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Zsolt Pásztélyi — 2024-12-09

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Options of End-of-Life Decisions in Hungary Part 1.

Ágnes Anita Tóth — 2024-12-09

The purpose of this article is to present the situation regarding options for end-of-life care decisions in Hungary. The study first outlines the current relevance of the topic domestically, then, after a brief international overview, it introduces the most important concepts, such as the different forms of euthanasia, therapeutic obstinacy, and palliative care. The aim of the article is to shed light on the complex issues surrounding end-of-life decisions from various perspectives, including legal, religious, ethical, and professional medical aspects. The paper provides a detailed account of the relevant national laws and regulations, analyzes the viewpoints of different religious denominations, and discusses official ethical guidelines. Special attention is given to presenting the factors influencing medical practice that determine the everyday decisions of physicians in this sensitive area. The authors outline the difficulties and challenges associated with end-of-life care decisions and offer suggestions on tools and support that can assist physicians in making these critical, complex, and emotionally taxing decisions appropriately.

Complex challenges in hospital management

Zsuzsanna Antal — 2024-12-09

Hospital managers in Hungary face substantial challenges in their daily operations, primarily due to central regulations, resource constraints, and limited managerial autonomy. Henry Mintzberg's "care, cure, control, community" model highlights the complexity of hospital structures, the duality of leadership roles, and the leadership challenges that arise from this complexity. Utilizing a qualitative research methodology, this study investigates these leadership challenges within the Hungarian context and identifies strategies that leaders can employ to effectively address these issues.

The findings reveal that the most significant challenges for hospital managers include managing scarce resources, navigating an uncertain environment, addressing conflicts inherent in leadership roles, diminishing autonomy, and maintaining employee motivation. To effectively confront these challenges, systemic reforms and a holistic approach are necessary in Hungarian hospitals. Despite the constraints, numerous instances demonstrate managers’ ability to correctly interpret contextual factors, apply sound managerial instincts and experience, and implement effective solutions.

The study provides essential guidelines for hospital managers, helping them make more informed decisions and operate more efficiently in the face of complex organizational demands.

An intermediate step in bridging the gap between evidence and practice: developing and applying a methodology for “general good practices”

Heléna Safadi — 2024-12-09

The gap between evidence and clinical practice has been in the focus of researches for decades. Although successful implementation means the new knowledge must work in particular environments, it doesn’t mean that the entire process should exclusively be executed by the individual institutes. This is the point where we assumed that an intermediate step, the “general good practice”, could help to ensure that translation is done in a more professional way.

The development of the general good practice methodology was based on our infinitE model, which organized the factors of successful translation into an evidence-editing-embedding-effect on practice framework, using tools from the disciplines of Evidence-Based Medicine, Quality Improvement and Change Management.

The methodology organised the editing and embedding part of the development into a process involving three full-day sessions carried out with different health professionals, experts and moderators. After pilot testing, it was finalized and applied to other topics as well.

The methodology presented in detail in this paper, centred on flow chart, process analysis, failure mode identification and Kotter’s 8-step model. Beside the pilot topic of the institutional process of resuscitation, the methodology has also proved applicable to more than ten other topics, meaning that at least all the core elements of the proposed bundle of general good practice have been produced in the development process.

Compared to the guidelines, general good practices demonstrate the evidence in operation, helping to develop workflows, responsibilities, documentation, trainings, etc. and can also be a starting point for the digitalisation of care processes.

The next step is to examine how healthcare institutions can build on these in their own editing and embedding activities, and what the results will be. Further studies could explore the applicability of the development methodology in different healthcare systems or at different levels of maturity in terms of quality.

Developing an audit checklist to assess the hygiene of gastroenterology endoscpoy examination sites

Beatrix Varga — 2024-12-09

The number of gastrointestinal endoscopic procedures performed each year exceeds 20 million in the United States and tens of millions in Europe. In our country, 120,958 colonoscopies and sigmoidoscopies were performed in 2019 under the health insurance scheme, while no such reported data are available for gastroscopy. This figure is further increased by the growing private health care sector, which also performs a large number of endoscopic procedures, so that the number of endoscopic procedures in Hungary may exceed several hundred thousand per year. The Government of Hungary has decided to introduce a nationwide programme of targeted, organised colonoscopy for public health purposes, which is expected to increase the number of colonoscopies, so it is crucial that the infection control activities of endoscopy workplaces are of the highest possible standard.

During endoscopic procedures, transmission of infection is possible through different routes. By following current instrument cleaning and disinfection procedures, using disposable accessories, disinfecting examination rooms and using the appropriate level of personal protective equipment, the risk of infection can be minimised.

The aim was to develop a specific checklist, in line with international and national regulations, to assist in the monitoring of compliance with infection control regulations, which can be used in clinical audit investigations, and which any endoscopy unit can tailor to its own operational processes, while at the same time using it for regular internal quality assessment.

