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Pain and its limits. An interdisciplinary approach from the perspective of phenomenology, enactivism and neuroscience
Wagner, Judith ; Sepp, Hans Rainer (advisor) ; Schmiedl-Neuburg, Hilmar (referee) ; Wojtecki, Lars (referee)
Bolest a její hranice. Interdisciplinární přístup z pohledu fenomenologie, enaktivismu a neurověd Chronická bolest je celosvětově významným sociálně-medicínským problémem s vysokými následnými náklady. Syndromy bolesti jsou však jako samostatné onemocnění uznávány až od poloviny 20. století. Zatímco nocicepce popisuje smyslové vnímání bolestivého podnětu, bolest popisuje stav prožívání takové události, její interpretaci z hlediska významu pro postiženého a prožívání řady souvisejících emocí. Zde se ukazuje, že bolest je subjektivní, kontextově závislý, a tudíž také modifikovatelný fenomén, který podléhá vědomé i nevědomé interpretaci jedince z hlediska jejího projevu a formy. Z této komplexnosti je zřejmé, že empirické lékařské vědy samy o sobě nemohou vysvětlit všechny aspekty bolesti. Proto se také stala předmětem fenomenologického výzkumu. Filozofický pohled na bolest je přinejmenším stejně mnohotvárný a lze k němu přistupovat z nejrůznějších perspektiv. V následujícím textu se pokusíme charakterizovat bolest z filozofického - fenomenologického a enaktivistického -, ale také neurovědeckého hlediska. Jako vůdčí struktura této úvahy nám poslouží koncept tělesné hranice: jaký je vztah mezi bolestí a vnímáním tělesných hranic? Existuje vzájemný vliv? A lze toto vnímání modifikovat ve prospěch pacienta...
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Saturation of patient needs during acute admission to a surgical ward
JIRÁČKOVÁ, Anna
The diploma thesis deals with the issue of satisfying the needs of a patient acutely admitted to a surgical department. The research focused on feelings and perceptions in the area of satiration of the needs of acutely admitted patients, but also on the view of the nursing staff, who saturate the needs of acutely admitted patients. We investigated whether the patient is perceived as a holistic being, and what problems the nursing staff most often faces during the saturation of the needs of an acutely admitted patient. The theoretical part of the thesis describes the structure of the patient's admission to a hospital facility, and specifies human needs and factors that affect them. In the empirical part, the methodology and results of the research methods used are presented. For the empirical part of the thesis, quantitative and qualitative research was chosen. As part of the quantitative research, a questionnaire was compiled addressing nurses working in surgical outpatient departments or nurses who perform acute admission of patients in surgical wards. The information obtained through the questionnaire survey approximated the opinion of nurses on the saturation of the needs of acutely admitted patients and partly on the working conditions of nursing staff in the surgical department. Methods of semi-structured interview and covert observation were used for qualitative research. Interviews were conducted with acutely admitted patients who were hospitalized after unplanned treatment in the surgical department. Patients were informed about the use of the information obtained and had to give their consent to conduct the interviews. The results of quantitative research have shown that nurses prioritize satisfying the basic (biological) needs of patients, and higher (psychosocial) needs are provided as secondary. The thesis also points out that in many cases nurses act through established competencies. In the interview, the nursing staff mostly said that they would like to have more time for the patient. We also found that most nurses have at least one experience with providing for an urgently admitted patient in one person, and pain relief in an acute admission comes more often from nurses than from doctors. Although nurses cited more staff as the primary factor that would help them reduce stress levels while satisfying the patient's needs. When testing hypotheses, it turned out that the impossibility of satisfying the patient's needs is not related to the working conditions of the nursing staff. The qualitative results of the research answered that patients are unable to assess the validity of the nursing interventions performed during their acute admission. However, the quality of nursing care was most often deduced from the level of communication of the staff, information, reactions to expressed concerns, calm approach, etc. We have found that patients who have previous experience with hospitalization are affected by the experience and often bring negative fears about upcoming hospitalization. Covert observation supported the results obtained from the methods already mentioned. It shows that nurses primarily provided physiological needs in all outpatient departments and surgical wards. And only then did they saturate the psychosocial needs. Nurses satiated the needs of patients both according to the doctor's office and independently, acting as an autonomous part of a multidisciplinary medical team. The results of the diploma thesis could contribute to the improvement of care in the acute admission of the patient, and serve as a possible algorithm for the admission of the patient in the form of a brochure. The thesis can be processed as a teaching material within the framework of lifelong learning for medical staff working not only in emergency departments.
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An external pulse generator for neuromodulation
Flídr, Lukáš ; Čech, Petr (referee) ; Chmelař, Milan (advisor)
The main objective of this work is to explain and familiarize with neuromodulation, its use and possibilities of its application in current medicine. It will also focus on the basic configuration and the block concept of an external generator and the time courses of the generator are described. In the first phase the base of neuromodulation is explained, then the main application, the implementation of this technology and the possibility of its application in modern medicine. Further to the work we will find an overview of equipment used for neuromodulation. The other part is focused on a design of an external generator using a MOTOROLA Nitron HC08 series microcontroller, its configuration and finally description of the time courses (impulses) from the device, that are used for neuromodulation.
