The Role of Health Care Professionals in the Social Adaptation of Patients With Secondary Progressive Multiple Sclerosis

Introduction: Secondary progressive multiple sclerosis (SPMS) develops in patients who have had relapsing-remitting multiple sclerosis (RRMS) as a second stage of the disease. SPMS increases disability to the point of inability to walk, and cognitive dysfunction occurs. There is scientific evidence for the beneficial effect of professionally conducted medical and other forms of treatment, health, and social services on the quality of life in SPMS.Objective: to study the role of health care professionals in the social adaptation of patients with SPMS.Materials and methods: Sociological and statistical methods were used, including documentary analysis of Bulgarian and international literature and a survey conducted among patients diagnosed with Secondary Progressive Multiple Sclerosis (SPMS). A graphical analysis was performed to illustrate the studied indicators. The study was conducted in the period 25.05.2021–28.08.2021 during scheduled meetings with a multiple sclerosis nurse, who is the author of the study and survey.Results and discussion: The results of the survey show that it is important for respondents to have information about the stages of the disease (84%). All respondents (100%) want health professionals to be honest and train them at all stages of the disease (98%). The participants in the survey expect health professionals to be responsible and loyal to them (89%), and they also expect to rely on their professional knowledge and skills in their social adaptation.Conclusions: The results of the survey give reason to believe that the role of the World Health Organization is extremely important for both long-term comprehensive care and the social adaptation of patients with SPMS

Need for nursing and social care in patients with multiple sclerosis

The need for nursing and social care, as well as factors which determine their appearance and management, are crucial for multiple sclerosis patients. Together with the diagnostic and treatment activities, nursing and social care can contribute to a better satisfaction of patients and their relatives and to a better quality of life. The most frequently reported needs of this specific group of patients are related to movement disorders, fatigue, pain, bowel and bladder or sexual disturbances, and to psychological support. A professional answer to these needs is impossible without the presence of a specifically trained nurse

Pregnancy and Multiple Sclerosis: Clinical Cases

Multiple sclerosis is a disease that primarily affects people in young, active age. It is known that women are affected more often than men. It is also known that pregnancy and delivery have an impact on the development of the disease. While during pregnancy the course is more benign, relapses are rare, a severe seizure often occurs after delivery, and the degree of disability increases. It is considered no exception for the disease to be diagnosed following a first-time relapse that occurs soon after delivery.We present two cases of female patients with multiple sclerosis: one with a severe relapse and a rapid progression of the disease after delivery, and another with no such complications. The differences between the two cases are discussed, focusing on the need to inform patients with multiple sclerosis about the possible postpartum risks and the role of the healthcare professional in this process

Expert assessment of practical approaches to optimize the participation of nurses in obtaining informed consent from the patient

INTRODUCTION: Nurses are an important resource to the health system and occupy a significant place in providing effective and quality healthcare. At the same time, obtaining informed consent is an important aspect in the nurses` work. Therefore, the opinion survey and the evaluation of experts on developing practical approaches aim to optimize the participation of nurses in the process of informed consent and have a great scientific and practical significance.AIM: To study the opinion and evaluation of experts on developing practical approaches to optimize the participation of nurses in the process of obtaining informed consent.MATERIALS AND METHODS: We have attached an analysis of the literature and used a documentary and an expert assessment method. An expert assessment of our own developed practical approaches was performed in the period March-September, 2015. It involved 50 experts - chief and senior nurses at the St. Marina University Hospital and used a questionnaire method of interviewing. Its aim was to optimize the participation of nurses in the process of informed consent of the patient.RESULTS: The majority of the experts approved the presented algorithm for obtaining informed consent from the patient and confirmed that the algorithm can be applied in the working process of the nurses. With regard to the presented data sheet for obtaining informed consent for intravenous injection (invasive nursing manipulation) the experts expressed concerns about the possible difficulties in putting it into practice, citing the shortage of nursing staff and time. A significant majority of experts, however, approved the technical sheet and evaluated it as applicable in nursing practice.CONCLUSIONS: The results of the expert assessment lead to the conclusion that the proposed practical approaches are applicable in nursing practice and will help to optimize the process of informed consent, respect the patient‘s right to informed consent, the professional comfort and safety of nurses

Individual training for self-injection of disease-modifying medications in multiple sclerosis patients - a guarantee for successful treatment

