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Open access

Debra Pollard and Steve Chaplin

Abstract

Haemophilia treatment is characterised by intravenous infusions of clotting factor concentrates, with nurses frequently taking the lead role in administration, patient training and patient care. In recent years, a number of novel factor and non-factor-based therapies delivered by subcutaneous injection have been developed. These therapies are now undergoing clinical trials and will shortly be available in clinical practice. The coming era of at least some haemophilia treatments being delivered by subcutaneous injection clearly represents a significant change not only for patients (for whom they may be more convenient) but also for haemophilia nurse practice, particularly with respect to bleed and surgical management plans, and hence for nurse training and education. This review describes evidence-based guidance on subcutaneous injection technique and summarises the implications for nurses.

Open access

Kate Khair and Steve Chaplin

Abstract

Long-standing inhibitors present many day-today difficulties for the affected individual; the unpredictability of bleeds, bleed management, pain and treatment efficacy all affect quality of life. This study explored these issues through focus groups of affected individuals aged 16-25 in the UK. The data from the focus groups was analysed for recurring themes, which were coded under three umbrella headings: ‘daily impact’, ‘education and future’ and ‘resilience and support’. Participants felt isolated through geography and being extra ‘rare’ within the bleeding disorders community; used pain as a gauge of bleed resolution, often without use of analgesia; described transition to adult care as particularly worrying; and explained the potential impact of living with an inhibitor on future career options. Peer-to-peer networking could provide emotional support for these young adults, who could also be role models for the future. Despite the burden of living with an inhibitor and its treatment, participants described a good quality of life from their own perspectives. With new therapeutic options for these individuals on the horizon, they look forward to a future with fewer bleeds and less pain.

Open access

Debra Pollard, Kate Khair, Cléa Percier, Yen Wong and Robyn Shoemark

Abstract

Management of haemophilia involves on-demand or prophylactic intravenous administration of recombinant or plasma-derived replacement clotting factors or bypassing agents. These products are provided as lyophilised powder and diluent, which need to be mixed to produce a solution for infusion. While this process has previously involved multiple time-consuming steps, several reconstitution systems are now available to make mixing easier and more convenient. This study aimed to investigate experience of use and perceptions of the Novo Nordisk MixPro® mixing device among patients and carers using activated recombinant factor VII (rFVIIa) or recombinant factor VIII (rFVIII) with MixPro, and nurse specialists who were either familiar or unfamiliar with MixPro. Nurses were asked to simulate the preparation of an inactive solution using MixPro. Semi-structured interviews were used to gain insight into participants’ opinions of mixing systems in general and their perceptions of MixPro. Likert scales were used to rate the performance of MixPro against predefined characteristics of mixing systems, and the importance of the predefined characteristics to the design of a mixing system. Patients/carers and unfamiliar nurses identified low contamination risk when mixing as the most important characteristic of a mixing system; the most important criterion for familiar nurses was confidence that patients/carers could prepare the system correctly. MixPro was perceived to perform very well overall, particularly in parameters identified as most important. It was described as being user-friendly, simple and quick; its compactness and portability were highlighted as advantages for storage and travel. The main disadvantages reported related to its small components. The majority of nurses said that they were highly likely to recommend MixPro to their patients.

Open access

Jenique Bailly and Johnny Mahlangu

Abstract

With improved replacement therapy, people with haemophilia (PWH) live longer, with the consequent emergence of age-related chronic diseases not previously seen in haemophilia. The prevalence of cardiovascular disease and associated complications in older PWH appears to be on the rise. Management of myocardial infarction in a person living with severe haemophilia presents a particular challenge, as treatment options often include antiplatelet therapy, anti-coagulation and invasive procedures. Current guidelines for managing acute myocardial infarction are not specifically designed for people with bleeding diatheses such as haemophilia. We present a patient with severe haemophilia A on extended half-life factor VIII prophylaxis who developed an acute ST-elevation myocardial infarction (STEMI), discuss his clinical management and highlight lessons learned.

Open access

B. Sulochana, Roseminu Varghese and Girish Menon

Abstract

A person with haemophilia is at risk of intracranial haemorrhage caused by spontaneous or traumatic events, potentially resulting in long-term disability. Early initiation of timely treatment is essential to prevent this. In developing countries, morbidity and mortality is common in intracerebral haemorrhage (ICH) cases with haemophilia as a result of patients and family members having inadequate knowledge, lack of awareness regarding referral, lack of availability of treatment products, and delays in the treatment decision. These barriers can potentially be managed by the haemophilia nurse taking responsibility for the coordination of care. This case report addresses the nurse-coordinated care of a haemophilic patient with ICH in a developing country, and may provide insight into the benefits of a haemophilia nurse undertaking a coordinating role.

