Lege Artis Medicinae

[Friedrich Schiller – a Physician or a Poet Prince?]

BECHER Péter, PATAI Árpád, MÁJER Katalin

AUGUST 20, 2010

Lege Artis Medicinae - 2010;20(08)

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Lege Artis Medicinae

[Variations to the Kreutzer Sonata – Leo Tolstoy Passed Away 100 Years Ago]

KISS László

Lege Artis Medicinae

[A chance to concretize the teratogenic risk: healthy babies born to mother with isotretinoin treatment during pregnancy]

TIMMERMANN Gábor, KONDÉR Béla, GIDAI János, CZEIZEL Endre

[The teratogenic risk means the probability of the occurrence of congenital abnormalities in fetuses after the exposure of teratogenic agents, mainly drugs during pregnancy. The recent highresolution ultrasound scanning may help us to concretize this teratogenic risk. The Genetic, Teratogenic and Family Planning Counseling Clinic of the authors in Budapest were visited by 10,557 couples or client between 1998 and 2007. Ten pregnant women visited this Clinic due to the isotretinoin (Roaccutan) treatment during pregnancy during the 10 years study period. At present Roaccutan is the most teratogenic drug among the medicinal products in Hungary because its teratogenic risk is 25% for a characteristic pattern of congenital abnormality syndrome including a/microtia, ventriculomegaly and contruncal cardiovascular malformation. These fetal defects are detectable by the high-resolution ultrasound scanning between 18th and 20th gestational week of pregnant women. Thus this examination was recommended for the 10 pregnant women with unintended use of isotretinoin (Roaccutan ) in early pregnancy. Six pregnant women followed our advice and the repeated ultrasound scanning was not able to detect the above-mentioned characteristic defects and all the 6 newborns were healthy after birth. In conclusion the recent highresolution ultrasound examination provides a chance for the diagnosis of certain fetal defect between 18th and 20th gestational week of pregnant women. The Hungarian law allows these pregnant women to decide the termination of pregnancy until 20th (24th) gestational week after the diagnosis of severe fetal defects. However, this approach can protect the life of the major part of fetuses in pregnant women at high risk.]

Lege Artis Medicinae

[Shall we save?]

KIS János Tibor

Lege Artis Medicinae

[Tiotropium as a first maintenance drug in COPD: secondary analysis of the UPLIFT trial]

BALIKÓ Zoltán

Lege Artis Medicinae

[On the safety of angiotensin-receptor blockers - A new attack on this drug class]

FARSANG Csaba

[Up until now, angiotensin-receptor blockers have been considered to be the safest cardio-, cerebro-, reno- and vasculoprotective drugs. In a previous metaanalysis, ARBs were accused of increasing the risk of myocardial infarction, but a number of metaanalyses and randomised, controlled trials have disproved this hypothesis. In a recent metaanalysis, ARBs were associated with an increased risk of tumours. The author reviews this issue, discusses the flaws of the above metaanalysis and, on the basis of the most up-to-date data in the literature, expert opinions and official statements (FDA, EMA), concludes that members of this drug class should continue to be used according to their approved indications, which is supported by their cardio-, reno-, cerebro- and vasculoprotective effects demonstrated in a number of appropriate, large-scale clinical studies.]

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Lege Artis Medicinae

[Committed physicians, emotional resonance for a better physician-patient relationship]

LAZÁNYI Kornélia, SZLUHA Kornélia

[With the advent of holistic medicine in the second half of the 20th century, the range of behavioural patterns that are expected from healthcare workers has also changed. Nowadays, numerous references in literature put emphasis on the potential positive impact of personal interactions between physician and patient on the healing process and overall well-being of patients. However, it does not come naturally to all workers with caring professions to seek personal interactions with their patients or display appropriate emotions. Some will have to make deliberate efforts, perform emotional labour, to achieve that goal. A healthcare worker’s commitment to healing and caring may make it easier for him/her to perform emotional labour. Emotional labour and commitment of 84 healthcare workers involved in oncology, and organizational factors with impact thereupon, were studied to explore the potential relationship between commitment and emotional labour. PANAS-X questionnaires were used to quantify emotional labour, while commitment and influencing factors were surveyed by means of explicative questions. Our findings confirmed a correlation between commitment and genuine acting as corroborated by literaure data. It was demonstrated that committed healthcare workers’ spontaneous emotions were more in compliance with what their patients expected them to display, and even their behavioural patterns were more in tune with the patients’ expectations. Confirmation as an organizational factor and colleague/ patient attitudes were found to have the strongest impact on commitment. It is essential that selection criteria for healthcare workers include examination for an altruistic caring attitude. Even more importantly, operators and managers of healthcare institutes should make efforts to create a good working environment and offer regular confirmative feedbacks for improved commitment by their employees.]

