Beata Haor

Depression, social factors, and pain perception before and after surgery for lumbar and cervical degenerative vertebral disc disease.

Objectives The purpose of this study was to evaluate the effects of psychosocial factors on pain levels and depression, before and after surgical treatment, in patients with degenerative lumbar and cervical vertebral disc disease. Patients and methods The study included 188 patients (98 women, 90 men) who were confirmed to have cervical or lumbar degenerative disc disease on magnetic resonance imaging, and who underwent a single microdiscectomy procedure, with no postoperative surgical complications. All patients completed two questionnaires before and after surgery – the Beck Depression Inventory scale (I–IV) and the Visual Analog Scale for pain (0–10). On hospital admission, all patients completed a social and demographic questionnaire. The first pain and depression questionnaire evaluations were performed on the day of hospital admission (n=188); the second on the day of hospital discharge, 7 days after surgery (n=188); and the third was 6 months after surgery (n=140). Results Patient ages ranged from 22 to 72 years, and 140 patients had lumbar disc disease (mean age, 42.7±10.99 years) and 44 had cervical disc disease (mean age, 48.9±7.85 years). Before surgery, symptoms of depression were present in 47.3% of the patients (11.7% cervical; 35.6% lumbar), at first postoperative evaluation in 25.1% of patients (7% cervical; 18.1% lumbar), and 6 months following surgery in 31.1% of patients (7.5% cervical; 23.6% lumbar). Patients with cervical disc disease who were unemployed had the highest incidence of depression before and after surgery (p=0.037). Patients with lumbar disc disease who had a primary level of education or work involving standing had the highest incidence of depression before and after surgery (p=0.368). Conclusion This study highlighted the association between social and demographic factors, pain perception, and depression that may persist despite surgical treatment for degenerative vertebral disc disease.

Measuring scales used for assessment of patients with traumatic brain injury: multicenter studies

Background Application of adequate numeric scales is essential for assessment of a patient’s condition. The scales most commonly used by the therapeutic team for assessment of a patient with traumatic brain injury (TBI) include deficit scales, functional scales, and scales assessing quality of life. The purpose of this study was to establish the relationships between the particular scales used for assessment of patients with TBI. Methods This multicenter study included 159 patients with TBI. The direct observation technique was used. Two measurements were made (at hospital admission and discharge) using standardized assessment scales, ie, the Glasgow Coma Scale (GCS), the Functional Capacity Scale (FCS), the Functional Index “Repty” (FIR), and the Glasgow Outcome Scale. Results Patients with mild impairment of consciousness were most numerous in the examined group at both admission and discharge, ie, 118 (78.8%) and 134 patients (89.3%), respectively. The mean score for functional capacity measured with the FCS was 34.41 points (71.7%) on the day of admission and 41.87 points (87.2%) on the day of discharge from hospital. A significant correlation was found between results obtained using the GCS and results on the FIR, on both the day of admission [R t(n-2) =7.612=0.530; P=0.00] and the day of discharge [R t(n-2) =8.998=0.595; P=0.00]. Further, a high correlation was found between the FCS and the FIR (rs= −0.854 on day of admission and rs= −0.840 on day of discharge). Conclusion The majority of examined patients had mild impairment of consciousness. A moderate correlation was found between the GCS and the scales assessing activities of daily living. A high correlation was found between FCS and FIR, which may result from the similarities between the analyzed tools in the scope of their construction and application.

