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The type of vascular access and the effectiveness of haemodialysis 血管通路的类型和血液透析的有效性
Pub Date : 2020-01-01 DOI: 10.5114/PPIEL.2020.103536
Agata Cieniawa
Introduction: Chronic kidney disease has been perceived in recent years as a disease of civilisation. Patients with stage 5 or 4 renal failure require renal replacement therapy. Ninety per cent of patients with renal failure are treated using haemodialysis. In order to perform extracorporeal blood purification procedures, it is necessary to establish a vascular access for the patient. The efficiency of haemodialysis can be determined based on the urea reduction rate and dialyser’s urea clearance. One of the main factors influencing the adequacy of dialysis is the type of vascular access. Aim of the study: To ascertain whether the type of vascular access influences the effectiveness of haemodialysis. Material and methods: The study included 61 patients dialysed at the University Hospital in Cracow in the period from December 2018 to February 2019. The study compared potassium values before and after haemodialysis, the degree of urea removal, and the urea clearance of the dialyser. Results: The best results were obtained by patients dialysed using an arteriovenous fistula; for those patients the urea reduction ratio (URR) was 0.7 and the Kt/V was 1.7; the worst values were found for patients dialysed using a Gero-trex artificial vessel. Conclusions: The type of vascular access affects the effectiveness of haemodialysis.
近年来,慢性肾脏疾病已被视为一种文明疾病。5期或4期肾功能衰竭患者需要肾脏替代治疗。90%的肾衰竭患者采用血液透析治疗。为了进行体外血液净化程序,有必要为患者建立血管通道。血液透析的效率可以根据尿素还原率和透析者的尿素清除率来确定。影响透析充分性的主要因素之一是血管通路的类型。目的:探讨血管通路类型对血液透析效果的影响。材料和方法:该研究包括2018年12月至2019年2月期间在克拉科夫大学医院透析的61例患者。该研究比较了血液透析前后的钾值、尿素去除程度和透析器的尿素清除率。结果:采用动静脉瘘进行透析效果最好;尿素还原比(URR)为0.7,Kt/V为1.7;使用Gero-trex人工血管透析的患者值最差。结论:血管通路的类型影响血液透析的效果。
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引用次数: 0
Patient safety and nurse managers’ competencies in decision making relating to rationing of care – the state of the art 患者安全和护士管理人员在配给护理决策中的能力-最先进的状态
Pub Date : 2020-01-01 DOI: 10.5114/ppiel.2020.96091
I. Uchmanowicz, P. Gurowiec, R. Zeleníková, E. Gurková, D. Jarošová, Agnieszka Zborowska
To prevent potential health- or life-threatening events during patient care at every stage of hospitalisation, all possible causes that could lead to adverse events should be recognised by the highly qualified medical staff who are responsible for patient safety. The aim of this state-of-the-art paper is to summarise the issue of patient safety in the hospital and nurse managers’ competencies relating to rationing of care, and to discuss implementation of the evidence-based practice as the key foundation for the development and knowledge management of nursing care. Research evidence does not provide any innovative solutions to direct knowledge management in clinical settings. Therefore, we should implement innovative interventions to be developed and evaluated for the implementation of knowledge management. The fact is that a global lack of nurses leads to missed care, which is a common threat, and it manifests itself as a potentially dangerous medical error that deserves special attention. The influence of various factors on knowledge management and the roles of senior nurses have not been well recognised or researched. Moreover, it was shown that practical mediations in order to implement knowledge management need to be refined and assessed. This is especially true in contemporary, challenging work environments with a lack of time for further professional development due to an increasing workload.
