Organizational development and management factors involved in the prevention and effective therapy of pressure ulcers: The results of the national survey conducted among Hungarian public hospitals.

The prevention of pressure ulcer (PU) or pressure injury (PI) wounds is of public health importance in developed countries, including Hungary. The study aimed to assess the PU/PI prevention and care practices of Hungarian public hospitals and identify organizational and management factors. In 2022, a national, questionnaire-based survey of inpatient institutions relevant to PU/PI care was conducted, providing a picture of the practices of 86 hospitals for the year 2019. The questionnaire was processed using descriptive statistics and regression analysis. The survey results show that good practices in Hungary are isolated, the reporting system is inhomogeneous, and documentation is not uniform across our institutional system. Of the 86 institutions, 71.0% operate a PU prevention team, 64.0% use prophylactic dressings, and 88.3% use an anti-decubitus mattress, with an average ratio of 26.1% to the number of beds. Less than half of the institutions reported the incidence of hospital acquired pressure injuries (HAPIs). In this sample, we found no significant association between hospital type and hospital size with the incidence of full-thickness HAPIs (stage III and IV wounds). Developing a comprehensive PU/PI reporting system and updating the national PU/PI prevention and care guidelines are essential in Hungary.

[Dysphagiafelmérések akut stroke-ban]. / Akut stroke-betegeken validált ágy melletti dysphagiafelmérések az elmúlt húsz évben ­ szisztematikus irodalmi áttekintés.

BACKGROUND AND PURPOSE: Stroke associated dysphagia can have serious consequences such as aspiration pneumonia. The Hungarian guideline on nutritional therapy for stroke patients recommends dysphagia assessment, as early screening can optimize disease outcome and hospital cost. Thus far, this may be the first study in Hungarian that has documented a systematic review about the available validated dysphagia assessments of acute stroke. Purpose - The aim of this study was to summarize the instrumentally validated bedside dysphagia screening tools for acute stroke patients, which were published in the last twenty years. Our objective was to describe the characteristics of the validation studies, examine their study design, and sample the sub-tests and the diagnostic accuracy of the assessments. METHODS: A systematic research was carried out of the literature between 2001 and 2021 in eight scientific databases with search terms appropriate to our objectives. Subjects of the study - 652 articles were found and were reduced to eight. We made a comparative analysis of these. RESULTS: The GUSS test reached a high level of sensitivity compared to the others. In our study sample, the prevalence of instrumentally confirmed dysphagia among acute stroke patients was 56.1%. CONCLUSION: The focus and the composition of the analyzed studies differed and posed problems such as the ambiguity of the concept of dysphagia, the difference in outcome indicators, or the timing of screening. The GUSS test, which offers domestic management, is a suitable tool for the Hungarian clinical use.

Classification of conductance traces with recurrent neural networks.

We present a new automated method for structural classification of the traces obtained in break junction experiments. Using recurrent neural networks trained on the traces of minimal cross-sectional area in molecular dynamics simulations, we successfully separate the traces into two classes: point contact or nanowire. This is done without any assumptions about the expected features of each class. The trained neural network is applied to experimental break junction conductance traces, and it separates the classes as well as the previously used experimental methods. The effect of using partial conductance traces is explored, and we show that the method performs equally well using full or partial traces (as long as the trace just prior to breaking is included). When only the initial part of the trace is included, the results are still better than random chance. Finally, we show that the neural network classification method can be used to classify experimental conductance traces without using simulated results for training, but instead training the network on a few representative experimental traces. This offers a tool to recognize some characteristic motifs of the traces, which can be hard to find by simple data selection algorithms.

Stability of a Bifunctional Cu-Based Core@Zeolite Shell Catalyst for Dimethyl Ether Synthesis Under Redox Conditions Studied by Environmental Transmission Electron Microscopy and In Situ X-Ray Ptychography.

When using bifunctional core@shell catalysts, the stability of both the shell and core-shell interface is crucial for catalytic applications. In the present study, we elucidate the stability of a CuO/ZnO/Al2O3@ZSM-5 core@shell material, used for one-stage synthesis of dimethyl ether from synthesis gas. The catalyst stability was studied in a hierarchical manner by complementary environmental transmission electron microscopy (ETEM), scanning electron microscopy (SEM) and in situ hard X-ray ptychography with a specially designed in situ cell. Both reductive activation and reoxidation were applied. The core-shell interface was found to be stable during reducing and oxidizing treatment at 250°C as observed by ETEM and in situ X-ray ptychography, although strong changes occurred in the core on a 10 nm scale due to the reduction of copper oxide to metallic copper particles. At 350°C, in situ X-ray ptychography indicated the occurrence of structural changes also on the µm scale, i.e. the core material and parts of the shell undergo restructuring. Nevertheless, the crucial core-shell interface required for full bifunctionality appeared to remain stable. This study demonstrates the potential of these correlative in situ microscopy techniques for hierarchically designed catalysts.