Въведение: МС е хронично инвалидизиращо заболяване, което е сред най-често срещаните причини за сериозно физическо увреждане при възрастни в трудоспособна възраст. Индивидуално обучение за самоинжектиране на медикаменти, модифициращи хода на заболяването, е гаранция за успешно лечение при пациенти с множествена склероза (МС). Цел: Да се проучи мнението на пациенти с МС, преминали индивидуално обучение за самоинжектиране на медикаменти, модифициращи хода на заболяването (ММХЗ), относно ефективността му. Материал и методи: Проведено е проучване сред пациенти с МС (n=50) през месец октомври 2016 г., преминали индивидуално обучение за самоинжектиране с медикаменти, модифициращи хода на заболяването чрез пряка индивидуална анкета. Използваните методи са документален, социологически (анкета), статистически и графичен анализ. Резултати и обсъждане: Анкетирани са 50 пациенти с диагноза МС, посещаващи специализирана комисия към УМБАЛ „Света Марина` ЕАД - Варна. Всички анкетирани пациенти са преминали обучение при медицинска сестра - спе циалист по МС. Повече от половината пациенти (58%) са се нуждаели от над три визити за обучение. Почти 80% от участниците в анкетното проучване посочват, че при проблем се обръщат към медицинската сестра, специалист по МС. Изводи: Всички анкетирани, без изключение, считат, че не биха се справили със самоинжектирането без обучение. Източникът на информация за наличие на медицинска сестра - специалист по МС, която може да проведе обучението по самоинжектиране, отразява актуалната ситуация. Заключение: Индивидуалното обучение за самоинжектиране с медикаменти, модифициращи хода на заболяването, е една нова различна потребност от здравни грижи и психологическа подкрепа, която би била удовлетворена от медицинска сестра -специалист по МС. Пациентите в ситуация на хронично заболяване като МС и тяхното продължително лечение зависят и от собственото им умение да се справят. Затова още по-голяма значимост може да се отдаде на постигнатото чувство за сигурност след проведено индивидуално обучение за самоинжектиране на ММХЗ.Introduction: Individual training for self-injection of disease-modifying medications is a guarantee for successful treatment in patients with Multiple Sclerosis (MS). MS is a chronic disabling disease, which is among the most common causes of serious physical disability in working-age adults. Aim: The aim of this paper is to investigate the opinion of patients with MS, who have undergone inductive self-injection training to modify the course of the disease. Materials and Methods: A study through a direct individual survey was conducted among patients (n=50) in October 2016 who had undergone individual self-injection training for medications modifying the course of the disease (MMCD). The used methods were documentary, sociological (questionnaire), statistical and graphical analysis. Results and Discussion: Fifty patients with an MS diagnosis visiting a specialized commission at St. Marina University Hospital, Varna were interviewed. All of the surveyed patients have received training with a nurse, an MS specialist. More than half of the patients (58%) needed more than three study visits. Nearly 80% of the survey respondents indicated that they contacted an MS specialist nurse, if there was a problem.Conclusion: All respondents, without exception, consider that they would not cope with self-injection without training. The information about the presence of a nurse specialist on MS who can carry out self-injection training reflects the current situation. Individual training for self-injection of disease-modifying medications is a new and different need for health care and psychological support that would be met by a nurse specialist on MS. Patients with a chronic disease such as MS and their long-term treatment depend on their own ability to cope with it. Therefore, even greater significance can be attributed to the attainment of a certain sense of security after individual self-injection of MMCD

Pre-graduate traineeship in the Midwife program at the Medical University of Varna. Expectation and reality

