[How can the specialists be contacted? Ways of communication in the specialist-patient consultation]
MOLNÁR Regina1, PAULIK Edit1, SÁGI Zoltán2, KÖVES Béla3
MOLNÁR Regina1, PAULIK Edit1, SÁGI Zoltán2, KÖVES Béla3
[Consulting the specialist means face-to-face meetings traditionally. Nowadays patients do not need to go to the outpatient clinic to see the doctor since many new communication options have already been available. The aim of our study was to explore how typically doctors and patients use other options (as phone call or e-mail) beside face-to-face appointments in the outpatient clinic. We conducted a focus group interview with specialists and health workers and an in-depth interview with the chief nurse of an outpatient clinic in Budapest. The specialist-patient consultation is mostly face-to-face in the specialist’s office in the presence of the nurse, whose role is complex and pivotal. Furthermore, the landline phone is an essential device, as the patients can reach the specialist or nurse in their office hours. The application of e-mail or mobile phone is incidental. The website of the outpatient clinic provides practical information to patients. Traditional postal letters, leaflets, and publications are also typical for providing information. The doctors’ opinion was rather heterogeneous about the patients’ Internet usage and about the online contact with patients. Beside increasing the capacities the deliberate and organized introduction and application of technical devices, may reduce the overburdening of health professionals.]
Lege Artis Medicinae
[Thyroid disorders are very frequent not only among endocrine diseases but also the general conditions. Every clinician, regardless of their specialty, meet patients with thyroid disorders during their everyday practice. While diagnostic and therapeutic options remained almost unchanged in the past decade, there are several intensively researched topics in the patient’s care, advances of which we ought to familiarize ourselves with. In this present paper we sought out to cover three of these fiercly discussed topics. ]
Lege Artis Medicinae
[Nociceptive, neuropathic and central mechanisms are involved in the perception, transmission and processing of chronic pain and shaping of cerebral pain image. Alarmins – molecules alarming defence and signing the presence of pathogens and tissue damage - trigger a series of pathogenic events resulting in inflammatory pain stimuli. Proinflammatory cytokines play a determining role in the pain perception at the level of the nervous system. Continuous inflammatory stimuli while sensitizing the periferic and central neurons activate the pain-related cerebral areas and develop the complex pain image, the pain matrix. Cerebral functional connections are operating in networks and can be visualized by functional MRI. Cytokines activate the neurons directly or indirectly by other neuromediators. Cytokine receptors are expressed on nociceptors and even on higher-level neurons and on various non-neural cells, such as microglia and astrocytes. The most ubiquitous cytokines are the Tumour Necrosis Factor and Interleukin 6 in the nervous system. The signaling pathways are the Nuclear Factor κB and the Janus-kinase enzyme system. The proinflammatory cytokines and the Janus-kinase are therefore primary therapeutic targets. Anti-cytokine biologicals and small molecular kinase inhibitors decrease the pain and improve functional activity in rheumatoid arthritis. Decrease of pain was more pronounced than expected only from the decrease of the clinical biomarkers of inflammation. The early and rapid painkiller effect of targeted biological and chemical-biological response modifiers is attributed to their direct analgesic effect on the brain.]
Lege Artis Medicinae
[During the COVID-19 pandemic caused by the SARS-CoV-2 virus, elderly people in long-term nursing homes were especially risks exposed. In this study, the authors analyse the causes of local outbreak at the Olajág Elderly Home Vezér street facility in Budapest and the means and ways to curb the spreading of infection. They summarise the measures, which proved to be effective in isolation and treating the patients. The number of infected residents as well as the course of the disease are demonstrated by statistical data. The authors consider as pre-eminently important to identify asymptomatic but infected residents, further the rapid introduction of screening tests, strict compliance with protocols, patient path regulation and the use of enhanced, supportive communication.]
