THE ROLE OF THE PERIOPERATIVE NURSING CARE IN THE SATISFACTION OF PATIENTS AFTER LARGE JOINT REPLACEMENTS.

The medical services market is inevitably changing. Competition among health care institutions is growing, patients' health awareness and expectations regarding the quality of health services are increasing. This translates directly into, among others, to the patient's choice of medical facility. "Satisfaction" defined as "general satisfaction accompanying the consumption of products or services" is an important aspect affecting the position of a healthcare institution on the health services market. While in the hospital, the patient carefully observes and remembers many details of behaviors and reactions he encounters. Opinions of patients about a medical facility are usually subjective and relate mainly to satisfaction with the treatment process, therefore the lack of proper care in terms of patients' needs may result in the loss of the hospital's reputation. A very important aspect of the assessment of any medical service is the direct relationship between the patient and medical staff, mainly nurse. Among the factors affecting the level of patient satisfaction during a hospital stay are, inter alia, the availability of a doctor, nursing care, conditions in the ward, the possibility of patient participation in the treatment process, providing the patient with information in a clear and reliable manner, and improved health. Factors related to nursing care that have the greatest impact on the patient's level of satisfaction comprise the nurse's individual approach to the patient, time devoted to him, providing professional information, patient education and scrupulous nursing activities. The aim: The aim of the paper was to assess the role of perioperative nursing care in the satisfaction of patients after hip and knee joint replacements.

[Comparative assessement of the elderly females before total hip or knee replacements].

OBJECTIVE: Introduction: Osteoarthritis (OA) is the most common and burdensome illness in the elderly patients. It is the main cause of locomotor impairment and disability resulting in significant decrease of the quality of life (QL) in highly developed countries. Sf-36v2 questionnaire was standardized in the United States by J.E. Ware et al. in the years 1985-1992 and at present SF-36v2 is the most commonly used questionnaire for investigations in patients with various conditions. The aim: To compare two cohorts of post-menopausal female patients with the predominantly clinically active one-site advanced osteoarthritis of the hip and knee joint prior to the replacement surgery. PATIENTS AND METHODS: Material and methods: Two cohorts of fifty female postmenopausal patients aged from sixty to eighty were investigated. The inclusion criteria relied on sex, age and clinically single joint predominant OA disease prior to hip and knee joint replacement. The Polish version of SF-36v2 for the quality of life was accomplished by the patient under direct supervision of a trained nurse. The sets of obtained data were analyzed with the use of Statistica 10.0 (Shapiro-Wilk test, U - Mann-Whitney test, Spearmann, Kruskall-Wallis, Friedmann's ANOVA and Chi 2 Pearson). p <0.05 was regarded as significant. RESULTS: Results: It was found that patients with advanced knee OA demonstrated significantly lower QL than these with hip OA in Vitality (p=0,004), Functioning in Social Roles (p=0,0001), General Health (p <0,000001) and Pain (p <0,000001). No significant differences within the cohorts were observed as the other scales were concerned (p >0,05). In the general assessment as for the QL in the Physical domain significant difference was found with lower scoring in the knee group (p=0.00001). In the assessment of the general QL two domains were considered -Physical and Mental Health. Highly significant difference was recorded for the Physical better in regard for hip OA (p <0,00001). In the Mental Health domain no significant difference was found (p=0,09). CONCLUSION: Conclusions: 1. Quality of life of postmenopausal women with hip OA is predominantly lowered by the local disease whereas lower quality of life of these females with knee OA is related to the general poor health, low index of vitality and decrease of function in social functioning resulting from co-existence of chronic illnesses due to overweight and obesity. 2. Reduction of overweight or obesity in the group of patients with knee arthritis could improve their quality of life and general health.

Effect of Perioperative Bacteriological Safety on Hip Joint Infection after Hip Replacement.

