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  • Author: Madalina Iliescu x
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Therapeutical Management of the Tibial Plateau Fractures

Abstract

The study was aimed to identify the role of surgical treatment of tibial plateau fractures, its functional outcome and complications. Demographic data for the patients and details of current clinical and radiological follow-up findings were obtained to assess range of motion, clinical stability, alignment of the knee, and posttraumatic arthrosis (Kellgren/Lawrence score). 64 cases of tibial plateau fractures treated by different surgical methods and variuos implants type were studied from 2013 to 2015 and followed-up for minimum period of 6 months. The systematisation of the casuitry was made using Schatzker and AO classifications. The treatment methods consist of: percutaneous cannulated cancellous screws, ORIF with buttress plate with or without bone grafting, locking or nonlocking plates, external fixator. As complications we found: redepression 4 case, malunion 2 cases, knee stiffness 9, wound dehiscence in 1 cases and non-union or infection in none of our cases. The average flexion of the injured knee was significantly lower in comparison with the contralateral side (124.9°/135.2°). Knee stability did not differ statistically significantly. There were no signs of posttraumatic arthrosis in 45% of cases, mild signs in 30%, clear signs in 18%, and severe signs in 7%. As conclusion we found that surgical management of tibial plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion and reduce arthrosis risk and hence to achieve optimal knee function. The choice of optimal surgical methods, proper approach and implant is made in relation to fracture type according Schatzker and AO classification.

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Nursing’s approach and rehabilitation in a severe case of miliary tuberculosis complicated with stroke.

Abstract

Background: Miliary tuberculosis is a haematogenuous dissemination of Mycobacterium Tuberculosis (M. tuberculosis) witch involves especially lungs, central nervous system and lymph node. It is a very severe disease with an increased risk of respiratory failure, extensive neurologic sequelas and high mortality. A rapid diagnosis and specific treatment is tremendous important for outcome. Association of strokeis common in tuberculous meningitis (MTB) and could delay the diagnosis and worse the prognosis.

Case presentation: We present a case of 24 years old male, who present asthenia and 20 kilo weight lossduring the last 2 years before admission in hospital. He came in hospital, directly in Intensive CareUnit (ICU) for left hemiplegia followed within hours of fever, repeated focal seizures and coma, reaching a Glasgow score of 6 about 48 hours after admission. Patient requiredorotracheal intubation. The Chest radiograph reveal micro-nodular opacities compatible with miliary TB and the cerebrospinal fluid (CFS) examination led to suspicion of TB meningitis. The Tb etiology was bacteriologically confirmed in sputum and cerebrospinal fluid. After 24 hors, theCT and angio-MRI detected the ischemic lesion in the middle cerebral arterial territory. The injectable antituberculous treatment with 4 drugs was immediately initiated. Parenteral cortichosteroids, anticoagulant, symptomatictreatments were associated. The patient received a very complex and prolonged nursing intervention followed by neurologic and pulmonary rehabilitation in ICU and in the Pneumophtisiology Department. The rehabilitation team identifies the all subjective and objective demands and plan the nursing process of care. When patient gains consciousness the neurologic and pulmonary rehabilitation were started. The evolution was slow, but favorable, after 6 moths of treatment the impairment of left hand movement being the only remaining sign of the past disease.

Conclusions: Collaboration medical team consisting of a neurologist, pulmonologist, infection disease specialist and physiotherapist increased the success rate, diminish the sequelas and improve the quality of life of the patient.

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Considerations Regarding The Quality Of Rehabilitation And Physical Medicine Services From Patients Perspective

Abstract

The research study aims to assess the quality of physical medicine and rehabilitation (MFR) services offered to the population by specialized sanatoriums and hospitals in Dobrogea, in order to identify some appropriate measures to improve the quality of such services.

The target group (593 respondents) consisted of 6 independent batches, different in number, selected from 6 medical units. The patients responded to a specific questionnaire regarding the quality of MFR services and the collected data were analyzed statistically.

