The Voice Rehabilitation in Patients After Total Laryngectomy. What Has Changed?

The most unpleasant consequence of laryngectomy is the inability to communicate with a sonorous voice. One way to overcome these depressing feelings is to focus on the most important problem at the moment: learning replacement speech. The mechanism of creating the esophageal voice is as follows: the role of the vibration generator is taken over by the upper part of the esophagus, the so‑called mouth of the esophagus, forming a pseudoglossus, and the esophagus is the reservoir of air. The air expelled from the esophagus with an antiperistaltic movement vibrates the pseudo‑loudspeaker, creating a basic sound, which is then appropriately modulated in slightly altered resonance and articulation cavities. It is advisable to start the introductory exercises for learning voice and substitute speech before the surgery. The actual rehabilitation begins after the wound has healed, preferably during hospitalisation. The first exercises should be conducted by a doctor to prevent developing abnormal habits that make it difficult to master the substitute speech. The quality of esophageal speech and the speed of mastering it depends not only on the persistence and regularity of the practitioner. The effectiveness of rehabilitation is delayed by high tension of the esophageal mouth sphincter, the extent of surgery, radiotherapy, hearing loss, poor dental condition, and coexisting diseases. Voice prosthesis implantation is one of the two currently considered equivalent methods of voice rehabilitation in patients after complete removal of the larynx due to cancer. It is a method of surgical voice rehabilitation. The pioneer of this method in Poland was a well‑known and recognised otolaryngologist, prof. Erwin Mozolewski, who first applied voice rehabilitation using a voice prosthesis in Szczecin in 1972. The method of surgical rehabilitation of speech in patients after laryngectomy consists in creating a tracheo‑esophageal fistula and implanting a simple, unidirectional air valve, the so‑called voice prosthesis. This allows the patient, when closing the tracheostomy with a finger, to direct the exhaled air from the lungs to the esophagus and the lower pharynx to produce a substitute basic tone in the same place as in the case of esophageal speech (in the so‑called pharyngeal segment).Najbardziej przykrą konsekwencją operacji usunięcia krtani jest niemożność porozumiewania się dźwięcznym głosem. Sposobem na pokonanie przygnębiających uczuć jest skoncentrowanie się na najważniejszym w danej chwili problemie: uczeniu mowy zastępczej. Mechanizm tworzenia głosu przełykowego jest następujący: rolę generatora drgań przejmuje górny odcinek przełyku, tzw. usta przełyku, tworzące pseudogłośnię, a zbiornikiem powietrza jest przełyk. Powietrze usuwane z przełyku ruchem antyperystaltycznym wprowadza w drgania pseudogłośnię, tworząc dźwięk podstawowy, który następnie jest odpowiednio modulowany w nieznacznie zmienionych jamach rezonacyjnych i artykulacyjnych. Ćwiczenia wprowadzające do uczenia się głosu i mowy zastępczej korzystnie jest zacząć jeszcze przed operacją. Właściwą rehabilitację rozpoczyna się po wygojeniu rany, najlepiej jeszcze podczas pobytu w szpitalu. Pierwsze ćwiczenia powinny być prowadzone przez lekarza, by nie powstawały nieprawidłowe nawyki, utrudniające opanowanie mowy zastępczej. Jakość mowy przełykowej oraz szybkość jej opanowania zależą nie tylko od wytrwałości i systematyczności ćwiczącego. Skuteczność rehabilitacji opóźniają: wysokie napięcie zwieracza ust przełyku, rozległość zabiegu operacyjnego, radioterapia, ubytek słuchu, zły stan uzębienia, choroby współistniejące. Implantacja protez głosowych stanowi jeden z dwóch, obecnie uznanych za równoważne sposobów rehabilitacji głosu u pacjentów po całkowitym usunięciu krtani z powodu raka. Jest metodą chirurgicznej rehabilitacji głosu. Pionierem tej metody w Polsce był znany i uznany otolaryngolog – prof. Erwin Mozolewski, który w 1972 roku w Szczecinie jako pierwszy zastosował rehabilitację głosu przy użyciu protezy głosowej. Metoda chirurgicznej rehabilitacji mowy u chorych po usunięciu krtani polega na wytworzeniu przetoki tchawiczo‑przełykowej i wszczepieniu prostej, jednokierunkowej zastawki powietrznej – tzw. protezy głosowej. Pozwala to, przy zamknięciu otworu tracheostomy palcem, kierować powietrze wydechowe z płuc do przełyku i gardła dolnego w celu wytworzenia zastępczego tonu podstawowego w tym samym miejscu co w przypadku mowy przełykowej (w tzw. segmencie gardłowo‑przełykowym)

