Journal of Nursing Theory and Practice

[The place and role of physiotherapy in total joint replacement surgery patients improve their quality of life]


DECEMBER 25, 2015

Journal of Nursing Theory and Practice - 2015;28(06)

[Aim of the research: The objective of investigation was to survey the efficiency of the rehabilitation of the patients operated with complete knee endoprosthesis (TKR) nursed in the Rehabilitation Centre and whether the bath course with the applied complex physiotherapy and the spring water of induce any change in the life quality of the patients and whether the efficiency of the physiotherapy can be measured. Research and sampling methods: prospective, quantitative, describing research, with non-random, convenience sampling method. 50 TEP-operated patients have filled in the self-filling questionnaires and participated in the examination of the walking time. The examination was performed between 03/01/2013-12/01/2013 in the Musculoskeletal Rehabilitation Centre of the Gunaras. The patients have filled in the WOMAC, SF-36, BDI, questionnaire compiled by us. Additionally we have measured the walking speed on flat ground and during climbing stairs. The patients have taken a bath in 36C spa for 3 weeks, 7-times a week for 20 minutes and 5-times a week they have received electrotherapy, physiotherapy and hydrotherapy. Results: The majority of the participants of the investigation belonged to the age group of 71-75. The patients avail themselves of the treatments regularly, once or twice a year, which are evaluated by women as more efficient than by men (p <0,001). After the treatments the extent of depression has significantly reduced (p <0,001). There was a significant improvement in the walking speed (p < 0,001), in the SF-36 (TF, PCS) dimensions and we have detected a significant relation between physical and mental health (p <0,001). The movement range of the patients has significantly improved (WOMAC, p=0,001). Between the result of the SF-36 and WOMAC questionnaires we have found also a significant relation (p=0,001), with the improvement of the physical function the life quality has also improved. Conclusions: The results have shown, that the application of the spring water and physiotherapy have proven as efficient treatment in the life quality improvement of the patients operated with complete knee prosthesis. ]



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Journal of Nursing Theory and Practice

[Prevention of type-2. diabetes in the light of gestational diabetes mellitus (GDM)]


[Aim of the research: The main objective of the present study is to call women’s attention to the importance of preventive medical screenings and to increase the participation rate by emphasizing preconceptional care. Other aims include: Maintaining good health of pregnant and non-pregnant women; Ensuring a smooth antenatal period and the delivery of healthy infants; Primary prevention before the occurrence of GDM; Emphasizing the importance of secondary prevention for clients with already developed GDM; Highlighting the necessity of lifestyle change; Motivating patients to participate at follow-up checkups as tertiary prevention. Research and sampling methods: Questionnaire involving pregnant women of age 20-45 years (n=104) The questionnaires are uniform, each containing the same questions. Data collection was supported by antenatal care staff at Szent Margit Hospital where great emphasis is placed upon the early detection of GDM. Results: Age, body weight, education level and social background correlate with the occurrence of GDM as well as with the outcome of GDM-affected pregnancies. Due to the regular prenatal care including regular GDM care, the outcome of GDM-affected pregnancies is complaint-free, spontaneous delivery and postpartum period. Conclusions: It is essential that pregnant women receive adequate information about the importance of GDM prevention and its early diagnosis. The significance of educating pregnant women to adopt a healthy lifestyle must be given top priority. ]

Journal of Nursing Theory and Practice

[Practice of the Hepatitis B vaccination with non-responder patients in our Centre]

GÓZ Lászlóné, KÖRTVÉLYESINÉ Bari Krisztina, BECS Gergely, SZABÓ P. Réka, BALLA József, KÁRPÁTI István, MÁTYUS János, UJHELYI László, BEN Thomas

[Introduction: End-stage renal disease patients under dialysis have impaired immune system and are more susceptible to infection, even those infections that can be prevented by vaccination (e.g. hepatitis B). If the antibody titer (anti-HBs) remains <10 IU/ml after two consecutive vaccinations, patients are classified as non-responders. Reasons for unsuccessful vaccinations include technical, immunological (e.g. multigene haplotypes) reasons. They are often also associated with chronic diseases. Aim of the research: To re-vaccinate patients after unsuccessful intramuscular vaccination to achieve immunity. Research and sampling methods: Intracutaneous vaccination can be a viable alternative for successful immunity. 6 months after re-immunisation, anti-HBs titer>10 IU/mL indicate a successful immune response. Results: 22 haemodialysed patients received intracutaneous hepatitis B vaccination with the total dosage of 6 μg. An anti-HBs titer elevation (21-100 IU/ml) was observed in 15 cases (68.18%). In those cases, where we failed to achieve successful immunity, we identified malignancies, immunosuppression, amyloidosis, psoriasis diabetes mellitus, or coeliac disease as a possible reason. Conclusions: The rate of successful immunisations against HBV infections can be improved by means of intracutaneous vaccination. ]

