Autopsy findings in cancer patients infected with SARS-CoV-2 show a milder presentation of COVID-19 compared to non-cancer patients.

COVID-19, caused by SARS-CoV-2, manifests with differing severity across distinct patient subgroups, with outcomes influenced by underlying comorbidities such as cancer, which may cause functional and compositional alterations of the immune system during tumor progression. We aimed to investigate the association of SARS-CoV-2 infection and its complications with cancer in a large autopsy series and the role of COVID-19 in the fatal sequence leading to death. A total of 2641 adult autopsies were investigated, 539 of these were positive for SARS-CoV-2. Among the total number of patients analyzed, 829 had active cancer. Overall, the cohort included 100 patients who simultaneously had cancer and SARS-CoV-2 infection. The course of COVID-19 was less severe in cancer patients, including a significantly lower incidence of viral and bacterial pneumonia, occurring more frequently as a contributory disease or coexisting morbidity, or as SARS-CoV-2 positivity without viral disease. SARS-CoV-2 positivity was more frequent among non-metastatic than metastatic cancer cases, and in specific tumor types including hematologic malignancies. COVID-19 was more frequently found to be directly involved in the fatal sequence in patients undergoing active anticancer therapy, but less frequently in perioperative status, suggesting that the underlying malignancy and consequent surgery are more important factors leading to death perioperatively than viral disease. The course of COVID-19 in cancer patients was milder and balanced during the pandemic. This may be due to relative immunosuppressed status, and the fact that even early/mild viral infections can easily upset their condition, leading to death from their underlying cancer or its complications.

Associations between diabetes and cancer: A 10-year national population-based retrospective cohort study.

AIMS: To investigate the risk of cancer in people with diabetes compared to the population without diabetes and to gain insight into the timely association between diabetes and cancer at national level. METHODS: A retrospective cohort study was conducted to analyse the role of diabetes in the development of cancer, based on service utilisation and antidiabetic dispensing data of the population between 2010 and 2021. Univariate and multivariate Cox regression were used to examine how diabetes status, in relationship with age and sex are related to the time to cancer diagnosis. RESULTS: Examining a population of 3 681 774 individuals, people with diabetes have a consistently higher risk for cancer diagnosis for each cancer site studied. Diabetes adds the highest risk for pancreatic cancer (HR = 2.294, 99 % CI: 2.099; 2.507) and for liver cancer (HR = 1.830, 99 % CI: 1.631; 2.054); it adds the lowest - but still significant - risk for breast cancer (HR = 1.137, 99 % CI: 1.055; 1.227) and prostate cancer (HR = 1.171, 99 % CI: 1.071; 1.280).The difference in cancer rate is driven by the younger age group (40-54 years: for patients with diabetes 5.4 % vs. controls 4.4 %; 70-89 years: for patients with diabetes 12.7 % vs. controls 12.4 %). There are no consistent results whether the presence of diabetes increases the risk of cancer diagnosis differently in males and females. The cancer incidence starts to increase before the diagnosis of diabetes and peaks in the year after. By the year after the start of the inclusion date, the incidence is 114/10,000 population in the control group, vs 195/10,000 population in the group with diabetes. Following this, the incidence drops close to the control group. CONCLUSIONS: Screening activities should be revised and the guidelines on diabetes should be complemented with recommendations on cancer prevention also considering that the cancer incidence is highest around the time of the diagnosis of diabetes. For prostate cancer, our results contradict many previous studies, and further research is recommended to clarify this.

Analysis of the practices and influencing factors of referral to inpatient rehabilitation following hip fractures based on data from the Hungarian healthcare funding database / A csípotáji töréseket követo intézményi rehabilitációra utalás gyakorlata és a beutalást befolyásoló tényezok a hazai közfinanszírozási adatok alapján

Introduction: Hip fractures heavily burden healthcare systems in aging populations. The health and quality of life of the patients depend not only on the acute care, but on rehabilitation practices as well. There is insufficient data on Hungarian rehabilitation rates following hip fracture surgeries. Objective: Our goal was to examine the rehabilitation rates within 30 days of hip fracture related admissions and to observe the factors that influence admission to inpatient rehabilitation. Method: We analysed patient level data from the Hungarian healthcare funding database between 2005 and 2015 by multivariate logistic regression, and observed rehabilitation rates through descriptive statistics between 2005 and 2015 and between 1 January 2019 and 31 December 2020. Results: Rehabilitation rates show a rapid increase between 2005 and 2015, and further increase is observed in 2019, while 2020 shows a fall in admission rates. The regression analysis showed significant results for the patients' gender, age, and the variables assessing healthcare practices and accessibility. Complications after the acute care has a strong power on admission to rehabilitation, but the majority of the observed comorbidities have significant effects as well. Conclusion: Admission to rehabilitation after hip fracture shows increasing trends. Factors influencing the admissions show a consistent direction but changing strength. The increasing strength of our regression model suggests that rehabilitation practices grew more consistent over time.