为了防止在病人住院治疗的每个阶段发生潜在的危及健康或生命的事件,负责病人安全的高素质医务人员应认识到可能导致不良事件的所有可能原因。这篇最先进的论文的目的是总结医院患者安全问题和护士管理人员与护理配给有关的能力,并讨论实施循证实践作为护理发展和知识管理的关键基础。研究证据并没有为临床环境中的直接知识管理提供任何创新的解决方案。因此,我们应该实施创新的干预措施,为知识管理的实施进行开发和评估。事实是,全球缺乏护士导致错过护理,这是一种常见的威胁,它表现为一种值得特别关注的潜在危险医疗错误。各种因素对知识管理和高级护士角色的影响尚未得到很好的认识和研究。此外,研究表明,实施知识管理的实际中介需要改进和评估。在当今充满挑战的工作环境中尤其如此,由于工作量增加,员工缺乏进一步专业发展的时间。
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引用次数: 0
Knowledge and health behaviours connected with melanoma prevention among people living in Poland and Australia 波兰和澳大利亚居民与黑色素瘤预防相关的知识和健康行为
Pub Date : 2020-01-01 DOI: 10.5114/ppiel.2020.98770
E. Walewska, L. Ścisło, G. Puto, P. Obrzut, A. Gniadek
Introduction: Melanoma is a malignant skin tumour. Its incidence doubles every 10 years. The sooner it is diagnosed, the better the chances for successful treatment. Therefore, the need has arisen to spread knowledge about early detection of melanoma and its prevention. Aim of the study: To assess the knowledge and the extent to which skin cancer preventive measures are followed in selected groups of inhabitants of Poland and Australia. Material and methods: The study was conducted in a group of 267 people, 151 of whom lived in Poland and 116 in Australia. The study was carried out with the application of a diagnostic survey method. The research technique was a survey, and the research tool was a questionnaire designed by the authors. The study findings were examined by means of statistical analysis. Results: The study showed that although the average level of knowledge is good (46.4%), the extent to which the rules of melanoma prevention are applied is still unsatisfactory in the majority of population (42.3%). It was observed that Australian inhabitants had higher scores in both aforementioned cases ( p < 0.001); 91.4% of respondents had at least satisfactory knowledge about melanoma and 78.4% of them took proper preventive measures, whereas in Poland it was 75.5% and 41.7%, respectively. Conclusions: In most cases the respondents have a good level of knowledge, but they do not follow the rules of melanoma prevention. Australians have more knowledge about melanoma, and they are also more likely to take preventive measures.
黑色素瘤是一种恶性皮肤肿瘤。其发病率每10年翻一番。越早诊断出来,成功治疗的机会就越大。因此,有必要传播关于黑色素瘤的早期检测和预防的知识。研究目的:评估波兰和澳大利亚选定的居民群体对皮肤癌预防措施的了解程度和程度。材料和方法:研究对象为267人,其中151人生活在波兰,116人生活在澳大利亚。本研究采用诊断调查法进行。研究方法为问卷调查,研究工具为自行设计的问卷。通过统计分析对研究结果进行了检验。结果:研究显示,虽然平均知识水平较好(46.4%),但大多数人群(42.3%)对黑色素瘤预防规则的应用程度仍不理想。观察到,澳大利亚居民在上述两种情况下得分较高(p < 0.001);91.4%的受访者至少对黑色素瘤有满意的了解,78.4%的受访者采取了适当的预防措施,而波兰的这一比例分别为75.5%和41.7%。结论:在大多数情况下,受访者有良好的知识水平,但他们没有遵循黑色素瘤预防规则。澳大利亚人对黑色素瘤有更多的了解,他们也更有可能采取预防措施。
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引用次数: 0
Definition of the profession of midwife. Commentaryon Article 5 Section 1a of the Act of 15 July 2011on the professions of nurse and midwife 助产士职业的定义。2011年7月15日关于护士和助产士职业的法案第5条第1a节
Pub Date : 2020-01-01 DOI: 10.5114/PPIEL.2020.103533
Dorota Karkowska, Tomasz Karkowski
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引用次数: 1
Assessment of the implementation of therapeutic education in patients with chronic disease in the context of perceived social support 在感知社会支持的背景下对慢性病患者实施治疗性教育的评估
Pub Date : 2020-01-01 DOI: 10.5114/PPIEL.2020.103535
Beata Ogórek-Tęcza, A. Gniadek, Zuzanna Radosz, A. Piskorz, Monika Rucka
