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Kowalski G, Domagalska M, Słowiński K, Grochowicka M, Zawadzki M, Kropińska S, Leppert W, Wieczorowska-Tobis K. Morphine (10, 20 mg) in a Postoperative Dressing Used with Patients After Surgical Debridement of Burn Wounds: A Prospective, Double-Blinded, Randomized Controlled Trial. Adv Wound Care (New Rochelle) 2024; 13:115-122. [PMID: 37742106 DOI: 10.1089/wound.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023] Open
Abstract
Objective: This is the first clinical trial to evaluate the analgesic effect of 10 and 20 mg of morphine used in a postoperative dressing with patients after surgical debridement of burn wounds. Approach: In this randomized controlled trial, 20 adult patients with third-degree flame burns, who had undergone surgical debridement under general anesthesia, were randomly assigned to either group A, whose members were treated with a burn dressing that contained 10 mg of morphine, or group B, whose members were treated with a burn dressing that contained 20 mg of morphine; the dressing was also soaked with octenidine and phenoxyethanol in the case of both groups. The plasma morphine concentrations were measured 1, 2, 3, and 6 h after surgery, while the level of pain intensity was determined on the Numeric Pain Rating Scale (NRS), and the occurrence of side effects was observed. Results: The serum morphine concentration levels were very low, but statistically different between the two groups at all time points. The NRS value was similar in both groups at all time points (p > 0.05). Despite this, in group B, the NRS value was 0 in all patients in postoperative hours 1, 2, and 3. No adverse effect of morphine sulfate was observed in any patient. Innovation: This project is the first clinical study to have demonstrated that morphine administered in dressings in concentrations of 0.02-0.08 mg/mL significantly reduces the occurrence of pain. Conclusion: The use of morphine in dressings after surgical treatment of burn wounds is very effective when it comes to pain management and is safe for the patient.
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Affiliation(s)
- Grzegorz Kowalski
- Chair and Department of Palliative Medicine, University of Medical Sciences, Poznań, Poland
| | - Małgorzata Domagalska
- Chair and Department of Palliative Medicine, University of Medical Sciences, Poznań, Poland
| | - Krzysztof Słowiński
- Department of Trauma, Burns and Plastic Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Grochowicka
- Chair and Department of Palliative Medicine, University of Medical Sciences, Poznań, Poland
| | - Marcin Zawadzki
- Wroclaw Medical University Department of Forensic Medicine, Wroclaw, Poland
| | - Sylwia Kropińska
- Chair and Department of Palliative Medicine, University of Medical Sciences, Poznań, Poland
| | - Wojciech Leppert
- Chair of Palliative Medicine, Institute of Medical Sciences Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
- University Hospital of Heliodor Święcicki, Partner of Poznań University of Medical Sciences, Poznań, Poland
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Sawik B, Tobis S, Baum E, Suwalska A, Kropińska S, Stachnik K, Pérez-Bernabeu E, Cildoz M, Agustin A, Wieczorowska-Tobis K. Robots for Elderly Care: Review, Multi-Criteria Optimization Model and Qualitative Case Study. Healthcare (Basel) 2023; 11:healthcare11091286. [PMID: 37174828 PMCID: PMC10178192 DOI: 10.3390/healthcare11091286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
This paper focuses on three areas: the first is a review of current knowledge about social and service robots for elderly care. The second is an optimization conceptual model aimed at maximizing the efficiency of assigning robots to serve the elderly. The proposed multi-criteria optimization model is the first one proposed in the area of optimization for robot assignment for the elderly with robot utilization level and caregiver stress level. The third is the findings of studies on the needs, requirements, and adoption of technology in elderly care. We consider the use of robots as a part of the ENRICHME project for long-term interaction and monitoring of older persons with mild cognitive impairment, to optimize their independence. Additionally, we performed focus group discussions (FGD) to collect opinions about robot-related requirements of the elderly and their caregivers. Four FDGs of six persons were organized: two comprising older adults, and two of the other formal and informal caregivers, based on a detailed script. The statements of older participants and their caregivers were consistent in several areas. The analysis revealed user characteristics, robot-related issues, functionality, and barriers to overcome before the deployment of the robot. An introduction of the robot must be thoroughly planned, include comprehensive pre-training, and take the ethical and practical issues into account. The involvement of future users in the customization of the robot is essential.