Quality of life in patients with diabetic foot ulcer in Visegrad countries.

AIMS AND OBJECTIVES: To identify the quality of life of patients with diabetic foot ulcers in the Visegrad countries. BACKGROUND: The diabetics with foot ulcers are principally evaluated on the basis of physical parameters, but this does not always reveal much about the patient's experience of life with ulceration. DESIGN: The cross-sectional study. METHODS: The standardised generic questionnaire World Health Organization Quality of Life-BREF was used. The sample was made up of 525 participants and the calculations were performed using the IBM spss statistical program. RESULTS: The significant negative correlations between demographic data such as age, duration of diabetes mellitus, duration of diabetic ulceration treatment and a lower level of quality of life were found across the sample. The statistically significant differences according to clinical characteristics such as Wagner classification, frequency of foot ulcers, present peripheral vascular disease and pain in terms of quality of life were also revealed. Significant differences of quality of life among Visegrad countries were revealed: Hungary's participants had a worse quality of life than others, while Slovak participants expressed lower satisfaction with their health than Czech. CONCLUSIONS: Socio-demographic factors and clinical characteristics influence the quality of life of patients with diabetic foot ulcer. Significant differences between patients of Visegrad countries were found in all domains of quality of life: physical, psychological, social and environmental. RELEVANCE TO CLINICAL PRACTICE: The quality of life of patients with diabetic foot ulcer reflects the conditions and healthcare system in each of the Visegrad countries. We have to respect socio-demographic factors and clinical characteristics in nursing care. This could have an impact on managing patient care not only with regard to their diabetic foot ulcer but also with regard to the patient as a personality with their own problems in relation to physical, psychosocial and environmental conditions.

Creation of high mobility two-dimensional electron gases via strain induced polarization at an otherwise nonpolar complex oxide interface.

The discovery of two-dimensional electron gases (2DEGs) in SrTiO3-based heterostructures provides new opportunities for nanoelectronics. Herein, we create a new type of oxide 2DEG by the epitaxial-strain-induced polarization at an otherwise nonpolar perovskite-type interface of CaZrO3/SrTiO3. Remarkably, this heterointerface is atomically sharp and exhibits a high electron mobility exceeding 60,000 cm(2) V(-1) s(-1) at low temperatures. The 2DEG carrier density exhibits a critical dependence on the film thickness, in good agreement with the polarization induced 2DEG scheme.

Patients' decisional control over care: a cross-national comparison from both the patients' and nurses' points of view.

BACKGROUND: Patients' decisional control over care is the ability or power for patients to decide what their involvement will be in healthcare decisions. There is evidence of limited agreement between the perceptions of patients and the perceptions of nurses and/or caregivers with regard to the degree of patient involvement in the planning and performance of their care. AIM: To analyse and compare patients' and nurses' perceptions of patients' decisional control over their own care. METHOD: A multisite cross-sectional comparative survey design was employed. Data were collected from hospitalised surgical inpatients (n = 1315) and their caregivers (n = 960 nurses) in five European countries. The Individualised Care Scale part B was used for collecting data from both the patients and nurses. Ethical standards were followed throughout the study. RESULTS: Significant between-country differences were found between patients and nurses. In all countries, both patients and nurses regarded that decisional control over care had been actualised (ICS-B: M = 3.75-4.47 and 3.48-4.33, respectively), but there were significant differences in their perceptions regarding four of the six items of the decisional control factor of the ICS-B. CONCLUSIONS: The results show that there are disparities between patients' and nurses' perceptions of patient involvement in care, probably due to cultural issues that need further exploration. CLINICAL RELEVANCE: The disparities between patients' and nurses' perceptions on patients' decisional control over their care should be taken into consideration as a potential cause of patient dissatisfaction with nursing care.

[The role of oxidative stress in the development of diabetic neuropathy]. / Az oxidatív stressz szerepe a diabeteses neuropathia kialakulásában.

Diabetic neuropathy may be one of the most common and severe complications of diabetes mellitus. Oxidative stress plays a pivotal role in the development of microvascular complications of diabetes. The majority of related pathways like polyol and hexosamine, advanced glycation end products, poly-ADP-ribose polymerase, and protein kinase-C all originated from initial oxidative stress. In this review, the authors present the current oxidative stress hypothesis in diabetes mellitus and summarize the pathophysiological mechanisms of diabetic neuropathy associated with increased oxidative stress. The development of modern medicines to treat diabetic neuropathy needs intensive long-term comparative trials in the future. Orv. Hetil., 2016, 157(49), 1939-1946.

