Lege Artis Medicinae

[Communication in hospital]


SEPTEMBER 29, 1993

Lege Artis Medicinae - 1993;3(09)

[The rules of everyday communication apply differently in different situations. If we accept that communication is nothing more than the communication or exchange of information, which takes place in "spaces" of different types and sizes, then when analysing communicative situations we must make the actors involved in communication and the place, i.e. both components, the object of our analysis.]



Further articles in this publication

Lege Artis Medicinae

[Ceftazidime - over ten years in the clinical practice]

SZALKA András, PRINZ Gyula

[This review discusses the principal features of ceftazidime based on the ten years experience since the introduction of the drug in the clinical practice: its broad antibacterial spectrum including Pseudomonas aeruginosa, favourable pharmacokinetics, wide range of indications, excellent clinical efficacy using empiric treatment or elective therapy and safety profile. ]

Lege Artis Medicinae

[What to expect of PTCA today?]


[This article is a review of the changing indications for percutaneous coronary angioplasty during the last decade. The role of revascularisation and especially of PTCA in the treatment of coronary heart disease is explained. Coronarography is the most important morphol gic diagnostic tool for coronary artery disease. The importance of the topic of this article is enhanced by the position of Hungary at the top of morbidity and mortality statistics, and by the infrequency of revascularisation procedures, especially PTCA. PTCA proved to be a real alternative to a surgical procedure in about half of the patients indicated for revascularisation. PTCA is less invasive, requires less time for recovery and is less expensive compared to bypass surgery. This article should draw attention of the family practitioner to the importance of this method. ]

Lege Artis Medicinae

[Myocardial contrast echocardiography]


[Symptoms of ischemic heart disease will occur when myocardial perfusion diminishes below a critical level. Coronarography will disclose the anatomic stenoses, but there is no direct correlation between the grade of stenosis and the change of myocardial perfusion. Myocardial contrast echocardiography is a new technique to analyze the myocardial perfusion. The contrast agent contains micro bubbles which have nearly the same dimensions as red blood cells. The microbubbles increase the „whiteness" of the perfused myocardium during the echocardiographic examinations. The change in „whiteness" of the myocardium correlates with myocardial perfusion. Intracoronary injections delineate the perfusion area of the coronary artery, and Thus the coronary flow reserve and the collateral flow area can be measured. The cardioplegia fluid distribution and the graft perfusion area are examined intraoperatively. Bedside myocardial perfusion studies will be possible through the transpulmonary passage of intravenously injected contrast agents. Myocardial contrast echocardiography can be applied both in the diagnosis and treatment of ischemic heart disease.]

Lege Artis Medicinae

[Randomised assessment of (the effect of) digoxin on inhibition of the angiotensin-converting enzyme study]


[Circulatory failure worsened to the point of discontinuation in 23 patients in the diuretic + ACE inhibitor + placebo only group, compared to only four patients in the digoxin group (p<0.001). The relative odds of worsening circulatory failure with placebo compared with digoxin was 5.9. All measured parameters of functional capacity (maximal exercise capacity, submaximal exercise capacity, NYHA grade) worsened with digoxin withdrawal. Similarly, quality of life (p=0.04), ejection fraction (p=0.001), heart rate (p<0.001) and body weight (p<0.001) decreased with digoxin instead of placebo.]

Lege Artis Medicinae

[Investigation of uterine circulation by transvaginal color doppler in early pregnancy]

SZABÓ István, CSABAY László, NÉMET János, PAPP Zoltán

[The circulatory changes and the characteristics of blood flow in certain uterine vessels can be detected by transvaginal color Doppler in early pregnancy. The uterine circulation of 53 patients with normal intrauterine pregnancies at 4–14 weeks of gestation and 104 non pregnant patients were investigated. The main uterine artery, arcuated and spiral arteries were demonstrated by color Doppler in all patients in early pregnancy and characteristic flow velocity waveforms were obtained in 94% of the cases. The impedance to flow in the main uterine artery was significantly lower and the mean velocity was significantly higher in early pregnancy than in non pregnant patients. The indices of impedance to flow decreased with gestation in the uterine branches and there was a progressive fall in these indices from the uterine artery to the spiral arteries. Mean blood velocity in the uterine artery increased with gestation. The hemodynamical changes which are proportional to gestation age give an indirect evidence of the adequate maternal blood supply for the growing embryo.]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

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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.

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[Dysphagiafelmérések akut stroke-ban]

SZABÓ Pál Tamás, MÛHELYI Viktória, BÉRES-MOLNÁR Katalin Anna, KOVÁCS Andrea, BALOGH Zoltán, FOLYOVICH András

[Stroke associated dysphagia can have serious consequences such as aspiration pneumonia. The Hungarian guideline on nutritional therapy for stroke patients recommends dysphagia assessment, as early screening can optimize disease outcome and hospital cost. Thus far, this may be the first study in Hungarian that has documented a systematic review about the available validated dysphagia assessments of acute stroke. Purpose – The aim of this study was to summarize the instrumentally validated bedside dysphagia screening tools for acute stroke patients, which were published in the last twenty years. Our objective was to describe the characteristics of the validation studies, examine their study design, and sample the sub-tests and the diagnostic accuracy of the assessments. A systematic research was carried out of the literature between 2001 and 2021 in eight scientific databases with search terms appropriate to our objectives. Subjects of the study – 652 articles were found and were reduced to eight. We made a comparative analysis of these. The GUSS test reached a high level of sensitivity compared to the others. In our study sample, the prevalence of instrumentally confirmed dysphagia among acute stroke patients was 56.1%. The focus and the composition of the analyzed studies differed and posed problems such as the ambiguity of the concept of dysphagia, the difference in outcome indicators, or the timing of screening. The GUSS test, which offers domestic management, is a suitable tool for the Hungarian clinical use.]

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Capability of stroke scales to detect large vessel occlusion in acute ischemic stroke – a pilot study

TÁRKÁNYI Gábor, KARÁDI Nozomi Zsófia, CSÉCSEI Péter, BOSNYÁK Edit, FEHÉR Gergely, MOLNÁR Tihamér, SZAPÁRY László

Rapid changes of stroke management in recent years facilitate the need for accurate and easy-to-use screening methods for early detection of large vessel occlusion (LVO) in acute ischemic stroke (AIS). Our aim was to evaluate the ability of various stroke scales to discriminate an LVO in AIS. We have performed a cross-sectional, observational study based on a registry of consecutive patients with first ever AIS admitted up to 4.5 hours after symptom onset to a comprehensive stroke centre. The diagnostic capability of 14 stroke scales were investigated using receiver operating characteristic (ROC) analysis. Area under the curve (AUC) values of NIHSS, modified NIHSS, shortened NIHSS-EMS, sNIHSS-8, sNIHSS-5 and Rapid Arterial Occlusion Evaluation (RACE) scales were among the highest (>0.800 respectively). A total of 6 scales had cut-off values providing at least 80% specificity and 50% sensitivity, and 5 scales had cut-off values with at least 70% specificity and 75% sensitivity. Certain stroke scales may be suitable for discriminating an LVO in AIS. The NIHSS and modified NIHSS are primarily suitable for use in hospital settings. However, sNIHSS-EMS, sNIHSS-8, sNIHSS-5, RACE and 3-Item Stroke Scale (3I-SS) are easier to perform and interpret, hence their use may be more advantageous in the prehospital setting. Prospective (prehospital) validation of these scales could be the scope of future studies.