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Clinical Neuroscience

JANUARY 30, 2016

[Financing of medicines for treatment of rare diseases of the nervous system. orphan drugs in rare neurological diseases]

SZEGEDI Márta, KOSZTOLÁNYI György, BONCZ Imre, MOLNÁR Mária Judit

[Objectives – Nervous system involvement is expected up to 60-70% in case of rare diseases. This article aims to present the financial methods and expenditures of rare neurological diseases’ orphan medicinal products being financed in the frame of Hungarian social insurance system in 2012. Methods – The subsidized orphan medicines were selected on the Orphanet portal 2012 while orphans financed by compessionate use were provided by the Hungarian National Insurance Fund Administration (OEP) database. Three products exist without orphan designation, however those are intended for the treatment of rare neurological ailments. The medicines were categorized by financial methods and determined by costs. Results – Numerically, out of 36 pieces of subsidized orphan or orphan criteria fulfilled medicines 17 were authorized for the treatments of rare neurological diseases in the year of 2012. Most of the drugs (14 pieces) were to be financed in the frame of compassionate use by the reimbursement system. The cost amount of social insurance for 387 rare neurological disease patients reached more than 4.5 billion HUF (1.4% of the total pharmaceutical budget in outpatient care). Conclusions – In Hungary half of the subsidized orphans are intended for the treatments of rare neurological ailments. 30% of the total amount of social insurance for rare diseases’ medicinal treatments were used to subsidizing rare neurological disease patients in 2012. Most of the orphan medicines were to be financed in the frame of compassionate use by the reimbursement system for outpatient care. Consequently, a great deal of crucial problems occurred in relation with the unconventional subsidizing method. At the end of 2012 new financial methods have been elaborated and introduced in a pilot phase from 1 January 2013. In spite of the high cost commitment, nearly the entire diagnosed rare disease subpopulation have been provided with subsidized treatments in Hungary. In order to facilitate the acces to orphan medicines, collaboration shall be achieved by financing authority and professionals for identificating the descently sustainable, affordable and viable financial method. ]

Clinical Oncology

FEBRUARY 20, 2019

[Liquid biopsy in clinical oncology – fine-tuning precision medicine]

PRISKIN Katalin, PINTÉR Lajos, JAKSA Gábor, PÓLYA Sára, KAHÁN Zsuzsa, SÜKÖSD Farkas, HARACSKA Lajos

[The classical method of genetically characterising a tumour requires tissue biopsy with which a small sample is removed from the affected organ. This sample represents the tumour in the further analyses. However, the localised nature of sample collection limits representative characterisation. The so-called circulating tumour DNA, isolated from blood plasma after a simple sample collection, potentially enables the oncological analysis of all tumour tissues carrying genetic alterations that can be identifi ed as markers. In order to maximally exploit the potentials of circulating tumour DNA, we must adjust the analytical tools to its specifi c features. The preanalytical handling and storage of the sample signifi cantly infl uences its further usability. In order to be able to detect a potential mutation in a mostly wild-type background, the development of new, specifi c methods is needed, most of which are based on next-generation sequencing techniques. In the past decades, the pronounced decrease in the costs of such techniques led to an accumulation of an immense amount of genetic information on tumorigenesis. Due to the development of sequencing technologies, the turnaround times of tests also decreased enabling their employment in routine care besides research. Starting from our research, this can be realised via three approaches: technological development, the implementation of our already existing diagnostic methods in liquid biopsy, and the construction of well-planned disease-specifi c gene panels. Based on international trends and our experience in serum diagnostics, we are certain that liquid biopsy will become a central pillar of oncological screening and precision oncology in the near future.]