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Affiliation(s)
- Bartosz Sawik
- Department of Business Informatics and Engineering Management, AGH University of Science and Technology, 30-059 Krakow, Poland
- Institute of Smart Cities, Department of Statistics, Computer Science and Mathematics, Public University of Navarre, 31006 Pamplona, Spain
- Haas School of Business, University of California at Berkeley, Berkeley, CA 94720, USA
| | - Sławomir Tobis
- Occupational Therapy Unit, Chair of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, ul. Swiecickiego 6, 60-781 Poznan, Poland
| | - Ewa Baum
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Aleksandra Suwalska
- Department of Mental Health, Chair of Psychiatry, Poznan University of Medical Sciences, ul. Szpitalna 27/33, 60-572 Poznan, Poland
| | - Sylwia Kropińska
- Geriatrics Unit, Chair of Palliative Medicine, Poznan University of Medical Sciences, os. Rusa 55, 61-245 Poznan, Poland
| | - Katarzyna Stachnik
- Geriatrics Unit, Chair of Palliative Medicine, Poznan University of Medical Sciences, os. Rusa 55, 61-245 Poznan, Poland
| | - Elena Pérez-Bernabeu
- Department of Applied Statistics and Operations Research, Universitat Politècnica de València, Plaza Ferrandiz y Carbonell, sn, 03801 Alcoy, Spain
| | - Marta Cildoz
- Institute of Smart Cities, Department of Statistics, Computer Science and Mathematics, Public University of Navarre, 31006 Pamplona, Spain
| | - Alba Agustin
- Institute of Smart Cities, Department of Statistics, Computer Science and Mathematics, Public University of Navarre, 31006 Pamplona, Spain
| | - Katarzyna Wieczorowska-Tobis
- Geriatrics Unit, Chair of Palliative Medicine, Poznan University of Medical Sciences, os. Rusa 55, 61-245 Poznan, Poland
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Tobis S, Jaracz K, Kropińska S, Talarska D, Hoe J, Wieczorowska-Tobis K, Suwalska A. Needs of older persons living in long-term care institutions: on the usefulness of cluster approach. BMC Geriatr 2021; 21:316. [PMID: 34001000 PMCID: PMC8130415 DOI: 10.1186/s12877-021-02259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Long-term care units’ residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care. Methods The needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75–102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis. Results Cluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p < 0.001 vs. C1 & C2). Their GDS (7.6 ± 2.3) were higher than C1 (p < 0.001) but lower than C2 (p < 0.001). The number of met needs was higher in C2 than in C1 (10.0 ± 3.2 vs 8.2 ± 2.7, p < 0.001), and in C3 (12.1 ± 3.1) than in both C1 and C2 (p < 0.001). The number of unmet needs was higher in C3 than in C1 (1.2 ± 1.5 vs 0.7 ± 1.0, p = 0.015). There were also differences in the patterns of needs between the clusters. Conclusions Clustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives.
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Affiliation(s)
- Sławomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, ul. Swiecickiego 6, 60-781, Poznan, Poland.