BACKGROUND: In terms of clinical importance, deep infections are the most severe and problematic complications of hip replacement, and limiting the risk of these complications continues to pose a medical and organisational challenge. The aim of this retrospective study was to compare the incidence of early deep infection after hip arthroplasty in two 5-year periods separated by a long interval (1985-1989 and 2005-2009) with respect to analysing changes in the conditions of perioperative bacteriological safety. MATERIAL AND METHODS: The records of 1408 women and 920 men who underwent the implantation of various types of hip endoprostheses were analysed. Due to changes in medical procedures over the years, two periods at a considerable interval were compared as the procedures and standards of aseptics and antiseptics in use between 1985 and 1989 differed significantly from those adhered to in 2005-2009. RESULTS: Statistically, early deep infections after hip replacement were significantly more (15 times) common in 19851989 than in 2005-2009 (4.71% and 0.32%, respectively). Old age was a risk factor for early deep infection after hip replacement; another important issue was the manner of qualification for hip replacement surgery, with early deep infections being more common in patients after hip hemiarthroplasty performed on an emergency basis. The incidence of these complications did not depend on the patient's gender. CONCLUSIONS: 1. Emergency hip hemiarthroplasty is associated with a higher risk of deep infection. 2. Old age contributes to the development of early deep infections after hip replacement. 3. Gender does not correlate with the incidence of early post-operative deep infection after hip replacement. 4. Standardisation of aseptic (masks, caps, draping) and antiseptic (disinfectants for the equipment and hands) techniques as well as antibiotic prophylaxis decrease the risk of early deep infection after hip replacement.

Biomechanical parameters of the BP-enriched bone cement.

Bisphosphonates (BPs) are well-known substances with very efficient antiresorptive properties. Their beneficial actions are useful not only in achieving better bone mineral density but also in improving bone microarchitecture, strength and, consequently, its quality. Surgical cement, being a polymer composite, is required to be highly biocompatible and biotolerant. The goal of the presented study was to assess whether the enrichment of cement with pamidronate has changed its biomechanical properties. We compared the biomechanical parameters of clean bone cement and BP-enriched bone cement, which were both used formerly in our rat models. Biomechanical properties of BP-enriched bone cement are defined by two basic terms: stress and strain, which are caused by the influence of external force. In the investigatory process of the bone's biomechanical parameters, the compressive test and the three-point flexural tests were used. During the three-point flexural investigation, the sample was supported at both ends and loaded in the middle, resulting in a flexure. After a specific range of flexure, the sample was fractured. In obtained results, there were no significant differences in the values of the stress determined at the point of maximal load and the energy stored in the samples for proportional stress-strain limit (elastic region). There were also no significant differences in the density of the samples. The study shows that the enrichment of bisphosphonates causes yielding of the bone cement material. In the presented data, we conclude that use of pamidronate implanted in bone cement did not have a detrimental effect on its biomechanical properties. Therefore, the obtained results encouraged us to perform further in vivo experiments which assess the biomechanical properties of bones implanted with BP-enriched bone cement.

Principles of social security and health insurance for farmers in Poland and Germany--a comparative assessment.

INTRODUCTION AND OBJECTIVE: As landowners occupied with agricultural production comprise a sizeable part of the populations in mid- and western European countries, it seemed reasonable to assess the organization of health care systems concerning farmers and their families in Poland and Germany. Both countries have similar geographical conditions and rural environments. It so happens that in Poland the principles of the system of agricultural insurance (KRUS) is based on the experiences of Germany and France. STATE OF KNOWLEDGE: Basically, both in Poland and Germany, the agricultural health insurance companies provide the same insurance cover as other health insurance companies. In both countries, under certain conditions, in the case of illness, the insured farmers receive instead of sickness benefit operational assistance and home help. In spite of the similarities that characterize both administrations, many particular differences are to be noted, e.g. the farmers' social insurance in Poland is subject to only one ministry, in contrast to Germany where two ministries are responsible for farmers' social insurance. In Poland, KRUS is a monopolistic organization, whereas in Germany, nine similar independent structures fulfil the task of a health insurance company. Needless to say, many more funds are available for prevention, treatment and rehabilitation in Germany than in Poland, due to obvious differences in the overall national income.