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Lege Artis Medicinae

FEBRUARY 22, 2007

[EFFECT OF END-OF-LIFE EDUCATION ON MEDICAL STUDENTS’ AND HEALTH CARE WORKERS’ DEATH ATTITUDE]

HEGEDÛS Katalin, ZANA Ágnes, SZABÓ Gábor

[INTRODUCTION - The aim of our research was to evaluate the effect of courses for health care workers and medical students that deal with death, dying and bereavement and that of courses on hospice care of dying patients. The goal of the courses is to make communication on death more open by exploring critical issues related to fear of death to reduce inner anxiety and to improve attitude to dying patients. PARTICIPANTS AND METHOD - Participants (n=168) completed Neimeyer and Moore's Multi-dimensional Fear of Death Scale (MFODS) and Shortened Beck Depression Questionnaire (BDI) on the first and last day of the courses. In case of health care workers a follow-up survey was also performed 2 to 3 months after the course (n=32). RESULTS - The most significant factors of fear of death are: fear for significant others, fear of the dying process and fear of premature death. Overall fear of death scores are reduced as an effect of the courses, the alteration of the components of fear of death depends on the participants’ gender, age and profession as well. Improvement was observed in both groups in attitudes that can be related to the increase of knowledge on the quality care of dying patients like fear from the process of dying and fear from conscious experience of death. CONCLUSION - Besides education containing training as well it is important to strengthen the support function of workplaces in caring for the mental health of the health care staff. Furthermore it is important during gradual education that students participate in courses that aim to achieve opened communication in the most anxiety-evoking issues.]

Lege Artis Medicinae

APRIL 21, 2006

[BURNOUT PHENOMENON IN THE MEDICAL PROFESSION]

MAJOR János, RESS Katalin, HULESCH Bors, TÚRY Ferenc

[Burnout, a physical, emotional and spiritual exhaustion, is caused by chronic emotional stress, and is considered to be the end-state of a multistep process. It is most frequently observed among professionals who work with people and are faced with people's negative emotions every day. Apart from emotional stress, certain personality traits as well as high workload have also been linked to the development of burnout. Burnout symptoms include physical exhaustion (depleted energy, tiredness, illnesses), emotional exhaustion (hopelessness, depression, suicide), and spiritual exhaustion (pessimism, negative attitudes, dehumanization of patients). Approximately 20% of all medical practitioners in several European countries, as well as in the United States, have been demonstrated to show burnout symptoms. Its prevalence appears to be similar across countries, but shows differences according to medical specialty. Doctors mostly seeing patients with easily curable diseases or with good prognosis have a lower risk of burnout, whereas those seeing chronic or dying patients on a daily basis are at a much higher risk. The prevention is possible in a number of ways, such as ensuring proper work environment, providing personality development and soft skills trainings, and participation in clinical case study workshops. The Humania Professional Socialization Workshop was set up with prevention in mind at Semmelweis University in 2002 to formally provide medical students, as part of their vocational training, with skills and techniques that later will help them cope with hard emotional situations and thus reduce the risk of burnout.]

Clinical Neuroscience

DECEMBER 20, 2003

[Thallium poisoning induced polyneuropathy - clinical and electrophysiological data]

LUKÁCS Miklós

[Introduction - The aim of the study was the electrophysiological investigation of thallium induced polyneuropathy. Beyond the rarity of the illness, the motivation of this work was the possibility of following up the pattern of neuronal damage. Thallium is one of the most toxic heavy metal and its wide use increases the chance of chronic or accidental acute poisoning. The entero-hepatic circulation makes the accumulation of this toxic agent in tissues possible, mostly in neurons, in the epithelial cells of the digestive tract, in the germinative cells of the skin and testicles. In addition to alopecia and digestive complaints, the clinical picture of thallium poisoning is dominated by neurological signs. Severe axonal polyneuropathy develops in almost all cases, with further damage to the retina and impairment of cognitive functions being not unusual. The diagnosis is confirmed by finding high levels of thallium in body fluids, especially in saliva and urine. Case report - Electrophysiological examination of our accidentally poisoned patient revealed severe, sensory-motor, predominant motor axonal polyneuropathy and pointed out some aspects of the pattern of neurotoxic process: the initially distal lesion, the dying-back course and the capacity for regeneration. Conclusion - Because thallium has the same molecular targets as potassium ion thus impairing the energetical supply of the nerve cell, the most effective treatment is carefully loading with potassium. If recognized and treated early, thallium poisoning has a favourable prognosis.]