Lege Artis Medicinae

[A model for a separate comprehensive insurance sector within the OTF]

APRIL 28, 1993

Lege Artis Medicinae - 1993;3(04)

[In order to ensure a smooth transition to the new organisational model, the OTF should and can take action in the following areas:]

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Lege Artis Medicinae

[Value of laboratory tests in alcohol abuse and alcoholic organ injuries]

NEMESÁNSZKY Elemér, JUHÁSZ Péter

[Alcohol has a toxic effect on the whole body. Alcohol abuse must be considered as one of the risk-factors to be able to challenge a broad spectrum of organ injuries. Chronic alcoholism, however, is a disease. In order to take preventive measures and to discover the early stages of organ damage caused by alcohol abuse, it is important to conduct those laboratory tests which can help to reveal the under Tyingetiology. With regular alcohol intake, the activity of serum enzymes (GGT, SGOT) and the SGOT/SGPT-index become elevated and the mean corpuscular volume of red cells (MCV) will increase. On the basis of their own experiences and supported by data found in the literature, the authors point out that regular alcohol intake cannot be proved by a single test. To enhance the specificity as well as the sensitivity of the laboratory tests, a combination of parameters must be obtained and tests should be repeated after a certain abstention period.]

Lege Artis Medicinae

[Alcohol induced specific cardiomyopathy]

TÁTRAI Tihamér

[Alcoholic cardiomyopathy represents a serious public health problem in Hungary. The author describes the diagnostic criteria and three clinical types: Vitamin B, deficiency, arrhythmic form and congestive alcoholic heart disease. The importance of arrhythmias is emphasized with regard to pathogenesis and clinical features. Non-invasive and invasive diagnostic methods are discussed. The latest therapeutic possibilities are discussed, but emphasis is placed on the importance of prevention.]

Lege Artis Medicinae

[The nomenclature of morphogenetic anomalies]

ÁDÁM Zsolt, PAPP Csaba, TÓTH-PÁL Ernő, PAPP Zoltán

[In spite of the unifying intentions on the nomenclature of congenital anomalies the problem is still considered to be unsolved internationally. Contradictions among each classifications are mainly based on the different viewpoints of practice and scientific researchers. The authors present here a proposition of nomenclature that fits the recommendations of the major international scientific committees but, as a synthesis, they are trying to give a role to etiopathogenesis as well as clinical presentation of congenital abnormalities in their classification. They intended to make this classification to give a proper nomenclature to everyday practice and scientific research work, too.]

Lege Artis Medicinae

[Position of the College of Respiratory Medicine on the care and screening of people with chronic pulmonary diseases]

[The Professional College, on the recommendation of the Epidemiology and Care Section of the Society of Lung Physicians, discussed the above topic at its meeting on 5 February 1993. After a lengthy discussion, and after the clash of opposing views, a compromise resolution was reached, summarised in the following points.]

Lege Artis Medicinae

[Pro-urokinase in myocardial infarction trial]

MATOS Lajos

[The patency of the vessel leading to infarction at 60 min was 71.8% in the rscu-PA group and 48% in the streptokinase-treated group (p < 0.001). At 90 min, the same values were 71.2% and 63.9%, respectively (p = 0.15). Between 24 and 36 h, reocclusion of the vessel occurred in 6/121 cases treated with rscu-PA and 5/114 cases treated with streptokinase. At the end of thrombolytic treatment, fibrinogen concentrations decreased to 0.44 g/l for rscu-PA injection and 0.17 g/l for streptokinase administration. The incidence of bleeding complications was significantly lower after rscu-PA treatment than after streptokinase (p<0.01).]

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[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

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[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. ]

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

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[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. ]

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