Journal of Nursing Theory and Practice

[Ethical Codex of the Chamber of Hungarian Healthcare Professionals]

APRIL 30, 2012

Journal of Nursing Theory and Practice - 2012;25(01)

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Journal of Nursing Theory and Practice

[Current issues in geriatric care from a nursing perspective at certain patient wards of Sárvár Municipal Hospital ]

BARTA Katalin, RAJKI Veronika

[Aim of the study: The authors aim is to identify differences in the aspects of nursing at rehabilitation, chronic internal medicine and nursing departments, and to assess the characteristics and personality traits regarded as essential by the specialist nurses participating in the survey, as well as to identify the factors and causes named by patients as leading to an improvement in their satisfaction and comfort. Sample and method: The survey was performed in three departments of the Sárvár Municipal Hospital (chronic internal medicine, nursing and rehabilitation), and involved the specialist nurses working in the departments and the patients of the three departments. The questionnaire-based surveys were conducted both among the paramedical workers and the patients. The results and correlations were examined using descriptive statistical methods. Results: It can be concluded from the survey of the patients that a high proportion of them (42%) are admitted to the nursing department on the basis of social considerations. The opinions of patients at the individual departments differ significantly with regard to the skill of the nurses and the necessity of increasing the nurse headcount. The most important conclusions of the survey of the workers include the findings that the self-assessment of their own knowledge by workers at the surveyed departments is relatively low; a significant proportion of the nurses would like to see an increase in the number of paramedical workers; and verbal ward handovers are still overly preferred among nurses, rather than the use of nursing documentation. Conclusions: Nurses working the field of rehabilitation need to be prepared for the new tasks emerging as a result of the increasingly marked demographic changes. For this, a strengthening of the rehabilitation-oriented approach is essential. ]

Journal of Nursing Theory and Practice

[The process of patient admission and triage, and nursing competencies in the Emergency department ]

PÁPAI Tibor

[A key factor in the successful and efficient operation of any emergency department is the rapid and precise classification of patients, following a preliminary examination, for the purpose of determining the order in which to provide treatment. A prerequisite for applying this procedure is the satisfactory regulation of the process, which also involves the appropriate management of human resources, the provision of training, the clear definition of competencies, and management of patient careers. The author introduces the triage process suitable for application at emergency wards in Hungary, through adaptation of the Canadian Triage and Acuity Scale. ]

Journal of Nursing Theory and Practice

[New nursing tasks in the Children’s Heart Centre]

VINCZE Beatrix

[The Children’s Heart Centre began operation in the Gottsegen György Hungarian Institute of Cardiology in 1999. In response to the technical advancements of the recent period and the achievements of medical science, paramedical workers are faced with new tasks such as the care of children undergoing interventional cardiology, ablative intervention and treatment as a part of the heart transplant program. The nurses and assistants assimilate the skills set necessary for performing the new tasks through in-house education programs and further training courses. An important challenge for nursing management is incorporating the changes into the operating procedures of the departments, and ensuring the human resources necessary to provide the care. The author’s aim is to give an insight into these specialist nursing tasks. ]

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Clinical Neuroscience

[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]

Clinical Neuroscience

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Clinical Neuroscience

[SELYE’S CONCEPT OF PLURICAUSAL DISEASES AND ITS IMPACT ON REGULATORY SCIENCE]

SOMOGYI Árpád

[Science assumed in recent decades an increasingly important role in the regulatory field. Regulatory science is now regarded as established specific brunch of science. A disturbing anomaly, the emergence of fraudulent data is of major concern both in the field of research and in the regulation. Hans Selye’s work on stress, on several forms of pluricausal diseases and on other experimental models came into the focus of interest on the occasion of the Selye Symposium - 2013 held in May 2013 at the Hungarian Academy of Sciences in Budapest.]

Clinical Oncology

[First-line treatment of epithelial ovarian cancer]

RÉVÉSZ János, SZÁNTHÓ András

[The restructuration of Hungarian oncological attendance and medicinal fi nancing resulted in the more intensive participation of clinical oncologists in the therapy of patients with ovarian cancer. The aim of the authors was not to defi ne the taxative therapeutic recommendations, but to give an overview on the development of the therapy and to introduce the deliberation aspects and therapeutic alternatives. While the primary and secondary prevention have developed in case of cervical cancer - with the possibility of eradication - the improvement of surgical techniques and clinical oncological treatments may result in the decrease of mortality in ovarian cancer. It is important to emphasis that only the appropriately aligned application of the two therapeutic modalities can lead to the desired outcome. It has become clear by the end of the ‘90s, that paclitaxel-carboplatin combination is the standard chemotherapy against ovarian cancer. Alternative cytostatic treatments like intraperitoneal treatment and triplets were not breakthroughs. The dose intensive treatment increased the survival rates besides good tolerability, however the results require further confi rmation. Neoadjuvant therapy should be considered in case of patients with advanced and metastatic disease in selected cases. Recently, therapeutic use of angiogenesis inhibition comes with signifi cant improvement. Bevacizumab is the fi rst of targeted therapies, and studies on the effectiveness of similar compounds are under way.]

Lege Artis Medicinae

[In vitro efficiency of doripenem, a new carbapenem against Gram-negative, aerob, problem bacteria - Prospective, multicentric, Hungarian study]

NAGY Erzsébet, SAQQA Muhammad, SZABÓ Judit, MESTYÁN Gyula, SZIKRA Lenke, KONKOLY THEGE Marianne

[INTRODUCTION - Doripenem is a new carbapenem derivative, it’s chemical structure is similar to that of meropenem (substitution of one sulfamoxil-aminomethyl chain for the dimethylcarboxy chain) and has one 1-beta-methyl chain which provides resistance to dyhidropeptidase-I enzyme produced by the human kidney. It has a broad-spectrum of activity against multiresistant Gram-negative bacilli such as ESBL-producing Enterobacteriaceae and non-fermentative Gramnegativ bacilli including some strains of Pseudomonas aeruginosa that are resistant to other carbapenems. In 2010 between February and June a multi-centre comparative study was carried out including 5 Hungarian laboratories to investigate the in vitro activity of doripenem. MATERIAL AND METHODS - 1000 fresh, clinically relevant isolates were included both ESBLproducing and non-producing Enterobacteriaceae strains and resistant and multi-resistant Pseudomonas aeruginosa and Acinetobacter strains. The activity of doripenem and the comparator antibiotics (other carbapenems) were tested by the disc diffusion method. In the case of intermediate resistant strains the MIC of doripenem was also determined by the E-test methodology. RESULTS - All but one isolate belonging to the Enterobacteriaceae (592 isolates) were fully susceptible to doripenem. The only Enterobacter strain which proved to be intermediately susceptible to doripenem by the disc diffusion method was also found to be susceptible showing an MIC of 0.125 μg/ml. In the case of the 163 Pseudomonas aeruginosa and the 121 Acinetobacter spp isolates doripenem was the most active carbapenem compared with imipenem and meropenem (78.6% and 50.5% for doripenem versus 67.5% and 42.0% for imipenem and 68.7% and 30.2% for meropenem, respectively). CONCLUSION - According to our multi-centre study doripenem was highly active against both the ESBL-producing and ESBL-non-producing Enterobacteriaceae strains and against a great part of the Pseudomonas and Acinetobacter isolates often involved in nosocomial infections.]