Robert Ślusarz

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.

Quality of life in patients with leg ulcers or skin lesions – a pilot study

Introduction Attempts to determine the quality of life are advisable in patients with ulcers as the group affected with this problem is relatively large. According to one Polish randomized trial, approximately 0.3–2% of the adult population suffers from active or healed venous ulcers. Aim To compare the quality of life of patients with leg ulcers of venous and arterial etiology and those with lower limb skin lesions due to chronic venous insufficiency. Material and methods This study included 90 consecutive patients with ulcers of venous (n = 30) or arterial etiology (n = 30), or patients with trophic disorders of the skin associated with chronic venous insufficiency (n = 30) treated at the Venous Ulceration Outpatient Clinic and at the Department and Clinic of General Surgery, Dr. J. Biziel Memorial University Hospital No. 2, in Bydgoszcz. This study was designed as a questionnaire survey and included the Skindex-29 instrument for the assessment of quality of life in patients with dermatological conditions. Results Overall, the global Skinndex-29 scores of all studied participants ranged between 37 and 136 points, 23.93 points on average. The analyzed groups of patients differed significantly with respect to the average level of the global quality of life determined using the Skindex-29 questionnaire. Conclusions Significant differences were observed in the global quality of life of patients who suffered from venous or arterial leg ulcers or skin lesions resulting from chronic venous insufficiency.

Tissue Factor and Tissue Factor Pathway Inhibitor in the Wound-Healing Process After Neurosurgery:

Objectives: The aim of the study was to assess the concentrations of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in the blood of patients with a postoperative wound after neurosurgery. Method: Participants included 20 adult patients who underwent neurosurgery because of degenerative spine changes. The concentration of TF and TFPI in the patients’ blood serum was measured 3 times: before surgery, during the first 24 hr after surgery, and between the 5th and 7th days after surgery. The control group comprised 20 healthy volunteers similar to the patient group with respect to gender and age. Results: A statistically significant difference was observed between TF concentration at all three measurement time points in the research group and TF concentration in the control group (p = .018, p = .010, p = .001). A statistically significant difference was found between TFPI concentration at the second time point in the research group and TFPI concentration in the control group (p = .041). No statistically significant within-subject difference was found between TF concentrations before and after surgery. A statistically significant within-subject difference was found between TFPI concentrations within 24 hr after surgery and 5–7 days after surgery (p = .004). Conclusion: High perioperative concentrations of TF indicate not only the presence of thrombophilia but also the importance of TF in the wound-healing process. Perioperative changes in TFPI concentrations are related to its compensatory influence on hemostasis in thrombophilic conditions.

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.

Functional capacity scale in assessment of patients with intracranial aneurysms: reliability and validity.

ABSTRACT The aim of the study was to investigate the use of the Functional Capacity Scale (FCS) to measure functional outcome of patients who had undergone surgical removal of an intracranial aneurysm in the early postoperative period. Reliability and validity of the tool were tested as well as its utility in nursing practice. The study included 120 patients, operated on for intracranial aneurysm. Phase I included 23 patients. Reliability of FCS and the amount of time used for the assessment were tested using observation and direct measurement methods. Phase II included 97 patients, and the tool was administered along with standard outcome assessment tools (Barthel Index, Functional Index “Repty,” Glasgow Outcome Score, and Rankin Scale) to determine concurrent validity. Kendall’s coefficients of concordance (W) between particular care markers of FCS ranged from 0.910 to 1.000. Mean amount of time used for assessment was 90 seconds. Differences between time used for measurements by individual examiners were insignificant (p > .05). Correlation of FCS with the following scales was statistically significant: Functional Index “Repty” (p < .001), Glasgow Outcome Score (p < .01), Rankin Scale (p < .01), and Barthel Index (p < .001). The FCS appears to be a reliable, valid, and practical assessment tool for neuroscience nurses to use with patients who have undergone surgical removal of an intracranial aneurysm.

