Journal of Nursing Theory and Practice

[The significance of post-reanimation treatment using therapeutic hypothermia in the intensive care ward]


FEBRUARY 28, 2015

Journal of Nursing Theory and Practice - 2015;28(01)

[Aim of the research: To assess the significance of applying therapeutic hypothermia (TH) in order to prevent cerebral neurologic damage following cardiopulmonary resuscitation (CPR). Research and sampling methods: Retrospective and quantitative research, applying stratified, not random sampling. The research was conducted by analysing medical and clinical nurse documentation, using direct data collection. The total number of patients (n) referred to the intensive care ward of county hospital due to prolonged life support (PLS) during the two different years was 68. In 2005, the number of patients (n) not receiving TH was 28 whereas in 2010 the number of patients who did receive TH was 29 and the number of those who did not receive TH in the same year was 11. Results: Comparing the research results of the two patient groups, it can be concluded that the patients who received TH in 2010 left the intensive care ward with better neurological function, no significant difference. PLS carried out with full body cooling proved to be more effective by decreasing hypoxic damage in the brain tissue, in consequence of which better neurological results are expectable. Conclusion: the application of TH is necessary following CPRs when the patient remains unconscious even after regaining spontaneous circulation. In everyday practice of intensive care wards, TH should be applied as per standard protocol. All clinical nurse staff should be aware of the cooling techniques and of the use the necessary medical equipment. Practical application and the earliest possible start of TH can be done more effectively by improving the nurses’ relevant knowledge, providing higher financial support and expanding the circle of medical equipment. ]



Further articles in this publication

Journal of Nursing Theory and Practice

[Value research of students in the patient care sector. Research carried out in a vocational secondary school]


[Aim of the study: Mapping out the value system, the professional motivation and the socio-cultural background of care provider students at the Zsuzsanna Kossuth Vocational Secondary School Sample and methods: Descriptive type research, number of elements 169 (n=169). The data was synthesized with Microsoft Office Excel 2007. Results: Taking into consideration the influence of the parents’ educational and professional background it can be stated that the parents’s influence gains control of their children’s school choice. In every analyzed group students are backed by strong family support. Regarding their career choice most students were motivated by the desire to help people. Graduate students demonstrate a more consistent career choice than younger students. The most important values of the care provider career proved to be: professional knowledge, know-how, responsibility and precision. An increase in career values related to age has not been demonstrated. Conclusions: It is very important to know the students’s value system because the values gained in the family and at school play a determining role in the care providers’s job. ]

Journal of Nursing Theory and Practice

[Knowledge on elderly home care residents’ rights among caregivers and nurses körében]


[Aim of the study: To survey the awareness of carers and nurses regarding to patients’ rights as outlined in Act III of 1993 and Act CLIV of 1997, regulating welfare management, welfare services and health care. Sample and methods: The survey was conducted with the means of data collection with questionnaires, analysis of documents and statistical methods. The Survey was conducted in December 2013 and January 2014. The sample of respondents consisted of the carers and nurses of the Gödöllő unit of the Budapest Metropolitan Home for the Elderly. The analysis of the document aimed to introduce the of the house rules of the Home. The author used SPSS 22 statistical software to analyse the data collected with questionnaires. A chi squared test was employed to investigate the relations between the descriptive statistical methods and variables. Results: The knowledge of carers and nurses have deficiencies in the area of patients’ rights. They are more familiar with the rights provided for by the welfare act, as the majority of the workers have worked in the welfare area for a long time, and, in the course of their work have become aware of the rights described by the act in question. Conclusions: as the workers had no possibility to familiarise themselves with the patients’ rights during their education, the Home is to provide the workers with adequate training to make up for the above mentioned lack of knowledge. ]

Journal of Nursing Theory and Practice

[The founder of industrial nurse training in Hungary, Maria Baloghy was born 120 years ago]

HIRDI Henriett Éva

[Maria Baloghy, founder of industrial nurse training in Hungary, was born 120 years ago at Košice. This short paper intends to commemorate her merits, which remained valid even after long decades after her death]

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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.

Hypertension and nephrology

[About the care of patients with hyperuricaemia and gout]

[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]

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

The etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis

ALTAY Servet, GÜRDOGAN Muhammet, KAYA Caglar, KARDAS Fatih, ZEYBEY Utku, CAKIR Burcu, EBIK Mustafa, DEMIR Melik

Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

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.