Tekst artystyczny między stylami i gatunkami (genologiczne „silva rerum" nowej i najnowszej literatury polskiej

The paper discusses the state of literary art whose genres result from an interplay of various genological instruments. Multidimensional relations between styles, forms, and languages (uncommon and common speech practices) together with intertextual mechanisms of "making texts from texts" result in hybrid forms of expression, in their multidimensional and "blurred" genre classifications.The paper discusses the state of literary art whose genres result from an interplay of various genological instruments. Multidimensional relations between styles, forms, and languages (uncommon and common speech practices) together with intertextual mechanisms of "making texts from texts" result in hybrid forms of expression, in their multidimensional and "blurred" genre classifications

Nieznane groby średniowiecznych duchownych z kolegiaty pw. św. św. Piotra i Pawła w Kruszwicy

In 1960–1961 excavations were conducted in the interior of the collegiate church of St. Peter and St. Paul in Kruszwica as part of studies conducted by the Management for Research on the Beginnings of the Polish State. The research was supervised by Ewa Springer, M.A. Among 326 tombs explored in the interior of the building two, containing coffins, were opened but, unfortunately, had been previously tampered with and partly raided. One of the tombs (no. 24/II) contained a silver chalice with a paten and fragments of silk tape with an embroidered inscription, while the other (no. 70/VII) – an embroidered stole. The form of the chalice and the paten, the shape of the letters of the embroidered inscription, and the embroidery on the stole showing clergymen carrying two-horned mitres make it possible to date the Kruszwica monuments as twelfth-century. Their presence in tombs located in the Kruszwica collegiate church would indicate the high status within the Church hierarchy of the men buried there. Regrettably, both tombs were robbed of part of their outfitting and thus it is impossible to exclude that originally they also contained pastorals and rings.In view of the scarcity of the preserved sources with diverse and enigmatic contents it is difficult to recreate the history of the church of St. Peter in Kruszwica as well as that of the Kruszwica bishopric. Undoubtedly, in the first half of the twelfth century Kruszwica was the seat of bishops and the church of St. Peter was the burial site of the local prelates.Zarys treści: Autorka omawia obiekty datowane na XII w., odnalezione w grobach w kościele kolegiackim w Kruszwicy: kielich z pateną, fragmenty taśmy jedwabnej z wyhaftowanym napisem, i jedwabną, haftowaną stułę. Zabytki te wskazują, że pogrzebane z nimi osoby zajmowały wysoką pozycję w hierarchii kościelnej. Zdaniem autorki pochówki tych osób potwierdzają opinię, zgodnie z którą Kruszwica była w pierwszej połowie XII w. siedzibą biskupią, a omawiany kościół miejscem pochówków prałatów.Abstract: The author discusses objects dated as twelfth-century and discovered in tombs in the collegiate church in Kruszwica: a chalice with a paten, fragments of a silk fabric with an embroidered inscription, and an embroidered silk stole. The monuments in question indicate that the persons buried together with them occupied a high position in the Church hierarchy. In the opinion of the author these burials confirm a view maintaining that in the first half of the twelfth century Kruszwica was the seat of a bishopric and the discussed church – the burial site of prelates

Intercultural Competences in Health Care - Judaism

The present times and Poland's entry into the European Union, the opening of borders, has intensified the phenomenon of migration of the population and contact between different cultures. In Poland, national minorities have been living since the dawn of time, but the current situation has a different dimension. Until now, the term "Transculturality" was not known in our country. However, the influx of people from the remotest parts of the world caused a situation requiring medical personnel to perceive the patient through the prism of biological, social and psychological needs as well as from the angle of other religions. Problems that appear taking care of such patients have caused that I decided to look at this issue on the example of Judaism believers. The aim of my work is to get the opinion of health professionals about intercultural competences in direct care of these patients

Stopień przestrzegania zaleceń przewlekłej terapii alendronianem 10 przez pacjentów leczonych z powodu osteoporozy

