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Clinical Oncology

FEBRUARY 28, 2020

[Opportunities and challenges in online support of cancer patients]

B. PAPP László

[The online support of oncological care may increase patients’ adherence, and by this it can contribute to the effectiveness of treatment, the improvement of quality of life and physician-patient communication as well as to a higher sense of control over the disease. With the online support of supportive care, patients and their relatives can get information on what they can do in order to improve their conditions, how they can recognize side effects and alarming symptoms of complications, what kind of changes they need to make in their lifestyle and how they can reduce the level of distress. Though the positive outcomes are feasible in many cases, quite considerable number of reports in the fi eld do not meet the requirements of evidence. The online support of oncological care may offer considerable opportunities, however, it may further increase inequality: the more educated and well-off patients with higher level of health awareness may benefi t more, meanwhile for the ones at the bottom of digital divide, the disadvantages may increase. The Hungarian internet coverage and accessibility make the broader online support technologically possible, however, its effectiveness may be hindered by the lack of human skills. Therefore, it is a real challenge to establish such platforms that can be used by the broadest spectrum of society, they are comprehensible for patients and their relatives with lower education, but also satisfying for patients and their relatives with higher level of literacy and expectations.]

Journal of Nursing Theory and Practice

DECEMBER 30, 2018

[Treatment and nursing of patients placed in prone position]

KISS Eszter

[Acute respiratory distress syndrome (ARDS) is a medical condition characterized by a high mortality rate. ARDS may be triggered by various pathologies such as sepsis and can have a significant impact on the overall outcome of primary disease. Prone positioning as a supportive strategy in the treatment of ARDS that has been investigated  since 1974. Lying face down has become more and more popular because it might have helped to improve oxygenisation in 70 percent of patients with ARDS. Occurence of ARDS did not change in the last 10 years in Europe and the syndrome is still associated with a quite high death rate between 40-50% despite of technologic and therapeutic improvement of last decades. It has already been investigated whether prone positioning may increase survival in patients with ARDS. However, approaches to the exact use of position are often occasional. Guideline development would be crucial to emphasize beneficial effect of prone positioning in patients suffering from ARDS and describe the process by which the manoeuvre may be performed. Primarily, it is substantial to improve oxygenation through the use of the prone position whilst promoting patient safety. Complications can be minimized by using a predefined strategy of placing patients in a prone position and a related checklist. ]

Clinical Neuroscience

JANUARY 30, 2019

[Tension type headache and its treatment possibilities]

ERTSEY Csaba, MAGYAR Máté, GYÜRE Tamás, BALOGH Eszter, BOZSIK György

[Tension type headache, the most common type of primary headaches, affects approximately 80% of the population. Mainly because of its high prevalence, the socio-economic consequences of tension type headache are significant. The pain in tension type headache is usually bilateral, mild to moderate, is of a pressing or tightening quality, and is not accompanied by other symptoms. Patients with frequent or daily occurrence of tension type headache may experience significant distress because of the condition. The two main therapeutic avenues of tension type headache are acute and prophylactic treatment. Simple or combined analgesics are the mainstay of acute treatment. Prophylactic treatment is needed in case of attacks that are frequent and/or difficult to treat. The first drugs of choice as preventatives of tension type headache are tricyclic antidepressants, with a special focus on amitriptyline, the efficacy of which having been documented in multiple double-blind, placebo-controlled studies. Among other antidepressants, the efficacy of mirtazapine and venlafaxine has been documented. There is weaker evidence about the efficacy of gabapentine, topiramate, and tizanidin. Non-pharmacological prophylactic methods of tension type headache with a documented efficacy include certain types of psychotherapy and acupuncture. ]

Clinical Neuroscience

SEPTEMBER 30, 2018

Caregiver burden and quality of life in early stages of idiopathic Parkinson’s disease

YUKSEL Burcu, AK Dogan Pelin, SEN Aysu, SARIAHMETOGLU Hande, USLU Celiker Sibel, ATAKLI Dilek

