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Lege Artis Medicinae

JANUARY 20, 2020

[History of Daytime Hospital of the Department of Psychiatry in the University of Debrecen ]


[In Hungary, there was a ward related psychotherapy already since the 1960s, yet without any national network to the 1980s. In Debrecen the spreading of the psychotherapeutic approach started in the psychiatric facilities since the 1990s. Daytime Hospital was founded first in the County Hospital and later on in the Department of Psychiatry of the University. The latter option was provided by separating the psychiatry from neurology. This study presents the development of the day care at the Psychiatric Department along the opportunities and shows the structure of the actually functioning system finally reports on our future plans respectively. Initially started the occupational therapy, gymnastics, community cooking and walking, which did not require any separate rooms. The 22-bed psychotherapeutic unit was established 2014 with its joined capacity for 11 persons in the Daytime Hospital. The County Hospital is engaged primarily in socio-therapy of psychotic psychiatry pa­tients, however the Psychiatric Department is rehabilitating mainly patients with affective spectrum disorders. Patients are treated in socio-therapy and psychotherapy small groups for a half or one year. Afterward they enter the outpatient program, may join the Patient Club or decide for therapeutic occupation aiming the best way of recovery. According to the feedback, there is a long-term change in the mental state of the patients leading to improvement in their quality of life, which we plan to prove by an efficacy research program. ]

Clinical Oncology

APRIL 30, 2020

[Hormone replacement therapy in cancer survivors – Review of the literature]

DELI Tamás, OROSZ Mónika, JAKAB Attila

[Rapid advance in oncology leads to increasing survival of oncologic patients. More and more of them live long enough to reach either the natural age of menopause or, as a side effect of their oncotherapy, experience the cessation of gonadal function, leading to premature ovarian insuffi ciency, with disturbing vasomotor symtoms and long-term negative cardiovascular and skeletal effects. Thus, an ever increasing number of cancer survivors search endocrinologic help in the form of hormone replacement therapy (HRT). The misinterpretation of the WHI (Women’s Health Initiative) Study has lead to an irrational fear of female hormone replacement, both by the general population and medical professionals. It has seemed the logical and safe conclusion to many physicians to avoid HRT, supposing that this attitude defi nitely causes no harm, whereas the decision of prescribing estrogen alone or with progestins might bear oncologic and thromboembolic risks and may even lead to litigation in case of a potentially related complication. However, it was known even before the WHI results that premature menopause and hypogonadism decreases the life expectancy of women by years through its skeletal and cardiovascular effects, and this negative effect correlates with the length of the hypoestrogenaemic period. Yet, the oncologic risk of HRT is extremely diffi cult to assess. In this work we review the latest evidence from in vitro experiments to clinical studies. We group tumours regarding the oncologic risk of properly chosen female hormone replacement therapy in cancer survivors as follows: ’HRT is advanageous’ (e.g. endometrial cancer type I, cervical adenocarcinoma, haematologic malignancies, local cutaneous malignant melanoma, colorectal cancer, hepatocellular cancer); ’HRT is neutral’ (e.g. BRCA 1/2 mutation carriers without cancer, endometrial cancer type II, uterinal carcinosarcoma and adenosarcoma, certain types of ovarian cancer, cervical, vaginal and vulvar squamous cell carcinoma, prolactinoma, kidney cancer, pancreatic cancer, thyroid cancer); ’HRT is relatively contraindicated’ for various reasons (e.g. leiomyosarcoma, certain types of ovarian tumours, brain tumours, advanced metastatic malignant melanoma, lung cancer, gastric cancer, bladder cancer); ’HRT is diasadvantageous and thus contraindicated’ (e.g. breast cancer, endometrial stroma sarcoma, meningioma, glioma, hormone receptor positive gastric and bladder cancer).]

Lege Artis Medicinae

JANUARY 20, 2020

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


[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. ]

Journal of Nursing Theory and Practice

AUGUST 30, 2020

[Assessing the Nutritional Status of the Elderly using Standard Status Scales]


[Aims of the study: assess the nutritional status of elderly patients in hospital wards. A prospective, cross-sectional, quantitative study was conducted in a department of a county hospital. In a non-randomized, targeted, expert sample, the target population was elderly patients over 65 years of age (N=100). Patients with cognitive dysfunction and end-stage patients were excluded from the study. According to the MNA, 46% of patients are malnourished and 47% are at increased risk. 55% of patients were at risk using the NRS 2002 method. According to the NSI, 91% of patients are at risk. Participants with incomplete(/defective) teeth (p<0.05) and over 80 (p<0.05) are effected by malnutrition (p<0.05). The correlation was significant between the swallowing problem and malnutrition (p<0.05). Conclusions: more than half of the participants are malnourished or at increased risk. Screenings take short time, but they are informative as first assessment and for follow up. ]