Introduction: Therapeutic education should be an integral element of treatment, especially in chronic disorders, because good disease control and less frequent relapses or exacerbations contribute to improving the quality of life, including increasing the patient’s mental comfort and self-determination in the disease. An important element of the ability to involve the patient in the process of therapeutic education is social support. Aim of the study: To understand the relationship between the assessment of the effectiveness of therapeutic education in patients treated for chronic diseases and the level of experienced social support. Material and methods: The study included 98 patients. The study involved the diagnostic survey method. To collect the data, the author’s questionnaire and a standardised tool (ISSB) were used. The obtained data were analysed statistically. Results: Among the patients suffering from chronic diseases, therapeutic education was most often carried out once (42.6%), without a previously prepared educational program (61.4%) and mainly providing methods (46.5%). The surveyed most often participated in educational activities carried out by a single member of the therapeutic team (69.3%), and the duration of education was adjusted to individual needs. The evaluation of the program was carried out only in a minority of those surveyed (43.7%). Conclusions: Patients with chronic diseases had the opportunity to participate in one-time education. Therapeutic education in clinical practice is far from the recommendations of theoreticians and requires work on each stage of educational activities.
导言:治疗性教育应是治疗的一个组成部分,特别是在慢性疾病中,因为良好的疾病控制和较少的复发或恶化有助于改善生活质量,包括增加患者的精神安慰和对疾病的自决。使病人参与治疗性教育过程的一个重要因素是社会支持。研究目的:了解慢性疾病患者治疗性教育效果评价与体验性社会支持水平的关系。材料与方法:纳入98例患者。本研究采用诊断性调查方法。为了收集数据,采用作者问卷和标准化工具(ISSB)。对所得资料进行统计学分析。结果:慢性疾病患者中,治疗性教育以一次为主(42.6%),无事先准备教育方案为主(61.4%),以提供方法为主(46.5%)。被调查者最常参加由治疗小组的一名成员开展的教育活动(69.3%),教育时间根据个人需要调整。只有少数受访者(43.7%)对该计划进行了评估。结论:慢性病患者有机会参加一次性教育。临床实践中的治疗教育与理论家的建议相去甚远,需要在教育活动的各个阶段进行工作。
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引用次数: 0
Institutional support for people with dementia of Alzheimer’s type and their carers – Cracow’s experience 对老年痴呆症患者及其护理人员的机构支持——克拉科夫的经验
Pub Date : 2020-01-01 DOI: 10.5114/PPIEL.2020.103531
Katarzyna Wojtas, A. Kamińska
Introduction: Cognitive deficits in the course of dementia are commonly diagnosed among elderly people. In con-nection with their progressive, incurable nature it is necessary to provide professional care for patients and their caregivers. Unfortunately, help for people with dementia and their carers is not sufficient, and deficits in legal and social areas are also noticed. Aim of the study: To present the functioning of the Day and Activation Centre for Dependent People in the Municipal Care Centre in Cracow, at 267 Wielicka Street. Material and methods: Analysis of scientific literature and the authors’ own experience from the implementation of the program for the Day and Activation Centre for Dependent People. Results: The facility is an example of an indirect form of service provision between care in the community and round-the-clock care. It provides caregivers with support in various dimensions. Conclusions: The establishment of day centres for people with dementia should be a trend in providing specialist assistance to patients and their carers. Providing caregivers with professional knowledge about dementia allows them to understand emerging changes in the behaviour and functioning of those under their care, and at the same time gives them the opportunity to prepare themselves to meet the challenges of a progressive disease. words:
导读:认知缺陷在老年痴呆症过程中被普遍诊断。鉴于其进行性和不可治愈性,有必要为患者及其护理人员提供专业护理。不幸的是,对痴呆症患者及其护理人员的帮助是不够的,而且还注意到法律和社会领域的缺陷。研究的目的:介绍位于Wielicka街267号的克拉科夫市护理中心的受抚养人日间和活动中心的运作情况。材料和方法:对科学文献进行分析,并结合作者自己在依赖者日间活动中心项目的实施经验。结果:该设施是社区护理和全天候护理之间间接服务提供形式的一个例子。它为护理人员提供不同维度的支持。结论:建立痴呆患者日间中心应成为一种趋势,为患者及其照顾者提供专业帮助。向护理人员提供有关痴呆症的专业知识,使他们能够了解他们所照顾的人在行为和功能方面的新变化,同时使他们有机会做好准备,迎接进行性疾病的挑战。词:
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引用次数: 0
Skin phototype and selected sociodemographic factors and their correlation with health behaviours connected with melanoma prevention strategies 皮肤光型和选定的社会人口因素及其与黑色素瘤预防策略相关的健康行为的相关性
Pub Date : 2020-01-01 DOI: 10.5114/ppiel.2020.98771
E. Walewska, L. Ścisło, G. Puto, P. Obrzut, A. Gniadek