Introduction: It has been shown that more than 50% of people with a chronic disease, including osteoporosis, discontinue treatment during its first year. This problem increases with the time of observation. The aim of this study was to assess alendronate compliance over a period of 6 or 18 months in clinical practice of postmenopausal osteoporosis. Material and methods: Using a retrospective study of clinical histories (357) obtained in our Outpatient Clinic, as well as telephone interviews with patients, the compliance with alendronate therapy in postmenopausal patients was assessed. Results: After 1.5 years on observation 20.4% of patients, and after 0.5 years 8.5% of patients, discontinued their treatment as a result of intolerance (especially side effects on the gastrointestinal tract) (47.8%), health problems unrelated to osteoporosis (8.7%), inconvenience of the daily regimen (13.1%), costs (4.3%), and improvement of clinical condition (26.1%). It is worth mentioning that in both periods of observation (1.5 and 0.5 years) almost the same percentage of patient discontinued visits at our Outpatient Clinic (15.6% and 14.4%, respectively). Telephone interviews with patients who stopped attending the Outpatient Clinic at the Regional Centre of Menopause and Osteoporosis revealed that more than 50% of them discontinued the treatment. Conclusions: Not all patients treated with alendronate are compliant. Osteoporosis is a chronic disease, which needs long clinical observation and constant adherence to medication. Effective communication between doctor and patient, and follow-up visits that are more frequent would greatly improve the adherence to osteoporosis treatment modalities. Compliant patients achieved increases in bone mass density with simultaneous fracture risk reduction.Wstęp: Wykazano, że ponad 50% pacjentów leczonych z powodu chorób przewlekłych, w tym osteoporozy, przerywa terapię w ciągu pierwszego roku jej stosowania. Problem ten narasta z czasem trwania obserwacji. Celem pracy była ocena stopnia przestrzegania zaleceń terapii przewlekłej przez pacjentki leczone z powodu osteoporozy. Materiał i metody: Ocenie poddano 357 losowo wybranych historii chorób osób, które pierwszy raz były konsultowane w Regionalnym Ośrodku Osteoporozy i Menopauzy w łodzi w roku 2003 i 2004. Analizą objęto pacjentów leczonych preparatem alendronian 10. Wzięto pod uwagę czas trwania obserwacji, zakres kontynuacji, przyczynę przerwania stosowanego leczenia. Wyniki: W okresie 18 miesięcznej obserwacji leczenie przerwało 20,4% pacjentów, natomiast w okresie obserwacji 6 miesięcznej 8,5%. Przyczyny przerwania terapii alendronianem 10 były następujące: brak tolerancji ze strony przewodu pokarmowego (47,8%), współistniejące choroby (8,7%), uciążliwość przyjmowania leku w terapii codziennej (13,1%), cena leku (4,3%) oraz poprawa kliniczna (26,1%). Zarówno w jednym, jak i drugim okresie obserwacji stwierdzono porównywalną grupę pacjentów, którzy nie zgłosili się ponownie na konsultacje lub z którymi nie ma kontaktu od co najmniej pół roku do roku (odpowiednio: 15,6% dla obserwacji 1½ rocznej; 14,4% dla obserwacji ½ rocznej). Po weryfikacji telefonicznej stwierdzono, że ponad połowa pacjentów nie zgłaszających się nie kontynuuje zaleconego leczenia. Wnioski: Nie wszyscy pacjenci leczeni z powodu osteoporozy kontynuują zalecone leczenie. Im dłużej trwa leczenie tym większy jest odsetek pacjentów przerywających terapię. Choroba przewlekła wymaga wypracowania zasad współpracy pomiędzy prowadzącym lekarzem a pacjentem, której celem jest lepsze przestrzeganie zaleconych zasad postępowania terapeutycznego co może odnieść wymierny skutek w postaci poprawy stanu klinicznego

Wprowadzenie

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Is a normal chest radiograph sufficient to exclude pulmonary abnormalities potentially associated with chronic cough?

Introduction: There are few original studies on the true role of normal chest radiograph (CXR) in exclusion of pulmonary conditions that may be associated with chronic cough. Thus, the aim of the study was to assess whether a plain CXR is a sufficient tool to exclude relevant pulmonary causes of chronic cough. Material and methods: A retrospective analysis of chest computed tomography (CT) scans in non-smoking patients with chronic cough and normal CXR was performed. The percentage of individuals in whom chest CT revealed relevant abnormalities was compared with the percentage of patients with irrelevant findings or normal chest CT scans. The negative predictive value (NPV) of the CXR in diagnosing the causes of chronic cough was calculated as a proportion of true negative CXRs (normal CXR AND irrelevant CT findings OR normal CT scan) to all negative CXRs (all patients, who had both a CXR and CT scan). Results: The study group consisted of 59 adult patients with chronic cough, normal CXR and CT scan performed to diagnose the cause of chronic cough. In 21 patients (21/59, 36%), chest CT revealed abnormalities that were classified as relevant to chronic cough. The most frequent were: bronchiectasis (7/59, 11.9%), bronchial wall thickening (6/59, 10.2%) and mediastinal lymphadenopathy (5/59, 8.5%). The NPV of a CXR in diagnosing the causes of chronic cough was 64%. Conclusions: In conclusion, the NPV of CXR in diagnosing pulmonary causes of chronic cough is relatively low. Thus, plain CXR seems to be insufficient to exclude pulmonary diseases potentially associated with chronic cough

The utility of oesophageal pH monitoring in diagnosing gastroesophageal reflux disease-related chronic cough

