Until now, the assessment of health care services provided by psychiatric institutions in Latvia has not been carried out and questionnaires to provide assessment from the patient’s perspective have not been adapted. For this study, a questionnaire that has been validated and successfully employed for several years in Norway was chosen to assess patients’ experience and in a psychiatric inpatient setting. The aim of the study was to determine patients’ satisfaction with the quality of mental health care services in Latvia in the subacute inpatient psychiatric ward in Rīga, adapting during this process the PIPEQ-OS (Psychiatric Inpatient Patient Experience Questionnaire) tool in Latvia. The pilot quantitative study was conducted from June 2016 till February 2017. In the study, an anonymous patient self-assessment questionnaire PIPEQ-OS containing 21 questions was used. During the adaptation process, the questionnaire was translated from English into Latvian and Russian and backwards. The quality and compliance of the translation was subsequently tested in cognitive interviews. During the study, 297 patients were discharged from the unit, and 231 of them completed the questionnaire. 12% of the completed questionnaires were not included in data processing due to being incorrectly filled in. Cognitive interviews with 20 patients were carried out; the average length of an interview was 15 minutes. Overall, the translation of the questionnaire proved to be relevant to the research theme. The subsequent factor analysis revealed three significant factors that reached the Cronbach’s alpha index of 0.7. Further studies using socio-demographic data and based on various inpatient units as well as the comparison of satisfaction indicators across different diagnostic groups are needed.
Competitiveness as a factor of a company selling its services in the market is becoming more relevant in the healthcare sector. The number of institutions that offer their services to international patients is growing. Research shows that the development of medical tourism is country-specific. The main objective of this publication is to discover positive and negative factors for engagement in the provision of services to non-residents. The data was obtained from a cross-sectional study in which 86 managers of health care institutions in Latvia completed a questionnaire. A total of 80.2% of health care institutions had provided services to non-resident patients in the previous year while 19.8% did so regularly. Institutions mainly used websites to advertise their services. Only a small number of institutions employed a marketing specialist or had a strategy to attract non-resident patients. Heads of institutions pointed to a number of internal and external barriers in this connection, including lack of staff, low motivation, limited language skills, inadequate infrastructure, insufficient state-level support to promote the export of services, the social environment, and problems in the health system itself. The study revealed areas that need to be improved regarding future policies to attract non-resident patients and to increase global competitiveness.
Mārtiņš Kalējs, Edgars Prozorovskis, Kaspars Kupics, Ivars Brečs, Uldis Strazdiņš and Pēteris Stradiņš
Permanent pacemaker implantation (PPI) after open heart surgery is required in 0.4–8.5% of patients. The aim of our study was to determine the incidence of PPI after cardiac surgery at Pauls Stradiņš Clinical University Hospital and to assess its influence on intrahospital outcomes. This was a single-centre retrospective study. We reviewed all patients who underwent either open heart surgery or transcatheter aortic valve implantation (TAVI) between the years 2015 and 2017. Included were all patients with PPI postoperatively before discharge. We compared the patient demographics, and perioperative state, incidence of PPI and intrahospital stay among groups. After cardiac surgery a total of 135 (4.2%) patients received a PPI. The PPI incidence was highest in the tricuspid valve intervention group — 8.8% followed by aortic valve replacement (AVR) patients with 3.3%. After TAVI incidence of PPI was 4.0% after Sapien valve and 8% after CoreValve implantations, respectively. Incidence of PPI after TAVI with the Sapien valve was not significantly higher when compared to conventional AVR, but it was significantly higher after TAVI with CoreValve. Regardless of the initial procedure a need for PPI significantly increased the total length of hospital stay.