Aggregate causes of adverse events and possible methods to mitigate them within healthcare: Results and lessons learned based on the reports sent to the Hungarian NEVES reporting and learning system / A nemkívánatos események általános okai és kezelési lehetoségei az egészségügyben: Eredmények és tanulságok a hazai NEVES jelentési és tanulórendszerbe érkezett jelentések alapján

Összefoglaló. Bevezetés: Hazánkban 2007-ben indult el a NEVES (NEm Várt ESemények) rendszer, amelybe az eltelt idoszakban több mint 26,5 ezer nemkívánatos eseményre vonatkozó jelentés érkezett. A jelentések feldolgozásával hét témakörben készültek oki kutatások és ajánlások a feltárt okok megelozésére. Célkituzés: Az oki kutatások eredményei alapján a hazai ellátási gyakorlatban meglévo legfontosabb, nemkívánatos eseményhez vezeto általános okok azonosítása és ajánlások megfogalmazása a kezelésükre. Módszerek: Témakörönként végeztünk szakirodalmi kutatást a lehetséges okok és kezelési lehetoségek feltárására. Leíró statisztikai elemzéseket alkalmaztunk a jelentések adatai alapján az összefüggések megállapítására, majd Ishikawa-diagrammal kerestük az alapveto okokat. Fókuszcsoportos megbeszélések alapján gyujtöttünk lehetséges megoldásokat. A munkacsoportok eredményeibol összefoglaló táblázatokat készítettünk. Eredmények: Kilenc fo oki csoport volt meghatározható: a szabályozás, szabálykövetés, a végzett tevékenységek hiányosságai; az eseményekbol való tanulás hiánya; az oktatás, a humáneroforrás, a kommunikáció és dokumentálás, illetve az eszközhasználat, infrastruktúra problémái. A megoldási javaslatok hat csoportba sorolhatók: a szabályozások kialakításával és a gyakorlati alkalmazás elérésével kapcsolatos teendok; az oktatások megszervezése és lebonyolítása; beszerzés a szükségletek alapján; a kommunikáció fejlesztése; tanulás a hibákból, nemkívánatos eseményekbol; motivációs eszközök alkalmazása. Következtetés: Az eloforduló nemkívánatos események oki szerkezete hasonló mintázatú, ezért az eseményekrol szóló információk gyujtése, elemzése alapján megállapíthatók a legfontosabb kezelendo okok. Az országos szintu elemzések kiinduló pontot jelenthetnek a helyi sajátosságok és fejlesztési irányok azonosítására. A kutatások alapján feltárt muködési gyengeségek kiküszöbölésével, kezelésével nemcsak a kutatásba bevont témakörökben, hanem általánosságban is javulhat a betegellátás biztonsága. Ehhez elkötelezett vezetés, a változtatások meghatározáshoz betegbiztonsági ismeretek és szemlélet, illetve változtatási hajlandóság szükséges. Orv Hetil. 2022; 163(6): 236-245. INTRODUCTION: In 2007, the NEVES system started its operation in Hungary. Ever since, more than 26.5 thousand adverse events reports arrived. By analysing these reports, causal research was conducted and recommendations were made to prevent these causes. OBJECTIVE: Based on the results of the causal research, the identification of the most important causes of adverse events within the Hungarian healthcare settings, and the creation of recommendations on how to tackle these causes. METHODS: To identify possible causes and actions that can be made, a literature survey was conducted for each area. Descriptive statistics was conducted to identify possible associations, after which Ishikawa chart was used to search for possible root-causes. Possible solutions were gathered via focus groups discussions. Summary tables were created based on the results of these focus groups. RESULTS: Nine main groups of causes were identified: regulation; following regulations; shortcomings of activities that should be carried out; not learning from previous events; education; human resources; communication and documentation; the usage of devices; problems with the infrastructure. The recommended solutions can be grouped into six areas: actions regarding the creation and everyday usage of regulations; organising and conducting educations; procurement based on needs; improving communications; learning from mistakes and adverse events; using motivation tools. CONCLUSION: The analysis made at the national level can be the basis to identify local circumstances and areas of improvement. This requires dedicated leadership, adequate patient safety knowledge and perspective to achieve changes and willingness to make changes. Orv Hetil. 2022; 163(6): 236-245.