[The role of induced pluripotent stem cells in modeling of neurological diseases]. / Indukált pluripotens ossejtek szerepe a neurológiai betegségek modellezésében.

The longitudinal follow-up of the development and course of central nervous system related diseases on a molecular level was unsolved for decades. Direct examination of the pathological state on organ or tissue levels was feasible in the late stage of the disease. Modeling diseases has an important role in studying the pathophysiological mechanism underlying central nervous system disorders but animals used as model organism due to species specific nervous system differences can lead to less valid conclusions in translational research. The model of induced pluripotent stem cells may help to solve partially these types of problems. In recent years this model had a strong effect on understanding the pathogenesis of neurodegenerative and neurodevelopmental disorders. Although induced pluripotent stem cells have a low impact on clinical research studies, they have a prominent role in the field of cell physiology and molecular biology research.

The effects of lactation on impulsive behavior in vasopressin-deficient Brattleboro rats.

Vasopressin (AVP)-deficient Brattleboro rats develop a specific behavioral profile, which-among other things-include altered cognitive performance. This profile is markedly affected by alterations in neuroendocrine state of the animal such as during lactation. Given the links between AVP and cognition we hypothesized that AVP deficiency may lead to changes in impulsivity that is under cognitive control and the changes might be altered by lactation. Comparing virgin and lactating AVP-deficient female Brattleboro rats to their respective controls, we assessed the putative lactation-dependent effects of AVP deficiency on impulsivity in the delay discounting paradigm. Furthermore, to investigate the basis of such effects, we assessed possible interactions of AVP deficiency with GABAergic and serotonergic signaling and stress axis activity, systems playing important roles in impulse control. Our results showed that impulsivity was unaltered by AVP deficiency in virgin rats. In contrast a lactation-induced increase in impulsivity was abolished by AVP deficiency in lactating females. We also found that chlordiazepoxide-induced facilitation of GABAergic and imipramine-induced enhancement of serotonergic activity in virgins led to increased and decreased impulsivity, respectively. In contrast, during lactation these effects were visible only in AVP-deficient rats. These rats also exhibited increased stress axis activity compared to virgin animals, an effect that was abolished by AVP deficiency. Taken together, AVP appears to play a role in the regulation of impulsivity exclusively during lactation: it has an impulsivity increasing effect which is potentially mediated via stress axis-dependent mechanisms and fine-tuning of GABAergic and serotonergic function.

3D and Multimodal X-Ray Microscopy Reveals the Impact of Voids in CIGS Solar Cells.

Small voids in the absorber layer of thin-film solar cells are generally suspected to impair photovoltaic performance. They have been studied on Cu(In,Ga)Se2 cells with conventional laboratory techniques, albeit limited to surface characterization and often affected by sample-preparation artifacts. Here, synchrotron imaging is performed on a fully operational as-deposited solar cell containing a few tens of voids. By measuring operando current and X-ray excited optical luminescence, the local electrical and optical performance in the proximity of the voids are estimated, and via ptychographic tomography, the depth in the absorber of the voids is quantified. Besides, the complex network of material-deficit structures between the absorber and the top electrode is highlighted. Despite certain local impairments, the massive presence of voids in the absorber suggests they only have a limited detrimental impact on performance.

Triple junction transport and the impact of grain boundary width in nanocrystalline Cu.

Triple junctions (TJ), singular topological defects of the grain boundary (GB) structure, get a dominant role for grain growth and atomic transport in nanocrystalline matter. Here, we present detailed measurements by atom probe tomography, even of the temperature dependence of TJ transport of Ni in nanocrystalline Cu in the chemical regime of interdiffusion. An unexpected variation of the effective width of merging GBs with temperature is detected. It is demonstrated that proper measurement of TJ transport requires taking into account this remarkable effect. TJ diffusion is found to be a factor of about 200 faster than GB diffusion. Its activation energy amounts to only two-thirds of that of the GB.

[Detailed methodological recommendations for the treatment of Clostridium difficile-associated diarrhea with faecal transplantation]. / Módszertani ajánlás a Clostridium difficile fertozéshez asszociált hasmenés széklettranszplantációval történo kezeléséhez.

