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Beköszöntő - Merre tartunk: erőteljes korrekciót igényel(ne) az egészségügy működtetésének választott iránya?

2024-06-17T12:36:06+00:00

Alkotmányos logika érvényesítése az egészségügyi technológia fordulópontján

2024-06-19T13:41:18+00:00

In order to establish a sustainable structure and stable operation of the domestic healthcare system, the adapted introduction of internationally proven procedures of telemedicine is necessary. When using the extremely important advantages of data-rich healing, the data protection of self-active data and the exclusion of use contrary to the patient's health interests must be ensured. Without proper regulation, healing processes using self-active data will mainly serve the business models of market players - instead of the interests of the national risk community and the stabilization of the new sector service provider structure.

THE Discreet charm of preanalytics

2024-06-19T13:41:17+00:00

Laboratory diagnostics are of decisive importance in the operation of the health care system. In addition to its role in medical decision support, it is also a significant cost factor. The constantly increasing number of cases poses a serious challenge in the organization and quality operation of laboratory services. In this article, the author wishes to draw attention to the importance of the pre-analytical phase of the laboratory diagnostic process, and to a methodology that can be used in this phase to improve the quality, efficiency and cost-effectiveness of the service. The process description, called the ARCO-P model, was created during the development and operation of the experiences gained in connection with the laboratory diagnostic operation of health institutions in Hungary and the related processes. In its practical implementation, supporting IT is essential. Healthcare developments and operations require significant resources. Designing an operation according to the ARCO-P model is an investment that pays off in the short term because it results in efficient and cost-effective operation. What is particularly interesting is the active involvement of the patient in the management of their own patient journey. Extensive application of the methodology could have a positive effect on the entire care system.

An overview of the situation of tube feeding in Hungary: challenges and possible solutions from a patient safety and health economics perspective

2024-06-19T13:41:17+00:00

Abstract: Malnutrition, which signifies a pathological nutritional state, can have numerous negative effects on the patient, including the possibility of a fatal outcome. Furthermore, complications arising from inadequate nutrition burden the capacities of the healthcare system capacities. The research, utilizing national data and interviews, analyzes the current situation of tube feeding in Hungary and the possibilities for system support. The research involved 769 tube-fed patients in 2022 and 705 in 2023, who were admitted into the system of a home care service specialized in tube feeding between May and October of the respective years. The two main indicators of the study are the specialized ENFit syringe, conforming to international standards, suitable for tube feeding, and the safe patient pathway from the hospital. Our interventions in the two pilot hospitals showed significant results. The number of patients equipped with the ENFit syringe increased by more than 40% in one institution, while the other hospital demonstrated a 26% improvement. The process of safe discharge also showed significant improvement from both pilot hospitals. The study highlights the importance of practical implementation of tube feeding, with a special focus on educating patients and healthcare professionals, and the significance of communication and patient pathway management. Discharge from inpatient care requires particular attention from both patient safety and health economics perspectives. During this critical transition period, it is essential to ensure the availability of medical devices, specialized nutritional solutions, and home nursing care necessary for tube feeding. The study will demonstrate the impact that increasing healthcare professionals' knowledge of feeding tube, engaging and educating patients early, and optimising discharge processes can have on safe patient care and healthcare provider operation

Characteristics of heteroaggressive behavior in patients admitted to an acute psychiatric ward

2024-06-19T13:41:17+00:00

Aggression is a common cause of acute psychiatric admission. In the National Institute of Mental Health, Neurology and Neurosurgery a new, high security psychiatric unit was started.

The aim of this study was to observe and evaluate the occurrence and change over time of aggressive behavior among patients admitted to an acute psychiatric ward, and defining that patient population who should be potentially transferred to the high security unit. The study included those patients who were admitted to the acute psychiatric ward of the Department of Psychiatry and Psychiatric Rehabilitation of Jahn Ferenc South-Pest Hospital in a 5 months period. Data about aggressive behavior appeared during the first week of inpatient treatment has been processed. Evaluation of the occurrence of aggressive behavior was part of the routine nursing care. Aggressive behavior was assessed by the 7-item Dynamic Appraisal of Situational Aggression-Inpatient Version (DASA-IV) with two additional items evaluating the presence of physical aggression and physical assault. DASA-IV questionnaire was completed by the nursing staff at the end of each 12-hours shift for a whole week. During the study period there were altogether 290 acute admissions. 60% (N=174) of the patients showed at least low level of aggression. Among these patients, men had significantly higher scores of aggression than women (p=0.008). The level of aggression observed in the first 12 hours following admission significantly correlated with higher level of aggression during the first week of treatment (p <0.001). Furthermore, appearance of physical threat and physical assault also had a significant predictive effect on the higher DASA-IV score during the observational period (p <0.001). Considering the diagnostic groups, any form of aggression occurred most frequently in patients with mental retardation, paranoid disorders, bipolar disorders and dementia. DASA-IV score decreased at the earliest in patients with adjustment disorder, and at the latest in patients with mental retardation during the first week of treatment. As a result of effective therapy, till the fourth day of treatment occurrence of aggressive behavior significantly decreased in all diagnostic groups, except mental retardation. Our results show that after the first 3 days of inpatient treatment most acutely admitted patients do not need to be transferred to a special high security unit due to persistent aggressive behavior, except some patients with mental retardation.