Aim of the study: To assess the correlation between skin phototypes and selected sociodemographic factors and health behaviours connected with skin cancer prevention. Material and methods: The study was conducted in a group of 267 patients. It was carried out with the application of a diagnostic survey method. The research technique was a survey and the research tool was a questionnaire designed by the authors. Results: The study showed a correlation between skin phototype and following the rules of skin cancer prevention (p < 0.001): people with skin phototype I, characterised by pale white skin, were more likely to apply sun protection rules. The percentage of respondents with a higher level of health behaviours increased with the respondents’ age (p < 0.001). The higher the respondents’ education, the higher the percentage of them who took proper melanoma precautions (p < 0.005). The level of health behaviours was also higher in people who had been diagnosed with melanoma or had been treated for skin cancer in the past or whose family member or friend suffered from this type of cancer (p < 0.001). Conclusions: Respondents with a phototype characterised by fair complexion were more likely to follow skin cancer prevention rules. The intensity of health behaviours aimed at cancer prevention increased with the respondents’ age and level of education. Both melanoma diagnosis and the incidence of skin cancer in respondents’ family or friends led to a higher level of their health behaviours.
研究目的:评估皮肤光型与选定的社会人口因素和与皮肤癌预防有关的健康行为之间的相关性。材料和方法:本研究在267例患者中进行。应用诊断调查方法进行了研究。研究方法为问卷调查,研究工具为自行设计的问卷。结果:该研究显示了皮肤光型与遵循皮肤癌预防规则之间的相关性(p < 0.001):皮肤光型I的人,其特征是皮肤苍白,更有可能使用防晒规则。健康行为水平较高的受访者百分比随着受访者年龄的增长而增加(p < 0.001)。受访者受教育程度越高,采取适当黑色素瘤预防措施的比例越高(p < 0.005)。被诊断患有黑色素瘤或过去接受过皮肤癌治疗或其家人或朋友患有此类癌症的人的健康行为水平也较高(p < 0.001)。结论:肤色白皙的受访者更有可能遵循皮肤癌预防规则。旨在预防癌症的健康行为的强度随着受访者的年龄和受教育程度而增加。在受访者的家人或朋友中,黑色素瘤的诊断和皮肤癌的发病率都导致他们的健康行为水平更高。
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引用次数: 0
Care of a pregnant woman with aortic stenosis and intrauterine growth restriction – case study 1例主动脉瓣狭窄合并宫内生长受限孕妇的护理
Pub Date : 2020-01-01 DOI: 10.5114/ppiel.2020.96096
Oliwia Stępień, A. Leja-Szpak
Introduction: Stenosis of the aortic valve is the most common acquired heart defect, which involves reducing the area of this valve. In the case of pregnant women, this defect, due to changes in the cardiovascular system, results in miscarriages, pre-term delivery, or intrauterine growth restriction (IUGR). IUGR is a condition in which the foetus is too small in relation to gestational age, and its consequences may include perinatal hypoxia, meconium aspiration syndrome, or respiratory distress syndrome. Aim of the study: To analyse the case of a 30-year-old female patient with aortic stenosis and intrauterine growth restriction, diagnosed during pregnancy, as well as to formulate diagnoses and plan nursing and obstetric care for this pregnant woman. Discussion: The present thesis includes a case study of a pregnant woman with aortic stenosis detected during pregnancy and intrauterine growth restriction. The analysis concerned the patient’s planned hospitalisation. The essential elements of hospitalisation included the control of general and obstetric conditions, monitoring of the foetus’ condition, as well as pharmacotherapy that aimed at improving the haemodynamic conditions of the pregnant woman. Conclusions: Narrowing of the aortic valve in pregnant women complicated by the occurrence of IUGR is a rare clinical condition. Providing medical care of such a pregnant woman focuses on the control of general and obstetrical parameters. The participation of a midwife in pharmacotherapy and assisting in the doctor’s examinations also constitutes an important element in obtaining information about this medical condition, as well as planning nursing and obstetric care.