Въведение: Преддипломният стаж в специалност „Акушерка` на МУ-Варна протича под формата на клинична практика в продължение на 4 години, 1600 часа, разпределени в 10 отделения на учебно практически бази. Обикновено студентите имат очаквания относно протичане на стажа, тъй като по време на клинична практика са посещавали учебно практическите бази и са запознати с естеството и ритъма на работа. Невинаги тези очаквания съвпадат с реалността, както се вижда от проведеното проучване. Цел: Да се проучат очакванията на стажант акушерките относно протичане на преддипломния стаж. Материал и методи: Проучено е мнението на студенти ІV курс от спец. „Акушерка` на МУ-Варна (27) чрез пряка индивидуална анкета през м. юли 2017 г. Използвани методи - документален, статистически - анкетен, графичен анализ. Резултати и обсъждане: Повечето от студентите считат, че по време на преддипломния стаж са усъвършенствани своите практически умения и са упражнили манипулативна техника (74.1%). Студентите твърдят, че са усетили дискомфорта на разминаване на теория и практика (70.4%). Те са убедени, че са имали възможност редовно да упражняват манипулации (88.9%) и се чувстват подготвени за започване на работа (77.8%). Изводи: От проведеното проучване може да заключим, че има съвпадение в очакванията на студентите относно протичане на преддипломния стаж. Студентите са надградили усвоените знания и умения.Introduction: The pre-graduate traineeship in the Midwife program at the Medical University of Varna takes place in a real working environment. It has a duration of 1600 hours, distributed in 10 sectors of train-ing and practice bases. Normally, students have expectations of the internship as they have attended the practical training bases and are familiar with the nature and rhythm of work, on the one hand, and on the other hand they are more self-reliant during the pre-graduate practice and have the opportunity to discover gaps in their training that must be filled. Aim: The aim of this paper is to examine the expectations of the midwives of the organization of the pre-graduate traineeship. Materials and Methods: Students` opinion has been studied among the seniors from the Midwife program at the Medical University of Varna (27) through an individual inquiry card during the month of July, 2017. The methods used were as follows: documentary, statistical based on the inquiry, graphical analysis. Results and Discussion: Most of the students believe that during their pre-graduate internship they have improved their practical skills and practiced treatment technique (74.1%). A significant proportion of them think that they felt discomfort from the divergence of theory and practice (70.4%). Students are convinced that they had the opportunity to regularly exercise treatment techniques (88.9%) and feel ready to start work (77.8%). Conclusion: From the survey we can conclude that in half of the students there is a match between the expectations and the actual course of the pre-graduation traineeship. Students have upgraded their knowledge and skills

Continuing education of nurses from outpatient care - prerequisite for improving quality of life in patients with chronic diseases

Въведение: Комплексните грижи за пациенти с хронични заболявания като множествена склероза са предпоставка за повишаване качеството на живот както на пациентите, така и на техните семейства. Тези грижи се планират от медицински сестри, които работят в извънболничната помощ. Цел: Да се проучи мнението на медицински сестри от извънболничната помощ относно ефек-тивността на сестринските грижи за пациенти с хронични заболявания. Материал и методи: Проведено е проучване сред медицински сестри от извънболничната медицинска помощ (ИБМП) (n=50) в периода декември 2015 - април 2016 г. Използваните методи са документален, социологически (анкета), статистически и графичен анализ. Резултати и обсъждане: Анкетирани са 50 медицински сестри, работещи при невролог (64%) от ИБМП и при ОПЛ (36%). Превалира процентът на анкетирани (88%), които считат, че е необходимо периодично опресняване и обогатяване на професионалните компетентности. Висок дял от респондентите (96%) подкрепят идеята за продължаващо обучение, a 92% изразяват готовност за инвестиране на време за продължа ващо обучение, като предпочитаната форма е кратък специализиран курс (58%). Изводи: Продължаващото обучение на медицински сестри в ИБМП е ключов елемент от повишаването на качеството на живот на пациенти с хронични заболявания. Идеята за продължаващо обучение на медицинските сестри намира подкрепа от почти всички. Представеният избор на формата на обучение вероятно отразява не само собственото мнение, но и личните възможности. Силният стремеж за продължаващо обучение се доказва от изразената готовност от мнозинството за инвестиране на време и финансови средства. Заключение: Опитът в редица европейски държави показва, че медицинските сестри са заели своето място в мултидисциплинарни практики. Този процес в България е в начален етап. Медицинските сестри от ИБМП трябва да придобиват нови знания и умения, за да могат да организират комплексни мероприятия за обучение на пациентите и техните близки.Introduction: Complex care for patients with chronic diseases such as multiple sclerosis is a prerequisite for improving the quality of life of both patients and their families. These cares are planned by nurses, working in outpatient care. Aim: The aim of this paper is to investigate the opinion of outpatient care nurses about the effectiveness of nursing care for patients with chronic diseases. Materials and Methods: A survey was conducted among outpatient nurses (n=50) between December 2015 and April 2016. The used methods were documentary, sociological (questionnaire), statistical and graphic analysis. Results and Discussion: Fifty nurses were interviewed and 64% of them work with a neurologist in outpatient care and 36% work for general practitioners. Most of the respondents (88%) considered that periodic refreshing and enrichment of professional competencies is necessary. Almost all of the respondents (96%) support the idea of continuing education and 92% express their willingness to invest time in continuing education. The preferred form is a short specialized course (58%). Conclusion: Continuing education for nurses in outpatient care is a key element in improving the quality of life of patients with chronic diseases. The idea of continuing education for nurses finds support from almost everyone. The presented choice of form of education probably reflects not only their opinion but also their personal abilities. The strong pursuit of continuing training is evidenced by the willingness of the majority to invest time and money. Experience in many European countries has shown that nurses have taken their place in multidisciplinary practices. This process in Bulgaria is at an early stage. Outpatient care nurses need to acquire new knowledge and skills to be able to organize comprehensive training events for patients and their relatives

