Quality of life and its relationship to the degree of illness acceptance in patients with diabetes and peripheral diabetic neuropathy.

PURPOSE: Assessment of quality of life, especially from the psychological point of view, is likely to be strongly influenced by the degree of acceptance of one's own illness and the resultant negative emotional reactions associated with the illness itself. The aim of the present study was to determine the relationship between quality of life and the degree of acceptance of illness in diabetic patients with and without peripheral diabetic neuropathy. MATERIAL AND METHODS: 59 patients with diabetes were included in the study; they consisted of patients both with and without peripheral diabetic neuropathy. The degree of acceptance of illness was assessed using the Acceptance of Illness Scale (AIS) and quality of life (HRQOL - health-related quality of life) was measured using the SF-36v2. RESULTS: Quality of life in people with diabetes was reduced and related to their levels of illness acceptance. Factors affecting illness acceptance in patients with peripheral diabetic neuropathy included feelings of being a burden to their family and friends (p < or = 0.05) and the belief that people in their company are made anxious by the patient's illness (p < or = 0.05). These patients also defined their health status as being worse than that of diabetic patients without additional disease complications. CONCLUSIONS: Quality of life and illness acceptance were found to be strongly related. In general, patients with chronic peripheral diabetic neuropathy express lower degrees of acceptance of their illness than diabetic patients without peripheral diabetic neuropathy. Their subjective assessment of health status is also significantly worse than that of diabetic patients without neuropathy.

Exposure the doctors to aggression in the workplace.

PURPOSE: To evaluate the frequency, source and type of aggression towards doctors, depending on their place of work and position. MATERIAL AND METHODS: The study was conducted among 501 doctors from the area of Podlaskie Province. To evaluate the level and type of aggression towards doctors in their workplace we used a questionnaire prepared for the needs of this study by modifying the questionnaire "The frequency and consequences of exposing nurses to workplace aggression", which had been drafted by the Institute of Labour Medicine in Lódz. The results were analysed with the application of the chi-square and the Kruskal-Wallis tests. RESULTS: The most common form of aggression was voice raising, which happened to 80% of doctors employed in inpatient medical centres and 91% doctors from outpatient centres. More than a half of the subjects have heard threats from their patients. Verbal aggression from doctors' superiors happened most often in surgery wards (48%), neurology wards (40%), admission rooms (33%). The causes of aggression most often quoted by doctors include: staff shortages (9%), stress--tiredness (9%). CONCLUSIONS: Workplace aggression towards doctors may be inflicted both by patients and colleagues. The aggression in the medical environment can take on different forms and create a threat in the workplace. Doctors working in hospital wards (psychiatry, surgery, neurology) are the ones who are the most exposed to aggression.

Nursing problems of patients with systemic sclerosis.

UNLABELLED: Systemic sclerosis (SSc) is a chronic autoimmune disease connective tissue and one of the most common collagen diseases. There are several clinical types of scleroderma which differ in their course, possible complications and prognosis. The most characteristic form SSc is limited and diffuse systemic sclerosis. The SSc is characterized by the progressive fibrosis of the skin and internal organs, leading to their failure, morphology and blood vessels disorders. PURPOSE: The aim of our work is to identify the main health problems of patients suffering from systemic sclerosis depending on its clinical form: limited systemic sclerosis (ISSc) and diffuse systemic sclerosis (dSSc); to determine the influence of disease duration on symptom intensification in patients with LSSc and dSSc. MATERIAL AND METHODS: The study group consisted of 63 patients with systemic sclerosis diagnosed according to the criteria of the American Rheumatism Association (ARA), 47 of whom had limited systemic sclerosis (ISSc) (74.6%) and 16--diffuse systemic sclerosis (dSSc) (25.4%). CONCLUSIONS: The key thing in the complex therapy is to recognize the individual care problems of the patient, to assess his ability to cope with the disease in daily life and to plan care, support, education and help of other professionals. The main aim of individual nursing care is to alleviate ailments, prevent infections, observe life-threatening conditions and to educate the patient as regards self-care and self-observation.

The education of patients with rheumatoid arthritis--the knowledge and expectation of patients-the opinions of rheumatology nurses.

Rheumatoid arthritis (RA) is a chronic, progressive, immunologically dependent, systemic diseases of connective tissue, leading to disability, cripplehood or even premature death. Helping to improve the quality of life of RA patients involves teaching them how to cope with disease-related problems of everyday life, with stress and with suffering. The aim of the presented work is to determine the following: the patients' level of knowledge about rheumatoid arthritis; their educational needs; the impact of the level of knowledge on the patients' pro-health behaviours; the knowledge of nurses and their ability to recognize patients' problems; the nurse's tasks in preparing an RA patient for self-care. The subject group consisted of patients with RA diagnosed according to The American Rheumatism Association criteria and nurses from rheumatology clinics and wards. The research method used was a survey questionnaire, which had been constructed for the purpose of the research. The research results indicate a great need of patients, especially those with early rheumatoid arthritis, for education, support and help in adaptation. At the same time, the nurses, even though they do not fully fulfil their educational role, declare a willingness to participate in organized forms of health education.

