Dóra Endrei

Toe–brachial index (TBI) measurement helps to detect peripheral artery disease (PAD) in patients with incompressible ankle arteries due to medial arterial calcification, which is most frequently associated with diabetes. We aimed to evaluate how an automated four-limb blood pressure monitor equipped with TBI measurement could contribute to PAD screening. In 117 patients (mean age 63.2 ± 12.8 years), ankle–brachial index (ABI) measurement was performed using the Doppler-method and the MESI mTablet. TBI was obtained via photoplethysmography (MESI mTablet, SysToe) and a laser Doppler fluxmeter (PeriFlux 5000). Lower limb PAD lesions were evaluated based on vascular imaging. A significant correlation was found between Doppler and MESI ankle–brachial index values (r = 0.672), which was stronger in non-diabetic (r = 0.744) than in diabetic (r = 0.562) patients. At an ABI cut-off of 0.9, Doppler (AUC = 0.888) showed a sensitivity/specificity of 67.1%/97.4%, MESI (AUC 0.891) exhibited a sensitivity/specificity of 57.0%/100%; at a cut-off of 1.0, MESI demonstrated a sensitivity/specificity of 74.7%/94.8%. The TBI values measured using the three devices did not differ significantly (p = 0.33). At a TBI cut-off of 0.7, MESI (AUC = 0.909) revealed a sensitivity/specificity of 92.1%/67.5%. Combining MESI ABI and TBI measurements recognised 92.4% of PAD limbs. Using an ABI cut-off level of 1.0 and sequential TBI measurement increases the sensitivity of the device in detecting PAD. The precise interpretation of the obtained results requires some expertise.

Intermittent claudication is a frequent complaint in lower extremity artery disease, but approximately two thirds of patients are asymptomatic, most of which are diabetic patients. Non-invasive angiological and microrheological tests on diabetic subjects with and without intermittent claudication were performed in the present study. In total, 98 diabetic patients were included and divided into two groups: 20 patients (63.5 ± 8.8 years, 55% men, 45% women) had intermittent claudication, 78 patients (65.5 ± 9.3 years, 61.5% men, 38.5% women) were asymptomatic. Hand-held Doppler ultrasound examination, transcutaneous tissue partial oxygen pressure (tcpO₂) measurement, Rydel–Seiffer tuning fork tests, and 6-min walk tests were performed, and erythrocyte aggregation was investigated. Ankle–brachial index (p < 0.02) and tcpO₂, measured during provocation tests (p < 0.003) and the 6-min walk test (p < 0.0001), significantly deteriorated in the symptomatic group. A higher erythrocyte aggregation index and faster aggregate formation was observed in claudication patients (p < 0.02). Despite the statistically better results of the asymptomatic group, 13% of these patients had severe limb ischemia based on the results of tcpO₂ measurement. Claudication can be associated with worse hemodynamic and hemorheological conditions in diabetic patients; however, severe ischemia can also develop in asymptomatic subjects. Non-invasive vascular tests can detect ischemia, which highlights the importance of early instrumental screening of the lower limbs.

Background: Intermittent claudication is a frequent complaint in lower extremity artery disease, but approximately two thirds of patients are asymptomatic, mostly in diabetic population. Non-invasive angiological and microrheological tests among diabetic patients with and without intermittent claudication were studied. Methods: 98 diabetic patients were included and divided into two groups: 20 patients (63.5±8.8 yrs, 55% men, 45% women) had intermittent claudication, 78 patients (65.5±9.3 yrs, 61.5% men, 38.5% women) were asymptomatic. Hand-held Doppler, transcutaneous tissue partial oxygen pressure (tcpO2) measurement, tuning fork test and 6-minute walk test were performed and erythrocyte aggregation was investigated. Results: Ankle/brachial index (p<0.02), and tcpO2 measured during provocational tests (p<0.003), 6-minute walk test (p<0.0001) were significantly deteriorated in the symptomatic group. Higher erythrocyte aggregation index and faster aggregate formation could be observed among claudicant patients (p<0.02). In spite of the statistically better results of the asymptomatic group, 13% of these patients had severe limb ischemia based on the result of tcpO2 measurement. Conclusion: Claudication could be associated with worse hemodynamical and hemorheological status in diabetics; nevertheless, severe ischemia can develop even in asymptomatic subjects which can be revealed by noninvasive vascular tests, which highlights the importance of the early instrumental screening of the lower limbs.