Wstęp: Przewlekły kaszel jest częstą dolegliwością, która może pogarszać jakość życia chorych oraz wywoływać liczne powikłania. J edną z częstych jego przyczyn jest choroba refluksowa przełyku (GERD). Do metod diagnostycznych stosowanych w celu potwierdzenia diagnozy kaszlu związanego z GERD należy pH-metria przełyku. Celem badania była ocena przydatności pH-metrii przełyku oraz określenie, który z parametrów mierzonych w czasie jej wykonywania jest najczulszy w diagnostyce kaszlu związanego z GERD.Materiał i metody: U 204 chorych z przewlekłym kaszlem wykonano 24-godzinną pH-metrię przełyku. Kobiety stanowiły 65% pacjentów, a mediana wieku wyniosła 59 lat. Epizod kwaśnego refluksu rozpoznawano, gdy nagły spadek pH poniżej 4 trwał co najmniej 12 sekund. Rozpoznanie GERD opierało się na całkowitym czasie pH poniżej 4, czasie pH poniżej 4 w pozycji stojącej lub leżącej oraz wskaźniku DeMeester. Kaszel związany z GERD diagnozowano, jeżeli epizody kaszlu odnotowane przez pacjentów pojawiały się nie później niż 2 minuty po epizodzie refluksu. Z wiązek pomiędzy epizodem refluksu i wystąpieniem kaszlu oceniono za pomocą następujących parametrów: symptom index (SI ≥ 50%) lub symptom association probability (SAP ≥ 95%).Wyniki: Na podstawie wyników pH-metrii przełyku u 135 chorych (135/204, 66%) wysunięto podejrzenie GERD. U większości z nich (117/135, 87%) diagnozę postawiono na podstawie wskaźnika DeMeester. Wśród pacjentów z GERD 61 osób (61/135, 45%) spełniło kryteria kaszlu związanego z GERD, co stanowiło 30% wszystkich pacjentów. U 36 pacjentów (36/61, 59%) kaszel związany z GERD zdiagnozowano na podstawie parametru SAP, u 12 chorych (20%) na podstawie parametru SI, natomiast u 13 (21%) na podstawie obu parametrów. Współczynnik korelacji Spearmana dla SAP ≥ 95% i SI ≥ 50% wyniósł 0,46 (p < 0,05).Wnioski: Na podstawie wyników pH-metrii GERD został zdiagnozowany 2-krotnie częściej niż kaszel związany z GERD. Parametr SAP jest bardziej czuły niż SI w diagnozowaniu kaszlu związanego z GERD. Introduction: Chronic cough is a common medical complaint, which may deteriorate patients’ quality of life and cause many complications. Gastroesophageal reflux disease (GERD) is one of the frequent reasons for chronic cough. Oesophageal pH monitoring is one of the diagnostic methods performed to confirm diagnosis of GERD-related cough. The aim of the study was to analyse the utility of oesophageal pH monitoring in diagnosing GERD-related cough and to identify the most sensitive pH monitoring parameters for diagnosing GERD-related cough.Material and methods: 24-hour oesophageal pH monitoring was performed in 204 patients suffering from chronic cough. The group consisted of 65% females and the median age was 59 years. An acid reflux episode was defined as a rapid drop in pH to a value below 4 for at least 12 seconds. The diagnosis of GERD was based on total fraction time of pH < 4, upright or supine fraction time of pH < 4, or DeMeester score. The diagnosis of GERD-related cough was made if cough episodes, marked by the patients, appeared within 2 minutes after the reflux. The association between reflux episode and appearance of cough was analysed using two parameters: symptom index (SI ≥ 50%) and/or symptom association probability (SAP ≥ 95%).Results: Based on results of pH monitoring, 135 patients (135/204, 66%) were diagnosed with GERD. Among them, 117 patients (117/135, 87%) were diagnosed based on DeMeester score. Among patients with GERD, 61 patients met the criteria of GERD-related cough (61/135, 45%), i.e. 30% of the group as a whole. Thirty-six patients (36/61, 59%) were diagnosed based on SAP, 12 patients (20%) based on SI, and 13 (21%) based on both parameters. Spearman rank correlation coefficient for SAP ≥ 95% and SI ≥ 50% was 0.46 (p < 0.05).Conclusions: Based on pH monitoring results, GERD was diagnosed twice as often as GERD-related cough. SAP index is more sensitive than SI for the diagnosis of GERD-related cough

Speech therapy — a non-pharmacological method to manage difficult-to-treat chronic cough

  Cough is the most common symptom of respiratory diseases. The results of management of chronic cough in adults are still unsatisfactory. Unexplained and difficult-to-treat chronic cough causes significant impairment in patients‘ quality of life. The results of recent studies suggest that speech therapy (speech language intervention) is one of the few methods which are usefull in management of persistent chronic cough. We present a case of a patient with chronic cough due to chronic nonallergic rhinitis and gastroesophageal reflux disease, who had been unsuccessfully treated for 18 years. In the patient speech therapy resulted in a significant decrease of cough severity and improvement of quality of life.