Objectives - The aim of this study was to assess the impact of early stage of idiopathic Parkinson’s disease (IPD) on caregiver burden with disease severity, duration, disability and psychiatric symptoms. Methods - 30 IPD patient (15 female, 15 male) - caregiver (18 female, 12 male) pairs participated in the study. Hoehn and Yahr (H-Y) scale was used to provide the assessment of disease progression and Unified Parkinson’s Disease Rating Scale (UPDRS) was used for assessing disability and impairment. Zarit Caregiver Burden Inventory (ZCBI) was used to ascertain the distress experienced by caregivers. Hospital Anxiety and Depression scale (HADS) was performed on both patient and caregiver groups to evaluate anxiety and depression. Depressive symptoms of both groups were also measured by Beck Depression Inventory (BDI). Patients’ psychotic symptoms were assessed using the part 1- mentation, behavior and mood section of UPDRS. Mini-Mental State Examination (MMSE) was used to evaluate dementia symptoms and Short Form-36 (SF-36) was also used to assess quality of life. Results - We found significant correlation between caregiver burden with disease severity and duration. There was a significant difference between high UPDRS scores and the caregiver’s will for placing her/his patient in a long-term institution. Patients who had depression risk according to BDI had also high UPDRS scores. Patients with off period had higher UPDRS scores and lower SF-36 subdomains of general health, physical functioning, emotional role and social functioning. Conclusion - IPD is a chronic, progressive neuro- degenerative disease and comprises substantial burden on patients, families of patients and caregivers. The disease duration and disability have a remarkable impact on caregiver burden. For the good quality of caregiving, protective therapies should be recommended for caregivers if needed.

Clinical Neuroscience

SEPTEMBER 30, 2017

[Diabetes, dementia, depression, distress]

SZATMÁRI Szabolcs, ORBÁN-KIS Károly, MIHÁLY István, LÁZÁR Alpár Sándor

[The number of people living with diabetes continues to rise. Therefore neurologists or other health care practitioners may be increasingly faced with comorbid neuropsychiatric disorders commonly presented by diabetic patients. More recently there has been an increasing research interest not only in the interactions between diabetes and the nervous system, the fine structure and functional changes of the brain, but also in the cognitive aspects of antidiabetic treatments. Patients with both types of diabetes mellitus may show signs of cognitive decline, and depression. Comorbid insomnia, anxiety, and distress may also occur. The bi-directional relationships between all these phenomena as well as their connection with diabetes can lead to further health and quality of life deterioration. Therefore it is important that all practitioners involved in the care of diabetic patients recognize the presence of comorbid neuropsychiatric disturbances early on during the healthcare process. Identifying higher risk patients and early screening could improve the prognosis of diabetes and may prevent complications.]

Journal of Nursing Theory and Practice

OCTOBER 30, 2016

[Empathy research among nurses - comparison of the scales empathy: Jefferson Scale of Physician Empathy (JSPE) and the Interpersonal Reactivity Index (IRI)]

NAGY Ivett Klára, ÖREG Zsolt

[Aim of the research: comparison of the two internationally validated self-administered questionnaire (Jefferson Scale of Physician Empathy (JSPE) (Hojat et al., 2001, 2002a, 2002b, 2003) and the Interpersonal Reactivity Index (IRI) (Davis, 1983) - during empathy research among nurses. Research and sampling methods: a quantitative cross-sectional study applying two internationally validated self-administered questionnaire (Interpersonal Reactivity Index (IRI), Jefferson Scale of Physician Empathy (JSPE)), as well as home-made socio-demographic survey, shared online. The online questionnaires have been completed by 101 nurses in different age, having different qualification levels and working currently in Hungary in different areas of health care. The sample consists of 91 women and 10 men nurses. 89 nurses work in hospitals in the sample, 7 of them work in health centre one of them is ambulance officer and 4 of them are home nurse. Results: The applied questionnaire is acceptable based on the reliability statistical analysis (Cronbach’s  0.798 and 0.817). The results of IRI show in scale exploiting the professional specificity. In case of Perspective taking the used scale range is 11-28, while in the case of personal distress it shrank to 2-22 interval (as long as the total range is 1-28). Average and standard deviation in each dimension are (s): EC = 19.4 (s = 4.26); PT = 18.5 (s = 4.26); FS = 17.23 (s = 5.32), and PD = 10.85 (s = 4.66). In the total range of JSPE scale the mean empathy level is 98.5 and the standard deviation is 14.425. The same correlation relationship turned up between these two questionnaires as the developer published. These underline profession specific dimensions with direct association of the patient care (r factor EC=0,507, PT=0,447). Most of the questions related to socio-demographic factors have not been verified. Relationship emerged between the gender and the IRI personal distress dimension and the empathy value of JSPE according to the assumption for the benefit of women. It appears in scale of JSPE in perspective taking factor primarily. The extra working time had no show link with empathy, but private sector workers’ empathic concern was higher. The religion as a sociological characteristics was represented in the fantasy scale dimension of the IRI with a significantly higher value. It failed to detect any connection between the empathy and satisfaction of needs. Conclusion: Based on the study the JSPE questionnaire is admissible in Hungary. Next to the IRI it can reveal the empathy dimensions major from the patient’s view and it can make so comparable the empathy levels in other similar research projects. The women’s higher emphatic level was verified, but the length of the practice, the qualification and other socio-demographic aspects need further investigation, their effect aren’t discovered even in the research literature. Researchers steady emphasize how important is the empathy in the patient care to improve the efficacy of which would be accounted in Hungarian postgraduate courses as well. ]

