Volume 128 (2018): Issue 3 (September 2018)

Introduction. Peritonitis is still a serious complication of peritoneal dialysis (PD). Consequences of peritonitis can be severe. The most severe are peritoneal dialysis discontinuation and patient’s death. In majority, peritonitis is bacterial in the origin. Mainly there is a gram-positive infection, less commonly gram-negative one. Some peritonitis are culture-negative, because of former antibiotics use. In minority, fungal, tuberculous or even viral peritonitis are observed.

Aim. The aim of the present study is to analyze the number, origin and serious complications of peritoneal-related peritonitis cases found in our PD center.

Material and methods. We performed a retrospective five-years evaluation of medical records. The total number of peritonitis episodes was 56 cases, underwent by 30 adult patients on chronic peritoneal dialysis. Peritonitis was diagnosed according to ISPD recommendations. Causes and serious complications of peritoneal-related peritonitis were analyzed in every single year. Etiology of peritonitis was classified on the basis of the result of effluent dialysate culture as: gram-positive, gram-negative and culture negative. Peritoneal dialysis discontinuation or patient’s death were defined as serious complications.

Results. Among 56 cases of peritoneal-related peritonitis 44.6% were gram-positive, 26.8% gram-negative and 28.6% culture-negative. No fungal or tuberculosis peritonitis were found. Because of the peritonitis complications in the evaluated period, six patients discontinued peritoneal dialysis and were switched to hemodialysis (20%), two others died (6.7%).

Conclusion. The further improvement in peritonitis’ causes identification and treatment is needed in order to reduce number of serious complications in our medical center.

Introduction. Neurofibromatosis type 1 (NF1), caused by mutation of the tumour-suppressor gene encoding neurofibromin, is an autosomal dominant disorder affecting various organs.

Aim. The aim of the study was to discuss the clinical symptoms of NF1 based on seven cases of the disease with regard to the literature.

Material and methods. We analyzed retrospectively patients with NF1 (4 females and 3 males) aged 19-52 who were treated at Endocrinology Department between 2003 and 2017. The diagnosis was made in childhood (4 patients) or in adolescence (3 cases), based on clinical symptoms and genetic tests.

Results. Five patients had a positive family history of NF1, two cases represented spontaneous mutation. All of analyzed subjects presented café-au-lait spots and neurofibromas on the body. We observed neurological disorders such as: epilepsy (2 patients), Arnold-Chiari malformation (1 man), benign brain neoplasms (2 persons). Optic gliomas appeared in two cases. Tumours were also found in other organs, including the uterus (2 women), the lung, the adrenals, the pituitary and the parathyroid gland (with signs of primary hyperparathyroidism) – each tumour in another patient. Four subjects suffered from cognitive impairment. Skeletal manifestations of neurofibromatosis type 1 such as scoliosis (1 man) and short stature (6 patients) have been noted as well. Five patients presented thyroid disorders – hypothyroidism due to Hashimoto’s disease (4 patients), toxic nodular goiter (1 woman). Other clinical symptoms e.g. vitiligo, alopecia areata and coarctation of aorta have also been found.

Conclusions. Variety of clinical symptoms causes that NF1 still remains a diagnostic and management challenge for many physicians. Therefore, multidisciplinary approach is needed to optimize patients’ treatment.

Introduction. The approach to women, menopause and its consequences have changed – the perimenopausal period has stopped being treated as the end of femininity, career and sexual activity. However, symptoms coexisting with menopause influence health and female’s life quality. A decrease of sexual activity is observed as one of the most frequent symptoms, and it is induced by physiological and psychological factors.

Aim. Assessment of sexual life quality among women with menopause and defining the main factors influencing this area.

Material and methods. Thanks to an original questionnaire composed of 28 questions, single and multiple choice, 200 women in the perimenopausal period were examined between July and September 2017.

Results. The number of 200 women in perimenopausal period were chosen accidentally. The questionnaire was filled out via the Internet. Statistically significant factors occurred to be: level of education – higher education is connected with more frequent sexual activity, professional activity – 81% of working women remain sexually active while 73% of non-working females deny being sexually active. Hormonal Replacement Therapy does not influence the frequency of sexual contact but it alleviates vagina dryness, and provides a higher level of agitation during cohabitation.

Conclusion. Higher educated and professionally active women declare better life satisfaction and see themselves as attractive. However, marital status remains meaningless as well as Hormonal Replacement Therapy. It was observed that men from rural areas and towns initiate sexual contact more often.

Introduction. Choosing medical specialty is one of the most crucial decisions about future career of graduates. Multiplicity and variety of available options make great opportunities for development of interests and ambitions of future doctors. Unfortunately, it can also be an impediment in making decisions about path of medical career.

Aim. The aim of the study was to discover if medical students have problem with choosing specialty and to ask about availability and need of career guidance for medical students.

Material and methods. Voluntary survey was conducted via the Internet among medical students in Polish and foreign medical universities.

Results. The total number of 565 medical students completed the survey – 371 women (66.5%) and 189 men (33.5%). They were students of 16 medical universities, 10 Polish and 6 foreign ones. Problem with choosing medical specialization reported over 70% respondents. Only 11.9% of the group declare that they participated in classes that were helpful in making decision about their future medical career. Need for career guidance was revealed in over 91.5% answers. Significant difference between genders has been found in reporting problem with choosing medical specialty – it was reported by 75.5% of women and 62.4% of men. There were no differences between the Polish and foreign students and between students in different years of study in all the questioned issues – choice of medical specialization, participation in classes which were helpful in decision making and necessity of counseling in choosing specialization.

