Lege Artis Medicinae

[Relationship Networks]

BUDA Béla

MAY 20, 2011

Lege Artis Medicinae - 2011;21(05)

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Lege Artis Medicinae

[Man is not Made for Defeat – Hemingway’s Pathography]

KISS László

Lege Artis Medicinae

[Psychological Approaches to the Psychedelic Experience: James Maslow and Transpersonal Psychology Part I ]

SZUMMER Csaba

Lege Artis Medicinae

[To fight for our self-esteem as well]

PAPP Magor

Lege Artis Medicinae

[The modern disciplines of diagnosing and treating back pain]

BÁLINT Géza

[The author presents the recommendations of international guidelines in the modern diagnosis and treatment of low back pain. Regarding diagnosis, it is very important to differentiate between “specific” and “aspecific” or “nonspecific” low back pain. The term “specific low back pain” includes all diseases and pathologies with well-defined aetiology and pathological process, including bacterial spondylitis, rheumatic spondylarthropathies, primary or secondary tumours, malignancies, myelon- or cauda equine compression, paresis, metabolic base diseases, pathological or nonpathological fractures are suspected. The presence of so called “red flags” indicate“specific” low back pain. This type of low back pain requires quick and precise diagnosis and specific treatment. All other kinds of low back pain, even those with very painful radiculopathy, and without paresis, cauda- or myelon compression can be considered as aspecific, even if caused by a herniated disc, because there is no absolute indication of discectomy. In case of aspecific low back pain, there is no need of any diagnostic imaging methods, because they would not influence treatment. The main points of treatment are to keep the patient active, quick mobilisation with appropriate analgesia and antiinflammatory treatment following no more than 2-3 days of bed rest, and return to work as soon as possible, with easier work conditions if needed. The longer the patient is on sick leave, the higher the risk he or she will never return to work. If initial active treatment is not is effective enough, the patient's case should be reassessed in 3-6 weeks. If a herniated disc is suspected, the necessary imaging methods should be performed, and the patient should be operated if necessary. With this method, chronic, disabling low back pain can be avoided in many cases. The danger of developing chronic low back pain are indicated by the so called “yellow flags”: dissatisfaction with work, allowance claim, insufficient and even false ideas about the causes and consequences of low back pain, fear, anxiety, depression. These problems can be alleviated by the positive athmosphere of the workplace, appropriate patient education, activity, anxiolytic and antidepressant drugs, activity and regular exercise.]

Lege Artis Medicinae

[Development of anticoagulation in the past two decades]

SAS Géza

[In the past two decades we have witnessed a gradually increasing significance of both prophylactic and therapeutic anticoagulation. The importance of thromboprophylaxis has become widely accepted in the course of surgical interventions and in various other fields of medicine, too. The introduction of low molecular weight heparins was a milestone in this respect. The need for long-term anticoagulation has become a common problem. The various recent aspects and topics of anticoagulation have been described in the current Hungarian medical literature, therefore, I focus on two general problems of medicine of our days from the aspects of our subject. The evaluation of information on the new, direct-acting inhibitors (anti-IIa and anti- Xa),and their high price present great difficulies, especially in the case of long-term anticoagulation therapy. Clinical data and experiences have been collected from patients who are greatly different from the majority of patients in the real world. The lack of antidote may also be a serious problem in case of these new drugs, as urgent neutralization might be necessary, for example in case of serious bleeding, accidents etc. Today, cost-effectiveness of medical interventions and drugs has become a major aspect, therefore, the high price of new anticoagulants might prevent their use in the clinical practice. Despite the optimistic expectations regarding new anticoagulants, at present we have to strive to treat our patients with the currently available, effective but affordable drugs, widening and improving their use.]

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Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

VOKÓ Zoltán

[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

Journal of Nursing Theory and Practice

[Assessing Nurses’ Knowledge of Surgical Wound Care, Complications and Knowledge of Bandages]

FERENCZY Mónika, BÁLINT Beáta, KOMLÓSI Kálmánné, KARÁCSONY Ilona

[Aim of our research was to assess the knowledge of nurses working in surgical departments about surgical wound treatment, phases of wound healing, its complications, and intelligent bandages. Our quantitative, cross-sectional, descriptive examination was carried out in a hospital in Transdanubia with non-random, expert sampling and a self-made questionnaire. Our target group was nurses working in the surgical departments of the hospital (N=85). During the data analysis, the descriptive statistical methods of MS Office Excel 2016 software were calculated: mean, standard deviation, frequency. A χ2-test was used to examine the relationship between variables (p <0.05). Knowledge of bandages was not affected by educational attainment (p>0.05). Those who perform wound care in their daily work have more knowledge about the wound treatment sequence of the wounds that are primarily healing, as well as about intelligent dressings (p<0.1). For the classes, there was a significance for the recognition of complicated wounds, knowledge of the benefit of the absorbable suture and the use of analgesic procedures (p<0.001). In the interests of patient safety, nurses’ knowledge of wound treatment needs to be continuously improved. It is necessary to provide an accessible source of information and further training.]

Journal of Nursing Theory and Practice

[The Effects of the Children’s Temperament and their Parents’ Dental Fear on developing Dental Fear]

APRÓ Zoltán, NÉMETH Anikó

[The aim the present study was to assess the level of dental fear among 5-7 years old children and its correlations with dental-hygienic habits and their temperament. Furthermore, the relationship of the dental fear of parents and children was also analysed. This cross-sectional study was conducted by the means of a self-constructed questionnaire in 2017. The responses of 70 people were analysed with the help of SPSS 22.0; descriptive statistics, 2-sample T-probes, Mann-Whitney probes, analyses of variance and correlations were calculated (p<0.05). High level of dental fear was detected by 30% of the included children. There was no correlation between the dental fear of the parents and their children’s. Dental fear had no effect on the frequency of tooth-brushing. Children’s dental fear had no correlation with either previous painful experiences at the dentist’s or the temperament of the child. Dental fear is present among children and not only family but dental hygienists might play an important role in reducing it. ]

Journal of Nursing Theory and Practice

[The Effect of Asthma Bronchiale on Everyday life Activities Among Adolescents]

RÁCZ Viktória Kinga, HEGEDŰS Bianka Ágnes , SZEBENI-KOVÁCS Gyula , FERENCZY Mónika

[The aim of this study is to assess the relationship between the physical activity of asthmatics, sleep disorders, the extent of asthma treatment, and to assess the quality of life in terms of physical activity. We conducted our quantitative, cross-sectional survey between 2020-2021. In a non-randomized, comfort sampling the target group was defined as adolescents aged between 14–18 years, their diagnosis of asthma bronchiale had to be for at least 1 year ago. The data were collected by a self-prepared questionnaire, the domains included: socio-demographic questions related to physical activites, symptoms, sleep disorders, severity of asthma. We used miniAQLQ to assess quality of life. The statistical analysis were performed by using Microsoft Excel 2016 and SPSS v 24 programs. Descriptive statistics (mean, standard deviation, minimum, maximum), two-sample t-test, Chi-square test were performed. The mean age of the respondents was 16±1.51, 38% were boys and 62% were girls (N=105). There was no significant difference between physical activity and the frequency of seizures and sleep disorders (p>0.05). There is a significant difference between the genders and the symptoms increasing with intense exercise (p=0.02). We found significant correlation between the active participations in physical education classes and the severity of the disease (p=0.021). There is a significant correlation between moderate-, social activities and physical activity (p<0.05). Appropriate health education, recommendation in career choices as well as in physical activities done by nurses may lead to decrease in the number of suffocation attacks in cases of adolescents suffering from asthma bronchiale.]