Clinical Neuroscience

MARCH 30, 2019

[Epidemiology, cost and economic impact of cerebral palsy in Hungary]

FEJES Melinda, VARGA Beatrix, HOLLÓDY Katalin

[Objective - The purpose of our communication was to determine the total cost of cerebral paretic patients in Hungary between 0 and 18 years and to assess their impact on the national budget. Methods - Based on the data of Borsod county we calculated the CP characteristics. The cost of CP was determined by routine care of individuals. Lost Parental Income and Tax were calculated on the basis of average earnings. The ratio of GDP, Health and Social Budget and Health Budget to CP is based on CP annual average cost and frequency. We have developed a repeatable computational model. Results - Of the risk groups, premature birth (30.97%), low birth weight (29.64%), perinatal asphyxia (19.47%) were the most common. Source is unknown of 37.61% of the cases. CP prevalence was 2.1‰. The two-sided (59.7%) and the one-sided (19.0%) spastic pareses dominated. The most serious form is the two-sided spastic paresis (42.5% GMFCS 3-5 degrees). Epilepsy was 22.0%, incontinence was 27%, mental involvement was 46%. Care for one child up to 18 years of age costs an average of 73 million HUF (€ 251,724). The lost family income was 27.36 million HUF (€ 94,345), and lost tax and health care contributions were 14.46 million HUF (€ 49,862). Additionally, 0.525% of the GDP, 0.88% of the full health and social budget and 1.83% of direct medical costs were spent for CP families. Conclusion - The cost of CP disease is significant. Costs can be reduced by improving primary prevention. From the perspective of the family and government, it is better to care for families so they can take care of their disabled children.]

Journal of Nursing Theory and Practice

AUGUST 30, 2017

[Workplace conflicts in health care]

IRINYI Tamás, LAMPEK Kinga, NÉMETH Anikó

[Health care requires the cooperation of many professions and often comes with stressful situations. Therefore conflicts might develop among health care providers more frequently. Moreover the staff is interdependent, which might be another source of conflicts. This phenomenon not only affects the crossing parties, but also triggers emotional changes in the individuals (anger, stress and negative emotions) and has long term consequences, too (medical malpractice, fluctuation, sick leaves, discontent patients and bad reputation of the institution). All these can have financial effects, e.g. law costs. The present publication discusses the different definitions of conflicts and explains their reasons and types. This article has a special focus on health-care team conflicts, their consequences and the possible management methods.]

Lege Artis Medicinae

SEPTEMBER 20, 2017

[Dementia and pseudodementia - depression as a risk factor of dementia]

NÉMETH Attila

[Dementia and depression have the highest annual costs for brain disorders (mental and neurologic disorders) in Europe. The prevalence of these disorders is very high in the old age. The depression is common and an underrecognized part of the dementia syndrome because of similar symptomatology and the comorbidity. The correct differential diagnosis is important in the therapeutic approach. The pseudodementia of depression can be improved by antidepressants. The author reviewed the symptomatologic and neurobiological connection of these two disorders.]

Clinical Oncology

DECEMBER 10, 2016

[Biopharmaceuticals]

LÉVAY György

[Biopharmaceuticals represent a new class of very effective medications in the management of debilitating and often life-threatening diseases but the costs of these therapies exceed the costs of regular therapies. Biological medicinal products (i.e. smaller proteins or monoclonal antibodies) are mostly complex macromolecules, produced by microbial or mammalian cell cultures in bioreactors through application of complex process technologies. After patent expiry, the production of compounds with comparable quality features and comparable clinical safety and effi cacy profi les become available, however, the complexity of the macromolecules means they are not equivalent in the sense of small molecule generics. Biologics that are similar to a given licensed reference compound and meet regulatory requirements within this context can be termed as biosimilars. The similarity of the two products must be appropriately proven during the products’ marketing-authorisation procedure. As more and more biosimilar compounds have been approved by regulatory authorities in the EU and US it is expected that these products will bring signifi cant healthcare savings and much greater patient access to these revolutionary therapeutics.]