Assessment of risk for pressure ulcers using the Norton scale in nursing practice.

PURPOSE: The aim of our study was risk assessment for the development of pressure ulcers and thus defining a group of patients considered to be at risk of developing pressure ulcers. It also helped to define the role of the nurse in the early assessment of the risk for developing pressure ulcers. MATERIAL AND METHODS: Risk assessment for the development of pressure ulcers was carried out in 199 patients hospitalised in The District Hospital in Bielsk Podlaski. The research was carried out with patients admitted to The Departments of General Medicine, Infectious Diseases and Long-Term Care. Risk assessment for the development of pressure ulcers was performed with the aid of the Norton scale. CONCLUSIONS: An increased risk for the development of pressure ulcers was found in more than half of the patients examined (53.8%). Pressure sores developed in 17.6% of the patients, women being at significantly greater risk. Risk assessment for the development of pressure ulcers with the aid of one of the recommended scales facilitates the early recognition of those patients at risk of developing pressure ulcers.

The importance of the health education in life quality improvement in patients with psoriasis.

PURPOSE: The aim of the study was to determine the influence of the psoriatic patient knowledge of the disease on the quality of life. MATERIAL AND METHODS: The study was carried out in 149 patients with psoriasis. All patients answered on anonymous questionnaire, in according to Psoriasis Disability Index (PDI). RESULTS: Almost 43% patients could not show any factor which provoked their disease, 31.5% could not tell any recommendations for cure and care of the psoriatic lesions and 32.2% patients could not point out any methods to avoid psoriatic lesions spread. Almost 60% of the group admitted that their quality of life fell because of the disease. At the same time, patients who did not have enough information concerning the disease had lower quality of life index. CONCLUSIONS: The level of the disease knowledge in the patients with psoriasis influences their quality of live. Therefore it is indicated for the patiens and their families to be involved in the proper educational program.

Educational and nursing problems of parents of children with stoma.

In children, it is usually one of the stages of treatment of lower alimentary congenital defects. Such patients require long-term professional medical and nursing attention as well as solicitous care of the parents at home. The aim of the study was the analysis of educational and nursing problems that are faced by parents of children with stoma, the influence of a nurse on the quality of their care, and determination of nurse educational assignment in preparing the parents for the care at home. The study was performed in the group of 30 parents of children, 0-2 years old, with lower alimentary congenital defects who had intestinal stoma inserted in 2003. The questionnaire revealed that the main causes of the stoma were Hirschsprung disease (40%), anal atresia (37%), perianal fistula, intestinal perforation and necrosis (10% each). All responders stated that the knowledge acquired in the ward was of great help while nursing a child at home. The results showed that above 80% of parents had the opportunity to change the stomal sacks by themselves, once or more times, in the presence of medical staff. Skin changes (33%) were the most common complications in case of stoma, which could encounter for inappropriate care. Other complications included hemorrhage (20%), prolapse (13%), and stoma narrowing (10%).

Cyclophosphamide reduces neutrophilic alveolitis in patients with scleroderma lung disease: a retrospective analysis of serial bronchoalveolar lavage investigations.

OBJECTIVES: To determine whether cyclophosphamide is beneficial for patients with scleroderma lung disease (SLD). METHODS: The effect of 6 months' treatment with intravenous cyclophosphamide on the functional capacity of patients, lung function tests, high resolution computed tomography of the lungs, and cytology of bronchoalveolar lavage was evaluated in 21 patients with SLD. RESULTS: The treatment was well tolerated and all patients completed 6 months' treatment. Intravenous cyclophosphamide stabilised or improved the patients' functional status and lung function tests. The extent of the lungs affected remained unchanged, as assessed with HRCT of the lungs. Patients with SLD and neutrophilic alveolitis (NA) showed greater improvement than patients with normal levels of granulocytes in the bronchoalveolar lavage fluid (BALF). Significant reduction of neutrophils was also seen in the patients with SLD and NA, whereas no significant change was seen in the level of granulocytes in patients with SLD and an initially normal percentage of granulocytes. CONCLUSIONS: Previous reports that patients with SLD with increased levels of granulocytes in BALF are more likely to benefit from treatment with intravenous cyclophosphamide are confirmed. Additionally, clinical improvement in this group of patients is accompanied by a significant decrease in the percentage of granulocytes in BALF.