The incidence of Clostridium difficile associated enteral disease shows dramatic increase worldwide, with appallingly high treatment costs, mortality figures, recurrence rates and treatment refractoriness. It is not surprising, that there is significant interest in the development and introduction of alternative therapeutic strategies. Among these only stool transplantation (or faecal bacteriotherapy) is gaining international acceptance due to its excellent cure rate (≈92%), low recurrence rate (≈6%), safety and cost-effectiveness. Unfortunately faecal transplantation is not available for most patients, although based on promising international results, its introduction into the routine clinical practice is well justified and widely expected. The authors would like to facilitate this process, by presenting a detailed faecal transplantation protocol prepared in their Institution based on the available literature and clinical rationality. Officially accepted national methodological guidelines will need to be issued in the future, founded on the expert opinion of relevant professional societies and upcoming advances in this field.

[Health policy approach to the treatment and prevention of pressure ulcers]. / A felfekvés (decubitus) ellátásának és megelozésének szakmapolitikai megközelítése.

INTRODUCTION: A pressure sore (decubitus) is a wound that develops on the skin and subcutaneous tissue in places exposed to pressure. Primarily occurs in elderly, non-mobile individuals, the prevention and control of which requires not only medical and nursing participation, but it also financial expenditure. OBJECTIVE: In our study, after a systematic document analysis, we present the relevant results of the decubitus survey conducted among state hospitals during Q2 of 2022, focusing on the organizational and management factors of decubitus prevention and care. METHOD: The national survey was comprehensive in terms of the range of institutions relevant to decubitus care. After defining the selection criteria, we got a picture of 86 institutional practices for the base year of 2019. RESULTS: During the review and systematization of domestic and European Union professional policy documents, regulators and strategy documents, it can be established that pressure ulcer prevention and care can be adapted to several development policy objectives, and its incidence appears as a quality indicator of the health sector. DISCUSSION: Based on the results of our national decubitus survey, it can be said that domestic good practices operate in isolation, our reporting system is inhomogeneous, and the documentation is not uniform in our institutional system. 17 of the 86 institutions have new (2021-2022) documents regulating decubitus care at the institutional level, which in 17% of the institutions are dated 2010 or earlier. The scope of revision of the regulatory documents is set at 10% of the institutions. 61 of the examined institutions (71%) operate decubitus teams, 55 institutions (64%) use prophylactic bandages. There is a lack of professional monitoring measures and quality indicators, institutional-level expenditure analyses, controlling-type feedback, which would form the basis of costing and cost-effectiveness analyses. CONCLUSION: In addition to our proposals for several organizational and managerial measures, we advocate the renewal of the relevant professional directive and the introduction of a uniform institutional reporting system as well. Orv Hetil. 2023; 164(21): 821-830.

Identification of heart rate change during the teaching process.

Internet of Things (IoT) technology can be used in many areas of everyday life. The objective of this paper is to obtain physiological functions in a non-invasive manner using commonly available IoT devices. The aim of the research is to point out the possibility of using physiological functions as an identifier of changes in students' level of arousal during the teaching process. The motivation of the work is to find a correlation between the change in heart rate, the student's level of arousal and the student's partial and final learning results. The research was focused on the collection of physiological data, namely heart rate and the evaluation of these data in the context of identification of arousal during individual teaching activities of the teaching process. The experiment was carried out during the COVID-19 pandemic via distance learning. During the teaching process, individual activities were recorded in time and HR was assigned to them. The benefit of the research is the proposed methodology of the system, which can identify changes in students' arousal in order to increase the efficiency of the teaching process. Based on the results of the designed system, they could also alert teachers who should be able to modify their teaching style in specific situations so that it is suitable for students and provides a basis for better teaching and understanding of educational materials. The presented methodology will be able to guarantee an increase in the success of the teaching process itself in terms of students' understanding of the teaching materials.

Aspiration Risk Screening With Tongue Pressure Measurement in Acute Stroke: A Diagnostic Accuracy Study Using STARD Guidelines.

Introduction: Dysphagia can affect more than 50% of stroke patients in the acute phase. Aspiration pneumonia is a serious complication that can be prevented with dysphagia screening and assessment. Measurement of tongue elevation pressure is suggested to be a useful tool in aspiration risk screening. Objective: This study aimed to assess the diagnostic accuracy of maximum anterior tongue elevation strength (Pmax) in acute stroke care. Method: In this prospective study, data were collected in a neurology department (stroke center) where patients formed a consecutive case series. The sample consisted of thirty stroke patients who failed an initial dysphagia screening. Patients underwent anterior tongue elevation strength measurement (index test) during bedside dysphagia assessment by a speech-language pathologist and flexible endoscopic evaluation of swallowing (reference test) by an otorhinolaryngologist on the same day. Outcome variables (index values in kPa, reference values interpreted on the penetration-aspiration scale) were used for estimating measures of diagnostic accuracy in aspiration risk screening. Results: Ten patients aspirated on instrumental evaluation. At the cut-off point of ≤ 34 kPa the analysis showed 90% sensitivity, 35% specificity, 41% positive predictive value, and 88% negative predictive value. The area under the curve (AUC) for Pmax was AUC = 0.700 (95% CI [0.500-0.900]). Conclusion: Although individuals with low anterior tongue elevation strength tend to have a higher risk of aspiration, this variable alone is not capable of screening aspiration in acute stroke. In combination with a thorough noninstrumental bedside examination, it might have the potential to reduce the number of false positive cases. Further studies in this area would be worthwhile.

