Rational Therapy

DEPRESSION AND ANXIETY LEVELS IN NURSES/TECHNICIANS WORKING WITH PATIENTS WITH MENTAL DISORDERS

2019-02-17T13:03:40+01:00

Introduction: Medical staff working with patients with mental disorders faces high demands of the medical profession as well as exposure to a large amount of stress factors in professional conditions. The presence of symptoms of depression and anxiety can negatively affect the quality of work, but also on the quality of life of employees, which can lead to a reduction in the quality of nursing care for patients.

The aim: Тhe aim of this paper was to determine the levels of depression and anxiety among nurses / technicians working with patients with mental disorders, the level of health functioning, as well as difference in the socio-demographic characteristics of the two studied groups.

Material and methods: The research was carried out at the Clinical Center in Kragujevac, after receiving the permission of the Ethics Committee and conducted according to the principles of Good Clinical Practice. The research was conducted as a cross sectional study that included 80 nurses / technicians classified in two groups: nurses / technicians working with mentally ill patients (n = 40) and nurses / technicians from the Internal and Infectious Clinic (n = 40). Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) were used to assess the level of depression and anxiety levels of nurses / technicians. EQ-5D scales were used to assess the level of health functioning, and the impact of the socio-demographic questionnaire was examined with a socio-demographic questionnaire.

Results: subjects working with patients with mental disorders showed higher levels of depression (P <0.01) and anxiety (P < 0.01) than those who do not work with mentally ill patients, there is also a difference in the values of the level of health functioning on the day of the examination (p <0.01). The sociodemographic questionnaire showed a statistically significant difference in the incidence of somatic illness in nurses / technicians working with mentally ill patients (p <0.05), as well as a greater tendency to use psychopharmaceuticals (p <0.05).

Conclusion: The results of the study showed a higher level of depression and anxiety, as well as a more frequent occurrence of somatic illness among nurses / technicians working with people with mental disorders.

RISK FACTORS FOR NOSOCOMIAL INFECTIONS IN MECHANICALLY VENTILATED NEONATES АТ INTENSIVE CARE UNIT

2019-02-17T13:03:40+01:00

Introduction and aim. Neonatal nosocomial infection (Nis) is defined as the occurrence of infection 48 hours after birth which is caused by a nosocomial pathogen. Newborns admitted to neonatal intensive care units (NICU) are at increased risk for developing Nis. The aim of our study was to describe risk factors for Nis at mechanically ventilated (MV) neonates in a NICU.

Materials and methods. The study was designed as a case/control study nested in the prospective cohort study. The study population consisted of the neonates supported by MV and admitted at the NICU. Risk factors were identified and their influence quantified by logistic regression.

Results. Our study showed that MV neonates in NICU, who were longer carrying peripheral venous catheter (PVC) and spend more time in a hospital, were more likely to get NIs (OR=1.091, CI=1.035-1.151). The neonates having an infection on admittance were less likely to acquire NIs.

Conclusions. Development of NIs in MV neonates could be prevented by education of hospital staff and shortening of hospitalization. The rate of nosocomial infections will drop if exposure of newborns to pathogens from the hospital environment and to invasive devices is decreased.

QUALITY OF LIFE OF PATIENTS SUFFERING FROM SCHIZOPHRENIA AND TREATED WITH LONG-ACTING RISPERIDONE AND PALIPERIDONE-PALMITATE

2019-02-17T13:03:40+01:00

Introduction: In recent decades, researchers devoted a lot of attention to studying the quality of life of people with mental disorders. Improving quality of life of people with schizophrenia is becoming an obligation of pharmacological therapy.

The aim: The aim of the paper was to assess certain aspects of quality of life of the patients suffering from schizophrenia treated with long-acting risperidone and paliperidonе-palmitate and to determine the impact of socio-demographic characteristics on the quality of life of these patients.

Method: The study was done as a cross-sectional investigation after receiving the decision of the Ethics Committee, and it was conducted according to the principles of Good Clinical Practice. The study covered 45 patients of both sex with the diagnosis of schizophrenia (MKB-10, F20.0-F20.9). The respondents were classified in two groups of 25 and 20 patients: those who received long-acting risperidone and those who received long-acting paliperidone palmitate, respectively. The assessment of the quality of life of respondents was done by a scale of personal and social impact (PSP). The socio-demographic questionnaire was used to assess the influence of socio-demographic characteristics on health-related quality of life.

Results: Statistically significant differences were observed in personal and social functioning, in favor of patients treated with long-acting paliperidone palmitate (PSP score: 78.30 ± 5.03). The subjects of this group were more satisfied with their own health and themselves than those who were treated by long-acting risperidone. Data obtained by analyzing sociodemographic questionnaires indicate that patients who received long-acting risperidone had more hospitalizations annually (r = 0.03) compared to patients treated by the paliperidone-palmitate. There was also a statistically significant increase in absenteeism (r = 0.009) from work in patients receiving long-acting risperidone.