Functional Capacity Scale as a new tool for early functional assessment in patients after surgical treatment of intracranial aneurysms: A prospective study involving 128 patients

Summary Background Functional assessment of a patient focuses on the assessment of independence in activities of daily living. The aim of the study was to verify the usefulness of a new tool (Functional Capacity Scale – FCS) for early functional assessment of patients after surgical treatment of an intracranial aneurysm. Material/Methods The study was conducted in the Neurosurgical Department and Clinic, CM in Bydgoszcz, NCU, within a group of 128 patients after surgical treatment of an intracranial aneurysm. Direct observation and measurement were used in the study. In clinical assessment, the Hunt and Hess Scale was applied. For the final functional assessment, the Functional Capacity Scale (FCS), the Glasgow Outcome Scale, the Functional Index “Repty”, the Barthel Index, and the Rankin Scale were used. Results The study shows that on the day of discharge almost 60% of patients are independent or slightly dependent on others for functional capability, and 15% are significantly or totally dependent. FCS significantly correlates with FIR (0.93, p<0.001), GOS (0.89, p<0.01), RS (−0.88, p<0.01) and BI (0.82, p<0.001). Conclusions 1. Fifty percent of patients with intracranial aneurysm assessed at the early postoperative stage leave the ward as functionally capable of performing everyday activities. 2. There are significant correlations between FCS and the other scales used for functional assessment. 3. There is a significant relationship between functional capacity of the patient on the day of discharge and clinical condition before the surgical treatment.

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)

Clinical, Functional and Quality of Life Assessment of Patients with Spinal Pain Syndrome

The development of civilization leads to a continuous increase in the number of diagnoses of spinal pain syndrome in patients in each age group, thus leading to the need to develop new treatment standards. Spinal pain syndromes due to the often unknown etiology cause difficult diagnosis and introduction of effective therapy. That results in difficulties in causative treatment and thus sets pain as a leading problem in the therapy. Spinal pain syndromes are a complex clinical problem that may affect the patient’s psychological and social state as well as that of their family. The result of the research carried out with the use of standardized scales in the course of the disease is the development of the patient’s nursing process. The patient’s assessment is holistic, it allows to determine the factors predisposing to the occurrence of the disease and the current state of the patient. The clinical, psychological, social as well as professional and social aspects are analyzed in a multidimensional way. The level of performing independent activities by the patient is determined by means of functional scales. Spinal pain syndromes as a global problem are also the subject of research on the quality of life of this group of patients. The essence of using these tools is the ability to correlate them with other tools. (JNNN 2017;6(4):170–173)

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)

VEGF-A, sVEGFR-1, and sVEGFR-2 in BCR-ABL negative myeloproliferative neoplasms

BACKGROUND AND OBJECTIVE Data from the literature indicate the relationship between the bone marrow microvessel density and the blood parameters of angiogenesis. The aim of this study was to evaluate selected parameters of angiogenesis (VEGF-A, sVEGFR-1, and sVEGFR-2) and their correlations with white blood cells, platelets, and red blood cells. MATERIALS AND METHODS The study included 72 patients (mean age, 61.84 years) with myeloproliferative neoplasms (MPNs): essential thrombocythemia (ET) (n=46), polycythemia vera (PV) (n=19), and primary myelofibrosis (PMF) (n=7). Serum VEGF-A, sVEGFR-1, and sVEGFR-2 were determined using the ELISA assay. RESULTS We observed a significantly higher level of VEGF-A and reduced concentrations of sVEGFR-1 and sVEGFR-2 in the whole group of patients with MPNs as compared to controls. Detailed analysis confirmed significantly higher level of VEGF-A and lower concentration of sVEGFR-2 in each subgroups of MPNs patients. However, sVEGFR-1 concentrations were significantly lower only in PV and ET patients. CONCLUSIONS The study showed an increased level of VEGF-A, which may indicate the intensity of neoangiogenesis in the bone marrow. Decreased sVEGFR-1 and sVEGFR-2 in the blood of patients with MPNs may reflect consumption of these soluble receptors.