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External pulse generator for neuromodulation
Flídr, Lukáš ; Říčný, Václav (referee) ; Chmelař, Milan (advisor)
This thesis deals with the treatment of chronic pain by using neuromodulation, where a external generator is used in a trial period. In the first section the principle of pain management is described and then the main nature of neuromodulation. The possibilities of chronic pain suppression are described, where we are mainly dealing with neurostimulation (stimulation with electric current). For better understanding, examples of neurostimulation usage are shown, where and in what problems it is used. Because this work deals with an external generator for a trial period (a trial system), the possibilities of testing electric impulses are described, which are then used in a implantable generator IPG. The requirements for such a external generator are also described, which are important for the design of such a device. The design of the device is firstly modeled by a block scheme, where function of the separate blocks is described and afterwards, the entire design of the external generator for neuromodulation is given. The test sample of the external generator is manufactured and tested.
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Genetic factors in the etiology of migraine
Skoblíková, Daniela ; Šolc, Roman (advisor) ; Mravec Bencúrová, Dominika (referee)
Migraine is a chronic condition with a significant prevalence in the human population- Its aetiology involves a combination of both environmental and genetic factors; however, the primary cause is still not entirely clear. The pathophysiological mechanism of the brain, which forms the basis of migraine aura, is considered to be a transient wave of neuronal depolarization in the cortex, known as cortical spreading depression (CSD). Despite considerable discrepancies, there is a wealth of information on suspected or already identified genes whose mutations could potentially be responsible for initiating the migraine state. Currently, there are three recognized responsible genes that have been identified through classical linkage analysis. All three known FHM mutations encode mechanisms that affect ion transporter: the CACNA1A, ATP1A2, and SCN1A genes. Their dysfunction ultimately leads to an increase in neuronal excitability. Pathogenic variants in other genes, such as PRRT2, PNKD, SLC2A1, SLC1A3, SLC4A4, and KCNK18, have also rarely been found in HM. Keywords: migraine, genetic factors, pain, aura
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Individual possibilities of involvement of relaxation techniques in rehabilitation care of patients after implantation of a total hip joint endoprosthesis
Gallová, Iveta ; Strnad, Pavel (advisor) ; Mahrová, Andrea (referee)
Title: Individual possibilities of involving relaxation techniques in the rehabilitation care of patients after implantation of a total hip joint endoprosthesis Objectives: The goal of the thesis is to offer to individual probands the possibility of including relaxation techniques in therapy, beyond the scope of normal rehabilitation after implantation of a total hip joint endoprosthesis. Methods: The diploma thesis is of a theoretical-empirical nature and is conducted as qualitative research. The monitored group consisted of 4 people - 3 women and 1 man, aged 50 to 55 years, all after primary implantation of a total hip joint endoprosthesis, who were hospitalized in the hospital's rehabilitation department for 3 weeks. The research part of the thesis was focused on the inclusion of exercises with elements of relaxation techniques in the therapy of individual probands. The intervention was an individually designed exercise using elements of relaxation techniques for individual probands. The structure of this exercise changed during the research depending on the fitness of the probands and their current physical and psychological state. The following methods were used for data collection: semi-structured interview, taking anamnesis, inspection, palpation, measurement of joint ranges according to the...
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Psychological aspects of pharmacological pain management in palliative care
Trefná, Klára ; Niederlová, Markéta (advisor) ; Šivicová, Gabriela (referee)
This thesis deals with the psychological phenomena that are associated with the pharmacological pain management in a context of palliative care. The issue involves patient himself, but also a caregiver and a medical staff. The theoretical part of this thesis deals with pain and pharmacological pain management from a psychological point of view and focuses on a problematic attitude toward opioids. This thesis is based on the latest scientific findings by Czech and international researchers. This thesis also includes a research plan, which deals with the psychological factors that affect the attitude toward opioids in Czech environment.
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Pain in patients with multiple sclerosis
Paulů, Kateřina ; Novotná, Klára (advisor) ; Grosserová, Barbora (referee)
The bachelor thesis deals with the topic of pain in patients with multiple sclerosis. The aim of the thesis is to map the prevalence of pain among patients with multiple sclerosis, its localization, time course, triggering factors, type, character, intensity and some other aspects pain through a shortened Czech form of the standardized questionnaire of McGill University. The thesis consists of theoretical and practical part. The theoretical part deals with the issue of pain in general, but also focuses on the individual types of pain that are characteristic of multiple sclerosis. The practical part relies on data collection by means of a questionnaire survey that focuses on mapping the prevalence of pain, its location, haracter, duration, intensity and other possible related factors. To collect data, I used a shorter form of the Czech version of the standardized McGill University questionnaire. The questionnaire survey was carried out with patients of the Centre for Demyelinating Diseases, Department of Neurology 1. LF UK and VFN in Prague, who were given a paper questionnaire. The information I obtained was processed into graphs and tables. The results showed that pain is present in 60 % of respondents with multiple sclerosis, most often localized in the spine and lower limbs. The intensity of...
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