Journal of Nursing Theory and Practice

[Pearls of Nursing History: Remembering Mary Seacole]

VITTAY Fedineczné Katalin, PERKÓ Magdolna, SÖVÉNYI Ferencné

AUGUST 30, 2017

Journal of Nursing Theory and Practice - 2017;30(04)

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Journal of Nursing Theory and Practice

[How to break medical bad news? The importance of the course for breaking medical bad news and an evaluation of his curriculum]

MÁTÉ Orsolya, PUSZTAFALVI Henriette, BRANTMÜLLER Éva

[Breaking bad news to patients is a difficult task for health care professionals and there are many unsolved issues in this area. There are several ways of delivering bad news and the quality of the communication could affect the whole life of the patient. However the wrongly delivered bit of bad news could not only cause a crisis for the recipient but will create a stressful situation for the communicator. The course created at the University of Pécs, Faculty of Health Sciences is specified to the delivery of bad news with modern communication methods, which uses video feedback method to analyse and develop the participants’ communicational attitude, thus providing potent aid for the acquisition of the proper communicational techniques, from which both the patient and the care giver can profit.]

Journal of Nursing Theory and Practice

[The importance of serum albumin level in patients with chronic renal disease on maintenance dialysis]

TÓTH Csitkovicsné Tünde, SZAKÁCS Gyuláné, KULCSÁR Imre

[The aim of the study: Evaluation of changes in serum albumin levels and their effects on mortality in chronic haemodialyzed (HD) population. Material and Methods: We analysed the serum albumin values and survival in 253 HD patients, in a retrospective observational study. Data were analyzed using Spearman-correlation, Cox-modell, endpoint analysis and Kaplan-meier analysis. Results: We did not find any significant correlation between serum albumin levels and gender or basic diseases, but the median serum albumin level was lower in patients with ages 65 years or older than in younger ones, and had decreased until observational period (5.4±3.0 years). Lower the serum albumin level the risk of mortality was higher (if the serum albumin level was <35 g/L versus >40 g/L), the HR was 5.69. Conclusions: The serum albumin level is a main indicator of the nutrition in dialyzed patients, but the target level would be different in older and younger patients. The serious malnutrition (lower serum albumin level) increases the risk of mortality in haemodialyzed patients.]

Journal of Nursing Theory and Practice

[Report of the 5th ETNA Conference]

PAPP Katalin

Journal of Nursing Theory and Practice

[Workplace conflicts in health care]

IRINYI Tamás, LAMPEK Kinga, NÉMETH Anikó

[Health care requires the cooperation of many professions and often comes with stressful situations. Therefore conflicts might develop among health care providers more frequently. Moreover the staff is interdependent, which might be another source of conflicts. This phenomenon not only affects the crossing parties, but also triggers emotional changes in the individuals (anger, stress and negative emotions) and has long term consequences, too (medical malpractice, fluctuation, sick leaves, discontent patients and bad reputation of the institution). All these can have financial effects, e.g. law costs. The present publication discusses the different definitions of conflicts and explains their reasons and types. This article has a special focus on health-care team conflicts, their consequences and the possible management methods.]

Journal of Nursing Theory and Practice

[The role of a weekly geriatric exercise programme in successful aging]

KOVÁCS Éva, VIRÁG Anikó, DUDÁS Flóra, ERDŐS Réka, PETRIDISZ Anna Niké, ROZS Franciska

[Objective: The aim of this retrospective study was to examine the effects of a weekly held group multicomponent exercise programme (consisting of aerobic, strengthening, flexibiliy, and balance exercises) on the functional abilities (muscle strength, walking speed, and static balance) among elderly people. Methods: Thirty eight older people were divided into two groups: the active group for those elderly who took part is the training for at least 2 years, and the inactive group for those who did not take part in the training before. The global muscle strength in the lower extremity was measured with the 5 sit-to-tand test, the walking speed was measured with the 4 meters walking test. To examine the static balance, we used the one-leg stance test. To determine the subjective well-being, a Visual Analog Scale was used. Results: The Active group was significantly better in 5 sit-to-tand test (t(36)=2,602; p=0,013; Cohen’d=0,99), and marginally significant difference was found in the 4 meters walking test (t(36)= 1,769; p=0,085; Cohen’d=0,66) to the benefit of the Active group. In the term of static balance, we could not find significant difference. Conclusions: This programme for elderly people is effective to improve the global lower limb muscle strenght and walking speed of the elderly, but not very effective in improving static balance.]