Development of a European Centre of Excellence (Coe) for Research in Continuing Professional Development (UPGRADE).

The European Centre of Excellence (CoE) for Research in Continuing Professional Development (UPGRADE) is a pan-European network of researchers, clinicians, regulators, educators, and professional bodies, established in 2020 through a consensus group of experts, who defined its mission, vision, values, aims and objectives. The Centre's aim is to advance the science of Continuing Professional Development (CPD) for healthcare professionals through research and dissemination of best practices for CPD. Debate among UPGRADE partners and interchange of research data will yield best practices across countries to optimise quality CPD programmes. Collaboration, information exchange and communication among CPD experts will be facilitated through UPGRADE via an online Community of Inquiry (CoI). UPGRADE aims to evolve as a driving force network of academics and health professional leaders in research, education, professional regulation, and clinical practice whose collaborative work ensures quality and safe person-centred care. UPGRADE members are from 22 European countries, represented by strategic leaders in diverse sectors of health, policy, academia, and professional organisations. Three research-working groups constitute the pillars of UPGRADE, which addresses gaps in research, collect and create critical databases, and solidify the effectiveness of CPD.

Case report: Metastatic pancreatic neuroendocrine tumour associated with portal vein thrombosis; successful management with subsequent pregnancies.

Background: Splanchnic vein thrombosis due to co-existing metastatic pancreatic neuroendocrine tumour (pNET) and JAK2V617F mutation is a rare condition. Case report: Here we present a case of a young woman with complete remission of a non-functioning grade 2 pNET with unresectable liver metastases, coexisting with JAK2V617F mutation. Splenectomy and distal pancreatectomy were performed. Neither surgical removal, nor radiofrequency ablation of the liver metastases was possible. Therefore, somatostatin analogue (SSA) and enoxaparine were started. Peptide receptor radionuclide therapy (PRRT) was given in 3 cycles 6-8 weeks apart. Genetic testing revealed no multiple endocrine neoplasia type 1 (MEN-1) gene mutations. After shared decision making with the patient, she gave birth to two healthy children, currently 2 and 4 years old. On pregnancy confirmation, SSA treatment was interrupted and resumed after each delivery. Ten years after the diagnosis of pNET, no tumour is detectable by MRI or somatostatin receptor scintigraphy. PRRT followed by continuous SSA therapy, interrupted only during pregnancies, resulted in complete remission and enabled the patient to complete two successful pregnancies.

The temporal dynamics of the effects of monoacylglycerol lipase blockade on locomotion, anxiety, and body temperature.

Studies with the monoacylglycerol lipase blocker JZL184 have suggested that enhanced 2-arachidonoylglycerol signaling suppresses locomotion, lowers body temperature, and decreases anxiety. Although the neurochemical effects of JZL184 develop within 30 min, its behavioral and autonomic effects have been studied much later. To clarify temporal dynamics, we studied the effects of intraperitoneal injections of JZL184 in mice on home-cage locomotion and body temperature for 120 min using in-vivo biotelemetry. We also studied the effects of 4, 8, and 16 mg/kg JZL184 in the open field and elevated plus maze at various time points. In the home cage, JZL184 blunted injection-induced body temperature increases but exerted no long-term effects. Vehicle injections increased the duration of rapid movements whereas the duration of motionless periods was decreased, a pattern also abolished by JZL184. Although the highest dose exerted a mild long-term effect on the relative duration of motionless periods, JZL184 seemed to have phasic rather than tonic effects in the home cage. By contrast, open field and plus maze behavior was affected 80 and 120 min but not 40 min after treatments, which may indicate tonic rather than phasic effects in these tests. Our findings confirm earlier reports of a mild anxiolytic effect of JZL184, but surprisingly, the compound markedly and dose dependently increased locomotion in the open field in both CD1 and C57BL/6J mice. These findings are difficult to reconcile at present, but suggest that the effects of monoacylglycerol lipase inhibition are more complex than previously believed and may depend strongly on as yet unidentified factors such as environmental conditions, the time of testing, species/strains, etc.