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Clinical Neuroscience

JULY 30, 2020

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Clinical Neuroscience

SEPTEMBER 30, 2018

[The evaluation of paroxysmal events in neonates and infants]

NAGY Eszter, FARKAS Nelli, HOLLÓDY Katalin

[Introduction - Differential diagnosis of neonatal and infantile seizures based only on inspection poses a challenge even for specialists. Aims - To investigate the evaluations of neonatal and infantile paroxysmal events based only on inspection. Research question - Is there any difference in the opinion of neonatologists, paediatric neurologists and neurologists about the assessment of common paroxysmal events in infancy? Patients and methods - Video recordings about paroxysmal movements of 15 neonates or infants (aged 2 days- 5 months) were displayed for 47 paediatric neurologists, 35 neonatologists and nurses working in Neonatal or Perinatal Intensive Care Units and 43 neurologists. They had to decide without knowing the past medical history or EEG results whether events presented were epileptic or nonepileptic in nature. Results - Answers of neonatologists and paediatric neurologists were correct in 67% of cases (824/1230), no significant difference was found between their results. The largest uncertainty was in the judgement of discrete hand movements and very rapid clonus with epileptic origin, they were judged correctly by only one third of participants. The result of neurologists was only slightly, but not significantly different from that of paediatric neurologists. Conclusion - In most cases, the correct diagnosis of neonatal and infantile paroxysmal events requires video-EEG recording. No significant difference was revealed between the evaluation of neonatologists and paediatric neurologists about the differential diagnosis of movements. The ongoing cooperation of paediatric neurologists and neurologists going back to several decades facilitates the shaping of a common perspective.]

Clinical Neuroscience

MAY 30, 2017

[Non-contrast brain ct based systemic thrombolysis of two wake up ischemic stroke patients in rural settings]

POZSEGOVITS Krisztián, RENCZ László, CSÚSZ Lajos, SZABÓ Géza

[Background and presentation - Conventionally the acute ischemic stroke patients who wake up with symptomes (WUS - wake up stroke) cannot benefit from systemic thrombolysis due to the uncertainty of the exact onset time of the cerebrovascular event. Perfusion brain imaging could be used as patient selection tool but the method is not available in many settings. Simple non-contrast CT scan is easily accessible and reliable as it shows the different stages of the evolving ischemia with high accuracy. Early brain CT scan results of WUS patients have the same characteristics as the ones who are surely within therapeutic window. The intravenous thrombolysis with recombinant tissue plasminogen activator (rTPA) of WUS patients seems to be similarly successful as the ones with known onset time, the treatment does not come with excess complications, higher rate of symptomatic intracranial hemorrhage was not found in previous reports. Purpose - In this report we present two systemic thrombolysis cases of acute ischemic stroke patients who woke up with stroke symptoms. Methods - In 2014 and 2015 we performed systemic thrombolysis for one wake up stroke patients, respectively. Both patients had large vessel occlusion. Indication was based on favourable non-contrast brain CT scan results. Results - Treatment of these two patients with rTPA proved to be safe, no hemorrhage occurred after treatment. Conclusion - We presented two acute ischemic stroke patients with symptomes at early wake up who were treated intravenously with recombinant tissue plasminogen activator based on non-contrast CT alone without complications and some moderate improvement at 90 days in the settings of a rural town hospital in a middle income country.]