主动脉瓣狭窄是最常见的获得性心脏缺陷,它涉及到主动脉瓣面积的缩小。在孕妇的情况下,这种缺陷,由于心血管系统的变化,导致流产,早产,或宫内生长受限(IUGR)。IUGR是一种胎儿相对于胎龄太小的情况,其后果可能包括围产期缺氧、胎粪吸入综合征或呼吸窘迫综合征。本研究目的:分析1例30岁女性妊娠期诊断为主动脉瓣狭窄合并宫内生长受限的病例,为该孕妇制定诊断和护理及产科护理方案。讨论:本论文包括一个在怀孕期间发现主动脉狭窄并宫内生长受限的孕妇的病例研究。分析涉及病人计划的住院治疗。住院治疗的基本内容包括控制一般情况和产科情况,监测胎儿状况,以及旨在改善孕妇血流动力学状况的药物治疗。结论:孕妇主动脉瓣狭窄并发IUGR是一种罕见的临床情况。为这类孕妇提供医疗保健的重点是控制一般和产科参数。助产士参与药物治疗和协助医生检查也是获取有关这种疾病的信息以及规划护理和产科护理的重要因素。
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引用次数: 0
The history of University Midwifery Training in Krakow in the years 1780-1918 in the context of historical and organisational conditions 在历史和组织条件的背景下,1780-1918年克拉科夫大学助产培训的历史
Pub Date : 2020-01-01 DOI: 10.5114/ppiel.2020.96090
Malgorzata Dziedzic, Elżbieta Sibiga, M. Dziubak, Paula Janczyk
Midwifery training in Krakow started within the University structures and was closely related to the reform of the Academy in 1780. Following H. Kołłątaj and Prof. A. Badurski’s ideas, the first clinical hospital was created in Krakow, where midwifery training started. Prof. R. Czerwiakowski gave lectures for midwives and supervised the maternity clinic. The changing political relations remodelled the structure and organisation of the school authorities, which affected the working conditions of the University. Obtaining a diploma was preceded by the so-called strict exam in front of an exam board consisting of professors. The positive result of the exam then authorised the student to take an oath in front of the Dean, the secretary, and a professor of the Faculty of Medicine, which, as stated on the diploma, gave “the right to practice midwifery”. Following professors and heads of the maternity clinic made special efforts in organising midwifery courses and improving continuously difficult learning conditions. Many documents issued to midwives or provided by midwifery students have survived from their professional activity. Prof. H. Jordan achieved outstanding results in this respect, as he managed to obtain permission from the partitioning authorities to organise an independent midwifery school. It opened in 1895, and Prof. A. Mars became its head. The importance of achieving this idea promoted by Prof. H. Jordan for the further development of midwives in Krakow is worth emphasising. The independent institution took the name of the Imperial Royal School of Midwives.