A pilot study -on assessment, evaluation and management of the mental and somatic health of physiotherapists of the Semmelweis University Rehabilitation Clinic

2024-06-19T13:41:17+00:00

Due to the nature of their work, the physical and psychological burden of healthcare workers is high, according to both national and international research, and the psychological effects of the Covid-19 pandemic also have exacerbated this. In Hungary, many researches focus on studying the mental and somatic health of healthcare workers in general or in different specializations, but there is a lack of targeted research regarding specifically the health of physiotherapists following the pandemic.

The authors' aim is to map the indicators of mental and somatic health status and cognitive emotion regulation strategies of physiotherapists working at the Semmelweis University Rehabilitation Clinic (former National Institute for Medical Rehabilitation), to make proposals for risk reduction and to present supporting research and guidelines for managers in the field.

The physiotherapists were surveyed in the fall of 2023 through a cross-sectional online survey with validated measurement instruments. Regarding mental and somatic health, we examined depression (BDI-9, Rózsa et al.: 2001), burnout (COPSOQ II, Nistor et al.: 2015), perceived stress (PSS-10, Stauder et al.: 2006), somatic symptoms (PHQ-15, Stauder et al.: 2021), and cognitive emotion regulation (CERQ, Miklósi et al.: 2011). A total of 68 individuals participated in the study. The data were analyzed using the SPSS 20.0 program and descriptive statistical methods.

According to the results, 29.41% of the studied population reported symptoms of clinical depression, 20.60% fell within the „high risk” and 44.10% in the „moderate risk” range for burnout, furthermore, a high stress level of 20.47% was found. In addition, 25.0% of the total sample reported moderate and 16.18% severe somatic symptoms, despite the fact that the adaptive and non-adaptive cognitive coping strategies of physiotherapists are similar to those of the average population.

In light of these findings, we aim to provide guidelines for risk mitigating interventions both at national and the institutional level. Simultaneously, in order to protect mental and and somatic health, managers of the field are provided with options at the individual and organisational level.

Treatment of childhood attention deficit and hyperactivity in the Hungarian public healthcare service

2024-06-19T13:41:15+00:00

In Hungary, no population-level survey has yet been conducted on the prevalence and incidence of attention deficit hyperactivity disorder (ADHD) in children and adolescents. Methylphenidate and atomoxetine are authorized for the treatment of pediatric ADHD in Hungary, however, it is unknown how many children with ADHD have access to publicly funded specialist care and how many receive pharmacotherapy.

Our study aimed to determine the annual prevalence and incidence of ADHD in children and adolescents within the Hungarian national healthcare system from 2013 to 2022, and to identify the proportion of children treated with pharmacotherapy. Anonymized raw data from the Hungarian public health fund were standardized to determine the annual prevalence and incidence of pediatric patients with ADHD diagnosis receiving care in the public healthcare system. As nationwide prevalence and incidence data on pediatric ADHD are not available, we used international meta-analyses to determine the expected number of children with ADHD. Descriptive analyses were performed by age groups (0– 6, 7–10, 11–14, and 15–18 years), sex, and geographical region within Hungary. Additionally, we assessed the proportion of diagnosed children receiving medication, the time elapsed between initial diagnosis and initiation of medication , and the type of pharmacotherapy initially prescribed.

Our analysis revealed a progressive increase in the annual prevalence of children with ADHD in the Hungarian public healthcare system from 2013 to 2022, although it remained significantly lower than the expected 5% based on international epidemiological data: the highest prevalence during these 10 years was 0.69% in 2022. The male to female ratio was 4:1 for newly diagnosed cases (incident patients) and 5:1 for prevalent patients. The data suggest a trend towards earlier referral of children with ADHD symptoms: the number of new cases gradually increased in the two younger age groups, with fewer new cases in the older age groups. In terms of pharmacological treatment, only 21.7% of diagnosed children received medication, with atomoxetine emerging as the predominant first-line pharmacotherapy (65.0%).

Based on our findings, there is an increasing trend in the diagnosis and treatment of ADHD in children in Hungary. However, this increase remains considerably lower than expected based on international epidemiological data, and the vast majority of children with ADHD still do not appear in the publicly funded healthcare system. Regional differences in the prevalence of children with ADHD are large, with some regions lagging even behind the already low national average. The difference in the prevalence and incidence between males and females suggests that many girls with ADHD are only seen once and treatment is not initiated. Besides, current pharmacotherapeutic practices in Hungary appear to deviate from established international recommendations. Firstly, the majority of children with ADHD are not treated with any medication, and secondly, the non-stimulant atomoxetine is the first choice of medication in most the treated cases.

IME Adatvezérelt egészségügy és kiberbiztonság konferencia XXII.

2024-06-17T12:36:15+00:00