The Assessment of Sanatorium Treatment Impact on the Results Obtained in the Oswestry Questionnaire in the Areas of Sitting, Standing and Sleeping

Introduction. Back pain in the lumbar spine has become the most common disorder of the 21st century. Nearly 80% of population aged over 40 have already experienced a painful episode in their spine. Aim. The aim of the study is to assess to what extent the rehabilitation influences the occurrence of pain while sitting, standing and sleeping in patients with lumbar spine pain syndromes. Material and Methods. The research was conducted among 300 (100%) respondents aged 35–65. The studied population included 111 women, i.e. 37% and 189 men — 63%. Most people declared secondary education (40%), which was followed by vocational education (29%) and then higher education (24%). Patients were treated for lumbar spine pain syndromes. The research was carried out at the Sanatorium “Uzdrowisko Wieniec” Sp. z o.o. in Wieniec Zdrój. Results. After the end of the stay, it was noticed that the number of people who could sit in the chair any number of hours significantly increased (p≤0.05) from 7% to 29%, while the number of respondents who could stand any number of hours also increased (p≤0.05) from 4% to 26%. On the day of discharge from the sanatorium, the number of people declaring that pain does not affect sleep also significantly increased (p≤0.05) from 96 out of 167 of those surveyed. Conclusions. Taking into account the intensity of pain, it can be concluded that after the sanatorium treatment the number of responses related to the reduction of pain symptoms increased. Significantly increased the number of those who can sit, stand and sleep without pain in the lumbar region. (JNNN 2018;7(2):70–74)

Selected Aspects of Nurses' Burnout Compared to Other Employees of Social Welfare Homes

Introduction: The staff of social welfare home is exposed to the phenomenon of occupational burnout due to the specificity and characteristics of social welfare homes functioning. In social welfare homes there are people covered by 24-hour nursing and rehabilitation care, which required a significant amount of work on the part of the staff of such a centre. Nurses in their work constantly encounter situations which result in experiencing professional stress, which in turn results from the contact with another person waiting and requiring professional care and assistance. Due to specific conditions of the profession, nurses are particularly exposed to occupational burnout. As members of an interdisciplinary therapeutic team in social welfare homes, they spend most of the time with the residents, which promotes emotional exhaustion. The aim of the research was to present selected aspects of professional burnout of nurses compared to other welfare home employees. Methods: The methods used in the research consisted of the diagnostic survey method and estimation method; research techniques: surveying and estimation scale technique, as well as PSS-10 (perceptible stress scale) and DS-14 (scale for D-type measurement) questionnaires were used. Results: The study showed a statistically significant relationship between the intensity of stress between groups of social welfare homes staff, among whom there were nurses. The highest intensity of stress was observed in the occupational group of physiotherapists and nurses, followed by the medical caregivers/caregivers in the social welfare homes, social workers and occupational therapists/cultural and educational workers. Conclusions: Nurses and medical caregivers/caregivers at SWH are the representatives of the therapeutic team most exposed to the occurrence of burnout syndrome. It is important to be aware of the threat existence and have a decisive attitude to counteract the phenomenon of occupational burnout.

Wpływ umiejscowienia guza mózgu na wydolność funkcjonalną chorego

Introduction . The vast majority of lesions of the nervous system are located intra cranially. Their location in each brain structure results in the appearance of different deficits affecting the functional capacity of patients, and ultimately their quality of life. Aim . The aim of the study is to investigate the effect of tumor location on the functional capacity of patients with such tumors in the preoperative and postoperative periods. Material and Methods . Material includes 236 patients hospitalized in the Department of Neurosurgery 10th Military Hospital with Policlinic IP HCC Bydgoszcz. The research was approved by the Bioethics Committee at Collegium Medicum in Bydgoszcz (KB 222/2011). The analysis included 5 subgroups of patients taking into account the location of intracranial lesions in these patients. There were defined: a group of patients with tumors located in the temporal lobe (1), frontal lobe (2), parietal lobe (3), cerebral chamber (4), and cerebral lesions (5). The functional capacity was assessed by the KPS Scale (Karnofsky’s Performance Scale) (three times: on the day of admission to the Clinic, on the 5th and 30th day after the surgery) and by the GOS Scale (Glasgow’s Outcome Scale) (twice: on the 5th and 30th day following the surgery). Results . On the fifth day of the postoperative period, a statistically significant decrease in the functional capacity was observed in patients with tumors located in the cerebral, the extra cranial tumors, in the frontal and temporal lobes (p<0.05). In the postoperative period, significant increase in functioning was observed in patients with ventricular tumors cerebral and extra cranial (p<0.05). The final outcome of the treatment was improved on the 30th day in patients with extra cranial tumors (p<0.05). Conclusions . In the early postoperative period the functional capacity of most patients decreases, and the lowest functional capacity decline is observed in patients with parietal lobe tumors. 30 days after the surgery, the functionality of the patients increases, particularly with tumors located in the cerebral cortex as well as with extra cranial tumors. (JNNN 2017;6(2):66–72)