Journal of Nursing Theory and Practice

APRIL 30, 2015

[The effect of work uncertainty on burnout and health of nurses]

NÉMETH Anikó, LANTOS Katalin, BÁRSONYNÉ KIS Klára

[Aim of the research: To measure how work uncertainty effects on burnout, psychosomatic symptoms and subjective health conditious. Research and sampling methods: In this cross-sectional study the authors have conducted a group of nurses (N=29) at Mátra Health Institute in 2013-2014. The survey was designed by the authors. Results: The burnout becomes higher as the uncertainty at the workplace rises (p=0,038; r=0,387). The degree of the burnout correlates with the subjective negative health status (p<0,001; r=-0,650) and with the appearance of psychosomatic symptoms (p=0,003; r=0,530). The most common psychosomatic symptoms are the backache and dorsal pain, weakness, weariness, headache and sleeping problems. Conclusions: The uncertainty influences only the degree of the burnout, and it had no any effect on other variables) ]

Journal of Nursing Theory and Practice

APRIL 30, 2014

[Job satisfaction and well-being among nurses]

NÉMETH Anikó, LAMPEK Kinga, BETLEHEM József

[Aim of the study: To monitor the changes in job satisfaction and well-being of nurses and to investigate whether the uncertainty caused by the reorganisation of workplaces affected their well-being. Sample and methods: Two cross-sectional studies were conducted in six Hungarian teaching hospitals in 2003 and in 2010 involving full time worker female inpatient care nurses who were asked to complete a questionnaire developed by the researchers. Results: The degree of acknowledgement and psychological strain at the workplace decreased significantly since the first survey. The autonomy at work dropped which is reflected by the diminished decision making and fewer opportunities to plan the working methods, work tasks, pace of work and jobs. Nurses evaluate the working community as worse, but the judgement of the head nurses did not change in 7 years. The rate of positive well-being significantly decreased since 2003, although the extent of negative well-being did not change. Conclusions: The job satisfaction of nurses decreased and the uncertainty at workplace affects their well-being.]

Lege Artis Medicinae

JULY 20, 2014

[In vitro diagnostic medical testing laboratories and EU standards; basic elements]

DEBRECZENI Lóránd, FEKETE Mátyás, VÁSÁRHELYI Barna

[In the “in vitro diagnostic testing medical laboratories” particular attention should be paid to the confidental and reliable operation as to 60-75% of the information for medical decisions are derived from laboratory tests. The high-quality laboratory work is based on the standards created by the national professional boards. Laboratories in Hungary (as any other country around the world) should comply with the various directives and/or standards set out requirements: MSZ EN ISO 15189:2013, MSZ EN ISO 22870:2006, MSZ EN ISO 15197:2013, Guide to the Expression of Uncertainty in Measurements (GUM), guidelines of the International Union of Pure and Applied Chemistry (IUPAC), etc. Special attention should be devoted to the quality of the work (internal and external quality assurance). Participation in proficiency testing (MSZ EN ISO 17043:2010) is a must, where the results are evaluated by statistical methods as defined by the ISO 13528:2005 standard. Some aspects are summarized how to select appropriate laboratory services.]

Journal of Nursing Theory and Practice

DECEMBER 31, 2013

[The health care changes affected the everyday lives of nurses ]

NÉMETH Anikó, BETLEHEM József, LAMPEK Kinga

[Aims of the study: To examine the changes inpatient care nurses had to undergo following the reorganization of health care system during the last few years. Sample and methods: This was a cross-sectional study conducted in six teaching hospitals of Hungary involving nurses who worked full-time in inpatient care applying self-developed questionnaires between October and December 2010. Results: Nurses had to face many negative events and the feeling of uncertainty during the reorganization, which also affected the self evaluation of their health status. The fear of relocation, reduced salary or losing the job and the worsened psychic status and bad workplace communication are significant. The six-question uncertainty scale can be divided into a promotional and an environmental subscale. Responders expect significant support from their employers, mainly financially. Conclusions: The reorganization of the health care system caused uncertainty by the nurses. ]

Lege Artis Medicinae

DECEMBER 18, 2013

[Vitamin D treatment: hormone therapy for patients who need it or simply a supplementation for everyone?]