Lege Artis Medicinae

DECEMBER 15, 2015

[Rare genetic disease of copper metabolism]

SZILI Károly, VANYA Melinda, MÁGORI Krisztina, LAJOS György

[INTRODUCTION - Wilson’s disease is a rare genetic disease of copper metabolism. Nearly, 300 patients in Hungary suffering from Wilson’s disease CASE - 25-year-old male patients were examined because of because speech impairment and ocular symptoms. The increase in blood copper and ceruloplasmin and point mutations in the ATP7B proven confirmed the diagnosis of Wilson’s disease. DISCUSSION - In diagnosis of rare disease is not easy because of the variety of symptoms and the high costs of genetic testing, we would like to draw the attention to it.]

Journal of Nursing Theory and Practice

APRIL 30, 2015

[The international practice and acceptation concept on Hungary of the Advanced Practice Nurse (APN) training on the MSc level]

OLÁH András, MÁTÉ Orsolya, BETLEHEM József, FULLÉR Noémi

[In Hungary it was a niche and a reasonable developement according to the international trends to start the BSc nursing programme in 1989 - then the MSc nursing programme in 2000 -. However the structure of the nursing specialities’ education was not reviewed with the increase of the level of nursing education, so all of the nursing specialities’ education happens under BSc level. Also did not happened the determination of the nursing competencies on each educational level. These causes just contribute to have decreased number of nursing students within the BSc programmes and the numbers of nurses who intent to leave the profession are also increased. Migration of nurses, increased costs of the health care system, aging society, lack of physicians and the special knowledge of nurses to use for diagnostical and therapeutical equipements are challanges too beside these problems regarding the nurses. However, international literature says that with the employment of well-educated BSc, MSc nurses with expanded competencies the the problem of the lack of the physicians, waiting times, costs of the care, patients’ mortality may be decreased, patient’s satisfaction increases and because of the expanded nursing competencies the migration and nurses intent to leave are decreased. That is why it is reasonable to create BSc/MSc nursing specialities and expand nursing competencies in Hungary as well according to the international trends. Authors of this paper draw up a possible recommendation for the Hungarian implementation.]

Lege Artis Medicinae

JUNE 01, 2015

[Use of surgical checklists to improve the patient safety]

BENEDEK Zsófia, MOLNÁR-GALLATZ Zsolt

[In the millennium working groups were formed in several countries to create and implement control- or checklists to reduce the mortality rate and complications during surgical care. The research revealed that the use of checklists improved patient safety, reduced mortality and complication rate, and several additional positive effects were identified. The checklists improved teamwork and the communication in the surgery team. The starting financial and time costs of using checklist are low, and the maintaining costs are minimal. On the other hand, checklists result significant financial savings. These savings primarily are the costs of malpractice lawsuits and the costs of treatment complications. To ensure patient safety multiple checklists were developed. By the literature data three checklists are the most detailed and widely used: the World Health Organiza­tion’s checklist, the Universal Protocol and the Surgical Patient Safety System. Common characteristics are that they significantly reduce the complications and the mortality rate, improve patient safety, teamwork and communication. The main differences are in the using and timing. In this publication we present the most typical and used checklists, their advantages and possible disadvantages, and finally we give an overview of the examples of the Hungarian experience.]

Journal of Nursing Theory and Practice

OCTOBER 30, 2014

[The malnutrition and the possibilities of its therapy in childhood]

GELENCSÉR Erzsébet

[Malnutrition is a very important clinical condition in pediatrics. However, undernutrition as negative impact on length hospital stay, risk of infection and health care costs. Moerver, it also effects the cognitive development of children. STONG is an easy-to use screening tool that can be recorded in a few minutes, and it does not require special knowledge measurement or follow-up. In Kaposi Mór Hospital (Kaposvár) the risk of malnutrition was assessed by STRONG nutritonal risk screening tool in 31 patient of child-gastroenterology ambulatory (02.01.2014-30.06.2014). In case of malnutrition counselling and use of special formulas are essential besides evaluating tehe cause of malnutrition.]