Conclusion. The results of the study clearly indicate that most of medical students have problem with choosing medical specialty. Guidance is not realized among most of students, despite the fact that the vast majority of them reports need for that kind of consultation.

Introduction. Social networking sites are virtual online communities, where users can design personal profiles available for public assessment, interact with friends, and meet with others, based on shared interests. SNS (social networking sites) have been defined as a “global consumer phenomenon” because they have been experiencing a sharp increase in popularity and use over the last decade. SNS websites, such as Facebook, are becoming increasingly popular, however, little is known about psychosocial variables, which are risk factors for excessive use of these websites.

Aim. The aim of the work was to characterize personality traits (self-image characteristics, ways of coping with stress and aggression intensity) of youth who have a profile on a social networking site.

Material and methods. The study included a total of 590 individuals from 16 to 18 years of age. Among the subjects, a group of 51 people without a profile was identified and 539 – with a profile on a social networking site. The group of teenagers was examined by means of statistical methods: a socio-demographic survey by the authors’ own design, H. G. Gough and A. B. Heilbrun’s Adjective Check List (ACL), Stress Coping Questionnaire (SCQ) constructed by W. Janke, G. Erdmann, K. W. Kallus, in the Polish language compilation by E. Januszewska, Buss-Durkee Hostility – Gild Inventory, developed in Polish by Choynowski.

Results. Statistically significant differences were found in terms of self-image features, ways of coping with stress and activity displayed on the Internet between the youth who had and did not have a profile on the social networking site.

Conclusions. Significantly more young people who have a profile on a social networking site share their personal data with strangers met through the Internet, use internet services and make purchases online, compared to the youth who do not have this profile. Young people with a profile on a social portal are characterized by greater timidity, difficulties in coping with stress and everyday tasks, less perseverance, entrepreneurship, effectiveness in the implementation of tasks, less self-confidence, less autonomy, responsibility and tolerance in comparison with young people who do not have a profile. Young people who have a social media profile are more likely to turn to other people in a stressful situation to request support and advice.

Introduction. Well-implemented, holistic care of the dying patient requires appropriate qualifications from the medical personnel.

Aim. The aim of the study was to collect the opinions of nursing and medical students before the end of their professional education on their preparation to provide care to the dying patient.

Material and methods. The survey was carried out in a group of 213 medical and nursing students during their final year of professional education.

Results. Students were unable to clearly express their opinion on their preparation to provide care to patients at the end of their lives (87; 40.8%). Nursing students were more likely to perceive themselves as prepared for such care – 30 (26.7%) than medical students – 11 (10.9%). Statistically significant correlation was observed. A large group of the students (92; 43.2%) had never been present at the scene of a patient’s death during clinical classes. The majority of the respondents chose ‘definitely not’ (59; 27.7%) and ‘rather not’ (53; 24.9%) answers when asked if their university education had prepared them for work with patients at the end of their lives. Students considered their knowledge to be lacking mostly in areas such as coping with their own emotions in the face of a patient’s death (137; 64.3%); communicating with a dying person (119; 55.9%); providing care to the patient’s family (154; 72.3%); cooperating with the patient’s family (125; 58.7%).

Conclusions. Students of both majors are not certain about the level of their preparation to provide care to people at the end of their lives, nor about the extent to which their university education had introduced them to the specificity of care of a dying patient. The medical students were observed to exhibit higher statistical significance as compared to the nursing students. The university curriculum prepared the students to take care of the dying patient’s biological sphere, but did not prepare them to assume a holistic approach to care of the patient and his family.

Motivational interviewing (MI) is a specific style of communication based on collaboration, aimed at achieving a goal and focused on change talk. This is conducted in an atmosphere of comprehension, acceptance and compassion, being intended to strengthen inner motivation and commitment to attain goals by the search for, and assessment of, the individual’s reasons for change. Change talk may refer to new behaviours, lifestyles or the introduction of treatment adherence. Therefore, it can be a part of health care provider – patient communication. The application of MI contributes to an increase in patients’ concordance and compliance as well as rightness of the therapy prescribed because it heightens an individual’s awareness and eagerness to change and triggers positive thinking, being focused on resources and values. The aim of this article is to familiarise the MI character and present some interesting examples characterised by a diversity of ideas in the overall vision of public health concentrated on health promotion. A non-systematic literature review of the years 2003-2018 on the use of MI in health promotion in PubMed provided evidence of great interest in MI in such contexts as body weight reduction, an increase in physical activity, or coping with risk behaviours e.g. addictions. The aforementioned problems are a major cause of non-communicable diseases. The application of MI results in health behaviour improvement along with increased self-esteem and self-efficacy, inner motivation and willingness to change habits.

Injection is the delivery of medication into the tissues. It is the administration of medication by means of a needle (cannula) into the body tissues, cavities or blood vessels. An injection is one of aseptic procedures, i.e. those that require the use of sterile equipment, sterile medication, and treatment in compliance with the principles of asepsis. Failure to observe these rules as well as those that have to be followed in connection with the delivery of medication regardless of the route of administration may result in many complications. The administration of medications by paramedics is one of their competencies defined in the Regulation of Health Minister of 20 April 2016 on the medical emergency treatment and health services other than medical emergency treatment that can be provided by a paramedic. A paramedic can himself administer 47 drugs specified in the foregoing Regulation, and he can also administer other drugs as ordered by a doctor. The article describes the principles of safe intramuscular injection as one of the methods of administering medication in emergency medicine.