Lege Artis Medicinae

[PHYSICAL AND PSYCHOLOGICAL CONDITION OF HEALTH CARE WORKERS DEALING WITH THE SERIOUSLY ILL]

HEGEDÛS Katalin, RISKÓ Ágnes, MÉSZÁROS Eszter

NOVEMBER 21, 2004

Lege Artis Medicinae - 2004;14(11)

[INTRODUCTION - Health care professionals undertaking treatment/nursing of the seriously ill are equally overburdened emotionally, intellectually and physically. This condition might have several, sometimes irreversible negative consequences: avowed difficulties within the communication with patients, families and colleagues, various harms of accumulating, unprocessed stress, severe physical and psychological symptoms of mental burn-out which is very frequent and failures and difficulties of the private life. In our survey we aimed to gain a realistic image of the physical and psychological condition and quality of life of professionals working in Hungarian clinical care in order to provide with indelayable help. METHODS - The basis of the survey was a version of the Hungarostudy 2002 questionnaire, modified for health care professionals. In our sample there were 200 health care professionals dealing with seriously ill and in the control groups 1356 non health care professionals, and 227 health care professionals, choosen from the Hungarostudy survey. In all three groups the proportion of gender, age and education were the same. The results were analysed by the SPSS 10.0 statistical program and the relationship analysis was completed by ANOVA test. RESULTS - The analysis of the answers of those attending in our questionnaire survey - compared to those working in other health care field and to the control group of non health care workers - proves that the ratio of exhaustion and stress-dependent physical and psychological symptoms are prominently, in many cases significantly higher among health care workers dealing with the seriously ill, addiction is more frequent and social net is more unfavourable. These data are even worse for nurses than for doctors and other graduates. CONCLUSION - In treating difficult cases we can start to help with special education that should be general both in gradual and postgradual training.]

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[Analgesic nephropathy in Hungary: the HANS study]

PINTÉR István, MÁTYUS János, CZÉGÁNY Zoltán, HARSÁNYI Judit, HOMOKI Marietta, KASSAI Miklós, KISS Éva, LADÁNYI Erzsébet, LŐCSEY Lajos, MAJOR Lajos, MISZ Mihály, NAGY Lajos, POLNER Kálmán, RÉDL Jen

Lege Artis Medicinae

[The 46th Congress of the Hungarian Society of Gastroenterology]

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Lege Artis Medicinae

[BENIGN SOLITER FIBROTIC TUMOR OF THE PLEURA - A CASE REPORT]

BOHÁCS Anikó, TAMÁSI Lilla, SOMOSKÖVI Ákos, MÉSZÁROS Zsolt, SÁPI Zoltán, BÁRTFAI Zoltán

[INTRODUCTION - Rare asymptomatic pleuropulmonary neoplasms can represent serious differencial diagnostic difficulties both for clinicans and pathologists. Immunohistochemical tests are essential tools for the diagnosis of soliter fibrotic tumor of the pleura. These tests are also of diagnostic and prognostic importance. CASE REPORT - The report summarizes the case of an asymptomatic 63 years old man. The patient was admitted to hospital with a parahilar infiltrate of the right lung. Based on this chest X-ray abnormality pulmonary malignancy was suspected. The patient was referred to surgical intervention and the diagnosis of was based on post-surgical histology. These fibrotic tumors have typical immunohistochemical features. Although the histomorphology of the tumor suggested the presence of a benign tumor the p53 positivity and focal CD34 positivity indicated the possibility of malignant transformation as well. The patient is alive 17 months after surgery and there is no relapse of the disease. CONCLUSION - Although histologically benign, soliter fibrotic tumors of the pleura may occasionally transform into malignant variants. Therefore complete surgical resection and longterm clinical and close radiological follow-up is recommended for these patients. Clinician can plan well ahead the frequency and time of the follow-up with the help of the prognostic factors of hystology.]