Journal of Nursing Theory and Practice

[Patients with type-1 and type-2 diabetes mellitus in the program of peritoneal dialysis]


[Aim of the research: To evaluate the efficacy of the treatment and incidence of complications in diabetes type 1 and 2 patients treated with peritoneal dialysis. Research and sampling methods: During a retrospective study with 85 diabetic PD patients (19 type 1 patients and 66 type 2 patients) was compared data of 22 years with regard to the following parameters: Glucose metabolism, body weight, changes in residual urine clearance values, distribution of quantity and glucose content of the solutions used, incidence of infections, and average duration in PD programme before transferring to haemodialysis. Results: All patients, irrespective of their type of diabetes: spend the same time in PD on average, gained body weight during PD. Diabetes type 1 patients: had a lower residual urine clearance, had HbA1c values decreasing during PD, reported peritonitis less frequently, had a higher incidence of catheter-related infections. Diabetes type 2 patients: had a better glucose metabolism, had a higher body weight from the beginning of therapy, required PD solution with higher glucose concentration. Conclusions: Diabetes patients, irrespective of the type of diabetes, can successfully be treated with PD, but require more attention because of their underlying disease and associated complications. ]

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Clinical Neuroscience

[Disease burden of Duchenne muscular dystrophy patients and their caregivers]


[Background and purpose - Data on the disease burden of Duchenne Muscular Dystrophy are scarce in Hungary. The aim of this study was to assess patients’ and their caregivers’ health related quality of life and healthcare utilisations. Methods - A cross sectional survey was performed as part of the European BURQOL-RD project. The EQ-5D-5L and Barthel Index questionnaires were applied, health care utilisations and patients’ informal carers were surveyed. Results - One symptomatic female carer, 50 children (boys 94%) and six adult patients (five males) participated in the study, the latter two subgroups were included in the analysis. The average age was 9.7 (SD=4.6) and 24.3 (SD=9.8) years, respectively. Median age at time of diagnosis was three years. The average EQ-5D score among children and adults was 0.198 (SD=0.417) and 0.244 (SD=0.322), respectively, the Barthel Index was 57.6 (SD=29.9) and 53.0 (SD=36.5). Score of satisfaction with healthcare (10-point Likert-scale) was mean 5.3 (SD=2.1) and 5.3 (SD=2.9). 15 children were hospitalised in the past 12 months for mean 12.9 (SD=24.5) days. Two patients received help from professional carer. 25 children (mean age 11.1, SD=4.4 years) were helped/supervisied by principal informal carer (parent) for mean 90.1 (SD=44.4) hours/week and further family members helped in 21 cases. Correlation between EQ-5D and Barthel Index was strong and significant (0.731; p<0.01) as well as with informal care time (-0.770; p<0.01), but correlation with satisfaction with health care was not significant (EQ-5D: 0.241; Barthel Index: 0.219; informal care: -0.142). Conclusion - Duchenne muscular dystrophy leads to a significant deterioration in the quality of life of patients. Parents play outstanding role in the care of affected children. This study is the first in the Central and Eastern European region that provides quality of life data in this rare disease for further health economic studies.]

Clinical Neuroscience

[The quality of life of the cluster headache patients during the active phase of the headache]


[Introduction - Cluster headache (CH), which affects 0.1% of the population, is one of the most painful human conditions: despite adequate treatment, the frequent and severe headaches cause a significant burden to the patients. According to a small number of previous studies, CH has a serious negative effect on the sufferers’ quality of life (QOL). In the current study, we set out to examine the quality of life of the CH patients attending our outpatient service between 2013 and 2016, using generic and headache-specific QOL instruments. Methods - A total of 42 CH patients (16 females and 26 males; mean age: 39.1±13.5 years) completed the SF-36 generic QOL questionnaire and the headache- specific CHQQ questionnaire (Comprehensive Headache- related Quality of life Questionnaire), during the active phase of their headache. Their data were compared to those of patients suffering from chronic tension type headache (CTH) and to data obtained from controls not suffering from significant forms of headache, using Kruskal-Wallis tests. Results - During the active phase of the CH, the patients’ generic QOL was significantly worse than that of normal controls in four of the 8 domains of the SF-36 instrument. Apart from a significantly worse result in the ‘Bodily pain’ SF-36 domain, there were no significant differences between the CH patients’ and the CTH patients’ results. All the dimensions and the total score of the headache-specific CHQQ instrument showed significantly worse QOL in the CH group than in the CTH group or in the control group. Conclusion - Cluster headache has a significant negative effect on the quality of life. The decrease of QOL experienced by the patients was better reflected by the headache-specific CHQQ instrument than by the generic SF-36 instrument. ]