The aim of this study was to evaluate the utility of the pathological personality traits in predicting suicidal ideation, especially in combination with other risk factors, such as the level of depression, prior attempts of suicide, low self-esteem, low level of perceived social support and self-esteem-by-social support interaction, both in general and in psychiatric inpatient samples. Data were analysed within two samples: non-clinical general sample (n = 461) and psychiatric inpatient sample (n = 131). Latvian Clinical Personality Inventory (LCPI) was used as the instrument for data collection. LCPI is a comprehensive multi-scale multi-item inventory, which consists of nine clinical scales (including Depression Symptom Scale), 33 pathological personality scales, five functioning scales, and five additional scales, including a Suicidal Ideation Scale, Low Self-esteem Scale and Lack of Perceived Social Support Scale. Results of the hierarchical regression analysis showed that several facet-level pathological personality traits (depressivity, self-harm, dissociation proneness, submissiveness, and suspiciousness) added significant incremental variance to the prediction of suicidal ideation above and beyond the well-known main risk factors of suicidal ideation, such as depression and prior suicide attempt. This effect remained stable even after taking into account additional interpersonal risk factors, such as low self-esteem, low level of perceived social support and self-esteem-by-perceived social support interaction. The incremental effect of personality traits was medium in the psychiatric inpatient sample and small in the general sample. Findings of the study may assist in early screening for persons with suicide risk and for developing prevention programmes in different settings.
Astra Zviedre, Arnis Eņģelis, Pēteris Tretjakovs, Irisa Zīle and Aigars Pētersons
The aim of the study was to determine whether the Alvarado score (AS) together with laboratory tests could be used to distinguish patients with acute appendicitis (AA) from acute mesenteric lymphadenitis (AML). Fifty-seven patients (7–18 years) with suspected AA were included in the prospective study (October 2010 – October 2013). Thirty-one patients underwent surgery for AA and 26 were not treated surgically and were diagnosed AML on ultrasonography. AS, white blood cell count (WBC), C – reactive protein (CRP) and serum cytokines (EGF, IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, TNF-α) were obtained on admission and were compared between groups. Mean age of the 57 patients was 12.9 (SD 3.2). Accuracy (AR) for AS ≥ 7 alone was 73.7% for AA. Modified AS with certain serum cytokines seemed to be a reliable tool for initial differential diagnosis between AA and AML in school-age children. Based on these results, AS ≥ 7, WBC ≥ 10.7 × 103/µL and serum IL-6 ≥ 4.3 pg/mL assessed altogether will yield more sensitivity for AA. Also for further advanced diagnostics, we propose to take into account the serum IL-6, IL-8, MCP-1, CRP cut-off levels in the differential diagnosis between complicated and uncomplicated AA to decide whether the treatment should be conservative or surgical.
Baiba Līcīte, Arvīds Irmejs, Jeļena Maksimenko, Pēteris Loža, Genādijs Trofimovičs, Edvīns Miklaševičs, Jurijs Nazarovs, Māra Romanovska, Justīne Deičmane, Gunta Purkalne and Jānis Gardovskis
The aim of the study was to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) in the restaging of node positive breast cancer after neoadjuvant chemotherapy (NAC). From January 2016 – October 2018, 90 node positive stage IIA-IIIC breast cancer cases undergoing NAC were included in the study. The largest, most superficial and the most caudal axillary node metastasis confirmed by fine needle aspiration cytology (FNAC) was marked with clip. After NAC, restaging of axilla was performed with ultrasound and FNAC of the marked and/or the most suspicious axillary node. Of the 90 cases, 58 with available ultrasound guided percutaneous needle biopsy data were further evaluated. Axilla conserving surgery was performed in 37 of 58 cases and axillary lymph node dissection (ALND) in 21 of 58 cases. False Positive Rate (FPR) of FNAC after NAC was 12%, False Negative Rate (FNR) — 58%, sensitivity — 54%, specificity — 82%, accuracy 62%. FNAC after NAC had low FPR and was found to be useful in predicting residual axillary disease and to streamline surgical decision making regarding ALND. However, FNR was unacceptably high and FNAC alone was not able to predict ypCR and omission of further axillary surgery.
