Wpływ wybranych czynników na jakość umierania i śmierci w opiece paliatywnej

Wstęp. Najważniejszym celem opieki paliatywnej jest osiągnięcie dobrej jakości procesu umierania i śmierci. Jednak interpretacja niniejszych zagadnień jest nadal niejasna, głównie z powodu trudności w określeniu, końcowego punktu opieki paliatywnej. W związku z tym konieczna jest weryfikacja składników jakości umierania i śmierci. Celem pracy była analiza wpływu wybranych czynników na jakość umierania i śmierci przez pryzmat „dobrej śmierci” w opiece paliatywnej. Materiał i metody. Pracę przygotowano w oparciu o przegląd literatury z zakresu badań dotyczących oceny jakości umierania i śmierci w opiece paliatywnej. Dokonano przeglądu baz danych: Pub Med (od 1973 r. do listopada 2015 r.) oraz Web of Science (od 1974 r. do listopada 2015 r.) według słów kluczowych „quality of dying and death” oraz „good death”. Do analizy zakwalifikowano wyłącznie prace w języku angielskim, które dotyczyły oceny jakości umierania i śmierci w opiece paliatywnej. Wykluczono prace o charakterze: listów, opisów przypadków, artykułów redakcyjnych i przeglądowych oraz te, które odnosiły się do dzieci oraz populacji pacjentów z chorobą nienowotworową. Wyniki. W przeprowadzonych dotychczas badaniach wyróżniono szereg różnorodnych czynników wpływających na doświadczenie jakości umierania i śmierci. Najwięcej z nich związanych jest z systemem opieki zdrowotnej. Należą do nich między innymi: czas skierowania do placówki, dostępność opieki, kontrola objawów, rodzaj terapii, komunikacja. Do pozostałych czynników zalicza się miejsce śmierci, autonomię, przygotowanie do śmierci oraz czynniki społeczno-demograficzne. Wnioski. Z punktu widzenia organizatorów i dostawców opieki zdrowotnej ważne jest poznanie tych czynników, które można modyfikować, tak aby zapewnić podopiecznym wysoką jakość opieki, oraz umierania i śmierci.Introduction. The fundamental aim of palliative care is to achieve good quality of the process of dying and death. However, the interpretation of these issues remains unclear, mainly due to difficulty in determining the ultimate point of palliative care. That is why it is necessary to verify the constituents of the quality of dying and death. The aim of this study was to analyze the influence of selected factors on the quality of dying and death in the perspective of a "good death" in palliative care. Materials and methods. The study is based on a literature review in the field of research on the evaluation of the quality of dying and death in palliative care. The following databases were searched: Pub Med (from 1973 to November 2015) and Web of Science (from 1974 to November 2015), using the key words "quality of dying and death" and "good death". Only the papers written in English and concerning the assessment of the quality of dying and death in palliative care have been taken into account. The following texts have been excluded: letters, case studies, editorials, and review articles as well as the papers on children and non-cancer patients. Results. The studies carried out so far have distinguished a number of various factors affecting the quality of dying and death. Most of them are associated with health care system and include, among others: the timing of referral to a care facility, the availability of care, the management of symptoms, the type of therapy, communication. Other factors include the place of death, autonomy, preparation for death as well as sociodemographic factors. Conclusions. From the point of view of the actors organizing and providing health care, it is important to understand such factors, which could then be modified so as to provide patients with high quality in terms of care as well as dying and death

Influence of achronic pain and its treatment on subjective assessment of quality of life in patients with advanced cancer disease

Background. Appropriate clinical assessment of pain in cancer patients is a necessary requirement for establish an adequate pain management. Quality of life in the terminally ill cancer patients is used to measure as well as to show direction of operation of therapeutic group. Material and methods. In the period from July 2006 to July 2007 in the Department of Chronic Pain Treatment, Palliative Care and Clinical Pharmacology of the Jagiellonian University Medical College a group of 34 patients in the terminal phase of cancer were analyzed. Intensity of experienced pain was measured with Numeric Rating Scale (NRS) and Verbal Rating Scale (VRS). Fear, depression and aggression occurrence was measured with HADS - M scale. By the use of Rotterdam List general evaluation of quality of life and individual dimensions of quality of life. Results. Statistically significant relation between cancer pain intensity level measured and individual dimensions of quality of life. Conclusions. Our results confirmed the presence of warning a relation between intensity of pain and quality of life. They have called attention on problems of pain in a multi-directional manner and take many aspects into consideration, in order to improve care and quality of life.Background. Appropriate clinical assessment of pain in cancer patients is a necessary requirement for establish an adequate pain management. Quality of life in the terminally ill cancer patients is used to measure as well as to show direction of operation of therapeutic group. Material and methods. In the period from July 2006 to July 2007 in the Department of Chronic Pain Treatment, Palliative Care and Clinical Pharmacology of the Jagiellonian University Medical College a group of 34 patients in the terminal phase of cancer were analyzed. Intensity of experienced pain was measured with Numeric Rating Scale (NRS) and Verbal Rating Scale (VRS). Fear, depression and aggression occurrence was measured with HADS - M scale. By the use of Rotterdam List general evaluation of quality of life and individual dimensions of quality of life. Results. Statistically significant relation between cancer pain intensity level measured and individual dimensions of quality of life. Conclusions. Our results confirmed the presence of warning a relation between intensity of pain and quality of life. They have called attention on problems of pain in a multi-directional manner and take many aspects into consideration, in order to improve care and quality of life

Socio-demographic determinants of the acceptance of systemic connective tissue diseases