Lege Artis Medicinae
[After kidney transplantation, the administration of immunosuppressive therapy not only renders the patient susceptible to infections, but it may also damage the function of tumor cell recognition and elimination. Our study was performed at the Department of Surgery, University of Szeged. After establishing the inclusion criteria, 570 patients were involved in the study. We examined the age, sex, immunosuppressive therapy of the patients, and searched for the relationship between the different immunosuppressive agents and the type of the tumor. In 81 cases, de novo cancer was diagnosed. Among patients treated with cyclosporin and tacrolimus there was no significant difference in the mean age (p = 0.734) and body mass index (p = 0.543). There was no significant difference in graft function between the two groups of patients (Tac vs Cyc; 44 vs 20). Related to the time passed since the transplantation to diagnosing the tumors the earliest were prostate and cervix cancers however without significant difference. Skin cancers are the most frequent followed by post-transplant lymphoproliferative diseases. The increasing risk of developing tumors is mainly due to immunosuppressive therapy. ]
Lege Artis Medicinae
[Our research group, has studied psychiatric and psychotherapeutic teams since 2015. The aim of the present research was to identify the Hungarian characteristics of team composition and operation. Qualitative focus group survey has been conducted on the operation of multidisciplinary teams at the annual conferences of the Hungarian Psychiatric Society in 2017, 2018 and 2019. These three groups focused on the issues of leadership, communication within the team, and competencies. The groups of an average of 17 people formed spontaneously by participation of professionals with different qualifications. The main results of the focus groups were as follows: 1. The various types of leadership within the team require the distribution and allocation of responsibilities and roles and stop the destructions. 2. Within the teams there are prevailing the informal channels of communication. 3. It is important to clarify competencies and responsibilities. 'Actually, psychiatric specialists' list of competencies there is not available in Hungary. It seems necessary to define more precisely and reconsider the professional competences of the specialized training in psychiatry and integrating these in the education, further promote the development of „list of competences in psychiatric specialization” by the legislators. The second phase of the research continues as a quantitative study based on the foregoing results gained by questionnaires. ]
Clinical Oncology
[The move to shared decision model from the patriarchal model of doctor-patient relationship is a communication challenge for doctors and patients as well. Communication is extremely important in Oncology, because the suggestive effect of every action of doctors and nurses is outstanding in this fi eld of healthcare. This burden has to urge professionals to self-improvement. One of the most important success of the Doctor-Patient Relationship program of the Hungarian Hospice Foundation since its launch in 2014 is the statement of two clinical centres on the importance of communication skills in everyday praxis, and engaging themselves in self-improvement. The successful cooperation also depends on patients and their care-givers not just on professionals. To gain all the necessary information is a learning process for them; even as to fi nd out the depth of information and decision level they wish. The patient who is satisfied with his or her own communication in healthcare is less distressed than the one who feels like adrifting. That gives the sense of achievement to professionals as well.]
Clinical Oncology
[In the past 40 years the progressively growing fi eld of psychooncology has played an increasing role in the multidisciplinary practice of oncology. In this review methods for identifying and treating cancer patients’ psychological challenges will be summarized. Effective psychological interventiones will be discussed, and two methods especially devised for supporting cancer patients (Simonton Training and Mindfulness Based Cancer Recovery) will be introduced. We also deal with the communication traits that affect the doctor-patient relationship, the mental challenges that affect doctors dealing with terminally ill patients, burnout and its prophylaxis.]
Journal of Nursing Theory and Practice
[Aim of the research: The aim of the research was to examine the fear of death, the attitudes towards death, the way of processing death, related to the workplace and to assess the burn out and psychosomatic symptoms among oncology nurses and hospice care workers. Research and sampling methods: To execute our research self-developed surveys were distributed online and printed (N=116) in July-August 2015, completed with a control group, as well. For data analysis we used SPSS version 19.0 with the following statistical tests: Chi square test, independent two sample t-test, Spearman rank correlation and variance analysis (p<0,05). Results: Oncology nurses had slightly more positive attitudes towards death, with significant (p=0,034) proneness to concentrate on positive events too, in case of death of their patients, and tend to attend Bálint groups more often (p=0,017), than nurses working in other unists. In the latter group psychosomatic symptoms were more frequent (p=0,032). No significant differences (p=0,234) were found between the groups in cumulative scale of fear of death. Fear of death had great effect on appearance of psychosomatic symptoms (p=0,011) and the extent of burn out (p=0,001). Conclusions: There were no significant differences in fear of death between oncology nurses and hospise care workers.]
Journal of Nursing Theory and Practice
[Aim of the study: Assessing the effect of health pedagogy and health development courses on the health concept of nursing students (BSc). The authors assumed that attending these courses will enhance the health perception of the students. Sample and methods: This follow-up study was conducted in September 2013 and in May 2014 involving second-year nursing students (N=61). Drawing and discussing the pictures provided the material for the analysis. Results: Physical, social and emotional dimensions were the most emphatic at both samplings, whereas after the courses the importance of mental, spiritual dimensions and society was significantly higher. The pictures were more detailed (p<0.001), the number of each dimension and their elements was elevated. The importance of living and natural environment was also present. Conclusions: Attending the courses in health pedagogy and health development enhances and broadens the health concept of nursing students.]
Journal of Nursing Theory and Practice
[Aim of the research: The present study aim to assess how the stress level influences the life style, health and sleep. Research and sampling methods: A self-developed questionnaire was administered online during April and May 2015 (N=556). SPSS 9.0 was used for the data analysis; chi square, independent samples t-test and Spearman’s rank correlation were applied (p<0.05). Results: The higher the level of perceived stress is at work, the worse the self-rated health condition (p<0.001), quality (p<0.001) and quantity (p<0.001) of sleep and dietary habits (p<0.001) are. In the group with higher stress level at work intermittent insomnia (p=0.009) and tired mornings (p<0.001) were more frequent. Participants reported their meals to be irregular (p<0.001) and hasty (p=0.006). There were no significant differences regarding chronic illnesses and addictions compared to the group with lower work-related stress levels. Conclusions: According to these results the level of work-related stress correlates negatively with dietary habits, sleep and self-reported health status. ]
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