THE ROLE OF THE PERIOPERATIVE NURSING CARE IN THE SATISFACTION OF PATIENTS AFTER LARGE JOINT REPLACEMENTS.

The medical services market is inevitably changing. Competition among health care institutions is growing, patients' health awareness and expectations regarding the quality of health services are increasing. This translates directly into, among others, to the patient's choice of medical facility. "Satisfaction" defined as "general satisfaction accompanying the consumption of products or services" is an important aspect affecting the position of a healthcare institution on the health services market. While in the hospital, the patient carefully observes and remembers many details of behaviors and reactions he encounters. Opinions of patients about a medical facility are usually subjective and relate mainly to satisfaction with the treatment process, therefore the lack of proper care in terms of patients' needs may result in the loss of the hospital's reputation. A very important aspect of the assessment of any medical service is the direct relationship between the patient and medical staff, mainly nurse. Among the factors affecting the level of patient satisfaction during a hospital stay are, inter alia, the availability of a doctor, nursing care, conditions in the ward, the possibility of patient participation in the treatment process, providing the patient with information in a clear and reliable manner, and improved health. Factors related to nursing care that have the greatest impact on the patient's level of satisfaction comprise the nurse's individual approach to the patient, time devoted to him, providing professional information, patient education and scrupulous nursing activities. The aim: The aim of the paper was to assess the role of perioperative nursing care in the satisfaction of patients after hip and knee joint replacements.

Nurse's role in geriatric patients rehabilitation with musculoskeletal system diseases.

OBJECTIVE: Introduction: There is the increasing number of elderly patients with motion disabilities who require help and infatuations from nursing stuff. According to the Central Statistic Department (GUS), 25,4% people in Poland is over 60. In 2050 this number will increase to 40%(39,9%). This is very important topic because when the number of old people will increase the geriatric care will be more important. Especially because this is partially covered by nursing team. They should be satisfied and content of the job they do, and they should fulfill the aim they had when they started this profession. The aim: Analysis of nurse's work with patients, nursing procedures evaluation, how this procedure is scored by the nurse, what is the nurse's role in the rehabilitation process. PATIENTS AND METHODS: Material and methods: There were nursing process with geriatric patients analyzed in this article. There were nursing procedures investigated with the opinion of the person who performed this procedure. Role of the nurse in rehabilitation process was and the satisfaction from typical work load was analyzed. RESULTS: Results: Analyzed results showed that there is a deficit in the nurse's knowledge and the lack of the complex care in elderly patient with disabilities. There is lack of the preparation and education program to perform holistic patient care. This includes monitoring, examination and elderly needs. CONCLUSION: Conclusions: The nurse is the first link that helps the patient to understand his disease. The nurse develops therapeutic contact that helps the patient to feel safe and positively react for the introduced treatment.

[Comparative assessement of the elderly females before total hip or knee replacements].

OBJECTIVE: Introduction: Osteoarthritis (OA) is the most common and burdensome illness in the elderly patients. It is the main cause of locomotor impairment and disability resulting in significant decrease of the quality of life (QL) in highly developed countries. Sf-36v2 questionnaire was standardized in the United States by J.E. Ware et al. in the years 1985-1992 and at present SF-36v2 is the most commonly used questionnaire for investigations in patients with various conditions. The aim: To compare two cohorts of post-menopausal female patients with the predominantly clinically active one-site advanced osteoarthritis of the hip and knee joint prior to the replacement surgery. PATIENTS AND METHODS: Material and methods: Two cohorts of fifty female postmenopausal patients aged from sixty to eighty were investigated. The inclusion criteria relied on sex, age and clinically single joint predominant OA disease prior to hip and knee joint replacement. The Polish version of SF-36v2 for the quality of life was accomplished by the patient under direct supervision of a trained nurse. The sets of obtained data were analyzed with the use of Statistica 10.0 (Shapiro-Wilk test, U - Mann-Whitney test, Spearmann, Kruskall-Wallis, Friedmann's ANOVA and Chi 2 Pearson). p <0.05 was regarded as significant. RESULTS: Results: It was found that patients with advanced knee OA demonstrated significantly lower QL than these with hip OA in Vitality (p=0,004), Functioning in Social Roles (p=0,0001), General Health (p <0,000001) and Pain (p <0,000001). No significant differences within the cohorts were observed as the other scales were concerned (p >0,05). In the general assessment as for the QL in the Physical domain significant difference was found with lower scoring in the knee group (p=0.00001). In the assessment of the general QL two domains were considered -Physical and Mental Health. Highly significant difference was recorded for the Physical better in regard for hip OA (p <0,00001). In the Mental Health domain no significant difference was found (p=0,09). CONCLUSION: Conclusions: 1. Quality of life of postmenopausal women with hip OA is predominantly lowered by the local disease whereas lower quality of life of these females with knee OA is related to the general poor health, low index of vitality and decrease of function in social functioning resulting from co-existence of chronic illnesses due to overweight and obesity. 2. Reduction of overweight or obesity in the group of patients with knee arthritis could improve their quality of life and general health.

