Lege Artis Medicinae

[In the trap of polypragmacy]

NEMESÁNSZKY Elemér

JUNE 21, 2006

Lege Artis Medicinae - 2006;16(06)

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[NON-PHARMACOLOGIC TREATMENT OF TYPE 2 DIABETES AND METABOLIC SYNDROME]

[Type 2 diabetes mellitus and metabolic syndrome are important risk factors of cardiovascular morbidity and mortality. Both diseases present with a similar set of metabolic disturbances including hyperglycaemia, hyperlipidaemia, hypertension and obesity. Therefore, their nonpharmacological treatment is based on similar principles. Medical nutritional therapy aims to promote moderate weight loss through decreased energy intake, and to correct metabolic disturbances by ensuring appropriate composition of micro- and macronutrients. In a healthy diet, carbohydrates and cis-fatty acids make up approximately 60 to 70% of total energy intake. It is important to reduce the intake of saturated fatty acids and trans-fatty acids. The consumption of foods with low glycaemic index may be beneficial for diabetic patients. The increase of physical activity (both aerob and resistance exercise) is useful in maintaining weight loss, and it also improves blood lipid levels and blood pressure. Abandonment of smoking results in significant cardiovascular risk reduction. Lifestyle changes should include all of the above factors in order to achieve most reduction in morbidity and mortality associated with type 2 diabetes mellitus and the metabolic syndrome.]

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[The use of carvedilol following invasive interventions]

KOVÁCS Imre

[The primary goals of the treatment of AMI are to rapidly open - either mechanically or by thrombolysis - the blocked blood vessel and to keep it open. Restarting of the blood flow in blocked vessels results in an increased load in volume, pressure and metabolism in the blood vessel's supply area, which triggers the activation of a pathophysiological cascade. Pathophysiological processes accompanying the opening of the blood vessel include activation of catecholamines, RAS and neutrophils and subsequent free radical production, and increases in the levels of proinflammatory citokines and intracellular CA levels, that is, the so called oxygen paradox. The above mentioned processes can be blocked by beta receptor blockers (BRB) as demonstrated by class I, type A evidence. A number of clinical studies have shown their clinical efficiency following PCI. The PAMI, StentPAMI, AirPAMI and CADILLAC studies have proved that BRBs decrease mortality and morbidity after the intervention. The third-generation BRB carvedilol, which acts as a beta and alpha blocker in patients with STEMI successfully treated with PCI, and is also a Ca-channel blocker and a free radical trap, is the firstchoice agent for both theoretical and clinical reasons. Animal studies have shown that carvedilol results in greater reductions in the levels of markers indicating postinfarction reperfusion and ventricular remodeling (MCP1, MMP2, TIMP2) compared with metoprolol. Animal studies have also showed that carvedilol is the most efficient BRB for preventing the damaging of gap junction structure in reperfusion, and for inhibiting the ventricular arrhythmias induced by reperfusion, through restoring connexin 43. The beneficial effect of this drug on the cardiovascular events and mortality following myocardial infarction have been demonstrated in a number of human studies with hard endpoints. The unique efficiency of carvedilol in vascular prevention following PCI has been demonstrated by the short-term and longterm efficiency of carvedilol-filled stents, compared with BMSE-filled stents. Information on the postintervention, long-term (3-year) efficiency of carvedilol in a large (N :7500) patient group is expected to be published in 2015 in the CAPITAL-RCT study coordinated by the University of Kyoto. In summary, the results of experimental and clinical studies on carvedilol have shown that within the BRB group, carvedilol is highly recommended for the prevention of oxygen paradox following successful PCI and preserving the myocardium.]

Journal of Nursing Theory and Practice

[Trends in nurses’ conversation-leading skills]

PAPP László, NAGY Erika

[Aim of the study: The authors, in the course of their survey, assessed the conversation-leading skills of nursing students. Their objective was to analyse the extent to which the students’ conversational skills fulfi l the criteria for client-oriented treatment. Methodology and sample: The sample for the cross-section survey, conducted using the triangulation method, was selected using random sampling from among third-year students at the Nursing Department of Faculty of Health Sciences and Social Studies at the University of Szeged. The sample consisted of 55 full-time and correspondence nursing students. For the data gathering they used Helembai’s Trap Test method. The data was analysed using a combination of qualitative and quantitative methods. Results: The results pointed to domination of the studied conversations by the nurses. In the course of the communication the nurses primarily attributed cognitive communications to themselves, and affective communications to the patients. The nurses correctly recognised the importance of the principles of client management, which is shown by their effort to achieve a cooperative conversation-leading style. Conclusions: Based on the results, the principle of client-orientation is not fully upheld in the interactions of everyday nursing practice, a role in which is played by the biomedical focus and task-centred, paternalist approach that can still be observed in nursing today.]