Lege Artis Medicinae

[The doctor of palatine Wesselényi]

BUBRYÁK Orsolya

JULY 10, 2001

Lege Artis Medicinae - 2001;11(06-07)

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[Primary haemostasis in atherothrombotic processes]

UDVARDY Miklós

[It is now generally accepted, that the majority (>90%) of acute coronary and carotid syndromes are caused by thrombosis secondary to atheromatous plaque disruption, and approximately 75% of stroke cases are also of thrombotic origin. The prothrombotic changes in blood coagulation and in the primary haemostatic system may contribute substantially to the risk of occlusive arterial thrombotic events. The imbalance in the endothelium-platelet interaction seems to play crucial role in vessel wall response to injuries. Careful and complex analysis of platelet and clotting alterations may result in better understanding of arterial thrombotic processes and also in greater success of primary and secondary prevention by accelerating the development of better antithrombotic drugs.]

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[Current diagnostics and treatment of adolescent hypertension]

PÁLL Dénes, KATONA Éva, FÜLESDI Béla, JENEI Zoltán, POLGÁR Péter, PARAGH György, KAKUK György

[As the prevalence of hypertension in young people aged 14-18 is reported to be 1-1.5%, regular blood pressure measurement is proposed by the international committees in the adolescence, at least once a year. To establish the diagnosis of hypertension, repeated blood pressure measurements and sex-, age-, heightand weigt-based nomograms are needed. If casual blood pressures are consequently elevated, an ABPM measurement may provide additional informations, e.g. about white coat hypertension, daytime and nighttime blood pressure patterns and target organ damage. Thus, in such cases ABPM measurement is proposed to become the part of the routine examination. Following the diagnosis of hypertension in the adolescent, a further important step is to clarify the causes of the disease. In the majority of adolescent cases, essential hypertension is the diagnosis, but secondary (especially renal causes) are more frequent than in adulthood. First line treatment of adolescent hypertension is definitely non-pharmacologic. Pharmacologic treatment may be indicated if blood pressure is significantly increased (diastolic blood pressure, especially), if secondary hypertension is diagnosed or target-organ damage is present, or there are consistent complains related to the increased blood pressure. Treatment can be initiated with any of the antihypertensive drugs used in adults, but most frequently the use of beta-blockers and ACEinhibitors is recommended.]

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[How to „conjugate” our patients in the medical language?]

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[Role of patient clubs in successful treatment of osteoporotic patients]

SOMOGYI Péter, GAÁL János, SPEER Gábor

[The significance of osteoporosis is well known, however, the number of patients receiving treatment is only a small fraction of ideal. Besides, the fact that the population is uninformed, the difficulties of making an appointment with a specialist and the unsatisfactory communication of the doctor all play a part in the fact that a high proportion of patients receiving mediation give up treatment prematurely. The Inter - na tional Osteoporosis Foundation supports the establishment of public patient clubs with regular training courses and grants and by doing so it also acknowledges their importance in the prevention and treatment of osteoporosis. The publication, based on the questionnaire filled in by the members of the first Hungarian patient club, the Hungarian Society of Osteopo - rosis Patients in district 3rd, introduces the Hungarian results and points out how important patient clubs are in increasing the success of treatment and it also draws attention to the necessity of establishing further patient clubs in the future.]

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[How can the specialists be contacted? Ways of communication in the specialist-patient consultation]

MOLNÁR Regina, PAULIK Edit, SÁGI Zoltán, KÖVES Béla

[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.]

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[PRESENTATION OF ACUTE ABDOMINAL SYMPTOMS WITH UNDERLYING MALIGNANT DISORDERS]

ZARÁND Attila, BESZNYÁK István, MERSICH Tamás

[Patients with different type of undiagnosed malignancy occasionally referred to emergency departments with acute disease-related symptoms as first signs of their underlying process. However, this broad spectrum of clinical signs and symptoms do not occur very often but may result in very poor outcome for these patients. It is therefore essential to establish correct diagnosis in time and provide appropriate care of patients with acute abdominal complaints. Cancer patients are frequently referred to doctor because of gastro-intestinal obstruction, perforation or bleeding and with symptoms of inflammation. In 3-5% of the cases an urgent operation is necessary. As the cure rate of the cancer patients is largely dependent on the stage of the tumour, it is important to make relevant staging, to set up diagnosis at the earliest phase and start the appropriate therapy in due time in a multidisciplinary way.]

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[A faraway land: nursing in a “small” Swedish hospital]

FUCHS Rita

[The author is currently working as a degree nurse in Örebro County, Sweden. In Sweden she has a greater degree of professional autonomy, which allows her to make use of all the theoretical knowledge and practical skills acquired at college. For performing certain tasks the doctor’s written authorisation is not required; nurses proceed in accordance with their competencies and the rules set out in the given protocol. She sets out to give an insight into the day-to-day work of nurses at her hospital, by describing the documents that are used, briefly outlining the training system, and the authority exercised by the nurses. Keywords: nurse, nursing training, nursing documentation, competency]

Lege Artis Medicinae

[Ask your doctor!]

KRAMER Imre