Clinical Oncology

DECEMBER 10, 2015

[The role of physical activity in oncology]

PETRÁNYI Ágota, GYIMESI Zsófia

[Although nowadays there are a lot spoken about the role of physical activity in illness prevention, however it is barely connected to the treatment of malignant diseases. The regular exercises can improve physical performance and fi tness; increase muscle mass; change the body composition and proportion favorably. The positive psychological effects can decrease distress and depression; improve mood of patient; increase self-confi dence and self-respect. Finally, all of these will result in an improved quality of life. The malignant disease and the treatments can draw down either short-term or long-term consequences and side-effects that can largely infl uence or restrict everyday life. Most of them could be essentially reduced by the help of a physiotherapist experienced in oncology adopting a well-defi ned and customized workout.]

Clinical Oncology

FEBRUARY 10, 2015

[Psychooncology in the everyday practice]

ROHÁNSZKY Magda, PUSZTAFALVI Henriette

[In the past 40 years the progressively growing fi eld of psychooncology has played an increasing role in the multidisciplinary practice of oncology. In this review methods for identifying and treating cancer patients’ psychological challenges will be summarized. Effective psychological interventiones will be discussed, and two methods especially devised for supporting cancer patients (Simonton Training and Mindfulness Based Cancer Recovery) will be introduced. We also deal with the communication traits that affect the doctor-patient relationship, the mental challenges that affect doctors dealing with terminally ill patients, burnout and its prophylaxis.]

Clinical Neuroscience

SEPTEMBER 30, 2015

Anxiety management and functional magnetic resonance imaging - should it be a priority?

VANDULEK Csaba, DONKÓ Tamás, ILLÉS Anikó, EMRI Miklós, OPPOSITS Gábor, REPA Imre, KOVÁCS Árpád

Background and purpose - Studies have shown that a high proportion of patients undergoing MRI examinations experience anxiety and distress which may compromise image quality and successful data acquisition. Research on fMRI related anxiety is limited as to date, therefore, the purpose of this study was to assess the changes in anxiety as well as to examine its interactions with the implementation of a dedicated patient preparation phase prior to the examination. Methods - An fMRI examination consisting of six paradigms was performed on nine female and nine male healthy volunteers. Prior to the examination, the volunteers were subject to an extensive patient preparation phase including the professional support of a psychologist. The volunteers were subject to the State Trait Anxiety Inventory (STAI) pre and post fMRI. Blood pressure and heart rate were also measured pre and post fMRI examination. Results - A high level of trait and state anxiety was observed (STAI-T: 41.67±8.96; STAI-S: 34.78±9.79) prior to the examination. The level of state anxiety decreased significantly following the examination (STAI-S: 28.83±4.99, p<0.01). Correlation between the volunteers level of anxiety prior to the fMRI scan and the volume of the activation areas was observed in the finger-tapping (r=0.656; 0.561) and word generation (r=0.471) paradigms. Conclusion - The results of this study support the contribution of a supportive patient preparation phase inclusive of professional guidance to help reduce the volunteers’ level of distress and anxiety. These results encourage the study to be extended to clinical patients.

Clinical Neuroscience

MARCH 30, 2014

[PERSONAL RECOLLECTIONS OF DR. HANS SELYE AND OF HIS INSTITUT DE MÈDECINE ET DE CHIRURGIE EXPÈRIMENTALES (IMCE)]

MILAGROS Salas-Prato

[This article is a short personal recollection of Dr. Hans Selye (HS) and of his institute in order to show, first, why and how he influenced us; second, who he was as a person, human being, physician, scientist, professor, mentor; third, what was the structure and functioning of the Institut de mèdecine et chirurgie expèrimentales (IMCE) and fourth, what HS’ contributions and accomplishments were.]