Ocena stanu umysłowego — wybrane narzędzia pomiarowe w neurogeriatrii

Complete Cerebral Assessment (CGA) involves the assessment of a neurological patient in four basic areas where performance capacity, physical health, mental health, as well social and environmental factors are taken into account. Specially prepared research tools (scales, questionnaires) can be used to assess individual CGA components, which significantly facilitate it and influence its credibility. In addition, they allow to verify changes in patient’s condition over time, in the category of improvement or deterioration, and also help in the exchange of quantitative (clinical) information between health care providers. Based on the literature, there have been discussed the most frequently applied scales used to assess the mental state of neurogeriatric patients. There have been presented data of metrics such as Mini-Mental State Examination (MMSE), Abbreviated Mental Test Score (AMTS), Clock Drawing Test (CDT), Geriatric Depression Scale (GDS), Hamilton Depression Rating Scale (HDRS), and Beck Depression Inventory (BDI). ( JNNN 2017;6(3):130–133 )

Ocena efektywności leczenia sanatoryjnego wpływająca na zmniejszenie dolegliwości bólowych odcinka lędźwiowego kręgosłupa

Introduction . Today, lumbar spine pain is a global problem, as one of the most common health problems in developing countries, including in Poland. One of the main problems of patients with back pain syndromes in the lumbar spine is pain. This disease may be classified as a direct cause of the limitation of physical, social, and professional activities. Aim . The aim of the study is to assess the impact of sanatorium treatment on the reduction of pain occurring in the pain syndromes of the lumbar spine. Material and Methods . The survey was conducted among 300 (100%) randomly selected patients, aged from 35 to 65 years. The study was conducted in sanatorium “The Wieniec-Zdroj spa”. The severity of pain in patients with diagnosed pain syndrome of lumbar spine was studied in two stages prior to and following sanatorium treatment using the Oswestry Disability Index Questionnaire. The tests were carried out after obtaining the approval of the Bioethics Committee of Kuyavian-Pomeranian Regional Medical Chamber in Torun (34/KB/2013) and the Medical Director of the institution where the study was conducted. Results . Analysis of selected components of the Oswestry Questionnaire for comparing the efficiency of patients before and after treatment allows for the assessment of pain intensity. Taking into account the intensity of pain and the use of painkillers it can be determined that after sanatorium treatment because of minor pain patients do not have to take pain medication 89 respondents (30%), 38 patients fewer. The surveyed also responded that painkillers completely/partially remove the pain more than twice as often after treatment. Conclusions . Sanatorium treatment affected pain in the lumbar spine. After therapy the pain decreased. The respondents stated that after the therapy applied, painkillers partially or completely removed the occurring pain. (JNNN 2016;5(3):99–103)

Ocena czynnościowa pacjentów w okresie leczenia neurochirurgicznego

Introduction . The interests of scientists, especially in the field of medicine and health science, contemplate the functional condition of patient in recent years. Proper functional capacity with good state of being and psychological attitude are the most important health indicators. Proper functional capacity is defined as the ability for independent performance and covering of basic vital needs, e.g. the control of the sphincter, nutrition, mobility and maintaining proper hygiene. The proper functional capacity of the whole system of vital activities means independence. Aim . The main aim of this study was the functional assessment of patients in the period of neurosurgical treatment. Material and Methods . The study included 415 patients hospitalized on neurosurgical wards. The functional capacity of patients was assessed twice (on the day of admission — Assessment 1 and on the day of discharge — Assessment 2). Functional capacity was analyzed using Functional Capacity Scale (FCS). The direct observation with measurement technique was used. The research proposal was approved by the bioethics committee. Results . On the day of admission, most of the patients (n=249; 60%), showed independence. Most of the independent patients were in the group of patients with tumors — 138 (83.6%), the second group were patients with brain aneurysm — 63 (63.0%) and the third group were patients with trauma — 48 (32.0%) (p 0.05). Conclusions . Most of the patients after neurosurgical treatment showed better functional capacity when compared with the period before it. Patients with brain tumors showed considerably better functional capacity on the day of admission when compared with patients with trauma or aneurysm. (JNNN 2016;5(2):46–52)

