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  • Author or Editor: Gábor Fritúz x
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Mechanical ventilation (MV) is a life saving method usually applied in the Intensive Care Units (ICU) for patients in a critical condition. Today it is more and more obvious that patients treated in the ICU require not only intensive physical (medical) care, but also intensive psychological support in order to avoid severe stress and to cope with the situation. They need help to understand the aim and helpfulness of the treatment, and information about the peculiar or frightening aspects of the situation, in order to promote positive processing. In this paper we summarise an approach, called psychological support based on positive suggestions (PSBPS), where patients on MV were supported with suggestions based on the principles of hypnotic communication. We present the foci of the phases of (1) initiation, (2) maintenance and (3) weaning off from MV from a psychological point of view, along with some verbatim suggestions we used with patients during these three completely different phases of MV. The main results of a randomised prospective study testing the effectiveness of PSBPS are presented briefly.

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Abstract

This case report describes the way psychological support based on positive suggestions (PSBPS) was added to the traditional somatic treatment of an acute pancreatitis 36-year-old male patient. Psychological support based on positive suggestions (PSBPS) is a new adjunct therapeutic tool focused on applying suggestive techniques in medical settings. The suggestive techniques usually applied with critically ill patients are based on a number of pre-prepared scripts like future orientation, reframing, positivity, supporting autonomy, etc., and other, very unique and personalized interventions, which are exemplified with verbatim quotations. We describe the way several problems during treatment of intensive care unit (ICU) patients were solved using suggestive methods: uncooperativeness, difficulties of weaning, building up enteral nutrition, supporting recovery motivation, and so on, which permanently facilitated the patient's medical state: the elimination of gastrointestinal bleeding, recovery of the skin on the abdomen, etc. Medical effects follow-up data at 10 months show that the patient recovered and soon returned to his original work following discharge.

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Abstract

Research was conducted on ventilated patients treated in an intensive care unit (ICU) under identical circumstances; patients were divided into two groups (subsequently proved statistically identical as to age and Simplified Acute Physiology Score II [SAPS II]). One group was treated with positive suggestions for 15–20 min a day based on a predetermined scheme, but tailored to the individual patient, while the control group received no auxiliary psychological treatment. Our goal was to test the effects of positive communication in this special clinical situation. In this section of the research, the subsequent data collection was aimed to reveal whether any change in drug need could be demonstrated upon the influence of suggestions as compared to the control group. Owing to the strict recruitment criteria, a relatively small sample (suggestion group n = 15, control group n = 10) was available during the approximately nine-month period of research. As an outcome of suggestions, there was a significant drop in benzodiazepine (p < 0.005), opioid (p < 0.001), and the α2-agonist (p < 0.05) intake. All this justifies the presence of therapeutic suggestions among the therapies used in ICUs. However, repeating the trial on a larger sample of patients would be recommended.

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Abstract

Long stay in intensive care unit (ICU) and prolonged ventilation are deleterious for subsequent quality of life and surcharge financial capacity. We have already demonstrated the beneficial effects of using suggestive communication on recovery time during intensive care. The aim of our present study was to prove the same effects with standardized positive suggestive message delivered by an MP3 player. Patients ventilated in ICU were randomized into a control group receiving standard ICU treatment and two groups with a standardized pre-recorded material delivered via headphones: a suggestive message about safety, self-control, and recovery for the study group and a relaxing music for the music group. Groups were similar in terms of age, gender, and mortality, but the SAPS II scores were higher in the study group than that in the controls (57.8 ± 23.6 vs. 30.1 ± 15.5 and 33.7 ± 17.4). Our post-hoc analysis results showed that the length of ICU stay (134.2 ± 73.3 vs. 314.2 ± 178.4 h) and the time spent on ventilator (85.2 ± 34.9 vs. 232.0 ± 165.6 h) were significantly shorter in the study group compared to the unified control. The advantage of the structured positive suggestive message was proven against both music and control groups.

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Absztrakt:

A kutatási cél az alapszintű újraélesztés (laikus újraélesztés – basic life support, BLS) kortársoktatók által iskoláskorú diákok számára történő készségszintű megtanítása és annak tudományos mérőeszközzel történő hatékonyságvizsgálata. Az újraélesztést a nemzetközileg elterjedt négylépcsős készségátadási módszerrel oktattuk. A betanítás eredményességét kérdőíves módszerrel, szociológiai szempontok bevonásával is követtük (n = 91). Az újraélesztésre vonatkozó korábbi tudás és attitűd felmérése után, az általunk alkalmazott eljárás reprodukálható elsajátítása mellett kiemelhető egy váratlan szituációhoz való alkalmazkodásra történő hajlandóság fokozása is. Mindez jelentős életkori eltéréseket nem mutatott. A laikus újraélesztés vállalására irányuló érzékenyítő és technikai tréning eredményes nevelési eljárást igazol. Az alkalmazott kortársoktatási modell alkalmasnak mutatkozik az újraélesztési ismeretek átadására. Orv Hetil. 2019; 160(46): 1816–1820.

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