Peripheral artery disease (PAD) is a progressive atherosclerotic disease significantly impacting functional status and health-related quality of life (HRQoL). This study aimed to investigate HRQoL among PAD patients in Hungary using the validated Hungarian version of the PADQoL questionnaire. Patients with symptomatic PAD were consecutively recruited from the Department of Angiology, Clinical Center, University of Pécs, Hungary. Demographics, risk factors, and comorbidities were registered. Disease severity was measured by Fontaine and WIFI stages. Descriptive statistical analysis, Chi-square test, and non-parametric tests were performed (p < 0.05). Overall, 129 patients (mean age 67.6 ± 11.9 years, men 51.9%) participated in our study. The Hungarian PADQoL demonstrated good internal consistency (α range: 0.745–0.910). Factors on intimate and social relationships gave the best (89.15 ± 20.91; 63.17 ± 26.05) and sexual function (28.64 ± 27.42), and limitations in physical functioning (24.68 ± 11.40) the worst scores. PAD had a significant negative impact on the social relationships of patients aged 21–54 years (51.6 ± 25.4). Fontaine stage IV patients experienced significantly lower HRQoL due to fear and uncertainty (46.3 ± 20.9) and limited physical functioning (33.2 ± 24.8). The Hungarian PADQoL identified central aspects of HRQoL. Advanced PAD was found to impact several areas of HRQoL, primarily physical functioning and psycho-social well-being, drawing attention to the importance of early diagnosis and management.

A várólisták témaköre nemzetközileg is rendkívüli figyelemmel követett indikátor az egészségügyi ellátórendszerek összehasonlítása során. A várólisták körében kiemelt jelentőséggel rendelkezik a szürkehályog, mely megszüntetése az egyik legelterjedtebb várólista-köteles beavatkozás világszerte. A vizsgálat célja, hogy elemezze az egynapos sebészeti betegellátás várólista-csökkentési potenciálját a szürkehályog műtét várólistával összefüggésben Magyarországon a 2014-2019 közötti időszakban. Vizsgálati adatbázisunk a Nemzeti Egészségbiztosítási Alapkezelő finanszírozási adatbázisából származik és a 2014-2019 közötti időszak adatait tartalmazta. Az adatbázis a szürkehályog várólistához és a szürkehályog előjegyzési listához kapcsolódó várakozók és előjegyzettek számát, a váró-, illetve előjegyzési listán szereplők tényleges, átlagos várakozási idejét, az ellátott esetszámok ellátási típus szerinti megoszlását, a beavatkozások Orvosi Eljárások Nemzetközi Osztályozási (OENO) rendszerének kódját és megnevezését, valamint az ellátó egészségügyi intézmény típusát tartalmazta. A vizsgált időszak alatt évente átlagosan 6.251 fő volt szerepelt a magyarországi szürkehályog várólistán, azonban számottevő emelkedés nem volt kimutatható 2014-2019 között. Az átlagos tényleges várakozási idő 2014-ben 104 nap volt, mely 2019-ben csupán 39. Az esetek jellemzően egynapos sebészeti ellátásban és aktív fekvőbeteg szakellátásban kerültek elszámolásra. A vizsgálati időszak során a műtéti esetszámok érdemben nem változtak, ugyanakkor az egynapos sebészet esetszámok aránya folyamatos emelkedést mutatott. A legnagyobb mértékben elvégzett beavatkozás az 51474 OENO kóddal rögzített hajlított műlencse-beültetéssel kombinált phacoemulsificatios műtét volt, mely az összes vizsgálatba vont beavatkozás 96%-át jelentette (n=458.326). A várólistán szereplő várakozók száma számottevően nem nőtt az általunk vizsgált időszak alatt; az éves műtéti esetszám nem változott; ugyanakkor az átlagos várakozási idő jelentősen csökkent. Mindez azt igazolja, hogy érdemi műtéti esetszám növekedés nélkül sikerült az átlagos várakozási időt csökkenteni, ami felhívja a figyelmet az ellátás szervezésének fontosságára.