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Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Clinical Neuroscience

Simultaneous subdural, subarachnoideal and intracerebral haemorrhage after rupture of a peripheral middle cerebral artery aneurysm

BÉRES-MOLNÁR Anna Katalin, FOLYOVICH András, SZLOBODA Péter, SZENDREY-KISS Zsolt, BERECZKI Dániel, BAKOS Mária, VÁRALLYAY György, SZABÓ Huba, NYÁRI István

The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo­gical examination excluded mycotic etiology of the aneu­rysm and “normal aneurysm wall” was described. The brain stem haemorrhage – Duret bleeding – was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.

Clinical Neuroscience

Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.

Clinical Neuroscience

[Zonisamide: one of the first-line antiepileptic drugs in focal epilepsy ]

JANSZKY József, HORVÁTH Réka, KOMOLY Sámuel

[Chronic administration of antiepileptic drugs without history of unprovoked epileptic seizures are not recommended for epilepsy prophylaxis. Conversely, if the patient suffered the first unprovoked seizure, then the presence of epileptiform discharges on the EEG, focal neurological signs, and the presence of epileptogenic lesion on the MRI are risk factors for a second seizure (such as for the development of epilepsy). Without these risk factors, the chance of a second seizure is about 25-30%, while the presence of these risk factors (for example signs of previous stroke, neurotrauma, or encephalitis on the MRI) can predict >70% seizure recurrence. Thus the International League Against Epilepsy (ILAE) re-defined the term ’epilepsy’ which can be diagnosed even after the first seizure, if the risk of seizure recurrence is high. According to this definition, we can start antiepileptic drug therapy after a single unprovoked seizure. There are four antiepileptic drugs which has the highest evidence (level „A”) as first-line initial monotherapy for treating newly diagnosed epilepsy. These are: carbamazepine, phenytoin, levetiracetam, and zonisamide (ZNS). The present review focuses on the ZNS. Beacuse ZNS can be administrated once a day, it is an optimal drug for maintaining patient’s compliance and for those patients who have a high risk for developing a non-compliance (for example teenagers and young adults). Due to the low interaction potential, ZNS treatment is safe and effective in treating epilepsy of elderly people. ZNS is an ideal drug in epilepsy accompanied by obesity, because ZNS has a weight loss effect, especially in obese patients.]

Clinical Neuroscience

Isolated hypoglossal nerve palsy due to a jugular foramen schwannoma

ÖZTOP-CAKMAK Özgür, VANLI-YAVUZ Ebru, AYGÜN Serhat, BASTAN Birgül, EGEMEN Emrah, SOLAROGLU Ihsan, GURSOY-OZDEMIR Yesemin

Introduction – Although the involvement of the hypoglossal nerve together with other cranial nerves is common in several pathological conditions of the brain, particularly the brainstem, isolated hypoglossal nerve palsy is a rare condition and a diagnostic challenge. Case presentation – The presented patient arrived to the hospital with a history of slurred speech and an uncomfortable sensation on his tongue. Neurological examination showed left-sided hemiatrophy of the tongue with fasciculations and deviation towards the left side during protrusion. Based on the clinical and MRI findings, a diagnosis of hypoglossal nerve schwannoma was made. Discussion – Hypoglossal nerve palsy may arise from multiple causes such as trauma, infections, neoplasms, and endocrine, autoimmune and vascular pathologies. In our case, the isolated involvement of the hypoglossal nerve was at the skull base segment, where the damage to the hypoglossal nerve may occur mostly due to metastasis, nasopharyngeal carcinomas, nerve sheath tumors and glomus tumors. Conclusion – Because of the complexity of the region’s anatomy, the patient diagnosed with hypoglossal nerve schwannoma was referred for gamma knife radiosurgery.