Bank Regulatory Reform In The United States: The Case Of Goldman And The Volcker Rule

This case is an ethics case.  The focus is on corporate governance in a major Wall Street bank, Goldman Sachs.  The case discusses what Congress has done in the past and what it may do in the future to prevent breaches in ethics relating to proprietary trading.  In response to the current financial crisis, Congress has proposed many changes for the banking industry and the proposals have gained momentum because of the SEC’s accusation of fraud at Goldman Sachs.  One piece of proposed legislation, endorsed by President Barack Obama and former chairman of the Federal Reserve, Paul Volcker, is based on the Volcker Rule.  This rule would return the banking industry to the decades of the Glass-Steagall provisions of the Banking Act of 1933.  The Volcker Rule would reinstitute the separation of commercial and investment banking.&nbsp

Nursing Care for Outpatients with Multiple Sclerosis: Complex Approach and Medical-Social Aspects //// Сестрински грижи при пациенти с множествена склероза - комплексен подход и медико­ социални аспекти

[EN] The purpose of this thesis is to investigate the medical and social aspects of nursing in outpatient care for MS patients and to develop an algorithm for complex nursing activities and a model for a training centre for nurses involved with these patients. The following tasks have been formulated: to investigate the medical and social needs of patients with newly diagnosed MS and of those on disease-modifying treatment; to investigate the views of patients' relatives about the need and benefits of specialized nursing care; to investigate the assessment of general practitioners, neurologists and healthcare specialists regarding the provided complex care; to study the quality of life self-assessment in MS patients with the MSQL-54 questionnaire; to investigate the opinion of MS patients who have undergone individual self-injection training. The study explored the opinion of 296 responders divided into 4 groups. The following methods have been applied: sociological, including documentary; medicostatistical inquiries, SWOT analysis; own experience. Contributions: The medical and social needs of MS patients of timely and complete information on the choice of medication, training and monitoring the condition during the course of the disease were established; New information has been obtained through the MSQOL-54 questionnaire; The role of the nurse in the overall process of planning long-term care in relation to the course of the disease - training, monitoring and evaluation of the outcomes of care - was established; The need for measures to overcome the barriers of inequality between MS patients with complex quality health care has been demonstrated. An algorithm for complex nursing activities aimed at MS patients with outpatient care has been developed, which improves the monitoring, treatment and social adaptation of patients with MS by unifying and regulating certain activities. A Model of a Training Centre for Specialized Training for Healthcare Professionals has been proposed that provides highly specialized nursing services for MS patients and sustainable product development through ongoing nursing training. Participation in a team of authors to compile a patient's diary to track regular injections of Interferon Beta and to develop a step-by-step guide to the new Interferon Beta system.[BG] Дисертационният труд е насочен към проучване на медико-социалните аспекти на сестринските грижи в извънболничната помощ при пациенти с диагноза множествена склероза като чрез получената информация да бъде разработен Алгоритъм за комплексни сестрински дейности и Модел за обучителен център на медицински сестри, обслужващи тези пациенти. Сред задачите на разработката са проучване на медико-социалните потребности на пациенти с новодиагностицирана МС, такива, провеждащи лечение, мнението на близките, оценка на общопрактикуващи лекари, невролози и специалисти по здравни грижи, самооценка за качеството на живот чрез въпросник MSQOL-54 и пациенти, преминали индивидуален курс на обучение за самоинжектиране с интерферон. Изследвано е мнението на 296 респонденти, разпределени в 4 групи. Използваните методи се обобщават като социологически, медико-статистически, SWОТ­ анализ и собствен опит. На база на проведените проучвания са получени следните приноси: установени медико-социални потребности на пациенти с МС, получена нова информация чрез въпросника MSQOL-54, установена роля на медицинската сестра, доказана е необходимостта от мерки за преодоляване на бариерите на неравнопоставеност на пациентите с МС, разработен е Алгоритъм, предложен е Модел за обучителен център и е взето участие в авторски колектив за съставяне на дневник на пациента за проследяване на редовното инжектиране с Интерферон Бета и разработване на упътване стъпка по стъпка към системата за прилагане на Интерферон Бета