|
|
Quality of life of patients with Crohn´s disease
RENDL, Lukáš
Theoretical foundation Crohn's disease is a chronical autoimmune disease categorized, together with ulcerative colitis, in the group of idiopatic intestinal inflammations. But in spite of this categorization, Crohn's disease may not be found only in the intestines but anywhere in the gastrointestinal tract. However, the intestinal localization is most frequent and is related with numerous manifestations like stomachake, diarrhoea, bloating, flatulence, belching, loss of weight, etc. The pathogenetic cause of those discomforts consists in disorder of autoimmunity, when the body starts producing antibodies against its own tissues. But the cause of start of that pathogenetic mechanism has not been clarified so far. Experts speak about influence of infections, food, psychosomatics, smoking, genetic perceptiveness, etc. The hope of the patients is pinned on the continuously improving treatment, culminating by biological preparations that have most influenced the health condition of those persons so far. But in spite of the modern therapy, all characteristics of the disease can have negative impact on the quality of life of the patients. Goal of the thesis The goal of this thesis consists in ascertaining the quality of life of Crohn's disease patients. Hypotheses H1: Crohn's disease patients have problems in physical area. H2: Crohn's disease patients have problems in psychic area. H3: Crohn's disease patients have problems in social area. Methodology The practical part of the thesis was implemented based on quantitative inquiry within the grant Project No. 120/2012/S ?Reflection of life quality in nursing?. Two standardized questionnaires were used for the inquiry: the WHOQOL-100 general questionnaire and the IBDQ specific questionnaire, distributed among Crohn's disease patients. Valid licence was bought for both questionnaires. The size of the research set was determined at 100 Crohn's disease patients, the Crohn's disease diagnosis being the only criterion for selection of the respondents. The distribution of the questionnaires among the respondents took place with the help of gastroenterological centres. Results All data obtained were statistically processed in the SASD (Statistical Analysis of Social Data) program. The results of the processing can be divided into three areas, by the three main hypotheses verified. The first area of results provided information on the problems confronted by Crohn's disease patients in physical area. Only one problem was confirmed here: the Crohn's disease patients feel fatigue. All the remaining problems under verification in this area were refused. The second area brought information on psychical problems of the patients. Similarly to the preceding case, only one problem troubling the Crohn's disease patients was found here: feeling of irritation. The occurrence of the remaining psychical problems under verification was not confirmed. The last area of results found out the problems of the patients in social area. The results were the most positive in this case, as none of the problems under verification in this area was confirmed. Based on all results stated above, the hypotheses were evaluated as follows: H1 Crohn's disease patients have problems in physical area - refused; H2 Crohn's disease patients have problems in psychic area - refused and H3 Crohn's disease patients have problems in social area - refused. Conclusion The thesis provides comprehensive view on the issue of quality of life of Crohn's disease patients. The results may be used particularly in the work of so called IBD nurses, endoscopic nurses, but also general nurses working with the patients. The thesis can be also used as study material or as foundation for further research.
|
|
|
Diagnosis and therapy of Helicobacter pylori infection
POSPÍŠILOVÁ, Michaela
H pylori is a Gram-negative, microaerophilic rod-shaped moving bacterium, notorious for its urease production. It colonizes gastric mucosa and always leads to chronic gastritis, which may result in the development of other serious diseases, such as gastroduodenal ulcer disease and gastric adenocarcinoma. In 1994, H pylori was classified as a category 1 carcinogen. H pylori infection can be tested for invasively and noninvasively. The invasive methods include cultivation, histological examination and a rapid urease test. Noninvasive options are the carbon urea breath test, a stool antigen (HpSA) test and a blood antibody test. H pylori is sensitive to betalactam antibiotics. These should therefore be the essential part of the treatment; the instances of resistance are rare. Should the patient be allergic to betalactam antibiotics, nitroimidazoles can be used instead. H pylori is also sensitive to macrolides. The objective of my bachelor thesis was to acquire practical knowledge necessary for the correct processing of stool and serum samples in laboratory practice. I also intended to describe current trends in diagnosis and treatment of H pylori infection, together with the infection rates depending on age, sex and the season of the year. The findings were discussed in the context of relevant academic literature. Finally, I monitored the ways in which gastroduodenal ulcer disease caused by H pylori infection is diagnosed and treated by gastroenterologists in České Budějovice. The collection of the data for quantitative research was carried out between 1 January 2012 and 31 December 2012 in the microbiological laboratory Synlab czech s.r.o. in České Budějovice, which covers the whole of the South Bohemian Region. The samples were supplied mostly, but not exclusively, by GPs, and two methods of medical examination (euroSCREEN HP and EIA Helicobacter MONO IgG) were used. EuroSCREEN HP is based on the stool antigen (HpSA) detection, EIA Helicobacter MONO IgG is an immunoenzymatic method detecting IgG antibodies against H pylori in human serum or plasma. The data for qualitative research were collected in gastroenterologic ambulances in České Budějovice. Guided semi-structured interviews were carried out with one doctor in each ambulance. The acquired data were then processed as case studies and used to obtain categorization tables. The quantitative research confirmed all three hypotheses subject to evaluation. Higher age groups were found to have higher infections rates. However, no effect of either sex or the season of the year on the infection rates was registered. The qualitative research showed that gastroduodenal ulcer disease is most frequently diagnosed by České Budějovice gastroenterologists by the means of a biopsy check during gastroscopy. The samples are then sent to a microbiological laboratory for cultivation, histological examination and a rapid urease test. H pylori infection is usually treated by the standard triple therapy: amoxicillin, clarithromycin and a proton pump inhibitor. In case of hypersensitivity to betalactam antibiotics clarithromycin, a proton pump inhibitor and metronidazole are used instead. Occassional resistance to metronidazole and clarithromycin was reported. In these situations, cultivation is carried out in order to determine the sensitivity to antibiotics. The effects of the eradication treatment are evaluated by the means of a biopsy check during gastroscopy 6-8 weeks after its application. The samples are analysed in a microbiological laboratory. Some gastroenterologists also use a stool antigen (HpSA) test.
|
guest ::