Lege Artis Medicinae

[THE ROLE OF ORAL ANTIDIABETIC AGENTS AND ACE INHIBITORS IN THE PREVENTION OF TYPE 2 DIABETES MELLITUS]

KEMPLER Péter

[Nowadays Type 2 diabetes is considered as a cardiovascular disease,. The cause of death among 80% of people with Type 2 diabetes is of cardiovascular origin, with the most common cause of death of myocardial infarction. Optimal solution would be the prevention of the disease and there are also some possibilities for intervention. The present paper summarises the role of antidiabetic agents and ACE inhibitors in the prevention of Type 2 diabetes mellitus. The incidence rate of Type 2 diabetes decreased by 36% using acarbose in the STOP NIDDM Trial and by 31% using metformin in the Diabetes Prevention Program. The rate of risk reduction regarding the incidence of Type 2 diabetes during the ALLHAT Study compared the subjects treated with thiazid diuretics among those treated with amlodipine was 25% by the end of the second year and 16% by the end of the fourth year, while the corresponding data for patients treated with lisinopril were 40% and 30%, respectively. The action of lisinopril on the better bioavailability of Insulin like growth factor I. (IGF-I) probably contributes to the beneficial effect of lisinopril on insulin sensitivity.]

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[Background - The deleterious effect of primary headaches on the sufferers’ quality of life (QOL) has been abundantly documented using both generic and headache-specific instruments. The currently used questionnaires focus on a limited number of factors and therefore may not be sensitive enough to detect the effect of headache type and headache characteristics on QOL, despite the obvious clinical differences. We have devised a comprehensive questionnaire that may be more sensitive to the burden of headache. Objective - To assess the psychometric properties of the new questionnaire on a group of migraineurs. Patients and method - We studied 117 migraineurs who completed the validated Hungarian version of the SF-36 generic QOL measure and our new, 25-item questionnaire. Reliability was assessed by internal consistency, measured by Cronbach’s a of all items. Content validity was exam- ined by calculating the correlation of the items with subscales of the SF-36 measure. The correlation of the patients’ migraine characteristics with the questionnaire’s items was used to assess criterion validity. Results - The questionnaire was quick and easy to administer. The questionnaire demonstrated good reliability, with Cronbach’s alpha being 0.893. Content validity was adequate; most “physical” items of the new questionnaire showed significant correlations with the bodily pain and role physical SF-36 subscales and most “psychical” and “social” items were correlated with mental health and social functioning SF-36 subscales. Criterion validity was adequate, with headache severity being correlated with most of the items. Discussion - In this study the new headache-specific quality of life instrument showed adequate psychometric properties.]

Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, BOSNYÁK Edit, KOVÁCS Norbert

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

Lege Artis Medicinae

[End of the line? Addenda to the health and social care career of psychiatric patients living in Hungary’s asylums]

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[The authors are focusing on a special type of long term psychiatric care taking place in Hungary outside of the conventional mental health care system, by introducing some institutional aspects of the not well known world of so called social homes for psychiatric patients (asylums). After reviewing several caracteristics of institutional development of psychiatric care in Hun­gary based on selected Hungarian and in­ternational historical sources, the main struc­tural data of present Hungarian institutional capacities of psychiatric health and social care services are shown. Finally, the authors based on own personal experiences describe several functional ascpects of the largest existing asylum in EU, a so­cial home for long term care of psychiatric pa­tients. By the beginning of the 20th century, Hungarian psychiatric institutions were operating on an infrastructure of three large mental hospitals standing alone and several psychiatric wards incorporated into hospitals. Nevertheless, at the very first session of the Psychiatrists’ Conference held in 1900 many professionals gave warning: mental institutions were overcrowded and the quality of care provided in psychiatric hospital wards, many of which located in the countryside of Hungary, in most cases was far from what would have been professionally acceptable. The solution was seen in the building of new independent mental hospitals and the introduction of a family nursing institution already established in Western Europe; only the latter measure was implemented in the first half of the 20th century but with great success. However, as a result of the socio-political-economic-ideological turn following the Second World War, the institution of family nursing was dismantled while different types of psychiatric care facilities were developed, such as institutionalised hospital and outpatient care. In the meantime, a new type of institution emerged in the 1950s: the social home for psychiatric pa­tients, which provided care for approximately the same number of chronic psychiatric patients nationwide as the number of functioning hospital beds for acute psychiatric patients. This have not changed significantly since, while so­cial homes for psychiatric patients are perhaps less visible to the professional and lay public nowadays, altough their operational conditions are deteriorating of late years. Data show, that for historical reasons the current sys­tem of inpatient psychiatric care is proportionately arranged between health care and social care institutions; each covering one third. Further research is needed to fully explore and understand the current challenges that the system of psychiatric care social- and health care institu­tions are facing. An in-depth analysis would significantly contribute to the comprehensive improvement of the quality of services and the quality of lives of patients, their relatives and the health- and social care professionals who support them. ]