Romuald Weglowski (1876-1935) - Orthopaedic Surgeon, Forgotten Pioneer of Limb Saving Tumour Surgery.

On May 16, 1914, The Lancet Journal published a paper by Romuald Weglowski, a Polish-born professor of Moscow University, entitled "Malignant tumours of bones: a new method in conservative operative treatment." The idea of biological resection presented in the paper consisted in thermocoagulation of the apparently cancerous part of a bone with a jet of steam. According to the author, dead bone rid of live malignant cells reconstructed itself quickly, which helped to preserve the functionality of the organ without considerable limitations. The events of the First World War, political changes in tsarist Russia and the recovery of independence by Poland greatly complicated Weglowski's professional career. We thought it would be interesting to present the life story of the great Polish surgeon in the context of his own method of bone cancer treatment, which without doubt marked the beginning of Polish orthopaedic oncology aimed at limb-saving surgery.

[Peripheral nerves phenolisation in spasticity management - forgotten art or interesting perspective?]

INTRODUCTION: Spasticity is one of the most common obstacles in the process of rehabilitation after permanent central nervous system injury. Statistics show that the problem affects more than 12 billion people all over the world. Treatment of spasticity is necessary for proper rehabilitation, prevention of secondary disability, pain management and also strongly influences quality of life. Nowadays the most common formula used for the treatment of local spasticity is injection of botulinum toxin. Years ago and also nowadays physicians all over the world successfully used phenol as the chemodenervating factor. This technique today almost forgot in Poland but still used in other countries. MATERIALS AND METHODS: Peripheral nerves phenolisation had been used in STOCER (Konstancin) since 1965. The procedure was performed once in 59 patients, twice in 13 patients and three times in 7 patients. Evaluation was based on clinical presentation completed with patient self evaluation form. RESULTS: Good - 36 cases (45%), moderate - 34 cases (43%), bad - 9 cases (12%). CONCLUSION: Peripheral nerve phenolisation seems to be an interesting alternative to botulinum toxin in the management of spasticity.

[Peripheral nerves alcoholization in the spasticity managament].

INTRODUCTION: Spasticity is velocity dependent increased resistance to passive lengthening of the muscle. Mild spasticity doesn't require treatment, but severe impede with hygiene, constrict range of motion and mobility, interfere with gait pattern and can be the cause of pain and discomfort. Proper spasticity management is crucial for correct rehabilitation. THE AIM OF THE STUDY: The assesment of chemodenervation with ethyl alcohol in spasticity treatment. MATERIAL AND METHODS: 13 patients (5 female, 8 male) age 18-68 yrs (mean 46,8±13,3). Qualification to the procedure requiered high level of spasticity (mean 3,4 ± 0,5 in Ashworth scale), no response for pharmacological treatment, low level in Bartel scale. Patients were evaluated with VAS pain scale, EQ-5D before, day after and 6 weeks after procedure. RESULTS: Ashworth scale before procedure: 3-4 (mean 3.44±0.52), after procedure: 0-3 (mean 2.0±1.26), 6 weeks after procedure: 1-3 (mean 2.0±1.0). VAS before procedure: 0-4 (mean 1.49±1.9), after procedure: 0-2 (mean 1.33±1.0), 6 weeks after procedure (mean 1.0±1.0). Bartel scale before procedure: 0-16 (mean 9.25±6.7), after procedure: 0-16 (mean 6.0±8.71), 6 weeks after procedure: 0-16 (mean 9.25±6.7). EQ-5D results showed on Fig 5-19. CONCLUSION: Results shows improvement in every examinated aspect (decrease in spasticity level, decrease in pain, increase in quality of life and disability scale).