Comparison of hesitancy between COVID-19 and seasonal influenza vaccinations within the general Hungarian population: a cross-sectional study.

BACKGROUND: The willingness to get COVID-19 or seasonal influenza vaccines has not yet been thoroughly investigated together, thus, this study aims to explore this notion within the general adult population. METHODS: The responses of 840 Hungarian participants were analysed who took part in a nationwide computer-assisted telephone interviewing. During the survey questions concerning various demographic characteristics, perceived financial status, and willingness to get the two types of vaccines were asked. Descriptive statistics, comparative statistics and word co-occurrence network analysis were conducted. RESULTS: 48.2% of participants were willing to get a COVID-19 vaccine, while this ratio for the seasonal influenza was only 25.7%. The difference was significant. Regardless of how the participants were grouped, based on demographic data or perceived financial status, the significant difference always persisted. Being older than 59 years significantly increased the willingness to get both vaccines when compared to the middle-aged groups, but not when compared to the younger ones. Having higher education significantly elevated the acceptance of COVID-19 vaccination in comparison to secondary education. The willingness of getting any type of COVID-19 vaccine correlated with the willingness to get both influenza and COVID-19. Finally, those who were willing to get either vaccine coupled similar words together to describe their thoughts about a COVID-19 vaccination. CONCLUSION: The overall results show a clear preference for a COVID-19 vaccine and there are several similarities between the nature of willingness to get either type of vaccine.

Potential considerations in decision making on laparoscopic colorectal resections in Hungary based on administrative data.

BACKGROUND: Laparoscopic colorectal surgeries offer numerous advantages over their open counterparts. To compare these measurable short-time outcomes of open and laparoscopic resections in Hungary, data of colorectal surgeries were collected and analysed. The study focused on identifying patients' characteristics that can influence the decision on laparoscopic colorectal resections and on comparing efficiency of Hungarian colorectal operations with international data. METHODS: Using patients' data of laparoscopic and open colorectal surgery performed in 2015 and 2016 from the National Health Insurance Fund of Hungary, a countrywide retrospective comparative analysis was done. Logistic regression was used to explore main influencing factors for laparoscopic colorectal surgery. RESULTS: A total of 17,876 colorectal surgical cases, including 14,876 open and 3,000 laparoscopic resections were selected and analysed. Laparoscopy was used only in 16.78% of all cases. Comparison of age groups showed that odds ratio (OR) of laparoscopic colorectal resections was significantly lower in over 40 years than in younger patients (18-39 years). In university institutes patients had higher odds (OR: 2.23 p<0.0001) for laparoscopic colorectal resections. Presence of comorbidity codes and preoperative treatment in internal medicine department decreased odds for laparoscopic colorectal operations. CONCLUSIONS: Patients' age, comorbidities and hospital type influenced the likelihood of decision on laparoscopic colorectal resection. Selection of patients contributed to improved laparoscopic outcomes.

Examination of data validity of hip fracture patients in a Hungarian hospital / A csípotáji törést elszenvedett betegekre vonatkozó adatvaliditási vizsgálat egy magyarországi kórházban.

