[Brave new world?]
KAPÓCS Gábor
MARCH 26, 2024
Lege Artis Medicinae - 2024;34(3)
KAPÓCS Gábor
MARCH 26, 2024
Lege Artis Medicinae - 2024;34(3)
Szöveg nagyítása:
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Lege Artis Medicinae
[After a serious brain injury or trauma, there is damaged the functional capacity of the affected persons and their self-image too. Traditional rehabilitation pays little attention to the female patients’ lost femininity. The aim of this study was to present the way of supporting women to realize again their femininity psychologically and physically alike after a brain injury.
In the Brain Injury Rehabilitation Unit of the National Institute for Medical Rehabilitation, the authors completed the female patients’ rehabilitation with special group sessions once a week. The topics were tailored to the needs of participants. There were targeted two specific objectives: achieving to perceive femininity in an autonomous way and regaining the feeling of femininity in the changed life circumstances due to the injury.
Occupational therapist, physiotherapists and nurses provided service to develop functional abilities. A psychologist helped the participants in trauma processing. Since the beginning in January 2022, two therapy cycles have been completed so far, each of which with 10-12 sessions. A total of 31 female patients and 8 supporting team members participated in these two groups so far.
Personalised rehabilitation was adjusted to the involved persons’ life circumstances, individuality, personality, family and social relations. Our experimental female group helped the participants to experience their femininity physically, mentally and psychologically too, according to their feedback.]
Lege Artis Medicinae
[Indication for recanalization therapy of acute ischemic stroke is based on imaging procedures. In order to minimize the time loss passing by recognizing the condition and the transfer of images to other facility, we established a stroke imaging network (eStroke network) supported by Artificial Intelligence (AI) in Hungary. Our study aims to present this system.
Organized by the National Institute of Mental Health, Neurology, and Neurosurgery (NIMNN), we included a total of 28 stroke centers, among them 4 thrombectomy centers. An earlier network of the University of Pécs and the widened network parallel with the NIMNN project cover 10 centers thus the service is now available in 38 stroke centers of this country. Stroke CT scans are automatically transmitted via the central teleradiology server to a central image processing server which analyzes the size of the ischemic area (ASPECT score), detects large vessel occlusion and it’s localization, analyzes the quality of collateral circulation and standard CT perfusion parameters using an AI based software (eStroke, Brainomix Ltd.). Results and processed images are sent automatically back to the PACS system of the sending institution and that of the concerning thrombectomy center and become available in anonymous form via cloud by desktop computers or mobile application.
During the first year of operation, the system has processed 38,060 scans of 16,276 patients. In NIMNN experience by samples of 65 and 152 cases, for drip and ship patients the time from the first alerting of the ambulance service, until arrival at the thrombectomy center was reduced by 38 minutes from 4:18 to 3:40 minutes.
Building an AI based central stroke imaging network for improving of stroke care’s results is technically feasible. Operation of the eStroke system is capable of reducing patient transportation times, however, further optimization is needed. ]
Lege Artis Medicinae
[Migraine is a headache disorder affecting 14% of general population, being even more prevalent (20%) among women in the 20–64 age group, who are actively working and are mainly at reproductive age. 18–25% of migrainous women have an attack related to menstrual cycle, 7% of them having an attack only at this period. Fluctuation of estrogen level may be responsible for these attacks, we can use NSAIDs, slowly acting triptans or progestin-only treatment as short-term prophylaxis. Hormonal contraception is not contraindicated in migraine. Combined (estrogen+progestin) treatment is proposed only in migraine without aura, but in case of more frequent and/or severe attacks or the appearence of an aura treatment should be stopped. In migraineurs with elevated risk of stroke combined hormonal contraception should be used with caution. In migraine with aura patients progestin-only contraception is possible. During pregnancy in 55–91% of migraineus women attacks disappear or are less severe. In most cases migraine with aura attacks occur during this period. Non-pharmacological treatments should be considered as first in the treatment off attacks, with consideration of risk/benefit ratio paracetamol, metamizol or triptans may be used. With the menopause in 2/3 of patients migraine gets better but because of the fluctuation of hormon levels it can be worse than before. Hormonal replacement therapy is not contraindicated in migrainous women but it can result in worsening of migraine. ]
Lege Artis Medicinae
[Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia that can lead to thromboembolic events, including cerebral vascular catastrophe and peripheral embolization. AF treatment while managing directly the arrhythmia aims anticoagulation therapy and prevention of thromboembolic events too.
This study overviews the factors influencing the risk of bleeding while managing AF, and focuses especially on appropriate anticoagulant choice, its tailored use to patient characteristics, management of comorbidities and strategies of reducing risks of bleeding.
This analysis compares the efficacy and safety of specific anticoagulants (VKA, DOAC) while considering the patient characteristics such as renal function and comorbidities in anticoagulation treatment.
