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Journal of Nursing Theory and Practice

AUGUST 30, 2019

[The effect of whole body electrostimulation for the pelvic floor muscles ]

ARANYNÉ Molnár Tímea, NAGY Edit, DOMJÁN Andrea, FEKETE Zoltán, SURÁNYI Andrea, BÓDIS József

[The aim of the study: Few studies research the effects of trunk stabilizer muscle strengthening on pelvic floor dysfunctions. We assessed a new core strengthening method on the pelvic floor muscles. Material and method: Female patient (70 years) with stressincontinence and low back pain received the Whole Body Electric Muscle Stimulation for 10 weeks (2x25 minutes/week). The EMG (for the conditioning ability of pelvic floor muscle such as maximal isometric contraction, dynamic endurance and relaxation values), urodynamic assessment, introitus and the transabdominal ultrasound were used before and after training. Results: The patient’s the stressincontinence, low back pain and the conditioning ability of pelvic floor muscles improved. The urodynamic and ultrasounds values showed improvement in functions of the bladder neck and deep abdominal muscle. Conclusion: This method would increase the trunk stabilization and pelvic floor muscle strength of the eldery age group, which might decrease the prevalence of urinary incontinence.]

Clinical Oncology

APRIL 10, 2019

[New perspectives in the treatment of lung cancer]

SZONDY Klára, BOGOS Krisztina

[In recent years, huge research is going on in the fi eld of oncology and as a result, we can see a signifi cantly longer survival in this area of medicine. Lung cancer, which has been taken places in the back for decades, it has not become a curable disease, but begins to belong to the chronic diseases. As a result of brilliant surgical technics and stereotactic radiotherapy, or as a result of changes in drug treatment, 5-year survival is not uncommon in metastatic lung cancer patients, next to relatively long progression free survive. After the third-generation cytotoxic combinations the added growth inhibition (VEGF inhibitor) maintenance therapy or continuous pemetrexed cytotoxic chemotherapy were resulted in high survival benefi ts. The fi rst real breakthrough, long progression-free survival was achieved by targeted treatment, which proved to be effective with known driver mutations. The other great result, especially in squamous cell carcinoma, was the immunotherapy, the inhibition of immune checkpoints, which effi cacy was confi rmed in adenocarcinoma also. Several studies are going on with adjuvant or neoadjuvant immunotherapy, and combined use of immunotherapy (either in combination with radiotherapy or cytotoxic chemotherapy).]

Hypertension and nephrology

SEPTEMBER 10, 2019

[Hungarian Hypertension Registry. Different methods and effects of increasing physician-patient cooperation on target blood pressure]

SZEGEDI János, KÉKES Ede, KISS István

[The life expectancy, the mortality and the development of complications of hypertensive patients are fundamentally influenced by the treatment, the effectiveness of care and physician-patient cooperation, the achievement of target blood pressure. Based on the database of the Hungarian Hypertonia Registry, we present three examples of the effect of different solutions for physician-patient cooperation on increasing the blood pressure target. During the two years between 2005 and 2007, we used a complex, versatile method of increasing the patient’s adherence in treated hypertensive patients (17,114 males and 21,772 women), with information, education, home-blood pressure diary, and continuous, regular physician- patient communication (sms, green phone line, website). The target blood pressure was significantly increased from 38.8% to 43.9%, and the rate of growth was higher in women. The increase was also significant in the elderly (over 70 years). In the first quarter of 2011, we launched a wide-ranging education and patient support campaign for 28,018 hypertensive patients under the ‘Everywhere Good, Best Home!’ subprogram for promoting of home blood pressure measurement and its use in therapy. 81.3% of the patients had completed the diaries under ther observation period, the full completion of the diaries was 91.3%. At the end of the third month, the target blood pressure of 135/85 mmHg for HBPM increased from baseline 21.2% to 48.8%. Growth was significant (P <0.001). In the year 2015-2016 we started a one-year, multicentric, prospective, observational study, in which 7735 patients aged 18-64 years were included from the database of Hungarian Hypertension Registry. In the non-active group (3313 people), treated hypertensive patients were controlled according to the traditional care program so far, while the active group members (4422) participated in an intensive care program with telemedicine (smart phone application) and other helping opportunities. The control was done at the end of 3, 6, 9, and 12 months after the start. In the active group, blood pressure dier was done by smart phone and every month, in the non-active group, paper logging was done every 3 months. In the active group, the blood pressure dieries were filled with smart phone every month and in nonactive group the paper dieries only every 3 months. Patient adherence was high in both groups (around 70%) and in the active group was greater than in the nonactive group. Target blood pressure (<140/90 mmHg) in the active group increased from 53.8% to 73.4% and in the non-active group from 49.9% to 68.1%. Studies have shown that patient interaction is determined by good communication between the care team and the patient, success of home blood pressure monitoring. The communicative ability of the care team (physician-nurse pharmacist) greatly influences the achievement of the therapeutic target. Modern telecommunications is another useful option.]