| | - Krystyna Jaracz
- Chair of Nursing, Poznan University of Medical Sciences, ul. Smoluchowskiego 11, 60-179, Poznan, Poland
| | - Sylwia Kropińska
- Geriatrics Unit, Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Dorota Talarska
- Chair of Preventive Medicine, Poznan University of Medical Sciences, ul. Swiecickiego 6, 60-781, Poznan, Poland
| | - Juanita Hoe
- Division of Nursing, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Katarzyna Wieczorowska-Tobis
- Geriatrics Unit, Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Aleksandra Suwalska
- Department of Mental Health, Chair of Psychiatry, Poznan University of Medical Sciences, ul. Szpitalna 27/33, 60-572, Poznan, Poland
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Łukasik S, Tobis S, Kropińska S, Suwalska A. Role of Assistive Robots in the Care of Older People: Survey Study Among Medical and Nursing Students. J Med Internet Res 2020; 22:e18003. [PMID: 32784187 PMCID: PMC7450386 DOI: 10.2196/18003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 01/29/2023] Open
Abstract
Background Populations are aging at an alarming rate in many countries around the world. There has been not only a decrease in the number of births and an increase in the percentage of older people, but also an increase in the number of people living alone. There is growing demand for specialist medical care and daily care with the number of people who can act as caregivers reducing. The use of assistive robots can, at least partially, solve these problems. Objective The purpose of this study was to examine the opinions of future health care professionals (medical and nursing students) regarding the use of assistive robots in the care of older people. Methods The study was conducted with a group of 178 students from Poznan University of Medical Sciences, Poznań, Poland (110 nursing students and 68 medical students), using the Users’ Needs, Requirements, and Abilities Questionnaire. Results The participants of this study believed that assistive robots should, first of all, remind older people to take medication regularly, ensure their safety, monitor their health status and environment, provide cognitive training, and encourage them to maintain physical activity. In the students’ opinion, the robot should not be an older person’s companion but only act as an assistant. Nursing students had significantly higher scores than medical students in several statements concerning everyday use of robots, including reminding about meals (P=.03), monitoring the environment (P=.001), providing advice about a healthy diet (P=.04), monitoring the intake of food and fluids (P=.02), and automatic “switch on” function (P=.02). Nursing students were more focused on the social functions of robots, including encouraging contact with friends (P=.003) and reducing the sense of loneliness and improving mood (P=.008). Medical students were more aware of privacy issues in the statement concerning the possibility of switching off the robot in specific situations (P=.01). Conclusions Our study revealed a generally positive attitude of future doctors and nurses toward assistive robots, which can have an impact on their acceptance by older adults. In the future, medical professionals could help their patients to choose the right robots (and necessary functions) that are best suited to their needs. However, this would require expanding the curriculum to include the issues of gerontechnology.
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Affiliation(s)
- Sylwia Łukasik
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University in Poznań, Poznań, Poland
| | - Sławomir Tobis
- Occupational Therapy Unit, Chair of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznań, Poland
| | - Sylwia Kropińska
- Geriatrics Unit, Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Aleksandra Suwalska
- Department of Mental Health, Chair of Psychiatry, Poznan University of Medical Sciences, Poznań, Poland
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Talarska D, Kropińska S, Strugała M, Szewczyczak M, Tobis S, Wieczorowska-Tobis K. The most common factors hindering the independent functioning of the elderly at home by age and sex. Eur Rev Med Pharmacol Sci 2017; 21:775-785. [PMID: 28272705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Changes occurring with increased age as well progressive illnesses can negatively affect the independent functioning of older people. The goal of this study was to identify the most common problems that make independent life at home more difficult for the elderly and to try and present their relation with age and gender. PATIENTS AND METHODS A total of 506 persons over 60 years of age took part in the study. They were residents of Poznań, Poland and surrounding areas. The research instruments were the Abbreviated Mental Test Score and EASY-Care Standard 2010 questionnaire which makes it possible to analyze patient's functioning in seven areas and includes three risk scales: Independence score, Risk of breakdown in care, Risk of falls. RESULTS In the group studied the greatest difficulties included performing complex activities of everyday life connected with moving around (III area), difficulties with performing household tasks (50.8%), shopping (39.7%) and falls (35.0%). The most frequently reported symptom that was a cause of worry was pain (68.2%). Other health problems reported included sleep disorders (58.9%), incorrect body weight (52.6%), low tolerance of physical effort (48.4%), urethral sphincter functioning disorder (42.7%) and forgetfulness (40.5%). The feeling of being lonely was found in 45.8% of older people. CONCLUSIONS Significant differences in functioning between the genders were found in the areas of meal preparation, falls, mobility outside the home, not feeling safe, lack of physical activity, low tolerance of physical effort and almost all of area VII - Mental health and well-being. The main determinants of risk scores with the Independence Score, Risk of breakdown in care and Risk of fall domains were age and subjective feelings of pain.