Lege Artis Medicinae

[Treating methods of obstructive sleep apnea syndrome and related difficulties in daily practice ]

MOLNÁR Márton, CSATLÓS Dalma, HARGITTAY Csenge, MOHOS András, TERRAY-HORVÁTH Attila, DOMBOVÁRI Magdolna

[Obstructive sleep apnea syndrome (OSAS) is the most common breathing disorder during sleep. Its incidence is between 2-4%, but in many cases, the disease is not recognized. It has many symptoms, but the most typical symptoms are loud snoring and daytime sleepiness. Treatment always consists of several elements depending on the patients’ specific needs. When deciding on which treatment to use efficiency and the patients’ compliance are the key factors. The necessity of the therapy can be determined by three criteria: clinical complaints (daytime discomfort), the severity of the breathing disorder and the accompanying cardiovascular diseases. Treating possibilities for the mild to moderate OSAS are lifestyle changes (losing weight, avoiding alcohol and sedative drugs), positional therapy, oral appliances, and varied surgical corrections. For patients with moderate to severe OSAS and mild OSAS with severe symptoms the first line therapy is continuous positive airway pressure. In addition to presenting new therapeutic options, the authors describe the role of the family physician in the care of apnea patients.]

Lege Artis Medicinae

[Prevention of invasive meningococcal infection, recognition and first treatment of the disease in primary care]

KOVÁCS Ákos, KULCSÁR Andrea, KALABAY László, TORZSA Péter

[In this article, based on a short case report, the authors summarise what you must do and must not do as a primary care physician when suddenly meeting a young patient suspected of having meningococcus infection. Neisseria meningitidis, the meningococcus, is a Gram-negative diplococcal bacterium that is only found naturally in humans. The meningococcus is part of the normal microbiota of the human nasopha-rynx and is commonly carried in healthy individuals. In some cases systemic invasion occurs, which can lead to meningitis and/or septicemia. Invasive disease caused by Neisseria meningitidis is potentially de­vastating, with a high case fatality rate and high rates of significant sequelae among survivors after septicaemia or meningitis. Between 2006 and 2015 every year there were 34 to 70 cases of the registered invasive disease caused by Neisseria meningitidis, the morbidity rate being 0.02-0.07‱. Half of the diseases (50.7%) were caused by serotype B N. meningitidis, 23.2% were serotype C. ]

Journal of Nursing Theory and Practice

[Empathy research among nurses - comparison of the scales empathy: Jefferson Scale of Physician Empathy (JSPE) and the Interpersonal Reactivity Index (IRI)]

NAGY Ivett Klára, ÖREG Zsolt

[Aim of the research: comparison of the two internationally validated self-administered questionnaire (Jefferson Scale of Physician Empathy (JSPE) (Hojat et al., 2001, 2002a, 2002b, 2003) and the Interpersonal Reactivity Index (IRI) (Davis, 1983) - during empathy research among nurses. Research and sampling methods: a quantitative cross-sectional study applying two internationally validated self-administered questionnaire (Interpersonal Reactivity Index (IRI), Jefferson Scale of Physician Empathy (JSPE)), as well as home-made socio-demographic survey, shared online. The online questionnaires have been completed by 101 nurses in different age, having different qualification levels and working currently in Hungary in different areas of health care. The sample consists of 91 women and 10 men nurses. 89 nurses work in hospitals in the sample, 7 of them work in health centre one of them is ambulance officer and 4 of them are home nurse. Results: The applied questionnaire is acceptable based on the reliability statistical analysis (Cronbach’s  0.798 and 0.817). The results of IRI show in scale exploiting the professional specificity. In case of Perspective taking the used scale range is 11-28, while in the case of personal distress it shrank to 2-22 interval (as long as the total range is 1-28). Average and standard deviation in each dimension are (s): EC = 19.4 (s = 4.26); PT = 18.5 (s = 4.26); FS = 17.23 (s = 5.32), and PD = 10.85 (s = 4.66). In the total range of JSPE scale the mean empathy level is 98.5 and the standard deviation is 14.425. The same correlation relationship turned up between these two questionnaires as the developer published. These underline profession specific dimensions with direct association of the patient care (r factor EC=0,507, PT=0,447). Most of the questions related to socio-demographic factors have not been verified. Relationship emerged between the gender and the IRI personal distress dimension and the empathy value of JSPE according to the assumption for the benefit of women. It appears in scale of JSPE in perspective taking factor primarily. The extra working time had no show link with empathy, but private sector workers’ empathic concern was higher. The religion as a sociological characteristics was represented in the fantasy scale dimension of the IRI with a significantly higher value. It failed to detect any connection between the empathy and satisfaction of needs. Conclusion: Based on the study the JSPE questionnaire is admissible in Hungary. Next to the IRI it can reveal the empathy dimensions major from the patient’s view and it can make so comparable the empathy levels in other similar research projects. The women’s higher emphatic level was verified, but the length of the practice, the qualification and other socio-demographic aspects need further investigation, their effect aren’t discovered even in the research literature. Researchers steady emphasize how important is the empathy in the patient care to improve the efficacy of which would be accounted in Hungarian postgraduate courses as well. ]

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[Farewell to a Special Physician who Loved Literature – Remembering István Kiss MD]

MOLNÁR-TAGA Márta, VASAS Lívia