Lege Artis Medicinae

JULY 20, 2019

[Empirical examination of the persistence value among the students studying health-care at the beginning of student professionalization]

DINYÁNÉ Szabó Mariann, PUSZTAI Gabriella

[INTRODUCTION – Students in healthcare studies can help maintain the mental base and maintain their health if the lecturers know the degree of student persistence. When entering higher education, it is possible to measure the pre-university experience. Persistence determines the student's relationship to learning and can be a predictor of learning success. PARTICIPANTS AND METHODS – A questionnaire study (N = 200) of the 1st year student (N = 200) of the Health Care Organization (BSc) of the University of Debrecen and Semmelweis University. For the continuous Persistence Variable a descriptive statistical method was used, an independent two-sample t-test was used for comparison between groups, and Hedges-g was used to express the effect size. We used the GLM (General Linear Model) model for fitting the persistence model. By means of factor analysis, we constructed factors from the significant predictor variables of the GLM model, which helped us assessing students' chances of learning. To quantify the strength of evidence against null hypothesis P < 0.05 (5% significance) was chosen as a standard level for concluding that there is evidence against the hypothesis tested. Statistical analysis was performed with IBM SPSS Statistics 24.0 (SPSS, Chicago, IL). RESULTS – The persistence factor loadings can be divided into three types: high, medium and low. High persistence rearranges student preferences, low interest persistence, minimal interest in academic engagement. In the case of middle-ranking people, the importance of volunteering (life-experience) and friendship is paramount. CONCLUSIONS – The results indicate that at the beginning of the student life there is a willingness, diligence, acceptance of academic values, interest or lack of interest in future success studies. During the stu­dies, these features can be monitored and the necessary interventions can be made in time.]

Lege Artis Medicinae

MAY 20, 2019

[Treating methods of obstructive sleep apnea syndrome and related difficulties in daily practice ]

MOLNÁR Márton, CSATLÓS Dalma, HARGITTAY Csenge, MOHOS András, TERRAY-HORVÁTH Attila, DOMBOVÁRI Magdolna

[Obstructive sleep apnea syndrome (OSAS) is the most common breathing disorder during sleep. Its incidence is between 2-4%, but in many cases, the disease is not recognized. It has many symptoms, but the most typical symptoms are loud snoring and daytime sleepiness. Treatment always consists of several elements depending on the patients’ specific needs. When deciding on which treatment to use efficiency and the patients’ compliance are the key factors. The necessity of the therapy can be determined by three criteria: clinical complaints (daytime discomfort), the severity of the breathing disorder and the accompanying cardiovascular diseases. Treating possibilities for the mild to moderate OSAS are lifestyle changes (losing weight, avoiding alcohol and sedative drugs), positional therapy, oral appliances, and varied surgical corrections. For patients with moderate to severe OSAS and mild OSAS with severe symptoms the first line therapy is continuous positive airway pressure. In addition to presenting new therapeutic options, the authors describe the role of the family physician in the care of apnea patients.]

Lege Artis Medicinae

MARCH 20, 2019

[Long-term CPAP compliance among Sleep Apnea Patients at the Sleep Laboratory of the Hungarian Defense Forces Medical Center ]

DOMBOVÁRI Magdolna, BERNÁT István, TERRAY-HORVÁTH Attila, CSATLÓS Dalma, HARGITTAY Csenge, TORZSA Péter

[Obstructive sleep apnea syndrome (OSAS) is the most common sleep disorder, with a prevalence of 2-4% in the overall popula­tion. It is a risk factor for cardiovascular diseases and its daytime symptoms significantly impair the patients’ quality of life and increase the risk of work and road accidents. Its first-line treatment is the CPAP device (Continuous Positive Airway Pres­sure) the effectiveness of which is significantly determined by the compliance of the patient. Although the issue of compliance in such treatment is a very important factor, long-term studies including a large number of patients have not been published yet, and there are no known data about it in Hungary. OBJECTIVE - Examining the long-term compliance of CPAP among OSAS patients in a sleep laboratory in Hungary. METHOD - 3403 OSAS patients were selected for our study between January 1, 2007, and September 30, 2017. The diagnosis and titration of effective CPAP pressure were determined by polysomnography. Patients were controlled after 2 months of therapy and then every 6 and 12 months. During the care, their compliance value was determined by data downloaded from their device's memory card. RESULTS - The mean age (± SD) of patients was 59.0 (± 10.5) years, most of them were male, 2676 (78.6%), their average body mass index (BMI) was 32.6 (± 5.25) kg/m2, their average Epworth Sleepiness Scale score was 11.4 (± 5.0), their average Apnea-Hypopnoe index was 51.0 (± 19.5) events/hour. The average usage time of the CPAP device was 5.0 (± 1.9) hours. 72.3% of the patients used the device for over 4 hours and 27.7% used it for less than 4 hours. 34.7% of the patients used the device for more than 6 hours. The Epworth Sleepiness Score showed a significant and dose-dependent improvement over CPAP treatment, with a greater improvement among patients who used the machine for longer hours. The highest score improvement was achieved by users who used CPAP between 6-7 hours, averaging 7.3 (± 3.2) points (p <0.001). CONCLUSIONS - Our present study shows that high average compliance can be achie­ved among well-adjusted and well-maintained patients. ]