Open access

Anupam Dutta and Anup Kumar Das

Abstract

VELSEAL-Tis an innovative haemostatic medical device for the control of bleeding. Incorporating a clotting agent (thrombin) and anti-fibrinolytic agent (tranexamic acid), it enables rapid coagulation when blood flows into the dressing, leading to sealing and stabilisation of wound surfaces. A 36-year-old known to have mild haemophilia A presented with profuse bleeding from the forehead after injury following a fall on concrete surface. He attended hospital after 18 hours of injury as bleeding continued as soon as pressure was released from the injury site. A VELSEAL-T patch was applied to the injury site with the patient’s full consent. The bleeding stopped after 60 seconds, but the patient was instructed to hold the patch in place for a further 60 seconds. After two minutes of tight pressure application, there was no more oozing of blood from the injury site. This case shows that VELSEAL-T can be used as an aid in stopping external bleeding in haemophilia patients. Further trials should be undertaken to evaluate the safety and efficacy of this product.

Open access

Krzysztof Siejko, Aneta Tylec, Halina Dubas-Ślemp, Piotr Książek, Bartłomiej Drop, Artur Kochański and Katarzyna Kucharska

Abstract

Objective:

The aim of this work is to review the role of mental health care center and treatment center specialized in psychiatry in the Polish system of mental health care as a whole.

Review:

For many years in Poland, the process of transformation of psychiatric care model from the institutional (inpatient setting, most expensive) to community care model (personalized, much cheaper), has been taking place. The effective - coordinated system of community care should significantly improve cooperation in the treatment, while the community forms of health care should ensure full availability, complexity, and continuity of care provision. In many cases, the community support is inadequate and cannot provide patient with care at his home environment. For mentally ill, there may be a need for the use of the long term health care centers specialized in psychiatry.

Conclusions:

A long term mental health care center specialised in mental health plays an important role in long-term care for the mentally ill. As far as a mental health service user’s perspective is concerned, the continuity of care and treatment in the long term health care center (as a health care unit) appears to be more useful and satisfying compared to a residential home for people with chronic mental illnesses. There is a need for broad discussion on the special place of the long term health care center specialized in psychiatry in the present Polish system of mental health care and on the improving of care pathways between inpatient-, day care-and, community care package.

Open access

Anna Hunca-Bednarska

Open access

Olena Secheiko

Abstract

Aim.

The aim of the study was to establish depth and substantive characteristics of intrapersonal conflicts of bloggers. Internal conflicts were analyzed at the levels of individual typological characteristics, self-conception, and value orientation of personality.

Research methodology.

The study was based on the method of content analysis and psychodiagnostic tests. 100 respondents (50 respondents who have blogs and 50 respondents who do not have blogs) were examined with Sobczyk’s individual typological questionnaire, Stephenson’s Q sorting, Budassi’s scale of self-assessment, Leary’s interpersonal diagnosis of personality, Fantalova’s value / accessibility correlation in different life spheres. Mann-Whitney test and Spearman’s rank correlation coefficient were applied for statistical data processing.

Research results.

The results of the survey support the hypothesis regarding the special character of the intra-personal conflicts of bloggers in comparison with those people who do not have blogs and use the Internet less often. In fact, conflicts between real self and virtual self are characteristic of bloggers. Most of the tension is the result of contradiction of ideas about their personal social and communicative competence and the opposition of coping strategies “acceptance of struggle – avoidance of struggle”.

Conclusions.

There are different views on how the Internet influences psychological wellbeing. Social networks allow bloggers to present themselves in a certain desired light, to create some image, to stress their unique features, to attract attention to those character properties which are not manifested in real life as desired.

Open access

Ewa Zawadzka and Łucja Domańska

Abstract

Hypertension is a common problem in the elderly population. It is one of the factors determining the pattern of cognitive functioning of the patients, however the nature and severity of neuropsychological deficits are unclear. The main aim of the study was to assess effectiveness of cognitive task performance and the strategies of verbal material organization in patients with varying levels of productivity and control. The outpatients treated for hypertension (n = 46) were tested with the following neuropsychological tests and the experimental task: Ruff Figural Fluency Test (RFFT), California Verbal Learning Test (CVLT), Semantic Verbal Fluency Task (VF). The level of productivity and control in older hypertensive patients appeared to be important variables differentiating the effectiveness of structured task performance involving the memory and learning of verbal material. Patients with weaker productivity and control show less efficiency in formulating and sustaining a learning plan expressed by the compatibility of responses in subsequent attempts. Weaker productivity and control are associated with high risk of memory problems, especially in situations characterized by a high degree of structure. It is advisable to include an evaluation of certain aspects of executive functions at the initial stage of assessment of patients at risk of brain dysfunction.