Conclusion: Our study showed higher scores of personal and social functioning in the group of patients treated with long-acting paliperidone-palmitate. Longer dosing interval of paliperidone-palmitate enables greater mobility of the patients within the society and diminished sense of stigmatization.

MODERN APPROACH TO THE TREATMENT OF CLOSTRIDIUM DIFFICILE INFECTIONS

2019-02-17T13:03:40+01:00

Infection caused by Clostridium difficile (CDI) occurs as a result of an imbalance of bacteria in the intestinal tract mainly due to previous exposure to wide-spectrum systemic antibiotics. Nowadays, it is recognized as one of the most frequent infections acquired in hospitals. Contemporary clinicians often face an increased incidence of fulminant and recurrent CDIs that are accompanied by a number of colectomies, prolonged stay in hospitals, fatal outcome, and rising healthcare costs. Traditional antibiotics for CDI, such as metronidazole, vancomycin or fidaxomicin, have been linked to certain treatment limitations in previous studies. Thus, the aim of this narrative mini literature review was to critically evaluate the efficiency of each of the recommended modern therapy modalities for CDI, as well as the frequency and severity of adverse events associated with their use.

Based on current knowledge, the range of standard antibiotics approved for treatment of initial or recurrent CDI remains quite limited. Regardless of the severity of CDI, oral or rectal vancomycin should be considered as the first-line therapeutic option in adults and children, while fidaxomicin or metronidazole could be an appropriate alternative. The other potentially effective antimicrobials against CDI, such as rifaximin, nitazoxanide, fusidic acid, tigecycline, bacitracin and use of probiotics cannot be advised as the therapy of choice, as they did not provide any advantage over vancomycin or fidaxomicin in prior investigations. In an attempt to solve the problem of recurrent CDI events, which is one of the most important challenges facing health professionals today, adjunct use of human monoclonal antibody against toxin B (bezlotoxumab) or instillation of normal colonic bacteria obtained from healthy donor into patient’s intestine (Fecal Microbiota Transplantation), could be effective and safe approach where available. Besides clinical development of innovative therapy for CDI, such as new antibiotics and vaccines, primary focus should be on effective prevention of this infection, in terms of improving rational use of broad-spectrum systemic antibiotics and proton pump inhibitors

PREVENTION AND TREATMENT OF GLUCOCORTICOIDS-INDUCED OSTEOPOROSIS

2019-02-17T13:03:40+01:00

Glucocorticoid-induced osteoporosis is now a well-known form of the secondary osteoporosis, which increases the fracture risk in the patients and consequently the mortality and morbidity. Literature data show that more than 1% of the world's population is on continuous, oral therapy with these drugs. However, a large percentage of the patients (66%) who start the therapy have been deprived of adequate information on the duration of administration of these drugs and their adverse effects, like glucocorticoid-induced osteoporosis. Therefore, it is necessary to estimate the individual fracture risk in the patient at the beginning and during the therapy with glucocorticoids. Prevention should be undertaken in all patients and it includes general prevention and supplementation with calcium and vitamin D (or its synthetic analogs), where appropriate. The first line of the therapy involves administration of one of the three drugs from the group of bisphosphonates (alendronate, risedronate, and zoledronate) that inhibit resorption of bone. If they are ineffective, or patients have a higher risk of fractures, it is necessary to introduce teriparatide, which has the anabolic effects on the bone. During the implementation of the preventive measures and therapy for this type of osteoporosis, routine monitoring of patients is required and it includes regular measurement of the bone mineral density and assessment of treatment efficacy and adherence (especially during the use of bisphosphonates).

ACUTE RADIATION TOXICITY AFTER CONCURRENT CHEMORADIOTHERAPY IN PATIENTS WITH LOCALY ADVANCED CERVICAL CANCER

2019-02-17T13:03:40+01:00

Cervical cancer takes an alarming 4th place among tumors in women and is a serious global problem of modern society. The gold standard in the treatment of locally advanced cervical cancer is based on concurrent chemoradiotherapy (external beam in combination with brachy-therapy). However, during the treatment of cervical cancer, various forms of acute toxicity can occur, with the incidence of up to 84%. The most common adverse manifestations of this therapeutic approach include various hema-tologic, gastrointestinal, genitourinary and dermatologic problems.

Although most of the potential risk factors for acute radiation toxicity are primarily asso-ciated with certain features of therapeutic moda¬lities, individual patient characteristics must also be taken into account. Knowledge of potential risk factors and early detection of patients with increased risk of acute radiation toxicity may significantly contribute to the administration of adequate corrective measures in order to prevent the occurrence of both acute and chronic toxicity, which is even more complex. Such an approach also leads to improvement of the quality of life of patients with locally advanced cervical cancer.