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A 25-year-old female patient with a history of oral contraceptive use was admitted to hospital because of exertional dyspnoea, palpitations, chest discomfort and weakness. Since the clinical presentation was suggestive of some heart disease the patient underwent echocardiography which revealed indirect signs of acute pulmonary embolism. The diagnosis was confirmed with multisliced computed tomography of the pulmonary arteries. Blood test results raised suspicion of antithrombin III deficiency. Enoxaparin and warfarin were used as treatment regimen with good effect and the patient was discharged home without significant symptoms, signs, and with normal echocardiography.
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Outcomes of CPAP treatment in a sleep laboratory specialized in neuropsychiatry

88%
The rapidly increasing number of sleep laboratories implicates their specialization into various fields of sleep medicine. In our sleep laboratory that specializes in neuropsychiatry, patients with the symptoms typical for the obstructive sleep apnea/hypopnea syndrome (OSAHS) were routinely redirected to a local respiratory clinic. Some patients, however, admitted to our center for other reasons revealed OSAHS in nocturnal polysomnography. The purpose of this retrospective study was to assess the outcome of CPAP in treating the sleepiness in this group of patients. Our material consisted of 36 patients who started CPAP therapy due to OSAHS diagnosed in our laboratory in the year 2000 and who came for a routine checkup in 2001. The sleepiness was assessed by using the Epworth Sleepiness Scale (ESS). After CPAP, the mean group ESS score decreased from 10.9 ±4.4 to 8.5 ±4.3 points (P<0.01). Some patients showed, however, persisting excessive sleepiness (PTS) after CPAP, defined as ESS 12. We overviewed the documentation of those patients in search for the possible causes of PTS. We identified the following causes: narcolepsy - 1 patient, insufficient CPAP pressure - 1 patient, low CPAP compliance, fewer than 2 h/night, - 2 patients. In 5 other patients we found CPAP compliance to be between 2.0 and 4.5 h/night, which is less likely to be the cause of PTS. In 1 patient no cause was identified. Our patients showed relatively mild sleepiness before CPAP and only a slight improvement under CPAP. The CPAP noncompliance seems the most prevailing reason for CPAP failure, but in some patients the cause of PTS could not be unraveled by using standard diagnostic tools and some additional measures are to be employed to resolve the issue.
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ABSTRACT Background. The health system responsiveness, defined as non-medical aspect of treatment relating to the protection of the patients’ legitimate rights, is the intrinsic goal of the WHO strategy for 21st century. Objective. To describe the patients’ opinions on treatment they received in hospital, namely: admission to hospital, the role of patient in hospital treatment, course of treatment, medical workforce attitude, hospital environment, contact with family and friends, and the efficacy of hospital treatment in respect to responsiveness to patient’s needs and expectations (dignity, autonomy, confidentiality, communication, prompt attention, social support, basic amenities and choice of provider). Material and methods. The data were collected in 2012 from 998 former patients of the randomly selected 73 hospital in Poland. Results. Dignity: Over 80% of patients experienced kindness, empathy, care and gentleness, and over 90% of them had the sense of security in hospital, met with friendliness during the admission to hospital and never encountered inappropriate comments from medical staff. Autonomy: About 80% of patients accepted the active role of patients in hospital, they perceived they had influence on procedures related to hospitalization and course of treatment, and they felt medical staff responded to their requests and concerns. Over 90 % of them had opportunity to communicate their concerns to medical staff and to discuss the course of treatment. On the other hand, the explanation of the reason for the refusal to meet their requests was given to only 23 % of the patients interested. Confidentiality: 70-80 % of patients declared the respect for privacy and confidentiality during collecting the health information and during medical examinations, and were not examined in presence of other people. Nevertheless, only 23% of patients examined so were asked of their consent. Communication: About 90% of patients declared they trusted their physician, received from him explanation regarding the course of treatment and information about further treatment after discharge from hospital, but physicians devoted the time and attention to only 70% of them. Prompt attention: Over 90% of patients perceived simplicity of the formalities of admission to hospital, and short waiting for treatment and additional tests in hospital (but only 50% received explanation of reason if they waited long). Nevertheless, 10% of them % of them perceived they waited for admission to hospital too long, and over 20% for admission to a ward as long. Social support: The unlimited direct and phone contact with family and friends was declared by 96% of patients. Basic amenities: The high percentage of patients assessed positively the marking in hospital (97%) and cleanliness of linen (89%), followed by the general indoor appearance room in which patient stayed, lack of noise (70-80%), hospital meals, furniture (60-70%), availability of personal hygienic articles (50-60%), cleanliness of hospital room, toilet, showers and bathtubs, and availability of soap (40-50%). Choice of provider: Only 41% of patients declared that they had influence on choice of the hospital. Conclusion. Responsiveness of Polish hospital patient needs is similar to that of the OECD countries of the lowest health system responsiveness. Compared to the Central European countries, the responsiveness in Polish hospitals is lower than that of Czech Republic and only slightly higher of those of Slovenia, Slovakia and Hungary.
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