Problemy pielęgnacyjne pacjentów z chorobą Parkinsona — opis przypadku

Introduction . Parkinson’s disease is considered to be one of degenerative disorders of the central nervous system. It is classified as an incurable, progressive disease leading to significant deficits in self-care. It is regarded, just after Alzheimer’s disease, as a disease of the elderly, which relates to the central nervous system (CNS). The mechanisms being the basis of this disease have not been completely understood. Case Report . The case study refers to a 72-year-old woman diagnosed with Parkinson’s disease and comorbid dizziness. This work has presented nursing diagnosis and the nursing process. There have been defined patient’s problems, the purpose of the care and its implementation by planning activities. There has been also made an assessment, which is a comparison of the results of the care obtained with the objectives assumed. This work is a description of the case of a theoretical patient. Discussion . One of the most important persons taking care of a patient with PD is the nurse. In the proces of hospital treatment hospital nurse becomes the closest person to the patient. Therefore, she is required to maintain a professional therapeutic contact with the patient. The role of the nurse is primarily to motivate the patient to take actions which will lead to a slowdown in the progress of the disease (ie. encouragement to participate in activities with a therapist, to talk to a psychologist, exercise with a physiotherapist). The patient described has a problem with low self-esteem and a critical attitude towards herself. It is difficult for her to establish contacts and maintain relationship with another person. Such signals should be noticed by the nurse. The nurse is required to respond adequately to the aforementioned symptoms. Conclusions . Parkinson’s disease is defined as a primary degenerative process of the extrapyramidal system. In its course it is characterised by a slow and degenerative process. The patient described by us is fully aware of her state of health as well as of the nature of the disease. This involves a significant decrease of mood, apathy and fear. She cannot accept her condition and the developing deficit of self-care resulting from the progress of the disease. In the case of our patient after discharge from hospital there was recommended further therapy with a psychologist and participation in classes conducted by an occupational therapist and a physiotherapist. (JNNN 2016;5(4):156–161)

Problem bólu kręgosłupa wśród pielęgniarek oddziałów neurologii i neurochirurgii

Introduction . In the occupational medicine back pain is treated as a paraoccupational disease, mainly related to specific professional groups. They include those employed in the sector of health care, who are at the highest risk of developing back pain, nurses in particular. Aim . Assessment of back pain occurrence among nurses and determining the factors affecting this condition. Material and Methods . The study group consisted of 76 nurses working in neurology and neurosurgery wards/clinics. The research methodology applied consisted of diagnostic survey method, and as the technique, a survey of our own design was used. The VAS Pain Scale was used. Statistical analysis was prepared in the program SPSS20. The statistical significance of differences was determined at a confidence level of p<0.05. Results . 98.7% of the surveyed nurses complain about back pain. The biggest group consisted of those with very severe pain (47.4%). At the same time in 80.26% of cases the pain was located in the lumbosacral section. Multiple comparisons showed that the level of pain intensity was higher in those working on the contract than in the personnel working on the basis of a contract of employment (p=0.045). The analysis showed no statistically significant differences in the level of pain intensity between respondents in different workplaces: Chi2 (2)=3.69; p=0.158. Conclusions . The vast majority of nurses complain about back pain, in most cases it is a very strong pain. This pain is determined by seniority, form of employment (contract) as well as by additional activities apart from of work in the ward. (JNNN 2016;5(3):84–91)