Lege Artis Medicinae

[Postgraduate conference on hepatology]

TELEGDY László

JUNE 22, 2004

Lege Artis Medicinae - 2004;14(06)

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Lege Artis Medicinae

[NEW METHODS FOR NON-INVASIVE ASSESSMENT OF AIRWAY DISEASES]

HORVÁTH Ildikó

[In chronic obstructive airway diseases there are several unsolved questions regarding the early diagnosis, monitoring treatment, simple detection of exacerbations and the questions of differential diagnosis. These problems indicate the need for the development of new diagnostic methods and their application in clinical practice. This need is further emphasized by the fact that in most chronic airway diseases, including asthma and chronic obstructive pulmonary disease inflammation has a central role in the pathomechanism and its suppression is the main aim of treatment, but so far, we do not have adequate method for the assessment of inflammation intensity in clinical practice. In recent decades non-invasive sampling techniques directly from the airways have made a progress in respiratory research and at present some of them are available for clinical use. Among these techniques sputum induction, measurement of exhaled biomarkers including exhaled nitric oxide and mediators in exhaled breath condensate samples are used increasingly. The present review summarises our current knowledge on these methods and the most important findings obtained by their applications.]

Lege Artis Medicinae

[Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for coeliac disease in selective IgA deficiency]

KORPONAY-SZABÓ Ilma, DAHLBOM I, LAURILA K, KOSKINEN S, WOOLEY N, PARTANEN J, KOVÁCS JB, MÄKI M, HANSSON T

Lege Artis Medicinae

[A CASE OF PRIMARY HEPATIC AMYLOIDOSIS PRESENTING WITH GASTRIC BLEEDING]

STOGICZA Ágnes, GRABER Hedvig, SKALICZKI József, NÁDOR Katalin, MAGYAR Tamás

[INTRODUCTION - Amyloidosis - at an early stage - has no typical clinical findings, but severe weight loss, hepatomegaly and elevated serum alkaline phosphatase level can be clues to the diagnosis. CASE REPORT - We report a 66-year-old woman presenting at our unit with massive gastrointestinal bleeding. Gastroscopy was performed and a haemorragic ulcer was found. Before admission she had lost 20 kg-s in 6 months. The patient had hepatomegaly and markedly elevated serum alkaline phosphatase level. These findings suggested the presence of malignancy, but ultrasound, CT and MR examinations did not support this hypothesis. After liver biopsy the diagnosis of amyloidosis was proven. She had rapid downhill clinical course of gastric bleeding from an ulcer resulting in death. CONCLUSIONS - So far, no specific treatment exists for amyloidosis, but there have been promising results reported about liver transplantation and autologous stem-cell transplantation.]

Lege Artis Medicinae

[MEDICAL ANTHROPOLOGICAL APPROACH TO CHILDREN'S SURMISES ON SMOKING]

BAK Judit, PIKÓ Bettina

[INTRODUCTION - The aim of our study was to explore school children'’s surmises on smoking. The following questions were in the focus of our analysis: what concepts children have about smoking and smoking-related diseases before adolescence? Have they already tried smoking? METHODS - The study was conducted among 3rd, 4th and 5th year school children (N=128) in two towns of Békés County, namely in Békés and Köröstarcsa. The sample consisted of 57% males and 43% females. Regarding sampling we followed international studies with similar aims where samples of 9-11-year-old average children were thought to be ideal for such study purpose using the draw-and-write technique. RESULTS - Most respondents from the study have not tried smoking yet. On the other hand, there are great number of adults who smoke in children’s environments, in many times, both parents do. Despite these facts, children’s attitudes toward smoking is rather negative. Children'’ s opinions reflect many negative aspects of smoking: the health-damaging effect, the financial aspects, the negative effects for social and physical environment. CONCLUSIONS - Similar to previous international studies, children of our sample possess correct and comprehensive knowledge of the smoking-related health problems. Findings of our study provides a support to the need of a smoking prevention program for children in the age of their negative opinions of smoking and well before the peer group effect is getting significant.]