Objective: Patient safety and adverse event analysis are of paramount importance in the management of patient medication, given the significant economic burden they place on a country’s healthcare system. Medication errors fall into the category of preventable adverse drug therapy events and are therefore of key importance from a patient safety perspective. Our study aims to identify the types of medication errors associated with the medication dispensing process and to determine whether automated individual medication dispensing with pharmacist intervention significantly reduces medication errors, thereby increasing patient safety, compared to traditional, ward base medication dispensing (by a nurse). Method: A prospective, quantitative, doubleblind point prevalence study was conducted in three inpatient internal medicine wards of Komló Hospital in February 2018 and 2020. We analyzed data from comparisons of prescribed and non-prescribed oral medications in 83 and 90 patients per year aged 18 years or older with different diagnoses treated for internal medicine on the same day and in the same ward. In the 2018 cohort, medication was traditionally dispensed by a ward nurse, while in the 2020 cohort, it used automated individual medication dispensing with pharmacist intervention. Transdermally administered, parenteral and patient-introduced preparations were excluded from our study. Results: We identified the most common types of errors associated with drug dispensing. The overall error rate in the 2020 cohort was significantly lower (0.9%) than in the 2018 cohort (18.1%) (p < 0.05). Medication errors were observed in 51% of patients in the 2018 cohort, i.e. 42 patients, of which 23 had multiple errors simultaneously. In contrast, in the 2020 cohort, a medication error occurred in 2%, i.e. 2 patients (p < 0.05). When evaluating the potential clinical consequences of medication errors, in the 2018 cohort, the proportion of potentially significant errors was 76.2% and potentially serious errors 21.4%, whereas in the 2020 cohort, only three medication errors were identified in the potentially significant category due to pharmacist intervention, which was significantly lower (p < 0.05). Polypharmacy was detected in 42.2% of patients in the first study and in 12.2% (p < 0.05) in the second study. Conclusion: Automated individual medication dispensing with pharmacist intervention is a suitable method to increase the safety of hospital medication, reduce medication errors, and thus improve patient safety. Pharmacy Practice is a free full-text journal with a scope on the practice of pharmacy. Pharmacy Practice covers pharmaceutical care, social pharmacy, pharmacy education, process and outcome research, health promotion and education, health informatics, pharmacoepidemiology