克拉科夫的助产培训在大学结构内开始,并与1780年学院的改革密切相关。按照H. Kołłątaj和A. Badurski教授的想法,在克拉科夫建立了第一家临床医院,助产培训开始在那里进行。R. Czerwiakowski教授为助产士讲课,并监督产科诊所。不断变化的政治关系重塑了学校当局的结构和组织,这影响了大学的工作条件。在获得文凭之前,要在由教授组成的考试委员会面前进行所谓的严格考试。考试的积极结果随后授权学生在院长、秘书和医学院教授面前宣誓,正如文凭上所述,这赋予了“从事助产工作的权利”。随后的教授和妇产诊所的负责人在组织助产课程和不断改善困难的学习条件方面作出了特别努力。许多发给助产士或由助产学学生提供的文件从他们的专业活动中幸存下来。H. Jordan教授在这方面取得了杰出的成绩,他设法获得分区当局的许可,组织了一所独立的助产学校。它于1895年开业,A. Mars教授成为它的负责人。H. Jordan教授为克拉科夫助产士的进一步发展所提倡的实现这一理念的重要性值得强调。这个独立的机构取名为皇家助产士学校。
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引用次数: 0
Depressive disorders in type 2 diabetes – initial reports 2型糖尿病的抑郁障碍-初步报告
Pub Date : 2020-01-01 DOI: 10.5114/ppiel.2020.96094
K. Wojtas, K. Czyżowicz, Iwona Sibiga, Z. Musiał
Introduction: Diabetes patients experience burdens associated with adherence to treatment, self-control, and taking preventive measures against diabetic complications. These can contribute to the development of depressive disorders. Aim of the study: To assess the occurrence and severity of depressive disorders and factors connected with them among diabetes type 2 patients aged 35-64 years. Material and methods: The research was done with the use of a diagnostic survey method among 70 patients in the Metabolic Disease Department of the University Hospital in Krakow. The Beck Depression Inventory and the authors’ own interview questionnaire were used. Statistical analysis was carried out using Statistica 13.1, and p < 0.05 was the significance level. Results: The average number of points in the Beck Depression Inventory was 12.81 (moderate level of depressive disorders). Greater severity of depressive disorders was present in people who were professionally inactive, who defined their monthly income as insufficient, who felt uncertainty after diabetes diagnosis, whose treatment included both diet and insulin intake, who had problems with foot care, and who did not follow the diabetes treatment principles. The respondents who declared lack of support from their spouses felt the impact of diabetes on their mental well-being and confirmed the need for help in connection with the disease and had increased levels of depressive disorders. Conclusions: Due to the occurrence of depressive symptoms among diabetes patients it is necessary to conduct screening research for depressive disorders. It should be an indispensable element of the therapeutic team’s activities. enable action to be taken in order to prevent their aggravation and provide holistic care to patients. The presented results are fragments of research carried out as a part of statutory project disorders in
导读:糖尿病患者的负担与坚持治疗、自我控制和采取预防措施预防糖尿病并发症有关。这些都可能导致抑郁症的发展。研究目的:探讨35 ~ 64岁2型糖尿病患者抑郁症的发生、严重程度及其相关因素。材料和方法:本研究采用诊断调查方法对克拉科夫大学医院代谢病科的70例患者进行调查。采用贝克抑郁量表和作者自己的访谈问卷。采用Statistica 13.1进行统计学分析,p < 0.05为显著性水平。结果:贝克抑郁量表平均得分为12.81分,属于中度抑郁水平。不从事专业活动的人、认为自己月收入不足的人、在糖尿病诊断后感到不确定的人、治疗包括饮食和胰岛素摄入的人、有足部护理问题的人、以及没有遵循糖尿病治疗原则的人,都有更严重的抑郁症。声称缺乏配偶支持的答复者感到糖尿病对其精神健康的影响,并证实需要在与该疾病有关的方面获得帮助,并且抑郁障碍的程度有所增加。结论:糖尿病患者存在抑郁症状,有必要开展抑郁障碍筛查研究。它应该是治疗团队活动中不可或缺的元素。采取行动,防止病情恶化,并为患者提供全面护理。所提出的结果是作为法定项目障碍的一部分进行的研究的片段
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引用次数: 0
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