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[Introduction - Cluster headache (CH), which affects 0.1% of the population, is one of the most painful human conditions: despite adequate treatment, the frequent and severe headaches cause a significant burden to the patients. According to a small number of previous studies, CH has a serious negative effect on the sufferers’ quality of life (QOL). In the current study, we set out to examine the quality of life of the CH patients attending our outpatient service between 2013 and 2016, using generic and headache-specific QOL instruments. Methods - A total of 42 CH patients (16 females and 26 males; mean age: 39.1±13.5 years) completed the SF-36 generic QOL questionnaire and the headache- specific CHQQ questionnaire (Comprehensive Headache- related Quality of life Questionnaire), during the active phase of their headache. Their data were compared to those of patients suffering from chronic tension type headache (CTH) and to data obtained from controls not suffering from significant forms of headache, using Kruskal-Wallis tests. Results - During the active phase of the CH, the patients’ generic QOL was significantly worse than that of normal controls in four of the 8 domains of the SF-36 instrument. Apart from a significantly worse result in the ‘Bodily pain’ SF-36 domain, there were no significant differences between the CH patients’ and the CTH patients’ results. All the dimensions and the total score of the headache-specific CHQQ instrument showed significantly worse QOL in the CH group than in the CTH group or in the control group. Conclusion - Cluster headache has a significant negative effect on the quality of life. The decrease of QOL experienced by the patients was better reflected by the headache-specific CHQQ instrument than by the generic SF-36 instrument. ]

Clinical Neuroscience

[Treatment of dystonia by deep brain stimulation: a summary of 40 cases]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ILLÉS Zsolt, ASCHERMANN Zsuzsanna, TASNÁDI Emese, NAGY Ferenc, PFUND Zoltán, BÓNÉ Beáta, BOSNYÁK Edit, KULIFFAY Zsolt, SZIJJÁRTÓ Gábo

[Background - Bilateral pallidal deep brain stimulation (DBS) is an established treatment option for primary generalized and segmental dystonia. In the present study we evaluated the results of our dystonia patients treated by DBS. Methods - The surgical results of forty consecutive dystonia patients underwent DBS implantation were analyzed (age: 43.7±17.7 years; sex: 22 men; etiology: 24 primary and 16 secondary dystonia; topography: 24 generalized, 12 segmental and four hemidystonia; disease duration: 16.1±9.3 years). Severity of dystonia measured by Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and health-related quality of life measured by EQ-5D scale were obtained preoperatively and compared to the scores obtained at postoperative six months and subsequent yearly follow-ups. The average follow-up lasted 2.5 years (median, 0.5-8 years). In all cases the BFMDRS scores were re-evaluated by a rater blinded to the treatment. Treatment responsiveness was defined as an at least 25% improvement on the BFMDRS scores. Non-parametric Mann-Whitney, McNemar and Kruskal-Wallis tests were applied to test statistical significance. Results - Severity of dystonia improved from 31 to 10 points (median, 68% improvement, p<0.01) in the primary dystonia group, whereas in secondary dystonia these changes were statistically insignificant (improvement from 40 to 31.5 points, 21.2%, p>0.05). However, the health-related quality of life significantly improved in both groups (primary dystonia: 0.378 vs. 0.788 and secondary dystonia: 0.110 vs. 0.388, p<0.01). Significantly more patients in the primary dystonia group responded to DBS treatment than those in the secondary dystonia group (83.3% vs. 37.5%, p<0.01). Conclusion - Our results are in accordance with previously published international findings demonstrating that DBS is a highly effective and long-lasting treatment option for primary dystonia. DBS is considerably less efficient in secondary dystonia; however, it still has a high impact on the quality of life presumably due to its pain-relieving effect.]