: Despite the high prevalence of peripheral artery disease (PAD), the diagnosis is often delayed. The delayed diagnosis is due in part to comorbidities which can mask PAD symptoms, and in large part to the low use of conventional diagnostic tools. For PAD diagnostics, the guidelines recommend Doppler-based ankle-brachial index (ABI). The method is time consuming and requires skills. The toe pressure measurement which helps to eliminate the falsely elevated ankle pressures due to mediasclerosis is an almost neglected method for screening. In recent years, automatic, oscillometric four-limb blood pressure monitors have become available that provide data within minutes. We aimed to compare an automatic four limb blood pressure monitor with devices regularly used in our department. Methods: Blood pressure was measured in 92 individuals (mean age 65±14 years) using a Doppler device (Hadeco) and a conventional manual sphygmomanometer on all four limbs, as well as an automatic, four-limb pressure monitor (BOSO ABI system-100 PWV) which also measured pulse wave velocity (PWV). Toe pressure was measured with a laser Doppler fluxmeter (Periflux 5000) and a photophlethysmography based toe pressure monitor (Systoe). Patients without known PAD but with at least one abnormal test result underwent a vascular imaging including ultrasound, CT or digital subtraction angiography. Among the 92 individuals there were patients with confirmed PAD, persons at high or very high cardiovascular risk, patients with non-ischaemic cardial diseases and healthy volunteers. Results: ABI values of the posterior tibial artery at the corresponding side measured by Doppler and BOSO showed a strong correlation with each other (Pearson's r: 0.8 and 0.7), while the Doppler ABI values of the dorsal pedal artery showed a moderate or weak correlation with BOSO ABI values (r: 0.63 and 0.27). The toe pressure measured by laser Doppler and Systoe did not differ significantly. The ROC curve analysis of the Periflux TBI values supported 0.6 as a cut-off level (91.6% sensitivity, 84% specificity). Of the 52 individuals with high or very high cardiovascular risk, 15 with Doppler, 12 with BOSO and 29 with Periflux could be considered as abnormal, the vascular imaging confirmed PAD in 12 of them. Doppler ABI was abnormal in 96%, BOSO ABI in 69%, BOSO ABI combined with PWV in 92%, Periflux and Systoe toe brachial index (TBI) in 100–100% in 72 limbs with confirmed PAD. In control subjects, ABI, TBI, and PWV were normal; in subjects with high or very high risk, PWV was 58% abnormal, in confirmed PAD, 85%. All patients with abnormal PWV showed atherosclerotic lesions by the vascular imaging. Summary: For detection of PAD, the measurement of TBI had the highest sensitivity. PAD screening of a large population may be possible using automatic four limb blood pressure monitors. By combining with additional features (e.g. PWV) the detection ratio can be improved to the level of the Doppler ABI method. Funding Acknowledgement: Type of funding sources: None.

The authors wish to make the following corrections to this paper

Introduction The balanced scorecard (BSC) was implemented to improve hospitals’ performance evaluations (PE) in the last 30 years. BSC consists of six perspectives: financial, customer, internal, external, knowledge and growth, and managerial. However, patients were seldom engaged in such implementations. This research aims to engage Palestinian patients in BSC implementations. Methodology This is a cross-sectional study. We collected data between January and October 2021 using the printed BSC-PATIENT survey. We evaluated the patients’ experiences and attitudes toward BSC dimensions (BSCP ATT). The differences in evaluations based on admission status were also analyzed using the Mann‒Whitney U test. Additionally, we analyzed the causal relationships between patients’ experiences and attitudes using multiple linear regression, and the multicollinearity of the model was tested. Finally, the path analysis was performed to understand the BSC strategic maps based on the Palestinians’ evaluations. Results The mean scores for Palestinian patient experiences evaluation showed that the services experience factor had the highest score (87.7 ± 17.7), and the patient care experience factor had the lowest score (57 ± 34.5). The patient experiences collectively predicted 56.4% of the variance in the BSCP ATT. The experiences factors of information (β = 0.400, t = 13.543, P < 0.001), patient care (β = 0.241, t = 8.061, P < 0.001), services (β = 0.176, t = 6.497, P < 0.001), and building (β = 0.177, t = 6.308, P < 0.001) had the highest impact on BSCP ATT. The price had only a weak negative influence (β=-0.051, t=-2.040, P = 0.042). Accessibility to hospitals did not have any impact on BSCP ATT. Significant differences between inpatient and outpatients’ evaluations in regard to experiences related to patient care (P = 0.042), services (P < 0.001), accessibility (P < 0.001), and BSCP ATT (P = 0.003) were found. Conclusion Managers of Palestinian hospitals should prioritize enhancing the patient experience, particularly the information experience. The importance of patient education programs and information sharing with patients cannot be overstated. Other experiences as patient care, services, and building are also significant. By focusing on separate evaluations of patients' experiences and attitudes, the BSC strategic maps will be easier to understand from the patients' point of view. BSC-PATIENT survey may assist hospitals managers in achieving this objective and enhancing their action plans. Palestinian hospitals must enhance patients’ feedback and engagement culture.