Clinical Neuroscience

JANUARY 30, 2019

[Selection of the optimal device-aided therapy in Parkinson’s disease]

KOVÁCS Norbert, ASCHERMANN Zsuzsanna, JUHÁSZ Annamária, HARMAT Márk, PINTÉR Dávid, JANSZKY József

[For the treatment of advanced Parkinson’s disease the deep brain stimulation (DBS) and the levodopa/carbidopa intestinal gel (LCIG) therapies are available in Hungary. Although they may have similar impact on the health-related quality of life and disabilities associated with the disease, they have different indications, and inclusion- and exclusion criteria. Consequently, the patient population treated with DBS and LCIG may be different. In the present review, the authors try to help the process of selection of the optimal device-aided therapy for the patients with advanced Parkinson’s disease. ]

Lege Artis Medicinae

JANUARY 20, 2019

[Our stubborn misbeliefs on ageing ]

RAJNA Péter

[Stressing the continuous increase of elderly population, the author demonstrates the negative impact of technical development on everyday routines of old population. It can explain that members of younger generations often create false ideations on mental and cognitive abilities of older ones, and consequently some stubborn misbeliefs are existing here. He deals with the following four of them in details: (1) Young age means worth, while old age is equal to deficit, (2) Every old person becomes demented, (3) Elderly people loose their interest and social sensitivity, (4) Old people means ballast for younger ones. The author emphasizes, that even the elderly persons are able to fall into these traps of misbeliefs. In addition to complex refutations, he states that the “spacecraft-model” described by L. Hayflick offers efficient solutions to preserve an adequate quality of life both for old people and their society. ]

Journal of Nursing Theory and Practice

JUNE 30, 2018

[The importance of the hand hygiene compliance development in the light of prevention of nosocomial infections]

SAJTI Anikó, CSERNUS Mariann

[Good hand hygiene is the most effective means of preventing healthcare-associated infections, as contaminated hands are the greatest risk of spreading infections. It is critical that the infection control professionals emphasise the importance of good hand hygiene practices and help the health care professionals on the five steps of hand hygiene. The author presents in the case study that the numbers of positive urinary microbiological samples were decreased with systematic hand hygiene examination with direct methods and continuous feedback of experiences among the staff of the intensive care unit. For further development four sensory, alcoholic hand scrubbers with spraying automats were fitted by the management of the unit. Data obtained directly from observation further analysis is our goal a comprehensive study for the profession, which can serve as a positive example later to launch compliance development programs in other hospitals. ]

Hypertension and nephrology

AUGUST 20, 2018

[The role of telemedicine is to help the optimal patient-doctor cooperation in the treatment of hypertension]

KÉKES Ede, SZEGEDI János, †KISS István

[Telemedicine is now an indispensable part of healthcare and has overtaken the development of hospital information systems. Modern basic and specialized care requires the development of a state-of-the-art communication system between the patient and the physician. One of the main reasons for this is the attempt to raise the level of disease to a higher level, increase the level of prevention and care, involve the patient in the treatment, and care process as an active participant. The latter as a demand is growing ever since the various forms of telecommunication are becoming more and more informed. The technical solutions of telemedicine appear in two forms: In one, the signs and the values of the medical devices (sensors) through the various telecommunication systems are transmitted to the physician. The other solution is using smart phones and other devices (iPad, tablet), where patients send signals, data, and symptoms to your doctor. However, patient information (eg diet, lifestyle, etc.) and instructions from your doctor may arise, a continuous medical consultation can be established in which the patient is a doctor’s partner. This solution is promoted by the rapid spread of telecommunication tools in all layers of society. Authors present the methods of both solutions and details the practical aspects of telemedicine methods in hypertension disease.]