Összefoglaló. Bevezetés: A csípotáji törések jelentosen terhelik az egészségügyi ellátórendszereket. Magyarországon 13 000-15 000 beteg szenved évente csípotáji törést, jelentos részük mutéten is átesik. A betegek túlélését vizsgálták a EuroHOPE és BRIDGE kutatások, amelyek a Nemzeti Egészségbiztosítási Alapkezelonek a finanszírozási célból gyujtött, esetszintu adataira támaszkodtak. Az ilyen jellegu adatok megbízhatóságát több kutatás vizsgálta eltéro eredményekkel, ezért a további vizsgálatok elott szükségesnek tartottuk a csípotáji törésekre vonatkozóan is ellenorizni oket. Célkituzés: Egy magyarországi kórház reprezentatívan kiválasztott eseteinek vizsgálatán keresztül annak megállapítása, hogy a finanszírozási adatbázis adatai megfelelnek-e a betegdokumentációban rögzített adatoknak. Módszer: Egy magyarországi kórházba 2015-ben csípotáji töréssel felvett betegek kórlapjainak anonim, reprezentatív mintáját összevetettük a EuroHOPE és BRIDGE kutatások adatbázisával tíz különbözo adatelemre vonatkozóan. Az adatbázisokat rekordszinten párosítottuk, az egyezést adatelemre és rekordra vonatkozóan néztük. Eredmények: A reprezentatív minta 259 esetet tartalmazott. Az adatbázisok összevetése során nem találtunk eltérést a beteg neme, életkora, ápolást indokló fodiagnózisa és az osztályról történo távozás dátuma esetén. Egy eltérést találtunk az osztályos felvétel dátumában, a mutét dátumában öt darabot. A beteg további sorsa esetén tíz eltérést találtunk. A mutéttípusok esetén is alacsony mértéku (2-4 eset) eltérést tapasztaltunk. Jelentos mértéku eltérést a társbetegségek és a szövodmények esetén találtunk. Következtetés: Eredményeink alapján további vizsgálatokhoz felhasználhatók az alfanumerikus kódokat, számokat vagy dátumokat tartalmazó mezok (például fodiagnózis, felvételi és távozási dátumok), a társbetegségekre és a szövodményekre vonatkozó adatok azonban nem alkalmazhatók mélyebb elemzések során. Orv Hetil. 2021; 162(18): 712-719. INTRODUCTION: Hip fractures pose a heavy burden on healthcare systems. In Hungary, 13 000-15 000 patients experience hip fractures, most of them undergo surgery. Their survival was examined by the EuroHOPE and BRIDGE studies, using patient level data from the National Health Insurance Fund. Data from healthcare financing reports have been examined worldwide, with contradicting results, so we considered it necessary to observe data validity for hip fractures before further analysis. OBJECTIVE: The aim of our study was to observe a representative sample of patient records in a Hungarian hospital in order to validate the finance reports. METHOD: We matched a representative sample of hip fracture patient records in a Hungarian hospital with hip fractures in 2015 with the database of the EuroHOPE and BRIDGE studies. The databases were matched on record level, the analysis included ten data fields and was conducted for data fields and records. RESULTS: The sample included 259 cases. No differences were observed in the patients' gender, age and main diagnosis, or dates of discharge. One difference was observed in the dates of admission, and 5 in the dates of surgery. Minor differences were found in the types of surgery (2-4 cases), but the differences between the databases in comorbidities and complications were large. CONCLUSION: Based on our results, we can conclude that data fields containing alphanumeric codes, numbers or dates (e.g., main diagnosis, admission, discharge and surgery dates) can be used for further analysis, but comorbidity and complication data are not recommended for research purposes. Orv Hetil. 2021; 162(18): 712-719.

Health related quality of life and satisfaction with care of stroke patients in Budapest: A substudy of the EuroHOPE project.

BACKGROUND: Disadvantaged socioeconomic status is associated with higher stroke incidence and mortality, and higher readmission rate. We aimed to assess the effect of socioeconomic factors on case fatality, health related quality of life (HRQoL), and satisfaction with care of stroke survivors in the framework of the European Health Care Outcomes, Performance and Efficiency (EuroHOPE) study in Hungary, one of the leading countries regarding stroke mortality. METHODS: We evaluated 200 consecutive patients admitted for first-ever ischemic stroke in a single center and performed a follow-up at 3 months after stroke. We recorded pre- and post-stroke socioeconomic factors, and assessed case fatality, HRQoL and patient satisfaction with the care received. Stroke severity at onset was scored by the National Institutes of Health Stroke scale (NIHSS), disability at discharge from acute care was evaluated by the modified Rankin Score (mRS). To evaluate HRQoL and patient satisfaction with care we used the EQ-5D-5L, 15D and EORTC IN PATSAT 32 questionnaires. RESULTS: At 3 months after stroke the odds of death was significantly increased by stroke severity (NIHSS, OR = 1.209, 95%CI: 1.125-1.299, p<0.001) and age (OR = 1.045, 95%CI: 1.003-1.089, p = 0.038). In a multiple linear regression model, independent predictors of HRQoL were age, disability at discharge, satisfaction with care, type of social dwelling after stroke, length of acute hospital stay and rehospitalization. Satisfaction with care was influenced negatively by stroke severity (Coef. = -1.111, 95%C.I.: -2.159- -0.062, p = 0.040), and positively by having had thrombolysis (Coef. = 25.635, 95%C.I.: 5.212-46.058, p = 0.016) and better HRQoL (Coef. = 22.858, 95%C.I.: 6.007-39.708, p = 0.009). CONCLUSION: In addition to age, disability, and satisfaction with care, length of hospital stay and type of social dwelling after stroke also predicted HRQoL. Long-term outcome after stroke could be improved by reducing time spent in hospital, i.e. by developing home care rehabilitation facilities thus reducing the need for readmission to inpatient care.

