Journal of Nursing Theory and Practice

[Application of external circulatory assist device in cases of cardiac failure]

TAMÁS Csilla, BARATI Zoltán

AUGUST 30, 2016

Journal of Nursing Theory and Practice - 2016;29(04)

[The Heart and Vascular Centre of Semmelweis University was the first institution in Hungary to routinely apply external mechanical circulatory support (Extracorporal Membrane Oxigenation, Ventricular Assist Device) as a new alternative to treat cardiogenic shock cases. The objective of our study was to assess how frequently certain therapeutic methods were applied, and to evaluate the demographic characteristics, the case historic and the mortality data of the patients treated, as well as to demonstrate the incidence rate of the most frequent complications. Our study was based on the data of patients suffering cardiogenic shocks treated with external circulatory assist devices between 1. June, 2012 and 31. January, 2016. The study has been carried out analytically and retrospectively after data collection from written and electronic patient documentation. Data analysis has been executed by SPSS software. The results revealed uneven gender distribution, over 60% of incidence in case of four examined complications, and an elevated mortality rate of patients over 60 years old. We found that there is a higher risk for complications if mechanical circulatory support is applied, and we made a suggestion to reconsider the application of this support for patients over certain ages. The study demonstrated that our results match the statistical data found in international medical literature. ]



Further articles in this publication

Journal of Nursing Theory and Practice

[The evolution of skull reconstruction surgical techniques and it’s impact on patient’s care and the effect on patients from the nursing perspective]


[Background: Facts support that decompressive craniectomy allaviates life-threatening acute high intracranial pressure and it is performed worldwide. Less attention has been paid to the late negative consequences of the widely open cranium. Hence there is a need for timely closure of the defect and precise cranioplasty. Objective: The goal of the present study was to compare the clinical results and patient care data gained by a novel cranioplasty method, the so called computer-aided design and computer-aided manufacturing (CAD/CAM) technique, versus conventional operative procedures. Patients and Methods: Seventy patients were operated on by conventional reconstructive methods (n=70) in our department between 2004 and 2006. These patients served as the control group. Sixty patients had got cranioplasty with individually prepared cranial implants using the CAD/CAM technique (n=60) in 2011 to 2013. The total number of the investigated patient population was n=130. Age distribution of the group varied from 17 to 80. Retrospective neurological and patient care data were collected and compared at the two surgical technique. Results: More precise coverage of the cranial defect and acceptable cosmetic result were achieved in every case operated on with the CAD/CAM surgical technique. The ratio of patients with persistent vegetative-state decreased, and the neurological outcome improved following surgery using the CAD/CAM method. The patient care was easier and rehabilitation procedure was more favourable at the CAD/CAM population. Iatrogenic infection and wound- healing complications were less frequent at the department between 2011 and 2013. The quality of patient care have been improving considerably by regular education and continuous development of nursing standard. Patients need for hospital stay decreased, therefore health economic aspects and cost-benefit ratio improved at the Department of Neurosurgery in the Péterfy Hospital. Conclusion: This study demonstrates an improvement in neurological outcome and easier patient care following CAD/CAM reconstructive surgery of cranial defects in status of normalized intracranial pressure. Results support the extended use of the method in the XXI. Century. ]

Journal of Nursing Theory and Practice

[The treatment of verruca vulgaris combining conservative and cryotherapy]


[Aim of the research: Presenting the combined treatment of and ways of preventing verruca vulgaris (viral wart, simple wart), which is significant considering public health, by the help of general health education according to our own research results. Research and sampling methods: The research was implemented from 1st September, 2014 to 30th June, 2015 in Budapest with 124 patients being treated with verruca vulgaris. The research method is following the treatment, documentation and the analysis of our own research experience. Results: We treated 635 verruca vulgaris of 124 patients combining conservative and cryotherapy. 18,6% of the symptoms recovered after 3-6 weeks; 53,2% of them after 6-9 weeks; and 23,4% of them recovered in 12 weeks; 4,8% of them required further treatment. Conclusions: The optimal treatment of verruca vulgaris is combining conservative and cryotherapy, which is more effective, less painful, and delivers better aesthetic results than monotherapies. ]

Journal of Nursing Theory and Practice

[Nursing care workers to assess job skills calicivirus caused by the accumulation of tasks required hospital infections]


[Introduction: Author presents the results of surveys of knowledge-prepared nurses’ll need to Calicivirus infections at hospitals accumulation, which was conducted in 7 (a mix of invasive and non-invasive track) ward nurses skilled and unskilled workers. Aim of research: to find out which questions need to put the emphasis on nurses hospital hygiene education to subjects of age, prevention and early detection of infections from spreading which is an important part of the hospital wards enteric outbreaks may occur. Research and sampling methods: The research used an anonymous questionnaire method. The survey was conducted between January 04 2016 and whether 29 or not. The target population for the selection of the author of the favored classes of patient care, on which the last 6 years due to Calicivirus outbreak occurred, which was reported in the NNSR database. Results: 158 nurses participated. The obtained results show that nurses have the knowledge and experience to an infection caused by a Calicivirus, but there are also gaps in knowledge, particularly in the event of hospital infections overlapping actions to be taken to curb the epidemic. Conclusion: Keep the enteric infections also with regard to the knowledge acquired basic education level, especially since the hospital departments favor the spread of these infections are due to sanitary facilities shared by the patient’s condition resulting from lower personal hygiene and multi-bed wards. ]

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Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]


[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Clinical Neuroscience

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

VOKÓ Zoltán

[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]