Introduction: Socio-demographic forecasts indicate a stable increase in the population of elderly people, which gives rise to the need to examine the relationship between the acceptance of chronic illness and socio-demographic variables not only in terms of subjective negative emotions but also because of possible social consequences. The acceptance of a chronic disease is determined by factors related to its character including its severity and the discomfort it brings about but also by factors connected with the patient that is socio-demographic determinants. Objective: The objective of the study was to examine the relationship between socio-demographic variables and the acceptance of a chronic disease of locomotive organs. Material and methods: The study was conducted in the group of 150 patients diagnosed with a systemic connective tissue disease during its stable phase. A socio-demographic questionnaire as well as a standardised Acceptance of Illness Scale (AIS) adapted by Juszczyński were applied in the study. The study was conducted in accordance with the recommendations of the Declaration of Helsinki. Results: In the group of 150 patients suffering from a systemic connective tissue disease the percentage of women was higher than the percentage of men (60.7% vs. 39.3%). The indicator of the acceptance of illness in the group examined reached 24.5 ±7.5. The strongest correlation was found between the acceptance level and married probants (eta = 0.26; p = 0.01), high education (eta = 0.24; p = 0.04) and working activity (eta = 0.20; p = 0.01). Conclusions: Socio-demographic factors which determine the level of illness acceptance include age, marital status, education and the source of income. The acceptance of illness in the examined group of patients with systemic connective tissue diseases reached 24.5

Różnice behawioralne związane z zachowaniami zdrowotnymi między płciami, determinujące stan odżywienia u hospitalizowanych pacjentów w podeszłym wieku

Background: Health-related behaviours affect the preservation and maintenance of health. They form a important part of the everyday life of all individuals including the elderly. Some of the most significant factors affecting health are eating habits, physical activity, and the ability to handle stress and limiting the use of substances. Aim of the study: The aim of this paper was to assess the effect of health-related behaviours on nutrition in hospitalized elderly patients. Material and Methods: The study population consisted of 151 subjects over 60 years old. The study tools included a diagnostic survey, the Health Behaviour Inventory and the Mini Nutritional Assessment. Statistical significance for differences and strength of correlation between the variables was set at p < 0.05. Results: The general indicator of health behaviour was higher among women (88.78 ± 13.82 vs. 83.55 ± 12.93; p = 0.01). The analysis of health behaviour showed significant differences between men and women in relation to good eating habits (p = 0.01) and prophylactic behaviour (p = 0.01). Conclusions: Elderly people who followed a proper diet, which included fruit and vegetables, and avoided food with preservatives, were better nourished. A positive attitude was connected with the state of nutrition. Wellnourished status can be observed among the elderly who have positive attitude, avoid anger, anxiety and depression, and have friends and a stable family life.Wstęp: Zachowania zdrowotne osób starszych, będące elementem codziennego życia, wpływają na utrzymanie i wzmacnianie zdrowia. Do jednych z najważniejszych czynników warunkujących zdrowie należą nawyki dotyczące prawidłowego odżywiania i aktywności fizycznej, umiejętność radzenia sobie ze stresem czy ograniczenie stosowania używek. Cel pracy: Celem podjętych badań była ocena wpływu zachowań zdrowotnych na stan odżywienia osób starszych. Materiał i metody: Badania przeprowadzono wśród 151 osób po 60. roku życia, przy użyciu kwestionariusza wywiadu, Inwentarza Zachowań Zdrowotnych i Minimalnej Oceny Stanu Odżywienia. Istnienie różnic i siły związku między zmiennymi oszacowano na poziomie istotności p < 0,05. Wyniki: Ogólny wskaźnik zachowań zdrowotnych wyższy był wśród kobiet niż mężczyzn (88,78 ± 13,82 vs 83,55 ± 12,93; p = 0,01). Analiza zachowań zdrowotnych wskazywała istotne różnice między kobietami a mężczyznami w zakresie: prawidłowych nawyków żywieniowych (p = 0,01), zachowań profilaktycznych (p = 0,01). Wnioski: Osoby starsze, które dbają o prawidłowe odżywienie, jedzą warzywa, owoce, unikając spożywania żywności z konserwantami, charakteryzowały się lepszym stanem odżywienia. Pozytywne nastawienie psychiczne pozostaje w związku z oceną stanu odżywienia. Zadowalający stan odżywienia cechuje osoby starsze, które myślą pozytywnie, unikają gniewu, lęku i depresji, mają przyjaciół oraz uregulowane życie rodzinne

The relationship of demographic factors on level of pain, quality of life and individual domains of the patient's with chronic pain

Chronic neuropathic pain is a serious in medicine, primarily due to a significant degree of intensity of pain and resistance to traditional treatment, which affects the functioning of the physical, psychological, human’s social function and creates his quality of life. The purpose of the work was to the relationship between pain perception and the assessment of the situation of people sick with neuropathic pain and the chronic of back pain, under of the stationary care. Hundred-sixty patients with chronic pain, the study comprised patients of both sexes, and their age range from 25-85 years. Tested patients were divided into two groups. The first group of BN (n = 100), included patients with pain syndrome, such as: cranial neuralgia symptoms, peripheral neuropathies, complex regional pain syndrome. The second research group (PBK), included patients with chronic pain of back, the number to 60. The intensity of the pain has been collected employing following instruments: Numeric scale (NRS, Numeric Rating Scale), Verbal scale (VRS, Verbal Rating Scale). Assessment of the state of emotional using the scale of the HADS-M. However, the quality of life and individual domains were assessed using the scale of the AIS. Analysis of the harvested material of its own, has confirmed the impact of demografhic-social factors on the quality of life, the overall perception of the health, quality of life and its various dimensions of hospitalized patients. Conclusions. Own research, confirms the equivalence of demografhic-social factors of modulation level of pain and quality of life