provides up-to-date observations. Int J Occup Med Environ Health 2017;30(3):499-510.

Hemodynamic findings in patients with brain stroke.

INTRODUCTION: Standard procedures carried out at a stroke department in patients after a cerebral event may prove insufficient for monitoring hemodynamic indices. Impedance cardiography enables hemodynamic changes to be monitored non-invasively. The aim of the work was to describe hemodynamic parameters in patients with acute phase of ischemic and hemorrhagic stroke and to analyse the correlation between the type of hemodynamic response and long-term prognosis. MATERIAL AND METHODS: The 45 consecutive subjects with ischemic stroke and 16 with a hemorrhagic stroke were examined additionally with impedance cardiography during the first day of hospitalization. The heart contractility, pump performance, afterload and preload indices were recorded and calculated automatically and the data analyzed in terms of 6-month mortality. RESULTS: We found a significant association between the systemic vascular resistance index, Heather index, stroke index, heart rate, systolic and diastolic and mean arterial blood pressure and mortality in patients with ischemic stroke (p = 0.002, p = 0.008, p = 0.012, p = 0.005, p = 0.007, p = 0.009, p = 0.002 respectively). Logistic regression analysis identified the thoracic fluid content as the most significant variable correlating with the non-survival of the patients with ischemic stroke and in the whole group (ischemic and hemorrhagic stroke). The significant parameters were also mean arterial pressure and stroke index in ischemic stroke (the correct answer ratio was 86.67%) and heart rate in the whole group (the correct answer ratio was 80.33%). There were no significant associations in hemorrhagic stroke. CONCLUSIONS: The hemodynamic parameters correlate with long term prognosis in patients with ischemic brain stroke.

[Sleep apnea syndrome or atrio-ventricular block and hypertension?]. / Bezdech senny czy blok przedsionkowo-komorowy i nadcisnienie tetnicze?

A case of hypertensive patient with obstructive sleep apnea syndrome is presented. The third degree atrio-ventricular block was detected during diagnostic procedure and treatment of blood pressure in patient with obstructive sleep apnea. A heart pacemaker has been implanted. After this procedure the sleep apnea signs have not been detected.

Monitoring of myocardium state during off-pump coronary artery by-pass grafting.

A measurement technique for evaluation of processes occurring in the myocardium during blood flow arrest is presented. The system is devoted to monitoring the myocardium state during off-pump coronary artery by-pass grafting, i.e. during a surgical operation performed on a beating heart. A substantial part of the system is a probe whose construction is similar to a mechanical stabilizer. Such a stabilizer is used for preventing the myocardium from moving, thus it enables stitching of the graft and artery. In comparison to the commercially available stabilizer the developed probe is enhanced with a set of electrodes. These electrodes enable simultaneous measurements of impedance and electrograms. Examples of recordings made during in vivo studies are also presented. Thus, the proposed method is applicable and potentially very useful in clinical practice.