Bevezetés: A Parkinson-kór becslések szerint több mint 6,3 millió embert érint a világon. Ezek többségének és hozzátartozóinak egyedül kell megbirkóznia a gyógyszerszint-ingadozások motoros következményeivel és az anti-Parkinson-gyógyszerek pszichotikus mellékhatásaival. Nemritkán még az ellátók számára is gondot jelent a fellépő problémák helyes értelmezése és menedzselése. Célkitűzés: A szerzők célul tűzték ki a Parkinson-kóros betegek igényeinek rendszerezett áttekintését és ezek alapján egy bizonyítékokra épülő komplex Parkinson ápolási-gondozási modell kidolgozását. Módszer: A jelentkező igények meghatározásánál a szerzők egy idős, 28 éve Parkinson-kóros beteg többéves megfigyelése során szerzett tapasztalatokra támaszkodtak. A Parkinson ápolási-gondozási modellben a betegség specifikumaihoz illeszkedő multidiszciplináris ellátási keretrendszert fogalmaztak meg, amely meghaladja a standard ápolási modellek korlátait. Eredmények: A modell tartalmazza az egyes betegek köré szerveződő kooperatív problémamegoldási folyamat leírását és a betegek lehetséges problémáinak individualizált megoldására vonatkozó javaslatokat. Következtetések: A modell alkalmazása javíthat a Parkinson-kóros betegek életminőségén és megkönnyít-heti az érintett családok életét, feltéve, ha a családok tisztában vannak az új ellátási forma előnyeivel. Orv. Hetil., 2016, 157(22), 855-868. Kulcsszavak:Parkinson-kór, Parkinson-szindróma, életminőség, Parkinson ápolási-gondozási modell, ápolási-gondozási terv, betegedukáció Problem solving care models of Parkinson's diseaseIntroduction: Parkinson's disease affects more than 6,3 million people worldwide. Most patients and relatives are left alone to struggle with the symptoms associated with fluctuations in drug levels and the psychotic side effects of the anti-Parkinson's medications. Moreover, quite often even health providers may find difficult to interpret and manage the problems that have been encountered. Aim: The aims of the authors were to analyze systematically the biopsychosocial needs of Parkinson's patients, and to develop a complex, evidence-based Parkinson's-nursing-care model. Method: Patients' needs were assessed based on an observational study involving an old patient with Parkinson's disease for more than 28 years. The model has been specified as a multidisciplinary care framework adapted to the special characteristics of Parkinson's disease which transcends the limitations of different standard nursing models.Results: The elaborated model contains a detailed description of cooperative problem solving, which is organized around individual patients along with recommendations for addressing various potential problems that might be encountered. Conclusions: Implementation of the presented model can improve the life quality of Parkinson's patients and can facilitate the life of affected families provided that these families are well aware about the potential benefits of the novel care delivery system.
Introduction. typical symptoms of parkinson’s disease (pd) are motor symptoms. however, the non-motor symptoms, which may occur in any phase of the disease, are now in the center of the clinical attention. these symptoms include neuropsychiatric dysfunctions, dysautonomy, sleep disorders, and sensory symptoms, such as pain. sleep disorders are common in pd patients. Aim. the aim of our study was to estimate the prevalence and characteristics of obstructive sleep apnea syndrome (osas) in patients with pd. We also wanted to analyze the sleep architecture in parkinson’s disease using polysomnography. Material and methods. 50 patients who had visited the neurology department of hungarian defence forces military hospital between february 2014 and april 2016 were recruited for the study. Every patient with idiopathic parkinson’s disease stage 1 to 3 was included, regardless of their sleeping complaints. Every patient underwent nocturnal, in-laboratory polysomnography, the results of which were subsequently assessed by a somnologist. sleep stages were distinguished and the apneahypopnea index (ahi) was calculated according to the recommendations of the task force of the american academy of sleep medicine. Results. the total in-laboratory sleep time ranged from 189 minutes to 501 minutes, with the mean value of 298 minutes. total sleep time was reduced (< 5 hours) in 28 patients (56%). sleep latency was prolonged (< 0.5 hours) in 33 patients (> 66%). in older patients (≥ 75 years old), the sleep latency was longer. the normal sleep efficiency of > 85% was seen in only 8 patients. the sleep efficiency ranged from 56% to 89%, with a mean value of 74.1%. 9 patients in our study group had 3 rapid eye movement (rEm) sleep episodes, 37 patients had 2 rEm episodes and 4 patients had only 1 rEm episode. there was a negative correlation between the score on Epworth sleepiness scale (Ess) and the number of rEm episodes. rEm sleep onset latency was prolonged (> 2 hours) in 82% (n = 42) of our patients. periodic limb movements in sleep (plms) were seen in 18 patients. there was a negative correlation between age and plms index. all the patients in our study who had been diagnosed with restless leg syndrome (rls) had plms . sleep latency was prolonged in 7 out of 17 patients suffering from rls. 64% (n = 32) of our patients were diagnosed with osas. the prevalence of severe, moderate and mild osas was 22%, 32% and 10%, respectively. patients with moderate and severe osas (ahi > 15 hours) had higher age than patients without osas (p < 0.005). the mean Ess score was higher in osas patients (p = 0.05). snoring was present in 78% of the osas patients. apnea witnessed by a partner was the most specific symptom, present in 92% of osas patients. We did not find significant differences between the groups with and without osas in regard of updrs (unified pd rating scale) and hoehn & yahr’s modified evaluation scale and schwab & England’s functional evaluation scale. Conclusions. osas is a common sleep disorder in pd patients. it has a higher prevalence in older pd patients and it is associated with greater daytime sleepiness. snoring is the most sensitive symptom, and apneas witnessed by a partner are the most specific symptom of osas in pd patients.
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