After researching and comparing international and national literature recommendations and guidelines, a working group of healthcare professionals (chief hygienist, gastroenterologists, senior endoscopic assistant, public health inspector) developed an audit checklist to monitor infection control activities. No rating system has been defined for the results obtained, as the aim is not to give the health care provider under audit a rating (e.g. excellent, adequate, etc.), but to encourage the provider to strive to achieve the best possible quality of care. In order to ensure that the checklist delivers the desired results, a user guide has also been prepared. The checklist and the guide will be tested in a subsequent phase.

The checklist consists of 6 main sections: general data, methods, staff, criteria, summary and feedback. The criteria section consists of 10 main groups of questions summarizing the infection control activities of endoscopy units: 1. policies and procedures, 2. education and training, 3. physical environment, 4. cleaning procedures, 5. high level disinfection, 6. sterilizers and automated endoscope reprocessing equipment, 7. endoscope storage, 8. endoscope transport, 9. record keeping, 10. occupational health and safety. Each group of questions defines a total of 158 criteria.

A clinical audit based on a checklist provides an opportunity to identify the causes of failures in a given healthcare provider by conducting a desk review, root cause analysis, reviewing processes and, if necessary, reengineering, developing recommendations for solutions, and implementing changes to ensure patient safety and prevent infections. The experience gained from the clinical audits will provide an opportunity to further develop the checklist, to describe good practices and to produce a definitive methodological guide to assist in completing the checklist.

The clinical audit is an effective tool for testing infection control regimes. Domestic healthcare providers should be encouraged to develop and implement quality systems and to make clinical audit testing an integral part of their quality improvement activities.

The role of mentalisation-focused case discussion in strengthen the psychological resilience of helping professionals

Éva Kalla — 2024-12-09

Mental health and its potential for development are increasingly important in both treatment and prevention. The international literature also highlights the role of mentalisation skills in the mental health of aid workers and in the quality of relationships with patients. In the course of their responsible work, these professionals encounter mentally and psychologically impaired and ill people on a daily basis, with whom it is particularly difficult to develop relationships because of their condition. They are often faced with incredibly difficult, painful and often dangerous situations, which require a high level of reflection and emotion regulation, and the failure to do so places an enormous psychological burden on them. Taking into account international experience, it would be important to develop the mentalisation and emotion regulation skills of helping professionals, which, in addition to developing relational skills, contribute to enhancing resilience and mental health, and thus can also play a significant role in preventing burnout. In this paper, we present the possibility of integrating this into a processing group method, the case discussion, which helps them to work effectively.

Hungarian limb-saving application - a crucial solution

Anita Merse — 2024-12-09

Hungarian limb-saving application - a crucial solution!

Regular medical check-ups for those suffering from chronic illnesses provide safety and the possibility of preventing complications. However, for new patients, difficulties in entering the system had to be addressed. Complications of diabetic foot in diabetic patients can significantly worsen within weeks, so proper initial care can be crucial for limb preservation. Circulatory venous diseases accompanying diabetes further reduce the chances. (Unfortunately, we are at the forefront of European amputation statistics.) Dangerous consequences of both diseases may result in deterioration caused by developing wounds, so we developed the limb-saving application to reduce the formation of chronic wounds, which greatly supports the treatment of urgently distressed patients and prevention. However, it must be acknowledged that supporting patients alone is not sufficient, and not everyone on the healthcare provider side can be a specialist, so, in addition to patient-doctor communication, we also aim to assist the work of colleagues with the medical application interface. Thus, reaching patients becomes much more effective, and the application is already used by more than 14,000 patients.

During the early stages of development, one of the IT colleagues developing the application thought to have discovered a similarity in the images with the foot of their relative—who had previously refused to see a doctor as their wounds had healed earlier! With the prototype application, they conducted an assessment at the patient's home and, based on the results, they convinced the patient to see a doctor, which ultimately saved their leg due to timely and expert treatment.

As a second phase, we are developing a digital health platform, an online wound care center, to enhance the efficient operation of multidisciplinary care. Initially, it is aimed at diabetic patients and stakeholders in diabetes care, focusing on preventive strategies and effective complication management. In the first phase, we offer professional support on our patient platforms in this area. However, our long-term goal is to extend decision support for other conditions as well. The first step in reducing medical workload is establishing a preventive patient approach. We support care through our patient platform while actively participating in chiropody training and nursing education to impart the best knowledge to our partners and make it widely accessible. Meanwhile, we connect patients with healthcare service providers. We provide patients with maximum support in adhering to medical pathways and offer any kind of supplementary therapeutic tools that could help their health condition. We enable patients to take control of their own healing process.