Journal of Nursing Theory and Practice

Use of Imogene King’s Nursing Model in the Care for a Patient with Heart Arrhythmias


Objectives: To discover the benefits of implementation of Imogene King’s nursing model into nursing care in a patient with arrhythmias. To find out how these patients are limited in saturation of their own needs and what are the most severe limitations for patients with arrhythmias. Material and methods: Qualitative research using semi-structured interviews. The interview with patients with arrhythmia was conducted in accordance with the structure of King’s nursing model. Results: The research group consisted of 20 respondents; 13 men and seven women. All respondents expressed satisfaction with their cooperation with staff. The respondents described a change in the subjectively perceived state, the psychic state, and emotions. Conclusions: Assessment of the subjectively perceived quality of life of patients with arrhythmias using the King’s interaction model allows nurses to see the patient from the holistic point of view and plan and provide individualized care.


[Quality of life of patients with osteoporosis in Hungary]

VOKÓ Zoltán, INOTAI András, HORVÁTH CSABA, BORS Katalin, SPEER Gábor, KALÓ Zoltán

[AIM - The aim of our study was to estimate the loss of quality of life due to osteoporotic fractures. We performed a cross-sectional study including 840 patients in 21 centers that specialise in the care of patients with osteoporosis and in acute care of fractures. METHODS - Patients were selected randomly and stratified for the location of and time elapsed since the fracture. Quality of life (QoL) was assessed by the Qualeffo-41 and the EuroQol-5D questionnaires. RESULTS - Patients with morphometric fractures of more than one vertebra had the lowest median EQ-5D index value (0.59). Symptomatic vertebral, hip and arm fractures also considerably decreased QoL. Patients with morphometric fractures of more than one vertebra had the lowest total Qualeffo-41 score. When controlled for age and gender, patients with hip fracture or morphometric vertebral fracture had at least 0.2 less mean utility values than had osteoporotic patients without history of fracture. Patients with more than a oneyear history of hip fracture had QoL scores as low as had patients with an acute fracture. In case of wrist and arm fractures, the acute loss of QoL somewhat decreased with time. CONCLUSION - In conclusion, osteoporotic fractures, especially hip and vertebral fractures result in a significant loss of patients’ quality of life. Our results show that physicians need to pay a close attention to morphometric vertebral fractures, which contribute to a great loss of human capital.]

Clinical Neuroscience

[Effects of neural therapy on quality of live in patients with inoperable lower extremity artery disease ]

MOLNÁR István, DEÁK Botond Zsolt, HEGYI Gabriella, KOVÁCS Zoltán, KAPÓCS Gábor, SZŐKE Henrik

[Objectives - Our aim was to evaluate the effects of percutaneous neurolysis of lumbal sympathetic ganglions on pain and the resulting changes in quality of life with validated objective and subjective methods. To follow the adverse effects and complications of the procedure. Materials and methods - A prospective, non-randomized, interventional, clinical cohort study under real life conditons was conducted. The time of the observation was 6 months. Palliative neural therapy was performed to reduce the ischemic pain of the affected leg of the patients involved in the study. Prior to treatment and after 35 days, Visual Analogue Scale (VAS) was used to measure the intensity of lower limb pain. The related changes in the quality of life were followed by a general 36-Item Short-Form Health Survey (SF-36) questionnaire. We measured the changes of the patients’ skin temperature and ankle/arm index. The post-treatment results were compared to the pre-treatment results. We compared the results of objective and subjective measures. We followed the side effects and complications of the pain therapy. Each of the examined subjects had obliterative (Fontaine II/b stage) arterial disease of the lower limbs, in which no revascularization intervention was feasible and their ischemic pain was of VAS≥7. Results - Data of 124 patients (69 male, 55 female) could be evaluated. The decrease in intensity of limb pain in the post-treatment period was significant (p=0.001). Quality of life also indicated a significant improvement (p=0.004). Changes in skin temperature and ankle/arm index demonstrated significant improvement (p≤0.005): skin temperature increased from 27.6°C to 31.2°C, the ankle/arm index inceased from 0.67 to 0.83 on average. Changes in objective and subjective measures correlated with each other. No worthening of symptoms, serious adverse events or complications were observed. Conclusion - The chemical denervation of the lumbar sympathetic ganglions with percutaneous application is a minimally invasive intervention, useful in outpatient care, which can be well tolerated by the patient without any significant side effect or complication. Its hyperaemic effect and the pain reduction of the leg can improve the quality of life of the patients.]