[Who knows what? - About patient handover. Experiences of a Hungarian and Polish sample knowledge survey]. / Ki mit tud? ­ A betegátadásról. Egy magyar és lengyel mintán végzett tudásfelmérés tapasztalatai.

Introduction: The most common reason for the adverse events in healthcare is communication. Due to the development of health technologies and the increasing specialization of care, more and more healthcare professionals are involved in the treatment of patients, resulting in an increasingly important role and risk for patient handover. Aim: To present the current state of knowledge of patient handover through the results of an international project. Method: Self-developed, anonymous questionnaires with single and multiple choice questions were used to investigate handover knowledge among healthcare workers in 3 Hungarian and 3 Polish hospitals. The frequency of responses was analyzed according to their correctness. The factors that can influence the knowledge were studied using a regression model in the Hungarian sample. Results: The questionnaire was completed by 63% of the 2963 employees who received the questionnaires. In the two countries, there was no significant difference in the proportion of correct responses. Nearly half of the responders (49.4%-45.7%) gave the right answers to the question about the definition of patient handover. The lowest rate of correct answers (14.4%-11.1%) was given to elements of patient handover techniques. The difficulty of the questions also showed a similar pattern. Conclusion: Based on the results, it can be concluded that knowledge of handover needs to be improved in both countries. Although healthcare providers have some knowledge about handover, it cannot be considered accurate and complete. It is important to promote the knowledge and practice of handover together for the safety of patients and healthcare providers. Orv Hetil. 2019; 160(44): 1735-1743.

[Analysis of hip fracture care in Hungary between 2004-2009]. / A csípotáji törések hazai ellátásának elemzése a 2004­2009 közötti idoszakban.

INTRODUCTION: Proximal femoral fractures with severe outcome are most common in the increasing group of elderly patients. AIM: Based on the regular data gathered by the EuroHOPE research, the most important aspects and results of the treatment of proximal femoral fractures were studied. METHOD: Data of hospital admissions due to proximal femoral fractures were analyzed. RESULTS: There was a slight increase in the number of hospitalized patients between 2004 and 2009 in Hungary. 88% of the patients received operative treatment, 41% suffered femoral neck fractures. Mortality rates did not change significantly in the analyzed period. Standardized annual mortality rates for patients who had suffered a femoral neck fracture were 28% when prosthesis was implanted; this result was somewhat more favorable than in case of other surgical procedures. Annual mortality rates were higher in the peritrochanteric fracture group where intramedullary nailing was performed (36%). The ratio of operated patients did not differ significantly from international results. Mortality rates in Hungary were significantly less favorable. 30 day standardized mortality rate was 13.6% in 2008, twice as high as the rate in Finland, The Netherlands, Norway, Scotland and Sweden. The 40% mortality rate calculated for 365 days was significantly higher than international results. CONCLUSION: To define the measures needed to improve results, systematic analysis of both in-hospital treatment protocols, and follow-up treatment is necessary. Orv. Hetil., 2016, 157(41), 1642-1648.

[Methods of the EuroHOPE research program]. / A EuroHOPE kutatási program módszertana.