Clinical Neuroscience

MAY 30, 2021

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and two main groups (PELD-MD) me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Lege Artis Medicinae

SEPTEMBER 30, 2020

[A forgotten physician in the history of Hungarian Psychiatry. Dr. Ferenc Klein’s biography]

SZABÓ József

[The Psychiatry Department of St. Raphael’s Hospital in Zala County celebrated its 110th anniversary last year. This important anniversary raised the idea of studying deeper than usual the life of our professional ancestors. We tried to discover the personality, character, and oeuvre of our first appointed chief physician Ferenc Klein while using historical recollections and press articles published by our county, city and hospital. An image of a prominent physician, psychiatrist, patriot and individual was emerging before our very eyes by processing the available sources. As a pulmonologist, a field surgeon, or a psychiatrist he was able to meet the expectations of his age. He was highly appreciated by his patients and the people of Zalaegerszeg. Despite his significant oeuvre and martyrdom, he sank in oblivion and his name was not preserved either in the history of psychiatry or in the general memory. In the present study, we want to commemo­rate him by collecting and publishing his biography. ]

Clinical Neuroscience

JANUARY 30, 2016

Comparison of hospitalized acute stroke patients’ characteristics using two large central-eastern european databases

ORBÁN-KIS Károly, SZŐCS Ildikó, FEKETE Klára, MIHÁLKA László, CSIBA László, BERECZKI Dániel, SZATMÁRI Szabolcs

Objectives – Stroke is the third leading cause of death in the European region. In spite of a decreasing trend, stroke related mortality remains higher in Hungary and Romania when compared to the EU average. This might be due to higher incidence, increased severity or even less effective care. Methods – In this study we used two large, hospital based databases from Targu Mures (Romania) and Debrecen (Hungary) to compare not only the demographic characteristics of stroke patients from these countries but also the risk factors, as well as stroke severity and short term outcome. Results – The gender related distribution of patients was similar to those found in the European Survey, whereas the mean age of patients at stroke onset was similar in the two countries but lower by four years. Although the length of hospital stay was significantly different in the two countries it was still much shorter (about half) than in most reports from western European countries. The overall fatality rate in both databases, regardless of gender was comparable to averages from Europe and other countries. In both countries we found a high number of risk factors, frequently overlapping. The prevalence of risk factors (hypertension, smoking, hyperlipidaemia) was higher than those reported in other countries, which can explain the high ratio of recurring stroke. Discussion – In summary, the comparatively analyzed data from the two large databases showed several similarities, especially regarding the high number of modifiable risk factors, and as such further effort is needed regarding primary prevention.

Journal of Nursing Theory and Practice

APRIL 30, 2018

[Quality of Life of Cancer Patients’]


[Aim of the study: This research is the part of an extended examination. It’s aim is to assess the cancer patients’ quality of life, how the diseas effects in the way of life, and also the psychologycal burden of the patients. Furthermore to assess the patient’s knowledge of their desease. Material and Methods: The research is descriptive, empirical, supplemenary, which in nurses and patients in oncology departments of Hondvéd Hospital in Budapest and Bács-Kiskun County Hospital in Kecskemét were attend. The method of the survey was an individual questionnaire. The evaulation of the results made with MS Excel and SPSS. The complete evaluable questionnaire’s rate is 74,9% (N=131). Results: the patients judge their own health and quality of life to low in a rate of 56,6%, and 75% of them stated that their way of life and their daily routin has changed in a significant extent. 50% of the responders described their actual emotional condition with a negative indicative, and also occur different psychic disfunctions amuong them. For example the depression in a rate of 17,5%, anxiety is in 18,5%, and reduced self-evaluation in 14,1%. A significant majority (76,3%) of respondents don’t possess the appropriate knowledge. Conclusions: The disease effect on cancer patients’ way of life and quality of life in a significant way. Patients are exposed to a significant psycholigycal burden. ]

Clinical Neuroscience

JUNE 09, 1950

[Aphasia in the context of Heller’s dementia infantilis]


[Lange draws attention to the importance of establishing the diagnosis of dementia infantile, in the sense that if there is no doubt about the diagnosis, such a patient can be placed in an appropriate mental hospital instead of a costly placement in a special educational institution if he cannot be kept in family care because of his restlessness.]