According to the patients′ answers, the medical staff meets their expectations in terms of the information provided at the time of admission, promptitude, kindness, availability, which reflects just one segment of the quality of medical rehabilitation services.

As regards the entity recommending the medical rehabilitation physician, of the total answers, the lowest ratio in the study is held by the answer “family doctor / another doctor”. It thus highlights the poor knowledge of family doctors or other doctors on the therapy benefits specific to medical rehabilitation and therefore the access to such services is not facilitated, a disservice to the patients′ life quality. There is a dependence relation between the level of education and the reason of admission. We see that is not prevention taking the first position, but the pain, which reflects a deficient education for health in all social levels.

Assessing the patient’s satisfaction regarding the mobility facilities in the sanatorium / hospital a percentage of 6.6% patient responded that they are not satisfied. It results that all the 6 partner institutions in the study must evolve to provide decent conditions ensuring the mobility independence to the patients.

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Increasing the quality of health management in Romania through specific consultancy services

Abstract

Health management consultancy has become an important source of innovation in management, a bridge between the academic environment, companies and opinion-makers in the field. The objective of this work is to identify the success factors of a consultancy mission within the health system, with the proposal of direct investigation of the hypothesis regarding the positive association between the success of consultancy missions and the consultant’s professional integrity. The survey was carried out during January and February 2017, in Bucharest health units, by applying questionnaires to 68 managers both in the public and private system. The analyzed parameters were: the consultant’s professional integrity, the consultant's competency, the relations with the consultant, the correct definition of the mission, available financial resources, term observance, and related costs. The information obtained was statistically processed using the SPSS system. The answer options to the items in the questionnaire allowed statistical correlations, verifying the survey hypothesis regarding the association between success and professional integrity. Any consultancy mission entails negotiation skills from the consultant, as well as an open attitude, listening and communications skills. The environment created by the manager can even further influence the change acceptance.

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Correlations between serum cortisol and body mass index at old patients under balnear treatment

Abstract

Introduction. Glucocorticoids provide a significant resource of scientific progress in medical research, being studied in terms of molecules, genetics, physiopathology at the level of the human body, starting from animal models, with valuable recent discoveries regarding their implications in the human psychic level, stress reaction and the search of new possible therapeutic effects unknown until now. Our work are illustrated the correlations between serum cortisol and body mass index - BMI at old patients under balneal treatment with natural factors from Techirghiol lake. Material and methods. The study monitored 52 patients admitted in Balneal and Recovery Sanatorium of Techirghiol for complex balneal treatment, using mud baths (cold or warm), and physical treatments. The patients were grouped in two batches: batch of cold baths with mud- CMB (15 patients, 28.8%, 6 men and 9 women) and batch of warm baths with mud-WMB (37 patients, 71.2%, 19 man and 18 women). The following issues were statistically analysed: BMI, respectively serum cortisol value variation for each batch studied, both at the time of admission and at the time of discharge; comparative analysis between the two moments for each batch; and the comparative analysis between the two study batches at the time of admission, respectively discharge and the BMI value variation in statistical relation with the serum cortisol values for each batch studies at the time of admission and at the time of discharge. Results. From statistical analysis of the correlation between the body mass index (BMI) of patients included in research in the CMB batch at admission and discharge according to the variations of the serum cortisol level , the two variables (Serum cortisol / BMI) both at admission and discharge are not correlated (r = -0.366; p = 0.180 > α = 0.05; r = -0.035; p = 0.901 > α = 0.05). Also, from statistical analysis of the correlation between the body mass index (BMI) of patients included in research in the WMB batch at admission and discharge according to the variations of the serum cortisol level , the two variables (Serum cortisol / BMI) are correlated at admission (r = -0.406; p = 0.013 > α = 0.05), but are not correlated at discharge (r = 0.200; p = 0.236 > α = 0.05). Conclusions. Previous studies have shown that high levels of adiposity can increase the cortisol stress response. While overweight and obese men showed an increased cortisol response upon each food intake, they can be more susceptible to develop stress associated disorders.

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