The gardener’s house – the form, the value, the state of behaviour (on the example of buildings from the area of the former rejencja opolska)

The article covers issues relating to the19th-century buildings which accompanied the park complex, called the gardener’s house. They presented the most important contemporary trends in the formation of residential-park complexes, as well as examples of preserved objects in the former rejencja opolska. It also presents the form, present values, and opportunities for adapting them

The gardener’s house in 19th century German architectural and landscape traditions

This article is devoted to the topic of garden houses, characteristic of buildings in garden architecture in many epochs. In the 19th century, owing to the creator of German culture, they assumed a characteristic form, becoming part of the design trends of that time. The main considerations will include their characteristics, the importance and value in creating 19th-century cultural landscapes against the conditions connected with the gardener’s occupation

Assessment of patient knowledge and awareness of the occurrence of addiction

Introduction. Drug treatment and substance abuse treatment centers are mostly involved in the treatment of alcohol or drug addicts. At present, an increasing number of patients depend on several psychoactive substances simultaneously. These people have a phenomenon called mixed addiction.Aim. The aim of the study was an attempt to answer the question about the state of mind of psychiatric hospital patients about the occurrence of addiction.Material and methods. The study included a group of 100 patients in the Neuropsychiatric Hospital's Neuropsychiatric Ward and the SPZOZ Psychiatric Day Ward in Kraśnik. The survey was conducted between February and August 2017. The author's questionnaire method was fully anonymous.Results. Misuse of psychoactive substances is a serious social problem. The phenomenon of addiction is more common among men living in rural areas, working professionally in the age range of 31 to 40 years. The respondents acknowledge that their knowledge of narcotics is based on their experience and their friends.Conclusion. Respondents are aware of the occurrence of mixed dependency

The readiness for hospital discharge of patients after acute myocardial infarction: a new self-reported questionnaire

Introduction. Medical care providers are responsible for adequate preparation of patients for discharge from the hospital. The purpose of this study was to validate a new self-reported questionnaire assessing the readiness of patients for hospital discharge. Methods. The Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD MIS) was validated in 201 patients, 57 (29%) females and 144 (71%) males (mean age 63.3 ± 11.3), hospitalised due to myocardial infarction. Results. For the considered 23 items the a-Cronbach coefficient was 0.789, indicating a high level of reliability and homogeneity of the questionnaire. The RHD MIS fulfilled the assumption of factor analysis: the determinant of correlation matrix was 0.001, Kaiser-Mayer-Olkin (K-M-O) statistic was 0.723, and the Bartlett’ test of sphericity was statistically significant. The analysis of internal consistency of the three areas confirm the rightness of the distinguishing of three subscales. Answers to each item were assigned a score from 0 to 3. The highest total score is 69 points. The total score of the scale and total scores of the subscales have skewed distributions and statistically significant results of Shapiro-Wilk test (p < 0.001). The scoring less than 44 points for the entire questionnaire indicates low readiness, obtaining between 44 and 57 points indicates medium readiness, and scores over 57 points are classified as high readiness for discharge from hospital. Conclusions. The validation procedure revealed that RHD MIS is a reliable and homogeneous tool to measure the readiness of patients for hospital discharge. The set of items divided into three subscales allows subjective and objective evaluation of the patient’s knowledge and expectations. Further investigation is needed to assess the potential impact of RHD MIS scoring on long-term outcome

New star-shaped polyether-pentols (PEPOs) for fabrication of crosslinked Polyurethanes-synthesis and characterization