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Affiliation(s)
- D Talarska
- Department of Preventive Medicine, University of Medical Sciences, Poznan', Poland.
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Zasadzka E, Kropińska S, Pawlaczyk M, Krzymińska-Siemaszko R, Lisiński P, Wieczorowska-Tobis K. Effects of inpatient physical therapy on the functional status of elderly individuals. J Phys Ther Sci 2016; 28:426-31. [PMID: 27065526 PMCID: PMC4792984 DOI: 10.1589/jpts.28.426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/30/2015] [Indexed: 01/19/2023] Open
Abstract
Purpose] The aim of the study was to analyze the impact of inpatient rehabilitation on the functional status of the elderly. [Subjects and Methods] A total of 100 patients (>65 years of age) in a rehabilitation ward were enrolled in this study. Age, absence of depression and signs of dementia in screening tests constituted the inclusion criteria. A comprehensive geriatric assessment was performed of all of the subjects twice, at the beginning and end of hospitalization (Assessments I and II, respectively), and included fall risk assessment (Timed Up and Go Test, TUG), evaluation of physical function (Short Physical Performance Battery Test, SPPB), the handgrip strength test, as well as patients' self-reports of pain intensity, well-being and functional status. [Results] At the end of inpatient rehabilitation, significant improvement was observed in reduction the TUG time, physical function, and handgrip strength, as well as in subjective parameters such as self-reported pain intensity, well-being, and functional status. [Conclusion] Our results show the high efficacy of inpatient rehabilitation as a means of improving functional independence. Hospital rehabilitation should be recommended for elderly people, not only in cases of absolute indications for hospital admission, but also periodically for patients at risk of physical disability.
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Affiliation(s)
- Ewa Zasadzka
- Department of Geriatric Medicine and Gerontology, Karol Marcinkowski University of Medical Sciences, Poland
| | - Sylwia Kropińska
- Department of Palliative Medicine, Karol Marcinkowski University of Medical Sciences, Poland
| | - Mariola Pawlaczyk
- Department of Geriatric Medicine and Gerontology, Karol Marcinkowski University of Medical Sciences, Poland
| | | | - Przemysław Lisiński
- Department and Clinic for Physiotherapy, Rheumatology and Rehabilitation, Karol Marcinkowski University of Medical Sciences, Poland
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Wieczorowska-Tobis K, Talarska D, Kropińska S, Jaracz K, Tobis S, Suwalska A, Kachaniuk H, Mazurek J, Dymek-Skoczyńska A, Rymaszewska J. The Camberwell Assessment of Need for the Elderly questionnaire as a tool for the assessment of needs in elderly individuals living in long-term care institutions. Arch Gerontol Geriatr 2016; 62:163-8. [DOI: 10.1016/j.archger.2015.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/30/2022]
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Szczepańska-Gieracha J, Mazurek J, Kropińska S, Wieczorowska-Tobis K, Rymaszewska J. Needs assessment of people 75+ living in a nursing home or family home environment. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mazurek J, Szcześniak D, Talarska D, Wieczorowska-Tobis K, Kropińska S, Kachaniuk H, Rymaszewska J. Needs assessment of elderly people living in Polish nursing homes. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.gmhc.2014.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wieczorowska-Tobis K, Talarska D, Kropińska S, Dymek-Skoczyńska A, Tobis S, Mazurek J, Rymaszewska J. CANE Questionnaire for the assessment of care needs in elderly individuals living in long-term unit. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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