The European Health Care Outcomes, Performance and Efficiency research was financed by the European Union between 2010 and 2013. In this program a new methodology was developed which made the analysis of regularly collected data and international benchmarking of the healthcare results of 5 socially and economically critical diagnosis group between the 7 participant countries possible. This paper presents the most important areas of the development, such as (1) the principles of the methodology, (2) the definition of available databases, code systems, (3) the events to be analysed, (4) the general rules of analyses and indicator development, (5) the exact methodology of data collection, processing, and analysis, (6) the methods of risk adjustment, (7) and the development of the standardised database. The databases which include all information of all patients and healthcare activities serve as perfect inexhaustible data sources for decision makers, healthcare personnel, and researchers. The indicator results of this program serve as starting point for further root cause analysis and development measures based on the results of the abovementioned analyses. Orv. Hetil., 2016, 157(41), 1619-1625.

[Results of stroke care in Hungary in the frame of international comparison]. / A stroke-ellátás hazai eredményei a nemzetközi adatok tükrében.

INTRODUCTION: The EuroHOPE FP7 project analysed the effectiveness and efficiency of stroke care between 2010 and 2014. AIM: The study introduces Hungarian data in comparison with international results and explores the causes of differences. METHOD: The analysis was performed on data available from regular data collection in Finland, The Netherlands, Hungary, Italy, Scotland, and Sweden, with standardized indicators. Hungarian data was analysed between 2005 and 2009, and the international benchmarking in 2008, with multivariate logistic regression analysis for risk adjustment. RESULTS: Stroke incidence in Hungary was the double of the Italian or Finnish results (43.3/10,000 inhabitants), while comorbidities did not differ among countries. In Hungary, 19.9% of patients purchased anti-coagulants, one-third of the rate in Finland. One-year mortality in Hungary was 30%, the worst among the countries. Possible causes are inadequate prevention, more severe status of patients, and deficiencies of hospital care and rehabilitation. CONCLUSION: Causal analysis of these results and corrective measurements are recommended. Orv. Hetil., 2016, 157(41), 1635-1641.

[Main characteristics of the care of acute myocardial infarction in Hungary between 2005-2009, based on the results of the EuroHOPE research]. / Az akut myocardialis infarctus fobb hazai ellátási jellemzoi 2005­2009 között a EuroHOPE kutatás eredményei alapján.

INTRODUCTION: The EuroHOPE research developed the standardised methodology of the analysis of the healthcare process. AIM: The aims of the authors were to analyze the care of acute myocardial infarction in Hungary and to compare the results to those of the partner countries. METHOD: The authors analyzed the application of early and late invasive interventions, medication purchase, and mortality. The results were compared to Finnish, Norwegian, Italian, Scottish and Swedish data. RESULTS: By the end of the observed period, approximately half of the patients received early treatment, which is an internationally acceptable result. Purchase of statins, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers was around 90%, but the application of beta-blockers has decreased for unknown reason. The mortality rate has improved, but it was still significantly worse than that in the partnering countries. One year mortality in the early intervention group was 1.5 times higher, and in the late intervention group was 2 times higher than the second worst results. CONCLUSIONS: The causal analysis concerning the professional activities, operational practices, and the role of the patients in the observed period is highly recommended. For more detailed analysis it is necessary to follow the trends and to separate the diagnoses of ST- elevation and non-ST-elevation acute myocardial infarction. Orv. Hetil., 2016, 157(41), 1626-1634.

[Changing of the patient safety culture in the pilot institutes of the Hungarian accreditation program]. / A betegbiztonságot támogató szervezeti kultúra változása a hazai akkreditációs programot tesztelo intézményekben.

INTRODUCTION: The accreditation system for health care providers was developed in Hungary aiming to increase safety, efficiency, and efficacy of care and optimise its organisational operation. AIM: The aim of this study was to assess changes of organisational culture in pilot institutes of the accreditation program. METHOD: 7 volunteer pilot institutes using an internationally validated questionnaire were included. The impact study was performed in 2 rounds: the first before the introduction of the accreditation program, and the second a year later, when the standards were already known. Data were analysed using descriptive statistics and logistic regression models. RESULTS: Statistically significant (p<0.05) positive changes were detected in hospitals in three dimensions: organisational learning - continuous improvement, communication openness, teamwork within the unit while in outpatient clinics: overall perceptions of patient safety, and patient safety within the unit. CONCLUSIONS: Organisational culture in the observed institutes needs improvement, but positive changes already point to a safer care. Orv. Hetil., 2016, 157(42), 1667-1673.

[Role of reporting and learning systems in the improvement of patient safety]. / A jelentési és tanulórendszerek szerepe a betegbiztonság javításában.