Inga Ziemele, Man Xu, Anda Vilmane, Santa Rasa-Dzelzkalēja, Klaus Hedman, Maria Söderlund-Venermo, Dace Gardovska, Zaiga Nora-Krūkle and Modra Murovska
Since its discovery in 2005, human bocavirus 1 (HBoV1) has globally been one of the most common respiratory viruses. It is currently accepted that HBoV1 is a pathogen, causing upper and lower respiratory tract infections (LRTIs) in children. However, due to the prolonged HBoV1 DNA shedding from the upper airways and the subsequent high rate of co-detections with other respiratory viruses, the interpretation of positive polymerase chain reaction results is challenging. The aim of this study was to identify acute HBoV1 infections by the presence of HBoV1-specific IgM and IgG measured by competition enzyme immunoassay, to elucidate the induction of Th1/Th2 cytokines, and to describe the clinical characteristics associated with acute HBoV1 infection in hospitalised children less than five years of age with LRTI. HBoV1 IgM was detected in 19/102 (18.6%) and IgG in 66/102 (64.7%) patients. HBoV1 IgM was most frequently found in patients aged 13 to 24 months. Pneumonia and acute wheezing were the most common clinical diagnoses among HBoV1 IgM positive patients. The seroprevalence of HBoV1-specific IgG increased with age, reaching 85% by the age of five years. INF-γ, IL-4, IL-5, and IL-10 were observed to be higher in patients with acute HBoV1 infection.
Mihails Tarasovs, Sandra Skuja, Sofija Semenistaja, Modra Murovska and Valērija Groma
The role of inflammation in the development of osteoarthritic joint degeneration is not completely understood. Recent data suggest that processes that cause and orchestrate inflamed synovial lesions may be implicated in the development of the disease. The morphological changes of the synovium in patients with osteoarthritis (OA), as well as the level of synovial inflammation cautiously graded, in association to the presence of human parvovirus B19 (B19V) infection markers, were evaluated. Qualitative and quantitative detection of B19V genomic sequence was performed in OA and rheumatoid arthritis (RA) groups. The expression of CD68, S100 (Ca2+ binding proteins soluble in 100% ammonium sulfate) and B19 VP1/VP2 capsid proteins found in the synovium were investigated by single and double immunolabeling, whereas fine features of synoviocytes — by electron microscopy. One-third of OA and RA patients demonstrated synovial expression of B19V antigen, which was confirmed in both types of synoviocytes. The overall expression of B19V in OA patients was weaker than that found in RA subjects. Positive correlation between B19V-positive vascular endothelial cells, sublining infiltrating lymphocytes, macrophages, and B19V-positive synoviocytes was established. No correlation between synovitis score indices as well as the expression of S100 and expression of B19V was found. The results suggest that the synovial membrane maintains local joint homeostasis, and that virus mediated synovitis is implicated in the development of OA.
Ludmila Vīksna, Mārtiņš Vilcāns, Indra Zeltiņa, Aija Leidere-Reine, Angelika Krūmiņa, Oksana Koļesova, Jeļena Ļeviņa and Aleksandrs Koļesovs
Health care personnel (HCP) are at high risk of acquiring influenza due to exposure to patients. However, vaccination in HCP is lower than 40% for most European countries. The aim of this study was to determine the attitude towards influenza vaccination and possible reasons for this attitude in HCP. A cross-sectional study was performed in a multidisciplinary hospital of Latvia. The sample (n = 1099) included doctors (239), nurses (418), care services (236), administrative staff (108), and technical support staff (98). Five questions addressed vaccination of planned patients and HCP, knowledge of etiological anti-influenza drugs, and their storage at the hospital for immediate use. The results revealed that the level of regular vaccination against influenza in HCP was relatively low (14%). This contrasted with a more positive attitude towards vaccination of patients (53%) and personnel (60%). This contrast provided evidence for a low level of proactive action. High expectations regarding medications covered by the hospital (82%) indicated transferring of part of personal responsibility to the organisation. Doctors demonstrated a better understanding of the problem and a higher level of vaccination. However, some of doctors’ attitudes showed underestimation of influenza-associated risk.