SPEER Gábor

[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine (IOM), the target vitamin D level is 20 ng/ml, whereas the Endocrine Society (ES) recommends 30 ng/m as the miminum target value. According to the ES, a 1 ng/ml increase of vitamin D level can be reached by a daily intake of 100 NE, while the IOM recommends 3.6 ng/ml. Moreover, the IOM states that the effect of therapy on serum level is nonlinear. These differences show that the ES and IOM have different views on the risk of adverse effects. The IOM recommends 400 IU vitamin D daily for children younger than 1 year, 800 IU for those above 70 years and 600 IU/per day for everyone else. The ES recommend 400-1000 IU daily for all infants and 1500- 2000 IU for adults. Screening, however, is not recommended by either society. To decrease uncertainty concerning the side effects of higher-dose vitamin D treatment, it is important to understand, use and support the function of the pharmacovigilance system of the pharmaceutical industry that manufactures and markets various (prescription, over-the-counter) preparations. This is what the author aims to highlight in the second part of this article. Using this system, both the doctor and the patient can help support and accept the justification of higher-dose vitamin D therapy.]

LAM Extra for General Practicioners

DECEMBER 17, 2013

[VITAMIN D TREATMENT: HORMONE THERAPY FOR PATIENTS WHO NEED IT OR SIMPLY A SUPPLEMENTATION FOR EVERYONE?]

SPEER Gábor

[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine (IOM), the target vitamin D level is 20 ng/ml, whereas the Endocrine Society (ES) recommends 30 ng/m as the miminum target value. According to the ES, a 1 ng/ml increase of vitamin D level can be reached by a daily intake of 100 NE, while the IOM recommends 3.6 ng/ml. Moreover, the IOM states that the effect of therapy on serum level is nonlinear. These differences show that the ES and IOM have different views on the risk of adverse effects. The IOM recommends 400 IU vitamin D daily for children younger than 1 year, 800 IU for those above 70 years and 600 IU/per day for everyone else. The ES recommend 400-1000 IU daily for all infants and 1500- 2000 IU for adults. Screening, however, is not recommended by either society. To decrease uncertainty concerning the side effects of higher-dose vitamin D treatment, it is important to understand, use and support the function of the pharmacovigilance system of the pharmaceutical industry that manufactures and markets various (prescription, over-the-counter) preparations. This is what the author aims to highlight in the second part of this article. Using this system, both the doctor and the patient can help support and accept the justification of higher-dose vitamin D therapy.]

Journal of Nursing Theory and Practice

JULY 30, 2013

[Attitudes to careers and the future among students at Semmelweis University]

VÁCZI Anna, FEITH Helga Judit, NÉMETHNÉ GRADVOHL Edina, SOÓSNÉ KISS Zsuzsanna, FARKAS Boglárka

[Aim of the study: The authors studied the attitudes, regarding the future, of female students who had chosen a paramedical vocation. In the course of their work they assessed the students’ vision of the future, and obtained a detailed knowledge of their family and career plans, and the correlations between them. Methodology and sample: The quantitative sociological survey, based on a self-completion questionnaire, was conducted among 2nd, 3rd and 4th year student nurses, student midwifes and student health visitors at the Semmelweis University Faculty of Health Sciences. The results were analysed with the SPSS 19.0 program, using a descriptive statistical method. The proportion of useful responses to the questionnaire was 94.1% (N=257). Results: The students clearly prefer motherhood, but their vision of the future is uncertain. Achieving new and higher professional targets was considered important by 29.2% of the sample, and going to practice their studied profession by 54.5%. With regard to career plans, the authors found a statistically provable difference between the specialisations (p<0.001). Of the nursing students who responded, 82.6% wanted to attain middle-management status by the age of 40, while only 8.7% would also be happy to work as general staff. Conclusions: The female students at Semmelweis University are preparing both to have children and to practice their paramedical vocation. The responses given regarding their vision of the future could show that the reconciliation of these two future roles is already causing uncertainty. A higher proportion of the respondents would like to achieve middle-management status, which represents greater prestige for them. A positive shift in their vision of the future could help prevent career abandonment and emigration. ]