The principles and requirements of a patient safety related reporting and learning system were defined by the World Health Organization Draft Guidelines for Adverse Event Reporting and Learning Systems published in 2005. Since then more and more Hungarian health care organizations aim to improve their patient safety culture. In order to support this goal the NEVES reporting and learning system and the series of Patient Safety Forums for training and consultation were launched in 2006 and significantly renewed recently. Current operative modifications to the Health Law emphasize patient safety, making the introduction of these programs once again necessary.

[Accreditation in health care]. / Akkreditáció az egészségügyben.

Besides the rapid development of healing procedures and healthcare, efficiency of care, institutional performance and safe treatment are receiving more and more attention in the 21st century. Accreditation, a scientifically proven tool for improving patient safety, has been used effectively in healthcare for nearly a hundred years, but only started to spread worldwide since the 1990s. The support and active participation of medical staff are determining factors in operating and getting accross the nationally developed, upcoming Hungarian accreditation system. However, this active assistance cannot be expected without the participants' understanding of the basic goals and features of the system. The presence of the ISO certification in Hungary, well-known by healthcare professionals, further complicates the understanding and orientation among quality management and improvement systems. This paper aims to provide an overview of the history, goals, function and importance of healthcare accreditation, and its similarities and differences regarding ISO certification.

European Regional Differences in All-Cause Mortality and Length of Stay for Patients with Hip Fracture.

The objective of this study was to compare healthcare performance for the surgical treatment of hip fractures across and within Finland, Hungary, Italy, the Netherlands, Norway, Scotland, and Sweden. Differences in age-adjusted and sex-adjusted 30-day and one-year all-cause mortality rates following hip fracture, as well as the length of stay of the first hospital episode in acute care and during a follow up of 365 days, were investigated, and associations between selected country-level and regional-level factors with mortality and length of stay were assessed. Hungary showed the highest one-year mortality rate (mean 39.7%) and the lowest length of stay in one year (12.7 days), whereas Italy had the lowest one-year mortality rate (mean 19.1 %) and the highest length of stay (23.3 days). The observed variations were largely explained by country-specific effects rather than by regional-level factors. The results show that there should still be room for efficiency gains in the acute treatment of hip fracture, and clinicians, healthcare managers, and politicians should learn from best practices. This study demonstrates that an international comparison of acute hospital care is possible using pooled individual-level administrative data.

Individual and Regional-level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries.

Using patient-level data for cerebral infarction cases in 2007, gathered from Finland, Hungary, Italy, the Netherlands, Scotland and Sweden, we studied the variation in risk-adjusted length of stay (LoS) of acute hospital care and 1-year mortality, both within and between countries. In addition, we analysed the variance of LoS and associations of selected regional-level factors with LoS and 1-year mortality after cerebral infarction. The data show that LoS distributions are surprisingly different across countries and that there is significant deviation in the risk-adjusted regional-level LoS in all of the countries studied. We used negative binomial regression to model the individual-level LoS, and random intercept models and ordinary least squares regression for the regional-level analysis of risk-adjusted LoS, variance of LoS, 1-year risk-adjusted mortality and crude mortality for a period of 31-365 days. The observed variations between regions and countries in both LoS and mortality were not fully explained by either patient-level or regional-level factors. The results indicate that there may exist potential for efficiency gains in acute hospital care of cerebral infarction and that healthcare managers could learn from best practices.

Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries.

Percutaneous coronary interventions (PCI) on acute myocardial infarction (AMI) patients have increased substantially in the last 12-15 years because of its clinical effectiveness. The expansion of PCI treatment for AMI patients raises two questions: How did PCI utilization rates vary across European regions, and which healthcare system and regional characteristic variables correlated with the utilization rate? Were the differences in use of PCI associated with differences in outcome, operationalized as 30-day mortality? We obtained our results from a dataset based on the administrative information systems of the populations of seven European countries. PCI rates were highest in the Netherlands, followed by Sweden and Hungary. The probability of receiving PCI was highest in regions with their own PCI facilities and in healthcare systems with activity-based reimbursement systems. Thirty-day mortality rates differed considerably between the countries with the highest rates in Hungary, Scotland, and Finland. Mortality was lowest in Sweden and Norway. The associations between PCI and mortality were remarkable in all age groups and across most countries. Despite extensive risk adjustment, we interpret the associations both as effects of selection and treatments. We observed a lower effect of PCI in the higher age groups in Hungary.