Polyether-pentols (PEPOs) were synthesized from glycidyl ethers and butylene oxide with the application of tripotassium salts of 2,2,6,6-tetrakis(hydroxymethyl)cyclohexanol (HMCH) activated 18C6 for ring-opening polymerization (ROP). The construction of the applied initiator system reflects the ability of crown ether to influence the degree of ion-pair separation with an increased activating effect. As a result formation of bi- or trimodal polymers was observed with molar masses in the range of (Mn = 1200–6000). The observed multi-fraction composition is prescribed to the formation of ionic aggregates with different reactivities during polymerization. The mechanism of the studied processes is discussed. The obtained PEPOs served for a crosslinked PUR synthesis, for which the hydrogen bond index for coupling of hard segments was calculated. Additionally, the range of phase separation was calculated that was higher for PUR-containing aromatic rings as the substituent

The Adherence Scale in Chronic Diseases (ASCD). The power of knowledge: the key to successful patient — health care provider cooperation

Introduction. Patients’ adherence to long-term therapies is low. It translates into reduced quality of life and significant deterioration of health economics. Identification of potential barriers of medication-related adherence is a starting point allowing implementation of more advanced interventions directed to adherence improvement. Aim. The purpose of our study was to create and validate a simple instrument used to assess patients’ adherence to recommended medications. Material and methods. The Adherence Scale in Chronic Diseases is a self-reported questionnaire with 8 items and with proposed 5 sets of answers. The total score in the Adherence Scale in Chronic Diseases ranges from 0 to 32 points. Three levels of adherence were considered (low: scores of 0 to 20; medium 21 to 25; high > 26). The validation of the questionnaire was conducted in accordance with the validation procedure. Assessment of the internal consistency was performed using a-Cronbach coefficient. In order to conduct the factor analysis, we assessed: the determinant of correlation matrix, Kaiser-Mayer-Olkin (K-M-O) statistic and the Bartlett’s test of sphericity. Factor analysis was conducted using principal component analysis with Oblimin rotation. The Kaiser criterion and scree plot were used in order to determine components of the questionnaire. Adherence levels were determined based on the percentiles. Results. Grand total of 413 patients with a cardiovascular disease were included in the study. The reliability and homogeneity of the questionnaire were confirmed by a-Cronbach coefficient (0.739). Factor analysis showed that in this questionnaire we can extract two components. The analysis of factor loadings indicated excluding item 2 from the questionnaire. After exclusion of the mentioned item, we repeated the validation procedure. For such a new dataset, according to the Kaiser criterion, only one component was extracted. Conclusions. The Adherence Scale in Chronic Diseases is a practical, reliable, consistent and well validated instrument for identifying specific obstacles to medication adherence. Its simplicity causes that it can be successfully applied in daily practice by health care professionals. Our survey has the potential to improve patient — health care professional communication and relationship.

The effect of hemodynamically-guided hypotensive therapy in one-year observation: Randomized, prospective and controlled trial (FINEPATH study)

Background: The use of impedance cardiography (ICG) revealed to provide beneficial blood pressure (BP) lowering effect. However, the follow-up in previous trials was short and brachial BP was the only evaluated hemodynamic variable. Thus, we aimed to estimate the influence of ICG-guided therapy on brachial and central BP, impedance-derived hemodynamic profile and echocardiographic features after 12 months in a randomized, prospective and controlled trial (NCT01996085). Methods: One hundred and forty-four hypertensives were randomly assigned to groups of empiric (GE) and ICG-guided therapy (HD). Office BP, ambulatory BP monitoring, central BP and echocardiography (left ventricular hypertrophy and diastolic function assessment) were performed before and after 12 months of treatment. Results: Blood pressure reduction was higher in HD (office BP: 21.8/14.1 vs. 19.9/11.8 mm Hg; mean 24-h BP: 19.0/10.9 vs. 14.4/9.2 mm Hg). However, the only statistically significant differences were: percentage of patients achieving BP reduction of minimum 20 mm Hg for of­fice diastolic BP (27.3% vs. 12.1%; p = 0.034) and mean 24-h systolic BP (49.1% vs. 27.3%; p = 0.013). More pronounced improvement in the left ventricular diastolic dysfunction (delta E/A 0.34 vs. 0.12, p = 0.017) was the only other beneficial hemodynamic effect. Conclusions: Beneficial BP lowering effect of hemodynamically-guided pharmacotherapy, observed previously in short-term observation, persists over time. Hemodynamic effects of such a treatment approach, especially those of prognostic value (central BP, myocardial hypertrophy), should be evaluated in further studies including patients with resistant hypertension, heart failure, diabetes mellitus and chronic kidney disease