Lege Artis Medicinae

[On teaching, with personal overtones]

BODA Domokos

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[The carrier model of neurology in Hungary: a proposal for the solution until 2020]

BERECZKI Dániel, CSIBA László, KOMOLY Sámuel, VÉCSEI László, AJTAY András

[Based on our previous survey on the capacities of neurological services and on the predictable changes in the neurologist workforce in Hungary, we present a proposal for the organization of the structure of neurological services in the future. We discuss the diagnostic groups treated by neurologists, the neurological services and their progressive organization. Using the current capacities as baseline, we propose patient groups to be treated by neurologists in the future, and the levels of services. Based on the tendencies seen in the last years we suggest to consider to allocate acute stroke services exclusively to stroke units in neurological departments, and we identify a few other diagnostic groups where neurology should have a larger share in patient care. We define three levels for inpatient care: university departments, regional/county hospitals, city hospitals. Instead of minimum criteria we assign outpatient and inpatient standards that are functional from the economic point of view as well. University departments cover all areas of neurological services, have a function in graduate and postgraduate training, and on a regional basis they participate in professional quality assurance activities at the county and city hospital levels, and would have a more independent role in residency training. As far as patient care is concerned, the task of the regional/county hospitals would be similar to that of university departments - without the exclusively university functions. A general neurological service would be offered at the city hospital level - the representation of all subspecialties of neurology is not required. Neurorehabilitation would be organized at special units of neurological wards at the city hospital level, at independent neurorehabilitation wards in regional/county hospitals, and also as an outpatient service offered at the patients’ home. The most significant organizational change would affect the outpatient neurological services. In addition to the special outpatient units associated with university departments and regional/county hospitals, the general neurological outpatient services would be organized as private practices, similarly to the current system of general practitioners, where the individual practices contract independently with the health insurance fund. Their task would be a general neurological service offered 30 hours per week, and also basic, screening neurophysiological and neurosonological examinations, with proper equipment and trained assistance. A transformation in residency training and a change in financing is needed for this plan to fulfill.]

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[Viral hepatitis in focus: messages of the hepatological conference about screening, diagnostics and possibilities of effective therapy]

NEMESÁNSZKY Elemér

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[Evidence-based practice guidelines for nursing and rehabilitation of stroke patients]

BALOGH Zoltán

[Stroke is a common problem, being the third most frequent cause of death in the United Kingdom and Hungary, accounting for about 20% of bed occupancy. It is also an important cause of morbidity and disability mainly for those aged over 65. As a result, stroke care constitutes as an important part of health services use. Home care services working in the field of stroke rehabilitation have not used a unified evidence-based approach and well-described professional principles and protocols. There was little cooperation between the teams working in the institutional rehabilitation and home care rehabilitation services. No agreed rehabilitation processes, and standardised scales and documentation, showing the change of quality of life, were in use. There were no quality indicators and efficiency measures of nursing and no provision of services either. The Hungarian Nursing Association played a pioneering role in the introduction and dissemination of Evidence Based Nursing in Hungary and in adopting it into routine clinical practice. The successful implementation of the Association's project could be a good example for another field of care and nursing in Hungary and other countries in Europe. Our projects are supported by the Department For International Development (UK) in the framework of the TUDOR project. The Hungarian Nursing Association (HNA) developed a postgraduate training programme entitled "Evidence based nursing in practice". The participants were required to be members of the HNA, have a degree in the field of nursing (nurse teacher, degree nurse, nurse director). Members of the target group were all working in the field of stroke rehabilitation at hospitals or out-patient clinics and home nursing. The Hungarian Nursing Association's professional group developed an evidence based practice guideline for rehabilitation of stroke patients, which was published in the Bulletin of the Ministry of Health (11/2002, 23rd May, 2002). These evidence-based stroke rehabilitation guidelines focused on bladder management, position therapy and patient information.]