The risk of bleeding can be reduced by appropriate anticoagulant choice and its patient-specific administration. Consideration of comorbidities is a key issue to ensure safe and effective treatment. VKA requires maintenance of stable INR values, while DOACs lead to fewer major bleeding events. For planned and emergency interventions, the use of bleeding risk reduction strategies is also important. Consideration of patient characteristics, such as renal function and comorbidities, as well as appropriate anticoagulant choice and use are essential to ensure efficient and safe anticoagulation therapy.
]
Lege Artis Medicinae
[
Chronic thromboembolic pulmonary hypertension (CTEPH) is a vascular disease associated with pulmonary artery thrombosis, which causes changed flow patterns and remodeling of pulmonary blood vessels. CTEPH is a rare long-term complication of pulmonary embolism the cumulative incidence of which ranges between 0.1-9.1 in symptomatic patients. Early sign is the effort dyspnoea, later are dominating the right heart failure symptoms, and rarely the syncope.
CTEPH should be suspected if there are emerging signs of chronic pulmonary artery thrombosis and echocardiography indicates symptoms of pulmonary hypertension. Demonstrating thrombosis V/Q scan, CT angiography or pulmonary angiography can be performed and in case of pulmonary hypertension right heart catheterisation. The modern approach to CTEPH treatment is a multimodality strategy. Pulmonary thromboendarterectomy is the first treatment of choice, but if the patient is not suitable for surgery, or he/she has chronic thromboembolic pulmonary hypertension, balloon pulmonary angioplasty and/or drug therapy should be considered. Treatment of chronic thromboembolic pulmonary hypertension patients is recommended in a CTEPH program center.]
Clinical Neuroscience
Atrial fibrilla- tion diagnosed after stroke (AFDAS) is a new term used for AF resulting from autonomic dysregulation. It is associated with a lower stroke recurrence compared to patients with known AF before a stroke (KAF). The aim of the study was to explore the characteristics and mortality rates in AFDAS patients. 134 ischemic stroke patients (66.1±14.2 years old, n=73 male) were consecutively included in the study.
Clinical Neuroscience
Parkinson’s disease (PD) is a heterogeneous neurodegenerative disorder characterized by contradictory clinical outcomes among its several subtypes. The disease can manifest with a tremor-dominant (TD) or a non-tremor-dominant (NTD) phenotype. Although the TD subtype may show a better prognosis, there is limited information on the phenotypic differences regarding the level of axial symptoms. For this reason, in this study it was aimed to make a quantitative comparison of axial posture and spinal mobility between PD with TD and NTD.
Journal of Nursing Theory and Practice
[Educational programs play a key role in managing the educational process. They contain important and useful information for training institutions, instructors and students, for organizing and conducting training. This issue is of particular importance nowadays, as the strengthening of the autonomy of vocational training institutions and the end of the compulsory nature of the program curricula present new challenges to schools. Based on the regulations, vocational training institutions must independently develop their training programs (of which the educational program is a part) based on the training and output requirements (KKK) and can no longer rely on the guidelines of the centrally issued program curricula (PTT).
The following summary study reviews methods and approaches that can assist educators in creating quality nursing education programs.]
Journal of Nursing Theory and Practice
[In the field of wound care, the standard treatment these days is moist wound healing. Numerous advantages of this approach can be found in various studies. In cases of burn injuries, we also prefer this approach in order to provide an optimal wound environment, avoiding scab formation, crust formation, and scar formation. One excellent dressing for moist wound healing is a unique dressing containing PHMB in the world of dressings. It has numerous beneficial properties that can be used in burn injuries, but we have also bravely experimented with the dressing in other areas of wound healing. Currently, I would like to share my experiences related to burn injuries through case studies.]
1.
Clinical Neuroscience
Is there any difference in mortality rates of atrial fibrillation detected before or after ischemic stroke?2.
Clinical Neuroscience
Factors influencing the level of stigma in Parkinson’s disease in western Turkey3.
Clinical Neuroscience
Neuropathic pain and mood disorders in earthquake survivors with peripheral nerve injuries4.
Journal of Nursing Theory and Practice
[Correlations of Sarcopenia, Frailty, Falls and Social Isolation – A Literature Review in the Light of Swedish Statistics]5.
Clinical Neuroscience
[Comparison of pain intensity measurements among patients with low-back pain]1.
Clinical Neuroscience Proceedings
[A Magyar Stroke Társaság XVIII. Kongresszusa és a Magyar Neuroszonológiai Társaság XV. Konferenciája. Absztraktfüzet]2.
3.
Journal of Nursing Theory and Practice
[A selection of the entries submitted to the literary contest "Honorable mission: the joys and challenges of our profession" ]4.
Journal of Nursing Theory and Practice
[End of Life and Palliative Care of Newborns in the Nursing Context]5.
Journal of Nursing Theory and Practice
[Aspects of Occupational Health Nursing for Incurable Patients ]